Clinical Case #4 : Tonsillitis

          One male patient aged 30 visited my clinic for chronic tonsillitis. He had taken lots of allopathic medicines for over 1 year but no relieve at all. Continue recurrent tonsillitis occurs. Patient was advised for tonsillectomy. Patient don’t want to remove tonsils so that he search about alternate way and found out about homoeopathy. Eventually he found my clinic at nearest to his home, he visited me. He is teacher at school and had to speak whole day. Pain was only when eating or drinking.

Patient was very hot. Even in winter he take bath with cold water. Can’t stay without fan at maximum speed. I examined his throat, tonsils are red but left sided tonsil more inflamed. I asked patient from which side pain started in throat? He told me, left side throat was initially painful then after right side also become painful. Clearly, Left sided medicine will come

Stool, urine – NAD

Sleep – NAD

Past history – No any major illness previously

Family history – Father:- A/H

                         Mother:-A/H

I didn’t find any other important symptoms in physical plane so I asked patient about his social life and married life. This is the one knock on his mind. He started telling everything about his life.

Problem started before 1 year since his divorce. He was loving his wife very much but she didn’t understand him. She always finds fault in him and start to fight. We didn’t have any children. I don’t want to leave her but she did not want to stay with him. May be she lost interest in me. I couldn’t accept that she left me.

I was silently listening the patient without any interruption and he keeps speaking continually.

Patient told, I had done many MANTA (Wish) to the god so that his relation may become normal and his wife come back to him. I walked to the AMBAJI MATAJI temple with naked legs which is about 20 km form my home.

Then suddenly patient stopped speaking. I remained silent. He again start speaking. He told, I had done lots of hard work to reach in this position (As school teacher in well-known school). And he was nominated to promote as a principle of school but due to my throat complaint, he was rejected. In his place, one teacher promoted as principle in spite of not as good as him. He had lack of many quality to became principle.

THAT’S IT. Case taking over.

Clear cut remedy came out of this case. That is LACHESIS.

But I still want to conform it with repertorization.

I took following rubrics.

1)      Disappointed Love

2)      Swelling tonsils, Left

3)      Swallowing, Difficult

4)      Religious

5)      Loquacious, Delirium

6)      Jealousy

Lachesis covers all above rubrics. I prescribed Lachesis 30 single dose of 6 globules stat with placebo for 1 week.

Follow up:- Patient came with smile on his face and told me that, The day 1^st visit after 1^st dose, that night he had dinner WITHOUT ANY PAIN. After that he hadn’t suffer for pain for even single time. I examined his throat, for my astonishing, there is no any sign of inflammation. Just single dose of perfect medicine cleared his tonsillitis in just 1 week. That is the power of our homoeopathic medicines. I prescribe him 1 week of placebo.

He thanked me literally 4-5 times before leaving my clinic.

Some Trios of Medicines

In my daily practice I had seen that many cases have clear therapeutic indications, which are very important in acute cases as well as chronic cases. So, in my opinion a physician must have knowledge of therapeutic indication in cases. In chronic cases also, physician must focus on his recent complain of chronic case first, and then he can approach different medicine according to case. Now trios, which are given by our mentors, are very useful in acute & chronic cases. These are medicine which having similar indication yet having differential symptoms. Here some trios of medicines with their differential symptoms, which may help in clinical cases.

Trio of thirstlessness:
Apis Melifica:  Thirstlessness especially during dropsy, with burning micturition.
Desire for cold milk

Pulsatilla: Thirstlessness with dry white coated tongue.
Drinks often & little at a time which provokes vomiting.
Bad taste in mouth.

Aethusa Cynapium: Complete absence of thirst
 Intolerance of milk; all complaints worse after drinking milk.

Trio of pain:
Chamomilla: Intolerable pain with numbness of affected parts.
Over sensitiveness
great debility as soon as pain begins < from heat.

Aconite: Acute sudden & violent invasion
scream with pain, intolerable, drive him crazy with restlessness.

Coffea Cruda:
great sensitiveness to pain & pain seems almost insupportable, driving patient to despair.
Pain with insomnia.

Trio of croup:
Aconite: Hoarse, dry croupy cough.
Dry hacking cough worse at night & after midnight.
Loud labored breathing, shortness of breath.
Oppressed breathing on least motion.

Spongia: Croup worse during inspiration & before midnight.
Feeling of plug in larynx, cough after eating or drinking warm things.
Awakes in fright; feels as if suffocating.

Hepar Sulph: Croup with loose, rattling cough.
Cough excited whenever any part of body gets cold or uncovered.
Chocking cough.

