October 2014

Shattered and shocked: a case of Gelsemium

by Arul Manickam

Our patient, a middle aged woman, has had a CT scan which shows left third cranial nerve palsy, due to left posterior communicating artery aneurysm.

The oculomotor nerve is responsible for the majority of eye movement (eye, eyelid, and pupil). Paralysis leads to ptosis, pupil dilation and impaired movement of the eyeball.

Presenting history
- Drooping of left sided upper eye lids (ptosis) for fifteen days, no pupillary light reflex, mydriasis (pupil dilation), eye movements reduced
- History of left sided headache for the past five or six years. Throbbing pain in left temple. Angry when disturbed during headache, scolding others when angry. During headache, pain in the eye, as if she wanted to pull the eye out.
- Vomiting  four to five times, with an odor of neem seed

Physical generals
Chilly patient, unable to tolerate winter with rainy weather
- Bowel motions: once every four or five days. Difficulty to pass stool ++
- Sleep: sleepy , overpowering +++
- Sweat: profuse; offensive odor; smell of neem seed

Mental generals
The main incident that affected her is her son-in-law’s death, one year previously. She feels forsaken, with nobody there to take care of her health and her daughter’s family: “Who will look after my family, who will take charge of my grandchildren’s education?” On hearing of her son-in-law’s death, she went into a shock and fell down suddenly in an unconscious state. At the time, her main experience was “shattered and shocked”.

She has a great anxiety about her grandchildren and family, with a fear that someone will tell bad things about her grandchildren. She is fearful about having an operation, wondering if it will end successfully or in her death. She is sympathetic in nature.  

Totality of symptoms
Forsaken feeling
Intense anxiety, anticipatory
Shocked and shattered
Ailments from grief, shock
Perspiration profuse , offensive
Left sided paralysis, left sided headache
- Chilly patient
- Ptosis

Prescription: Gelsemium 200 C, one dose

In the course of the next year and a half, the progress is slow but steady. The patient regains her energy, is not drowsy, and she sleeps well; she becomes active and energetic. She has no difficulties with her stool, and her perspiration loses its acrid odor. More importantly, her eye regains its mobility and the eyelid ceases to droop. Her vision improves and her eye ceases to water, as it had previously done. Her pupils are dilating appropriately. Her headaches gradually disappear. In general, she is feeling more secure in herself and is not so “shocked and shattered” anymore.

Differential diagnosis: Gelsemium – Calcium carbonicum
A Gelsemium patient’s reaction is shock: “How could this happen? I was just talking to them yesterday and now they are dead.” Gelsemium feels shocked and shattered.
A Calcium carbonicum patient’s reaction is anxiety from watching or hearing about cruelty, for instance on TV; they leave the room and close their eyes. Although many rubrics suit Calcium carbonicum – fear of operation, fear of the opinion of others, insecurity, dependent, horrible sad stories affected her profoundly, profuse, offensive perspiration, constipation, chilly – Gelsemium is better indicated as drowsiness is more characteristic of Gelsemium than Calc carb. Calcium carbonicum is a right-sided remedy, here the affinity is the left side.

Photo: Shutterstock
Shattered dancer; Markos86

Categories: Cases
Keywords: intense anxiety, shocked and shattered, insecurity, ptosis, headache, sleepiness, constipation
Remedies: Gelsemium


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Arnon Vered
Posts: 7
Reply #1 on : Thu October 02, 2014, 01:51:20
Gelsemium is like a close friend that will come to ones help when things seem dire. It was his sucesses with gelsemium that motivated Hale to write his classic New Remedies. In the essay on gelsemium Hale states that there is still much to learn about its possible applications. A century and a half later this still holds true.Thank you for this interesting case.