A revised chapter from “Homeopathy through Harmony and Totality” Vol II

MONOGRAM: FROM MULTITUDE TO ACCESS

*Dr Ajit Kulkarni M.D. (Hom.)

With REFLECTIVE insights from Guy Tydor and Alexander Martuishev

___________________________________________________________________________

“You are not a drop in the ocean. You are the entire ocean in a drop.”

– Rumi

___________________________________________________________________________

1. INTRODUCTION

• Rumi’s vision: Ocean in a drop
• The emergence of the Monogram concept
• The architecture of a remedy’s quintessence

2. EVOLUTION OF HOMEOPATHIC MATERIA MEDICA

• Unfolding the essence: A matrix-based approach to remedies
• Hahnemann’s ground-breaking start
• From raw proving to refined application
• Key contributors and methodologies

3. THE PROBLEM WITH SOLE RELIANCE ON SYMPTOMS

1. Incompleteness of symptoms – Absence, Atypicality, Identicality, Non-specificity, etc.

2. Navigating challenges

3.Need for deeper insight beyond symptoms

4. THE KEYNOTE SYSTEM: STRENGTHS AND WEAKNESSES

1. Advantages of Keynote system
2. Drawbacks of Keynote system  – Oversimplification, lack of totality, arbitrary nature, etc
3. Overreliance and reductionist approach

5. FROM KEY NOTES TO KEY THEMES

1. Moving from symptom to essence
2. Defining themes: Traits, dispositions and patterns
3. Case illustrations
4. The role of theme in totality

6. Unlocking THE MAGNIFICENCE OF DATA: THE MONOGRAM APPROACH

1. Definition: Design and thematic essence
2. Philosophy of abstraction and generalization
3. The Monogram as remedy’s DNA
4. Advantages of Monogram use  – Integration, depth, personalization, group & individual remedy

7. UNIFYING LOGIC: GENERALIZATION AND THE MONOGRAM

1. Monogram words are not pedantic
2. Components of monogram
3. Traits and dyscretic states
4. Characters from deductive inference
5. Behavioural patterns
6. Pathological generals
7. Miasmatic state
8. Energetic signature, body language, polarities

8. USE OF PRECISE LANGUAGE IN MONOGRAM CONSTRUCTION

1. Importance of word selection
2. Examples of word triads compared (13)
   • Fagged vs. Weary vs. Worn-out
   • Hard vs. Indurated vs. Hardening
   • Degenerative vs. Degenerating vs. Degenerant
   • Violent vs. Vigorous vs. Intense
   • Dyspeptic vs. Flatulent vs. Gassy
   • Acidic vs. Choleric  vs. Bilious
   • Old vs. Aged vs. Senile
   • Fidgety vs. Restless vs. Anti-rest
   • Debilitated vs. Prostrated vs. Enervated (vs. Collapsy)
   • Rigid vs. Tense vs. Stiff
   • Slowed-down vs. Declining vs. Broken-down vs. Run-down
   • Septic vs. Putrescent vs. Suppurative
   • Dropsical vs. Exudative vs. Fibrinous

9. MONOGRAM OF INDIVIDUAL REMEDY: OPIUM

1. Explanation of each Monogram theme
2. Core state: Insensibility
3. Related attributes: Torpid, paralytic, adynamic, etc.
4. Clinical insight and comparative remedies

10. GROUP MONOGRAMS

1. Carbon group

– Devitalized, adynamic, degenerating, etc.

1. Halogen group

– Concreting, malignant, agile, etc.

11. CLINICAL ILLUSTRATION

1. Case summary
2. Monogram-based analysis
3. Remedy selection

12. MONOGRAM AND REPERTORY: A SYNERGISTIC MODEL

1. Monogram does not replace repertory…
2. Deepening repertory with thematic understanding
3. Call for a dedicated Monogram repertory

13. PACE AND EVOLUTION AS DETERMINANTS OF MONOGRAMMATIC

     ANALYSIS
     1. Monogram of Carbo-veg as an example
2. Defining inter-relations of Monogram themes
3. Co-relating clinic-pathological states through evolution

14. THE MONOGRAMMATIC WORDBOOK
15. Contextualization of the words
16. Clinical and therapeutic implications
17. FINAL REFLECTIONS

1. Generalisation and abstraction as foundation
2. Monogram: Logic, patterns and evolution of disease
3. Utility of Monogram

• Monogram in contemporary homeopathy
• Monogram: Bridging modules, prognosis and patient persuasion

1. Monogram: A critical objective tool
2. Monogram as bridge: MindàBodyàPathologyàRemedy
3. Conclusion

16. REFLECTIVE INSIGHTS
17. Monogram: Exploring the Golden Key of Tarkas and Kulkarni by Guy Tydor
18. Monogram: Meticulous analysis of clinical approach by Alexander Martuishev

 

 

 

 

 

 

 

 

MONOGRAM: FROM MULTITUDE TO ACCESS

 

Abstract: The concept of the Monogram in homeopathy introduces a unifying framework that synthesizes the fragmented data of Materia medica into a dynamic, coherent and individualized structure. This paper presents the Monogram as a philosophical, clinical and practical advancement in remedy profiling, moving beyond isolated symptoms and keynotes toward energetic pattern recognition. The author explains the psycho-clinico-patho-miasmatic co-relations that can be effectively constructed and perceived through the concept of the monogram. This approach enables an integrated understanding of the mental, emotional and pathological layers within a case, along with their symbolic and metaphoric expressions.

Keywords: Materia medica, evolution, limitation of symptoms, keynote symptoms, keynote themes, problems with keynote system, individual remedy, group study, monogram. abstraction, pace and evolution, holistic approach, benefits

 

 

1. Introduction

The ever-growing database of symptoms, proving data and clinical experiences in homeopathy often leaves the homeopaths challenged, resulting in fragmented perceptions of remedies. To address this, the concept of the Monogram emerges as a method of abstraction and integration, offering a holistic grasp of a remedy’s inner structure. Every remedy carries a unique quintessence expressed through distinct characteristics – mental generals, physical generals,   physical particulars, pathological generals, pathogenetic action, constitution and diathesis, behaviour and patterns, along with known and yet-to-be-explored interconnections among these elements. The Monogram highlights these unique features, helping to establish meaningful integrations. It distils, refines and extracts the very essence or nectar of the individual remedy or group of the remedies.

The monogram serves as the remedy’s signature. It is like a piece of art for adorning the esteem of a remedy. It unifies the essential threads and weaves together the fabric of the remedy.

The monogram is not just a word or an isolated concept; it stands by association, resemblance, identification or convention.

 

2. HOMEOPATHIC MATERIA MEDICA: THE TRANSITION

Homeopathic Materia medica is the collection of pathogenic effects of drugs and the derangements, they are capable of causing in a healthy individual. It is through this collection that the principle, ‘let likes be treated by likes’, is applied at the bedside.

Homeopathic Materia medica has evolved with Master Hahnemann who contributed the unique and ground-breaking concept of ‘proving on healthy individuals.’ The data gathered from these ‘provers’ formed the basis of Hahnemann’s ‘Materia Medica Pura*’, a foundational yet unrefined collection of symptoms that would later shape the field of homeopathy.

Then arrived the colossal work of  T. F. Allen ‘The Encyclopaedia of Pure Materia Medica’ which consisted of protean proving symptoms.

*Note that it will be a challenging job for a modern homeopath to practice with the raw data of MM Pura.

