RETROSPECTIVE CASE ANALYSIS (page 2 of 2)

Case 1
Mrs A. first attended the clinic in May 1992 when she was 44 years old. She complained of bouts of low energy which had been present on and off for 2 years but more recently had become almost continuous. She had been undergoing a lot of personal stress and had had to cease paid employment some 3 months earlier although she did try to do some voluntary work every week. The sleep pattern was good with about 8 hours per night, but she never woke feeling rested. Mental processes, memory and concentration were all poor and there was sometimes depression and especially a feeling of guilt for the burden she was becoming on her husband. The medical diagnosis she had been given was "either Chronic Fatigue Syndrome or Fibromyalgia" and she had been prescribed amitryptyline which she had not taken. 

Apart from endometriosis in her 20's, Mrs. A. had been in remarkably good health all her life. The only known allergies were to wasps and bees. She had never been pregnant and at the time of the first consultation the endometriosis was completely asymptomatic. She exercised a little (as much as the level of fatigue would allow) and her diet was extremely good although she did not drink enough water. She was also taking the following supplements daily: vitamin E 800 iu., beta carotene 25,000 iu., zinc 15 mg., B complex, selenium 100 mcg every other day, vitamin C 300 mg. every other day and calcium-magnesium at certain times through the month.

The recommendations given to her included that she completely avoid all cheese, milk and other dairy products, that she minimise her intake of meats and that those she did eat were certified organic, that she boost her water intake and that she increase her vitamin C to bowel tolerance. It was also recommended that about 50% of the dietary intake be in the form of fresh vegetables, raw wherever possible and that she make beans a main source of protein.

She was given blue green algae capsules 2 to be taken tid.

The herbal formula given to Mrs. A consisted of the following herbs:

Ginkgo biloba (1:4)	15 ml.
Avena sativa (1:1)	15 ml.
Turnera diffusa (1:4)	10 ml.
Taraxacum off. radix  (1:3)	10 ml.
Kola vera (1:5)	10 ml.
Zingiber off. (1:3)	10 ml.
Fucus vesiculosis (1:1)	15 ml.
Urtica dioica (1:3)	15 ml.
		100 ml. sig. 5 ml. tid, aqua cal, ante cibum

The Ginkgo was given to improve circulation to the brain; the Avena and Turnera were given as tonic, stimulating nervines and thymoleptics; the Taraxacum was given to improve liver function and enhance the cleansing of toxins from the system; the Kola was used in a very small dose as a pure stimulant; the Zingiber was used as a warming circulatory stimulant; the Fucus was used to enhance the metabolic process and provide essential trace elements; the Urtica was used as a blood cleanser and blood builder and to provide energy in the form of chlorophyll and iron.

Mrs. A. returned to the clinic a month later reporting a definite and consistent increase in energy levels, more clarity of thought processes and improved concentration. She had followed all the dietary recommendations to the letter. The herbal formula was repeated for another 5 weeks and this time she was also given the following Bach Flower Remedies in a separate bottle, 4 drops to be taken 4 times a day: Aspen, Centaury, Cerato, Clematis, Elm, Scleranthus, Olive. These were chosen for emotional states of fear, vacillation, lack of confidence in herself, difficulty making decisions, day dreaming, mental exhaustion and emotional lability.

On her third visit Mrs. A. was continuing to find a steady improvement in her symptoms. She had 2 days of very low energy following a head cold but had picked up again quite quickly. There had been some mood swings (hyperactivity and depression) which she related to being "hard on herself" about having been sick. She had been craving licorice. After this visit the formula was changed slightly to include the adaptogenic Glycyrrhiza glabra that her body was craving, and to eliminate the Kola vera which, if taken long term may ultimately cause adrenal and nervous exhaustion.

Glycyrrhiza glabra (1:3)	15 ml.
Ginkgo biloba (1:4)	15 ml.
Avena sativa (1:1)	15 ml.
Turnera diffusa (1:4)	15 ml.
Zingiber off. (1:3)	10 ml.
Fucus vesiculosis (1:1)	15 ml.
Urtica dioica (1:3)	15 ml.
	100ml. sig. 5 ml tid, aqua cal. ante cibum.

