Managing Pain with Homeopathy: A Collection of Cases

The Importance of Pathological Generals and Structured Repertorisation- Dr Rajan Sankaran and Dr Rishi Vyas

The importance of the pathological generals and the genius of the remedy are irreplaceable when treating and managing pain with homeopathic treatment. Further, there is a need for structured repertorisation. By structurally repertorising, the homeopath rebuilds the patient’s experience bit by bit. This concept takes a phenomenon of the patient in one sector (may be physical, emotional or sensation) along with all of its components such as modality, concomitant, or location, and reconstructs what has been broken, into fragments in the repertory, during the case to form a sectorial totality. The idea of the repertory is to break down symptoms into component parts so that each phenomenon is in itself a totality.

The idea of structured repertorisation is that one must elicit all of the characteristics of that particular area, whether it is a chief complaint, cough, dream, fear or stressful situation. One must go deep into a single area and complete the pattern of the strange, rare and peculiar characteristics of that area. It’s a type of fingerprint of exact symptoms. Let us look at a case example.

This is a case of a middle-aged woman who came to see me in her acute migraine pain. In addition to this, she had breathlessness and asthma, where in her attacks she would get a continuous cough. The most pressing issue for her was the headache and breathlessness.

She described her headache, ‘The headache is always on the left side and it is like squeezing and drawing pain. It is very intense and it comes suddenly and then goes. I notice especially after an emotional upheaval or if I am stressed, the headache gets worse. It happens after any argument or if someone does not agree with me. Also, I noticed after the death of my four dogs one after another it was much worse. All of my dogs were 2-3 years old so I never expected that it would happen like this, it was much unexpected and it was a shock because they were supposed live for ten years. It was a sudden shock for me. I was unprepared and it was so sudden for me. Everything stops for me at that time.  I am getting migraines weekly now because of the consecutive deaths of my dogs.’ 

Describing her headache pain further she said, ‘It is drawing from all sides and at one point. There is also a pulse point in the left temple region. It is as if there is a line of sensation, a line on the temple or occipital region, but on left side. Sunlight and noise makes it worse, I cannot stand in sun. It reaches a final point very quickly. I sort of see it coming; I feel nausea and feel it will come. Pressure feels better, but not by much. It needs to run its course, as nothing really helps. I get the breathless feeling when I am worried and anxious about the family, I cannot breathe but I have to breathe. A sort of fear is there, when I take a deep breath, I feel relaxed. When my logical mind is taken over by my emotions, I panic. I also panic when I am frustrated or want to do things. I feel I am struggling hard to come to something’. 

 I asked her about her dreams, ‘I often have dreams that someone is missing, or I am not prepared for an examination. I feel very scared, I feel I will fail and it is some important exam. I dream my loved one is missing; I wake up with a ‘jerk’ as I am falling. I get tense and sleepless when someone is terminally ill or when I am worried about my daughter and husband. I feel very insecure, but I am not concerned about financial aspect.’ 

The most important characteristic symptoms of the case are from her pathology and mental emotional state. She gets severe migraine pain, in the left side of the head as if it had been pulled and she feels better by pressure, and worse by sunlight and noise. The pain comes on when there is emotional excitement. For example, the recent demise of her dogs consecutively in one month was giving her weekly migraines. These deaths were unexpected and she was shocked that it happened. In this case, we see some very prominent and clear rubrics:

When we look at the mental-emotional experience it is that of sudden surprise that is characteristic of the Loganiaceae family. Also she is very stressed and anxious regarding her future with the family. In her anxiety she gets anxious and breathlessness.

The main sensation of Loganiaceae is that of being shocked, shattered, torn to pieces. The shock is so sudden as to paralyse the person, or produce convulsions. In the mind it is expressed as shock, disappointment, ailments from grief, bad news and so forth. In this family we have medicines like Nux vomica, Gelsemium, Ignatia, and Spigelia as the most prominent remedies.