Later, Constantine Hering, in his mammoth work of ‘Guiding symptoms of our Materia medica’, brought structure by categorizing symptoms under appropriate headings, focusing especially on those symptoms that had been clinically validated. Hering’s approach laid the groundwork for the ‘mosaic’ of symptoms that modern homeopathy now relies on.

 

UNFOLDING THE ESSENCE: A MATRIX-BASED APPROACH TO REMEDIES

The evolution of applied Homeopathic Materia medica (as against and complementary to the pure proving symptoms) is a continuous process and a homeopath has many methods today by which he can study the remedies. It began with the proving of authentic type where the provers i.e. the healthy human volunteers, expressed their honest experiences with the remedies that were given for knowing their effects at various levels of operation of the human economy. The symptoms that were painstakingly gathered over months and years were collected together.

First evolution in the study of Materia medica occurred in the field of symptoms. The symptoms in Materia medica are variable, profound and ought to be integrated.

The collection was pure but raw and there was a need to refine it and make it understandable for clinical application.

 

There was a need to streamline the raw and scattered data in order to make it more organised and usable. It was necessary to make headings and sub-headings, to incorporate the symptoms in a relevant way. It was essential to look at the toxicological data in terms of symptoms and pathology. It was required to throw light on the action of a remedy, how it unfolds at the level of mental and physical states of the economy.  There was a need to understand the remedies as living individuals.

The concept of totality gains substance when a homeopath builds a meaningful, purposeful, and derivative matrix for understanding the remedies.

2.4 KEY CONTRIBUTERS AND METHODOLOGIES

• Throughout its evolution, each stalwart in homeopathy has sought to make the tool of Materia medica more effective. Various pioneers like Hering, Allen, Lippe, Clarke, Boericke, Kent, Tyler, Boger, M.L. Dhawale, Bhanja, Pulford, Pathak, Scholten, Catherine Coulter, Edward Whitmont, Philip Bailey, Vithoulkas, Rajan Sankaran, Farrington, Vassilis Ghegas, Massi, P.I. Tarkas, Ajit Kulkarni, and others have contributed to the shaping of Homeopathic Materia medica through their own distinct approaches.

• Anatomy, physiology and pathology were emphasised as the pillars for interpreting and differentiating the data by Boericke, Clarke, Boger, Hughes, M.L. Dhawale,  Tarkas-Kulkarni and many more.
• T.F. Allen, in his Handbook of Materia medica and Therapeutics, went beyond the factual data, addressing the clinical application of remedies. This approach makes Allen a pioneer in clinical correlation.
• Pulford and Allen focused on identifying keynotes within the data that could help individualize the portrait of a person or disease.
• Kent, with his artistic perspective, interpreted the remedies’ data through the lens of a drug’s ‘personality.’ His approach was influenced by his philosophical understanding of human suffering, partly inspired by Swedenborg’s philosophy.
• Vithoulkas focused on the hard data and explained the essence of personalities of the remedies.
• Scholten delved deeply into the periodic table, analyzing the relationship between cations and anions and developing remedy personality profiles based on these elements.
• Dr M.L. Dhawale provided an integrated meaning to the data, incorporating insights from various basic sciences and correlating it with the patient’s life, values, and the model of thought-feeling-conscience-action-result.
• Edward Whitmont contributed deeper psychological prototypes of various remedies based on Jungian psycho-analytical approach.
• Dr Ajit Kulkarni offered ‘integration of Psychological modules with homeopathy’ through his volumes on ‘Harmony and Totality’.

• The concept of the ‘Monogram’ is explored for each remedy in the book, ‘Absolute Homeopathic Materia Medica’, by P. I. Tarkas and Ajit Kulkarni, published by B. Jain Publishers, New Delhi.

(The readers are requested to read Preface of ‘Absolute Materia medica’ to appraise themselves of the contribution of stalwarts towards the evolution of Materia medica).

Dr SAMUEL Hahnemann on symptoms                        

“Now, as in a disease, from which no manifest exciting or maintaining cause (causa occasionalis) has to be removed, we can perceive nothing but the morbid symptoms, it must (regard being had to the possibility of a miasm and attention paid to the accessory circumstances, § 5) be the symptoms alone by which the disease demands and points to the remedy suited to relieve it – and, moreover, the totality of these its symptoms, of this outwardly reflected picture of the internal essence of the disease, that is, of the affection of the vital force, must be the principal, or the sole means, whereby the disease can make known what remedy it requires – the only thing that can determine the choice of the most appropriate remedy – and thus, in a word, the totality of the symptoms must be the principal, indeed the only thing the physician has to take note of in every case of disease”.

                                                                                     – Organon of the Medicine §7

 

Dr Samuel Hahnemann placed great emphasis on the totality of symptoms, recognizing their pivotal role in understanding disease. However, as medicine evolved, the limitations of relying solely on symptoms became evident. Symptoms alone do not always capture the full essence of a disease and certain cases challenge the classical understanding of symptoms as the primary indicators of illness.

3. PROBLEM WITH SOLE RELIANCE ON SYMPTOMS

 

INCOMPLETENESS of symptoms

• Symptoms may be unobservable, hidden or even absent.

1. The asymptomatic phase of a disease

• This is a critical window which is often overlooked in clinical practice. The pathological processes are present but no clear clinical symptoms are manifested. The absence of obvious symptoms does not mean that there is no disease.

The causes

1. Low intensity or early-stage pathology: The body is able to contain the dysfunction, so no overt symptoms occur yet. Pathogen or disease hasn’t reached the symptomatic threshold.

• Examples: Initial stages of Type 2 Diabetes (insulin resistance with normal glucose). Early hepatitis C infection.

2. Effective immune surveillance: The innate immune system handles the problem silently and toll-like receptors (TLRs) and phagocytes work without triggering inflammation.

• Example: Latent tuberculosis; body walls off bacteria in granulomas.

3. Immune tolerance: The immune system doesn’t react aggressively to self-antigens or mild pathogens. The organism enters a state of non-responsiveness (tolerance).

• Examples: Autoimmune diseases in early stages (e.g. Hashimoto’s thyroiditis before symptoms). Cancer cells evading detection due to immune tolerance.

4. Pathogen evasion or latency: Some microbes hide from immune detection (immune evasion). Others enter latency – low replication, no immune provocation.

• Examples: Herpes viruses (e.g. HSV, VZV). HIV clinical latency phase. Epstein–Barr virus (EBV) hiding in B-cells.

5. Compensatory mechanisms of the body: The body masks dysfunction via redundancy or compensation. No symptoms appear until compensation fails.

• Examples: One kidney compensating for the other. Coronary artery narrowing masked by collateral circulation.

6. Medical or artificial suppression: Drugs like steroids, antipyretics, NSAIDs, or immunosuppressants suppress symptoms while disease continues. They can create a false sense of health.

• Examples: Rheumatoid arthritis treated with steroids: inflammation is hidden but joint erosion continues. Fever suppressed with paracetamol during a viral infection.

7. Mind-body disconnect/Psychosomatic compensation: The patient may not be aware of body sensations. Chronic stress, trauma, or repression can disconnect the mind from early signals.

• Examples: People under chronic stress not perceiving fatigue, hunger or early warning signs. Alexithymia: Inability to recognize bodily emotions.

8. Slow progression: Diseases that develop gradually over years or decades often stay asymptomatic for long periods. More observed in degenerative disorders.

• Examples: Hypertension (silent killer). Atherosclerosis. Glaucoma.

