A Case of Acidity by Dr Devang Shah
This is a case of a 36-year-old female who complained of acidity and bloating of the abdomen. The bloating would result in difficulty of breathing and this would eventually lead to a panic attack.
She consulted a sound, physician who instead of putting her on any psychiatric medicines, he referred her for a homeopathic consultation. She was also diagnosed with irritable bowel syndrome in 2008.
She feels uneasy due to cramps in the abdomen, the heat in the body rises and she looks for a cool place, walks in the balcony for fresh air and wants to drink water. Her stomach is also disturbed before menses; occasionally there is scanty bleeding in stools as well.
As a person, she is very emotional and trivial things have an immediate impact on her. She is scared of the dark, feels suffocated and claustrophobic and avoids crowded places. The fear of dark is so much that she cannot even close her eyes. She also has a fear of becoming blind. She is extremely dependent on her husband and loves the care and pampering she gets from him. A major stressful event in her life was the death of her grandmother with whom she was very much attached.
The aspect of breathless and suffocation or claustrophobia came up with the chief complaint and is also one of her biggest fears. This aspect is clearly intense and carried lot of energy. So she was inquired further regarding the experience of this suffocation or claustrophobia.
‘‘It is like I am disoriented, my lips and palms go numb, I feel giddy and want to take a deep breath. It feels choked, suffocated as if something around the neck or throat. It is like death, you are sweating, restless, as if something is blocking your throat. It is as if something big is passing through a narrow opening like you swallow a big chocolate. Something is stuck. This is exactly what happens with my acidity and I need to pass lot of eructations which gives me relief.’’
‘‘There is a kind of pull in the lower abdomen as if something wants to come out, like something is stuck in a cave. It is the same like claustrophobia. I feel giddy, dizzy, choked and suffocated.’’
She said, ‘’This is exactly what happens with my acidity…’’, this was the most significant sentence, as she joins the experience of suffocation with the same experience of the chief complaint. That means that what is true for her mind (fear of closed places) is also true for her body (acidity and bloating). Thus, this becomes the vital sensation* in the case. The sensation of choked, suffocated, breathless, stuck, and blocking as if something big passing through a narrow opening, is her deepest experience.
Her physical generals included a marked desire for coffee, lime juice, and spices; aversion to papaya. Thirst was increased and desired sips of cold water. She was overall a hot person, and perspired profusely on the face, axilla and thighs. She slept on her sides.
Case Analysis and Repertorisation
In this case, the strange, rare, peculiar symptoms that were selected to formulate the totality of the case are:
- Suffocation – desires for fresh air
- Desires to drink water
- Air hunger
- Fear of dark
- Fear of narrow places
- Fear of crowded places
- Fear of closing her eyes
- Fear of becoming blind
The centre of the case, which is clear, intense and comes up again and again is also very evident – suffocation and claustrophobia.
For this patient, the experience of suffocation and claustrophobia was described as disoriented, numb, dizzy, giddy, choked, suffocated, as if something around the neck, something big passing through narrow opening, stuck, like a pull something wants to come out.
The two most peculiar symptoms were the fear of suffocation, the fear of closing her eyes and something being forced through a narrow place. I felt this was the anchor in the case. So, the remedy must cover these rubrics. On repertorising, it is seen that only two remedies cover both these peculiar symptoms, Carbo animalis and Sulphur. However, it is Carbo animalis that covers the fears as well.
We see that through the symptom approach we get the following set of remedies. Here, the knowledge of sensation method is also very valuable. The patient’s main sensation was of being choked, suffocated, stuck, and dizzy, as if something is around the throat and wanting to come out. This is the sensation of row 2 of the Periodic Table, and especially that of the right side of the periodic table i.e. carbon, nitrogen or oxygen.
Prescription and Follow up
In the light of the repertorization stated above, Carbo animalis was given to this patient as it matched the patient from the symptom as well as the system point of view. Both complement each other.
