Armeen Jasasvala, Alifiya Merchant
A 26-year-old female patient consulted Dr. Tejas Shah on 3rd December, 2013for acute pain in the abdomen, around the umbilical area over the last 5 days. The pain increased on walking and was better after drinking beverages like tea and water. The pain was also alleviated by passing urine and was accompanied by short naps which relieved her. The pain was mainly stitching in nature, as if a needle was poking her. The patient had a similar episode, but of a lesser intensity after 6 months and was better with allopathic medicine. She had undergone some investigations and a USG which showed multiple renal calculi. Renal function tests were within normal limits.
The lady was very sensitive to odours especially that of meat (she was a strict vegetarian) and felt nauseated from any strong odours. On asking about her nature, she described herself as a very angry person who could not control her anger if someone said something which was not to her liking. She felt intensely angry then and though she did not express it, internally she had the impulse to bite, tear, pull the person’s hair, strike and sometimes even kill the person who had offended her. In those moments, she felt very heated up and did not know what to do. She does not forget such incidents easily and keeps getting thoughts about it which she could not get rid of.
She also felt very bad when someone pointed out her mistakes or corrected her, as she did not like being criticized. She was also very sensitive to being scolded. When scolded she felt frightened and wept immediately and experienced trembling in her body. When asked about things that she was sensitive to while watching TV, she spontaneously replied – murder!
On inquiring about fears, she said she was afraid of men before getting married. As a result, when she received proposals for marriage, she refused to speak to the men. She also had intense fear of strangers, so much so, that she could not face them and preferred to remain in another room rather than facing them.
As a child, the patient was very afraid of making a mistake. She was extremely timid and could not have food at anyone’s place and was scared of speaking on stage as well.
Describing her dreams, she said that they were mostly about daily events. She also had dreams about communicating with her father who had passed away when she was just 9 years of age. Talking about this dream, her eyes became moist but she masked her feelings with a laugh. She then stopped talking for a while and said, “It happened all of a sudden. We never expected it and it was like a big shock to the family! We were all stunned. It was the worst moment of my life. Even today I have not forgotten the day. It is as raw for me even now. I wanted to cry but could not cry. I used to faint intermittently on thinking about him while sitting idle.
The patient also had dreams of murder, describing which she said, “It happens so suddenly. A person from nowhere holds a knife and stabs you”. She woke up startled from these dreams and could not sleep again for a long time.
The patient complained of giddiness and a fainting sensation before her menses. She often craved raw mango but got sour eructation from it. She mainly perspired on her face and was sensitive to extremes of weather, particularly to cold weather.
Analysis and synthesis of the case:
According to the Sensation Approach, the symptoms can be divided into 7 different levels based on the level at which they are expressed. When applied to this case, the seven levels of experience can be summarized as follows:
- Name (the name of disease or pathology) : renal calculi
- Fact : Level of expression of local symptoms
- Pain in abdomen
- Location – umbilical region
- Sensation – pricking
- Pain in abdomen
- Modalities :
- > drinking >sleep after
- > urination after
- Smell sensitive to/agg
- Emotion :
- Anger :
- <slightest contradiction
- expression – goes into rage – want to beat, bite, tear, kill etc (do violent things to the opp person)
- in front of strangers
- Anger :
- anticipation – on stage
- Delusion :
- I am criticised
- Dream – of daily events
- Dream of loved ones – talking to them
- Dream murder sees
Reaching the sensation level (level 5) in the case:
Sensation is a level of experience deeper than that of delusion and it encompasses the mind and the body. and since it manifests at the level of both mind and body, it is also called the Vital Sensation.
One of the ways to reach the sensation very easily is to explore the “hotspot” in the case. Hot spot is often the most peculiar or individual aspect of the case which when explored can elicit maximum response from a patient. In this case, the incident of the father’s death acted as the hotspot which when tapped lead to the vital experience in the case which was grief, shock, sudden, unexpected, which was expressed through her reaction of not being able to express, and fainting. In other areas, we see the exact opposite of that, viz fear of losing control and getting violent, rage – biting striking, tearing.
Delusion that is level 4 is the closest to the level of sensation and is comprised of fixed ideas, imaginations and dreams and when explored leads to sensation also. The experience in the dream of murder was sudden, unexpected and like a shock.
Thus from two different incidents, we see here that there is the same sensation and the reaction coming up in the case. The sensitivity with a peculiar sensation and its opposite, is a peculiarity of plant remedies. The issues seen in plants are that of sensation, reaction and polarities of both, where the mineral themes are competitiveness, one up-man-ship, or me versus you or mineral themes of capability and incapability. Hence she needs a remedy belonging to the plant kingdom.
The plant family Loganiaceae has the sensation of sudden, shock, unexpected, grief, not expressed, fainting. So now we try and find which remedy from Loganiaceae suits her best.
Which remedy from loganiaceae?
The remedy from a family can be selected by miasm (depth, pace) at which the sensation is experienced by the patient. However, since this was not very clear in the above case, I analyzed it mainly using the characteristic symptoms, the repertorization of which is:
We see that Ignatia belonging to the cancer miasm from loganiaceae family comes very high on repertorization.
Are the local symptoms covered by Ignatia?
On using bogers grand generalisation we see that Ignatia still covers all the main components of the local symptoms
On one hand we see that the Sensation approach leads us to the family and then to the remedy and on the other hand the traditional approach of materia medica and repertory also leads us to the same remedy. The combined application of both the modern and the traditional approaches is termed Synergy by Dr. Rajan Sankaran and is a very effective approach to successful prescribing. She was given Ignatia 200, repeated infrequently.
Follow up 5th Jan 2014- (1month later):
Her abdominal pain was 40-50% better. She had occasional episodes of burning micturation which settled on its own. Emotionally, the number of anger outbursts had decreased to a great extent and she could now control it well.
24th July 2014-(6months later):
She had been feeling much better with no pain in the abdomen for the last few months. She had mild occasional burning on urination which subsided by itself. Her family felt there were lot of changes in her. She would not get offended and angry the way she did earlier. She has calmed down and become more understanding. They rate it at about 60% better in anger. No dreams at all. Her appetite was good. She had gained weight and was happy about that. She was advised to repeat USG.
Follow up 13-01-15:
A few days back she had burning in urination with coryza and occasional sneezing. Her urine showed occasional pus cells and amorphous material. Other parameters were normal. She was advised Ignatia 1M. She immediately improved.
Her urinary tract infection and coryza were much better. In her emotional sphere, she was almost 80% better. She was calmer. Her generals were fine. Her sleep was good. No other complaint. Her mind continues to be calm.
Her constitutional remedy was infrequently repeated over a period of two years. Overall she continues to do well and has not been taking any other medications.
Note to readers:
Medically – I wanted to rule out causes of multiple renal calculi, especially parathyroid in this case but the patient was reluctant to undergo the test as she could see the improvement on USG.
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(*the above case was previously published in NJH- October 2017 issue)