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A case of Stage III essential hypertension treated with homoeopathy through the windows of the unconscious mind: A case report
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Received: ,
Accepted: ,
How to cite this article: Patil MK. A case of Stage III essential hypertension treated with homoeopathy through the windows of the unconscious mind: A case report. J Intgr Stand Homoeopathy 2021;4:128-32.
Abstract
A 36-year-old man presented with Stage III accelerated hypertension and reluctance to start anti-hypertensive medication. This case is an attempt to demonstrate the importance of unconscious emotions and dreams with their psychodynamic correlations in essential hypertension through the portrait of disease. Mag carb was selected based on the totality of symptoms in view of the evolution of person, dispositions and adaptive patterns along with available physical characteristics through the psychodynamic study.
Keywords
Essential hypertension
Unconscious emotions
Repression
Disguise dream
Mag carb
INTRODUCTION
Hypertension is one of the most prevalent chronic diseases worldwide. In most cases, hypertension has no obvious cause; this is termed essential hypertension. Genetic factors play a significant role. It is known to be precipitated by emotions such as fear, anxiety, anger and excitement. If conscious, these states are appropriate and self-limiting but endure if unconsciously repressed.[1] For decades, psychosomatic research in hypertension has focused largely on consciously experienced emotional distress, such as anger and anxiety while paying minimal attention to unconscious emotion.[2] However, some psychotherapeutic studies of patients with essential hypertension show evidence of massive repression of unacceptable feelings, predominantly rage and hostility.[1,2] Repression plays a prominent role in the genesis and progression of hypertension. Proving this hypothesis requires further study on the underlying emotions in cases of hypertension.
The Homoeopathic management of essential hypertension, like all other diseases, is based on the core concept of “similia similibus curentur,” wherein similarity is established not only at the level of signs and symptoms but also at the level of portrait of disease to understand the essence of the problem and create a drug picture.[3-5] The objective of Homoeopathy is to treat the underlying cause and individual susceptibility.
Here, we present a case of essential hypertension that was treated with the Homoeopathic constitutional medicine Mag carb, which was selected on the basis of totality of symptoms.
CASE REPORT
Preliminary data
Age: 36 years, Occupation: Gram Pradhan (head of village) and Farming
Caste: Hindu Koli, Marital status: Married in 2010. 1 Son: 5-year-old.
Chief complaints
Accelerated asymptomatic hypertension diagnosed during a regular check-up camp 2 months prior. The blood pressure (BP) range was 180–160/120–110. He was resistant to starting anti-hypertensive treatment, as he believed that he would need to take the anti-hypertensive for the rest of his life.
Patient as a person
Appearance: Broad face with flabby hanging cheeks ++ , prominent acne scars on the face. Generalized obesity with lax abdomen. He looked older than his age +++
Craving: Eggs ++, Fish ++ Sweet ++
Thermal: Chilly C3H
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Dreams
Angry, large-horned bull is running to hit someone +++
Sometimes few angry bulls chasing to hit him.
These dreams are since childhood
Sleep: Disturbs due to dreams ++ since childhood out of fright.
Physical examination
T: Afeb BP: 180/120 WT: 75 kg. No pedal swelling
RS, CVS, PA = NAD
Family/Medical history: Nil.
Investigation
Lipid Profile: Normal Urine R: Normal S. Creat: 1.
Diagnosis
Essential hypertension Stage: 3.
Life space
The patient was serious and non-expressive during the interview. He was born and brought up in an extremely underprivileged family and faced numerous adversities in life. When asked about his childhood, he said that he was never a child, and had been similarly perceived by others. His family comprised an elder brother and mother. His father died when he was 1 year old, so his brother started earning, but even that was insufficient. Hence, the patient started working at the age of 10 years. He would work after school. He was an average student, so he studied only till the 12th standard. Since childhood, no one had taken care of him. He said he was not blessed with a childhood one could be nostalgic about; he said he did not bother to think about it. He also said he was unable to recollect his childhood memories due to the family’s miserable condition. Their financial condition was so poor that they could not afford even the necessities like food, clothes, and household things, but they never asked for help from others. They often had to sell their possessions to afford food and most of the time, his family had faced starvation.
At the age of 15 years, he started helping poor and needy people around him. He was unaware of why he helped them when he was deprived of the basics. As he helped solve people’s problems, he became very popular in his village. In doing this, he developed the ability to deal with people and get work done. Therefore, he was appointed head of the village. He accepted the position as he feels that since he experienced the pain and suffering of poverty, he can help people better.
His relationship with his older brother was good. Later, the brother got married and decided to live separately. The patient accepted this turn of affairs without any emotional disturbance and hesitation. However, the patient received no help from the brother when he got married or when his wife was pregnant and had a medical emergency. Patient managed by himself without any emotional outburst and a neutral attitude towards the brother and circumstances. He said he is calm and never becomes irritated or agitated.
