Individualise
NATIONAL JOURNAL OF HOMOEOPATHY 1996 Nov / Dec Vol V No 6.
Mohan Gune.
Cases.
` Nux-v / Sep

Who has to decide about an approach to a case? A Physician? No, it is the Patient! The approach to a case should change according to the situation in which the patient is presenting.

Dr. Samuel Hahnemann has stated in Aph 153 of the Organon of Medicine the more striking singular, uncommon and peculiar (characteristic) signs and symptoms of the case of a disease are chiefly and most solely to be kept in view. In following aphorism 154 and 155 he discusses how the similar remedy cures without any considerable disturbance.

Dr. Hahnemann never postulated about relative value of symptoms except searching for uncommon, peculiar, queer, rare, strange ones. However, his followers while interpreting Aph 153, renamed the peculiar symptoms as PQRS. These again are renamed by Dr. Boenninghausen as Concomitants and he gave highest importance to them in his approach. Dr. Kent gave importance to mental symptoms. These are concomitants of physical diseases and as they individualize a case of physical nature, the importance of mental symptoms started mounting up. Dr. Kent was followed by many Homoeopaths, few of them started saying that ONLY MENTAL SYMPTOMS are important.

Dr. Dario Spinedi - Switzerland has given the opinion of Dr. KUNZLIs in the Links 3/96 - which is a very important point to ponder. He says, the mental symptoms come in last and not first. First we have to consider the symptoms according to paragraph 153. One should always balance the prescription on the positive facts of the case, and not just the hypothetical state of mind, where the patient can deceive the physician if he intends to. He can give half truth or total untruth about himself, may be because he feels ashamed of his deeds or because he does not have the courage to accept the facts of life and put them before the society. In which case the symptoms taken for consideration will bring out only a false or untrue remedy, which of course is a failure to the Homoeopathic Physician.

Many Physicians give importance to dreams in their prescription, which really speaking are the symptoms of the mind. Dr. Vakil while discussing his approach to dreams has cautioned about the misleading dreams - which one gets in Homoeopathic practice (Homoeopathic Prestige - March 96).

Dr. Hahnemann himself while discussing about one-sided diseases in aphorism 172 to 184, explains it as a zigzag approach. Where the chief complaint only is taken as totality and matched with the drug, then the second group of symptoms is taken into consideration, then the third one, and ultimately the disease is cured. Which shows that the Homoeopathic remedies do act even on partial totality.

Dr. Kees Dam, Holland while discussing in 1/96 Links gave excellent preview of aphorism 210 by asking the question, Do all physical diseases have mental symptoms? He also agrees that they do not, though Dr. hahnemann in aphorism 212 states that, The creator of therapeutic agents has also had particular regard to this main feature of all diseases, the altered state of the disposition and mind, for there is no powerful medicinal substance in the world which does not very notably alter the state of the disposition and mind in the healthy individual who tests it, and very medicine does so in a different manner.

However, this only makes one sure that the mental state is to be differentiated on a much broader scale and not just from Repertory. One should always try to find out the medicine and then see as to whether the Repertorial analysis is pointing to correct medicine or whether there is anything else, which is to be considered as predisposing factor. Dr. R. Sankaran called this a basic delusion of the drug as well as of the patient.

The above discussion may give the impression that I do not believe in mental symptoms. No, it is not so. I would always like to differentiate the remedies from Materia Medica on the mental field as Dr. Boenninghausen had advised. Though grand generalization done by Dr. Boenninghausen is to be discarded as it is not the truth, his opinion about the mental symptoms is equally true and holds good in practice, and I dont have any hesitation in accepting him to find out the similar remedy. He gave a lot of importance to pathological symptoms, seat of disease and the time modality. The causative factors when present get utmost importance especially so if is mental in origin. The only precaution to be observed is that it is unprejudiced true observation as is advised by Dr. Hahnemann in aphorism 83.

Unless the quest of finding out the remedy is done as a third part of observer without any emotional involvement in the case and maximum attempt is done to individualize a case, no matter what the nature of disease is, one is not likely to get correct remedy.

Homoeopathy is a Science of INDIVIDUALIZATION and there are many ways to individualize the case. Individualization is the true way to cure. Whether the symptoms are mental, physical generals or characteristic particulars do not make any difference as long as they leads to a remedy almost similar to a disease picture which the patient presents. I would always say that instead of being Kentian or Boenninghausenian, be a Hahnemannian where there is no Similimum but a similar remedy. I am giving four cases where importance of symptoms changes from case to case.

