A CASE OF PREMENSTRUAL SYNDROME

A CASE OF PREMENSTRUAL SYNDROME

Introduction

I am very pleased to participate in what has rapidly become one of our finest homeopathic gatherings.

The case I am going to present was an important learning experience for me, and I hope it will also be of value to some of you. I see it as an interesting study in case management rather than an illumination of esoteric materia medica or even an unusual insight into premenstrual syndrome as a clinical entity. What I mean by case management is our expectations of certain kinds of results when we give a remedy, how we assess those results when they occur, and what it means when those results are not forthcoming.

It is a rather lengthy case. I have been following this patient for almost four years. As you will see, I can now make good use of what our colleague, Robert Schore, has aptly termed the "retrospectoscope," which increases one's visual acuity a thousandfold!

I completely agree with Rajan Sankaran when he likens us to archaeologists. It is indeed not case taking that we are practicing, but rather "case uncovering." So, let's begin to uncover this case.

Initial Visit

November 4, 1989

Female

Age 37

Observation: She is dark-haired, small and "chunky," and somewhat masculine in appearance.

She suffers from severe PMS (3) one week before her menses.

Feels suicidal, hopeless (2), despairing (2), and angry (3).

She has violent delusions of hurting others with a knife or car.

Wants to kill others (1). Just walking down the street, she will have an impulse to kill people who irritate her.

She is critical (2) of others; self-righteous (2).

Her menstrual flow begins between 6 and 9 a.m. (2).

Bright-red clots; moderate-to-heavy flow.

She gets diarrhea with her menses.

She also gets shooting spasms in her left lower quadrant (1) with the dysmenorrhea, a spasm-like shooting pain that extends down into her vagina. It feels as if her insides are falling out (3).

She has a bearing-down feeling with cramps (3).

The cramps come only with clots on the fourth or fifth day.

Her emotional state is immediately ameliorated with the flow (2).

She has tenderness of the breasts, which is also ameliorated with the flow.

She had an unstable childhood. Her father was alcoholic.

She is extremely reclusive (2); cannot be spontaneous.

She is a perfectionist (2); things must be done in routines (2).

Desires ice cream (3), chocolate (3), bread and butter (2), and fat (2).

Averse to fish and liver.

Has a thirst (2) for cold drinks.

She suffers from insomnia; wakes at 3 a.m. and broods (2) on her problems.

Feels restricted in her life.

Her sleep is not refreshing (1).

She goes downhill from 2 p.m. onwards.

Fears spiders (2) and driving in heavy traffic.

Slow walking ameliorates her symptoms.

She feels chilly, and feels worse from humid heat.

Has bunions on her left foot.

She is a loner; is moody, indifferent (2), and apathetic; and has few interests.

Relationships have been very unsatisfactory for her.

Masturbates a few times a week.

The only relationship she's had so far was with a woman. It didn't work out because of the patient's tendency to withdraw and be critical. She is angry about this.

She easily gets confused (1), has poor concentration, and is forgetful.

Her mental state has been aggravated since the death of her mother a year ago.

She can't weep, even when alone (1). A constriction in her throat (2) prevents weeping.

A melanoma on her back was removed.

She can't stand to be with people. They irritate her. She is so critical (2).

Maryann Ivons: This is perhaps an obvious suggestion, but she is like a Sepia "run amuck."

Chavarria de Shore: How do you mean?

Maryann Ivons: Well, Sepia patients are irritable and they certainly have all the premenstrual symptoms described in this case, yet this patient seems so much more violent than I would expect with Sepia.

Chavarria de Shore: Actually, I have seen Sepia patients go into states of tremendous irritability. I have seen it a number of times. In my experience, Sepia can become quite violent inside with the irritability -- wanting to throw the children out the window. They don't do it, but their thoughts can be very violent.

Sheryl Kipnis: I looked at the desire to kill and to kill with a knife and began thinking about Platina. Platina is in bold type in all of the rubrics I was looking at -- the clotted menses, the bearing-down pain. And she describes herself as being very critical. If her relationships with people aren't good because she is so critical of them, that could reflect the egotism of Platina.

Durr Elmore: Mercurius comes to mind, because of the impulse to kill and the extremely closed nature -- the inhibited nature of the person. She has a Mercurius keynote of desiring bread and butter, among other things. And she is thirsty. So, Mercurius would probably be my first choice.

Chavarria de Shore: Yes. I thought of Mercurius also. I was stopped from giving it because this hormonal kind of emphasis is not the pathology that one tends to think of for Mercurius.

