Homeopathic management of the patient requires not only thorough knowledge of Materia Medica and repertorization techniques but also clear understanding of what is going in the organism during the treatment. Besides the totality of the symptoms, which is sometimes announced as the one and only method of right prescription, there are also other methods, more suitable for some special cases. These methods was outlined by G.Vithoulkas as prescriptions based on keynotes, mental-emotional pictures (essence), specific combinations of symptoms (essentials), pathology and causative factors. The other very important issue in taking a case is an underlining or matching the symptoms according to the degree of their intensity. This is particularly important in cases of so named “one-sided diseases”, where the patient shows a paucity of symptoms and we need to select the most prominent ones to prescribe correctly.
The main goal in treatment by homeopathy is not only the right prescription but also proper evaluation of the case and selection of the next necessary remedies. The utter importance of this evaluation together with more than 20 patterns of possible reactions was outlined in a treatise of G.Vithoulkas “Levels of Health”.
The following case is given to show usage of the above mentioned principles in practice.
N.A. is a female, born 1965. Her height is 170 cm and body weight is 78 kg. She has rather stout complexion with dark eyes and hairs. She works as a teacher in a university. Her main complaint is a painful anal fissure and piles for which she was about to be operated on. However, she didn’t want surgery and has decided to try homeopathic treatment first.
Main complaints and modalities, present illness history:
(The score in brackets is used to indicate intensity of the corresponding symptom). She has painful hemorrhoids and anal fissure. She first had it in 2006 and at that time doctors recommended operation but she refused and tried allopathic treatment, which had some effect. Since August of 2013 she again has been having this problem. She has a tendency to constipation and her bowel motion is once in 2-3 days (2). Her stool is usually hard, sometimes even like sheep-dung. There are no visible piles, but they go out during the stool. Since August of 2013 she had 3 episodes of slight anal bleeding. There is burning pain before stool which is better after defecation (3). Then, after 3-4 hours of emptying there is dull pulsating pain, which is better from walking (3), worse from lying. She often uses suppositories and micro enemas for relief of anal discomfort. Sometimes she has headaches (no other details).
She has flatulence, which is worse after farinaceous food and fizzy drinks (1). She feels heaviness in stomach 1-2 hours after eating (1).
Personal history (past illnesses, medications, vaccinations):
She got all the child vaccines and had mumps in childhood. 7-8 years before she had strong backaches, which were treated allopathically. Then she had episodes of sensation of swelling in the mouth and throat, which passed without any interventions. In 2003 she has an episode of cystitis treated by allopathy. Since 2006 she was diagnosed with fibroids of the uterus. From time to time she has leucorrhea for which she uses allopathic treatment. In 2006 she developed exacerbation of her anus problems after vaginal douche. Three years before she had sclerotherapy for varicose veins of the legs, after which she developed edema of a foot, which is better from walking and worse from sitting. Two years ago she developed urticaria with eruptions all over her body and swelling of her lips. It lasted for 5-6 months and was treated by allopathy together with ozone therapy (complementary treatment). The previous year she had unpleasant sensations in the region of the heart caused by problems of her children. She doesn’t reveal details. She took tincture of Passiflora for this.
Generals:Temperature regulation (feels warm or cold) – how weather affects complaints (e.g. wet, dry, stormy weather):
She experiences occipital headache from wind. She doesn’t like cold as she feels very chilly during winter. She doesn’t like the sea, as she has palpitation and difficult breathing at the seashore. She feels stiffness in knees during damp weather (1).
Perspiration (e.g. inability to perspire, profuse perspiration, which parts): No particularities.
Thirst and characteristics (e.g. for sips, for large quantities, desire for warm drinks, cold drinks): She likes tea and doesn’t like water. She particularly doesn’t like cold water.
Appetite (e.g. increased, decreased, changeable, specific time): No particularities
Foods that aggravate: She has flatulence after farinaceous food (1).
Desires: Pepper and spicy food (1).
Aversions: Doesn’t like smell of offal (1).
Sleep: (position of sleep, cold feet at night or uncovers feet, salivation during sleep, grinding of teeth during sleep, repeated dreams):
She goes to bed at 22.00, watches TV and falls asleep at 01.00. She sleeps on her right side and can’t sleep on the back or abdomen (1). She gets up at 07.00.
