Case of Allergic Rhinitis treated with Coccus Cacti
Dr. Rishi Vyas MD (Hom)
Co-author- Armeen Jasavala, Editor, ‘the other song’
This is a case of a 19-year-old female who came to the clinic in February 2015. Her chief complaint was recurrent cold and cough often resulting in breathlessness. Her complaintswere worse by dust, over- exertion and change of weather. She also had a few other complaints including acne and dandruff causing hair fall.
The following is the abbreviated transcript of the case-taking (D-Doctor, P-Patient). Following the case, a full case analysis and explanation have been provided focusing on the understanding of an Animal Kingdom prescription.
D: Please tell me about your complaints.
P: They are all chronic complaints and they have been persisting for long without improvement. They are there since childhood and they are getting worse.
D: When are they more?
P: Usually I am worse in the morning on waking. I sneeze and cough. Over-exertion, like running or climbing stairs, makes me breathless. I even took allopathy but it got worse. When I was taking allopathy, it also affected my menses making them irregular, so I stopped taking it. I also got a rash all over my body and dryness in the throat then.
I also notice that when I am doing too many things and have got a ton of work to do, I get sick e.g. when I have a big event, I get sick. So, I blame myself. I try to curb my work, but I end up doing so much. I cannot remain without my work.
D: When do the complaints get worse?
P: When the weather changes, I get sick for a long time.
D: How did this start?
P: Since childhood. I have vomiting and cough. It is a part of life and it has exhausted me. I sing, so it ruins my voice. I feel the complaints are always hiding below the surface of wellness. There is no pattern to it but when it happens, I just want to just sit still.
D: There is no pattern meaning?
P: Like if there is viral fever going around I get sick. I also get worse with the change of weather, with exertion and in the cold. My complaints just do not leave me, they are inside me and just not leaving. I feel that it is not external and I do not get them from outside, but it is just because I strain myself and fall sick. When I am exposed to dust I also get allergies.
D: Can you explain the whole process to me?
P: It starts with throat itching, I then get head pain with a lot of salivation and phlegm in my throat. There is increased expectoration first and then it becomes dryer. I also sneeze. I have a lot of phlegm first, with much coughing and I have to vomit it out, then it dries quickly either if I vomit or cough it out. The discharge is watery, and there is so much of it. It is yellowish. To get it out I have to strain a lot and bring out expectoration by vomiting; only this ameliorates. Then it slowly dries up and I feel that on lying down, it lodges in my throat.
D: What makes this problem better or worse?
P: I am always worse in morning and am better when in a warm room, after vomiting or coughing out the discharge and sitting still. I got scared once and felt I may have asthma. One day, I was scared because I could not even climb up 5 steps. This had never happened to me before.
The main thing about her cough is that she gets this severe bout of cough in the morning when she wakes up. She cannot stop coughing and the only way the cough stops is when she vomits. This entire episode of cough is very exhausting and it ends only by vomiting and expectoration. The pathological process in this case is that first it affects the throat then nose. So we can understand that the direction of complaints is ascending.
D: Tell more about scared.
P: I was apprehensive, praying that it should not lead to anything else. I was going to classes and having very long days, going from place to place. I did not want others to know about this problem and I did not want the attention. I also travel a lot and don’t have time to concentrate on my sickness, my days are too strenuous and I do not think too much about my health. I do not even have time to pause,I am not free even on Sundays. So I was scared – that I will not be able to carry on because of the cough. I have had this problem for so long and I ignore it. I do not want to feel debilitated and hopeless in a situation.
This definitely overpowers me. It is annoying but it doesn’t prevent me from doing everything. I fear I will miss out in doing so many things and it is annoying to be sick.
D: What happens to you during this episode?
P: My lungs are creaking, it is a wet cough and I cannot breathe properly. I get spots in front of eyes. I have to pause and take a breath, walk, then again pause and take a breath. Every time I pause, I do not want anyone to notice, but it is very noticeable. I walk fast as I am always late, so it was agonizing to take such few steps and have to pause. With this problem I cannot live my fast-paced life.
D: Tell more.
