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Date posted: April 4, 2012

Dr Jawahar Shah

Time and again every Homoeopath have been taught to consider each and every aspect of the patient before arriving at a remedy and selecting The Similimum.

We have been told to
Study Mentals, … Emotions …Gestures
Study Generals, …Concomittants
Study Past History, … Family History
And so on…..

And I also believe that this is the proper way to practice Homeopathy.
One must study all of the above and then carefully consider the remedy for prescribing.
Plus I also advocate keeping a close watch after the administration of prescribed dosage for the ensuing resultant effects on the patient and constantly compare them with the proving of the prescribed drug as per the source books. This will help us to achieve the cure as per the Herring’s law of Cure.
But as one advances in to the practice and treats a large number of the patients, one comes across the cases where there is a marked paucity of the symptoms and if ever the drug is visible the same would be very hazy and the clear cut choice seems distant.

During such times one of the most wonderful aspects of Homoeopathy is the single remedy rubrics. Many times such uniqueness found in the patient proves a real boon to the practitioners.

A patient can be successfully treated by prescribing a particular drug on the bases of a single peculiarity reveled by them.In homoeopathy all drugs have some unique and singularly peculiar symptoms that exclude all other closely comparable or related remedies.

Belladona -3 Biting Children in
Sepia -3 Rectum Lump sensation of stool not amel by
Lachesis -3 Rectum Moisture menses during
Platina -2 Religious affections, Penance desires to do, wishes to live in order to mitigate her eternal punishment in sadness
Col -3 Nausea soup Agg, odour & thoughts of
Ferrum -3 Desire tomato for raw
Ox – Ac -3 Desire strawberries

To impart further credence to this aspect I present some cases wherein  the presence of uch particular Symptom we have been prescribed to successfully cured the patient.

Case: 1  
A young girl, aged 7 years, had fever since 3 days and was unable to get any relief with the medicine. The fever would rise in the evenings and she was thirstless.
I noticed   the girl constantly asking her mother to rub   her   stomach.  I asked why and the mother told me that the rubbing seem to ameliorate the abdominal pain
Here we find that two remedies came very close
Pulsatilla and the Lycopodium considering the following symptoms
1.Fever increasing in the evening i.e. Aggravation in the evening 2.   Thirstlessness
But here I found the PQRS symptom for Lycopodium that easily ruled out the Pulsatilla i.e.:  [Kent] Stomach; pain rubbing amel. 2 Lyco
So the patient was given Lycopodium 200, 1 dose.
Next day morning, the pain had subsided, the child was  afebrile and  playing around.

Learning :
This single remedy rubric “ Stomach; pain rubbing amel – Kent ” was s very important to differentiate two close seeming remedies and this would have otherwise posed a difficult choice of the Similimum.
Also it projects that even a deep acting; chronic medicine like Lycopodium can be indicated during the acute phase. And appreciation of a single remedy rubric by giving  Lyco 200 one dose made the patient  alright in very short time within 12 hours of giving 1 dose of Lyco.

Case 2: 
A male 77 Years .A case of Bronchial asthma with corneal opacity and retinal detachment.
Asthma -
< Monsoon
< Change of weather
< Eating after
< 11.30 am
< Air conditioner
He also had dry cough +3
< Evening to night
< Cold +3 this led to wheezing.
He has to cover himself up. He feels better after taking warm drinks.
He has trouble in his vision since 1992 during this period he was operated for Cataract in both the eyes. There was a scar left in the left eye which was untreated.
There is haziness of the vision till afternoon he is better in bright sunlight and again the complaints are aggravated after 4-5 p.m.
He has undergone a laser treatment in the US but there was no marked improvement.
The nature of the patient as jovial and easy going. He mixes very easily with people.
He is not satisfied with the present situation and sometimes there are confrontations with his wife. He tries to control his anger. He said he very seldom losses his temper & till this date he has lost his temper on 2 occasions.
He is sensitive and emotional he cannot see emotional movies he gets moved and he cries. He loves classical music. He was student of literature and a production manager by profession.
On further inquiry into his past he said he had a love affair when he was 23 years of age and due to some reason their affair broke but till date he is unable to forget this and while narrating the whole event he started crying. He also requested to keep the whole thing confidential.

