AN AGGRESSIVE, AMOROUS MAN WITH ALLERGIC RHINITIS AND VARICOSE VEINS

Bhavik R. Parekh, MD (Hom) ¹*, KS Sinthuja, BHMS ²

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¹ Associate Professor, Department of Homoeopathic Materia Medica and Head, Clinical Academics

² PG Student Part I, Department of Homoeopathic Materia Medica

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

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*Corresponding Author: Dr Bhavik Parekh

Email: drparekhbhavik@gmail.com

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How to cite this article:

Parekh BR, Sinthuja KS. An aggressive, amorous man with allergic rhinitis and varicose veins. Journal of Integrated Standardized Homoeopathy (JISH) 2019; 02(01)

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Received on: February 18, 2019

Accepted for Publication: April 05, 2019

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Abstract:

This case report describes a 32-year-old man who presented with allergic rhinitis, varicose veins, and stasis dermatitis. The patient had a history of deep vein thrombosis with pulmonary embolism. The main pathological generals in the case were identified as veins as the main chief tissue affinity with varicosity and thrombosis with metastasis. Boger’s approach helped to solve the case and the qualitative study of the mind helped in finer differentiation with the help of psychodynamic understanding. Lachesis was the final remedy chosen. The case brought out the importance of Boger’s approach in Homoeopathic practice and also the role of Homoeopathy in a case with structural pathology and its efficacy in halting and to some extent reversing the pathological process.

Key words: Varicose Veins, Stasis Dermatitis, Lachesis, Boger’s Approach, Tissue affinity, Pathological Generals

PRELIMINARY DATA:

Date of Case Taking: 15/6/2018

Name : DSS	Age/Sex: 32 years/male
Education: 6th std	Occupation: Production shift officer in company
Status: Married since 6 years	Spouse: KJY, 24 years old, housewife
Father : 50 years	Mother : 45 years
Brothers: 1 Younger (30 years), married	Daughters: 2 (4 ½ years, 3 years)
Income: 20,000 / month	HIMS: PAL-10170

PRESENT HISTORY:                                           

CHIEF COMPLAINTS:

No.	LOCATION AREA, DIRECTION, SPREAD, TISSUE, ORGAN, SYSTEM, AND DURATION	SENSATION & PATHOLOGY	MODALITIES A.F., <,>	ACCOMPANIMENTS   STRICT TIME RELATION
1.	Respiratory system (Nose) Since Childhood (12 years of age) O – Daily D – Continuous F – Daily (1 to 2 times) P- No progression	Watery thin coryza +2   Sneezing+3 Irritation of nose +2 (has to touch nose continuously)   Cough occasionally   No nose block No throat irritation	< Dust+3 <Sun +3 <Mental tension+3 <Travelling+2 <Early morning <Change of weather >Drinking alcohol+3 >Soup <Physical exertion >Rest+2 <Night Watching+2 >Steam inhalation <Night+2	Headache (whole head)

ASSOCIATED COMPLAINTS:

2.

Veins Extremities (lower) both knee joints extending down in both legs (right to left) Since 10 years (increased since 2 years)

Varicosity+1 Pain+1 Itching+1 Discoloration Greenish black++

<Rising from seat after sitting+3 <Walking+1 <Squatting >Sitting

 

PAST HISTORY:

1.

Extremities (lower) Right leg Veins – popliteal and tibial Right sapheno-femoral junction In 2017 April

Deep vein thrombosis with history of pulmonary embolism

>WARF 5 mg >Rx CROPIVAS – AP 75 (stopped since 6 months)

 

PATIENT AS A PERSON:

 Physical Characteristics:

Appearance	Fair, stocky
Weight	Weight gain after starting alcohol since 12 years of age
Facial Configuration and expression	Rectangular face
Skin	Face – clear, fair Greenish black discolouration on right leg and greenish on left leg
Perspiration	Increased all over body
Digestion	Eructations++
Cravings	Alcohol3 (all types), spicy3, cold drinks3
Eliminations	Normal
Sexual Function	Increased desire but feeling inferior and not fully satisfied after hydrocele surgery
Sleep	Normal, refreshing

LIFE SPACE INVESTIGATION:

A 32-year-old male patient from Bihar, born and brought up in Mumbai, came to the OPD for case definition at the appointed time. His father was quite strict and hence his relations with father were not good. The patient and his brother had to follow whatever the father said. This caused much vexation to the patient. The mother is good-natured, but she followed whatever the father said. Hence, his relationship with his parents was not good since he was a boy. The patient studied up to the 6^th Std. after which he had to go to a far-away school with higher travel expenses. The father did not have enough money to educate both children, so he asked the patient to work and sent the brother for further studies. The patient felt sad, angry, and rejected, even though he had not been interested in studies. He thought “why only brother, why not me?”. After this, he started detaching emotionally from his parents and brother. He started going for manual work from the age of 12. While expressing this, he said “I did almost all difficult works in childhood”. Initially, he used to give his earnings to his father, but stopped later on as he thought, “Father is not taking care of me, then why should I give money to him?”