P: I whiz by people, I don’t walk. I walk really fast, and I am not a clumsy person. I usually assess the road and know how to reach my destination. When I could not even walk 5 steps, it was an alienated feeling. I looked up at that moment and I saw an old person. I felt, that this is the way old people feel. I had to take frequent pauses and it was more of an annoyance. At that time I was waking very early and there was a lot of work. On top of the work, there was my internship and I had to commute long distances and change trains frequently for that, 6 days a week.
The intensity of the cough is so much that a girl was so fast paced became very slow. She had to take lot of pause while walking. Her work suffered. She felt as if the cough was overpowering her. Through this we get a soft clue about her nature in terms of pace of working. She is very fast, wants to do many things, walks fast, talks fast (observation) and now she feels like an old person due to her complaints.
D: Tell about this.
P: I was overwhelmed quickly and easily. I wanted to live my life fast-paced. I kept thinking I had many plans and I don’t want this to be a cause to stop me. I thought I cannot go trekking and it was very bad. I liked having a fast-pace life, this was such an obstacle. It was an unavoidable obstacle. As a hyper person, I tend to do things more quickly, I go from doing one thing to another.
D: What affects you the most?
P: The breathlessness. I can deal with anything but the breathlessness. I can deal with the cough but the breathlessness is not easy. I always have to think in my mind where am I going to go and cough? My diet is also not good.
D: Tell about being a hyper person.
P: As a hyper person I do things quickly, go from one thing to another. Like for example, if I am reading a bad book, I do not stop reading. I keep on reading it. I cannot leave it incomplete. I am in a rush to finish it. I feel so many things are on my plate. At one point I was learning Japanese and I love learning other languages. I do extra-curricular activities all the time. I feel that this is something new and shiny – so I do it. This is the tendency I have. I feel that I will regret it if I do not do that activity. So I take up everything that comes my way. This totally whacks my health, and at the end of the day I am exhausted. I fear missing out. I strain myself to keep up to this impossible schedule, but I don’t know why. It is fatal flaw!
D: Tell about this more.
P: I always like to take new subjects. I love to search and do unfamiliar things. I like to do new things because it is something others are not aware of. I want to know more. Something new is like searching for new knowledge. When I am on unfamiliar ground, I don’t know how much is good, so I do my best. If I am familiar with exams – I will just stay to get marks, I will not strain. I like new things and look for unfamiliar ground.
We see that her pace is too fast and she likes to do many things and have many things on her plate. Another aspect about her individuality is that she likes to explore new things. There is a desire for new experience. Let us go deeper into this experience.
D: How is it to be on unfamiliar ground?
P: It is a feeling of being exhilarated, happy, it is a high, in its own sense. There is a sense of superiority and that I am broadening my horizon, more than my fellow peers. I am good at what I do, both in singing and dancing.
D: What do you feel in this exhilaration?
P: You don’t know you can do it, but when you do it, you excel in it. I am like that. It is a feeling of high, like you have just climbed a mountain. It feels exciting. Familiarity is boring. I am in a college that is miles away from home, I love this. It is just exciting to put myself in a new situation where I can learn more. If I would have gone to college close by, I would not have had so many experiences. The learning experience is exciting!
P: It helps me in my thinking process and allows for me to better my understanding. I am a sociology student, so it is about superiority. If I made a movie, though I am not media person, people would acknowledge it and appreciate me, for my ideas. That is the high. The high is being appreciated. I want people to acknowledge me. I get to prove over and over in different situations that this happens. Like if you travel and trek, you have to survive and if you can do this a feeling of adaptation comes that I can face any different situations. I like testing myself again and again and proving myself. You can accomplish it and conquer hurdles if you do this. It is a never ending hunger for new things.
D: Why do you want to prove yourself?
P: I feel I am doing nothing with my life and not achieving anything. I feel unappreciated and underestimated. I want to just run away from here. If people feel I am not doing enough, I will take something new and complete it. I don’t get the highest marks because instead of focusing more on one subject, I take different subjects. I over exert myself but I choose different subjects so I can be appreciated and so that I can boast about myself and my knowledge.
D: What is the feeling?
P: As I have been under appreciated in this class, I move to a different one, I don’t ponder on it. There is no anger or sadness. Once I feel low I will not do it. I like doing new things; it is a factor of distraction.
