A Study of Ambra grisea: Two Case Histories

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A Study of Ambra grisea: Two Case Histories

Abstract: Two cases of Ambra grisea are presented. In one case the factors central to the remedy choice were the specific etiology of a loss of one's relatives coupled with leukoplakia, rectal hemorrhage, and a shy, timid personality. The other case displayed the following symptoms which led to the prescription of Ambra grisea: ailments from a reversal of fortune, fear of poverty, anxiety aggravated by thinking about it, asthma worse from emotion or excitement. Ambra may display breathing problems due to slight causes, anxiety, anything unusual. Ambra individuals may become embittered by fate and feel powerless to defend themselves against the vicissitudes of life.

Keywords: Ambra grisea; leukoplakia, asthma, proctitis, anxiety; relatives, loss of, ailments from

Case K.A.

"I can't take any more."

May, 1994

K.A. is a 55-year-old woman who has been plagued with proctitis for 6 years. A gentle, lady-like, soft-spoken, sweet woman, she sat demurely and related the story of her struggle with this problem over those long years. With her reserved quality was an undercurrent of anxiety. Her first symptoms appeared in 1988 and consisted of bloody stools. Sometimes the blood was mixed with her stool, and other times it just filled the bowl with red. The first time she saw the blood she was frightened, thinking that she had a fatal disease and would die.

Allopathic medical evaluation included a colonoscopy which revealed proctitis. She was treated with a cortisone based medication, Rowasa, by enema. Initially, this treatment worked, but every time she stopped her enemas, the blood returned. K.A. continued this regime for several years, not daring to interrupt her doses. As time progressed, she began to notice 3-4 episodes of blood each year, even with the medications. These episodes were heralded by white mucus discharge from her rectum, accompanied by flatus. Later the blood appeared. She noticed that unusual strain or traveling precipitated the attacks.

Even before the proctitis began, K.A. had trouble with her bowels. She had constipation for many years prior to her current situation. In college she had some rectal bleeding, but a sigmoidoscopy at the time did not reveal any abnormalities. It was presumed the bleeding was related to constipation.

K.A. stopped her medications about 8 months prior to first corning to my office and had been treating herself with an herbal tea preparation. During this time she had no recurrence of the bleeding until recently.

Currently, she has episodes of abdominal gas pains, with churning and cramping in her abdomen. She has difficulty and pain passing a very hard stool, and occasionally blood will be passed with it.

K.A.'s other problems included chronic leukoplakia. Irregular pathes were noticed in her mouth as early as 1960. They were located on the roof of her mouth, under her tongue, and on the inside of her cheeks on the buccal mucosa. Over the years she had numerous biopsies, some excisional, to assess the progession of the leukoplakia. All samples were negative for cancer. She smoked one package of cigarettes each day and continued to do so after the diagnosis was made. She finally quit in 1985, after which the leukoplakia went away completely. Recent biopsy of her oral mucosa showed nothing more than dysplasia.

K.A. describes herself as a shy person who is not comfortable around people. She prefers to be on her own. When she does find someone she likes, she becomes very attached. She is extremely sympathetic and had repeatedly assisted others even to her own detriment. It is just not possible for her to hurt anyone for any reason. She never criticizes anyone, although she reproaches herself often. Frequently in the interview she apologizes for herself. Adventure holds no allure for her, and she doesn't like to try new things. For example, despite her desire to be alone, she does not travel alone because of all the new things that she might have to face. Usually, she prefers tending her garden, going to movies and working with animals. She has 5 cats, 2 dogs, 2 tortoises and a rabbit. She is tidy to the point of being fastidious.

K.A. has pleasant memories of growing up and recalls a loving home and childhood. Her mother was domineering, but she "ruled with love." She never fought with her mother as her sister did. She was the "good daughter" and was always very close to her mother. Even to this day she can not tolerate being around others who fight.

K.A.'s first husband was very domineering and an alcoholic. She withdrew from his forceful nature, yet at the same time blamed herself for his drinking. During the last five years of marriage he started traveling in connection with his work and was drinking more than ever. At this time, he brought his mother to live in their home. This was not of her choosing and did not work out. Her mother-in-law died while she was in the house alone with her. K.A. grew to hate her husband, and finally in 1979 she divorced him. The idealism she had about marriage was destroyed. She never has remarried because she hates the idea of her freedom being taken away from her by any relationship. She also never has really "let go" of the intense feelings she had about her first husband. She holds grudges and never forgets or forgives.

K.A. had several other emotional upsets in her life. In 1985 her mother died of a stroke. Her father, who had been totally dependent on his wife, was devastated at her death. He moved in with K.A. and became totally dependent on her. In addition to the grief at the loss of her mother, she then had the added stress of having her father living with her. She eventually eased the situation in 1988 by arranging for him to live in the house next door to hers. Her father died in 1989.

