November 2014

A simple approach to clinical practice: three cancer cases

by Sunirmal Sarkar

The approach to homoeopathy should be summed up in one word, simple. Most things in life are simple and should be kept simple, and homoeopathic practice is not an exception to this tenet.

The main aim in my understanding is to find out the most characteristic symptoms in the case and prescribe on these very symptoms. These characteristic symptoms can come in the form of keynote(s), rubrics, themes, pathologies, or even a sensation. When this characteristic symptom is established and is sure, the remedy is prescribed based on this.

This style of approach is backed by impressive clinical results and a growing acceptance of homoeopathic practitioners and students all across India. The goal is to simply share and spread this knowledge of homoeopathic medicine to my colleagues in India and all over the world, in order to facilitate more success in homoeopathic practice.

I should also mention that my experience and practice has been mainly and hugely influenced by Dr. Burnett. I have read and memorized all of his material, and the results have been fruitful. His work has helped me tremendously in my own clinical practice, as well as that of other masters, including Pulford, M.L. Tyler, Allen, Boericke, Boger, P. Sankaran, Hering, Nash, Knerr, Bernoville, Blackie, Borland, N.M. Choudhuri, John Henry Clarke, Farrington, Lippe, and Teste. Matthew Woods has influenced my clinical practice greatly as well. Also, my in-depth reading of Allopathic pharmacopeia has contributed to my knowledge, which has definitely helped me to become a well-versed practitioner.

A word about the role of other remedies, like sarcodes, allopathic drugs, Indian drugs, biochemical drugs, organ-specific drugs. Many of these types of remedies are needed in pathological cases. Using one remedy and one dose in pathological cases has not proven to be efficient in my clinical practice.

What is greatly needed for prescription is the current symptom totality. I look at the current symptom totality, see which remedy is the closest to this totality, and I prescribe it. I also take into account the pathogenesis of the remedy and the patient.

For me, the first prescription is just the beginning. Often, in severe pathological cases, the patient requires a change in the remedy. In fact, this change can happen as often as every one or two months, because disease patterns are rapidly changing.

Most diseases today are complicated by allopathic medicines, hormonal dysfunctions, addictions, like alcohol and tobacco, and past history of illnesses. All of these factors must be taken into account when prescribing.

When I approach a case, I begin looking for a chronology of events, and I ask questions such as: when and how did it start? What were the first symptoms? Which organ system is affected? What were the characteristics of those symptoms at that time? In addition, I also look at the direction in which the symptoms move – on which side did it start, did it move or did it stay in a local area?

I aim to elicit exact symptoms and look for the causative factors – there may be one, usually there are many. With each symptom, location, sensation, modality, and concomitant are critical to make that very symptom complete, and to aid in prescribing an accurate remedy.

When investigating each symptom, I explore it in depth until I get a peculiar characteristic. This can be in any area of the case, mental, emotional or physical. I emphasize the importance of peculiar symptoms because that is what will ultimately help to match the patient to the remedy. I also place great importance on concomitant symptoms as they will help to quantify and qualify the experience of the patient.

Usually, the mind symptoms come at the very end. Unlike other schools of homoeopathy, who investigate the mind and mental picture of the patient first, I choose to leave it to the end. If we start with mind symptoms, then we theorize and conceptualize what the patient says. This is dangerous because if the mind symptoms are not clear and exact, then you are taking the risk to theorize. It is much more useful to start with the symptoms that are sure and dependable – to choose symptoms that are factual.

In a clinical setting, we must try to understand the “apparent” behaviour of the patient, and must question whether or not what they are showing is true – is there a shield that the patient is putting up or are they revealing their true self? We have to distinguish between persona versus reality – persona is a mask or shield, and as homoeopathic practitioners, we have to aim to remove the mask and find the reality. In order to do this, we must first and foremost analyze ourselves before others. If the patient is comfortable with the physician, then you can find out hidden information. When there is a good bond at an emotional level with the patient, you can ask about the mental symptoms. Once your patient is weeping in front of you, it is the best sign that there is a good bond developing.

At each level of the case, I choose the symptoms that are factually reliable, dependable, and solid. Once I have a good grasp on these symptoms, I have a few remedies in my mind and the rest of the case is just confirmation of one of these very remedies. Eventually, I find a remedy that correlates with most aspects in the case.

