Category Archives: CASE TAKING

मानसिक अवसाद और “NWS “ का होम्योपैथी प्रिसक्रांबिग मे महत्वपूर्ण कार्य ( Mental depression & role of “NWS” in homeopathic prescriptions)

श्रीमती रुही खान (नाम बदले गये हैं ), आयु ४५ वर्ष , आपके पति की अकस्मात मृत्यु एक रोड एक्सीडेंट मे गत वर्ष हुयी और उसके बाद शुरु हुआ मानसिक उलझनों का न अंत होने वाला लम्बा सिलसिला । घबराहट , नींद न आना , रात मे किसी के बुलाने की आवाज और भी कई लक्षण ।आरम्भ मे एलोपैथिक दवाओं का मानसिक चिकित्सक की सलाह पर इलाज शुरु किया लेकिन दवा का  सिर्फ़ असर क्षणिक  |

यही हाल कुछ १५ वर्षीया साजिया का भी रहा , पिता की अकस्मात मृत्यु ने सबसे अधिक उसको प्रभावित किया । बाकी घर के सदस्य तो बहुत जल्दी ही इस सदमे से उबर गये लेकिन वह न उबर सकी । हाथ पैर ठंडे हो जाना , दिल की असमान्य धडकन ,घबराहट होना , अजीब सी बैचैनी , घर मे मन न लगना इत्यादि लक्षण प्रमुख थे ।

पिछ्ले सप्ताह  मेरे घर के सामने रहने वाली  सक्सेना आंटी  की मृत्यु ने उनकी पुत्र वधू शालिनी पर सब से अधिक मानसिक प्रभाव डाला  । उलझन , घर से बाहर भागने एंकात की तीर्व  इच्छा , हर समय रूलाई सा आना आदि ।

मन के किसी कोने पर लगनी वाली चोट सबसे अधिक असर इंसान के व्यक्तित्व पर दिखता है । असीमित महत्वकाक्षायें , दिल का टूटना चाहे वह मृत्यु के रुप मे हो ( NWS-Grief or death of beloved one : Nat Mur , Aur Met ( if suicidal , feels like life is gone), Ignatia )या विछोह ,  प्रेम (NWS- broken heart : Natrum Mur, Ignatia, Lachesis) या व्यपार मे असफ़लता के कारण  (NWS – business failure-Ambra Grisea , Aur. calc. Cimic. coloc. Hyos. ign. kali-br. kali-p. nat-m. nux-v. ph-ac. puls. rhus-t. sep. sulph. verat.) या अपने लक्षय की पूर्ति न होते देख कर ,इन सब का अंतिम परिणाम मानसिक लक्षणॊं के उभरने पर ही मालूम होता है । एक बालक के अन्दर झांक कर देखें जहाँ उसके माता -पिता का पूरा कन्ट्रोल उसके व्यक्तित्व को पूरी तरह से ग्रसित कर जाता है ( NWSDomination , children dominated by parents: CARC,Nat Mur, Staph) या उस अबला से जिसकी अस्मिता का शिकार कुछ हवशियों द्वारा किया जा चुका हो और पूरी जिदंगी वह उन सदमों से उबर पाने मे अपने को लाचार पाती हो (AILMENTS FROM – abused; after being – sexually-ACON. am-m. ambr. anac. androc. ARN. ars. aur-m. bapt. bell-p-sp. berb. calc-p. cann-i. CARC. caust. croc. cupr. cur. cycl. falco-pe. foll. hyos. IGN. kreos. lac-c. lac-f. lyc. lyss. Med. Melis. nat-c. Nat-f. NAT-M. nux-v. OP. Orig. oxyg. petr-ra. Plat. SEP. STAPH. stram. thuj. toxi. tub. ust. xanth. ;AILMENTS FROM – abused; after being – sexually – rape-aster. Carc.)।  जो हो चुका है उसकी भरपाई करना असंभव है लेकिन हाँ , इन न दिखने वाली मानसिक चोट की भरपाई हम होम्योपैथिक औषधियों से अन्य पद्दतियों की अपेक्षा अधिक सुगमता और दवा बन्द होने के बाद बगैर दवा पर आश्रित रह कर कर सकते हैं । लेकिन अफ़सोस कि होम्योपैथिक चिकित्सक को ऐसे केस देर से मिलते हैं औत तब जब व्यक्ति अपनी बीमारी से अधिक उन दवाओं पर पूरी तरह से आश्रित हो जाता है और चाह कर भी वह उसे हटा नही पाता ।