Case Analysis

I looked at the obvious local symptoms around the quality of the dysmenorrhea, and her emotional characteristics of indifference, irritability, and being a loner.

I also looked at these rubrics:

- MIND, Company, unsociable, difficulty making contact (new rubric -- Complete Repertory/MacRepertory) (Sepia).

MIND, Suicidal disposition, despair, from, miserable existence, about his (new rubric -- Complete Repertory) (Sepia).

MIND, Company, aversion to, menses, during (Complete Repertory) (Conium, Platina, Saponinum, Sepia).

Now, what are my expectations at this point? Certainly, I hope to affect and alleviate the PMS symptoms and the dysmenorrhea. But she also has severe depression, an inability to relate to others, and tremendous irritability and anger. I want to touch these symptoms as well. But these symptoms are very deep -- what Sankaran would consider as part of the "central disturbance." So, I might see only a little movement. Of course the correct remedy could quickly produce a notable shift, but I'm just referring to the subtle changes that I can accept as indications that the remedy is acting.

Plan: Sepia 200c, single dose.

Follow-Up: Initial Improvement

First Follow-Up: December 14, 1989

She feels much better.

Her symptoms were aggravated after the remedy; she experienced anger, headaches, stomach pain, and fatigue.

She had nightmares about spiders.

Her menses on December 7 occurred with no pain and minimal PMS. But she caught a cold and had fatigue then.

Her energy is fairly good now.

For a few days after the remedy she went over her "list" of all the people who have hurt her and she thought about what they did to her. (This is an old symptom that she hadn't mentioned in the initial interview. She has done this for years -- lies there and thinks about people who have hurt her.)

On December 2 she had one day of deep suicidal depression, and then felt much better.

Her sexual energy is better (2).

She is planning to have periodontal work done soon.

Assessment: I'm encouraged. There was a general aggravation of, and then an impressive change in, the chief complaint. The strong aggravation of her depression is somewhat better now. Her sexual energy is better. (She is not in a relationship but masturbates more often.) I take this as a sign that the general physical energy and the emotional state have improved. There were no notable changes in the generalities, such as foods and temperature.

Plan: Wait.

Second Follow-Up: February 8, 1990

She had the best Christmas ever, and her PMS was 60 percent better.

Then, in January, she had dental work -- drilling, extraction, and antibiotics for infected gums. Afterward, she became depressed, her food cravings returned, her sleep became disturbed, and she had a terrible menses. She is back to her usual story.

Assessment: Simple, I think. The dental work and antibiotics have disrupted or antidoted the remedy.

Plan: Repeat Sepia 200c, single dose.

Third Follow-Up: March 6, 1990

She is depressed and discouraged. Her PMS is terrible.

Plan: Wait.

Fourth Follow-Up: April 6, 1990

She is no better.

Assessment: I am still convinced at this point that we have just a simple antidote here, although her vital force is probably quite low. In retrospect, I should have been more suspicious of my original prescription, but I was willing to wait.

Plan: 1. Sepia 1M, single dose.

2. Return in one month.

Fifth Follow-Up: May 12, 1990

She feels overwhelmed (2); everything is too much of a demand. even eating.

She fears she is insane (2). She talks to herself out loud (2).

Loves the rain and fog (2). Wants to move to Seattle. Feels like a different person in the rain (3).

She feels bitter, ripped off, and resentful (3).

Desires beer (2) and ice cream.

Cursing (1).

Her PMS is not as bad as before, but she felt terrible after her menses (2).

Fastidious (2). (I asked about this.)

Peggy Chip kin: I'm puzzled t hat the Sepia seemed to work very well initially. It's hard to go away from a remedy that worked really well, so probably my first choice would be to go back to the lower potency of Sepia. However, the liking of rain, the cursing, the fear of insanity, and the desire for fat that were in the first case go against Sepia. Nux vomica complements Sepia, so I would think about that.

Nick Nossaman: I really appreciate your sharing your reality with us like this. The symptoms she has now -- the cursing, the preference for rain and fog, the fear of insanity -- are not strong for Sepia. I'm wondering if they could be proving symptoms from an incorrect prescription. How much should we emphasize these symptoms, as opposed to emphasizing the symptoms in the original case? Or should we be looking at a mixture of the two? I'm sure you're planning to talk about that. Also, Belladonna seemed like a remote possibility for consideration in the original case, although there wasn't a lot of support for Belladonna either. But it does have the clotted menses and the impulse to kill.