Personal History :
Appetite ; good Craving : bitter ++, sweets   Aversion : sour things   Thirst : +3
Perspiration : Nil  Urine : n  Stools : n   Sleep : Disturbed   Covering : Must half of the body must cover his legs.
O/E
Wt : 74 kgs.,  Mild vertical ridges on the nails. Eruptions on the face, moles, Warts
Tongue mild coated, Throat +2, B.P: 140/100 mm of Hg , R.S : Bilateral Rhonchi ++
Here we can consider Lycopodium, Ignatia, and Nat-M but there is a strong mental causative factor- suppressed for so many years and yet unforgotten, this particularity  rules out all other remedies except Nat-M.
Rubric considered is: Complete (Mind) ailments from disappointment deceptions old: 4 Nat-m
This gives us entry to our prescription ……

Case: 3             

Mrs. D.R., a 22 year old patient, weight: 52 Kg., reported with allergic colds since the last three to four months.
She has a continuous running nose with greenish watery discharge.
As soon as she gets up her nose runs continuously.
All the symptoms start immediately after she has washed her face.
She has a feverish feeling, burning in the eyes with headache.
She feels tired, lethargic and run down
When she is suffering she has to go to bed for at least six to eight hours
She also complains of irritation in the upper part of her mouth, nose and throat.
She is better by rubbing the nose and ear vigorously. Face tends to become hot.
Aggravations :
Cold climate;  Air conditioning; Fast fan        Cold drinks, Ice creams, Juice
Touching nose ; Cooking;,                                      Summer, Morning early bath
Change of temperature: nose block (2),   Mental tension (3)
Ameliorations  :
Evening,  By brushing teeth at night,                 Avoid washing of face till afternoon,
Warmth,  Love, affection and consolation,
Concomitants :         Headache
Further information :     She feels the floor is uneven and is bumpy.
Graying of hair at age 21
She has giddiness worse on standing, better lying down.
Irritation with blocked nose.   Nails breaking & cracking
Few eruptions in the face; dark ring around eyes
Acidity
Appetite: normal, avoids food if she has any work to do .
Constipation, worse from tea.
Craving: spicy -2, egg
Thirstless
Urine: Burning sometimes   Stool: semi solid
Sleepy. Ameliorated by going to sleep in afternoon.
If she doesn’t sleep she gets cold and feels unrefreshed.
Dreams: Day to Day life, does not remember
Menses  Dysmenorrhoea. First menses at the age 15 years.
Cycle:  3/25 days.       Occasional Leucorrhoea
Perspiration: summer, stains yellowish, more on underarms and legs
Desires winter   Likes fan but aggravates- 2
Bath: Hot or Tepid water    Covers only legs

Family history :  Father: high B.P ,  Grandfather: heart attack
Paternal grandmother: died of cancer   Mother: obesity and hairloss
She always craves to go to her mothers home.
If her ego is hurt, she thinks about it a lot, but is unable to confront her mother-in-law
The fact that she cannot have a child is known to her relatives.
After they had been married some time they planned to have a child. She consulted a gynecologist. She has no problems but her husband has oligospermia. This hurts her a lot.

She likes to spend money and likes to have her own cash.  At her in-laws place she has limited amount available for spending as she was given only a sum of Rs. One thousand only per month.  Earlier she used to buy one new dress every day; even now she would even buy new dress every day now if she could. She would not like to wear the same dress twice. During the consulting I must have seen her at least 30 different occasions and always she has worn a different dress.

Her friend told me that she does not wear the same dress again during two years and she would change her clothes twice during the day. She is tall, slim, beautiful and fair. Hailing from a very rich family as a child she has been pampered and brought up in a very luxurious and protected environment and always got whatever she wanted. She has two sisters and a brother. Her parents had also given her a lot of money, many dresses and lots of jewellery at the time of her marriage.

Her Mother – in – Law would who was also very egoistic often taunted her.  She was very fat till the age of eight years. OK in studies, graduated in commerce.    Reserved in nature. Takes a long time to mix with people. Only after entering college did she started to make friends.