Here again we come to the fact that she has a rapid pace and that she constantly needs some or the other change (studying, trekking, exploring unfamiliar places). There is also an intense desire for appreciation which gives an experience of exhilaration and the other aspect is of not being appreciated, not achieving and being under estimated.
D: Factor of distraction?
P: It’s a distraction. I like to do new things but I ignore problem. The new and shiny things are attractive and the problem is repulsive. The new things seem problem-less. In a group, if there is an argument, I distract myself and go with a new group, I draw myself in (Hand gesture showing hand going towards chest). I try to get accustomed to the situation and the group but I cannot. I throw tantrums if I am stuck with that place or situation. I develop bitter feelings and it annoys me.
So she likes new things and new experiences at the same time this problem makes her feel repulsive. She feels like drawing herself in (HG) and feels stuck.
D: Tell about “draw myself in” (HG: showing hand going towards chest).
P: I feel stuck. Even with friends I feel stuck and there is no escape route and I tend to get bitter feelings about them and myself. I feel I should be part of this group of friends and not a bitter person. I wanted to end the situation. I know it will end and friends will not last. I just wait and it’s usually coupled with lot of helplessness.
D: What’s the experience in helplessness?
P: I feel stuck, static.
D: Static means?
P: Static means unimportant, like if I was there or not it would not matter either way. If I am not contributing, I do not like to be there. I do not like when there is a feeling where I am making no difference.
D: How is the experience for you?
P: The experience is intense helplessness, being static and stuck. It’s like there is nothing to go on with and there is no progress in that situation, there is a real need to bring change or whatever. Like a deer caught in headlights. Like I am trapped there.
D: More about this?
P: I want to hibernate at that point. I feel defeated and not in control. Like somehow, in my mental tally of wins and losses, I feel I have lost. In a group I am the proud, haughty one. I like to be acknowledged and I do not like if I am not appreciated. So, if I am not appreciated I do not want to be there. I want to be appreciated. Somehow I feel I deserve better than this, it is not the feeling I deserve. If the class is reading or doing one thing, I will not do it, as it is demeaning. Like if I think it is too menial, or too small to pay attention to, I will not even do it. I am too proud to solve this problem, I have better things to do. They are below me. Anything that can be ignored, I ignore.
So the experience for her is stuck, static, helplessness as if a deer is caught in headlights, feeling trapped. She feels defeated and not in control. Till now we see that she is very intense person, too busy, too occupied, likes to do new things and the experience of which is exhilarating. On the other hand we see that see feels stuck, static helpless and trapped. These are main issues that have emerged till now. We will explore her nature more and see what comes up.
D: Tell more about your nature.
P: The pros and cons? I am a cynical person, I talk a lot, read a lot, love writing and updating myself on good books and music. I love travelling. I want to be a historical linguist, who gets to travel a lot. I participate in music and like to organize things. I like the process of creation, like making movies, writing, and poetry.
D: What about, travelling reading, writing you like?
P: When I write, I vary in it, I write random things, most is “what if’s”, like what if it happens like this or that, and in travelling I feel if I would be in this place or doing that my self worth would be better.
D: Tell about this self worth?
P: Being happy with who I am because I am not always. When I am in a new situation I am happy. If I get bored and make mistakes I feel static, bored, helpless, and not wanted. I am a paranoid person and feel they don’t want me there. I could be apart of the furniture. If they ignore me they ruin it. The whole experience will be ruined. I have short experiences. Like a chapter in a book. I want to finish and move on to something new. I have no favorites, as I have never stayed so long as I am afraid of making things worse. When it is enough, I draw a line and move. They do not hate me and I do not hate them either, but they are predictable and that is why you start disliking them. It should be a sense of surprise.
This is interesting. We see she likes writing. Initially it seems like it is about self worth but as we go deeper it is again about being static, bored, helpless and not wanted. So this is the pattern in the case. One polarity is too much activity need for change and the other is being static, bored and helpless. Now we will explore her fears and see what comes up.
D: Tell about your fears.
