Breaking the Ice of Favorites and Exploring the Unknown

- By Interns: Shweta Dhulekar, Nitisha Gala

Under guidance of Dr. Kamlesh Mehta, Reader, Dept. of Case Taking and Repertory

Case no: 3053* Date of Consultation: 2/ 4/2007

Case taken and processed by: Shweta Dhulekar, Nitisha Gala (Interns)
Kshiteej, Zalak (Students)
Hon. Homoeopathic Physician: Dr Kamlesh.Mehta M. D. (Hom.)
Unit Head: Dr. Jai Patel M. D. (Hom.), Unit: Repertory.

Name: Mrs. P. P.
Age: 40 years Gender: Female Marital Status: Married since 25 yrs
Children: 20 yrs old son and 15 yrs old daughter
Address: Mumbai Western suburb in slum area Occupation: Housemaid

C/c:
Pain in anal region since 3 months. Frequency: Pain-2-3 episodes/week
Sensation: “Biting” “pricking” type of pain. Itching with pain, Swelling felt at anus
Modalities:
Pain-<during passing stools < spicy food >after passing stools about half to
<sour food < during menses (1st day) one hour
< Non veg and papaya > by hot or cold application
Stools: Soft, no straining, no bleeding, no mucus. Occasionally blood spots on stool
associated with pain

H/o:
Pain in abdominal region – Rt. lumbar region in last 2-3 days, nausea. Today no pain

Patient as a person:
Likes: Sour food, Thirst: 4-5 glasses a day
Urine: normal, Sleep: normal, Perspiration: normal
Sick on riding bus.

Gynaecological H/O:
Menses: 2 days, Dark red, every 25-28 – regular, no staining or odor. No complaints
Obst. Hisory: G3P2A1L2

Mental Symptoms and Relevant Situation: She was given address of this place a week
ago but couldn’t come as she didn’t know the place. She always has a fear that she will loose
the way home and would not be able to return to her house. She called our hospital for proper
way. She was given landmark of Cooper Hospital. Since she had come to Cooper Hospital
before, she could come.

Thermal Reactions: ? Hot

*OPD of Mumbadevi Homoeopathic Hospital, attached to Smt. C. M. P. Homoeopathic Medical College,

Superintendent: Dr. N. O. Goel M. D. (Hom.)
Family and Past History:
F/H – Brother ? Ca 6-7 yrs back P/H – Operated for fibroid – 10 yrs back

Seen by Hon. Surgeon: On Inspection: Fissure in 6’oclock position which was having
induration on palpation. Impression: Fissure in ano acute on chronic

Diagnosis: Fissure in ano - acute on chronic (6’o clock position)

Approach:
Obvious choice for Fissure in ano with intense pain was Ratanhia peruviana. This is a great
remedy for the condition and learnt in the therapeutics. More over it was ‘acute pain’ and
nothing much was obtained in the case so our target was to make her free at least from the
pain. Hence we thought it as specific drug.

Dr. Boerick’s Materia Medica was referred. The relevant reference is stated below:
‘Aches, as if full of broken glass. Anus aches and burns for hours after stool. Feels
constricted. Dry heat at anus, with sudden knife-like stitches. Stools must be forced with
great effort; protrusion of haemorrhoids. Fissures of anus, with great constriction, burning
like fire, as do the haemorrhoids; temporarily relieved by cold water. Fetid, thin diarrhoea;
stools burn; burning pains before and after stools. Oozing at anus. Pin-worms. [Sant.; Teuc.;
Spig.] Itching of anus.’

It was hard to move from ‘specific’ drug for the condition to relive the suffering, but the type
of pain, its severity and duration with type of stools that Ratahnia can produce was not
matching to the description required to be cured.

Second best specific choice was Nit. acid for the condition like fissure in ano. References
from Materia Medica did not support its curative power of type of pain and bleeding with
patient’s symptoms.

Other point was her fear about losing her way at this age . Reference from Synthesis
Repertory 9.1 page no. 122 stated: Fear, losing one’s way home; of – cassia s. (Source
CCRH). It was unknown remedy and we knew nothing from where to refer; and also just to
prescribe on one mental symptom in such acute pain.

As there were no other data, it was difficult to proceed further and we were tied up from not
to prescribe ‘specific’ drugs unless they match Materia Medica details. Then we started to
look at the case differently after the discussion in OPD, excerpt of it is given below:

 Case is not an acute but a chronic case. It was acute exacerbation of chronic case as in
between attacks also she was not free from her symptoms completely.
 It was important to note that despite soft stools and easy defecation, the patient
developed fissure.
 Another point to be noted was her fear at this age about loosing her way.
 In all the cases we homoeopaths need to prescribe ‘Case Specific’ remedy not
specific for pathological condition, disease, location or miasm.
Now our venturing began.
On referring Synthesis Repertory 9.1 page 1018: Stools, soft – Cassia s.

As some correspondence to Cassia soph was seen in the case it was worth exploring further.

We approached CCRH unit in our hospital and requested to get monogram. We could
correlate the following symptoms in the monogram:
1. Mind: fear of losing way to home
2. GENERALS - COLD - amel. ( ccrh1, cdd7 )
3. GENERALS - WARM - amel. ( ccrh1 )
4. STOOL - SOFT ( ccrh1, cdd7 )
5. ABDOMEN - PAIN - menses - during - agg. - first day - cramping ( ccrh1 ) which is
not present in the case but it suggests that the remedy has during menses < esp. on
the first day.

Remedy Selection: Hence the choice was Cassia sophera. Only mother tincture was
available. We prepared up to 6C at our pharmacy department.

Progress Notes:

2/4/07 As references were to be taken, patient was kept on SL

9/4/07 Pain in anal region once a week, pain in abdomen-0- Generals N

Rx Cassia sophera 6c HS for 3 days
SL 30 tds X 15d
23/4/07 Pain in anal region >> 1st episode 15 day during her 1st day of menses
says fear of visiting new place is much better
Rx cosmos 30 tds I month
24/6/07 Pain in anal region>>
Rx SL 30 tds 1 month

Learning:
1. As per APHORISM 257 not to become victim of favorite/ known drugs routinely:
“The true physician will take care to avoid making favourite remedies of medicines, the
employment of which he has, by chance, perhaps found often useful, and which he has had
opportunities of using with good effect. If he do so, some remedies of rarer use, which would
have been more homoeopathically suitable, consequently more serviceable, will often be
neglected.”
2. Referring different sources like recent repertories and source material medica.
3. Not to compromise but to work qualitatively.
4. Confidence in making potencies which we saw acting clinically.

Thanks to:
1. Case Taking and Repertory Department
2. Pharmacy department
3. Materia Medica Department
4. CCRH regional department.