2007 Septembre

Kreosote in chronic urticaria

de Dr. Manish Panchal

A 39 year old lady from a middle-class family saw me for chronic urticaria. She continuously scratches herself. Her violent itch is worse in the evening from 4 p.m to 6 p.m. which compels her to scratch vigorously, but it gives no relief at all instead it causes burning-sensation > bathing with cold water.

Other complaints:
1. Pain in both heels ….. since 2-3 months
< first touching the ground
> after walking
2. Lumbar backache < esp. winter
< Rest > if she keeps on working.
3. Pain in breast, cracks in right nipple with yellowish discharge….. since 8 days.

Physical generals:
Thermal: Very Hot – cannot tolerate heat at all, feels even like removing her clothes.
Appetite: Cannot tolerate hunger (3), Cannot remain fasting (3). (In India, women do fast on auspicious occasions, but she could not).
Thirst: Much thirst for cold water (3).
Sweat: Profuse sweat, stains the blouse in axillae, but washable. Profuse offensive sweat if she goes out in summer. Sticky sweat, so ‘as soon as I reach back home I go directly to the bathroom, to bath thoroughly and put on fresh clothes’.
Desires: Meat (3), fish (2), tobacco-brushing (3)….it is a must.
Aversions: warm food (2).
Sleep: Needs good sleep, every afternoon needs a nap at least for 2 hours( it is a must ).
Menses: Only 3 days, scanty, stains indelible, 8 days earlier every time.

Family consists of four daughters and her husband.
Her husband is working in a post and telegraph department and has a limited income. She feels very angry if anyone lies she will not quarrel but she will take it out on daughters and husband. She is always busy keeping the house clean, almost compulsively. When tired and retiring in bed at night and she sees some dust on the fan above her bed she immediately cleans it up. The youngest daughter wets the bed so everyday she washes not only her bed-sheet, but also the pillow-covers She keeps her daughter’s clothes separate from her own clothes so that the smell of bedwetting does not permeate in them. She gets very irritated if clothes are mixed together. If the elder daughter is menstruating she does not allow her to have her food after coming home until after she thoroughly cleans herself.

‘When guests come I want my house to be clean. When I go to my relatives house and there is dirtiness around I will not drink tea or even water there. Every month I clean my kitchen thoroughly and arrange everything properly. If I find any dust I will immediately clean it."

Her menses leave stains on her inner clothes. If the stain mark is still there after she has washed them she will wash them again, even if they have dried in the meantime.

Analysis :
Most of the above symptoms appear like Sulphur - hot, aggravated by warm, thirst for cold water, < fasting, Craves - meat & tobacco, profuse offensive sweat, intolerable itching < evening.
Sulphur is known to be very dirty, but our patient is very fastidious. So I decided to give deeper thought to the case and find a remedy which is like Sulphur, but fastidious.
I gave Placebo for a week to the patient and to report back.

In the meantime while glancing through the repertory my mind was drawn to 2 small remedies in the most important symptom i.e < Fasting : bov, kreos, sulph etc.
Also we know < 4 – 8 p.m is bovista along with sulphur ( kreosote also has itching < evening like sulph.).
Teste includes in Sulphur group, bovista and kreosote along with crot-t, merc-cor, aeth, lob-i, merc-sol, aster, cic, ratania.
It was now important to know more about kreosote & bovista.

After reading Phatak and Clarke's materia - medica, kreosote seemed to match the case almost perfectly; mentally, physically and even particularly.
I wished in my heart that if I there were fear of rape it would be icing on the cake. But how to ask about or get this sensitive information from an uneducated, orthodox lady coming for urticaria? I was sure the patient would start doubting my character. Still I decided to try to get this sensitive information and was eagerly waiting for the patient to return after a week.

Second visit after one week :

During conversation the patient narrated the following important information on her own: “My mind gets very disturbed for few days after reading articles in newspaper about small girl molested by an elder, minor girls being raped or molested etc.
I have 4 daughters, what if such a thing happen to them. So I don’t allow them to venture out in the afternoon when the road is deserted. I tell them if anyone stops on your way to school or back home and asks about you, where you live, you should try to avoid such persons and go away quickly from that place”.

