Tresorie – HYPERTENSION ILLUSTRATIVE CASES [Hypertension Illustrative cases]

Subject: Cases

Remedy: Sil / Sep

Dr.
C. B. Jain L.C.E.H.

(*Hon. Asst. Director (Research)
Institute of Clinical Research: Bombay.)

CASE -1

Mr. SRP, age: 61 years, Widower (1991),
Hindu Brahmin B.A. (Hons) occupation: earlier RR Steel Union. 1 son
adopted: 18 years, Fa: 72 years, expired in 1970 due to accident. Mo:
staying in village, 3 brothers.

CHIEF COMPLAINT:

C.V.S. 4 years back Chest

HYPERTENSION

B.P.- 180 systolic

Uneasy

Restlessness

Disturbed sleep

Weakness

Cough

> allopathic Rx

T. Depin retard 1 qds

T. Sorbitrate 2

T. Deriphylline 1BD

T. Ecosporin 1BD

Feb-March 1991

B.P.- 230 / 130

Uneasy feeling3

Palpitation3

No breathlessness.

Chest pain.

AILMENTS FROM- emotional disturbance

– Perspiration ++

– Heat++

– Mild nausea

ASSOCIATED COMPLAINT:

Skin 15 years back Both ankles

Eczema++

Itching Occ.

Oozing++

Taken Ayurvedic Rx

PHYSICAL GENERALS:

Craving: Sweets3, ghee2, highly
seasoned food2. Bowels: N, urine N, Perspiration: axilla, no smell or
stains. Thermal State: Chilly Patient. < cloudy weather2-----> Heavy
chest, choking. Sleep: Disturbed Since thoughts. Dreams: Occ. father after
his death, family.

LIFE SPACE INVESTIGATION:

Patient is a well built, muscular, tall
person, looks tough with furrows on forehead, gray hairs and long gray
moustache.

Patient submitted history with a
detailed account in which he mentioned deep impact of recent, untimely
death of his wife. Other details of the history are incorporated in life
space.

Patient is a second sibling of 4
Brothers. Eldest brother after his retirement from government service went
to an Aashram. He was not married. Younger brother is staying in Bombay
with his family. Youngest brothers whereabouts is not known for last 4-5
years. He wanted easy money without working for it.

Patients father was running a press. He
also had land at village and used to get farming done by labourers.
Patient came to Bombay after Matric. He joined college, simultaneously
looking after the press. He completed his B.A. Press was running quite
well. 12 years back he sustained a heavy loss due to cheating by his
partner. He closed down the press. It was a great shock to him. He took up
a job as a clerk. Recently he retired from the job. Job was full of
responsibility. He was known for his sincerity and quality of work. He is
still remembered for his work. His name is given as an example for
sincerity and dedication.

Patient and his wife adopted a son from
his friends sister from his infancy as they did not have issue after early
death of their daughter. They both brought him up with tremendous love and
care. Adoption created dispute between him and his family on the issue of
property. His brothers wife asked them to choose between son and family.
Patients wife was firm about keeping the child.

5 months back, patients wife suddenly
expired in the village because of acute GI disturbance when they went to
attend a wedding. It was a great shock to him. No sooner the funeral of
his wife was completed, his sister-in-law revived issue of his son and
property. Disturbed patient remained firm on his stand. Dispute remained
unresolved. He came back to Bombay. He remained upset about the whole
thing. On the day of Holi, he started missing his wife acutely. He kept
thinking about their plans to settle at village with his mother after his
retirement. In this emotional state, he came down with an attack of
angina. He was immediately hospitalised.

Inspite of dispute with his
sister-in-law, he is ready to keep his newly married nephew with him as
they have a space problem. Marriage was arranged by his wife and D-I-L is
also interested in staying with them.

About properly he has taken a firm and
sensible decision. His house, provident fund and bank balance will go to
his son. He left his rights on properly worth lakhs at their village.

He left the impression of a very firm
and sentimental man. He is very attached to his family. He even used to
visit them in the village at least once a month.

O / E- B.P. -150 / 90 Teeth- Caries++
Clinical Diagnosis: Essential Hypertension with IHD.

