10 W’s OF CASE TAKING

(An extension of the Boenninghausen Method)

by Dr. Sunil Anand

The way successful companies manage their businesses and machines can provide some useful clues to us pertaining to case - taking. Just-in-time, pioneered by Taiichi Ohno in Japan at the Toyota car assembly plants in the early 1970s, is a manufacturing organization philosophy. It emphasizes on optimum efficiency during assembly and is primarily based on the “ Why ?, Why ? ” analysis, till one reaches the core solution to any one problem. It worked wonders for the automobile industry.

On the other hand, the inquiry into - “ What ? ” is the experience of a physical symptom or an emotional disturbance, is also an added value-based form of questioning in homeopathy.

While both these W’s ( Why and What ) are of course vital to case taking, Boenninghausen stated years ago, that there are in fact 7 universal questions that are all important. These include :

1. Who

2. What

3. Where

4. With what ( concomitants )

5. Why

6. What effects ( modalities )

7. What mode ( intensity of pace or miasm )

No one question can cover all situations all of the time.

The questioning model suggested ensures that all essential parameters of a case, whether acute or chronic, and irrespective of the age of the patient, are covered by the end of case taking.

Keeping recent developments in the field of homeopathy in mind, and as my own practice has evolved, adding the last three W’s as an extension to the earlier Boenninghausen method, has proven to be very useful leading to accuracy and quickness in selection of the remedy.

Below is a synopsis of the same, along with a sample case at the end.

1] QUIS – WHO SUFFERS ?

The homeopath must know who it is they are treating if they wish to know what it is they suffer from. The personality, the individuality of the patient must stand at the head of the image of the disease, for the natural disposition rests on it. By knowing the natural disposition of the individual in health we can judge what is strange, rare and peculiar to the present diseased state.

· Bodily constitution – vitality, physique, tone, hair coloring, bony structure, skin/tissue type, shape of head, complexion, leanness or corupulence. Also we can note marks of chronic miasm – like thin chest and thin bones of TB miasm, gaining watery weight and flesh like sycosis, and congenital deformities of syphilitic miasm etc.

· Temperament – choleric, phlegmatic, sanguine, melancholic.

· Influencing factors – work and family environment, mode of living and occupation.

· Interest and hobbies.

2] QUID – WHAT ?

It is essential to know the kind of disease and the stage of disease we are treating, so we need to know the nature and peculiarity of the disease.

· Acute, Acute of the Chronic or Chronic.

· Effect of the disease on patient’s life.

· What is experience of the complaint – physical and/or mental, a peculiar general that runs through the case?

· Key notes and Characteristics.

· The dreams further build and confirm the grand generals.

3] UBI – WHERE ?

It is important for the physician to know the seat of the disease, i.e. where the problems arise. Where are the objective signs and the subjective symptoms located ? On what level are the characteristic signs and symptoms found, physical, vital or mental plane ?

· Location of the disease as indicated by chief complaint, which could be physical or on a mental plane.

· Target organs.

· Systems or tissues affected.

· Side affections.

4] QUIBUS AUXILIIS – CONCOMITANTS

Concomitants are those symptoms that appear in the patient synchronistically to the main complaints. They give balance to the anamnesis and help the practitioner to avoid the use of suppressive or palliative remedies. The concomitant symptom is to the totality what the condition of the aggravation or amelioration is to the single symptom.

We have been taught that a complete symptom has Sensation, Location, Modality and Concomitant, and this has confused us endlessly as we search for the concomitant.

A complete symptom in fact, has ONLY the Sensation, Location, and Modality. A concomitant will have all three as well, and it becomes a concomitant by its nature of being another symptom in the case (other than the main symptom), even though it may appear unrelated to the main complaint.

· Symptoms of intellect, memory, sensorium, emotional disposition.

· Delusions, dreams ( as they also lead to the inner sensation due to sub-conscious representation )

· Desires and aversions, sex and sleep.

· Sensations, as if.

· Thermals.

