A case of Acne Vulgaris treated by Kentian Method

As per Dr J T Kent, ‘Man is prior to the organs…Man is the will and the understanding, and the house which he lives in, is his body.’ The disease occurs from center to periphery. The first expression occurs in the feeling state, followed by general state and then the particulars. The changes in the feeling state as well as in the physical generals represent the whole person. Hence they are sure guides in understanding the totality and selecting the similimum.

Acne Vulgaris is a polymorphic disease characterised by comedones, papules, nodules and cysts occurring predominantly on the face and also on the neck, back, shoulders and chest. The prevalence of acne has risen over the years. It affects about 80% of population in the age group 11-30 years. Aside from scarring, its main effects are psychological.

This is a case report of 27 year old girl, who presented with complaint of acne on her face, back and shoulders. She had this complaint since 5-6 years. The details of the presenting complaints have been described below.

Date: 7/7/2002

Name: Miss APA

Age: 27 years

Sex: Female

Religion: Hindu

Education: B.Com

Occupation: Working in a BPO

Marital Status: Unmarried

Address: Dhankawadi, Pune.

The patient presented with reddish eruptions on her face, back and shoulders. These were observed to be maculo-papular eruptions, a few nodules and pustules on face, forehead, shoulders and upper back. (See Table 1)

Location	Sensation	Modalities	Concomitants
Acne on face, forehead, shoulders and back since 5-6 years, most prominent on both the cheeks, along with redness	Itching3+ Redness Burning2+sensation on affected parts	< from eating sour fruits < from drinking milk < even from slight emotions > by Eryacne gel (Erythromycin Topical) local application	Anxiety Fear and despair

The patient had taken allopathic treatment for this complaint two years before. The treatment included the local application of Eryacne Gel (Erythromycin Topical) and Acnil soap, which was discontinued by the patient on her own, as this used to give only temporary relief and later on led to marked dryness and exfoliation of skin and irritation.

No other major illness in the past.

Nothing significant.

Diet: Both Vegetarian and Non-vegetarian

Appetite- good

Thirst- Normal

Craving- Tea and coffee

Aversion- Sweets; milk disagreed

Sleep- Disturbed due to itching

Dreams- Nothing specific

Bowels- Twice a day, satisfactory

Urine- Normal

Menses- No complaints, regular cycle

Thermal Reaction- Chill

Pulse- 72/min

BP- 110/70 mm of hg

Temperature- afebrile

Weight- 47 kg

Clinical signs like pallor, oedema, lymphadenopathy, icterus and cyanosis were not present.

There was no significant abnormal finding on examination of her nervous system, cardio vascular system, respiratory system and the abdomen.

Red maculopapular eruptions, nodules on the face, back and shoulders were observed.

Miss APA, a 27 year old female, a BPO employee, stayed with her mother, father and younger sister. Her mother was a housewife and her father was a school teacher. Her younger sister was a college student. The patient shared good relation with her parents and her sibling.

Her childhood days were typically like that of the ‘middle class family’, where there were a lot of financial restrictions. Now, the family’s financial condition had been better yet this patient had a fear of poverty. She was an average performer in her education and career. Now she had a job in a BPO Company yet there was a constant fear of failure as she said that this was very hard earned.

Her parents had been searching for a suitable life partner for her; however, she was quite anxious about her looks due to oily, greasy skin full of acne. When, in the family, the topic of her marriage used to come up, she would get disturbed. Even the slight emotions affected her. She was very close to her family, yet she preferred to be alone.

She had taken allopathic medicines and had tried many local ointments in the past. It gave her a temporary relief but the situation reverted back. Now she had given up hope of recovery from acne problem.

Classification of disease– Chronic disease

Disease diagnosis- Acne Vulgaris

Rubrics Selected	Classification and Evaluation of symptoms
Mind, Sadness	Mental Characteristic, Emotional, Dispositional Symptom
Mind, Fear, Poverty of	Mental Characteristic, Emotional, Dispositional Symptom
Mind, Desire to be alone/Company aversion to	Mental Characteristic, Emotional, Behavioral, Dispositional Symptom
Mind, Fear, Failure of	Mental Characteristic, Emotional, Dispositional Symptom
Mind, Despair, Recovery of	Mental Characteristic, Emotional, Dispositional Symptom
Mind, Anxiety	Mental Characteristic, Emotional, Dispositional Symptom
Generalities, Cold in general aggravation	Physical general characteristic, Dispositional aggravating symptom.
Generalities, Food, Fruit, Sour	Physical general characteristic, Dispositional aggravating symptom.
Generalities, Food, Milk, aggravation	Physical general characteristic, Dispositional aggravating symptom.
Face, eruptions Acne, itching	Physical particular symptom.