CASE 1:

Mrs. MSG age 48 years, presented with H/O backache (Rt) side; (Rt) upper limb and (Lt) elbow since 2 months. She had already visited an Orthopaedic surgeon and was found to be RA factor positive. Very much tensed due to opinion of Orthopaedic surgeon. She was very anxious to know the scope of Homoeopathy in her case. I assured her about the treatment.

Presenting symptoms:.

Both her elbows were swollen with continuous pain, < emotion, > rest, > Hot fermentation. Swelling is associated with numbness < morning. Associated with this she had varicose veins in (Lt) leg since 6 years and Hyperacidity (since 4 years) < morning > lime juice, < fasting, < on empty stomach. She gets eructation often even on empty stomach it relieves all her symptoms. Eructations with pain in chest and a suffocative feeling with difficult respiration.

Personal history:

Appetite : Normal
Desires : Milk and warm food
Aversion : Spicy and pungent food. Bread disagrees giving rise to fullness of abdomen.
Thirst : For cold water
Sleep : Unrefreshing, < morning. No specific dreams. She dislikes fan, which causes heaviness all over the body.

Past History:

Jaundice 24 years back. Operated for Uterine fibroid 31/2 years back.

Family History:.

She is the only sister and has 4 brothers : one has varicose veins, second one is hypertensive, third one is diabetic and fourth one is healthy. Married 25 years back, has 4 children, 2 daughters, 24 and 22 years and has 2 sons, twins, 18 years old. Being the wife of a district officer she has many social relations. Very happy in her marital life, but she has strained relations with her mother-in-law.

Mental Symptoms:.

Very talkative, desires company, weeps easily, she has fear of hospitals. Very firm in her decision. A strong minded lady who manages her home very well.

Comments:

This case though had a duration of 2 months, was a challenge due to R A Factor positive 1:80, the ASO Titre was negative and her S. Uric acid level was 5.9 mg percent, Hb : 10.8 gm percent WBC (T) : 5400/ cmm, N : 56 percent, L: 38 percent, E: 4 percent, M: 2 percent, E.S.R.: 08 mm at the end of 1st hour.

Rubrics selected:

1. < Morning ; (K: 1341)
2. Eructations >; (K: 490)
3. Eructations on empty stomach; (K: 493)
4. Unrefreshed sleep; (K: 1254)
5. < Fanning; (K: 1344).

Treatment:

She was given Nux-vomica 30 1 QID to start with and it was raised upto 1M followed by placebo.

She is absolutely better with no swelling on face and elbows, has sound sleep and is enjoying life very well.

CASE 2:

Smt. PAP, age 25 years, divorced, came to us with complaints of pain in abdomen off and on since last 10 years. Pain very severe, associated with perspiration and coldness of body < at night 10 pm. onwards, < eating meat, spicy food and feels hungry during the attack. Restlessness (physical) with the pain.

She was married at the age of 13, against her wish. She lost her father six months before her marriage, who was a drunkard. Her mother had responsibility of this girl plus two sons and one daughter who is mentally retarded. Two elder daughters had already got married and two sons aged 17and 15 years were not earning. She was in a state of agony due to poverty.

The marriage proposal of this girl was therefore accepted, but this young girl tried to oppose the marriage. She knew the bridegroom, as he was staying in nearby village. Inspite of her opposition she was forced to get married. After the marriage she was very angry, the house allotted to her was not good, and she was just not able to adjust, so she ran away from that place. She came back to her mother, who did not accept her. For about 4 - 5 days she was moving from place to place to get shelter. Even her sisters refused her shelter. In the height of depression, she attempted suicide by taking poison, but her mother came to her rescue. She got her admitted to the hospital where she survived.

When she got a little better, she ran away again to the city, this time with great courage to live separately. This absolutely helpless illiterate girl of 13, came to a big temple in the city, for the first time. She started to work with the family of a senior retired military officer. Her relatives tried to bring her back, but she refused, she did not go back to her husband who is very ugly, indolent and so poor. She allowed her husband to remarry, but was very firm on her decision to leave him and be a good human being in her own way.

She learned to read and write to a certain extent, and now she can do all her routine work like banking, shopping etc. very well, to the point of riding a two wheeler, which she owns.

Unfortunately after the death of the retired general couple, she was homeless again but this time also she was lucky enough to get shelter with a lonely old lady who was staying all alone inspite of having a son and 3 daughters. A well to do lady, she required a housemaid-cum-companion. Since last 6 years she is staying with this lady who is a total vegetarian. This girl also became a vegetarian and started disliking meat. However, whenever, she gets the opportunity she takes meat, and gets pain in abdomen, for which she came to us.