9. Subclinical pathology: Laboratory abnormalities are present but no physical symptoms yet. This is common in pre-disease states.

• Examples: Subclinical hypothyroidism (high TSH, no fatigue or weight gain yet). Mild anemia with no apparent fatigue

10. Biological thresholds not yet breached: The pathological activity is below clinical detection level. Symptoms only appear when a quantitative or qualitative tipping point is reached.

• Example: 30% of liver can be damaged without symptoms; the symptoms may arise after 60–70% damage.

b. The deceiving characters of symptoms

·         The assumption that ‘symptoms are the sole representation of the disease’, needs to be re-considered.

In clinical medicine, it is often assumed that symptoms represent the disease in its entirety. However, this is a reductionist view. The presence of symptoms does not always equate to diagnostic clarity and the absence of symptoms does not confirm that one is healthy.

• Symptom or symptoms might represent just a fragment of a larger disease portrait.
• The immune system performs its responsible job to throw off the warning signals in multiple ways. It is possible that a disease’s symptoms are present, but the physician is unable to connect them with a specific clinical condition.
• Disease is a phenomenon. The Law of Existence denotes that nothing is without cause and effect. It is rarely found that the disease is present but outward manifestations are absent. Remember, apparently absolute and silent nothingness is a certain type of existence. Even in absolute nothingness, intelligence exists. Hence, it is the duty of an intelligent physician to perceive the deeper essence of disease and of the sick individual in miniscule availability of symptoms or in asymptomatic phase of the disease.
• Homeopathically, in strong pathologies, it is the syphilitic miasm that suppresses the host’s susceptibility to such a degree that the system is no longer capable of reacting and expressing symptoms outwardly. This lack of symptomatic expression gives a false sense of health and can mislead even experienced clinicians in assessing the true depth and severity of illness. The asymptomatic phase is thus deceptive, often masking the internal morbific state and making accurate evaluation challenging. This miasmatic dynamic results in what may appear to be ‘silent’ or ‘masked’ diseases – states where pathology progresses undetected due to the absence of overt symptoms. The danger lies in assuming wellness based solely on superficial and apparent calmness.

Examples of symptom limitations

• Streptococcal infection without a sore throat
• Myocardial infarction without chest pain (silent heart attack)
• Silent ischemia in diabetes mellitus due to neuropathy
• Diabetes mellitus without polyuria or polydipsia
• Duodenal ulcer without peptic symptoms
• Viral hepatitis without jaundice
• Atypical hyperplasia of the breasts (typically it doesn’t cause symptoms and diagnosis is made on mammogram or biopsy)

1. Symptoms may be atypical

Clinicians hinge on the typical presentation of common illnesses. Yet, what is often left out from medical training is the frequent occurrence of atypical presentation of illness. These are termed ‘atypical’ because they lack the usual signs and symptoms characterising a particular condition or diagnosis.

Sometimes, the affected anatomical part may not reveal the pain or the sensation or the discomfort but may be felt in another area, misleading both the patient and the physician. In some cases, subtle or seemingly unrelated symptoms may indicate serious underlying conditions.

Examples

• Instead of anginal pain, the patient of ischemic heart disease might report indigestion or gastro-intestinal discomfort.
• Instead of pain in the chest, the patient of myocardial infarction may complain of pain in the jaws.
• Instead of epigastric pain, the patient of duodenal ulcer may present with excessive salivation.
• A change in behaviour or functional ability in an old age patient is often the only sign of a new, potentially serious illness.

 

Clinical Implications

• Delayed diagnosis: Atypical presentations can lead to missed or delayed diagnoses, as the physician may focus on symptoms that seem unrelated to the actual disease.
• Misinterpretation: Without considering the possibility of atypical symptoms, a clinician might treat the symptom instead of identifying the underlying disease.
• Importance of comprehensive evaluation: Physicians must remain vigilant and perform a thorough evaluation, considering the full context of the patient’s medical history, behaviour and less obvious symptoms.

1. Symptoms may be non-specific

• Non-specific symptoms usually do not involve a specific organ or an isolated system. They do not indicate a specific disease or abnormality and can be a feature of many clinical conditions.
• Several diseases may represent the same common symptoms; therefore, it becomes a difficult task for a physician to make a proper diagnosis and it may lead a physician astray.
• Despite being non-specific, these symptoms still play an important role in clinical evaluation, as they provide clues to broader physiological or psychological issues.

Examples

• Anorexia, nausea and vomiting remind of possible gastrointestinal and hepatic disease, but they may be the presenting features of chronic renal failure, hypercalcemia, digitalis toxicity etc.
• Fatigue is a feature of many medical conditions which may be acute or chronic, physical or mental, primary or secondary or sometimes even due to nutritional and caloric (iron, vitamins, protein, calcium, carbohydrate) deficiency. If a person is fatigued at the end of a hard day or after exertion, it is normal too.
• Non-specific somatic symptoms act as clue to changes in emotional well-being. These symptoms, which can include general body aches, tension, or discomfort, often signal emotional distress. They can be early clues to changes in mental well-being, such as anxiety or depression.

1. Identical symptoms

Sometimes, completely different or even opposing conditions can present with identical symptoms. This complicates diagnosis and requires careful consideration of the patient’s history, circumstances and broader clinical context.

Examples

• Both hypokalaemia and hyperkalaemia may manifest the same symptomatology, muscle weakness and the same physical signs, loss of tendon reflexes and diminished muscle contraction in response to direct percussion.
• Their correct identification is aided by considering the circumstances in which the symptoms occurred. Thus, vomiting, diarrhoea and diuretics would provide a setting for hypokalaemia while oliguria and anuria, crush injury and shock would provide one for hyperkalaemia.

1. Some symptoms remain unexplained

• There are many cases where symptoms cannot be explained, even after thorough investigation.
• These unexplained symptoms can pose significant challenges and it is important for a physician to remain open-minded and maintain curiosity for future learning.
• The key to differentiation lies in understanding the context in which the symptoms occur.

 

Examples

• Some people have the tendency to explain everything in great detail creating a complex picture that may obscure the real problem. Physicians should be cautious about this and avoid jumping to conclusions based solely on the patient’s subjective experiences.
• It is always good to record an unexplained symptom or an unexplained physical sign as ‘not understood’. This keeps the mind open to further exploration and learning in the future, allowing room for new insights or additional diagnostic approaches.

Navigating challenges

Non-specific symptoms, identical symptoms in opposing conditions and unexplained symptoms remind us of the complexities in clinical practice. A physician must rely on  medical knowledge, clinical judgment and careful observation to navigate these challenges. Keeping an open mind and understanding the context in which symptoms occur is key to arriving at an accurate diagnosis and appropriate treatment.

In short, there is an extreme need for deeper insight beyond symptoms.

 

4. THE KEYNOTE SYSTEM: STRENGTHS AND WEAKNESSES

         

 

1. THE STRENGTH OF KEYNOTE SYSTEM

Dr Samuel Hahnemann’s emphasis on individualization marked a significant shift in the study of homeopathic Materia medica. The distinct difference between common disease symptoms and uncommon individual symptoms was being sought and PQRS symptoms became the influencing essentials. A widespread belief has been disseminated that the study of Materia medica means focusing on keynote symptoms and that successful practice requires memorizing these symptoms by heart.

Even today, the keynote symptom system is widely used because of its simplicity and minimalistic form of applying the Law of Similars. It allows for a quick correlation between patient symptoms and the homeopathic remedy.

