Case StudyBronchitis with a feeling of weight in the chest, and a cough with choking and gagging that brings up thick yellow mucus, may respond to this remedy. The cough tends to be dry and tight at night, and loose in the morning. The fever may be worse in the evening and at night. Feeling too warm or being in a stuffy room tends to make the person worse, and open air brings improvement. Thirst is usually low. A person who needs this remedy often is moody and emotional and wants attention and sympathy. (This remedy is often helpful to children who are tearful when not feeling well and want to be held and comforted.)

1. CASE PRESENTATION
SURGERY DEPT

2.  Name : Mrs Sumuna Chakraborty
 Age : 38 yrs
 Gender : Female
 Religion : Hindu
 Marital Status : Married since 8yrs
 Occupation : Solution Engineer
 Address : Hugli, West Bengal
PRELIMINARY DATA

3.  Coryza and cough with breathlessness since 22yrs.
Previously took Hom treatment, had relief but complaints
have aggravated since last 2 yrs. 2 episodes/year
A/F- Hot weather, Dust.
O- Sudden D-Constant P-Increasing
Coryza with sneezing Throat Irritation Cough
with yellow thick expectoration Breathlessness with
wheezing in chest.
Sensation – Choking sensation, feels as if she cannot get
enough breath.
M - < Lying down on back, walking, climbing stairs, warm
room
> Sitting position, open and cold air.
CHIEF COMPLAINTS

4.  Pain in B/L knee joints Lt > Rt since 11 yrs of age
A/F - Warm weather, Humidity
O - Fever
D – Throughout the day
P – Increasing and decreasing occasionally
Sensation – As if bone is breaking.
Pain in lt side of hip radiating to calf, ankle.
Shifting type of pain, swelling in both the knee joints
with stiffness, tingling and numbness.
M < Standing for long time, raising after sitting,
evening, warmth
> Massage, rest, cold air.

5.  Appearance – Fair , average built.
 Appetite – Good, can tolerate hunger.
 Likes – Spicy, salty+, cold water and food.
 Thirst – 4-4.5L per day, prefers cold water.
 Stools – Satisfactory.
 Urine – NS.
 Perspiration – Profuse on face, scalp, N.O, N.S.
 Sleep – Unrefreshing due to night shift, prefers sleeping on left side+.
 Dreams – She is in trouble but no one is helping her (only once)
 Habits – None
 Thermal modality – Hot patient Likes winter season.
Bathing – Summer (cold water), Winter (warm water)
Fanning – Needs AC in summer and rainy season, Fan in winter.
Covering – Not required in any season.
 Cannot wear socks, sensitive to strong odour.
PHYSICAL CHARACTERISTICS

6.  Family History –
Mother – RA since 30 years, breast cancer (2006)
Father – Vertigo, DM since 16 yrs
 Past History –
K/C/O – Rheumatoid Arthrities since 11 yrs of age
H/O – Rheumatic Fever, took allopathic treatment for
5yrs
K/C/O – Bronchitis since 20 yrs
K/C/O – Mitral vulvulities

7.  Gynaec History –
L.M.P – 13 Jan 2020
Duration – 5 days
Cycle – 28-30days
Quantity – First 2 days heavy
Colour – Bright red with clots, N.O, N.S
Complaints (B) – Pain in lumbar region
Leucorrhoea – White, watery, N.O, N.S
 Obs History –
G1 P1 A0 L1
7 yrs male child - FTND

8.  Stays with her parents, husband and son. Working in
night shifts since 1yr. Loquacious, want to interact with
people, takes first initiative for conversation. Due to
complaints, she feels she has become lazy and lost
enthusiasm. When her in laws and husband complain
about this, she used to get angry and start shouting
on her husband. She says they think I am lazy but they
don’t understand my pain but now she has become
used to it and she just ignore them and what she
wants. Indifferent She says ‘now things doesn’t
bother me and I am a strong women and I don’t hold
grudges’. Discontentment feeling with husband. She
is not happy with husband, has no understanding with
him.
MENTAL CHARACTERISTICS

