Abstract: This unique case of Chronic Fatigue Syndrome reflected the psychosomatic state of the individual who presented with characteristic symptoms as susceptibility was high, which made it easy to clinch the remedy. The acute, intercurrent and constitutional remedy was used to achieve the cure.
Introduction [1]
Chronic fatigue syndrome is the current name for a disorder characterized by debilitating fatigue and several associated physical, constitutional and neuropsychological complaints. In past patients presented with conditions such as vapors, neurasthenia, effort syndrome, chronic brucellosis, epidemic neuromyasthenia, myalgic encephalomyelitis, multiple chemical sensitivity syndrome, chronic candidiasis, chronic mononucleosis, chronic Epstein barr virus infection; all comes under chronic fatigue syndrome.
Specific symptoms reported by the patients with Chronic fatigue syndrome.
1. Fatigue.
2. Difficulty concentrating.
3. Headache.
4. Sore throat.
5. Tender lymph nodes.
6. Muscle aches.
7. Joint aches.
8. Feverishness.
9. Difficulty sleeping.
10. Psychiatric problems.
11. Allergies.
12. Abdominal cramps.
13. Weight loss.
14. Rash.
15. Rapid pulse.
16. Weight gain.
17. Chest pain.
18. Night sweats.
Chronic Fatigue Syndrome (CFS) causes persistent fatigue (exhaustion) that affects every day life and does not go away with sleep or rest. It is also known as ME (Myalgic Encephalomyelitis). CFS is a serious conditions that can cause long term illness and disability but many people particularly children and young people improve over time. Anyone can get the condition, although it’s more common in women than men. It’s not known exactly what causes Chronic Fatigue Syndrome2.
Causes [2]: – a viral or bacterial infection
– Problems with the immune system
– An imbalance of hormones
– Psychiatric problems, such as stress and emotional trauma.
CDC Diagnostic Criteria for CFS [1] : Severe fatigue that last for 6 months or more.
1. Clinically evaluated, unexplained, persistent or relapsing fatigue that is of new or definite onset, is not alleviated by rest & results in substantial reduction of previous levels of occupational, educational, social or personal activities. &
2. Four or more of the following symptoms that persist or recur during six or more consecutive months of illness & do not predate the fatigue.
· Post exertional malaise lasting > 24hours
· Muscle pain
· Self reported impairment in short term memory or concentration
· Headaches of new pattern or severity
· Multi-joint pain without redness or swelling.
· Unrefreshing Sleep
· Sore throat
· Tender cervical or axillary lymph nodes.
This case was chosen for the presentation as it had many layers which had to be removed in order to achieve cure. This reflects the teachings of our Master Dr Hahnemann as cited in 6th edition of Organon
Chief Complaint:
A 58 years old male patient, diagnosed as suffering from Chronic Fatigue Syndrome came with the complaint of Tiredness+3since 2011. He complained of body ache and having a sore and bruised sensation, predominantly aggravated in the morning, +++ & +++ business tension+++, also on exposure to scorching sunlight and when alone. It improved after sleep, taking rest, when occupied and busy doing work and towards the evening+++. Patient says that these symptoms were accompanied by a peculiar pain in the region of lower back which disappeared as soon as the tired feeling abated.
He was taking allopathic medication tablet Alprax 1 tds and tablet Servector 1 daily. Inspite of this treatment the complains persisted.
Past History:
- Borderline DM controlled by medicines since the last 10 years
- Recurrent colds on & off since the last 15 years which was relieved by allopathic medicine
- Tonsillectomy done in childhood
- Threadworms and pica in childhood
- Bleeding gums off and on
Family History
Two sisters suffering from Chronic Fatigue Syndrome
One brother expired due to Heart Attack
Personal History:-
Appetite: good
Thirst: reduced
Craving: Sweets++, Spicy++, pungent +++, salty items +, hot food
Aversion: nil
Perspiration: profuse, scalp, odour offensive
Sleep: disturbed due to business and domestic tension, cramps in calf muscles, crying when in sleep and salivation during sleep
Dreams: frightful as if someone was torturing him
Thermals: Ambithermal
Mental State
Irritability at his place of work as he used to shout and abuse his co-workers. At home he used to suppress his anger due to the dominating nature of his wife. He was very anxious especially when undertaking new assignment at work and was exceptionally meticulous and fastidious in whatever he did.
H/O Suicidal thoughts.
Life Situation
The patient highlighted that at his place of work he had to cope up with situations which made him very anxious and nervous. In the afternoon he used to take short nap and would work till 7 pm and would come home late – between 9-10 pm. He then went for either swimming or jogging. He would consume alcohol and dine late at night due to business commitment. His wife was dominating and he would have to listen to her or else she would threaten him with dire consequences.
He would take care of all his wife’s needs as he was very much attached to his two daughters and did not want any unpleasantness at home. This resulted in suppression of anger at home. Many a times he had suicidal thoughts, but lacked courage to take any irrevocable steps. Thus, his pent up feelings at home would result in giving vent to his anger at his place of work (this same feeling of suppressed anger was reflected in his dreams).
The differential diagnosis would include Hypothyroidism and Fibromyalgia which was ruled out due to the above mentioned diagnostic criteria seen in the case.
Case Analysis:
In this case, the patient was taking allopathic medicine since last 5-6 years and in spite of this he was not relieved. The susceptibility was good enough as the patient exhibited PQRS symptoms on Mental, Physical General and Physical Particular level.
Case Evaluation
Done using Kentian Method as characteristic Symptoms pertaining to Mind and Body were present.
Thus the whole case revolved around suppressed grief+++ which forms the core of the case.
Prescriptive Totality
1. Suppressed Grief+3
2. Irritability
3. H/o Suicidal thoughts
4. Anticipatory Anxiety
5. Dreams of being tortured
6. Craving – sweets
7. Craving – spicy, salty, hot food.
8. Craving – salty
9. Craving – hot food
10. Disturbed sleep
11. Perspiration on head
12. backache < morning, > evening.
13. tired feeling
14. Crying sleep in.
The Case was repertorized by using RADAR software from which following rubrics were taken.
Repertorial Totality:
1. Mind: Grief: Suppressed (see silent)
Mind: Grief: silent
2. Mind: Irritability
3. Mind: Suicidal disposition: thoughts
4. Mind: Anxiety: anticipation, from
5. Dreams: tortured, of being
6. Generals: Food and drinks: sweets: desire
7. Generals: food and drinks: pungents things: desire
8. Generals: food and drinks: salt: desire
9. Generals: food and drinks: warm food: desire
10. Sleep: disturbed.
11. Head: Perspiration of scalp
12. Back: Pain: morning
13. Generals: weakness
14. Mind: Weeping: sleep in
The remedy which emerged out which fits the case was Natrum Muraticum. The core of the case revolves on suppressed grief.
Homoeopathic Materia Medica by Farrington [3] tells us the mental state: We find these patients sad and tearful. You will seldom find Natrum muriaticum indicated in chronic affections unless there is this low-spirited condition of the mind. The patient seems to be made worse by any attempt at condolence. Consolation may even make her angry.
In addition to this melancholy mood we also have irritability developed by Natrum muriaticum. The patient becomes angry at every little trifle. He stores up in his mind every little real or imaginary offence. He wakes up at night with palpitation of the heart and cannot go to sleep again, because past unpleasant events occupy his mind.
Homoeopathic Materia Medica by Dr J.T. Kent [4] says that Nat-m. is a deep acting, long acting remedy. It takes a wonderful hold of the economy, making changes that are lasting when given in potentized doses. Emaciation, weakness,