The Bach Flower Remedy and the blue green algae was repeated.

On her next visit 6 weeks later Mrs. A. reported significant improvement such that she was no longer needing to take an afternoon nap, was taking a computer course and was doing yoga daily. Her emotions were more stable and she felt optimistic of total recovery for the first time. At this time the formula was repeated for 8 weeks along with the Bach Flower Remedy and the blue green algae. 

On her last visit Mrs. A. reported that she felt "almost back to normal" and that she was returning to part time work. Although she flagged towards the end of the day, her overall energy level was good and she was able to concentrate easily and remembered things well. At this time the formula was changed slightly and was dropped to twice a day for 6 weeks.

Glycyrrhiza glabra (1:3)	10 ml.
Borago off. (1:3)	15 ml.
Rosmarinus off. (1:3)	15 ml.
Turnera diffusa (1:4)	15 ml.
Avena sativa (1:1)	15 ml.
Urtica dioica (1:3)	15 ml.
Verbena off. (1:3)	15 ml.
	100 ml Sig. 5 ml. bid, aqua cal. ante cibum.

The Borago was added as a gentle adrenal tonic and the Verbena was used in place of Taraxacum as a bitter digestive tonic that is also thymoleptic. 

The Bach Flower Remedy was also changed to keep pace with the patients changing mental outlook: Vervain, Scleranthus, Cerato, Centaury, Pine. These were chosen for the emotional states of mental tension, perfectionist tendencies, guilt and self reproach.  

Towards the end of 1995 this patient returned to the clinic for treatment for a superficial but severe burn. She reported being in excellent general health with no signs of the CFS except a better understanding of how to pace herself and not  get overstretched.

Case 2
Ms. K. first attended the clinic in September 1992 when she was aged 41. She had been diagnosed with M. E and Fibromyalgia and was taking the following medications: Naprosyn (a non-steroidal anti-inflammatory and analgesic), Cytotec (a gastric acid inhibitor to protect against damage from the Naprosyn), Euflex and occasional OTC anti-histamines. 

Her family history included Multiple Sclerosis and Ankylosing Spondylitis. Her previous medical history included Scarlet Fever and Pertussis as a child, Rubella and Amoebic Dysentery as an adult, as well as one ectopic pregnancy in 1983, two cesarian births in 1981 and 1985, and a partial hysterectomy in 1991 because of severe fibroids.

Ms. K. began to be unwell in 1986 following a serious viral influenza. Since that time she has suffered with overwhelming fatigue, inability to concentrate and focus, very poor memory, severe muscle pain and weakness, headaches, abdominal bloating and gas, nightmares and poor sleep, sporadic facial flushing, cold hands and feet, restless legs at night, depression, shortness of breath and palpitations. She also has nasal mucus, itching eyes and earaches from her allergies to smoke, pollen, many trees and many foods. As well there is a high serum testosterone level leading to hirsutism and some loss of head hair. In 1989 she was able to afford a nanny for a year and began to feel some improvement in her condition as she was able to rest more. In 1991 she took Evening

Primrose Oil and received magnesium injections for the palpitations. Presently she feels "a 50% improvement" over how she was at the outset of the illness and is now able to walk slowly for about 40 minutes per day as exercise, but she is still far from well.
Ms. K's diet was far from perfect. She was somewhat overweight and had a bowel movement only every 2 or 3 days. She typically ate meat, cheese, milk, candies, cakes and coffee daily but took no alcohol as it significantly worsened all symptoms. She was a non-smoker. She also took the following supplements: a multi vitamin/mineral formula, vitamin B complex, bromelain, vitamin E, Evening Primrose oil and sporadically calcium and magnesium.

Initially she was not recommended to undergo a major cleansing and detoxification program because it was too radical a change for her to take at the outset of the treatment. Instead it was simply suggested that she reduce meat to once or twice a week, cut right down on all dairy products, eat more fresh fruit and vegetables, avoid sugars and cut out coffee. She was also recommended to continue with her supplement regime but to be sure to use natural source and to add in vitamin C to bowel tolerance. She was also advised to take calcium citrate (750 mg) and magnesium (300 mg) daily.

