A CASE OF CROHN'S DISEASE

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A CASE OF CROHN'S DISEASE

A Review of Inflammatory Bowel Disease and Its Conventional Treatment

This case is quite interesting. We can learn a great deal from it. The patient is articulate, and a lot of emotional information comes through. I have edited about four hours of videotape down to approximately half an hour.

Before we look at the case, however, I want to review some basic information about Crohn's disease and inflammatory bowel disease in general, taken from Harrison's Principles of Internal Medicine.

Crohn's disease and ulcerative colitis make up the two primary types of inflammatory bowel disease that can affect various parts of the gastrointestinal tract, including the buccal mucosa, esophagus, stomach, small intestine, large intestine, and rectum.

The cause is not really known. There are a number of theories. Many researchers believe that an autoimmune mechanism is involved. Interestingly, Harrison's describes a psychological profile of sorts for Crohn's disease and inflammatory bowel disease:

It is not uncommon for these diseases to present initially or to flare in association with major psychological stresses such as the loss of a family member. It has been suggested that patients with inflammatory bowel disease (IBD) have a characteristic personality which renders them susceptible to emotional stress, which, in turn, may precipitate or exacerbate their symptoms.

This sounds a lot like homeopathy. Unfortunately, this is as far as the description goes.

The areas in the gastrointestinal tract that are affected by inflammatory bowel disease can be quite varied and unpredictable. For example, the small intestine and rectum can be involved, while the majority of the large intestine is unaffected. Ulcerative colitis nearly always involves the rectum, whereas Crohn's disease involves the rectum only about 50 percent of the time.

The disease results in thickening and narrowing of the different layers of mucosa involved. In ulcerative colitis, just one layer is affected; in Crohn's disease, all layers are involved. The biggest problem is bowel stenosis, a luminal obstruction resulting from all the mucosal inflammation and thickening.

The symptoms and associated sequelae can be quite debilitating. They include diarrhea, bleeding, abdominal and rectal pain, fever, malabsorption, anemia, weakness, and weight loss.

The standard allopathic treatment is Azulfidine (sulfasalazine) and related compounds. If this is not effective in controlling the symptoms, then corticosteroids are used. And if they are not effective, then surgery is usually recommended. In fact, patients with inflammatory bowel disease will have an average of three different bowel surgeries in their lifetime.

Initial Visit: "I can't find my center...."

Female

Age 36

September 19, 1992

(Video excerpts were shown.)

I have Crohn's disease and depression (2).

We moved to Portland from the East Coast three years ago.

My life is a series of losses (3).

I got married four years ago.

I am a dance movement therapist. Back east, I was dancing and felt strong emotionally, physically, and spiritually, with lots of friends and support.

Soon after we moved here my dad died suddenly of a heart attack. I had a panic attack (3) after we buried him: spears going through my chest (3), couldn't breathe (2), passed out.

I have a master's degree in dance therapy, but couldn't find work in Portland. I had to work as a secretary for $5 an hour. Now I'm working in community mental health, social work, and case management. It's not me (2).

We're having financial problems. We bought a house a year ago.

My hair was always curly; now it's gone straight (3). All that I was -- curly hair, spiritual, alive, dancer -- is gone (3).

I've had some strange relationships with women here. Had some trust problems. Some have said my anger is too much. In New York I learned to express my anger, get it out. Here my directness has scared people (2).

Last year, I was having a lot of bowel movements (2). I have persistent painful hemorrhoids. Had a hemorrhoidectomy in October 1991. They never healed (3), and fissures developed (3). Extreme pain (3), like a knife, shaking and screaming after a bowel movement (3). My body felt raked, stiff.

I stopped dancing. I was unable to. Now I do yoga and some swimming.

I saw a doctor who did a colonoscopy. He said I had Crohn's disease and colitis. Prescribed Azulfidine and pain medications. After a while I quit the medications.

I saw an acupuncturist and received Chinese herbs and acupuncture, which helped some but then it relapsed.

I went to another doctor who diagnosed "aggressive Crohn's disease in anus." I started taking lactobacillus and using cortisone cream for fissures.

The fissures are deep (3) and painful (3).

I get extreme gas pain (3); the attacks inundate me. I must breathe, lie on the floor, and roll. I had two episodes of muscle spasms (3). I lay on the floor and couldn't move (3) from the pain. They lasted 30 minutes and then went away. Both times it happened after I extended my back.

