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Case Study

Acute Ankle Pain With Swelling
Dr S K Mamgain
'Chel / Colch

On 21/3/92 I was called to see a 40 yr. old patient, suffering from severe pain and swelling in [R] ankle and in [R] big toe. The patient was writhing with pain in the bed. Following points were noted:
- Large swelling around the [R] ankle
- Slightest pressure on the swollen ankle caused the patient to shriek with pain.
- The pain was always during night
- Pain was AGG in cold. 
- Previously he used to vomit mucus and ingesta during severe pain.
- Thirst ++ and increases with pain
- Frequent bouts of paroxysmal cough, with expectoration of lumps of mucus. 
- A lot of chilliness, shivering and yawning.

Past history :
The trouble started about 6 yrs. ago. He donated blood twice in one month. He recalls that he also had a sprain. After about 1 ½ yrs. of the above he went on a pilgrimage to Rajasthan in the month of January, where, around a big temple, he walked barefoot, on very cold marble, 108 times. When he returned back to Dehradun, he found difficulty in coming out of the car due to severe pain in the [R] ankle. Since then the pain is continuing in spite of Allopathic and Homoeopathic treatment. The pain used to worsen intermittently, forcing him to be confined to bed.
He had taken the following medicines before I was called in -
Homoeopathic medicines:
Phyto 1M 5 to 7 drops once in 15 days.
Ac-phos 200
Bryonia 1M for past 1 year regularly
China 1x
Rhus-tox 1M
Antimony-crud 200 + Rhus-tox 200
Biochemic medicines: 
Nat-mur 12X and 30X
Ferrum-phos 30X
Calc-phos 30X

Diagnosis : (by the Orthopaedic surgeon) Gouty Arthritis

Investigations : 23.3.92
- ESR 48 mm/ at the end of 1 hr
- S. Uric Acid 8.9 mg/dl
- Blood Urea 32 mg/dl
- RA factor -ve, though the patient was suffering a lot with rheumatic like pains.

Treatment: Camphora 200 1 dose Chelidonium 30 TDS. He started the medicine on 23/3/92. His pain worsened during the night, with the dose of Camphora, but after taking the dose of Chelidonium he had instant relief and slept well. This was followed by a dose of Colchicum 200 every fifth day and Chelidonium 30 TDS till 24/5/92. Subsequently Colchicum 200 was given at longer intervals.

On 13/6/92 S. Uric acid was 6.4 mg /dl Last medicine was given on 7/7/92 for a week. During the past 5 years, the pain and swelling have not recurred i.e. so far the cure is holding..

As the patient had been taking various Homoeopathic medicines for a long period and as Camphor antidotes most of the remedies, a dose of Camphora 200 was given to make the selected remedy work favourably. 
Kent repertory was consulted on following rubrics:

K 1078

pain ankle < motion

K 1201

pain ankle rheumatic

K 1201

swelling ankle

K 1201

swelling, ankle rheumatic

Looking into materia medica under Chelidonium. Other symptoms of the case were found fitting in it. Dr Clarke, in his "A Dictionary of Practical Materia Medica", says, in rheumatic affections Chel has a large field: Oedema, heat, tenderness, and stiffness are the leading indications.

Swelling of feet, mostly round ankles. The slightest movement or touch extorted screams.

Colchicum is a gouty remedy and controls S. uric acid., vide Allen's Encyclopaedia. Hence Colchicum was given intercurrently. And, the Chelidonium plus Colchicum worked and cured the patient.