I was not their real daughter!
NATIONAL JOURNAL OF HOMOEOPATHY 1999 Mar / Apr VOL VIII NO 2.
Dr K N Kasad 
'Magh-sulph / Thuja

Dr (Mrs) X, MD, aged 31 yrs, had a severely painful chronic disease for which she was advised Steroids by various specialists. Desiring to avoid steroids, she telephoned me to ask whether I could help. Many consultants - Allopathic and Homoeopathic, had recommended her to me. A MD in Modern Medicine, she was well aware of Iatrogenic Disorders resulting from allopathic drugs and had opted for Homoeopathic treatment.

On 18.2.95 the patient came with her mother, looking pathetic and miserable. She was limping and her neck and body tilted to the left side. She could manage to sit down in the chair only with great effort and shrieks. After taking the case history, she was given a proforma for filling in further details of her life story. After this a 2nd Interview would be planned to be held at her house, due to her physical condition.

Interview - 1
She was an MD doctor in Community Medicine and since 1993 worked in a Hospital as Marketing Manager, Quality Control
Married on 21.11.91.
Menstrual History:
Menarche- 11. Normal ovulatory cycles of 7/28. Heavy Bleeding for 7d.
Calcium supplements from 4th day on. Conceived in June 1992 - took Ciprofloxacin for ear infection in the first 15 days of pregnancy. So M.T.P advised and carried out on 30.07.92. On 06.08.92 spontaneous evacuation of some membranes; heavy and erratic bleeding continued. A second D&C with Hysteroscopy done on 30.09.92 because the endometrium was persistently thickened. E.B. revealed secretory endometrium, no Ca, no products of conception. Bleeding profuse from 3rd day following D&C; not amel by progesterone. After many months of treatment with LH-RH, nasal spray, natural Oestrogens and injectable progesterone, a normal cycle was re-established on June 1993. Conceived again in September 1993, only to learn that the foetus was dead on 16.11.93. D&C for I.U.F.D could be performed only on 22.11.93 on account of Diwali. Normal regular periods from December 1993 till August 94.

The present illness started from 24.11.93 after D&C. Excruciating pains +++ all over, ACHING, HARD PRESSURE, HOT SHOWER amel - feeling as if someone is wringing her body. Aggr at night, Brufen-600 helps partially. Cannot sit up. Muscle fatigue+++. Cramps+++ amel Brufen-600. RESTLESS WITH PAINS. SPASM - neck, left head, ear, left shoulder around left trapezius, nape. AGOINZING PAINS. Chilliness with low-grade fever. Spasm right sternomastoid muscle - left and right trapezius, pectorals, triceps, branchioradialis, hands, and fingers. STIFFNESS, SPASM - KNOTTED - cannot lift a glass of water. Cord-like muscular spasms, as if in knots. Aggr FAN, COLD CLIMATE and HOT HUMID WEATHER, cannot lie in one position - RESTLESS. Amel in Pune -DRY WEATHER, HOT FORMENTATION, lying down, AM, support. Sudden onset. Limping while walking with a tilt to the left ie torticollis to the left side. Amel from accupressure but not from accupuncture. No response to host of painkillers, anti-inflammatory agents, tranquilisers etc. Mag-phos CM and Bry ameliorated a little along with Muscle 6 and laser treatment.

Investigations:
Blood: CBC: L-40-50; M-10-11; ESR-N; WBC: 3000; gen-N; ANA- Negative
CMV: +ve
EMG: N. MRI- cervical -dorsal spine: N (Cytomegalo virus).
IgG: elevated: 1.2. IgA: Negative.
RA Test: Negative.
DNA: Negative. LE: Negative.
T-cells: reduced.
Na- Reduced. K- N. Mg N
The specialists were unable to give a clear diagnosis of the disease.
O/E: normotensive-110/75; Euglycaemic. No organomegaly.
No Lymphadenopathy. No neuralgic signs.
Baggy lower eyelids. Cold hands/ feet.
RS./CVS/ PA normal.
Neck- torticollis to left. Joint movements restricted, especially of finger joints. Tenderness all over. Pathetic look. Scars of suffering obvious as she limped to the clinic. Throat: N. Thymus not investigated. Stiffness and spasms all over, especially in neck, nape and finger joints and left ankle; Extensors more affected than flexors. Muscle biopsy advised but the patient declined lest she develop paralysis.

