Integrating the Prognosis in the Homeopathic Treatment or the Learning Process in Homeopathy

Abstract

When the defense mechanism weakens, we can expect that prescription on totality becomes more and more difficult. The useful symptoms to find the correct remedy will become less and less. This case of headache presents with immune deficiency. It shows the need to have insight in the different strategies and techniques to be able to judge the symptoms and come to the right prescription in cases with a lower overall state of health.

Keywords

homeopathy - headache - pathology-oriented analysis - immune deficiency - level of health - Ferrum phosphoricum

Anamnesis

[Number] refers to symptom grade.

A 32-year-old lean [⅔] woman consults me because she has been having headache for months [3]. It used to be pulsating pain on the vertex, as if it was going to explode, that aggravated in the afternoon at around 17.00 hours [3]. But now the pain is different every time and changes places constantly. The pain is worse from stress [3], noise [⅔], sun on her head [⅔], motion [2], jar [2] and jumping [2]. It is better from massage [2]. She has had several studies done, but no reason could be found for the headache. When she was 10 years old, she has had concussion, but no headache afterwards for years.

The last 2 months she has severe pain in the wrists and index fingers [⅔]. This is worse on holding things [⅔]. Her sister has the same problem. I observe some swelling of the right wrist near the hand. She also has a painful swelling on the right big toe.

When she is under stress, she gets a sore throat [3] and loses her voice [2]. Last months she gets severe pharyngitis with high fever and white patches in the throat. Once she got severe diarrhea with colic afterwards, for which she took Arsenicum album 30C, Chamomilla 30C and Colocynthis 30C.

Her sleep is bad. She has difficulty falling asleep because she keeps thinking about small things [⅔] or because of headache [2]. She falls asleep at around 2.00 hours and sleeps until noon. She wakes up tired [⅔], exhausted, without strength, as if being an old person. This is also better from massage [2]. She prefers to sleep on the abdomen.

She has, what she calls, neuralgic pain all over the body, stitching-shooting pains here and there [2].

During ovulation she has shooting pains in the ovaries when stepping [2]. She has been pregnant twice. Her first child died after birth from suffocation due to the gynaecologist's mistake.

The papillae on the sides of the tongue are enlarged and inflamed and give a constricted sensation [2].

When lying she has irregular heartbeat [2].

When she becomes excited, she gets red spots on the neck [2].

She has cold hands and a hot head as if she was having fever [⅔]. In general she does not like too cold or too warm weather [⅔].

She has an aversion to shell fish [2]. She stopped eating meat when she was 17 years old. She eats all other things. Her thirst is normal.

She is affected by every little emotional stress [3]. As a child she became angry easily with pulsating carotids. Still she becomes angry easily, especially when contradicted [3] and touched slightly [⅔]. She prefers hard touch, which gives problems with her boyfriend. She is also irritable during headache [3]. She always wants to stay at home because she is afraid to get headache. She has fear of the dark, snakes and sleeping alone [⅔].

She was born with asphyxia, was cyanotic and did not cry. She was given antibiotic in the hospital for staphylococcal infection. As a child she was given antibiotic regularly for sinusitis but became resistant to it and was given Biseptol, a strong complex antibacterial medicine. Later she had recurrent otitis media with high fever and swelling of glands of the neck. When she was 10 years old, she has had concussion. In puberty she had seborrhoea from the ear to ear over the head. Three years ago she had occipital seborrhoea, which went away without treatment. She has had flat warts on the face treated with electrocautery.

She was given Belladonna 50M, which aggravated her headache and all her other symptoms. Two years ago she was given Glonoinum for congestive headache during which she had fear of a stroke. She also was given Ignatia amara and Antimonium crudum.

