A case of Fibromyalgia

Case Study


The presenting case of fibromyalgia and the patient’s etiology and long-standing pathology truly unfolded for me as a learning experience on all levels. Our aim, as practicing homeopaths, is to find the similimum in order to meet the totality of symptoms of our patients. We look and search for the most appropriate and indicated remedy, yet so often, we also realize, that we are asked to meet especially deep-seated pathology with patience and a multi-layered approach.

January 2015

FEMALE patient, 54 years old, a strict Mormon devotee, very obese / 236lbs) consulted me with fibromyalgia. For the last 10 years, she receives regular steroid injections in her back and hip, which also contributed to her excessive weight gain. Her general etiology covered carpal tunnel syndrome, scoliosis…since childhood (was in a back brace), bulges in her discs (lower back) as well as hiatal hernia, TMJ, arthritis of rips and IBS (needs daily stool softener). In the past had ovarian cysts and fibroids with partial hysterectomy. Today, the scar tissue of this past surgery causes her constipation and obstruction of colon. She also had a miscarriage. As a young teenager, she experienced mononucleosis / Epstein Barr. She displays excessive restless leg syndrome (a symptom of fibromyalgia). The patient is in pain all the time and can’t remember anymore not being in pain!

I do believe, that the provided treatments are and will be life-changing for the patient, but due to her structural pathology of vertebrae and disc misalignment, the onslaught of steroidal medication, and her excessive weight, the prognosis of improvement will be slow and will require regular treatments.

The patient’s cellular inflammation activates the presenting symptom of fibromyalgia. Initially, I tried the more physical approach in treating her for the back, hip and joint pains with RHUS TOX 30 (restless leg syndrome and overall symptomatology better for continued movement), IGNATIA AMARA 1M for her grief and suppressed anger about her grandparents, and NAJA 1M (due to her presenting behavior of snake energy (jealousy) and feeling emotionally injured). She had some temporarily improvement, but the core breakthrough was missing and I realized, that I had to change my approach in order to see a more lasting improvement. Her mental and emotional behavior required a new constitutional remedy as well as a nutritional supplementation protocol:

  • Next to homeopathy, it was also apparent, that my patient required a cleansing and rebuilding protocol of her Digestive System with Leaky Gut / Dysbiosis…which is often the initiator of autoimmune diseases.
  • To change her diet with elimination of gluten and sugar, daily supplementation products and the introduction of more complex carbohydrates and less acidity.
  • To providing her with natural supplementation to meet the dormant Epstein Barr virus infection.

Of course, this all needs time and I am aware, that this case will go on for many more years to come, yet already, in a very short time span, she displayed a remarkably improvement, not only in her mental / emotional attitudes, but also in her physical symptomatology.

It would be easy to explain this case just on her mental/emotional perception to life, yet with such severe pathology, there is more to it. I learned, that not all cases can or should be explained and treated according to the presenting personality picture. This case required deep-acting supplementation protocols as well as homeopathic treatment.

Fibromyalgia is an expression of an autoimmune response within the ailing body. Taken from scientific research, today, we are aware, that fibromyalgia is caused from cellular inflammation, in which cellular free radical destruction is present.

Cellular inflammation is the body’ natural, protective mechanism to help:

  • Remove the offender (pathogen, toxin)
  • Initiate the body’s healing response.

It is not the same as infection (caused by bacteria, virus, fungi, parasites, prions, viroids), but functions as a healing agent to destroy the pathogens and to heal the damaged tissue.

On the other hand, chronic cellular inflammation is caused by the cellular NO/ONOO (NO=Nitric Acid Cycle; ONOO=Peroxynitrate (unstable form of NO3 nitrate) which damages the mitochondria, membranes, DNA and proteins; it also coverts to two free radicals (superoxide, NO). When Nitric oxide turns to peroxynitrate and superoxide, we see oxidative stress within the body, which results in a chronic inflammatory process.

