Approach to treating TB cases
NATIONAL JOURNAL OF HOMOEOPATHY 2000 Sept / Oct VOL II NO 5.
Dr C B Jain 
Dr Bipin Jain
'Kali-c / Ars-a / Sil / Phos / Kali-bi

Mr P V M, Kutchi Brahmin, 29 yrs, Married 2 ½ yrs, reported at Dr (Mrs) S S Shah's clinic on 23/08/97 with the following acute complaints.
Low grade fever T:99.4 since 1 week. A/F Cold bath when heated. Cough with white expectoration
O/E: RS NAD. Weakness3 last 2 days. Thirst: Poor3 TASTE bitter
Patient received Gelsemium 200 4 hourly for 2 days.
Keeping in mind the course of the disease, XR chest was ordered.
25/08/97 Headache > 2, cold + cough +. O/E fever 99^oF
XR mild infiltration in both apices. ? Koch's origin

Rx Gels 200 4 hrly ct for 4 days
Without any general symptoms XR showed bilateral infiltration. The primary Physician telephoned me for help. I asked to see the XR. I could confirm presence of infiltrates but plate quality was poor. XR repeated with another radiologist.
29/08/97: No fever since last 4 days. Weakness >3 mild cough
Repeat XR: (Lt) apical cavitation of Koch's origin.
As he was better, Placebo given, but the tissue level disease was progressing. Within 4 days between two x-rays, infiltration  cavity. This alarmed us. The case was defined immediately.

Chief Complaints: See the follow up 23/08/97 - 29/08/97

Associated Complaints

Location	Symptoms	Modalities
Head, Rt side	Severe pulsating pains	< Increasing and decreasing with sun
Sinuses 3-4 years back; for 2-3 days and 8 months back for 4 days		< touch < stooping > pressure
UR Tract Recurrent Throat and Nose	Coryza + thick discharge Throat irritation
Ears	Sensitive to draft	< cold draft >with allopathic RX

Patient As A Person:
Appetite N, irregular eating habits
Desire - salty food, aversion - spicy2, sweet
Perspiration: General 2 in hot weather
No stains or odor
Sleep: OK.
Dreams: Black snake
Friend committing suicide in front of him
Playing cricket
Running and someone behind him, trying to catch him, all doors closed, can't run.
Thermal: Chilly C3H2
P/H/O: Typhoid
O/E B P - 130/90, wt 64 kg, temp - N
Chest NAD, teeth - cavities

Investigations: CBC - ESR - WNL
XR chest already reported
XR PNS: Mucosal thickening Rt. Maxillary sinus S/O chronic sinusitis. Bony nasal septum is deviated to Rt.

Life Space: Patient a graduate from Kutch, married 3 years, is from a joint family. Right now he is alone in Mumbai while rest of the family is at native place. Highly anxious person, his main anxiety revolves around family, their well-being and their telephone calls. Whole night he is disturbed and restless, if he has not received message from family! Apart from this, life is not stressful. Making the totality on the basis of emotional state of person, his constitutional selected was Kali-c.

High sensitivity (emotional) and deteriorating tissue: so susceptibility: moderate. Selected moderate (30) potency and cautiously repeated daily doses.
3/11/97: Repeat X-R: cavity absent with fibro-nodular shadows with calcifications at left lung apex. All these days he did not have any symptoms.

Important point that strikes is the absence of cavity and enhancement of healing process up to calcifications in the small period of 8 weeks.

Case 2
A similar case: of a young boy of 21 years already under my care. He reported to me after a gap of 6 months for fever for 2 days - 100-101^oF with mild chest pain, Rt Side pleural reaction and fibronodular infiltration. An experienced radiologist diagnosed an early tubercular lesion.

Fever and generals were taken care of within 2 days with acute Ars-alb 200 4 hrly. I did not hesitate to give his constitutional medicine Silicea 200 in single dose. 2 doses in few weeks cleared every thing. X-R totally normal after 6 weeks of treatment. In both these cases, because of the prompt action, there was a prompt response and quick result, healing was fast and complete at the end of few weeks. This proves the efficacy of Homoeopathic Treatment. At minimum expenditure of energy we could restore the susceptibility. This was possible because the disease had just begun. The damage was minimal and susceptibility was un-tampered by other medicines. We struck with right force at the right time- first the acute and immediately the constitutional force. This conclusion is the result of research at the hospital level practice. The results are better and very quick. This is what we are trying to teach and spread.

