A thirty-seven year old married woman consulted us on 14th July 2011, with pain in the abdomen. The whole case was given in Hindi, the patient being originally from a neighboring country. The meaning of local words in our national language varies, so initially there was a lot of difficulty in communication. The case was first taken by two resident doctors at The Other Song Clinic, who prescribed for her totality of symptoms, but over two months’ time she showed little improvement. Hence she was referred to Dr. Sankaran.
The patient described pain in the entire right side of her abdomen, as if something is pricking or biting her there. It is almost a continuous pain, and it has been with her for two to three years. A doctor told her that it is due to a lump in her abdomen, which was diagnosed as a left ovarian hemorrhagic cyst. The following are the test results from an ultrasound performed on July 11th, 2011
When asked about the exact location of her abdominal pain, she indicates two areas: the right lumbar region and right iliac fossa, often going into the right side of her chest, which she has experienced on and off for the past three to four years, but which has been aggravated and continuous for the past week. The whole area feels heavy, ‘kadak’ (hard) and ‘caught up’, as if jammed or stuck. The pain is worse by sitting or by remaining in one position, and is better when walking or by changing position- she experiences this modality when she is lying down as well. Her pains are mainly aggravated when she is works for long hours and in cold weather. She mainly describes the pain as a lot of stiffness and heaviness of the parts.
Besides this problem, she complains of severe dysmenorrhoea which causes heaviness in the abdomen and back, and further aggravates her chief complaint of abdominal pain. Also her joints, especially the interpharyngeal joints, have become painful and stiff, particularly during wintertime, for the past few years.
There was a good deal of interesting background discovered by the resident doctors when they first took her case. They had to take some time to coax her story from her, giving repeated explanations as to why it was important in finding her a good remedy, as she believed her life history and emotional stresses to be irrelevant to her physical problem.
The main thing observed by the resident doctors was that in all things, the patient was anxious. She worked as a member of a security team for a reputed firm. A few years previously, her husband had met with an accident which left him with hemiplegia. As a result, the responsibility of supporting her family and bringing up her three children fell completely on her shoulders. So she became very anxious about money matters, like paying the rent, meeting her husband’s medical expenses, and paying for the children’s education. So when she developed severe pain, for which she had so far been unable to find any solution, she became all the more anxious. She said that she used to feel “ghabrahat” (suffocating restlessness) and fear when she was confronted by someone over money matters, or when was asked by the landlord to pay the rent. She would just stand and listen and would not be able to reply.
As she gradually opened up to the two residents taking her case, she described about how she had been married off at a young age, and had to move from her village in a neighbouring country to an India city where her husband was working. In the beginning she was very scared to be among so many strangers, and she used to feel very much alone, as all her family were back in her native place. She used to be very scared of rickshaw drivers, thinking they would kidnap her and sell her off. As she did not know her husband well, she sometimes even doubted him, thinking he would sell her off for money.
In her current situation she often feels all alone, as if there is no one to help her. She said that she is afraid of sleeping alone at night.
The patient was very quiet as a child. She is afraid of talking to men. She avoids conversation out of the fear that if a quarrel or fight were to ensue she would have no one to support her.
She had many dreams during childhood, most notably recurrent dreams of flying high and then falling, during which she felt fear. Now she has dreams that she is offered meat, and she eats it.
She is generally angry when contradicted or when there is a lot of noise around her, and she hits the children in anger. She is not very hopeful of getting well.
She perspires most on her upper lip.
The main complaint of the patient seems to be musculoskeletal, having no apparent correlation to the pathology of left ovarian cyst. The pain, which is very severe, is worse when sitting or when at rest, with relief when walking or changing positions. And her pains are mainly expressed as ‘stiff’ and ‘heavy’. Such pains with postural modalities of being aggravated at rest and better when in motion are characteristic of the Anacardiaceae family.
The patient has a feeling that she is all alone, with no support of any sort from her family, including her husband, father and brothers. There are also underlying fears of being sold off by her husband and of being kidnapped. Furthermore, the patient is not very hopeful about her recovery. The feelings of being isolated and helpless and having very little hope are indicative of the leprous miasm.
We see specific symptoms in the dreams of falling, with fear, and of eating meat – these are both found in the remedy Rhus glabra, which is a leprous miasm remedy belonging to the Anacardiaceae.
The main rubrics of the case are as follows:
On considering the rubrics which are very specific to the patient, we get:
Prescription: Rhus glabra 200C, a divided dose which is dissolved in water, two be taken twice a day for 2 days.
She received the 200C potency because she had a lot of anxiety and many symptoms manifesting at the emotional level. She was given the medicine in the centesimal scale as her complaints were non-progressive.
Follow-up on 27th October 2012
The patient says that there is still some pain in abdomen, but it is much less than before. The chest pain is now gone. She says, “When I do get the pain, the intensity is much less and I can tolerate it.” She says that the intensity has reduced by 75%. She is no longer experiencing dysmenorrhoea.
She says, “When I have more tension, or when I do not eat on time, it affects me, and the pain starts. Suddenly when I get tension, I get a sort of zhatka in the right side of my chest (as if pain of heart attack) Once or twice it happened. There is a sudden lump-like sensation which is very tight, pulling, tight. When I get the pain, I sit and bend my legs and put pressure on the abdomen, then I feel better. I cannot sit or stand straight at that time. I feel as if there is an insect inside and that insect is eating away at my muscles.”
She tells us that with stress she used to get a headache, but that is also much better now.
Her sleep is good. She says, “I had a dream of a robber who was entering my house when I was sleeping. I was trying to shout, but I could not. I thought he might steal my mangalsutra. I was afraid. I thought if he just steals it that is okay, but what if he kills me?”
Her energy levels are good.
She says, “Now there is no ghabrahat. Before I used to get very afraid, with palpitations. These episodes would come suddenly. And now if someone says something confrontational to me, I don’t get frightened. I used to get tense due to the smallest things, but now, though the same stresses arise, I don’t react like that. And I’m no longer afraid of sleeping alone at night.”
When asked about her overall level of improvement, she says, “I am much better, almost 75-80%. I am just getting occasional episodes of abdominal pain, joint pains and headache.”
An ultrasound was again done on April 24th, 2012, with the following results:
1. “A Mangalsutra (Mangala sutra, Mangalasutra or Thaali) is a symbol of marriage union in India. It is a sacred thread of love and goodwill worn by women as a symbol of their marriage. Traditionally the mangalsutra is considered the most revered token of love and respect offered to the bride during the marriage ceremony.” – Wikipedia. “Mangalsutra”. http://en.wikipedia.org/wiki/Mangalsutra
This is a case where the Sensation approach was used since the Sensation was quite prominent and clear . Getting the sensation from the chief complaint and identifying the miasm helped to close in on the remedy, which was then confirmed with some characteristic symptoms.
Dr. Rajan Sankaran, Head, The Other Song: International Academy of Advanced Homoeopathy
Dr. Rishi Vyas & Dr. Sneha Thakkar, Senior Resident Doctors