Depression with this. I'm tired of it (weeps). Feel I can't live my life.

My husband is depressed. He doesn't like his job. I'm doing work with him to save our relationship. Communication and cultural stuff. He's from Ireland.

When I'm depressed I withdraw (3), want to be alone.

I feel I need to protect my body (2).

Not as much sex now. Sex usually doesn't hurt, though.

Unhappy with my job. It's not what my spirit needs to do. I want to work with my body -- movement, dance, my calling (sighs).

Why can't I take in and keep foods? I can't assimilate, can't accept. Autoimmune disease. Do I really dislike myself? I don't know what's wrong. I'm a shell. I don't know anything about myself now.

Change is essential. I am changing. I go through changes intensely, explosions.

A theme of loss in my life (3), coming just after feeling so much a part of life; I felt special, confident, spiritually connected. It fell out the window (3) as we drove across the country and moved here.

Last year I was depressed (2), from my pain and poor health. I had to drag myself to work. I resisted taking antidepressants. I disguised myself, so it seemed as if I was doing okay.

I've always liked people. For a time I couldn't be around them. I almost had a panic attack in the market. On first coming to Portland I had an aversion to people (2) I didn't know. I'd sit in the car. I couldn't go into the store. My husband would have to shop.

I've moved a lot. I've traveled alone in Europe. Always been quite independent (2). Why has life gotten scary?

Now the focus is in my body. I'm so tired of having food exit me. I worry about anemia. Am I ruining my colon? I'm a worrier (3).

I can't find my center now. I'm hard on myself (2).

I have PMS, mood swings (2), for three days.

I can be affectionate or distant. Irritable (3). I'll find something to fight about. Lately I've been crying, deep sobbing (3), out of frustration. It's now a year since my illness began. I don't cry at work, but will with my therapist or husband. Consolation is okay at times, but usually it's not okay (2).

I have no close friends in Portland. I've always had lots of friends. I've always attracted people. Here I repulse them.

My mother is pessimistic. She has Paget's disease. She is 66 years old, Italian, Catholic, full of guilt. I was the strange one in the family: artist, dancer, a creative, happy child. Age eight was my happiest year. I was active. My dad was physically abusive. Both parents had low self-esteem, which they projected onto me and my older brother. My father was extremely critical. I was a slow learner in school (2). I took remedial reading and slow math classes. I felt stupid (2). In high school I had boyfriends, lots of friends.

I've used some drugs in the past -- pot, some speed, cocaine, mushrooms. Anxiety with pot. Smoked twice last year.

I went to secretarial college, met a man, and formed a serious relationship. I ended it. I was on an independent track (2). I decided to become a dance therapist, did well, got a degree in psychology, really pushed myself (2). I met and lived with a man for 2 1/2 years. Then I went to Europe for two months, met my husband, fell in love, and ended up staying in Europe for a year.

Before I'd perform (dance) I'd be irritable (1).

In New York I was with a man for three years. He was emotionally abusive. I did intense shedding of him (3). I would sit on the toilet (2), grieving (3) and saying good-bye to part of me.

I had weird bowel movements on the trip to Portland. Got thirsty, slept a lot, felt insecure, felt dependent (3). In Portland we immediately searched for work. The relationship got tense. I felt he wasn't looking hard enough for work. My reaction was to get busy, calling lots of people, worrying (3). I complained (2) to my husband constantly. I was unhappy with my work.

I'd been in Oregon six months when my dad died in January 1990. He had many locked-up feelings.

I've had vivid dreams lately (3). I woke crying today. Anger at my husband. Dreams of my dad; a calm, good feeling. Some dreams of him are insane, violent.

I feel tension in my mid or low back.

No headaches.

I've been getting colds these past three years. Cold drinks aggravate (1). Lately, I get laryngitis after a cold (2); hoarse, painless.

When I don't cry I feel something in my throat, like a ball in my throat.

Shallow breathing. I've always sighed (2).

I'm always very shy to speak. When I hear my own voice on tape I don't like it (2).

After eating I get burning in my stomach. I used to always be bloated (2). Tension in stomach and abdomen. I massage it, which helps. It also feels better from warm applications.

I crave pasta (2), fruit (2), cheese (1), wine, eggs (1), spicy foods (1), and bread (1).