Investigations:

April 91

S. Cholesterol- 266 mg percent. Bl.
urea- 27 mg percent.

S. CPK- 21 IU. Hb- 12 gm percent,
ESR-63

ECG- Inferolateral wall injury with
sinus tachycardia.

Subsequent ECGs showed regression of
changes.

CASE ANALYSIS: Emotional state of the
patient is very striking in the case. After wifes death and current
problems of, property distribution, all his sentiments are aroused
followed by anginal attack. His lingering emotional state and inability to
come out of it created the problem. It seems as if emotional stagnation
has occurred. This state characteristically indicates dominant sycotic
activity.

From above totality drug selected was
SILICA. It was difficult to assess anginal activity as he is asymptomatic
with two sorbitrates. His B.P. remained under control with Depin. Although
there are structural changes of myocardial injury, they are reverting back
in subsequent ECGs. Irreversible damage is not available. Susceptibility
is moderate with high sensitivity, medium potency was selected. Repetition
has an added danger of overstepping sensitivity. Once aggravation of
functional complaints warned us of the sensitivity. Hence cautious
repetition of single dose was done. This saw well controlled B.P. and
total recovery in his eczema. Due to circumstantial problems of settling
in life again, loneliness and anxiety persisted.

TREATMENT AND FOLLOW UP:

Treatment was commenced on 10-7-91 with
SILICA 200 single dose, gradually increasing repetition to daily with
tapering of antihypertensive and anginal drug. Patient remained
asymptomatic with B.P. 130 / 90. On 23-10-91 patient came down with
aggravation of all functional complaints. He settled with withdrawal of
the remedy. SILICA 200 was repeated infrequently in single doses guided by
his blood pressure. On 11-11-92 he was again aggravated with activation of
eczema. Potency was stepped upto 1M. B.P. remained stable between 130 / 80
and 140 / 90. On 3-11-93 again his eczema flared up. He received single
dose of SILICA 10M. B.P. remained stable between 150 / 90- 120 / 90. He
remained symptom free although passed through tremendous anxiety. He
rejoined his work which supported him by keeping him busy.

CASE II

History submitted by the patient was
written by her husband. When enquired the reason for not writing it
herself, without any hesitation she said, it is boring. I dictated and he
wrote. (It was not expected from a principal of a school).

Salient features of the history:
(Translated from Gujarati) Mrs. SMS, 45 years old, Married, Hindu, B.A.
B.Ed. I am working as a teacher. I am totally satisfied about my
responsibilities in past and present. But sometimes I feel boredom /
uncomfortable about work. Often I feel how nice it will be if I dont have
to work.

Family Set Up:

Husband- Stainless Steel Business, 1
son- 17 years, studying in XIth Std, 1 Daughter-13 years, studying in
VIIth Std.

FIL- Expired at the age of 75 in 1985
due to liver problem. MIL- Expired at the age of 74, in 1992 due to
myocardial infarction. Relations- sometimes we get into some altercations.
Financial responsibilities- worries about family / school problems.
Earlier difficulties in family.

Chief Complaint: Tension / B.P. Trouble
started 11 / 2 years back with tension. Fell down from 1st floor, Internal
injuries.

Personal history: Short obese- Nature-
Hurried / Irritable: Intellectual attainments- OK but expectations, wishes
are not fulfilled. Sleep, dreams- bad. Sex- irregular, frequency 1-2 /
week. 2 FTND.

CASE RECORDING:

CHIEF COMPLAINT:

C.V.S. Since 11 / 2 years

HYPERTENSION

Giddiness-things moving around

Occipital headache3 blackouts, blurred
vision

< tension Mixed emotions of anxiety, anger, frustration. > Pressure.

Did not respond to I / II
antihypertensives. At present on T. Vasopril (5mg) OD, Hipress D Atenolol
(50 mg) OD, T. Nifedipine (10 mg) OD. T. Trika 0.5 mg.