The physical sensations of shattered and torn to pieces is the same as the feelings of ruin, shock, let down and disappointment at the level of the mind, which is so sudden as to paralyse the person (passive reaction) and hence we see the rubric of Ignatia- Mind; Silent grief, cannot cry-a form of emotional paralysis. If the main feeling of Loganiaceae combined with the malaria miasm (spigelia), the feeling could be, ‘Stuck in a position where, from time to time, he is shocked, shattered, disappointed or torn to pieces.’

We gave the patient Spigelia 200. With this medicine, her migraine went away within 2 days. She has been following up monthly and reporting that the migraine has not returned. We re-dosed her monthly with Spigelia 200 and for the past 1 year she has been migraine free. Other than this, her mood and mental –emotional state has become balanced as she does not have any more migraines triggered by emotional upset. Her sleep is good and because of the reduction in anxiety, her asthma and continuous coughing has also gotten considerably better.

In this case, we see that all seemingly separate areas in the patient’s life form various structural totalities that point to the same remedy, Spigelia. Through repertorisation (see above), we analyse each area separately, and then can conclude thatSpigelia covers the totality.

What happens very often is that we take one rubric from the mind, one from the generals, one from particulars and then repertorise. The idea is to understand one phenomenon totally. So, if we gather the complete totality of that phenomenon, put all the rubrics of that phenomenon together, we are recreating material medica in a way. This accurate totality of a given phenomenon is finger printing or structured repertorisation. If that accurately matches, then the remedy will be applicable to whole patient. This method has been used with great advantage in my practice recently.

This was a case of a 37-year-old woman with an intervertebral disc prolapse. The disc prolapse (at L4 and L5) was due to an old injury, where she had fallen down and developed severe pain.

I asked her to tell me what was happening, ‘There is extreme pain. I cannot tell you the type of pain. It is excruciating and at times it is too much. There is a cold sensation that I am getting in my feet. In the whole leg, there is a chilly sensation and the pain is killing me. It is as if a cold air is hitting the legs all the time. It is the kind of pain you would want your enemy to have. The orthopaedic told me to do surgery. I am wondering if there is a remedy in homeopathy.’ 

Comments: I found many interesting symptoms in this statement, but the most characteristic was the cold sensation in the legs.

I asked her to tell more about herself and as she chuckled to herself she said, ‘I am a happy go lucky person. I am generous person. I like to meet people and talk to them but I cannot take it if they don’t give me attention. I like to go shopping, wear good clothes. I like to go partying, have fun…’ 

The patient was very loquacious and she continued to speak about herself for a long time, until I asked her about her dreams. While she was speaking she was waving her hands wildly in the air, using various gestures and motions.

Comments: The patient’s loquacity and extreme talkativeness stood out to me, as it kept going until I interjected. Throughout the whole case taking I noticed her animated hand gestures.

She told me, ‘I usually do not get dreams, but I do get one recurrent dream. I am running and running, everything is pitch dark, everything is black. I see black people and everything is black. Someone is running behind me. I am running and running, but somehow I am unable to run. Then, I see something pounce on me. It is black, dark and black. I feel something will happen.’  At this point of time, the patient laughed and said there was nothing more to tell about her dreams, but explained that she was very afraid of black things and darkness.

Comments: Here, the most peculiar symptom is this feeling that everything is dark, where she is being pursued. There is also the quality of the running. She is running and running but is unable to run. Even here, she spoke for a long while before the next line of questioning.

I asked her about her childhood and she summarised it in a couple of sentences, ‘I had happy childhood and I was the spoilt brat. I was like the ones like we see in Hindi movies and I just would not listen to anyone.’ 

I asked her about her crisis moment in life and she explained a time in her life where there was a problem with her sister. Both of them had wanted something and she had become suspicious about her sister. I asked her to tell more, ‘There was so much anger at that time, and it was as if it happened yesterday because I still cannot forget it. But that is life.’ 

Comments: The most characteristic symptoms from this section of the case include her extreme aversion to her sister, suspiciousness and her spoiled nature as a child.

I tried to note down the most characteristic qualities in case and on repertorisation I found that the main remedy that came up was Moschus.

We can study this case from a System point of view, where we see many qualities of the animal kingdom. There is a theme of you versus me in both her dreams and real life crisis situation; there is highly animated talk, an element of competition, and a delusion of being pursued by an animal. Interestingly, when we study the source of Moschus, we see that the medicine is made from the musk deer. This animal has to use running as part of its survival mechanism.