Remedy Chosen: Carbo animalis 1M
After taking one dose of Carbo animalis 1M, she felt better. The case was followed up for seven months, during which there were no acute episodes and she felt better. The bloating and gas has reduced drastically and there had been no episodes of acidity. There was no nervousness or stress and the bloating was not troublesome to her; she still experienced abdominal bloating, but with much less intensity. Overall she was 80% better both mentally and physically. She discontinued the treatment and continues to live her life free of any anxiety.
Row 2 Remedies of Periodic Table
The remedies in the second row are Lithium, Beryllium, Boron, Carbons, Nitrogen, Oxygen, Fluorine and Neon.
When we study the remedies in the context of the stages of human development(2), we can see that the row 2 remedies reflect the stages just following conception and coming into existence (row 1). It is representative of the intrauterine phase within the womb, through to the phase of labor, and finally to the separation from the womb.
The remedies on the left side of this row like Lithium and Beryllium correlate with stages before labor where the foetus is still connected and dependent on the mother. Hence we see a lot of themes of dependence here.
From Borax onwards we see the symptoms related to process of labor until oxygen where the foetus is out of womb, and lastly when we come to Fluorine, the foetus is separated from the womb.
So here, it resembles the passage of foetus through the birth canal. Thus carbon onwards the sensation of being stuck, constriction and suffocation can be seen as the most prominent feature among the carbons, nitrogens and oxygens.
This patient classically presented her experience as if something big was passing through a narrow place and something wants to come out, which is the exact representation of the birth process.
The themes of the Row 2 are:
Experience which mimics the process of separation; birth process.
- Birth and separation
- ‘Am I a separate entity or am I a part of something?’
- ‘Am I attached or detached?’
- Suffocation, claustrophobia, wanting to come/get out (in Carbon, Oxygen, Nitrogen)
- After conception, the main concern of the foetus in the womb is stability and survival. Within the womb, the foetus is in a totally protective, stable and relatively unchanging environment. Since the ancient times, womb has always been regarded as a ‘privileged sanctuary’ in which the foetus is well-protected against most kinds of harm. It was also known that any disturbance to this secured environment could lead to fear and anxiety in the foetus.
Similarly, a person stuck in the foetal stage of development perceives any threat (issue related to separation from the mother figure) as a sudden, unexpected violence or danger and reacts very instinctively to it. The response is generally an instinctive, reflexive and physical in nature.
Carbon is exactly in the middle of row 2 (stage of separation) and hence has an alternating state. On one side, a Carbon person feels, ‘Can I be on my own or do I need to be still here (inside the womb)?’ and on the other side, ‘I have to let go; can I let go? For the first time I have to sense, I have to react and I am on my own. Am I capable of being on my own?’
There are two sides of carbon; one is dull, still, flat, and non-reactive while the other side is hyper reactive from the slightest things. Thus, the theme of Carbon in is summarized as:
- Letting-off the hold (attachment) on the parental figure.
- Trying to find if he has the stability and security in his own self especially in a new and unfamiliar place.
- Restricted/bound/tied, and strong desire to be separate/independent/not restricted.
- Non-reactive states: They have an exactly opposite state than the reactive carbon compounds; these forms are totally non-reactive; ’I cannot do it for myself.’
In the totally non-reactive condition, these persons don’t have an independent existence; they are not firmly rooted, not confident about oneself and show marked irresolution. The irresolution is intense in Graphites and Baryta carbonica. Carbon remedies like Adamas, Charcoal etc. too are hardly reactive.
The main issue in Carbons is about sensing and reacting; this is termed as the vital reaction of a person. The feeling is as mentioned earlier, ‘Is the outside going to dull me into no reaction or is it going to stir me to react (activity)’?
A Case of Acute Gastritis by Dr Gajanan Dhanipkar
This is case of 34-year-old man who presented with acute gastritis. He had severe burning in the epigastric region after eating spicy and fatty food, which he could not resist eating. He also had burning of the feet. He felt better by lying on his abdomen. Further, he also mentioned that he also got such episodes of pain whenever he had orange juice.
I repertorized these simple symptoms and came up with Medorrhinum:
A single dose of Medorrhinum 200C was prescribed and the acute pain had disappeared in one day. He could even eat spicy food and drink orange juice without much discomfort.