ASSOCIATED COMPLAINT

– h / o URT Childhood upto 17 years of
age

Throat pain cold, sneezing ASCENDING
COLD

AILMENTS FROM Cold Water

– General

Bodyache

< Sour2 – Knees Since 6-7 years < Since 2 years Stiffness – as if paralysed – Skin -h / o after marriage Urticaria3 Itching3 AILMENTS FROM – Sour buttermilk with salt. PHYSICAL GENERALS: Craving: Salt2, Perspiration: face, Bowels: N Urine- night frequency 3 times Menstrual history: Regular, No complaints. H / o Leucorrhoea 8 years back for 2-3 years with backache++ > exercise3. Sexual desire: decreased since 1
year, after chief complaint. Pregnancy- Morning Sickness++ for 3 months
< smell of food2 sleep- disturbed with anxious thoughts. Dreams- ++ Unremembered, robbers, death of father (once). Thermal state- Chilly Patient. LIFE SPACE / MENTAL STATE: Patient hails from a Gujarati Hindu business family. She stays in a nuclear family with her husband and two children. While describing about her bodyache, tiredness and boredom she coolly said that she goes to sleep and her husband and both children complete the household work. (For me, how a wife / mother can relax with such a trivial complaint, when this is a frequent occurrence?) She described herself as highly irritable excitable lady. If gets angry she prefers to express it out. She beats children at home and in school also. Weeps when cannot do anything. Husband and children do not throw counter reactions. So things appear smooth and life moves on. Her current anxiety has come up in respect to her flat which they booked 7 years back. Builder has got into some difficulties with authorities and he is trying to come out of the situation. He is a genuine and known individual. Husband is confident of getting possession. All other members are supportive. He deals with the builder. Recent price hikes and rumours about builders intention made her insecure. Flat is booked from her money which she keeps in a separate account while household expenses are borne by husband. While describing about this she said “Parsevano Paiso” (hard earned money). This adds to her anxiety. Additional responsibilities of principalship accentuated her state. She is always anxious about how she will cope up with work. While describing about her mothers death, she wept saying, now father is all alone. Who will take care of him? Hurry in everything is a peculiar expression whenever She is tensed about routine matters. She is highly sensitive to noise. O / E: Pulse-60 / min. B.P.- 140 / 90, systemic – NAD. Investigations: Aug 91- FBS- 85.7 mg percent PPBS- 97.8 mg percent. Bl. urea – 17.1 mg percent BUN- 8 mg percent, S. creatinine- 1 mg percent, S. cholesterol- 200.4 mg percent, CBC-N, ESR- 29, ECG-WNL. March 92 – ECG-NAD (B.P.- 164 / 100). CASE ANALYSIS: Essential hypertension is a deep seated constitutional disorder which very often presents without characteristic form or with few common symptoms or remains silent with no symptoms. This case also presented with very few common symptoms. Defining underlying problem patient is facing, with psychosomatic co-relation makes the case. This lady is available to us through her interactions with the immediate environment, family / work. Detailed anamnesis provides some definite characteristics which helps us to see the congruency at mental / physical level. From this totality SEPIA was undoubted prescription. Susceptibility- Moderate. Sensitivity- High. With a combination of antihypertensives and anxiolytic drug, preferences was given to 30 over 200 potency. FOLLOW UP: Date: 16.3.93 Rx Sepia 30 Hs daily To stop Trika Date: 24.5.93 B.P.- 120 / 90. Pedal oedema < exertion. Pt. Symptomatically felt better. Gradually antihypertensives stopped. Rx Sepia 30 HS. Date: 5.7.93 B.P. fluctuating between 120 / 90-150 / 100 Investigations- FBS, PPBS, BUN, S. Creatinine, ECG-WNL Rx Sepia 30 HS Date:4.4.94 Patient almost remained asymptomatic with some complaints with knee especially with over exertion. B.P. range- 130 / 70 to 140 / 94 Rx Sepia 30 HS Date: 11.4.94 Residual Pedal oedema not improving Rx Sepia 200 single dose Date: 23-1-95 Reported infrequently. B.P. range 130 / 80-140 / 90 Got operated for Cataract Apart from anxiety, no emotional disturbances. Rx Sepia 200 single dose SOS.