Family History:
Father -84 supra-ventricular tachycardia Mo: 67- Pulmonary TB, Diabetes-M, obesity, hypertensive Encephalopathy and 7 abortions (3rd and 4th months). Diabetes and hypertension- maternal side-MGM, MU & MA.

Life Story and Self- Description as given by the Patient:
The patient described herself as quick tempered, but at times unsure of herself and hence subdued. Tends to be shy in crowds and extremely sensitive. Likes to make friends but on a selective basis. Has 2-3 close friends. Though enjoys intellectual conversation, gets easily bored. Tends to think and worry too much, with great fear of future. Detests dishonesty, hypocrisy, conventionalism and sweet-talking. As she is very orderly and neat in her habits, she feels jittery and uncomfortable in dirty and untidy surroundings.

Loves music. Has a very loving and understanding relationship with her husband. Very attached to her parents but hold s diametrically opposite views on many issues. Respectful of her in-laws but finds them very narrow-minded and orthodox. Hence she is not close to them mentally and emotionally. Enjoyed working and was well respected in the hospital from the top to lower level and the staff wanted her to return to work. She is prepared to help others but at the same time does not like over-possessiveness in friends and would like to keep to herself at times.

She said "I feel responsible for my work, parents' health, which is not good, my husband's career and future, health of her husband's family and other household responsibilities. I feel often that too much is expected of me (except my husband who is not at all demanding) and I wish I had more physical energy to cope with everything. I like to do things and hate sitting in one place for long. I love to travel and move around but I feel that I take up more than what I can manage and hence get irritated when I fall short of my own expectations. I want to slow down my pace and spend time for myself. I am impulsive and extremely emotional and sentimental and easily upset by other's sufferings; now irritated at my own illness."

Food: prefer vegetarian food and detests bitter things. Milk, curd, oily and fatty things, pulses, spicy foods bulk food with too much roughage, nuts, chocolates, meat, pork, cream do not suit her. Carbohydrates, thin dal, cooked vegetables, fish, chicken in small quantities, buttermilk suit her. Loves hot tea, hot food and cold drinks.

Loves moderately cool and non-windy environment. Extremities usually cold and the nose turns cold at the first change of weather and during rains. Prefers to wear socks at night. Likes heat and dry weather. Fan aggravates = blocked sinuses and headache. Takes warm bath always unless it is very hot and humid. "I do not sweat profusely, only in axillae and lips; no smell and no stain. I do not drink lots of water and if I do, I excrete it in next 20-30 minutes. Though I like swimming and outdoor activities I feel tired soon and catch cold easily. Sleep is disturbed if something is bothering me. Lack of sleep is my greatest enemy and if I have slept less, the next day is miserable. I get irritated, extremely tired and get refreshed only if I make up for the loss of sleep. Early waking up or interrupted sleep causes terrible acidity and gastritis. Have been constipated since childhood but it has become worse in the past 10 years".

" In September 1994, MC was delayed for 15 days and once started it did not stop till November, when once again I started LH/RH+ oestrogen+ progesterone and normal withdrawal of bleeding took place on 28-1-95. Again bleeding persisted for 6 days and was ameliorated only with Hamamelis and Bursa- pastoris Q in 2 days. Since then I have stopped all hormonal therapy. Next period is due on 25-2-95. Menses are profuse, odourless, bright red or maroon, no clots and at times stains but delible.

