In this I don’t want you to find questions as it is quite difficult even with all information. For me it was very difficult case as the patient is very old and very sick.
85 years old lady came to me in very desperate state suffering from chronic functional dyspepsia. The main problem is that if she does not eat every one and half hour, she has a terrible pain in stomach. She has a benign tumor in stomach 24 x 20 mm, but she has had it since 2005 but pains have started 2 years ago without apparent reason. She suffers from fibrosis and chronic hepatitis. She is forced to eat very often and as soon as she eats something, the pain is gone but relief lasts 1,5 hours only and then in account of pain must eat again. Eating is only think that gives a relieve to pain. She does not eat because of hunger but because of pain. Pain is felt as a pressure that is getting worse more directly proportional to duration of fasting. She is very desperate (3) due to pains and has depression for which uses allopathic medication. She is very chilly, must sleep on back, otherwise she cannot sleep. She drinks in sips but not so often, approx once an hour.
She was telling me: I tried all therapies that exist but nothing had any single effect to any degree to my pains.
She is taking a lot of allopathic drugs and there are no other symptoms and this case can be considered as one sided, most probably due to heavy allopathic medication.
After the remedy was given, the interval between pains prolonged from 1,5 hours to 3-3,5 hours and became less intense and her psychological condition improved accordingly. There was no aggravation after the remedy as she is incurable and the effect of remedy was palliative but it was only think that affect the pains. Unfortunately I have only one follow-up after 1 month after the remedy.
Summary of this case for students of homeopathy!
The most important symptom of the case was the pain in stomach by eating. The effect of this pain on her psychological level was one of desperation. The very first remedies I thought of was Arsenicum album and Calcarea, she was so desperate as if she was dying but none of these remedies have a second keynote that became GUIDING SYMPTOM of the case for me. I knew I must stick to that symptom and try to understand the mechanism of the problems she described and soon I realized that the pains coming at the moment the digestion stops and when the digestion is stimulated by taking food, the pains goes away. So I realized that she must keep the digestion active by taking food very often in order to prevent herself from pains. The relevant rubrics regarding this symptom are:
STOMACH - PAIN - pressing - eating, amel (11 remedies only in the rubric, Anac is in first degree and only remedy in 2nd degree is Nat-c that is not possible to confirm in materia medicas concerning this symptom in detail)
STOMACH - PAIN - empty, when (There are only 2 remedies, one in first degree (Petr) and one in second (Anac)
I knew that symptom AMEL by eating is most important for Anacardium and it is its keynote but I did not know at that time about interval in dyspepsia in Anacardium and that was the point I had to go to Materia medica. I choose MM Viva from George Vithoulkas and in Anacardium, in chapter Stomach is written (MM Viva volume 2, page 316): A general AMELIORATION BY EATING is a strong keynote BUT SYMPTOMS RETURN SOON AFTER EATING. Pressing pain in the stomach after mental exertion AND ONE OR TWO HOURS AFTER EATING, DURING THE TIME OF DIGESTION!
That means that my previous understanding was not correct as the digestion process does not start immediately after eating bur after some time. And that, when digestion starts is causing stomach to suffer from pains. When the digestion is maximized, the pains are worse and then when she eats again, she interrupts the process and relieves the pains.
I said to myself: well, it fits perfectly but what about despair of her health? I was thinking about it and try to imagine to be in such state when one cannot go even for a walk to 1,5 hours without thinking of pain is going to be here soon. I considered this symptom for something that having it for long time most of people will be despair but anyhow was not sure and tried to find if there is some link to Anacardium. In repertory in rubric MIND - DESPAIR, recovery, of - the Anac is not listed at all. Then I read Kent, Clarke, Boericke but nothing was found. Finally I opened Hering guiding symptoms and find in second degree the following sentence: "ANXIOUSNESS; DESPAIR OF GETTING WELL." And that was my confirmation I was looking for.
Lessons for us coming from this case:
1) Try to understand the pathology process in the whole before you search for the remedy.
2) If you find something very strong and peculiar, stick on it.
3) Always focus on symptoms that create uppermost layer if you see symptoms of more remedies. don’t mix all together.
4) Always try to find in reliable medica more information, which is one of the most effective ways of learning remedies in detail.
5) Always be observant, try to imagine how the patient feels, and try to imagine this feelings. If you will do it in every patient your real understanding of human mind and remedies will improve significantly
Thank you all of you and hope it was not too easy for you because for me it was a hard nut to break.
Case by: Dr Petra Zach