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Case & Rubric of the
month
By Dr. Dhiraj Nanda
Case of renal cortical
cyst
Presenting Complaints
01/09/04
1. Pain Left side in lumbar region of back on and off –
3 months.
2. Joint pains affecting both knees – 1 month post
accident. “Oh doctor, I fell down on my knees when my
husband suddenly put the breaks of his scooter. Since
then pain is there but it is much better now”.
Observations
1. Patient is dressed up in fancy ear rings.
2. Very lean, thin frame, looks older than her age.
3. Hairs are sticking to scalp.
Past history
Married 6 months back but never had any such problem in
recent past. Nothing else significant found.
Physical Generals
Appetite - N.
Thirst – N
Stools – N
Urine – N
Sweat – More on soles.
Sleep – Un-refreshing.
Dreams – Unremembered.
Thermals – Chilly. Likes heat and has less tolerance to
cold.
Desires – Ice-creams, Chocolate, Fruit, Raw food (+++).
Aversion – Milk (++); Cauliflower, Cabbage, Cooked food
(++).
Silent listening - When I was asking about desires and
aversions, husband remarked, “She is like a goat, eats
every thing raw. In restaurants also she prefers to have
juices or salads instead of cooked food”.
Mind (questions and answers actual words)
Q. – Tell me about your nature?
Patient remained silent. After two minutes I asked her
husband, “Tell me about her nature?”
A. – She does not interfere with others and is busy with
her own life.
Q. - Tell me more?
A. – Like what?
Q. – Like how does she react to good or bad news or how
she reacts in anger?
Patient answers, “I will switch off TV or walk away from
the room if there is any unpleasant news on TV”
Q. – And anger?
A. – She will shout. She feels I should obey her or
agree to her point otherwise she will continue to
endlessly stretch her point of view.
Q. – How does she express her anger outside the house?
A. – She does not interfere with outsiders. If there is
a fight she would like to make peace immediately. She is
very conscious about good image outside.
Q. – How is her speed of eating / walking?
A. – Slow. She is generally slow than normal.
Selecting the Rubrics
Following rubrics are taken for analysis:
1. Horrible things, sad stories affect her profoundly
(Shuts down the TV or goes into other room);
2. Obstinate, headstrong (endlessly stretches her point
of view);
3. Raw food, desires;
4. Cooked food, aversion, to;
5. Milk, aversion, to;
Repertorial Analysis
Prescription
The remedies that cover the rubrics selected are
Calcarea; Ignatia and Silica.
Patient is lean, thin. There is no history of any grief.
So Silica 30 / 1 dose followed by Vital force 30 was
given.
07/09/04 - Patient reported with no change
whatsoever. Given PL 200 to be taken as when pain is
severe.
10/09/04 - Patient called on phone. No change in
frequency and intensity of pain attacks. Is it a stone
that is causing renal colic? Advised for a U/S scan.
Asked to take Berberis vulg Q 10 drops in water and
report after scan is done.
13/09/04 - Patient reports no improvement. U/S
report.
U/S dated 13/09/04 - report
Evidence of cystic lesion of size 5.1 x 4.3 cms noted at
the lower pole of left kidney. ? Left renal cortical
cyst. ? Dilated adherent bowel loop.
Re-analysis
If remedy is correct it should have started giving
relief till now. That means our selected remedy is not
correct. We have to do a re-analysis.
During re-analysis we have segregate the information
that is absolutely dependable from any hypothetical
information / conclusions.
We are sure of:
1. She likes raw food.
2. She has aversion to cooked food.
3. She has aversion to milk.
We are not sure:
1. Why she switches of TV (?) Is she sensitive; or
something from past haunts her; or is it any fear or
anxiety.
2. Whether she is obstinate or argumentative (Goes on
endlessly stretching her point).
To understand what we are not sure of, we have to go
into details of her ESD before marriage / childhood.
Re-probing and induction
Probing using induction to confirm our observation of
hairs is sticking to scalp.
Q. – Tell me about something your childhood and parents?
Patient is silent for about 4-5 minutes. This means
definitely there is something. I have to repeat my
question. Suddenly the aggressive / courageous tone gets
changed to a timid one. She had an unhappy and insecure
childhood, with parents having frequent fights. This
explains her behavior and sticking of hairs to scalp.
Prescription
ESD point towards lack of affection and security –
Magnesium element that has dominated patient’s major
portion of life.
She is chilly. Earlier we had ruled out all remedies
leaving Silica behind.
Remedy – Magnesium silicata 30 /1 dose followed by Vital
Force 30 three times a day.
“They like to present an image of being tough. They want
to be a leader and impress people with their bravery.
They
love to show the world how aggressive and daring they
are. They hate contradiction and are quite capable of
teasing and taunting. They show off their bravery to the
point of being arrogant.” …….Jan Scholten on Mag. Sil.
Follow-up
21/09/04 -The pain attacks have improved. The
pain is less intense. Continue Vital Force 30 three
times a day.
23/10/04 - The pain attacks have disappeared.
According to patient’ husband she appears to have become
less aggressive also. Continue Vital Force 30 three
times a day.
23/11/04 - No pain attacks. Continue Vital Force
30 two times a day.
22/12/04 - No complaints. Continue Vital Force 30
once a day. Advised for U/S abdomen.
U/S dated 05/02/05 - Sonologicaly nothing abnormal
visualized in this examination.
Rubric of the month
Reveals, secrets
Meaning - This rubric is applicable to patients who have
a particular tendency of revealing things which were
hitherto ‘studiously concealed; unknown’. These patients
have a habit of telling out things and facts to the
people to whom these are not supposed to be told.
Miasmatic background – Sycosis
Remarks - If patient reveals secrete because of his
mental ineptness, insensitivity or naivety then the
rubric may be indiscretion. ‘Indiscretion’ is applicable
to patients who lack the ability to assess what to say
and what not to say, whereas ‘secrets, reveals’ is
applicable where the patient is aware what is being
divulged is confidential and should not be revealed. |
