This is a case of a 35-year-old female diagnosed with allergic rhinitis and left sided migraine, seen by Dr. Rajan Sankaran at ‘the other song’ in September 2011. The allergic rhinitis often caused recurrent upper respiratory tract infections. She was referred by her husband who was already a patient at ‘the other song’ as well and was doing well on homoeopathic treatment for severe acid peptic disease.
When the patient entered, she was quiet and observant and hesitant. On talking to her, it became apparent that she was not very comfortable speaking English so we switched to Hindi. The case–taking interview went as follows. The index for short forms is D: Doctor, P: Patient. The case has been edited for brevity.
D: Please tell me what brings you here?
P: I have colds over the past 10 years, and they are mostly allergic in origin. They start with change of weather, or exposure to dust. The doctor diagnosed it as allergic rhinitis. I also have lot of headaches. They are mostly left sided. The doctor said it is migraine. I get them almost every 20 days to a month and they are intense. These started after I was involved in a vehicular accident, where I had injured my head and there was lot of swelling in my vertex with pain. This was around 9-10 years back again.
D: Tell me more about these headaches.
P: They are mostly on left side. The pain is in vertex and occipital region. It starts from back of head and comes up, to vertex, sometimes to forehead and even to the eyes. If I have a cold or acidity then pain is almost unbearable…
D: Describe this pain more.
P: It is very intense pain. When I have the headache, I feel it is so severe.. It last for 1-2 days. When the pain goes away, I am fine.. for next 20-30 days it is as if I did not ever have migraine, then the pain starts again and it is same as before. I often feel why do I have this pain? It is so sharp a pain.. Almost as if pricking, stabbing – as if my head was being stabbed with knives or needles. I cannot bear anything then. Have to take a painkiller then and there, only then it gets better, but still does not go away completely. It lasts for a couple of days before it goes away completely. The pain comes suddenly and goes away suddenly as well. It is almost like lightning, like electric shock. It gets worse till noon, then slowly subsides towards evening.
D: What makes the pain better or worse, other than the painkiller medication?
P: When I have headache, I cannot bear loud noise. My children are very talkative and loud. I get so irritated when they make noise, I just want to close the door and lie down. The pain is also worse from sunlight, I cannot go out anywhere in the sun with the pain. I am sometimes better with steam inhalation. When the headache becomes very severe, I sometimes end up vomiting too.
D: How do these complaints affect you?
P: With the coryza and pain I am completely drained out. When I have the pains it is so tiring. I feel why am I suffering so much? Do I not take care of my health? I do not know what I am doing wrong. These are the only two complaints that I have. When I have no complaints, I feel as if my health is perfect, but then I am again disappointed once they start.
D: Tell me something about yourself.
P: I am very sensitive by nature, so I cry a lot (laughs). There are many things which hurt me. Things at home affect me easily. I am a housewife, so I am at home all the time, doing household work and looking after the kids. Husband is short-tempered by nature. My mother-in-law also has a similar nature. They always keep finding faults saying that I do not keep the home neat or that I do not make good food, that I am lazy.. (weeping). My mother-in-law is getting old and irritable by the day. Always keeps criticizing whatever I do. I feel so bad that time. This was since the time I got married, I should be used to all of this by now as I know this is their nature, but I get hurt all the same. I end up weeping most of times. I feel very angry and irritated later and shout at children.
D: What is the feeling?
P: I feel disappointed. I did not know that my husband possessed such a nature. After marriage, within a couple of days he started finding fault with my parents’ behaviour, saying that they do not respect him. He started quarreling with me when I tried to tell him that it was mistake and that they did not do it intentionally (weeps). It was so bad then. I was shocked! I did not expect this.
D: Tell me more about the shock.
P: It was not at all expected! It was so sudden. I could not speak out. It was as if I was blank in the moment, could not believe that this could happen. I started getting palpitations. Was scared, but could not react. I just kept weeping for a few hours after that. Every time someone quarrels with me, it is like a similar experience, I go blank and start with palpitations. This happens also when I get some bad news suddenly. Recently one of my cousins passed away, I was again blank then. Just could not believe it! (weeps)
D: What other things are you sensitive to?
P: I am very sensitive about what people say about me or my family. My child has ADHD, so he is very hyperactive and restless. If any of my relatives comment on his abnormal behaviour I feel very sad. I cannot see emotional scenes in movies, I start weeping then too. I am very sensitive especially to comments by my husband, he knows that I am sensitive, but he still keeps on torturing me, despite me doing everything to keep him in a happy mood.
D: Tell me more about torture.
P: Torture is harassing; he knows I do not like it.. but he will do it again and again and every time I feel so hurt.
D: Tell me more about your nature.
P: I have very less confidence. I cannot talk confidently to new people. You saw how hesitant I was in beginning. But then once I am comfortable, I make great friends. I feel that I should pursue my hobbies and develop them into a career, but do not have enough confidence for that too. I feel I should take up a job, but feel I will never be able to get one. I feel I should learn to control my emotions, be strong, but I cannot do it.