Prognosis

Depth of the Disturbance/ Nature of the Pathology

The main complaint is on the physical plane, but making a prognosis for a case of headache is not always easy. There are many different possible causes for a headache. They can be quite innocent like tension in the muscles or very serious like a brain tumor. Clearly, the prognosis will be very different for each case. In the case we are going to treat nothing serious could be found. The concussion she has had did not give headache for years. The strong pulsation she used to have indicates congestion and can point to a circulatory problem. There is also an emotional component provoking the headaches, as the patient is easily stressed. In this case the emotional plane is clearly affected. Looking at the pathology from a homeopathic point of view, we see that the irritability is a strong feature in the case. However, irritability is not in a deep area of the emotional plane. Lately she developed joint complaints, a superficial complaint in the physical plane. The recurrent throat infections also are not a serious affection. The only symptom she has that affects an organ higher in the physical hierarchy is palpitation. But from a pathologic point of view, it is not a serious problem.

Personal Medical History

The patient was born with asphyxia, cyanotic and did not cry. She became resistant to antibiotic at a young age and was given much stronger allopathic medication. She had recurrent otitis media with high fever and swelling of glands of the neck. In puberty she developed seborrhoea, which returned 3 years ago. It went away without treatment. She has had flat warts on the face treated externally. Her first child died soon after birth. Belladonna 50M aggravated her headache and all her other symptoms. She also was given Glonoinum, Ignatia amara and Antimonium crudum.

Conclusion

In this case we see many different symptoms, mainly physical but also emotional. None of them are seated in a deep area of those planes, except of the palpitations.[1] The latter, however, is not a serious affection from a pathologic point of view. Her main complaint has changed. This can be due to partly fitting homeopathic remedies given. They sometimes change the symptoms but do not cure the patient, making the case less clear and thus more difficult to treat.[2]

The way the patient looked like and responded when born can point to a birth trauma. Also, the loss of her own baby can have left its marks. The treatment with stronger allopathic medication due to resistance to antibiotics could have affected the defense mechanism negatively. Both traumas and the suppressive therapy could have influenced the case as a causal factor and added a remedy layer.[3] The fact that her complaints could not be suppressed by antibiotics is a good sign and shows that here defense mechanism was strong. The period of recurrent otitis media with high fever shows that she was in group B of the levels of health by that time.[4] It is possible that the strong allopathic treatment given before weakened the defense mechanism so that the patient dropped from group A to B. This is not a good sign. That she developed skin complaints later is positive, but it would have been better that they would have stayed. The fact that they went away by themselves again can show a weaker defense mechanism. Warts are a positive symptom, but it is not good to treat them externally because of the danger of suppression.

In this case we see how a stronger defense mechanism becomes weaker through wrong treatment. At the moment the patient still has frequent acute complaints, pharyngitis with high fever, which puts her in group B. As the acute complaints do not affect organs, she is most probably in level 4 or 5. The goal of the treatment is to stimulate her defense mechanism in such a way that the patient's level of health raises again to group A. Of course, the pathology in the case should improve, but as long as there is no scientific prove of a recuperation of the defense mechanism, we should not be satisfied with the treatment.[5] The curability of the case now depends on the extent of the suppression by allopathic treatment and the confusion brought in the case by partly fitting homeopathic remedies.

Selection of symptoms

Peculiar Symptoms

• Pulsating pain on vertex, as if going to explode, < at around 17.00 hours [⅔]

• Severe pain in wrists and index fingers [⅔]

• Sore throat [3] and loss of voice [2] < stress [3]

• Difficulty falling asleep due to thinking about small things [⅔]

• Waking up tired [⅔].

• Stitching-shooting pains here and there [2]

• During ovulation shooting pains in ovaries when stepping [2].

• Papillae of sides of tongue enlarged and inflamed with constricted sensation [2]

• Irregular heartbeat < when lying [2]

• Red spots on the neck when excited [2]

• Cold hands and a hot head as from having fever [⅔].General < by too cold or too warm weather [⅔]

• Aversion to shell fish [2]

• Angry easily, < when contradicted [3], touched slightly [⅔]. Prefers hard touch.

• Fear of the dark, snakes and sleeping alone [⅔]

Intense Symptoms

There are so many peculiar symptoms that the repertorisation already is large. Therefore I only list the intense ones without putting them in the first repertorisation. We can still use them to differentiate the remedies or add them later if necessary.