9.  General examinaion
Pulse-76/min BP- 110/85mm Hg
RR- 19/min temp- Afebrile
Pallor+ tongue- clear
Wt- 81kgs
Palms and soles hot to touch
 Systemic examinaion
Lumbar – Sacroiliac Knee Examination
Lt Rt Lt Rt
SLR -- -- Flexion Painful --
FO4 -- -- Extension Painful --
Crepitus + --
RS – AEBE clear

10.  Investigations
HB – 7.9mg/dl
RBC – 4.1 millions/mcl
WBC – 13000/ul
Rheumatoid factor – 35 IU/ml
CRP – 1.8mg/ml
ESR – 30mm/H
Xray Knee – Mild marginal erosion seen
 Investigations can be done
For RA – Anti CCP antibody test, Synovial Biopsy,
Synovial fluid examination.
For Bronchitis – Chest Xray, sputum examination, HRCT,
PFT, spirometry.

11. PROVISIONAL DIAGNOSIS
RHEUMATOID
ARTHRITIS BRONCHITIS ANAEMIA

12.  It is a chronic inflammatory auto immune disorder
which affects multiple joints.
 Causes - It occurs when immune system attacks the
synovium. This results in inflammation and thickening
of synovium which eventually destroys the cartilage
and bone within the joints. The tendons and
ligaments that hold the joints together weakens and
stretch. Gradually the joint loses its shape and
alignment.
 Symptoms - Tender, warm, swollen joints with
stiffness worse in morning and after inactivity.
Fatigue, fever and loss of appetite.
 Complications - Osteoporosis, rheumatoid nodules,
carpel tunnel syndrome, lymphoma.
RHEUMATOID ARTHRITIS

13.  Causes
Acute - Viral or bacterial infection. Exposure to irritants
such as smoke, dust, fumes, vapors and pollution.
Chronic - Genetic factor. Long term exposure to
irritants. Repeated episodes of acute bronchitis. History
of respiratory disease or GERD.
 Symptoms – Persistent cough which may produce
mucus , wheezing, low fever and chills, feeling of
tightness in chest, sore throat, body ache,
breathlessness, head aches, locked nose and sinuses.
BRONCHITIS

14.  HAHNEMANNIAN CLASSIFICATION OF DISEASE
- Dynamic Chronic Disease
 Susceptibility - High, symptom similarity, reversible
pathology.
 Miasm - Syphillitic miasm.
 Totality of Symptoms

15.  Final Remedy with dose and potency - Kali Sulph
200 qds X 15days
 Remedy indications – Mentals – indifferent, loquacious
Phy Gen – Increased thirst, salty+
Phy Part –Yellow expectoration,
mouth breathing
< Evening, hot weather
> Cool open air
Shifting wandering
rheumatic pains
< Evening, hot weather
> Cool open air

16.  Auxiliary mode of treatment
Bronchitis – Avoid exposure to pollution, dust, smoke
Steam inhalation
Hot water Gargle
RA - Physiotherapy for low impact exercises
 Diet and Regimen
Avoid grilled, boiled, fried meat.
Avoid fatty food full of omega 6 – fatty acids
Avoid sugar and refined carbs
Avoid cold drinks.
Take Vitamin D supplements, Citrus fruits.