D: What are your hobbies and interests?
P: I like to paint and draw. I like being in nature. Love plants and gardening. I just love traveling, going to woods. I like going shopping too.
D: What was your nature as a child?
P: I was very shy, but at home I used to play a lot of mischief. Was very good at studies and loved playing with my friends and sisters.
D: What fears do you have?
P: I don’t have any fears since childhood, except one. Somehow when I see sharks, I get very afraid, rather when I see their sharp teeth.. I was terrified watching jaws.. their teeth are so sharp and pointed. When they eat someone, it must be so painful and terrifying.
D: What dreams do you get?
P: I often dreams of snakes. They can be small ones or big snakes like python, they are just there and sitting and watching me. They are not doing anything, just sitting. I do not feel scared or anything.
D: How is your appetite? Can you tolerate hunger?
P: Appetite is Ok. I cannot tolerate hunger since childhood. I feel very weak if I don’t eat immediately when I am hungry.
D: What do you like or dislike eating?
P: I like to eat everything, there is nothing specific that I like or dislike. I like sweets a little more and I sometimes get an urge to eat sweets.
D: How is your thirst for water?
P: Average, I drink around 2 litres a day.
D: Any complaints in urine/stool?
D: How is your sleep? Which position do you sleep in?
P: Sleep is good, normal. I generally sleep on my sides.
D: How are your menses? Do you get any complaints before during or after your menses?
P: Menses are Ok. Before, they used to last long, now maybe only for 2-3 days. They are quite regular. Not too heavy a flow. No complaints generally with menses.
D: Which weather do you like and tolerate better?
P: I like moderate weather. Not too hot or cold. Get more coryza in cold weather. Cannot tolerate cold weather well.
The patient presented with many peculiar symptoms. Starting with her chief complaint, we see the following characteristics:
Left sided headache
Sudden onset and sudden decline of pain
Pain extending from occipital region to forehead
Pricking, stitching pain
Pains like electric shock
The allergic rhinitis, did not present any characteristic symptoms. However when we are to look at the nature of the client, we see that she is very sensitive and gets affected by small things. She starts weeping and feels hurt as if disappointed. So we see a strong ailment from disappointment from unexpected things and from shock. Besides, we see lack of confidence. In the fears, we have fear of sharks, namely from their pointed teeth and dreams of snakes. On using all the above symptoms for the totality and considering the following rubrics for repertorization, we get:
(Complete Repertory, copyright @Roger van Zandvoort, from MacRepertory 8.2.01, Professional)
On repertorization Spigelia, Belladona and Nat-mur come up strongly. The repertorization gives us a fair idea of the remedies indicated for the case. However, narrowing down onto a simillimum often becomes a dilemma. In such cases, the use of modern approaches, one such being the Sensation Approach, comes in handy.
When we are to look at the case from the perspective of Sensation, we see that the patient indicates a lot of sensitivity to various factors in her surrounding and tends to react. This sensitivity and reactivity typically indicates a plant kingdom. According to the Sensation approach, the main experience of the plants has to do with sensitivity; the main issue of minerals relates to structure – of losing, forming or maintaining a structure, and the main experience of the animal remedies has to do with survival. Hence the themes of animal kingdom are commonly seen in the form of competition, you versus me and aggressor versus the victim.
Taking the analysis further, so as to determine the plant family of the remedy that the patient may require, we see that her sensitivity is mainly seen through the experience of feeling shocked at every intense situation in her life, which is sudden and unexpected. The experience of the shocked feeling is that she goes blank and cannot react and has palpitations. This is the experience of the plant family Loganiaceae. The main experience of the family Loganiaceae can be summarized as shocked, shattered, torn to pieces ( shock so sudden as to paralyze the person), disappointment, ruined, paralyzed, I cannot move, sadness, grief, faint, besides oneself.
Further, the concept of miasms helps distinguish between the remedies from the family. The miasm is the pace and the intensity with which the patient experiences her complaints and her innermost feelings. Her complaints are intermittent with episodes of normalcy in between. Also, we see the feeling of tortured and being harassed by her husband and the persistent feeling of intense suffering. These are indicative of the malaria miasm. The remedy belonging to malaria miasm from the family Loganiaceae is Spigelia, which is known for its sharp, pricking pains, intermittent lightning like pains and fear of pointed objects.
On one hand, we see that the remedy is very prominent on repertorization, and on the other hand the Sensation approach leads us to the same, not only helping clarify but confirming the reasons for prescription.
References from Materia medica:
Phatak’s Materia Medica
Mind – Afraid of pointed things; pins, needles. Easily offended.
Head – Pain from left occiput to over left eye
Worse – periodically, with sun.
The patient was given Spigelia 200, in water, twice a day for 2 days. The 200th potency was selected for her, due to her high susceptibility and many peculiar symptoms at the physical and emotional level. Also, the 200th potency is best suited for Level 3, which is the level of emotions, where the emotions affect the body and vice-versa.
