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- By Interns: Shweta Dhulekar, Nitisha Gala Under guidance of Dr. Kamlesh Mehta, Reader, Dept. of Case Taking and Repertory
Case no: 3053* Date of Consultation: 2/ 4/2007 Case taken and processed by: Shweta Dhulekar, Nitisha Gala (Interns) Kshiteej, Zalak (Students) Hon. Homoeopathic Physician: Dr Kamlesh.Mehta M. D. (Hom.) Unit Head: Dr. Jai Patel M. D. (Hom.), Unit: Repertory. Name: Mrs. P. P. Age: 40 years Gender: Female Marital Status: Married since 25 yrs Children: 20 yrs old son and 15 yrs old daughter Address: Mumbai Western suburb in slum area Occupation: Housemaid C/c: Pain in anal region since 3 months. Frequency: Pain-2-3 episodes/week Sensation: “Biting” “pricking” type of pain. Itching with pain, Swelling felt at anus Modalities: Pain-<during passing stools < spicy food >after passing stools about half to <sour food < during menses (1st day) one hour < Non veg and papaya > by hot or cold application Stools: Soft, no straining, no bleeding, no mucus. Occasionally blood spots on stool associated with pain H/o: Pain in abdominal region – Rt. lumbar region in last 2-3 days, nausea. Today no pain Patient as a person: Likes: Sour food, Thirst: 4-5 glasses a day Urine: normal, Sleep: normal, Sick on riding bus.
Gynaecological H/O: Menses: 2 days, Dark red, every 25-28 – regular, no staining or odor. No complaints Obst. Hisory: G3P2A1L2 Mental Symptoms and Relevant Situation: She was given address of this place a week ago but couldn’t come as she didn’t know the place. She always has a fear that she will loose the way home and would not be able to return to her house. She called our hospital for proper way. She was given landmark of Cooper Hospital. Since she had come to Cooper Hospital before, she could come. Thermal Reactions: ? Hot
*OPD of Mumbadevi Homoeopathic Hospital, attached to Smt. C. M. P. Homoeopathic Medical College, Superintendent: Dr. N. O. Goel M. D. (Hom.)
Family and Past History: F/H – Brother ? Ca 6-7 yrs back
P/H – Operated for fibroid – 10 yrs back
Seen by Hon. Surgeon: On Inspection: Fissure in 6’oclock position which was having induration on palpation. Impression: Fissure in ano acute on chronic Diagnosis: Fissure in ano - acute on chronic (6’o clock position) Approach: Obvious choice for Fissure in ano with intense pain was Ratanhia peruviana. This is a great remedy for the condition and learnt in the therapeutics. More over it was ‘acute pain’ and nothing much was obtained in the case so our target was to make her free at least from the pain. Hence we thought it as specific drug. Dr. Boerick’s Materia Medica was referred. The relevant reference is stated below: ‘Aches, as if full of broken glass. Anus aches and burns for hours after stool. Feels constricted. Dry heat at anus, with sudden knife-like stitches. Stools must be forced with great effort; protrusion of haemorrhoids. Fissures of anus, with great constriction, burning like fire, as do the haemorrhoids; temporarily relieved by cold water. Fetid, thin diarrhoea; stools burn; burning pains before and after stools. Oozing at anus. Pin-worms. [Sant.; Teuc.; Spig.] Itching of anus.’ It was hard to move from ‘specific’ drug for the condition to relive the suffering, but the type of pain, its severity and duration with type of stools that Ratahnia can produce was not matching to the description required to be cured. Second best specific choice was Nit. acid for the condition like fissure in ano. References from Materia Medica did not support its curative power of type of pain and bleeding with patient’s symptoms. Other point was her fear about losing her way at this age . Reference from Synthesis Repertory 9.1 page no. 122 stated: Fear, losing one’s way home; of – cassia s. (Source CCRH). It was unknown remedy and we knew nothing from where to refer; and also just to prescribe on one mental symptom in such acute pain. As there were no other data, it was difficult to proceed further and we were tied up from not to prescribe ‘specific’ drugs unless they match Materia Medica details. Then we started to look at the case differently after the discussion in OPD, excerpt of it is given below: • • • Case is not an acute but a chronic case. It was acute exacerbation of chronic case as in between attacks also she was not free from her symptoms completely. It was important to note that despite soft stools and easy defecation, the patient developed fissure. Another point to be noted was her fear at this age about loosing her way.
In all the cases we homoeopaths need to prescribe ‘Case Specific’ remedy not specific for pathological condition, disease, location or miasm.
Now our venturing began. On referring Synthesis Repertory 9.1 page 1018: Stools, soft – Cassia s. As some correspondence to Cassia soph was seen in the case it was worth exploring further. We approached CCRH unit in our hospital and requested to get monogram. We could correlate the following symptoms in the monogram: 1. Mind: fear of losing way to home 2. GENERALS - COLD - amel. ( ccrh1, cdd7 ) 3. GENERALS - WARM - amel. ( ccrh1 ) 4. STOOL - SOFT ( ccrh1, cdd7 ) 5. ABDOMEN - PAIN - menses - during - agg. - first day - cramping ( ccrh1 ) which is not present in the case but it suggests that the remedy has during menses < esp. on the first day. Remedy Selection: Hence the choice was Cassia sophera. Only mother tincture was available. We prepared up to 6C at our pharmacy department. Progress Notes: 2/4/07 As references were to be taken, patient was kept on SL 9/4/07 Pain in anal region once a week, pain in abdomen-0- Generals N Rx Cassia sophera 6c HS for 3 days SL 30 tds X 15d 23/4/07 Pain in anal region >> 1st episode 15 day during her 1st day of menses says fear of visiting new place is much better Rx cosmos 30 tds I month 24/6/07 Pain in anal region>> Rx SL 30 tds 1 month Learning: 1. As per APHORISM 257 not to become victim of favorite/ known drugs routinely: “The true physician will take care to avoid making favourite remedies of medicines, the employment of which he has, by chance, perhaps found often useful, and which he has had opportunities of using with good effect. If he do so, some remedies of rarer use, which would have been more homoeopathically suitable, consequently more serviceable, will often be neglected.” 2. Referring different sources like recent repertories and source material medica. 3. Not to compromise but to work qualitatively. 4. Confidence in making potencies which we saw acting clinically. Thanks to:
1. 2. 3. 4.
Case Taking and Repertory Department Pharmacy department Materia Medica Department CCRH regional department.