Trio of restlessness: 
Arsenic album: Mental restlessness but physically too weak & exhausted to move about.
Restlessness with great prostration.
Sinking of strength out of proportional to degree of illness.

Aconite: Restless with intense nervousness; can’t remain in one place.
He is full of energy , vigor & strength; as such moves frequently.

Rhus toxicodendron: Can’t stay in one place. Must change position frequently to obtain relief from pain.
Great rigidity , stiffness & lameness.
Pain on 1^st moving the joint after rest or on waking up in morning; > by waking / Continued motion.

Trio of flatulence:
Lycopodium: Accumulation of gas & flatulence in lower abdomen with loud grumbling, croaking.
Rolling of flatus as through fermentation was going on.
Not > by passing flatus & eructation,
Belching always sour & acrid.

Carbo veg: Simple food disagree, causing excessive flatulence; weak digestion.
Abdomen is full to bursting point especially on UPER PART.
<: from least food; >: eructation, on passing flatus

China: Tympanitic abdomen with much flatulence & belching which gives no relief.
Great distension of entire abdomen; sensation as is abdomen is full of gas.
Each food particles seems to have turned into gas.

Trio of sleepiness:
Antim tart: Irresistible desire to sleep nearly with all complaints. Great drowsiness.
On falling asleep feels electric like shocks.

Opium: Sleepiness from nervous irritation.
Great drowsiness; falls into heavy stupid sleep.
Profound coma; loss of breath on falling sleep. Picking at bed clothes. Very sleepy but can’t go to sleep. Sleeps with half eye opened.

Nux Moschata: Drowsiness & sleepiness which accompany all ailments.
Complaints cause sleepiness. Coma.

Trio of burns:
Sulphur: External burning; all over the skin in the parts on which he lies.
< From heat of bed & covering.

Arsenicum album: Violent & acute > by heat, except in head which is > by cold.
Burning with marked prostration & restlessness.
Burning especially in acute disease; < mid-day, mid-night.
Has fear of death

Phosphorus: Internal burning; anywhere & everywhere all over body.
Burning in spots along the spine between scapula, of the palm, hands, in chest, lungs etc., < evening.

Trio of prolapse of uterus:
Sepia: Bearing down pressure from back of abdomen. Must cross her legs to prevent protrusion of parts.
Mentally pt. is very indifferent & apathetic with complete absence of sexual desire.

Lilium tig: Bearing down, everything forcing down, as if contents of pelvis were being pushed down through a funnel, the outlet being vagina.
Must support vagina with her hands; mentally pt. is hurried, worried; sexual desire much more marked.

Murex: prolapse of uterus with sore pain. Profuse & excessive hemorrhage. Intense sexual desire. Must keep her legs tightly crossed. Pain from rt. Side of womb to right / left breast. Nymphomania.

Trio of delirium: 
Belladonna: Delirium with throbbing of carotids, the heat, redness & congestion of face & conjunctiva; when it passes away then delirium subsides.
In proportion- great violence & excitement.
Flood of subjective visual impression & fantastic illusions. Hallucination; sees monsters, hideous face.

Hyoscymus: Non-inflammatory type of increased cerebral activity. Ridiculous gesture.
Horrible lascivious mania & desire to remain uncovered.

Stramonium: During delirium, pt. gets up & wants to escape; difficult to be located.
Loquacious, furious delirium but not much inflammation found. Religious mania.
Strange delusions about his own identity.

Trio of offensiveness:
Baptisia: Offensive breath, ulcerated mouth with offensive smell. All discharges like urine, stool and sweat are offensive. It is very difficult for doctor to examine the patient.

Kreosote: With offensiveness, there is acridity, putridity of all discharges.
Cadaverous smelling with corrosiveness of discharge.

Mercurius: Offensiveness with profuseness of discharge foulness pt. as a whole smells offensive.
Discharges are bloody, profuse & offensive.
< At night.

Trio of offensive urine: 
Benzoic acid: Urine dark, brown, scanty & urinous odor. Highly intensified. Nocturnal enuresis.
Repulsive odor, changeable color. Cystitis.

Nitric acid: Scanty, dark offensive urine, smells like horse’s urine. Cold on passing. Burning & stinging.
Urine- bloody & albuminous. Alteration of cloudy, phosphatic urine with profuse urinary secretion in old prostatic cases.

Sepia: Red, adhesive, sand in urine, Involuntary urination, during 1^st sleep.
Chronic cystitis. Slow micturition with beating down sensation above pubis.

Trio of ptosis:
Causticum: Ptosis, vision impaired as  if film were before eyes. Paralysis of ocular muscles after exposure to cold. Inflammation of eyelid.

