Homeopathic Grand Rounds

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Homeopathic Grand Rounds A Patients with Iron Deficiency Anemia

Abstract: A patient with chronic menstrual difficulties, acne, depression, fatigue, headaches, and alcoholism seemed to be improving slowly after Sulphur followed by Sepia. About 18 months after beginning her treatment, she developed an iron deficiency anemia and was given Medorrhinum, which not only cured the anemia, but also led to a marked improvement of her health in general. If a patient improves significantly in many ways, but develops an anemia, even if there is a history of anemia, this means that the remedies either were palliative or suppressive. The curative remedy initiates improvement of both the patient and her anemia, or the patient improves and an anemia is prevented.

Keywords: Medorrhinum, Sepia, Sulphur, acne, alcoholism, anemia, depression, fatigue, headaches, menstrual difficulties, palliative, pre-menstrual syndrome, suppressire.

Chief complaints: Acne, weight problems, alcoholism, fatigue, depression, menstrual cramps.

[Note: (1), (2), (3), or (4) indicates the intensity of a symptom.]

This woman's (call her "P.C.") main concerns were menstrual difficulties(3) which began at 20 years-old, two years after menarche. She had been taking birth control pills for two years but had discontinued them two months before consulting me. The pill helped her menstrual cramps(2) and painful lower abdominal bloating(l). Menstruation was regular with heavy bleeding for 5-7 days accompanied by large, dark clots(l). The menstrual flow changed from brown to red to brown. Her menstrual cramps began at 20 years-old following her first sexual intercourse. Accompanying the cramps were nausea, low grade fever, back pain; and an intolerance of clothing around the abdomen. Later P.C. developed pre-menstrual syndrome(2) consisting of increased or insatiable appetite, acne, irritability, depression, fatigue, and a feverish feeling. She has had various types of vaginal discharges, "yeast infections", and bladder infections. At age 32, she developed venereal warts which were treated with liquid nitrogen. At that time she and her husband had had a monogamous 3-year relationship, but he had had venereal warts before he met the patient.

Another complaint was that of her weight fluctuations of 8-10 pounds from her normal 140 pounds. P.C. attributed this to overeating compulsively. Her weight has been as low as 135 pounds and as high as 175 pounds. She desired sweets(l), especially premenstrually, sour(2) (lemon, vinegar, pickles), bread(1), spicy(2), meat fat(2), raw meat(1). She had an aversion to string beans and butter. Dairy products caused chest and throat congestion; chocolate caused headaches. She was very thirsty(2), especially late in the evening, and often woke thirsty at night.

P.C. had had cystic acne since age 16, associated with blackheads and oily skin. She still has acne(1). There is a strong family history of acne.

P.C. was anemic at age 6, but not anemic when she first consulted me. However, she was quite tigued and found it very difficult to wake up in the famorning(1). Exercise made her feel better(2). The fatigue was worse before and during the menses.

Another of P.C.'s problems was alcoholism(2); she had not drunk any alcohol for eight months prior to consulting me, but maintained that she could not stop drinking once she started. She loved vodka with sour drinks(l). There is a strong family history of alcoholism and a dysfunctional family setting.

P.C. had headaches especially on the second clay(l) of her menses. They were in her forehead, worse from sunlight(1), loud noise(1), and becoming too warm(l). They were better in a clark quiet room and by holding a wet cold cloth on her head. Sometimes she had nausea and vomiting with the headache.

P.C. suffered from a low-grade chronic depression manifesting as a lack of motivation(1) and apathy(2). She was very sensitive to what people said about her and is sometimes weepy before her menses. If depressed, she prefered to be alone(1), felt sorry for herself(1), shunned consolation, became quiet(l) and irritable with her husband. She did not like to be hugged(1), claiming that this felt unnatural.

During sleep she uncovered her feet because they were hot(2) (usually the soles). This she has done her entire life. She prefered to sleep on her back, but her head would go back too far and she did not like a pillow, so she slept on her abdomen. Infrequently she had cramps in her calves during sleep(1). Drooled during sleep(2). As a small child she had recurring nightmares of a monster coming to get her.