I'm averse to cabbage and turnips. I'm tired of veggies. Aggravated by caffeine (3), dairy (2), and fruit.

I get irritable about tobacco smoke (3). I'm adamant, vocal, about it.

I have bowel movements three or four times a day. It's as if I'm not getting it all out. About 20 to 30 minutes later I go again. The stool is unformed (2). Balls, gas with stool, mucus, brown, undigested food. Twelve hours transit time. Occasionally I get an urge, but nothing is there (1).

I must carry food with me. I get hungry (2). If I can't eat I get acid in my stomach; causes shooting pain in my jaw (2); jaw feels tight, squeezed (2). Better after eating (2). Worse if hungry (2).

The discharge from the anal fissures is yellow. There was a lot of gas; it's okay now. I used to get bladder infections; took antibiotics.

Took birth control pills for five years. My cycle was irregular but monthly. No clots. Cramps (1). Dark blood. PMS: irritable, weepy, diarrhea (3), bloating, and sore breasts. I get hypersensitive to odors.

My sex drive is low now. Afraid of anything hurting my anus (2). Orgasm relaxes my anus. We have sex once or twice a month. It used to be twice a week.

I'm frustrated because I'm married to a man who's bright and talented, but he can't decide what to do with his life. He's not assertive enough. I get angry (3) because he doesn't assert himself. I'm critical (1).

I feel isolated (2).

I'm chilly (2). My back, arms, hands, and feet are cold. I dislike hot weather (2); can panic from heat. I avoid hot sun; makes me lethargic.

I sleep well, on my back or right side, for eight hours. I'll wake to pee. Sometimes I have a bowel movement during the night.

I feel toxic if urine stays in me too long (1).

I must breathe deeply to wake up my lungs (1).

Active dreams, of dead people (1); anxious dreams, afraid I'll be in jail. Anxiety that I'll marry someone else (2), an arranged marriage. I wake up frightened (2).

Afraid of fainting (3). I've fainted a lot. I fear hospitals (1), needles (1), blood (1), snakes (1), insanity (1), being paralyzed, not realizing my potential, rape. I was date raped.

My abdomen is a very emotional place for me (2). I fear violation from bodywork. The rectal pains shoot upward.

My heels and soles are sensitive. I want deep massage (2).

Assessment: Severe Crohn's disease of the rectum.

Elmore: I made three incorrect prescriptions before the correct remedy was found. She has now been completely asymptomatic for about 2 1/2 years and has not required any other treatment. I consider her to be cured. I don' t think it will be especially profitable to give a lengthy or elaborate rationale for the first incorrect prescription. We can make better use of our time today talking about the correct remedy. However, before we do that, would someone like to offer any thoughts about the case?

Judyth Reichenberg-Ullman: I do have one idea. I was struck by some of her words. She described her panic as "spears going through my chest" and her pain was "like a knife." Also, it is not written in your case notes, but on the video she said her pain "pinned" her to the floor. And then later she talked about her body fighting against itself. These references and images make me think about a remedy made from a metal. And there is the issue of performance -- she is a dancer -- which also suggests a metal, according to Sankaran's ideas. So, I was trying to think what metal it might be. She talks about having lost herself, losing her identity, and about not being able to find her center. So I thought of Alumina.

Elmore: Yes. Any other suggestions? What's the obvious homeopathic prescription?

Audience: Ignatia.

Elmore: Yes. You can probably see I was asking some confirmatory questions for Ignatia. Did you see her sigh a n umber of times on the video? There had been a lot of grief. I prescribed Ignatia in the office. In retrospect, it would have been better to have studied the case further before prescribing, especially for such a serious case. However, I still make mistakes even after I study cases (laughter). It looked like Ignatia to me. There was all this sighing and grief. Her father had died. And there were some confirmatories -- weak confirmatories. She liked cheese and had an aggravation of sorts from tobacco smoke. But I guess it wasn't a strong enough case for Ignatia because it certainly didn't work (laughter).

Plan:

Ignatia 200c, single dose.
A diet of natural foods.
Multivitamin and mineral supplement.
Follow-Up

September 24, 1992

Telephone consultation.

I had severe gas pains (3). They wiped me out.

I became depressed, weeping and moaning (3).

I have a bowel movement one hour after I eat.

Tired. Been doing physical labor. Extra stress. Decided to look for other work, a stressful edge.

