CONTINUING HOMOEOPATHY MEDICAL
EDUCATION SERVICES
QUARTERLY HOMOEOPATHIC DIGEST,
JUNE 1991
Vol. VIII
CURRENT LITERATURE LISTING PART I
A list of current homoeopathic literature,
subjectwise, is given below. Except for the CCRH
Quarterly Bulletin all the others are form the
British, American, German, etc. journals not
readily accessible to every homoepath. Some of the
articles may appear in PART II in later numbers of
the Quarterly Homoepathic DIGEST, as
abstract/summary/condensation/full, etc.
I. PHILOSOPHY:
1. HAHNEMANN and HEGEL or the
medicament is the picture of the disease,
BUTNER, S (ZKH, 34, 3/1990)
2. On provings and clinical symptoms
KELLER, G.V. (AHZ, 235, 3/1990)
3. Is vitalism valid,
LEARY, Bernard (BHJ, Vol. 79, 2/1990)
4. Another personal viewpoint,
CHAPPELL, Peter (The Homoeopath, 8,
3/1988)
5. CANDEGABE versus EIZAYAGA :
Reservation of conflict?
CHAPPELL, Peter (The Homoeopath, 8,
4/1988)
6. The CANDEGABE seminar,
ROBERTS, Ernest (The Homoeopath, 8,
4/1988)
7. Signs and indications of cure: Some cases,
CHAPPELL, Peter (The Homoeopath, 8,
4/1988)
8. Homoeopathic aggravations – a myth or a
fact?
HARI SINGH; MANCHANDA, R.K;
ARORA, Subhash (CCRH Quarterly
Bulletin, 12, 3&4/1990)
II. MATERIA MEDICA:
1. Ailments of lower abdomen – Nitric acid,
GYPSER, K.H, (ZKH, 34, 2/1990)
2. Sensitivity to noise – Asarum europaeum
SRINIVASAN, K.S. (ZKH, 34, 2/1990)
3. Verifications and clinical symptoms,
(ZKH, 34, 2&3/1990)
4. Constriction of the sphincter – Causticum,
EICHLER, R. (ZKH, 34, 3/1990)
5. Cardiospermum halicacabum – proving
with potencies D6 and C30
RESPONDEK, U. (ZKH, 34, 3./1990)
6. Folliculinum
COOPER, Dorothy (BHJ, 79, 2/1990)
7. Folliculinum : Efficacy in premenstrual
syndrome
MARTINEZ, Bruno (BHJ, 79, 2/1990)
8. A case of colitis treted with Secale
JACK R.A.F. (BHJ, 79, 2/1990)
9. Arsenicum album,
ELMORE, Dutt (Resonance, 12, 3/1990)
10. A case in point – the insemination reaction
in fruit flies,
HERSUC, Paul (Homoepathy Today, 10,
10/1990)
11. An Arnica save
HERSCU, Paul (Homoeopathy, 40,
5/1990)
12. Melilotus alba,
WILLIAMS, H.N. (The Hahnemannian,
June 1990)
13. Arsenicum album
WILLIAMS, H.N. (The Hahnemannian,
June 1990)
III. THERAPEUTICS:
1. Understanding asthma,
HOAGLAND,
Guy
D.,
(The
Hahnemanian, June 1990)
2. Nehrolithiasis depression
HEUSTERBERG, K-H, (AHZ, 235,
2/1990)
3. Multiple sclerosis,
MULLER, H.V. (AHZ, 235, 3/1990)
4. Progesterone deficiency syndrome – a
case,
GUISCHARD, A. (AHZ, 235, 3/1990)
5. Dreams,
WHITNEY, Kaaren (The Homoeopath, 8,
3/1988)
6. Homoeopathy
and
counseling:
a
worthwhile combination,
LEE, Felicity (The Homoeopath, 8,
3/1988)
7. Work in progress: The Camelford Water
pollution incident,
SMITH, Peter (The Homoeopath, 8,
3/1988)
8. Three Cases, Ran-b, Sel., Anac.
SWEELVIET, Annete (JAIH, 83, 2/1990)
9. Sewer gas – a 20th Century obstacle to
cure
ROULEAU, Patricia (JAIH, 83, 2/1990)
10. Sciatica: a case study and differential,
KIPNIS, Sheryl R., (Reasonance, 12,
2/1990)
11. Toothache,
STEPHENSON, David (Resonance, 12,
3/1990)
12. A case in point,
HERSCU, Paul (Homoeopathy Today, 10,
10/1990)
13. NCH/IFH Annual Conference Report,
PENNA, Maite (Homoeopathy Today, 10,
10/1990)
14. Post-operative remedies,
HOPINS, Barbara (homoeopathy, 40,
5/1990)
15. Evaluation of homoeopathic drugs in
Psoriasis
HARI SINGH; MANCHANDA R.K.,
ARORA, Subhash (CCRH Quarterly
Bulletin, 12, 3&4/1990)
16. AIDS and Homoeopathy,
KHURANA, Anil (CCRH Quarterly
Bulletin, 12, 3&4/1990)
IV. REPERTORY:
1. Remedy errors in KENT’S Repertory Cocculus and Coccus cacti
EPPENICH, H. (ZKH, 34, 2&3/1990)
2. Analysis of rubrics in KENT’s Repertory
– “Theorizing”
SCHINDLER, M. (ZKH, 34, 2/1990)
3. Confirmation of symptoms in KENT’s
Repertory and additions from the Materia
Medica,
GYPSER, K.H., WALDECKER, A.
(ZKH, 34, 3/1990)
4. The story of KENT’s repertory,
SAINE, Andre (Resonance, 12, 3/1990)
V. RESEARCH
1. Analysing homoeopathic prescribing
using the READ classification and
information technology.
VAN HASELEN, R.A., FISHER, Peter
(BHJ, 79, 2/1990)
2. Thinking what we are doing
DEMPSEY, Thez; SWAYNE, Jeremy;
(BHJ, 79, 2/1990)
3. A study of antibody formation by Baptisia
tinctoria in experimental animals,
ENGINEER,
S.J.,
VAKIL,
A.K;
ENGINEER, L.S; (BHJ, 79 2/1990)
4. Scientific support for Homoeopathy,
CROOK, Alan (The Homoeopath, 8,
4/1988)
5. Initiatives in homoeopathic research
DAVEY, R.W. (Homoeopathy, 40,
5/1990)
6. Drug proving and CCRH,
NAGPUL, V.M. (CRH Quarterly Bulletin,
12, 3&4/1990)
7. Clinical verification of hypoglycaemic
effect of Cephalandra indica in patients of
diabetes mellitus,
RASTOGI, D.P. (CCRH Quarterly
Bulletin, 12, 3&4/1990)
8. Literary research and Central Council for
Research in Homoeopathy
NAGPAUL, V.M. (CCRH Quarterly
Bulletin, 12, 3&4/1990)
VI. PHARMACY:
1. The legacy of HAHNEMANN-the fifty
thousand potencies,
BARTHEL, P (AHZ, 235, 2/1990)
2. Commentary on the above
SCHOPFER, H.J, (AHZ, 235, 2/1990)
3. Mortar & Pestle,
BORNEMAN, Jay P. (Resonance 12,
2/1990)
4.
An up-date on the regulation of
homoeopathic drugs
BORNEMAN, Jay P. (Resonance, 12,
3/1990)
5. Homoeopathy and the community
pharmacist,
AINSWORTH, JBL (Homoeopathy, 40,
5/1990)
VII. VETERINARY:
1. Paralysis in a German shepherd,
BLAKE Jr., Steve (resonance, 12, 3/1990)
2. Here is a lesson or two
LILLARD, Joe (Resonance, 12, 3/1990)
VIII. BIOGRAPHY:
1. Robert Thomas COOPER, an introduction
to his work,
WATSON, Ian (The Homoeopath, 8,
3/1988)
2. John
and
Elizabeth
PATERSON:
Reflections and reminiscences;
BROWN, Geoffrey (The Homoeopath, 8,
4/1988)
IX. HISTORY:
1. Transcription of Hahnemann letters (4),
GENNEPER, T. (ZKH, 34, 2/1990)
2. History of the Berlin Homoeopathic
Physicians
SOHN, FWPH (ZKH, 34, 3/1990)
3. Homoeopathy in 19th century American
novels,
MICHOT-DIETRICH,
Hela
(The
Homoeopathy, 8, 3/1988)
4. Clinica homoeopathica of Oaxaca: a major
homoeopathic teacher center in Mexico,
JACOBS, Jennifer (Resonance, 12,
2/1990)
5. The story of KENT’S repertory.
SAINE, Andre (Resonance, 12, 3/1990)
X. GENERAL:
1. Homoeopathy in the computer age
MULLER, H. (ZKH, 34, 2/1990)
2. Survey of the homoepathic periodicals in
France
BAUR, J. (ZKH, 34, 2/1990)
3. Supervision : a homoeopath’s perspective
CASTRO, Mirando (The Homoeopath, 8,
3/1988)
4. The homoeopathic telephonic consultation
LAKSKY, Philip, S (JAIH, 83, 2/1990)
5. Homoeopathy and computers
MASIELLO, Domenick (JAIH, 83,
2/1990)
6. The IFH professional course – a review of
the fourth week
LEVATIN, Janet (Resonance, 12, 3/1990)
7. The patient’s choice,
JOHNSON, C.D.G. (Homoeopathy, 40,
5/1990)
Vol. VIII
PART II
ARTICLES
JUNE 1991
THE ANXIOGENIC
EFFECTS OF
CAFFEINE,
BRUCE, Malcolm
S.
Postgrad Med. J.
(1990) 66,
(Suppl.2)
Introduction :
During psychiatric history taking in the U.K.
enquiry into caffeine use remains the exception.
Current psychiatric text books used in the U.K. do
not give caffeine any prominance, if mentioned at
all. The Br. Med. JI. has referred to the association
between caffeine and anxiety (Ashton C. H:
Caffeine and health, Br. Med. JI. 1987, 295 : 129394). The American Psychiatric – DSM-III-R has
specific diagnosis in the organic mental disorders
section, Caffeine intoxication – Table I.
Table I. Caffeine toxicity as defined in DSM-IIIR.
A. Recent consumption of Caffeine, usually in
excess of 250mg.
B. At least five of the following:
1. Restlessness
2. Nervousness
3. Excitement
4. Insomnia
5. Flushed face
6. Diuresis
7. Gastrointestinal complaints
8. Musle twitching
9. Rambling flow of though and speech
10. Tachycardia or cardiac arrhythmia
11. Periods of inexhaustibility
12. Psychomotor agitation
C. Not due to any other mental disorder, such an
Anxiety Disorder. Tabel II and III show the
similarity between the accepted somatic symptoms
of anxiety and caffeine effects. Table II for
generalized Anxiety Disorder (GAD) and Table III
Criteria for Panic Disorder (PD).
Table II. Symptoms present in Generalized
Anxiety Disorder
1. Dyspnoea
2. Palpitations or tachycardia
3. Muscle tension
4. Trouble swallowing
5. Dizzines
6. Nausea, or abdominal distress
7. Restlessness
8. Easy fatiguability
9. Hot flushes
10. Sweating
11. Trembling
12. Insomnia
13.
14.
15.
16.
17.
18.

Dry mouth
Frequent urination
Feeling keyed up or on edge
Exaggerated startle response
Difficulty concentrating
Irritability
= also listed as symptom of caffeine
toxicity.
Table III. Symptoms present in Panic Disorder.
1. Dyspnoea
2. Plapitations or tachycardia
3. Chest pain
4. Choking
5. Dizziness
6. Nausea, or abdominal distress
7. Depersonalization or derealisation
8. Paraesthesia
9. Hot flushes
10. Sweating
11. Trembling
12. Fear of dying
13. Going crazy, or loss of control.
*= also listed as symptoms of caffeine toxicity.
Dietary Sources: Caffeine is consumed mainly in
drinks either naturally occurring or as an additive.
The actual ‘per drink’ caffeine varies with the
method of preparation and the size of the cup.
Highest concentrations are found in percolated
coffee. Lowest amounts occur in instant coffee.
Caffeine levels in tea depend greatly on the length
of brewing. Note the number of milligrams of
caffeine in a kilogram of tea leaf is greater than that
found in an equivalent weight of coffee bean. Hot
chocolate drinks average about 5 mg. per cup.