The known cause of NO/ONOO Cycle is:

  • Fibromyalgia
  • Chronic Fatigue Syndrome
  • Multiple Chemical Sensitivity
  • Post Traumatic Stress Disorder…just to name a few

The NO-part of the NO-ONOO cycle launches this cascade of free radical damage. Often, the lack of antioxidants (which quench peroxynitrate) and the damage to the mitochondria and cell membrane can result in the condition of fibromyalgia. As free radicals damage the mitochondrial production of ATP (Adenosine TriPhosphate), the patient will experience lack of energy and physical exhaustion as well as pain. ATP protects the mitochondria from free radicals and recovers metabolic wastes that can foster free radicals. Today, we also understand, that fibromyalgia is the result of a dormant EPSTEIN-BARR infection, which continuously affects the patient, especially with fibromyalgia.


In my practice Medica Nova, I also use Iridology/ Sclerology. The patient’s iris clearly indicated a chronic infection affecting her lymphatic system.


Patient: I have fibromyalgia, sine 10 years; pain in shoulders…it feels as if hot water pours down my back. When it is all inflamed, my body feels hot to touch and it hurts to touch it. My legs and hip hurt, just to touch them; it feels like knives going in somebody, as if knives sticking in me.


I have very sore muscles. Had two rotary cuffs surgeries and two surgeries on elbows / wrist. I also had carpal tunnel syndrome.


Homeopath: Do weather changes influence the pain?


Patient: Yes, change of weather makes my hand lock up and my fingers bold over each other. Everything is worse rain and snow, worse humidity. There is a lot of stiffness.

I also have scoliosis, which affects my back. If I sit too long, then I have a hard time to move around. Definitely, better if I move around. Standing too long really hurts my hips.

I have pain in my calves. When I put my hands on it or touch it, it feels as if needles go into the skin. I guess its neuropathy. My nerves are on fire! During the night, it is really bad. I daily take painkillers (ibuprofen, steroid injections).


I also get sinus headaches, from weeds and trees. I had surgery for polyps.

I have TMJ, not as bad now. I have H. pylori and hiatal hernia, which gives me heartburn and fibrocystic breasts. And there is the osteoarthritis in my ribs.


Homeopath: Anything else, which gives you discomfort?


Patient: My digestive system isn’t so good either. I have constipation and diarrhea (IBS). When I supposed to have my period, everything clogs up.My stool is flat and I get constipation. Then after the period is finished, I get diarrhea. I take stool softener every single day.


I had a hysterectomy and now scar tissue, which obstructs my colon. Only have my left ovary. I had ovarian cysts.


Homeopath: Tell me about your food dislikes and likes.


Patient: I like more salty food. I never can drink water, as it tears me to pieces. I only can drink carbonated- form of water. If I drink normal water, I throw up immediately. I had this most of my life.


I also have bleeding piles.


Homeopath: Anything else?


Patient: My knees shake all the time.


Homeopath: Anything else?


Patient: I feel quite foggy mentally.


Homeopath: Tell me more about yourself.

Patient: I am pretty good at storing pain, I don’t think about it. If I let it come to the surface (thoughts), then I am in pain, especially back and hips. Instead of going for shots (steroid shots regularly), I store it away. I try to keep myself busy. I stay away from “me-behavior”. Nobody can touch me. I don’t let people in. It’s emotionally upsetting.


Homeopath: Tell me more about what you mean with “me-behavior”?


Patient: When my grandpa passed away, I was 5 years old….he was everything to me. It bothered me that I didn’t tell him good-bye. I didn’t get to go to his funeral. I never told him good-bye. I have five siblings who lived with grandma, but I was so close with grandpa. With two years old, I stayed with grandpa. After he died, I stayed with grandma.


Homeopath: How about your parents?


Patient: Since, I remember, I decided I wanted to live with grandpa, not with my parents. I resented my grandmother on Dad’s side, as he sat on my grandpa’s chair (after he had died). I was never be hurt again so much. I never allowed people in that space. I didn’t belong to either my mum or dad. Although I had parents there was a sense, that I didn’t had a home. My grandparents lived opposite my parents. I wanted to “live over there” …with my grandpa.