K.A. had two sons during her marriage. One son became a truck driver. Her other son had a long history of behavior problems, truancy and drug use. In 1980, at the age of 17, he developed schizophrenia. She was devastated when he became ill. Over the next ten years, he was in and out of mental institutions. He often stopped taking his medications which resulted in auditory hallucinations and violence. Initially, she was his conservator, which he resented. Eventually, she decided that she couldn't fight the situation any more and allowed him to be turned over to a public conservator. In 1991 he was living in a halfway house not far from her home. When he ran away from that home, he purposely banged his head on the sidewalk causing serious injuries to himself. He was then placed in a rehabilitation facility. There he committed suicide. The shock was so great she felt completely numb. She wasn't even able to cry at his funeral.

When her son first became ill, she met a man who became her friend, companion and support during the next 10 years. Almost immediately after her son's death, they split up. She cried long and hard as a result.

By 1990 she felt totally lost. She knew she had to try to find a new life for herself. She reproached herself repeatedly about her son's death, thinking about what she should have done. She recalled her son as having been gregarious, outgoing and popular. She blamed herself because she was in the middle of the divorce with his father when his breakdown started. She is still not reconciled to his death.

Temperature: warm with cold hands and feet.

Time Modality: worse at 2 p.m.

Food Desires: salt (3), vegetables, chicken, sweets, chocolate (1), fish, milk

Food Aversions: meat, sour (2), spicy (1).

Thirst: High, up to 10 glasses a day.

Urinary: nocturia 3 nights each week.

Surgeries: Breast implants with revision in 1986. In 1992 she broke her right hip and femur while ice skating eventuating in a surgical repair with pins.

Menses: Her menses stopped suddenly in 1989, followed by several months of hot flashes. When she had menses, she had no pain or other problems.

Sex: Sex drive absent for several years. Before this decline, she had a good interest. She had one severe episode of herpes in 1983.

Fears: flying (2), being a passenger in a car (2), heights (2), elevators (2), speaking in public (3), cancer.

Sleep: Either side, and she grinds her teeth while sleeping.

Discussion

This case seems to hold no challenge. Natrum muriaticum is just jumping off of the page! She is a quiet, withdrawn person, who is sympathetic and loves animals. She prefers to be alone, but can become very attached. She holds strong grudges and never forgives. She has had several intense griefs, one being a love disappointment which she states she hasn't gotten over yet. She has grief for the death of her mother, her father and the suicide of her son. She couldn't cry at his funeral.

In addition to all of these mental and emotional symptoms, her physical and general symptoms also support Natrum muriaticum. Chronic constipation and rectal bleeding from a hard stool (Kent 619) are clearly symptoms belonging to Natrum muriaticum, as is rectal bleeding during any kind of stool. K.A. loves salt and is extremely thirsty. There is also a desire for fish. She has a fear of high places.

With all of these symptoms, how could there be any hesitation in giving Natrum muriaticum? The hesitation comes from the few little details that just don't fit. When this happens, I always evaluate these points to see if there is a remedy that fits the picture better than the remedy I already have in mind. It is always possible that there won't be a better choice, but until I entertain the possibility, I won't know.

The grinding teeth at night is a characteristic symptom (Kent 432) for Tuberculinum, which is a complimentary remedy to Natrum muriaticum. This symptom can be explained by presuming that she will need Tuberculinum after Natrum muriaticum -- unless, of course, I find a remedy that has all of these classic Natrum muriaticum symptoms and grinding of teeth.

The leukoplakia is also not covered by Natrum muriaticum. This is an important symptom because it has been present for so long. Notwithstanding the fact that it resolved after she quite smoking, it is still a significant finding. Despite constant removal by biopsy, she continued to develop more spots, indicating a strong preference for this symptom. It was only after the leukoplakia finally disappeared in 1985, that her rectal hemorrhage appeared three years later. We must pay attention to this symptom.

The only Repertory reference to leukoplakia lists Kali muriaticum, an addition from Voisin. Kent lists it as "discoloration, white spots in the mouth" (page 400) with Salicylic acid and additions of Mercurius, Phosphorus, Sulphur and Carcinosinum. There is another rubric that caught my attention which refers to leukoplakia. In the original Kent (page 398), he describes "blotches under the tongue, like vegetable growths." This is certainly a very apt way to describe the plaques of leukoplakia. There is only one remedy and it is an interesting one: Ambra grisea.

Let's think about Ambra grisea in relation to K.A.'s other symptoms. First and foremost, Ambra grisea is noted for rectal hemorrhage during stool (Kent 619). Interesting is its absence from the rubric for bleeding after stool. Ambra grisea bleeds during, but not after stool, and K.A.'s rectal hemorrhage always had exactly this distinction. Boericke mentions the symptom "rectal inflammation, proctitis" (788), which coincides with her allopathic diagnosis.