I swam tonight for 30 minutes. It felt great. I felt weightless. Water and bathing. Image of being inside, like a bowl of organs in there not doing anything.

My organs are so sensitive, as if I can feel each one (2).

More diarrhea today. It wiped me out.

Fissures are okay. I can relax after a bowel movement.

Assessment: No improvement, but it is still very soon after the initial prescription. Plan: Wait.

October 5, 1992

Telephone consultation.

Stomach bug. Diarrhea and nausea. Wiped out.

Depressed. I can barely function at work.

I've been having a really bad burning pain in my abdominal cavity (2), like very bad gas. I could only pant and hope it would go away. What's going on inside?

I'm not taking vitamins.

I've been feeling like this for a full week. The pain is chronic, scary. I want to curl up into a ball (2).

I pass gas only when I have a bowel movement. Before, doing yoga postures would expel my gas pains.

After I drink room-temperature water I get pain as if I need a bowel movement, as if too much liquid. Drinking causes bowel movement.

Assessment: Acute illness. No improvement in chronic condition.

Plan: Wait.

October 10, 1992

(She sighs.) Lots of depression (3).

Diarrhea (3), like a virus. Wiped out (3). Diarrhea in soft, small amounts. I push and hardly anything is there.

Intense dreams (3). I woke three times last night to have bowel movements.

I get pains at work. It's very uncomfortable. I try to put on a happy face (2). I come home and feel like dying, as if my organs are moving around (2). Pain below the xiphoid.

I wake up very thirsty and drink water.

Bloated abdomen, water. Nothing absorbs.

Chilly (3); cold a lot.

Night sweats.

I feel really sick, like I'm totally crippled (2). Feel as if I'm not even in life (2). I don't know my body, myself. I feel stripped, fragmented, and weak. I envy people who are active, who ride bikes and do other things. I can't do that anymore (weeps).

I feel guilt about my relationship with my husband.

I want to leave work and come home. I'm so happy to get home and undress. I isolate myself. I don't have the strength.

A lot of depression. Do I need antidepressants?

It's been a year of this. It got worse in late August.

Since taking the remedy, my fissures have been better but my insides are worse (2). My body is so sensitive. My back hurts if I stand a lot.

I'm holding my head; it feels hot.

I've come to a realization that I must quit work (sighs). I'm stuck. I'm angry at the mothers I work with. They don't know their children are in danger. Last night I dreamt I resigned from my job and was happy.

I have loads of anger at my husband. He can't motivate himself to get a good job.

Lots of dreams about death (3). I was driving a hearse. I thought it was my dad, but the ushers were my dad and brother. Then I thought it was me dying (3).

Change is scary when you're at the bottom.

My way of dealing with transformation is to isolate myself.

I want to go to a healing camp where I'm worked on, permeated with healing energy.

I hate American society in some ways. You can't take time off to heal. I dread going to work. I have to move a lot. It's so painful. I thought of taking a medical leave of absence, but it wouldn't look good on my record.

I'm tired of sitting on the toilet, of lying down, and of sitting on the sofa. I'll have sparks of feeling good after I eat, get some food in me. Then I get almost elated. I can cry because I'm feeling good. Then the yuck moves in and the pain returns.

I try not to be angry at myself, to be more accepting. Sorrow. I feel hunched over, tightness in my chest. I need to have bodywork done on me.

Laboratory results show severe anemia: calcium 8.3, albumin 3.3, globulin 4.4, hemoglobin 9.9 (11-16normal), hematocrit 31.8 (33-48normal), and platelets 619 (150-440normal).

Assessment: No improvement. Significant anemia, fatigue, and depression. It has been three weeks since the initial prescription. She continues to work but needs time to rest and heal.

Plan:

Recommend leave of absence from work.
Refer for allergy testing.
(The lab work and her report indicated that she was not in very good shape. She had a dream that she had resigned from work. She told them she couldn't work anymore. Her condition was quite serious and she needed all of her energy just to survive. So, I told her that she had to stop working. I wrote a letter to her employer asking to place her on a no-duty status, a temporary leave of absence.

It is sometimes necessary to take such measures. One commonsense principle of natural healing is that the body needs the opportunity to rest and to heal. I'd given her a multivitamin and mineral supplement, and we had discussed her diet. I covered the possibility that food allergies may be aggravating her condition by sending her to a colleague for some testing. The testing indicated some foods to avoid, but the avoidance did not appear to help her. Nothing was very helpful until she received the right remedy later on.)