5] QUR – WHY ? (CAUSATIONS/AILMENTS FROM)

Cause of disease is a very important study because it helps in choosing a proper homeopathic remedy, managing the case and removing the obstacles to cure. Homoeopathy sees cause and effect as two sides of one phenomenon. Cause (aetiology) and effect (symptoms) are functional polarity that appear and disappear together.

· Proximate cause – based on internal causes within the constitution and the temperament, inclusive of spiritual, mental, emotional and genetic factors.

· Occasioning or exciting causes – Acute disorders that are rapid in their onset, quick to reach crisis and end in complications or recovery. These could be individual, sporadic and epidemic.

· Fundamental causes – These are the miasmatic causes which predispose the organism towards acute miasm, crisis and immune disorders.

· Maintaining causes – Includes environmental stresses, poor diet, excesses of all kinds, prolonged deprivation of necessities, poor living conditions, lack of exercise, constant worry and stress.

· Toxic cause – Diseases caused by poisons, toxins and drugs inclusive of alcohol, tobacco, drugs, medicines and external environmental pollutions.

· Iatrogenic cause (suppression) – Miasmatic diseases which are suppressed due to long term medications repress the natural symptoms, producing obstruction to the cure. Vaccinations, invasive testing,

unnecessary surgeries, toxic drugs and over medication are also few of the major causes.

· Traumatic causes – Includes physical injuries as well as mental shocks.

· It is of note that in pediatric cases the mother’s history during pregnancy and labor has a major role as a causative factor.

6] QUOMODO – WHAT EFFECTS ? (MODALITIES)

This relates to the modalities that make something better or worse. It includes factors like:

· Effects of temperature, air, weather, motion, rest, positions, pressure, discharges, time affinities and moon phases, eating, drinking, emotions, sleep, sex, menses, etc.

7] QUANDO – WHEN ? (SEQUENCE AND DIRECTION OF DISEASE)

This section studies the chronological development of disease and the complete case history.

· The pace of the onset and development of disease, symptoms and pathology – a clue to the miasm.

· First to last : specific sequence to trace the Herring’s law of direction of cure.

The next three that follow are my own extensions, found practical from clinical experience :

8] WATCH OUT FOR :

· Gestures – These are a form of non-verbal communication in which visible bodily actions communicate not only the intensity of the complaint but may also lead us to the sensation experienced.

· Body language – The difference between words people speak and our understanding of what they are saying comes from body language such as facial expressions, body posture, eye movement, touch and use of space.

· Energy – This can be observed in two contexts. Firstly, as in where the energy of the case lies i.e. the intensity expressed by the patient either by verbal or non-verbal emphasis on a particular complaint and secondly, the overall experience of the case by the physician.

· Doodles - These drawings done leave traces of your personality and your inner world. Doodling usually happens under the effect of many unconscious parameters including your personality, current mood and other variables. They can also be used as a part of specific probing of a chief complaint, when patients find it hard to describe or express their chief complaint beyond a point.

· Words of source – The words used during the case spontaneously in any context may usually indicate the kingdom and sometimes even the exact remedy.

9] WHICH KINGDOM ?

Classification of the patient in the process of case taking helps us to narrow down the search of the simillimum to a group of remedies.

· Broader classification according to prime features of the kingdoms like structure for Minerals, survival for Animal, sensitivity for Plants, desperation for Nosodes, exaggerated organ association for Sarcodes, infinite and immaterial themes for Imponderabilia.

· Once the kingdom is classified, further narrowing down to rows and columns ( in case of a mineral remedy ), sub-kingdom of animals and families of plants help to reach to the simillimum with accuracy.

10] WHAT INTENSITY ?

· The miasm has to be settled upon while searching for the remedy. The drug and the potency selection must match the pace, nature and pathology of the disease.

· One has to discern how the patient perceives his disease - whether it is threatening (acute miasm), a struggle (psora), an irremediable weakness or a fixed image of inadequacy within the self (sycosis), revulsion/isolation ( leprous ) or self-destruction (syphilis).

A case with illustration to highlight the concept of 10 W’s :

S.G. Male 38 years.

D – Ok please tell us what are all your problems ?