What about the mental and emotional state of Ambra grisea? A key feature is the etiology. Predisposing factors are overwork, domestic cares, grief, business failure or the shock of bad news. These causations are shared by many remedies, including Natrum muriaticum. There is, however, one etiology which is very specific for Ambra grisea -- the loss of relatives, specifically "the deaths of one after another in the family." This certainly applied to K.A. Between 1985 and 1990, she lost her mother, father and son.

The temperament of Ambra grisea also fits this lady. Phatak gives an excellent description backed up by rubrics from Kent, which matches her on so many points. He speaks of the dread of people with a desire to be alone (Kent 12). There is a marked timidity and shyness (Kent 89). Clarke says she has an embarrassed manner in society." Although K.A. didn't have the symptom, Ambra grisea is so bashful she cannot urinate, pass stool, or vomit with anyone in the next room. George Vithoulkas adds that Ambra grisea will reproach herself most severely. These characteristics do sound like K.A. One mental symptom that doesn't fit is her tendency to hold grudges. That takes us right back to Natrum muriaticum.

What about her teeth grinding? Ambra grisea isn't listed in Kent for this under"Grinding." We will, however, find Ambra grisea in a nearby rubric: "Clinch, constant inclination to" (Kent 431).

With strong reasons for each of the contestant remedies, how do we make the choice for K.A.? I chose Ambra grisea for the following reasons. I concluded that she had probably been in this state since she was a child -- a sensitive, shy and timid child. The first physical evidence I had of Ambra grisea is the blood with stool during her college years. This was followed by leukoplakia, which started when she was about 22. Leukoplakia was her predominant physical symptom for many years, and all through her marriage.

Throughout marriage she was timid, not standing up for herself, but rather tolerating an abusive and difficult relationship. When she finally did divorce, her brief reprieve was marred by the advent of the mental illness of her son, for which she blamed herself. She never remarried and stated that she never would. This portion of her story looked very much more like Natrum muriaticum than Ambra grisea until recalling that at the time of her divorce, when her son became ill, she began another relationship which lasted 10 years. Although they were not legally married, all other aspects of this intimate and close relationship qualified emotionally as a marriage. So, in effect, she did "remarry," and it was very soon after her divorce. I doubt Natrum muriaticum would have accepted such a loving relationship so soon.

Finally, her rectal inflammation started during the series of family deaths commencing with her mother, with whom she had a life-long closeness. The etiology of the death of a relative here was more timely than the love disappointment which occurred 10 years earlier and did not precipitate any rectal problems. Natrum muriaticum is more suited to the demise of a love relationship. If she needed that remedy, I would have expected a significant increase in her problems after the decline of her marriage and her divorce. This did not occur. Rather, she demonstrated continuing leukoplakia and, some years later, a reaction to the death of her family members. This tipped the scale towards Ambra grisea.

We often over-prescribe Natrum muriaticum as if by a knee-jerk reaction whenever we hear of a grief in the history. We must be cautious and evaluate the entire case and pay attention to details. Not every grief is an etiology, and not every patient becomes Natrum muriaticum as a result of grief. There are dozens of remedies for ailments after grief, and each has its own particular niche. For Ambra grisea, that unique circumstance is many family deaths in a short period of time.

Prescription: Ambra grisea 200c.

FOLLOW-UPS

One month

Immediately after the remedy, K.A.'s bowel movements became normal. She had not had a normal bowel movement since 1988, and certainly not without any daily medications. She notices her sleep is more peaceful and she needs less of it.

Even though she hadn't complained of any sleep disturbance, once the remedy allowed her a more restful sleep, she could tell by comparison that her previous sleep hadn't been the best.

Her overall energy is markedly increased. She wakes earlier and with more pep. Her interest in sex has returned to normal.

It would have been easy to assume that her lowered sex interest was a result of menopause, but here we see that even 5 years after menopause, without hormone replacement, she has a normal sex desire.

K.A. also reports feeling mentally stronger, more assertive and not as "up tight" and has been laughing a lot more. She says she feels so much better about herself.

I notice much less tension and a more "alive" woman with happiness radiating from her face.

The other significant development is that she met a man and has started seeing him on a regular basis. She says, smiling, that he makes her so happy. Recall that she had not had any male friendships since the death of her son in 1990.

Three months

Since the last visit she has had several episodes of a trace of blood on the stool. In the past this was always accompanied by bloating and cramps, but now she has no other symptoms.

K.A. is doing many more things, accepting more social invitations and says she has returned to "the main stream of life." She is more motivated to get projects done and procrastinates far less than ever before.

She is beginning to feel unsure about her new man friend. He is showing characteristics of being over-bearing and inconsiderate. He is just"too much." She's thinking maybe he isn't really right for her after all. Her sleep was much improved until her friend began spending the night. Now she has disturbed sleep because he wakes so often and causes her to wake. Another problem is that she can't go to the bathroom when he is in the house.

