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Michael Knapp, ND, DHANP
A compelling case of chronic anxiety, compulsive behavior, and digestive distress resolved through precise homeopathic prescribing guided by pattern recognition and physical symptom correlation.
A 25-year-old male with lifelong anticipatory anxiety, compulsive checking behaviors, and stress-related digestive distress achieved significant, sustained improvement through individualized homeopathic care. Treatment guided by detailed case analysis and correlation of mental-emotional and physical symptoms resulted in reduced anxiety frequency, resolution of compulsive behaviors and gastrointestinal symptoms, diminished sugar cravings, and restored social confidence. This case demonstrates the effectiveness of precise homeopathic prescribing in addressing chronic anxiety patterns rooted in adverse childhood experiences.
Blaze is a 25-year-old young man with lifelong anxiety. Despite the heavy nature of discussing trauma and details about anxiety, he is jovial, vibrant, laughing, and articulating his experience clearly. He has undergone counseling, EMDR, neurotransmitter testing, and nutraceutical treatments with some transient benefit. He comes to see me specifically for homeopathic treatment of anxiety.
He experiences anxiety constantly and has frequent episodes of intense anxiety spikes. He anticipates speaking to people and worries he might make a fool of himself. “I feel like I’m out of practice with small talk. How much is too much information? If they ask me how my weekend was, I panic. I don’t know how it was!” After a conversation, he picks out all the things he could have said better or that he feels were stupid.
He grew up in a home with a verbally abusive, manipulative father, and he always had to be hyper-vigilant, ready for something to happen because his father might yell at him at any time. “The vigilance is still there. I’m always ready.” He currently runs a successful online business, but this vigilance leads to anticipation and makes him constantly check sales, comments, and DMs. “What if someone sent a message in the last minute and a half? Logically, I know it’s stupid, but I have to check. It’s lizard brain. I check sales numbers 100 times per day.”
Since a recent move across the country, he feels overwhelmed in stores. “I know I need flour, but there are eight kinds. Which one do I want?” He gets decision paralysis and then realizes that other people could come talk to him. He worries he’ll make a fool of himself. When he’s with someone else, it’s no problem. He can get confused about the flour, and they laugh it off, but alone, he’s anxious, frantic, and feels unprepared.
I asked him more about being overwhelmed. He describes having to make every decision at work and delegating tasks, which burns him out. So when he gets home, simple things like deciding to do dishes or to shower are overwhelming. Sometimes, he calls someone and “word vomits” to say it all out loud, which releases some of the pressure.
He is anxious about appointments. Anytime something is scheduled involving others, it leads to full-blown anxiety, and if it is just him, then he feels overwhelmed as if he’s “out of practice with time management.”
Physically, he gets flushed with heat, his heart races, and his stomach feels as if it is shrinking or tightening. He can’t eat during anxiety. He has been gagging when stressed for the past 6-7 months, and when it’s bad, he will vomit. He could only eat or drink sugar, like soda and candy. He also experiences stomach tightness if he hasn’t eaten all day, and if he eats at that time, he gets nauseous unless it’s sugar or something sweet. He burps loudly and frequently right after eating or even drinking tea in the morning. If anxiety gets very intense, the burping turns into gagging. This first started during a stressful time and was never resolved. He’s had hair loss during times of intense stress.
He experiences anxiety if he stays up past midnight when he is prone to irrational thoughts, fear of death, or worry that the world is beyond repair. “What if I died tomorrow? What would I do if something terrible happened?” He has stressful, anxious dreams 1x/week, then wakes with a headache on the sides of the head which extends over the top like a headband up to the crown.
He is sensitive to heat and gets “hot and bothered” quickly and is likely to answer snappishly, be irritable, and feel overwhelmed with difficulty solving problems.