P – The problem is at a physical level, the lower back pain, stiffness of the neck. If I continue working with a stiff neck then it starts paining. And due to lower back pain I was at home for a month around two months back, that was a big problem. It recurs after a certain period of time. I’ve done a bone scan also, which shows some inflammation in sacro-iliac joint of both sides. That time I had consulted the orthopedic surgeon who said that maybe I have arthritis type of symptoms. So I did a RA factor test and other tests which were all negative. But the symptoms still persist. Now I am taking some medicines and I am definitely better than before.

( It is common for patients to perceive their complaints as purely physical at the start of a case interview. It is the experience of the attending physician to create the awareness of the mind body quotient, by making the right inquiries at appropriate moments of the case )

D – Since when are you taking these medicines?

P – 2-3 months.

D – Since you are better why do you feel there is scope for homeopathic treatment?

P – I want to have a permanent solution because it keeps on recurring. Typically when I sit for long time it comes back, so doctors say that my posture is not correct, even though I do exercises, swimming, stretching. Also all this effects my working capacity and levels of confidence.

D – So why do they feel that your posture is not correct?

P – Looking at the X-Ray report, some straightness has come; loss of lordosis is the word they were using.

D – So have they advised how to correct that posture?

P – Yes, they have advised me to sit straight with my tummy out so that the ‘S’ curve is maintained.

D –And you are implementing it ?

P – I do it but I feel pain if I sit for long time with that posture. So may be the strength of the back is less that’s why I cannot sit for long. Theoretically the back rest should not be taken, should sit with spine straight without any support which I am not able to do, maybe the strength of the back is less.

D – Since when have you been feeling that the strength of the back is less?

P – This I have been feeling because I am not able to sit erect.

D – Since when?

P – Long back, may be 20 years, I have this back pain since a very long time.

D – How long, since when does it date back to?

P – May be college days, when I was 20-21 years old I have been feeling that pain. With some exercise or swimming I am able to maintain it but the pain was always there.

D – Is there history of arthritis in your family?

P – No.

D – So what phase of your life were you in when you were 21 years of age ?

P – I was in engineering college.

D – How was that period for you ?

P – It was a stressful period for me. My history is that I get easily hurt, somebody speaks loudly at me or hurts me or abuses me, I get hurt easily. I feel depressed at least for that moment. And I am not able to work freely then, this is my basic problem. Even now I feel that way; in fact the intensity of feeling bad has increased now.

D – What are the consequences of that ?

P – Even my sleep gets affected, sound sleep I’ve lost for almost 2-3 years. Morning 3-4 am I am definitely awake, frightened.

D – You wake up frightened?

P – As if, like I sweat even though I put on the A.C, some fears, some feeling I have.

D – Can you describe those feelings in more details?

P – Typically something in the company, I am not able to complete that work, then that disturbs me, continuously those thoughts keep on coming and practically I am out of control. I am not able to control those thoughts.

D – What are the thoughts regarding ?

P – Some work which is left incomplete, what will happen, what will my boss tell, how will I answer him. These types of series of thoughts which doesn’t allow to sleep properly. I feel shakiness in head, as if my head is moving. In my back also I feel some movements, trembling or as if my heart beats have increased, ‘thak thak’ like that.

I prepare a lot but while presenting I have a feeling that will I be able to present properly, tell in right manner, answer the questions that will come out of it, that type of fear is always in my mind. I feel my memory is a big problem, I always doubt my memory.

I feel will I be able to speak at a stretch, whether my flow of thoughts will be proper, or will my presentation be proper ? If some cross questioning comes In a presentation in between 10-15 people, if my boss hurts me in front of all these people than it is more of a problem, then whatever I have prepared I tend to forget, and I go blank.

D – In which other areas you feel your memory being a problem?

P – What I feel is when someone is explaining something, my mind gets diverted, I am not able to fully concentrate on it. Suddenly thoughts of things I was supposed to do will come. I have to complete that work, I have to do this, I have to do that and then I am not able to concentrate on the person who is talking to me and that’s why I am not able to memorize things. So diversion of mind is the major reason of the problem.

