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Case Study

Short Repertorisation: A Case Of 'Hiatus Hernia'
Dr Supriya Nayak

From a large number of my cases I have chosen a very interesting 'so-called' 'surgical' case of 'Hiatus Hernia' to be presented here. 55 year-old Hindu patient, Mr JSK from New Delhi
Date of first visit - 15/10/96

Chief Complaints:
1. Coming up of food and fluid with local swelling in upper abdomen esp during and after meals. Present since childhood but worse since 1992. AGG immediately after taking food and drink
2. Burning, scalding sensation with ulceration at margins of the tongue since 1992 
3. Acidity, burning in chest, heaviness of abdomen- since 1992.
AGG immediately after taking food.
4. Burning pain in stomach - since 1992.
AGG empty stomach and also after food.
AGG along with regurgitation of food.
Slight AMEL rubbing stomach region gently
Used to take allopathic Antacid [Digene] to get relief. 
5. Itching in between toes of [R] foot - since about 10 years AGG rainy season; used to apply ointment. 

Treatment Taken So Far - Both Allopathy and Homeopathy tried. As far as the patient can remember he took Homoeo medicines like Sulphur - 30, Psorinum 200 etc on another doctor's advice.
Last Homoeo medicine taken 1 week ago.
Had no relief from all these treatments. History of vaccination - present.

Family History : Sister - Chronic gastric ulcer. Mother - Uterine prolapse.
Son- Eczema

Personal History - Some sort of mental difficulties in domestic life.
Habits/ Addictions 4-5 cups of tea daily.
Meals, sleep, rest, etc irregular.
Physical Generals -
 - fried, fruits, fish.
Thirst - ++, dryness of mouth.
Urine - occasional burning urethra.
Stool - normal
Sexual Function - normal
Sweat - scanty
Sleep - poor due to over crowding of thoughts.
Thermal - likes autumn and rainy season.
Dislikes extremes of heat and cold.
Built And Constitution - Fair, tall and medium built.
Mentals - Very sentimental, sensitive, gets easily offended, much anxiety when alone, about future. Irritable, gets angry suddenly but cools down rapidly. Loquacious.

Examination: Pulse 100/min, regular, moderate volume and tension.
Tongue - moist, clean, margins red and glossy
PA - Liver - tender, abdomen tender in epigastrium 
BP -140/98 Hg
Special Investigations - Barium meal of stomach revealed sliding prolapse of a part of fundus through oesophageal hiatus. Impressions - HIATUS HERNIA [Sliding type.]

Analysis And Evaluation Of Data:
Guiding /leading symptoms of the case: The following striking mental characteristics have been taken into consideration as the supreme guiding symptoms of the case:
1. Anxiety when alone
2. Anxiety about future http://www.njhonline.com/images/rtarrow.gif Eliminating symptoms
3. Sentimental
Other strong physicals are as follows:
4. Desire for fish
5. Worse from extremes of cold weather
6. Worse from extremes of heat
7. Regurgitation of food AGG immediately after eating

Repetorial Analysis: The two eliminating symptoms mentioned above have been taken as the eliminating rubrics. Only 1st and 2nd graded drugs are taken into consideration [1st grade in BLOCK letters and 2nd grade in small letters]. 
All rubrics are from Kent's repertory.
1. ANXIETY, alone when [pg 5] ars, dros, me\, Phos
2. ANXIETY, future about [pg 7] anac, bar-c, bar-m, Bry, Calc, calc-ars, caust, chin, Chin-s, cic, dig, dros, dulc, fee-p, gels, graph, iod, lach, mur-ac, nat-c, nat-m, nux-v, ph-ac, Phos, puls, rhus, Spongia, Staphis, 3. SENTIMENTAL [pg 74] Phos 4. DESIRE, fish [pg 485] nat-m [phos], indicates 3rd grade 5. COLD, air AGG [pg 1348] Ars, Bar-c, bar-m, bry, Calc, caust, dig, dulc , graph, nux-v, ph-ac, phos, puls, rhus-t, spong, staph. 6. Warm AGG [pg 1412] - bry, dros, dulc, graphp, Iod, lach, mez, nat-m, phos, Puls. 7. Eructations, food [regurgitation] eating, immediatly after- phos 

Result: The remedies carrying higher to highest marks are only given below: Dros, Graph, and Nat-m 3 /6, Bry, Dulc, Puls - 3 /7, Phos 7 /15.
Thus Phosphorus has not only covered all the l7 outstanding rubrics of the case by scoring highest marks but has also attained the goal of the most similar remedy [similimum] by way of a thorough investigation of the case under the spectrum of MM and miasmatic/constitutional view point. The physical constitution [fair, tall, medium built] f/h/o chronic gastric ulcer, particular symptoms like burning ulceration of tongue, acidity, burning in stomach, etc have all gone in favour of Phosphorus. Syphilitic miasm has become the predominant fundamental cause in this case.
Therefore, Phosphorus was selected with complete confidence case. 

29/10/96: 1. Phosphorus 30-4 doses -one dose every night [O.N]
2. SL - 1dose - o.m.
14/4/97: Troubles as before.
1. Phos 200 - 4doses - every 7 days, night and morning.
2. SL - 21 doses -O.M
5/4/97: Regurgitation better than before [frequency less]
Acidity S.Q. Local epigastric swelling during and after meals has reduced much. Burning tongue -slightly better. Took Allopathy for burning urethra during coitus about 1 week back.
New symptom: Itching, painful eruptions on the scalp [since 1 month]
1. Phos 1M -4 dose BD
2. SL -26 doses - O.N

27/4/97: Regurgitation better than before. Weakness better than before. Itching eruptions of scalp as before 
1. SL 28 doses O.N.
10/8/97 - No further improvement. Itching eruptions scalp disappeared totally. Burning tongue slightly <
1. Phos 1M - 4 doses BD
2. SL - 26 doses O.N.
7/11/97-Regurgitation much better than before [80%] Burning mouth +
1. Ars-alb 30-7 doses [O.M]
2. SL -14 doses [O.N]
3. Phos 1m - 2 DOSES [BD]
4. SL - 7 doses [AM]

Discussion: It can be noted that in the following study, after appearance of the skin rash on the scalp, the pt started feeling better as regards the hiatus hernia [regurgitation] which was his main trouble and improvement has been steady and uneventful thereafter. Still he is advised to continue treatment.