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Case quiz: eruptions on the tongue
The patient presented with an eruption on the left side of the tongue. There was a small spot just under the tip of the tongue, and what looked like small flat red circles on the tongue itself. The area under the tongue on the right side was very dark red. The tongue itself was slightly white coated, but the patient said she had not yet eaten and that may be why.
The patient said the tongue felt like it was burning, and was especially aggravated by hot drinks, and eating in general. She said when anything touched the spot on the tongue the pain was excruciating. She said her tongue felt very rough against her teeth, giving a sensation that the teeth were not clean, when they had just been cleaned.
Several remedies were prescribed, which all helped slightly but did not hold. The patient then reported a change in symptoms. There were now two spots on the tongue, one under the tip and one on the edge of the right side of the tongue, both extremely painful and white-ish in colour, and the tongue had become mapped.
Remedy 1 was prescribed and the condition improved significantly. The pain diminished by around 50% after the first dose, even though the spots were still present on the tongue. By the following morning, after three doses of Remedy 1, the tongue was clear, the discolouration had disappeared, and the patient was pain free.
At this point a further symptom appeared, which was not helped by Remedy 1. The patient reported a sensation of mouth ulcers inside the lower lip and then the upper lip on the left hand side. A further ulcer was reported the following day on the inside of the upper lip on the right hand side. The ulcers were hardly visible, and the lips were slightly swollen on the inside. The swelling in the lips felt firm but not hard. The patient reported that the ulcerated areas felt dry and reported discomfort when the areas touched the teeth and on pursing the lips. There may have been a slight discolouration on the ulcerated areas but the patient was not sure. The area was completely flat, not raised at all.
In addition, the patient reported a deep crack on her tongue, along the centre towards the tip.
Remedy 2 was given and the ulcers cleared significantly within a day, and completely within two days, after two doses.
What were the two remedies?
AND NOW FOR THE REST OF THE STORY…
Thanks to all those who actively contributed to this discussion, and to those who worked on the case even if you didn’t chose to comment online.
Arsenicum seemed so certain for this case, that it briefly shook my confidence in homoeopathy, Hahnemann, Boeninghausen, the prescribing pharmacy and myself when it didn’t hold… Carbo-v also looked good, but did not help. Phosphorous came up, but on checking the materia medica did not look right.
The white spots (P&W’s TPB no. 1579) narrowed the choice down to 8 remedies: Alum, Am-c, ARS, Carb-an, Phos, Sep, SIL, Sulph
I checked the other remedies in the materia medica, and since Arsenicum clearly was not working, Sepia looked like the next best candidate. I have also seen Sepia working very well in previous cases where a central presenting symptom was white apthae in the mouth.
The patient wrote after receiving the Sepia: “I had felt as if my tongue was held in pincers, almost as if there was a crab latched on to my tongue! With the first dose of the Sepia it was if it had loosened its grip, the pain eased a lot, and gradually disappeared.”
I must admit I was glad she didn’t say anything about crabs and pincers during the intake or following phone calls – it was so much easier just to look for white spots…
Remedy 2 was indeed Mercury. I used:
Face, sensations lips (247)
Ulcers, flat (26)
Aggravation, motion of affected part (2227)
Belladonna did show up in grades 4, 2, and 3. Mercury however presented here in even grades of 3 and checking in Materia Medica confirmed the prescription.