There are many over-the-counter preparations used
for analgesia and migraine.
Pharmacology: Caffeine (1,3,8 – trimethylxanthine) is one of the naturally occurring xanthine
derivatives or methyl- xanthines. Caffeine is
readily absorbed following all routes of
administration, for example, absorption after oral
ingestion is 99% complete at 45 minutes. Caffeine
is distributed into all body compartments, it crosses
the placenta and is excreted in mother’s milk. 15%
is plasma protein-bound. It is highly lipid-soluable
and higher concentrations are reached in the CSF
and brain than in plasma. Liver metabolism is by
demethylaton followed by excretion in the urine,
about 1% o the caffeine remaining unchanged. the
mean plasma elimination may vary, increased in
pregnancy and with the use of oral contraceptive
pill for more than 6 months, decreased in smokers,
possibly in high caffeine users and in patients
taking drugs which induce liver enzymes, e.g.
refampicin. The biochemical action of caffeine is
believed to be mediated by blocking receptors for
adenosine. Adenosine dilates blood vessels,
particularly in the coronary and cerebral
vasculature and inhibits the release of
noradrenaline from the autonomic nervous system.
Effects of caffeine on normal subjects:
Much research contains contradictory evidence
about caffeine’s actions. The findings and
observations need dividing up into 4 groups. A)
acute studies (i.e. on caffeine-native subjects); B)
acute on chronic studies (i.e. caffeine challenges in
habitual caffeine users); C) toxic effects; D)
withdrawal effects.
A. Acute Studies: Caffeine produced significant
increases in anxiety and nervousness at 30 minutes
and a decrease and calmness at 90 minutes. dose
related increase was observed. 2 subjects developed
unequivocal panic attacks characterized by acute
fear of imminent death; hyperventilation and carpopeddal spasm was prominent in one case.
B. Acute on chronic studies: Regular users given
500mg show less response. This is due to tolerance.
Any caffeine intake, a sudden increase of more
than 500mg of caffeine in a day will result in
caffeine toxicity. More gradual increases may not
do this. Regardign sleep, tolerance does occur, but
if omitted, people still report falling asleep sooner
and having a better quality of sleep. The one
benefit of regular caffeine use seems to be boosting
performance that otherwise fails due to boredom or
fatigue.
Measures used to study caffeine’s relation to
many physiological and psychological correlates of
anxiety:
i)
Self
rating
scales,
ii)
Electroencephalogram, EEG is the only true
measure readily available for psycho-physiological
study. In anxiety states alpha activity is reduced
and there is a higher proportion of beta activity.
Generally, stimulants affect on-going EEG by
increasing alpha, iii) Skin conductance. Palmar
sweating is believed to be emotionally determined
and evidence of increased skin conductance in
anxious patients has been repeatedly shown. A
rreduction in skin conductance was also found to
correlate with clinical improvement.
C. Toxic effects: High sudden increases in
consumption have been associated with delirium,
abdominal cramps, vomiting, high anxiety, hostility
and psychosis. All these symptoms clear within 48
hours of abstention from caffeine. Rare fatalities
have occurred with oral doses about 6.5 grams in
adults.
D. Withdrrawal effects: The best-known of the
withdrawal effects is headache. withdrawal
syndrome has an onset at 12-24hou peak at 20-48
hours and duration of about one week. Headache
and fatigue are the most frequent withdrawal
symptoms with a wide variety of other signs
occurring less often including anxiety, impaired
performance, nausea, vomiting and craving.
Caffeine and anxiety disorders: Caffeine toxicity
may be in-distinguishable clinically from anxiety
states other than by history. Caffeine intake enquiry
as a routine part of a psychiatric history taking will
ensure that this diagnostic error is avoided. Of
equal clinical interest is how important is normal
caffeine intake as an external factor in the
triggering and or maintenance of anxiety states, and
does caffeine affect the subsequent severity of the
anxiety state. Anxiety disorder patients were
significantly more sensitive to caffine and drank
less caffeine than the control group. The caffeineassociated symptom check list showed increased
sensitivity to caffeine with respect to anxiety,
tremors, muscle tension, panic attacks, lightheadedness and diarrhea. There is marked
significant correlation between trait anxiety and
caffeine consumption in anxiety disorder patients.
Using caffeine challenges, two pain disorder
patients with agoraphobia were more sensitive to
the anxiogenic effects than 7 controls.
Case : A 33 year old single female, working as
an assistant architech and looking after a 3 year old
child. Daily caffeine consumption was 540 mg. in
the form of tea only as she found coffee made
‘everything go inside-out’ with the onset of tremor
and other panic-like symptoms. She gave a 10year
history of anxiety with panic attacks. 10 years ago
the initial symptom was palpitations, with later
unsteady feelings, depersonalization, paraesthesia,
fear of dying and the fear of doing something
uncontrolled. Attacks had a rapid onset, lasted 5 to
30 minutes, and the recent frequency was 2-3 per
week. Additional symptoms during panic attacks;
hyperacusis and an urge to get home, although
there was no agoraphobic avoidance behaviour nor
any specific fear of being in places where panic
attacks might occur. Previous treatments included
chlordiazepoxide for 6 months once weekly
psychotherapy for 4 years, relaxation therapy, and a
trial of propranolol, all with minimal benefit. Her
family history was negative. Her father died when
she was 5 years old from heart disease and she was
brought away from home from the age of 11 at
various schools as her mother was severely
handicapped with emphysema. She was not in a
long term personal relationship at the time of
presentation.
Panic disorder was diagnosed and after 1
week’s abstention from caffeine she felt better and
volunteered herself to abstain from caffeine.
Treating her panic disorder with drugs seemed no
longer appropriate. At 8 months follow up she
continued to be free from panic and limited
symptom attacks. She had remained on an almost
caffeine-free intake. On 2 occasions when she took
more caffeine mild anxiety symptoms recurred.
All 6 cases had either GAD or PD. caffeine
abstention improved symptoms in all 6 cases, in 5
such that anxiolytic medication was no longer
required and in 1 where the dose of anxiolytic was
probably less than would otherwise have been
required. caffeine abstention patients should be
advised of the short term withdrawal symptoms of
increased headache, sleepiness and laziness and
decreased alertness and activeness. High users of
caffeine might be advised to taper their in-take over
a week or two to obviate such withdrawal.
(condensed slightly by Dr. K.S. Srinivasan)
FURTHER ON COFFEE
The oil content in coffee powder ranges rom 9 to
13%. Boiled coffee decoction extracts partially the
oil present in coffee powder. When such decoction
is drunk it effects what is called a
hypercholesterlemic state among the consumers,
i.e. the cholesterol level rises in the body system.
The oil in the coffee bean is unusually high in
unsaponifiable matter which is responsible for
increasing the cholesterol level. In the ‘instant
coffee’ the oil is removed in the process and in the
‘drip filter’ the oil is retained in the residue. Only
boiled coffee extracts the oil which increases the
cholesterol (Extract from Letter to the Editor, The
Hindu, Madras, from G. Azeemoddin, Jt. Dir.,
TNTU Inst. of Chem. Tech. Anantapur. = K.S.S.)
INDIFFERENCE,
CATHERINE R.
COULTER,
The Hahnemanian,
September &
December, 1989.
The Nature of
Indifference : This mental state, defined by
WEBSTER mainly in negative terms to portrary an
emotional void, is actually a highly complex
emotion, full of substance and fraught with inner
tension.
Its manifestations differ in the various
constitutional types and according to the causes
from which it originates.
For instance, in Phosphorus indifference often
takes the form of unresponsiveness, in Lycopodium
of detachment, in Sulphur of egocentricity, in
Natrum muriaticum of self-denial, in Sepia of lack
of interest, in Lachesis of “switching off.” and so
forth.
Sometimes the indifference appears innate
(Lycopodium), sometimes acquired (Phosphorus,
Phosphoric acid), sometimes assiduously cultivated
(Natrum muraticum, Staphysagria), sometimes a
blend of the above (Sepia).
In its purest form, indifference is a sickness
arising from total physical collapse or mental
shock, with no strength to care, and its addressed
by such remedies as Phosphoric acid and
Carbovegetabillis. but sometimes it is part of a
curative process – offering the vulnerable
individual a way to find emotional equilibrium and
assisting him to become disengaged from
unendurable reality.
In these cases the physician will administer
medium instead of high potencies so as not to
disturb the defence mechanisms at work. For the
action of the homoeopathic remedy is paradoxical:
the one that can dispel an unhealthy indifference
can sustain and encourage a curative one.
The physician further learns to distinguish a
true emptiness from one which masks an
underlying vulnerability or obsession. And this
latter state can, in turn, be subdivided into healthy
versus unhealthy masking indifference – all of
which forms will be examined below.
However, sustained indifference, even when
curative, is often unnatural. Feeling, caring,
enjoyed, relating, being moved by interest or
curiosity, are all integral to being human, and a true
indifference, in the sense of emotional stasis,
denies a vital aspect of the human experience. Even
the “healing” (or “protective”) indifference, taking
the form of self-renunciation or self-deprivation,
entails a certain degree of withdrawal from life.
And the individual who remains too long in an
emotional void, lacking positive feelings risks
replenishing the vacuum with negative ones.
Forestalling this evil by extricating the patient from
his slough of indifference and restoring him to a
fuller state of existence becomes the physician’s
prime objective.
Yet another species of indifference is not a
rejection of life, but only a rejection of overly
powerful and uncontrolled emotions which
endanger one’s serenity. It is the calm after an
emotional storm, emerging when pain and
bitterness have been exhausted, emotional injury
and disappointment overcome, rancour and
resentment dispersed. The patient has progressed
beyond the subversive anger that tends to turn
against him, beyond “extreme loathing of life”
(HAHNEMANN-Sepia), and has arrived instead at
an indifference that offers a way of confronting
harrowing emotional ambiguities and softening
rigidities of personality without risking a fracture.
The task of the homoeopathic remedies may often
be to help the patient arrive at this highly desirable
state of poisa and serenity.
The term “indifference” thus covers a range of
functions, both curative and masking, emotions
both healthy and unhealthy, and manifestations
both desirable and undesirable meaning, in
homoeopthy, that we have a large assortment of
possible medicines. Apart from Phosphoric acid,
the newest member of our portrait gallery, the
following pages touch primarily, upon the finer
shadings of several remedies already discussed in
these Portraits.
This selection merely reflects the author’s own
observations and experience with cases exhibiting
the emotional state called “indifference” and is not
meant to exclude such remedies as China, Platina,
Lilium tigrinu, and dozens of others which have
also been found to benefit patients in whom
indifference is a prominent symptom.
Genuine Indiffernece Resulting from Physical
Ailments or Mental Shock: A genuine
indifference, in the sense of true emotional
emptiness, can be provoked by such acute physical
ailments as influenza, pneumonia, mononucleosis,
malaria, typhoid, and others. The patient is left too
feeble to muster a mental or emotional response.
Carbo vegetabilis comes first ot mind for the utter
indifference accompanying the state of collapse
following a severe illness. The patient is aware of
his surroundings but “hears everything without
feeling pleasantly or unpleasantly, and without
thinking of it” (HERING). He cannot “whip
himself into activity or rouse a desire to do
anything (and is ) unable to perceive or feel the
impressions that circumstances ought to arouse”
(KENT). These mental symptoms reflect one
aspect of the well-attested Carbo vegatabilis
“sluggishness” (KENT).
But, overall, this polychrest suffers from a
paucity of idiosyncratic or sharply delineated
psychological traits. In addition to its picture of
indifference and mental sluggishness, the sketchy
mental picture of this important remedy is made up
principally of variations of HERING’s memory
feeble or temporarily lost .. with a tendency to
fixed ideas; mental confusion making thinking
difficult: and HAHNEMANN’s” out of humor,
great irritability, peevishness; impatient after angry
outburst of temper.”
Another commonly prescribed medicine for
indifference after an exhausting illness (influenza
in particular) is Gelsemium. Here the mental
“dullness, listlessness, and languor” (BOERICKE)
correspond to the patient’s physical picture of
droopy eyelids, heavy limbs, and complete absence
of energy. And, in a perhaps fanciful extension of
the Law of Similars, the state of both mind and
body are reminiscent of the torpid, sultry languour
induced by the intoxicating perfume of the yellow
jasmine from which the remedy derives. Psorinum
should also be considered for indifference arising
from lowered vitality and lingering weakness in
patient never fully recovered from some previous
illness – a “never cared since” syndrome which
parallels the “ never well since” syndrome
discussed in an earlier chapter.