Judith Pruzzo: Sepia did seem to fit very well. However, Platina also fits well, in that it has the amelioration from the rain and the fear of insanity. It also has the uterine symptoms, the pain in the left ovary, and the other mental symptoms in the case. I get the impression that she is haughty, based on some of her statements.

Maryann Ivons: I just want to say something about Nux vomica and Sepia. In my practice, I have found that sometimes I have a terrible time differentiating between the two. I have preconceived notions -- how men can't be Sepia and how women aren't necessarily Nux vomica. But when I have given Sepia to men and the remedy is well indicated, Sepia works fantastically. And when I've given Nux vomica to women for premenstrual kinds of problems, it works fantastically. I've made the mistake in the past of giving Sepia first because the patient was a woman. So, I think Nux vomica is a good choice.

Chavarria de Shore: Yes. One of our mentors has said that in this culture at this time we see many more female Nux vomica patients because of the change in roles -- the assertiveness that's often required of women in their work.

Maud Nerman: I have tried to put into practice some of Sankaran' s ideas. I looked at the delusion of being abused, because she made the "list" of all the people who have hurt her. Among a number of remedies is Palladium, which also has the cursing, the uterine prolapse, and the bearing-down pain. It's true that generally she doesn't seem like a Palladium, with the masculine appearance.

Chavarria de Shore: I'm sorry that I do not have a video of this case, because it would be very helpful here. With the video I think you would see why Platina and Palladium did not come up here. She actually has a very different essence than either of these remedies. I don't really think it's necessary to go into that, because I'm sure you know what I'm saying. The visual information and the intuitive feeling, which are so important, are lacking in a paper case.

Bob Ullman: The totality stacks up pretty well for Platina, but I had one more thought. I had a case recently in which a patient had a delusion of being tormented and also a strong impulse to kilt with a knife. I used Lyssin, and it has worked very well.

Durr Elmore: I want to say one thing about Nux vomica. This remedy generally covers the case well and it complements Sepia, but it seems that her personality is so different from that of Nux vomica. I mean, Nux vomica is a remedy that is very " yang" and "out there." You'd think she would be having sexual affairs and so on. But she is so closed and inhibited. I would have a hard time giving Nux vomica for such a closed, introverted person.

Jeff Baker: This is one of those tricky places in a case. You had all this information originally. It was more compelling, and there was more pathology. This reminds me of my own cases. You have only a half hour or so to do the follow-up, so you don't get a lot of information. The more time you have in the interview, the more information you can get. I'm not sure if that's why we have a small amount of data here in this follow-up.

If you look at the current totality of symptoms, it seems much less bothersome than the original totality. You are certainly justified in doing nothing, because you can say she's still quite a bit better. The PMS is not as bad, although she was aggravated after the menses. She was tremendously bitter and resentful to begin with. This new fear of insanity is something to be concerned about, but overall I don't think you're justified in leaving the remedy.

Michael Carlston: I think that the Sepia was an incorrect prescription. It was disruptive. Durr's initial idea of Mercurius is still a very good choice. Some other Mercurius features are appearing here.

I think that often our prescriptions are "similar" rather than the simillimum. They are close to the correct remedy, but they are not precisely the correct remedy. Often that's enough to be very helpful to the patient, especially if the vital force is strong enough. However, hitting the nail on the head really does a better job, although few of us are such skilled carpenters. Most of us, myself included, have bruised thumbs much of the time.

Here's an example. Several years ago I had a patient who responded very well to Calcarea carbonica. A year later, she relapsed. So, I ordered Calcarea carbonica for her again from the pharmacy. On follow-up, her response to the remedy was surprisingly slow and it was rather odd. She did improve, but I was perplexed by the slowness of the response. The remedy worked, but in a very sluggish way. Then, I discovered that she had been getting Kali carbonicum by mistake! So, here was almost a perfect line or cohort study of one person, comparing the response to two different remedies. The slow improvement lasted only about nine months, and then she relapsed. Then, I gave her Calcarea carbonica again, and she was well for two years afterward.

The Kali carbonicum was close to the Calcarea carbonica, and the patient was healthy enough to elicit a positive response even though the remedy was not exactly correct. I've seen this happen often with other patients. I give a remedy, and the person gets better. But I know from the kind of response that it was not the simillimum. I'm glad there is improvement, but I expect to have to find a better remedy sometime soon.

Michael Traub: I found a remedy that covers a lot of this patient's symptoms. I don't know the remedy well. It's Bovista. Bovista is better in the rain, has menstrual disorders, has skin problems (she had a melanoma), and is complementary to Sepia. A keynote of the remedy is diarrhea during menses, which you discarded initially because it's a common symptom. But, because it is a keynote of Bovista, I thought it might be important.