I also found an interesting single drug rubric when I studied the reversed repertory.

Delusions, imaginations: figures, sees: large black, about to jump on him. ⁽¹⁾ – Moschus

If we see Moschus from Kent’s Materia Medica: Moschus cures many hysterical girls who have come to adult age without ever learning what obedience means. They are self-willed, obstinate and selfish. When they have been encouraged to resort to crafty cunning, to have every whim gratified from infancy to eighteen years of age they become fit subjects for Mosch., Asaf., Ignatia and Valer. They not only have volumes of real and imaginary symptoms…However much they pretend to be honest and truthful their reported sensations are untrustworthy.

Moschus from Phatak’s Materia Medica: Spasmodic, nervous effects with a feeling of coldness. As of a cool wind blowing on part. Tension, in muscles, skin, mind. Nervous; shuddering, laughter, hiccough etc.. Girls who are selfish, obstinate, self-willed, and much pampered; resort to all kinds of cunning to have their whims gratified. Coldness; general or of single parts.

I gave the patient Moschus 1M. In one month’s time she reported that the coldness has reduced and her pain had reduced by 40%. She feels less angry at people and less anxious about the health of her daughter. Overall, she feels much better.

Moschus 1M was repeated monthly. After 6 months’ time, the patient reported that she was seventy percent better with the pain and coldness sensation improving every month. Best of all, she avoided the surgery she was advised.

This case was in my opinion a huge amount of learning for us. As the patient was in extreme pain, she was advised to have surgery by an orthopaedic doctor. Therefore, it was a challenging case where we had to focus on the characteristic symptoms at the level the patient came to us in. This was the key. The characteristics were at two levels, the first being her state – where we saw the animated way she conducted herself, through gestures and describing her expressions very deeply. The second were the symptoms – the coldness, observations of her hysterical behaviour and the keynote of exaggeration. When we match this together, it was synergy. As if every single piece of the puzzle gelled together. Her animated talk giving us a hint towards the animal kingdom and the idea of being pursued giving a theme of the mammal family. This case was an example of when everything comes together to the same remedy, and Moschus was the remedy that helped the patient in the end.

This is a case of a 55-year-old female who came with the complaint of rheumatoid arthritis. She explained that she has pain in the whole body, in all of her bones and muscles. The pain begins from the small joints in her fingers and toes and is worse when she wakes up in the morning. She cannot fold her hands or put her feet onto the ground because they are very stiff.

It all started when something used to touch her toes or she used to hit her toes on the table, and for the past 4-5 years she has been getting this severe pain. She also feels pain in the knees and lower back. Wherever she touches, there is pain. Slowly over time the pain started feeling heavy, and she developed swelling in her fingers. The joint complaints started in the cold season. The pain is worse in the cold weather, also with fanning or draft of air. If she sits too long she gets stiff and it is difficult for her to get up and start walking. Once she starts walking the pain gets better and the movement becomes easier. With this pain the patient feels like it will never end and is upset it happened at such an early age. Before she used to be happy in doing all kinds of work but now she doesn’t feel like doing anything and wonders if she will even be able to do it. Earlier, she used to cook whatever her son and husband would like, but now she is unable to do it.

For her, the most important thing in life is to keep her husband and children happy. She is more stressed and tense when her children have problems and if any important work does not get finished. She explained that she feels hurt very easily; especially if someone says that the work she has done is wrong. When her children and husband are happy with her then she is not worried. If they are not happy, then she feels sad and has a feeling as if she has not done anything wrong, and wonders why they hate her. This even happened with her husband’s relatives who live in a village. She explained that they are not doing anything for her but they are using her things. She wonders why they hate her and love the husband. She feels like she is not accepted to his family and this has troubled her since the time of marriage.

When asked what she is sensitive to the patient mentioned that she cannot see anybody’s suffering or troubles. If she sees a death of a loved one, then she feels sad and wonders why this happens. She is always worried that this is going to happen to her husband and children.