• Headache < from stress [3], noise [⅔], sun on her head [⅔]

• Severe pain in wrists and index fingers < on holding things [⅔]

• Pain in ovaries on stepping [2]

• > Massage [2]

• Affected by every little emotional stress [3]

I use the original symptoms of the headache, as it is possible that they have been changed by wrongly prescribed remedies. In such a case it is good to start with the symptoms as they were. The modalities have always been the same so they can be used. There are a lot of modalities and some are quite common; therefore I only take the ones with the strongest underlining. Although she falls asleep late, I do use the fact that she is so tired on waking, as she does sleep many hours. As she is easily irritable in general, it is logic that she also is irritated during headache.

Repertorisation and Selection of the Remedy

I use the rubric for Head—pain—vertex—bursting pain for sensation as if the head is going to explode. Sore throat and loss of voice from stress I cannot find in the repertory. Shooting pain often refers to stitching pain in Kent's repertory; therefore I use Female genitalia/sex—pain—ovaries—stitching pain. I cannot find a rubric for inflamed papillae of the tongue nor for the sensation of constriction due to problems with the papillae. There is no rubric Generals—food and drinks—shellfish—aversion. There is no rubric for anger from slight touch; therefore I use the one in the chapter Generals. There is no rubric for redness in the neck due to excitement ([Tables 1] and [2]).

Table 1 Sum of symptoms and degrees—sum of symptoms and degrees—intensity is considere d

1	1234	1	HEAD—PAIN—constant, continued	32
2	1234	1	HEAD—PAIN—Vertex—pulsating pain	32
3	1234	1	HEAD—PAIN—Vertex—bursting pain	29
4	1234	1	HEAD—PAIN—Vertex—afternoon—walking agg. —bursting pain	2
5	1234	1	EXTREMITIES—PAIN—Wrists	122
6	1234	1	EXTREMITIES—PAIN—Fingers—First	32
7	1234	1	SLEEP—SLEEPLESSNESS—thoughts—activity of thoughts; from	92
8	1234	1	GENERALS—WEAKNESS—morning—waking; on	74
9	1234	1	GENERALS—PAIN—shooting pain	53
10	1234	1	FEMALE GENITALIA/SEX—PAIN—Ovaries—stitching pain	45
11	1234	1	MOUTH—PAPILLAE of tongue—enlarged	10
12	1234	1	CHEST—PALPITATION of heart—irregular	45
13	1234	1	CHEST—PALPITATION of heart—lying—agg.	38
14	1234	1	EXTERNAL THROAT—DISCOLORATION—redness—spots; in	8
15	1234	1	HEAD—HEAT—coldness—Extremities; with coldness of	34
16	1234	1	GENERALS—COLD—heat and cold	59
17	1234	1	MIND—ANGER—easily	58
18	1234	1	MIND—ANGER—contradiction; from	43
19	1234	1	GENERALS—TOUCH—slight touch agg.	28
20	1234	1	MIND—FEAR—dark; of	63
21	1234	1	MIND—FEAR—snakes, of	19
22	1234	1	MIND—FEAR—alone, of being	72

Table 2 Repertorisation (RADAR)

	lyc.	sep.	bell.	nux-v.	ars.	ferr.	sulph.	lach.	sil.	phos.
	43	40	39	37	33	32	32	31	30	28
1	–	1	–	–	–	3	1	–	–	1
2	2	2	1	2	1	2	1	2	2	1
3	–	–	–	1	–	2	–	–	3	–
4	–	–	–	–	–	–	–	–	–	–
5	2	1	1	–	1	1	3	1	2	–
6	1	–	–	–	–	–	–	–	3	–
7	2	2	1	3	3	2	2	2	2	–
8	2	2	1	2	–	–	–	2	2	2
9	–	1	1	1	1	1	3	–	1	1
10	2	2	2	–	2	–	–	2	–	1
11	–	–	2	–	–	–	–	–	–	1
12	2	–	–	1	3	–	1	1	–	1
13	1	1	–	3	1	2	3	2	–	–
14	–	3	4	–	–	–	–	–	–	–
15	1	–	3	–	–	2	1	1	–	–
16	3	2	1	1	–	1	2	2	2	–
17	3	1	1	3	1	2	–	–	–	2
18	3	3	–	2	1	3	1	–	2	–
19	–	–	3	3	1	–	–	3	–	2
20	2	1	1	1	1	–	1	–	1	2
21	–	1	1	–	1	–	1	2	–	–
22	3	2	1	1	3	–	–	–	–	3