There is aggravation before menses= generalised water retention, backache and abdominal pain radiating to thighs, ecchymosis, chilliness and coldness; pains spasmodic and crampy, which get ameliorated with the flow in the next 24 hours. LMP on 28-1-95. Low grade fever and treated with mycins. " The quality of my life has gone very low. Doctor, please help me."

After studying the above life story, the remedy was clear in my mind but I abstained from administering it, for the data interpersonal relationship were lacking and I wanted to probe the life situation further, so as to be certain of the remedy.

History of Previous Illness: (See Chart)

Patient as a Person:
Thin 3 64 kg, Ht 5' 10"
Cravings: sour but agg = bile. Likes dal, sweet, potatoes and spicy but aggr; = acidity, indigestion, diarrhoea; pulses and oily things aggr; very hot weather aggr =lethargic, miserable and irritable; sun aggr = headache. Draft and fan aggr = headache and noseblock¸ AC. Very hot bath all he year, cannot tolerate cold weather-fingers bend, cannot write. Dry Pune weather suits well. Sensitive to cold = nose and limbs cold.
C4H.
Recurrent tendency to catch colds-larynx SLEEP normal except with pains. Must sleep for long as short sleep & loss of sleep aggr acidity, becomes irritable, tired and sea-sick.

Interview II (21-2-95)
The real life situation emerged in the second interview. Though she said that she was very attached to her patients, it transpired that they ill-treated her. Father was hot- tempered, sarcastic and used to beat her till the age of 13-14 and used to tell her "you are not my daughter." The mother was conventional, religious and dictatorial. She wanted her way only and did not allow the patient to go out with others. Very possessive. The patient was scared of her mother even now; her mother harboured resentment, inward agitation and a feeling that there was no one to look after her especially in the last two years as she was sick. Her mother would bang patient's head on the wall even till her marriage. The patient said " my marriage was an arranged one; our ideas matched and we had very happy relations; sex no problem. Husband is also a good friend. As I spent more time with him my mother feared "my daughter is not with me"; she behaved badly with me. During the wedding she kept aloof; on the wedding day she refused my embrace. I felt bitter, bad, hurt and frustrated. She made up after sometime." " Parental disharmony and quarrels were constant to which I was a witness. I was a buffer between my husband and parents. My mother is scared of my father but still she fires me and beats me." As her grandmother was harsh and used to beat her mother, the latter had an unhappy childhood; also she lost her mother due to paralysis at the age of 12. Her mother was afraid of her husband and took it out on the patient. She said " father does not express love while my mother wants love, appreciation and has not received it and hence is frustrated. I am averse to fights and when parents quarrel, I am upset & depressed. Brooding, feel low; have palpitations gnawing, heavy feeling in the heart, unhappy and bogged down." The patient was, therefore, angry and bitter but suppressed her emotions and felt frustrated. She also had fear of ghosts. Fearful and anxious since childhood-scared of violent movies, blood, anybody being beaten and an apprehension that something will happen to her parents when they go out or that they will die or worries when her husband comes home late. Often depressed, she suffered from anticipatory anxiety-eg before an event, such as giving exams, reading a paper at the conference and catching a train etc. Very Tearful. Feels better when alone.

After this interview was over, while I left her house, she said in a whisper " Doctor, they are not my true parents. They adopted me right from birth through the obstetrician, who was treating my adopted mother for her 7 abortions. This was disclosed by mother just before my marriage, first to my husband and later to me. This news rattled both of us but we accepted the situation and the marriage went through without any mishap." She became aware that her real parents were still alive somewhere in the city and when asked whether she would like to make inquiries and contact them, she categorically declined lest it produce an intense trauma, which she feared she would not be able to handle. Her husband and his parents accepted the situation and held the same opinion. I could not interview her husband as he was on voyage.
Drug released on 26-2-95.

