Homeopathy Online's first interactive case analysis is moderated by Ian Townsend, Clinical Director of the Sheffield School of Homeopathy in the United Kingdom. Ian acts as a tutor at both the Sheffield School and the Scottish College of Homeopathy, and has also taught at the London and Manchester Colleges of Classical Homeopathy.
To read over the case, scroll down. If you've already studied the case and read the comments of others, you may now wish to participate in the analysis.
The notes provided below are terse and deliberately unedited. But they are the same notes that were used to solve the case. If you are unfamiliar with terminology used by the moderator, please ask - terms vary from country to country, and in note-taking abbreviation is necessary.
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What follows is a verbatim record of the patient, edited only insofar as is necessary to preserve her anonymity.
She has given us her permission to use this case for teaching purposes. Please respect her details as you would wish your own to be.
Since this is the first interactive case to appear in Homeopathy Online, I'd like to propose some ground rules - rules which I would see as negotiable and changeable as we evolve this forum.
For me, the use of a patient's case details call for guidelines which we all agree to. All of our students here in Sheffield agree to follow them as part of their taught course.
Useful rules we have evolved (and others I'd like to suggest for Homeopathy Online) are to keep printed case details in an envelope, secure with the rest of your case or homoeopathy notes. If you're working on them at home or at college, don't leave them lying around whilst you break off for that important shot of caffeine, TV program or whatever.
Please don't be tempted to discuss cases outside the teaching environment (classroom or tutorial) - for us I guess we add - the environment of Homeopathy Online.
Please resist the urge to distribute paper copies of this case after its resolution on Homeopathy Online.
I'd be happy to discuss - with study groups, or other schools or colleges, any future use of this case and its analysis - let's make this a process of discussion!
Paragraph spacings represent a pause on the part of the patient. ? before a sentence indicates a question I have asked her.
A thorough head-to-toe questioning was carried out (for physical symptoms): only replies which yielded potentially useful information have been included here.
My "style" with this patient was to sit back, invite her story, and let her tell it - with pauses for her to catch her breath, ponder, reflect, and so on. The interview took 90 minutes - I rarely ask questions with this sort of delivery until into the last 1/3rd of the time - that's when I "head-toe" the patient, and clarify things she has said.
A friend (who has been for homeopathic treatment) felt could help me. What I've come to see you about goes back a long, long time. goes back long time
A year last January I developed a continually sore tongue. Dr. dg'd thrush - and treated with Nystatin. Saw a dentist - who said it wasn't due to rough teeth. In Feb. '95 I felt so ill - I had shingles in head left side - Dr. gave me antiviral treatment.
I really didn't feel very well. In April felt so ill. I had dreadful diarrhoea - went to different Drs. - salmonella dg'd - felt really ill, so weak, so ill, I had 5 blood tests. One for thyroxin - I was spot on. One was for sugar, one for infection, and one was anemia - said slightly. Another was for GF and it came back slightly dubious - Dr. said I didn't have it, she said I had toxoplasmosis - but not to worry since the tests showed it was a long time ago.
Still have the sore tongue - put on Prothioadin because had I developed depression after the virus. Don't like taking it - and brought it down to almost just one. I went back to Gps and said I'm worried about this sore tongue. Dentist has ground the teeth, doesn't think it is them causing it.
Dr. said it could be Vitamin B deficiencies. While I was at the drs. I was given injections for flu and one for viral pneumonia.
Long history of - I've - you know - I've - always been very sensitive, anxious, worried. I don't have a TV because I'd want to switch it off - I want to put the world right - I just care - Dr. said I cared too much, and that is the basis of my trouble.
Some the things on TV - you know - you hear such bad language. I don't like it - it distresses me and you see so much . . . . - even in these party political broadcasts - they say such dreadful things to one another, I don't like it.
I wouldn't associate with a lot of those people because of their morals - a lot of them so immoral, and pop music, and ones really immoral.
Right from being a teenager fai been crushed (she puts both hands on her upper chest)- until I get chronic indigestion - fai I am being crushed and pains go all around and that comes and goes I always had that.
I've always had a lot of trouble - daughter died young, many years ago from a brain tumour. It devastated me. I had miscarriages when she was two, and my own father and brother was killed in a crash when I was 2 - it was traumatic -
I was always well-dressed, always well-fed but never knew mother to show me any affection; she never held me kissed me. She had to go back to work and we were tagged onto bottom of grandmother's family. I seemed to just get bullied and not happy. As a teenager feeling had the feeling I wasn't really here - insecurity and I was never well.
Always been with my husband - we just drifted along and then got married, then he had to go in Forces. Grandmother as soon as found out I was expecting - she died; and then I had daughter and then everything seemed to be OK.
. . . . everything I loved I seem to have lost. I just never - parents thought - left me money and OK but no love.
Had dreadful cystitis got < and < and <. Tests always showed infections so I was always full of antibiotics. I had to keep going and taking urine samples.
They still px'd the antibiotics. Every time I took a urine sample it was always full of dead cells and protein. Gradually cleared up - not had for a couple of years. Seems to have cleared up and don't get the cystitis now.
He said I had had thyroid trouble: I used to fall asleep even at table eating a meal. Even having a wash - I felt SO ill. Dr. says I have to take Thyroxine for the rest of my life. I think that is it about to date.