From the age of 12, he befriended several older people and started drinking alcohol and smoking daily. Once, he got so angry on being scolded by his father that he went to Kerala for 3 days with 2 friends. He started going away in difficult situations, especially when the father was angry and he could not retaliate. He shares everything with friends or weeps when alone. Patient said that he feels better by drinking alcohol if alone or sharing his troubles with friends.

He had relationships with many girls and many were ready to marry him. However, when they approached him for marriage, he refused as he did not have the courage to tell his father. Again, the father arranged his marriage without informing him beforehand. He was angry but could not do anything. He saw his wife for the first time when they got married. He had numerous expectations from a wife e.g., she should work with patient or somewhere else, take care of family and financial responsibility, and should be supportive. However, his wife does not work and makes demands that he has to fulfil. Due to this, they often fight. He gets angry with wife’s demands and scolds her “You don’t like me that’s why you are getting angry at me, if you go to your parents’ home, I will be happy”. Then she cries and they reconcile after some time. The patient feels guilty and thinks he should not say such things to his wife, but he never expresses his guilt.

He said that he doesn’t like his wife because her nature is like his father’s. Due to her demands, he feels happy when she is at her mother’s home. He also feels that she does not spend time with him and doesn’t care for him. When the primary physician asked him what he likes about her, he replied that she is an excellent cook who prepares a variety of dishes. He does not like it if her cooking becomes monotonous.

Father, mother, and brother (married) stay together in a house near the patient’s house, but he never visits. He does not have a good relationship with his brother. Even if he visits, he does not talk to the father because the father is upset that the patient is not giving him money. The patient does not care about that. He is very close to his daughters.

The patient is very ambitious and works very hard for success. He is satisfied with the current job. Initially, he worked as a normal labourer and later got promoted due to his ability and experience. There is a lot of work and pressure in the job.

After marriage, the patient has many girlfriends. He is particularly close to one, who is his colleague since 3 years. She is married; her husband is the patient’s friend. He takes her advice as he feels she plays the roles of father, mother, and friend. He reduced alcohol and smoking because of her. Patient spends a lot of time with friends and feels better. He said that friends are very important in his life and they are like family members. They stand with him in all situations.

REACTIONS-PHYSICAL FACTORS:

Season	SUMMER	WINTER	RAINY
Fan	Likes (speed 4)	Likes (speed 4)	Likes (speed 4)
Covering	Doesn’t like	Doesn’t like	Cover up to neck if feels chilly
Bathing	Cold water	Cold water	Cold water

Thermal – Hot

PAST HISTORY:

1. In 2016 – surgery for hydrocele.
2. In April 2017: DVT- Right leg and pulmonary embolism. Hospitalized in the ICU for 4 days.

Treatment taken previously:

Tab. WARF 5, Tab. DAFLAN 1000, Tab. PAN 40, Tab. CHYMORAL PLUS, Tab. UPRISE D3 60k, Tab. FOLVITE (5), Tab. ATARAX (10), and Tab. HOSIT XT.

FAMILY HISTORY:

Father – COPD                       Mother – HTN, asthma, and DM

ADDICTIONS: Alcohol, beer, and tobacco

PHYSICAL EXAMINATION:

GENERAL: Pulse-74/min, Respiratory Rate-18/min, BP-118/80 mm hg

Throat – NAD            Nose – DNS (left)       Tongue-Pink & White coated RS/CVS/PA- NAD

SYSTEMIC:

Lower Limbs – Right leg (below knee) – varicose veins and greenish black discoloration++

Left Leg (below knee) – varicose veins

INVESTIGATIONS:

USG both LL venous Doppler on 12/4/2017:

Right leg -There is extensive deep vein thrombosis involving the right popliteal and tibial veins causing almost 80% lumen obliteration. There is a poor resting flow in this segment.