Third Interview 0n 3-3-95
Pt better 50%-lt neck, nape, sternomastoid, shoulders, legs- cramps, knotted muscles and bodyaches. Muscle fatigue less. Mother is RUDE to me, as I lie down the whole day, because of the pains. This HURTS me. I want to join my husband in the Merchant Navy; so saying she broke into tears. I have never had a heart to heart talk with them at all. I am rebuked, and so I cannot stay with them. I feel guilty, therefore, I stay with them. My husband agrees with this. I have no rest here. He too feels guilty. Mother tells me that I am rude.

Now The Work-Up:
Case Analysis:
This case was referred to me after the patient had undergone treatment under several experts of different systems of treatment, but defied solution and resolution. It exhibited several mental and psychological aspects running parallel to and in temporal correlation with the number of diseases suffered by the patient since age 4, abetted by the various environmental stressors - physical, emotional, chemical and biological- in an uncongenial and unfavourable psycho-cultural milieu in the family. This case is the perfect demonstration of how the environment shapes the disposition, and when adverse, culminates in psychosomatic disease, in this case- crippling Rheumatism.

Thus the main sphere of affection was the fibro-musculo-skeletal system, especially of the shoulder girdle, more left and going to right; sudden and rapid onset with intense pains, spasms, cramps, stiffness and knotted feeling as if the body was put through a wringer, with attendant muscle fatigue, restlessness and low grade fever. The clinical, bio-chemical and immunological parameters (lymphocytosis, monocytosis, decreased T-cells and increased IgG level) suggested R E S involvement- an autoimmune process in the case. SLE and RA were ruled out in the absence of articular involvement and normal ESR and negative RA Test, ANA reaction, LE cells.

Probable Diagnosis: Polymyalgia or Polymyopathy.
The slow evolution, from 24-11-93 till the date of consultation on 18-2-95 and functional muscular derangement, with no structural damage, aggr from hot, humid weather and amel in dry weather suggested SYCOSIS as the dominant miasm, with the characteristic cramps, spasms and torticollis. The migraine and tendency to colds with hoarseness are tubercular.

Patient as a Person:
Thin 3 64 kg, Ht 5' 10"
Cravings: sour but agg = bile. Likes dal, sweet, potatoes and spicy but aggr; = acidity, indigestion, diarrhoea; pulses and oily things aggr; very hot weather aggr =lethargic, miserable and irritable; sun aggr = headache. Draft and fan aggr = headache and noseblock¸ AC. Very hot bath all he year, cannot tolerate cold weather-fingers bend, cannot write. Dry Pune weather suits well. Sensitive to cold = nose and limbs cold.
C4H.
Recurrent tendency to catch colds-larynx SLEEP normal except with pains. Must sleep for long as short sleep & loss of sleep aggr acidity, becomes irritable, tired and sea-sick.

Interview II (21-2-95)
The real life situation emerged in the second interview. Though she said that she was very attached to her patients, it transpired that they ill-treated her. Father was hot- tempered, sarcastic and used to beat her till the age of 13-14 and used to tell her "you are not my daughter." The mother was conventional, religious and dictatorial. She wanted her way only and did not allow the patient to go out with others. Very possessive. The patient was scared of her mother even now; her mother harboured resentment, inward agitation and a feeling that there was no one to look after her especially in the last two years as she was sick. Her mother would bang patient's head on the wall even till her marriage. The patient said " my marriage was an arranged one; our ideas matched and we had very happy relations; sex no problem. Husband is also a good friend. As I spent more time with him my mother feared "my daughter is not with me"; she behaved badly with me. During the wedding she kept aloof; on the wedding day she refused my embrace. I felt bitter, bad, hurt and frustrated. She made up after sometime." " Parental disharmony and quarrels were constant to which I was a witness. I was a buffer between my husband and parents. My mother is scared of my father but still she fires me and beats me." As her grandmother was harsh and used to beat her mother, the latter had an unhappy childhood; also she lost her mother due to paralysis at the age of 12. Her mother was afraid of her husband and took it out on the patient. She said " father does not express love while my mother wants love, appreciation and has not received it and hence is frustrated. I am averse to fights and when parents quarrel, I am upset & depressed. Brooding, feel low; have palpitations gnawing, heavy feeling in the heart, unhappy and bogged down." The patient was, therefore, angry and bitter but suppressed her emotions and felt frustrated. She also had fear of ghosts. Fearful and anxious since childhood-scared of violent movies, blood, anybody being beaten and an apprehension that something will happen to her parents when they go out or that they will die or worries when her husband comes home late. Often depressed, she suffered from anticipatory anxiety-eg before an event, such as giving exams, reading a paper at the conference and catching a train etc. Very Tearful. Feels better when alone.