Phosphoric acid is another viable candidate for
total indifference to his surroundings. Although
BOERICKE says of it, “mental debility comes first,
followed later by the physical”, many physicians
find it useful in cases of indifference following a
debilitating physical illness, where the patient
simply has too little energy to care.
Indifference can also result from severe mental
shock – after a fright or overwhelming sorrow.
The immediate aftermath might call for
Aconite or Ignatia But once the initial shock has
been overcome, Opium with its “ailments that
originate from fright” (HERING) or Phosphoric
acid, with its “system (that) has been exposed to
the ravages of grief and loss” (BOERICKE) are
frequently resorted to.
Opium’s stupefaction (and ) indifference”
(HAHNEMANN) is easily recognized by those
familiar with the effects of opium and other opiates
(“complains of nothing, wants nothing; tranquil
indifference to earthly things” (HAHNEMANN)
and requires no further clarifying examples. But the
Phosphoric acid indifference that descends on the
patient who has undergone the shock of grief,
chagrin, or disappointment in love: (HERING)
does call for elaboration.
Like a stone thrown into still waters, after the
initial shattering, the emotions spend themselves a
series of ripples of decreasing intensity, and
Phosphoric acid is a major remedy for these
peripheral reverberations. Thus it better fits the
second stage of emotional trauma, when acute
shock has become a “settled despair”
(BOERICKE) that may take the form of
indifference.
The Phosphoric acid patient is quiet and
seemingly unperturbed. Although he might appear
absorbed, in reality no feelings or sensations
smolder beneath the surface (“no howling
emptinessinside,” as one patient put it). He is
adverse to conversation and unable to react
appropriately (“speaks little and answers
unwillingly the questions put to him”;
HAHNEMANN) – not because he is sullen or out
of humor (although he may “look very illhumoured and sullen”; HAHNEMANN), but from
a sense of futility. No comment is adequate to the
trauma he is undergoing or has undergone, and no
one who has not experienced a similar grief can
understand it. He does not permit himself to fee, les
he reopen old wounds and rekindle the former pain.
He will dutifully go through the required motions
of living but appears abstracted – almost in a
dream. Or he will sit numb and dazed, staring
vacantly into space.
He might tell himself to clean the house, work
in the garden, or vist a friend, but then appends,
“Why bother? Why pretend to care? Nothing
matters any more… “In extreme cases he takes to
his bed, lying motionless, “like a log, utterly
regardless of his surroundings” (H.C.ALLEN), and
unwilling to be disturbed.
Phosphoric acid, however, may also be
indicated for the polar opposite of indifference –
the overt forms of grieving where the patient is
visibly torn asunder, uncontrolled dand frantic
(“hysteria”; HERING; “restlessness.. weeping..
hurried talking”; HAHNEMANN).
A woman of fifty, diagnosed several years
earlier with multiple scierosis, suddenly realized
that her condition was incurable. She had been
valiantly ignoring it and trying to live normally, but
her progressive physical disability now caused her
continually to trip and fall. In the last few months
she had gone from a cane to a walker, and was now
confined to a wheelchair. Her back hurt
continuously; at right she had severe tearing pains
in the legs; she had neither bowel nor urinary
control; and her clumsy fingers could not open jars
or bottles, or even hold objects without dropping
them, Her tongue, moreover, was so thick and
inagile that she sounded inebriated when she spoke.
Hence she had totally lost her composure and
came to the physician sobbing in terror and despair.
Ignatia was initially prescribed for her hysteria, and
several other remedies were tried, but the case was
really turned around by Phosphoric acid 200c (in
weekly doses for a month) with its two rather
colorless supporting symptoms: “better for warmth
of bed and warm food” (HERING).
Today, ten years later, the patient has not been
cured of her degenerative disease but has very
definitely improved. She can walk with only
occasional use of a cane, has really full control of
her bowels and urine, talks normally, and has
recovered more than eighty percent of her manual
dexterity. She receives constitutional remedies at
least monthly to maintain her improvements, and if
she relapses into overt fear and hopelessness,
Phosphoric acid invariable comes to the rescue.
Worth mentioning, in connection with this
case, is that Phosphoric acid, with its “extremities
weak and greatly debilitated; tearing pains in joints,
bones, and periosteum; stumbles easily and makes
mistakes, “and Picric acid (TNT!), with its “great
weakness of the extremities, tired heavy feeling all
over body, especially the limbs; acute ascending
paralysis” (BOERICKE), are among the half-score
or so remedies that have proven exceptionally
valuable in multiple sclerosis.
Phosphoric acid is another important
homoeopathic remedy (cf. Carbo vegetabilis,
above) that is not endowed with a well-developed
or clearly defined personality, Although possessing
a rich and varied collection of physical symptoms,
its mental and emotional picture is rather meager –
always overshadowed by the related, and more
colorful, Phosphorus. HERING has summarized
the Phosphoric acid personality in a few key traits:
“unwilling to speak listless, apathetic; remarkable
indifferent to everything in life… weak memory;
loss of ideas; weakness of mind; cannot collet
thoughts; cannot find the right word when talking;
answers reluctantly and slowly or shortly and
incorrectly. “Later textbooks of material medica
merely reiterate this picture, or elaborate on it, and
the prescriber must rely largely on the physical
symptoms and supporting modalities.
Yet, in its power to dispel the indifference
resulting from despondency, negativity, lack of
interest, or emotional emptiness, to restore the
physically exhausted or emotionally depieted
patients’ vitality and ability to care; also in its
capacity to enable the despairing patient to acquire
a SAVING indifference, and the stoical one to
sustain his mental equilibrium through mental and
emotional strain Phosphoric acid has earned its
rightful
place
among
the
homoeopathic
polychrests.
The Masking Indifference: Often the indifference
is not genuine but merely feigned – a sheath
concealing some underlying drive, fear, or
vulnerability. The aim is not to deceive. The mask
of indifference helps preserve self-control and
maintain emotional stability, it serves to contain an
otherwise consuming emotion. It also signals to
others that this reserve should not be violated but
be respected.
Phosphoric acid plays a major role in all these
instances.
A representative case was the middle-aged
man suffering from arthritic pains of recent onset
who, with the noblest intentions in the world, could
scarcely tolerate the chronic infidelities of his
attractive young wife. His love for her and their
two young children, together with his innate
stoicism, enabled him to conceal his pain behind a
mask of indifference, and his calm disposition,
seemingly incapable of rancour, helped him appear
unperturbed. Only his sorrowful, pleading eyes –
those of a dog gazing imploringly at his master and
unable to express his pain – betrayed his true
feelings. Although he forgive his wife in his hear
and appeared indifferent to her behaviour, his body
possessed a will of its own. Expressing its grief
through the pain in its joints, it refused to allow his
to ignore the repeated injuries to his psyche.
Being closely related chemically to
Phosphorous, Phosphoric acid has the same affinity
for the bones and joints – with “tearing,”
“burning,” “boring,” “digging,” or “cramping”
pains – and this remedy was prescribed (In medium
potencies) with gratifying results the physical pain
vanished, and even the emotional trauma became
more tolerable.
Admittedly, other homoeopathic remedies are
available to assist patients who conceal their
injuries under a cloak of indifference, but whose
unforgiving and unforgetting body develops
pathology in consequence. Natrum muriaticum is a
prime example – hiding his sorrow under a
beaming smile so as not to burden others with his
interminable difficulties (“No, nothing’s the matter
.. Yes, I’m perfectly fine?”) or maintaining a stoic
front and stiff upper lip to prevent his feelings from
becoming too real. Prominent here, too, is
Staphysagira – whose masking indifference
conceals even from himself the emotional origins
of his bursitis, rheumatism, sciatica, tendonitis, or
whatever.
Sometimes, in fact, the patient recognized the
emotional basis of his illness only in hindsight –
after Staphysagria has been successfully prescribed
and helped to cure his physical condition.
A typical case was the woman with a persistent
sciatica which resisted all pain-killers, After trying
every conceivable medical test, including a CAT
scan, she eventually turned for help to
homoeopathy.
At first she was treated with such conventional
sciatica remedies as Rhus toxicondendron,
Hypericum, and Colocynthis, but when these
proved unavailing, the physician inquired more
closely about her family. Underlying her condition,
as it turned out, was an anger at her son’s school
teacher, who was critical of his behaviour and
insensitive to his needs. She disguised this by a
cavalier indifference (“So, she’s incompetent. I
suppose she’ll be out of his life after this year !”),
but her body did not allow her to suppress this
resentment and asserted itself in no uncertain terms
until the situation was righted by Staphysagria.
Such are the psychic depths addressed by the
homoeopathic remedy even without the patient’s
conscious participation. Without forcing him
laboriously to examine the distressing present, or to
disinter and relive the traumatic past (in this case, it
was the excessive parental criticism the patient had
been subjected to in childhood), the Simillimum
proceeds to disperse their untoward consequences.
Indifference to Everything in Life: “Indifference”
in the KENT Repertory has a number of subrubrics.
We begin with the one which is broadest in scope –
“indifference to everything in life.”
This state is akin to ennul, that mental
weariness and overall dissatisfaction with life
which in former years was regarded as a malady of
the leisured class but which today, under conditions
of democracy, is shared equally by all.
The patient does not display a Hamlet-like
loathing for life out of intellectual Angst or
ambiguity, nor yet a Werther-like tedium vitae out
of sorrow or despair, with active desire for death;
his attitude is more defeatist, his mood is calm, but
his outlook is somber.
For this condition Phosphoric acid is a
homoeopathic mainstay. It befits the patient with
complete lack of interest in his surroundings. Even
when young, he is so fatigued in spirit, so firmly
convinced that pleasure, success, affection, and
excitement are not for him , that he has ceased
striving for happiness or meaning in life.
It is not a sense of grievance that deprives him
of responsiveness but rather a settled
discouragement and demoralization – dispirited
reaction to his environment. He displays no
urgency, no desire for accomplishment, no
impatience to overcome his mental stagnation – to
move out of his emotional limbo. “I need time to
remain Ill ..I haven’t the energy to start getting well
… I have to stay in this apathetic state a while
longer…. please don’t force me!” – are his more
typical supplications; and “I don’t want any of your
remedies. I refuse to be potentized!” – a more
unusual one.
A man of the church, who had returned weak
and depressed from a tour of the Third world in an
official capacity, was loath to resume his parish
duties. While the diarrhea he had contracted in
Africa was debilitating enough, something more
subtle and profound than any physical ailment had
transpired during his trip. Witnessing so much
poverty, illness, starvation, and suffering in his
enfeebled state had undermined his faith, and he
was now quite indifferent to the spiritual welfare of
his American flock. He saw no point in continuing
his mission on earth. He had, in short, given up: “I
feel that I have passed the summit of life; from now
on th path goes only downhill.”
The minister’s uncharacteristic. but now
engrained, indifference was so startling that a
friend recommended that he try homoeopathy. On
the basis of his continuing diarrhea (prominent in
Phosphoric acid), and also by virtue of the modality
“worse when walking out of doors, better form
sitting in the house” (HAHNEMANN), one of the
remedy’s few idiosyncratic symptoms, it was
prescribed in the IM potency.
The effect was spectacular! It not only restored
the clergyman’s former optimism and happy
disposition but accomplished the more formidable
task of renewing his faith in an ultimately merciful
(even if His ways are not always comprehensible)
Deity.
The Phosphorus “indifference to everything in
life” presents an even more striking contrast to the
type’s usual liveliness or joie de vivre. Sometimes
his lack of response reflects an overall satiety with
life’s pleasures, after having burnt the candle at
both ends – and in the middle. At other times the
“strange, rare, and peculiar” aspect is the sudden
loss of his former attractive enthusiasms.
A homoeopathic physician in his mid-thirties
who was relatively new to th trade suddenly lost all
interest in life - including family, friends, hobbies,
even (difficult to believe!) his profession. His
former ebullience and eagerness to follow the
homoeopathic method had turned into a profound
despondency (“the whole world seems dreadful to
him”; HAHNEMANN) and was later moderated to
a less alarming listlessness (“afterwards total
apathy”; HAHNEMANN). When he finally turned
to a colleague for assistance, the latter had no
difficulty arriving at the root of the problem.