During her 2nd pregnancy she developed eczema on her thighs, groin, and shoulder-blades. It was not better by ointment, but disappeared on its own after pregnancy.

During her 4th pregnancy she wanted a boy, so there was tension whether it will be boy or girl. She dreamed someone else delivered a boy.

Important features of case:
1. Fastidiousness/cleanliness. ( dream- dirt / dirty linen: kreosote )
2. Sensitive / fear about molestation, rape.
3. Thermal: hot.
4. Cannot tolerate hunger / < fasting. ( fear- fasting: kreosote )
5. Desires: fish, meat, tobacco.
6. Thirsty, esp. cold water.
7. Menses scanty and indelible.
8. Sleep >
9. Profuse sweat.
10. Intolerable itching < evening.

kreosote in Phatak and Clarke:

Generalities: Affects mucous membrane of digestive tract, female genital. Burning like fire. Profuse, foul discharges.
Worse: Summer, Rest.
Better: Sleep after, motion.
Stomach: Greedy drinking, great thirst. keen appetite for meat, craves smoked meat. Dares not remain fasting. < fasting.
Sleep: Constant inclination to sleep. Dreams of foul & disgusting linen etc.
Skin: Violent itching all over the body, esp. towards evening and with burning sensation in arms and legs after scratching. Burning, itching at night and heat over whole body. Eruption, like bug-bites with violent itching esp. in evening.

Remedy: kreosote 1m, single dose and Placebo for a week.

Follow – up: ( in course of 1 month ) :
a) Urticarial rash with violent itching - reduced significantly though still present.
b) Fastidiousness - now much less. Anger is also less.
c) Can remain fasting without much discomfort.
d) Craving for tobacco much less now.
e) Lumbar backache absent.
f) Crack and yellowish discharge from right nipple absent.
g) Pain in both heels worse than before.

Good reaction at all levels with worsening of pain in her heels.
So I decided to give placebo for a week & see if the heel pain improves or not.

Follow up: (after further 1 month)
Everything continued to be better, but Pain-heels worse, therefore she does not feel like working in morning.

kreosote 1m, single dose and Placebo for 2 weeks.

Follow up (after further 2 months):
Most significant & deeper change occurred. There was a story in the newspaper about a woman in London who was in a Coma for many years. Recently the doctors taking care of her accidentally discovered that she was pregnant. A staff-member of the hospital had raped her and hence the pregnancy.
She was not disturbed much mentally after reading the story.

Urticarial rash better.
Thermal: feels less heat this summer. (Presently it is a hot season – march).
Can do fasting without problem.
Thirst: drinks much water

Pain in both heels worse; < first motion > continued motion. ‘Feel like putting my feet in hot water.’

Everything is better except her heel-pain whose modalities match with rhus-tox.
Interestingly, rhus-tox follows well after kreosote (Clarke).

I decided to put faith in kreosote 10m and if there is no change in her heel-pain rhus-tox would be worth considering.

No further follow-up: by the patient.
She felt disappointed that I could not heal her completely.

Understanding Kreosote:
It is a product of the distillation of wood tar and a preservative principle in smoke used for smoking meat and fish.
Kreosote has a craving for smoked meat.

Excessive indulgence in smoked meat & fish is injurious to health.
It can cause:
a. Scorbutic condition of gums.
b. Salling & decay of teeth.
c. Foul breath, costiveness, malaise.
(Early decay of teeth & foul discharges are prominent features of Kreosote.)

The name is derived from Greek, meaning "Flesh Preserver".
In material form it preserves dead organic matter, but has an opposite effect on living tissues.
Destruction of tissues, i.e it preserves dead organic matter and causes destruction of living tissues.