I get so - seem to worry about everybody problem. I'm just anxious and afraid - and I really love my husband's mum and dad because I could always go there and I loved them . His mum lived with us for 15 years and then she died and his dad died I was 30.
My Mum died, 6 months later my daughter died with brain tumour.
I always had this feeling as if - wondering if I was doing what was right. And now husband has retired and I think I am anxious now - horrible fai I am melting - All panicky.
I used to be afraid of going out, used to feel secure; I love to be in the house, and look after the home and look after husband. I used to not want to go out at all. I still not want holidays I am happy at home.
I don't like travel, I don't like change. I feel I am a drawback you know, I have always felt like that.
Really I said to my husband - if I'd been born in Victorian or Edwardian times when everything was nice and proper - I can't stand the stress and I don't like to hear bad language it just distressed me.
Feels this is an injustice because shouldn't be put on other people - old couple - if watching it, it could embarrass them.
I want everything to be proper. Husband says you can't live normal in an abnormal world. I find it difficult. - it distressed me - think they shouldn't be doing that sort of thing - it's unkind.
I don't get rheumatics, things like that; I get this all upset - I can remember - a long time ago - on holiday and all the time we were getting ready at home - and I were thinking I do feel ill, I do feel ill - I didn't say anything and I went on holiday. Got there and it was a lovely day - I felt so - everything was ill, wobbly, dreadful; decided we would take a picnic down to the beach - fai I were doing it and not really there oh it was strange, I felt strange and they were enjoying it and I all tensed up.
We were having this picnic - all a sudden this rumble of thunder and I was . . . and the cloud came over and it seemed to block the sun out and without warning was just like a cloud burst and it started to rain and I in charge now come on and packed the picnic up and put cloth around our L and it just absolutely poured and poured and got back and switched the fire on and coped with everybody and I felt fine and I had a wonderful week's holiday.
"Come on," I said, "I didn't want any of you to get cold."
After that I had lovely holiday and I was fine.
That's the pattern: I've had incidents - that seems to be the pattern it is taking - can feel ill and then somebody will come and I start to look after them or I seem to - something else happens and I don't feel so ill.
I always wanted to nurse, always. Father's sister was a matron in hospital.
They used to say what's the good of you going nursing - I always had this desire to go nursing. I joined the St. John's.
Head-Toe:
Shingles: Feb. 95. sometimes just a bit tender. Very little details remembered.
Tongue: Pain: sore ai rubbing = where the teeth touch. Fai it has nettles stinging. Both sides. Won't talk when having a meal because hurts teeth and tends to bite.
Used to have eczema a lot when I was a child - it just stopped. I used to - as a child - all round the ears and patches.
The tension I feel is ai somebody squeezing and fai indigestion but isn't just comes and goes no not pains.
Appetite: + bread. and will have a sandwich like cheesy things. and chocolate + I love chocolate - have the sense not to have it.
+ Cheesy things.
Stomach - more of a fear - seem to get a lot of gas seems to be coming from the tension rather than from . . .
Abdomen: was dreadfully, unbearably constipated with Myxoedema. Is OK now.
Sleep: can wake up after two or three hours and then are sorting out everything which has gone on.
Sometimes I dream have lost all me teeth and lost me clothes. I have nice dreams about daughter as a child and holding her hand and we are happy.
Wind <: it just irritates me I CANNOT stand the wind blowing I don't mind the rain.
Had two miscarriages: first after a few weeks; then 4th month.
FHO varicose veins. All died with thrombosis.
Clarifications:
? Re TV: what distresses you more - I don't like bad language because it is unnecessary - they have to put it in and it doesn't make sense. I don't like immorality . . . I still don't condone. Sex violence and bad language. Could write a play about the NICE side of life. Why do they always have to bring sex into it. When we were young, could watch a nice love film, or Lassie, Come Home.
Feels it is out of place, I don't feel sex is entertainment and it is embarrassing. . . I like things nice and proper.
?examples of things not being proper: Couple we know took us out for meal last Saturday - we were walking along a road and this old man passed us, he had a lovely little dog and we were walking very slow and had to step into the road and they stepped immediately in front of us and from the flats a huge Alsation came bounding across road, grabbed little dog and shook it; knocked the man down, he was on the floor and Alsation fighting his dog on chest; and it bit him - 3rd time he has done it. Next door neighbor came out - I said - you'd better come down here - and he just went (shrug) and walked in - bloke sent for ambulance and . . . I couldn't get it out mind how horrible it was - his dog and old man was really mauled. An hour later - took away, huge chunk out of his arm, and ambulance men sending for the police.
It really upset me because I couldn't believe anybody could - not like the Good Samaritan is it - there's no compassion today is there ?
Police didn't come - old man just goes down another street to get to where he wants to go. Just an everyday occurrence. I get all distressed about that.
Francoise de la Cressonniere fremma@cam.org
I would select the following Sx: -Mind; Cares, worries for others -Mind; Ailments from grief -Mind; delusion, time, space, lost (she is not here) not here) -Mind,; Dreams, dead people, relatives -Mind: Fear something bad will happen (she is always anxious and afraid about every problem) bad will happen (afraid and worried about everything) and Mind; Intolerance of wind And I would select Caust. Thank you for sharing this case!