Additional symptoms: loved windy weather(1); got cold very easily(2); tended to daydream(l); worried(2); tended to clutter, but knows where everything is; history of plantar warts; history of recurring tonsillitis; infectious mononucleosis at 20 years-old; fibrocystic breasts; isolated self from people(2); trusted too much, then got hurt(2); tended to be a "people pleaser"; worked with animals and is exposed frequently to chemicals.

P.C. felt her health had improved over the previous eight years from treatment with a few doses of Lycopodium, Sulphur, Natrum muriaticum, and Pulsatilia. Sulphur helped the most, lasting for many months after each dose.

Physical Exam: 33 year-old female; height: 5'8"; weight 150 pounds; somewhat apathetic; blue eyes; blond hair; tongue grayish color; slight scoliosis; cold hands and feet: the remainder of her physical, including pelvic exam, within normal limits.

Assessment: Having considering the above symptoms, her recent use of birth control pills, the continued exposure to chemicals at work, and the fact that Sulphur had worked well in the past, I began her treatment with Sulphur 10M (Schmidt-Nagel), one dose.

Follow-up, 7 weeks after remedy:

Energy improved; only headaches were those during the menses; acne, same; mood much improved with less worry; less pre-menstrual hunger, but otherwise no change of pre-menstrual symptoms; menstrual cramps improved and menses only 5 days instead of 7; less thirst at night; continued to uncover feet at night and to salivate at night during sleep; much less chilly in general; patient feels her health definitely is improved, in general, mainly because

she feel so much better emotionally.

Assessment: Curative response

Plan: Wait

Follow-up, 3 months after remedy:

Feels in general about the same; stressed last month by deaths of a relative and a friend, causing her to drink and smoke cigarettes for one week; energy improved to normal; only one headache, which was during the menses; acne same; mood good; no premenstrual symptoms with last menses; remains less chilly in general; continued to salivate and uncover feet during sleep.

Assessment: Doing well; continuing to feel much better in general compared to before the remedy.

Plan: Wait

Follow-up 51/2 months after remedy:

3 weeks pregnant; acne had been improving before became pregnant; no further improvements with menses; thirst at night improved further', since pregnant has not felt as sick as had with previous pregnancies, not tired, only mild nausea, appetite not increased, feels better in general than had before the pregnancy; desire for alcohol slightly increased; continues to salivate and uncover feet during sleep.

Assessment: Continued general improvement.

Plan: Wait

Follow-up, 8 months after remedy:

Miscarriage last month; brown vaginal discharge and intermittent bleeding and cramps have continued since miscarriage; pelvic exam normal; ache worse; fatigue; only one headache since last visit has had; desire for sour foods and vinegar; no current desire for alcohol but has drunk heavily twice in past 2-3 months; continues to uncover feet in sleep; patient's mood is quite different from that of 8 months ago in that she seems quite dull and apathetic.

Assessment: Change of mood, loss of energy, and the changes since the miscarriage indicate a different remedy.

Plan: Sepia 1M (Schmidt-Nagel), one dose

Follow-up, 2 months after remedy:

After remedy, bleeding and discharge stopped and followed by two normal menstrual periods; energy much improved; a few days after the remedy had a few bad headaches, but none since; acne same; mood good; has continued to have desire for sour food; no longer uncovering feet during sleep; much less desire for alcohol; overall feels better, as well as had 5 months ago.

Assessment: Curative response following aggravation

Plan: Wait

Follow-up, 3 months after remedy:

"Yeast infection", irritating, itchy, sour odor, intermittent, not as bad as similar infections in past, appears to be improving spontaneously; no headaches; acne same; feels about the same in general.

Assessment: Cleansing reaction

Plan: Wait

Follow-up 41/2 months after remedy:

After last visit had a menstrual period, then vaginitis disappeared; main concern now is that her menstrual complaints are worse, bad headaches with menses; pre-menstrual insatiable appetite; uterine cramps during menses; drinking beer about twice a month; sleeping a lot more, 9-10 hours at night; acne improved; more fatigued; emotionally feels same as last visit but notes that she no longer feels depressed as she did one year ago; continues to uncover feet during sleep because they are hot; salivation during sleep continues but is much less of a problem.