Some years earlier this fledgling doctor had
been converted to homoepathy by one of those
energetic and charismatic leaders periodically
spawned by this movement, who sat themselves up
as more than mere teachers – rather as “master” or
“gurus” – and thereupon develop a strong and
devoted following.
For a few years this patient had been the
favourite son, a privileged position which sustained
him in his studies and his work. But when he was
duly superseded by a younger disciple, the light of
his enthusiasm dimmed and was finally
extinguished altogether. He no longer had the heart
to seek the company of his former colleagues, or
even to practice homoeopathy, and became quite
indifferent, or even to practice homoeopathy, and
became quite indifferent to life.
Phosphorus is an enthusiast and, like many
enthusiasts, requires an outside force to nourish and
sustain his interest (the Phosphrous personality, we
recall, may lack a clearly defined core or sense of
identity), and in these cases his enthusiasm is a
weakness rather than a strength. When this
nourishing force withdraws, he is lost and empty,
unable to function on his own. He then laments the
“master’s” unsubstantiated promises, which are no
less meaningful to him for being largely tacit, and
feels rejected and bereft. Furthermore, because it is
an “outside” force that he has never fully
understood, he is confronted with the pain of
disillusionment in a God (who “passeth human
understanding”) that has failed. Such was this
patient’s predicament.
he has dosed himself with Aurum metalicu,
Ignatia, Natrum muriaticum, and other remedies,
but he started slowly to pull out of his debilitating
mental state only when Phosphorus was prescribed
– largely on the contrast between his present
indifference and his former strong enthusiasm. He
eventually resumed his former practice – in a
quieter mode but this time with truer inner strength.
Natrum muriaticum can be equally indifferent to
life after some painful disillusionment or loss of
enthusiasm but has another mode of reaction. He
seldom abandons completely any activity involving
an element of duty and thus, despite his current
apathy, joylessly goes through the motions of what
was once meaningful. Hence his indifference is
burdened with more subliminal anger and
resentment than that of Phosphorus, Phosphoric
acid, or Carbo vegetabilis. However, it is rarely
maintained with any consistency. Rather it
alternates with spells of diligence, animation, and
resurging enthusiasm, and this all contributes to the
type’s well-known mood swings and sudden
reversals of taste and opinion.
Although Natrum muriation might be
genuinely indifferent to his own life or welfare, he
is not indifferent to death. While perhaps
welcoming it in the abstract, he cannot be apathetic
about leaving the world improperly attended to.
who will set things right once he has departed?
Hence he must stay around – at least until someone
equally farseeing and responsible materializes to
take over his important duties. What is more, when
he does recover from a debilitating indifference, he
embraces life with the eagerness appropriate to one
miraculously vouchsafed another opportunity of
assisting a world in travail.
Lycopodium presents quite another picture of
“Indifference to the highest degree…. insensibility
to external impressions” (HAHNEMANN). Ever
skeptical of emotion and both relativistic and
ambivalent in his perception of the world, his
apathy seldom proceeds from lost enthusiasm but is
rather an off-shoot of his innate detachment. He bot
instinctively and on principle repudiates whatever
jeopardizes this detachment; any enthusiasm,
eagerness, or too-strong emotion.
A case emblematic of Lycopodium’s
principled reluctance to betray enthusiasm was the
lady gardener whose gowing indifference to life
had been exacerbated by a mid-life depression.
when challenged by a friend to react to a beautiful
be of geraniums, she replied; “I don’t find this
flower bed the least bit interesting. But perhaps the
fault lies in the geraniums themselves and not in
my own apathy. Uninspiring flowers at best, they
do not grip the attention of even the healthiest
individuals.”
The Lycopodium characteristic is not easily
analyzed but is best appreciated in context. Another
instance is his way of reacting to another’s excited
concern with a cool “Does it really matter?”
Indeed, in cosmic terms, the event might not really
matter, but it was not seen that way until
Lycopodium placed it in perspective.
Or, when told that some undertaking is bound
to be “unforgetable,” Lycopodium may remark
wryly, “That is certainly possible!” The
implication, of course, is that the experience may
well match the enthusiast’s expectations, but not
necessarily in the way desired.
Such laconic, even-tempered skeptcism could
be viewed charitably, as reluctance to take too
seriously his own or another’s feelings-a healthy
characteristic when not accompanied by emotional
withdrawal. Those less partial to the typical
Lycopodium aloofness ascribe this “indifference”
to an unyielding desire for psychological mastery.
In Calcarea carbonica “Indifference to
everything in life” carries a note of resignation.
In sickness this can appear as “Indifference
about his recovery” (KENT) with loss of all desire
to fight illness. If there has been much physical
pain and suffering, the remedy is often Arsenicum
album (“carelsss about approaching death, neither
hopes nor wishes to recover”; HAHNEMANN). In
health he may refuse to worry about the morrow;
“What will be, will be”, states he with oriental
fatalism, “Sufficient unto the day are the problems
thereof.”
Thus he resists the modern tempo of haste and
urgency and handles all conflicts and ambiguities
through a placid indifference. Tracing back through
the case history, the physician may find
indifference rooted in disappointment that some
anticipated event did not occur, some long-awaited
change never came to pass. The patient has
relinquished hope and become indifferent so as not
to be disappointed second time.
It is not only older persons, who may have
outlived the need for passion and intensity in their
lives, who suffer from phlegmatism and inertia, but
younger ones as well. This state compares with
Sepia’s emotional “stasis” (FARRINGTON), but
without the latter’s “Soured” outlook. Calcarea
merely exhibits a preference for rest over motion.
even if (since life is motion) this entails some
denial of the itself.
OBLOMOV,
the
archetypal
Calcarea
carbonica figure mentioned by us more than once
in these Portaits, represents this indifference to
everything – the man who wishes sonly to be left in
peace. To achieve this he will sacrifice love,
friendship, accomplishment, and even self-respect.
This Calcarea indifference, that neither
condemns nor condones the surrounding world,
does not repudiate life generally but simply sets
little value on his own.
A kind and sensitive, but lonely, Calcarea soul
suffered from dizziness, constipation, poor sleep,
tension in the neck an shoulders, heartburn, and
low self esteem. In her marriage she had long
resigned herself to second class citizenship, and
now, with her children grown and gone, she was
also suffering the particular loneliness of the
“empty nest syndrome.” Her life offered no tragedy
or trauma, merely stagnation and an unclear picture
of how to use her potential. She had withdrawn into
her shell and was “indisposed to talking, without
being ill-humoured” (HAHNEMAN). Mindful that
at times this type can be jogged out of passive
indifference only by some external stimulus, the
physician in the full and august majesty of his
authority, instructed her to adopt a kitten and two
canaries. This mandate, reinforced by a prescription
of the potentized oyster shell, accomplished the
desired physical improvement.
And there was even some mental
improvement, as even from her remarks a few
months later; “Certainly at birth we are dealt a
weaker or stronger hand, but I now realize that this
does not justify a fatalistic indifference to the game
being played. The Challenge lies in how you play
your cards, in scoring as many tricks as you can. A
not-too-original discovery, to be sure, but one
which in my apathy I never really absorbed until
now “she sighed.” I suppose that, with the kitten
now fully grown and the canaries singing away
contentedly, I sall have to decide how to play My
hand better. But, oh, my! What a daunting
prospect!”.
The Staphysagria “indifference to everything
in life” usually follows some injury or insult which
the conscious mind is willing to overlook but the
implacable physical constitution has no intention of
letting go by.
A young woman, temporarily institutionalized
for a nervous breakdown, was unable to pass urine
without a catheter. She ws the picture of
indifference, sitting un-reactive and unresponsive
and staring all day out the window. Her urinary
retention, which had commenced in the hospital
immediately suggested Staphysagria, and closer
questioning revealed the presence of suppressed
indignation. Her room had no doorknob on the
inside, and she had been furious at the indignity of
being so incarcerated. After carrying on about it for
two days, her passion spent, she relapsed into
indifference, and had refused, or been unable, to
urinate since that time. Three doses of th remedy in
high potency, administered at twelve hour
intervals, released both her urine and her anger.
After this outbreak of emotion she became anxious
to be released from the hospital and, in
consequence, became cooperative and mad a
speedy recovery.
Sepia and Sulpur, two major remedies in this
particular subrubric, are accorded much coverage
in the following sections, Here we need only state
that Sepia’s overall indifference (“Very indifferent
to everything: the death of a near relative or some
happy occurrence leave her equally unaffected”;
HARING) – for which previous trauma or sorrow
cannot always be established – often merely
reflects a chronic physical lethargy and prostration
that renders her incapable of feeling (“lies
(indifferent) with her eyes closed.” KENT).
Sulphur’s indifference to everything, on the other
hand, usually strikes the physician as a temporary
unnatural state in glaring contrast to the
individual’s customary assertiveness.
HOMOEOPATHY
AND MIND,
BAUER, E.
ZKH, 30, 2& 4/1986
Patient 1 : On a Monday a
couple came to me for a ‘fasting treatment’. On the
following Thursday the wife said; “we must go
back home by Saturday at the latest, then…” and
laughingly looked at me. It was about her dog. He
was sad, just lying at home with total apathy,
without eating or follows: the dog had been at one
time, gravely ill. Her husband had brought it up
with love and care. Both of them were inseparable.
This time her husband had, for some reason, not
taken leave of the dog when he went away. The
dog did not find him any more.
a single globule of the size of the poppy seed
of Ignatia XM was sent by speed post. It was sent
by speed post. It was given to the dog at 2200
hours. On the following evening the telephonic
inquiry revealed that since that morning the dog
had recovered to its earlier state. He is cheerful,
eating and drinking. The argument for the
exclusive use of the deep potencies and the
indisputable success of the homoeopathic high
potencies and Homoeopathy itself in general is,
according to opponents of Homoeopthy, the faith
which the patient places upon the personality of the
physician. The success with animals particularly
when the physician had no chance to see the
animal, rebuts this. The other objection is chance.
Now that is totally rebutted when, for example, we
cite a series of 4 continuous similar cases of
animals in which immediate and permanent effects
were obtained.
Ignatia is one of our wonderful and reliable
medicines,
specially
indicated
in
those
overwhelmed by sadness and grief.
An elderly woman lost her husband. She is
sleepless, lost her appetite, overwhelmed by grief,
Ignatia XM transformed her strikingly. Only
apainful remembrance remained. In this case
Ignatia XM was given one hour before the burial
for the second time and generally five days later
same potency for the third time.
Patient 2: A music teacher who an year ago had
cared for her mother till her death an dhad
witnessed the tormenting agonies of death due to
cancer, felt since an year, simply unwell. Her
constitutional remedy was Silicea and it had earlier
relieved her asthma, her recurring bronchitis, her
disposition to catarrhs as also her unendurable
anxiety for appearing before public which was
necessary in her professional practice. She got over
all these but since an year things were not
progressing forward, she did not feel well,
complained of all kinds of ailment, Ignatia XM
restored her well-being again and later Silicea
worked better again.
Patient 3 : On 23-09-1959 a then 47 hears old
Foreman came to consult me. His wife had
telephoned to me already before his arrival. She
was afraid that he had cancer. Her husband spoke
little, was always serious, depressed, did not laugh,
little appetite and since an year had lost about 6 kg.
weight.
The man was pale, taciturn, emaciated,
answered in monosyliables and not a word more
when interrogated. it was, however, learnt that he
felt well until 4 years ago. Since 4 years no courage
to face life, nothappy with anything and less
appetite. During methodical interrogation, to the
question; “Have you sons?” we learnt that his only
son died in an accident. “When?” “Four years ago.”
The right pupil showed flattening at 12 hours
and indicated the deep mental depression, indeed
the so-called “asthenic form” (while in right eye).
These people hold their grief within themselves,
could commit suicide before anyone had event the
premonition, to the great surprise of those around.
The Patient had the following symptoms:
1. Aliments from grief. This symptom takes the
first place because it is the causative one.
2. Silent grief. This rubric contains Ignatia, Natrum
muriaticum in highest, Pulsatilla in 2 grade.