Comment: Here we see the classic Ambra grisea symptom (Kent 12) that appeared missing in the original case. She probably had the symptom, but it was so natural for her to avoid public restrooms that she wasn't even aware of it. It wasn't until someone else was so often in her house that she became aware that she reacted in this way.

We see her reproducing the same kind of relationship that she had in the past and left unresolved, namely, one with a strong, domineering partner who overpowers her. Let's see if the remedy will assist her this time to handle the situation differently.

Four months

K.A.'s concerns about her relationship are changing. For the first time, she has been able to express her desires and opinions openly without fear. She has been talking to her partner and it has definitely improved the relationship. Even her sister noticed the changes in her and in the relationship. Her energy is still fantastic, and she is involved in a lot of activities.

The rectal symptoms are slightly worse. She has noticed slightly more blood, and it occurs with every stool. The good news is that she has no pains, cramps, bloating, flatus or constipation. Overall, her rectum is still very much improved.

Comment: It was tempting at this point to repeat her remedy because of the return of blood during stool. I decided to wait because everything else about her was still better. Especially pleasing was the way she was handling her relationship. It was also important to remember that K.A. had years of cortisone enemas, so it was not unexpected that she would have a return of suppressed symptoms as part of the correct action of her remedy.

Six months

K.A. reports that she has broken up with her male friend. Despite the improved communication, there were still some incompatibilities. She is proud of the fact that she was able to take this action, which in the past would have been impossible. She is sad that it didn't work out, but happy that she didn't stay in a relationship that wasn't working. He has been persistent in attempting to get her back, but she has remained firm in her decision. After the break up she got a fever and headache that lasted several days.

Her stool continues to contain blood each time. Since the break up she has noticed some cramps and bloating.

Comment: It took so much energy from her to face the kind of difficult situation that has plagued her whole life -- standing up to domineering people -- that she used up the energy of her remedy. The decision to wait at the previous visit was validated by the fact that she was able to stand up to her male friend by herself. With the return of abdominal symptoms and her rectal bleeding, it was time to repeat Ambra grisea 200c.

Eleven months

The last dose completely eliminated all the rectal complaints again. She continues to feel very good with high energy and activity. She has enrolled to take a trip to Holland by herself to join a tour group conducting a bicycle trip through the country.

Several months after the six-monthvisit she decided to have another revision of her breast implants, replacing her silicon with soy oil prostheses. I discouraged her from doing this because it would interrupt her homeopathic treatment and most certainly result in the return of her rectal problems and possibly a relapse of her emotional symptoms. The surgery was not being considered because there was anything wrong with her implants. It was an elective procedure, part of a voluntary clinical study of soy oil versus silicon implants. There was no real probability of any benefit to her. After considering all the factors, including my warnings, she decided to have the surgery. She also had dermabrasion at the same time.

One week before leaving on her Holland trip (two months after surgery), all her symptoms came back with a vengeance. She was having bloody stools, constipation, bloating, flatus and abdominal pain. In addition, she was severely depressed and couldn't find the energy to even leave the house.

During her visit to assess these problems, she reported that she was not happy at all with the results of her new implants. Since the dermabrasion her face has been very red with flushing. She went to a dermatologist who diagnosed rosacea and gave her a cortisone ointment which also contained antibiotics. K.A. used this for several weeks without result.

I strongly advised K.A. to stop all topical medications and explained the reasons why. Her skin, which did not have this redness before, had it now as a result of the dermabrasion and needed time to heal properly. The breast surgery and dermabrasion were both certainly enough to stop the action of her remedy, as it appeared they had done. As a result of this relapse, she was terribly anxious about her upcoming trip to Holland. This was just the kind of reaction she would have had months ago before homeopathic treatment.

How did it happen that she had the breast surgery knowing the problems it would cause her? Since she never had a skin problem, how did the dermabrasion fit into the equation? Why did she take the advice of the allopaths instead of her homeopath? We know she had a lifelong difficulty standing up for herself in relationships with domineering people. She was very successful at overcoming the recent one with her male friend. Maybe she wasn't as adept at standing up for herself as it seemed. Who might have been more domineering, a surgeon or a homeopath? In this case, the results gave us the answer. She was overwhelmed by the dominance of the surgeon who needed volunteers for his study.

I am not domineering to my patients and never would have demanded she take the direction I thought best. I only outline the risks and benefits as I see them. I am sure that the surgeon didn't overtly browbeat her; however, the trappings of the dominant allopathic world and a surgeon's natural authoritative demeanor were enough to tip the scales.

Unfortunately, K.A. was left with breast implants she hated, a red and damaged face and a ticket to a dream vacation that she came to think of as a nightmare.