Advantages of the keynote system

1. Simplicity

• It provides a straightforward way of selecting remedies, especially when time is limited.

2. Focus on individualization

• Keynote symptoms help highlight the most distinctive features of a patient’s illness, supporting Hahnemann’s principle of individualization.

3. Speed

• By focusing on a few key symptoms, a physician can make quicker decisions about which remedy to prescribe.

4. Memorization aid

• Practitioners can memorize these PQRS symptoms and apply them in many cases, making it a part of clinical practice.

1. WEAKNES OF THE KEYNOTE SYSTEM

Despite its usefulness, the keynote system has limitations, which can affect the accuracy of remedy selection.

1. Oversimplification

• The keynote system is based on the principle of focusing on a few distinctive symptoms, which might cause a physician to overlook the totality of symptoms. Relying solely on keynotes can lead to prescribing errors, as the complexity of the patient’s condition might be ignored.

2. Limited view of the remedy

• Remedies are multi-dimensional and focusing on just a few key symptoms may not capture the holistic picture or the essence of the remedy. Keynotes might ignore mental, emotional or deeper physical states that are equally important in the analysis of the case.

3. Risk of generalization

• Some keynote symptoms may be found in multiple remedies, creating confusion and increasing the possibility of incorrect remedy selection. When a physician uses only the keynote approach, the specificity of remedies can be lost.

4. Lack of comprehensive analysis

• The keynote approach doesn’t take into account the miasmatic background, aetiology or constitutional type of the patient, which can be critical in chronic or complex cases.

5. Over-reliance on memorization

• Memorizing keynote symptoms can lead to mechanical prescribing, where a physician relies more on learned symptoms than on understanding the patient’s full case. This could result in missing deeper, less obvious aspects of the patient’s suffering.

6. Lack of consensus and uniformity

• Different homeopaths and authors have provided their own set of keynote symptoms, leading to a lack of consensus on what constitutes the true keynote of a remedy.
• The authors provide their own interpretation and as a result, keynotes can differ between them. This variation causes confusion among physicians about which symptoms are universally accepted as keynotes.

7. Selectivity and favouritism

Lippe’s keynotes are different from Allen’s and Hutchinson’s red line symptoms are exclusive being not given by Allen or Lippe. Keynote symptoms often reflect the author’s subjective views or preferences. Some symptoms are deemed ‘keynotes’ because they are uncommon or unrelated to the main disease process, yet they stand out in the proving of a remedy. However, this selectivity is frequently based on the personal judgment of the authors without objective or clinical justification.

• Many authors may prioritize symptoms that they feel are most peculiar and there is no standardized method for deciding which symptoms should be considered keynotes.
• As a result, the system often lacks logic and may even seem arbitrary. Physicians may select remedies based on these peculiarities, even when such symptoms are not well-supported by clinical evidence or universal observation.

8. Proliferation of keynote symptoms

The body of keynote symptoms has been growing continuously, with new symptoms being added by different authors over the years. If one were to combine the keynote symptoms from all these sources into a single collection, it would result in a massive Materia Medica of keynotes.

• This overabundance of keynotes makes it increasingly difficult to determine which symptoms are actually useful or clinically relevant or even keynotes.
• The expansion of keynotes has led to over-reliance on memorization rather than a deeper understanding of remedies. Instead of focusing on the whole picture of a remedy, physicians might become too focused on memorizing an ever-growing list of isolated keynote symptoms. (Dr William Gutman’s book “Homeopathy – The Fundamentals”, shed light on interconnections between the symptoms and how the ‘whole portrait’ can be perceived well).

9. Not always available

One of the major limitations of the keynote system is that it is not always possible to find keynote symptoms in every case or at all times.

• Acute or chronic conditions: In some cases, especially acute conditions, keynote symptoms might not be prominent or obvious.
• Complex cases: Patients with complex diseases or those in chronic states often present with a multitude of symptoms that are not easily condensed into a few keynotes. In such cases, relying solely on keynotes may overlook the totality of symptoms, which is critical to finding the correct remedy.
• Asymptomatic cases: In some conditions, like early-stage diseases or latent conditions, there may be a lack of observable or peculiar symptoms altogether. These cases demand a more refined approach beyond just keynotes.

• A holistic paradigm for the interpretation of symptom deficiency: The issue of the non-availability of PQRS symptoms necessitates a deliberate and structured response from the homeopathic profession. To this end, it is essential to develop a standardized clinical and philosophical framework that prioritizes the organismic wholeness of the individual. This approach must integrate the conception of the human being as a dynamic bio-logical and bio-social entity, defined by a unique Archetype and Gestalt, thereby broadening the homeopathic inquiry with the complex realities of human health and disease expression.

5. FROM KEY NOTES TO KEY THEME
6. KEY CHARACTERS
7. Keynotes versus Totality of symptoms

While the keynote system remains popular, homeopathy fundamentally revolves around the totality of symptoms. The totality represents the complete picture of the patient’s state-including mental, emotional and physical aspects, with the unique biological system he possesses, rather than just a few standout symptoms. The keynotes must never be mistaken for the whole.

A single keynote is like a bright star – useful for navigation, but meaningless without the constellation it belongs to. The real task of the homeopath is to perceive and synthesize the totality of symptoms – the patient’s generalities, modalities, mental state, physical particulars, tendencies, pathologies and miasmatic background and evolving patterns – into a coherent image of dynamic disease.

 

 

 

2. Keynote symptoms in the domain of health and disease

• The PQRS symptoms may be within the domain of health and may not fall within the domain of a disease. ‘What is to be cured in a patient’ remains a pertinent question.
• These symptoms are considered distinctive simply because they deviate from typical disease symptoms. ‘What is to be cured in a patient’ remains a pertinent question, then. Defining and treating the true sickness of an individual is the very basis of homeopathy.
• Homeopathic provings often generate a large number of symptoms, should all of these be classified as keynotes if they fall outside the orbit of disease symptoms?
• The tendency to focus on such peculiarities can sometimes lead to remedies being prescribed based on rare and unrelated symptoms, which might not be central to the patient’s overall disease picture.

3. Keynote symptoms, pathology and personality

 

 

 

• In many cases, the keynote symptoms, the pathology or the very process of the disease or the type of personality doesn’t get covered by the remedy. Even though the keynote symptoms are regarded as the heart or the soul of the remedy, the selection of a remedy amounts to one-sided coverage of the data and then the follow-up becomes a non-disciplined affair.
• When the initially chosen keynote symptoms prove ineffective, they become redundant soon and at each next follow-up, a physician is compelled to select another set of keynote symptoms. In short, the true totality of the case is brushed aside, not comprehended well and it becomes a repetitive practice of chasing a superficial pursuit of symptom matching under the method of “ Keynote system of prescribing”.
• Pathology cannot be dissociated from the mind. Emotions enter in the vulnerable tissues. They change the function, the structure and the form is created. Every deviant alteration within the biological system reflects the state of the whole organism. The mind, body and physiological systems communicate in a unified language, each mirroring the other. What appears as localized pathology is, in essence, an expression of deflected vital energy manifesting in specific tissues. Consequently, the multitude of diagnostic labels merely categorizes expressions of a deeper diseased state. As clinicians, we must transcend these superficial labels and seek to perceive the underlying sickness in its entirety – only then can we initiate curative treatment based on truth.