Chavarria de Shore: Thank you, Michael. Interesting thought. I don't know anything about that remedy.

Michael Carlston: I had a patient who benefitted from Bovista. She had a lot of breast pain and also a lot of stomach pain. There are two other points that I forgot to mention. One is that I also think of Lilium tigrinum for this case, with its irritability and menstrual problems. And the other is that I would strongly encourage somebody who has the energy to start supplementing the paucity of good information about women's health in the repertory. Diarrhea with menses, for example, is very common. In some women it's profound and it's significant, and it would be nice to be able to know what remedies are most useful in these circumstances. We have some very "colored" literature to deal with, so if anybody has the interest I would strongly support trying to flesh that out a bit more.

Chavarria de Shore: I really would like to support that. I often find it quite frustrating to deal with the lack of information in our literature I do a lot of work with menopause. If we have some time at the end, I might just mention a few thoughts about menopause and then ask for your feedback.

Assessment: She's in bad shape. I now base my analysis on her irritability, impatience, resentfulness, desire for fat, fastidiousness, and tendency to be a hard worker. I also use the following three rubrics:

GENERALITIES, Wet, weather, ameliorates (several remedies, including Nux vomica).

STOMACH, Desires, beer (several remedies, including Nux vomica).

MIND, Talks, alone, when (new rubric -- Complete Repertory) (Calcarea silicata, Lachesis, Nux vomica, Stramonium).

I decide to prescribe my second consideration for the case, which is Nux vomica. And it complements Sepia.

Plan: Nux vomica 200c, single dose.

Sixth Follow-Up: June 9, 1990

In this telephone follow-up, she tells me she feels really great (2). The remedy worked wonderfully.

Plan: Wait.

Seventh Follow-Up: September 4, 1990

She has been feeling crazy and overwhelmed in the past month.

Insomnia (2).

Desires sweets.

She is emotionally upset (2).

She cannot get past a giant black wall.

Assessment: She's suffering again. I decide to try a 1M.

Plan: Nux vomica 1M, single dose.

Eighth Follow-Up: October 12, 1990

In this telephone follow-up she says she feels okay but not great.

Her emotional symptoms have somewhat improved.

Assessment: She seems better. I'm not thrilled, but I accept this. It this situation were to present itself to me now, I probably would not accept it so easily.

Plan: Wait.

Ninth Follow-Up: December 6, 1990

She has been feeling terrible this past month.

She is suicidal (2), and experiences rage (2) and violent homicidal (2) feelings.

She is sad and hopeless (2); suicidal with a knife (2).

Her PMS is bad.

Feels chilly, yet likes cold brisk weather and does not tolerate heat well.

(Her temperature modalities are puzzling.)

Further Case Analysis: Getting to the Crux of the Matter

Now I can no longer accept these results. Both remedies have acted, but they haven't held or gone deeply enough. Should I go to LM potencies, or look for remedies that complement Sepia and Nux vomica?

There was a very interesting article in the January 1989 issue of Resonance (the IFH magazine) in which three homeopaths responded to the question, "Is there more than one simillimum?" Is there more than one remedy that will act curatively for a patient at a given point? The respondents were Dana Ullman, Dick Moskowitz, and William Shevin. The consensus was "yes."

Dana's use of a musical metaphor was helpful. A person's disease may have the greatest resonance with a B-flat and C-sharp chord, but the prescriber may give a remedy that has a B-flat and C resonance. This chord may be similar enough to initiate a healing response. If the person's vital force is strong enough, the remedy may even act in a deep way.

In this patient's case, her vital force was not very strong. So, I kept getting these temporary ameliorations. Sometimes these ameliorations were striking, but nothing lasted.

Dick Moskowitz said in this same article, "Since the remedies represent archetypal or universal possibilities in all of us, it is not surprising that often several polycrest remedies seem suitable." He goes on to say that many patients will respond favorably to various well-indicated remedies given over a period of time. This phenomenon is known as "zigzagging."

I believe that my case was zigzagging. It was not a one-sided case, as described earlier in this conference by Jeff Baker. I don't think Sepia or Nux vomica "opened up" this case. Rather, I finally was able to understand her state correctly. In order to do this, I went back to the original case, which is always the key. I had found similar remedies, but not the simillimum.

Where is the center of gravity in this case? In a way, the PMS was a red herring for me. It's a big problem for her, and the Sepia certainly helped there. But where is the real pathology? As I said earlier, it's the emotional state: her inability to relate and to care, her tremendous anger, her resentment, and her violent reactions. Also, I realized that she was quite a closed person.