Gelsemium: Heavy eyelids; ptosis.
Pt. can hardly open then. Double vision blurred. Smoky. Dim slighted; pupils dilated & insensible to light. Orbital neuralgia with contraction & twitching of muscles.

Sepia: Muscular asthenopia.
Black spots in field of vision. Tarsal tumor; ptosis cilliary irritation.
Venous congestion of fundus.

Trio of warts:
Causticum: Warts large, jugged, bleeding easily on tips of fingers & nose.
Cicatrices freshen up- old injuries reopen.

Dulcamara: Warts large smooth, on face & palmer surface of hands.
Thick, brown yellow crusts; bleeding when scratched. <: in cold, wet weather.

Thuja: Warts in ano-genital region. Eruptions only on covered parts. Brown spots on hands & arms. Coldness of one side.

Trio of diarrhoea: 
Gambogia: Rumbling & rolling. Pain & distention of abdomen from flatulence, after stool.
Dysentery, diarrhoea with sudden & forcible ejection of bilious stool. Tenesmus after, with burning at anus. Profuse watery diarrhoea in hot weather.
Pain in coccyx.

Gratiola: Diarrhoea; green frothy water followed by anal burning. Forcibly evacuation  without pain.
Constipation with gouty acidity. Rectum constricted.

Oleander: Undigested faeces. Stool passes when emitting flatus. Burning pain in anus.
Gnawing around navel.

Apis Mellifica

General Introduction about Apis Mellifica:
Apis Mellifica is medicine from animal kingdom, which is prepared from poison of western honey bee (Apium Virus). This bee sting produces stinging pain, burning, redness, soreness & puffiness of particular affected part. Pain from bee sting is too much that it will make any person cry!

Apis Mellifica has few characteristic symptoms which we should keep in mind which are HOT+TIRSTLESS+RIGHT SIDED. If one is going to approach a case with these symptoms then he should keep apis in mind. Well, thirst of apis has peculiarity which is thirstless is marked but especially in dropsy but it is thirsty when there is chill stage of intermittent fever.

Clinical Uses:
Abscess, apoplexy, asthma, carbuncles, constipation, diarrhoea, DROPSY, eye affection, gangrene, intermittent fever, renal affection, skin affection, urinary complain & more.

Action of Apis Mellifica:

It acts on cellular tissues, glands, skin, urinary organs, and serous membrane.
Constitution of Apis Mellifica:

Apis is adapted to person with strumous constitution (goitrous). Enlarged & indurated glands, Scirrous or open cancer & tendency to dropsy of external coverings.

 Bag like swelling under lower eyelids. Pale, waxy, oedematous face. 
Temperament: irritable temperament.
Thermal: HOT patient.
Miasm: Psora in the background.

Diathesis: Scrofulous.

Mental/ Mind symptoms of Apis Mellifica:
          Apis patient is very much awkward, he drops things easily while handling things; so when we see a patient with butterfingers that patient might be apis.
          Person who cannot concentrate his mind while reading or studying are might be apis patient. Apis patient cannot keep his mind in studying. Patient cannot think clearly.
          Apis patient is very irritable, nervous & having fidgety. Patient maybe irritable due to unbearable stinging pain.
          Apathy, indifference & unconsciousness are well marked in apis. Weeping disposition; cannot help crying; he is quite discouraged.
          Muttering delirium, loquacity; suppression of rosy eruption. Stupor alternating with erotic mania.
          There is fear of impending death. Jealousy & suspicion.
          All mental complains aggravates from heat & in warm room, better by after cold weather.

Physical general / key-note symptoms:
         
          Apis affects right side of the body. In apis symptoms goes right to left. As apis is hot medicine its general modalities will be aggravation from heat / warmth & its amelioration will be cold in general.
          Pain: burning & stinging pain which is suddenly goes one part of another part of the body. Apis is great pain remedy.
          Oedema: puffy, bag like swelling under the lower eyelids. Here is difference in apis mellifica, kali carb & phosphorous; kali carb has bag like swelling but in upper eyelids, but in phosphorous has puffy swelling around eyes. Swelling of hands & feet.
          Dropsy: Dropsy & fever with thirstlessness & scanty urine. In dropsy skin become transparent, with a waxen look, whitish yellow. There is ‘dropsy of brain’ that is hydrocephalus. Hydrothorax especially when the trouble is of cardiac origin. He feels suffocated as if every breath would be his last breath, especially in dropsical condition.
           There is aversion to tight clothing, bandage. He cannot tolerate tight clothing around waist, he must loosen them. There is extreme sensitiveness to touch.
            Skin is dry but alternates with perspiring. Tongue of apis is fiery red.