Selection of approach: Structuralisation
Approach to the case depends upon its symptomatology and quality. In this case, evident unconscious reactions expressed through dreams and behaviours revealed the problem genesis; this helped evolve the essential evolutionary totality. The genesis and essence of problem will not be understood or identified if any other traditional approaches are directly applied over a case without understanding the evolutionary totality. Due to a paucity of characteristic qualified expressions at the mind and body level, we had to follow the non-repertorial approach of Structuralisation.[5] Concepts introduced by Sigmund Freud were used to understand the structure in terms of evolution, adaptation and dreams.[6-8]
Case analysis
The patient was severely deprived in terms of basic physiological and psychological needs since childhood. As he said, he was never a child, indicating deep repressed bitterness. Starvation at the level of body and mind evoked a forsaken feeling in him; the repressed hostility caused by the emotional turmoil was expressed through disguise dreams such as angry, large-horned bull is running to hit someone. Bulls are notorious for their unpredictable aggression; the presence of the bull in his dreams symbolically represented the fulfilment of the patient’s repressed aggression [Figure 1]. This subconscious impulse from the Id reached to consciousness during sleep and it disturbed his sleep.
- Psychosomatic and psychodynamic (PSPD).
The patient’s altruism despite his own adversities indicates a certain strength and a unique way of adapting to his stressors. Repression served a constructive purpose in him. Even after marriage, when his brother refused to help, he managed without any emotional turmoil. The expected emotional and behavioural reactions to the circumstances were absent. The same pattern of response is observed in all stages of life. The other important aspect of this individual was fixity. He had fixed ideas about anti-hypertensive medicine and he did not want to be dependent on medicine all his life; this led him to resist the physician’s advice.
Prematurely old appearance, acne scars, flabby hanging cheeks, generalized obesity with prominent abdomen, and hypertension are the predominant sycotic expressions at the physical and pathological levels.
Totality
Forsaken 3
Deprived of Love and care 3
Repressed hostility 3
Toughness 2
Independent 2
Responsible 3
Fixity 2
Helpful 2
Dreams: Angry, large horn bull is running for hitting someone 3
Premature old
Acne scar mark
Craving: Eggs 2, Fish 2 Sweet 2
Thermal: chilly C3H
Final impression
Mag carb.
The remedy should correspond with the portrait of illness in terms of the evolution of person, quality and pattern of adaptation, and the response to life experiences along with the physical characteristics. Lycopodium appeared similar due to the responsibility, strength, and prematurely old features, but Lycopodium lacks the sensitivity to being forsaken, repression, and altruistic pattern of adaptation. Carcinosin was also close due to its responsibility, benevolence, and altruistic response, but it lacks the strength to deal with the hardships of life and it does not show prematurely old features. From the above analysis and psychodynamic study, the magnesium group of remedies were the most similar. Although magnesium does not cover the specificity of dream in the repertory but it covers the essence of dream. Indium met and Tarentula cover the specific dreams but do not correspond with the rest of the portrait and totality.
Final selection of Mag carb
The main theme of Mag carb is a strong sense of starvation in terms of care, protection, and nourishment. This results in tremendous emotional turmoil, which is usually repressed; this repression becomes a strong defence of the evolving Magnesium personality.[9,10] In most Magnesium patients, there is total repression – they feel that they should not make any demands or ask anyone for help. This makes them seem independent.[11] Repression is pushing down of painful emotional experiences into the unconscious. When it reaches a certain limit, it leads to somatization or is reflected in dreams. The repressed emotions are not destroyed but go on seething inside such as a volcano, finding expression through various devious channels; the most striking channel is the dreams, the sleep is consequently disturbed with starts, shrieking, talking, and weeping.[11,12] Another peculiar feature of Magnesium is their seemingly stress-resistant personality that gives the person strength of character and a humane disposition. Due to the strength of character, Magnesium converts the deep negativity of the ‘love experience’ into the positivity of giving love. He goes out of his way to help people.[11,12] The other important disposition of Mag carb is fixity. He has fixed ideas and resists change. Fixity of ideas, values, attitudes, and feelings make him immobile.[12] Magnesium is a deep acting constitutional drug it has expression in all four miasms. At the physical level, premature senility is marked in Magnesium due to affected elastic tissue (elasticity lost) skin hangs. Acne scar marks and offensive discharges that leave indelible stains are the peculiar features of Magnesium.[12,13]
Planning and programming of treatment
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Susceptibility
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Nature of disease: Chronic, Accidental detected, and Asymptomatic
BP range 180–160/120–110 with no signs or symptoms
No characteristics at the tissue level
Pathology: Functional
Susceptibility: On the lower side
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Sensitivity: Moderate to high
Mind: +++
Dreams: +++
Sleep: disturbed due to dreams +++
Availability of unconscious reaction and its expressions
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Repression: Emotional
Hostility/Aggression
Correspondence at constitutional Rx: Mind +++ Body ++
Vitality: Good
Dominant Miasm: Sycotic.
