Acute Bronchitis: Two Cases
Acute Bronchitis: Two Cases
Abstract: Two cases of acute, epidemic bronchitis are presented along with discussion of the characteristic symptoms in each case and the case analyses. Some of the author's confirmed characteristic symptoms of Carcinosin are identified; e.g., waking at 4 a.m., amelioration from music, sleep position on the back with one or both hands above the head, craving for sweets or fats. Suggested guidelines for the taking of the acute homeopathic case (which may be considered controversial) are provided; i.e., focus upon only those symptoms which have arisen in association with the acute disturbance, ignoring all preceding chronic symptomatology. The common misconception of dividing remedies into acute and chronic disease categories is debunked, the author emphasizing that any remedy may act curatively in either setting.
Keywords: bronchitis, acute case taking, characteristic symptoms, acute remedies, chronic remedies, Carcinosin.
Two cases of acute, epidemic bronchitis are reported below. The first of these patients had seen me once two years ago for another acute, epidemic illness; the second sees me regularly for ongoing treatment and well-child care.
Both cases were taken in a very specific manner: focusing in on those changes that have occurred since the patient became ill. Only symptoms of the acute episode are included, and all of the patient's recent changes are included in these reports. None of the symptoms in either case comes from the patient's chronic state.
Hering tells us, "In all...cases the symptoms appearing last...are always the most important."( 1) Hahnemann teaches, "In [acute disease] the principal symptoms become prominent and recognizable to the senses more quickly, so the taking of the case requires far less time and there are far fewer questions to ask..."( 2) I ask only one question when I take an acute case, but I ask it over and over again: "What has changed since...?"
When taking an acute case focus your patient on his or her state since the illness began. Don't allow any divergence. Keep asking what else has changed since they've become ill. Interrupt whenever they move off track and bring them back to the time since they've been sick. Consider only these symptoms in your case analysis. If you haven't tried acute case taking using this approach I'd encourage you to do so. The accuracy and effectiveness of your prescribing for acute cases will improve dramatically.
HC is a 10 year old who'd had a cough and a sore throat for 3 days when she saw me 12/22/95. She was much worse after 7 p.m. She described a pain behind her ears when she coughed. Her throat was better while warm drinks were being swallowed. She had a tickle in her throat pit after eating ice cream or drinking milk. She described a light green expectoration that tasted a bit salty. She coughed when her throat hurt and when her throat tickled. Exertion made her throat tickle, which made her cough. Her right ear hurt when she coughed. She had decreased energy. She couldn't sleep after a party last night (she was up till midnight). She woke at 4 a.m. to blow her nose. She felt warmer than usual. She wanted to listen to music the night she got sick, which was not only unusual for her but also helped her feel better. She had a grilled cheese sandwich for lunch today, which didn't hurt to swallow.
Exam: Afebrile. Tympani: R -- cerumen, L -- clear. Oropharynx red. Shotty cervical nodes. Clear lungs. A throat swab sent to the lab was negative for Strep.
Impression: Bronchitis with pharyngitis.
The characteristic symptoms in this case were: 1) waking at 4 a.m. (why should a 10 year old who was up till midnight wake up at 4 a.m. for any reason?); 2) ameliorated by music (she not only wanted to listen to music, but she also felt better by doing so!); 3) desired fatty food which ameliorated (a grilled cheese sandwich is nothing if it isn't greasy -- cheese between buttered bread that's warmed till it oozes); and 4) warmer than usual.
The following chart represents the MacRepertory(R) repertorization of the above symptoms with the "Analysis" options set to "Strange, Rare & Peculiar" and to "Keynotes" with the "Analysis Preferences" set to "Enhance Analyses" and to "Double Underline Value" for both choices. These settings make the program rank the remedies according to what's most characteristic about the remedies in relation to the symptoms I've chosen to repertorize.
Sulphur, on first pass, seems an appropriate prescription for this patient who is hot, wakes at 4 a.m., and craves fatty food. Natrum muriaticum also covers all these symptoms and is sensitive to music as well. However the best match, the most similar remedy, is Carcinosin.
Prescription and Follow-Up
Carcinosin 1M once.
Mom reported complete disappearance of all acute symptoms within 36 hours. HC has been well since.
KS (19 months old). Acute cough. She awoke at 11:30 p.m. and 4:30 a.m. She had circumscribed red cheeks. Her tongue was bright red in the center. Her ears itched. It looked like she was scratching in them. She wanted music on a lot, in the kitchen, in the bathroom, in the car, etc. She sang along and danced. It made her more lively. She slept on her back with one or both arms above her head. She craved sweets.