3. He is uncommunicative, keeps his grief to
himself, shared it with no one. Cyclamen in 1
grade, Ignatia in 2 grade, Uncommunicative :
Ignatia is 2 grade.
4. Consolation aggravated : here Ignatia was in
high grade. So in this case Pulsatilla is excluded.
5. cannot tolerate contradiction: again Ignatia in
high grade.
The patient received Ignatia XM and left my clinic
relaxed and laughingly.
Report 5 weeks after the single dose; health
excellent. Has even improved which was not the
case since years.
Report after 3 months after dose; since 14 days
again unwell. Now he received the second dose of
Ignatia XM. Since then in good health.
I saw him 4 years later fro rheumatism. The
flattening of pupil of the right eye was gone and so
also the symptom “consolation aggravates.”
Again 3 years alter I heard from him. He
suffered from fever with bronchitis. Since then
asthma and cough, both unceasing, day and night.
He was, just now, in hospital and despite the
medicines prescribed had not benefited. I was again
asked to take the case since his agonizing condition
was intolerable.
I received him during my usual clinic time
with a room full of patients. He received a dose of
Ignatia XM, Why?
1. Because the medicine had helped him so good.
2. Agonising, woebegone appearance, the heavy
and shattering cough and the asthma had something
dramatic about it.
3. Because the eihe point for Ignatia was clearly
positive.
4 Above all, because I had not much time then for
him.
I had little hope of success with this lightening
like remedy choice and told him so and
recommended him to begin a fasting treatment so
that we will have sufficient time to retake his case
with all the detailed symptoms and prescribe. But
with the dose given the patient felt undoubtedly
well; cough and dyspnoea went away.
Report form his daughter few months later;
free from complaints.
An Ignatia – symptom which has proved
effective in grown-ups is what BORLAND
(Children’s Type) explains: Tensed appearance:
“When the child speaks there is a strained tensed
appearance of the facial muscles, to the extent of
definite grimacing.” Our patient had this tensed
appearance.
Regarding symptom “Consolation aggravates”;
If it is clearly present, it is a valuable symptom as
we have seen.
the opposite “Consolation ameliorates” is not a
peculiar symptom but is a normal state. At the
same time, if a total amelioration strikingly occurs
as also physical symptoms are relieved through
consolation then only Pulsatilla has it and in 2
grade.
“Consolation aggravates” is one of those small
list of symptoms which when it is very strongly
present, excludes Pulsatilla and Phosphorous.
There are exceptions. My teacher Pierre
SCHMIDT cured a young physician suffering from
lung tuberculosis with 7 old cavities. The cases has
been seen by tuberculosis specialists. With
Pulsatilla XM improvement began to set in, the
fever passed off and temperature became normal.
An year later the lung collapse could be thoroughly
treated. These lead to total cure without a single
allopathic medicine. The young physician indeed
showed aggravation from consolation but all the
remaining symptoms indicated Pulsatilla.
Pierre SCHMIDT has in his KENT’s repertory,
added Syphillinum in high grade under the rubric
“Consolation
aggravates,”
FOUBISTER
Carcinominum and the extraordinary KENT pupil
DELMAS the remedies Sabal, Sulphur and Kalium
sulphuricum. All these additons are very valuable, I
have found.
Patient 4 : On 20-3-1952, Mr. H.F. a worker in
neighbouring village consulted me. Since 3 weeks
sensation of pressure in stomach, a strange
sensation in the region of heart, poor appetite.
Since 3 months poor sleep, cannot go to sleep,
tired, often almost trembling of whole body. Within
the last 2-3 months has lost 7 kg weight. Besides
these he complained of his jealousy which has been
there always. his wife suffered the hell with him
because of his jealousy. She was on the point of
leaving him and he held her. If his wife just only
looks at another man, he quarreled with her the
whol day, upset her with the bitterest reproaches
and he knew very well that she did not deceive
him, that she remained true to him, but he could not
be otherwise. He received a dose of Lachesis XM
(Korsakof). One week later: until now better in
every way, however, today again jealous.
Three weeks after the medicine: jealousy is
relatively better. Again pressing sensation in
stomach.
On 20-4, that is one month after the medicine:
The jealousy has gone. The unpleasant sensation in
the stomach has almost become better. Appetite
improved.
One month later: Further improvement.
On 11-8, I was called at my house in the
morning at 5 hours because of lumbago. I treated it
then shudder to say, allopathically. Three days
later, the rheumatism was still bothering and so the
patient received the second dose of Lachesis XM,
Since 4 weeks the jealousy had been slowly
coming up again and increased. On the next day
after Lachesis the patient felt very much btter,
cheerful.
I saw the patient again any year later this time
because of slight Angina and in the course of the
following 6 years, approximately once an year
because fo sudden, passing, rheumatic attacks.
Now I meet now and then his relatives. The
jealousy has not recurred again and Lachesis had
not to be given for the third time.
How would I proceed with the case now? The
loss of weight of 7 kg. within a period of 2-3
months calls for special tests beside the usual ones.
In my own laboratory it is possible to check
neuroaminoacid reaction from the patient’s serum.
It gives only one indication. f it were doubtful
or bad then according to Prof. NEUNHOFFER
treatment through Hydroxylamine reaction is called
for . This is by far the most certain symptom of
early reaction for cancer. It is examined in the
urine, it can be well handled by our method of
treatment.
The peculiar sensation in the heart region
would require the proving of Mozer’s point,
especially
the
interaction
of
the
left
medicolavicular line with the second intercostals
space which is the place to demonstrate it, that the
source of the trouble is in the heart. Rheumatic
ailments in the precardial region of simple heart
involvement can be differentiated from it. The first
one is healed easily by us through Homoeopathy
without making any great changes in diet which is
essential in the second case, and proceed to
succeed.
Since the new disease was only of 2-3 months
duration we may be right to give the ‘acute
medicine’ in the first instance and thereby
hopefully remove the new disease rapidly.
Following it we may search for the jealousy which
has been there all along.
The acute medicine is chosen on the basis of
the newly come up symptoms and of cours if we
are able to perceive it, keeping in view the
causative factors. Entirely different will be the
method for the choice of the constitutional
medicine for the patient which is essential in
respect of all ailments which persit for six months
or more. We then choose the medicine on the basis
of the totality of the symptoms. We mean thereby
not just the later and present symptoms but the
earlier ones also. The sicknesses which the patient
had suffered, also his parents, grandparents, uncles
and aunts and brothers and sisters are all taken into
account (Tuberculosis, Cancer Syphilis). Finally
we methodically examine in a planned way with
about 100 questions in the Pierre SCHMIDT
Questionnaire. What is necessary is there would be
no haste, the patient should be least interfered with,
to hear him patiently. The sequency in which the
questions are to be asked is also important.
The questionnaire of Pierre SCHMIDT begins
with the so-called ‘Generals’, that is, the general
symptoms, the attitude, reaction of the total patient
to warmth and cold, seasons, thunderstorm, sun etc.
Only then-after the patient had rapport with us in
the meantime after he had seen that we are
genuinely working to help him and that the system
goes into the totality – do we venture to enquire
about the mental domain. The first of these
questions is: What was the greatest grief in your
life? The second: What was you greatest joy?
These two questions are very essential because they
help the patient open up to us and give out.
Questions regarding sexuality comes last and
questions which are unwelcome to the patient are
kept for a later interview. It is also good to inquire
about the spouse in confidence, when alone. You
avoid this because it makes the patient sad? Not
correct. Instead in cases where there are marital
discords you will get a useful word about the
partner. To convey this word, naturally only this,
later, at the right moment. It has always impressed
me how in seconds the hatred in love turned up,
particularly if the patient already ticked well with
us.
In respect of the case reported above all these
have been left off. The remedy choice rested upon
the reportorial segments: We have:
Jealously: Hyos., and Lach. are in highest grade.
The Apis, Calc.s., Cench., Nux v., Puls. and Starm.
in second grade.
Further complients: jealously, as foolish as
irresistible: Lach. is given as the only medicine in
second grade.
Further, quareisome from jealousy: Cench., Lach.,
Nux v.
The case of Mr. H.L. is a typical example
before us, how one should not make it. But
Homoeopathy is generous. It gives us only the
Similie where we are perhaps unable to find the
Simillimum.
Patient 5 : Years later came to my clinic the young
Mrs. Ruth. She is the eldest daughter of the above
cited patient. Since sometime ago she has been
married, Modest, Hesitant, she was before me
bashful with flushed cheeks. She complained of
jealousy. And how ! if her husband just only looks
at another women or danced with any one, she
would then reproach him the whole day.
Now, she is the eldest daughter of Mr. H.L.
and we know that eldest daughter is almost similar
to the father, wholly seldom the father’s sister. Just
as exactly as the eldest son almost like the mother,
seldom like the mother’s brother.
The constitutional medicine of the patient was
Pulsatilla and it healed of her jealousy.
Patient 6 : Totally unusal form of jealousy in an
entrepreneur
which
was
responsible
for
insignificant occupational experiences. I am not
able to recall now his name and am unable to
therefore pick up his record but the peculiarities are
recalled. 12 years ago he had married. He soon
learnt that before the marriage his wife had gone on
holidays in the company of a man. His wife clearly
explained that they had only a platonic friendship.
Her husband did not think so and the thought as to
what could have happened in these two weeks
tormented him all these 12 years. yes, this idea
possessed and tormented him. He neglected his
business at times, spoiled himself by boorish
behaviour with his clients, considered committing
suicide and constantly pestered his wife to confess.
His constitutional medicine was Nux vomica.
Some months after treatment, I think after the
second dose of Nux vomica XM, his wife told that
her husband was likd a glove. He was completely
well. I have not, since then, heard from them.
The favourable action was not the last. it is not
possible that Nux alone could heal a chronic and
deepseated psychotic complaint and for that this
apsoric plant medicine is less deep. The nosode
Tuberculinum was fore seen as soon as Nux was
not satisfactory. The severe, hatred-filled character
of the man would be suitable for this nosode. Also
in mental disturbance we think of this nosode. In
KENT’s Repertory we find the rubric ‘malicious’
with Nux v and Stram. in highest grade. Pierre
SCHMIDT has added Tub also in highest grade.
And to the rubric threatening’ he has added tub. in
2 grade.
These addition to KENT’s repertory by Pierre
SCHMIDT is based on reliable sources (mostly
HERING, HAHNEMANN, ALLEN) and his own
experiences over many years.
How is it now with our Enterpreneur? We have
seen that the second dose of Nux vomica XM
opened up its action.
There are two possibilities.
1. It works at least for 5 weeks or longer. That is,
the well-being becomes worse after 5 weeks or
later. We do not then alter the medicine. Since a
third dose of the same potency does not work as a
rule satisfactorily we proceed to the next potency
according to KENT’s steps and that is Nux vomica
50 M.
2. It is assumed that the second dose of Nux
vomica XM works lesser that 5 weeks, that is, too
short. The medicine does not then work deeply.
There are hindrance from the chronic miasms
which Nux cannot overcome. Now we set the
nosode. We give Tuberculinum XM.
In case of 1 above three things are possible:
(a) ux vormica 50M one dose works at least for 7
weeks. Then we give Tuberculinum XM when the
improvement regresses.
(b) The dose of Nux vomica 50M shows no
perceptible action. We wait for 14 days more and
the give Tuberculinum XM.
In (a) we remain with Nux vomica, according
to KENT’s potency steps, of course until this
medicine works satisfactorily. In (b) and (c) there
are three other possibilities:
1. With Tuberculinum XM there is relief and it
continues for 5 weeks or longer. Then we give the
second dose Tuberculinum XM when the
improvement lags.
2. The amelioration is lesser than 5 weeks. Then we
give the second dose of Tuberculinum Xm despite
it being within 5 weeks after the first dose and after
another 5 weeks Nux vomica 50M.
3 There is no perceptible amelioration fro
Tubeculinum XM. Then 5 weeks after the first dose
of Tuberculinum XM the second dose
Tuberculinum XM and wait for another 5 weeks. If
no perceptible action is forthcoming we give then
Nux vomica 50M. Evidently Tuberculinum has
cleared hindrances which stood in the way of Nux
vomica.
In 1 since Tuberculinum alone acted
perceptibly for a sufficiently long time we hold on
to Tuberculinum as long as this medicine acts
satisfactorily adhereing to KENT’s scale. KENT’s
scale is : XM, XM, 50M, CM, DM, DM, 1MM,
1MM.
