CLINICAL

AN ANGRY, IMPATIENT LADY WITH ASTHMA: A CASE REPORT

Bhavik Parekh, MD (Hom) 1

Ashutosh Lohiya, BHMS 2

 

ABSTRACT

The patient is a 37-year-old woman who presented with the chief complaint of bronchial asthma since the last 17 years. The patient initially received Kali Ars based on the immediate impression of the patient obtained during case taking. The medicine did not relieve the patient, leading to a review. The key to unlocking the case lay in meticulous analysis and evaluation of the plethora of symptoms, which involved using Boenninghausen’s approach. Nux Vomica was prescribed, giving significant relief. The case helps to understand the evolution of the sensitivity and reactivity of a Nux Vomica woman at the level of the mind and body. The case also demonstrates the process of differentiation between Kali Ars, Arsenic Alb, and Nux Vomica by understanding the causation, evolution, and expression of impatience. It enables the understanding of susceptibility that enabled selection of the LM potency, which finally restored the patient to health.

Keywords: Sensitivity, Reactivity, Impatience, Irritability, Nux Vomica, LM Potency

1 Reader, Department of Homoeopathic Materia Medica and Head, Clinical Academics

2 PG Student- Part II, Department of Repertory

Dr. M. L. Dhawale Memorial Homoeopathic Institute (MLDMHI)

*Address of correspondence: Dr Bhavik Parekh Email: drparekhbhavik@gmail.com

How to cite this article:

Parekh BR, Lohiya AA. An angry, impatient lady with asthma: A case report. Journal of Integrated Standardized Homoeopathy (JISH) 2018; 01(01):23-29.

Received on: August 14, 2018

Accepted for Publication: September 12, 2018

 

Preliminary data:

Name: Mrs. MSP Age: 37 years
Sex: Female Education: BA (Hindi)
Occupation: Teacher (Nursery) Religion –Kunbi, Maratha
Veg/ Non-veg: Both
Spouse: -Mr. SBP 49 years

Occupation: Clerk in court Add: LNP

Income: 24000/month

 

LOCATION SENSATION MODALITY CONCOMITANT
RS

URT

Nose

Throat

Lt toRt

LRT

chest

Bronchioles

O-gradual

D-continuous

P-progressive

F-acute exacerbations more than 3-4 times

winter and rainy season

 

 

 

 

 

Eye

since 17 yrs

 

 

Sneezing3

Watery discharge

Pain

Irritation

Cough dry

Occ. whitish thick discharge

Breathlessness3

Leads to sleep disturbance

Rattling3

 

 

 

 

 

 

 

 

Watery discharge+

Itching+

<dust3

< cold air3

< winter3

< cloudy weather3

< rainy3

< early morning3

<exertion3

< lying down3

<night3

<talking3

< spicy/oily thing2

<inspiration

> warm drink3

>allopathic Rx

1)Asthalin rotacap sos

2) Foracort rotacap 1 HS

3) liq. Astharide sos

4) tab Cetrizine sos

 

>raising head while sleeping2

>sitting2

 

 

Impatience3 (hence immediately takes Rx even with slight ailment).

Sweating3

Back itching3

Occ weakness

Anxiety2– hope doctor will cure me

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PHYSICAL GENERALS:

Acidity: burning in chest (retrosternal region) < spicy+3

Appetite: good Thirst: adequate

Craving: fish3, Non veg3, cold drink2

Aversion: sweet

Stool: regular Urine: pale yellow, occasionally burning

Menstrual function:

FMP: 14 years Initially irregular menses

Duration -5 days Flow-4 pads/day clot-occ. no staining

Before menses: Headache+,nasal discharge+, occ. breast pain, leg pain+, back  pain+

During menses: only 1st day abdomen pain, leg pain, back pain

Leucorrhoea before menses 4-5 days

Sexual function:

Decreased since 3-4 years

Obstetric history:

1st abortion: 3rd month of pregnancy because of growth defect

2nd abortion: 1st month of pregnancy because of tubal pregnancy

Sleep: Disturbed due to anxiety for her son, occ. due to dreams, complaints

Dream: of relative3, death etc.

Thermals –chilly

LIFE SPACE

Childhood:

The patient is born and brought up in Mumbai. She feared her father as he was a short-tempered man. Her mother, in contrast, was calm and quiet. The patient was pampered and attached to both parents. She is the eldest child with a younger sister and brother. Both her siblings are short-tempered. Since childhood, the patient has been very irritable and obstinate. She described an incident from her childhood to elaborate on her nature. One day, at lunch, she demanded to eat in a particular plate. She would not take no for an answer and kept arguing with her mother and sister. When her father slapped her, she stopped talking and left the room in a huff without eating. She was very angry with her father but did not express the anger. After some time, she calmed down and ate the food. She would often quarrel with her sister and would not talk to her for 1-2 days. This behaviour of the patient continues till today.