I was afraid of evil spirits. I was afraid of dead people. I am not afraid of death. I feel, I would like to be on the other side, as I finally feel, this is where I belong. There is perfect peace!


I am suspicious of family members. My sister-in-law made my life hell. There is always a tug of war! I can’t deal with her. I am an independent self, but I have had fear of being murdered (Spanish-Mexican people lived close to patient and she is an orthodox Mormon). I was watching my back for four years. I constantly thought I get stabbed with knives. Since then, I take anti-depressant…now for 25 years.Patient experienced episodes of hives during this time.


Homeopath: A bit more about yourself?


Patient: I had a miscarriage. I delivered my first child, but with the second child, I got heavy periods and fibroids. Terrible pain! I was heavy bleeding from fibroids, every two weeks.


Homeopath: Which weather condition affects you the most?


Patient: In general, I am worse with hot weather and I am better in the shade. I get headaches in the sun and often feel sick to my stomach. I like to have my windows open. My physical pain is worse snow, rain, and humidity.


Homeopath: More…


Patient: I don’t cry easily. If people make me angry to the point of crying, I get angry. It’s either me or the other side! I am either closed or excessive!


Homeopath: Tell me more about your fears


Patient: I don’t like darkness or enclosed spaces. I am a bit claustrophobic.

Even driving, I can’t stand a car in front of me. I have to be able to see. I get panicked and then I get nervous. If there are cars piling up, I get nervous. I hate a big crowded room.


Don’t back me into a corner – then I am like a “charging bull”.


Homeopath: What do you mean, a bit more?


Patient: I take on problems with everybody and I fix things. But, don’t put me in the corner and tell me…once they come down on me…like my family…. You will not do that to me! You can’t get me cornered. I physically don’t want to hurt anybody. I don’t fight…I think, if I do, I could beat endlessly…but I don’t go there. (She takes care of people all the time, like taking care of her family, community etc.)


I hold onto my religion. If they (family members) take that on (my religion) or degrade it…I will get very verbal with the person I love the most. Don’t go there! No, you don’t want to take that away from me (my religion). My solace with Jesus Christ and Holy Father.


I have a fear somebody is trying to corner me or trying to take something away from me, like my religion, faith or grandpa…..then I am like a lion with a baby cup.


My mother said to me: “As long as everything is well, you do a lot for others”. I take on everybody’s problems, if it needs to be done (very responsible). But, they don’t cross the line and don’t push my button.


Homeopath: Tell me more about your initial miscarriage.


Patient:  I was very angry after the miscarriage. How does that happen to me? How dare that happen to me? I was angry with everybody. Everybody’s baby, I wanted. I lost my baby. I was angry with husband and infuriated with the person who told me, that I have lost the baby. I was angry again, that’s I couldn’t bury my baby. It was still mine and I never got to say good-bye.

Homeopath: Go back to your physical pain. Tell me more about it.

Patient:  When I type for a bit (on the computer), my neck gets tired and I feel as if hot water is running on my shoulders; it’s a tingling feeling. There is a lot of stiffness.

Homeopath: You mentioned, that you keep yourself busy. Tell me a bit more.

Patient: I thrive off staying busy. When I keep busy, then I don’t have time to feel the pain, then, my mind doesn’t concentrate on the pain. So, when everybody is gone to bed, I need my resting space.

Homeopath; Were you always busy, even before the pain?

Patient: Since 18 years old, I feel, I needed to be busy. After mum and grandma died, I realized, that I was going to keep myself occupied. I always had responsibility to take care of grandma. When she died…I thought what am I going to do? I got a job…driving a school bus.

Homeopath: Tell me more about what upsets you.

Patient: It bothers me the most if people think…I don’t know anything or call me a liar. In no way, are you gonna call me stupid!

Homeopath: Tell me more about your husband and family members.

Patient: When we got married… I am very much into religion. I am a Mormon. My father-in-law is a Mormon. I often had to defend myself. If somebody had done something wrong, he wouldn’t approve of that person. He then calls the person: “That stupid Mormon”, although he is a Mormon too. He constantly has thrown that sentence in my face. I get very defensive if he calls me: “The people from the valley, the stupid Mormons”. I get very angry. It’s like, as if he is slapping the Lord in the face. The Lord is my savior. I get very upset if somebody hurt somebody who is very dear to me.

