Abstract: This case report illustrates the application of the Boenninghausen approach in homeopathic repertorization for a patient presenting with acne vulgaris, membranous dysmenorrhea, migraine, and associated symptoms. The repertorization process identified Sepia as the simillimum based on the patient’s mental and physical symptoms, leading to significant improvement across multiple complaints. This study underscores the relevance of Boenninghausen’s method in modern clinical practice for effective homeopathic prescriptions, particularly in cases with complex presentations.
Keyword: Boenninghausen approach, homeopathy, acne vulgaris, dysmenorrhea, migraine, repertorization, Sepia, simillimum, case report, homeopathic prescription.
Introduction: Acne develops when hair follicles under skin get clogged by sebum or dead skin cells. It is specially observed on face, back shoulders and upper chest. It is common in teenagers especially in males.
Morphologically it can be present as white heads, black heads, papules and pustules to nodular cysts. It occasionally develops blackish discolouration and scarring (ice pick lesion to keloid formation – Acne conglobate; if gets infected with cutibacterium avidum) raising cosmetic issues due to disfiguration of face.
Excess androgen levels and proliferation of propionibacterium acne are the main cause to develop acne at puberty while more oestrogen level has opposite action. Diet like chocolates, coffee, nuts and fizzy drinks, humid environment (acne humidata), too hard scrubbing (Acne michanica) and cosmetic products (Pomade acne) can increase risk to develop acne. Premenstrual exacerbation is due to fluid retention in sebaceous glands facilitating more humidity. Excessive perspiration supports the same theory.
Halogen acne, Occupational acne, Tropical acne, Infantile acne and acne fulminans are some rare variants of acne.
Case Report
Date: 28/06/24
A 17 years old girl came with the complaint of acne and severe hair fall since 2 to 3 years. She is a student of 12th standard from Hindu community.
Chief complaint
| LOCATION | SENSATION | MODALITY | CONCOMITTENT |
| Face
Since 2 – 3 years |
Acne- popular
No pain No itching Reddish blackish discolouration |
< ++Before Menses | |
| Head
Scalp Since 2-3 years Increases since 1 year |
Hair fall+++
Thinning at ends++ Widen Part of hair line++ No dandruff |
< stress (12th exam) | |
| Female genital tract
In between the menses |
Menses- regular,
profuse++, clotted++, painful+++, dark red in colour LMP 19/03/24 leucorrhoea long, stringy, transparent, offensive+ no stain |
>++ lying on abdomen
> Tab Meftal plus on 2nd and 3rd day of menses |
Unable to move due to severe back pain
Acne++ |
Associated complaint
| LOCATION | SENSATION | MODALITY | CONCOMITTENT |
| Head
Left temple Since 2 – 3years Frequency – once/2-3 days Duration – not relieves without medicine |
Hammering pain+++
Nausea+ No photo/phono sensitivity No giddiness |
< +++sunlight
< +++lack of sleep >+ tea > Tab seridon |
Irritation++ |
Physical Generals
- Perspiration- offensive++, Axilla++
- Appetite – wanting since 1 year, h/o voracious appetite
- Thirstless+++
- Desire: Fat (milk cream)+++, mint+++, Raw cumin+++
- Aversion: Fruits++, milk++, rice+
- Addiction: Tea+++ (twice daily, if not drink induced headache)
- Stool: hard, dry, offensive, frequency once/ 1-3 days
- Urination: no any complaint
- Menses:
- Menarche: 13yrs of age
- Regular, duration 5 – 6 days, dark red, clotted++, no odor, no stain
- Before menses: acne++, Breast pain+
- During menses: Back pain+++, Abdomen pain++,leg pain+, irritation ++due to pain
- After menses: no complaint
- LMP- 19/03/24
- Sleep: sound, position on abdomen
- Dream: not specific
Thermal: chilly
Past history: UTI twice
Family History:
Father – psoriasis
Mother – Acne during puberty period, Migraine
Life Space:
Patient is an eldest daughter from well to do joint family. Father is a vegetable merchant. Mother is a home maker. Younger brother is mischievous and always annoys patients. Often tiffs occurred between them. When mother interferes between them she feels mother favours his side. She also feels that mother loves him more as she cooks his favourite dishes daily, serves him warm food, irons his uniform, fulfils his demands etc. and complains her to look after her same as of brother. There are many difference of opinion between patient and mother. She gets offended over slightest command of mother. She feels not being loved by grandparents too as they often scold her for overlooking her work. Father is a sole source of love for her who cherishes her and fulfils all demands. However she hates him due to some restrictions laid by father on her like not attending friends’ birthday party, no movies with friends etc. She is average in study and afraid to examination. She feels jealous if any friend gets more marks. She has very few friends as she feels that all are not trustworthy. She gets angry if thing does not goes according to her wish or somebody scolds her.