Mental & emotional symptoms: No particular symptoms here. Before she liked to be in company, but the last years she prefers to stay alone. She is calm, but doesn’t like when a third person interferes in dialogue. Sometimes she feels like crying when getting angry. She feels exertion at work, as she must be precise.
Phobias: No symptoms
Marked mental symptoms (e.g. too timid, reserved, excessive loquacity, haughty): No symptoms
Mood (sadness, anxiety, discontented): Normal
Memory-concentration: (e.g. weakness of memory, forgetful for words) When she exerts herself, she sometimes forgets words during talking.
Head (headaches, perspiration, eruptions): Occipital headache during exposure to cold wind. Pulsating headache in temples 1 day before menses (1-2).
Face, nose, ear: Normal
Respiratory system: Normal
Cardiovascular system: No symptoms
Gastrointestinal system (pain, eructation, distention and modalities): Described as a main complaint.
Urinary system (e.g. urination offensive, feeble stream, forked stream): No symptoms
Genital system (e.g. menses in women, painful, copious, intermittent, clotted):
Menses are regular and since age of 15 years. She has pulsating headache in temples, 1 day before menses and takes painkiller for this (2).. Sometimes this headache is better from sleeping.
For the last 2-3 month she has pains low in the abdomen during menses.
Sexual desire: Normal
Back-extremities, joints (e.g. pains and modalities, sensations): No symptoms
Skin: No symptoms
Nails (e.g. hard, brittle, in-growing toenails): No symptoms
Other: No symptoms
Latest high fever: She doesn’t remember.
Family history: Her father, brother, sister were operated on for hemorrhoids. Her father died from cardiac insufficiency. Her paternal grandmother had diabetes. Her mother had arterial hypertension.
Level of health: As we don’t have a clear picture here and long absence of acutes we can think about group C. However, there is no great disturbances in general health and the vital force is able to localize symptoms on peripheral tissues, so we can suppose placement of this patient in lower levels of group A.
Comments: It seems that she has got inherent weakness of veins which is presented as hemorrhoids and varicose veins. Suppression by allopathic treatment can be considered an exciting cause of her diseases. Based on her personal history we can trace development of pathology as following: 2006 hemorrhoids and fibroid of uterus, 2007 backaches, 2010 varicose veins, 2011 urticaria, 2012 heaviness in the heart because of stress with children, 2013-2014 return of hemorrhoids and development of dysmenorrhea.
There are no clear mental, emotional or general symptoms in this case. However, as I was not aware of other methods at that time, I just used totality of the symptoms. According to the flat repertorization, I selected Nux-vomica. She was given Nux-vomica C30 at 27.03.2014. The repertorization was performed by Homeopathy Pro software and based on Kent’s repertory.
Follow-up 1, 27.04.2014
She arrived after a month with the same symptoms. The pains in anus were even more, with no amelioration of the general energy or mood. She had one episode of elevated arterial pressure before menses, which she never had before. However she didn’t have pulsating headache this time (This can be supposed to be a shift of the symptom).
Notes: Clearly there was no local amelioration but aggravation and shift of the symptoms without any change in the general state of organism. According to pathology she was given Aesculus C6 and after 2 weeks Aesculus C30 with very short amelioration. She had to repeat the remedy every 10-14 days. Again there was no positive progress in the case.
Follow-up 2, 22.10.2014
Her case was retaken and Sulfur 30 was prescribed at 14.08.2014. The prescription was based on most prominent local symptoms and their modalities. After taking 2 doses of Sulfur c30 and one of C200 (each every 3 weeks approximately) her symptoms changed as follows.
Her menses become less, her headaches before menses disappeared. Now she complains of absence of urge for defecation and constipation (1 stool in 4-5 days), pulsating pain 1-2 hours after defecation. She says that she isn’t much bothered by having constipation (3). She also says that her leucorrhea has increased (1). She also notes flatulence after apples and dates. She tends to be chilly; likes to wear socks at night, and notices ameliorations of rectal pains from it (3). Again sometimes she has urticaria (1). A day before she had heart pains and numbness of the left hand. She notices that after-stool, pains are radiating onto the back (1). She has eructation with smell of rotten eggs at morning, particularly if eating something late in the evening (2).