Practitioner's Response:Using both Zizia (100+ MatMed CD) and a test version of Similia (Kent, Clarke, Phatak, Boericke I wasn't able to satisfy myself about your selection of delusion, time and space (etc): It's sure in the rubric, but referenced to someone called Caspari in Roger van Z's complete Repertory. So I couldn't bear out your interesting thoughts by good solid references to the materia medica I have: anyone able to help us here ?
I quite deliberately left out 'grief' rubrics since I wanted how the route I did take would help me.
And the potency - you suggest a 30, with contact once a week to allevaite her worries. Let's wait and see what other contributors think on potency - and whether any other remedies emerge as likely contendors ? After all, with over 2500 to choose from are we really going to let Caust have the case ? So everyone reading this - come on in with your ideas - we're waiting to hear
l the best
Ian
dante dante@interport.net
The obsession with "propriety" brings to mind Kali Carb, which also has as a keynote "intolerant of drafts", which would also include wind. I looked up "sleepiness during eating" and Kali-C is the only 3 in the rubric. This is a first take on the case, a more rigorous repetorization might reveal something else. (will do so when time permits)
Practitioner's Response:So I'll look forward to hearing more of your thoughts on the case.
By now Ian
sherill sherill@ix.netcom.com
This woman seems to have no boundaries and is not well unless she is taking care of others. She worries about others' problems and makes her dislike of impropriety a worry for how others will act/react. She has lost so many people close to her I think she has lost herself. I used rubrics: Mind, sensitive, moral impressions, to plus sensitive, external impressions, to all; Mind, anxiety, others, for; General, Tension, internally; General,Wind. I like phosphorus.
Practitioner's Response:I particularly like your
A. K. Nath anjan@s867.thu.edu.tw
The patient has quite a few mixed symptoms which seem to contradict each other. However, her mental state should be given main consideration. I would put stress on the following:
1: Concern for self and others
2: Fastidious/ squeamish
3: Loquacious/ repetitive
4: Fear
5: Suffering from long-drawn grief
6: Reckons that she did not have enough love
7: Hides behind religion (high or imagined moral sense)
The above, combined with her physical symptoms like the rash, diarrhoea, aggravation from winds etc. would point to CARCINOSIN first before another remedy can be considered which could be CAUST, KALI CARB, ACID PHOS, ARS. A thorough repertorisation is necessary to determine the correct remedy, BUT after CARSIN. As she is 65 yrs, I would recommend a potency no lower than the 1M, but would prefer the LM scale beginning with 0/3.
Practitioner's Response:I liked your reading of the mental/smotional side of the case - do you see fastidious the same as squeamish (*are* they the same ? - if not, how would you choose to repertorise squeamish ?); similarly is 'repetetive' the same as 'loquacious' ? You make a nice case for quating 'high or imagined moral sense' with 'hides behind religion' - hmm - lots of rubrics here in the mind section, which one(s) *do* we go for ?
Your reading of the case points you to Carcinosin - a remedy I did consider for this client. You'd chose do to a thorough repertorisation AFTER you had given carcinosin ? I take the point that in some print repertories this remedy is not well supported; and/but the computer ones I used do have the full carc. picture in. - more of that later.
Like you, I preferred to use the LM scale of remedies, though I chose to start with LM1 - I'm not familiar with the justification for jumping straight in at Q3. Perhaps you'd share your experience doing this with us ?
Thanks very much for taking part in this exercise - Ian
Kathie Blue bcoburn@bconnex.net
Nothing is conveyed about this woman's manner of dress, appearance, or weight. Based on what information is available I would suggest Lycopodium Clavatum. I have chosen this remedy because of the indigestion, anxiety, haughtiness, past excema, past constipation, sore tongue, family brain tumours, fatique, varicose veins, aversion to change, and general conservative outlook. It seems as though this woman has moments of brilliance when she can respond to the needs of others. (desire to nurse) She also appears to prefer indoors and quiet pursuits rather than the outdooors. I also took into consideration her liking for chocolate. Due to the woman's age I would suggest a low potency, such as a 6x, 3 times in 24 hour period at weekly intervals until marked improvement.
P.S. I am a layperson only, but homeopathy is my passion.
Practitioner's Response:The idea of giving a 6x was not one I'd thought off, since I rarely use such potencies, preferring the Q, or LM scale. So if you know about dosing with low xs as you suggest - do write back and tell us all, please.
Thank you for contributing to this discussion.
Best wishes,
Ian
Looking at this lady, the thing that struck me about her was how gentle and proper she was - a very kind, concerned figure who gave ample evidence of spending time worrying - worrying about what might happen to her friends, her family and the world in general.
I was frustrated by the lack of physicals in the case, and decided to take the rubric a central GENERAL as an eliminative rubric: WEATHER, WIND I get all upset - I can remember - a long time ago - on holiday and all the time we were getting ready at home - and I were thinking I do feel ill, I do feel ill - I didn't say anything and I went on holiday. Got there and it was a lovely day - I felt so - everything was ill, wobbly, dreadful; decided we would take a picnic down to the beach - fai I were doing it and not really there oh it was strange, I felt strange and they were enjoying it and I all tensed up.
We were having this picnic - all a sudden this rumble of thunder and I was . . and the cloud came over and it seemed to block the sun out and without warning was just like a cloud burst and it started to rain and I in charge now come on and packed the picnic up and put cloth around our L and it just absolutely poured and poured and got back and switched the fire on and coped with everybody and I felt fine and I had a wonderful week's holiday.