What do we mean by satisfactory action?
Progressive amelioration with every scale of
potency for characteristically least period. These
are : for XM 5 weeks, 50M, 7 weeks, CM 3
months, DM 6 months for the first tie and 4-6
months for the second time, for the MM 1 year.
Pierre SCHMIDT gave addition to the KENT
rubric ‘Jealousy’ on the basis of GALLAVARDIN
as following: highest grade for Nux v., and Lyc.,
and Staph, in second grade.
In Repertoire de Medicine Psychique of
GALLAVARDIN we find “Jealousy, Criminal”
hyos., Lach., and “Consequence of jealousy”: apis.,
hyos., nux v., and puls.
Patient 7 : 33 years old engineer. He is a
homosexual. We can also say bisexual because he
also loved at the same time a girl and it is his desire
to raise a family. Sulphur quickly improved his
disposition so much that he could venture to marry.
He remained under treatment because his
“temptation”, as he put it, rose to the surface again
but lighter and more rarely.
He came under my treatment on 26-11-1960
and he looked very pale. Earlier he had frequent
Angina. the tonsils were removed. Family history
of Cancer. He remained under infrequent doses of
Psorinum and Tuberculinum, 3 years under
sulphur. After this the symptoms indicated
Psorinum. Now he remains cured. He looks better,
improved efficiency, increased vitality and
mentally very clear and bright.
Patient 8 : Chauffer 31 yearrs old. He was
sentenced for 3 years for his preference for small
boys. After one year he was released on parole
without his sickness having changed. Therefore his
prosecutors had to shut him in again. Sulphur was
the constitutional medicine. It improved him
quickly but for another year small boys were
dangerous to him although as year by year it
became lesser and lesser. Simultaneous with the
mental defect his physical complaints like
rheumatism and eczema were improving. The
vitality of the patient improved continuously
progressively which was visible in his younger
looking face so much more as the treatment
progressed. It must also be remarked that now we
are dealing with a bisexual conduct. The patient has
since been married.
Patient 9 : Lady teacher, 22 years old, lesbian
disposition, with every fibre of her being indeed, as
she said. Extremely passionate. Never has she had
the least sensitivity to the other sex. Her
constitutional medicine is Sulphur. Yes, in this case
we have the entire picture of the remedy before us.
Amongst many other symptoms she had: “sadness
in evenings, in bed,” Four remedies have it:
Arsenicum, Grahphites, Stramonium and Sulphur,
She received on
9-3-1963 : Sulphur XM
21-5 report : Felt well.
4-6 report : Iesbic disposition normally improved.
21-6 report : for the first time in her life she was
thinking of ‘man’!
She began to improve in the respect. She has
not of course forgotten girls. Her chronic cold
occurred this year only very mildly (In the earlier
years it was severe)
10-8: Since 3 weeks relapsed with a girl friend;
Now the second dose Sulphur XM, that is 5 months
after the first.
11-9: Further improvement. Her dispositions are
changing progressively.
5-10: Improvement is continuous although slowly.
I did not hear from her further. Probably there was
a relapse after the action of Sulphur XM became
weaker.
Patient 10: This young businessman was also
similarly disposed towards same sex exclusively. In
this case, Lachesis chosen on the basis of the
totality of his symptoms, brought about a slow
change. For the first time in his life he began to get
a progressively increasing liking for the other sex.
But in this case too, just as in the previous one, our
contact ended suddenly and in some ways
similarly.
In the repertory we have the sction: “Love with
one of own (feminine) sex” and find therein Lach
and Sulph. In smaller grade. Pierre SCHMIDT has,
in this section, put Plat, in the highest grad and
added Cal. in the smaller grade.
To summarise: Homosexual tendencies react
positively
to
homoeopathic
constitutional
medicines. We know this from GALLAVARDIN.
But the inveterate cases require spiritual guidance.
Together we can, in the future, alter these patients.
When they do not report to us, we must go to them.
“If the mountain does not come to Mohammed,
then Mohammed goes to the mountain.”
Patient 11: The Marriage Counseller referred to
me a 37 years old Production Engineer, Since 2
years he suffered from attacks of rage while in
house, During those moments could kill his family,
he told me. His wife assured that he was generally
an affectionate husband and father. but those
attacks of rage were so terrible for the family that
they approached the Marriage Counsellor.
The complaints began 2 years ago. The
Engineer, then, had mad a name in the automobile
manufacturing fabrications and its economic and he
had a process against a concern. This involved his
representing through many lawyers who made his
case weaker and made his opponents strong. Our
patient remained quietly before the court and
defended his case alone and won the process. Since
then he felt himself unsettled. Trifles brought about
extreme rage in him and this only when in his
house.
We have a very pale looking, haggard man
before us, who complained of heart pains from
least excitement, choking sensations, profuse
perspiration, muscle spasms, tremors and a number
of other ailments.
As the first symptom we choose: “Ailments
from indignation: Staph. Is in the highest grade,
Coloc. and Nux v. (from Pierre SCHMIDT) in 2
grade; Ip and Plat. in smallest. Colcynthais is
indicated more in physical ailments from
indigestion, like abdominal colic and diarrhea;
Staphisagria
predominantly
in
mental
consequences.
As second symptom we choose: “violent
anger”; Staph and Nux v. and other sin highest
grade.
As the third symptom: Diarrhoea from anger”
and in the Repertory we find Staph. and Nux v. and
other sin second grade.
The Weihe point is sensitive in such a way that
pressure from my finger brought about vomiting.
Staphisgria XM made the patient feel changed,
the Mozer point which indicate excitement of the
heart chambers was gone.
Report after 4 days: Feels himself significantly
calmer, Now he can tolerate. Heart pain from every
time he traveled in car, Sleep better.
14 days later : Sleeps peacefully.
2 months later : his wife reported : Excellent,
Free from complaints. Sleeps peacefully. No heart
pains.
4 months after the first dose I see the patient
again. slight heart pain. I am astounded at his
improved appearance. The deep pale appearance
has totally gone away. The Mozer’s Coronary
points are negative.
He receives the second dose of Staphisagria
XM.
Report 2 months later: Free from ailments,
even though in the meantime he had to accomplish
a gigantic work.
Staphisagria is one of those medicines
indicated very often in these days. The employee
who must swallow much, be it from his superior or
his colleague and becoming ill therefrom, and the
housewife who cannot vent her anger against the
domestic servant lest she gives her quite notice,
both need it.
And Mr. Lycopodium, whose daughter enters
into marriage with one who is not of her social
standing and who feels that his pride is hurt, needs
it (ailments after mortification: Staph.). We see
now Lycopodium does not affect him any more,
but again only after Staphisgria has rectified the
hindrance.
And the wife deceived by her husband also
requires it. Here we do not take the rubric
“Disappointed love”, which contains Staph. in
second grade, but the next rubric “ailments from
mortification” in highest grade. A valuable
symptom of Staphisgria is” “angry at his own
faults.” Nit-ac., Staph., and Sulph. have this, all in
second grade.
According to GALLAVARDIN Staphisagria is
among the three remedies which cannot bear
injustice (Ign., Staph., Nux v.).
Patient 12 : The young 30 years old wife was
again sent to me by the marriage counseller. She
thought that she did not get the right husband and
wanted to divorce him.
Her youth was unpleasant, soon after marriage
psychic depression developed due to which she was
in a Nerve clinic 6 years ago. Since then it was
tolerable until 21/2 years ago when she gave birth
to her second child and all her ailment came on
again. She feit herself in the same condition as she
was before she was hospitalized, became excited
over trifles, particularly with regard to her husband.
She is not aware of her surroundings, sleepless, has
no control of herself. Also headache, migraine,
pain in the liver region and swollen ankle.
After a three hours case recording and
evaluation of the symptoms I could not find out the
suitable medicine. I recalled the advice of Pierre
SCHMIDT IN A SIMILAR CASE. The anamnesis
indicated that her father had assaulted her in her
youth. This is always combined with great fear
even when the patient does not recall it. Here
Opium is indicated (ailments from fright)
We have:
ailments from fright (Opium in highest grade)
becoming afraid very easily (Opium in second
grade)
very sensitive to noise (Opium in second grade)
cannot bear warm room (Opium in second grade)
Opium is also a so called reactive medicine.
We find it in the repertory section “Lack of
reaction”. If KENT had 4 essential grades then this
rubric would have Carbo Vegetabilis, Opium,
Psorinum and Sulphur in 4th grade, perhaps also
Nux vomica which will act because it antidotes the
allopathic medicaments taken before.
We may also expect a favourable action and it
will bring into order the confusion in symptoms, so
that it would be possible to choose a constitutional
medicine easily.
The patient received on 6-9-1961 Optium XM.
On the next night itself she could sleep. Five weeks
later report said: Since 10 days very well totally.
since her youth, she has never felt so good, so easy.
She can have refreshing sleep. Only the
leucorrhoea which she has been having all along
has become worse.
On 9-10, that is 5 weeks after the first dose,
Opium XM was again called for because – the
sleep had become had after an excitement.
On 26-11 Opium 50M
On 26-12, tht is 3 months after the
commencement of the treatment, I see the patient
again. Since she suffered influenza the sleep was
somewhat wanting. But in general, she felt
excellent and calm despite temporary set back in
sleep.
“And how is your husband?” Oh, he is very
well, he is nice. Before our treatment I have seen
him as if through a spectacle, everything about him
was crooked. Now I see him rightly. He is well in
every respect.”
A needle prick in Ling-sin point in the left side
of the 24 point of the kidney-meridian, with a gold
needle, set right the sleep again.
The patient got Sulphur later. She is free from
ailments.
We must now terminate our expedition. My
purpose was to convey certain hints which perhaps
are not so well-known as they deserve to be. I
personally am thankful to my teacher Pierre
SCHMIDT.
DEPRESSION IN
A CASE OF
GASTRITIS –
PODOPHYLLUM
WEGNER, A.
ZKH, 32, 3/1988
A 41 year old female
patient complained of cramping stomach pains
during nights. It all began 3 years ago in spring
with a Gastritis which recurred every year. The
patient has always been suffering from a sensitive
digestive system; as a child she used to easily get
diarrhea from excitement.
The cramps which awaken her occurred at
three O’ clock mornings. It was better from
pressure upon the abdomen, after eating and lying
on abdomen.
She had avoided rich foods since it could cause
diarrhea.
As a child she had peculiar desire for sour
things.
At 21 years her gall bladder which was full of
stones was removed surgically because of colics.
In 1979 she suffered Hepatitis with nausea,
pressing sensation in the right upper abdomen,
much diarrhea particularly in mornings with
shining, almost white, stools and paroxysmal
itching. She has not till date recouped after that.
Three years ago she observed a peculiarly
depressive disorder. Different anxieties came up.
Daily routine work were affected badly because of
this anxiety; anxiety about something which to her
was very ominous to environment; anxiety about
things which earlier had not anytime caused her
restlessness. She characterized these states as: “as if
the-world-was-coming-to-an-end state”, anxiety
about life and mortal anxiety”.
Gastroscopy was done and a clearly marked
erosive gastritis was diagnosed and it was treated
conservatively. since then it recurs annually as a
gastro-intestinal disease which was contrary to the
manner in which it began with a depressive mood
but with colicky type pains explained above.
The patient was observed to be having a
vehement urge to talk which came up after an
initial reservation.
Repertorisation: In the repertories of GENTRY
and KNERR the central symptom of the patient
could be found:
“Depression in gastritis”.
“Depressed, in gastralgia: Abrot. (KNERR, p.38)
“Depressed, in gastric affection: Pod. (KNERR, p.
38)
“Depressed, in chronic gastritis: Mez (KNERR, p.
38)
“Depression of spirits accompanying gastric
affections: Pod. (GENTRY, Vol. I., p.30)
From repertoristation certain symptoms with clear
indication for Podophyllum were found (KENT):
“Mind Loquacity, p.63: Podo.
“Stomach, desires, sour, p.486: Podo.
“Stomach, pain, cramping night, 3 a.m. p. 517:
Podo.
“Abdomen inflammation, Liver,p.553: Podo.
“Abdomen , pain, liver, colic, gall-stones, p.568:
Podo.