I gave her another dose and Ambra grisea 200c and sent her on her way to the airport for her trip to Holland.

Thirteen months

K.A. is back from her trip. She did have a good time and was exceedingly pleased that she was able to keep up with many of the more experienced cyclists. Unfortunately, the remedy didn't have any effect. She continues to have one bloody stool each day accompanied with flatus. She does not have any pain or cramping.

She has continued to be depressed and her energy is very low. She is concerned about her red face and wonders what can be done about it.

When she returned from her trip, she had a mole surgically removed from her right calf. It was not causing any symptoms, she just decided that she wanted it removed.

Comment: The last dose of Ambra grisea was the third dose of 200c, and it didn't improve her condition. Although mole removal interferes with remedy action, the lack of action was already apparent and cannot be laid at the door of the surgeon this time. Once again, the critical importance of not treating anything with conventional means, be it surgery or medication is emphasized. I administered a dose of Ambra grisea 1M.

Fourteen months

By phone she tells me that her most recent dose has helped and she is feeling better. Her rectal problems have resolved. She is emotionally better. She has started to do volunteer work for a local veterans hospital. She has not had the need to visit my office again in the five months since her last visit.

Case J.Y.

May 1994

J.Y. is a 35 year-old man whose chief complaint is shortness of breath. He has always had some disturbance in his breathing, such as slight dyspnea, mild chest oppression and an awareness of his breathing. In the last several years, especially the last two months, he has been experiencing more severe symptoms. Now he has a tightness in his chest which limits his respiration and is aggravated when he takes a deep breath. Once the dyspnea starts, he feels panic overtake him, which makes his breathing even worse. At these times he has the thoughts, "Can I breathe? Will I be able to keep breathing? What if my breathing stops?" Occasionally he will begin to hyperventilate.

Aggravating factors are reading, relaxing or generally being idle. The dyspnea is also aggravated when he encounters the unknown, something unexpected or tries something new. He is better with a structured, predictable environment or in family surroundings. He is also relieved with exercise or any form of occupation. He already does meditation and other relaxing techniques, but they haven't solved his problem.

He reports being under a lot of stress at his job. He is the co-owner with his father in a manufacturing company. He got involved with this business after college. He really likes the business aspect of his job, the interactions with people, deal making and problem solving.

The decline in his enjoyment of work started about two years ago coincident with a downturn in the economy. Over the last 6-8 months, there have been many reversals in his business adding to his unhappiness. J.Y. is mentally exhausted and overwhelmed by the problems at work.

His business is a heavily regulated industry, even more so since he and his father started the business. The government regulations and bureaucracy take all the fun out of what he is doing. In fact, he feels "suffocated" by the bureaucracy. He takes all the government regulations and requirements seriously. Any fault of the company he takes personally and tries to rectify it immediately. He wants to abide by the rules and do what is right.

He became "enmeshed" in the family business and now feels a responsibility to continue to work very hard to keep it successful. J.Y. is a very responsible man and takes his duties seriously. What started out enjoyable now has him feeling trapped. With all the problems that have occurred, he doesn't feel he can leave. He doesn't know what else he would do to support his family. There is a great deal of pressure to stay and carry on the family name. He just doesn't see a way out.

The most important thing in J.Y.'s life is his family. He feels a very strong sense of duty to his family. J.Y. describes himself as a cynical person who has lost his idealism as he has gotten older. He is not as happy now that he has realized that he has no control over his world. He has planned things for his future and security, but they haven't turned out the way he expected, and now he feels vulnerable. As a result of his company's problems he is nervous that his personal financial future is at risk. Whether it is actually true or not, he is worried that he could lose everything. He is in anguish over the thought that he may have let his family down or exposed his family to hardship and difficulties.

As has been true of many companies, there had been a decline in business for several years. One specific incident, however, stands out as being the most unnerving. At the end of 1993 there was an industrial accident involving some of the materials that his company had br okered for another company. His company never saw, handled or inspected the materials. They just linked up a seller and buyer. Despite their peripheral involvement with the materials, the government included them in the open-ended damage assessment for the problem. He is most upset because here was an incident in which he had done everything "right," yet was being accused and penalized for a problem another had caused. This violates his sense of fairness, equity and honor. To add insult to injury, his company is also liable for any future problems that may arise from this initial difficulty. In other words, there is no closure. Anything could happen later on that would result in further penalties and wipe out all that he has worked for. In addition to the gross unfairness, he is literally "worried sick" about his future.

Other problems include a nervous cough which is worse when he thinks about it. He often has rhinorrhea.

Temperature: warm.

Time Modality: worse 8-9 p.m.

Food Desires: spicy(2),ice cream(2),pasta(2),chocolate(1), fish, sweets, salt, cold milk(3), eggs(3).

Food Aversions: meat, nuts, sour.