Along with this pain in abdomen, she also gets hyperacidity since 10 years, following the episode of consuming poison. Nausea at smell and sight of food. Vomiting after nausea, < eating after. Nausea > empty stomach, > lime juice. Heart burn < night, < night watching, < heavy meals or food.

Personal History:

Appetite : Good
Desires : Spicy meat which <, Fish, eggs ++, cold food even though warm food is available, she prefers cold food.
Aversion: Sweets, milk and milk products
Thirst: Little, only after principal meals
Bladder/ bowels: Regular
Perspiration: Profuse in palms and soles, neck, axilla, stains the linen yellow.
Menses: Menarche at the age of 12 years. Dysmenorrhoea on first day. A regular cycle of 2-3/30 days, dark red, stains difficult to wash.
Sleep: Good, likes heavy covering
Dreams: Snakes, frightful dreams.

Past History:.

Fell on her back while cleaning the house, with fracture of vertebra, for which she was admitted in the hospital for 20 days.

Mental symptoms:.

Mentally very strong with firm decision, she has not gone back to her family, who meet her occasionally. Suspicious that they would poison her. Has no desire for remarriage. Loves to be alone at home; does not like to amuse herself by seeing movies but likes to clean her house and keep it absolutely tidy. Likes gardening and keeps herself busy all the time. She weeps alone sometimes which ameliorates her. Very irritable and expressive. Now desires to have her own house, so that she may not be homeless again. Fear of dogs, does not like animals, fear of height after H/O fall.

Rubrics Selected:

1. Pain in abdomen < night; (K: 556)
2. Nausea from smell and sight of food; (K: 507)
3. Aversion to milk; (K: 481)
4. Dreams of snakes; (K: 1243)
5. Company aversion to; (K: 12)
6. Indifference; (K: 54)
7. Occupation >; (K: 69)

Remedy : Sepia

COMMENTS:

This is a case where physical symptoms gave the remedy and mental symptoms confirmed the choice.

Case 3:

A 58 year old lady, well educated, fair, flabby with Chinese face, working as head of the Department of Geography in a well known college. Has written many text books on Geography, recognised by the government. Presented herself on 12-7-96 with the complaint of Bronchial Asthma since 12 years, Hypertension since 10 years, Diabetes M, since 6 years. She has to travel 6-10 kms daily to her working place. She used to wear a mask to avoid pollution on the road.

She has 3 sons, all of them well educated. Two of them are married and one is still unmarried who is planning to stay abroad. She had a keen desire to have a daughter, but unfortunately didnt. Therefore had great expectations from her daughter-in-law.

In the beginning she used to stay with the son and daughter-in-law. Basically very mild in nature, had conflicts with her mother-in-law and did not want to repeat the situation with hers. Unfortunately her daughter-in-law coming from an entirely different family background, is very much dominating and possessive. Gradually conflicts started and her son started living separately, which still hurts her. Since then she has lost confidence in herself and is confused, and has become pessimistic. She started brooding on her past disagreeable things and weeps, which ameliorates her. She constantly feels whether she was wrong in her behavior? When her husband tries to console her, she does not like it. She is not sure of her decisions. She started suppressing her anger.

This family situation had repercussions on her working place. She has developed inferiority complex with the feeling that she has an ugly face and therefore her colleagues are avoiding her, and she feels that she has no friends. She likes company, even enjoys it but at the same time she does not like to attend kitty parties and gossiping. Instead she prefers reading alone. She gets so much absorbed in her professional reading that she forgets her daily routine.

Her husband has retired as a Bank officer. Previously, he was very strict according to her. She used to hand over all her salary to her husband, and if she required some money for personal use, she hesitated to ask for it. Now a days he has become soft and caring towards her, since their son has started staying separately. Inspite of this even today when her husband is away from home or is out of station she feels relaxed.

Chief Complaints:

Bronchial Asthma since 12 years, complaints < in Sept. and Oct, i.e. at the end of monsoon. But this time it started at the beginning of Monsoon. Breathlessness < lying down, > sitting > bending forward, > fan at a close distance associated with perspiration, wants doors and windows open.

Cough +++, with difficult expectoration, > by expectoration, which is yellowish in colour and with bitter taste. Cough < ice cream.