The first step of analyzing a case is to take a pearl from Stephen Messer, ND, DHANP, and ask ourselves, “What is the main thing in this case?” and “What is the main thing about the main thing?” What about the main thing helps to differentiate it from other cases of the main thing? At times, this seems so obvious that it is overlooked, which can lead to our confusion by haphazardly throwing symptoms together. At other times, the case is complex with many disorders or a minefield of mental/emotional information and other (apparently true) data recorded from the interview, so that it takes significant time to cut through to what is essential. This case is quite clear; the main thing is anticipatory anxiety.
In working with a primary complaint on the mental and emotional plane, it is important to ask about the physical symptoms experienced during the complaint. If the patient has trouble answering, one way to get more information is to ask them to scan sequentially through their body. “When you are having anxiety, how does your head feel? Your chest? Stomach?”. Often, they will describe very common symptoms of anxiety, but if any of them are intense or particularly distressing, then they can be important individualizing symptoms. Sometimes, the physical experience of anxiety will be far more important than the object of anxiety or the mental chatter. For example, if a patient is afraid of flying, getting cancer, snakes, burglars, losing their job, closed spaces, dying, and public speaking, the only thing you can conclude is that they are afraid of lots of stuff. Okay, you need a medicine with lots of fear, with hundreds to choose from. But if this same person has violent, very distressing palpitations in bed at night with anxiety, then that may quickly narrow you down to a medicine like Phosphorus. The secondary complaints on the physical level, such as headaches, asthma, digestive, urinary, or reproductive problems, should also be questioned because they can help clarify the best medicine. There are not many physical complaints in this case, but the ones that are present are all clearly linked to the chief complaint of anxiety. When the patient is anxious, he burps or gags. He experiences GI symptoms at other times, but the anxiety influences them. This makes the analysis easier because all the troubling symptoms belong to the same current disease or remedy state that needs treatment.
It is tempting to look for the “weirdest” thing about anxiety, but in this case, it’s a dead end. How often do patients tell you they start gagging when they are anxious? Kind of strange, right? The rubric “Mind-Anxiety-retching” has only five remedies all in grade 1 (ars. bar-m. bism. cupr. podo.). None of these is similar to the rest of the case. Hence, this narrow symptom needs to be generalized and broadened into its separate parts by using the nature of the anxiety (anticipatory) as a symptom and any of the descriptors and qualifiers of the gagging and belching as a second symptom that both point toward the concept of “retching with anxiety”.
Pattern recognition is an essential part of successful prescribing. Still, for the pattern recognition system to quickly and successfully get you to the indicated medicine, it needs to be fed with a lot of reliable, bite-sized chunks of information that are applied. Then, feedback is received so that you can correct the course. The case is taken and analyzed, the medicine is given, and the response is gauged at follow-up. Wash, rinse, repeat. This can be deceptive to newer doctors when they see a doctor with many years of experience prescribe quickly and easily with good results. One of the best self-study resources to build the basis of this pattern recognition is Gunavante’s “The Genius of Homeopathic Remedies,” which lists key symptoms of the most common remedies but also has over 120 very short cured cases from literature to study.
One way to synthesize the information from this case is to ask, “What remedies have anticipatory anxiety, lots of belching, and strong craving for candy/sweets?” Check your pattern recognition. What remedies come to mind? Take 30 seconds or even 5 minutes. Go ahead, grab a resource.
If you thought of only one medicine, it was Lycopodium, which is a good place to start, but there is a much better medicine in this case. As Amy Rothenberg, ND, DHANP says, “You see what you look for and you look for what you know.” There are at least 50 remedies that cover the three main symptoms. Learning the basics of using a repertory, whether computerized or by hand, allows you to quickly translate the essential features of the case into a net that captures the most important remedies to consider, while further building your pattern recognition.
I combined smaller rubrics into a total of 3 categories in order to get a usable dataset:
MIND – AILMENTS FROM – anticipation
MIND – ANTICIPATION
STOMACH – ERUCTATIONS – eating – after – agg.
STOMACH – ERUCTATIONS – drinking – after – agg.