Forgetful – 2, forgets names -2, forgets her relatives. She is very emotional, moody,. Sensitive-3 Hot tempered and outspoken Talks a lot without reason.  She becomes tense about numerous things without reason.
Husband is good. She prefers his company.  She had tried to please everybody after marriage. But she has been repeatedly hurt by her in-laws. Her mother-in-law frequently insulted her, as she didn’t knew much about cooking or house keeping.
She is better by consolation. Wants to sleep, sleepy -3
Feeling depressed and cries easily -2.  Needs company to go outdoors, even if it is nearby.
Now she is jealous as her sister-in-law is pregnant.
Upset -5 as her sister-in-law is pregnant for the second time.
Very scared of lizards, cockroaches or insects.
After they had been married some time they planned to have a child. She consulted a gynecologist. She has no problems but her husband has oligospermia. She started having negative thoughts soon after that and then she became depressed -2. She fights with her husband but she loves him too. She used to cry again and again.

Follow-up                   November 1995

As Gratiola C200, which is the desired potency, was not available, I had to give Gratiola C6. Because of this low potency, I had to repeat the dose frequently for about two months.

After one week. Better with medication.     
Stool improved. Better passing flatulence.
After one month All complains better.
After six months All symptoms ameliored. No complaints.
After two years Reappearance of the symptoms.

 Gratiola C6 repeated for two weeks.

After due treatment of the couple, She had conceived during the period and now she has accepted her in-laws better.  She is able to cope with family problems, and can express her feelings clearly. She can now adapt a positive approach and take right decisions. She does not allow anybody to suppress her anymore. Her sleep has improved and she started cooking. Her resistance has improved to a greater extent.      

Case: 4
I saw a patient, when I was lecturing in a European country.
A young boy of 7/8 yrs. was suffering from a progressive muscular disease- and he was losing muscle strength. He could not walk. He was not able to do most of the routine activities. He had to be assisted for everything.
His parents had many brothers and sisters but he was their only son, the only male child in the entire family and their only hope of life.
The doctors could not do anything. The case was taken in detail.
The short description is as follows:
The patient can just do basic activities with the help of someone.
He cannot walk but whenever he tries to walk, he literally runs.
He falls on attempting walk backwards.
There was a marked salivation +3 and drooling he had to be cleaned frequently.
Two remedies were coming very close. 1) Mercurius 2) Manganum

Rubric and reference to the Materia Medica 
Extremities : Fall, liability, walking backward
Dictionary of practical Materia Medica:
Paralysis with inclination to run forward if he tried to walk. (Clarke J.H.)
Finally, I re-interviewed the patient and the patient was given
1 dose of Manganum (200).
Later the patient was given a few more doses during treatment.

Reasons:
Both remedies have been indicated for progressive degenerative diseases.
Both remedies have syphilitic expressions.
Merc. has more salivation But Manganum has two clear symptoms like
1) Cannot walk – any attempt to walk, makes him run.
Refer allen’s encyclopedia  and  Clarke’s dictionary.
2)  On attempting to walk backward patient falls.
Complete Repertory- Mind “Fall liability to walking backward”

Result:
Substantial improvement in patient’s condition.
He  could correlate better,  he had a better gait.
He could understand better.
There progress of the disease had halted and showed clear indications of regression.

Learning 

1] Differentiating closely related remedies by using peculiar symptoms.
2] Using single remedy rubrics to differentiate  Merc. And Manganum
3] How a progressive pathology can be asserted.

Case: 5
Mrs.P.J., aged  73  yrs,  diagnosed  as  a  case   of  cardiac  Ventricular-valvular regurgitation  came with a complaint of  severe breathlessness on slightest exertion.
She could not walk even two feet to go the toilet. She would get exhausted. She was breathless even at rest and even unable to lie down. Since 28th Nov., she was in the sitting position because as soon as she lied down, she would get cough and breathlessness again.
Cough, with thick, whitish, yellow expectoration. Restlessness of  the body. Chill running through the body with severe palpitations.
The trouble started when she had chilled water  for many days. She would have cold water with a number of ice cubes in it.
Pronounced weakness. She felt very hot with desire to uncover. She   wanted sips of water frequently. The important concomitant was that she had frequent nausea  and vomiting  with frequent yet ineffectual desire to pass stool. She would retch loudly with  strong nausea and desire to vomit.