Materia – Medica Comparison: good corresponding
symptoms for Podophyllum were found:
“Depression: Imagines he is going to die or be very
ill, in gastric affection.” (GS. Vol. VIII, p. 504)
“Delirium, loquacity during heat: afterwards
forgetful of what has passed.” (GS. VOL. VIII, p.
504)
“For years subject to diarrhea which would come
on now and then after breakfast, with considerable
pain in rectum…, an acute attack caused by bad
news caused an early morning aggravation, as well
as after eating; attack would also be induced by any
depressing emotions or excitement of any kind…,”
(GS. Vol. VIII, p. 507)
“Jaundice: With gall-stones, pain from region of
stomach to region of gall bladder, with excessive
nausea; with hyperaemia of liver, fullness,
sourness, and pain; alternate constipation and
diarrhea, itching of skin…,” (GS. Vol. VIII, p.508)
“Diarrhoea from indigestion after eating canned
fruit…,” (GS. Vol. VIII, p. 510)
“Awakened by violent pains in the stomach and
bowels; the pain were of a griping, stitching
character, and were relieved for a short time by
pressure on the bowels, at 3 A.M. (EN, Vol. VIII,
p.132, No.71)
“Diarrhoea early in the morning which continues
through the forenoon, followed by a natural stool,
in the evening” (EN, Vol. VIII, p.133, No.107)
Prescription: Podophyllum 0/6.
After an aggravation on the second day after
taking the medicine a sustained amelioration
followed until she was completely free of the
ailment, within two weeks, Two months later a
relapse which came in a weaker form was promptly
cured by Podophyllum 0/18.
GS: Guiding symptoms by HERING.
EN: Encyclopaedia of Pure Materia Medica, by
T.F. ALLEN.
CHRONIC
FATIGUE,
VIRUSES AND
DEPRESSION
R. E. KENDELL
The Lancet,
Vol.337: Jan.19, 1991
Patients often complain
of persistent fatigue or generalized muscular
weakness. A US survey found that chronic fatigue
was “a major problem” for 24% of all adults
attending primary care clinics1, and in a community
survey in the UK 25% of women and 20% of men
reported that they “always fee tired”.2 The causes
of these symptoms are poorly understood and often
generate strong differences of opinion both
between doctors and between them and their
patients.
In some patients the weakness and fatigue
developed after epidemics of an obscure illness
known in the UK as benign myalgic
encephalomyelitis and in the US as epidemic
neuromyasthenia, but isolated cases are more
common.
The
Myalgic
Encephalomyelitis
Association claims that there are 150.000 patients
with myalgic encephalomyelitis (ME) in the UK;3
most of these are sporadic cases rather than part of
well-defined epidemics, and BEHAN has
suggested that the condition is as common as
multiple sclerosis (about 3 cass per 100, 000.4)
Whether these sporadic cases are caused by the
same putative infection are important in the genesis
of these states of persistent debility are unresolved
issues. The terms “postviral fatigue syndrome”
(PVFS), “postviral exhaustion”, ME and “chronic
Epstein-Barr (EB) virus syndrome” embody an
assumption that a viral infection is responsible for
the patient’s weakness and fatigue.
patients with a diagnosis of ME or PVFS have
often been found to have a high frequency of
unusually high viral antibody titres.4-6 However, as
these patients have experienced a recent viral
infection more commonly than the rest of the
population almost by definition, firm conclusions
cannot be drawn. In the US, despite reports of
raised antibody titres to Epstein-Barr virus and
human herpesvirus type 6, no evidence of
persistent viral infection has been found7. In the
UK, two groups have found persistent Coxsackie B
virus infection in a proportion of patients with the
PVFS. 8,9 Confirmation of these claims and the
development of a reliable test for persistent
Coxsackie infection would have a striking and
salutary effect on the management of patients with
chronic fatigue. At present, however, claims of
abnormally prolonged “Jitter values” on single
fibre electro-myography10 are un-confirmed and the
histology, electrophysiology, and glycolytic
enzymes of affected muscles appear to be normal.
The development of excessive intracellular acidosis
during exercise in a single patient examined by31 PNMR11 also seems to be a non-specific finding. 12
That most patients with PVS find mental exertion
as exhausting as physical exertion also suggests tht
a disorder of skeletal muscle is unlikely to account
for all their symptoms.
Although psychiatrists who see patients with
these puzzling symptoms often diagnose a
depressive illness, this or any other psychiatric
diagnosis is frequently unacceptable to them,
especially if it has previously been suggested tht
they have ME. They are unshakeably convinced
that their symptoms are due to organic illness and
refuse antidepressive theory.
It is not sufficiently widely appreciated, even
by doctors, that affective illness characteristically
cause a profound disturbance of energy. Manic
patients have boundless energy and are overactive;
depressed patients complain bitterly that they have
no energy and are notably underactive, Indeed, the
disturbance of energy and activity is almost as
fundamental as the disturbance of mood. In the new
(10th) revision of the International Classification of
Disease the basic description of depressive episode
begins with statement that “the subject suffers from
lowering of mood, reduction of energy, and
decrease in activity. Capacity for enjoyment,
interest and concentration are impaired, and
marked tiredness after even minimum effort is
common.”13 Apart from the absence of any
reference to previous viral infection, this
description is almost indistinguishable from that of
PVFS. Depressive illnesses are also twice as
common in women as in men and are uncommon in
children, two prominent and otherwise puzzling
features of PVFS.
Although ME and PVFS are new concepts,
there is nothing novel about unexplained chronic
fatigue and profound muscular weakness made
worse by exercise. Both have been recognized for
at least a century. The American neurologist
George BEARD described what he called
neurasthenia in 1867 and attributed it to exhausting
of nerve cells through depletion of their stored
nutriment.14 There are striking similarities between
BEARD’s neurashthenia and ME: in symptoms, in
the social setting in which it presented
(predominantly
middle
classes),
treatment
(complete rest was advocated), and in presumed
aetiology (a real illness, not a psychiatric disorder),
15
Neurashtenia initially encompassed much of
what is now regarded as neurotic illness but by the
early years of this century had come to mean
unexplained exhaustion and fatigue. There was
considerable debate about causation and the
relative importance of physical and psychological
factors and many therapies were tried, from
absolute rest to psychoanalysis. By the 1940s there
was general agreement that psychological
influences were more important than overwork or
endotoxins and, although the diagnosis is now
rarely made, neurasthenia has survived as a discrete
form of neurotic illness in the international
classification even in new revision.
When patients with chronic fatigue are
assessed psychiatrically, between 50 and 80% are
found to fulfil operational criteria for psychiatric
disorder. 1-7,16,17 Most patients have major
depression, others have anxiety or somatisation
disorders, and many have an unusually high
frequency of depressive episodes before the onset
of fatigue. Only one study has failed to find a
abnormally high prevalence of current and past
psychiatric symptoms, but even here 22 of 48
patients (46%) met criteria for major depression at
some stage in their illness.18
The relation between PVFS and the symptoms
of both depressive illnesses and peripheral
neuromuscular disease has been clarified by a
prospective study. 17 47 patients with PVFS, 33
patients with fatiguing neuromuscular disorders –
eg., myasthenia gravis and Guillain Barre
syndrome, and 26 consecutive admissions with
major depression were compared. Even when
fatigue was excluded as a symptom, 72% of PVFS
patients met operational criteria for psychiatric
disorder, mainly major depression. Morever, the
symptoms of the PVFS group and the depressive
controls were almost identical. Fatigue brought
about by mental and physical exertion was
common in both groups, However, 18 of 21 PVS
patients who met criteria for major depression were
convinced that their illness had a physical basis.
The neuromuscular disorder control patients
described little mental fatigue, except in the
presence of intercurrent psychiatric disorder, and
had fewer somatic symptoms of other kinds.
Patients may object to any suggestion that they
have depression because such a diagnosis implies
tht their symptoms are imaginary of “all in the
mind”.19 Sadly, this assumption, with its crude
distinction between real/organic illnesses and
psychiatric disorders, seems to be shared by the
ME Association and many doctors. Many of the
symptoms of patients with ME or PVFS can only
be understood as disturbances of cerebral
functioning. Impaired concentration and memory,
depression, insomnia, and irritability are not
attributable to localized muscle disease, even if
there is good evidence of muscle abnormalities.
Evidence suggests that the whole range of
depressive illness, not just endogenous depression,
is familial and in part genetically transmitted. 20-21
Antidepressive drugs elevate mood in people who
are depressed with little effect in normal people.
These facts imply that there must be biological
differences, qualitative, between people who are
prone to depression and those who are not (trait
differences) an between people who are currently
depressed and those who are not (state differences).
These differences must involve, or influence,
cerebral function. Depression are commonly
precipitated by stressful circumstances or life
events, but the same is true of other disease such as
myocardial infarction. Where then is the
fundamental difference between depressive and
‘organic’ illnesses?
Irrespective of the role of chronic viral
infection. the symptoms of most patients with
chronic fatigue states are real, pervasive, and often
incapacitating. The only patients whose symptoms
can legitimately be described as “all in the mind”
are those whose disabilities are learnt behaviour
and whose complaints have been moulded and
potentiated by the advantages of the invalid role. 22
it is important to recognize that , in a society where
ME is portrayed as a mysterious, rather
glamourous, and disabling illness, people who have
acquired this diagnosis may obtain attention and
sympathy from friends and relatives, and perhaps
also a justification for not fulfilling career
ambitions or coping with the demands of everyday
life. They may therefore lead less unhappy lives
with their symptoms and their diagnosis than they
could do otherwise.
The statement that someone has a depressive
illness is merely a statement about their symptoms.
It has no causal implications, despite the fact that
depression tht are secondary to a toxic state or
metabolic abnormality – eg., Cushing’s disease or
drug-induced depression, are usually classified
separately. Furthermore, malaise and debility
associated with infection may, by non-specific
mechanisms shared with other stressors, help to
predispose to subsequent infection by an effect on
immune mechanisms and lymphocyte activity. 23
No fundamental distinction can therefore be drawn
between depressive illness and other kinds of ‘real’
or ‘organic’ illness. Moreover, depressions have
the great merit of being eminently treatable, unlike
the chronic viral infections thought ot underline
ME and the PVFS.
Patients diagnosed as ME or PVFS are alsmot
certainly heterogeneous. Some probably have
chronic viral infections that are causally important,
8,9
others may have unrecognized disorders of their
skeletal musculature. A substantial proportion,
however, have depressive illnesses or other wellrecognised psychiatric disorders and in some there
may be no clear distinction between these three
categories. It is essential that a detailed psychiatric
assessment is carried out on all such patients to
ensure that a correct diagnosis is made and that
appropriate treatment is given. The sudden
appearance of symptoms in someone of normal
previous personality does not exclude psychiatric
disorder. Depressive illness commonly presents in
this way.
Terms like postinfective fatigue syndrome and
myalgic encephalomyelitis, with their unproven
assumption about aetiology, need to be replaced by
neutral terms like chronic fatigue syndrome, unless
there is hard evidence of persistent viral infection.
It is also vital that in future all diagnostic terms are
operationally defined. The Centres for Disease
Control (CDC) in Atlanta have proposed an
operational definition of chronic fatigue syndrome,
partly to discourage clinicians from assuming, on
inadequate evidence, that their patients have a
“chronic EB virus syndrome” 24 The CDC definition
has been made deliberately narrow to maximize the
chances of those who fulfil its criteria having a
chronic viral infection. Few patients with chronic
fatigue meet these requirements.25 Broader
definitions will therefore be needed if the majority
of patients currently regarded as having ME or
PVFS are to be covered. it is likely, though, that
these definitions will include many patients who
also fulfil criteria for major depression or other
psychiatric disorders.
REFERENCES
1. Kroenke K, Wood Dr, Mangelsdorff D, Meier
NJ, Power JB. Chronic fatigue in primary care.
JAMA 1988; 260; 929 -34.
2. Health Promotion Research Trust. The health
and lifestyle survey. London. HPRT, 1987.
3. Annual Report. Myalgic Encephalomyelitis
Association. Stanford le Hope, Essex: ME
Association, 1989.
4. behan PO, Behan WMH, Bell EJ. The
postviral fatigue syndrome – an analysis of the
findings in 50 cses. J Infection 1985; 10: 21122.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Straus Se, Tosato G, Armstrong G, et al.
