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Case Study

RA: The Price To Pay
Dr. Ajit Kulkarni
'Kali-carb / Rhus-t

The Plan of Presentation

  1. Perceiving the totality of sickness through:

      a.        Physical complaints

      b.        Life space investigation of the patient including the inter-personal relationship.

      c.        Deriving the mental traits leading to the development of the personality structure.

      d.        Physical examination (systemic and local).

      e.        Diagnosis of the disease with proper investigations.

  1. Analysis and Synthesis of Data
  2. Structural presentation
  3. Planning and programming of Treatment
  4. A brief follow-up of the case and Conclusion

Mrs. K. Female, DOB-5/12/1933, 55 years.
Status- Married
Religion: Hindu-Brahmin.
Spouse: 58 years. Vegetarian.
Education: Matric.
Siblings-3 1-male and 2-females.
Date of Consultation: 23/5/1988.

Chief Complaints
Location sensation Modalities Concomitant and Pathology

1) Joints
Knees, shoulders,
Wrists, elbows,
Since 2 years
Gradual onset


< Touch
< Rest during
<3 am onwards

Above upper

2) Lumbar


>Lying on back


Associated Troubles


Hyper acidity

< Frustration
< Stress Antacid

II) Patient as a Person
Average built. Height- 5'.2". Weight - 54 Kgs.
Perspiration- scanty. Teeth- caries.
Digestion - Appetite - poor. Acidity+ A.F. - Vexation
Thirst- frequent, for large quantity at small intervals.
Craving- Sweet3, Highly seasoned2, Ice- cream2

Menstrual Function:
Menopause - 7 years back without any trouble. P/H -regular menses.

Pregnancy, Labour and Puerperium :
P/H- Morning sickness ++ first four months
Five abortion- four induced (as they were female babies ).
Sleep - Unrefreshing. Disturbed ++ A.F. anxiety, vexation.
Awakens- around 3 a.m. than sleepless.
Dreams - Dirty water, drowning in water, frightful.

III) Life Space Account
The family consisted of parents, one brother and two sisters. Father was the farmer in the village in Satara Distrcit. Patient was the eldest in the family. Childhood pleasant as family was rich, father was extreme attachment with the parents esp. with the father as he pampered the patient.

The 1948 tragedy of communal riot was the catastrophic event for the whole family Burning of the house and property resulted in sudden proverty. Although father somehow sustained this blow, mother went into the phase depression. Her age was 15 years old when the event occurred. She vividly remembers the hardships the family had to undergo subsequently. Father's toil was painful to the patient. She also did the service in order to run the family(from 1950-57).

In 1957, at the age of 24, patient got married and started residing at Satara. Soon husband compelled the patient to leave the service against patient's will. She described her husband as a perverted, eccentric fellow who has given a lot of trouble to the patient.

Structural Presentation:


Husband was quite dominating, irritable and used to hit her. Careful interrogation revealed an important fact :- husband is a sadist. Except one natural abortion (this also occurred due to husband's neglect in the opinion of the patient ), 4 abortions were of induced type against her will. Husband did not allow her to go outside home, he used to give not a single paisa to her. She was not permitted to see her patients.

She describes her past marital life - "nothing occurred as per my wish". In 1976, father organized a ceremony of entering a newly built house at the village. Husband resisted her to attend the function. After much argument, the aggrieved patient was allowed. To her dismay, she came to know the sudden death of her father just one hour prior to her arrival in the village. She couldn't sustain this shock and had nervous breakdown for which she was given psychiatric including 4 E.C.T.

The eldest daughter had a long love- affair with an inter-caste boy causing agony to the patient. Resisting the patient's will, daughter finally married. Feeling of loneliness, 'no one is for myself' were the expressions, "I love all my family members, but no one has an affection for me". At present if the son is the late in coming at home, she feels a lot of anxiety.