October 16, 1992

I've been waking every two hours with abdominal pains and diarrhea (scanty); passing a little gas.

Stomach pains are worse at night.

Assessment: Her condition is worsening. I need to change the prescription.

Plan: Aloe socotrina 6c, one to two times per day.

November 16, 1992

Feels like it's been forever. I'm not recovering. I'm a little better, but it's not fast enough.

I'm doing hydrotherapy.

I saw a different gastroenterologist.

My marriage is going really well. He is so supportive and loving.

I'm still getting up at night.

Night sweats (3).

I still have pain but not quite as many bowel movements. I'm afraid to go out of the house when I have the pain, afraid that I'll have to have a bowel movement and there will be no bathroom around. Very spacy when in pain. The rectal pain has been okay until recently.

I'm using Chinese salve now on the fissures.

I lost 12 pounds this last month (3). I can't eat much. I crave food but have no appetite.

I dream of things that happened during the day.

I hate medical stuff, such as blood tests. I pass out. I talk to myself and feel angry. Assessment: No significant improvement from Aloe. Time to represcribe.

Plan: Nitric acid 30c, single dose.

December 7, 1992

Telephone consultation.

I'm depressed.

I started Azulfidine five days ago. I may take prednisone.

I crave nourishing food. I crave eggs (2), fish (2), pasta (2), milk (2), and cold things (2).

Night sweats (2).

Usually I'm worse at night.

My sleep is okay.

Assessment: No change. Restudy the case.

Elmore: The Nitric acid prescription covered many of the symptoms -- the negativity, the sharp pains, and so on -- but it didn't work. Does anybody have any ideas or suggestions at this point?

Michael Thompson: Like Judyth, I thought of a metal for the same reasons she mentioned. There is also a strong theme of loss. In a way, you could say that her whole life has just "gone down the toilet." (No pun intended.) There appears to be an issue about losing her former position as a dancer, which would support the idea of a metal. Perhaps it is a kind of pride from the loss of her social position. You could take the rubrics, Ailments,from loss of position, and Delusion, she is not appreciated. This second rubric has Aurum, Platinum, Argentum nitricum, and Palladium in it. Platinum covers both rubrics. So I would suggest Platinum.

Teresa Salvadore: She seems to be in shock, yet her thoughts and emotions are still moving freely. She continues to work and express herself. It seems like all of the grief went straight to the rectum, very strongly. So I went straight to the rectum in my books. I was thinking of Ratanhia, focusing on the fissures and the terrible stabbing pains.

Elmore: It is a good thought. Roger Morrison says Ratanhia is the primary remedy for terrible long-lasting rectal pains after a stool.

The Case Is Reconsidered and the Remedy Is Found

Once more, I thought about the case. I asked myself what was unique about it.

She dreamt frequently of her dead father. And then she dreamt that she herself was dead, so I took the rubric, Dreams, dead, people, of. This is in the MIND section in the complete Repertory.

Also, she had given us a keynote symptom on the second follow-up (October 10, 1992) that I hadn't noticed initially. She felt as if her organs were "moving around" in her abdomen. She could feel it all moving around when she walked. I took the rubric ABDOMEN, Movements, in.

I repertorized in the "old-fashioned" way. I wrote out all the remedies in these two rubrics and went through them. I hadn't really been thinking about Thuja occidentalis, but when I looked at these two rubrics it came out strongly. Then, as I looked over the other prominent symptoms in the case, I realized that Thuja covered them quite well. (Figure 1 is a MacRepertory graph of the complete list of symptoms considered at this point.)

I also realized that my patient's own words, such as "I feel as if I'm not even in life" and "fragmented and weak," aptly expressed the sense of fragility, delicacy, and frailty that is well-known as a keynote for Thuja. In the repertory we find rubrics such as the following:

- MIND, Delusion, body, delicate, is.

- MIND, Delusion, body, brittle, is.

- MIND, Delusion, glass, that she is made of.

- MIND, Delusion, existence, exist any longer, she cannot.

- MIND, Delusion, die, about to, he is.

- SLEEP, Dreams, death, of.

- SLEEP, Dreams, dying, of.

Many of these are additions to Kent's repertory.

Other remedies that came up for consideration included Natrum muriaticum (which can look a lot like Thuja), Phosphorus, Arsenicum, Nux vomica, Sulphur, Sepia, Nitric acid (which I had given), Ignatia (also given), and Silica.