4. Challenges with keynote symptoms

                                   

• During Hahnemann’s time and later on too, the faculties like physiology, anatomy, pathology, histopathology, laboratory medicine, radiology, etc. were not developed. In the light of the knowledge gained in these faculties, the homeopaths are now in a better position to differentiate between common and uncommon symptoms and perceive deeper meaning behind the symptoms.
• In many cases, the keynote symptoms, the pathology or the very process of the disease or the type of personality doesn’t get covered by the remedy. Even though the keynote symptoms are regarded as the heart or the soul of the remedy, the selection of a remedy amounts to one-sided coverage of the data and then the follow-up becomes a non-disciplined affair.
• Today’s keynote symptoms, if not helpful, become redundant soon and on next follow-up, a physician is compelled to select another set of keynote symptoms. In short, the totality is brushed aside, not comprehended well and it becomes a repetitive practice of chasing the keynote symptoms.
• The study of personality type and the advancement in clinical psychology are not taken into account in the selection of keynote symptoms and it deprives the physician of right selection of a remedy and overall management. This is essential given the complexity of modern life, the stressors operating in patient’s life and clear correlation between psyche and soma. When the problem definition becomes so complex, it is no wonder that it also demands solution of complex character and goes beyond just matching the symptoms.

5. The field of concomitant symptoms

Concomitant symptoms refer to symptoms that appear alongside the chief complaint but may not seem directly related according to classical nosology. In early homeopathy, when physiology and pathology were underdeveloped, these associated symptoms were simply recorded as ‘peculiar’ or ‘unconnected’. Hahnemann and his followers emphasized them because they often helped individualize the case and select the similimum when diagnostic understanding was limited. Further, concomitant symptoms can be ‘general’ and ‘particular’ and they have ‘preceding’, ‘during’ and ‘following’ manifestations in the disease expression.

However, with modern advances in physiology and pathology, many ‘concomitant symptoms’ can now be understood as logical extensions or manifestations of the underlying disease process – or of the patient’s general reactive mode. This calls for a review and refinement of how we view concomitants: they should be seen not merely as random side phenomena, but as meaningful clues about the person’s individual response to disease, grounded in psycho-neuro-immunological, endocrinological and systemic pathways.

Physio-pathological correlation

Example 1: Nausea with headache

• Nausea is regarded as an unconnected and peculiar concomitant symptom in homeopathy. Patho-physiologically, many headaches (e.g. migraine) activate the brainstem vomiting center due to trigemino-vascular irritation → nausea and vomiting. So nausea is a direct neurogenic consequence, not a random accompanying feature.
• Nausea assumes a PQRS symptom when it is characterized by modalities and other factors that qualifies nausea.

Example 2: Chilliness with diarrhoea

• Why chilliness with diarrhoea, it is characteristic – a homeopath’s view.
• Patho-physiologically, acute gastroenteritis activates immune response → cytokine release → affects hypothalamic thermoregulation → chilliness.

Example 3: Toothache better by cold drinks

• Why should cold ameliorate toothache? It is ‘strange’ in homeopathic way.
• Patho-physiologically, dental pulpitis → inflamed pulp with increased intrapulpal pressure → cold application causes vasoconstriction → reduces pressure → relieves pain.

To summarise:

Concomitants are not inherently ‘unrelated’; they often reflect the dynamic interplay of systems – neuro-endocrine-immune links, organ cross-talk or compensatory phenomena.

In homeopathy, the peculiarity still matters: the timing, sequence, localization, alternation, and modalities of < and > transform these ‘logical’ symptoms into highly individualizing features.

Therefore, the field of ‘concomitant symptoms’ needs to be re-examined in light of modern physiology and psycho-somatic and neuro-immunological links.

Although the keynote system is widely used, there are significant issues and limitations associated with its approach.

6. So many questions crop up:

1. Is the keynote system a comprehensive and self-sufficient method for prescribing homeopathic remedies?
2. Does the keynote system rely on guesswork, making it a ‘hit-and-miss’ approach?
3. Can this system effectively address complex, variable conditions?
4. Are there limitations (lacunae) in the keynote system, and if so, can we develop an improved approach?

1. Given the possible lacunae within the keynote-based prescribing method, is there scope for a more evolved and systematized approach to case understanding and remedy selection?

6. Is the keynote system popular due to its perceived convenience and shortcuts in clinical practice?
7. Does the key note system truly represent the holistic approach of homeopathy in principles and practice?
8. KEY NOTES vs. key themes

 

Behind the disease, there is a person and his consistent unique characters which define the very individuality of him. In spite of the changes that occur in life or in disease, these characters remain unchanged. Hence, they define the uniqueness of an individual and they must be a part of totality.

In keynote symptoms, the main theme is to

• focus on prominent symptoms ( PQRS type)
• emphasis on specific, isolated symptoms

In key themes, the focus is on

• exploring the personality type, characters, dispositions, traits, values and coping mechanisms, in health and disease, in favourable and non-favourable circumstances, compensated and decompensated stages
• identifying consistent patterns in thinking (delusions), feeling (sensations) and acting (behaviour) which is inseparable from the system
• uncovering the essence of the individual, gleaned from case data
• highlighting pivotal aspects defining the case

 

Dr P. I. Tarkas: “Every remedy has multiple hearts and multiple nuclei”.

 

By shifting from ‘key notes’ to ‘key themes,’ it is possible to adopt a more holistic approach, recognizing the intricate web of factors that shape an individual’s unique identity.

 

Examples

Case 1

Let’s take the case of a boy. He was sensitive, delicate, born premature, would fall sick often and couldn’t bear any criticism. He used to become nervous and tears would soon start streaming from his eyes. He was susceptible to cold air and unusual stimuli.

Analysis of the boy’s data reveals a key theme of ‘fragility,’ characterized by:

• Physical vulnerability (frequent illnesses, premature birth)
• Emotional sensitivity (tearfulness, nervousness)
• Environmental sensitivity (cold air, unusual stimuli)
• Physical, emotional and environmental sensitivities converge to define the boy’s unique character of fragility.

Case 2

Let’s take another example. A case of a boy aged 15 years had recurrent tonsillitis, rhinitis and dermatitis. They were ever-present one after another and parents were exhausted as the boy was constantly ill and had to be given anti-inflammatory drugs, antibiotics and steroids. The boy was rebellious, didn’t want to follow the norms and would quarrel with everyone and if his wishes were not fulfilled, used to view others  as enemies. He was addicted to war games often skipping school.

Analysis

The key theme emerging from this case is ‘being at war’, reflected in both physical and mental realms. He was fighting at body level through inflammation and there was enough evidence that the mind had the set-up of war. One can’t think of any remedy without the concept of war in this case. There is a rubric which epitomizes his key theme “mind; fight, wants to” and important remedies are androc., aster., aur., carc., caust., hyos., lac-eq., lac-f., lac-leo., lach., lyss., med., merc., nux-v., scorp., tub., uran.

Given its central significance and high gradation, this rubric can function as a key eliminative criterion in remedy selection.

To put it concisely

• The extroverted or introverted types point towards the key themes that these personalities represent through their basic dispositions. The study of a patient through temperament focusses on the basic traits.
• Let it be clear that themes do not stand alone for themselves in prescribing. One theme (no matter how major) does not hold a case alone. It must be a part of the totality, along with the general symptoms – physical, mental and pathological as well as physical particulars.