Objective observations (such as white-coated tongue, mapped tongue, hot body or cold extremities) and overall constitution (fat, thin, tall) are also critical to success in clinical practice. I often use physical examination and objective observations as confirmatory symptoms. Physical generals, such as perspiration, menses history, appetite/cravings/aversions, and sleep position are also key in clinical practice and aid in confirming the remedy of choice. Family history and personal history are also areas which I investigate throughout my case-taking. Other important things to consider include addictions (such as smoking and alcoholism) and what the patient is exposed to (for example, does the patient work in close quarters with petroleum or cement?). Dreams are also important and can assist in prescription.

In summary, when I take a case, I build a solid foundation, addressing the pathology, toxicology, symptomatology, and then the mind. It is a hierarchy, which helps to organize my approach to cases and case taking.

I also frequently utilize the “Ladder of Remedies” concept of Dr. Burnett, to assist in chronic, complex cases. A ladder approach uses a series of remedies one after another, which ultimately leads to the restoration of the health in the patient. I find that to effectively help patients, the ladder approach is very beneficial because it targets the patient’s current ailments at the very moment they are experiencing them – with the ladder approach, you can treat the presenting picture of the patient and move onto the next remedy when that picture is no longer present. It should be mentioned that I do not employ or use polypharmacy (prescribing 2 remedies at the same time). Suppose a patient comes with an organ-specific problem, we can simply use a organ-specific remedy to alleviate their suffering. Once this suffering has been reduced or eliminated, a new picture of the patient will come up, and we can prescribe on the new totality.

Here, are some case examples from my clinic illustrating the various approaches mentioned above.

1. Case of Grade 2B Squamous Cell Carcinoma of the Cervix

This is a case of a 52-year-old woman who had four children. Her symptoms were blood mixed with vaginal discharge, menopausal for the past two months. Extremely chilly patient, cannot tolerate damp weather, gets a cough and cold in damp weather, pain in lower abdomen on the left side, warts, family history of cancer. Mentally, she gets scared easily, is fearful, and does not have dreams.

Initial Investigations show that there is a mass in the cervix, 3.15cm X 2.29cm, which is indicative of a cancerous mass.

Remedies prescribed:
1. Calendula 10M, 4 doses
2. After 15 days, Radium bromide 30, BD for 14 days. This is one of the main remedies I give as an intercurrent in cancers – especially cancer of the cervix with hard indurations.

Follow-up after one month: patient is better and the bleeding and pains have stopped. The remaining symptom of “damp weather aggravates” is still there.

ficusRemedies Prescribed:
1. Calendula
10M, 4 doses
2. Placebo,
for 15 days
3. Hydrocotyle asiatica
1X, BD for one month. This is the main remedy for cervical cancer and erosions/thickening. It is one of the Indian drugs that I use as an intercurrent.

Follow-up after one more month: there is bleeding of a dark color, with pain. This is an indication for the remedy Ficus religiosa.

Remedies Prescribed: 
1. Ficus religiosa
200, BD for 15 days  
2. After 15 days: 5-Fluorouracil 30, BD for 14 days.  This is a drug that is a pyrimidine analog which is used in the treatment of cancer.

Follow-up after two more months:  The patient overall is much better. The pain is not there, although the bleeding increased.

Remedies Prescribed: 
1. Ficus religiosa
200, BD for 15 days
2. Placebo,
for 15 days

Follow-up after another one month: The patient is feeling chilly, she cannot tolerate hunger, is having vaginal discharge, but there is no bleeding. She is wearing thick, woolen clothing, and has revealed that she had a history of skin eruptions.

These are all indications for the remedy Psorinum.

Remedies Prescribed:
1. Psorinum
10M, 4 doses
2. Placebo,
for 15 days
3. Hydrocotyle asiatica
30, BD for 15 days

Final follow-up: overall the improvement has been remarkable. Refer to the investigations below for visible evidence.

Investigations: in the most recent investigations, we can observe that within 4-5 months the mass has disappeared and the doctors have written that the cervix is slightly thickened, which indicates that the pathology has reversed.

2. Case of Papillary Serous Cystadenoma Carcinoma of the Ovary 

This is a case of a post operative-papillary serous cystadenoma carcinoma of the ovary. The patient has a history of anxiety and indigestion, due to stress at home. There was also a police case in the family, which gave her a lot of stress. Other symptoms include motion sickness, thirstlessness, burning sensation before micturition, radiating pain from LIF to umbilicus, electric sensation in the abdomen, aggravated by lying on the left side, and hot flushes from the vertex. The patient has been menopausal for the past four years. She has a past history of typhoid, irregular menses, and dysfunctional uterine bleeding. She has dreams of snakes all around her, is fearful of snakes, and is generally fearful. The patient is extremely forgetful, gets angry, and throws things in anger. She cannot tolerate hunger, desires spicy food and sweets.