D – This problem is recent or it has been since long ?

P – Always.

D – Even as a student?

P – Yes, even as a student, I had to sit down for the same topic for 3-4 times to grasp it. I had to really mug it rather than understand the topic. Reading once I felt was insufficient. Plus when I talk I feel saliva accumulation is there and it will spill out which further reduces my confidence. Since my sleep is not sound, sometimes I feel heavy headed, and sleepy in the afternoon after lunch.

Under pressure I feel my beats increase because of over thinking, if I put my hand on neck I can feel my beats have increased. So whenever my boss calls me, before taking the call, I feel the tremor. Now what will he ask, whether I will be able to answer him, whether I am prepared ? Suppose he sends an e-mail, opening his mail also creates a fear in my mind, I am not able to freely open the mail without any kind of fear.

So in this area I felt homoeopathy and your advise would help me, physically I think with some exercise I can pull on, but since it was a recurring problem I thought maybe homoeopathy can help me.

D – What else?

P – I think I have covered most of the things.

D – Tell little about your childhood, what was it like?

P – I was not bold, I was fearful. Even at that time I feel I carried lots of tension, of studies, the future and physically also I was not strong.

D – What do you mean?

P – Means I was not healthy. I used to catch colds and fevers very fast, maybe my immune system was not strong.

D – What was the home environment like?

P – I am the youngest among 3 siblings. My father used to work in P.M.T. ( Municipal Transport ) as a controller, so income was medium. And staying in a small house at that time, financially not good but stable.

D – Tell me more about your parents, your sisters.

P – My father was a very hot tempered person, so I used to get afraid of him.

D – Why were you afraid of your father, in what way were you affected by his hot tempered nature?

P – Suppose I failed to study properly and don’t get good marks and whether he will be able to provide me all the facilities as finance was a problem, so those were the thoughts.

D – So what was the fear about, say you don’t get good marks, what was your concern?

P – He may scold me, he may think that I am working so hard for you and you are not taking the efforts, so those were the thoughts.

D – So these were just the thoughts or he actually used to scold you?

P – He never scolded me but I always felt that. Rarely he must have shouted on me.

D – Then why did you feel like that?

P – Because of my thinking process, it is a problem since childhood.

D – Tell more about it.

P – I think a lot, like how will the person in front of me take me; react to me if I tell this or that ? So that type of thoughts comes in the mind and they make a mess and I am not able to present properly.

D – So what is the feeling, what will the person in front think, what will he do, what will he say?

P – Suppose he doesn’t like it, suppose he shouts, will it affect my future performance, will I be able to cater to his needs. Thoughts mostly will be regarding company, more of the boss, how will he take, how will he react.

D – This used to happen in school also?

P – Yes with the teacher it used to happen. If I won’t do the homework on time, teacher will scold me, I won’t get good marks. I had made a target that I will become an engineer, even if my memory is not good, I will study hard, I will put in efforts. And in 12th I didn’t spend even an hour for play, I just kept on studying till the exams are over, I thought only hard work will take me there. Even during that time I used to have that tension. Like for instance if I lost 2

hours due to a social function, so how will I be able to cope up ? So that was a mental block, that only if I study I will get success, any wastage of time will cause me problems.

D – So what was your nature like at that time?

P – Fearful, not bold, worry of future, having tensions of will I be able to settle properly – like good job or will I be able to meet the engineering criteria. Even after getting in B.E, ( Bachelor Engineering ) I used to study hard, and no extracurricular activities.

D – What else happens during a presentation, suppose there are people there, besides the boss issue what else is the issue with the audience during a presentation?

P – Audience is not a big issue, issue is more with the boss and if he scolds me then what all these people think about me. They may taunt or the remarks afterwards will hurts me.

D – Taunt as in?

P – He can’t remember such a small thing and an easy thing ! They may not pass such comments, but I think they are doing it behind my back, and that will spoil my record or stature and those thoughts disturb me more. May be if I had presented only to my boss and he scolds me then that may not hurt me as much...

