August 2015

It is a big task to turn on my side: a case of Ruta

by Pratik Desai

This is the case of a twenty-seven-year-old single man living in central India who requested an urgent appointment. I first saw him in September, 2013. The patient complained of pain in his hip joints, on either side but not both sides at once. The pain started after an accident in September 2011, where he had fallen from his bike and had some bruises on his left knee and left upper arm, but no fractures. His injuries were better after two weeks and the pain ceased, but two months later he began to have pain in his hip joints. Over the past six months, the intensity and the frequency of pain had markedly increased.

The pain was severe and came in periods, each lasting for eight to ten days; it was then difficult for him to manage his routine. He described the pain as unbearable; it was aggravated mostly at night and in cold weather. Whenever the pain started, it became difficult for him to turn over when in bed or to pick up anything from the floor. He said that the pain was so horrible that it used to take half an hour to just turn over. He only managed to turn over if he took hold of something.  

He described the pain as a kind of electric shock, or jerk, as if someone had bitten him hard. Sometimes, he felt as if his leg was not there, as he could not twist or turn and hence had to be in one position for a considerable time. The pain got worse when he stretched his leg or bent it at the joint. It then felt as though his bone was broken or as if someone was pulling intensely at the bone. As a result, it became difficult for him to stand from a sitting position, or to ride a bike or drive the car. When in pain, he became very irritated if someone tried to talk to him.

He further described the pain as very stiff and hard, and he had to make cycling motions so as to render the part soft. He said that it was as if someone was twisting the leg from the hip joint; it was so intense that he often felt that he should remove the entire leg.   He said it was like being twisted, as if somebody was giving too much pressure or squeezing the leg, like a wet cloth being wrung out. The pain felt as if it would break the bone or remove it from its attachment.

Now we have a complete description of the pain in the hip joints: a sensation as if pulled, stiff, beaten, broken, twisted and squeezed. We need to find a remedy which has all these characteristics regarding pain, and to examine other areas of his life to see whether they match the remedy we are looking for.

The patient described his nature as being aggressive, unable to control his anger. He did not trust people easily. He is helpful to others and gets sentimental over small matters. He was emotionally hurt when his friend, to whom he had extended help and support, broke off his friendship due to some misunderstanding. He described the experience as of being ‘used’ and said: “When his need was over, he had used me and thrown me out, as if I had done something wrong.”

He described another situation where his elder cousin had promised him that he could stay with him as long he wished, but when the cousin got married, he asked the patient to leave his home. He felt very bad that his cousin has told him something but acted differently, letting him down. He felt that all the responsibility of his family came on him and he was controlling his aggression within himself.

The patient has a fear of being killed by ghosts, saying that ghosts kill you by tying a rope around your neck and pulling it up so that one is hanged. He is scared of snakes and has dreams of them. He craves non-vegetarian food and fresh juices, especially orange or sweet lime. 

                                                                                                          rue

Analysis 

Prominent and particular in this case is the description of the pain in the hip joint. We have the following information:

-          It started after  an injury

-          Affection of hip joint

-          Pain on alternating sides; only one hip is affected at a time.

-          Pain worse at night, in cold weather, from stretching or turning on the side.

-          Sensation of an electric shock, as if pulled, twisted, squeezed, pressed hard and broken.

-          Tries to control the pain, as if it is a big task for him to turn on his side in bed.

-          Irritated and frustrated by the pain.   

We have only one remedy which has all these characteristics: Ruta graveolens.
If we look at the other aspects of the case, we see that he felt used by his friends. They had stopped talking to him, as if he had done something wrong (delusion he has done something wrong). In another incident with his cousin, who asked him to leave his home after his marriage, the patient felt that he could not trust anyone. The main feeling was that people do not keep their promises; they say something and do something else. Here we have the rubric: Delusion, deceived being.

Another peculiar aspect of the case was the dream of a ghost who would tie a rope around his neck and hang him. We have the following rubrics :

ruta

At the local level:

Roger van Zandvoort, Complete Repertory, Mac Repertory, 8.2.01, Professional, Kent Homoeopathic Associates

 

Mind rubrics:

ruta2

Roger van Zandvoort, Complete Repertory, Mac Repertory, 8.2.01, Professional, Kent Homoeopathic Associates

We see that Ruta graveolens is the most prominent remedy on repertorisation. If we are to look at the case from the System understanding, through the Sensation approach, we get:

  • Kingdom:  the patient’s sensitivity and reactivity indicates that he needs a plant remedy.
  • Vital sensation and reaction: pulling, stretching, twisting, squeezing, breaking. This is the sensation of the Rutaceae family.