Then, I feel every nerve in my body and I tremble. When the family upsets me and they want to say “it” (the statement, that she is a stupid Mormon from the valley), but they don’t really say it or they want a group-hug…I can’t. Every fiber hurts in my body. They just hit my fiber core! (hand gesture: clutching her dress at her upper chest)

Homeopath: Describe what you feel or the sensation in your body when you feel angry.

Patient: I just feel an emotion. It starts from the bottom of me and goes up toward my fingers. Inside my body, I tremble. It gets to the point…then I even cry and break down…then all hell wants to break loose.

Homeopath: What would you like to do, if you could?

Patient: I would want them to feel what I feel, then, they wouldn’t be able to downgrade people or me.

Homeopath: More about “downgrading”.

Patient: Don’t attack me…what I feel. You don’t take away what I know. There is a wall inside of me. You can downgrade me and call me fat and lazy…but don’t go there!

Homeopath: Describe the wall a bit more?

Patient: There is a big wall around me. It’s like a glass shield! Nothing you can say or do will change my mind about it. Don’t degrade the most precious thing to me. I get very defensive.

Homeopath: More about your father-in-law.

Patient: I can see myself that his eyes are piercing through me. I don’t feel like hitting him (them), but I would get out of the situation…and never go there again. I live in my own world. I have nothing to do with them (family). For me, it’s like a fly flying by…every time I see them.

Homeopath: Which animal do you feel an affinity with?

Patient: More like a bear or a dog.

Homeopath: A bit more?

Patient: An animal…something where the hair raises up its back. I feel like that, especially when I am angry. You have been warned now don’t push more. I feel like that when the family just wants to get over with the argument. It’s like, my hair is still up…if you keep pushing….I could bite. It never has gone to this point. I then feel sorry for the person that he/she can’t have what I have (the Lord). I would stand up and defend my territory …I would not submit myself. Right now, it’s more like a dog that keeps its distance…I usually get out of the situation as fast as I can.

Homeopath: A bit more?

Patient: Even if my father-in-law calls on the phone, I am very short with him. I may be saying 3-4 sentences, that’s all…I keep it short. I am apprehensive…even if I pick-up the phone. I put up a barrier!

My brother and sister live opposite me, they have their house across of me. My sister-in-law is vindictive; she stabs me in my back. She wants to hurt me, and she gets joy out of it. I feel that I get stabbed in my back.My sister-in-law is the top dog…she is superior. She got to be the one on top of me. I say go for it…and I couldn’t care less.

My sister-in-law says: “There is the bitch who took Lammy (my husband) away from him” (my cousin). You and I are close friends, but it’s always about competition. In their mind…it’s always about competition. I don’t need to be the best in their competition. I am happy to be myself.  Once, I was trying to unite with the family, but then, I realized it’s not gonna happen.

I just want them behind me…they are all over there (hand gesture = pushing away).

Homeopath: How about snakes?

Patient: I can’t stand snakes.

Homeopath: A bit more?

Patient: I think, I said everything. I put a lot of weight on because of these emotions.


Initially, I got the impression, that the patient’s expression and perception to life resembled a remedy from the animal kingdom, the snakes. She displays feelings like, jealousy, possessiveness, deeply religious, responsible and also spitefulness. The main speech idioms, which kept coming up, while taking her case, were: I FEEL CORNERED…DON”T GO THERE! She feels threatened (by family members), yet she also threatens back the family members. She is worse heat (weather) and feels much better being occupied.

As already mentioned, initially, I gave her Naja (Elapidae), based on the following mental/emotional symptoms below and neurotoxin affinity (patient’s neuropathy). There were many indications in this case, which led me to give the patient a snake remedy, for example:

The reptilian feature of feeling defenseless and at a disadvantage is particularly enhanced in snake cases. They have an inherent feeling that they are weak, powerless, inferior, and in competition with someone much more powerful and superior.

