As presented at the Eight Annual Conference of the Homeopathic Academy of Naturopathic Physicians in Seattle, WA on April 16, 1994.
We had the good fortune, along with seven other homeopaths from the United States, Europe, and New Zealand, to attend a three and a half week intensive course in January in Bombay with Rajan Sankaran and his colleagues. The format was a three to four hour clinical session with one of the doctors each day plus a two-hour video/lecture presentation each afternoon. We also spent six days of intensive lectures with excellent video cases at a seaside resort called Manoribel.
The main teachers were Rajan Sankaran, Jayesh Shah, Sunil Anand, Nandita Shah, Rajan’s wife Divya Chhabra, Sujit Chaterjee, and Sudhir Baldota. The reason we mention their names is so that you can recognize them when you read their articles in Homeopathic Links, a journal published in Switzerland. Each of these teachers is a brilliant homeopath in his or her own right. The majority have been consulting together on cases for ten years, which is a feat since all are in their late twenties and early thirties. Their goal, very explicitly, was to teach us the methods they have found, through much trial and error, to be effective. None of them received any money for the teaching. The tuition fee went to their foundation in hopes of setting up a teaching facility in the near future. None of them was trying to prove what a good homeopath he was. They repeated over and over to us that what is most important is to understand the patient and her STATE and to have the skills to FIND the best remedy, even if you have never heard of it before.
This was the most inspiring and concentrated homeopathic learning experience we have ever experienced .Because our trip occurred only three months ago, we are still in an intensive process of integrating the material. We spend approximately half an hour outside of of scheduled patients to study each case which is not clear to us or not responding well to the remedy which we have prescribed. We are understanding our patients much better and consistently prescribing remedies which would have never occurred to us before our Bombay experience. So many people have asked us to share some of what we learned. We are just beginning to refine what we learned, we are taking the leap to share with you now rather than wait until next year. Hopefully you can glean some of what we found so inspiring.
We thought about what would be a good way to share with you how our approach has changed. Rather than giving you a case of a small remedy, of which we have many since Bombay, we decided to share “a before case and after case”. These are cases of two women who have benefitted from the same remedy. We want to show you how we are understanding the person and the remedy on a deeper level.
Case I: Laurel, 27 years old.
“My health has been frustrating over the past three years. First I was diagnosed with endometriosis then ulcerative colitis. I tried various hormones for endometriosis. Nothing really works.
I’m a high stress individual (2). It goes straight to my stomach and GI system. My work psychologist suggested I try an alternative therapy. I want to have some control over the situation (2). I work for a high pressure ad agency. I do a whole myriad of duties. It’s a very deadline-driven job. It’s hard to maintain a reasonable workload. When I relax, there are two sides of me: gregarious and reserved. I have lots of friends, but I also enjoy alone time and doing crafts.
Back in high school I started having gastrointestinal problems. After high school I was diagnosed with irritable bowel syndrome and colitis. I’ve been dealing with it for ten yrs. Is just flares up during periods of high stress… like looking for a job. It’s been bad again this past year. It’s hard to tell if it’s colon or gynecologic pain.
I had surgery for endometriosis twice. The first time was two and a half years ago. The laparoscopy showed localized endometriosis up behind the top of the uterus. I had laser surgery. I started having problems again within three months. They gave me DepoLuprin for six months, which gave me menopausal symptoms and panic attacks. I’ve had problems w. anxiety since. Then they put me on birth control pills to suppress my periods. It didn’t help. About eight months later I had the same pains. They gave me a double dose of the pill for another sevento eight months. I had a second laparoscopy in March of this year. The endometriosis was worse… all over the inside of my pelvic cavity. I had laser surgery again. I’ve been getting Depoprovera shots every three mos. The next one is in Jan. After surgery, my colitis was worse. An eight inch ulcer was found in my lower colon in a colonoscopy in August, 1993.
Anxiety has stayed with me (3). I have mild agoraphobia. One year ago I tried to get on a bus but couldn’t do it. I felt totally out of control. What if I get sick? The same thing happened at Christmas. What if I’m out with friends and my ulcer acts up? I get nervous going out with friends (3). What if I get sick?
