Sycotic misaim in clinical practice
NATIONAL JOURNAL OF HOMOEOPATHY 2005 Mar / Apr VOL VIII NO 2.
Dr N L Tiwari
Dr Mohammad Sayyed
'Thuja / Cocc-cacti / Kali-c

Consultant: Dr N L Tiwari
Physician: Dr M G Sayyad
Date of Case Taking: 5-10-2004
Name of the patient : Mrs Suverna Kalya pawar
Sex: Female
Age: 27 yrs
Status: Married since 12 yrs
Education: Illiterate
Occupation: Farmer, housework
Religion/Caste: Hindu
Veg/Non. Veg. / Egg / Milk: Non veg
Husband: Farmer, labour work
Father: Farmer
Mother: House wife
Sister: Elder married
Children: 4 sons, among these 1 died 1 daughter
Address: Boranda.

A. Present History
I. Chief Complaint(s)

II. Patient as a Person: (Attributes & Functions)
A. Physical Characteristics

1. Appearance
   Built - Lean, thin,
   Skin: Black complexion.
   No suppurative tendency if injury occur heal without suppuration
   Eyes: NAD
   Ears: NAD.
   Perspiration: Excessive - more on face and scalp < during coughing, dyspnoea
   Wet the cloth, foul smell.
   Coldness: palms and soles
2. Digestion
   Appetite: Decrease since 6 months
   No Vomiting on traveling long distance.
   Aversions: Sweets+
   Cravings: Sour+++, pungent++
   Thirst: Decreases since 6 months
3. Eliminations
   Stool: Semisolid, mucous+, F-1/ day
   Urine: F: 4-5 in day/4-5 in night, Pain: mild intensity burning, Colour: Yellow while Dyspnoea

Menstrual Function: Regular, Duration-2 days, Quantity- mild, Colour-red, Stains- red+, Odour- fouls smell, no clots
Beginning of menses- Backache and abdominal pain > after menses
During of menses- dyspnoea, weakness. No leucorrhoea

Obstetric History: G5 P5 A0. 4 male children among this 1 child died due to illness (fever). 1st studying in 6th STD. 2nd studying in 2nd STD. 3rd: studying in 2nd STD.
4th Died. 1 Daughter 3 yrs old. All deliveries was FTND.

Sleep: Disturbed due to complaints- Dyspnoea.
Dreams: Of pursuit by snakes++
Of ghost++
Of died son+++
Of water- profuse rain+
Of robbers+

B. Reactions - Physical Factors
Season : summer likes.
Fan : Not available in house
Covering : summer: not require, winter: 2 godhadi, rainy season: 2 godhadi.
Clothes : uses woolen sweater in winter
Bath : Tepid water in all season
Son : no aggravation
Cold : < cough dyspnoea

Thermal : C3H2

Past History: NS
Family History: NS

C. Life Space Investigation
Mrs S K P 27 yrs is a homemaker and farmer. She is staying at Boranda with her husband, three sons and one daughter.

She was born and brought up in Boranda, Tal Vikrumgad. Her father does agriculture and mother is housewife. Their economical condition is poor; there was no income source except farming. She has one elder brother, married, she has no sister. After marriage she lived with Father-in-law, Mother-in-law, husband and one younger Brother-in-law in same village ie in Boranda. Her father's house was around ½ km from in-laws house. Patient's Mother in law is very irritable, quarrelsome. She quarrels with patient on small household, agriculture problems and shouts at her. At that time patient gets angry but can not do anything; cannot express her anger in front of Mother-in-law. After some years of patient's marriage, Mother-in-law, Father-in-law stayed separately in the same village. Brother-in-law also got married and lived separately with his wife.

Patient's husband is calm in nature but a drunkard, drinks 1-2 glasses alcohol once in 2-3 days but does no quarrel with patient. Good interpersonal relation between husband and wife. Patient has three sons 1st son in 6th Std, 2nd in 2nd Std, 3rd in 2nd Std, 4th son died 4 yrs back at age of 3 yrs. due to fever with chills (undiagnosed disease) After that incident, patient suffered from fever for eight days. She felt very sad at that time. Even now when she dwells on son's death, she feels nervous, weak, anxious, and her appetite decreases. In dreams she sees her son who died 4 yrs back. She also has many frightful dreams like pursued by snake, Dreams of ghosts, dead bodies and heavy rain.

