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This is the case of a male, 50 years of age, who presented at

the Palghar Hospital OPD on 20th August 05 with


tingling/numbness of the upper and lower limbs on the left
side. This had begun 10 days earlier and was progressively
getting worse. It began with weakness of the limbs on the left
side and he was now unable to move them. An episode of
severe anxiety and fear had precipitated this onset of
symptoms. It had progressed further and now he had slurred
speech and was laughing immoderately. He also had a strong
feeling of being intoxicated ++. Along with this there had been
a recurrent headache that tended to be worse in the morning,
around 9-10 am.
2 months earlier he had developed hypertension. The
symptoms at that point were a similar tingling and numbness
on the left upper and lower limbs. This too, was precipitated
by an episode of fear. He was put on anti hypertensive
medication which helped and he stopped this on his own after
a while.
There were no other CNS symptoms of unconsciousness,
projectile vomiting, convulsions, fever or head injury.
There was no Past History of diabetes, or ischemic heart
disease as possible precipitating factors.
On Examination:
Pulse:

84/min

BP:

150/100

RS:

Clear

CVS:
PA:

S1S2

Normal
NAD

CNS: Conscious, Cooperative, Well oriented in time, space and person

Higher

Functions,

Cranial

Nerves:

Normal

No Palliloedema
Motor

Sensory

Right

Left

Tone: UL

Normal

Increased ++

Tone : LL

Normal

Increased ++

Muscle Power: UL

Normal

Proximal
Muscles:
Power
1/5
Distal
Muscles: Power 4/5

Muscle Power: LL

Normal

Complete
power: 0/5

Reflexes: UL

Normal

Hypertonic ++

Reflexes: LL

Normal

Hypertonic ++

Normal

Loss of fine touch in


Upper
and
Lower
limbs

loss

of

At this point in the OPD we had to decide whether this case


needed to be admitted as inpatient for homeopathic
management. We follow a set of criteria to make this decision
for all cases, including this one. Here are the criteria that
indicate mandatory in-patient admission for a homeopathic
patient.

Close monitoring for a potentially fatal illness


Observation for developing complications.
Detailed investigation of the acute condition and risk factors.
Homoeopathic remedy reaction
Ancillary measure physiotherapy

In this case, hospital admission was a necessity for further


investigations and management to be carried out.
Investigations:

Hb : 15.2

T.L.C.: 7800 N 68 E 0 B 0 L 26 M2
RBS : 65.2
B .U. N. :9.0
S. CHOLESTROL : 300.2
S . TRIGLYCERIDES : 254
S. CREAT : 1.0

E.C.G. : L.V.H. Pattern


CT SCAN BRAIN (Pictures can be viewed in the attached
slide presentation)
E/o ill-defined hypodense lesion seen in the Rt high parietal
lobe involving centrum semi ovale, mostly suggestive of recent
non-hemorrhagic infarct in Rt MCA area.
E/o multiple lacunar infarcts in Rt internal capsule & basal
ganglia.
E/o old small size infarct in Lt anterior limb of internal
capsule in Lt MCA area. Periventricular white matter ischemic
changes seen.
FINAL DIAGNOSIS:

LT SIDED HEMIPLEGIA, secondary to Right MCA (Middle


Cerebral Artery) non-hemorrhagic infarct involving the
parietal lobe of the cerebrum.
HYPERTENSION
HYPERLIPIDAEMIA
Management:

Once these preliminary medical observations are complete,


we must now appraoch the case from the homeopathic
standpoint for appropriate homeopathic management and
care. In fact the homeopathic diagnosis is an integrated

ongoing process even through the medical work being done


above.
What is obvious from above, is that there already exists a
chronic process going on over many months that has
precipitated now as a hemiplagia (stroke). This is an acute
complication of chronic disease. Our plan was to decide on the
acutely indicated remedy to overcome this acute picture of
symptoms, followed by the constitutional remedy. This is how
we reasoned it out:
There was a distinct change in the susceptibility
during the acute episode that presents with new
symptomatology, a clear causative factor and characteristic
modalities and concomitants. These were indications for an
acute remedy.
Constitutional remedy: Is expected to continue with healing of
the infracted area of the brain. It is also expected to deal with
the underlying causes of hypertension and hyperlipidaemia so
that such episodes will not recur. In addition, the
constitutional remedy must deal with the excessive tendency
to be morbidly anxious and fearful over circumstances.
With this philosophical understanding of our approach, we
concentrated on the acutely presenting totality which was as
below:
Acute remedy:

Ailments

From

FRIGHT

FEAR

<
HEAD

ANXIETY
PAIN

STUPEFACTION,
LAUGHING

MORNING
AS

IF

10

INTOXICATED,
TENDENCY,

PARALYSIS,
PARALYSIS,
PARALYSIS ONE SIDED LEFT

NUMBNESS

a.

m.

