Peptic Ulcer
1. PRELIMINARY DATA
- No.: 213/2026
- Patient's Name: NOP
- Address: Flat 405, Silver Springs, Pune.
- Occupation: Sales Representative (frequent travel, irregular meals, stress targets)
- Religion: Hindu
- Date: 01/05/2026
- Age: 41 Years
- Sex: Male
- Education: B.Com
- Status: Married
2. CHIEF COMPLAINTS AND ASSOCIATED TROUBLES
| LOCATION | SENSATION & PATHOLOGY | A/F & MODALITIES | CONCOMITANTS |
|---|
| Epigastrium & Stomach | Burning pain in epigastrium, hunger pain, gnawing sensation, relieved temporarily by eating | < Empty stomach (2-4 hours after food), < Spicy/acidic food, < Night 12-2 AM, > Eating small frequent meals, > Milk/warm drinks, since 7 years (worse last 3 years, endoscopy shows duodenal ulcer) | Nausea, sour eructations, bloating, irritability |
| General | Weakness, weight loss | < Stress | Anxiety about perforation/bleeding, low mood |
3. PERSONAL PAST & FAMILY HISTORY
- Past History: Recurrent acidity since youth treated with antacids; suppressed boils/furuncles with antibiotics; frequent NSAIDs for back pain; smoking 10 cig/day (quit 2 years ago); alcohol occasional.
- Family History: Father has peptic ulcer & gastric cancer. Mother has chronic gastritis. Brother has hyperacidity.
- Developmental Landmarks: All milestones were reached at the appropriate age.
4. PATIENT AS A PERSON (PHYSICAL CHARACTERISTICS)
A. Physical Characteristics
- Appetite: Increased hunger pains, eats small frequent to relieve
- Desires: Milk (+++), Cold drinks (++), Spicy food (+)
- Aversions: Fatty food, sour things
- Thirst: Increased, for cold water
- Elimination:
- Urine: Normal
- Stool: Regular but dark
- Perspiration: Profuse on upper body, sour
- Sleep: Disturbed by hunger pain at night; wakes 12-2 AM
- Thermal State: Hot patient (prefers cool, uncovers)
B. Reactions - Physical Factors
- Weather: Aggravation in hot humid weather
- Position: Better lying on back with knees flexed
5. MENTAL STATE (Psychodynamic & Life-Space)
- Nature: Irritable, impatient, ambitious
- Anxiety: About job targets, health (fear perforation/cancer)
- Fear: Fear of serious disease, fear death
- Dreams: Falling, business failure, bleeding
- Other: Suppressed anger, feels overworked
6. PHYSICAL GENERAL EXAMINATION
- Wt: 68 kg | Ht: 172 cm | Temp: 98.6°F
- RR: 18/min | Pulse: 84 bpm | B.P.: 132/84 mmHg
- Face: Anxious, pale
- Tongue: Clean but dry
- Nails: Normal
- Skin: Oily, occasional boils
7. SYSTEMIC EXAMINATION
- GIT: Epigastric tenderness, no guarding, hyperacidity signs
- CVS: S1, S2 Normal
- Respiratory: Clear
- Endocrine: Normal
8. ANALYSIS AND EVALUATION OF SYMPTOMS
- Mental General: Irritability, anxiety about health/job, fear death/cancer (Grade 3)
- Physical General: Hot patient, desire milk/cold drinks, thirst cold, sour sweat (Grade 3)
- Particular: Chronic peptic ulcer with hunger pain, burning < empty stomach/night, > eating/milk (Grade 2)
9. SELECTION OF REPERTORY WITH REASON
- Repertory: Kent’s Repertory of Homoeopathic Materia Medica
- Reason: Chronic gastric ulcer with strong Mental Generals (irritability, fears) and Physical Generals (thermal, desires, sweat) dominating; Kent suits stomach rubrics for ulcer symptoms.
10. TOTALITY OF SYMPTOMS FOR REPERTORISATION
- Irritability and impatience
- Anxiety about health/job
- Fear death/cancer
- Desire milk and cold drinks
- Hot patient
- Profuse sour perspiration
- Epigastric burning hunger pain
- < Empty stomach, night 12-2 AM
-
Eating, milk, warm drinks
- Sour eructations
- Family ulcer/cancer 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 | Fear death | Mind; FEAR; death, of | 43 |
| 4 | Desire milk | Stomach; DESIRES; milk | 485 |
| 5 | Stomach pain hunger | Stomach; PAIN; hunger, from | 514 |
| 6 | Perspiration sour | Perspiration; ODOR; sour | 1298 |
| 7 | Heat sensation | Generalities; HEAT; sensation of | 1366 |
12. SELECTION OF REPERTORIZATION (NUMERICAL ORDER)
| SR. NO. | REMEDIES | RUBRICS COVERED | TOTAL MARKS |
|---|
| 1 | Argentum Nitricum | 7/7 | 21 |
| 2 | Nux Vomica | 6/7 | 18 |
| 3 | Arsenicum Album | 5/7 | 15 |
13. MIASMATIC INTERPRETATION
| PSORA | SYCOSIS | TUBERCULAR | SYPHILIS |
|---|
| Burning pain, irritability, anxiety | Ulceration, hunger pain | Family gastric issues | Destructive fear cancer/death |
Dominant Miasm: Psora-Sycotic
14. FINAL STEPS
- Provisional Diagnosis: Peptic Ulcer (duodenal)
- Differentiation of Remedies: Compared Argentum Nitricum with Nux Vomica. Nux Vomica has more digestive irritability, chilly; Argentum Nitricum matches hot, anxious/fearful about health, hunger pain > eating, desire milk/sweets, impulsive irritability, < anticipation/stress. Arsenicum more restless/fear death with chill.
- Selection of Remedy (Materia Medica): Argentum Nitricum matches chronic peptic ulcer with hunger gnawing pain > eating, burning < empty stomach, hot patient, anxiety/fear about health, desire milk/sweets (Ref: Allen’s Keynotes, Boericke).
- Selection of Potency: 200C (Chronic gastric miasmatic case, sensitive constitution)
- Actual Prescription:
- Argentum Nitricum 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 |
|---|
| 20/06/2026 | Hunger pain gone, burning reduced 70%, no night episodes, endoscopy shows healing | Placebo | Small frequent meals, avoid spicy/acidic, stress reduction |
| 20/10/2026 | No pain/recurrence, weight stable, energy better, repeat endoscopy normal | Placebo | Maintain diet, avoid NSAIDs, regular check-up |