Assessment: Relapse because more fatigued, more sleepy, more menstrual complaints, and drinking more.

Plan: Sepia 1M (Schmidt-Nagel), one dose

Follow-up, 41/2 months after remedy:

Day after remedy developed upper respiratory congestion, fever, joint pains, intermittent hand numbness, chills, vomiting; patient called at the time stating that,"It's as if everything that was ever wrong with me is happening now! I was not exposed to the flu, nor have I had the flu in a long time." The fever lasted three days and was followed by a menstrual period which was only two weeks after the previous period. After all this she felt physically better than before the remedy; emotionally she felt some better, stating that she is "standing up more for herself"; still drinking and smoking cigarettes intermittently; acne same; next two menses were very heavy; says her health is better than two years ago; feels "compulsive", a kind of anxiety leading her to drink or smoke.

Assessment: Curative response following strong aggravation having the flavor of old symptoms.

Plan: Wait

Follow-up, 8 months after remedy:

No alcohol for one month; smoking cigarettes only once a week; acne same; menstrual cramps were improving until two months ago; only occasional mild headache; not feeling "compulsive;" energy same, good; sleeping a lot; feels overall unchanged from four months ago; dental work under local anesthesia two weeks ago had no side-effects.

Assessment: Case stalled, no further significant improvement.

Plan: Sepia 10M (Schmidt-Nagel), one dose

Follow-up, 41/2 months after remedy:

Two weeks after last remedy the patient was immunized with MMR and Tetanus toxoid, and she received a TB skin test required for her to attend school. Her CBC was normal, but specific hemoglobin value is not available. For the past two months, she has been having frequent canker sores in her mouth, craving ice (old symptom), having leg calf cramps, mainly at night, waking her from sleep. The first menstrual period after the immunizations had been very heavy, and she almost fainted from the pain. Headaches have returned on the day before and the first day of her menses. Ache worse; energy fair; drinks coffee on days must stay up late studying; more salivation during sleep; drank alcohol and smoked cigarettes only one day in past three months; concentration is difficult; mistakes in speaking, e.g. saying "dietetic" instead of "diabetic"; mentally more slow; memory not good; still uncovers feet during sleep because soles are hot; stressed from too much school work.

Assessment: Very difficult to be certain what happened; last remedy may have disrupted; immunizations may have disrupted. She needs treatment, because she feels and looks worse. New symptoms fit a different remedy.

Plan: Calcarea carbonica 200 (Schmidt-Nagel), one dose

Follow-up, 2-1/2 months after remedy:

Blood tests five weeks after remedy revealed an iron deficiency anemia with a hemoglobin of 10.9. No canker sores for one month; acne worse; taking multivitamins; memory improved; all other symptoms remain unchanged; patient feels no improvement in general.

Assessment: Incorrect remedy; entire case reevaluated taking into consideration the original case history and the ongoing unusual complaints such as desire for ice, heat in soles of feet, salivation during sleep, anemia, canker sores, anemia as child, alcoholism and family history of alcoholism.

Plan: Medorrhinum 1M (Schmidt-Nagel), one dose

Follow-up, 6 weeks after remedy:

Energy improved immediately after the remedy; no canker sores; patient feels better (and she looks better than ever!); three weeks after remedy hemoglobin was 11.4; not drinking or smoking; continues to uncover feet in sleep, crave ice, and salivate in sleep; menses same.

Assessment: Probably curative

Plan: Wait

Follow-up 5, months after remedy (November, 1992):

Energy normal; CBC two weeks ago was normal with a hemoglobin of 13.2; left sacral pains recurring which feel just like pains she had after an injury at 18 years-old; looks and feels much better;, no menstrual complaints; not drinking alcohol or smoking; no longer craving ice; uncovering feet and salivation during sleep are the same; drinking one cup of coffee per week which loosens her stool but causes no other side-effects.