It was worst when I went to Los Angeles in June for a week. I’d never been there. My doctor had prescribed Zanax for me as needed. Just knowing I had it was a relief. My teeth chattered from nervousness and tension. I had to reassure myself. The last to years I’ve been up and down. I’m very frustrated.
My parent divorced about three years ago. My mother remarried recently. Her new husband is hot and cold with me and my brothers. I’m pretty easygoing. It takes a lot to anger me. I’m pretty reserved when I first meet people. Then I’m very open. I’m demanding of myself. I can lose perspective on what’s reasonable. I think, “If I don’t do ____, I’ll get fired.” It’s hard for me to say “no” (3). I’m trying to learn to do it.
In high school I was involved in lots of activities… tennis, cheerleading. I was extroverted and had lots of friends. I got good grades. I placed a lot of demands on myself and beat myself up when I didn’t do the best. I was busy from 7:30 a.m. till bedtime. I don’t recognize immediately that I’m good at things (2). “I should always do better. (3)” I’m starting to realize there are things I can do well. Not thinking that I’m good enough (3).
People say I’m intimidating… guys. I don’t feel that way at all. People say I come across confident, knowing where I’m going, what I’m doing, but I don’t feel that way inside (3). I used to be a real doormat. I never used to confront people. If someone treated me badly, I’d take it and wonder what I did wrong. I still struggle with it.
I feel tightness in abdomen. It’s almost like I have to bend over because it feels something will snap (3). I wake in the middle of the night w. sharp uterine pain (3). Sometimes a dull ache (2). Sex causes my uterus to hurt (2). It’s better with the hormone shots. My periods have always been very painful (3). They used to be so bad that I had to take Tylenol III with codeine. I’d be doubled over with pain… on my side curled up. Without the shots, the menstrual pain starts about half a day before my period and lasts one to two days. I get a sharp (3), really deep, cutting pain (3) across my abdomen. I don’t get periods with the DepoProvera. I still have an adhesion of the right side from my laser surgery. It’s painful after I eat (2).
My sexual energy is usually pretty high. I haven’t been sexually active in the past year.
I have abdominal cramping (3)… a lot of cramping (2) and bloating (2) then diarrhea (3). I take Immodium. The diarrhea comes about once every two weeks. I also have gas (2) and a burning pain in my abdomen (2). I tend to be blated a lot (2).What if I feel sick? People are gonna ask me, ‘What’s wrong?’ When the cramps start, I worry, ‘Oh, what if I get diarrhea now?’ I don’t want to be bothered with the colitis.”
Fears: “What if I’m somewhere without a bathroom? (3).
Keeping my job (2). I was surprised to hear that my employers are afraid I might leave. I’m just trying to be the good daughter who wants to please (3).”
Temperature: “I’m always cold (2), especially my hands, feet and nose.”
Sleep- Not good past four mos. I can wake at two or three a.m. occasionally. Mostly not a restful sleep.
“I worry a lot about the future (2). Will I meet someone, marry, be able to have kids, have enough money? I asked for a raise last year. My employers argued about what to pay me. I was afraid I wasn’t doing a good enough job. I used to stew a lot. I think about something a lot before I act (2)… about other people and what they thought of me… do they like me? Am I making a good impression? I’m not too excited about much of anything (2).”
Foods: Desires microwaved popcorn (3). Aversion to sauerkraut (2)
Uses Retin A and antibacterial wash for facial acne
Now, take a few minutes to think about Laurel. Before looking in your repertory or thinking of remedies, ask yourself what is unique about her. Then list up to ten symptoms that are most prominent for her on a physical, mental, and emotional level. Then use your repertory to choose four to six rubrics which really fit Laurel well. Select several possibilities for remedies. Then, if you have not found a remedy you feel really good about, consult a materia medica to see which of the remedies fits Laurel most closely. Then turn to page ____ for the case analysis and the rest of the article.