Food Aggravations: lentils, carrots, cabbage, all nuts all produce hives

Thirst: high, 7-8 glasses of cool water a day.

Sex: moderate to high drive.

Fears: mice, heights, cancer, heart problems(2), health(2), speaking in groups.

Sleep: usually very good, until recently. Position: on his back. Now wakens at 1-2 a.m. thinking about work.

Hobbies: golf, biking, walking, reading, talking with people.

Family: He has good memories of childhood. His mother was in business with his father. His father has always been involved with the business world. He played a lot of sports in school.

Character: J.Y. is a private, reserved man who is not gregarious. He prefers the company of his family and enjoys spending time doing activities with his wife and two daughters. He is an organized person and likes structure, predictability and consistency. He is extremely loyal as a friend and in business. He demonstrates his innate trust of people and the world by holding the fundamental attitude that "you will be rewarded by being good."

Discussion

J.Y. is a reserved, conscientious man who takes his work seriously and loves his family. He believes in goodness and the idea that there is a right and wrong. A quick glance reminds us of a Kali carbonicum person who has these strong ideas of structure and defined roles. Let's look more closely at the case and see what we can perceive about J.Y.'s situation.

J.Y. has had minor breathing difficulties his whole life, but in the last several months he has noticed a dramatic increase in the severity and frequency of his episodes of dyspnea. These problems began accelerating after the 1993 problem with the industrial accident. Being the fair-minded man he is, this incident affected him in many ways. It offended his sense of fair play, compromised the workings of his business and thereby threatened his family and security. It was an unexpected event which is just the kind of situation to which he is extremely sensitive. It brought to his life numerous cares and worries that didn't exist before. We need a remedy that treats the results of excessive worry from unexpected events, especially when they affect a business or family.

Now let's examine the way he responds to this etiology. What symptoms does he produce as a result of being sensitive to this kind of problem? He has always had some slight dyspnea indicating a ness of his respiratory function. Therefore, it is not weak-surprising that his breathing is most affected when he is placed under strain. We see anxious dyspnea with chest oppression and a feeling of suffocation. These symptoms have been brought on by an overall situation of anxiety and fear. The episodes occur randomly ???

???

??? restful. He dreams about people from his past and the relationships he has with them. J.Y.'s energy is much better. He is able to stay awake longer and accomplish more during the day.

He had 6-7 days without any breathing problems at all. In fact, he completely forgot about his respiration altogether. Previously, he had been experiencing disturbing difficulties everyday.

His breathing is much improved. He still has slight dyspnea, but it is much less intense and he is far less anxious when he does have the sensations. He is coughing less.

There were several episodes of sharp knee pain which reminded him of a knee injury he had many years ago. He had not had any knee problems for years.

Most pleasing is the improvement in J.Y.'s mood. He is more relaxed. His despair is gone. He no longer feels hopeless with a need to escape from life. He is not taking things so seriously; he can relax and handle events as they come. The dread to go to work that occupied his entire morning is now gone. He enjoys going to work again. He has decided to hire an assistant to help him at work so he can have more time to enjoy his life. He is laughing more.

He is seeking out old friends to rekindle the relationships. Just as his dreams indicate, he has a growing sense of value for all his friends, old and new. He wants to be around people more, to engender a sense of "belonging." Interesting is that his best friend just announced that he is moving away and J.Y. says that he is exceptionally sad about this, more so than he might have been in the past.

Comment: J.Y. is greatly improved and no change is needed in his treatment.

Three months

Overall J.Y. has continued to feel very well in all respects. There were several episodes of dyspnea as he had in the past, but he recovered from them quickly and was not as anxious about them. The majority of the time he has felt just fabulous.

The problems that have resulted from the industrial accident two years ago are on going, but they don't bother him nearly to the degree they did in the past. He is now able to express his opinions and ideas more freely without fear. He realizes that he is just not responsible for the whole world.

His grandfather died, but he reports that although he was sad at the time, it was appropriate for the occasion. He doesn't feel overwhelmed by the event, nor does he notice any deterioration in his health as a result.

Comment: J.Y. showed continued improvement. It was interesting that the death of a family member, which was a particularly sensitive event for Ambra grisea, was handled in a healthy way without aggravating any symptoms.

Five months

J.Y. had a syncopal episode a few days before, necessitating this visit. He was in a book store and had wandered into the medical/self-help section. He had purposely chosen a book about breathing problems. As he was reading about all the diseases that could produce shortness of breath, he started to get very scared. The more he read, the more scared he got. He began to wonder if there really was some undiagnosed, horrible disease lurking inside of him that was getting worse and worse as he stood by not doing anything about it. His breathing began to accelerate as he got more and more frightened. He could feel the panic to the point of real terror overtake him. He was terrified that he was going to die. A real and overwhelming feeling of imminent death overcame him. He was paralyzed with this fear that his life was threatened. He fainted. The paramedics were called and by the time they had arrived, he had recovered consciousness. He was taken to the emergency room for evaluation. All his tests, including EKG were normal, and he was diagnosed with a syncopal episode.