P: I am afraid of the dark, heights, fearful of being stuck and claustrophobia. It is more of an emotional claustrophobia where I feel helpless, stuck, like I am in a totally helplessness situation. Not knowing, like oblivion, where there is an existential fear. When you try to comprehend the scale of universe, you think what is out there? I want to know each person and each place in the world. I have a fear of not knowing. Also a fear of being small, feeling small, easily dismissed, inconsequential, like if I die, no difference will be made, like I am unimportant. All of this is intertwined. There is a fear that you have not affected the world enough. That’s reason I am participating in all these things, you want to leave a mark in the world, it is not just that you are living and dying … this is so intense that she also dreams exactly of the same scene.
D: Describe this fear of being inconsequential, unimportant, being small and not making a difference?
P: fear of not knowing, just makes me want to die, as it will not matter. It’s a very dark thought. It’s a fear, like I have this nightmare where people, like there is a lot of crowd (HG: hands coming together) and all of us are just walking (HG: hands together) and there are some people who are touching your way through and running ahead. And I as person in the nightmare, am just wondering as why anyone would make way through this crowd. Then you reach at the end of it, and you realize that there is a cliff and people are dying so basically people are climbing and dying in the cliff. That’s what most of the people do in life, they don’t achieve anything in life in any way you are so small, and so you just live and die. Like I am pretty sure, a village in Africa will never be affected by my existence that annoys me. Like there are so many people in this world that they will never know that you have ever lived. It’s just scary. That fear is so strong. You feel small, useless and helpless. The only way to get away is by doing things. I have a feeling to push myself forward but the feeling of exhaustion comes and then I feel I should not have done it. I regret it as I realized its futility.
D: Tell about futility?
P: It’s futile and it was not necessary. At one point it was necessary for me but then it is not. When I am doing it, my entire self worth is dependent on it.
This is something very very strange in the case. She feels small as if there are many people, lot of crowd and they die and she feels so small. This is a bit that does not fit in this moment. Once we understand the remedy then this part will beautifully join in the remedy. The only way for her to overcome the fear is by doing things.
Desires – Chocolates, non-vegetarian food, shrimp (prawns), milk products, fruits. I especially love tea.
Aversion – cold drinks
Thirst – very less
Sweat – more in axillae
Thermal – chilly
Case Understanding and Analysis
This patient came to us with the main complaints of cough and recurrent colds and cough since childhood. This is a classic case of Chronic Obstructive Pulmonary Disease (COPD), where there is chronic bronchitis with breathlessness, and the patient has to resort to inhalers in acute exacerbations. She has come to us because she has been aggravated with this problem for the past 2 months and the inhalers are no longer helping.
We can approach the analysis of this case via the Synergy Approach. Where we understand the Symptoms, System and Genius of the case.
The concept of Synergy denotes the coming together of two or more things to create an effect that is much greater than the sum of the two. In homoeopathic practice, using two or more different approaches in tandem produces the best results. The utilization of traditional homoeopathic tools such as materiamedica and the repertory in combination with more modern homeopathic approaches such as sensation and kingdom, generate the most success in clinical practice.
When the areas of symptom and system are used corroboratively and synergistically with the genius, the view of the case and of the remedy is widened. This allows for the greatest understanding of what is to be cured in disease, and what is curative in a remedy.
Her main complaint is recurrent cold and cough. The most intense thing in the cough is that she cough and coughs and then she becomes exhausted. The cough is worse in the morning; change of weather, over exertion which would ultimately makes her breathless. Cough is also worse from any kind of smoke or dust. The only reliable amelioration is from expectoration or vomiting which brings out the cough.
These are the sure shot symptoms of the cough. when we repertorize these complaints we get the following remedy suggestions.
Then comes the next aspect of understanding her as a person – as to how does this problem affect her.
The patient said that, “It (the complaint) has exhausted me, it is always with me and never leaves me. It is always hiding within the surface of wellness”. She explains that this problem has affected her pace. She now has to slow down her pace of work, walking, and climbing, and she still gets breathlessness. The coughing is too intense and it exhausts her completely. The coughing is bothersome, but more so, it is the breathlessness. This for her is very annoying and does not allow her to do what she wants to do.