Differentiation of the Remedies

Lycopodium clavatum is the first remedy on totality but cannot be confirmed on keynotes. The intolerance of contradiction is part of the psychological essence, but the latter, lack of self-confidence is not confirmed.

Sepia officinalis cannot be confirmed on keynotes or essence.

Belladonna has been giving without positive effect.

Nux vomica is confirmed by the strong irritability and sensitivity to noise. The aggravation from warmth contradicts its keynotes.

Arsenicum album has fear of being alone as keynote and part of the psychological essence. The latter is not clearly seen in this case. It also has been giving without general effect.

Ferrum metallicum has long-lasting headaches, congestive headaches, pain in the joints of the upper limbs, weakness, irritability and aggravation from noise as keynotes. The irritability also confirms the psychological essence.

Sulphur has aggravation by heat and congestions as keynotes. The essence cannot be confirmed.

Lachesis muta has congestive headache and red spots in the neck as keynotes. The essence cannot be confirmed.

Silicea terra has stitching pains as keynote. But the aggravation by warmth and the emotional symptoms of the patient contradict the keynotes and the essence of the remedy.

Phosphorus has unrefreshing sleep and tendency to loss of voice as keynotes. Fear of the dark and of being alone are part of the psychological essence. The strong sensitivity to slight stress can confirm the essence.

Out of these remedies that come out first when analysing on totality, Ferrum metallicum and Phosphorus are the only ones that can serve the case. When trying to differentiate them we see that both are confirmed on totality, keynotes and essence, that both cover peculiar and intense symptoms, and that both have keynotes in the local symptoms, the general symptoms and the mental-emotional symptoms.[6] From this point of view we cannot decide upon the remedy. The next step in the analysis is to look at the pathology-oriented analysis.[7] Ferrum metallicum is the one that has the main complaint as keynote and therefore has preference over Phosphorus. Also the irritability which is, according to homeopathy, a pathological feature in the case is also a keynote for Ferrum metallicum. What disturbs me is that the pathology that puts the patient in group B instead of group A—the recurrent pharyngitis—is not a keynote of Ferrum metallicum. The technique combination of pathologies,[8] which refines the pathology-oriented analysis, makes me doubt of Ferrum metallicum. This makes me reflect a bit more about the selection of the remedy. The solution for the problem is the technique combination remedies [9] that refines the analysis on totality. This case has very strong features of Ferrum metallicum, but when adding the recurrent pharyngitis and the fears, we recognise Ferrum phosphoricum.

Ferrum phosphoricum is thought of by using the technique combination of pathologies and recognised through the technique combination remedies. It is confirmed by one of its own keynotes the tendency to pharyngitis.

Choice of Potency

Patients in level 4 or 5 should not get an initial potency higher than 1M. But any patient who is quite sensitive should not get an initial potency higher than 200 (K).[10]