Violence in snakes comes out of malice, that someone has treated you with extreme violence, torture, cruelty and inhumanity. So then being violent seems to be a kind of retaliation of that. We will see a feeling “that I will treat you with the same inhumanity and cruelty, that I perceive you treating me with” (Rajan Sankaran). In my patient’s words: “I would want them to feel what I feel, then, they wouldn’t be able to downgrade people or me”.


The feeling of being powerless and weak, in comparison to other creatures, makes them feel prone and vulnerable to attack. This is represented by these rubrics:

  • Mind; Suspiciousness, mistrustfulness: Cench, Crot-h, Lach
  • Mind; Delusions, imaginations; injury; injured, is being: Elaps, Lach, Naja
  • Mind; Delusions; imaginations; injury, is being surrounded, by his: Lach, Naja

Method of attack or defense with the Elapidae family – Injury

  • Strong impulse to produce injury (and vice versa – sensitive to being injured)
  • Desire to injure others: fight, bite, kick, box, etc.
  • Delusions; about to receive injury

In the Elapidae family, the snakes generally live and act alone. This is unlike the Crotalinae subfamily of the Viperidae family’s tendency to form groups. It is one man versus the group; one man fighting a group.

Naja 1M was given monthly for 4 months.

Two Follow-up Sessions (period of 4 months)

Homeopath: How are you?

Patient: Not too bad! My husband and I went to California for a memorial of a family member and we had to meet the whole family.

Homeopath: Tell me more about this event.

Patient: The trip went well and I actually didn’t feel so tense about meeting the family. I didn’t get so upset. I decided to remove myself from the family…they were over there and I was over here playing with children. In this way, all felt much better. I just didn’t engage with my sister-in-law, who I hate. I removed myself completely from the situation.

It felt easy, there was no fight. I also removed myself from my niece during the last six weeks. She only calls me when she is drunk. In the past, I would have listened to her, although I felt uncomfortable. This time, I cut her off and removed myself from the situation. I said, my batteries of my phone will run out and ended the conversation. I felt a bit guilty about to break this connection, but it was for the better.

I am trying to be more open to things, I am trying to release a lot. I am opening up a little more and let people see, that I too experienced dark times in my life. I am admitting to myself, that I had a hard time and also let others know that I did suffer. I don’t hold things in anymore. I am less guarded!

Homeopath: How about your fibromyalgia pains?

Patient: My left hip and legs are really bad. The legs ache all the time and they feel heavy. When I get up in the morning, I almost feel paralyzed. They are very stiff. Both outer sides of my legs hurt and tingle, like little needles. Everything is worse lying down and better sitting up. I am restless in bed and move around. I have arthritis in my hips, which affect my legs.

Homeopath: Describe how you start the day with your pains in your legs and hip a bit more?

Patient: When I get up in the morning, I feel very stiff and the first movements are really bad, really painful. Then, during the day, I feel better, and during the night, I feel worse again.

Although the patient improved on the emotional level, I did not see any amelioration of her physical symptoms at all. In fact, the patient stayed the same.


At this point, as an intermittent treatment, I introduced the BOWEL NOSODE MORGAN 30, daily, for 4 weeks. This nosode is especially indicated for fibromyalgia. I also started giving her a Basic Gastric-Pathogen Purge Program with Amazonian, Western & Chinese herbology combination to meet the dormant EPSTEIN BARR symptomatology and her weakened digestive system.

Follow-up Session

June 2015

Patient is feeling better regarding her physical pains and overall function of her digestive system. Her extreme sensitivity to touch her skin disappeared and she doesn’t feel so much stinging pains. Her mental/emotional aspect regarding to her family is still very volatile.

As I re-studied her case notes again, I realized, that the core of this case doesn’t so much focus on the perception of the “victim and aggressor”, but more on her possessiveness and jealousy if anybody (like family members) is trying to take something away from her which is dear to her, like religion, faith, newborn child etc. Then, she feels as if she was attacked with knives, as well as the physical symptomatology, which is experienced of being stabbed by knives / needles.