She was closed in a way I hadn't yet encountered in my practice, so I didn't give it enough weight. She was very articulate. She answered my questions and presented her symptoms in what seemed to be an open way, but I have gradually learned over the years to discern differences in patients' manner of presentation.

Often, after a comment or question from me, she would sit back in her chair, pulling back somewhat. She would get a look on her face that for a while I thought was haughtiness or a critical attitude. It was as if she were thinking, "What is this homeopathy? Why is she asking me these weird questions?" I realized finally that she was very closed and very shy. Her job had pulled her out into the world in a certain way, so she had an open manner that deceived me.

I looked at the following symptoms: closed, violent impulses, self-destructive, and fear of loss of self-control. I had to give Mercurius, did I not? The main physical symptoms I used to confirm were the craving for bread and butter and the instability of the temperature modalities, which I just kept seeing as confused reporting and case taking.

Here are some of the rubrics on the emotional and mental planes that helped:

- MIND, Impulse, morbid, violence, to do (Mercurius).

- MIND, Kill, desire to; sudden impulse to, offence, for a slight (Hepar sulphuris calcareum, Mercurius, Nux vomica).

- MIND, Kill, desire to, sudden impulse to, herself (Iodum, Melilotus, Mercurius, Natrum sulphuricum, Nux vomica, Rumex crispus, Thea, Thuja).

- MIND, Kill, desire to kill the person that contradicts her (Mercurius).

- MIND, Kill, desire to, knife, with a (Alumina, Arsenicum album, China, Hepar sulphuris calcareum, Hyoscyamus, Lycopodium, Hydrophobinum, Mercurius, Nux vomica, Platina, Stramonium).

- MIND, Fear, killing, of.

The last rubric has a of number of remedies in it. Mercurius is listed in just plain type, but I thought it was interesting nonetheless. The follow-up was very informative. In some ways, it was not as dramatic as after the first two remedies.

Plan: Mercurius vivus 200c, single dose, on December 6, 1990.

More Follow-Ups: A Lasting Improvement from Mercurius

Tenth Follow-Up: January 14, 1991

Her energy was low for three days after taking the remedy.

Her emotions are unstable, going up and down.

She had no PMS with her last menses (2).

She is no longer suicidal.

Feels much less anger and violence.

She is handling stress at work well.

Desires pasta (2), beer (2), and sweets (2).

Her sleep is good.

She daydreams a lot.

Her sexual desire is a bit better.

She is exercising a little.

In general, she feels very good.

Plan: Wait.

Eleventh Follow-Up: March 14, 1991

She was feeling wonderful until two weeks ago. Then, she suddenly slipped back into feeling overwhelmed, angry, violent, and hopeless.

She felt so frustrated that she smashed her fist into a cabinet, hurting her hand.

She gets a sensation in her face when she's angry, like a heavy iron mask.

With rage, she feels like an "evil, slimy witch." She is afraid she will hurt someone or herself (2). It just takes her over.

Desires chocolate and beer.

Plan: Mercurius vivus 30c, single dose.

Twelfth Follow-Up: March 17, 1991

In this telephone follow-up she says she is feeling much better.

Plan: Wait.

Thirteenth Follow-Up:August 19, 1991

Emotionally, she feels really good.

She has been feeling a pain in her foot from bunion surgery she had in April 1990. It is nerve (1) and bone pain, a long-standing problem. She is talking Motrin.

Desires bread (2), pasta (2), ice cream (2), and chocolate (1).

She is a compulsive eater (1).

Plan: Wait.

Fourteenth Follow-Up: November 4, 1991

She had bunion surgery and has been taking several medications.

She is tired (2). (She is lying down in the waiting room.)

She is worn down from the pain in her feet.

Has had problems with her back, vertebral facet problems.

Lost ten pounds on instruction from her chiropractor.

Her PMS is terrible. She felt suicidal (1) and hopeless for two weeks before her menses.

She has dysmenorrhea (2), a constant constricting pain. It is worse at night (2), like a fist in the uterus.

She has been angry and irritable the past few months. It has been getting gradually worse.

Feels isolated.

About three or four days before her menses, she wakes up suddenly just after falling asleep. She feels as if all the blood is draining from her body; her face gets hot and flushed and her heart begins to pound. She's afraid she will stop breathing.

Fears she has no control over her body (1). Anything can happens.

Her sexual energy has been very low the past two months.

