I conducted an Anamnesis for Confidential Patient. I thoroughly observed and questioned the patient, as well as listened to any additional information and clues he offered. I recorded the following in his patient file:
Name: Confidential Patient
Age: 42 Weight: 169 Height: 5’9” Ideal weight: approx. 150
Physical: itchy anus, bleeding, irritation and fissures from scratching, internal hemorrhoids
(has had condition for 10-15 yrs), distended abdomen, carvings for alcohol as well as adverse reactions to it
Emotional: zero patience in dealing with our kids, easily angered, moody
Yellow/Jaundice as baby, drug and alcohol addiction, remembers skin being itchy as a kid, suffered from MRSA in knee, surgery on knee to clean out infection
Liver Issues: As indicated by anger and pain in back/under shoulder on right side
Kidney Issues: possible as indicated by black circles around eyes
Digestive: gas, bloated stomach, hemorrhoids
Nerve: agitation, anxiety, stress, anger, frustration, at times depression and fear
Skin: severe anal itching
General: silver fillings, possible hypoglycemia as indicated by irritability when not eating within certain period of time, craves sweets,
Observations: outer eyebrows missing–indicating thyroid weakness/deficiency, blood pressure and pulse normal, I determined this patient’s ailments were chronic
My Research Findings for this Patient:
Constitutional Type: Carbonic Type
The morphology of the Carbonic Type mostly closely matched the characteristics of this patient.
Guiding factors include accumulation of fat around the abdomen, impaired thyroid function and water retention. The physiology of the hand of the Carbonic Type; large, stubby with short strong bones and square fingers and nails was a very good match for this patient. The mentality of the sick calcarea carbonic type includes depression, fits of anger, irritation and mood swings. This too matched the symptoms of this patient. I also noted similarities in the Baryta carbonic Type. Its pathogenesis included hemorrhoids, weak thyroid gland and the tendency toward becoming an alcoholic.
To create a magistral for this patient I began by first addressing the underlying issues with his digestive system and liver. I prescribed a draining complex for the first week to begin detoxifying. I also chose Bryonia and Nux Vomica as the first two remedies in my magistral. I chose these two because they are polychrests and in addition to their draining qualities, the emotional identifiers were a match. Bryonia for marked irritability, and Nux Vomica for those who seek stimulants and alcohol in excess. The third remedy I chose for the magistral was Calcarea carbonica for his Constitutional Type. The provings for this remedy in addition to the emotional included physical aspects such as distended abdomen, craving for sweets and hemorrhoids. I then began to look more closely at what was causing the patient the greatest physical discomfort. The itching of the anus was causing him the most distress so I chose Argentum nitricum as the next remedy. The fourth remedy not only addresses the itching of the anus but also the patient’s craving for sweets, distention of abdomen, gas and emotional aspects such as anger, fear and impulsiveness. The fifth remedy was aimed at more specific symptoms. Arsenicum album is a deep acting remedy and said to be helpful in all chronic situations. Its clinical indications included many symptoms of this patient such as irritability, fear, hemorrhoids and excoriated skin around anus. Arsenicum album is also a polycrest for itchy skin. I chose Lycopodium as the 6th remedy due to its provings for little things annoy, bloated abdomen and hemorrhoids. Next, I added Silicea as my 7th remedy using the provings intolerance of alcoholic stimulants, bloated abdomen, anal fissures and hemorrhoids as a guide. The 8th remedy I chose was Sulphur because its action has an elective affinity for the skin. Other provings included irritability, itching and burning of anus and hemorrhoids. That completed the capsule/powder form of my magistral. I also added these remedies to my liquid formulation. It included Baryta carbonica, Aloe sucotrina, Cina, Lachesis and Staphysagria. I chose Baryta carbonica because its pathogenesis included hemorrhoids, weak thyroid gland and the tendency toward becoming an alcoholic. The rectal symptoms determined the choice for Aloe socotrina as they were an excellent match, especially the sense of insecurity in rectum, when passing flatus–uncertain whether gas or stool will come. Cina was a match for irritability of temper, craving for sweets, bloated abdomen and itching of anus. I chose Lachesis because hæmorrhagic tendency is marked for this remedy as well as craving for alcohol. Staphysagria’s provings for marked irritability, lacerated tissues, and hemorrhoids made it seem like a good choice for this patient as well.
The patient began his first week taking 6 drops of Drainer at night and 6 drops of the liquid magistral formulation in the morning on an empty stomach. On the eight day he took the first of the capsules, followed by the liquid magistral. He continued in this way taking the drainer every night, the liquid magistral formulation every morning and a capsule in the morning once a week. In addition, he adjusted his diet to include more green leafy vegetables and less simple carbs and sugar. He stopped drinking regular coffee and anything containing caffeine. He also began taking an isotonic multi-vitamin and mineral supplement. He reported slight improvement each week until week five where he began to notice a more drastic improvement. He continued to notice marked improvement until week seven where the progress seemed to steady and drop off a bit. Based on the patient’s response Argentum nitricum, Arsenicum album and Lycopodium seemed to produce the most positive effect on his current symptoms.
After the 8 weeks, a follow-up consultation was conducted and the patient reported a shift in some symptoms. The patient reported on an emotional level feeling low, depressed and wanting to withdraw from family. He felt too much noise made him want to leave and get away. On a physical level he felt the itching was less constant, but when he did itch it was not relieved by scratching. He also stated his greatest discomfort was now from cuts and bleeding around the anus.
I used this input to formulate a new magistral. The 8 weeks of capsules were now as follows: Bryonia, Nux vomica, Calcarea flourica (new), Argentum nitricum, Arsenicum album, Lycopodium, Sepia (new) and Ignatia (new). The new liquid magistral also consisted of these eight plus Lachesis (which was in the last formulation) and three new ones; Ledum palustre, Phosphorus and Aesculus.
I chose Calcarea flourica for the mind symptoms it addressed which were great depression and groundless fears and the physical symptoms; gas, fissure of the anus, intensely sore crack near the lower end of the bowel and bleeding hemorrhoids. Sepia was chosen for its provings for indifferent to those loved best, averse to family, gas and itching not relieved by scratching. I chose Ignatia because of its indications for changeable mood, silently brooding, much flatulence, itching and stitching up the rectum. Ledum palustre was chosen primarily for its provings on anal fissures and hemorrhoidal pain. I chose Phosphorus for great susceptibility to external impressions (in this patient’s case to noise), great lowness of spirits, easily vexed and bleeding hemorrhoids. Last, Aesculus was chosen because the action of this drug is most marked on the lower bowel, producing engorged hemorrhoidal veins. For the mind, it addressed being depressed and irritable and the physical covered the anus being raw and sore.
The patient has not completed this magistral yet but has reported that right now he is feeling better and seeing mild to moderate improvements in all areas of complaint. I will re-evaluate after 8 weeks when he has finished taking this magistral. At that time, I will review with him which weeks he felt the greatest improvements, which complaints if any were resolved, and decide if he may need anything in a higher potency and which remedies to repeat again.