Considering the above parameters, 200 potency was selected with weekly repetition.
Ancillary measures
Regular walk for minimum 45 min; Low sodium diet; Avoid alcohol consumption.
| Follow-up summary | |||||||
|---|---|---|---|---|---|---|---|
| Date | Dreams | Sleep | BP range chart | BP (mmHg) | Wight | Exercise | Treatment |
| January 15, 2018 11 AM | 180/120 | Mag carb 200 1P stat | |||||
| January 15, 2018 6 PM | 140/90 | ||||||
| January 21, 2018 | + | > | 150–140/90–84 Over 7 days |
130/100 | 77 kg | Not started | Mag carb 200 1P HS |
| February 1, 2018 | + | > | 150–140/90–84 Over 15 days |
130/90 | 77 kg | Not started | Placebo |
| February 7, 2018 | + | > | 150–140/100–94 Over 7 days |
140/90 | __ | Not started | Mag carb 200 1P HS |
| February 14, 2018 | > | 140–120/90–88 Over 7 Days |
120/80 | Not started | Placebo Advised for exercise |
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| February 21, 2018 | Nil | > | 150–140/90–84 Over 7 days |
144/100 | 77 kg | Irregular | Mag carb 200 1P HS Advised for exercise. |
| March 1, 2018 | Nil | >2 | 140–130/96–88 Over 7 days |
140/92 | 77 kg | Irregular | Placebo Advised for exercise. |
| March 14, 2018 | Nil | >2 | 140–130/96–88 Over 7 days |
130/90 | 77 kg | Occ | Mag carb 200 1P weekly |
| April 15, 2018 | Nil | >3 | 140–130/94–80 Over 1 month |
130/90 | 77 kg | Regular | Mag carb 200 1P weekly |
| May 11, 2018 | + | >3 | 146–130/92–82 Over 1 month |
138/88 | 76 kg | Regular | Mag carb 200 1P weekly |
| June 15, 2018 | Occ | Good | 140/88 | 75.5 kg | Regular | Mag carb 200 1P weekly | |
| July 20, 2018 | Nil | Good | 146–130/90–80 Over 1 month |
132/88 | 75.5 kg | Mag carb 200 1P weekly | |
| September 15, 2018 | Nil | Good | 130/86 | 74 kg | Mag carb 200 1P weekly | ||
| November 20, 2018 | Nil | Good | 140–130/88–80 Over 1 month |
130/80 | Irregular | Mag carb 200 1P weekly | |
| February 10, 2019 | Nil | Good | 138/84 | 73 kg | Irregular | Mag carb 200 1P weekly | |
Mag carb 200 was discontinued after 1 year of treatment; since the last 2 years, the patient has been normotensive without any other treatment.
DISCUSSION
This case was managed on an outpatient basis; the patient opted for Homoeopathic treatment to avoid anti-hypertensive medication. Through this case, we could explore the efficacy of Homoeopathic medicine in essential hypertension. Problem definition was an indispensable aspect and strength of this case; through this, the physician gained the confidence to formulate a therapeutic Plan A in terms of constitutional medicine. Plan B involved clearing the prejudices about the use of anti-hypertensive medication. The patient was oriented regarding the consequences of untreated hypertension and certain limitations of Homoeopathy. Anti-hypertensive medication was put forth as an option if Plan A did not work successfully within a reasonable time frame; this was a limitation of the case. An essential aspect of the case was the psychodynamic dimension identified through the behaviour and dreams. Freud stated that dreams should not be taken at face value. In this case, the essence of dream was more important when using the structuralisation approach. While the Magnesium group of remedies has been researched, it remains poorly represented in Materia Medica and Repertory. Therefore, in this case, the traditional approach would not have been helpful for case processing and understanding the depths of the patient. The portrait of Magnesium established in the ICR literature and their unique analytical tools helped the treating physician to analyse and evaluate the case and achieve the expected outcome.
CONCLUSION
This case report demonstrates the role of unconscious emotions in treating essential hypertension, through psychodynamic study. It includes the identification of concealed repressed desires through the dreams and its somatic effects. Repression was identified as a core defence in this case. Hostility was unconscious emotion born out of adversity & it was repressed & symbolically represented through disguised dreams of angry bull to fulfil unconscious aggressive wish. Mag carb seemed to be the most suitable similimum in terms of portrait of disease & symptom similarity with the help of structurlisation approach. Administration of Mag carb generated an effective action result complex in Stage III essential hypertension. However, this is a single case report and further larger studies with different study designs and large sample sizes are required for determining the efficacy of homoeopathic treatment in Stage III essential hypertension.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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