The pain in her left foot, just below the big toe, is a constant, bruised, throbbing pain. Her podiatrist says it is nerve entrapment, like carpal tunnel syndrome.

She feels hopeless and despairing. No one understands how she thinks. It is so hard for her to open up to people.

She has been spending long, stressful hours at work.

Gets tension headaches.

It is hard to fall asleep. She goes into long, complicated imaginings about people who struggle and accomplish in their lives.

Now she can sit in the sun (1). She could never do this before.

(She weeps while telling her symptoms.)

She wants to cry but has been unable to do so for a long time, even though she goes to therapy regularly.

Averse to acids (2).

Plan: Mercurius vivus 1M, single dose.

Summary of Further Follow-Ups

May 22, 1992

She had additional surgery for the same foot condition.

Plan: Mercurius vivus 1M, single dose.

September 1, 1992

She had a negative response to the Mercurius prescription. She was obsessing about the death of her mother.

Plan: Ignatia 1M, single dose.

October 1, 1992

The Ignatia was very helpful. She felt she could finally feel the grief of her mother's death. She was able to cry and release many of those old feelings that she always had to control before.

January 11, 1993

She is having back pain, fatigue, and PMS.

She is irritable and impatient.

Plan: Nux vomica 1M, single dose.

February 22, 1993

She had a negative response to the Nux vomica.

Plan: Mercurius vivus 1M, single dose.

March 1993

She feels "absolutely right again."

I asked her how she felt she had changed over the course of the years of treatment with Mercurius. She said, "When I first came in I was desperate. I'm seldom suicidal now -- only with an occasional short period of depression when I'm premenstrual. I'm much more comfortable with others. I'm no longer afraid to do new things socially. I never have thoughts of doing violence to others now, even though I can still sometimes get very irritable."

Remember, she is not an effusive, outgoing person. So, this much acknowledgement of her improvement, given quite freely, is remarkable. She has done well on Mercurius for 2 1/2 years. She grew from being one of my less pleasant patients to someone who is really a pleasure to deal with. She leaves humorous messages on my telephone when she needs to speak to me, and so on. She is a very different person now.

The Unfolding of My Knowledge About Mercurius

I learned a great deal about Mercurius with this patient. Jonathan Shore has done much work with a new rubric he's put together around issues of control and fear. Mercurius patients have enormous fear around loss of control because they have a weakness of the mind and will. Their concurrent characteristic of violent impulses, of course, is very frightening to them because they feel too weak to control these impulses. They are very afraid to express their anger because they fear their actions.

Mercurius is a syphilitic remedy (syphilitic miasm), so there is a strong tendency to self-destruction. Although I did consider Mercurius along the way, I was thrown off by the absence of any of those great physical syphilitic keynotes for Mercurius, such as the perspiration, salivation, ulceration, and metallic taste.

But then I realized that the syphilitic symptoms were clearly on the emotional plane. That was when the light came on. She was extremely suspicious. I think this is what made her so unwilling to be spontaneous in relationships and what made her feel so envious. She felt people were out to get her. It is different than the Nux vomica kind of envy. She was quite shy. Her extreme reclusive tendencies probably had to do with this shyness and her paranoia.

One could consider this patient in terms of Rajan Sankaran's idea of a "core delusion." It is an approach that considers illness as a delusion and then looks for the delusion that causes the illness. Using this approach, I would say, that this patient's delusion was that the world was a hostile environment and that she was surrounded by enemies (MIND, Delusion, enemy, everyone is an [Mercurius, Platina]; MIND, Delusion, enemy, surrounded [Anacardium, carboneum sulphuratum, Crotalus horridus, Mercurius]). This was why she was so irritable and why she wanted to be violent toward people if they brushed against her the wrong way.

The waking at night and brooding fit Nux vomica well enough, but I finally saw it as the nighttime aggravation of Mercurius. All the feelings of distrust and hostility really overcame her at night. Life is a hostile place. Mercurius patients feel very vulnerable. They want to speak with people and open up, but they can't. It's very hard to relax. It isn't so much that they're critical. They're distrustful.

In Roger Morrison's new book, Desktop Guide to Keynotes and Confirmatory Symptoms (which I highly recommend), we find the following:

On the emotional level, the Mercury patient tends to be withdrawn and introverted. The emotions are often strong internally but are rarely given expression. The patient feels different than other people and has a sort of instinctive reserve about expressing himself or even a suspiciousness of others....The patient will often confirm a noteworthy symptom: It is necessary for him to feel that the person he speaks to is listening carefully, with undivided attention or he would be unable to speak.