After the Thuja was prescribed, there was an immediate and gratifying improvement, as you can see from the follow-up reports.

Plan: Thuja occidentalis 12c, twice a daily.

More Follow-Up

January 16, 1993

Telephone consultation.

Doing really well.

I'm still taking Azulfidine.

I'm doing yoga, swimming, and eating.

I take the remedy three times a day.

One or two bowel movements a day.

No depression.

Lab work shows that I'm still anemic. I'm taking one iron pill a day.

Assessment: She continues to improve. The remedy appears to be correct.

Plan: Thuja occidentalis 12c, two or three times daily.

April 12, 1993

I went back to work on February 10.

My energy is fine. I'm swimming, doing yoga, riding my bike, and even taking a dance class.

I'm grateful to be alive.

The last lab work was a little better regarding the anemia.

My bowels are fine. One or two bowel movements a day. No pain.

I'm still taking Azulfidine. I'm afraid to quit it.

I get an occasional twinge in my right lower abdomen.

I feel happier overall.

Meditating.

More creative. I'm sewing again.

I'm seeing synchronicity come back into my life. That's good!

My sexual energy is a lot better.

I've gained weight. I'm almost back to my original weight (114 pounds). Last fall I weighed 102 pounds.

I'm more social now. That's much better.

I'm listening to myself.

I had positive dreams about two old lovers.

I wake feeling good.

No more night sweats.

Fissures have closed up.

No more constriction in my rectum.

The sickness felt like the end of a three-year phase.

The feeling of loss comes up again around dance. I have a friend who is a dancer. I felt again like the independent, creative woman I was back east. It was like a love lost, a grief, 18 months ago. I felt burnt. I tighten if I think of her and how I used to be. I feel adolescent (3).

Assessment: She is much improved. She is afraid to discontinue the sulfasalazine, although it has not helped her in the past.

Plan: Thuja occidentalis 200c, single dose.

July 17, 1993

I'm happy (2).

Maybe I'm where I'm supposed to be, although pay is low in the mental health field.

I stopped taking Azulfidine two weeks ago.

Good appetite.

I quit taking birth control pills in November 1992.

Recently I was bloated for a day. I had an image of hating my appearance as a child, hating my belly and breasts, around age 15 or 16. I was concerned that I was ugly.

Dreamed a bear was chasing me. Dreamed I was dead, like an angel.

My weight is up to 117 pounds.

Assessment: She is doing well.

Plan: Wait.

December 7, 1993

I'm doing well.

Moody and bloated before my period.

I catch colds easily.

I feel so much better.

Occasionally I get gas, especially if I eat beans.

I pray a lot.

I've been thinking of going to massage school.

Assessment: She continues to do well.

Plan: Wait.

January 16, 1995

Really good.

I'm still working in mental health.

Went on a one-month bike ride in Europe. I felt so healthy I even ate candy. I felt like I did in my adolescence. Real freedom.

I'm dancing strongly and doing yoga.

Assessment: She is doing well. Her symptoms have been resolved since January 1993, and she has had no remedy since April 1993.

Plan: Wait.

June 1995

I called her just last week. She was out of town, but her husband reported that she continues to do very well. There have been no relapses, and her health has been excellent in general.

(The beauty of homeopathy shines through in a case like this. Once she received the correct remedy, her progress was rapid and lasting. And it was quite inexpensive. My fees were approximately $200 for her whole treatment. This is not much when compared to the cost of conventional treatment and medications, notwithstanding the cost of surgery.

Of course, the main point is that her successful homeopathic treatment has dramatically changed her whole life for the better. She has regained her joy. She's dancing, she's engaged in life, and she's found herself once again.)

Thuja: A Remedy We All Struggle With

Even our old books say that Thuja is a remedy that prescribers frequently miss. We know a lot about the remedy, yet it is often hard to perceive in the patient who sits in front of us.

Indeed, Thuja can present in many ways in the clinical setting. For example, George Vithoulkas, in his so-called "essences" and in other lectures, has characterized Thuja as closed, cautious, secretive, and deceptive, with an inner sense of ugliness and a controlled facade of properness. He describes a suspicious, manipulative person with a quality of scheming and hardness.