Case 3
Mr S 25 years old, NV married since 6 month; consulted on 22/07/97
Occupation: Begari. Residence in slums.

L	S	M	C
R S For 2 months 1 yrs Back in village In between Inc. since 7 months	Cough with yellowish Expectoration	< 2 lying on back < 2 eating rice < 3 evening 4 pm X 5 pm
Inc. 3 since 1 month	Thick now thin, not Stringy NO HAEMOPTYSIS Breathlessness	<lying on sides >1(AKT-for 4months) Discontinued due to Money shortage < exertion < cycling- double seat
Chest (Lt) side & sternum D-> 5-10 min	Pain3 stitching pain like needle, Difficulty breathing Fever with chilliness3 Weakness++ Fever with chilliness3 Wants covering Wants to sit in sun Bodyache3 App.3 decrease Cough-SNo cold, breathlessness, Increased, Weakness3, giddiness cannot move/getup	< inspiration Headache3 Eyepain3,Burning3,Watering of eyes,Headpain3 Sleeplessness Yellow urine < 3coughing <evening	Thirst no change
GIT> Abdomen More than 1 yr Generalized	Pain3, drawings3Does not allow me to get up from the bed. No nausea/vomiting, no burning	2<6 pm 3 < 4 am to 8 pm 2 > pressure no abd. Bending
Again started since 1month After chest pain	Stool-N, no flatulence. App 2 decrease. Cannot go to work due to abdominal pain	lying on abdomen 3 < empty stomach 3 > eating.

Associated Complaints:
Extremities: < 2 exertion < 3- 4 pm
< 3 morning(4 - 8 am

Physical Characteristics:
Tall, lean, thin, dark complexion, long eyelashes
Wt: 43 kg
Perspiration: general on exertion, no odor, no staining
App: dec. since 1 year
Cr: Highly seasoned - > spicy2
Sleep: Good otherwise, less since 4 days
Dreams: not much; 2 years back++ dreamt of village.
Meterological
Sun < covering - S-x, W-1 Blanket
Getting wet < 
Bath-cold throughout
No major significant F/H or P/H

Physical Examination
T: Afebrile. P: 80/mon (R)
BP: 120/80 mm of Hg
Conjunctiva - pale+ clubbing, throat-NAD
Tongue: clean, moist imprints+
No Lymphadenopathy
RS: Trachea-central, chest expansion equal, air entry equal, percussion - NAD breath sounds normal (vesicular) crepts in infra-scapular areas Lt > Rt.
P/A: NAD. CVS-NAD
Chest XR case caverabues lesions Rt. mid and lower zone

Objectives of the case presentation

1. Learning the importance of interpretation of data and its repercussion on construction of TOTALITY.
2. Experiencing the fixities of ideas we carry about the MMI.
3. Understanding the significance of appropriate assessment of susceptibility in management of ILL-TREATED KOCHS.

Analysis
The totality undoubtedly pointing towards Phosphorus. Yes, everybody had a fear in his mind that it can damage the case. The susceptibility/sensitivity was studied; it was moderate with high respectively. The potency selected was moderate, structural changes in lung tissue and high tubercular sensitivity forced us to prescribe the dosage cautiously.

29/7/97: Phos 30 1/week. Within 3 weeks patient was asymptomatic. In absence of symptoms team overcautiously gave Placebo and observed for few weeks.
14/10/97 Symptoms recurred. Phos 30 1/week till 16/1/97. Patient was again asymptomatic. XR chest showed marked improvement. Patient gained weight by 2 kg, but c/o weakness and feverish feeling. Phos 200 single dose. Patient is under observation till date and does require infrequent doses of Phos 200 for other complaints, but tuberculosis is completely healed. This case also gives us the learning that we need not be scared with this drug force but we should follow the rule of defining susceptibility and manipulating it with required/indicated force for our advantage i.e. the healing.

Case 4
Mr TSD, 38 years old, a Keralite, well built stocky male patient, whose wife and children were under PP's treatment, came with one of the neighbors who also had fever since last few days. The patient appeared to be quite nervous, reserved and communicated with difficulty in Hindi/English .

