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Case Study

The Yielding Child
Dr Anita Lobo

Case 1
Mst CL, aged 16 years, a Roman Catholic, consulted me on 19/10/98 for recurrent colds and running nose, since last one year. He had earlier taken ayurvedic medicines with only temporary relief. It was aggravated by exposure to cold air, cold drinks, rainy season, dust, at night and while lying down. There was wheezing and breathlessness at night and while lying down.




Respiratory system

Cold; running nose; watery discharge

A/F exposure to cold breeze & cold drinks< cold food


Nasal irritation

< rainy season


Throat irritation

< dust


Cough+ - dry

< night



< lying down



< night

Past History: 
Malaria twice for which allopathic treatment was taken.

Family History: 
Father- Diabetes. MGM - Pulmonary Tuberculosis.

Physical Generals: 
Diet - Mixed. APPETITE - Decreased.
Desires - Sweets3, ice - cream, fish
Thirst - Decreased - 3-4 glasses / day
Perspiration - Increased on head and neck
Stool - semi -solid; once a day
Urine - D/N - 3-4/1-2.
Birth - FTND (Hospital delivery)
All Milestones - normal

Reactions - Physical Factors:
Time - < Night3
Meteorological - Likes rainy season
Thermal Reaction - C2H3

Memory - good; Studying in Xth Std; Performance- Average.

Emotional State: 
Mild, yielding3, likes company but shy and timid2; likes consolation2; gets irritated fast but keeps quiet; very affectionate2; Fear of ghosts3, darkness2, meeting new people, girls; indecisive, moody.

Action: Slow in answering
Sleep And Dreams: Sleep: 8 pm - 6 am Disturbed due to frightful dreams

Physical Examination: 
Appearance - Moderately built and nourished .
Weight - 64 kgs, HT - 5' 7".
Skin - Fair, pinkish complexion
Nails - White spots.
Pulse - 86/min.
RR - 24/min.
BP - 130/84 mm.of Hg.
Temp - 98.60F
No pallor, jaundice, cyanosis, clubbing, oedema.

Resp System



Nose & nasal cavity - nasal mucosa congested.



Broncho- vesicular breathing.
Bilateral diffuse Rhonchi.


CBC: Hb - 13 gm %.
WBC: Total - 11,000/cu. mm.
DC - N - 62 %; L - 24 %; E - 12%; M- 01%; B - 01%
ESR (Westergreen) - 28mm at the end of 1st hour

Life Space Investigation :
The patient hails from a middle-class family; stays with parents and a younger brother; is very close to his mother and relates everything freely with her. His father works abroad. He likes to watch TV, but is very scared of violent movies; prefers indoor games, particularly chess. He is very shy at school, indecisive and has few friends. He seldom takes part in school activities. He is very sensitive & cries when scolded by the teacher. Sleeps early as he has fear of darkness. Even at home, he wants someone to be with him all the time. He never speaks to any girl in his class; has variable moods.

Diagnosis: Atopic Asthma Extrinsic?
Analysis & Synthesis:
A) Acute Totality:

Nasal discharge - watery with irritation in nose and throat; AF: exposure to cold air2, cold drinks3 < cold food < rainy season < dust < night.
Cough Dry < night3
Breathlessness < night
Wheezing < lying down
Rx Antim-ars 30

Chronic Constitutional Totality:
Mental Generals
Mild, yielding3 - listens to his parents & teachers.
Sensitiveness to external impressions, weeping > by consolation2
Fear of ghosts3, darkness2, meeting new people.
Irritability - angry soon but keeps quiet
Changeable moods2

Physical Generals
Appetite - Decreased.
Thirst - Decreased
Desires sweets3, ice- creams, fish
Perspiration - Increased on head & neck.
Sleep - Disturbed due to frightful dreams.

Characteristic Particulars

RespiratorySystem since

AF Exposure to cold air2, cold drinks3

15 years

Nasal discharge - Watery 

< night


With irritation+

< cold food


Cough+ - Dry




< dust




Rx Pulsatilla 200

Intercurent Totality: 
Repeated respiratory affections i.e. frequency, duration, of these complaints is indicative of Tubercular miasm. Also there is family history of Pulmonary Tuberculosis. Intercurrent remedy: Tub-bov 1M

Miasmatic Background:
Fundamental Miasm: Tubercular - Family history of Pulmonary Tuberculosis; repeated respiratory affections.
Dominant Miasm: Psora - because of hyper-sensitivity to external impressions, fears, irritability.

Diet : 
Avoid cold food, cold drinks, cold fruits, ice-creams, oily food .
Auxiliary Measures: Avoid exposure to dust, cold air. Wash curtains, bed-sheets, pillow covers regularly. All clothes to be dried in the sun.
Education and Orientation - Advised the patient about health care and not to worry regarding his complaint as it is not a grave disease. Floors and domestic articles must be wet - mopped regularly.
First prescription: Antim-ars 30/ 4 pills. TDS given on 19/10/98, based on the acute totality.

Criteria For Follow-Up: Fear, appetite, thirst, sleep & dreams, perspiration. motion, nasal discharge, throat irritation, cough, wheezing and breathlessness were the indicators monitored during the follow-up.


Symptom Changes




Nasal discharge and irritation better, so also wheezing and brethlessnessO/E - RR 22/minO/A- Rhonchi+

The acute remedy has helped only marginally.Therefore a deep-acting constitutional remedy must be given 

Puls 200/4powders, 1powder wkly
HS x1month
Pla 4-4-4 x 1month


Motion, nasal discharge, wheezing and breathlessness better and others status quoO/E-R.R. - 22/ minO/A - Rhonchi+ 

Even though the well indicated remedy is given there is no further improvement \ potency of the remedy must be increased

Puls 1M (1P) HSPla 4-4-4 x 15 days


No change in the symptoms

Definitely a miasmatic block - Tubercular; well-indicated constitutional remedy not acting.

Tub-bov 1M -1P HSPla 4-4-4 x 1 month


Much better-Appetite better; thirst good except fear, sleep, dreams and perspirationO/E - R.R - 20 / minO/A - Rhonchi occasionally

Relative improvement in all complaints after Tub-bov. Now deep-acting medicine will complete the cure. 

Puls-1M- 1 HSPla 4-4-4 x 1 month (1/2 oz pills)


Fear>++. But marked improvement in the complaints of the patient O/E - R.R - 18 / minO/A - Chest - clear
Investigations were repeated
WBC: DC N-68% M -02% E - 05%L - 24% B -01%
ESR - 18 mm at the end of 1st hour

Better, therefore Placebo must be given. 

Pla 4-4-4 x 1 month(1/2 oz-pills)

In this case, we see how a constitutional remedy can function to strengthen the patient's immunity and improve his general condition. Here the constitutional drug was well indicated but there was no marked improvement. The case was again evaluated and based on the family history - maternal grand mother having had Pulmonary Tuberculosis and patient himself having had same complaints since childhood on & off; & two attacks of malaria, a miasmatic block was suspected. It was Tubercular in the patient and hence one dose of Tub-bov helped the next dose of constitutional remedy, Pulsatilla, to wonderfully relieve him of his complaints. Thus, this case highlighted the importance of the intercurrent remedy.