In fact I decided that the rubric, FEAR, SOMETHING WILL HAPPEN would be much more important - since I saw anxiety (about others) a illness a doing something about it: she says That's the pattern: I've had incidents - that seems to be the pattern it is taking - can feel ill and then somebody will come and I start to look after them or I seem to - something else happens and I don't feel so ill.
So - I understood this case as one where the client's state of excessive sympathy compensated for her anxiety. I represented this by crossing
Fear, something will happen with Sympathy, compassion (Synthetic) - and then looked at the remedies coming through which were in, WEATHER, WIND AGGRAVATES.
Enough for now: try doing this cross and see what you end up with.
Anjan K. Nath anjan@s867.thu.edu.tw
Thanks for your response and subsequent questions. Regarding "fastidiousness" and "squeamish", I would say that they are not the same when they appear individually, but when they present in the same patient one does tend to see the "fastidiousness" as a result of being "squeamish" or vice versa. One can follow this quite often to early childhood experiences like severe "potty training" or very strict parents who reprimand their children at the drop of a pin. Here it is also interesting to observe whether whether the cart comes before the horse or vice versa, i.e., whether the symptoms were dormant in the child and got aggravated and "excited" as a result of the parent's action or the reverse. I have not been able to determine this to any solid conclusion, but have been happy over the fact that our remedies do bring about remarkable changes in a young patient's outlook after treatment. In older patients this is not so noticeable, perhaps, owing to a "habit" being formed and ingrained in the character! One can see "fastidiousness" and "squeamish" appearing in SYPHILLINIUM cases too. One author (I can't remember who) refers to the action of rubbing of hands as an unconscious act of 'washing away one's past sins'. When I have had the opportunity of observing this symptom, I traced the other symptoms too to a greater or lesser degree. I wish I could confirm this observation, but I guess I need more cases of this nature before I can relate one to the other. Not having had much experience with Carsinosin yet, I choose to reserve my comments. Earlier I used Syphillinium or Leuticum with good results followed with Arsenicum or whatever constitutional remedy was necessary after retaking the case. I have, very rarely, seen any one nosode completely clearing up a case. "Repetitive" and "loquacious" fall in a similar category as the above. It is often observed that loquacious people also tend to be repetitive, though repetitive people need not be loquacious. It is these combinations of symptoms that are interesting. "lack of coherence" can also present itself along with the other two, either all together or in pairs. Let me know what you think of these. "As if he had sinned away his day of grace" as Kent puts it in describing the mental aspect of a number of his remedies, has always interested me when dealing with "men of the cloth"--preachers and even self-appointed-do-gooders. I don't know how to refer to it, but in layman's terms it would be "over and overtly religious", "religious fanatic" and sometimes, simply a "bigot"! Once again we find these symptoms in a number of remedies, but all the more so in CARSINOSIN as we find in the case of the lady under consideration. Must do good, must save his soul from eternal damnation; have heard the voice of God telling him/her what to do; has prophetic dreams; sees visions of judgement day; etc. etc.. Does it all sound familiar? Alas and woe! If only these "patients" could be treated homeopathically, they would be more logical in their thinking and definitely see the "light". I think that "enlightenment" would be preferable to the one they seem to seek! Lastly, about the jump to LM/1. There is, as far as I know, no definite rule regarding this, but as my mentor used to say: "follow the rule of thumb." Arguing that the patient in question is 65 yrs old, and has been severely medicated by the old school, and has perhaps also taken some homeopathic remedies before seeing you, you could cut corners and jump straight to the third, and I've seen some practioners even jump to the sixth. Their argument is: "can you wait for that long?" I guess its the case of using the CM potency in a single dose when one is absolutely certain of one's selection. I wonder if this comes from an interpretation of Hahnemann's sixth edition of the ORGANON where he says that it sufficient ot administer a single dose of the selected remedy, and where generally the 30th potency suffices. Could it be that the 30th here is interpreted as the LM/30? I have to go back and read this again now that I have mentioned it. Anjan
P.S. I have never used a computerised repertory yet, but am looking into the RADAR system and have written for more information on it. I am familiarizing myself with the SYNTHESIS (Frederik Schroyens ed.) at the moment.
Practitioner's Response:than you for responding so fully - I look forward to hearing from you again, Anjan.
Ian
Jennifer Craig jcraig@awinc.com
Here is a woman who says "everything I loved I seem to have lost." Rubric: Ailments from grief.
"I don't like travel, I don't like change. I feel I am a drawback you know. I have always felt like that." rubric:want of confidence.
She wants everything to be "proper". She says that more than once. Rubric: fastidious
Those were the MIND rubrics I used. Then I added: Gens: Weather, wind Gens: Food, cheese and bread and chocolate. MOUTH, pain, tongue.
These repertorized as Puls, 16/8, Phos 14/7, Nat. Mur. 11/5
I think it is Pulsatilla as she is tender-hearted and affectionate. She dreams of holding her child's hand. She is happy when she is looking after others.
She is disgusted by vulgarity which fits Puls. She has a tendency to abortion. Gibson says that Puls is often called for when troubles date from adolescenc which fits her saying that her problems go back a long time.
On the other hand it could be Phos who has a great need for affection and also a desire to show sympathy with others and a tendency to become anxious on their behalf which is prominent in this case.