STOMACH – ERUCTATIONS – violent
STOMACH – ERUCTATIONS – forcible
GENERALS – FOOD AND DRINKS – sweets – desire
This is a textbook case of Argentum nitricum, which best matches the anticipatory anxiety, compulsiveness, indecision, loud belching, and craving for candy. But why not any of the other remedies? Lycopodium doesn’t have the impulsive/compulsive symptoms strongly marked in the case, and we don’t see any of the bossiness or haughtiness, which is how the Lycopodium state compensates for feeling insecure. Pulsatilla almost always requires support and consolation related to their complaints, which is missing in this patient. Sulphur is worse in heat, and it causes lots of digestive problems. Still, the most essential symptom of anticipation is not a strong symptom of the medicine, which tends more toward indifference and overconfidence. You could get led astray thinking of Causticum because it has a keynote of checking things compulsively, but this chilly remedy is more strongly noted for being averse to sweets.
Argentum nitricum in Gunavante’s “Genius”
Anticipatory anxiety before any important engagement.
Fear of being alone.
Aggravated by warmth, heat, summer
Impulsive. Tormented by strange ideas.
Desires SWEETS, sugar. Every kind of food disagrees.
Eructations are loud, explosive.
Argentum nitricum 30c – 2 pellets daily
Blaze reports reduced anxiety overall. His social interactions are improved. He was able to receive a delivery today at work without a huge spike in anxiety, heart racing, or getting worked up by answering the door unexpectedly. He’s had moments of feeling shocked because he thought he should be nervous, but wasn’t.
1. Persistent Anxiety
Baseline frequency: at least 1x daily, easily 3-4x somedays
Current frequency: 1-2x/week and not as debilitating. 50% improved at least.
Continue Argentum nitricum 30c – 2 pellets daily
Things continue to get better. He notices “more and more that the symptoms are less and less”. “Before today’s call, I was working right up to the meeting and not activated at all. Everything is calming down, which is wild. I’ve never experienced this level of calm throughout the day.”
After 3 months, symptoms started to backslide, so the potency was changed to Argentum nitricum 200c, to which he responded even better. He received a few doses over the next 8 months. During that time, the anxiety decreased to situationally appropriate levels, anticipation “melted away”, excessive checking of business numbers resolved, the burping and gagging resolved, sugar craving eventually reduced, and a healthier appetite for other foods was replaced. “I’m just so excited. I didn’t know life was supposed to be relatively this easy.” He now engages excitedly in social activities intended to bring strangers together to become friends, which would have caused him debilitating anxiety less than a year earlier.
Blaze suffered an ongoing adverse childhood experience (ACE), which is highly correlated with mental health diagnoses. However, those events didn’t play into the case analysis because the more critical information is the individual mind and body response to the trauma, which is a clear Argentum nitricum state. Unsurprisingly, his siblings who grew up in the same house also experience mental health complaints, but their health responds to different homeopathic medicines despite growing up under mostly similar circumstances. With homeopathic medicine, we can provide precise, individualized medicine within our greater naturopathic practice.
Dr. Michael Knapp attended National University of Natural Medicine in Portland, OR and completed a one year teaching and clinical residency at the university. His practice has an emphasis in the interconnection of digestive problems, (dis-)stress, hormonal and immune system complaints.
Dr. Knapp is a certified mindfulness meditation teacher and has taught meditation in jail for inmates in substance misuse treatment. He has provided outreach to the homeless and at domestic violence shelters in Northern Arizona. He is currently president of the Homœopathic Academy of Naturopathic Physicians.
Michael Knapp, ND, DHANP
A compelling case of chronic anxiety, compulsive behavior, and digestive distress resolved through precise homeopathic prescribing guided by pattern recognition and physical symptom correlation.
A 25-year-old male with lifelong anticipatory anxiety, compulsive checking behaviors, and stress-related digestive distress achieved significant, sustained improvement through individualized homeopathic care. Treatment guided by detailed case analysis and correlation of mental-emotional and physical symptoms resulted in reduced anxiety frequency, resolution of compulsive behaviors and gastrointestinal symptoms, diminished sugar cravings, and restored social confidence. This case demonstrates the effectiveness of precise homeopathic prescribing in addressing chronic anxiety patterns rooted in adverse childhood experiences.