In her dreams, she sees her dead relatives. For example, one dream was she saw her elder sister-in-law who had died but was back and laughing with her family. Her only fear was of ghosts in childhood, otherwise she is not scared of much.

In other physical complaints, she also gets frequent urination and dribbling after urination. She also had been having the complaint of constipation since childhood. Other notes of interest in her past history include an episode of tuberculosis, history of recurrent boils, and heavy bleeding when she had her menses. She now has been in the menopausal stage for the last two years.

Two years ago she was in the worst pain of her life. She was not even able to sit. At that time, she could not tolerate any noise. She kept on lying down and did not want to talk with anyone. There was a nervous feeling and a huge change in her state. She would get angry suddenly at whoever would talk to her because no one was helping her, even to get a cup of tea. She felt like she needed one relative to look after her.

In approaching chronic cases of pain, we have to first discover how the problem started and also examine the patient thoroughly. In this case, the patient explained that the severe pain started when anything used to touch her toes. On physical examination, we saw that she was having pain mainly when we pressed the joints in the fingers and toes. Further, she said that in the morning when she wakes up she cannot fold her hands or put her feet on the ground as they become stiff and she is unable to move them much. Once she starts walking she feels better. We can finally conclude that the patient’s smaller joints are more affected than the bigger joints. There is a sensitivity to touch as well. We have to think of a remedy that has these characteristics.

To understand further, we have to look at the pathology along with the examination findings. When we pressed her fingers and toes, the pain and inflammation was located more on the joint itself, not the muscle surrounding the joint. This points us toward an articular inflammation of the small joints. She also has an aggravation to cold weather and the complaint began when she had been in a cold season. The only other system affected in our patient was her stomach. She has constipation.

When we look at her life story we see that she feels as if her husband’s family does not accept her. When we asked about her sensitivities it always came back to her family; she was only concerned with the health, happiness and well-being of her family, and her own happiness was heavily dependent on this. For our patient, the only importance in her life was her family. She was anxious for them, their health and their eventual death – worrying what will happen to them at any moment. In her dreams she sees her dead sister-in-law reuniting with the family and everyone is happy. Our patient only speaks of and is concerned with her husband and children. This puts her into more of a kali theme, from the periodic table of elements.

With this in mind, we looked for a remedy in the kali group that has an affinity for small joints and stomach affection. The medicine that came up was Kali bichromium. This remedy has the main symptoms of chronic rheumatism of small joints, sudden onset of symptoms and the extreme sensitivity to touch.

With this remedy in 30 potency (aqua dose, once per day for one month), the patient’s joint pain improved. After three months she reported the pain had reduced drastically especially in the fingers and toes, as well as a reduction in swelling. She is feeling good about herself and even stopped her allopathic medicine.

This is a case of 65-year-old female a known case of diabetes mellitus who came with pain in the right shoulder. The investigations suggested torn ligaments and the orthopaedic doctor advised

the surgical line of treatment.

She developed this pain a month back which was worse on

exertion, raising the arm and she could not bear any pressure on that spot. The only relief came from rest. She said that there was a ligament tear 5 years back when she lifted a heavy bag and now has to take precautions. She also has a very high sugar and creatinine level.

She also complains of pain in her knee, especially the right knee. It gets locked which is worse on any exertion and better by rest. In the past she used to have problems with her stomach that got better with homeopathy.

As a person, she is a very fearful type. She constantly keeps thinking negative about the future to such an extent that she used to say to her children, ‘When you go out you tell me what colour clothes you have worn so if tomorrow there is a bomb blast then I can recognise you from your clothes’. This is the extent of negative thoughts that come to her mind.

Once she got a call that someone had met with an accident and a girl was killed. She just asked what dress the girl was wearing and luckily for her she found it was not her daughter. She is a very cautious lady. Due her such state of mind she keeps taking precautions everywhere in her life. If the maid did not come on time she gets anxious. She once travelled to Yemen and as she sat in the plane the thought of the plane crashing came to mind. She gets dreams of robbers and snakes.

One of the most sensitive situations in her life was when she was bringing up her daughters alone. She used to be alone because her husband would travel most of the time. She felt the entire responsibility of the house came to her. She had to single-handedly manage the house and kids. At one point in time her husband had to undergo a surgery and this was very scary for her because she kept thinking what if something happened to him.