She has a lot of fixed ideas.
If she did not want to eat a particular thing, she would pretend nausea.
Repeatedly, she would request her daughter-in-law that she wanted to go away from the house.
She would say, “Get me out of the house, Put me in a hospital  and never bring me back again or take me to the rail tracks and leave  me there,  so that I can die  peacefully. ”
There was constant inclination to go somewhere and at the same  time,  she had a desire for somebody to be near her all the time.  She  would call her daughter-in-law and not allow her to get up  from her bedside. The only thing she can eat is sweet lime. On being coaxed to eat, she would develop epigastric pain, palpitations and giddiness.
Weakness +3.  Feeling as of a hole in the stomach.Bad taste in the mouth. Anger +5. Contradiction, intolerance of ++. Anger expresses her own self. Will not eat for 3/4 days. Used to beat children +5.  Weeping +3. Everybody must obey her order immediately. Everybody must hurry.  Slightest delay would make her angry, Irritable and disturb her for a long time.

Learning
1] Prescription was based on a strong mental concomitant with a major physical illness.
2] Rubric Kent “Mind ; Home, desire to leave home.”
“Throw me out of the house” – at any cost and put me on rail track was interpreted as desire to run away “DESIRE TO LEAVE HOME”
Elaterium was based on this symptom-strong mental concomitant to physical complaint.
3] Finally disease got exteriorized on the skin.
4] Once it expressed on the skin the repetition of medicine has to be stopped. Any further repetition can produce aggravation.
5] Totally immobile patient became mobile in short span of 5 months.

Case 6 
A Muslim patient, reported with severe breathlessness. He was brought on a stretcher. He was feeling hot, was aggravated by cold things and had marked perspiration. He would feel better after having warm drinks.
He could not even talk. (Whatever could be collected of the history suggested Ars. Iod.The patient was given Ars.Iod (6) every 2 hours. After a few days of treatment there was only partial relief.
Once his friend came along he told me that the patient had to stand for the entire night!  He has been doing so for a number of years! The patient would stand holding the bar of a window grill or he would support himself with his hands on his knees for the entire night.

Note:
The importance of history given by a friend or a relative.
The patient was given 2 pills of Cannabis Sativa (6) every 2 hours and  the patient started improving.  The improvement was substantial followed by suppressed discharge coming out and  the asthma got relieved.
Reason :  Asthma better by hands supported on knees.
Result   :   Release of suppression and cure of asthma.

Learning 
1] Importance of receiving history from a friend or relative to complete a case for eg. Asthma better standing history was given by a friend we would have never found the Similimum.
2] Importance of single remedy rubrics in practice.
3] Managing the old symptoms recurrence following Hering’s law of Cure.
4] Appreciating the advance pathology & using low potency repeatedly to produce desired results. The symptoms were matching at the physical level lower potency is appreciated.
The mental symptoms were not available one could not give medium or high potency.
5] Managing suppressed discharge and managing the past history of Gonorrhoea & keeping it away from wife’s awareness is a problem so as to avoid social complications.
Patient never wanted his wife to know that he had suffered from Gonorrhoea.
The usefulness of Single Remedy rubrics in Homoeopathic treatment :
1] Confirmation of a prescription.
2] Differentiating the drug from the closely related remedies in order to arrive at the prescription.
3] To know such PQRS symptoms of the remedy and gainfully utilize this uniqueness for  an otherwise difficult choice for the cure
4] To store these symptoms separately found during proving and or during the Clinical verification.
5] To base a prescription on a keynote.
6] Use this to open a case on the base of single remedy and then corroborate the  choice with the ensuing effects on the patients as per the proving of the drug.
7] Find a partial palliative effects esp. in a pathologically advanced cases.
8] When a strong peculiar symptom rules out all generals.
9] When there is a strong mental concomitant to physical complaint or there is a strong
physical concomitant to a mental complaint.
When not to use single Remedy Symptoms for prescription :
1] Case is clear and complete evolution is available.
2] When case is clear and definite totality for the Similimum is available.
3] When vitality is high, and clear expressions are available.
4] When pathology is not very advanced.
5] When peculiar symptom is in low intensity or it has not been verified or confirmed  clinically

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