Blaze is a 25-year-old young man with lifelong anxiety. Despite the heavy nature of discussing trauma and details about anxiety, he is jovial, vibrant, laughing, and articulating his experience clearly. He has undergone counseling, EMDR, neurotransmitter testing, and nutraceutical treatments with some transient benefit. He comes to see me specifically for homeopathic treatment of anxiety.
He experiences anxiety constantly and has frequent episodes of intense anxiety spikes. He anticipates speaking to people and worries he might make a fool of himself. “I feel like I’m out of practice with small talk. How much is too much information? If they ask me how my weekend was, I panic. I don’t know how it was!” After a conversation, he picks out all the things he could have said better or that he feels were stupid.
He grew up in a home with a verbally abusive, manipulative father, and he always had to be hyper-vigilant, ready for something to happen because his father might yell at him at any time. “The vigilance is still there. I’m always ready.” He currently runs a successful online business, but this vigilance leads to anticipation and makes him constantly check sales, comments, and DMs. “What if someone sent a message in the last minute and a half? Logically, I know it’s stupid, but I have to check. It’s lizard brain. I check sales numbers 100 times per day.”
Since a recent move across the country, he feels overwhelmed in stores. “I know I need flour, but there are eight kinds. Which one do I want?” He gets decision paralysis and then realizes that other people could come talk to him. He worries he’ll make a fool of himself. When he’s with someone else, it’s no problem. He can get confused about the flour, and they laugh it off, but alone, he’s anxious, frantic, and feels unprepared.
I asked him more about being overwhelmed. He describes having to make every decision at work and delegating tasks, which burns him out. So when he gets home, simple things like deciding to do dishes or to shower are overwhelming. Sometimes, he calls someone and “word vomits” to say it all out loud, which releases some of the pressure.
He is anxious about appointments. Anytime something is scheduled involving others, it leads to full-blown anxiety, and if it is just him, then he feels overwhelmed as if he’s “out of practice with time management.”
Physically, he gets flushed with heat, his heart races, and his stomach feels as if it is shrinking or tightening. He can’t eat during anxiety. He has been gagging when stressed for the past 6-7 months, and when it’s bad, he will vomit. He could only eat or drink sugar, like soda and candy. He also experiences stomach tightness if he hasn’t eaten all day, and if he eats at that time, he gets nauseous unless it’s sugar or something sweet. He burps loudly and frequently right after eating or even drinking tea in the morning. If anxiety gets very intense, the burping turns into gagging. This first started during a stressful time and was never resolved. He’s had hair loss during times of intense stress.
He experiences anxiety if he stays up past midnight when he is prone to irrational thoughts, fear of death, or worry that the world is beyond repair. “What if I died tomorrow? What would I do if something terrible happened?” He has stressful, anxious dreams 1x/week, then wakes with a headache on the sides of the head which extends over the top like a headband up to the crown.
He is sensitive to heat and gets “hot and bothered” quickly and is likely to answer snappishly, be irritable, and feel overwhelmed with difficulty solving problems.
The first step of analyzing a case is to take a pearl from Stephen Messer, ND, DHANP, and ask ourselves, “What is the main thing in this case?” and “What is the main thing about the main thing?” What about the main thing helps to differentiate it from other cases of the main thing? At times, this seems so obvious that it is overlooked, which can lead to our confusion by haphazardly throwing symptoms together. At other times, the case is complex with many disorders or a minefield of mental/emotional information and other (apparently true) data recorded from the interview, so that it takes significant time to cut through to what is essential. This case is quite clear; the main thing is anticipatory anxiety.