And somehow the lack of presence of mind - like a question comes and I may know that answer but at that time I won’t be able to recollect it. Afterwards I will remember it, but at that point of time I totally become blank.

D – Blank as in, what happens?

P – Blank means, because of fear I really stop thinking at that point of time, I am not able to recollect what I should have.

D – This memory issues comes in areas outside work place also?

P – Yes, but to some extent not to a greater extent.

D – For example?

P – Like remembering a relative’s name, names I forget, name of a place, route. Suppose I have to go to a place where I have been before, I don’t recollect it easily.

D – This is also happening since beginning?

P – Yes.

D – Now let’s come back to the back and the neck, can you describe the symptoms exactly? Which one came first the lower back ache or the neck ache?

P – The lower back ache came first.

D – So let’s talk about it, describe it. What happens exactly?

P – I feel the stiffness in the back.

D – What do you mean by stiffness?

P – I am not able to move swiftly, I cannot bend, and feel as if something has become hard in that region. If I sit for a longer time then the striking pain starts.

D – Striking as if ?

P – As if now I have to lie down, that’s all.

D – What do you mean by striking pain, describe it some more?

P – Striking means, now I am not able to bear the pain any more.

D – What’s the sensation there, as if what is happening?

P – Not able to explain it.

D – So in what way is it striking then?

P – Striking means I cannot sit further, I have to get up, lie down.

D – So what do you do at work place, you actually go and lie down somewhere?

P – I had not felt that striking pain at work place, when that happened I was at home. I was home for one month, taking rest for that.

D – Anything more about the lower back ache?

P – No. The basic history I have told you about the joints, and that the gaps and discs are normal.

D – Anything gives instant relief in the lower back other than medicines ?

P – By some massage, some stretching exercises, swimming also gives me lot of comfort and strength, so I do swim regularly around 400-500 meters.

D – So describe that comfort and strength experienced during swimming?

P – Means when I come out after swimming, I can sit straight without any support, I feel I’ve gained that strength, and I feel fresh. And I am certain that tensions, too much of thinking is more related to my back pain.

D – What do you mean?

P – Means if I am tensed, even though my back is ok at that time, I feel will that pain come up now. So tensions, pressures are one of the major reasons for my backache.

D – So when you say swimming gives you strength and also lot of comfort, what do you mean by comfort?

P – I feel that now I’ve swam, now it’ll be ok.

D – So what’s the experience in the water?

P – I feel better.

D – In what way?

P – I have a feeling that my pain is going away.

D – On a particular day if your are unable to go for swim, what will be the feeling?

P – It will be like today I haven’t swam so whether my back will create a problem. Like past 2 days I was unable to go for swimming because of some urgency in work, so I felt that I will have some pain.

D – And about the neck, what is that like?

P – If I sit on a computer for long time, I feel the neck getting stiff and it gets better if I do some neck exercises. So if I write even for 15 minutes I get that

stiffness. So I have to see straight without a bend in my neck, so any bend in the neck for time about 15-20 minutes like while writing creates problem.

D – Swimming which style do you do?

P – Breast stroke mainly, as free style I cannot do for long.

D – What happens if you do free style?

P – My breathing gets affected, I feel exhausted fast, with breast stroke I can continue for 400-500 meters as my breathing pattern is better with that.

D – As a child any major illnesses?

P – Nothing major.

D – Any skin problem of any kind, rashes, itching, you needed ointment for anything?

P – Not really, but some 3 years back I had Dengue, so I had rashes at that time.

D – Remember the symptoms?

P – Red spots all over skin and platelet count was down.

D – Other symptoms.

P – Terrific headache and fever.

D – Explain that headache and what happened during it.

P – I was not able to concentrate on anything. It was as if something was hitting on my head. Temperature was also tremendous and the whole body was red hot and was admitted in KEM hospital for 7-8 days.

D – This was 3 years back?

P – Yes.

D – Since then have you seen that your health has deteriorated further?