Practitioner's Response:You picked up her wanting everything to be 'proper'. "Fastidious" might fit the case - but are there any other rubrics which might do better ? 'fastidious' is such a small rubric. Can we refine our understanding of what this woman means by 'proper' - have a look at what she says about her reactions . . .
I certainly wondered if this was a Puls case - she came over very much like other men and women I have used Puls with, to great effect. You noted how she was "disgusted with vulgarity" which fits Puls. Hmm - I'd like to see this backed up in the repertory.
Do her troubles date from adolescence - or from a time before that ?
I wouldn't like, myself, to claim that just because Gibson says that the remedy is often called for when troubles date from adolescence; thus it is justified for problems goingback a long time. If we look at the materia medica of Puls, we'll see that it's pretty specific, timewise, for adolescence.
And then - could it be Phos ?
Problem is, we have to come down to a remedy - Phos ? Puls ? Carc ? Caust ?
Only time (and another look at the case) will tell . .
Thanks for your input on this one.
Ian
Suzanne Lepage slepage@odyssee.net
I choosed to retain those symptoms:Mind:Injustice cannot tolerate- Ailments from death of parents-Idealistic-Sympathetic-Fear that something will happen-Dreams: dead people of relatives-Generals: Wind <-food;cheese desire.With those symptoms I would give CAUST. 200K.I would have liked to have more symptoms in the generalities for example: How is her thirst,body temperature, position in sleep and if anything special in her sleep, any perspiration, what kind of wind < her (cold, dry) ect..I really enjoyed doing that case and send us more.Thanks.
Practitioner's Response:Ian
Jennifer Craig jcraig@awinc.com
OK let's give this another whirl. Getting the right remedy is like looking for a needle in a haystack, I think!
I can't see Fear that something will happen from the thunderstorm incident so I have left it out. She felt better after looking after everyone, for the rest of the hol.
Still like Want of self-confidence.
Then believe it or not, nurses are compassionate, sympathetic and absolutely wonderful individuals, ( I am one) so I have put in Sympathetic.
Struggled with the aversion to vulgarity and don't really know how to repertorize it but I think it is important. Tried MIND, disgust, everything.
Then the Generalities: Wind, Food, chees and chocolate.
Mouth, pain, tongue.
Came out as Phos 14/7, Puls 10/6, Calc 8/6.
So this time I go for Phos. As someone else said, she lacks boundaries. Takes on other people's woes.
I removed Ailments from grief as the death of her daughter was a long time ago.
Practitioner's Response:“Fear something will happen” comes from her general outlook, her anxiety - she is behaving as if she expects the worse to happen.
You’re right of course, nurses ARE compassionate, sympathetic and wonderful individuals (I worked for the central UK Government nursing Body for 10 years, and enjoyed their hospitality, wit, and honesty the length and breadth of the U.K.) But even I wouldn’t want to use the rubric ‘sympathetic’ just because of this - it’s too common. Indeed, imagine we had a nurse who was a MONSTER, who was sarcastic, cruel, malicious - this would be stranger and more homeopathically useful, no ?
Still, our client reveals in her words and actions - how sympathetic she is - so we’ll allow her that rubric.
I struggled with the aversion to vulgarity too - it seemed SO important. as I’ve posted my breakdown of the case elsewhere in HO - I won’t go back to that.
Good to see you trying to use the Generalities and food desires to pin down the remedy. I find food desires SUCH a pain - think they’ve been diluted by overuse. “Oh yes I like chocolate” means what ? If the client can leave a 5lb box of chocs in her house without wolfing the lot, in my book that means she hasn’t got + chocolate very strongly.
Anyway, you came down to Phos because she lacked boundaries and takes on other people’s woes. Well, I gave Causticum, quite successfully, so will we ever know if Phos would have worked ?
You removed Ailments from Grief since her daughter died a long time ago. Ah - but you didn’t hear the wobble in her voice, see the tears in her eyes, as she described the loss of her beloved 21 year old from a brain tumour - years and years ago.
Thanks for jumping in again with another go at the case - later on this week (it’s 22/04 now) I’ll post details of her reaction to Caust Q1.
Best wishes now, Ian
Geir E.T Marcussen getm@nord.eunet.no
Wonderful, at last a useful web site.using syntetic and Kent, there are left Kali c. after repertorising.Used symptoms. 1.shingles head.2.sleepiness,eating.3.stomach, more of a fear-seem to get a lot of gas seems to be coming from tension rather than from... this is a keysymptom fore kali c.i would give kali c. d30 once aweek, and follow up with kali c d200 after 14 days. But,if there are no reaktions to kali c after 14 days, i would give one dose thuja d12 and one dose tuberculinum to clear this picture, because there are to many unclear, vague and unreable mind symptoms, and there are to little clear body symptoms, and there are to many contradictions, and there is also a big symptoms picture, that leads to the conclusions that agaricus and tuberculinum is to be considdered as problemsolvers in this case, and also sulfur. should kali c fail to act, one may also have the option to go up and down wit the potensies to produce an reaktion if nesseceary, but this is only of value if there is 100% sertainty that the right remedy has been chosen. Regarding to the choice of potencies, one should know, and be able to use all of them,according to the patients age, reaktions and constitution. In som cases you will not be able to produse the correct reaktion, before you get rid of allopatic preparates that may be in use. As fore your discussions about computer programmes, i would like to add,i have tested out several, none found of use as a repertorie, fore solving cases, the human mind seems to have no match yet, computers and programs have no inititution. It seems to me, that this case anamnesis is not thourogh enough, there are no informations about allopatic preparates in use, and other things that may be of value.
