John is of German ancestry, unmarried, from Ohio. He identifies himself as a recovering alcoholic. He has worked at a variety of jobs in his life: theater director, technical writer, truck driver—“all over the map.” He speaks in a dry, plodding way. His chief complaint is thickening and cracking of the skin on the soles of his feet. His case was taken entirely by phone and email.
“I have this skin condition. It started after the start of the year and stayed in relatively mild form for several months. As the weather got more humid it worsened. I have no idea what it’s about. I’ve been doing all these ‘good’ things for myself—yoga, qigong—and my diet is better than ever. I’m still binge eating—I eat candy, ice cream.
“I have COPD [Chronic Obstructive Pulmonary Disease]—I was a heavy smoker for 30 years.
“I have Charcot Marie Tooth disease—one of the mildest cases, according to my doctor.
“The arches of my feet are very high. My feet have always been a nuisance. The little toe on my left foot is raised. I’ve had these problems since early childhood. I don’t experience any weakness or fatigue, although I do feel weaker than I used to. I get out of breath more quickly than I used to.
“I had surgery for Dupuytrens contracture. I had ‘claw hand.’ It was a nuisance to reach into my pocket. My little finger was all out of whack.
“It crossed my mind that the skin condition on my feet might be a symptom of something… It doesn’t get better. Is there something wrong with my immune system?
“I drink elderberry juice and take echinacea. I’ve been on Nardil, an antidepressant, since the late 1970s.
“The Nardil has made me gain weight. I’m 5’ 7” and weigh 200 lbs.
“I take Albuterol [inhaler] for my breathing problems. Also, Spiriva [bronchodilator].
“I forgot to mention one thing—I have a torn tendon in my left foot. I tore it doing yoga one year ago. I use kinesio tape on it, which helps immeasurably.
“I have some arthritis in my left foot.
“I sleep good—no trouble falling asleep. I take naps.
“I urinate a lot, once every 2-3 hours. I get up once a night.
“My bowel function is good—no constipation or diarrhea.
“I was hospitalized once, several years ago, for depression.
“In the 6th grade I had a mastoid infection. I tried to pretend it wasn’t there.
“As a baby I had a double hernia repair.
“I don’t have a diagnosis for the skin condition. The skin is thick, hard, grossly discolored, a deep yellowish brown. There are cracks all through the hard stuff. Sometimes they grow as long as two inches and go deep. The hard skin wraps around my heels on both sides and covers my big toe.
“I was planning to go hiking in the wilderness…”
From a homeopathic perspective, the case is challenging. John does not go beyond the bare facts of his condition. There are no sensations, no modalities, no peculiarities—a perfect case for allopathy! In fact, John remains committed to allopathy. He is not looking to cure himself, only to get rid of his skin problem.
If we focus only on the skin symptoms, using rubrics such as “Itching,” “Hard, with thickening” and “Cracks,” we come up with remedies like Antimonium crudum, Graphites, Rhus toxicodendron, Sepia and Sulphur. Malandrinum and Castor equinus are also possibilities.
Such an analysis falls short of treating John as a whole, however. Although he is in relatively good health, he has some deep problems. Charcot Marie Tooth disease, for example, is a genetic disorder affecting the myelin sheath of the peripheral nerves, symptomatic of tertiary syphilis, as are alcoholism and depression. If John is treated symptomatically, there is a danger of adverse consequences from suppression.
John’s strategy for dealing with illness is to ignore it, as when he had the mastoiditis. When he can no longer ignore it, plan B is to suppress the symptoms and live with it. This strategy of avoidance is typical of the sycotic miasm. Sankaran characterizes sycosis as a “fixed, irremediable weakness within the self.” The response is to “cope with it and hide it.” [Insight Into Plants, 54] Decompensation occurs when the weakness can no longer be ignored.
The over proliferation of skin cells also points to the sycotic miasm.
Medorrhinum is known for a variety of skin conditions such as eczema, psoriasis, warts, etc. Although it is the nosode of gonorrhea, it covers syphilitic symptoms as well. It is in fact multi-miasmatic; Banerjea classifies it as psoric++, sycotic++++, syphilitic++, and tubercular++.
I came to Medorrhinum mainly through a process of elimination. There was very little in the case to prescribe on—in fact, the only thing I could see was its sycotic character. The essence of sycosis is hiding, and so what does one prescribe when everything is hidden? I reasoned that if the case were Thuja or Nat Sulph or one of the other sycotic remedies, some characteristic features of those remedies would have been evident.
Rx: Medorrhinum 1M (Hahnemann Labs) diluted in water, one dropperful per day x 28, starting Aug. 21, 2010
Follow-up Sept. 8, 2010 email (17 days later):
An advance warning: some of my frustration over my skin condition may come oozing out. It is a frustrating condition. It’s a condition that could bring you down, drive you to drink, or binge eat. But it isn’t doing those things to me. I am ok. Actually, much better than ok.
Why is it frustrating? Because it feels like something has taken over my body, something up to no good. Like this morning, I got up, put weight on my left foot, and immediately realized that during the night the first crack down to live tissue on the bottom of my foot had occurred. Getting to the bathroom was a real adventure. Fortunately, the raw pain subsided a short time later; sometimes it goes on for days, sometimes not.
Far worse, the condition has migrated to my hands. It manifests somewhat differently there, but after a good deal of thought and scrutiny I convinced myself it was the same culprit. The cracks are very much like large paper cuts; right now I have about twelve. Also, between the thumb and index finger on either hand, a scaly, sensitive, burning lesion. My current treatment is crazy glue on the most bothersome cracks and the wearing of gloves a lot of the time.
Just before leaving on vacation I saw my conventional-medicine doctor. He called it lichenification. He also said it was chronic and that I had a particularly virulent case. When I told him I was applying apple cider vinegar to the lesions, he responded, “What can I say? I have nothing to offer you.” I read around in Medscape, where they called it lichen simplex chronicus [aka neurodermatitis]. I thought of the guy who said that a chronic disease is one they haven’t found a way to treat.
Even though I have more to say, I’m going to end soon. I’ll conclude tomorrow. For tonight I’m going to wrap up by describing the progress of the disease since I started taking the homeopathic medicine. There’s the invasion of my hands, as I said. The lesions on my feet have been remarkably stable. Cracks come and go. About 10 days ago, small portions of a very large lesion on my left foot began to lift and separate from the skin beneath. Over the next three days a section about the size of a silver dollar flaked off. The stuff smelled awful. At first the newly exposed skin looked fairly smooth, almost normal. Now it resembles the uneven, pockmarked skin of a baby alligator. That’s about it.
Follow-up Sept. 23, 2010 email (one month after Rx):
Since I last wrote, there has been a remarkable improvement in, for lack of a better name, my chronic lichen. About 75% of the area that had been thick, scaly skin on my feet has gone away and has been replaced with ‘new’, pinkish skin. To a large extent the new skin resists becoming ‘re-lichen-ized’. So far. Halleluah.
Also, at one point after two days in and out of hot springs, my hands felt back to normal. Wow! However, 12 hours later the slices in my thumbs and fingers returned. Anyway, things are happening, changing.
My real purpose here is to order some more medicine. I’ll be out before I return home.
Thank you. I’ll settle up with you as soon as I know how much to send.
I mailed the medicine and did not hear back from John (nor receive payment) for three months. I sent an email reminder. No response. Finally, a letter came on Dec. 24th with a check and a request for more medicine. John would have finished his previous bottle by Oct. 23rd but apparently was doing well enough to ignore the problem until the middle of December. If his symptoms had not come back, I doubt he would have paid me.