Although the event was several days before the visit, J.Y. still has a constant sense of danger and anxiety about his health. He is extremely worried that he might not be doing the right thing by doing homeopathy and not having a conventional full work-up with tests, X-rays and cardiograms to make sure nothing is going on that I had missed.

Comment: This event brought up a new aspect to J.Y.: an anxiety about his health. As the worries about his work and financial future resolved, this deep-seated concern for his health grew. Look at the reaction he had from reading about breathing problems. He had a full blown panic attack that resulted in fainting. "Generalities; FAINTNESS; fright, after" (Kent 1360), "Mind; UNCONSCIOUSNESS; emotion, after" (Kent 90) and "Mind; FEAR; death" (Kent 44) all addressed his current circumstance. The most telling part of the story he related was the profound sense of imminent death which is not adequately described by the main rubric fear of death. We know that this sensation is particular for Aconitum. Aconitum is in bold type in each of the other two rubrics. Aconitum is present in "Mind; ANXIETY; health" (Kent 7).

Prescription: Aconitum 200c.

Eight months

J.Y. felt better after the Aconitum and stayed that way for many weeks. He had no further fainting episodes. He did have continued concern about his health, but was more easily reassured.

Recently, however, he has been experiencing a return of his dyspnea. He has periods of feeling uncomfortable. He has noticed his sleep isn't quite as good as it had been. He is still very much better than he was initially, but not as well as he was after the initial dose of Ambra grisea.

He is more frustrated at work because he doesn't see that he is getting the kind of personal reward and satisfaction that he would like considering all the work he does. He is thinking about a change.

He has begun an exercise program. He works out every day during lunch at a local gym. He really loves it and has noticed a great improvement in his stamina even in the few weeks he has been doing this.

Comment: It appeared J.Y. was going back to his Ambra grisea state with the return of some of his original symptoms: dyspnea, sleep disturbance, and discontentment at work. The Aconitum was a necessary remedy for the situation at the time, and now J.Y. was returning to his previous state.

Pescription: Ambra grisea 1M

Ten months

After the last dose of Ambra grisea, J.Y. felt better; however, the improvement wasn't as great or long-lasting as his original dose. He is less anxious but still concerned about his health. His breathing is better, but not completely problem free. His sleep is fine most nights, but there are still those annoying nights when he doesn't sleep restfully. He states that his breathing problem is only 30% as bad as it was. He can go periods of time without thinking about it, but it comes back eventually.

J.Y. feels lethargic and without motivation to do much. He still enjoys his noon time exercise, but the rest of his life seems empty and uninteresting. The only enjoyment he gets is with his family. He doesn't have the same anxiety and disappointments that he had at the beginning when he was so overwhelmed by his work situation.

Comment: J.Y. displays apathy with anxiety about his health. The last dose of Ambra grisea helped, but it doesn't appear that it was strong enough to clear all his symptoms as it did in the past. This situation calls for an increased dose. Usually a patient needs an increased dose only after several doses at the same potency. Here his second dose of Ambra grisea 1M didn't appear strong enough. This makes me suspicious that he may need a different remedy, and I will consider that if the increased strength doesn't give an excellent result.

Prescription: Ambra grisea 10M.

Eleven-thirteen months

J.Y. has not experienced any improvement with the Ambra grisea 10M. He still has anxiety about his health and its effect on his ability to function. He has disturbed sleep and fatigue the next day. There are no new symptoms to add to what he has reported in the past. Over these months Calcarea carbonica 1M and Kali carbonica 200 were tried without success. Other considerations were Arsenicum, Phosphorus and Moschus, but there wasn't enough reason to try them. Review of the original case for foods, generalities and other points contributed to these choices.

Fifteen months

J.Y. has developed a new symptom which was extremely concerning. He noticed skin lesions on his arms and legs. They are circular, crusty lesions measuring one inch in diameter. Initially he had three, one on each arm and one behind his left knee. The lesions are moderately itchy. He has never had anything like this rash before, or any other skin problems.

His breathing has still been difficult with episodes of distress. He wakes each night at 1 a.m. and goes back to sleep at 2 a.m. He is very worried about his health, and what these skin eruptions can mean. His work does not bother him at all now. He is only worried about his health.

Comment: With this new symptom, a more clear picture emerges. He is inconsolably anxious, especially about his health, and wakes at 1 a.m. He has skin eruptions with his dyspnea, for which we use the rubric: "Respiration; ASTHMA; eruptions, suppressed" (Kent 765).

Prescription: Arsenicum 200.