After this interview was over, while I left her house, she said in a whisper " Doctor, they are not my true parents. They adopted me right from birth through the obstetrician, who was treating my adopted mother for her 7 abortions. This was disclosed by mother just before my marriage, first to my husband and later to me. This news rattled both of us but we accepted the situation and the marriage went through without any mishap." She became aware that her real parents were still alive somewhere in the city and when asked whether she would like to make inquiries and contact them, she categorically declined lest it produce an intense trauma, which she feared she would not be able to handle. Her husband and his parents accepted the situation and held the same opinion. I could not interview her husband as he was on voyage.
Drug released on 26-2-95.

Third Interview 0n 3-3-95
Pt better 50%-lt neck, nape, sternomastoid, shoulders, legs- cramps, knotted muscles and bodyaches. Muscle fatigue less. Mother is RUDE to me, as I lie down the whole day, because of the pains. This HURTS me. I want to join my husband in the Merchant Navy; so saying she broke into tears. I have never had a heart to heart talk with them at all. I am rebuked, and so I cannot stay with them. I feel guilty, therefore, I stay with them. My husband agrees with this. I have no rest here. He too feels guilty. Mother tells me that I am rude.

Now The Work-Up:
Case Analysis:
This case was referred to me after the patient had undergone treatment under several experts of different systems of treatment, but defied solution and resolution. It exhibited several mental and psychological aspects running parallel to and in temporal correlation with the number of diseases suffered by the patient since age 4, abetted by the various environmental stressors - physical, emotional, chemical and biological- in an uncongenial and unfavourable psycho-cultural milieu in the family. This case is the perfect demonstration of how the environment shapes the disposition, and when adverse, culminates in psychosomatic disease, in this case- crippling Rheumatism.

Thus the main sphere of affection was the fibro-musculo-skeletal system, especially of the shoulder girdle, more left and going to right; sudden and rapid onset with intense pains, spasms, cramps, stiffness and knotted feeling as if the body was put through a wringer, with attendant muscle fatigue, restlessness and low grade fever. The clinical, bio-chemical and immunological parameters (lymphocytosis, monocytosis, decreased T-cells and increased IgG level) suggested R E S involvement- an autoimmune process in the case. SLE and RA were ruled out in the absence of articular involvement and normal ESR and negative RA Test, ANA reaction, LE cells.

Probable Diagnosis: Polymyalgia or Polymyopathy.
The slow evolution, from 24-11-93 till the date of consultation on 18-2-95 and functional muscular derangement, with no structural damage, aggr from hot, humid weather and amel in dry weather suggested SYCOSIS as the dominant miasm, with the characteristic cramps, spasms and torticollis. The migraine and tendency to colds with hoarseness are tubercular.

Patient as a Person:
Born in a family after 7 abortions in the mother, one would have expected very congenial and affectionate parental care. But parental discord, quarrels and violent ill treatment by way of beating or banging of the head against the wall were her lot. Mother being possessive and dictatorial, did not allow her to mix with peers. The patient's response - mute and submissive- with bottled-up hurt, anger, resentment and frustration. Basically shy, passive and submissive, she felt better when alone and weeping.

