A 52-year-old woman with a rash, and she has hypertension, intestinal problems and significant excess weight. She is a cheerful, uncomplicated, uninhibited woman who is good at expressing what she wants and means, although she does not seem to consider her complaints particularly important and the conversation is chaotic. She often laughs heartily in between. She arrives by bicycle in the pouring rain and tells her story while dripping wet. “I've been coming, actually, um, for about six weeks now. Look, my left calf is covered in a red rash, dark red, almost purple.” The skin is thickened, and inflamed, and looks like erysipelas but is much more purple in color. She scratches it open because it itches terribly. There are scabs, and the leg feels warm. It suddenly appeared six weeks ago. Warm showers or heat irritate it terribly. There is a swelling on her left foot, worse in the evening, it doesn't hurt, this came after the rash. Fluid sometimes comes out of the back of her knees. She does not want to see a dermatologist; she does not feel like dealing with ‘all kinds of nonsense’. Occasionally, she feels stinging on the tops of her feet. She has had fungal infections in her groin. She has been taking medication for her blood pressure for 25 years, since her pregnancies. She used to see a dietitian; she is overweight but eats out of habit. Weight: she has always been on the heavy side. When she laughs very hard, her neck cramps up and she gets a nasty feeling in her head. Her neck is stiff, massage helps. Her energy levels are good; she is always busy and never grumpy. She works as a residential care assistant, which involves a lot of cycling, walking, carrying, and physically demanding work. Mentally, she can let things go. She chose this job because she wanted to work in a team. She has always worked in healthcare. When she left school, she thought, well, what now? Her mother did this too. During her pregnancy, her blood pressure rose, and later there was a lot of stress within the family. She suffered from postnatal depression for too long and was prescribed antidepressants. They moved four times in a short period, and the children were abused by the neighbors. A lot was going on with the children, and a lot was going on with her husband, who was at home. However, she is someone who always keeps going. Only after years, when things had calmed down, did she start having intestinal problems, with extreme abdominal pain. When she feels the urge, she has to go to the toilet immediately. There was some blood in her stool, ischemia, and inflammation of the intestines. With her, complaints always come afterward. She had a lot of stress with the children at school, etc. It always touches her. ‘You bottle it all up’. She has been very tired for a long time. After giving birth, she was quick to anger. She was busy with the children all day, her husband was away all day, and her mother-in-law helped a lot. Anger because that's how it all went. In her youth, her mother was ill, and in psychiatric care. She had a difficult relationship with her, always fighting. Later with her son she had similar problems. Normally, she rarely gets angry; she hates arguments. She never argues with her husband. Arguments cause her too much stress. She never complains; she tends to just keep going. ‘What good does complaining do?’ She hasn't had her period for two years. She used to be quiet when young, but over the years she has learned a lot, she is less insecure, and she can talk very animatedly, talking is her outlet. She got along very well with her father, and spent a lot of time with him, when her mother was away from home. At home, she took care of the family, her father, and especially her mother. She relaxes by walking in the park or listening to music. Diet at the time: certain foods cause more discomfort: spicy foods, white bread, foods high in yeast, ready-made foods, alcohol, and a lot of meat. Likes cheese and Indian food, dislikes cabbage.
AnalysisThere was no immediate reason for the skin problems, hence the search is in history. The left leg often has portal vein problems, known as ulcis cruris.
Fabales: Just carry on. Carrying on as a theme: it is the only option, a solution, or a burden. Cheerful, enjoying life, complaints of gastrointestinal problems, overweight, tension. Fatigue is the primary symptom.
Series 4: Focused on practical things, work, not thinking about everything you can't change anyway. The ‘world’ for her is the group you live with: family and work. Study: she didn't do it, rolled up her sleeves.
Phase 5: cheerful, enthusiastic, enjoying life. (Her mother was always pushing her; she can't stand the word ‘must’, then she rebels, she says later).
Subphase 6: doing a lot for others, mother not capable, intestines.
Stage 11: holding on to tension, protecting, holding back. We see responsibility, as seen in other Caesalopinia bonduc cases, but it is more the
Fabaceae point “okay, I am in so lets do it”.
Prescription:
Caesalpinia bonduc MK
Follow-upThe first few weeks are going well. At first, she felt very restless, with a kind of muscle pain in her arms and legs, ‘as if I'm coming down with the flu’. Her neck and lower back are no longer stiff. She feels relaxed otherwise. The rash on her legs looks better, but she still has occasional itching attacks. The red and purple color has disappeared, with a few rough patches of a few centimeters here and there, and scabs from scratching on the lower calf in other places. Her feet are no longer so swollen. Her intestines are now fine. There are still problems with her son, and she wants to find solutions, she cannot let him go, so she continues to care for him. After 3 months, she feels good, and rested. P 130/85, she is going to taper off the medication. Cholesterol 6.1 (LdL 3.6, Hdl 4), sugar 6.2. After six months without medication, her blood pressure is 120/95. She sometimes feels a little dizzy when standing up, after bending over, or when laughing hard. She has more energy. Things continue to go well in the years that follow.