Practitioner's Response:thanks for your thoughts on the case - and your appreciation of HO. I’m sure all the good folks who poured hours and hours into creating it appreciate the feedback - they’re a great lot.
You give us lots and lots of food for thought in your posting. And you selected Kali carb as your remedy. I liked your analysis of it - you’ve stuck to observable physicals. You might want to compare our two analyses together, and then look at a good materia medica of both Caust and Kali carb. Gibson, for example, is a fairly modern one, and one I find easily accessible.
Your suggestion of using Kali carb 30, repeated once a week was an interesting one to me, since I hadn’t thought of dosing in this way in this case. I’ve sometimes used repeat dosing to advantage in acute situations, and mostly observed good remedies reacting and holding longer in chronic situations, without the need to repeat. And - which confuses me even more - remedies not kicking in to their full action until some time has passed, so I guess these factors have made me cautious about repeating too soon. If, indeed, it is too soon.
Similarly, the idea of putting a 200 in after 14 days - I wonder how I’d know it was time to do this, or what might guide me here ? Dosing is fascinating isn’t it - so many variables and factors - esp.. since we will see that one drop of the LM1 had an immediate effect on this client.
Reading on through your response, I see that you obviously have experience I lack - since I’ve never been taught to use Thuja and Tuberculinum to clear a picture thus. Do tell more - this is fascinating - how would I land on the 12th potency, what potency of tub then (and how long after) - and what can we expect as a result of this ? If you had cases to illustrate your methodology here, it would be great to share them.
I look forward to getting more information from you - thanks for mailing in.
Ian
Jeff Sutherland jeff.sutherland@vmark.com
I found the comments from others on this case most helpful in focussing on the excessive fear and anxiety the patient feels for others and "lack of boundaries". Her own illness is alleviated when she cares for others, i.e. she no longer fears for them, suggested that some of her illness is brought on by these excessive concerns.
This past year I have found Bach Flower remedies very effective at quickly dealing with conditions dominated by mental/emotional situations. The standard remedy for excessive fear and anxiety for others is Red Chestnut. I feel that if this were given her mental state would improve and some of the symptomology would disappear. That which remained could be more clearly targeted by the appropriate homeopathic remedy.
I'd give her four drops of Red Chestnut several times a day for a couple of weeks, then review the persisting symptom pattern and see how it was altered from the initial interview. Then prescribe homeopathic treatment.
Practitioner's Response:Your idea of using Bach Flower Remedies is a very interesting one here - the more so since I started off as a Flower Remedy practitioner in my early days in practice, before I had found, studied, and qualified as a homoeopath. so I can really appreciate your suggestions. It’s a nice idea to clear the mental and emotional with the remedy, to bring up the homeopathic picture more clearly.
Whilst I’ve a lot of sympathy for this idea, I’d steer clear of it myself - out of respect for Bach Flower Remedies, and for my patient. I’d want to be at least as skillful in my use of them as I am in my homeopathic practice, before I chose to combine both in one patient’s treatment. Again, we’ll see when I post the first follow up, how one drop of the chosen homeopathic remedy addressed the mental, emotional, and physical elements of the case - and how this remedy, some 6-9 months later, is still helpfully unfolding the case.
If you have cases that help illustrate your observation of the use of BFRs in the homeopathic treatment of clients, I’m sure a future issue of HO would be the place to feature them - and help more of us appreciate the wonderful different therapeutics available. I’ve a lot of time for old Dr. Bach - who started off in life as a homeopath, and spent his closing years wandering the countryside and developing this subtle system. Sat here late at night, hunched over a keyboard, I have to remind myself of the question - which is the more healthy state ?
best wishes,
Ian
Børre Nordbakken borre@nord.eunet.no
Testing
Geir E.T. Marcussen gem@nord.eunet.no
Hi there Ian, and thank you for your interest in my experiencies.I will try to answer your questions as good as i can. My teacher was Gert Eselbøck of the Dorcsi school, and it is mainly his little mat.med i am using, constantly building this out with my own experiencies, this in a way that i do find chemical explainations, related to allopatic treatment, place of living, way of living and so on, as inhibiting factors.
I do also use Boericke, and Vermeulen, but Vermeulen is not of use during anamnesis because its is to big, and to vague to use in practic analysis.I would love to compare ouer analysis, and share cases, but how to do this practically?Would you mail me some advise on the matter, please? As for my reasons of using d30, repeated once a week, is that you hav only three possible reactions in this way, positive, negative, or no reaction at all.
You have to control this after two weeks, setting up a new appointment, and during these weeks, the patient must be striktly advised to take contact if to strong reaktions should occure, this to intervene and change potencies,change remedies, or/and stop them from acting.You see, i seek total control over the case, there are several reasons for this.
I do not like to use high potencies with long intervalls, because i have seen to hard effects, and the patient may also belive that homøopthy is not working, and seek allopatic treatment again, or hospitlision culd be one result from these effekts.Using lower potencies, and short interwalls betveen appointments, and gradually going up to high, you control the case better.
There are also psycological reasons for doing this, because the minds way to handle diseases, is to block out things that are unpleasant, during recovery, sutch as way of living that culd have triggered disease, or mental states they have been in, it is best to start treatment on easely reconizable physicals, and have them dissapear, this they dont deny having taken place, and the way to further threatment is open.