P – Then afterwards once during annual checkup, cholesterol was increased, same period about 3 years back. Cholesterol levels had gone up to more than 400, and the doctors had advised tablets. I think allopathic tablets have a lot of side effects and I’ll have to take these tablets for the rest of my life, so that

created a lot of worries for me. Plus the company pressures at that time, I was very worried. I had palpitations at that time which I can feel now also, I had shakiness in my head because of continuous thoughts.

D – What kind of work pressures are there?

P – Typically my boss, he is very talented and time sensitive, suppose he has committed a date and someone is not able to maintain that date, then he gets wild and shouts, that creates lot of worry. Plus his memory and his able to handle pressures is tremendous, so I feel if he is able to do so much of work then why even 5% of him I am not able to do, so that creates further pressure.

D – Experience pressure right now, what will happen within the body?

P – I feel that palpitations in the body, heart beats increase, pulse goes up, mind becoming blank – not able to remember what I am going to tell, forgetfulness, fearful and as if how I can avoid going to him now, what reason I can find to avoid him.

D – So what you do?

P – Can’t do anything, this is all I experience and then I go.

D – So what happens when you are standing in front of him?

P – Slight shakiness, slight trembles.

D – Where?

P – Throughout the body. And that blankness, suppose he asks a question, I am not able to reply very positively.

D – Mind totally becomes blank?

P – Almost. And sometime I feel that all these pressure will create some kind of health issues for me, maybe I will have BP problems, that trembling of body – will that be a permanent issue, should I continue this job, why not look for a job which is peaceful and relaxed, maybe less money but peaceful, so these are the thoughts.

D – Then why didn’t you consider that?

P – I considered but I am not able to get out, I did try.

D – Why not?

P – Because situation changes and things become relaxed, then again that pressure comes and I again think that way. So it’s an on and off procedure and so I don’t venture lot on it. Main thing is I have to be in Pune, I don’t want to go outside Pune, so the job and limitations.

D – Why you think you have to stay in Pune?

P – I have not been to any other place throughout my life, I feel climate here is better, all relatives, friends are in Pune, so that creates a feeling that I should not go out.

D – Has there been a period of a week or two or a month that you have to be away from Pune for work?

P – Yeah.

D – Then how is the feeling for those 1-2 weeks?

P – It’s a nice feeling because I have to return back.

D – But while you are there, do you miss Pune?

P – Not that much.

D – Have you ever sensed a feeling of loss or that you are actually missing your home, if you are out of the city?

P – Not really. Sometimes if about 2 weeks I do feel like being at home, this happened when we went 6-7 years back for a family trip, the feeling was like too much of traveling and fatigue and that I want to go back now.

D – So what is it about that home that makes you feel so good?

P – Difficult to describe.

D – Any other surgeries or something like that?

P – No.

D – Tell your sleep dreams.

P – Fearful dreams are more prominent.

D – Like what?

P – Some incomplete work, pending work, will I be able to complete it.

D – How does it figure in the dreams?

P – It is continuation of non-stop thoughts in the dream. For example – if I had to complete some work and there are lots of problems in it, so the thoughts are like how will that happen, whether some steps I have to take, did I take them, did I miss something, will I be able to remember the step at the right time. This type of continuation of thoughts comes in mind.

D – This you see in dreams ?

P – I become awake because of it and can’t continue sleeping. And in winters also I sweat and I feel warm too.

D – But you are wearing a sweater?

P – Today while traveling I wore it and I wear it in office also.

D – So why do you wear it if you feel so warm?

P – I don’t know, I feel better with a sweater, as if I will catch cold, that feeling is always there.

D – Describe the feeling.

P – I have a feeling that staying warm is better for the back, and I feel that my body is getting cold if I don’t wear a sweater.

D – And that’s when you sweat also?

P – No, sweating is more in the sleep, not when I am awake.

D – So about the chill factor, would you say you feel chillier than others?

P – Yes, because I have to go for urination frequently, toilet I feel I have to go more times, which I feel is result of feeling chilly.

D – Which part of body you feel the chill most?

P – My hands, chest, neck.

D – So if you are going out early morning for a walk, would you want to cover your face and head also?

P – Yeah, I put a strip on my ears. I have a feeling that if something goes in my ear then I will catch cold early, and I wear a sweater.