Marriage:

She was married at 19 years. Her husband is a government servant. The in-laws are good natured and well educated. In arguments with the husband, the patient usually gets her own way as she is more dominating. She constantly demands things like a washing machine or other home equipment. She pesters her husband until he gives in. She usually spends his money on household expenses; the money she earns is saved for the future. If she is not obeyed, she becomes irritable and angry.

She has been taking tuitions after marriage. The cough due to chalk dust has started since then.

Her child often falls ill. She worries about what will happen to him and whether the doctor will be able to cure him. She has gotten him examined by numerous doctors; she even consulted a native healer. The patient experiences constant anxiety about her son.

She has fear of being electrocuted when she touches a switch, also fearing hospitalization. She has a fear of the dark, which produces palpitations. If she hears about anyone being admitted to a hospital, she feels the same thing will happen to her and she then worries who will take care of her home.

HISTORY:

P/H: abortion 2
F/H: FA-Hypertension MO-Hypertension
AUNT-Diabetes +Cardio-Vascular Accident   UNCLE: DM
O/E: Temp: afebrile, BP-140/80 mmHg, PR: 73/min, RR: 20/min
G/E: Icterus/pallor/cyanosis/lymphadenopathy/ oedema-absent
S/E: Nose: Hypertrophic turbinate, RS-Bilateral Rhonchi

Investigations: X-ray Chest-NAD, PFT-Obstructive with good reversibility.

Clinical Diagnosis: Allergic Rhinitis, Pharyngitis with Bronchial Asthma

TOTALITY OF SYMPTOMS

1)      <anxiety+3

2)      < contradiction+3

3)      <menses before+2

Mental aggravating modality

Mental aggravating modality

Aggravating modality

4)      < winter+3

5)      < cloudy weather+3

6)      < rainy+3

7)      < early morning+3

8)      < spicy+3

Aggravating modality

Aggravating modality

Aggravating modality

Aggravating modality

Aggravating modality

9)      Perspiration-profuse3

10)  Craving: fish+3,

11)  Craving: Non veg+3,

12)  Dream: relative +3

Physical general and Concomitant

Characteristic Physical general

Characteristic Physical general

Mental Subconscious

13)   Impatience +3 hence immediately took Rx

14)  Back itching+3

Concomitant

Concomitant

15)  Anxiety about son+3

16)  Anxiety anticipation+2

17)  Constant demanding+2

18)  Quarrelsome +2

19)  Anxiety future about +2

20)  fear of something will happen

21)  Fear of dark with palpitation

22)  Fear of electric current

Characteristic Qualified Mental-Emotional

Characteristic Qualified Mental-Emotional

Characteristic mental state

Characteristic mental state

Characteristic Qualified Mental–Emotional

Characteristic Qualified Mental -Emotional

Characteristic Qualified Mental-Emotional mental with physical expression

Characteristic Qualified Mental-Emotional

 

This case needs Boenninghausen’s approach since there is a plethora of symptoms with a lot of modalities along with concomitants, physical generals, and a few qualified mentals.

Repertorization Table

PDF

  1. Chilly patient
  2. Sycotic miasm
  3. Hypersensitivity and reactivity of both mind and body
  4. Demanding
  5. Quarrelsomeness
  6. Anxiety children about his
  7. Craving meat
  8. Craving fish

 

Differentiation:

The predominant remedies are Sepia, Nux Vomica, Calcarea carb, Arsenic album, and Kali carb. The PDF of the repertorization helps narrow the remedies to Nux Vomica and Arsenic with a possibility of Kali Ars. All the above remedies cover irritability, impatience, and anxiety, with an affinity for the mucous membranes of the respiratory tract. This lady comes across as extremely impatient, as is evident through her intolerance/sensitivity to her suffering. Kali ars and Arsenic Album remedies are extremely anxious and their impatience arises from this anxiety. With Kali Ars, sentiments and attachment to the family are the primary focus. However, in this case, her attachment expresses only as anxiety for her son. The impatience of Arsenic album arises specifically from fear of death and anxiety for health, which makes them restless. In Nux Vomica, the impatience stems from intolerance to suffering; as stated by William Boericke: ”Very irritable; sensitive to all impressions, even least ailment affects her greatly”. S R. Pathak mentions ”Nux Vomica cannot stand pain, so mad that he cries in pain”. In this patient, the intolerance is also seen when denied anything or when contradicted, with great irritability and reactivity. Her relationship with her husband also reflects her impatience and domineering nature. Thus, in this case, oversensitivity and reactivity are seen at the mental and physical level, the impatience and intolerance pointing more towards Nux Vomica.

