A Case of Chronic Fatigue

Donna was a slim, attractive 29 year old woman who said she was tired, really tired. She had been that way for close to five years, since moving to Seattle from Kansas. She was exhausted after work. Even when she wasn’t working she was still extremely fatigued at the end of the day, but especially so toward the end of the work week. When she was tired, Donna felt like a cloud came over her, and she would get “a deep feeling” under her eyes. Her body felt like it just faded away, and before she knew it she was asleep. Her fatigue was more physical than mental. She was a sweet and gentle person, and she just didn’t have the energy to get upset over things. However, when she was tired, she could become somewhat defensive and irritable.

She loved to sleep, slept heavily, and said she felt better from sleeping. She would sleep nine hours a night normally, and catch a two-hour nap on Saturday and Sunday from 1-3 P.M. She usually slept on her stomach or her left side, and liked to have the window open, but be well covered. On waking, Donna was still exhausted. She felt like she could sleep for another two hours.

Before the fatigue had come on, Donna was quite industrious and enjoyed cooking, gardening, and making jelly. She had married three years ago after a year-long courtship. Her marriage was going quite well, but her husband complained that she had no energy for sex. She had gone through a career change just after marrying. She worked for a corporation now, after having been a social worker. Her work was challenging with a lot of responsibility, but she enjoyed it and did not consider it to be too much for her. But, if she took a vacation, she just had to make up the lost work time. It seemed like she was caught in the middle, with no way to regain her lost energy. She didn’t want to change jobs because she “wasn’t a risk taker” and she had a fear of starting new things.

She complained of severe headaches, which were only on one side of her head at a time. She would get throbbing pain on the side of her head. These would only come on a few times a year, but were quite debilitating. Her stools were normal, but she frequently had bowel movements only every three days. Her evacuations were complete. She had no other digestive symptoms. She complained of mild PMS, with some facial acne before the period. Donna was very chilly, especially her feet, and loved to wrap up in a blanket and be out in the sun. She didn’t perspire very much, except on her face.

She had a desire for cheese, and bread, but denied any food aggravations or aversions.

Her overall health had been good until the fatigue had set in. She had never had mononucleosis and had a negative Epstein-Barr titer. A CBC revealed that she was not anemic. In her family, her father had multiple sclerosis, but her mother had a lot of energy. No other family members suffered from extreme fatigue like Donna did.

Fatigue is a common symptom in many kinds of illness, and indeed is common to the pictures of many homeopathic remedies, but when fatigue is the main symptom in the case, there is a group of remedies which come immediately to a homeopath’s mind. The most common remedies for this kind of state are found among the acids, especially Phosphoric acid, Muriatic acid and Picric acid. Other remedies are Ferrum, Sepia, Silicea, Calcarea Carbonica, and Nux Vomica.

In this case there are few symptoms that are striking, rare or peculiar. The patient herself is not extreme in any regard except for her fatigue, and possibly her headaches. There is no obvious etiology for the fatigue, no history of viral infection, anemia, extreme overwork, unusual stress, loss of sleep, emotional trauma, marital dysfunction, or family problems. This patient is a sweet, gentle person who is simply very tired, with no obvious cause.

So how do we approach a case like this, where there is nothing striking to prescribe on?

The first thing is to examine the idea that this might be an essence case, meaning that the central theme of a particular remedy picture may be represented in the case. Although not every remedy has an “essence”, that mixture of characteristic mental and emotional symptoms, keynote symptoms that are very typical of the remedy, and other symptoms such as food cravings, sleep position, daily time of aggravation and others which combine to give each remedy its particular flavor.

If we look at the essences of the remedies listed above, as a starting point, we immediately can begin to narrow the field. The acid remedies usually have a state of profound exhaustion, either mental, as in Picric acid, with its exhaustion from mental exertion and study; emotional as in Phosphoric acid, with exhaustion after grief and disappointment; or physical, as in Muriatic acid, with utter physical exhaustion and a state of collapse. When we look at Donna’s cass we see severe fatigue, but not a state of utter exhaustion. Also there is not such a strong component of either mental, physical or emotional causation.

So if we look to the commonly prescribed or “polychrest” remedies, as they are described by homeopaths. Sepia could be considered for the lack of energy, premenstrual symptoms, irritability and low sex desire. But there is no amelioration from exercise, apathy and the center of physical symptoms is not in the female reproductive system, as one would expect in a Sepia case. Calcarea carbonica might be thought of because of the desire for cheese, exhaustion from overwork, industrious nature, fear of new things, chilliness and sweating on the face. Donna was not overwhelmed by too much responsibility, however, and her exhaustion was present even when she wasn’t working. Nux Vomica would also have to be thought of for the chilliness, irritability and overwork, but Nux vomica people are not usually sweet and gentle, and afraid of starting a new job. Instead, they are hard-driving, ambitious and aggressive, often having insomnia at night. The lack of anemia would tend to rule out Ferrum, although Ferrum people are industrious and care very much about their occupation.

After such a process of elimination, we are left with Silicea, which is potentized silicon dioxide, ie. sand or quartz. It is said that Silicea people lack “grit”, that they just don’t have the energy to respond to the demands placed upon them. Silicea has desires and strong opinions, but it is just too much effort to act on them. They are quite tired and fear undertaking anything new, because they lack the stamina to meet the challenge of a new situation. They are generally mild, gentle, refined and timid by nature. They are chilly and often constipated, as Donna was. One sided migraine headaches are also a typical Silicea symptom. The facial sweat was also confirmatory, although foot sweat would have been more typical. In this case we see the essence of Silicea, and it worked very well. Donna was given a single dose of Silicea 1M.

By one month Donna reported that she was no longer exhausted, just normally tired at the end of the week. Her need for sleep had been reduced. Her desire for cheese and bread were less, and she had developed an aversion for vegetables (1). She still had stools only every 3 days. Her mind was clearer and she could think better. Now, she said, she could enjoy her weekends again. She was waking more refreshed. Her PMS symptoms did not appear before her last menstrual period, but she had had her usual acne breakout. She had no headaches , and she was happy to report that her sexual energy was back to normal. Her body temperature seemed warmer
She reported being more assertive, and she had begun sailing lessons for the first time, which she enjoyed. She had had some irritability, especially when she had to wait. She said that she had been like that when she was a teen-ager.

By six weeks after the remedy, Donna reported that her energy was back to normal and that she was no longer feeling irritable. Even though she was under stress she was coping quite well. Her bowel movements had not become more frequent, but it did not trouble her. She continued to improve over the next several months, and her remedy has not needed repetition in the last year.