The working periode of several remedies you will find in the back of Kent, but these differ and are not completely realiable, you must get your own experiencies on this matter In general d12 works from 2-12 houers, d30 from 12 houers up to 12 days, d200 from 14 days up to 80.
When it comes to thuja d12, i use it only as a pathclearer for tub CM, this because vaxination can block the way for tub.DO NOT USE TUB UNDER CM, UNNLESS IT IS CALLED FOR.( during pnemonia,influensa and so on).If the patient have a heart condition, threat this first before using tub. Tub is a big remedie, and covers most of the big remedies, after using tub Cm(a month) the remaining symptoms are threatened with correct chosen remedie, sutch as cc.You use tub when the picture is big and confusing, and unclear.
If you have to little symptoms to work with, use sulpd30 once a week, twice, prosedure as before mentioned, because sulp will surface underlying, hidden symptoms. A thougth came to mind, the old dog that needs caust, like to stay out in the rain because it is cooling down his arthrities, but careful , careful, is it wise to choose caust from an vague mention in the case analysis, i prefer not to interpret sutch informations, they are not clear guidelines. But a chair stands better on four legs than three.(was there a visional confirmation on myxoedema? if so i choose kc). Comments? Geir
Geir .E.T. Marcussen getm@nord.eunet.no
correct emailadress.
Practitioner's Response:thanks again
Ian
The remedy – Causticum. Now then, what potency did I give? Well, I decided to give it in the LM, and started with LM1. My method is to ask the patient to take one drop, wait two days to clarify any reactions (sometimes patients can do very well – or aggravate badly – even on one drop); if no discernible reaction, have the patient take another drop, wait two days; then go onto daily dose if necessary.
So – let's see how the patient did:
Follow-up Appointment, 11/95: I have felt better – I am intrigued that just one little drop . . .
I took one little drop at first – and I didn't sleep all night – and in the morning felt well – so what – and I started thinking nice things and then went to sleep. When I've woken up [since] it's been more natural, more relaxed.
[So, here is an immediate aggravation followed by amelioration]
It's wonderful – I have taken one little drop – and definitely sleeping better – and husband says I have to tell you – drops are doing him a world of good because all his imperfections must be fading because I haven't noticed them for a few weeks . . .
[A piece of feedback worth its weight in gold.]
I'm definately not as tense, not as nit-picky. I have felt more able to cope. More relaxed. I have not had any of what you would call crisis or trauma. Where I had the shingles – back of head – only a week ago I seemed to feel – don't know whether to have a head cold – I felt miserable, I felt aching back head, shoulders, back, and I just wanted to sleep – and thought I'm not going to worry – did jobs – gave into it, sat down and went to sleep, woke up and didn't feel bad at all.
[And a return of old symptoms]
Definitely the thing I notice when I go to bed, I am NOT putting the world right – right, the bedroom's the place to sleep – don't put the world to right.
Husband says he can see a difference. Now just take one thyroxine tablet every morning and that is it. And one drop every night. And it still baffles me. [By the middle of the month I had asked her to take a daily dose of the Rx, since the sleep pattern was changing back.]
Tongue is not as dry and is bearable – it is rough teeth – as getting older enamel is getting fragile. No problem now.
?Bad language – still the case but I realise it is the way of the world – if I can't change the world I'll change me attitude. It doesn't distress me to the point . . . it used to really distress me.
?Fai melting – don't feel that – it was such an exhaustion I felt. I am more able to cope. I feel more naturally tired now I can go to sleep and charge me batteries.
? Feeling crushed – I used to get so anxious, oh it was horrible, I haven't had it. At all.
One big milestone – I told you bout the car crash [I hadn't included this in the original case – the patient had been in a very bad car crash and had not driven, or been in a car, for something like 26 years because of her fear and anxiety around it] – but a fortnight ago, right out the blue, two friends of ours – how you fixed to go to XXX this weekend – my normal reaction to say, "Oh, no, no, no. I daren't" – the only thing then was – I thought – it was November. Beautiful, and it did us good. I went and do you know I felt relaxed driving all the way up – we had a wonderful weekend. Coming back it was dreadful and raining, normally I would been on edge – I could not have done that – that the furthest I been in the car since a crash in 1977.
Not had those horrible anxious dreams I used to have.
Rx: Definitely working. Continue drops; see in two months.