The economical condition is low, pt's husband does agriculture work only in rainy season, rest of period he does labour work outside the village (on sand vehicle). Pt is more attached with family members, moreso to children.

During interview, when asked why she quarrels with the Mother in law, she did not give more information but she tried to avoid the question. She said that her complaints increased after marriage ie since 12 yrs, but why they increased after marriage, she does not know.

The Mental State

1. Anger suppressed+++
2. Grief - son's death+++
3. Brooding- over son's death, quarrel with MIL++
4. feel nervous- because of son death++
5. Attachment-children's++

Physical Examination
General Appearance: T. 99.4F, P. 130/M, RR.41/M, BP 120/90 MMHG
Conjunctiva: pale+, Nail: pale +, Tongue: Dry, white coated trembling, Lymph node: Not palpable

Systemic Examination:
Respiratory system: Trachea- normal in position, Chest expansion - equal both sides, Air entry- bilateral equal, Adventitious sounds-bilateral ronchi, basal rales.
Per abdomen: L 1 F palpable. No Spleen, no liver no tenderness.
CVS: Heart sound-S1S2 normal

Investigations:
7/10/04: HB-11, WBC-total 8200, N-58%, L-26%, E-14%, M-2%
Urine-pus cells-3-4/hpf, Epithelial cells-occasionally. Bacteria-+
Chest X-ray- NAD. ECG- WNL

Diagnosis: Bronchial Asthma
Chronic Totality of Symptoms
Grief - death of son+++
Anger - suppress+++
Brooding - death of son++
Attachment- family-children's++
Dreams- Of pursuit by snake++, - Of died son+++, - Of ghost++, - Of heavy rain +
Appetite decreased when brooding+++
Desires- sour+++, pungent++
Aversions-sweet +
Thermal: chilly
Perspiration: profuse+++ on face, scalp < During Dyspnoea, Foul odour+
Coldness feeling of palm and soles
Menses regular, duration only for two days, red colour, foul smell, stain-red
Cough with white sticky expectorant and Dyspnoea++
< After mid night 2-3 AM +++
< During menses +++
< Rainy season +++
> Sitting position, bend forward with both hands on head and both knees flex +++

Remedy- Correspondences

1. Kali-carb
2. Silicea

Remedy Differenciation
Kali-carb - time modality - < 2-3 AM+++
Dyspnoea > sitting position +++
Cough with sticky expectoration, difficult to pass out++
Attachment with family+++
Grief - death of son+++
Dreams - of dead son+++, Of ghost++

Acute Totality
Cough with sticky expectorant
Dyspnoea
< 2-3 AM +++
< Rainy season +++
> sitting position +++
Joint pain, headache, chest pain < During coughing +++
Thirst decreased
Thermal chilly - C3H2
Stool mucous+
Spasmodic pain in abdomen
< Before stool ++
> After stool++

Remedy Correspondence

1. Coccus-cacti
2. Nux- vomica

Intercurent Totality
Onset, progress- gradually
Thermal - chilly
Modalities < 2-3 am+++
< Rainy season +++
Sphere of action-RS
Miasm- Sycotic

Remedy Correspondence

1. Thuja

First Prescription With Reasons
5/10/04 Thuja 30 (1P) HS
SL (6P) HS
Coccus-cacti 30 x 4 pills x 4 hrly x 7 days.

The patient lives in a tribal area. She presented with acute respiratory complaints, but the ODP of the complaint is overall slow, gradual. Therefore, considering the dominant Sycotic Miasm, so prescribed Thuja as an antimiasmatic and for the acute episode, the totality corresponded to Coccus-cacti.

Second Prescription With Reasons
Kali-carb 200 1P HS
SL

Patient felt better after first medicines, so followed by constitutional medicine Patient felt better in subsequent follow ups.

Conclusion: Importance of understanding the miasm and concept of time, causation, evolution, phase and concomitances in Homoeopathic Practice.

Phase was dominant Sycotic miasm, to facilitate the action of acute remedy and then constitutional remedy unless we deal with phase we will not get effective action of acute and chronic remedy.