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Case Study

I can't work....
Dr C B Jain
Dr Bipin Jain
'Ars-alb / Tub-b / Calc-fl

Mr. M N R 50 yrs. Male.
Occupation- Retd 4 years- tiles factory
Wife- 45 years, a sweeper in the same factory. Jobless 4 years as factory closed down. Siblings-One elder brother expired. 2 younger brothers. Stay at Malvani chawl, in room 16x 10ft.

Chief Complaint:

Respiratory tract. Lungs More than 4 years he was sick, when he was working

Cough2 Yellow thick expectoration Fever Body ache

Started with anti Koch's treatment
Felt better for few months
Discontinued treatment for 1 year since in native place
Restarted the treatment regularl. No improvement.

In last 2 years admitted to hospital thrice, last before the resistant line of treatment started.

Recently took resistant Line of treatment from Oct'92 to Feb '93

Cough Increased. Expectoration
No haemoptysis
No breathlessness

Chill with fever Bodyache
He could judge the progress of illness by weakness

AGGR Night3
AMEL Drinking water
AMEL Expectoration
AMEL Lying on Rt side with bending
AGGR 7pm to 1 am

can't stand in train
Feels will fall
weight loss
App decreased 

Patient As A Person:
Appearance: A lean thin dark complexion
Appetite: poor. H/O smoking bidi now left it since illness.
Stool: 2/day. Micturition - No complaints
Sleep: disturbed since because of cough. Dreams parents
Thermals - C3H2

One brother had hypertension & 5 years back had hemiplegia. Elder brother expired. Wife had tuberculosis 10 years back; took treatment for 9 months and she was cured. O/E Temp 99.2 F P. 84/min. R R 22/min. Pallor. Wt- 35kg. BP 110/70 Chest- Ant. Bilateral crepts. RT More than It. Examine posteriorly with bronchial breathing.

Life Space
He is from Andhra Pradesh: Father expired when patient was 5y. At the age of 20 patients came to Mumbai. He was doing "Begari work" (labourer) earning Rs 3/- a day for 2 years. Later he joined this tiles factory. For his hard work & precision, he was promoted to the colour department, where he was exposed to silicon, zinc, barium and soil. When he left the job he was earning Rs 1500/- per month. Patient had 5 children out of which 4 expired immediately after delivery (within an hour to a day). Only one daughter survived who is now married at native place. He later adopted his brother's son; who is now married and stays with patient. Both son and DIL work, while patient and his wife look after the household without any difficulty.

Patient narrated all this without quite emotionlessly. (Observer found- a blank face). But he described his work with a lot of enthusiasm.

X-ray chest PA- extensive bilateral upper lobe Koch's lesion
Latest X-ray does not show any further improvement.
AFB+ve in3 samples.
This case was one of the first of our research project. That time our knowledge was bookish, our experience scanty and confidence shaky. Gradually general guidance was derived from the understanding of susceptibility and sensitivity, which helped.

Definition Of The Case:
Advanced tubercular pathology not healing by any line of treatment. Characteristic expressions poor. Only clinico-pathological symptoms present. Tubercular caseating lesion, tissue pathology, progressive wt loss and progressive weakness, F/H/O Brother hypertensive a Hemiplegia (syphilitic)
Dominant Miasmatic Activity: TUBERCULAR
Tissue Susceptibility= poor. Sensitivity=poor. Reactivity= in the declining zone (mind & nerves) but not poor or absent.
The progress of disease was marked by the weakness, night< and tubercular lesions. This pointed to Ars-alb as a phase remedy.

Constitutional: The personality: A hard-working man. Not emotionally affected by unfolding of the life events. Mentally & physically a hard person. This interpretative understanding helped us to arrive at the diagnosis of Calc-fl.

Antimiasmatic - Tuberculinum
Now we had done the planning, but had to decide which remedy to use and when? What will be the outcome? Prognosis? Examine this: Susceptibility= poor, sensitivity= poor reactivity declining. Dominant= Tubercular.

All this meant the system cannot support itself on its own. It needs the support of the indicated superficial similar force. (ref: Boenninghausen Therapeutic Pocket Book) 20/12/93 Case was opened with Ars-alb 30 OD- this repetition was initiated with caution Drug showed registration by 3/3/93. patient did not have chills and increase of fever. Appetite improves

With the gradual improvement, frequency of Ars-alb 30 was made QDS.
Editor: The Qs which will come to the mind of the reader is why increase repetition. In these cases of advanced pathology and poor susceptibility, the frequent rptnof the phasic or acute remedy is required to bring up the susceptibility. Remember, these are not your rum-of the -mill cases and require different handling.

13/5 weakness=0, No fever. Appetite = N. Chest findings better. Cough better. X-ray showed improvement in lesions but AFB +ve.

27/5/93 and 17/6/95 Patient had acute viral upper respiratory tract infection. Patient did not have nay UR TI for last 1 year. Patient did not respond to the indicated acute drug. Took Allopathic Rx, but did not show improvement. There was excessive weight loss. There are no indications for Ars-alb now.

Improved state of susceptibility and new symptoms coming up suggested use of the deep acting constitutional drug. Calc-fl 30 was then continued. He did not require any further dose of Tub-bov.

By October 1994 patient was almost asymptomatic. Weight had gone up to 40 kgs, X- ray showed healing. AFB-ve in 3 samples of 23/6/94, 24/6/94, 25/6/94. Treatment continued till Nov 1994 after which, due to family problems, he shifted to his native place.