Ankylosing Spondylitis
1. PRELIMINARY DATA
- No.: 215/2026
- Patient's Name: TUV
- Address: Row House 21, Maple Woods, Pune.
- Occupation: Civil Engineer (field work, prolonged standing, heavy lifting)
- Religion: Hindu
- Date: 10/05/2026
- Age: 36 Years
- Sex: Male
- Education: B.E. Civil
- Status: Married
2. CHIEF COMPLAINTS AND ASSOCIATED TROUBLES
| LOCATION | SENSATION & PATHOLOGY | A/F & MODALITIES | CONCOMITANTS |
|---|
| Spine & Sacroiliac | Chronic low back pain & stiffness, sacroiliitis, ascending to dorsal spine, morning stiffness >2 hours | < Morning/cold damp weather, < Rest/inactivity, < Night, > Gentle continued motion, > Warm applications, > Exercise, since 8 years (progressive, HLA-B27 positive, X-ray shows bamboo spine changes) | Fatigue, weight loss, eye redness (uveitis episodes), irritability |
| General | Heaviness in back | < Prolonged sitting | Anxiety about disability, low mood |
3. PERSONAL PAST & FAMILY HISTORY
- Past History: Recurrent back strain from work; childhood joint pains dismissed; recurrent uveitis treated with steroids; suppressed skin psoriasis in 20s; frequent NSAIDs with gastric side effects.
- Family History: Father has ankylosing spondylitis. Paternal uncle has psoriasis. Mother has rheumatoid arthritis.
- Developmental Landmarks: All milestones were reached at the appropriate age.
4. PATIENT AS A PERSON (PHYSICAL CHARACTERISTICS)
A. Physical Characteristics
- Appetite: Normal but diminished
- Desires: Warm food/drinks (+++), Spicy food (+)
- Aversions: Cold food/drinks
- Thirst: Moderate
- Elimination:
- Urine: Normal
- Stool: Regular
- Perspiration**: Profuse on back & head, sour
- Sleep: Disturbed by stiffness/pain; wakes stiff
- Thermal State: Chilly patient (cannot tolerate cold drafts)
B. Reactions - Physical Factors
- Weather: Aggravation in cold damp/monsoon
- Position: Better gentle movement/walking
5. MENTAL STATE (Psychodynamic & Life-Space)
- Nature: Irritable, impatient, determined
- Anxiety: About career impact, disability progression
- Fear: Fear of becoming bedridden, fear losing independence
- Dreams: Being paralyzed, falling, work failure
- Other: Suppressed frustration, feels restricted
6. PHYSICAL GENERAL EXAMINATION
- Wt: 75 kg | Ht: 175 cm | Temp: 98.6°F
- RR: 18/min | Pulse: 82 bpm | B.P.: 130/82 mmHg
- Face: Tense
- Tongue: Clean
- Nails: Normal
- Skin: Dry
7. SYSTEMIC EXAMINATION
- Musculoskeletal: Reduced spinal mobility, Schober's test positive, sacroiliac tenderness, postural stoop
- Eyes: History of uveitis, no active now
- CVS: S1, S2 Normal
- Respiratory: Clear
8. ANALYSIS AND EVALUATION OF SYMPTOMS
- Mental General: Irritability, anxiety about disability, fear dependence (Grade 3)
- Physical General: Chilly, desire warm food/drinks, sour sweat, morning stiffness prolonged (Grade 3)
- Particular: Chronic ankylosing spondylitis with sacroiliitis, ascending stiffness, < cold damp/rest, > motion/warmth (Grade 2)
9. SELECTION OF REPERTORY WITH REASON
- Repertory: Kent’s Repertory of Homoeopathic Materia Medica
- Reason: Chronic autoimmune spinal disorder with strong Mental Generals (irritability, fears) and Physical Generals (thermal, modalities) dominating; Kent suits sycotic/syphilitic rubrics for ankylosing spondylitis.
10. TOTALITY OF SYMPTOMS FOR REPERTORISATION
- Irritability and impatience
- Anxiety about disability
- Fear dependence
- Desire warm food/drinks
- Chilly patient
- Profuse sour perspiration
- Morning stiffness >2 hours
- Low back/sacroiliac pain
- < Cold damp, rest
-
Gentle motion, warmth
- Family autoimmune history
11. CONVERSION INTO REPERTORIAL RUBRICS
| SR. NO. | SYMPTOMS | RUBRICS WITH SUB-RUBRICS | PAGE NO. (Kent) |
|---|
| 1 | Irritability | Mind; IRRITABILITY | 57 |
| 2 | Anxiety health | Mind; ANXIETY; health, about | 6 |
| 3 | Desire warm drinks | Stomach; DESIRES; warm drinks | 486 |
| 4 | Back stiffness morning | Back; STIFFNESS; morning | 946 |
| 5 | Back pain cold damp | Back; PAIN; cold damp agg. | 894 |
| 6 | Motion continued amel | Generalities; MOTION; continued amel | 1374 |
| 7 | Chilly | Generalities; COLD; agg. | 1348 |
12. SELECTION OF REPERTORIZATION (NUMERICAL ORDER)
| SR. NO. | REMEDIES | RUBRICS COVERED | TOTAL MARKS |
|---|
| 1 | Rhus Toxicodendron | 7/7 | 23 |
| 2 | Bryonia Alba | 6/7 | 18 |
| 3 | Calcarea Fluorica | 5/7 | 15 |
13. MIASMATIC INTERPRETATION
| PSORA | SYCOSIS | TUBERCULAR | SYPHILIS |
|---|
| Stiffness, irritability, chilly | Fusion/deformities, sacroiliitis | Autoimmune family history | Destructive fear disability |
Dominant Miasm: Sycotic-Psoric
14. FINAL STEPS
- Provisional Diagnosis: Ankylosing Spondylitis
- Differentiation of Remedies: Compared Rhus tox with Bryonia. Bryonia has > absolute rest, < motion; Rhus tox matches chronic AS with prolonged morning stiffness > continued gentle motion, chilly, < cold damp, > warmth, irritability/anxiety. Calc fluor more for bony exostosis.
- Selection of Remedy (Materia Medica): Rhus Toxicodendron matches ankylosing spondylitis with stiffness > continued motion, chilly patient, sacroiliac/low back pain, < cold damp/rest, > warmth/motion (Ref: Allen’s Keynotes, Boericke).
- Selection of Potency: 200C (Chronic autoimmune spinal case, sensitive constitution)
- Actual Prescription:
- Rhus Toxicodendron 200 — single dose (one dose only, wait & watch)
- Placebo — 4 pills twice a day for 8 weeks
15. FOLLOW-UP'S TABLE
| DATE | COMPLAINTS | REMEDY | ADVICE |
|---|
| 05/07/2026 | Morning stiffness reduced to 45 min, pain 60% less, mobility improved | Placebo | Daily gentle exercises (yoga/swimming), warm compress, avoid cold exposure |
| 05/11/2026 | Stiffness minimal, no flare-ups, posture better, energy up | Placebo | Continue physiotherapy, balanced diet, regular follow-up with rheumatologist |