Her herbal formula consisted of the following herbs:

Harpagophytum procumbens (1:3)	15 ml.
Menyanthes trifoliata (1:3)	10 ml.
Taraxacum off. radix (1:3)	15 ml.
Avena sativa (1:1)	10 ml
Ginkgo biloba (1:3)	15 ml
Vitex agnus-castus (1:3)	10 ml.
Urtica dioica (1:3)	15 ml.
Echinacea spp. (1:3)	10 ml.
	100 ml. sig. 5 ml. tid, aqua cal. ante cibum

The Harpagophytum and Menyanthes were included as musculo-skeletal anti-inflammatories with the added bonus that Harpagophytum is also a protector of the gastric mucosa specific for peptic ulcers. The Vitex was included to balance the testosterone levels via a regulatory action on the pituitary gland.

After 6 weeks on this formula Ms. K. returned to the clinic for a follow up visit. At this time she reported that despite a bit of a cold in the first couple of weeks on the formula, she now felt significant improvement. She had attempted to follow the dietary recommendations but found it hard to be very strict. She had noticed a definite lessening of the nasal mucus and other allergy symptoms, slowing down of hair loss, reduction in flushing and heat sensations and a considerable lifting of the mental "fogginess and spaciness" that had plagued her since the outset of the illness. She was having fewer nightmares and less frequent and milder headaches. There was still significant fatigue but the severe muscle pain had eased somewhat and she had begun to take an evening class in jewellery making. She was taking 3 grams of vitamin C daily and having a bowel movement every day. At this visit the formula was changed to allow a slightly more warming and stimulating action:

Hypericum perforatum (1:3)	15 ml.
Zingiber off. (1:3)	10 ml.
Ginkgo biloba (1:4)	15 ml.
Vitex agnus-castus (1:3)	15 ml.
Urtica dioica (1:3)	15 ml.
Harpagophytum procumbens (1:3)	15 ml.
Menyanthes trifoliata (1:3)	15 ml.
	100 ml. sig. 5 ml. tid. aqua cal. ante cibum.

In 1991 Mrs. B. began to consult with a Naturopathic Doctor and underwent a rigorous cleansing program as well as taking various homeopathic remedies (Ignatius & Lachius) plus some immuno-modulating herbs (Astragalus membranaceous, Glycyrrhiza glabra and Echinacea spp.). She also supplemented her diet with blue green algae and Evening Primrose Oil. A series of colonic irrigations was also undertaken. Following this regimen she became much sicker with exacerbation of all symptoms. There also began severe right upper quadrant pain and nausea. A diagnosis of biliary dyskinesia was made by a gastroenterologist and she was offered a gall bladder removal which she declined. Allergy testing at this time (skin prick method) revealed sensitivities to wheat, rice, soya, bananas and broccoli. 

Between May and November 1991 Mrs. B. received regular intra-muscular injections of vitamin B12 and Magnesium and once took intravenous vitamin C. She was also prescribed Luvox (an anti-depressant) and Flexeril (a muscle relaxant) and used a TENS machine daily. 

In early 1992 Mrs. B. began receiving acupuncture and took some Chinese herbs of which the names are not available. She also used Black radish juice and Lateroflora to remove Candida albicans from her body. 

As of August 1992 the following symptoms were still present: extreme fatigue - able to walk slowly for 5 blocks then had to rest for up to an hour to recover, flu-like feelings with activity, frequent nightmares and generally poor sleep, nausea and right upper quadrant pain several times a week, sporadic cervical lymphadenopathy, palpitations, cold hands and feet, dizziness and spaciness, tingling, numbness and weakness on whole right side almost continuously, very low mental energy and great difficulty in concentrating or remembering things, headaches, sore throats, frequent blurred vision and visual disturbances, and emotional lability. All symptoms worse pre-menstrually and exacerbated by severe dysmenorrhoea. 

Mrs. B's diet was exceptionally good with lots of fresh fruit and vegetables, fish or grain-fed chicken only once or twice a week, mostly organically grown foods, virtually no dairy products, no caffeine, no refined sugars and no alcohol.  

