Time Modality to the rescue: A Case of Asthma – Kali Carb.

Miss S.C. of 31 years first consulted us on 20-10-99. She was of short stature, had fair complexion, black curly hair, freckled face & her built was on the heavier side.

Presenting complaints:
Breathlessness since the age of 12-13 years.
Constipation since childhood.
Headache since the age of 16-17 years.


She feels breathless on walking fast and on climbing stairs.
Breathlessness < Dust, change of weather, indigestion, twilight, dusk.
> If skips lunch or dinner, sitting propped with pillows.
The patient complains of constipation since childhood. She says that she takes time to pass stool and passes more of gas. The bowels remain unclear and she has to take laxatives. If she has not taken a laxative then she passes hard stool.
She also complains of headache since the age of 16-17 years. It is usually located on the top of the head. Earlier she had half sided headache with nausea.
Headache < If bowels not clear.
> Hard pressure, bandage.

Treatment taken:
Has been on inhaler since a long time.

Past illnesses:

– Chicken pox in childhood.
– Worms in childhood.
– Boils in summers in childhood in legs only.

Family illnesses:
– Father suffered with asthma and died of cardiac arrest.
– Mother suffering with D.M. and hypertension.
– Maternal aunt suffered with cancer.
– Both maternal grandparents suffered with cancer.
– Sister is suffering with hyperparathyroidism.

Personal history:
Unmarried, working in a bank, non-vegetarian, besides inhaler no addictions.
Menses: Cycle: 5/ 24-25 days. No other complaints.

Appetite: Does not feel hungry, non-vegetarian.
Thirst: Less
Desires: Eggs++, chicken+, chocolate ice creams and chocolates++, sweets++, coffee+
Aversion: Milk++
Urine: Normal.
Sleep: Sleeps on sides preferably left and in dark.
Dreams: None marked.
Perspiration: More on back.
Thermal reaction: ? Chilly

Life and circumstances:

Her father was in air force and was thus transferred from place to place. On retirement he started his business in which he did not do well. At that time she was in class 11th. Since then she says that she never had mental peace in life. Her younger sister suffers with hyperparathyroidism and is very weak and her mother suffers with D.M. and H.T. After a few years when she was in college her father died and she could not cry much as she knew that she had to take care of her mother and younger sister from now onwards. She has not yet married as she says that she has not found the right person for herself. In the beginning she had to struggle but now has a secure job.


She is very fond of dancing and loves traveling, driving cars and photography. She enjoys being near the sea. She fears dogs. She cannot sit idle and likes to keep working. If circumstances permit she likes to take revenge from whosoever has wronged her. She likes company and does not like to stay alone.

On examination:
Tongue: clean, moist and indented.
Auscultation: At present no rhonchi ; prolonged expiration present.

When she was seen for the first time she was much troubled with her breathing problem and was regularly using inhaler. Though she seemed to be of Carcinocin/ Sepia types but as she was having an acute exacerbation of her chronic complaint, I thought of giving her an acute remedy at that time.

Considering her aggravation at dusk and her sitting posture she was prescribed:
Arsenicum album 6 seven powders (dissolve one dose in half cup of water and take 1 tsp every 10-15 minutes at the time of attack.)

No relief in breathlessness, had to use inhaler regularly. All the seven powders have finished.
(I thought if this medicine would be given regularly then she would be helped much.)
Arsenicum album LM 1 T.D.S.

Bowels much better, goes daily, normal stool, no laxative required.
No headache in between.
In asthma no relief at all. Has to use inhaler as well as asthalin tablets twice daily.
On auscultation: as she had taken inhaler sometime back so no rhonchi was found.
Arsenicum album LM 1 T.D.S.

Has had some food outside thus irregular bowels again.
No headache in between.
Appetite much improved. Now feels hungry and wants to eat.
No change in asthma.
(Here I was in a dilemma as to what should be done next. Should I stick on with this remedy, which has helped her in every way except in her most distressing complaint that is asthma or should I give her some other intercurrent drug like Carcinocin or Sepia, as she appeared to be one of these. I thought of consulting one of my senior colleagues Dr. Pankaj Aggrawal about what I should do next. He advised me to retake the case and go through all the symptoms very carefully and then decide upon the remedy.)

On re-case taking she gave 2 very marked modalities of her attacks of asthma which she said, always occurred in the morning at 4:30- 5:00 a.m. and in the evening at 6:00 p.m. She had not mentioned this earlier.

Keeping Hahnemann’s ? 153 in mind and after consulting my senior again I decided to find a drug, which covers these, marked time modalities. Here the time modality was the most striking (intensity) feature. Dr. Hahnemann (in ?153) advises us to prescribe on the more striking, singular, uncommon and peculiar (characteristic) symptoms in the case. The first quality of a characteristic is its marked intensity and here the maximum intensity lies in the time modality. The occurrence of the asthmatic attacks only at this particular time is also quite peculiar to the case.
I looked up in the repertory section of the Boger’s Synoptic Key, which incidentally has one of the best time modalities of various drugs. The common drugs under 5:00a.m. and 6:00 p.m. aggravation are Kali carb. (2+ under both), Natrum mur (2+ & 1+ respectively), Sepia & Silicea (1+ under both).
All of these drugs were studied carefully in the materia medica after which Kali carb was selected as in this drug only do we find this time modality in the highest grade (as in the patient). Like the drug Kali carb the patient had relief by sitting up and had desire for company prominently. Sepia, the other drug, which seemed quite prominent after the case taking was eliminated because though the patient appeared with quite a few symptoms of this drug but the essence was lacking- there was no indifference. In Sepia kind of asthma the patient is better by dancing or walking rapidly and worse by sitting.

Kali carb L.M.1 Q.I.D.

Her sister came and reported that she is feeling much better.
She has not used inhaler since last one week and she does not have breathlessness while climbing stairs now.
Appetite has improved much.
No headache in between.
Kali carb L.M.1 Q.I.D.

Feeling much better now.
No attack of breathlessness in between. Now she can walk fast and run up the stairs without any difficulty.
No other complaint.
Appetite is much improved.
Auscultation- normal breath sounds. No added sounds.
Kali carb L.M.1 T.D.S.

Feels absolutely fine now.
She does not feel uneasy or breathless even in dust anymore.
Auscultation- normal breath sounds. No added sounds.
Kali carb L.M.1 B.D.

The patient was told to discontinue the treatment after finishing off the medicine. Her sister who came to us for some treatment reported in May 2000 that she is having no complaints and even during the months of March and April (change of weather) she was leading a normal life.

Dr. Gyandas G. Wadhwani and Dr. (Mrs.) Parul G. Wadhwani

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