Patient said that he developed chilliness and fever while on tour to Gujarat. Chill when temperature was beyond 102. H/O cold, cough previous week. Backache, right leg pain, soreness of head with fever starts at 1 am-waking him from sleep; was given paracetomol and cholorogin for 2 days at Gujarat, weakness increases with fever. Does not want fan. Keeps his shirt on, at home remains without shirt even during winter) App. N. Tongue sticky, feeling insipid.

Thirst decreased2. Sweats on legs after taking paracetomol, throat irritation, thick white coryza, cough +, thick white expectoration. Blood stained since yesterday, fresh blood (no H/O gums problem)
SLEEP disturbed - changes position in sleep
DREAM - accident electric shock; takes contracts
Loose motions twice a day 102 F. P-96/min
Head warm, extremities cold, palms moist
Throat congestion2. tongue coating +, slightly moist

Chest NAS PA ND
05/03/94 Inv: 9 pm - WBC - 14600 Hb - 11.8
Temp: 2 pm-103.4, 3 pm - 103, 4 pm - 103.4, 5 pm - 102.4, 6 pm - 103.2, 7 pm - 103.2, 8 pm - 103.2, 9 pm 102.4 degree: 4.30 pm - perspiration all over.
Doesn't want fan now, but no covering (usually wants fan) head soreness in morning, thirst -drank several times little quantities, extremities loose3 cough since 15 days aggravated. Morning 5-6 am blackish expectoration; loose motions since 4-5 days, 3 per day, painless, scanty offensive and drowsiness2 craving for some because no taste in mouth, craving for salt (usual craving) Dream accident once, tongue post coating, moist. weight 64 kg, examination fit.

7/3/94
Previous whole day temp was 102 - 101.8 max. 7 pm - 104
7 am - 101, today 100.2, 7 pm 100.6
Hemoptysis - twice yesterday fresh blood once.
Cough - chest pain rt. Side agg turning in bed. Agg stooping, agg deep breathing, body ache + yesterday
Today feeling better, taste better, since evening: taste better, hands and feet cold with 104 degree F. Headache +. App N Loose motions - 4 times, offensiveness. Weakness better today.
75% better but +.

Investigations Reports-
S. typhi O nil, H nil paratyphoid nil A B - H
E. 01 M: 1. urine (R) pus cells 2-3 /HPF
ESR - 112 min
X-ray chest consolidation Rt. Mid Zone few atelectetic shadows at left base.
Chest NAD. Temp: 100 degree P:80/min

Chief Complaints

R S Since 15 yrs	Cold wateryThick yell (going out of station)No sneezes; no nose blockOcc. Throat irritation; occ coughOcc. P N D; Expectoration thich yellow	A/F C D W TravellingTiredness towards eveningUsually after coming to Mumbai< cold: < Bombay2>warm drinks> after stopped smoking
< Since 2 month	Stringy white expectoration Sticking in throat	Doesn't come out easily
Since 1 year	Breathing difficulty	< winter < climbing stairs and crossing bridge
2) G I TSince 10 yrs on and off Rt. Hypoch whole abdTwice severe	Gases; Distention of abd. Pain shifting all over abdomenContinuous dull pain, Nausea, regurgitation. of Food-some bitterStool-undigested food; Mucus plus; No burning abd; Stool-unsatisfactory; 4 times/day well formedUsually before going outOr whenever opportunity available	Aggr. Empty stomach Aggr. Deep fried food Aggr. Meal delayed Aggr. Outside food Aggr. Movement3 Better eating Better drinking water, (if because of fasting)
3) Skin ButtocksScalp: Since 2-3 years	Boils, Redness induration; No fever/chill; Pain	A/F change of weather From summer to monsoon

Physical Characteristics:
Stocky. Broad shoulders. Well built
WT GAIN - 20-22 kg In last 15 years i.e. after marriage
52-62 Kg (Last recorded)
Skin: cracks soles plus (in kerala)
Hair: Greying since 2 yrs
Perspiration. Forehead, extremities, palms (after fever) no odor, on stain
CR. Sour3 spicy3, salt (H/O adding plus raw salt)

Sexual Function: supression3 because wife does not co-operate; wife's desire poor3
After second son very infrequent3
Irritability from suppression
Premature ejaculation
Emissions 2-3 times / month
Masturbates 3-4 times/month before marriage, once/month after marriage.