Rutaceae is also known as rue, from the Citrus family, the family of lime and oranges. This family includes fruits of great economic importance such as sweet oranges (citrus sinensis), lemons (citrus limonum), Mexican lime (Citrus aurantifolia), sweet lime (Citrus limettioides Tan), grape fruit (citrus decumana), tangerines (citrus reticulate), Bengal quinces or Bael fruit (Aegle marmelos), Casimiroa or white sapote (Casimiroa edulis) and Wampee (clausena lansium), etc. It includes common remedies such as Aegle (A. marmelos, A. folia), Angustura vera, Pilocarpus pinnatus/ Pilocarpus. jaborandi, Ptelea trifoliate, Ruta graveolens and Xanthoxylum americanum.

Ruta graveolens is well proved and well known in our Materia Medica, so it represents the central theme or sensation of the Rutaceae.

In Ruta, we find many references related to sensation words such as choking, constricting, strangling, squeezing, crushing, twisting, stretching, pressure, broken, sprain or injured.

Sensation and reactions of the Rutaceae family

Squeezing

Squeezing and twisting

Squeeze and break/crush

Squeeze and compress

Constrict and squeeze

Twist, compress and break/crush

Choking/compressing/strangling and then crushed.

Miasm

Miasms are the coping mechanism of a person in response to how an external stimulus is being perceived. In other words, it is the pace and depth or degree of how the vital sensation is being perceived.

In the cancer miasm, an individual perceives the external stimuli as chaotic and he wants total control over his situation.  They have too many expectations: for that they need to do a superhuman task, beyond one’s capacity or limitation.

We find the same expression in our patient when he said that to turn in bed is a big task for him and to stand up from sitting is a huge task. In the situation with his cousin, when told to leave the home he said “I kept my anger in control. I wondered how to manage so many things. The situation was out of control and I needed a super-human effort to bring things in order.” This is indicative of the cancer miasm.

Prescription: Ruta graveolens (Rutaceae + cancer miasm) 200C

Follow-ups

One month later, Oct 5, 2013: “I am doing much better; in fact the pain disappeared on the second day after taking the medicine and has not come back. Now I am able to do my work quickly.  Day-by-day things are getting better and better. I am also less lazy. I am sleeping well; I have no problem turning on my side. Over all I feel 99% better. Earlier, the pain used to come on after driving or after exertion; that is not the case anymore. I am more confident, I’m not worried if I have to go somewhere or have a meeting with some senior people - I feel confident.”

Prescription: placebo

24th December 2013 (three months later): “I am feeling better day by day, now there is no problem while travelling, I can run and even chase the bus. I have no pain, even in the middle of winter. I feel totally fit in mind and body. I feel positive, everything is going well. I sleep well and have no problem driving.  I am looking for another opportunity for my career. I feel that I can achieve my targets now that I am free of doubts. I am more positive towards myself and about my work.”

One year later:  “I am much better. I have not experienced any pain since the first dose. My life has changed entirely. Earlier, because of the pain, my entire confidence was lost, but now I take part in many activities. Recently, I participated in a play in our annual company event. I even danced there and met all sorts of people. I can do all the work assigned to me, I can travel anywhere, anytime. I have no sleeplessness and no fear. My confidence is at its best. I can solve any problem. Earlier, I was very aggressive; I used to come to conclusions without understanding the problem, but now I take time to think and understand the issue and then I give my opinion so my reactions are under control. I also listen to people’s perspective. I don’t feel any fear or tension in my mind.”

Until now, he is doing fine: there is no recurrence of pain in his hip joint and no need to repeat the remedy.

Differential diagnosis: here, where the patient presented with pain in his hip joints on alternating sides, with electric-shock  or current-like pain, one can think of the Ranunculaceae or, with the expression of pain ‘as if bruised and broken’, one can think of Arnica; with the words ‘stretching and twisting or bending/ turning’ one can think of Dioscorea; with ‘stiffness with the need for movement’ one can think of Rhus tox. When we see all the expressions and symptoms of the patient together, we get an exact picture of Ruta, where we have affections of bone and hip joint, ailments from an accident, with the pain described as bruised/broken, electric shock-like, twisting, stretching and squeezing. The patient feels “wrung out”, “squeezed out like a lemon”, used and abused by others and then tossed aside. The simillimum thus selected acts wonders.

Bibliography
1: Rajan Sankaran, Rutaceae, Insight into Plants – Vol 3, Homoeopathic Medical Publishers.
2: Rajan Sankaran, Miasms, Sensation in Homoeopathy, Reprint 2009, Homoeopathic Medical Publishers.

Photo: Shutterstock
Rue flowers; Scisetti Alfio

Categories: Cases
Keywords: hip pain after accident, twisting pain, squeezing pain, pain alternating sides, Rutaceae, cancer miasm
Remedies: Ruta graveolens

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Dr Pratik Desai
Posts: 2
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Reply #2 on : Fri September 11, 2015, 04:57:23
yes.because his level of Experience at the time of first consultation was at level 3(emotions) his spontaneous admission that he gets irritation and frustration because of pain. secondly is pathology at functional level, there is no underline structural pathology, hence given one dose and wait for the response.
pratik dave
Posts: 2
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Re:
Reply #1 on : Mon September 07, 2015, 17:18:57
Ruta 200c 1 dose only??

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