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PRACTICAL ILLUSTRATION OF THE CASE WITNESSING PROCESS
Dr. Dinesh Chauhan, consultant and Faculty – the other song
Dr. Devang Shah M.D. (Hom), in-house consultant – the other song

(Note: D: Doctor, P: Patient, Italics: Consultants commentary.

Preliminary data:
A lean thin emaciated 10-year-old girl of dark complexion coming from lower middle class family consulted us on 23rd July 2012 for PUO (pyrexia of unknown origin and USG s/o of hepatosplenomegaly) since 4 months.
Her main complaint was recurrent fever which used to recur every week, with loss of weight; she used to get fever with chills esp. in the evening.

PASSIVE CASE WITNESSING PROCESS:
D: What is happening now?
Father of the patient: Now there is nothing specific, no fever, was not eating much, weakness, after every 15 days she use to get fever.

D: Tell me about you?
P: Sometimes when I eat there is pain in the stomach. I don’t like to eat anything then, many weird thoughts come to my mind and I don’t like it.

It was already about 5 minutes in the case and this child had only spoken few lines. This for me meant that she needs to be given more time and space so that she could connect with her own individualistic expression.

D: Tell me more about yourself, what you like and dislike?
P: I don’t like to eat dal and rice, if I eat anything more then feels nauseating.

D: Tell me more about yourself what do you like to do? Tell me how is your nature?
P: I like to do painting and drawing.

D: Tell me more about yourself so that I can understand you well?
No answer.

D: What more you like to do?
P: Nothing more.

Since the child was not speaking much I had to be more active in asking questions, but the questions were more broad ended ones which will help me to understand her area or sensitivity or focus as I call it. Throughout the case I observed that she would say few lines then there was a pause.

D: Tell me more?
P: I am scared to cross the tracts, if someone hits me it hurts on hands.

D: Tell me more?
P: I like to see pictures which are there in the books.

Since I felt that child is not coming out with her expressions on her own I had to become active and go in different areas and see what is the focus that comes up. So I ask about the fears and try to understand the peculiarities of her subconscious mind. Here we begin the active case witnessing process with the aim to find the focus.
Observation: the manner of her answering was very slow.

ACTIVE CASE WITNESSING PROCESS WITHOUT FOCUS:
D: What are your fears?
P: I am scared of ghosts and aliens.

D: Tell me more?
P: I am scared of insects also.

D: Think more and tell me what else you are scared of?
No answer.

D: Tell me more about your childhood, do you remember?
P: I got burnt in my childhood at abdomen area.

D: Think and tell me.
P: I was scared to cross the roads.

D: More?
P: Can’t go out in night, scared to go alone at night.

We tried to explore her fears as much as possible and once I felt there was not much she could say I thought to move into the area of dreams and see what is in her subconscious mind.

D: Tell me about your dreams?
P: I get dreams of ghosts, sometimes I get good dreams, once there came a ghost at our place and we were scared. We tried to hide but the ghosts finds us and eat us up. Once I saw that I went to my uncle’s place and some bad people came and started hitting everyone with a knife.

D: Tell me more about your dreams, which used to come earlier?
P: Once there came a ghost at our place and we were scared and were hiding, and ghost was shaking his legs and we were getting hurt by it.

What we see here is:
• If someone hits then she is hurt
• Memory of being burnt in childhood has had an impact on her consciousness
• The feeling of being hurt with knife by some bad people and getting hurt when the ghost was shaking his legs

Here in different areas the feeling of injured/ hurt is coming up again and again. Therefore this becomes the focus of our case. Now we begin the journey of active-active case witnessing process to zoom into this focus and understand the depth of it to arrive at the kingdom and subkingdom.

OUT OF PLACE AND OUT OF ORDER TILL THE END OF ACTIVE CASE WITNESSING PROCESS:
Many weird thoughts come to my mind and I don’t like it.
I am scared to cross the tracts, if someone hits me it hurts on hands.
I am scared of ghosts and aliens.
I am scared of insects also.
I got burnt in my childhood at abdomen area.
I was scared to cross the roads.
I can’t go out in night, scared to go alone at night.
I get dreams of ghosts, sometimes I get good dreams, once there came a ghost at our place we were scared and we went and hide and the ghosts finds us and eat us up. Once I saw that I went to my uncle’s place and some bad people came and started hitting everyone with a knife.
Once there came a ghost at our place and we were scared and were hiding, and ghost was shaking his legs and we were getting hurt by it.

ACTIVE-ACTIVE CASE WITNESSING PROCESS:
D: What do you mean by this, I didn’t understand?
P: He was hitting everyone.

D: How?
P: With his hands, he was carrying us and throwing us.

D: What do you mean by this?
P: Hitting us.

D: What more ghosts do in your dreams?
P: They hit.

