### Low Back Pain
1. PRELIMINARY DATA
- No.: 217/2026
- Patient's Name: ZAB
- Address: Bungalow 10, Orchid Gardens, Pune.
- Occupation: Driver (long hours sitting/driving, heavy lifting parcels)
- Religion: Hindu
- Date: 20/05/2026
- Age: 47 Years
- Sex: Male
- Education: 10th Pass
- Status: Married
2. CHIEF COMPLAINTS AND ASSOCIATED TROUBLES
| LOCATION | SENSATION & PATHOLOGY | A/F & MODALITIES | CONCOMITANTS |
|---|---|---|---|
| Lower Back (lumbar region) | Chronic aching & stiffness in lumbosacral area, shooting pain down right leg occasionally, limited forward bending | < Prolonged sitting/standing, < Lifting/bending, < Cold damp weather, < Night, > Warm applications, > Gentle continued motion, > Lying on hard surface, since 10 years (worse last 4 years, X-ray shows mild spondylosis) | Restlessness at night, irritability, fatigue |
| Right Leg | Sciatic-like pain, numbness | < Sitting long | Anxiety about work loss |
3. PERSONAL PAST & FAMILY HISTORY
- Past History: Recurrent back strain from occupation; suppressed pain with painkillers; occasional physiotherapy; overweight gain after 35; frequent acidity from irregular meals.
- Family History: Father has chronic low back pain & spondylosis. Brother has sciatica. Mother has osteoarthritis.
- Developmental Landmarks: All milestones were reached at the appropriate age.
4. PATIENT AS A PERSON (PHYSICAL CHARACTERISTICS)
A. Physical Characteristics
- Appetite: Normal
- Desires: Warm food/drinks (+++), Spicy food (+)
- Aversions: Cold food
- Thirst: Moderate
- Elimination:
- Urine: Normal
- Stool: Occasional hard
- Perspiration: Profuse on back, sour
- Sleep: Disturbed by pain; wakes stiff
- Thermal State: Chilly patient (cannot tolerate cold drafts)
B. Reactions - Physical Factors
- Weather: Aggravation in cold damp/monsoon
- Position: Better walking slowly or lying on hard surface
5. MENTAL STATE (Psychodynamic & Life-Space)
- Nature: Irritable, impatient, worried
- Anxiety: About daily income, family support
- Fear: Fear of permanent disability, fear losing job
- Dreams: Falling, being unable to move, work failure
- Other: Suppressed frustration, feels restricted
6. PHYSICAL GENERAL EXAMINATION
- Wt: 82 kg | Ht: 170 cm | Temp: 98.6°F
- RR: 18/min | Pulse: 80 bpm | B.P.: 136/86 mmHg
- Face: Grimacing when moving
- Tongue: Clean
- Nails: Normal
- Skin: Dry
7. SYSTEMIC EXAMINATION
- Musculoskeletal: Lumbar tenderness, paraspinal spasm, limited forward flexion, SLR positive right at 50°
- CVS: S1, S2 Normal
- Respiratory: Clear
- GIT: Normal
8. ANALYSIS AND EVALUATION OF SYMPTOMS
- Mental General: Irritability, anxiety about livelihood, fear disability (Grade 3)
- Physical General: Chilly, desire warm food/drinks, sour sweat, stiffness > motion (Grade 3)
- Particular: Chronic low back pain with sciatic radiation, < cold damp/sitting, > warm/motion/hard surface (Grade 2)
9. SELECTION OF REPERTORY WITH REASON
- Repertory: Kent’s Repertory of Homoeopathic Materia Medica
- Reason: Chronic musculoskeletal disorder with strong Mental Generals (irritability, fears) and Physical Generals (thermal, modalities) dominating; Kent suits back/extremities rubrics for chronic lumbago/sciatica.