Exam: Afebrile; tympani clear: oropharynx clear; no cervical nodes; lungs clear except for coarse central sounds posteriorly with no dullness or fremitus; regular heartbeat with no murmur.
The characteristic symptoms in this case were: 1) waking at 4 a.m.; 2) music ameliorates; 3) dancing; 4) sleeping on her back with her arms above her head; 5) desires sweets. Remember that all of these were changes from her chronic state.
The following chart represents the MacRepertory(R) repertorization of the above symptoms with the analysis options set as above.
Tarentula hispanica needed to be considered for this patient because of the combination of music and dancing in the characteristic symptoms. Sulphur covered the early waking and the craving for sweets. Pulsatilla covered the sleep position. Natrum muriaticum and Lycopodium also had to be considered. However, the best match for the totality of these characteristic symptoms was again Carcinosin.
Prescription and Follow-Up
Carcinosin 200c once.
Three day follow-up: She had an emotional aggravation for two days, then she became better. She was coughing less. Her cheeks were not as red. Her cheeks began to get redder again five days later, so Mom gave Pulsatilla without contacting me. (Don't you love those moms?) Her cough started to return three days later and a second dose of Carcinosin, was given at that point. She has been well since.
I want to make two points as I discuss these cases. The first is about how I prescribe Carcinosin. The second is about the distinction many homeopaths make between "acute" and "chronic" remedies.
Carcinosin is one of our newest remedies. Foubister's ground breaking work was published only about 40 years ago. Our collective literature is very sketchy when it comes to this remedy. It is not well proven. Some of the symptoms I find most characteristic of Carcinosin are not well described anywhere. A few of these symptoms are found in these cases: waking at 4 a.m., ameliorated by music (persons that respond well to Carcinosin may be so very sensitive to music that they weep at its inherent beauty), sleep position on the back with one or both hands above the head, and craving for sweets or, even more characteristically, fats.
Patients of mine who have responded well to Carcinosin have exquisite sensitivities to beauty, dancing, travel, reprimand, and world affairs, as well as music. They have intense cravings for fats, salt, ice cream, chocolate, bacon, and sweets. They are ameliorated by the ocean. There are many other Carcinosin symptoms; 996 are listed in the Complete Repertory, v. 3.01. But these exquisite sensitivities and strong food cravings form a core group of very characteristic symptoms, any one of which should lead you to investigate the possibility of prescribing Carcinosin.
The second point I want to discuss is perhaps the more important of the two: Carcinosin, a nosode, is generally considered a chronic remedy yet was prescribed quite successfully in these acute cases of epidemic bronchitis. Many homeopaths in America today, and perhaps in the world, seem to group remedies into "acute" and "chronic" categories, certain remedies like Arnica, Drosera, Arundo, and Sarsaparilla being labeled "acute" remedies and certain others like Sulphur, Natrum muriaticum, Lycopodium, and the nosodes being labeled "chronic" remedies. I believe this distinction is misleading. If one categorizes remedies into "acute" and "chronic" groups one will tend to miss prescriptions because one would never imagine Rumex, for instance, would fit a constitutional case or that Carcinosin would fit an acute case. Any remedy can act acutely under certain circumstances and act constitutionally under certain other circumstances, the certain circumstances being the characteristic symptoms in the case.
Please remember Hahnemann's often repeated directive to bring a pure mind to the practice of homeopathy. In a prefatory chapter to the Materia Medic Pura Hahnemann said the following about the pure mind: "In order to be able to observe well, the medical practitioner requires to possess...the capacity and habit of noticing carefully and correctly....Poetic fancy, fantastic wit, and speculation must for the time be suspended, and all overstrained reasoning, forced interpretation, and tendency to explain away things must be suppressed. The duty of the observer is only to take notice of the phenomena and their course....This capability of observing accurately is never quite an innate faculty; it must be chiefly acquired by practice, by refining and regulating the perception of the senses, that is to say, by exercising a severe criticism in regard to the rapid impressions we obtain of external objects, and at the same time the necessary coolness, calmness, and firmness of judgment must be preserved, together with a constant distrust of our own powers of apprehension."( 3)
The symptoms which characterize any case, be it acute or chronic, will lead to the proper prescription, be it an "acute" or a "chronic" remedy. I think that's worth repeating: the characteristic symptoms in each case necessarily lead to the proper, homeopathic prescription.( 4)
(1.) Hering, Constantine. Analytical Repertory of the Symptoms of the Mind, preface.
(2.) Hahnemann, Samuel. Organon of Medicine, S82.
(3.) Hahnemann, Samuel. "The medical observer: A fragment." Materia Medical Pura, vol. 2.
(4.) Hahnemann, Samuel. Organon of Medicine, S153.
American Institute of Homeopathy.
By Rodney Schaffer