Case l: Laurel
We prescribed Colocynthis (Bitter cucumber) 200C for Laurel based on her comment”stress goes straight to my stomach”, the combination of gastrointestinal and gynecologic pain, her inability to confront others similar to Staphysagria (which is complementary to Colocynthis), and her dysmenorrhea during which time she was doubled over in pain which was better from curling up on her side and her cramping, bloating, and diarrhea. We based my prescription more on her physical symptoms, though we understood that Colocynthis fit her mental state as well.
“I’ve actually been feeling a lot better with the colitis. Only five or six days of discomfort. I’m 70% better. I haven’t felt as anxious. My stools are regular… one to two times a day. I’ve had no diarrhea since last visit. I can still lose patience easily. It’s still hard to get motivated. My bloating is not as frequent. I’m not as bogged down so much anymore about all the “what if’s?”
We assessed that Colocynthis was correct and asked Laurel to return in two months.
Method of casetaking and case analysis of Rajan Sankaran and colleagues:
It is at this time that we left for India. Before continuing with Laurel’s case we wish to summarize for you some of what we learned about casetaking and understanding the patient from our Indian teachers.
- Observation of the patient
- LISTEN to the patient. Say as little as possible. Ask only the necessary questions to confirm the remedy.
- DO NOT OPEN YOUR REPERTORY/ BOOKS WHILE THE PATIENT IS TELLING HIS OR HER STORY.
- MAKE SURE YOU REALLY UNDERSTAND THE PATIENT. It is not lots of data that will help you find the remedy, it is understanding the patient. Do not hesitate to ask “why?”, or say “I don’t understand what you mean” or “Please give me an example” or “How did that make you feel?” It is fine for you to seem “ignorant” in order to fully understand the patient.
- We have found the most important question in the casetaking to be: “If I were to ask you ‘WHAT IS YOUR CORE ISSUE; THE THEME OR CHALLENGE THAT HAS RUN THROUGH YOUR ENTIRE LIFE, what would that be?” (This is our adaptation and not something which we were taught in Bombay.)
- Other questions we now ask:
- What has been the most difficult thing for you in your life?
- Which of your parents are you most like?…. Tell us about him or her.
- What was the hardest thing for you in your childhood?
- What is most important to you in your life
- If a person tells you about their hobby or passion or interest, ask why they like it/ what it means to them.
- If a person tells you she is afraid of something, try to create that imaginary situation in the consulation and ask how she feels. Eg: “Imagine a snake were five feet away from you right now”. The same is true if someone tells you criticism is difficult for him. You can say, “Imagine someone said _____ to you. How would that make you feel?”
- What has been the most difficult thing for you in your life?
- Don’t be satisfied with answers like “I’m afraid of failure” or “I feel abandoned”. You need to understand WHY she feels this way, what it means to her.
- Be sure to ask about dreams. If the person says, “I never remember my dreams, prod a bit.” Ask, “Have you ever remembered a dream?” or “Do you remember a dream from your childhood?” or “Tell me about just one dream…. any dream.” If the dream has an obvious theme, you may want to ask, “Is this a theme which has been an issue in your life as well?”
- If necessary, get more information from family members, friends, etc.
Back to Laurel:
At this point we wanted to understand Laurel’s state more deeply. Sankaran explains that physical symptoms are generally creepers on the vine, while the mental/emotional disturbance are the root. If her colitis and endometriosis were creepers, we wanted to know the state which was at the root for her.
“I’m doing pretty good. I saw my gynecologist and told her I didn’t want to continue hormones. She thinks it’s great. I have no idea when I’ll have a period because of the DepoProvera. I’ve had very minor colitis symptoms.”
“I’m getting married and it’s not the person I want to marry. Or forced into marriage and can’t get out. Same theme, different details: somehow someone or something has put me in this situation. It’s not what I want to be doing.”
We now asked Laurel about her core issue.” It’s other people’s expectations, wanting to please others, worrying too much about what others think. The littlest thing can happen in an interaction and it can plague me for days. A person at work handed me a birthday present. I thought it was for me, but it was for someone else. I felt embarrassed after. It’s either issues of embarrassment or worries about weight gain or my skin breaking out.. how will people who know me think of me now? They’ll think badly of me. I was in a wedding recently. I worried ‘What if I start getting sick and have to go out in the middle?’ I did take one tranquilizer just before. It’s the only one I’ve taken since the remedy.
