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Apparent aggravation due to Pulsatilla
Apparent aggravation due to Pulsatilla ANTHONY
CAMPBELL,
M . R . C . P . , F.F.HOM.
INTRODUCTION
The homceopathic literature contains m a n y references to the problem of aggravations, but it remains doubtful how frequent these really are. Few of the reported cases are supported b y adequate placebo controls, but in the absence of such controls it is very difficult to be sure t h a t a true aggravation has occurred. I n m y own experience indubitable aggravations have been rare, hut m y impression is t h a t they are more likely to occur in skin disease than in other conditions. The case presented here is of particular interest because it does include periods on placebo, so t h a t the probability t h a t a true aggravation occurred is relatively high. CASE
REPORT
The patient was a 5-year-old boy who was first seen in outpatients at the Royal London Homoeopathic Hospital on 2.9.77. He had suffered from eczema since the age of six weeks and had recently begun to have asthma attacks in addition. At this time he had moderately severe dry eczema affecting his face, arms, and legs. He had been born two weeks prematurely, but delivery was otherwise normal; his mother and brother both suffer from hay fever. He appeared a quiet, shy boy. His mother said he cried easily and wanted to be cuddled, especially during asthma attacks. He preferred cool weather. He liked sweets, but had a strong aversion to butter and eggs. He had not used any corticosteroid applications in the preceding two months; hence his skin condition when first seen was more or less stable, and his mother said t h a t he was not subject to violent exacerbations or marked remissions. Clinically and on the basis of the mother's history he appeared to fit the remedy Pulsatilla extremely well, and he was therefore given it in the 12c potency twice daily for two weeks, with sac. lac. twice daily to follow for a further two weeks; he also had Calendula and Urtica urens cream for local application. The Table shows the subsequent events and course of treatment. DISCUS
SIO~I
As will be seen from the Table, this child had an apparent aggravation to every potency of Pulsatilla tried between mother tincture and 10M; on the other hand, he had no reaction to placebo on four occasions, nor did he have aggravations when given four other remedies. I t is therefore difficult to avoid the impression t h a t these were genuine aggravations. I t might be objected t h a t the mother could have realized t h a t some of the medications used were placebo, but every effort was made to avoid suggesting this; besides, it seems
124
THE
BRITISH
HOM(EOI~ATHIC
JOURNAL
TABLE
Date
Treatment given
2.9.79
PulsatiUa 12c, b.d. for 2 weeks; sac. lac., b.d. for 2 weeks
30.9.79
Pulsatilla 3x, b.d. for 2 weeks S.V.R., iii doses over 24 hours, followed 3 days later by Pulsatilla 10M, iii doses over 24 hours Pulsatilla 0, 2 drops daily for 1 week
14.10.77
28.10.77 11.11.77
Mutabile (Bach) 30c, iii doses over 24 hours
25.11.77
S.V.R., iii doses; sac. lac. b.d. for 3 weeks Calc.fluor 6c, t.d.s. (patient not seen by me on this occasion) Sac. lac., b.d. for 6 weeks Mutabile (Bach) 30e, iii doses Silicea 30e, iii doses; sac. lac., b.d. for 5 weeks
10.1.78 7.2.78 21.3.78 18.4.78 4.7.78 5.9.78 3.10.78 28.11.78
Thuja 10M, iii doses; Mixed Pollens 30c, i daily PulsatlUa O, 2 drops stat. Sac. lac., b.d. for 6 weeks PulsatlUa O, 2 drops star.
13.2.79
Pulsatilla 0 2 drops star.