D: How they hit?
P: I don’t know.

D: Are you scared of ghosts?
P: Yes.

D: Which things of ghost you are scared of? What will they do?
P: Hit us.

She cannot go beyond this point so now I go in another area which was peculiar and understand her experience.

D: What was the dream of bad people?
P: They were hitting.

D: How they were hitting?
P: By knife.

D: How they were hitting?
P: (HG) like this.

D: You are scared of crossing the roads and railway tracks, what do you mean by this?
P: If I am crossing the railway track and then suddenly train will come then.

D: Then what will happen?
P: I am scared.

D: Of what are you scared of?
P: Car comes, and my father shouts and says see and cross the road; so I am scared.

D: If you don’t look and cross the road then what will happen?
P: Will get injure and hurt.

D: You were burnt on your stomach, what had happened tell me about it?
P: Mummy was making the tea and I was sleeping and as I turned the tea fell on my stomach.

D: You said you are scared of insects, what do you mean what insects do?
P: If they come near me also then I am scared.

D: About what?
P: The touch of their body I am sacred.

D: Why?
P: If they will bite then.

D: How will they bite?
P: They bite with their teeth.

D: You said you get weird thoughts; what are they?
P: When I sleep, what time I will get up tomorrow, how will be tomorrow’s day.

D: What are the weirdest thoughts you get?
P: If I will do mischief then teacher will hit.

D: What mischief you do?
P: If we talk then teacher hit us.

D: What else teacher do?
P: If we write wrong then teacher hits.

D: More?
P: If we don’t study and don’t do our home work then teacher hit us.

D: If teacher hits then what do you do?
P: Nothing, I tolerate it.

D: How much is your thirst for water?
P: Less.

D: How much angry do you get?
P: Medium.

From her Mother: She gets angry a lot.

D: What does she do in anger?
Father: If we give something to eat she gets irritated and doesn’t eat.

D: Do you feel chill?
P: Yes.

D: Where you get chill the most?
P: Legs.

D: Where in legs?
P: Soles.

D: Which food causes you trouble? Which type of food?
P: Fat, chapattis difficult to swallow.

D: And if you eat fatty food then?
P: There is gas in the stomach.

D: Is there any pain in the abdomen?
P: No.

Physicians’ observations:
This patient was very dull and very slow; she would hardly answer the questions. She seemed as if she lacked energy, there were many pauses before she could answer.

Physical examination: Liver enlarged 2 fingers

Ultrasonography of abdomen on 18th May 2012:

UNDERSTANDING OF THE CASE:
Out of place/out of order words during PASSIVE CASE WITNESSING PROCESS:
• Many weird thoughts come to my mind and I don’t like it.
• I am scared to cross the tracts, if someone hits me it hurts on hands.

ACTIVE WITNESSING PROCESS TO FIND THE FOCUS:
• I am scared of ghosts and aliens.
• I am scared of insects also.
• I got burnt in my childhood at abdomen area.
• I was scared to cross the roads.
• I can’t go out in night, scared to go alone at night.
• I get dreams of ghosts, sometimes I get good dreams, once there came a ghost at our place we were scared and we went and hide and the ghosts finds us and eat us up. Once I saw that I went to my uncle’s place and some bad people came and started hitting everyone with a knife.
• Once there came a ghost at our place and we were scared and were hiding, and ghost was shaking his legs and we were getting hurt by it.

FOCUS OF THE CASE AT THE END OF ACTIVE CASE WITNESSING PROCESS:
We see that if someone hits then she is hurt, memory of being burnt in childhood still has had an impact on her consciousness, the feeling of being hurt with knife by some bad people and getting hurt when the ghost was shaking his legs. Throughout we see that injury and being hurt is coming up very strongly in her subconscious areas thus this becomes the focus of our case.

LEVEL OF EXPERIENCE: HER DREAMS AND IMAGINATION ARE VERY PROMINENT
SO SHE IS AT LEVEL 4 i.e. DELUSIONS. So she needs 1M POTENCY.

ACTIVE-ACTIVE CASE WITNESSING PROCESS:
• He was hitting everyone with his hands.
• He was carrying us and throwing us.
• Bad people hit us with knife
• If I am crossing the railway track and then suddenly train will come then.
• I am scared.
• Car comes, and my father shouts and says that sees and cross the road so I am scared.
• Will get injure and hurt.
• Mummy was making the tea and I was sleeping and as I turned the tea felled on my stomach.
• If they come near me also then I am scared.
• They bite with their teeth.
• If I will do mischief then teacher will hit.
• If we talk then teacher hit us.
• If we write wrong then teacher hits.
• If we don’t study and don’t do our home work then teacher hit us.