Assessment: Much deeper curative response; patient looks and feels better than after any of the previous remedies. Although she was satisfied with slow steady improvement of her health for two years, she is even more happy now.

Plan: Wait

Author's Comments

P.C. and I both had been patient and satisfied with the slow steady improvement of a very chronic miasmatic illness. After the anemia surfaced, I was convinced that no remedy to date had stimulated healing deeply enough, or the anemia would have been prevented. The Sulphur and/or Sepia prescriptions may have been suppressive, leading to development of the anemia. Perhaps the immunizations caused the anemia. We will never know. If a patient is curable, during treatment no illnesses reflecting core biological malfunctions will surface. Instead, more superficial symptoms will appear as a defense reaction "protective" of the patient's more vital functions. The "Retrospectoscope" is one of the most useful "instruments" I use. I would have given Medorrhinum as the first prescription.

At the time of this writing, I do not consider this patient cured. If she feels and looks well and continues to improve significantly over the next two or three years (with or without additional remedies) and shows no signs of anemia, alcoholism, or any other serious chronic disease, I shall consider her cured of the illness which she carried into my consulting room three years ago.

Comments

Dr. William Shevin:

This case presents several interesting areas for discussion. The initial evaluation of the patient's case includes the information that the menses were characterized by "heavy" bleeding for 5-7 days. Although the patient's age at the first visit is not given, we can assume, from the history, that she had been having heavy menses for at least 14 years, probably longer. With a history of anemia at age 6, it is possible that her iron stores had been marginal for a long time. The presence of normal hemoglobin does not rule out iron deficiency. The menstrual period following the administration of Sepia 10M was "very heavy," and this blood loss may have precipitated the frank anemia. If this is true, the effect of the "incorrect" homeopathic treatment was to disturb, or to allow, through partial similarity, the continued development of menstrual dysfunction. In general, I agree with the author's comments regarding the development of important pathology during homeopathic treatment.

The onset of this patient's menstrual problems does not date from menarche, but rather from the first episode of sexual intercourse 2 years later. This indicates the presence of significant psychological factors which would be important in selecting the simillimum. Although psychological attitudes are not necessarily the ultimate expression of "core" pathology, (in a"homeopathic," rather than in a "biologic" sense), in a patient from a dysfunctional, alcoholic family, who herself has a drinking problem, a chronic depression, and the onset of menstrual difficulties following her first sexual intercourse, psychological factors are likely to represent the "core" pathology. By "represent," in this context, I mean that when the psychology profoundly changes (which may not, however, be possible solely from the administration of a homeopathic medicine, even the simillimum) the core pathology is likely to have changed as well, with corresponding positive changes in the biology of the organism. Once Medorrhinum was given, this, in fact, is just what happened to the patient.

Had the emotional and psychological state been understood at the first visit, it might have been possible to "see" the prescription of Medorrhinum. Not enough information beyond the "data" about the patient (desire for sour food, uncovering the feet at night, salivation during sleep, etc.) is given to properly assess the "correctness" of the prescriptions from this standpoint. Among the data supporting the initial prescription of Medorrhinum are the following:

- oily skin, cystic acne (Radar lists Generalities, Tumors, cystic, addition by Stuart Close,) leucorrhea, recurrent cystitis, venereal warts.

- desire for sweets, sour, spicy foods (addition by Hui bon Hua, Radar) fat (addition by Vithoulkas, Radar).

- sensitive, isolates herself.

- uncovers feet because hot, sleeps on abdomen, drools in sleep (addition "in research" in Radar program).

It is not unusual for a patient to consult a homeopath with a prior history of homeopathic treatment which may appear to have been successful. My experience suggests that if the prior treatment has been only partially similar, there will be a "core" of the pathology, as discussed above, which remains unchanged. Even if enough time has gone by properly to judge this, however, there is considerable pressure to continue the prior treatment. Eventually, the symptoms will call, ever more strongly, for the more correct prescription.

The change of prescription to Sepia seemed to give good results. The need to repeat the Sepia after 41/2 months is not, in and of itself, unusual, especially if the patient has experienced a marked stress.