She was taking a multivitamin/mineral supplement as well as additional vitamin C, Evening Primrose Oil, Co-enzyme Q10 and Barley Green powder. 

The herbal prescription on this first visit was:

The Hypericum was used as a relaxing, tonic nervine for the right-sided numbness and tingling, the Berberis and Verbena were used as bitter digestive tonics, the Verbena also being a nervine and thymoleptic as well as antispasmodic which can be helpful in biliary dyskinesia; the Echinacea was used as an immuno-modulator. 

It was also recommended that she increase her vitamin C intake and also take vitamin E 400 iu. Zinc 25 mg. and selenium 200 mcg. daily, these all being useful in boosting immune function.

On her second visit a month later Mrs. B. reported that within a week of commencing the herbal formula she had begun to notice significant improvement. She felt less tired, more emotionally stable and the right-sided numbness and tingling was somewhat better. A Reiki treatment at this time revealed a blockage of energy flow in the region of the neck and through the session, as this block was released, she described a feeling of lightness and calmness coming over her and the easing of a headache that had been present for 48 hours. The formula was repeated for 6 weeks.


On her third visit to the clinic Mrs. B. reported that all her symptoms had lessened although they tended to flare up when she was tired and pre-menstrually. She particularly noticed an improvement in the right-sided tingling and numbness. She had run out of the herbal formula for 2 weeks and had felt a noticeable worsening of all her symptoms without it. She had tried to eat some meat (beef and chicken) but it brought on the right upper quadrant pain so she had decided to leave it out again. She still felt a lot of fatigue but had taken up a yoga class and was trying to walk a little every day. Regular meditation and the use of visualisations and affirmations was helping her to feel calmer and less judgemental about herself and her illness. She complained in this visit of worsening dysmenorrhoea so the formula was adapted to meet this problem:

Usnea was exchanged for Echinacea because after weeks of continuous use the body can build up a tolerance to Echinacea which reduces its effectiveness. Both Borago and Verbena, as well as having their own individual effects in the body, are also glandular tonics and stimulants and were included to aid in the regulation of oestrogen, progesterone and uterine prostaglandins. The Angelica sinesis was used as an ovarian tonic for the dysmenorrhoea.

At this time Mrs. B was also given a dropper bottle of an analgesic formula to be used for myalgia or dysmenorrhoea. This consisted of Piscidia erythrina, Valeriana off. Viburnum opulus, Lobelia inflata, Gelsemium sempivirens and Aconitum napellus. She was also given the following Bach Flower Remedies: Wild Rose, Walnut, Olive, Pine, Elm, Hornbeam. These were chosen to treat the emotional states of weariness, transition & change in life patterns, doubt of ability to recover, guilt & self reproach, and overwhelming by responsibilities.

At her next visit 6 weeks later Mrs. B reported a continued slow but steady improvement in her physical symptoms and mental clarity although the fatigue was still greatly debilitating. Her formula was repeated for a further 6 weeks. It is anticipated that at the next visit the dosage will be reduced to 5 ml. bid. as a start to the process of weaning her down to a small, long term, maintenance dose. 

CONCLUSIONS
In conclusion it must be said again that each and every patient presents with their own particular set of problems. We may make general assumptions based on epidemiological evidence but we cannot treat successfully unless we acknowledge the uniqueness of each person. Holistic herbal therapy offers the potential to be infinitely adaptable for every set of circumstances. Utilising dietary and supplemental therapy enables us to precisely control the internal milieu and by cleansing and toning the digestive processes we can make the body a less hospitable place for disease to lurk. This has the added advantage of actively involving the patient in their own therapy and forcing them to take responsibility for their own healing. Bach Flower Remedies enable the practitioner to treat at very subtle, even esoteric, levels and to address issues which cannot be reached by conventional therapies nor by regular phytotherapy. The herbal formulas themselves offer us an infinite array of possibilities. Although the basic ingredients may be similar in many cases, the formula can be precisely tailored to the individual needs and can change over time as the needs change. The dose can also be adjusted as required so that the possible permutations are almost endless. Treating M.E. in this way offers great hope for amelioration of symptoms and hastening of the healing process.