Medorrhinum: Burning of hands feet. Rests more comfortably lying on abdomen. (boericke)
From the Generalities Chapter, Complete Repertory 2015:
FOOD and drinks; oranges; agg. (cont.)
juice: am-i androc med neod-o olea thal-s
An Acute Case of Acalculous Cholecystitis by Dr Rishi Vyas
This is a case of an 11-year-old male child, who consulted on 26th September, 2012, with the main complaint of recurring fever over the past 5-6 days along with severe body pain and headache. Since the last two days, he had started to vomit, felt dizzy and could not stand for long, since he felt that he would fall. Fever (103 -1040F) came almost daily, by afternoon, and he felt very cold and shivered. As the fever paroxysm began, he started to feel cold in his feet, head and then the whole body along with aching. He covered himself with 3-4 blankets when chilliness started. He felt better when he slept, but slightest noise or any disturbance in room woke him up. He generally had paroxysms of fever, 3-4 times a day, which lasted for 4-5 hours. No incident was reported where he was shouted at or scolded before these episodes of fever.
Figure 2: Case 2 Repertorisation
He also had a persistent headache, which increased in intensity as the fever rose. The pain remained even after the fever subsided, but lesser in intensity. The pains shifted sometimes behind the ears, or on the top of head. During the pain, he felt tired, and often could not understand what he should do. When the pain increased, he shouted and screamed that he could not bear the pain. Headache was worse by noise and jar. He put in a lot of efforts to get over the pain and in the process, observed that the pain was better if he was engaged in doing something, e.g. if he watched TV, he could ignore the pain.
Besides, he also complained of abdominal pain which was worse when fever started, and he would end up vomiting. The pain was unbearable, so he often screamed with the pain. ‘No one understands how much pain I am in. The pain comes on suddenly and goes; there is also similar pain in my legs. (Patients started to weep, and looked extremely tired). Pain gets even worse after vomiting.’
Further, his mother said that he day-dreamt a lot and was very sleepy with fever. When people shout, or talk loudly, he gets up. On awaking, he was sleepy and groggy.
He only liked having fruits like muskmelon and watermelon; anything else was vomited. Once he tried to eat pizza, it tasted very salty to him; other things seemed bitter. Sometimes he was unable to pass flatus, so there was increased abdominal pain. He had lot of flatulence and was much better on passing flatus.
There was a lot of dryness of lips with increased thirst for water. He perspired a lot on the neck, face and forehead. Sweat followed the heat and after the whole episode of fever was over, he was completely drained. Generally, he was feeling colder since the onset of the complaints.
Examination findings
He was a lean thin, tall boy, appeared exhausted and weak, found it very difficult to speak, had dry lips, sunken eyes, and was very slow to talk.
Moderate tenderness in the right hypochondrium and umbilical region.
- Respiratory system: clear; throat: clear. No tenderness of sinuses.
- Temperature: afebrile (2 hrs ago he had taken an anti-pyretic)
- Perspiration offensive2+
Analysis
In this case, the peculiarities at each of the below levels were:
Fever complex:
- Periodic; in morning 4-5 am, night
- Chills beginning in lower limb. Chills followed by heat, then by perspiration
- Perspiration: profuse, offensive, and debilitating following heat.
- With heat he feels internal chilliness
- Weakness: cannot stand, faintness
- Head pain aggravates with fever
- Bodyache, pain in legs
- Taste: Food tastes salty, bitter
- Thirst: decreased, but dryness, feels to drink
Headache:
- Aggravation from heat, noise, jarr; ameliorated by pressure
- Confusion: difficult compre-hension, noise aggravates
Bodyache:
- Shrieking pain
- Fainting from pain
Generals
- Perspiration: Offensive
- Desire: Fruits
- Sleep: disturbed due to noise; sleepiness fever during.
- Amelioration from distraction.
Here, we need to match the phenomenon of fever with a patient who is weak, drained, dull, sleepy, has offensive perspiration, profuse dicharges, craving for fruits and is sensitive to jar and noise.
Repertorisation
When we repertorize the above symptoms (Mac repertory software: version 8.1, complete repertory 2012), we get:
Materia Medica References of China
Aggravated slightest touch, ameliorated by hard pressure.