Personal History:

Diet : Mixed
Appetite : Good
Cravings: Sweets +++, bitter, ice-creams, fats
Aversion: Meat and salt
Thirst: +++
Bladder: frequency increases during mental tension
Bowels: Regular
Menses: Menopause since 2 years, menses were regular 3/24 blackish red in colour, difficult to wash, menarche 16 years, menopause at 56 years.
Perspiration: Drenching sweat since menopause. Offensive, stains the linen yellow. Hot flushes and perspiration still continues since menopause.
Sleep: Disturbed since 3 months, sleeps till 3 a.m. or from 3 a.m. to early morning. But if she doesnt get sleep, she enjoys reading or writing books.
Dreams: of dead relatives especially mother-in-law.

Family History:

Strong family history of Asthma and blood pressure.
Past History: Not significant.

Rubrics Selected:

1. Mildness; (K: 65)
2. Forsaken feeling; (K: 49)
3. Confusion of mind; (K: 13)
4. Pessimist (SR: 794)
5. Dwells on past disagreeable occurrences; (K: 39)
6. Consolation, kind words aggravates; (K: 16)
7. Company, aversion, to presence of other people agg. the symptoms; desire for solitude/ alone, am. when; (SR: 146)
8. Occupation >; (K: 69)
9. Urging to urinate (morbid desire) / anxious; (K: 653)
10. Desires sweets; (K: 486)
11. Desires fat; (K: 485)
12. Aversion to meat; (K: 481)

Treatment:

Sepia 1000 1 dose every fortnight followed by placebo. A month later she was much better; no asthmatic attack inspite of monsoon. Same medicine repeated. Her attitude changed and she started enjoying company, and does not feel lonely at her working place.

Case 4:

Mrs. SJS age 23 years presented with H/O Migraine on 3.8.92. Headache partial starts from forehead and goes back to occiput. throbbing pain, < going in crowd, < noise, > lying down, < looking at bright objects, < as soon as she sits up in bed, > tight bandaging. Associated with nausea. She was on Tegretol 200 mg. B.D. Headache almost every week, with which she was forced to remain at home.

This lady is beautiful, tall with fair complexion, soft spoken, a sibling of a Punjabi family. when she was 1-12 years old, her mother got divorced and got married to a Christian. Patient has a step sister. When patient was 18 years, her mother got her married to a Punjabi boy. She conceived a baby but was never happy with her in-laws. She was constantly under pressure.

She came to us 4 years back with the complaint of leucorrhoea which was offensive, profuse, sticky, acrid in nature. She was better with Sepia 200, in just 3 days, when she had not given any history of her mental tension.

Somehow she came back to us in 95. She was divorced and had got married to a Gujarati boy, 4 years ago.

Personal History:

Appetite: Good.
Desires : Cold milk, warm food, salty things, sour food.
Aversion : Sweets, Nausea on travelling by car.
Thirsty : Very thirsty.
Bowels: Regular.
Bladder: 10-12/ day and 5-6/ night.
Perspires only in summer.
Menses: Regular 30 days cycle, on 16 and 17th day of menses, leucorrhoea.
Likes hot water bath, does not like to cover in summer.
Sleep: Dreams of God, snakes, water, valleys etc.

A very fastidious and generous lady has expressed her power of clairvoyance. Irritable on children with small little disturbances in house made by them. Likes to be alone, undisturbed by society. However she likes travelling and visit places even though she gets nausea as soon as she rides in car. Very fast at work and gets irritated even by presence of lazy persons. She is indifferent to sexual life.Past History.

Epilepsy 4 years ago, Malaria 5 years ago, Tonsillectomy 9 years ago.

Rubrics Selected:

1. Indifference (K: 54)
2. Irritability (K: 57)
3. Fear of Crowd (K: 43)
4. Coition aversion to (K: 715)
5. Nausea riding in a carriage (K: 509)
6. Dreams of snake (K: 1243)
7. Urination frequent (K: 657).

Remedy: Sepia

COMMENTS:

The patient came to us 4 years back with physical complaints and was better on Sepia 200. Her visit after 4 years recalled Sepia on the mental field.

CONCLUSION:

These cases prove that the approach to a case has to be changed according to the presenting symptoms and cannot have a fixed approach. The first case is solved only on physical symptoms. the second case on physical symptoms, confirmed on mental symptoms. the third case only on mental symptoms, differentiated on physical particulars. And fourth case shows that constitutional remedy works in both physical and mental state. Thus, whether you give importance to mental or physical symptoms, when individualization is perfect the results are bound to be gratifying