Result After 2 days on Pulsatilla "never so bad in his life"; this lasted for whole of 2 weeks, but slowly improved on sac. lac. He then had an asthma attack and was admitted to another hospital. At present he is about back to what he was when he first attended us. (30.9.77) Again worse while taking Pulsatilla, but not so bad as on the first occasion. (14.10.77) :No effect from S.V.R. "Went wild after PulsatiUa 10M, with intense itching and scratching." Now about back to his usual state. (28.10.77) . Initial improvement--skin became clear, but as treatment continued it became dry again. (11.11.77) Better for a week, at least in himself--"really dramatic psychological effect"; now slipping back. (25.11.77) Skin better, but some asthma. Subsequent relapse. (13.12.77) No real difference. (7.2.78) No obvious effect. (21.3.78) No obvious effect. (18.4.78) No effect from Silicea. Getting hay fever. Skin is better when he has a fever; worst at 9.30 p.m. and 2.00 a.m. (4.7.78) Improved until beginning of September. (5.9.78) Very much bettor--rash almost gone. (3.10.78) Not as well as he was. (28.11.78) Remarkably much botter--"never so well"; appetite improved, and school comments that he is bettor as well. Skin began to clear 2 days after he bad the Pulsatilla. Now just beginning to slip back again. (13.2.79)
u n l i k e l y t h a t she w o u l d h a v e e x p e c t e d r e a c t i o n s t o o c c u r o n l y a f t e r P u l s a t i l l a and not after other remedies. A f u r t h e r p o i n t o f i n t e r e s t is t h a t t h e r e a c t i o n s w e r e a p p a r e n t l y s t r o n g e r the higher the potency used; thus mother tincture produced an aggravation o n l y a f t e r s e v e r a l d a y s , 3x p r o d u c e d a r e l a t i v e l y m i l d a g g r a v a t i o n , b u t 10M p r o d u c e d a v e r y v i o l e n t effect. T h i s also t e n d s t o s u p p o r t t h e v i e w t h a t t h e a g g r a v a t i o n s w e r e g e n u i n e . I n a d d i t i o n , o f course, it is w h a t o n e w o u l d p r e d i c t on orthodox homceopathic theory. On the other hand, such theory would predict t h a t a n i n i t i a l a g g r a v a t i o n o u g h t t o be f o l l o w e d b y a n i m p r o v e m e n t , b u t t h a t d i d n o t o c c u r i n t h e p r e s e n t case. From the therapeutic point of view, hindsight suggests that the initial i m p r o v e m e n t w h i c h f o l l o w e d t h e first use o f P u l s a t i U a 0 (on 28.10.77) o u g h t t o h a v e p r o m p t e d m e t o t r y a s h o r t e r c o u r s e o f t h e m o t h e r t i n c t u r e , as i n d e e d I did almost a year later, with gratifying results; but the child's extreme s e n s i t i v i t y t o P u l s a t i l l a m a d e m e a p p r e h e n s i v e a b o u t t r y i n g i t a g a i n for a l o n g t i m e , T h e i m p r o v e m e n t t h a t f o l l o w e d t h e first d o s e o f M u t a b i l e is also
APPARENT
AGGRAVATION
DUE
TO
PULSATILLA
125
of interest; just possibly the later good response to Pulsatilla 0 was due to the prior use of Mutabile. I n a case like this it would clearly have been unethical to have repeated the administration of Pulsatilla in potency once the genuineness of the aggravations had become apparent beyond reasonable doubt. However, such cases arc of the greatest possible theoretical interest, and I would make a strong plea for all homceopathic practitioners to record and investigate them systematically. An aggravation is often easier to recognize than an improvement; moreover, if genuine it should be repeatable. I t seems to me entirely justifiable to t r y to establish whether aggravations t h a t apparently occur in clinical practice are genuine or not, since this has a bearing on the subsequent management of the patient. I have seen several other cases of apparent aggravation, but in all these I t:ound equally strong reactions to placebo; so far as I am concerned, therefore, the present instance stands alone. I should be most interested to learn of anyone who has had a similar experience. This case does strongly suggest to me t h a t it would be well worth while trying to identify volunteers with specific remedy sensitivities who would be prepared to submit to proper double-blind testing. (This is something t h a t doctors might like to t r y out on themselves!) For example, if one could find an individual who, say, experienced headaches regularly and dependably while taking Glonoine in potency, it would be simple to demonstrate the fact b y means of an appropriate trial. Limited provings of this kind, using previously identified sensitive subjects as their own controls and looking for the occurrence of particular symptoms, would be relatively easy to carry out and extremely interesting and valuable. SUMMARY
A case of apparent aggravation due to Pulsatilla is presented and discussed. Possible research implications are considered.
Note added in proof: The patient continues to do well on Pulsatilla 0 , 2-4 drops at approximately monthly intervals. I have recently encountered a fairly convincing case of eczema aggravation b y Sulphur; I hope to report this in detail later.
