November 2014

A Synergistic approach: three cases

by Ashok Borkar

Case 1

This is a case of a fifteen-year-old girl with a painful keloid on the left arm.

P: “I have a keloid on my arm. It hurts me when I am studying and even when I go out. It appeared after a BCG injection, which was given at birth. It was very small when I was five, but now it has increased and itches a lot.”

Ashok Borkar (AB): Tell me more.

P: “It hurts all the time, especially if anyone touches it, and in between it is like a strike on the arm. Sometimes, I can’t raise my arm. It hurts more in winter.”

AB: Describe this a little more.

P: “It is as if a safety pin has pricked me and I feel like pressing it tight with my hand. But it goes on hurting, stitching. It also happens when I am sitting idle and when I am studying; then I just hold the arm with my hand till the pain is better. After some time, it hurts again. I am always conscious that this arm should not be touched. It hurts horribly and I feel as if I am going to faint. It hurts as if I have hit a cupboard door, or as if a sharp object is hitting my body. ‘Thaak! thaak!’ Then, the pain radiates down my arm. One second it hits me, and after two seconds again it hits me again, at regular intervals, then it becomes continuous.”

AB: Tell me more.

P: “It is a very tough pain. I get angry, tensed up, worried. I take that anger out on my sister. I beat her in anger. I feel as if somebody has held me very tightly and I am getting hurt. I can’t stop it. I try to pinch my hand to divert my attention. It hurts for two to three days. It is an unbearable stitching pain. The striking is so bad, so unbearable, that I feel frustrated. I feel almost unconscious for a moment till the pain decreases. At that time, I can’t talk to anybody. The pain is so intense that I am unable to sleep.”

AB: Tell me more.

P: “The arm muscle contracts and I feel as if it is held tightly and stamped on. It hurts badly, as if I am being hit with a baton; it is not stopping. The pain increases and increases, and it lowers my strength. Then, I feel tired. It is going above my limit, I just can’t bear it. I am tired of trying to stop it.”

AB: Tell me more.

whyP: “I feel like weeping. I don’t want to answer when people ask me about it. I feel downcast. Why me? I feel shattered when they ask me. I get angry, irritated, furious. I bang my hand in anger.”

Here we see some important emotions being expressed: weeping, downcast, shattered, furious, bang my hand in anger. She feels she is hit and then hits her hand in anger. In addition to this, she has a feeling of ‘why me?’

All of these descriptions are associated with emotions. From this explanation, we can conclude that the disease experience is intense at both the physical and emotional level.

AB: What dreams do you get?

P: “I am travelling in a car and the car is on a bridge. The bridge breaks and I am in the water. I try to save myself but the speed of the water is so much that I can’t do it. I am drowning, asking for help but no one is around. I am trying to come out of the water. I go completely blank at that moment.”

Her individual experience in this situation is that she is trying to come out and at that moment she goes blank.

AB: Any fears?

P: “When I hear of tsunamis and all, I feel as if I am struck. What will I do if a tsunami comes?”

Here, we get the same sensation that ran through and through the case, and this is the sensation of ‘being struck’.

Case Analysis

The sensation in this case is: hit, struck, and hurt. There is also an element of being very sensitive to touch, as it will cause pain. The same sensation is observed in all areas and indicates a plant remedy.

The passive reaction is: fainting, unconscious, and blank.

The active reaction is: anger and hitting. The plant family covering the sensation, passive reaction and active reaction is the Compositae family.

Some of my colleagues who watched the video of this case said that it was malarial miasm because of the intermittent nature of the pain and the persecuted (‘why me’) feeling (somebody beating me again and again).

However, the features of the cancer miasm came up strongly. The patient perceives the pain as ‘too much’. It is beyond her limitation and she tries hard to stop it.

What clinched the final diagnosis was the following rubric:

  • Cicatrices, keloid (Complete repertory)

Bellis perenis is one of the remedies listed under this rubric.

The following symptoms of this patient are mentioned in Murphy’s Materia Medica and are covered by Bellis perennis:

  • Pressure ameliorates
  • Squeezing pain (sensation of being pressed tightly and stamped on)
  • Feeling tired with the pain
  • Injury to nerves with intense soreness (radiating pain, touch aggravates)
  • Tumors from injury

The presence of Bellis perennis in the rubric ‘Cicatrices, keloid’ means that this remedy has the power to produce and cure keloids. Producing this type of pathology is a unique characteristic of Bellis perennis. Every remedy has its own special seat of action and the power to produce a specific disease process. The sphere of action and the type of action is always a characteristic symptom of the remedy.