She explained that she travels and commutes a lot for work and that she is very active in extracurricular activities. Her whole day is usually full and she is always busy, but because of this problem she is not able to do this anymore. Generally, she has many plans for a day, she wants to do everything and she cannot stay with one thing. She moves from one thing to the other. At the end of all of this activity she gets ‘exhausted, debilitated, hopeless’, and says it is ‘over powering me’. This is a pattern that we see in her chief complaint and also when she describes her nature.
These expressions are important pointers for kingdom analysis. As described above, we already know that the core experience of animal remedies is that of survival which may be expressed as ‘You versus me’, ‘victim-aggressor’, ‘someone doing something to me’, ‘weaker versus stronger’. We see similar expressions in her description of how she is affected by her complaints. This is in clear contrast to the experience of plant kingdom which is of basically of sensitivity and reactivity and of the mineral kingdom which is has to do with structure – of being complete or incomplete, of lacking, being stable or losing one’s structure.
Once the kingdom is clear, we go on to elicit the exact experience which can help finer differentiation of sub-kingdoms. For this, we have to look in other areas of her life or how she is as a person, as the experience of the animal kingdom is often a part of the pattern or the life processes / characteristics of the animal reflected in different areas rather that one individualized experience and its opposite.
The patient fears not living life and describes herself as very fast and hyper. She speaks, walks and does every activity very fast. As mentioned, she wants to many things, but then at the end, she gets exhausted. She gets annoyed by her own complaints. This gives us indication of a tubercular pace. She is very fast in all things, which then results in exhaustion.
To confirm this pattern, we looked in other areas of her life. The patient explained she liked trying new things. She likes shiny things and new things attract her. She cannot stay with one activity for long. She likes to be unfamiliar places, as it gives her a feeling of exhilaration, a high, a sense of superiority, so people know and appreciate her. If people do not do this, she feels like running away and has a desire to escape. She wants to move away from the situation. In this circumstance she experiences a feeling of stuck, helpless, need to bring change, like a deer caught in headlights, she is being trapped and feels like escaping. She wants to hibernate, hide and feels defeated and paranoid. These no doubt give us clarify the miasm, but also give us a pace and the experience of being stuck and trapped which can be compared to different sub-kingdoms to move our analysis a bit further.
Further, the patient says that she has short experiences, like a chapter in her life. She wants to experience everything and move on. She does not go for perfection, she just wants to know a little bit about it.
On asking about her fears she said she fears being small, easily dismissed, and not knowing. More so, she has a fear of being inconsequential, where if she dies, then she will die not making a difference. She has an existential fear and this makes her want to die, as it will not even matter.
Her nightmare also points to the same pattern, where she was walking in the crowd and people are running all around and touching each other. She has a fear of being stuck, it is claustrophobic (emotional claustrophobia as she described), where she feels helpless and stuck. She explains that in this dream that people are just moving and dying, no one knows what is happening. Here there is a feeling of being small, helpless, and not in control.
The patient explained that she wanted to make a mark in the world and feared that she would not do enough before her death. Lastly, she says, “You cannot slow the process of death, you cannot turn back. I want to push myself. It’s exhausting … life is short”.
Here, the genius of the patient is evident: we see this general idea of her life being too short and thus, one has to push themselves. For this, she does not want perfection, but wants to delve into different things one after the other as new things exhilarate and help her be on the move. If she does not be quick and on the move, she feels stuck and trapped. Her whole life feels inconsequential and that is very upsetting and unimaginable for her, so she keeps doing new things, fast. After the push, it is exhausting and debilitating. She wants to make a mark in the world and she gives the example of South Africa. You have to make mark of yours in this world. She gives an e.g. like if in S. Africa in a jungle the people staying will they know you? This thought itself is exhausting for her and scary, makes paranoid.
She explained that most of the time she is doing futile activity, like learning 3-4 languages at a time.
Here, the idea is about her existentiality and a thought of ‘you have to make a mark, by being quick, fast, and doing many things; life is too short anything can happen’.
In this patient’s case, when we see her life as a process, we see the whole energy of an insect coming up, which is tubercular in its form. There is a fear of sudden death, and therefore there is intense activity to make up for time that seems too short, and life seems too short.