                  Table 2: Repertorial totality with Classification and Evaluation of Symptoms

After building the totality of symptoms for a case ( See Table 2), the most important criteria in the selection of repertory is the reliability of the information found in the repertory. In this case, Kent’s Repertory was selected as it is the most reliable and authentic source and contains symptoms and drugs that have been frequently confirmed and verified clinically.

Kentian method of repertori-sation has been adopted as it is based on the philosophy of deductive logic i.e. from generals to particulars. This case contains mental general characteristics, physical general characteristics and particular symptoms and hence Kent’s Repertory is best repertory to be used for this c

On repertorisation using Kent’s Repertory, with the following rubrics, Psorinum came up to be the most prominent remedy. (Figure 1 and Table 3)

Figure 1: Repertorial Sheet

Remedy	Marks obtained	Thermally
Psor	25/11	Chilly
Sep	23/9	Chilly
Calc-c	23/9	Chilly
Nux-v	20/9	Chilly
Sulph	19/8	Hot

On repertorisation, the closely coming remedies are Psorinum, Sepia, Calcarea Carb, Nux Vomica and Sulphur. The patient is chilly, therefore Sulphur is eliminated. Fear of failure and aggravation from sour food are the prominent symptoms of the patient. Sepia, Calc Carb and Nux Vomica lack these symptoms hence are eliminated, which is promptly covered by Psorinum.

Acne has made this patient not only look ugly, but also feel ugly. It has hit right on her self-confidence. Due to chronicity of the complaint, she has given up the hope of recovery which is aptly covered by Psorinum.

Considering the mentals and the physical generals, the final drug of choice is Psorinum.

First Prescription: Psorinum 200

The factors taken into consideration for selection of ‘200’ potency are:

Age: Young adult with greater susceptibility

Occupation: Working in BPO, Hence night shifts and irregular sleeping habits

Chronic Disease: Duration of disease is since 5 to 6 years, so cannot start the treatment with higher potency like 1M or 10 M, to avoid the rigorous homeopathic aggravation.

Also, as per Dr Kent’s Doctrine of ‘Series in Degrees’, one must begin with lower potency and gradually increase the potency with patient’s response to the treatment. So the treatment was started with 200th potency.

Along with the homeopathic medication, the patient was advised regarding relaxation techniques for mental relaxation and basic practices for hygiene, especially of the face, like frequent washing the face with luke warm water. The follow up sheet demonstrating patient’s response to the treatment is given in the table. Considerable improvement was noticed post treatment. (Table 4) After the first dose of Psorinum 200, no new symptom had appeared when she reported in the subsequent follow up; potency was increased to 1M.

Date	Anxiety level	Fear and despair	Appetite / Thirst	Acne and itching	Action
6/8/2002	Same	Slightly improved	Improved	Slightly improved	Psorinum 200 single dose. S.L. 4 pills BD X 15 days
24/8/2002	Slightly improved	Slightly improved	Improved	Slightly improved	Psorinum 1M single dose. was selected. S.L 4 pills BD X 15 days
14/9/2002	Improved	Improved	Improved	Much Improved	Psorinum 1M Single dose SOS SL 6 pills BD X 15 days
05/10/2002	Improved	Improved	Improved	Marked Improvement	SL 6 pills BD X 15 days
02/12/2002	Patient came with Marriage invitation card. Had slight anxiety	Slight	No change	Slight acne on Forehead and cheeks	Psorinum 1M Single dose. SL 6 pills BD X 15 days
12/01/2003	No Complaints	No Complaints	No Complaints	Absent	SL 6 pills BD X 1 month

Overall improvement in the patient was noted with Psorinum. Hence she was kept on placebo and she was advised to report only if symptoms recurred.

It is observed that the cases of acne do not get cured with superficially acting homeopathic remedies. Instead, deep acting constitutional remedies that are chosen and given judiciously bring about complete relief in the symptoms and the skin lesions resolve permanently. When a remedy is selected on the basis on generals (mental and physical), the particulars fall in line and the patient gets complete relief. This case demonstrates the efficacy of ‘Kentian method’ of repertorisation in a case that has such general symptoms.