10. TOTALITY OF SYMPTOMS FOR REPERTORISATION
- Irritability and impatience
- Anxiety about income
- Fear disability
- Desire warm food/drinks
- Chilly patient
- Profuse sour perspiration
- Low back stiffness/aching
- Shooting right leg
- < Cold damp, sitting
-
Gentle motion, warm applications
-
Lying hard surface
11. CONVERSION INTO REPERTORIAL RUBRICS
| SR. NO. | SYMPTOMS | RUBRICS WITH SUB-RUBRICS | PAGE NO. (Kent) |
|---|---|---|---|
| 1 | Irritability | Mind; IRRITABILITY | 57 |
| 2 | Anxiety livelihood | Mind; ANXIETY; money matters, about | 8 |
| 3 | Desire warm drinks | Stomach; DESIRES; warm drinks | 486 |
| 4 | Back pain lumbar chronic | Back; PAIN; lumbar region | 893 |
| 5 | Extremities pain sciatica right | Extremities; PAIN; sciatica; right | 1064 |
| 6 | Back stiffness cold damp | Back; STIFFNESS; cold damp agg. | 946 |
| 7 | Motion continued amel | Generalities; MOTION; continued amel | 1374 |
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 | Nux Vomica | 5/7 | 15 |
13. MIASMATIC INTERPRETATION
| PSORA | SYCOSIS | TUBERCULAR | SYPHILIS |
|---|---|---|---|
| Stiffness, irritability, chilly | Shooting pains, chronic strain | Family musculoskeletal issues | Destructive fear disability |
Dominant Miasm: Psora-Sycotic
14. FINAL STEPS
- Provisional Diagnosis: Low Back Pain (chronic, mechanical with sciatica)
- Differentiation of Remedies: Compared Rhus tox with Bryonia. Bryonia has > absolute rest, < motion; Rhus tox matches chronic low back pain with stiffness > continued gentle motion, chilly, < cold damp, > warmth/hard surface, irritability/anxiety. Nux Vomica more for sedentary stress but less motion emphasis.
- Selection of Remedy (Materia Medica): Rhus Toxicodendron matches chronic low back pain/sciatica from strain, stiffness > continued motion, chilly patient, < cold damp/rest, > warmth/motion (Ref: Allen’s Keynotes, Boericke).
- Selection of Potency: 200C (Chronic musculoskeletal miasmatic 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 |
|---|---|---|---|
| 10/07/2026 | Stiffness reduced 60%, pain milder, better mobility | Placebo | Daily gentle walking, warm compress, avoid heavy lifting |
| 10/11/2026 | Minimal pain, no shooting, full bending possible, energy better | Placebo | Core strengthening exercises, maintain posture, report flare-ups |
1. PRELIMINARY DATA
- No.: 217/2026
- Patient's Name: ZAB
- Address: Bungalow 10, Orchid Gardens, Pune.
- Occupation: Driver (long hours sitting/driving, heavy lifting parcels)
- Religion: Hindu
- Date: 20/05/2026
- Age: 47 Years
- Sex: Male
- Education: 10th Pass
- Status: Married
2. CHIEF COMPLAINTS AND ASSOCIATED TROUBLES
| LOCATION | SENSATION & PATHOLOGY | A/F & MODALITIES | CONCOMITANTS |
|---|---|---|---|
| Lower Back (lumbar region) | Chronic aching & stiffness in lumbosacral area, shooting pain down right leg occasionally, limited forward bending | < Prolonged sitting/standing, < Lifting/bending, < Cold damp weather, < Night, > Warm applications, > Gentle continued motion, > Lying on hard surface, since 10 years (worse last 4 years, X-ray shows mild spondylosis) | Restlessness at night, irritability, fatigue |
| Right Leg | Sciatic-like pain, numbness | < Sitting long | Anxiety about work loss |
3. PERSONAL PAST & FAMILY HISTORY
- Past History: Recurrent back strain from occupation; suppressed pain with painkillers; occasional physiotherapy; overweight gain after 35; frequent acidity from irregular meals.
- Family History: Father has chronic low back pain & spondylosis. Brother has sciatica. Mother has osteoarthritis.
- Developmental Landmarks: All milestones were reached at the appropriate age.