D – What other dreams do you get ?

P – Some future plans, how will I be able to settle....

D – I am not saying thoughts, I am asking about actual dreams, what do you see?

P – Some animal dreams.

D – Like what?

P – As if I am caught in a jungle, lot of tigers are there and how will I survive. Mostly after watching a movie of animals I get these sorts of dreams.

D – So what is exactly in the dreams, how are you caught in the jungle, tell me exactly.

P – As if I had gone for a trek and I lost my way, I am alone, then something about snakes also.

D – What about it?

P – There is a snake in the house and it will bite me, how will I get rid of that ?

D – You can see it?

P – No.

D – Then how do you know that there is a snake?

P – Difficult to explain.

D – Then how do you know the snake is there, think a little.

P – This is mainly after watching those kinds of movies.

D – Any other dream? Either now or as a child, or repeatedly you remember of getting?

P – Not able to recollect.

D – You are sure as a child you have never had a skin related problem, disease, infection, pimples, acne?

P – Pimples I had, lot of problems.

D – What age?

P – 17-18 years old.

D – Does it have any smell or odor or does it leave any stain on clothes?

P – Yes it has a bad odor and it stains yellowish on the armpits, back.

D – All this performance issues and lack of confidence, does it affect your personal sexual life also in any way?

P – To some extent ( awkward at this question )

D - Can you be more specific ?

P – Ejaculation may not be always later, sometimes premature it happens.

D – Sexual desire is still fine?

P – Yeah.

D – Nightfall issues?

P – No, I had this problem when I was in 12th. I was not able to control myself and that used to lead to either a night fall or masturbation. Then someone told me that I should eat neem leaves, so I used to crush neem leaves and eat it. Then I had some real issues, I had lost my erection, and then I consulted lot of doctors who said that it was a psychological issues and not a physical issue. When I am very tensed at work, this happens even now.

D – Any other dream?

P – Related to sex sometimes.

D – Hair issues, have you greyed early?

P – Yes.

D – How early?

P – May be 33 I started graying.

D – Any other scalp related issues, dandruff, hairfall?

P – Dandruff but not much, I don’t use anything for it.

D – Any itching or scaling?

P – Itching sometimes when hairs are long so I keep them short normally. Mostly this happens in summers with lot of sweating, but normally no.

D – Anything else, you feel we have covered everything?

P – Yes.

FOLLOW UP 1ST post remedy after 2 months of commencing treatment :

D – Ok so just fill me in on what’s been happening since we first met and to date?

P – Basic issue was sleep, not able to sleep comfortable with lots of disturbances, shakiness in the body and head. Now that sleep has improved, and the shakiness has reduced but still that shakiness remains, it is there.

D – In what way we can say that it has reduced?

P – I think 70% it has reduced. And lot of negative thought that used to come has reduced, drastically reduced.

D – In what way, can you give an example?

P - % wise or?

D – With example.

P – Suppose I have not completed a work, then that series of thought of what will happen and total negative thinking that used to come earlier, that now I will be penalized, and feel ashamed in front of everybody, that does not bother me as much.

D – So now how do you deal with such situations?

P – Now surprisingly, even if I have overlooked something, I realize that it can always be do done later - that confidence in improving and that positiveness is coming. I won’t say my memory has increased a lot, but at least now whenever it is required, I am able to express something, maybe not 100% but I will definitely say that at least 30% improvement I am finding there. In prompt replies, which I had an issue earlier, now I can express myself, at least 30% better than before. Than the lower back pains are not felt much but the stiffness if I sit for long time has not improved much. But I can swim and do yoga with more strength and duration now.

D – This is more when you sit for a long time?

P – Yeah, that and early morning when I get up, I feel this stiffness more, as if like a plywood on the back and the movements become very critical. The stiffness in the neck has improved a lot. Pain in the right side chest muscle I used to feel more while driving, I have seen an improvement with the change in holding the mouse, so maybe it is related to the ergonomics of the way I hold the mouse for long time, it’s a guess I don’t know if that’s the only reason.