I always noticed with this particular patient that she needed me to pay close attention to her. I suspect that when people did not pay close attention, she would become irritable and angry and would close down. It was a form of distrust.

There is a line from a poem by Rumi that speaks to the reactivity and instability of Mercurius. Rumi was the Persian mystic poet who also was the founder of the dervishes. It is a beautiful line: "Stay here quivering with each moment like a drop of mercury."

The reactivity of Mercurius is tremendous. Here is another quote from Roger Morrison's book:

In fact there are 62 references in the repertory for factors which generally aggravate Mercury but only 8 factors listed which ameliorate, and 5 of these have to do with resting or lying down. Mercury combines weakness and over-reactivity.

The instability of Mercurius results in violent and very impulsive desires, which are not usually acted on. Mercurius patients often have a fear of insanity, and it is on the mental plane that they eventually break down. With Mercurius patients we can say that the fear of suicide and insanity is appropriate.

This patient came to me through her therapist, and she is still seeing her. This is a very deep case. However, she used to periodically tell me that she hated and distrusted her therapist and that she wanted to kill her. This hasn't happened since she took Mercurius.

A Discussion on Menopause

I do a lot of work with menopause and would like to take a little time to talk about it. As our population increasingly grows into that age range, I believe we all need to increase our knowledge of menopause. There are a number of issues to address, including the issue of hormonal replacement therapy (HRT).

Many women come to me with these menopausal issues. It is very interesting to me. Living, working, and practicing in Marin County, I tend to see rather sophisticated types of patients. They're exposed to every kind of complementary therapy in the world, every kind of alternative lifestyle, and so on. I have been quite amazed to find that a very deep, unconscious fear is triggered in many women when they reach the age of menopause, regardless of their education and background.

Our culture does not consider the aging process as a positive phenomenon. As women grow older, a lot of fears that they didn't even know were there suddenly emerge in a very, very deep way -- fears about looking old, no longer being desirable, losing their ability to have children, losing their ability to work.

I would like to ask about your experience with menopause and hormone replacement therapy. Does anyone have any experiences to share with us on this particular issue?

Peggy Chipkin: It's a big issue. Patients have a lot of fear about it. I think I get caught up in that fear because I am a woman myself. Sometimes I ask homeopaths who come into town for their views on this. I don't know the answer. I do think we need to be careful not to get too caught up in the allopathic viewpoint, because it's going to change in five years just like it does about many other things. Already, I think it's changing somewhat. And we have to remember our homeopathic theory and principles. Why would we want to give the same hormones to every woman as she approaches menopause? It doesn't really make a lot of sense.

I tell my patients that I'll support whatever they want to do, including taking hormones. However, I also encourage them to consider other approaches such as doing weight-bearing exercise, getting calcium in their diets, and all the other lifestyle changes that we know can help.

Annie Maguire: I do everything that Peggy has mentioned, along with homeopathy, and I also use some herbal preparations. In addition, I encourage all but the most "proper" of my women patients to bring back old rituals of passing over and celebrating this life change.

Maryann Ivons: I think the medical profession is doing quite a sales job on these hormones. We need to tell our patients that menopause is a natural part of the living process. I am sure a lot of parents would like to give their teenagers something for their puberty, but they don't jump in and do that.

Chavarria de Shore: Not yet.

Maryann Ivons: Tincture of lead pipe, perhaps...[laughter] Menopause is something that the body has to go through, something the body is designed to go through. The design may not be as good as it could be, but it's the one we've got. We can really help make it more natural for our patients by explaining exactly what's going on. We need to tell them this is not an illness. Pregnancy is not an illness; menopause is not an illness.

Maud Nerman: I have been told that research will soon come out indicating that estrogen causes cancer. There are a lot of rumblings about it. I think it is a time bomb. I'm much more frightened of the allopathic way of seeing things than I am of ours.

Durr Elmore: There is the issue of individual susceptibility. I recently had a patient who had a terrible reaction to estrogen replacement therapy. She took it for a month or two, six or eight months ago, and she's never been the same since. It affected her emotionally and physically in a number of ways. Some women seem to tolerate it better than others. Maybe it depends on the individual's vital force or on her own resonance with the hormones.

Chavarria de Shore: Durr, have you treated patients homeopathically that are on HRT, and have you seen that the hormones are an interfering factor?

Durr Elmore: I've seen the remedies work while women are taking estrogen, but I do encourage them to consider discontinuing the estrogen. I'd like to make one other point. I had one patient who had very painful sex because of atrophic vaginitis. I discussed it with Nancy Herrick. She said that in her experience a topical application of estrogen doesn't really affect the remedies. It's much more benign than taking it systemically.