शालिनी का केस कोई मुशिकिल नही था क्योंकि  उसका कारण मेरे आँखॊं के सामने था  , इग्नेशिया ( Ignatia ) की कुछ ही खुराखों से उस रात उसे नींद भी आई और अगले दिन मानसिक अवसाद उसके कन्ट्रोल मे थे । दो दिन तक कन्ट्रोल मे रहने के बाद जब स्थिति एक बार फ़िर पलटा खाने लगी तब Nat Mur   ने मानसिक अवसादों पर पूरी तरह से कन्ट्रोल कर लिया ।

लेकिन अधिक परेशानी उन केसों मे आती है जहाँ व्यक्ति लक्षणॊ के समूह को लेकर तो आता है लेकिन उन केसों मे हम पिछले इतिहास ( past history ) को टटोलने की कोशिश नही करते । लुक डी फ़िशर ने past history से मिलने वाले इन लक्षणॊं को NWS कहा यानि NEVER WELL SINCE  और केस को लेते समय इसकी भूमिका पर अपना प्रकाश डाला । NWS से संबधित यह ६ पृष्ठ लुक की पुस्तक , “ Hahnemann revisited “ का प्रमुख हिस्सा है , कापीराइट होने के कारण इस का अधिक विवरण देना यहाँ संभव नही है ।

कहना न होगा रूही और साजिया मे मैने उस NWS को ढूँढने की कोशिश की और सफ़ल भी रहा । बाकी का काम NWS से संबधित दवाओं की रही । Nat Muraticum ने इस केस को आसान सा कर दिया और रोगी को स्वस्थ  किया । सिन्थीसिस रिपर्ट्री ( Synthesis repertory ) मे इस के रुब्रिक ailments from के शीर्षक के अन्दर मिलेगें ।जो होम्योपैथिक चिकित्सक रडार प्रयोग नही कर रहे हैं वह इस  फ़ाइल को नीचे दिये लिंक से डाउनलोड कर सकते हैं ।

 
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Case taking outline

The patient's story

Let the patient talk until they run out of things to say.

Modalities 

Apply the following to each of the symptoms gathered so far in the following order:

  • Causes
  • Prodrome, onset, pace, sequence, duration
  • Character, location, laterality, extension and radiation of pain or sensations
  • Concomitants and alternations

Aggravation or amelioration

  • Time (hour, day, night, before or after midnight); periodicity; season; moon phases
  • Temperature and weather: Chilly or warm blooded usually, chilly or warm blooded in present illness; wet dry cold, or hot weather; weather changes; storm or thunderstorm (before, during or after); hot sun, wind, fog, snow, open air, warm room, changes from one to other, stuffy or crowded places; drafts, warmth of bed, heat of stove, uncovering
  • Bathing (hot, cold or sea), local applications (hot, cold, wet or dry)
  • Rest or motion (slow or rapid, ascending or descending, turning in bed, exertion, walking, on first motion, after moving a while, while moving, after moving), car and sea-sickness
  • Position: Standing, sitting, (knees crossed, rising from sitting), stooping (rising from stooping), lying (on painful side, back, right or left side, abdomen, head high or low, rising from lying), leaning head backward, forward, sidewise, closing or opening eyes, any unusual position such as knee-chest
  • External stimuli: Touch, hard or light, pressure, rubbing, constriction (clothing, etc.), jar, riding, stepping, light, noise, music, conversation, odors
  • Eating: In general (before, during, after, hot or cold food or drink), swallowing (solids, liquids, empty), acids, fats, salt, salty food, starches, sugar and sweets, green vegetables, milk, eggs, meat, fish, oysters, onions, beer, liquor, wine, coffee, tea, tobacco, drugs
  • Thirst, quantity, frequency, hot, cool or iced, sours, bitters, etc.
  • Sleep: In general (before, during, on falling asleep , in first sleep, after, on
  • Menses (before, during, after, or suppressed)
  • Sweat: Hot or cold, foot-sweat, partial or suppressed.
  • Other discharges: Bleeding, coryza, diarrhea, vomitus, urine, emissions, leucorrhoea, etc.; suppression of same
  • Coition, continence, masturbation, etc.
  • Emotions: Anger, grief, mortification, fear, shock, consolation, apprehension of crowds, anticipation, suppression of same

Strange, rare and peculiar symptoms

Pull these symptoms out when possible.