Persisting illness and fatigue in adults with
evidence of Epstein – Barr virus infection. Ann
Intern Med 1985; 102: 7 – 16.
Calder BE, Warnock PJ, McCartney RA, Bell
Ej. Coxsackie B viruses and the postviral
syndrome: a prospective study in general
practice. JR Coll Gen Pract 1987; 37: 11 – 14
Gold D, Bowden R Sixbey J, et al. Chronic
fatigue: a prospective clinical and virological
study. JAMA 1990; 264: 48 – 53
Yousef GE, Bell EJ, Mann GF, et al. Chronic
enterovirus infection in patients with postviral
fatigue syndrome. Lancet 1988; i. 146 -49
Archard LC, Bowks NE, Behan PO, Bell EJ,
Doyle D. Postviral fatigue syndrome:
persistence of enterovirus RNA in muscle and
elevated creatine kinase. JR Soc Med 1988;
81: 326 – 29.
Jamal
GA,
Hansen,
Hansen
S.
Electrophysicological studies in the post viral
fatigue syndrome. J Neurol Neurosurg
Psychiatry 1985; 48: 961 – 64.
Arnold DL, Bore PJ, Radda GK, Styles P,
Taylor DJ. Excessive intracellular acidosis of
skeletal muscle on exercise in a patient with a
post-viral exhaustion fatigue syndrome. Lancet
1984; i: 1367 – 69.
Yonge RP. Magnetic resonance muscle
studies: implications for psychiatry: J R Soc
Med 1988; 81: 322 – 25.
World Health Organisation Division of Mental
health. ICD – 10: 1989 Draft of Chapter V
Mental and Behavioural Disorders. Geneva :
WHO, 1989.
Beard GM> Neurasthenia or nervous
exhaustion, Boston Med Surg J 1969; 3: 217 –
20.
Wessely S. Old wine in new bottles:
neurasthenia and ‘ME’ Psychol Med 1990; 20:
35 – 53.
Kruesi MJP, Dale J, Strauss SE. Psychiatric
diagnoses in patients who have chronic fatigue
syndrome. Br. J. Psychiatry 1989; 50: 53 – 56.
Wessely S. Powell R. Fatigue syndromes: a
comparison of patients with the chronic fatigue
syndrome. Br. J. Psychiatry 1990; 156: 534 –
40.
Hickie I, Lloyd A, Wakefield D, Parker G. The
psychiatric status of patients with the chronic
fatigue syndrome. Br. J. Psychiatry 1990; 156:
543 – 40.
Church AJ. Myalgic encephalomyelitis: “An
obscene cosmic joke”. Med J aust 1980; i: 307
– 09.
Andersen NC, Scheftner A, Reich T, Hirschfed
RMA, Endicott J, Keller MB. The validation
of the concept of endogenous depression. Arch
Gen Psychiatry 1986; 43: 246 – 51.
21. Kendler KS, Heath A, Martin NG, Eaves LJ.
Symptoms of anxiety and depression in a
volunteer twin population. Arch Gen
Psychiatry 19876; 43: 213 – 221.
22. Kendell RE, Hysteria. In : Russell GFM,
Hersov LA, eds. handbooks of psychiatry 4:
The neuroses and personality disorders.
Cambridge University Press, 1983; 232 – 46.
23. Schliefer SJ, Keller SE< Camerion M,
Thornton JC, Stein M. Suppression of
lymphocyte
stimulation
following
bereavement. JAMA 1983; 250: 374 – 77.
24. Holmes GP, Kaplan JE, Gantz NM, et al.
Chronic fatigue syndrome: a working case
definition. Ann Intern Med 1988; 108: 387 –
89.
25. Manu P, Lane TJ, Matthews DA. The
frequency of th chronic fatigue syndrome in
patients with symptoms of persistent fatigue.
Ann Intern Med 1988; 109: 554 - 556.
Treatment for hypertension has undergone a
remarkable transformation in the pst twenty years;
prescribers now have a vast number of drugs from
which to choose. However, although much time has
been spent on defining classes of drug, none of the
resulting classification is satisfactory. If official
guidelines are followed, drug treatment should be
offered to anyone with a diastolic pressure
consistently greater than 100 mg Hg. 1 In the UK,
for example, use of this criterion would net 10 –
15% of the adult population, and with the emphasis
on detection and prevention, more patients than
ever are goint to be found. The potential market for
antihpertensive
agents
is
enormous
and
pharmaceutical companies know it.
One difficulty about treating high blood
pressures is that most patients have no symptoms –
therapy may cause side-effects in people who
previously felt well. In trials of antihypertensive
therapy, adverse reactions to drugs have resulted in
withdrawal rates of 16 – 33% 2,3 Practitioners are
often struck by the lower frequency of side-effects
when an agent is used for antianginal rather than
antihypertensive therapy, but the patient with
angina knows when something is working.
No antihypertensive drug is without sideeffects, although some are better tolerated than
others, Moreover, with the availability of so many
drugs, mere control of hypertension is not enough.
Clinicians must not only strive to minimize drugspecific adverse events but also to assess the
possible impact of treatment on a patient’s quality
of life.
CROOG and colleagues4 conducted one of the
first large studies to assess quality of life; this work
was supported by Squibb. Men with mild to
moderate hypertension were recruited into a
double-blind randomized trial for 6 months to
determine the effects of captopril, methyldopa or
propranolo on their quality of life as assessed by
interviews throughout the study. Blood pressure
control was similar with all three drugs, although
some patients needed additional diuretics. Fewer
patients withdrew from therapy with captopril
becauses of adverse events. Patients receiving
captropril scored better on measures of general well
being and had fewer side-effects and better
measures of life satisfaction than those receiving
methyldopa. Captopril also scored better than
propranolol in measures of well being. The
subsequent marketing campaign alerted physicians
to examine their prescribing practices but also
initiated the controversy about the validity of what
was measured.
The difficulty is how to make a formal
objective assessment of the subjective feelings and
needs of an individual and obtain results with
scientific credibility. Although captopril appeared
best in the study by CROOG et al.4 the trial did not
examine, for example, whether patients were
troubled by cough, which
is now known to affect
DOING BETTER,
15% of those who take this
FEELING
drug. The tests were
WORSE
confined
to
patients’
The Lancet, Vol.
subjective
responses,
336,
which may not be enough.
Oct 27, 1990
JACHUCK et al5 asked
physicians, patients taking
antihypertensive drugs, and patients’ relatives or
close companions about quality of life.5 In their
overall assessment of each patient’s condition,
100% of physicians thought the patient was
improved, 48 % of patients thought that they had
improved, but 98% of relatives or companions
believed that the patients’ quality of life was worse
during therapy.
To refine the objective estimate of quality of
life, BULPITT and FLETCHER6 have now
produced a questionnaire for use in short-term trials
(less than 1 year) of antihypertensive treatment.6
The questionnaire covers symptomatic (physical)
wellbeing, psychological wellbeing with the
symptom rating test, 7 and perception of the effects
of antihypertensive treatment on lifestyle. There are
46 questions, most of which require yes no
responses. This approach must represent the most
comprehensive attempt so far to obtain useful
information about antihypertensive therapy by
means of a standardized repeatable format.
however, the feelings of relatives are not assessed.
The test has been applied in three comparisons of
drug tratments7-9 in symptomatic wellbeing and
possibly increases depression, whereas nifedipine
may adversely affect self-reported cognitive
function.
In another study, verapamil was compared
with nifidipine with regard to effects on quality of
life by use of this questionnaire. 10 There was a
significant increase in reporting of side-effects with
nifedipine, and measures of psychiatric morbidity
tend to improve on verapamil and deteriorate on
nifedipine. Only the change in cognitive function
was significant between the drugs, being worse on
nifiddipine. Notwithstanding these results, many
patients will be satisfied with B-blockers or
nifedipine, and the possibility of a modest
improvement in cognitive function by a change to
verapamil might be offset by the increased risk of
constitpation.
So, do assessment of quality of life help
prescibers?
BULPITT
and
FLETCHER’s
questionnaire provides interesting information
about important aspects of drug treatment and may
highlight previously unsuspected adverse effects. It
will prove a standardized protocol for future studies
and may reveal small differences between drugs.
The relevance of such trial assessments to the
individual needs of patients or prescribing practices
is uncertain. They will not replace the close
personal monitoring that all patients should receive
when they are expected to embark on a treatment
regimen for life.
REFERENCES
1. Swales JD, Ramsay LE, Coope JR, et al.
Treating mild hypertension Report of the
British Hypertension Soceity Working Party,
Br. Med. J 1989; 298: 694 – 98.
2. MRC Working Party on Mild to Moderate
Hypertension.
Adverse
reactions
to
bendrofluazide and propranolol for the
treatment of mild hypertension. Lancet 1981;
ii: 539 – 43.
3. Curb JD, Borhani NO, Blaszkowski TP,
Zimbaldi N, Fotiu S, Williams W. Long-term
surveillance
for
adverse
effects
of
antihypertensive drugs. JAMA 1985; 253;
3263 – 68.
4. Croog SH, Levine S, Testa M. et al. The
effects of antihpertensive therapy on the
quality of life N. Engl J Med 1986; 314; 1657
– 64.
5. Jachuck SJ, Brierley H. Jachuck S, Willcox
PM. The effect of hypotensiv drugs on the
quality of life. J. Coll Gen Pract 1982; 32: 103
– 05.
6. Bulpitt CJ, Fletcher AE. The measurement of
quality of life in hypertensive patients: a
practical approach. Br. J. Clin Pharmacol
1990; 30; 353 – 64.
7. Fletcher AE, Chester PC, Hawkins CMA
Latham An, Pike La, Bulpitt CJ. The effects of
varapamil and propranolol on quality of life in
hypertension. J. Hwm Hypertens 1989; 3: 125
– 30.
8. Fletcher AE, Bulpitt CJ, Quality of life during
antihypertensive treatment: results from a
randomized double-blind trial of pinacidil and
nifedipine. J. Hypertens 1989; 7 (suppl 6): 364
(abstr).
9.
Fletcher AE, Bulpitt CJ, Hawkins CM, et al.
Quality of life on anti-hypertensive therapy: a
randomized double – blind controlled trial of
captopril and atenolol. J. Hypertens 1990; 8:
463 – 66.
10. Palmer A, Fletcher A, Hamilton G, Muriss S,
Bulpitt C.A comparison of verapamil and
nifedipine on quality of life Br. J. Clin
Parmacol 1990; 30: 365 – 70.
BOOK SHELF:
TIPS BY MASTERS OF HOMEOPATHY by Dr.
S.R. WADIA, MBBS, F.F. Hom. (Lond.), by Jain
Publishers (P) Ltd., Post Box 5775, New Delhi110 055, p.p.64, Rs 10/Dr. WADIA has, over the years collected,
some ‘gems from various sources. These have now
been compiled in alphabetical order and presented
to the profession. There are many ‘tips’ like:
“Calotropis gigantean – has depression as the
characteristic mental symptom.
“Drosera – has shivering at rest; not while
moving.
“Vipera - effective for chronic nose bleed –
even when the condition is life long.
Source has been mentioned for every ‘tip’.
There is no doubt that this compilation will be
most welcome to the practitioners.
Printing,
paper
etc.
good.
Warmly
recommended.
K.S. SRINIVASAN.
PRESS NOTE
ALL INDIA HOMOEOPATHIC SEMINAR will
be organized at AHMEDABAD (Gujarat) on 8th,
9th, 10th November 1991 by the Ahmedabad Unit of
H.M.A.I.
TOPIC : HEALTHY CHILD – HEALTHY
NATION
Lectures-discussions in different areas of Child
Health are planned on basis of clinical experiences
of the Homoeopathy attending the seminar from all
over the country.
Articles/Papers in this subject are invited, to reach
the Seminar office by 30.9.1991.
A NATIONAL HOMOEOPATHIC QUIZ is also
planned on the occasion, where teams of each State
are expected to participate.
Delegate Fee : Rs. 350/- RC Member Fee : Rs.
500/Student Delegate : Rs. 300/- Accompanying person
Rs. 350/Fees to reach the office by 30.8.1991.
Seminar Office: All India Homoeopathic Seminar
8, Shalimar Complex, Near
Mahalaxmi,
Five Road Junction, Paladi,
Ahamedabad – 380 007.