Hepar-Sulph - How I Perceive
NATIONAL JOURNAL OF HOMOEOPATHY 2000 Sept / Oct VOL II NO 5.
Reported by
Dr Gyandas G Wadhwani
Dr Mrs Parul Wadhwani
'Hep-s

A workshop held on 19th March 2000 at our clinic on allergic diseases, was presided over by Professor L M Khan. We present here a case of asthma seen and discussed by him. We have faithfully followed up the case till date and now share it with all students of homoeopathy.

Miss SF, 18 yrs, average height and build, extremely fair, fine delicate skin, brown eyes and hair.
Presenting Complaints
- Breathlessness with dry cough and wheezing since 5-6 years. - Headache since last few months.

History
The complaints started with persistent coryza 7-8 years back. The morning began with sneezing as soon as she got out of her bed followed by watery coryza. By night the nose was blocked.
Sneezing attacks were worse morning, dust, smoke, odor etc.

After 1-2 years this cold turned into asthma. Now at the time of attack she has breathlessness, wheezing and dry cough. Feels suffocated as the evening progresses, and then she cannot cover her face.
Breathlessness < Night, 10 pm; spring, dust, smoke, perfumes etc.
> Sitting bent forward
Since last few months she complains of throbbing headaches. Pain is felt in a spot at the temples bilaterally, which can be covered by a finger. > Pressing with finger.

Treatment Taken
Has been on asthalin inhaler regularly since 2 years
Has taken homoeopathic treatment since last 4-5 years regularly without any improvement.

Past Illness: Nothing significant

Family History
Father: Piles
Mother: Photo dermatitis and H T
Paternal Grandmother: H T
Maternal Grandmother: Renal and Gall bladder stones
Maternal Aunt: D M
Sister: Allergic rhinitis and allergic dermatitis

Personal History
Unmarried girl student, non-vegetarian diet, no addictions
MENSES: Regular, no complaints

Generals
Appetite: Less but cannot wait for food
Thirst: Normal , likes cold water++
Desires: sour+++, butter +++, fatty +++, rice ++, roasted chicken++
Aversion: milk +, sweets +
Bowels: Regular and Normal
Urine: Normal
Sleep: on sides, in littler light
Dreams: Frightening
Perspiration: especially around lips
Thermal Reaction: sensitive to both
Tongue: Red tipped, clean edges, white coated.

Mentals
Likes freaking out, fond of soft English music; fear of dark; fear of being alone, of all animals, gets scared very easily, mercurial temperament (sensitive, gets angry very easily), shouts easily when annoyed and then cools down quickly. She is always in a hurry and wants everything quickly, instantly. When hungry, she wants food immediately. If having some trouble, wants relief immediately. She wants to do everything fast.

On Examination
Chest auscultation shows normal breath sounds, no added sounds.
Nasal mucosa congested B/L
Throat: NAD
Diagnosis
Bronchial asthma

Prescription
Prof. Khan prescribed Hepar-sulph. LM 1 TDS

Discussion
Prof Khan explained that our prescription in a chronic case must always cover the predominant miasm. In this case of asthma both psoric and syphilitic miasm are prominent (as can be seen by the following symptoms- < at night and desire for cold which are syphilitic and desires sour and fat, fears , sneezing in strong odours , which are psoric).He also gave a very valuable tip regarding miasmatic diagnosis that the pain in temple region in one spot is syphilitc in origin.

The appearance and her cravings and her temperament all point to one remedy n our MM and that is Hepar-sulph, which is one of the anti-psoric as well as anti-syphilitic remedies. Another important thing in this case was that the patient's mother had been suffering from photodermatitis ( an allergic skin disease) since her childhood and which has been treated with ointments. Due to this suppression of the skin eruptions in the mother, there was deeper manifestation of allergic process in the daughter in the form of allergic rhinitis in one and allergic asthma in the other. After Prof Khan finished his presentation the participants asked certain questions and clarifications.

Q: Why is that the posture of the patient at the time of attack (sitting bent forward) does not match with that of the remedy prescribed (sitting with head bent backwards). In that case is the prescription of Hepar-sulph justified?

Prof Khan: While evaluating the case, if we see that most of the symptoms are pointing towards one remedy except one or two, it does not contra-indicate the prescription. He quoted from Organon: It does not follow that a homoeopathic medicine has been ill selected for a case of disease because some of the medicinal symptoms are only antipathic to some of the less important and minor symptoms of the disease, if only the others, the stronger, well marked( characteristic) and peculiar symptoms of the disease are covered and matched by the same medicine with similarity of symptoms; that is to say , overpowered , destroyed and extinguished, the few opposite symptoms also disappear of themselves after the expiry of the term of the action of the medicine , without retarding the cure in the least. (Aph 67- Footnote 1, para 2)

Q: Why was Arsenicum-album not considered in this case as it covers the sitting posture of the patient as well as the time modality of the attack and also the desires for fatty and sour things?

Prof. Khan: It is true that Arsenicum-album seems to be well indicated but only superficially, as the essence of the patient does not match with the essence if Arsenicum album. In Arsenicum the patient is more fastidious (morbidly fastidious-in words of Dr ML Tyler) and extremely restless and prostrated. Here the patient is more quick, active and impulsive which goes in favor of Hepar Sulph. In brief the difference between the patients of Arsenicum and Hepar-sulph. are:

Question: Cravings are given highest grade in analysis and evaluation of a patient. In this case the craving for roasted chicken as well as fatty things also reminds us of Calc-phos which incidentally is also one of our Antipsoric as well as antisyphilitic remedies. Should it be considered in this case?

Prof. Khan: The subject of Calc-phos is entirely different from that of Hepar-sulph. The former is dark complexioned, thin and spare, having dark hair and eyes and the latter is having light hair and complexion with torpid lymphatic constitution. Moreover Calc-phos has cravings for salty things and Hepar-sulph. for sour things. While prescribing in a case we should not merely cover the symptoms in a haphazard way because if we do that, then we can think of any remedy from the whole material medica. Our prescription should be based on the essence, the soil in the case so that once we decide upon the remedy it covers the patient in all aspects i.e the miasmatic background, the mental make up, liking, disliking etc.

Follow Up
2-4-2k No attack of breathlessness but still takes inhaler every night and also carries it with her wherever she goes. (Interpretation - Psychological dependency)
No sneezing in morning, only slight watering is present. Nose is not obstructed at night. No headache after starting the medicine.
Rx Hepar-s LM 1 TDS

21-4-2k No attacks of breathlessness. Not taken inhaler since last few days but still carries it around with her. No sneezing or watering in morning. No headache
Rx Hepa-sulph LM 1 BD

The case is still under observation.

Suggestion
Prof L M Khan also shared with us few views and observations: not to be followed blindly but to be verified over a period of time.

"In the cases of allergy, we usually find allergies in the family background, either on maternal or paternal side. In allergic rhinitis the most common modality is that patient starts sneezing in the morning after rising. In the repertory very few drugs are listed against this rubric, which does not include Hepar-sulph. This drug is also not mentioned under < dust, smoke, strong odors in any repertory - neither under coryza nor under asthma or respiration difficult. But still Hepra-s should be considered, because of its psoro-syphilitic background. I present my humble opinion to my colleagues so that it can be verified further."

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