My own practice in this situation, learned from Ananda Zaren, is to give either a 12c or a LM1 of the original remedy, either as a single dose or repeatedly for a few days, to "restimulate" the organism. This often will produce a good improvement which may last for several months. Should this happen, there is a significant likelihood that repetition of the original high potency would have produced a disruption of some sort. In this case, there was an aggravation of symptoms, which had not been present following the original prescription of Sepia 1M. This, to me, suggests a mis-timing of the prescription or a misjudgment of the potency for-the repetition. In the followup of that repetition of Sepia 1M, there does seem to be a return of old symptom states,.yet the feeling from reading the larger description is of disorder ("emotionally somewhat better" but "feels compulsive, a kind of anxiety that leads her to drink or smoke," two very heavy menses.)

It is interesting to note in this case, as in many others in my own experience, that partially similar remedies can elicit positive responses from the patient. These responses may be characterized by subjective and objective improvements of definite depth and duration, with or without initial aggravations of symptoms. As such, one may think that the simillimum had been given, at least until later events cause doubt, as in this case.

Also of interest in this case is the development of ice cravings, a strong Medorrhinum symptom. This symptom is, however, a common symptom of iron deficiency, especially in women. [Rector WG Jr, et. al.: "Non-hematologic effects of chronic iron deficiency," Medicine (Baltimore) 61:382, 1982 cited in Scientific American Medicine, ed. Rubenstein and Federman, pub. Scientific American Inc.]

Dr. Dean Crothers:

Dr. Schore's case of a woman with menstrual difficulties is similar to many cases seen in homeopathic primary care or family practice. I agree that the patient presents with a deep miasmatic problem. Such cases are problematic with respect to prescribing, as well as to analyzing the results of the prescriptions.

It appears from my reading of the case that the analysis and prescription at the first visit resulted in a positive movement of the patient toward cure. There is no doubt that the remedy acted. One can always ask, but never answer, the question, "Would a different remedy have acted better?" Had I been managing this case, I would have been satisfied with the initial results, much as Dr. Schore was.

I am not certain that the symptoms in the apparent relapse that the patient experienced after her miscarriage were sufficiently different from the initial presentation to justify a change in remedy from Sulphur to Sepia. I am reluctant to change remedies without strong evidence to do so when a prescription has worked well. There is no doubt that the patient did better after this prescription, but the case began to become confused.

The second dose of Sepia was followed, in one day, by an episode of fever, joint pains, chills, vomiting, etc. This sounds like an acute illness which was probably in its prodromal phase at the time that the remedy was taken. It is likely that this burst of symptoms had nothing to do with the remedy. The results of this prescription, as seen in the follow-up 4 1/2 months later, are not clearly curative. The patient reports feeling physically better and emotionally "some better." Other symptoms remained unchanged or slightly worse (heavy menses, feeling compulsive).

I agree with Dr. Schore's assessment after the third dose of Sepia. The remedy or the immunizations may have disrupted the case and she still needed treatment.

It is not clear in the case what may have lead to me development of me iron deficiency anemia which was diagnosed five weeks after Calcarea carbonica. It does seem clear, though, that the remedy was incorrect. It is also clear that Medorrhinum then produced a deeply curative reaction in the patient.

I do not agree with Dr. Schore's assertion that no remedy prior to the Medorrhinum "had stimulated healing deeply enough." The appearance of anemia in a patient whose health is improving in deeper levels does not indicate (to me) that the treatment was suppressive. On the contrary, I would probably consider it a curative response.

I do not know how Dr. Schore defines "core biological functions." Therefore it is difficult to respond to his statement that"no illnesses reflecting core biological functions will surface" during the treatment of a curable patient. I can say that, according to my understanding, the center of gravity of symptoms is a relative matter. IF deeper symptoms are resolving while relatively superficial symptoms appear, this is a sign of movement toward cure. It does not matter how deep the relatively superficial symptoms are, in an absolute sense. If the symptoms in the patient move from psychosis to congestive heart failure (probably a core biological malfunction), the patient could be moving toward cure. I would not assume that the treatment had been suppressive without evidence of a general worsening of the patient.