Rest of the venous channels showing normal phasicity. There is good compressibility. There is poor augmentation seen at the right saphenofemoral junction and popliteal veins on calf compression and ankle dorsiflexion.

An incompetent perforator is noted about 2 cm proximal to the right medial malleolus with mild reflux.

Secondary varicose veins are seen along the medial aspect of the right leg

Left leg-Mild varicose veins are also seen in the left leg. There are no incompetent perforators in the left leg. There is no saphenofemoral or saphenopopliteal incompetency.

On 19/8/2017:

Right Leg – Normal spontaneous flow is noted in the venous channels showing normal phasicity. There is good compressibility. There is good augmentation seen at the saphenofemoral junction and popliteal veins on calf compression and ankle dorsiflexion. There is no saphenofemoral or saphenopopliteal incompetency. There is almost complete regression of the DVT in the right popliteal & tibial veins.

An incompetent perforator is noted about 2 cm proximal to the right medial malleolus with mild reflux. Secondary varicose veins are seen along the medial aspect of the right leg.

Left Leg-Mild varicose veins are also seen in the left leg. There are no incompetent perforators in the left leg

CLINICAL DIAGNOSIS:

Allergic Rhinitis

Varicose Vein with Stasis Dermatitis

H/O Deep Vein Thrombosis with Pulmonary Embolism

PSYCHODYNAMICS OF THE CASE:

Since early childhood, the father’s strict and dominating nature affected the patient. He did not like father’s domination and restrictions, which led to lot of anger towards father. Father’s decision to allow brother to study and his marriage upset the patient a lot. However, in all instances, he could never speak up against the father and suppressed his anger. He felt wronged by the father, due to which he started detaching from family. He developed hatred towards them and even now cannot connect with them. There was somatization in the form of allergic rhinitis that developed at the age of 12 years after he was asked by father to leave his studies.

The perceived neglect from father also led the patient to indulge in smoking and alcohol, suggesting oral fixation. Alcohol helped the patient to feel much better generally as well as in his complaints and helped to relieve the stresses. At the same time, he also indulged in relationships with many girls suggesting a strong id drive and amorous nature. With his wife, however, he is more interested in her cooking where he is interested to eat different variety of foods.

Thus, in this case, we see a patient who perceives discrimination by father, feels he has been wronged, develops hatred towards family, suppresses emotions and indulges in id drives, with oral fixation, with somatization in the form of allergic rhinitis various venous pathologies, and feels greatly relieved by alcohol.

CLASSIFICATION OF SYMPTOMS:

1.	Tissue affinity – blood vessels -veins	Characteristic location
2.	Tissue affinity – circulation	Pathological General
3.	Thrombosis	Pathological General
4.	Embolism (metastasis)	Pathological General
5.	Varicosity	Pathological General
6.	<3Sun exposure	Characteristic Physical Particular Modality
7.	Alcohol >3	Characteristic Physical General Modality
8.	Desires alcohol3	Characteristic Physical General
9.	Desire cold drinks3	Characteristic Physical General
10.	Desire spices3	Characteristic Physical General
11.	Forsaken feeling	Characteristic Mental State
12.	Delusion wrong suffered	Characteristic Mental State
13.	Amorous disposition	Characteristic Mental Attribute
14.	Hatred towards family	Characteristic Qualified Mental – Emotional
15.	Thin watery coryza & sneezing <dust	Common Characteristic Particular
16.	Thin watery coryza & sneezing <sun	Characteristic Physical Particular
17.	Thin watery coryza & sneezing <mental tension	Characteristic Physical Particular
18.	Thin watery coryza & sneezing <travelling	Common Physical Particular
19.	Thin watery coryza & sneezing >drinking alcohol	Characteristic Physical Particular
20.	Thin watery coryza & sneezing <early morning	Common Physical Particular
21.	Thin watery coryza & sneezing <change of weather	Common Physical Particular
22.	Thin watery coryza & sneezing >soup	Common Physical Particular
23.	Cough <night	Common Physical Particular
24.	Cough < physical exertion	Common Physical Particular
25.	Cough > rest	Common Physical Particular
27.	Cough >steam inhalation	Common Physical Particular
28.	Headache – coryza during	Characteristic physical particular accompaniment
30.	Right leg greenish black discolouration	Common Physical general
31.	Right leg itching	Common Physical general
32.	Lower limb pain	Common Physical general
33.	Lower limb pain <walking	Common physical general
34.	Lower limb pain <squatting	Common physical general
35.	Lower limb pain >sitting	Common physical general

Selection of approach:

The case contains prominent tissue affinities, pathological generals and physical generals and few qualified mental symptoms, hence Boger’s approach suited the case.