Excessive flatulence of stomach and bowels, belching gives no relief (Lyc., Pod. gives relief, Carbo v.), aggravated after eating fruit.
Colic: at a certain hour each day, periodical, from gallstone (Card-m.). aggravated nights, after eating, ameliorated bending double.
Longing for sour things
Fainting
- Aggravation: From slightest touch, draft of air, milk, after the chills, mental emotion.
- Amelioration: during rest, pressure.
- Type: Variable.
Prodrome: Great thirst (Caps., Eup., Puls. – thirst and bone pains, Eup.)
Figure 3: Case 3 Repertorisation
“Restless sleep night before the paroxysm.” – Hahnemann.
Chill: beginning in the legs below the knees. Chill with pain in the liver. Shaking chill and internal coldness for several hours. Sensation of internal coldness in upper abdomen, after every swallow of drink, and renewed on every inspiration.(8)
Generals: The debility in china, is due to profuse, exhausting discharges; loss of vital fluids, excessive suppuration, diarrhoea, haemorrhages etc. Intermittent periodicity is very marked in fever and neuralgias. Patient becomes teak, over-sensitive and nervous; everything upsets him; light, noise, odours, pain etc.
Fever: Marked prodrome. Stages of chill, heat and sweat well marked. Drenching sweats; at night; worse least motion; from weakness; from depletions etc.( 1)
Treatment
He was prescribed China officinalis 1M twice a day. Next day he still got the fever but the temperature was lesser than earlier, however he was still complaining of pain in abdomen, legs and the whole body. Continued China 1M twice a day for another three days.
Investigations
The ultrasound suggested acalculus cholecystitis. The blood was negative for malarial parasite; Widal test was negative. ESR was 20 mm / hr. Urine had Ketones + present. (Figure 4, 5 and 6) The family had consulted a physician who had advised immediate hospitalization. However the family decided to wait and give homeopathy a try. The diagnosis being clear, it was made sure that at no point he would be excessively dehydrated or end up in complications.
Figure 4: Ultrasound (1/10/2012)
Figure 5: Complete blood count (1/10/2012) Figure 6: Liver Function Tests (1/10/2012)
Follow up
| Date | Follow up | Prescription |
| 2/10/12 | He is afebrile since yesterday, weakness is less, but he is still not moving, there is no episode of vomiting. Body pain and leg pain persist. He is little more active. | China 1M 6 hourly |
| 3/10/12 | He is better, there is no fever today, so almost since 24 hour he is afebrile. Weakness and bodyache is less. Off and on abdominal pain. Chest pain of lower region, which also comes and goes. A gastroenterologist’s opinion was sought who further advised for ct scan if the fever and pain persisted. | China 1M 6 hourly |
| 06/10/12 | He felt little warm in night, but there is no fever.. No pain in abdomen. Bodyache: He has a short span of pain, when he wakes up and go to sleep. Pain better by drinking. He started solid food, curd rice, and there was no pain. Occasionally, there was an episode of intermittent pain. Energy levels much better. He feels he is getting better gradually. Mood: good, not much angry or irritated. | China 1M 6 hourly |
| 10/10/12 | No complaints, was much better. Had no fever, bodyache, abdominal pain or chest pain. | Placebo given. |
Further, the patient was observed for the next six months. He did well and his general health improved too. He did not have recurrence of any similar complaint.
Discussion
In this case, a typical fever paroxysm, all the three stages, cold, heat and sweat all were distinct. This is well explained inAllen’s Therapeutics of Fever, that when every stage of fever paroxysm is elicited in detail so as to find the characteristics, the totality formed then of the peculiarities is an infallible road to the similimum.
What is important is to analyze what is peculiar to the case. The key to understanding the peculiarity of these lies in not looking at the symptoms individually but as a phenomenon as explained by H.C. Allen in Therapeutics of Fever. Symptoms like chill, heat, and sweat are very common to any intermittent fever, but what makes them uncommon is the observation about their presence and absence, how they come on, when they come on, what are the other symptoms that come before, during and after these symptoms. The observation of these symptoms then in entirety is what constitutes the totality. The change of any one factor in the phenomenon, changes the totality and may call for a different remedy, e.g. heat stage with absence of chill may call for a completely different remedy than chill stage followed by heat.