CAMPBELL,
M . R . C . P . , F.F.HOM.
INTRODUCTION
The homceopathic literature contains m a n y references to the problem of aggravations, but it remains doubtful how frequent these really are. Few of the reported cases are supported b y adequate placebo controls, but in the absence of such controls it is very difficult to be sure t h a t a true aggravation has occurred. I n m y own experience indubitable aggravations have been rare, hut m y impression is t h a t they are more likely to occur in skin disease than in other conditions. The case presented here is of particular interest because it does include periods on placebo, so t h a t the probability t h a t a true aggravation occurred is relatively high. CASE
REPORT
The patient was a 5-year-old boy who was first seen in outpatients at the Royal London Homoeopathic Hospital on 2.9.77. He had suffered from eczema since the age of six weeks and had recently begun to have asthma attacks in addition. At this time he had moderately severe dry eczema affecting his face, arms, and legs. He had been born two weeks prematurely, but delivery was otherwise normal; his mother and brother both suffer from hay fever. He appeared a quiet, shy boy. His mother said he cried easily and wanted to be cuddled, especially during asthma attacks. He preferred cool weather. He liked sweets, but had a strong aversion to butter and eggs. He had not used any corticosteroid applications in the preceding two months; hence his skin condition when first seen was more or less stable, and his mother said t h a t he was not subject to violent exacerbations or marked remissions. Clinically and on the basis of the mother's history he appeared to fit the remedy Pulsatilla extremely well, and he was therefore given it in the 12c potency twice daily for two weeks, with sac. lac. twice daily to follow for a further two weeks; he also had Calendula and Urtica urens cream for local application. The Table shows the subsequent events and course of treatment. DISCUS
SIO~I
As will be seen from the Table, this child had an apparent aggravation to every potency of Pulsatilla tried between mother tincture and 10M; on the other hand, he had no reaction to placebo on four occasions, nor did he have aggravations when given four other remedies. I t is therefore difficult to avoid the impression t h a t these were genuine aggravations. I t might be objected t h a t the mother could have realized t h a t some of the medications used were placebo, but every effort was made to avoid suggesting this; besides, it seems
124
THE
BRITISH
HOM(EOI~ATHIC
JOURNAL
TABLE
Date
Treatment given
2.9.79
PulsatiUa 12c, b.d. for 2 weeks; sac. lac., b.d. for 2 weeks
30.9.79
Pulsatilla 3x, b.d. for 2 weeks S.V.R., iii doses over 24 hours, followed 3 days later by Pulsatilla 10M, iii doses over 24 hours Pulsatilla 0, 2 drops daily for 1 week
14.10.77
28.10.77 11.11.77
Mutabile (Bach) 30c, iii doses over 24 hours
25.11.77
S.V.R., iii doses; sac. lac. b.d. for 3 weeks Calc.fluor 6c, t.d.s. (patient not seen by me on this occasion) Sac. lac., b.d. for 6 weeks Mutabile (Bach) 30e, iii doses Silicea 30e, iii doses; sac. lac., b.d. for 5 weeks
10.1.78 7.2.78 21.3.78 18.4.78 4.7.78 5.9.78 3.10.78 28.11.78
Thuja 10M, iii doses; Mixed Pollens 30c, i daily PulsatlUa O, 2 drops stat. Sac. lac., b.d. for 6 weeks PulsatlUa O, 2 drops star.
13.2.79
Pulsatilla 0 2 drops star.