Learning of her birth status evoked feelings of mortification.
Noise violence and horror movies frightened her. Anxiety at sight of blood.
Anxiety- exams, coming home late, with cold limbs, sweat, butterfly sensation in the epigastrium; with impulse to run away. But her sense of duty held her back.
Her attitude was thus ambivalent.
The climax came just before her marriage at 28, when told about the adoption, in spite of biological parents living. She was stunned, bitter, hurt and resentful. More humiliating was that her would- be husband was told first; and that the mother kept aloof during marriage functions and even refused her embrace.

Her two pregnancies in July 92 and Nov 93 not carried to the full term, added to her cup of misery with grief, depression, hopelessness. It left her with a feeling of " no one to look after me".
Despite these severe emotional and physical strains, she exhibited a degree of resilience in functioning as a buffer between her parents and her husband.
Her intellectual faculties were intact as is evident from good academic record, recognition in office, strong will and determination. She was cordial in her interpersonal relationships. Obviously the channeling of her negative feelings into creative fields of fine arts, prevented a complete break down.
REPRESSION and REJECTION form the core of the case, with the resultant undermining of the body's immunity.

Remedy Selection:
Considering the chief complaint alone, Mag-phos strikes the eye. But it did not register. Clearly the nucleus was Mag. Magnesium ion in the cell, though physiologically antagonistic, yet bears close relationship to Na ion. Although the patient was chilly, the muscular pains were agg by hot, humid weather and ameliorated in dry weather but aggr in too hot weather.

Work Up - Reference to Repertory
Kent's repertory: Wet weather agg- Nat-sulph3. Referring to BSK on Mag-sulph the related remedy is Nat-sulph.
Totality of Mag-Sulph was built up:
Fibro-muscular structure
Dominant sycotic miasm
Hot humid weather aggr
Cramps and spasms Nat-Sulph Mag-s (BSK-related remedy.)
The travel from the patient to the drug was Mag-p Nat-s Mag-s.

Assessment of Susceptibility:
Sensitivity - very high: emotional levels, noises, environmental stressors- Thermol, biological , foods drugs , etc.
Vitality - very low.
Functional - nerves with agonising pains
Incapacitation , diminished mobility
Immunity- moderate to low
Reactivity - tissue level - still functional , not yet structural.
Dominant Miasm - sycotic
Suppression - at the mental emotional level and the immune one
Overall Susceptibility - moderate
Intercurrent Remedy: Thuja - chilly antisycotic

Follow-Up

Conclusion:
The case showed remarkable palliation under Homoeopathic treatment. Cure appears remote as the immediate environment at home is not congenial. Follow-up was hampered due to erratic and irregular reporting by the patient. One happy ending was the normal delivery of a healthy child.
Counselling the patient for her problems would help .

Editor: The bold and remarkable use of high potency with frequent repetition till the point of amilioration, is the course to be followed in such severe pathology. Here single doses witl not prove adiquate.
Each case requies potency selection and repetition on its own merit. Th general rule liad down by Hahnemann and all Masters, includign current day masters like Dr K N Kasad, is MINIMAL DOSE, ( not single dose) TILL THE POINT OF REACTION. This varies in every case. These comments are being made in the context of the eternal controversy between Single dose and Repeated doses, high potency and low potency and so on.

Totality

1. TUB5 - SYC2 - SYPH- Fundamental Miasm
2. Suppressed Emotions Repression
3. Vexation
4. Mortification
5. Anxiety with Fear
6. Sycotic - Active/ Dominant Miasm
7. Cold in general <
8. Too hot weather <
9. Damp humid weather <
10. Tendency to catch cold
11. Sea-sickness
12. Desires: Sour2 Potatoes2.
13. Aversions: Bitter foods3.
14. Mental State: 2-5
15. Anticipatory anxiety
16. Guilt
17. Sentimental
18. Conscientious
19. Fastidious
20. Hopeless despair - recovery
21. Extremities: - Pains/ Cramps/ "Knotted as if"

Chart 2