The patient as a whole

Physical generals

  • The constitutional type of the patient (endrinologico-homeopathic correspondences, lack or excess of vital heat, lack of reaction, sensitiveness, etc.)
  • Ailments from emotions (see also mental generals); suppressions (emotions; discharges such as menses, sweat, leucorrhoea, catarrh, diarrhea, etc.; eruptions; diseases such as malaria, rheumatic fever, exanthemas, syphilis, gonorrhea, etc.; of pathology such as hemorrhoids, fistulae, ulcers, tonsils, tumors, other surgical conditions, etc.); form exposure to cold, wet, hot sun, etc.; from mechanical conditions such as overeating, injury, etc.
  • Menses, date of establishment, regularity (early or late), duration, color, consistency, odor, amount, clots, membrane, pain (modalities of), concomitants, aggravation or amelioration before, during, or after, both physically and mentally, menopause (symptoms of)
  • Other discharges (see above) cause, color, consistency, odor, acrid or bland, symptoms from suppression of, symptoms alternating with, hot or cold, partial discharges as of sweat, laterality, better or worse from discharges (before, during, or after)
  • Sleep, better or worse from, position in, aggravation after, difficulty in getting to sleep, waking frequently or early, at what hour, somnambulism, talking in sleep, dreams (see Mentals), restless during
  • Restlessness, prostration, weakness, trembling, chill, fever, etc.
  • Aggravations and ameliorations applying to patient as a whole as above.
  • Objective symptoms such as redness of orifices, superfluous hair, applying to patient as a whole
  • Pathology which applies to patient as a whole, such as tendency to tumors, wens, cysts, polyps, warts, moles, individual and family tendency to certain diseases or weaknesses of specific organs or tissues (also related to a. above and to physical examination), frequency of catching cold

Mental generals

These are studied last for convenience.

  • Will: Loves, hates, and emotions (suicidal, loathing of life; lasciviousness, revulsion to sex, sexual perversions; fears; greed, eating, money, emotionality, smoking, drinking, drugs; dreams; homicidal tendencies, desire or aversion to company, family, friends; jealousy, suspicion, obstinacy, contrariness, depression, loquacity, weeping, laughing, impatience, conscientiousness)
  • Understanding: Delusions, delirium, hallucinations, mental confusion, loss of time sense
  • Intellect: Memory concentration, mistakes in writing and speaking

Quick review

of condition of every systems and organ, beginning with head and following order of Kent's Repertory

Past history

of patient in seven-year periods

Family history

Physical examination and laboratory tests

Case Taking Questionnaire

It is not a bad procedure to say to the patient at this time: “ I have listened to you until now without interrupting you, now we will change the role, and please don’t be astonished if I seemingly stop you while answering, to ask you the next question, because this will mean that the answer I was waiting for is obtained. Do not believe that by so doing, I underestimate your answer , but this only signifies that a longer explanation will bring neither useful nor new details in the case.”

1. General Symptoms

  1. At what time in the 24 hours do you feel worst?
  2. In which season do you feel less well?
  3. How do you stand the cold, hot, dry, and wet weather?
  4. How does fog affect you?
  5. What do you feel when exposed to the sun?
  6. How does change of weather affect you?
  7. What about snow?
  8. What kind of climate is objectionable to you, and where would you choose to spend your vacation?
  9. How do you feel before, during and after a storm?
  10. What are you reactions to north wind, south wind, to the wind in general?
  11. What about draughts of air and changes of temperature?
  12. What about warmth in general, warmth of the bed, of the room, of the stove?
  13. How do you react to extremes of temperature?
  14. What difference do you make in your clothing in winter?
  15. What about taking colds in winter and in other seasons?
  16. How do you keep your window at night?
  17. What position do you like best — sitting, standing, lying?
  18. How do you feel standing a while, or kneeling in church?

You remark that this question of the standing position comes again. You will find this way of repeating it is intentional here and there in the questionnaire. It is a very useful and necessary procedure for verification.

  1. What sports do you engage in?
  2. What about riding in cars or sailing?
  3. How do you feel before, during, and after meals?
  4. What about your appetite, how do you feel if you go without a meal?

It will be often answered to you: “I can easily go without a meal but I never can stand a big dinner or banquet.” A question that you did not ask, but which demonstrates that the question was well formulate as it made the patient talk and left him his own choice.

