Importance of correct sequence of prescribing in the path of cure- a case of Hidradenitis suppurativa. A 30 yr old woman presented 2 yrs ago in our clinic with a h/o recurrent abscesses in the axillary area off and on for 10 yrs, abscess alternating both sides.Present Condition: Abscess in the right axilla 2.5 cm in diameter extremely red and tender, no h/o fever, unable to even move the arm due to intense pain and stiffness. IOur client was on antibiotics like amoxicillin and potassium clavulanate, along with anti-inflammatory analgesics for the past 10 days. Our client had no relief from the above treatment. She had a similar complaint 3 months ago when she had to go for surgical excision.Personal History: Patient had severe Acne over the face with large boils and eruptions, she also had the tendency to cold and cough since childhood with nose block and snoring, no h/o wheezingFamily History: Father 64 yrs old with diabetes mellitusMother 60 yrs old with hypertensionShe is the only child with no siblings.The patient is married and lives in Mumbai and has 1 daughter 5 yrs old.Personal history- Loves sweets, aversion to brinjals, patient has chronic constipation with deficient urging, and hard stool. The patient is ambi thermal towards chilly.M/H-Menarche at 11yrs old. menses had been irregular for 1 yr, have regularized in the past 3 months.Mental state – Patient was brought up in a conservative family with a strict and dominating father. The patient was very afraid of him and would not speak up in his presence. She is very timid and finds it difficult to express herself. She is married to an equally dominating and short-tempered man. Earlier used to cry but now gets angry, tries but is unable to retaliate. She feels better when alone and says she has become very irritable and short-tempered these days.Case was repertorised using the following rubrics:anger ailments from, agg-suppressedemotions, anger, vexationsdomination by others aggconstipation chronicabscess general, suppuration, recurrentskin, boils, recurrent tendencydesire for sweets
After repertorisation, the remedies that were coming up were lyco, staph, tub, ignatia and natrum mur.
In view of the suppressed anger and emotions, generals and craving for sweets, lycopodium 1M-4pills dry on tongue, given as a single dose.
Patient-reported for follow up after a week. The abscess had burst and drained within 6hrs of the first dose, Patient generally feels better. The patient was kept on SL.
Follow up after 3 months:
Our client was doing better in general
2 episodes of boils in the axilla, smaller than before and subsided without antibiotics. Tuberculinum 200C was given and the patient was asked to report after 3 months.
At the end of 3 months, patient-reported absolutely better, no episode of boils and abscesses, constipation also better. No medication needed.
The patient came back after 1 and 1/2yr with a new complaint, recurrent sty in both eyes, Present c/o a big supported sty on the right upper eyelid. The patient is in a very agitated state, husband is facing a career crisis and has become more angry and repulsive than before. The patient has now a 2nd infant daughter to look after, she is unable to express her anger out of fear but shows it to her older daughter and beats her off and on. The patient expresses that she has never been so violent before and feels bad about it. Staph 30C given for 3 consecutive days-the styes burst and drains on its own within a week, and has not recurred since.
Evolution of the case.
The first prescription had to be Lycopodium, as it covered the case in totality that of suppressed anger resulting from fear of dominating father, the nature of the abscess, and generalities.
Lycopodium took away the first layer of the suppressed constitution yet the miasmatic influence was persistent, Tuberculinum not only removed the constitutional block, but it was also one of the leading indicated remedies for her condition.
Both Lyco and Tub had almost wrapped up the case. The maintaining cause that of unexpressed anger against a tyrannical husband caused an exacerbation of her predisposition, that of tendency to boil and abscesses, resulting in stye. Now staph was the correct prescription as it removed the final layer of the impediment to cure.
Conclusion: This case is a perfect example of Prof. Vithoulkas’ theory; remedies need to be given in a correct sequence to unravel the real constitution, where the accurate similimum chosen last will complete the cure.