Initial Investigations: the initial cancer marker reads 710.2U/ml. 

Remedies Prescribed:
1. Lac can 200, 2 doses, first day
2. Lac can 1M, 2 doses, next day 
3. Lac can 10M, 2 doses, following day
4. Followed by Placebo for a month
5. Followed by Carcinosin 10 M, BD for one week
6. Followed by Placebo for a month

Follow-up after two months: the patient feels she is improving. She is having no pain and feels much better. Her intolerance to cold and growths are there, and she is getting stools after eating breakfast.

Investigation after 1 month of treatment: the investigations after two months show a considerable decrease in the cancer marker: from 710.2U/ml to 162.10U/ml.

Remedies Prescribed: 
1. Thuja
10M, 2 doses 
2. Followed by Placebo, BD for a month

Follow-up after one more month: the patient was having extreme acidity.

papayaRemedies Prescribed:  
1. Taxus baccata
30, TDS for one month  
2. Followed by Carica papaya 1x. This remedy is well indicated as the patient had extreme acidity.  
3. Followed by Placebo for a month

Follow-up after two more months: the patient is having pain in her abdomen, which is better on passing flatus. She feels chilly and has become restless. She also revealed that she has a history of gallstones.

Remedies Prescribed: 
1. Natrium ars 30, 200, 1M
2. Juglans cinerea mother tincture 8 drops TDS

Final follow-up: overall, the patient has considerably improved. Generals are better, even pathology is much better. The discomfort and pains have gone. The cancer markers have totally changed and the patient is continuously improving.

Most Recent Investigation: the cancer marker drastically reduced. Initially, the cancer marker showed a reading of 710.2U/ml, in five months time, it has gone down to 43.50U/ml.

3. Case of Thyroid Malignancy

The patient, a female, was brought into the clinic in an ambulance, on a stretcher. She was discharged from the cancer hospital because they said that nothing more could be done to help her. It appeared as if she was in the last stages of her life.

When I saw her, she was in agonizing pain. She had an open, suppurating wound with thousands of maggots crawling around an abnormally large, protruding mass. The tumour was the size of two tennis balls with blackish-purplish discolouration. When I asked her about what was happening, all she could utter was: “The pain is stinging. It is continuously burning and stinging.”

She was prescribed frequent doses of Tarentula cubensis 10M.

The very next day and much to my surprise, the maggots had died and there was minimal pain.

On the thenth day of taking the remedy, she came walking to the clinic and sat on the chair to talk to me. This was a miraculous recovery.

Boericke on Tarentula cubensis: “It is the remedy for pain of death; soothes the last struggles. Malignant suppurations, purplish hue with stinging pains.”

Photos: Wikimedia Commons
Ficus religiosa Puja; Biswarup Ganguly; CC BY 3.0
Carica Papaya; H.Zell; CC BY-SA 3.0

Categories: Cases
Keywords: symptom totality, chronology of events, ladder of remedies, cervix carcinoma, ovarian cancer, thyroid cancer
Remedies: Carcinosinum, Carica papaya, Ficus religiosa, Fluorouracil, Hydrocotyle asiatica, Juglans cinerea, Lac caninum, Natrium arsenicosum, Psorinum, Tarentula cubensis, Taxus baccata, Thuja

piyush jain
Posts: 2
ovaarian cancer
Reply #2 on : Wed February 25, 2015, 21:12:16
Sir,wonderful use of Tarentulla cubensis,first time understanding about indian remedy Hydrrocotyle asiatica,u nderstanding that Taxol main ingredient of Taxus baccata could be used.please reply if possiblee aggravation of Carcinocin 1M could be checked inmalignant patient.
Warm regards Piyush jain
Posts: 2
Reply #1 on : Tue November 18, 2014, 15:06:35
Hats off to you Sir.You are a true inspiration and a true Master of The Art. Thank you for sharing the cases Sir.Looking forward for your publications in book-form some day for the Homoeopathic fraternity. That will be a precious possession for the Homoeopathic world..

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