Louise Edwards: I have quite a number of menopausal patients, and I have a number of thoughts about it. If you took in the Physicians' Desk Reference (PDR) under estrogen, the long list of potential side effects is startling. I have seen quite a number of patients who have had dramatic mental, emotional, and physical changes after starting estrogen. When you consider the minute amounts of hormones that trigger profound responses in our bodies, toying with that system seems really dangerous. Unfortunately, I consider the women who are doing estrogen replacement therapy to be a group of guinea pigs. We haven't seen a full generation go through estrogen replacement therapy. It is my belief that the "great spirit" that designed this system had some purpose in stopping estrogen in women's bodies. I am reluctant to interfere with that.

I've seen quite a variety of gallbladder problems that seem to have been aggravated after the patients began taking estrogen, and I would like some feedback on that. Such problems are listed in the PDR under the side effects for estrogen.

Susun Weed, who is an herbalist, has just written a wonderful book on the menopausal years. It's not only useful in dealing with mother tinctures, but also for some of the mental and emotional aspects that relate to how our society deals with menopause. I really encourage people to suggest this book for their clients.

Chavarria de Shore: Thank you very much. I sell that book in my office. I think it's such a useful book -- The Menopausal Years, by Susun Weed.

Phyllis Coleman: I have worked in geriatrics for 13 years and have seen a lot of old women. None of them ever took any replacement therapy, and they've all survived. I saw only the ones that were living in institutions, which is not the majority. The ones that weren't in institutions were doing even better. I've seen a lot of very healthy women who have never taken it. I personally have tried replacement. I found it was very disruptive to me, just as birth control pills were when I tried them. When I was put on my homeopathic remedy, all of the symptoms for which I had taken the replacement therapy went away. I think a lot of it has to do with the vital force, as Durr mentioned. If the vital force is strengthened, any woman can get through menopause -- with a little bit of help from her homeopath.

Judyth Reichenberg-Ullman: I treat a lot of women who are menopausal. Most of them can be helped with the right remedy. Most of the women that I see are not on HRT. If they are on HRT, sometimes through my encouragement, they've made the decision to discontinue it. I do still have some patients who are on HRT, and I have found the remedies to work anyway.

Now that some studies have shown that HRT, particularly estrogen replacement, lowers the risk of heart disease by raising high-density lipoproteins, a lot of women feel this is a reason to take estrogen replacement. It's important for us to educate them that there are other ways to prevent heart disease. It's also interesting that the women on HRT who have uteri are also on progesterone. Progesterone can raise the risk of heart disease. Those studies that have been done do not take this into consideration. I'm also concerned about liver cancer and about gallbladder disease. I put women who take hormone replacement on liver herbs. There are formulas that do not seem to interfere with homeopathy.

Chavarria de Shore: Are these detoxifying herbs?

Judith Reichenberg-Ullman: Yes. And they are taken for a period of time. I usually do three months on and then a month off to give them a rest. And, as far as prevention of osteoporosis, I think that we need to be a little careful not to generalize. I don't think that we can help every woman with her menopausal symptoms. There are women who suffer terribly with menopause. There are plenty of women who have osteoporosis. I've seen them walking around with stooped shoulders. It's an awful fate. It's important to be aware of the body type of the women who are predisposed to osteoporosis and to pay attention to the women who have increased risk factors.

Randall Bradley: The biggest reason that we hear about estrogen replacement therapy is osteoporosis. But osteoporosis, at least in my view, is a lifestyle disease, much like many others, that we should be correcting by changing the lifestyle. If we correct the unhealthy habits -- such as the lack of exercise, the soda pop, the junk food -- the odds are very good that we are going to have a significant impact on the occurrence of osteoporosis.

Chavarria de Shore: Thank you all very much for your feedback. I am encouraging most of my patients to stop their HRT. I am a very strong believer in not using it. The homeopathic remedies will help. Susun Weed's book is wonderful for providing many alternatives. She also says that the cardiac studies that were done, which are now being touted in support of using HRT, were flawed studies.

Menopause is a bit like PMS. It is inevitable, perhaps, that there are going to be some symptoms and discomfort. Everyone wants to just take a pill and make it go away. No one wants to deal with anything! It seems much better to tell your patients that this is a natural phenomenon. We can live much better with that than with being guinea pigs.

International Foundation For Homeopathy.

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By Ana Chavarria de Shore

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