Introduction

Dr.Winston Vargheese, lecture, physician, and Research scholar is known to every body. His in depth study, innovative application makes every body surprise. He had written many articles in Souvenir, Magazines and Journal. And also presented many scientific papers in seminars. His rational approach to his patients and clinical evidence based documents are added advantage for our fraternity..

A female patient aged 51 years from a Village Malavilai, adjustant to Kulasekharam, presented the complaints of itching of the skin with blackish discoloration in small patches and thickening of the skin especially over the hands and leg. The complaints started since ten months. Itching is better by warm application and after scratching there used to be burning sensation. Patient had similar complaints 7 years back for which she has taken allopathic medicines and was feeling better with that. The complaints have reappeared once again three years before and she consulted a dermatologist who has diagnosed the case as Lichen Planus and then she was treated with steroids. She was also having headache since two years, which used to trouble her whenever she goes out in sun, when she travels by bus and when she is hungry.

Past History
In her childhood she used to have recurrent attacks of running nose and cold. These complaints have vanished completely after she developed the skin complaints.

Family History

Nothing was enquired about Menstrual History She had menopause without deterioration of any complaints, two years back.

Personal History

• She desires fish
• Does not prefer to be covered usually, but if too cold then uses a very thin covering. Wants to take cold water bath and prefers to emain in open air.
  
  

  Life space investigation Patient is the only child of the family from a lower middle class family. She has two daughters and two sons. Sons are doing their degree. The daughters are elder ones. Husband is a party worker involved with labour union and he spends most of the time for party work and even money he spends on party work. The daughters are to be married; patient feels that father is not very much bothered about it. She worries a lot about the irresponsibility of her husband and gets angry over the issue, yet does not express about. While narrating these there was tears on patients eyes and she was very quick to wipe it out so that the physician does not notice that. Physical Examination Pulse 74/min, BP110/70mm Hg Thickened lichenified patches all over the body Analysis and evaluation This is a case of Lichen Plannus and where the immunity plays a very major role. The immunity itself is maintained by the Psycho –Neuro - Endocrine mechanism. So in understanding the patient the importance has to be given for the mind. The prolonged worry and the suppression of anger is to be given more importance and so the mental generals need much importance in the construction of totality. More over there are no characteristic modalities available, so the prescription should be based on Mental Generals and Physical Generals. Totality Ailment from Prolonged worry (Grief) Anger Suppressed Weepy Desire for fish Hot patient Head ache aggravated in sun, hungry while Skin discolouration blackish The remedies which came up predominantly for this totality are Natrum. Mur and Pulsatilla. Reportorial Totality 1. Kent: Mind. Grief Ailment from 2. Kent: Mind. Weeping, tearful mood 3. Kent: Mind. Ailments from anger after silent grief 5. Kent: Stomach: Desires fish 6. Kent: Head. Headache in general sun from exposure 7. Kent: Head. Headache in general fasting from 8. Kent: Skin. Discolouration blackish Prescription 10-8-2002 First Prescription Rx Natrum. Mur 0/6 3 Doses on alternate days at night Not much change But generally feels better Rx Natrum. Mur 0/6 7 Doses daily night The remedy was continued till 31-8-2004 then there was marked improvement in the lesions and yet there was itching persisting. Later on the potency was raised to Natrum Mur 0/12 and was repeated frequently. Now the patient is completely free of the Skin lesions and no more itching. Patient also got Rhus tox and Pulsatilla in between when she developed fever and acute coryza as acute remedies. Discussion Since the disease is an autoimmune disease which is usually a functional change and not much of structural damage is not there a higher potency could have been used. But as auto immune disease where a flare up and aggravation could be expected the safer potency Millesimal was used so that a frequent repetition was done. During the course of treatment the old symptoms of cold reappeared. But those symptoms were so much troubling the patient that she even developed fever, which required an acute remedy intervention. Limitation The other physical generals such as Perspiration, Appetite, and thirst were not enquired. The family history and miasmatic background is not understood. Conclusion When there is physical disease and mental state or symptoms are available prime importance has to be given. In autoimmune disease where one expects flare up the medicine in Millesimal potency can be used without any aggravation and with positive results. Lichen planus is a disease, which allopathic system considers as an incurable disease and there could be remissions. It requires a prolonged medication especially with steroids. But with homoeopathic treatment the improvement is very fast and there are no remissions till now.