17.  Scope of Homoeopathy
Homoeopathic treatment gives absolute relief from
complaints and eventually reversing back the
pathology.
 Follow up
1st follow up after 15 days
Stiffness decreased to 50% and pain decreased to 30%
No episode of coryza or cough or breathlessness
Gen weakness and fatigue present
Kali Sulph 200qds for 15days
Stiffness decreased to 70% and pain decreased to 50%
No episode of coryza or cough or breathlessness
Generals – Normal
SL TDS for 15days

18.  Remedies that follows well too Kali Sulph are
Calc. Carb
Sepia
Rhus tox
Silicea
Ars. Alb
Sulph
Puls

19.  Differential Remedies
 Pulsatilla
 Pain that moves unpredictably from one joint to another
suggests a need for this remedy. The hips and knees are
often affected, and pain may be felt in the heels. Symptoms
are worse from warmth, and better from cold applications
and open air. A person who needs this remedy often is
moody and changeable, and usually wants a lot of attention
and comforting.
 Bronchitis with a feeling of weight in the chest, and a cough
with choking and gagging that brings up thick yellow
mucus, may respond to this remedy. The cough tends to be
dry and tight at night, and loose in the morning. The fever
may be worse in the evening and at night. Feeling too
warm or being in a stuffy room tends to make the person
worse, and open air brings improvement. Thirst is usually
low. A person who needs this remedy often is moody and
emotional and wants attention and sympathy. (This remedy
is often helpful to children who are tearful when not feeling
well and want to be held and comforted.)

20.  Causticum
 This relieves joint pain and arthritis pain with stiffness and
feeling that tendons are too short. Bronchitis with a deep,
hard, racking cough can indicate a need for this remedy.
The person fees that mucus is stuck in the throat and upper
chest, and may cough continually to try to loosen it. A
feeling of rawness and soreness can develop, or a
sensation as if a rock is stuck inside. Chills can occur along
with fever. Exposure to cool air aggravates the cough, but
drinking something cold can help. The person may feel
worse when days are cold and clear, and better in wet
weather.
 Dulcamara
 This remedy relieves joint pain and stiffness triggered by
dampness and cold. When a person easily gets ill after
being wet and chilled (or when the weather changes from
warm and dry to wet and cool) this remedy may be
indicated. The cough can be tickly, hoarse, and loose, and
worse from physical exertion. Tendencies toward allergies
(cats, pollen, etc.) may increase the person's susceptibility
to bronchitis.

21.  Bryonia
 This remedy relieves joint pain improved by staying
immobile and applying pressure.
 This remedy is often indicated when a cough is dry and
very painful. The person feels worse from any movement,
and may even need to hold his or her sides or press against
the chest to keep it still. The cough can make the stomach
hurt, and digestion may be upset. A very dry mouth is
common, and the person may be thirsty. A person who
wants to be left alone when ill, and not talked to or
disturbed, is likely to need Bryonia.
 Ruta graveolens
 Arthritis with a feeling of great stiffness and lameness,
worse from cold and damp, and worse from exertion often
is relieved by this remedy. Tendons and the capsules of the
joints may be affected. Arthritis may have developed after
overuse, from repeated wear and tear.

22.  Aconitum napellus
 This remedy may be helpful for pain and inflammation
that comes on suddenly after exposure to cold wind
and weather. The person is likely to feel fearful,
panicked, or agitated.
 Arnica
 Chronic arthritis with a feeling of bruised soreness can
indicate a need for this remedy. Pain is worse from
touch, and may occur in joints that were injured in the
past.
 Belladonna
 Sudden flare-ups of arthritis with a sensation of heat
and throbbing pain indicate a need for this remedy.
The joints look red and inflamed, and the surface may
feel hot to the touch.

23.  Ledum palustre
 Arthritis that starts in lower joints and extends to higher
ones suggests a need for this remedy. Pain and
inflammation often begin in the toes and spread up
through the ankles and knees. The joints may make
cracking sounds and may be very swollen. Cold applications
bring relief to both the pain and swelling.
 Rhus toxicodendron
 This relieves muscular and articular pains at the beginning
of motion, and then improved by slow motion.
 Antimonium tartaricum
 This remedy is indicated when the person has a feeling of
wet mucus in the chest, and breathing makes a bubbly,
rattling sound. The cough takes effort and is often not
quite strong enough to bring the mucus up, although
burping and spitting may be of help. The person may feel
drowsy or dizzy, and feel better when lying on the right
side or sitting up