 

6. Unlocking THE MAGNIFICENCE OF DATA: THE MONOGRAM APPROACH

• The data in the Materia medica is multifaceted.
• Each homeopathic remedy encompasses a kaleidoscopic spectrum of symptoms, each representing a unique fragment of the whole. In every patient, a distinct combination of symptoms forms a unique totality. Yet, since these symptoms arise from the same fundamental essence, they reflect the same remedy at its core. By understanding the central and generalized patterns of these fundamental elements, we can discern the key theme of the remedy, which unifies its diverse expressions.

Challenges

• How to shape the fragmented data in a concrete and cohesive whole?
• How to connect a network of paths and hedges out of the puzzle through which a homeopath has to find a way?
• How to make a meaningful portrait out of the maze of symptoms?
• Which symptoms fall in the category of connections and which symptoms fall in their quality of being redundant?

DEFINITION OF monogram IN HOMEOPATHY

The term Monogram is used in two contexts:

1. Design and patterns: It constitutes pattern, image, decoration, shape, ornamentation and logo.
2. Thematic concept: It is related to underlying idea, concept, topic or subject.

In homeopathy, both the contexts are being used with the concept of monogram.

In art and design, a monogram represents

• A symbolic pattern or image
• A decorative motif or ornamentation
• A unique logo or emblem

In literature and philosophy, a monogram signifies

• An underlying idea or concept
• A central theme or topic
• A unifying subject or essence

The monogram concept in homeopathy harmoniously blends both meanings.

• A unique, symbolic pattern of symptoms and characteristics (design context)
• An underlying, unifying theme or essence that defines a remedy’s identity (thematic context)
• Each Monogram is crafted from primary data, clinical insight and comparative Materia medica, providing a gestalt rather than a sum of symptoms.

 

MONOGRAM: A SYNTHESIS

                       

• Synthesizes complex data into a cohesive, meaningful pattern
• Reveals the underlying theme or essence of a remedy
• Provides a holistic understanding of the remedy’s characteristics
• Guides precise prescription and treatment

By embracing both design and thematic contexts, the homeopathic monogram offers a powerful tool for:

• Analyzing and integrating complex symptom patterns
• Uncovering the underlying essence of remedies
• Enhancing clinical accuracy and effectiveness

Integration and Gestalt

• The concept of monogram is developed out of the need for integration.
• Monogram integrates disparate data components.
• Without integration, the data will be just the quantity of components.
• Integration renders gestalt meaning and quality to the data.
• Integration defines the nature of components and opens up many new frontiers, new directions and new meanings hidden hitherto.
• Monogram represents the abstract yet concrete essence which gives a Gestalt feel and experience of the whole personality of the remedy from psychology to pathology.

     Benefits of Monogram approach

• Transforms data quantity into quality
• Defines component interactions and dynamics
• Uncovers new insights, directions and meanings
• Elevates interviews from data collection to profound understanding

     Monogram-inspired interviews

• Move beyond keynote symptoms
• Explore the interconnections between symptoms and system
• Uncover underlying themes and patterns
• Integrate mind and pathology
• Understand the speed with which the pathologies are developing
• Illuminate the remedy’s essence

     Through the Monogram lens, a homeopath can

• Distil complexity into clarity
• Reveal hidden connections and meanings (latent psora, dyscresia, diathesis, morbid constitution, miasm, etc.)
• Craft precise, personalized prescriptions
• Honour the indivisible human being with his unique biological system

 

 

 

 

 

 

 

THE MONOGRAM: THE GENETIC ENCODING

                                   

 

The monogram is the center from which one enters into the periphery and through the components of the periphery, one can create the monogram.

Monogram is like the genetic encoding of a remedy where the information of characters of a remedy is programmed. It is like nucleus/essence/core/kernel/central idea which encompasses remedy’s fundamental nature and disturbances at mental, emotional and physical levels.

The study of a remedy through monogram is a more specific way to describe the general manner in which the symptoms express themselves. This is the mode where the procedure itself takes place. It bestows an impression and conveys what a drug fundamentally is, in a very precise and concise way! The monogram becomes a distinct representation of the system’s language!

In essence, the monogram serves as the remedy’s DNA, encoding its unique characteristics and disturbances, offering a profound understanding of its core identity.

In selecting words for inclusion in the monogram box, one must exercise discernment. This is not merely a matter of linguistic flair; the chosen term must carry academic precision and resonate authentically with the patient’s experience or the essence of the remedy. Each word must capture a deep dynamic that can relate either to a patient’s core pattern or to the essence of a remedy. The word must be academically sound, contextually relevant and psychologically or pathologically meaningful. Choosing the most precise and expressive word is essential in monogram construction.

The author wishes to illustrate with examples.

 

7. UNIFYING LOGIC: GENERALIZATION AND THE MONOGRAM

Generalization is a logical process. It is the process of identifying symptoms of the totality, which belong to the whole. It is the basis of all valid deductive inferences. The symptoms, completely unrelated may be brought together as a group by establishing a common relation between them.

The study of monogram conforms to the concept of pathological general (Boger), but here it is being furthered with

• Mode of action
• Pattern
• Behaviour
• Pace
• Miasmatic activity

Thus, the concept of Monogram helps to see mental, emotional and pathological layers in integration and how mind and pathology run parallel in a case. In other words, psycho-clinico-patho-miasmatic co-relations can be constructed and perceived well with the concept of monogram.

Monogram words are not merely pedantic. They are like building blocks. They incorporate behavioural patterns, identifiable characteristics, habits, traits and trends and prominent dispositions of the person that are exhibited in a wide range of important psychological, clinical, pathological and miasmatic contexts. The study of monogram is a way to conceptualize and assess both stability and variability in behavioural patterns.

Each monogram word has its position, pace, energy, magnitude, intensity, direction and journey and that makes the management much more fruitful.

An individual can be analysed using monogram to come up with the key indicators of how he/she tends to behave according to certain tendencies. While the keynote/key theme involves personal interpretation of the factors, this can be influenced by the subjectivity of the physician; monogram projects the hard facts in an objective manner.

Components of Monogram

Essence of the system following the concept of generalization (the core idea or unifying theme that encapsulates the totality of the remedy or the patient’s presentation and reflects the deep energetic identity. The purpose is to derive a governing essence that can connect multiple facets – mental, emotional and physical – into one cohesive understanding).

Essential threads that run through and through (recurrent features or motifs (mental, emotional or physical) that appear in varied forms across the patient’s history or the remedy picture. The purpose is to trace the core theme manifesting in diverse ways.

• Traits and dyscretic states that identify the essence
• Characters evolved after the deductive inference
• Patterns (behavioural, tendencies, often repeated phenomena)
• Pathological generals
• Miasmatic state

Points worth noting

• Energetic signature (dynamic expression of the vital force, including tone, pace, rhythm and direction of symptoms e.g. rapid and progressive: Phos,, Tub. or, gradually deepening pathologies: Agar., Caust., Plb.).
• Language and expressions (Key phrases, idioms or metaphorical language used by the patient that resonate with themes of the patient or the remedy (e.g. “I feel constricted, Lach.).
• Polarities or contradictions (internal conflicts or paradoxes that define the dynamic struggle within the remedy type (e.g. biphasal: Carc, Med., Nat-m., contradictory: Ign., Tub., Valer.).

8. USE OF PRECISE LANGUAGE IN MONOGRAM CONSTRUCTION

There must be linguistic precision is essential in Monogram construction. The selection of descriptors must be deliberate and academically precise. Such clarity enhances thematic coherence and ensures that each word accurately reflects both the state and energetic essence of the remedy or the patient.