Follow up – 21st October, 2011
D: How are feeling?
P: I am feeling good. I had a migraine episode last week after I went shopping in bright sunshine. I was thinking of calling you, but I just decided to wait as the intensity of the pain seemed a little bit better. Then the pain was maybe 70% of its original intensity. I took a lot of rest and could manage without any painkillers this time. There have been no other complaints otherwise.
D: How are moods?
P: They are almost the same. 2-3 days back again my husband quarreled with me, I was very hurt and was weeping again. I wanted to speak up and defend myself, but could not answer him. Somehow I lacked the courage. My son is doing better, so that makes me cheerful and hopeful. I have noticed that I am not as irritated with my children.
D: Was there anything else that affected you?
P: No not much.
D: How are your energy levels?
P: They are good as well. I am drained after migraine.
Treatment plan: Spigelia 200 twice a day for 2 days.
Follow up – 19th December, 2011
D: How have you been doing?
P: Overall, I feel I am better. I got a mild episode of cold when the weather turned cold. But I was OK within a day, did not have to take any modern medicine for it. Also, last month I did not have migraine, which was unusual in itself. Last week, we had a big fight a home because my sister-in-laws were instigating my mother-in-law against my husband. She was accusing us of not taking good care of her. This disappointed me very much and I was taken aback. Last month she was so ill and I was taking so much care of her, so how could she say like this.. I wept a lot after the arguments taking place at home. Was very upset, had palpitations, and was afraid, could not speak up. After that I got the migraine episode. That time, I called you up. You then asked me to describe my state and advised me to take the remedy from the extra bottle. The first dose helped only a little bit, only after I repeated it thrice every 6 hours as you had said, was the pain significantly better. This time it went away in 1 ½ days.
D: How is your sleep? Are you getting any dreams?
P: Sleep is good, only when I was upset, could not sleep well.
D: How is overall state and energy level?
P: Quite good. This time I was not drained after the migraine. Felt that the remedy you had advised helped me with that too.
The patient was improving, but her migraines continued from any emotional upset. Also during the acute episodes, it was only after frequently repeating the remedy, that she was better. The other symptoms remained similar. This was an indication for stepping up the potency, so she was given Spigelia 1M, twice a day for 2 days in water.
Follow up – 23rd March, 2012
P: I am feeling much better over the past 3 months. I have had no migraine episodes. It is almost as they have vanished. I feel so happy. The pain used to drain me, now I don’t have any pain. The cold is still there, from any change of weather, but it is there for maybe half a day and very less intense. I sneeze, have a little nasal discharge and then as the day progresses I am better.
D: What other changes have you observed?
P: I feel happy overall. Pain is not there. Also feel much confident. I applied for some jobs related to art work and also went and volunteered there. Now, I have been offered a job for teaching artwork to kids below age 5. My family members were amazed, they could not believe that I could manage this and that I will be travelling a considerable distance alone every day. I feel so confident and free as if I can do everything. My mother-in-law keeps passing snide comments, but they do not bother to affect me so much. It is almost that I have accepted that she will be like that. My relationship with my husband has also improved a lot. He makes efforts to understand me and tries not to hurt me. I feel great because of all these changes. I feel as if I am at least 80% better and feel grateful to you and homeopathy. I keep advising all of my friends that they should all opt for homeopathic treatment.
D: Did you get any dreams?
Treatment plan: Wait
The patient continued to follow up with us for the next 2 years, as her family continued treatment. Overall she was a changed person and the complaints which she had when she started the treatment were much better. She was given a few doses of the remedy, which helped her very well even in acute conditions. It was amazing to see that when she developed severe bronchitis after getting wet in the rains and when her symptoms and state were studied, Spigelia covered it very well. A few well-monitored doses of Spigelia helped her recover within the next 10 days.
A well-selected remedy is the one which helps address the diseased state, both in mind and remedy. A combined use of the modern and the traditional approach, makes selecting a similar remedy, an easy, methodical and a reproducible task.
Dr. Rajan Sankaran uses the synergistic approach with amazing results in his practice which he regularly teaches through cases at the other song academy. He recently demonstrated the use of this approach with successful results through many cases in a 4-day-seminar from August 20th – 23rd, 2016, at Toronto, Canada.
About the other song:
‘the other song’ International Academy of Advanced Homoeopathy’ is a world class medical centre which puts good health and well being at the core of an academic culture dedicated to complete patient care. Situated in Mumbai, this institute is one of a kind, where a team of 35 doctors headed by Dr. Rajan Sankaran (the pioneer of the Sensation Approach in Homoeopathy) come together and practice Homoeopathy. At the Academy, the students and practitioners are trained in advanced Homoeopathic practices, using new methodologies in combination with the traditional approaches, all with the use of state-of-the-art technologies. The Academy is also a meeting point for different schools of thought in Homoeopathy, where renowned homoeopaths – national and international are invited, to share their knowledge and experience, so that there is a constant flow of ideas on a common platform.