Thermal: sun no agg. Prefers summer
Fan S: full no draft agg. W: 1-2
Air conditioned - likes but breathing difficult
Covering S:O sleeps bare chest throughout
W:O in Bombay if very cold thin
Bath: cold summer; warm early morning in summer and monsoon and winter C2H3
HABITS: H/O pan. H/o tobacco chew (to stop smoking.)
Smoking cigarettes.: 77-78, 2-3 cigarettes. / day- 87, 4 packs (16 - 18 hrs work) - 10 per day - since 3 wks stopped. Alcohol - whisky 3 pegs thrice a month. No aggr.
P/H - jaundice - twice in childhood, malaria 10 yrs age
P/H - Mother - Diabetes Mellitus.

Life Space
Mr TSD, Dipl in Elec Eng, employed as site engineer, married, spouse is (CMLT) Path, now housewife.
Children: 2 sons 8 and 3 ½ old
Occupation: Site Engineer.
Patient, from a well-to-do Keralite family, is the 4th of a family of 5 brothers and 2 sisters. Both the sisters are elder to him.

His father, a grain merchant was a perfectionist, wants everything on time and place and because of this there used to be occasional rift between him and his wife. But they never fought in front of children and there was no effect on children. Though strict with children regarding their studies, he was affectionate. Patient is more attached to his elder sister (age gap is quite big) and mother. But has good relations with all others and helped when needed.

They are all settled and separate. During his initial employment in Gandhidham he met his prospective father-in-law, who was his boss's friend. Later he married his daughter. Stayed in as she was born and brought up in Mumbai and the patient left his job and settled with them.

He started working for an Engineering firm and his site work made him tour to Delhi, Gandhidham and Ankleshwar. He is very conscientious in his work, worked very long hours if needed and tries to finish all projects within given time. (77-78) and he became addicted to smoking. He gets lot of contracts for his company and also concerned about labor. He cited an instance when a staff under him forgot to switch off a machine and machine got spoilt though it was not his negligence directly, when he came to know about this loss it created, he was disturbed and had tears in his eyes, feeling guilty as it happened under his supervision. He is very much sensitive and gets disturbed if any child cries (even if the child is not related to him). He cannot see anyone suffering and if children are hurt. He cannot clean their wounds etc. Patient's wife has to do this firmly. He would even give away donations without his wife's knowledge as she shouts at him.

Patient is very much attached to his children especially younger, elder is more close to mother.
Patient described his wife as rough, obstinate, and does not get along well with her. After marriage they faced initially a lot of problems of adjustment as he is from Kerala and preferred Keralite food whereas wife is from Bombay and is fond of Bombay type of food. But both of them tried to adjust to each other.

He was not satisfied with his sexual life as his wife had very poor sexual desire. of marriage also They had first intercourse 1 ½ months after their marriage. Then till their first son was born, it was okay but later on it decreased and after second son it is very infrequent. Hardly 2-3 times in last 5-6 months. His efforts to make her interested in sex were of no avail..

Patient usually adjusts and does not force her but sometimes gets irritated. They differ in other things also. If he talks on the phone, she gets irritated as he talks for a long time and does not wait for him to eat with him.
So far patient's wife has threatened to leave him 2-3 times, saying I don't want to see your face or we'll separate - I don't want to stay with you etc.

Last time it happened 3-4 days before his illness started. He wanted to have breakfast and seeing her busy with some other work, he went to the kitchen himself and started making omlette. On seeing this she lost her temper as she was preparing some other dish for breakfast. He was to go on a tour two days later, but his wife started shouting at him and told him "why don't you go now and don't show me your face again." This hurt him a lot. Two days later in the middle of the night he started having heavy chills and early morning he left for Baroda, on the way itself he developed fever.

He gets very much disturbed by such fights. He keeps thinking about it and does not like the evening at home, since they do not talk to each other for months. He would just come home, eat and sleep not talking with anyone. He said he usually tries to adjust but she does not give in easily.

Patient though initially looked reserved and had no earlier contact with PP ( personal physician) in initial 5-10 min. of interview only talked about his problem with his wife - IPRS and sexual area and had tears in his eyes. Whereas his wife had not talked about it in 1 ½ -2 years during her treatment. Even though the doctor found her disturbed many a times and thought that it might be due to her leaving her job, the patient on direct enquiry denied having any problem.