In working with a primary complaint on the mental and emotional plane, it is important to ask about the physical symptoms experienced during the complaint. If the patient has trouble answering, one way to get more information is to ask them to scan sequentially through their body. “When you are having anxiety, how does your head feel? Your chest? Stomach?”. Often, they will describe very common symptoms of anxiety, but if any of them are intense or particularly distressing, then they can be important individualizing symptoms. Sometimes, the physical experience of anxiety will be far more important than the object of anxiety or the mental chatter. For example, if a patient is afraid of flying, getting cancer, snakes, burglars, losing their job, closed spaces, dying, and public speaking, the only thing you can conclude is that they are afraid of lots of stuff. Okay, you need a medicine with lots of fear, with hundreds to choose from. But if this same person has violent, very distressing palpitations in bed at night with anxiety, then that may quickly narrow you down to a medicine like Phosphorus. The secondary complaints on the physical level, such as headaches, asthma, digestive, urinary, or reproductive problems, should also be questioned because they can help clarify the best medicine. There are not many physical complaints in this case, but the ones that are present are all clearly linked to the chief complaint of anxiety. When the patient is anxious, he burps or gags. He experiences GI symptoms at other times, but the anxiety influences them. This makes the analysis easier because all the troubling symptoms belong to the same current disease or remedy state that needs treatment.
It is tempting to look for the “weirdest” thing about anxiety, but in this case, it’s a dead end. How often do patients tell you they start gagging when they are anxious? Kind of strange, right? The rubric “Mind-Anxiety-retching” has only five remedies all in grade 1 (ars. bar-m. bism. cupr. podo.). None of these is similar to the rest of the case. Hence, this narrow symptom needs to be generalized and broadened into its separate parts by using the nature of the anxiety (anticipatory) as a symptom and any of the descriptors and qualifiers of the gagging and belching as a second symptom that both point toward the concept of “retching with anxiety”.
Pattern recognition is an essential part of successful prescribing. Still, for the pattern recognition system to quickly and successfully get you to the indicated medicine, it needs to be fed with a lot of reliable, bite-sized chunks of information that are applied. Then, feedback is received so that you can correct the course. The case is taken and analyzed, the medicine is given, and the response is gauged at follow-up. Wash, rinse, repeat. This can be deceptive to newer doctors when they see a doctor with many years of experience prescribe quickly and easily with good results. One of the best self-study resources to build the basis of this pattern recognition is Gunavante’s “The Genius of Homeopathic Remedies,” which lists key symptoms of the most common remedies but also has over 120 very short cured cases from literature to study.
One way to synthesize the information from this case is to ask, “What remedies have anticipatory anxiety, lots of belching, and strong craving for candy/sweets?” Check your pattern recognition. What remedies come to mind? Take 30 seconds or even 5 minutes. Go ahead, grab a resource.
If you thought of only one medicine, it was Lycopodium, which is a good place to start, but there is a much better medicine in this case. As Amy Rothenberg, ND, DHANP says, “You see what you look for and you look for what you know.” There are at least 50 remedies that cover the three main symptoms. Learning the basics of using a repertory, whether computerized or by hand, allows you to quickly translate the essential features of the case into a net that captures the most important remedies to consider, while further building your pattern recognition.
I combined smaller rubrics into a total of 3 categories in order to get a usable dataset:
MIND – AILMENTS FROM – anticipation
MIND – ANTICIPATION
STOMACH – ERUCTATIONS – eating – after – agg.
STOMACH – ERUCTATIONS – drinking – after – agg.
STOMACH – ERUCTATIONS – violent
STOMACH – ERUCTATIONS – forcible
GENERALS – FOOD AND DRINKS – sweets – desire
This is a textbook case of Argentum nitricum, which best matches the anticipatory anxiety, compulsiveness, indecision, loud belching, and craving for candy. But why not any of the other remedies? Lycopodium doesn’t have the impulsive/compulsive symptoms strongly marked in the case, and we don’t see any of the bossiness or haughtiness, which is how the Lycopodium state compensates for feeling insecure. Pulsatilla almost always requires support and consolation related to their complaints, which is missing in this patient. Sulphur is worse in heat, and it causes lots of digestive problems. Still, the most essential symptom of anticipation is not a strong symptom of the medicine, which tends more toward indifference and overconfidence. You could get led astray thinking of Causticum because it has a keynote of checking things compulsively, but this chilly remedy is more strongly noted for being averse to sweets.