In regard to the cautiousness and other such symptoms, my patient came across as quite the opposite. She was very open, as you could see on the video. She did not appear to be holding anything back, weeping freely in the interviews. One could argue, I suppose, that this openness was because she was so sick, but that was not my impression. In regard to the inner sense of ugliness, my patient did mention in the July 1993 follow-up that she felt physically ugly when she was 15 or 16 years old.

But George also says that Thuja patients can be some of the nicest, most sensitive people you will meet -- sensitive like a poet They have a delicate soul. My patient definitely had a sensitive and artistic nature.

Douglas Borland did not agree with the description of Thuja as manipulative, secretive, and so on. "That is not the Thuja familiar to me." He experienced Thuja patients as "well-mannered, sensitive, polite, grateful, responsive to kindness, truthful, considerate." This describes the type of patient that might be confused with Natrum muriaticum.

A word that fits well here is "fragility," as I described earlier. You are no doubt familiar with Thuja's sensation-delusion of being made of glass or of being about to break. I've seen this in other Thuja patients. I remember one woman who couldn't tolerate any massage or bodywork on her abdomen. She said she felt as if something would break in her abdomen. However, patients are not often going to say they are made of glass. You have to use your imagination a bit.

By the way, the whole idea of using "essence" descriptions to prescribe remedies is, as George himself has said, a double-edged sword. It can be very helpful in a given case but can be very limiting and misleading when applied routinely as a prescribing method. A remedy is always more than any word or series of phrases that we use to summarize its nature. The essences are not wrong, just inevitably incomplete.

This same warning applies, of course, to any methodology we may depend on for case analysis, whether based on totality, essence, keynote, peculiar symptoms, miasms, kingdom classifications, or some other approach. We must be careful, because homeopathy is broader than any of that. As Peggy Chipkin said in her presentation, openness and flexibility are the most important qualities for a homeopath to have.

The Chameleon

Two good articles have been published on Thuja in the Journal of the American Institute of Homeopathy. Two or three years ago, Bill Gray wrote an article entitled, "Thuja: The Great Masquerader," in which he presents his idea of the "essence." More recently, in the Winter 1994 issue, Catherine Coulter published an excerpt from her forthcoming book, Portraits of a Homeopath, in which she gives a beautiful description of Thuja.

In his article, Bill Gray has refined and added to the Vithoulkian picture of Thuja. The major aspect of Thuja, according to Bill's experience, is the feeling of being unlovable. It is a deep sense in these people that others would not love them if they really knew them. This is combined with a sense of being set apart, different from others, and profoundly lonely. However, this feeling of unworthiness or unacceptability is not something the patient will usually express directly in the interview, just as Lycopodium patients do not usually spontaneously reveal their lack of self-confidence. The differential between Thuja and Lycopodium can be quite difficult to discern.

Bill describes Thuja patients as being nondescript, fitting in, and adopting a middle-of-the-road behavior appropriate for whatever group they are a part of. They are the masquerader, the chameleon. They don't want to stand out too much; they want to avoid scrutiny. The person may seem like a Phosphorus, a Calcarea carbonica, a Nux vomica, and so on. As prescribers, we may be misled by the external facade, especially if we do not take the time to understand the inner person.

However, understanding the inner life of Thuja patients may not be easy, because, as Bill says, they don't have a good sense of themselves. After putting so much energy into a careful facade, they are often not sure just who they really are. Consequently, we tend to get a poorly developed and somewhat vague image on the mental and emotional planes, although there may be good physical data to support a Thuja prescription.

My patient, for example, referred to herself in the third person several times and said that she didn't know who she was anymore. "I'm a shell. I don't know anything about myself anymore. I can't find my center now."

Often the person who needs Thuja comes from a dysfunctional family with a history of some type of an abuse. The abuse does not have to be terrible. It can be a lack of love, various forms of emotional abuse, or maybe the death of a parent. Many situations can create a Thuja state in one who is predisposed to it.

Very Similar to Natrum Muriaticum

In her excellent article on Thuja, Catherine Coulter compares Thuja to Natrum muriaticum. She finds that the patients are very similar. She highlights the emotional inflexibility and rigidity, fear of and resistance to change, indecision, and troubled conscience with guilt as if they had committed a crime. Other similarities are as follows:

- Sense of isolation.

- Withdrawn nature.

- Aversion to company.

- Aversion to being touched or approached.

- Quiet.

- Self-absorbed.