Physical Examination:
Nail - moons. Nail biting plus
Palms moist (square with thick fingers)
Throat - O tongue plus glands nil
BP - 130/80 WT - 63 Kg
FU temp normal since morning. Chest pain if coughed. Cough better - aggr lying down - has to sit up at night, expectoration white - occ with black particles. No hemoptysis. App N, taste N motions - 3 well formed offensiveness - S, sleep disturbed every night. Headache. No body ache or weakness, feels fresh.

The patient's wife is a "Dry Lady" (not much careful about her physical appearance etc. used to work in a Pathological Lab (CMLT) before marriage But left job to take care of her children and is happy with her role of a housewife and appears to be dedicated to them.

She came with AFB positive report of her husband and was anxious. She discussed with PP about the scope of Homoeopathic Rx of TB and presented her conflict in very straight terms saying in all there is no full proof Rx for Koch's in allopathy as in Homoeopathy. She only brought her husband forcibly for hom. Rx. She herself can not decide what to do knowing it is Koch's.

She said that her husband was very conscientious and hardworking but without getting adequate compensation for his work. 6-7 years back patient and 2 of his friends left their jobs from Sterling Engineering and started business on their own. Since they were thick friends did not decide on any legal terms for the partnership. They had only distributed work among themselves. Patient is supposed to supervise site work and other two with supply of material and accounts. As nothing was decided about sharing profit etc, one partner drew more money and later left the partnership and started his own venture. Even then the terms of sharing the profits between the patient and the other not settled and is nebulous.. He only asks for money when there is a need and is given without disclosing how much is his share of profits. Patient's wife is not happy with this arrangement and keeps nagging to clear the matter. Patient has full faith on his partner. He is senior to him so cannot question him about getting equal share.

Problem worsened since the partner who left earlier approached him to join him with clear terms. He has made him and especially his wife more aware of the consequences that will follow in this nebulous arrangement; this made her insecure. The patient is however unable to decide as to whether to leave his senior partner and join the other firm.

While the wife of the patient was not worried about financial insecurity in this arrangement as she said would get her father's property, but very upset about her husband slogging without adequate She felt that her husband should be on his own and more than that, why slog without knowing his profits. If he is going to be one of the employees he should work like one, not putting his efforts like it was his own firm.

She said he is very much simple, also very childish. He has not attended a single function of their school and even teachers ask about him. If he sits to teach his son - they both break out in fight as he loses his temper fast and then would blame her for spoiling him and there would be a lot of noise. He was however fond of his younger son He is quite demanding and complains that wife does not take care of him since she is not able to pay attention to him after birth of her children. He likes to eat hot food, but in spite of taking all the care to serve hot food he would leave table and keep talking on phone and then would grumble and not eat properly, if food became cold.

When asked whether she had commented about her insecure future to him, she said one hardly gets any time since children are always there and I don't like to talk about all this in front of the children. Reason for their poor sexual life was also because of children. Elder son sleeps with them and so she does not feel relaxed and sometime she is out of her mood, which gets spoilt because of above reasons. She added the patient is always stuck with such minor problems, always feels hurt and would sulk, not eat or talk, and not thinking about serious issues.