Course of Treatment

The patient was prescribed Ferrum phosphoricum 30C, one dose. Eight months later she reports having repeated the remedy after 5 months of headache. Her headache is better, less frequent and less painful. The pain in the big toes is better and the pain in the wrists is gone. She is less tense and less intolerant of contradiction, more quiet. The neuralgic pains are better. She has had pharyngitis with high fever only once this winter, which improved with Ferrum phosphoricum D6. At the end of this consultation, she was advised to wait and to repeat Ferrum phosphoricum 30C if necessary. Four months later she reports having taken the remedy four times when the headache returned. The last dose had no effect. She is now three months pregnant and feels very bad with nausea [3] worse from smell of food and cigarettes [⅔]; and vomiting from cooked food [2]. She wakes up with strong pain in the stomach and abdomen [⅔]. She has constipation without urging and needs enigmas [3]. Burning pain in lumbar region [2]. Tiredness has returned again. The headache also returned and has been different since 2 weeks: from the root of the nose, stitching upwards to the head like line [3]. Her throat is much better. The pains in the feet are 90% better. Neuralgic pains all over body are gone. The tongue is better. Arrhythmia is much better, sometimes a little bit. Anger was better but is back now because she feels very bad and does not want to be bothered [3]. Her mother says that she was much more tolerant. Fear of the dark is better, fear of snakes and to sleep alone are less. She goes to work because it makes her feel better [2]. She is chilly, especially the hands [⅔] and feet [2]. As the last dose did not act anymore, she was given Ferrum phosphoricum 200C. She responded well to the remedy. When the baby was born, she repeated the remedy successfully to stimulate the milk. One year after the second consultation she was given Ferrum phosphoricum 1M when there was a general relapse. Another 4 months later she was given Ferrum phosphoricum 10M, when Ferrum phosphoricum 1M did not act for headache. With this potency she improved greatly, the headache went away, the other local symptoms also improved as described before, emotionally and in general she felt well. The follow-up on this case is 3 years. This improvement is very positive but is only meaningful because the patient lost the tendency to frequent acute diseases and raised in level of health from group B to A, where patients have infrequent acute diseases with high fever. Without this scientific prove of the recuperation of the defense mechanism, the amelioration of the symptoms can always just be a placebo effect. In homeopathy we need to see these directions of cure before we can talk about a cure. The fact that the patient responded with many different complaints and for several years to the same remedy is because she was originally born in group A. These patients have a much stronger defense mechanism that more easily recuperates. You will not see this in patients born in group B or C.

Bio

Erik van Woensel has been studying homeopathy since 1977. He started practising homeopathy in 1982. Since 1990 he has been teaching at several schools. He currently teaches at different international seminars all over the world. He supervises several groups of beginning and experienced homeopaths regarding their cases. He is the author of Characteristics and Peculiarities. A Compiled Materia Medica—Radar Keynotes 4 and of the series Classical Homeopathy—Evidence Based Medicine. He is co-author with Right Livelihood Award (Alternative Nobel Prize) winner professor George Vithoulkas of the book Levels of Health. Since 11 years he has advised and assisted the team that develops the repertory Synthesis. He is the moderator of Vithoulkas' e-learning program. His aim is to spread homeopathy by teaching and writing, to research the possibilities of homeopathy and make this public, to bring the appliance of homeopathy to a higher level and improve homeopathic literature. To achieve this he founded—amongst other things—the Archive for Homeopathy.

• References

• 1 Van Woensel E , Case Analysis in Homeopathy (Strategies and Techniques—Theory—Case Studies), Educatief Centrum voor Homeopathie, Groesbeek, The Netherlands; 2015, The Prognosis: Depth of complaints at the time of treatment, p. 23
• 2 ibid, Reaction to homeopathic remedies taken previously, p. 38
• 3 ibid, The Prognosis: Conclusion for causative factors, p. 31
• 4 ibid, The Prognosis: Personal Medical History, level of health, pp. 26
• 5 ibid, Guidelines to presented cases, pp. 12–14
• 6 ibid, Strategies for finding the homeopathic remedy, Totality, Using the components of totality for the prescription, pp. 49–50
• 7 ibid, Strategies for finding the homeopathic remedy, Pathology-oriented analysis, pp. 60–61
• 8 Van Woensel E , Classical Homeopathy—Evidence-Based Medicine, vol 2 (Theory: Case Studies—Long-Term Treatment), Educatief Centrum voor Homeopathie, Groesbeek, The Netherlands; 2013, Techniques to come to the right remedy, Combination of pathologies, p. 401
• 9 ibid, Techniques to come to the right remedy, Combination Remedies, p. 402
• 10 Van Woensel E . Case Analysis in Homeopathy (Strategies and Techniques: Theory—Case Studies), Educatief Centrum voor Homeopathie, Groesbeek, Netherlands, 2015, Potency Selection, p. 15–17