8.1 FAGGED vs. WEARY vs. WORN-OUT

 

                                       Fagged                                Weary                           Worn-out       

 

All describe exhaustion, but they have slight differences in usage and intensity.

1. Fagged

Meaning: Extremely tired, exhausted after hard work or effort.

Example: After working all day in the sun, I was completely fagged.

2. Weary

Meaning: Tired, especially due to long effort, boredom, or mental fatigue. Can be both physical and emotional exhaustion.

Example: She was weary of the same routine every day.

3. Worn-out

Meaning: Completely exhausted, physically or mentally drained.

Usage: Stronger than “weary,” often means someone is at their limit.

Example: After back-to-back shifts, he was totally worn-out.

Key differences

1. Medical context
2. Fagged (Physical fatigue after work or effort)

• An intensivist was completely fagged after a 12-hour shift in the emergency room.
• After assisting in back-to-back surgeries, the junior doctor looked fagged and drained.

2. Weary (Chronic fatigue, mental & emotional exhaustion)

• The cancer patient felt weary after multiple rounds of chemotherapy and long hospital stays.
• The doctor grew weary of seeing so many patients neglect their health despite repeated warnings.

3. Worn-out (Severe exhaustion, physically & mentally drained)

• The ICU staff were completely worn-out after handling critical COVID-19 cases for weeks without a break.
• After months of battling a chronic illness, the elderly patient felt worn-out both physically and emotionally.

1. Homeopathic context
2. Fagged

• A doctor working long hours in a clinic feels completely fagged but recovers after rest.

• Remedy: Arnica mont. (overexertion and physical strain)

• A student of ‘Remedy School’ preparing for medical exams is mentally fagged and unable to concentrate.

• Remedy: Kali Phos. (brain fatigue and nervous exhaustion)

2. Weary

• A homeopath treating chronic disease cases for years becomes weary of seeing no progress in some patients.

• Remedy: Phos-acid. (emotional exhaustion and indifference)

• A patient with chronic arthritis feels weary, as the constant pain makes daily activities difficult.

• Remedy: Rhus tox. (fatigue with joint stiffness)

3. Worn-out

• A homeopath looking after a terminally ill patient for years is completely worn-out, both physically and emotionally.

• Remedy: Phosphoric Acid. (exhaustion after long emotional strain)

• A homeopathy student, after years of intense study and clinical training, feels totally worn-out and unable to continue.

• Remedy: Picric Acid. (mental burnout and nervous fatigue)

To summarise:

WORN-OUT is generally the most precise and appropriate term for monogram use, because:

• It indicates total depletion, a vital theme in remedy patterning.
• It bridges mental, emotional and physical levels.
• It connects clearly with chronicity, suppression and miasmatic weakness.
• It evokes remedies across collapse, burnout and drained vitality states.

8.2. HARD vs. INDURATED vs. HARDENING

                       

                          Hard                                   Indurated                                       Hardening

1. Hard

• The term ‘Hard’ relates to general firmness. It can be related to emotional, physical or moral domains. A person can be emotionally hard or rigid. Hence often a character is mentioned, “ This person is a hard nut to crack.”
• Although the term is too generic, it can be incorporated in the monogram if it is available at both mental and physical level.
• Example: Calcarea fluoricum

2. Indurated

• The term ‘Indurated’ denotes pathological hardening of tissues and hence it is best when one defines the pathology only.
• Example: Baryta-carb. (Note that Bar-carb. is not hard at mental level; rather soft and vulnerable.)

3. Hardening

• The term ‘Hardening’ can be used when one is describing the dynamic progression and usually it is gradual. Here one is actually defining the miasmatic activity.
• Example: The cancer of the mammae is becoming stony hard in a gradual way. So one defines that the process is going on. Conium is the best example.

           Cross reference: Concreting: Condensing, hardening or solidifying of tissues.

To summarise:

For the Monogram, the term ‘HARD’ is most versatile and meaningful. It represents a trait, a response pattern, a tissue state or a vital quality.

8.3 DEGENERATIVE  vs. DEGENERATING vs. DEGENERANT

 

  

     Degenerative                           Degenerating                                      Degenerant

 

1. Degenerative

• The term ‘degenerative’ is an adjective describing a state that is already damaged or worn out. It implies a static condition, a breakdown that has already occurred in structure or function. The term can be applied to mental, emotional and physical contexts; in other words, at cell, tissue, organ, personality or moral levels.

2. Degenerating

• The term ‘degenerating’ refers to a dynamic, ongoing process, a condition in which the disintegration is actively occurring. It is used when pathology or personality is in transition from order to chaos, from health to decay.

3. Degenerant

• The term ‘degenerant’ is a noun. It refers to a person or a symbolic agent who represents moral, psychic or physical decline. Degenerant is used in monogram when one is describing an individual who has the very expression of degeneration, whether in behaviour, thoughts, desires, life patterns or pathologies.

To summarise:

The appropriate word to use in Monogram is ‘DEGENERATING’ as it defines the ongoing process of degeneration.

8.4. VIOLENT vs. VIGOROUS vs. INTENSE

 

 

                        Violent                                           Vigorous                                    Intense

 

1. Violent

• The term describes explosive, disruptive and uncontrolled force, esp. in pathology, behaviour or internal deviant disease process. It implies a sudden, forceful, often destructive or explosive discharge of energy – whether emotional, mental or physical.
• It suggests loss of control and frequently involves injury or aggression. It has clear individual-remedy-specific relevance both mentally (rage, destructive impulses, etc.) and physically (hemorrhage, convulsions, etc.). Violence is usually pathological and its use in the monogram is justified when the expression is extreme.
• It can be used in Monogram under Traits, Patterns, Pathological generals or Miasmatic state. Being violent implies tubercular and syphilitic miasm and it can be expressed as acute flare of destructive energy or as chronic progression of the disease.

2. Vigorous

• Vigorous indicates strong, energetic, robust activity. It is usually positive or neutral in connotation and reflects high vitality rather than pathological disturbance. While it denotes strength and determination, it does not indicate excess, destruction or dyscrasia.
• It may describe the personality or effort, but not a disease trait. Therefore, this word is not suitable for the Monogram.

3. Intense

• Intense means highly concentrated, deep or extreme in degree. It can relate to emotions, mental focus, physical sensations or perceptions. Unlike ‘violent,’ intensity does not imply loss of control but rather an amplified internal experience.
• It is well-suited to the Monogram because a) it describes the core pressure and density of internal processes, whether psychic or somatic. b) captures inner energetic pressure or concentration of response c) applicable to a broad spectrum: desire, pain, anxiety, effort, perception d) It can be used under essence, traits, patterns and dyscretic states.
• Example: Fever is expressed as ‘intense’ and not as ‘violent’ or ‘vigorous’.

To summarise:

The word ‘VIOLENT’ should be used for explosive, destructive expressions. The word ‘INTENSE’ should be used for internal, focused or deeply amplified states, emotional or physical. The word ‘VIGOROUS’ should be avoided for Monogram as it’s energetic and not pathological.

8.5 DYSPEPTIC vs. FLATULENT vs. GASSY

                       

                                     

                                                Dyspeptic                              Flatulent

1. Dyspeptic

• It refers to a disturbed digestion, broadly covering a syndrome of symptoms like bloating, nausea, belching, heartburn, discomfort after eating and early satiety. It involves function and psycho-gastrointestinal response. The term is more related to upper GIT.
• The term is appropriate for Monogram when one wants to generalize multiple gastric symptoms under one concept. It includes emotional correlates such as irritability, gloom or low tolerance.