10/03/	Wife reporting (wife's interview)Report AFB in 2nd sample, no significant change.	Placebo
14/03	S/B Consultant - Rt. Dorsal upper regionToday chest pain, mild once Fine crepts.	Kali-bich 30- 3P HS+ sac lac
17/03	Cough aggr. Since today morning chest pain at rt. Sight expectoration, better, blackish-white non sticky. App. normal temperature 5.45 pm-3.00pm- 99-99.2 degree sleep reduced. - sleeps late 12-12.30 am backache since yesterday pain in legs crepts persisting action.	Rx Kali-bi 30 (3P) HS Sac lac
21/03	Temp only at 3.00 pm - 99.2 degree F cough for 5-10 min. 2-3 bouts, expectoration slight white chest pain occ. Action.	Kali-bi 30 (3P) HS + sac lac
24/03	X-ray minimal pneumonic haziness tr. Lower zone medially few atelectatic linear shadows ESR - 67 mm. AFB neg. T 99.8 degree F cough better, chest pain better, rt. mid zone creps fine wt 65 kg	Kali-bi 30 (3P) HS
29/03	Chest pain more since 2 days, continuous, whole day, gases A/F oily food. Haemoptysis yesterday 2-4 times, fresh T 99.1-8, f5-8 pm. Since 3 days chest crepts (hardly available)	Kali-bi 30 BD
02/04	Expectoration thick white no haemoptysis, chest pain slight, gases plus motion N sleep N. T: maximum 98.8 degree F.	Rx repeat
09/04	Temp. 3/4 4/4 5/4 6/4 7/4 - 98.6 99.4 99 99.2 98.9 Medicine stopped on 7/4. 9/4-98.8 cough-occ expectoration white thick blackish, no haemoptysis, chest pain occ, rt. mid zone ant. Sleep-N App N gases chest NAD	Sac lac
13/04	Temp 11/4 - 8.30 pm - 98.9 13/4 7.30 pm 98.8 chest yesterday night now better Aggr. Jerk, bending, haemoptysis - dark red- mixed with phlegm , weakness in the afternoon now better, one loose motion today gases T chest NAD wt 65 kg.	Kali-bi 200 (1)
16/04	Yesterday 8 pm T-99.4 degree F 5 pm 99 degree F today 99 degree F chest pain till yesterday now-nil no haemoptysis problem white thin tiredness, nervousness in the afternoon, sleep N gases (fluctuating)	Placebo
21/04	Temp 10/4 - 7.30 pm 99.2 20/4 degree F chest pain and because of flatulence
25/04	Chest pain better T 98.8 looks fresh	Placebo
26/04	T 98.8 - 99 degree F Wt 66 kg no other complaint, going to Kerala for one month with whole family.	Placebo
06/06	For 2 days (15/5 - 16/5) temp. chest pain once at night - severe better phlegm white had boils better stock within 7 days.	Kali-bi 200 (2)
14/06	Temp - normal T 98.6	Kali-bi 200 Hs (3)
21/06	15/6, 16/6 temp 99 degree F feeling feverish expectoration found ;offensive flatulence	Rx- Kali-bi 200 HS (3P); IP HS 4P, placebo x 7days
27/06	ESR-3mm23/6 - 98.8 haemoptysis fresh, fluid bright red 25/6 6.30-8 pm 99.4 degree F26/6 98.8 8 pm 27/6 98.3 had chest pain shifting - rt. Side better today chilliness slight no weakness app N	Placebo HS
02/07	Fever chilliness T 100 at 7 pm gases pain in abd. Better after stool, weakness plus chest pain rt. Side on pressure. Thirst less. App less. Taste - in spite now better sleep reduced. Tongue yellow Coated. T 99.5.	Rx Phos-acid 200 IP stat HS
05/07	T 10 pm 2/7 3/7 9 pm 8pm 4/7 whole day normal99.2 99 99.25/7 7 pm all other C/O better	Placebo
10/07	Temp 99.8 degree F - 5 pm chest pain on pressuring	Rx Kali-bi 200 HS (1P)
16/07	14/7 8 pm - 99.9 degree F - loose motions 4-5 day watery gases plus offensive today twice consist. Normal came late on 14/7 - had a fight with wife, not on talking terms	Rx Kali-bi 200 HS (1P)
23/07	18/7 8.30 am 7 pm 19/7 8.30 pm/99 99.3 99.6 22/7 8 pm = 99.3Mucus white GIT >, motion loose 2-3 times, sleep, appetite, - normal	Rx Kali-bi 200 HS(1P)
01/8	3 pm to 9 pm 99 F since 3 days chest pain 0- motion normal, sputa >	Rx Kali-bi 200 HS (1P)
08/08	Haemoptysis twice fresh, temp. 99 after 3 o'clock, Headache right side above eyebrow, motion-normal.	Rx kali-bi 200 Hs (7P0

Analysis
The patient presented with chill, Fever, weakness and haemoptysis. The evolutionary disease pattern certainly indicates that he was sick before he went to Gujarat and the clinical pattern does not favor the diagnosis of Malaria. 7/3 Follow up and investigations clearly point towards the diagnosis of pneumonia. PP (Primary Physician's) totality: Quiet and nervous person presented with fever without thirst, weakness3 and painless diarrhoea, concomitant to the RS complaints Phos-acid is the only choice of drug.