In this case, the sphere of action is the scar tissue. The type of action is the tumor of the scar tissue (keloid) and the pain produced is a neuralgic type of pain.

Prescription: a single dose of Bellis perennis 200C, which is a remedy belonging to the cancer miasm.

Follow-up

After eight weeks, the pain and tenderness in the keloid stopped immediately. In two months, the size of the keloid reduced by five millimeters. The blackish discoloration around the keloid disappeared. She stopped getting angry and beating her sister, and she could concentrate on her studies. The patient’s father had taken a photograph of the keloid the day her history was taken in our clinic. He made a power point slide comparing this photograph with a new photograph two months after the remedy was given.

After nine months later, we observed that the keloid had flattened and become soft. The pain never came back again.

Case of Multiple Myeloma

A 52-year-old man was diagnosed with multiple myeloma in January 2012. When he was brought to the clinic on 10th January, he appeared very frail and he was barely able to walk, as he was in severe pain. He looked as though he was in his eighties.

The x-rays showed multiple tiny well defined osteolytic lesions in the skull, ilium, pubis, and the upper femoral shafts. X-ray of the lumbosacral spine showed marked osteoporosis, sacralisation of L5, and lumbar spondylosis. The normal spinal curvature was lost, resulting in straightening of the lumbar spine. Lower ribs showed multiple lytic lesions.

He was suffering for the past two months. He said that one day he sneezed and got a sudden sharp poking pain in the chest, like a catch. When he sneezed again, he got the same type of pain in the right side of the back, like a cramp. Since then his ribs started hurting. Then, he suffered from severe pain in the back, which meant that he could not turn sideways at all. He needed support to stand and had a dragging pain in the waist area. He said that he had to rise slowly from the chair and after walking slowly for a while, he felt a little better. When he would sit, the dragging, cramping pain would start again. Whenever he would turn in bed, he would get a sharp poking pain. On coughing, he would get pain in the chest. Whenever he would get a catching pain, he was unable to move due to the pain and would get stuck in that position. He was getting recurrent cramps in different parts of his body. He also had fullness of abdomen after eating a little food and so he would not eat at all at night. He had a peculiar sensation as if waves of water were flowing down his chest.

Prescription: Rhus tox 30C. First a single dose and later, twice a day for four days, as his pain had increased and he was unable to rise from the bed.

old manBy the 16th of January his condition worsened. The cramps had increased. He would get a cramp when straining to urinate. The pain was sudden, very severe, and it was worse with the slightest movement. He would scream with the sudden pain and could not bear the pain at all. It was a sharp poking pain and it would last for ten minutes. He wanted to be fanned. He had not passed stool for five days. The following rubrics were taken:

  • Mind; shrieking with the pain
  • Generalities; air draft ameliorates
  • Generalities; motion slightest aggravates

Sharp poking pains, constipation and the above rubrics indicated Bryonia.                                     

Prescription: Bryonia 30C was given once a day and follow up was taken every two days. He would be a little better for a day or two and worse again. This continued for a month, and he was on daily doses of Bryonia.

The case was reviewed on 28th February as he was bedridden and was scared to move because every movement would cause pain. He had great fear of being touched as that would cause severe pain. He was getting painful cramps in the axillary chest, ribs, and lower back. The cramp was worse by eructation.

At this point, I viewed the case from a different angle.

What was the pathology?

The pathology in this case is multiple myeloma, which is a malignant proliferation of plasma cells. The patient is suffering from osteoporosis and osteolytic lesions. The sphere of action is in the bones. In this case, the patient had a loss of calcium in the bones, resulting in the formation of holes. The other parts of the body, which are involved are the muscles and the muscles are cramping. The disease process going on in his body was cancer (a malignant proliferation of cells).

I took the rubrics:

  • Generalities; softening of bones (osteoporosis)
  • Generalities; necrosis (osteolysis)
  • Generalities; cramps muscles
  • Cancerous affections
  • Mind; shrieking pain with the
  • Mind; fear pain of

Prescription: Aurum metallicum 30C one dose

Improvement started immediately and his pains became less; he stopped shrieking with the pain. He was able to move without pain. He started moving around the house with the help of a walker. He started eating on his own. After a month, he came to meet me, walking with the help of a walking stick. He was looking strong and healthy and his age again.

