A case of Asthma treated with Dulcamara

A case of Asthma treated with Dulcamara
by

Dr. Meghna Shah (BHMS, FCAH)

This is a case of an eleven year old girl suffering from asthma since childhood. She was first seen on 18th Feb 2009. Her complaints started at age of two and a half after change in residence where she developed severe allergies, red marks with swelling all over her body. She also got dysentery; mucoid stools at times greenish in colour. She had a phobia that someone was punching her for which she was treated with Homeopathy and soon they moved to a new house. After taking allopathic medicines, she’d develop swelling of palms, cracks in her lips, burning while urinating, acidity and various phobias.

As she suffered from chest congestion very often, she was diagnosed with Asthma. She got a severe attack in her class 4 for which she was hospitalised and following that she has been taking Seroflo inhaler. Her asthma got aggravated in stressful situations like exams with cracking of her lips. She also suffers from migraine and stomach aches before exams.

She is extremely fearful and worried that something will happen to her mother and therefore hugs her while sleeping. She’s had dreams of someone shooting and killing her mother, or she has met with an accident.

Following is the conversation between the Doctor and Patient. The case is edited for brevity and better comprehension. The abbreviations D=Doctor, P=Patient.

D: Tell me what is bothering you the most?

P: (SMILES) Nothing

D: What is that you would like to get rid of?

P: (SMILES & NODS) Nothing

D: If you were to describe yourself, how would you describe.

P: I am good. I like playing, swimming, reading real stories; learning about countries, research. At times, I don’t like studying. I also like to compose songs and  poems. I enjoy music, dancing and playing the casio. I watch mystery and animated movies. I enjoy going for walks with my mom and sister and play with little babies. That’s it.

D:You told me about lot of things you like to do, now tell me something you don’t like to do?

P: I don’t like to eat spinach, liquid medicines and milk.

D: What is that thing that happens with you which upsets you very much?

P: When my friends blame me for something that I have not done, when my parents do not give me what I want and they fight with each other, all of this upsets me.

D: So tell me about friends blaming you for what you have not done a bit more ?

P: I mean, mostly all aunties like me so all my friends get very jealous and in my absence they talk bad about me to all the aunties.

D:What do you feel when they do such things?

P: I feel very sad and I stop playing with them  then after 2-3 days they come & say sorry.

D: How does the fight between your parents affect you ?

P: Sometimes, they fight because of me so I feel very sad.

D:  Describe this sad this feeling?

P: (LIPS PRESSED OVER EACH OTHER) I am not in good mood, I do not talk to anyone in school. I neither play during break time nor do I study well. All I want to do is sit or sleep.

D: So describe the feeling of sadness and don’t feel like talking to anyone or studying.

P: That time my mind is crowded with lots of  thoughts.

D: Describe this little bit more.

P: I don’t remember them.

D: So tell me what dreams do you get?

P: I dream of accidents, someone killing my mother. I see forests, ghosts, blood and at times dead bodies.

D: So tell me bit more about these dreams of accidents?

P: I see cars moving fast and suddenly a truck arrives, they clash and meet with an accident and someone shoots my mother and my family. There are many cars rolling down, at the same time many people are dying.

D: So when you see these dreams what effect it produces within you?

P: That moment I am very scared. When I get up that time I feel it is very real, I look around the bedroom and realise its a dream, but the thought lasts in my mind for long.

D:  What do you experience when you say scared?

P: That it shouldn’t happen with me. It should not affect my parents, family and friends. They should not meet with an accident.

D: Right, so when you say it should not happen with you, your family or your friend, describe that little bit more.

P: If my family meets with an accident it will affect me. It will be bit hard to live. My dreams will not come true and after few years I may also die. If this happens with any of my friends, I will be left alone with no one.

D:  What will you feel to be without your parents? How will it be for you?

P:  I will feel alone. My concentration will only be on studies and I will try to fullfill my mothers dream.