Argentum nitricum in Gunavante’s “Genius”
Anticipatory anxiety before any important engagement.
Fear of being alone.
Aggravated by warmth, heat, summer
Impulsive. Tormented by strange ideas.
Desires SWEETS, sugar. Every kind of food disagrees.
Eructations are loud, explosive.
Argentum nitricum 30c – 2 pellets daily
Blaze reports reduced anxiety overall. His social interactions are improved. He was able to receive a delivery today at work without a huge spike in anxiety, heart racing, or getting worked up by answering the door unexpectedly. He’s had moments of feeling shocked because he thought he should be nervous, but wasn’t.
1. Persistent Anxiety
Baseline frequency: at least 1x daily, easily 3-4x somedays
Current frequency: 1-2x/week and not as debilitating. 50% improved at least.
Continue Argentum nitricum 30c – 2 pellets daily
Things continue to get better. He notices “more and more that the symptoms are less and less”. “Before today’s call, I was working right up to the meeting and not activated at all. Everything is calming down, which is wild. I’ve never experienced this level of calm throughout the day.”
After 3 months, symptoms started to backslide, so the potency was changed to Argentum nitricum 200c, to which he responded even better. He received a few doses over the next 8 months. During that time, the anxiety decreased to situationally appropriate levels, anticipation “melted away”, excessive checking of business numbers resolved, the burping and gagging resolved, sugar craving eventually reduced, and a healthier appetite for other foods was replaced. “I’m just so excited. I didn’t know life was supposed to be relatively this easy.” He now engages excitedly in social activities intended to bring strangers together to become friends, which would have caused him debilitating anxiety less than a year earlier.
Blaze suffered an ongoing adverse childhood experience (ACE), which is highly correlated with mental health diagnoses. However, those events didn’t play into the case analysis because the more critical information is the individual mind and body response to the trauma, which is a clear Argentum nitricum state. Unsurprisingly, his siblings who grew up in the same house also experience mental health complaints, but their health responds to different homeopathic medicines despite growing up under mostly similar circumstances. With homeopathic medicine, we can provide precise, individualized medicine within our greater naturopathic practice.
Dr. Michael Knapp attended National University of Natural Medicine in Portland, OR and completed a one year teaching and clinical residency at the university. His practice has an emphasis in the interconnection of digestive problems, (dis-)stress, hormonal and immune system complaints.
Dr. Knapp is a certified mindfulness meditation teacher and has taught meditation in jail for inmates in substance misuse treatment. He has provided outreach to the homeless and at domestic violence shelters in Northern Arizona. He is currently president of the Homœopathic Academy of Naturopathic Physicians.
It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout. The point of using Lorem Ipsum is that it has a more-or-less normal distribution of letters, as opposed to using ‘Content here, content here’, making it look like readable English. Many desktop publishing packages and web page editors now use Lorem Ipsum as their default model text, and a search for ‘lorem ipsum’ will uncover many web sites still in their infancy.
It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout. The point of using Lorem Ipsum is that it has a more-or-less normal distribution of letters, as opposed to using ‘Content here, content here’, making it look like readable English. Many desktop publishing packages and web page editors now use Lorem Ipsum as their default model text, and a search for ‘lorem ipsum’ will uncover many web sites still in their infancy.
The point of using Lorem Ipsum is that it has a more-or-less normal distribution of letters, as opposed to using ‘Content here, content here’, making
The point of using Lorem Ipsum is that it has a more-or-less normal distribution of letters, as opposed to using ‘Content here, content here’, making it look like readable English. Many desktop publishing packages and web page editors now use Lorem Ipsum as their default model text, and a search for ‘lorem ipsum’ will uncover many web sites still in their infancy.
It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout. The point of using Lorem Ipsum is that it has a more-or-less normal distribution
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