Susceptibility

Disease-chronic, structural reversible.

Characteristic symptoms++   Sensitivity very high++

Susceptibility: High

Reactivity: High

Remedy correspondence: High (Both at the level of mind and body)

Patient on regular allopathic medications and inhalers

Planning: LM potency infrequently

Dominant Miasm: Chronicity, Recurrence of complaints since 17 years, Spasm, Thick greenish discharges

Sycotic2

Chronicity of complaints may need intercurrent remedy though infrequently.

 

Final choice of remedy

NUX VOMICA  0/1  3P HS

Follow-up criteria:

1)      Anxiety/Impatience

2)      Sleep-disturbance

3)      Sneezing

4)      Nose block

5)      Cough

6)      Throat irritation

7)      Breathlessness

8)      Rattling chest

9)      Allopathic medicine

10)  Inhaler pump

 

Abbreviation and its meaning

<=aggravation

>=amelioration

+=present

0=absent

S=same

↑=increased

↓=decreased

G=good

C=changeable

F=fluctuating

CL=clear

 

Date 1 2 3 4 5 6 7 8 9 10 Comments
9/1/2018 + + + + + + + + + S NUX VOMICA 0/1 3P for 1 wk.
16/1/2018 > G > > > + > 0 0 s Initially better but later require regular inhaler

Rx: NUX VOMICA 0/1 7P HS for 2 wks.

30/1/2018 + G > > > > + 0 2 A/D

 

Taken allopathic medicine inhaler and tablets twice

THUJA 0/1 1PHS, NUX VOM 0/1 6PHS for 2 wks.

Thuja was introduced perceiving the Miasmatic block as after increasing the repetition patient was better but there was mild increase in trouble
6/2/2018 > Occ

D

Occ 0 Occ Occ occ + 0 1

time

Overall 50% better, pump once

THUJA 0/1 1PHS, NUX VOM 0/1 7PHS 1p=2 for 2 wks.

 

20/2/2018 > D 0 0 + + + + 0 3 time

/2wk

Acute exacerbation

Nat Sulph 0/1 1PHS

NUX VOM.0/1 7PHS 1P=2

Complaints of heaviness of chest agg at 4 am-Natrum Sulph was used considering the time modality
3/4/2018

24/4/2018

0 G 0 Occ Occ Occ occ + 0 1

Time/wk.

New complaint eye itching

< dust

NUX VOM.0/2  3PHS

15/5/18

To 24/7/18

0 G 0 0 0 0 0 0 0 0 NUX VOM.0/3  3PHS

 

31/7/2018 0 G 0 0 0 0 0 0 0 0 1sttime in her life she did not use allopathic medicine. She enjoyed the rains without any complaints and was happy.
7/8/2018 No complaints Placebo

Follow-up management
The potency was gradually raised from 0/1 to 0/3. It was raised as and when recurrence of old symptoms was observed or any new symptom appeared. In a few follow-ups, BD dosage was used considering the regular use of inhalers. Retrospectively considering the susceptibility and sensitivity, it would have been better to step up the potency earlier. This was corrected in the subsequent follow-ups.

Experience narrated by the patient

I had a severe problem of Asthma and cough since the last 17 years. I suffered from breathlessness while walking and climbing stairs. I was not even able to do any exercise, not even yoga. Along with this I had sneezing while preparing food, while cleaning the house, followed by rattling in the chest and constant coughing. I used to require the inhaler daily, both in rainy and winter seasons.

I have started homoeopathic treatment at your hospital since the last 8 months, and after this treatment I feel much better now. The breathlessness has reduced considerably and I am even able to do Yoga. I don’t experience any trouble doing any household work of cooking and cleaning. Overall I feel relieved more than 80%. There have been no episodes of severe breathlessness in this rainy season which earlier was very common. Earlier I used to get impatient during the episodes of breathlessness and used to take inhaler immediately, that anxiety has also reduced now.

Learning from the case (the Primary Physician)

A retrospective analysis of the case enabled me to understand my mistake – without understanding case processing, I directly jumped into Repertorization. This case taught me the correct way of case processing and how to individualize the patient and the medicine at the core level.

This case opened a new way to understand the action of the LM potency and its utility in bronchial asthma.

I learnt about the personality of a Nux Vomica woman.