Case Presentation

Date:
Presented By: Dr. Shweta Yadav

Department of Practice of
Medicine
Topic: A Case of Allergic Rhinitis.
Preliminaries:
• Date: 20/06/2023
• Name: Miss. MDS
• Age/Sex: 12 yrs/Female
• Religion: Hindu
• Education: VIII std
• Occupation: Student
• Father:34 years
• Mother: 30 years
• Brother: One studying in V std
• Diet: Vegetarian
• Address: Sadguru Nagar, Satpur Nashik.
Chief Complaints:
Location Sensation Modalities Concomitant
Respiratory System
1. Nose– Mucous Membrane Irritation A/F cold breeze2+
Onset: Since 5 to 6 months Sneezing2+ < Early

Morning
Duration: 10 Mins Paroxysmal2+ < Night
Coryza2+ thin
to thick
Progress: Rapid
discharge
Irritation
Frequency: Daily 4- 5 times

Intensity: Moderate
• Chief Complaints:
• 2. Throat
• Frequency: Occasional
• > Antihistaminic
• Past History
• Febrile Convulsions- Took Antiepileptic
medication for 1 year
• Family History
• Mother had allergic rhinitis
Physical Generals:
• Appearance: Lean
• Skin: Fair
• Perspiration: General; Partial- Tip of Nose, no odor
• Appetite and Hunger: Normal
• Thirst: Normal
• Cravings: Spicy3+, Junk Food2+
• Aversion: Sweets2+
• Stool: Unsatisfactory, Consistency: Normal, Urge:
Normal
Physical Generals:
• Urine: Normal
• Sleep: Initially difficulty to sleep, afterwards
sleeps normally; alert
• Dreams: No dreams
• Ailments from: Getting wet leads to coryza
• Menarche: Not yet established
• Thermal State: Chilly
Life Space Investigation:
• The patient, from a middle class family stays with her father who works as a
senior peon at a Government office at Nashik, her mother, a housewife and
a younger brother studying in V standard. Her grandparents stay in the
village away from her residence and she meets them occasionally. The
family has good interpersonal relationship among them. The patient does
not contribute in household work as physical exertion exhausts her and also
she doesn’t like to work. She has average performance in academics. She
forgets about her assignments and needs constant supervision from her
mother for their completion. She gets exhausted after reading or writing one
or two pages. She also forgets about her belongings in school and is scolded
by her parents and teachers. After scolding she becomes angry but never
retaliates. She likes studying Marathi and Maths, drawing and also likes to
travel. She has fear of lightening, dark, ghosts, lizards, cockroaches, rats and
cats. She avoids these fearful things and if exposed to these, she needs
someone to be near her.
Examination Findings:
• General Examination • Systemic Examination
• General condition: Fair • CNS: NAD
• Temperature: Afebrile • CVS: S1S2 Normal
• Pulse: 80 /min • R/S: Clear
• RR: 18 /min • P/A: Soft
• Weight: 32 kg • * RR- Respiratory Rate,
• Height: 138 cms CNS- Central Nervous
• Nose: No discharge, System, CVS-
Congestion Cardiovascular System,
R/S- Respiratory System,
• Tongue: Moist
P/A- Per Abdomen
• Throat: NAD
Case Processing:
Cause Exposure to Cold
Disease Diagnosis Nasal mucous

membrane irritation
Coryza: Thin to thick
Effect
Allergic Rhinitis discharge
Sneezing: Paroxysmal
O/E- Nose: Nasal
congestion
Heredity: Mother:
Predisposing Factors
Allergic Rhinitis
Hahnemannian Classification of Disease: Chronic
• Miasm
• Fundamental Miasm: Tubercular
• Past History: Febrile convulsions
• Family History: Mother had history of allergic
rhinitis
• Dominant Miasm: Tubercular
• Sensitivity at mental and physical level
• Mental and physical exertion leading to
exhaustion
• Susceptibility: Moderate
• Potency: 200 (Considering the moderate
intensity of symptoms, level of susceptibility
and miasmatic understanding)
• Repetition: Infrequent- Chronic case having
hypersensitivity at mind and body level.
• Selection of Repertory: This case has qualified
mental and physical generals hence Kent’s
repertorial approach has been selected.
Repertorial Totality with Classification and
Evaluation of Symptoms:
Rubrics Classification & Evaluation

of Symptoms
Qualified
Mind, A/F Mental Exertion Modality Mental Causative
Mind, A/F Physical Exertion Qualified Physical