Other characteristics of the Insecta sub-class that match the patient include:
- Busy and constant work/activity
- Fruitless work resulting in an exhausting/draining feeling
- Experience of stuck, haplessness, static, claustrophobia and then the need to move away from there, escape, and get away
- Delusion of being small, diminished and inconsequential
- Task is beyond imagination; it is hectic and exhausting
- Need for appreciation, known, acknowledgement of existence
Also, when we look from the perspective of characteristic symptoms in this case, we firstly have to examine the key features and symptoms of the chief complaints, the cough and hair loss. The patient’s cough is aggravated in the morning on waking, where there is also sneezing at this time. She is also aggravated by any change of weather and over exertion, running, or climbing stairs leads to breathlessness. She is allergic to dust and smoke. She is also getting hair loss with dandruff.
There is also a process or sequence of how the events occur. It first starts with an itching throat, then the patient develops head pain and increased salivation with phlegm in the throat. She expectorates more and as it comes out, it gets more dry. She either coughs or vomits out this phlegm. She is also sneezing. This symptom is known as ascending coryza. Further, her discharge is watery and copious, with a yellowish color. She has to strain a lot and vomits about ten times. Lying down makes her feel as if the phlegm is getting lodged in her throat. Expectorating, vomiting, drinking warm drinks and sitting still helps ameliorate her symptoms.
So, on putting all the characteristic symptoms in the repertory, we get:
On repertorization, the remedy Coccus cacti, belonging to the sub-class of insects, covered all of the rubrics.
I looked at Phatak’sMateriaMedica to read about the medicine:
Coccus Cacti [Coc-c.]
This is an insect infesting the cactus plant. The tincture is prepared from the dried bodies of the female insects. It affects the MUCOUS MEMBRANES, causing catarrhal condition and irritation of throat, respiratory and genito-urinary organs. Intolerable internal itchings, burning like pepper. REGULAR PAROXYSMS OR VIOLENT TICKLING, RACKING COUGH ENDING IN VOMITING OR RAISING MUCH CLEAR ROPY MUCUS, hanging from mouth.
To finalize the prescription, we looked at details of the source:
Chineal is a cactus-eating, red-scaled insect of the Dacylopidae family, originally belonging to tropical and subtropical America and Mexico. Dactylopiuscoccus cacti, the cochineal insect that feeds on cacti in Mexico, the West Indies, etc. It prefers species of the prickly pear cactus, as well as the cochineal plant, Nopaleacochenillifera.
Though from the source we understand that it is no a NON-MOBILE insect trapped in a cactus. However, what I see is the strong pathology with insect energy which is very close to coccuscactic
In August 2015, the patient came back to us and reported that she was feeling pretty healthy and there was no sickness since February. She had no major attacks, just one episode of cough and cold. Even here, the intensity and frequency reduced and the episode improved on its own. There was no breathless this time with the episode. She also began travelling and reading. She said that her functions are improved and not getting affected. Even her hair fall has improved and her sleep is good. Her energy is good, despite doing the same amount of activity. One year later, she still continues to do well on the medicine with no major attacks.
Dr Rishi R. Vyas M.D. (Hom.)
Dr. Rishi Vyas is an In-house Consultant and Faculty member at the ‘the other song’ clinic. He has played a vital role in shaping the institute since its inception in 2011. He has assisted Dr. Rajan Sankaran at ‘tos’ clinic and prior to that he has worked with him for WWR I team (Wednesdays with Rajan I – an online homoeopathic training program). His keen interest in software and technology propelled him to develop the patient database management software of ‘the other song’.
He gained lot of clinical experience in managing acute as well as chronic cases, supervising and conducting training for interns, and junior assistants in the clinic. He is known for his dedication and hard work for each and every case which has made him an efficient clinician. His thirst for knowledge led him to ardently pursue various schools of thoughts and approaches in Homoeopathy, being able to integrate them effortlessly. His unique style of teaching and application of repertory to case analysis have been widely appreciated. His lectures on Sensation and Synergy have been well received as well. He is been conducting mentoring session for Australia and Newsland students which has been well appreciated. His cases have published in various peer reviewed journals like Homoeopathic heritage, Homoeopathic Links, Spectrum, National journal of Homoeopathy, and online magazine like H-pathy & Interhomeopathy.
July 10, 2019