HEADACHE

<
DURING,

IMMODERATELY
WITH,
PAINLESS

These were the rubrics chosen. Our next step was to consider
which repertorization approach was appropriate to this case
given the characteristic picture. Since there was characteristic
sensation, modalities, concomitants, and causation, we chose
the Boenninghausans approach for repertorization.
The

remedies
that
came
up
were: Nux
Moschata, Gelsemium, Opium, Rhus tox,Causticum.
Furthur discussion was required to decide on the appropriate
remedy.
Along with this
the Susceptiblity:

we

also

made

an

assessment

of

Susceptibility: Low Sensitivity: High


Pace: Slow
Characteristic: Few
Pathology: Structural Irreversible
Vital organ affected

Hence the choice of posology was: Low potency with frequent


repetition.
The next step was to evaluate the underlying Miasm:

10 a.m. <
SLOW PROGRESS
CONFUSION
INTOXICATED FEELING
IMMODERATE LAUGHTER
STIFFNESS
HYPERLIPDAEMIA

The miasm is SYCOTIC


The final choice of remedy was Gelsemium 30C.
Follow Up:
21/08/05:

No headache, no giddiness,
Mild nuchal pain.
TINGLING NUMBNESS > 50%O/E:
BP- 140/90

Lt:

UPPER

Hypertonia++
Power

left
knee & ankle 0/5

Plan:

LIMB

left

Continue

&

shoulder
hip

Gelsemium

LOWER

4/5

LIMB

>

30

++
3/5

QDS

23/08/05:
No TINGLING NUMBNESS.
Sensation of tightness in left upper and lower limbs > 75%
POWER: SAME

Plan: Gelsemium 200

QDS

26/08/05:
NO SUBJECTIVE COMPLAINTS
APPETITE, SLEEP NORMAL
POWER: SAME
The patient is now able to walk with support. But this support too is less that what he
required earlier.

Plan: To be Discharged and follow up in OPD regularly.


Continue: Gelsemium 1M QDS.

At this stage we also considered the Chronic totality for a


similimum so as to be able to appropriately begin with chronic
treatment when clinically indicated. Here is the chronic
picture:
The patient as a person:

He has 5 duaghters whom he loves very much.


Of all these, his 3rd daughters situation worried him the most. This
daughters husband was alcoholic and had allegedly killed his first wife in a
drunken rage.
Hence the patient remained constantly in touch with this daughter on the
phone. He remained tremendously anxious about her.
2 months ago when the hypertensive episode precipitated he had been
unable to talk to her on the phone. Not knowing the reason for this, his got very
afraid and thought that her husband had killed her. His BP went up with the
intense anxiety and he began to have tingling numbness on his left side.
Presently due to his deteriorating health, he remains very anxious about his
daughters future due to her alcoholic husband and his own wifes future, as he
did not have any sons.
He was a conscientious and a hard worker in order to support his large family
of daughters.
In addition he is chilly, has aversion for sweets.

The Totality based on this information is:

ANXIOUS
INDUSTRIOUS
SYMPATHETIC
SENTIMENTAL
AVERSION SWEETS
CHILLY

The constitutional remedy chosen was Causticum.


Follow up:
29.8.05
On Gelsemium 1M, his gait improved further, there was no more tingling numbness,
his BP was 120/80. But the weakness in his muscle power remained the same.
He was now put on Causticum 30C, 1 single powder at bedtime.
14.9.06
No intoxicated feeling

No headache
No Tingling Numbness
Power Improved:

Left Hip: 3/5


Left knee: 1/5
Left Shoulder: 4/5

Plan: Causticum 30C, 1 dose power daily at bedtime for 7 days.


His power continued to improve and he was normal with
blood pressure well within control, anxiety considerably
lessened. His lipid levels also began to reduce in time. The
healing and resolution took place over a period of just a few
weeks which is remarkable in itself. That the patient chose
to begin homeopathic treatment right at the outset was an
important reason for such a quick resolution, before any other
medication interfered with response of the vital force to an
appropriate simillimum.
This is a clear example of how serious cases can be managed
effectively on homeopathic treatment and management
without any need for allopathic interventions, provided we
have our principles of remedy choice and management clearly
in place.
Thank you,
Dr. Niranjan Pai,

Medicine Part II

with Dr. Navin Pavaskar


Medicine Department
Dr. M.L. Dhawle Memorial Trusts Rural Homeopathic
Hospital,
Opp S.T. Workshop, Palghar Boisar Road,

Palghar 401 404, Maharashtra, India


PH: (02525) 256932, 256933