Causative Modality
Qualified
Mind, A/F Exposure to Cold Modality Causative
Characteristic Mental
Mind, Fearsome
Emotional Symptom
Mind, Indolent
Behavioural Symptom
Mind, Desires to Travel
Emotional Symptom
Generalities, Thermal Characteristic Physical

State Chilly General
Generalities, Cravings: Characteristic Physical
Spicy3+ General
Generalities, Cravings: Characteristic Physical

Junk Food2+ General
Generalities, Aversion: Characteristic Physical

Sweets2+ General
Generalities, Sleep, Characteristic Physical

Alert General
Generalities, Stools
UnsatisfactoryGeneralit Characteristic Physical
ies, Stools General
Unsatisfactory
Perspiration, Partial, Tip Characteristic Physical

of nose General
Repertorial Sheet:
Figure 1. Repertorial Sheet using Radar software
Repertorial Result
Totality & Totality &

Chilly Symptoms Hot Symptoms
Covered Covered
Calc Phos 20/8 Sulphur 21/9
Lycopodiu
Phos 20/8 18/7
m
Sepia 20/8 Pulsatilla 15/8

Differentiation of Remedies:
• Calcarea phosphorica, Phosphorous and Sepia are the closely coming
up remedies in repertorisation and need a finer differentiation.
Inability to withstand any mental and physical exertion leading to
indolence, early exhaustion and aversion to work is the core of
Calcarea group. Lots of fears, the behaviour and the way of dealing
with the scolding by the lack of emotional reaction due to fearsome
nature is also characteristic of Calcarea phosphorica. In Phosphorous
the inability to withstand any mental and physical exertion leads to
profound exhaustion. Where as in Sepia, the inability to withstand
any mental and physical exertion leads to indifference, indolence and
irritability. Both Calc. and Phosphorous are covering the totality and
therefore Calcarea phosphorica is selected for this patient as it covers
both the remedy characteristics.
• Thermal status of patient is chilly.
• Final Selection of Constitutional Remedy
• Calcarea phosphorica
• First Prescription
• Calcarea phosphorica 200 one dose at bedtime
for consecutive 3 days
• Advice: Avoid exposure to cold and to have
proper covering of face to avoid contact with
cold breeze.
Date Follow Up On Examination Action
Patient reported
after 3 months. In
these 3 months
(20/06/23 –
17/09/23) patient
had no coryza,
sneezing or any Follow up Sabadilla 200 3 pills
other complaint.
Qds x 3 days
Now since 4 days Afebrile
(After 3 days of
due to exposure to Pulse- 88/min
completion of acute
cold for 3-4 hrs, she Nose- Congestion of
17/09/23 treatment)
has coryza- watery Mucous Membrane
Followed by
discharge1+, Throat- NAD
Calcarea
sneezing2+ paroxysm S/E: R/S- Clear
phosphorica 200
al. Mild throat
1Dose HS
irritation.
Once she had mild
fever; she took Tab
Levocetrizine
(Antihis-taminic) 1
tablet which gave
temporary relief.
Appetite and thirst is
normal.
Interpretation:
Disease: Acute
exacerbation of chronic
disease
Prescription: Acute
Totality for Acute
Prescribing:
A/F Exposure to Cold
Inflammation of nasal
mucous membrane
Placebo Pills TDS x 7 Days
Watery nasal discharge
Paroxysmal sneezing
On repertorisation:
Sulphur: 9/4(Hot), Calcarea
carbonica: 8/4, Natrum
muri-aticum: 8/4 (Deep
Acting), Nux vomica: 8/4,
Phos-phorus: 8/4 Rhus Tox:
8/4, Sabadilla: 8/4 –
Considering its functional
pathology and the
expression of disease.

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Date:

Presented By: Dr. Shweta Yadav

1. Nose– Mucous Membrane Irritation A/F cold breeze2+

Onset: Since 5 to 6 months Sneezing2+ < Early

Frequency: Daily 4- 5 times

Disease Diagnosis Nasal mucous

Rubrics Classification & Evaluation

Mind, A/F Physical Exertion Qualified Physical

Generalities, Thermal Characteristic Physical

Generalities, Cravings: Characteristic Physical

Generalities, Aversion: Characteristic Physical

Generalities, Sleep, Characteristic Physical

Perspiration, Partial, Tip Characteristic Physical

Totality & Totality &

Calc Phos 20/8 Sulphur 21/9

Sepia 20/8 Pulsatilla 15/8

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