By 7/3 one does see the improvement at general as well as at particular level. The improvement continues with Phos-acid 200 4 hrly, but PP did not rest at this junction she went ahead and prepared the complete case trying to find out what is the PAIN of this person. She took care of husband and collected the information from his wife as well.

Case further reveals that this man is suffering for 15 years with c/o sinusitis and dyspepsia for last 10 years. Skin is involved in last 2-3 years. The pain of marital disharmony is lasting ever since he is married. The evolutionary study reveals he is a sentimental3 - attachment++, Anxious3 and weak person can't resist or can't fight back, but a hard working individual, sticking to his commitments, hot thermal state and recent shift to chilly with pneumonia episode, sticky, stringy discharges skin summer aggravation, made the choice of constitutional medicine as Kali-bich.

I examined the case on 14/03.
Pneumonia with haemoptysis, evening rise of temperature, very high ESR-112.mm, and finally AFB +ve in sputum. (Wife being CMLT confirmed the samples).
It was tubercular pneumonia, the drug Phos-acid certainly helped the presenting phase and again change in phase will demand the deep acting constitutional drug to complete the cure.

Follow up 14/3/94 to 9/4/94
After consulting me the PP went ahead with treatment of case her own, thinking not to bother consultant for routine work.
We started with single dose of Kali- bich 30.
PP increased the dosage to bd on 29/03, this continued till until 7/4, then she waited for very short period.
The two symptoms of haemoptysis/fever persisted indicating reactivity and when she stopped on 7/4 the pt started settling.

This subtle but delicate disturbance (change) was overlooked by PP and she prescribed Kali- bich 200 single dose on 13/4, followed by placebo till 6/5. On 6/5 he went to native place till he reported on 6/6, he was free of complaints and he gained wt also by 2kg.
Here on 6/6 there was no demand for any treatment and PP prescribed Kali- bich 200 II dose. This was a crucial decision. This put the remedy response in confusion. You can very well see that PP did not learn the lesson from last episode.

She went on with her routine understanding and not really looking at the progress of disease symptoms on till 8th Aug, when she finally gave daily dose of Kali-bich 200 for a week But symptoms persisted despite treatment.
On 14/8 she consulted me. Taking note of the current state of the patient. PP was advised to analyse the follow-up properly on RREF (Remedy response evaluation form). PP was warned not to prescribe without consulting me.
Pt was given placebo for more than a month; all his complaints settled. We kept him on placebo for two more months without any symptoms.

By this settlement of Pt. PP also became wise. She did introspection & RREF and realized what went wrong.
I would like to share one more experience. I was treating a male child of 8-9 years of Tubercular lymphadenitis. Child was receiving Calc-phos as deep acting, chronic remedy. He was responding partially over a period of 6 months. Weight remained same, fever range restricted to evening few hours. Glands regressed 30-40%. Considering the tubercular miasm dominant, I gave Tub-bov 1M single dose. On same night after a couple of hours of taking the dose, patient got sudden high fever reading up to 104 - 105^oF along with drowsiness, weakness++, appetite-poor.

This lasted for a few days and all the symptoms reached its original place. Could not understand/interpret this reaction. I gave Tub-bov 1M twice at 9 months interval; at both times similar reaction occurred with same intensity in similar way. This scared me; I found it difficult to understand. I studied the immuno-pathology of tuberculosis. There I found similar response to tuberculin test by some hypersensitive people and some infants responding similarly to BCG vaccine. This enabled me to understand the hypersensitive reaction of system to Tub-bov. In the development of disease this general reactive symptom does come up with the starting as well as developing disease. Healing also takes place through similar route when macrophages gets activated to deal with the organisms.

This state of susceptibility is very crucial. This can guide us in the direction where we will get answers for questions like, role of deep acting drugs like Phosphorus, Silicea, Kali-c etc. As most of the practitioners of past have warned us about these uses in different situations. And the role of Tub-bov / Bacillinum in treatment of Tuberculosis. One of the key factors is the knowledge of susceptibility / sensitivity and the application of twelve observations of Kent about remedy response, which will always guide us in determining this state of hypersensitivity (susceptibility). It is desirable to know the non-reactive state of susceptibility also to use the drug like Bacillinum to evoke reaction. This aspect is very well demonstrated (case no. 3 page no 194 last issue of NJH) through cases.