  1. What quantity and what do you drink? What about thirst?
  2. What are the foods that make you sick, and why?

If the patient does not answer after a while, just ask looking closely at him: sweets, salty things, sour, greasy food, eggs, meat, pork, bread, butter, vegetables, cabbages, onions, fruits?

  1. What about wine, beer, coffee, tea, milk, vinegar?
  2. How much do you smoke in a day, and how do you feel after smoking?
  3. What are the drugs to which you are very sensitive or which make you sick?
  4. What are the vaccinations you have had, and the results from them?
  5. What about cold or warm baths, sea baths?
  6. How do you feel at the seaside, or on high mountains?
  7. How do collars, belts, and tight clothing affect you?
  8. How long are your wounds in healing, how long in bleeding?
  9. In what circumstances have you felt like fainting?

2. Mental symptoms

During all these questions, the physician must by kind words, put his patient at ease, but must watch him very closely, without the patient’s noticing it.

  1. What are the greatest griefs that you have gone through in your life?

Quite often the patient will lower the head and look quite moved, and a kind word of the doctor will be needed. It is why, as soon as the extra-version of self-expression has been made, this following question will make the patient look at you again in an astonished way, and sometimes with a happy smile.

  1. What are the greatest joys you have had in life?

These two questions are very important and, when asked at the right moment, will pave the way for the coming questions.

  1. At what time in the 24 hours do you feel blue, depressed, sad, pessimistic?
  2. How do you stand worries?
  3. On what occasions do you weep?

If the patient cannot answer, we will just ask — not losing for one second his expression — music, at reproaches, at which time of the day? Certain people can refrain from weeping, some others cannot.

  1. What effect does consolation have on you?

If the answer is “It depends by whom,” you may say: “Just by people you like,” because very often people say they do not like to be comforted because they think of members of their family they hate.

  1. On what occasions do you feel despair?
  2. In what circumstances have you ever felt jealous?
  3. When and on what occasions do you feel frightened or anxious?

If the patient does not answer, ask: “Some people are afraid of the night, of darkness, to be alone, of robbers, of certain animals, of death, of certain diseases, of ghosts, to lose their reason, of noises at night, of poverty, of storm, of water.” According to the way of answering, you will at once see the real fears, and be able to discriminate those which are not to be taken into consideration.

  1. How do you feel in a room full of people, at church, at a lecture?
  2. Do you go red or white when you are angry, and how do you feel afterwards?
  3. How do you stand waiting?

If he does not answer, just question him about impatience.

  1. How rapidly do you walk, eat, talk, write?
  2. What have been the complaints or effects following chagrin, grief, disappointed love, vexation, mortification, indignation, bad news, fright?
  3. In time of depression, how do you look at death?

Certain patients have presentiments of death, thoughts of death, ever desire to die; other have tendencies or desires of suicide, some would be courageous enough to do it, others are afraid, in spite of desiring it.

  1. Tell me about over-consciousness and over-scrupulousness, about trifles; some people do not care about too many details and too much order.
  2. What about your character before, during and after your period?

3. Food cravings and aversions

Of course, all these questions have been already asked in the beginning of the questionnaire, but by asking them again, you are able, by doing some cross-questioning, to determine if they have been answered well the first time or not.

  1. What is the kind of food for which you have a marked craving or aversion, or what are those that make you sick or you cannot eat?

Here, also, it is very important to watch very carefully the expression of the atient, because it is very easy to read on the face by observing the corners of the mouth coming down if the patient is disgusted, or on the contrary coming up with big shining eyes if the craving or a strong alimentary attraction is felt. Then, one can add, for example:—

  1. What about pastry and sweets?
  2. What about sour or spiced food?
  3. What about rich or greasy food?
  4. How much salt to you need for your taste?
  5. What about thirst and what do you drink? Coffee wine, beer, etc.

4. Sleep

  1. In which position do you sleep, and since when that position? Where do you put your arms, and how do you like to have your head?
  2. What are you doing during sleep?

If the patient doesn’t answer, you add: “Some people speak, laugh, shriek, weep, are restless, are afraid, grind their teeth, have their mouth or their eyes open.”

  1. At what time do you wake up, or when are you sleepy? What makes you restless or sleepy?
  2. What about dreams?

5. For Ladies, Menses

  1. At what age did they begin?
  2. How frequently do they come?
  3. What about their duration, abundance, color, odor, what about clots, etc.
  4. At what time in the 24 hours do they flow most?
  5. How do you feel before, during, and after menses?