- Feeling of never fitting in.

- Feeling foreign, like a stranger in a strange land.

- Feelings of inadequacy and alienation, always the outsider.

- No longer the old self, yet not understanding the new self.

- Feeling as if the soul is separated from the body.

Catherine Coulter also mentions the sensitivity of Thuja patients to psychic phenomena. She feels that this sensitivity is characteristic of Thuja and suggests that it can be used to confirm a Thuja prescription, even in cases with seemingly straightforward physical complaints.

Lost Between Life and Death

I have been fortunate to hear Jeremy Sherr lecture on Thuja. Jeremy has also expanded our idea of the "essence" of this remedy. He points out, for example, that the remedy contains many opposites: both a desire for and an aversion to open air, feeling both better and worse from open air, and a sensation of heat and a lack of vital heat. It is a remedy of contradictions.

And, as Jeremy has described, the remedy shows a lot of energy around death. In the circle drawing that he uses to understand remedies, Thuja occupies a place that is near the death point. These people have delusions of dead people and of conversing with dead people, dreams of dead people, and delusions of dying. Thuja is the main remedy for dreams of death -- of their own death, of death of other people, of dead people. There are many issues around death and many rubrics having to do with the soul leaving the body. Jeremy says that these people are stuck before death, with a sensation of being about to die. Patients may say things such as "I was so embarrassed I thought I'd die" or "I had a near-death experience" or "I nearly died when that happened." It is an internal state as if going into death.

Understandably, Thuja patients have a problem with letting go, with making transitions. They tend to be rigid, to have fixed ideas, and to be obstinate in thoughts and behavior. They can have scruples of conscience, a strong sense of guilt, and a tendency for self-reproach. Guilt is a big issue for Thuja. When my patient gave up on conventional treatment, she went back to her doctor and told him that she was stopping the treatment. Most people just wouldn't do that. To me, this is a form of conscientiousness.

Jeremy says that when you are talking to a Thuja person you are talking to two people, as if the patient is divided. That is because they are lost between two worlds, between being in the body and being in the soul or spirit. Thuja is averse to strangers because they are strangers to themselves.

This helps us to understand Thuja's weak memory and lack of mental clarity, which often present as linguistic confusion -- using the wrong word, misspelling words, omitting words, allowing lapses while speaking, and so on. In my experience, for example, Thuja is a good remedy for patients with dyslexia.

Sujata Owens: Why did you give your patient Thuja 200c at the April 1993 visit when she was doing so well on the 12c taken daily?

Elmore: Posology is always a debatable topic. I don't like to keep people on a low potency. In my experience, once a person does well on a low potency repeated and I am certain it is the right remedy, then a single dose, usually 200c, will work beautifully. And it is certainly simpler and less expensive for the patient. However, you have a good point about staying with what's working. I do find, though, that a low potency repeated will at some point tend to lose its efficacy, and I do not like to repeat remedies much beyond the 12c.

Barbara Dively: I had a patient with irritable bowel disease. She was in her 70s, of average height, and quite emaciated -- about 85 pounds. I asked her if there were times when she felt well. She said that she taught line dancing three nights a week, went ballroom dancing two nights a week, and, when she didn't have anything else to do, she rode her bicycle. She turned out to be a Tarentula patient. She had to keep moving.

After the remedy, her relationship with her daughter improved dramatically and then she began to gain weight. This was after one dose of 30x. After taking this dose, she was awake all night, was frantic, couldn't sit still, and was roaming all over the house. So, I felt it was not appropriate to repeat it. After about six months she weighed 91 pounds, her relationship with her daughter was going well, and she made some major life decisions.

Then she went to Florida for a six-month stay. She used to spend half the year there and half the year in my area. While down there, someone persuaded her to eat foods that she could never tolerate and she called me because she was having some problems again. I told her to repeat the remedy and to go back to the foods she had been eating before. I will be seeing her again soon.

Richard Mann: I was interested in the initial Ignatia prescription. It seemed to push the Thuja symptoms out, and I think it was a very helpful prescription.

Elmore: I think it was the wrong remedy. It was just one more stress on the vital force. It just stirred things up. She got sicker, which was not really desirable.

Michael Thompson: It occurs to me that another word for essences is, in fact, stereotypes.

Elmore: They can be useful, but only when used with caution.

International Foundation For Homeopathy.

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By Durr Elmore

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