As of May 1996, I have seen this client a number of times, and she continues to improve under the action of Caust LMs. She's now taking the drops only
Geir E.T. Marcussen getm@nord.eunet.no
Hi there again. I see that causticum was chosen. But could you tell why it was chosen?What did lead you there, and is it certain that the choice is correct? I see you mentioned aggravation and amelioration as proof , this i do know. But there are several ifs here.I have answered your questions, would you answer mine, please?As my experience and knowlegde tells me, there are somting here i either have no knowlegde about, or there are an explanation missing. I did understand that the purpose with the interactive case-analysis was learning, but how to do that when questions are not answered? My experience tells me that, with the potencies i have mentioned before, there is seldom patients who do need repeted dosages (and also in the same potence) after 50 days, in facto two out of five hundred. The need for repeating is usual tree times going up from d30 to d200 after 14 days, one out of twenty needs an upgrading to for instance CM, after ca. 50 days. In most of my cases, there has been a change of remedie if needed after 50 days. The only cases i have seen the need for repeating the remedie, is when there is somthing that do set back the effect (way of living, allopatic medicines, antidotes and so on). In other cases i have seen the need fore repeating, is when wrong remedies are chosen, they may bee very close, but they fail to act correctly and rapid, and as sutch the need for repeating is understandable.( in fact there are patients repeating the remedies fore years and years, this doesent nesseceary say that the remedies are wrong, if there is no other solutions!) Repeating when conditons are cronic, is understandable but there is little of it in this case, the most where mental mentionings, and i find it more difficult to understand the need of repeating, and the length of treatment related to this, i would have expected a shorter duration of time, but this may be related to thyroxine, what are your experience here? I am Looking forward to your answer, and as fore casis to share, have you read my earlier answer? Thats all for now. Geir
Practitioner's Response:With LMs (see Hahneman's notes in the Organon, and threads in the List archives on this topic) response can be different to what you are expecting with centessimal potencies. SH tells us to repeat the LM daily, sometimes more frequently, and to expect a gentle, safe and rapid result. It works ! What I have noticed with patients responding positively to this way of dosage is that they need less and less remedy as time goes on - and can vary the dosage according to their experience and lifestyle. Our patient responded very well to the first drop, then old symptoms returned, then responded to repeated dosaes - very well - with aggravation followed by long amelioration. I'm still learning about the LM style of treatment, so have no firm answers to offer !
You feel that this case is not chronic ? - but physical symptoms are absent - they have been there in the past, but as chronicity has come on, have been replaced with mental symptoms.
You wonder why Caust was chosen, and how did I know it was an accurate prescription ? - We can only tell the latter with retrospect, seeing the remedy working over time, and unfolding the case according to the Laws of Cure. It fitted the mental picture well - have a look in that Vermeulen of yours, or other more detailed materia medica, and you may well get a different picture, or a different understanding of it.
All for now - hope this helps.
Ian
Francoise de la Cressonniere fremma@cam.org
Dear Ian, I am really impressed by the effects of the Remedy and the careful monitoring of the case and follow-up you did. I am not at all familiar with LM, but (especially following David Little's contributions to the mailing list), quite interested in learning. I am totally convinced aggravations MUST be as much as possible avoided . First we are not there to make people suffer. Second, if a patient is aggravated, this is not true individualization of the prescription. SO LM in solution like you did was very appropriate. Most amazing are the changes in the patient as seen through the husband's eye" The best confirmation the Rx is working well. Also very significant the reflections of the patient that she is not obliged to change the world. I am intrigued about how you proceed to have such a nice follow-up. Are you asking the patient to take notes every day on the evolution of their Symptoms? Or are you relying on their memories only? Do you think the 30ch I was suggesting would have caused a serious aggravation? She could have taken it in water. One spoon first and then according to the follow-up? Thank you again for your supervision of the case analysis. This is not an easy job, and your comments to every people were always very stimulating" an easy job, and your comments were always very stimulating. Bravo!
Practitioner's Response:You wondered how I managed to have such a 'nice' follow up (wish every patient was the same !) - I simply ask the patient to tell the story in her own way. Some come with lists and lists of pages of notes they have made. Some say nothing happened - until we start looking at the results and questioning each symptom they presented with.
I don't know about the 30c causing/not causing aggravations, and the proble, with giving it in water as you suggest is then if we repeat it we would have to raise the potency somehow. The LM system does this automatically.
Thanks for your feedback - hope this has help[ed. Good luck
Ian
Geir E.T. Marcussen getm@nord.eunet.no
Hello i am back, seems that i have to clear up some possibilities to misinterpret. Due to that my natural language isnt English, i may have both read and writed badly, in sutch a way that misunderstanding could be.This i was aware of, after reading fremmas response. My intentions was to lead the observations to the fact, that in an anamnesis, one can only rely on experiencies of ones own, regarding to the interpretion of the mentals. In this discussion i would not lead the partakers to observe the picture of causticum, althoug it really was very clear.It is dangerous to trust medicinpictures completely, in many cases i have seen this!It is always a danger of choosing wrong remedie in plain paper- case analysis, in reality it works different! « ah-but you dident see the tears in her eyes», this was not to read in the case, and this was of importance, you lack the ability to observe, and get confirmation from that! Since i personally dident observe and confirm caust, i choosed kali.c who is the remedie confirmed by physicals! Quote: « second, if a patient is aggrevated, this is not true individualisation of the prescription, SO LM in solution like you did was very appopriate», in this case, yes, in others no!
Potencies are chosen, regarding to the patients condition, state of healt, cronicity, reactions, age and so on, and this you dont learn other ways than by experience.And one should know that every chosen type of potency, will give aggravations (how hard is individual), if they are not exactly fitted fore the patient! Want me to share some cases? I have some hvo are particulary tricky, and som involving combined symtoms that leads to combined treatment as chiropractic! Best wishes Geir.
Practitioner's Response:Best wishes
Ian
Geir E.T. Marcussen getm@nord.eunet.no
I have to say thank you fore answering my questions, chronicity moving to mental, has passed my by fore som time now, thank you for reminding me! I did submit my earlier answer not knowing about your answer. I will surely look into Lm, thanks for advising me, hope you will continue to contribute to this fruitful work. I will surely continue to partake in analysis and debates in any way i can. GM.
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