IV) Dispositional Characters : Interpretation :

Anxiety 3
Depression 3
Attachment 3
Frustration ++
Religious ++
Stress : post marital ++
Irritable 3 - expressions poor

A .F. Vexation
A .F. Grief
Weeping 3
Feeling of 'left out'
Hopeless 2
Insecurity 3
Brooding 3

Meterological Reactions :
Chilly patient. C3 H2. Likes winter but intolerable. Covering - woolen. ++ Sweater ++.
Bath- hot throughout. Fan = heaviness of head.
Past History :

  1. Cervical lymphadenitis- Tubercular treated with chemotherapy.
  2. Typhoid at the age of 9 years.
  3. Steriods for R.A. and E.C.T. and Tranquillizers.

Family History : Brother - Leucoderma.

Psycho - Immunology Rheumatoid Arthritis

·         Altered immune reactivity

·         Persistent antigentic stimulation

·         Genetic predisposition

·         Presence of circulating, IGM, IgG, and IGA serum antiglobulins

·         (R .A. Factor) as well as anticollagen and antinuclear antibodies.

·         Presence of serum factors which inhabit suppressor T lymphocyte.

Physical Exam :BP - 120/80 MM. of Hg
Pulse 74/ min Weight - 55 Kgs.
Pallor +
Teeth- caries. Face- oedema above upper eye-lids
Rest n. a. d.
Investigations : R. A. factor - positive.
Ser. Uric Acid - 3 mgm %.
Blood Group 'O' RH + VE.
Hb 11.2 Gm/ 100ml RBC. 4. 07 m/cum.
WBC . 7,800 /cumm
N-45 L-53. FBSL-96 mg%.
PPBSL - 107mg %.
Diagnosis : Rheumatoid Arthritis.

V) Planning & Programming Of Treatment :
The chronic constitutional remedy was fished out as KALI CARB on the basis of

  1. Strong Attachment--------------Characteristic mental disposition.
  2. Severe Anxiety, frustration, vexation, etc. http://www.njhonline.com/images/rtarrow.gif Somatization.
  3. 3 a.m.- General time modality of a characteristic type.
  4. Chilly patient.
  5. Characteristic particular modilities being covered.

In view of the auto- immune nature of the disease, moderate susceptibility (due to the use of tranquillizers, E. C. T. and steroids) but high sensitivity, medium does infrequent repetition schedule was being considered.

Rhux Tox was determined as an acute remedy to be given as and when necessary on the basis of - modalities > rest, motion, warmth; chilly patient and pathogenesis of Rhux Tox in rheumatology. Both Tuberculium and Thuja were considered as intercurrent remedies : The fundamental miasm being tubercular and dominant being sycotic.
The ancilliary measures are

  1. Diet
  2. Exercises
  3. Psycho-Therapy

VI) Follow- Up and Conclusions:
Treatment was started on 25/5/1998 with Kali Carb 200 H.S. The follow-up criteria for progress notes was determined as :

  1. Joints - Pain
  2. Joints - Swelling
  3. Morning stiffness
  4. Weakness
  5. Hyper - acidity
  6. Sleeplessness
  7. Lumbago
  8. E.S.R.
  9. R.A.Test

The patient started responding gradually. During the period from 25/5/1988 to 10/10/1990, Kali-Carb 200 was stepped up to 1000. She required Rhus Tox 200 -5/6 times for acute totality andTuberculinum and Thuja infrequently in 1M potency. The patient showed improvement in all the follow-up criteria; however hyper-acidity consequent to somatization mechanism in response to family stress had to be managed frequently with psycho-therapy. E.S.R. remained within the range of 25 to 30 mm from 62 to 70 mm. When last seen in 1991 she was symptom-free and was off the treatment. Her R.A. Test was however positive. Taking into account the nature of the illness, one will have to wait for many years to declare the case as cured.


  1. Sickness can be understood well provided the physician dives into the variable dimension of life of the patient.
  2. The holistic approach of Homoeopathy demands understanding the human being in its totality.
  3. It demands the comprehensive diagnosis of a case; which includes the disease diagnosis and individual diagnosis.