The destructions it causes are:
a. Teeth decays as soon as they appears.
b. Children old looking with marasmus.
c. Affects of the mucous membrane of GIT causing vomiting, diarrhoea; profuse and acrid with foul odor.
d. Affects of the mucous membrane of female-genital causing ulceration, acrid, foul leucorrhoea; i.e corrosion and erosion of mucous membrane with acrid, excoriating, foul discharges and burning pains.

Kreosote acts as a Flesh-Preserver or as a Flesh-Destroyer. It is required either in a situation where the flesh is destroyed or when the flesh is to be preserved for survival. Hence the theme of Self-Preservation in Kreosote.

The following case, (by ROBIN LOGAN, printed in homoeopathic heritage aug’96) will help us to understand the theme of Self - Preservation clearly.

CASE: A 30 year old female with a chief complaint of chronic vaginal thrush for 12 years. Profuse leucorrhoea which excoriates and causes severe itching. Swelling of vulva with stitching and burning pain in vagina. The leucorrhoea can be watery or thick but always offensive. Also suffered from hay-fever since child-hood.
Emotionally the case was unremarkable. She was quite a shy person, but liked socializing. Married for seven years and looked forward to marriage for the security and support she imagined it would bring. Not overly anxious, but suffered from anticipation a bit. No strong fears. No food desires or aversions except that she liked chocolate. She was chilly and perspired easily.

I prescribed Silicea with no effect.
The hay-fever season then started and we got involved in acute hay-fever remedies. She then developed bad pre-menstrual symptoms and I gave Sepia with no effect and so it went on for a while.
Seven years later her husband phoned me because she had developed an aversion to sex. In the consultation this never came out immediately. She spoke about her circumstances at length at first. She was in a state of shock, acute grief and despair. Her husband had lost his job totally unexpectedly and everything had come crashing down around them. The stakes were high, they lived in one of the most expensive parts of the country, had a big house, massive mortgage, children at private schools and so on. Suddenly they were faced with losing everything. In such a stressful circumstances it is not unusual for a person’s libido to go, she stressed however, that it was not just lowered libido, but a very strong fear of intercourse. The thought alone was terrifying to her. She was not able to understand, nor did she feel it was a manifestation of a change in her relationship with her husband, whom she was very much in love. She was also very irritable before menses.

Going into how she felt about her circumstances there was not so much a fear of poverty. She felt more inclined to let everything go than fight to keep it. She felt more prepared to simplify life than struggle to maintain their present standard of living against such odds. She decided it would be best to return to simplicity and a modest way of life in order to survive. She had taken up a part-time job to help them and felt good about being able to contribute in this way, but found it a great strain.

She was then given Kreosote 1m based on her fear of coition and her original complaint of thrush with profuse, excoriating and offensive leucorrhoea (this proved to be stubborn, but eventually cleared up after repeated treatment before Kreosote was given).

The effect was excellent. Things continued to get worse for the family, the stresses & pressures built up but her ability to cope changed drastically. She became much less agitated, much more relaxed and much calmer pre-menstrually. She said “I feel like the fog has cleared and am positive and on top of things again. Previously I was over-whelmed by a mountain of stress and yes, the fear of coition disappeared soon after the remedy.
CASE ENDS here by Robin Logan in the journal, but he does not explain the theme of Self- Preservation in this case. So I decided to explain the theme for better understanding.

Understanding of the theme in the case:
We see in the above case;
Destruction of genital mucous membrane causing acrid, excoriating leucorrhoea with offensive odor physically.
Mentally; she was in circumstances where everything had come crashing down and was losing everything (i.e everything was going to be destroyed). In such a scenario where everything is getting destroyed (physically in form of mucous membrane as well as mentally), there arises a need for "Preservation" of whatever is left in order to survive. Hence the patient returned to simple and modest way of life in order to survive (mentally) as well as developed fear of coition to prevent any further destruction of genital mucous membrane.
The theme of "S e l f – P r e s e r v a t i o n".

Manish Panchal

Catégories: Remèdes
Mots clés: kreosote, urticaria, self-preservation, Robin Logan

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