 She is very punctual about time and believes that work has to be done on time. She cannot watch sad or violent scenes on the television and avoids it when she can.

She desires raw fruits, sour things and panipuri (a mix of sweet, salty, and spicy tastes). She is thirsty and both heat and cold aggravate her. She has profuse perspiration all over the body, face and head.

The main thing that defines the patient as a person is the constant feeling that something bad is going to happen. This is the type of personality we are dealing with. It has to do with daughter, husband, herself or even in her dreams she is constantly in a state of anxiety that something bad will happen, a type of anticipation. This is the most central aspect of the case. She reacts to this perception by taking precautions that make her want to do things on time. She wants everything to happen on time, which makes her very fastidious, and if things are not done in time she becomes anxious again.

We need to find the remedy that has this anxiety as its main feature. Once we repertorize the main mind symptoms and general symptoms in her case we get the following set of remedies:

Once we get the portrait of disease or the totality of the case we see a set of remedies emerging. Next job is to which remedy exactly matches not only the symptoms but even the state of the patient. So we see the remedies like Medorrhinum, Lycopodium, Natrum Muriaticum, Pulsatilla and Phosphorous appearing. One thing about selection of remedy I have learnt from my teachers is that the main thing in the case should be the most important aspect of the remedy as well. For example, if the main thing in the case is about disappointment in love then one can think of Natrum muriaticum. Or if the main thing in the case was weeping for example, and this weeping is better by consolation and sensitive to rudeness insult then one can think of pulsatilla.

However, in this case, the main thing was fear that something will happen, a constant sense of anxiety as if something bad is going to happen. This is the main feature of the remedy Medorrhinum. The feeling is the constant fear that something is going to happen and the patient copes by avoiding such situations or accepting it. There is anticipation, avoidance and acceptance, which represents the heart of the sycotic miasm to which Medorrhinum belongs. ^{(3), (4)}

In her case she is not concerned about losing her support, which would make one think of the mineral kingdom. Instead, her worry is that something will happen and her focus is more on coping with this worry which she does by avoiding the situation. For example, she is scared to watch sad things on television and she avoids it by not watching them.

Hence the remedy selected was Medorrhinum. She was give a dose of 200 potency because her level of experience was more emotions i.e. level 3

This was followed by LM potency i.e. LM6.  LM5 and LM6 are the corresponding potencies for level 3.

LM potency was selected because the pathology which was chronic and progressive as her creatinine levels were increasing. So as the disease is progressing we need to administer a remedy on daily basis to arrest this progress.

(Potency selection is a vast topic. It would be beyond the scope of this article to elaborate on it. For the detailed understanding of level of experience the reader is advised to read the books Sensation in Homoeopathy and Sensation Refined.)

Over a period of six months, her pain is much better. She is reminded of pain only when she does severe exertion. This only happened once and it was just a small reminder that she had an issue with her shoulder. The pain in her knee is non-existent and about 90% better. The surgeon who advised surgery initially said to continue physiotherapy because the option of surgery does not even apply anymore.

More importantly, her energy levels are good; her creatinine, which was high, has come down to normal. The high sugar levels have come down to normal. Her daughter explained that she is now listening more and is calmer, whereas before they would have arguments and debates. Now, it is a simple conversation. ‘We had lot of debates and arguments earlier, now there is more of conversation.’ She is still under treatment and continues to do well.

Majority of people and students studying homeopathy believe that homeopathy is slow acting. Seeing cases of acute pain treated with homeopathy will surely encourage and inspire many young students to confidently take up homeopathy as a career option. The above cases are a short illustration of the relief in the suffering patients using homeopathic medicines only. The beauty in the results is holistic so if one part is treated using the classical holistic treatment, then the changes in the whole organism can be seen, as in the case 4 where the patient came for treatment of shoulder pain but to her surprise the creatinine levels also came down. Every case in practice needs an individual approach. Through these four cases, it has been attempted to demonstrate that each case needs to be viewed and analysed in its own peculiar way keeping the law of similars, law of individualisation and law of holism in centre.