D: Describe this feeling to be alone.

P: I will feel scared without them, in a state of depression..

D: Describe this scared feeling. Just the scared feeling, how is it for you?

P: It is as if the house has been suddenly caught with fire and someone will come and destroy everything .

D: What will you feel in that situation?

P: The enemy who killed my parents will now want to kill me.

D: Tell more about this enemy.

P: May be he doesn’t want anyone to be happy. He wants the entire world to be sad, only he should be happy with all the money, very greedy. He wants to destroy everyone

D: How do you feel in this situation?

P: First I will give him a slap and then go to the police or someone who can protect me.

D: Your mother was saying that you have this fear that you don’t want to leave her. Say something about that?

P: I always feel scared that someone should not kill my mummy or no one should hurt her.

D: Let us do some exercise. Take this paper and you need to make a story and explain

P: Once there was a very happy family. There were 4 members in the family. Surya, his wife & his children. His wife was very sick & she died. Before dying she said that my children should always be happy. After saying this she died. After some days he was sitting on a stone. His friends came & said come why are you sitting like that. Let’s go in forest & hunt. They were staying at an unknown unheard on top of the mountain. There were many deer. So they went to the forest. So Surya was ready with bow arrow & bow and suddenly he saw a witch. He was in a black dress with long hair, big nails & looking at that his bow & arrow falls down. She picked it up & gave it back to Surya. Then by seeing the witch Surya ran & sat on a tree & the witch converted into a very beautiful lady & went to him & said come down. Marry me otherwise I will kill you & eat you up. So he agreed & went to the village. He asks the witch to wait and went to bring all the things for marriage. He went inside, took a big pot. He told his children to be in this pot for 4 days. He told them, ‘If you come out of here, your step mother will eat you up’. Saying that he closed the lid of the top & took all the things that is needed for the marriage. They got married. After 4 days, children were feeling very hungry & wanted to see their step mother. So they opened the lid. Their reflection fell in the pot of water & that’s how their step mother saw them. After sometime she complained  of stomach ache. So they brought a Doctor. He told  if she wanted to be fine, she would have to eat the lungs of 2 children. She pleaded her husband to being her their lungs. ‘Please give me, my stomach is paining a lot’. So he went to the garden. He took the children out and killed them & took out their lungs & give to his wife. His wife was very happy. She was a greedy person. No sooner she was tired of eating vegetarian food and demanded for meat of villagers. After couple of months, she ate all the villagers too. Now only her husband was left. In sometime, she killed and ate away her husband as well. That was the end of the story.

D: What was bad for you in the story?

P: That she blackmailed her husband, married him and ate the lungs of the children. And after few years she killed and ate everyone including her husband.

D: What is bad in this thing?

P: That’s the bad thing.

D: Describe the migraine pain that you suffer from

P: It pains like a thunder comes suddenly and goes suddenly and goes on like that.

D: Describe this thunder which suddenly comes and goes.

P: The pain comes suddenly and goes but it is very severe. It comes again suddenly with increase intensity making me unable to talk with heaviness of the head which gets better only after I take a pill. My mother then puts me off to sleep.

D: Just imagine as if you have this headache now and describe what you experience with this headache. What is the type of pain, how is it for you?

P: The pain is as if hundreds of ants are bitting you.

D: Draw whatever comes to your mind any abstract shape and explain that

(She drew and is asked to focus and give it all her attention and describe what comes to her mind.)

P: There are many things to do. You take 1 step you don’t do it. You take another step & when something comes in front of you which is difficult you don’t do it. You feel that you are weak and run off.

D: What does weak mean?

P: You are weak (hand movement) you think you can not cope up.

D: What does weak mean?

P: You can do but can’t. You don’t want think that you are weak.

D: So then how does it feel to be in such situation?

P: Confused

This is the end of case conversation. Patient does not go beyond confused. Further analysis has to be done on the information we have.