           Urinary symptoms: painful & burning micturition, scanty urine which is coming in drops. As soon as few drops of urine collect in bladder, he has sudden urge to urinate; constant ineffectual urge to urinate. There is great incontinence of urine with great irritation of parts. He scarcely retains urine for while.

A case of apis mellifica:
          When I was in my internship days, I used to learn under some homeopaths. One day a lady came with her complain regarding pain in feet & weakness. My sir & I both learned detailed case but on her first visit sir gave her only placebo. Then sir told me that he need more time to understand case. After that sir asked that lady to visit another time & he gave her natrum mur. But when sir prescribed her natrum then I wasn’t there to ask why he had given her natrum mur. After few follow up she came to visit but then sir wasn’t present there so I asked her how she was. Is she having improvement? She said no doctor I have no relief in complain. Then I decided to re-take the case found strange thing that she said she had feeling of stinging in her feet. I asked few more question which was indicated that medicine was actually apis mellifica! Then I gave her apis, and next week she came & said doctor I have such relief! I think she had 75% relief in her all complain. Then I told sir what was happened. After this incidence I learn apis mellifica & this event show me the genius of this wonderful remedy!

Obstacle to cure : Diet & regimen

            Homoeopathy is application of minute dose of medicine for the treatment of various diseases. The action of this small medicinal dose should not be disturbed or removed by any foreign medicinal irritant through diet or regimen.

Diet & regimen in Chronic diseases:-

Careful investigation of diet & regimen which may act as obstacle to cure is necessary in chronic disease. This disease causing or maintaining errors may passed unnoticed which results in failure to achieve cure. Master Hahnemann has advised to avoid following type of diet & regimen in patient suffering from chronic disease.

1) FOOD:- Highly spiced foods & dishes of herbs, roots & stalks of plants possessing medicinal qualities, ONIONS & crude medicinal vegetables. All excesses in food & in use of sugar, salt, spirituous drinks. Chines foods are highly spiced with various oils mixed should avoided during treatment.

2) BEVARAGES:- Coffee, Herbal tea, liquors, beer made with medicinal substances, perfumes. Coffee & tea are most popular beverages all around world. It often become obstacle to cure as this drinks removes medicinal action of medicines.

3) TOILET ARTICLES:- Tooth powders, strong scented flowers in room, perfumes, odorous water.

4) CLOTHING AND MODE OF LIFE:-

- Sedentary life style

- Uncleanliness

- Long-time stay in heated rooms

- Woollen clothing next to skin

-  Onanism or suppressed sexual intercourse

- Poor living, Damp rooms

- Over exertion of body or mind.

Above all things are obstacle to cure. This all may result in failure in achieving cure. Let me tell you about one of my clinical case.

CASE :- One of my patient was taking medicines from me for his eczema. He was suffering for over 1 year and visiting my clinic for over 4-5 months. Now, I couldn’t recall which rubrics I had taken but single medicine Sulphur came after rapertorization. Sulphur was covering 8 out of 8 rubrics. I prescribed it in 30 potency but in follow up, no change at all I got. I tried 200 potency and even sulphur 1M also I prescribed but no change in eczema found. This all changing potencies runs for 4 months. I retake the case but after rapertorization, only 1 medicine came Sulphur. What will you do when your best selected medicine fails in give result? I couldn’t understand why my selected medicine didn’t bring cure. I decided to retake case again.

             During case taking I found out that patient was drinking COFFEE 4-5 times/day. I became damn sure that coffee is the OBSTACLE TO CURE in my case. I asked patient to stop drinking coffee and prescribed sulphur 200 single dose with sac lac TDS for 7 days. In next visit, patient’s eczema decreased about 30 %. On following visits, patient was completely cured.



         I faced failure then after I learned something that I will never forget in my lifetime. I am sharing this knowledge to you so that you don’t have to face what I faced. Diet and regimen is very important things while treating chronic cases. My personal advice is not to change medicines too rapidly if you don’t get results. First try changing potencies if didn’t get result then check for error in case taking as for example, diet and regimen and still not getting the result then only change remedy according to case which is most similimum.