TOTALITY OF SYMPTOMS:

1. Circulation – Blood vessels, veins
2. Thrombosis
3. Embolism
4. Varicosity
5. <Sun exposure
6. >Alcohol
7. Desire alcohol
8. Forsaken feeling
9. Amorous disposition
10. Hatred towards family

REPERTORIZATION TABLE:

 

PDF:

1. FORSAKEN FEELING
2. DELUSION WRONG SUFFERED
3. AMOROUS DISPOSTION
4. HATRED TO PERSONS OFFENDED
5. DESIRES – ALCOHOL

REMEDY DIFFERENTIATION:

The remedies coming close after Repertorization are Lachesis, Carbo veg, and Lycopodium. Both Lachesis and Carbo veg come close at the level of the tissue affinity and the pathology of vein, varicosity, and thrombosis. However, at the mental level, Carbo veg patients are slow, indolent, and sluggish; in contrast, our patient is aggressive and driven by his basic desires. Additionally, the pathology in Carbo veg is usually suitable to atonic conditions where there is a lack of reaction.

Lycopodium is more intellectually keen and goal-oriented with logical thinking. Our patient is driven by emotions of hatred towards people who have offended him and driven by the id. Lycopodium does not cover the pathology as well. Natrum comes close with the hatred towards people who have offended and sun aggravation, however the quality and depth of relationships as seen in Natrum is lacking. With this understanding of pathology and a person driven by id with aggression and amorousness, points coupled with sun aggravation and desire and amelioration by alcohol, points to Lachesis as the final prescription.

SUSCEPTIBILITY:

Disease: 1. Allergic Rhinitis – chronic, structural reversible

2. Varicose veins with stasis dermatitis – chronic structural irreversible

Characteristic symptoms++

Sensitivity: High                     Susceptibility: High                Reactivity: High

Remedy Correspondence: High (At the level of mind and body)

Fundamental Miasm: Syphilitic (DVT with pulmonary embolism)

Dominant Miasm: Sycotic (Chronic allergic rhinitis and varicose vein)

Plan: LM Potency and infrequent repetition

Final Remedy: Lachesis O/1 1P HS weekly to daily

Follow-up criteria:

1. Sneezing intensity and frequency
2. Coryza intensity and frequency
3. Pain in right leg
4. Varicose veins itching
5. Discolouration
6. O/E: Varicose veins and discoloration

Date	1	2	3	4	5	6	Action	Duration
15/6/2018	Case defined						Lachesis 0/1 IP HS weekly	2 weeks
29/6/2018	>+/SQ	>+/SQ	SQ	SQ	SQ	SQ	Lachesis 0/1 3P HS weekly	4 weeks
27/7/2018	>10%	>10%	>30%	> +	SQ	SQ	Lachesis 0/1 3P HS weekly	4 weeks
24/8/2018	>50%	>50%	++ due to injury	>80%	SQ	SQ	Secale cor 30 TDS	4 days
Small ulcer on right medial malleolus and pain increased since 20 days A/F – blunt injury <Day time +2 >Elevating leg+2 O/E: Small ulcer, oozing watery discharge, varicose vein, and greenish black discolouration same
31/8/2018	+	+	>50%	Occasionally	>+	>+	Ars iod 30 TDS x 2 days followed by Lachesis 0/1 7 P daily HS	5 weeks
Varicose vein itching occasionally / ulcer healed O/E: Greenish black discolouration slightly faded
12/10/2018	>++	>++	0	Occ	>+	>+	Lachesis 0/1 7P daily HS	4 weeks
3 episodes of coryza in last month but mild intensity Varicose vein itching occasionally O/E: blackish greenish discolouration >
16/11/2018	>++	>++	0	Occ	>++	>++	Lachesis 0/2 1P HS weekly	4 weeks
Varicose vein itching occasionally O/E: blackish greenish discolouration >

 

Conclusion:

This case demonstrates the importance of understanding the Clinico-pathological correlations in selecting Boger’s approach as well as using the mind for differentiation. It also shows the efficacy of the correct Homoeopathic medicines in halting and to some extent reversing the pathological process. The case also shows the indication and efficacy of the 50 millisimal potency.

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