Positiveness and confidence has gone up, dealing in meetings, talking in meetings I find a positive improvement. Saliva that came in mouth while talking has reduced, as I am less worked up now. Flow of thoughts also has improved to an extent but not to the expectations. Headache due to loss of sleep I used to have is not felt now.

D – Any recent dreams that you can recollect?

P – No.

D – So you are satisfied with your progress?

P – Yes, of course, very much.

Working Analysis of 10 W’s pertaining to the above case :

1. WHO ?

Influencing factors – work and family environment, worries, place and area of living and working for endemic or occupational diseases.

Not bold, fearful child, carried lot of tension of studies, future and physically not strong.

Adult - From the corporate world

Strict hierarchy at work

Fear of authority—Issues with boss and dominating father

Over taxing himself

Loss of performance

Interests and Hobbies : None

2. WHAT ? ( Sensation )

Experience of the complaint –

Shakiness in the head, increase in heartbeats, feeling that I will not be able to present properly.

Shakiness, trembles and blank feeling

Keynotes and Characteristics Rubrics :

Weakness of memory

Sexual weakness

Remembers forgotten tasks later

Premature senility—early graying of hair

Sweat with yellow stains

Tremors, stammering and palpitations with nervousness.

Salivation during speaking.

3. WHERE ? (Location)

Back---lower back—(inflammation in the sacroiliac joint), neck stiffness

Psychosomatic complaints

4. WITH WHAT ? (Concomitant / Associated Symptoms)

Insomnia

Palpitations

Hypertension

High cholesterol

Erectile Dysfunction

Premature greying

5. WHY ? – (Causation / Ailments From )

Ailments from: Stress during college days—someone abuses me/speaks loudly/hurts me.

Stress during childhood

Being reprimanded for incomplete work

What if I fail or don’t fare well ?

6. WHAT EFFECTS ? (Modalities) -

< sitting for a long time.

< emotions, tensions, pressures-- affects sleep and work efficiency

>Stretching exercises and massage

7. WHEN ? (ODP) – Onset, Duration and Progress

Since 20-21 years of age

Severe acne as a child

H/O Masturbation

Dandruff with itching

Premature hair greying

Fear of failure

Weakness of memory

Anxiety Neuroses

Dengue

High Cholesterol

Spondylitis

Chronic Fatigue Syndrome

Performance Anxiety

8. WATCH OUT FOR –

Gestures – automatic movements of face

Body language and Energy: Stuttering and evading look when talking of anxiety at work, intimidation by bossy senior, and sexual talk. Conveys lack of confidence, and performance anxiety issues.

Physical make up : Premature greying and creases on the forehead, indicating prolonged stress.

Doodles/drawing: Home and family. When asked about it, he said that his family is his world. And that what ever he has done or does, is to ensure that his family is happy and secure. This further endorses themes of Row 4.

Words of source:

Performance

Strength of back is less

Efficiency of work affected

Sensitive to criticism in presence of others

Task

Work

Duty

Failure

Guilt

Crime

9. WHICH KINGDOM / SUB-KINGDOM ?

Mineral, fourth row metal, 16th column

Defeated state

Little hope

Paralyzing

Spread to the entire system.

Right side of the periodic table

Powerless

Fear of failure

May lose his job

Loss of performance

Loss of strength

10. WHAT INTENSITY ? (MIASM/POSOLOGY )

- Very slow

- He is very rigid ( in mind and body both )

- Fixed idea of internal weakness

- Feels others are looking at him and taunting him

- Feels his body is not strong

He cannot get out of his comfort zone, indicating a high and chronic emotional component.

The above points suggest a SYCOTIC MIASM.

- He is a regular long distance swimmer, as well as a yoga practitioner, which conveys that his basic physical vitality is good and he can withstand a high C potency, if given infrequently.

-However, in view of the chronicity of symptoms and the sequential involvement of several systems of the body, inclusion of a LM potency, will further expedite the effects of the remedy and case management.

REMEDY GIVEN : SELENIUM

POTENCY: 1M single dose.

This was followed by LM3 given daily.