Analysis:

In this case, we a have a child with an allergic tendency that manifests on the skin and in the chest in the form of Asthma. We know her complaint gets worse in stressful conditions. Besides, she also has concomitant migraines and stomach aches.

During the case receiving, there are some interesting mind modalities that we come across in the patient. She has vivid dreams of ghost, accidents, killings, dead bodies, bloodshed etc. In her dreams, we see mass killings for eg. Truck falling of a mountain with people dying and cars crumbling.

This brings us to the theme of ‘Violence’. The violence is sudden and unexpected, resulting in an horrifying outcome. It is important to understand the effect of the dream in her. For her, she felt very scared. If something happened to her family, she’d be left alone and it was hard for her to live without them. So, her experience in this is scare or fright. This brings us to the Sensation in the patient.

Sensation

  • Fright
  • Death
  • Killing
  • Fire
  • Snakes

We know all the above theme are that of the ‘Solanaceae’ family. In this family, we see theme of sudden and unexpected violence, fear, fright, impulse to kill, life and death, murder, black & white, snakes etc.

When asked more about scared feeling, she described it as though house was set on fire. An enemy was after her to kill her just the way he killed her parents. In her imagination, he wanted to destroy the world and not want anybody to be happy. When asked her what would she in that situation, she said, ‘I will slap him and call the Police to protect me’. Now let us understand her emotions a bit in detail. Although the theme of ‘fear’ and ‘fright’ runs throughout the case, her reactions are not intense or acute. There is some amount of effort taken followed by coping up in that situation.

Another story she described about the witch, who was manipulative, bad intentions, killed and ate everyone. She spoke of the man who tried his best to save everyone but eventually succumbed to the witch. This brings us to the Miasm in the patient.

Miasm

  • Effort
  • Trying
  • Hope alternating with acceptance
  • Ringworm miasm

If we see Dr. Rajan Sankaran’s classification of miasms as per each family, Dulcamara corresponds to Ringworm miasm which lies between the miasm’s Psora and Sycosis. On one hand patient is hopeful that situation will get better on the other hand she gives up. We also see this in her complaint, where she has acute episodes followed by chronic underlying disease. Her disease does not get very intense in nature.

Reference Phatak’s Materia Medica:

  • This remedy is useful to those persons who are prone to catarrhal, rheumatic and herpetic affections on account of exposure to cold and damp.
  • Worse: Sudden changes of temperature; COLD WET. Damp ground, cellars, beds.

Repertorization:

Here in this case I would also like to draw the reader’s attention to the use of methods like:

  • Doodles (In this case, the doodle drawn by patient is missing from the case records)
  • Creating stories (good or bad)

I use these methods a lot in practise, and especially with children. I have seen them to be very useful, and safe paths for the patient to go deeper into their experience. And they often act as very useful by passes in cases which are stuck at level of emotions. And in other cases, they act as good conformations. These methods have also helped open up cases, which are probably one sided; also in cases when they you get too much information either at level of emotions and delusions. Then these methods act as a good breakthrough for the patient to good deep into the experience. I also see them feel safe and more easy to go deeper this way, as then they don’t relate the sensations they give to themselves.

She received Dulcamara 1M followed by LM8 once daily for 1 month. Gave her LM since she had a progressive and chronic pathology.

Follow-up summary:

While she was started with LM8, she was also given Dulcamara IM for any acute episodes, in place of any allopathic medicines. When she came the following month, in March’09 she was feeling 50% better in her fears; breathlessness had improved, and no more dreams. Seroflo inhaler was stopped at that time. Gradually her physical complaints improved further, her fears came down significantly and she became more bolder and outspoken. Each time 1M was given to her during the acutes and she would feel better. LM potency was stopped in September’09 and since then we repeat 1M only when indicated. She is doing well, no asthma, no dreams; mood is much better and has voluntarily moved into a hostel.

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