It may be that Medorrhinum should have been given as the first prescription. It may also be that Medorrhinum would not have acted had it been given before the initial dose of Sulphur. We will never know.

Dr. Jonathan Shore:

The author is to be commended on this well-taken case for which he carefully prescribed. It provides a good illustration not only of the effectiveness of careful prescribing, but also of the sort of record we need to leave such that future generations of homeopaths, looking back on our time, may have clear insight into how cases were managed in our day. I agree with the author that Medorrhinum most likely was indicated on the initial case.

I might add a few comments on the sequence of Sepia prescriptions. It is necessary to preface these with the note that, as we all have found, looking through the Retrospectoscope enhances both visual acuity and inner certitude a thousand fold. However, it is through careful dissection of me past that we come to an accurate prediction of the future. Thus, the indications for the initial prescription of Sepia are quite reasonable based upon the immediate state. However, the failure to progress at 4-5 months should mise a question concerning the depth of the prescription. If the remedy were "constitutional" for her, that is to say related to a fundamental pathological way of being-in-me-world corresponding to that remedy, a potency of 1M from a reliable pharmacy should continue to-produce significant amelioration at this point. It is not to imply that this always happens, but rather to indicate that; if it does not happen, an attitude of questioning must be evoked. If the prescription were appropriate to the immediate state of the patient, in other words, if she had entered into a Sepia state around the miscarriage, her clinical course would more closely correspond to our expectations. Thus, while we cannot say that the repetition of Sepia was incorrect, it should be accompanied by a high index of suspicion. This suspicion is justified by the response to the second intervention. There is a strong physical aggravation without much effect on the emotional plane. This sort of response to repetition of the remedy -- a strong aggravation, even stronger than the initial dose, without a true general amelioration-is a pattern which, in my experience, predicts a poor outcome.

Based upon this overview, it appears that the third prescription of Sepia in a higher potency was a definite error. Exactly what the effect was, of course, is hard to say, although my guess is that the dysmenorrhea was exacerbated by the remedy rather than by the immunizations. I Would not call it a disruption as the underlying pattern of Medorrhinum has still retained its integrity. Thus, the conclusion that Sepia was an incorrect remedy and the subsequent realization of the need to search even deeper into the case might have occurred at some 18 months earlier. It is only through this type of discussion and sharing of experience that we can hope to increase the precision of our prescribing.

A further comment can be added regarding the Law of Cure. All symptoms, all events must be taken in a context; that is, their relationship to what has gone before and what exists now must be well understood. Thus, the direction "inside to outside" is a principle, a movement which is not circumscribed by the exact organ or system affected. I feel it is misleading to state in absolute terms that "If a patient is curable, during treatment no illnesses reflecting core biological malfunctions will surface." The more superficial symptoms which arise may still involve a core biological function, but on a more superficial level. Thus, a patient who suffers from serious suicidal depression may well develop an anemia of a non-life threatening nature as part of the curative process.

Dr. Karl Robinson:

The most obvious difficulty with evaluating this patient's iron deficiency anemia was that no red blood cell, hemoglobin or hematocrit value was reported until two-and-a-half months after Calcarea carbonica had been given. So, for roughly two years, we have no idea if she did or did not have anemia. I would like to have had these values at the first consultation. I do not think that the anemia is the crucial element here. It is quite a common symptom with no distinguishing features. Along with Hahnemann, I am interested in the state of the patient. None of the symptoms reported give us a clear idea of her state. Medorrhinum was prescribed on her desire for ice, hot feet at night, salivation during sleep, anemia, canker sores, tendency to drink alcohol and a family history of alcoholism. Of the 96 Medorrhinum symptoms under MIND in Kent's Repertory, only sadness was mentioned in the history, so it is not possible to judge if she had improved on the crucial mental and emotional levels. Of course, in view of her improvement, Medorrhinum appears to have been a correct choice. However, I would like to know more about her state, and I would like to see eminent homeopaths such as Dr. Schore, who is a scholar of the Organon, detail those symptoms of the mind so peculiar to the person needing Medorrhinum.