4. PATIENT AS A PERSON (PHYSICAL CHARACTERISTICS)
A. Physical Characteristics
- Appetite: Normal
- Desires: Warm food/drinks (+++), Spicy food (+)
- Aversions: Cold food
- Thirst: Moderate
- Elimination:
- Urine: Normal
- Stool: Occasional hard
- Perspiration: Profuse on back, sour
- Sleep: Disturbed by pain; wakes stiff
- Thermal State: Chilly patient (cannot tolerate cold drafts)
B. Reactions - Physical Factors
- Weather: Aggravation in cold damp/monsoon
- Position: Better walking slowly or lying on hard surface
5. MENTAL STATE (Psychodynamic & Life-Space)
- Nature: Irritable, impatient, worried
- Anxiety: About daily income, family support
- Fear: Fear of permanent disability, fear losing job
- Dreams: Falling, being unable to move, work failure
- Other: Suppressed frustration, feels restricted
6. PHYSICAL GENERAL EXAMINATION
- Wt: 82 kg | Ht: 170 cm | Temp: 98.6°F
- RR: 18/min | Pulse: 80 bpm | B.P.: 136/86 mmHg
- Face: Grimacing when moving
- Tongue: Clean
- Nails: Normal
- Skin: Dry
7. SYSTEMIC EXAMINATION
- Musculoskeletal: Lumbar tenderness, paraspinal spasm, limited forward flexion, SLR positive right at 50°
- CVS: S1, S2 Normal
- Respiratory: Clear
- GIT: Normal
8. ANALYSIS AND EVALUATION OF SYMPTOMS
- Mental General: Irritability, anxiety about livelihood, fear disability (Grade 3)
- Physical General: Chilly, desire warm food/drinks, sour sweat, stiffness > motion (Grade 3)
- Particular: Chronic low back pain with sciatic radiation, < cold damp/sitting, > warm/motion/hard surface (Grade 2)
9. SELECTION OF REPERTORY WITH REASON
- Repertory: Kent’s Repertory of Homoeopathic Materia Medica
- Reason: Chronic musculoskeletal disorder with strong Mental Generals (irritability, fears) and Physical Generals (thermal, modalities) dominating; Kent suits back/extremities rubrics for chronic lumbago/sciatica.
10. TOTALITY OF SYMPTOMS FOR REPERTORISATION
- Irritability and impatience
- Anxiety about income
- Fear disability
- Desire warm food/drinks
- Chilly patient
- Profuse sour perspiration
- Low back stiffness/aching
- Shooting right leg
- < Cold damp, sitting
-
Gentle motion, warm applications
-
Lying hard surface
11. CONVERSION INTO REPERTORIAL RUBRICS
| SR. NO. | SYMPTOMS | RUBRICS WITH SUB-RUBRICS | PAGE NO. (Kent) |
|---|---|---|---|
| 1 | Irritability | Mind; IRRITABILITY | 57 |
| 2 | Anxiety livelihood | Mind; ANXIETY; money matters, about | 8 |
| 3 | Desire warm drinks | Stomach; DESIRES; warm drinks | 486 |
| 4 | Back pain lumbar chronic | Back; PAIN; lumbar region | 893 |
| 5 | Extremities pain sciatica right | Extremities; PAIN; sciatica; right | 1064 |
| 6 | Back stiffness cold damp | Back; STIFFNESS; cold damp agg. | 946 |
| 7 | Motion continued amel | Generalities; MOTION; continued amel | 1374 |
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 | Nux Vomica | 5/7 | 15 |
13. MIASMATIC INTERPRETATION
| PSORA | SYCOSIS | TUBERCULAR | SYPHILIS |
|---|---|---|---|
| Stiffness, irritability, chilly | Shooting pains, chronic strain | Family musculoskeletal issues | Destructive fear disability |
Dominant Miasm: Psora-Sycotic
14. FINAL STEPS
- Provisional Diagnosis: Low Back Pain (chronic, mechanical with sciatica)
- Differentiation of Remedies: Compared Rhus tox with Bryonia. Bryonia has > absolute rest, < motion; Rhus tox matches chronic low back pain with stiffness > continued gentle motion, chilly, < cold damp, > warmth/hard surface, irritability/anxiety. Nux Vomica more for sedentary stress but less motion emphasis.
- Selection of Remedy (Materia Medica): Rhus Toxicodendron matches chronic low back pain/sciatica from strain, stiffness > continued motion, chilly patient, < cold damp/rest, > warmth/motion (Ref: Allen’s Keynotes, Boericke).
- Selection of Potency: 200C (Chronic musculoskeletal miasmatic 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 |
|---|---|---|---|
| 10/07/2026 | Stiffness reduced 60%, pain milder, better mobility | Placebo | Daily gentle walking, warm compress, avoid heavy lifting |
| 10/11/2026 | Minimal pain, no shooting, full bending possible, energy better | Placebo | Core strengthening exercises, maintain posture, report flare-ups |