I don’t go out and join a group as I’d like. I think of reasons not to. I get real worried when I have to see my friends.”
Laurel has continued to do well. We were able to understood her mental and emotional state much more clearly. We now included the following rubrics, which all contain Colocynthis: Aversion to the company of intimate friends; ailments after anger; sensitive to reprimands; offended easily; escape, attempts to.
Case 2: Christine, age 32.
2/23/93. Long distance phone consultation.
“I saw you for homeopathy in 1985-6. You gave me Natrum muriaticum which helped a lot. Now I’m living in the Southwest. I’ve done homeopathy there with a practitioner for two years but I’m Not getting a lot accomplished with it.
I have aA lot of problems with jobs. I used to dance, then I waitressed, then I worked with plants. I fear getting another job I hate.I feel trapped (3). I don’t know where to move (3)… There’s nothing going on. I feel paralyzed by indecision (3)… which way to go? I’m afraid I’ll make a wrong move (3). I worked at a flower shop. I called it to my employer’s attention that someone was stealing. They didn’t want to do anything about it so I quit. I was unable to let go of it. I ended up in the hospital.with a probable diagnosis of pelvic inflammatory disease. I still get uterine pain every two months. I’m sensitive if people are upset (2). I think it’s my fault… I’m not able to separate myself from others’ feelings (2).
.. Then I worked for a CPA, then a pharmacy…. It’s always about other people and my not getting along with them or getting upset with them (3). If they ask me to make up their minds for them, I hate it… like choosing flowers. It irritates me (3). They should know. If they’re demanding, I feel severely put on the spot… they expect something of me tht I don’t feel able to give them. They’re a nuisance. I’d like to withdraw from it.
I don’t like when people are controlling. Most everything annoys me (3). I wish they’d go away… strangers, people on television. The things they’re interested in, I’m not. People seem unfeeling, unimportant, full of themselves, only concerned about themselves. They’re abrupt here… hard.
I feel powerless, indecisive (2)… like I have to struggle through everything.. like I’m treading water, unable to commit to things… so I sit here and I don’t know what to do (3). I have a fear of going after something and having it fail (3). I fearhaving power or the right to have power. I don’t have a right to have an opinion or say anything. If I know something about a plant, it’s always disputed. People seem to sense that they have power over me. It’s easy for them to criticize me. I don’t stand up for myself and, when I do, it sounds defensive. My mind means nothing. I’m not regarded as real, true. I started dancing at 15. My sister, who was ten years older, saw me dance one night and said, ‘If I’d been given dance classes for as many years as you have, I’d dance better than you.’
I was told as a child that I only cried to get something so I stopped crying. Or they said I was too happy so I settled down. I was a sweet child. My mother was cold. She never comforted me when I was upset.
Why should they [people] have a right to feel so self-important? I’ve always been different and people notice it. I feel noticed, put on the spot. People can see my weaknesses and pounce on them (3). Whatever I do is noticed (3). I don’t fit in I don’t understand other people. I don’t get interested in what they’re interested in (3). I am so different (3). I’m interested in more spiritual things… love and spirituality, not fighting, negativity, what color her shoes are… yet I’m irritated with others.”
“If I really showed who I was, I would be rejected. I don’t know if people appreciate someone who’s not playing [games]. I’ve tried hard to hide. I couldn’t ever say something without it coming back to me. I’ve tried to slip by life. I try to slip by w/o being noticed because they’re judgmental of everything I do. My parents had a way they expected me to be. I didn’t have the freedom. I didn’t have the freedom to be who I was.”
Dreams: “When I was little, I had a recurrent dream of a cobblestone street in Europe. It was raining. I was a little girl. I jumped up on a fruit wagon.”
Temperature- “I get really cold (2).”
ROS: wringing pain below umbilicus at end of urination (2) golden vaginal dischg. since PID. Stains underpants.