Fifteen months and two weeks

Immediately after the Arsenicum 200, he noticed his breathing improve. He is sleeping much better, without disturbance and wakes refreshed. His mood is great and he has far less anxiety than before.

His rash, however, has grown considerably. He now has 16-25 spots ranging from a dime to a quarter in size, and more appear each week. They itch much more than before.

Comment: Here the rubric: "Respiration; ASTHMA; eruptions, suppressed" (Kent 765) is confirmed by the observation that as his rash is getting worse, his breathing is getting better. Despite the increase of this unsightly and irritating rash, he is not nearly as anxious about it as he expected himself to be. He is clearly improving. We must wait and allow the remedy to continue to expel his rash.

Sixteen months

Just over the last few days, J.Y. has noticed that his breathing is declining again. He has some increased dyspnea. For the first time since the Arsenicum 200, he has had a few nights of disturbed sleep. Also for the first time since the remedy, no new eruptions have occurred. He remains calmer than he can remember in a long time.

Comment: As the eruptions stopped growing, so did his improvement. It was time for another dose of Arsenicum 200. Although it was only one month since the last dose, he displayed the symptom pattern necessary for repeating this early: clear amelioration from the remedy and then return of the same symptoms.

During this visit, I inquired whether he was certain that he had never had any skin problems before. No, he stated, he had never had skin problems. Then he recalled an episode of chickenpox in May 1991, at the age of 32. He described the episode as severe with pustules everywhere on his body. They were inside his nose, mouth, eyelids and ears. He was extremely ill with high fevers and delirium. Then in a moment of revelation, he recalled that his breathing problems became much worse after the chickenpox. Here we have the imprint of the Arsenicum layer!

The suppressed eruptions were the chickenpox. Suppressed doesn't necessarily mean active treatment with medications. It also means eruptions that go away on their own, but without improvement in the health of the person. His severe episode of chickenpox went deeply into him causing anxiety and dyspnea. Only after the eruptions came back did he remember the fact that his dyspnea began after the chickenpox. When he needed Ambra grisea, he recalled that the dyspnea had worsened after the industrial accident. The remedy state of the person is reflected in his memory, recall and the importance he places on events. When we have a return of old symptoms, we also have a return of old memories and ideas.

Prescription: Arsenicum album 200

Eighteen months

J.Y.'s eruptions began returning after the repetition of the Arsenicum 200. His breathing and sleep improved immediately. After several weeks, his rash began to fade without any deterioration in his other symptoms. He has remained very well during the entire two months. He is much less anxious, his breathing is good and without problems, and he sleeps well without disturbance. Now, his skin is almost perfectly clear. This brings us up to the current date.

What is the next step for J.Y.? We have to wait for him and his symptoms to let us know.

General Discussion

I have presented two cases of Ambra grisea to demonstrate the versatility of this fascinating remedy. Chronic conditions as well as situational problems can be addressed with Ambra grisea. We should think of this remedy when there are conditions of overwork, worries about business or home, business failure or money problems. Most characteristic is the etiology of the death of a relative or several relatives in a short period of time. Ambra grisea has a special relationship with family. They are very attached to their family to the exclusion of outsiders. Their attention is focused inside their clan, not on the world at large. This is the reason that the death of a family member is such a devastating event for Ambra grisea.

They do not like strangers, which means anyone not in their immediate family. Now we can understand why they are so timid, shy and reserved. They don't want interaction outside their family circle. Other symptoms known for Ambra grisea help define this quality more thoroughly. Ambra grisea has symptoms such as anxiety, restlessness, and even fainting from speaking, after conversation, or in company. Kent has many rubrics detailing the aggravation Ambra grisea has from conversation. They just don't like the social life. Kent lists Ambra grisea as the only remedy that has an aversion to smiling faces (page 12).

Many of us are familiar with the keynote feature of Ambra grisea -- they won't pass a stool if there is anyone in the next room. This also applies to urination and vomiting. They won't use a public restroom or even use their own toilet if there are other people in the house. This is a marked shyness around strangers.

Ambra grisea is a very sensitive person, as we saw in both of my examples. What was missing in each of these cases was the characteristic feature of sensitivity to music which is so common in Ambra grisea. He will weep from music, it affects him so profoundly.

Ambra grisea often is indicated in old age, with weak memory, forgetfulness and dullness.

There are a variety of physical symptoms that indicate Ambra grisea. My examples have demonstrated proctitis and dyspnea. I refer you to any of the excellent materiae medicae already in existence for further study of its physical effects.

I am sure Ambra grisea is often overlooked, other more familiar remedies taking the place rightly belonging to it. We must keep Ambra grisea in the back of our mind. There are so many conditions of modern living that fall into the category of Ambra grisea's etiologies that we should all have several interesting cases of this remedy.

American Institute of Homeopathy.

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By Linda Johnston

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