Follow up

After ten weeks: On 7th May (two and a half months after the first dose of Aurum) he was given another dose of Aurum metallicum 30C, as he developed a severe cramp when he sneezed. The sensation of water waves flowing down the chest had started again. The second dose made him comfortable again.

After fourteen weeks: I repeated his X rays and found that although he was better with Aurum met 30C, his x rays did not show any change in the lytic lesions of bones. I gave him Aurum met 6C, twice a day for a month.

After eighteen weeks: he was pain free and doing all his activities on his own without any aid, and without a walking stick. He developed a cough but this time, he did not get any cramp with the cough. The cough passed away without any change in the medication. Aurum met 6C was continued and he is still under treatment.

Case of Cerebral hypoxia with hallucinations and stupor

This is a case of an 85-year-old lady who had started hallucinating and was not in her full senses. Her daughter came to the clinic to give this history in October 2011.

“She has become forgetful. She does not remember how many children she has unless she is reminded. She does not want to talk. You have to ask her three or four times before she answers, and then she answers by just moving her lips: no words come out or the words are very soft, or she does not answer at all. She appears lost. She is a little better when relatives are around. She just wants to lie down. She is not focusing. She does not look at our face, she looks elsewhere. She has hallucinations. She sees children and says ‘give them something to eat.’ She wants to go back to live in Mumbai (the place has been sold 11 years ago). There is total apathy. She is not interested in anything. The other day, I burnt my fingers and I was showing her again and again but there was no response from her, just a blank look on her face. She is disinterested. Everything is slow; all her movements are slow. Her hands are icy cold. She cannot grasp objects; she can’t hold a teacup or a spoon. She likes fruit juices and cold drinks.”

Rubrics Taken:

  • General: Reaction lack of, old people in
  • Extremities: Coldness hands, icy
  • General: Food and drinks: juicy things, desires
  • Mind: Dullness, understands questions only after repetition.
  • Mind: Indifference, apathy, everything to
  • Mind: Talk, indisposed to
  • Mind: Forgetfulness of old people
  • Mind: Homesickness
  • Mind: Slowness of old people

Prescription: Phosphoric acid 30 twice a day for 3 days

Follow-up

She started improving immediately, reacting, talking, and focusing her eyes. The hallucinations stopped. She was able to hold things in her hands. After about two months, there was a relapse and the same prescription was repeated, which promptly made her comfortable again. She has been in good health for the last ten months.

Why did Phosphoric acid act so well?

Clarke states: Phosphoric acid shows a marked action on the emotional and sensorial faculties, a drowsy, depressed, apathetic state being produced. Phosphoric acid causes illusions of the senses, as well as of the sensorium; bells are heard; ciphers, sparks, etc., are seen.

In Phatak’s materia medica, under Phosphoric acid we find: slowness of mind and special senses. The sphere of action is ‘emotions and sensorium’ and the mode of action is that it causes ‘slowness of the special senses’. This is her main peculiarity, this is where her individuality is seen clearly.

Photos: Shutterstock
Why me; Roobcio
Old man in pain; Laurin Rinder

Categories: Cases
Keywords: painful keloid, multiple myeloma, cerebral hypoxia, hallucinations
Remedies: Aurum metallicum, Bellis perennis, Phosphoric acid

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ashok borkar
Posts: 3
Comment
Re:
Reply #3 on : Wed November 12, 2014, 14:31:34
Thanks! Shekhar.

Dear readers,
These cases have been taken from my book "Pathology factor in remedy selection".
It will be of greater benefit to read the whole book from start to finish in serial order for better understanding.
Ashok Borkar
drsrikar
Posts: 3
Comment
multiple myelomas
Reply #2 on : Mon November 10, 2014, 08:17:57
Sir, why aurum met 6 after 30?
Last Edit: November 12, 2014, 07:03:32 by mache  
SHEKHAR ALGUNDGI
Posts: 3
Comment
Re:
Reply #1 on : Fri November 07, 2014, 13:31:19
Dear Ashok.

Excellent cases, good learning simplicity thy name, practicality thy application, implimentation for all thy lesson.

Shekhar

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