Acknowledgement
I am thankful to Dr Rajan Sankaran for giving me the opportunity and being a guiding force. I would also like to thank Dr Kamlesh Mehta and Dr Sneha Vyas.
Summary
In any case of chronic or acute gastrointestinal disorders, the goal of the treatment is to match the remedy and the patient’s symptoms. We have to begin looking at what level the patient is at – facts, emotions, or sensations and what is uncommon or characteristic in the episode. As we know, each case requires a different approach; an interplay between Materia Medica and Repertory, and/or the Sensation and Kingdom. The case taking has to be very sharp and exact. It should bring out the exact physical symptoms along with their sensation, modality, concomitant and location, in addition to the symptoms of the mind. In every case we apply the principles of individuality, peculiarity and totality, but for each case, the approach may be different (sensation, system, themes, characteristics, materia medica, repertory). Homeopaths need to use every possible tool available when treating digestive disorders, but should maintain the same principle of holistic approach and the level they are at and the characteristics of the case.
When we read cases of the old masters we see that the emphasis was more on symptoms. As human consciousness evolved, there was a development in understanding the human mind and also the homeopathic community advanced. Different homeopaths all over the world developed their unique techniques like the Predictive Homeopathy, ICR Method, Sehgal School, Sensation Method and many more. These have broadened the horizon where one can prescribe on the symptoms, themes, drug pictures, miasms etc.
However these also lead to confusion to many of my young colleagues as to which path to follow.
The solution to this confusion is to take a thorough case followed by sound evaluation of the elicited aspects of the case. Once we identify what is the strangest and most peculiar thing in a case, then we bring in the wisdom of all our senior teachers and pioneers of homeopathy and decide which path to follow. Like, in this case the most peculiar thing was the symptom syndrome of her fear of narrow places. When we understand every aspect of this fear and repertorize, then a certain set of remedies show up.
Then, using the knowledge of the Sensation Method, we selected one particular remedy, Carbo animalis in this particular case. So all the latest advances shall be used in sync with what our old maters did. Therefore, it should never be confusing rather more enriching to see the similarity from where we started.
Therefore, the advances in homeopathy, like the Sensation Method and beyond, broadens our homeopathic vision.
‘Creating a new theory is not like destroying an old barn and erecting a skyscraper in its place. It is rather like climbing a mountain, gaining new and wider views, discovering unexpected connections between our starting points and its rich environment. But the point from which we started out still exists and can be seen, although it appears smaller and forms a tiny part of our broad view gained by the mastery of the obstacles on our adventurous way up.’ – Albert Einstein
References
- Phatak S R. Materia Medica of Homoeopathic Medicines. New Delhi: B Jain Publishers; 2007
- Sankaran R. Structure. Santa Cruz, Bombay: Homeopathic Medical Publishers; 2008.
- Boericke W. Pocket Manual of Homoeopathic Materia Medica, 9th ed. New Delhi: B Jain Publishers; 2006.
- Mac Repertory Software (Complete Repertory, 2015)
- Sankaran R. Synergy Synopsis. Santa Cruz, Bombay: Homeopathic Medical Publishers; 2013
- Sankaran R. Synergy in Practice. Santa Cruz, Bombay: Homeopathic Medical Publishers; 2012
- Sankaran R. The Soul of Remedies. Santa Cruz, Bombay: Homeopathic Medical Publishers; 1997.
- Allen H C. Therapeutics of Fevers. New Delhi: B Jain Publishers; 2009
- Mehta K P. Fever: Blessing in disguise. [Internet]. Available from: http://www.scribd.com/doc/6291646/Fever-Blessing-in-Disguise
About the Authors
The authors are consultants at the other song clinic. ‘the other song’ is a medical education centre, a meeting point for different schools of thought, which puts good health and well-being at the core of an academic culture dedicated to complete patient care and learning through in-depth live case-taking experience by a team of 35 doctors headed by Dr Rajan Sankaran.