Final Comments by Dr. Robert Schore:

I presented this case, somewhat reluctantly, knowing that Medorrhinum would have been a better first prescription, and that philosophical jousting would ensue concerning the various remedies, their potencies and the intervals between the doses. Nevertheless, given the deadline for preparing this case for the Journal, this was the only case I could. think of which illustrated the point to which I wanted to draw attention. That point is that no matter how well the patient feels during treatment, assuming the patient is curable, if an anemia develops, which is not due to external causes like loss of blood from injury or poor diet, the prescription was not curative.

I disagree with Dr. Jonathan Shore's statement implying that the development of a non-life threatening anemia is part of the curative process in a patient whose suicidal depression has improved. I perceive his statement to reflect a linear way of thinking about a living system which is animated by life forces whose nature is anything but linear. I think it is time that we visualized Hering's Law in terms of energy flow, vibrations, resonance; that is, in any terms which will help one to perceive a living system in a non-linear way.

Mental and emotional symptoms are not always more important than physical symptoms. Many patients exhibit symptoms on mental, emotional, and physical levels, all of which are guiding symptoms, all of which will resolve at about the same rate during the curative process. Each patient has a unique balance of symptoms. I believe we must be careful not to imply that there is always a linear relationship of symptoms with the mental and emotional symptoms being more important than the physical. This is the case only part of the time.

In the Proceedings of the International Hahnemannian Association, June 26, 1924, Julia M. Green, M.D., presented a paper entitled "The Place of Homeopathy in the World Advancement of the Near Future." It is amazing to find how apropos this paper is today, sixty-nine years later. Dr. Green writes, "Another modern trend of science is the comprehension Of the tremendous value of vibration in the function of almost everything in the universe. Waves of light, waves of sound, rhythm in music, electricity, radio, and many other things are vibrations. Probably health will be found to be orderly vibration and disease or symptom pictures disorderly vibration. The curative remedy may be recognized as the agent which `tunes in' and makes the vibrations orderly."

The thoughtful comments of Drs. Shevin, Crothers, and Shore lead me to reflect on Dr Crothers' comments. He was not sure what I meant by "core biological malfunctions." I `used a phrase which does not describe the thought I had in mind. I see now that the thought has to do with homeopaths' definition of "superficial" and "deep" symptoms, and I think this should be a topic for another discussion.

I thank Dr. Robinson for his comments which I received several days after I responded to Drs. Shevin, Crothers, and Shore.

A CBC was performed within a month before the dose of Sepia 10M, and it was normal. Unfortunately, that report has been misplaced and we do not have the specific hemoglobin or RBC count results. Yes, it would have been nice to have performed a CBC at the time of the initial visit as part of a routine work-up.

Although Dr. Robinson says that I am a scholar of the Organon, I prefer to state merely that I have read the Organon a few times. For me one of the most important paragraphs is 153 which stresses the importance of striking, peculiar, strange, and unusual symptoms. During case taking and study, what is striking to one homeopath may not be striking to another, but this, too, could be the topic of another discussion. An important lesson I learned from Dr. Künzli is this: if a symptom is not present, it is not important. If a patient does not have clear mental or emotional symptoms, then I cannot use the mental or emotional state as a guide to selection of the remedy. After selecting the remedy based on clear symptoms on any level, I read the materia medica with the patient in mind to be sure that there is nothing about the mental and emotional state which contraindicates the prescription.

I presented all the symptoms that I had in this case, and I used the clear and striking ones as the guide to the remedy. Frankly, had I been less concerned about defining her state of mind during the initial visit, and less influenced by the action of previous remedies, I think I would have given Medorrhinum at the first visit. Her mental and emotional symptoms seemed vague on the first visit, and vague on the last visit, and even as I think of them now, I think Sepia fits better than the other remedies. Nevertheless the mental and emotional states, along with the anemia, improved after Medorrhinum. As far as I am concerned, her anemia and mental/emotional state are equally important.

American Institute of Homeopathy.

~~~~~~~~

By Robert Schore

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