“The other day, while driving home, I was crossing the street and a woman driver was staring at me. That’s always happened. I was annoyed and angry. I feel, “Mind your own business”.
Discussion of Case 2:
The day after the telephone interview with Christine, we spent about twenty minutes trying to understand her state and to find the best rubrics. We looked at “offended easily”, “wrong, everything see7ms”, “complaining”, “discontented; everything another does is wrong”, and many other rubrics. We kept trying to find the one rubric which best fit her. Finally it seemed that the adjective which best described her was “indignation”. It seemed to run as a thread through her life. We then used Chitkara’s Word Index of Expanded Repertory of Mind Symptoms to find the five rubrics with indignation: “ailments from anger, with indignation”, “ailments from indignation”, “ailments from mortification with indignation”, “cheerful, alternating with bursts of indignation”, and “silent grief with indignation”, and “indignation”. We came up with Colcoynthis and then found the following rubrics in Agarwal’s Materia Medica of the Human Mind : ailments from indignation; indignation, bad effects following; ailments from reproaches; sensitive to reprimands;;ailments from business failure; ailments from anger, vexation with silent grief; anger, irascibility when obliged to answer; ;answers, aversion to; company, aversion to; complaining, day and night; offended easily; scorn, ailments after; talk, indisposed to; desire to be silent, taciturn; wrong, everything seems; escape, desires to. This collection of rubrics seemed to describe Christine extremely well and we felt reasonably confident about our remedy choice.
We then did a Reference Works search of “wringing pain around umbilicus at close of urination” and find the following under Colocynthis :
Clarke: “tenesmus in urethra and rectum after urinating”, Allen: “twisting pain in bowels”; “griping around the umbilicus”.
4/7/94. Phone follow-up with Christine:
“I think people still look at me, but I don’t notice. I’m not as irritated with people. One week after the remedy,
I was lying down reading and I felt a release in my lower abdomen. It lasted for about three or four days. The discomfort in my bladder with urination happens less often. It was every day and now it’s about twice a week. It’s a kind of bloated pain.
I still have my personality problems… I feel dimensional. I don’t feel a really deep connection to who I am. I almost have a fear of it. I want to float up high and not conect myself to the earth. I want to escape. I don’t know what I’m scared of.
I made myself look for work. It was easier than before. I found a job in accounts payable work. That’s what I wanted to do. I want to get away from working with the public for a while. I was offered all these waitressing jobs, but I didn’t take them. I’m not taking what others say as seriously. The other day at work, I told my boss that I’d like to learn to make soap from flowers. She replied, “I can think of better things to do.” I just thought it was funny. Before I would have gotten really upset. I still think I’m different from other people, but I supposed I feel more relaxed with people… less put on the spot. I used to make dates with friends and then cancel them. Now I go and don’t cancel out. I feel a little more hopeful. Not that feeling of desperation.
I feel this remedy has profoundly affected me physically. It felt like that abdominal release was a letting go from way back when I had the P.I.D. I just don’t feel that everything is such a major thing. I’m no longer afraid to make a decision. Before I felt like I couldn’t move… I still don’t like others’ expectations. I don’t feel so intensely that others are unfeeling. At work, I used to feel offended at each person who came in. I don’t feel that way anymore.
The one other remedy which my other homeopath gave me that made me feel strong was Staphysagria.”
Christine, like Laurel, continues to feel well, although more follow-up is definitely needed for her over time.
Learning to understand more deeply the state of the person and the state of the remedy has helped us tremendously in our prescribing. We sincerely hope that it will help you as well so that you, in turn, can help many more patients.
Dr. Judyth Reichenberg-Ullman and Dr. Robert Ullman are board certified by the Homeopathic Academy of Naturopathic Physicians. They are instructors in the Professional Course of the International Foundation for Homeopathy, of which Judyth is President. They teach and write widely and are just finishing their first book, The Patient’s Guide to Homeopathic Treatment. They practice at The Northwest Center for Homeopathic Medicine at 131 3rd Ave., N, Edmonds, WA 98020. (206) 774-5599.