Rajan Sankaran Notes

Apis: The patient will lead you to the animal kingdom with issues like competition, victim and aggressor, hierarchy or survival problem etc. and many of its human expressions. The sub-kingdom, Insecta displays features with restlessness, agility, sudden attacks, intruded, encroached, etc.

Features specific to Apis Mel.

  • Restlessness, fidgety, hyperactivity, hurry, rushing, frantic pace, wandering, hectic etc. (patient is busy with restless leg syndrome)
  • Social, colonies, workers, slave, royal status, swarming…
  • Industrious, busy, fruitlessly busy, occupation amel., workaholic
  • Stinging, burning, biting, sharp pains
  • Miasm Tubercular
  • Jealousy, comparison, competition
  • Dominance, dictatorial
  • Extremely hot patients
  • Intolerance of heat
  • Worse slightest touch, extreme sensitivity to touch

Some points from Homoeopathic literature(Homeopathy 1936)

The Characteristics of Individual Animals in Life in the Remedies by H.A. Robert, MD

We all recognize the typical stinging pains and white swellings of Apis. Do we recognize the mental traits as well? Naturalists tell us that the queen bee is the most jealous thing in nature.

Now let us look at the Apis patient. Jealousy in women; violence amounting to frenzy; all her ideas turn around jealousy; ailments from fright, rage, vexation, jealousy, or hearing bad news; great tearfulness, cannot help crying; irritable. The bee flits from flower to flower, never concentrating her effort on one, yet often returning to the same one; so the Apis patient flits from one idea to another, finding it impossible to concentrate on any line of thought, yet always swinging back to it at intervals.

We can hardly fail to recognize an Apis patient where a well developed mental condition manifests itself, for with the jealousy or bad effects there from there is usually the stinging pain which typifies the bee’s weapon of defense.


Notes from Jayesh Shah

Jealousy – They are jealous, very possessive and have a fear of being alone. When these elements come together, it is manifested as an abnormal clinging to their favorite parent. (e.g. A child could not bear anyone touching his mother)

My patient decided to live with her grandpa instead of her parents, as she felt very close to him, yet she is also possessive of him and very jealous if somebody else dared to sit on his chair.

  • Confirmatory symptoms of my patient (past medical history)
  • Ovarian cysts
  • Hives

Patient also mentioned, that her anger resembled more the image of an animal with hair on the back.

REMEDY: APIS MELLIFICA 200, one tablet, daily, for 3 days…repeated every 10 days, (for 30 days in total) and then one tablet, for 3 days only, repeated monthly.

NATURAL HERBAL SUPPLEMENT PROTOCOL: Amazonian, Western, Chinese herbal combination of anti-viral and anti-fungal products with systemic enzymes as well as products for the thymus (immune system), digestive probiotics and healthier diet.


January – June 2016…and on-going.

The patient immediately reacted just after one tablet of Apis 200 with an ulcerative sore throat (white pus in the back of the throat) and strep infection. Personally, I related this incidence to the dormant virus.

Over the last few months by repeating the remedy Apis 200 on a monthly basis (one tablet for three days), I can joyfully verify, that the patient has completely stopped all steroid injections. Her fibromyalgia pains are greatly reduced, especially in her hip and legs. Restless leg syndrome is almost gone.

Mentally and emotionally, she displays a much calmer disposition to her family members and in her own words: “Things are looking up!”

The patient still struggles to loose weight, which is a major issue in her long-term improvement.


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Angelika Maria Koch
DR. ANGELIKA MARIA KOCH (D.N.M. LCH H.N.H.Ir.) is a trained health care practitioner and health consultant of integrated medicine. With 30 years of experience, she is a Doctor of Natural Medicine (University of Natural Medicine, USA), Certified Classical Homeopath, Certified Iridologist, Certified Sclerologist, Certified Herbalist, Certified Reflexologist, Certified L.I.F.E.-System Practitioner, Certified Systemic Formulas Practitioner, and Certified Color Therapist. Her extensive international training and education were acquired in England and the United States.
  • Tineke van der Werff

    So many problems !