Result After 2 days on Pulsatilla "never so bad in his life"; this lasted for whole of 2 weeks, but slowly improved on sac. lac. He then had an asthma attack and was admitted to another hospital. At present he is about back to what he was when he first attended us. (30.9.77) Again worse while taking Pulsatilla, but not so bad as on the first occasion. (14.10.77) :No effect from S.V.R. "Went wild after PulsatiUa 10M, with intense itching and scratching." Now about back to his usual state. (28.10.77) . Initial improvement--skin became clear, but as treatment continued it became dry again. (11.11.77) Better for a week, at least in himself--"really dramatic psychological effect"; now slipping back. (25.11.77) Skin better, but some asthma. Subsequent relapse. (13.12.77) No real difference. (7.2.78) No obvious effect. (21.3.78) No obvious effect. (18.4.78) No effect from Silicea. Getting hay fever. Skin is better when he has a fever; worst at 9.30 p.m. and 2.00 a.m. (4.7.78) Improved until beginning of September. (5.9.78) Very much bettor--rash almost gone. (3.10.78) Not as well as he was. (28.11.78) Remarkably much botter--"never so well"; appetite improved, and school comments that he is bettor as well. Skin began to clear 2 days after he bad the Pulsatilla. Now just beginning to slip back again. (13.2.79)
u n l i k e l y t h a t she w o u l d h a v e e x p e c t e d r e a c t i o n s t o o c c u r o n l y a f t e r P u l s a t i l l a and not after other remedies. A f u r t h e r p o i n t o f i n t e r e s t is t h a t t h e r e a c t i o n s w e r e a p p a r e n t l y s t r o n g e r the higher the potency used; thus mother tincture produced an aggravation o n l y a f t e r s e v e r a l d a y s , 3x p r o d u c e d a r e l a t i v e l y m i l d a g g r a v a t i o n , b u t 10M p r o d u c e d a v e r y v i o l e n t effect. T h i s also t e n d s t o s u p p o r t t h e v i e w t h a t t h e a g g r a v a t i o n s w e r e g e n u i n e . I n a d d i t i o n , o f course, it is w h a t o n e w o u l d p r e d i c t on orthodox homceopathic theory. On the other hand, such theory would predict t h a t a n i n i t i a l a g g r a v a t i o n o u g h t t o be f o l l o w e d b y a n i m p r o v e m e n t , b u t t h a t d i d n o t o c c u r i n t h e p r e s e n t case. From the therapeutic point of view, hindsight suggests that the initial i m p r o v e m e n t w h i c h f o l l o w e d t h e first use o f P u l s a t i U a 0 (on 28.10.77) o u g h t t o h a v e p r o m p t e d m e t o t r y a s h o r t e r c o u r s e o f t h e m o t h e r t i n c t u r e , as i n d e e d I did almost a year later, with gratifying results; but the child's extreme s e n s i t i v i t y t o P u l s a t i l l a m a d e m e a p p r e h e n s i v e a b o u t t r y i n g i t a g a i n for a l o n g t i m e , T h e i m p r o v e m e n t t h a t f o l l o w e d t h e first d o s e o f M u t a b i l e is also
APPARENT
AGGRAVATION
DUE
TO
PULSATILLA
125
of interest; just possibly the later good response to Pulsatilla 0 was due to the prior use of Mutabile. I n a case like this it would clearly have been unethical to have repeated the administration of Pulsatilla in potency once the genuineness of the aggravations had become apparent beyond reasonable doubt. However, such cases arc of the greatest possible theoretical interest, and I would make a strong plea for all homceopathic practitioners to record and investigate them systematically. An aggravation is often easier to recognize than an improvement; moreover, if genuine it should be repeatable. I t seems to me entirely justifiable to t r y to establish whether aggravations t h a t apparently occur in clinical practice are genuine or not, since this has a bearing on the subsequent management of the patient. I have seen several other cases of apparent aggravation, but in all these I t:ound equally strong reactions to placebo; so far as I am concerned, therefore, the present instance stands alone. I should be most interested to learn of anyone who has had a similar experience. This case does strongly suggest to me t h a t it would be well worth while trying to identify volunteers with specific remedy sensitivities who would be prepared to submit to proper double-blind testing. (This is something t h a t doctors might like to t r y out on themselves!) For example, if one could find an individual who, say, experienced headaches regularly and dependably while taking Glonoine in potency, it would be simple to demonstrate the fact b y means of an appropriate trial. Limited provings of this kind, using previously identified sensitive subjects as their own controls and looking for the occurrence of particular symptoms, would be relatively easy to carry out and extremely interesting and valuable. SUMMARY
A case of apparent aggravation due to Pulsatilla is presented and discussed. Possible research implications are considered.
Note added in proof: The patient continues to do well on Pulsatilla 0 , 2-4 drops at approximately monthly intervals. I have recently encountered a fairly convincing case of eczema aggravation b y Sulphur; I hope to report this in detail later.