The Follow Up

When physician had taken the case & prescribed similimum medicine, the physician expects response in patient’s condition. What should a physician do when patient came for follow up? Answer to this question depends upon patient’s reaction toward remedy. Dr. J.T. Kent had given us possible twelve observations which are made after administration of the similimum medicine. Which are—

1.    A prolonged aggravation & then final decline of the patient.

2.    Long aggravation but final and slow improvement.

3.    The aggravation is quick, short & strong with rapid improvement of the patient.

4.    No aggravation, with recovery of the patient.

5.    The amelioration comes first & the aggravation comes afterwards.

6.    Too short relief of symptoms.

7.    A full time amelioration of the symptoms, yet no special relief of the patient.

8.    Some patients prove every remedy they get.

9.    The action of the medicine upon provers.

10.                     New symptoms appear after the remedy.

11.                     When old symptoms are observed to reappear.

12.                     Symptoms take the wrong direction.

So, these were twelve observations that Master Kent had given. What changes we sought in patient after giving similimum medicine?

We as a physician should look for both good & bad changes. What will physician will do in follow up? When patient had taken given homeopathic similimum medicine & then come for his further follow up, physician needs to look for changes in patient. Which may be good or bad, but one should know what needs to be done, especially in chronic cases & in acute also! So now what changes one have to find in case? Answer of the question is depend upon case, there may have following possibilities—

1.    Case has some aggravation but relief in complain.

2.    Case is in standstill situation after little improvement.

3.    Patient produces other symptoms which are not of current disease, but of medicine which is given to the patient in first prescription.

4.    Patient does not react to the medicine.

5.    Patient’s response to the first prescription is in satisfactory or good enough.

6.    A complementary medicine needs to be given.

7.    Case shows new group of symptoms, that is symptoms changed but there is no relief to the patient.

8.    Case shows symptoms of another miasm that the case had before. 

All these possibilities I had seen in my practice were based on twelve observation of Dr. J. T. Kent. I had seen that many of my students do not follow these observations during their practice. I insist them to do so.

Now if physician have above mentioned possibilities in the follow up, then he must give further prescription according to the case. Let’s understand these.

·       When a case has some aggravation but relief in complain, that means our medicine had acted. When medicine is right then there will be homeopathic aggravation. (Ok for those who are wondering what is homeopathic aggravation; it is slight, but noticeable intensification of patient’s current symptoms after given similimum homeopathic medicine, along with simultaneously better feeling.) Homeopathic aggravation is good sign in case. By which we can interpret that the case is curable & prognosis is quite favorable. Then one must not disturbed given medicine till it completes its action, one can give placebo for patient’s satisfaction.

·       When to repeat dose? Yes the repetition is necessary in some cases. When physician gives first prescription & then wait for its reaction with patient & finds that the medicine is acting and patient having improvement. But after some days or weeks may be patient stop improving. So then the repetition of the medicine (which was given in first prescription) is must. But to do so one must have to wait till medicine had acted in first place. And there is another situation where one can repeat same medicine. When first prescription had acted and there is relief to patient, but after some days original symptoms of case are seems to appear then one can also repeat the same medicine.

·       As I mentioned above ‘Patient produces other symptoms which are not of current disease, but of medicine which is given to the patient in first prescription.’ Then what one should perceive? & what should do? It is quite simple it is wrong medicine! In this case patient must be antidote first. When patient says medicine cured me those symptoms but now I have these symptoms. Ok means medicine is partly indicated but still it is wrong one. For curing the case one must give similimum medicine. So when wrong medicine given & it produces ill effect on patient then it must be antidote.

·        Patient does not react to the medicine means given medicine & potency is wrong. So what one should do in this case? He has to re-take the case thoroughly. When patient does not react to medicine this condition is call “status quo.”

·       What happen when we give wrong potency? There may be two possibilities; one can be higher potency than it needed or another is lower than it needed in case. If there is high potency then it will produce more aggravation in case, which is completely unnecessary. Yes our master Hahnemann said that potency & dose should be minimum, to avoid unwanted aggravation. What if potency is lower than it needed? Simply it will give relief to patient nut not satisfactory. So if the medicine is similimum than one must change its potency. Dr. J.T. Kent had given an opinion regarding potency that same potency be not repeated on more than two times.

·        We give exact similimum medicine to the patient but failed to complete cure. There are relations between remedies, and there are medicines to complementary to other medicines. In these cases our follow up should be complementary to first one.

·        When case shows new group of symptoms, that is symptoms changed but there is no relief to the patient indicates a new medicine. But before give another medicine make sure that these symptoms are not symptoms of the medicine given. If it is not, then on basis of current totality one should give another medicine.

A physician is dealing with case, suppose it is psoric case. During anti-psoric treatment patient shows symptoms from another miasm which may be sycotic or syphilitic, then he must not give anti-psoric treatment, but he should re-investigate case and have to change his way of treatment. That means he should treat the current miasm that case posses.

So, this was about the follow up, hope it helps in case study.