According to mother she is very lazy and not helps her in single household chores. She is very argumentative and always ready to fight. Many arguments occur between them over silly matters and ended only when mother gives up. She feels offended easily and gives back answer to anyone like teacher, grandparents etc. She feels that mother gives more warmth and affection to her brother and jealous of him. Many times she presents situation favouring her site where actuality was different.
Observation: Patient’s speech is very hasty.
Diagnosis:
- Acne vulgaris
- Membranous dysmenorrhoea
- Migraine
- Hair fall
- Constipation
Totality of symptom
Jealous
Deceitful
Laziness
Offended easily
Quarrelsome
Delusion she is neglected
Talking hurried
Menses painful
Menses clotted
Leucorrhoea albuminous
Perspiration offensive
Sleep on abdomen
Desire pungent
Desire fat
Aversion milk
Aversion fruit
Perspiration axilla
Face acne
Hair falling
As case has many physical general symptoms Boenninghausen’s approach is taken and mental symptoms are use for remedy difference.
Repertorisation: Zomeo software – android version was used
For differentiating this group of remedies, mentals were separately repertorised for final selection of similimum.
Potential Differntial Field
From Repertorisation and PDF upcoming remedies are Sepia, Puls and Lyco
As patient is chilly and not timid or coward as well as having much animal instincts Sepia is selected as a final choice of remedy.
Criteria for potency selection and repeatation
| No | Criteria | Reason | Potency | Repetition |
| 1 | Susceptibility at Tissue level-
Age and Stage of life, Pace of disease, General vitality, Characteristic symptoms, Pathological changes (functional/structural), Addiction |
Adolescence age,
Functional changes, Moderate pace, Good vitality, Addiction tea, |
Susceptibility – moderate to high | Infrequent |
| 2 | Susceptibility at Mind level | High | High | Infrequent |
| 3 | Level of correspondence with complaints | Good | High | Infrequent |
| 4 | Dominant and Fundamental Miasm | Sycosis | Moderate | Infrequent |
Final Prescription: 28/06/24 – Sepia 1M single dose and sac lac tds for 15 days
Ancillary measures:
Plenty of fluid intakes
Frequent face washes with tap water
Hot fomentation during dysmenorrhoea if needed, no use of pain killer
Follow ups criteria: (Same= S, Increase= <+, Decrease=+>)
Acne number
Acne type/ size
Headache frequency
Headache intensity/ Need of pain killer
Pain during menses/ need of pain killer
Leucorrhoea
Hair falling
Constipation ( stool frequency)
| DATE | FOLLOW UP | ACTION | INTERPRETATION |
| 11/07/24 | Acne – number/ type/ size = S
Headache- frequency/ intensity/ need of pain killer = twice/S/twice Leucorrhoea = S Hair falling = S Constipation (stool frequency) = >+ |
Sepia 1M 1dose | No much amelioration |
| 25/07/24 | LMP 19/ 07/24
Acne – number/ type/ size = >+ before menses/ S / S Headache – frequency/ intensity/ Need of pain killer = Twice / >+ / Once Pain during menses/ need of pain killer = >+/ once on 3rd day Leucorrhoea = S Hair falling = S Constipation ( stool frequency) =S |
Sepia 1M 1dose | Mild amelioraton, Sycotic trait persistent |
| 09/08/24 | Acne – number/ type/ size = >++
Headache – frequency/intensity/Need of pain killer= Once/ Severe/ Once Leucorrhoea = >+ Hair falling = S Constipation ( stool frequency) = >++ |
Sepia 1M 1dose | Still irregularity in complaints |
| 23/09/24 | LMP 18/09/24
Acne – number/ type/ size = >++ Headache – frequency/intensity/Need of pain killer = once/ >++/ – Pain during menses/ need of pain killer = >++/ – Leucorrhoea = >++ Hair falling = S Constipation ( stool frequency) = >++ |
Sepia 1M 3dose
Daily HS for 3 days |
No relief in hair fall |
| 21/10/24 | LMP 19/10/24
Acne – number/ type/ size = >+++ Headache – frequency/intensity/Need of pain killer = -/-/- Pain during menses/ need of pain killer = -/- Leucorrhoea = >+++ Hair falling = >+ Constipation ( stool frequency) = >+++ |
SL 3 dose | Starts relief in all complaints |
| 26/11/24 | LMP 19/11/24
Acne – number/ type/ size = >+++ Face looks clear, Blackish discolouration due to acne marks decreases Headache – frequency/intensity/Need of pain killer = Once due to night watching during exam/++/ >by tea, no need of Tab seridon Pain during menses/ need of pain killer = mild / – Leucorrhoea = absent Hair falling = >++ Constipation ( stool frequency) = daily |
SL 3 dose | Better in all complaints |
| 20/12/24 | LMP 19/12/24
Better in all complaints Pony tail volume increase |
SL3 dose | No any major complaints |