ESSENCE OF THE CASE:
We see that main thing in this child is about injury, hurt, burns.
Fear that she will be hit with knife, scared of being injured while crossing the roads, fear of being bitten by insects, of being hit by school teacher and memories of being burnt in her childhood. The sensation that comes up clearly in the case is of being injured.
And along with this she needs a remedy which also has prominently—dullness, sluggish, slow, with marked action on liver.

WHAT IS SENSATION?
This common point where the body (physical complaints) and the mind (fears, dreams and fantasies) both reflect the same phenomenon is the Vital Sensation. When we see that a specific pattern is running through both the physical symptoms and the mental aspects of a case, we are seeing the Vital Sensation.
For example we know that in a remedy, at the physical level there is aggravation from least motion, and at the level of mind it has an aversion to being disturbed. A little close attention to these two apparently different aspects allows us to see that aversion to being disturbed and aggravation from the least motion both convey sensitivity to disturbance. The commonality between mind and body shows us that this sensitivity to disturbance is the Vital Sensation of that remedy. The level of Vital Sensation is beyond mind and body, beyond emotions and situations; it is the meeting point of mind and body.

We see in this case the physical symptoms were very less however the symptoms of subconscious were very clear prominent.

The commonality of these subconscious areas (fears, dreams, and memories of the past, imaginations) lead to a common phenomenon that is injury, hurt, burnt. So the vital sensation in this case is of being injured, hurt.

Vital Sensation can be classified, at the most basic level, into plant, mineral and animal kingdoms. Each kingdom has its own characteristic kind of sensation.

A Mineral Sensation has to do with structure. The patient feels something lacking in himself, or that he will lose something of himself. Thus a mineral person sees the problem as being within himself – either as a lack, or as a potential loss. For example ‘I may lose my money’ or ‘I may lose my voice’ are typical mineral expressions. Everywhere in a case needing a mineral remedy, the Vital Sensation, the common phenomenon, would be ‘I lack’, or ‘I will lose’.

An Animal Sensation has to do with survival.An animal patient has the issue of ‘me versus you’. The problem is seen as ‘someone is doing something to me’; the problem is personified as someone who is attacking, or who is in competition. For example: ‘the pain is killing me’; or, ‘my mother in law is stronger and I am weaker.’ The entire pattern of his life will be experienced in the form of ‘me versus you’, victim versus aggressor, strong versus weak.

A Plant Sensation has to do with sensitivity. Sensitivity means that things affect him/her. For example,’ my husband’s screaming affects me.’ We see here that the husband is not the problem; rather she is affected by quality or a behavior in her husband. She is sensitive to his screaming and shouting. In the plant kingdom there is a stimulus and a reaction, and this reactivity comes from an underlying sensitivity.

KINGDOM:
We see that this child is very sensitive. She is deeply affected by the ghosts, thieves, teacher or father who might scold her. This point towards plant kingdom

SUB – KINGDOM:
• Fear of being hit
• Fear of being bitten
• Memories of being burnt
This is Compositae or the Arnica family.

MIASM:
The miasm was not very clear in the case. However what was seen was a very slow dull patient who hardly speaks and has developed a liver pathology.
The search was limited to remedies from Compositae family which has the dullness, slowness and the liver as its main sphere of action.
All the remedies in Compositae, Asteraceae family were carefully studied.

A remedy of the Asteraceae covered the essence of the case.

REMEDY PRESCRIBED: A remedy of the Asteraceae ONE DOSE

References:
Vermeulen
Listless, joyless and forgetful.
CHILLY. "Chilliness is prominent, on awaking; at night.
Intolerance of fats.
Influenza when liver is affected.

Phatak
Poor appetite. Nausea, retching and VOMITING of green acid fluid, or blood.

Pulford
Suffers greatly from the liver.
Extremely sensitive to cold.

Follow ups:
She received just 2 doses of the remedy of the Asteraceae, one dose for first two months
Since then for following 3 months she was on placebo.

Last seen on 23rd November 2012:
There have been no fever episodes except once in September 2012. Since treatment she gained few kilos of weight, her appetite came back to normal and started playing and enjoying her life. As far as the mind state is concerned the fears of ghost and crossing the roads were significantly better in fact she loves to cross the roads now. She was much more active and vibrant, and full of energy. Physical examination revealed no more abnormal enlargement of liver. She maintains good health till date.

Comment
In this case the miasm did not stand out very clearly. So one should not feel handicapped since if the miasm is not clearly evident in a case. One has to see what is characteristic in each case. In this case it was sensitivity to injury, the manner of answering which was very dull sluggish and the affection of liver. Here the sensation method took us to the plant kingdom and the Compositae family. The remedy could not be concluded on just the sensation approach; we had to resort to the Materia medica. This is an example of how the sensation approach is a tool to be included to be used in inclusion with classical Homoeopathy, and not as an exclusive method for treating patients.

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