2. Flatulent

• The term pertains specifically to gas formation in the digestive tract, often with distension, belching or flatus. It is more localised, descriptive of intestinal fermentation or sluggishness. It is more related to lower GIT.

 

3. Gassy

• This is a colloquial, non-medical term for being filled with or prone to gas.
  It lacks clinical depth, too generic and layman-style.

To summarise:

Use DYSPEPTIC to describe an individual’s general digestive sluggishness, poor response to food and even mental-emotional correlates.

Use FLATULENT when you want to isolate gas formation and discomfort as a repeated physical feature.

Better not to use GASSY for Monogram. It is not an academic word.

8.6 ACIDIC vs. CHOLERIC  vs. BILIOUS

 

     

                                       Acidic                                                Choleric                                Bilious

                       

1. Acidic

• The word acidus means ‘sour‘.
• Chemically it is used when pH is below 7 and there is increased hydrogen ion concentration.
• When a person is sharp, sour in temperament, sarcastic and bitter, he is called ‘acidic in character. Useful in themes like ‘corroding criticism’, ‘disintegration’, or ‘burnt out personality.’
• Clinically,  the term is used when there is increased acidity in stomach (hyperacidity), urine (aciduria), blood (acidosis). It can indicate inflammatory, catabolic or degenerative processes. There is ‘acidification’ in Diabetes mellitus.
• The term can be used both as a pathological trait and mental disposition (sarcasm, bitterness, corrosion).

2. Choleric

• Temperamental trait from ancient humoral theory (yellow bile dominance).
• Quick-tempered, irritable, aggressive, impatient, often dominant.
• Clinical/Pathological use: Rarely used today in scientific medicine.  The term is associated with high metabolic rate, tension, stress-related disorder
• Homeopathically, it can be used as ‘Temperament: Choleric type’.

3. Bilious

• Related to bile or liver/gallbladder dysfunction.
• In personality: Irritable, gloomy, melancholic (again from humoral theory).
• Clinical/pathological use: Conditions: indigestion, nausea, coated tongue, gallstone issues, hepatobiliary dysfunction. Often used when describing ‘bilious vomiting,’ ‘bilious headache’, etc.
• Homeopathically, bilious can be used for digestive disorders with hepatic connection.

To summarise:

The better word for Monogram  is ACIDIC because  it has multi-layered expression: physical (acid discharges), mental (sharpness, sarcasm) and pathological (acidosis). It blends well with the Monogram’s goal: integrating essence, pattern, traits and pathology.

 

8.7 OLD vs. AGED vs. SENILE

 

 

Old                                                         Aged                                              Senile

 

1. Old

• The term can refer to people, objects, systems or customs. It denotes having lived or existed for a long time. It is used broadly to describe things, people, animals or ideas from the past. May imply respect (e.g. ‘wise old man’) or decay (‘old and worn’).
• The term is suitable for general themes and good for neutral or descriptive purposes such as old age, old habits, old pathology, old trauma, old suppression, etc.
• ‘Old’ word doesn’t well fit in the monogram box.

2. Aged:

• The term describes someone advanced in years, often emphasizing the condition or state of aging. It can be an adjective (aged parent) or used to denote specific age (a man aged 85). Slightly formal, clinical or descriptive Often used in medical, legal or sociological contexts (e.g. ‘aged care,’ ‘the aged’).
• Aged word can be used in Monogram when a precise or medico-psychological emphasis is needed such as physical degeneration, loss of vitality or functional decline.

3. Senile:

• The term refers to the mental and physical decline associated with old age, esp. cognitive impairment (e.g. dementia). Senile has a strong pathological and clinical implication and it is often a negative

To summarise

• ‘SENILE’ is the right term to use in Monogram as it covers the pathological general concept of Boger in a better way.

8.8 FIDGETY vs. RESTLESS vs. ANTI-REST

 

 

Fidgety                                           Restless                                               Anti-rest

 

1. Fidgety

• A fidgety individual makes small, restless movements, often repeatedly and involuntarily and there is an inability to stay still. The term describes motoric unrest and is related to behavioural response.
• Examples: Tapping fingers, shifting in seat, swinging legs, biting nails, ADHD-like behaviour are some of the examples. Psychological causes are nervous tension, boredom, anxiety or hyperactivity. Common use example is “The child grew fidgety during the long lecture.”

Clinical and homeopathic terms

• The term Fidgety suggests a surface-level kinetic unrest, a motor expression of deeper mental or emotional states. It can be obsessive, anxious or overstimulated behaviour.

2. Restless

• Unable to rest, relax or remain still due to anxiety, agitation or an inner compulsion. Behavioural response is frequently changing posture, pacing, sleeplessness, a sense of mental or physical dis-ease that prevents inner stillness. There is an inner agitation – physical, emotional or existential.
• Psychological causes include Fear (e.g. fear of death), dissatisfaction or longing, pain (where movement brings relief) or suppressed emotions or worries.
• Example: Common use example is “She was too restless to sleep, her mind racing with thoughts.”
• In homeopathic language, Restlessness can be mental, emotional or physical and is a broad, core expression of disequilibrium. It reflects dynamic disturbance.

3. Anti-rest

• Literally means ‘against rest.’ Anti-rest implies someone who resists rest or relaxation, possibly by principle, will or habit. The term lacks emotional depth.
• Common use example is “His anti-rest attitude led him to work nonstop.”
• This word lacks clarity. It doesn’t reflect a natural psychological state, nor is it behaviourally descriptive. It might suggest a wilful avoidance of rest rather than an involuntary inability (as in restlessness). It is not a standard word in English usage.

To summarise

• RESTLESS is an appropriate word to use in Monogram.

8.9 DEBILITATED vs. PROSTRATED vs. ENERVATED vs. COLLAPSY

 

   

Debilitated              Prostrated                                   Enervated

 

 

                                        Collapsy

 

 

These four words express a state of extreme physical or mental weakness, but they carry different applications.

1. Debilitated

• Weakened or reduced in strength, energy, or function. It may be due to chronic illness, aging, emotional exhaustion, or nutritional deficiency.
• Examples: Physical: ‘Debilitated after chronic diarrhoea.’ Mental: ‘Debilitated by years of stress and grief.’
• A debilitated person may still be capable of basic activity though there is generalized weakness affecting function and it may be gradual or chronic in nature.
• The term is suitable for Monogram as it expresses a state that can be a trait (constitutional) or consequence (pathological). It’s a general state without complete collapse.

2. Prostrated

• Lying flat or completely exhausted to the point of collapse, powerlessness or submission. It’s a stronger term than ‘debilitated.’
• Examples: ‘Prostrated with high fever’. ‘Prostrated after sudden grief.’ ‘Prostrated by violent emotions’.
• The term is often used in acute, intense conditions where the person is utterly powerless, physically lying down, unable to speak or react.
• The term is suitable for Monogram and more useful in acute expressions or as a pathological general. It shows collapse and exhaustion, possibly after suppression.

3. Enervated

• Drained of vitality or energy; lacking vigour. Originally meant “weakened from within.” The term has an connotation of an internal depletion.
• Examples: ‘Enervated from long-standing intellectual work’. ‘Enervated from long-standing fear’. ‘Enervated by repeated emotional trauma’.
• It can be mental, physical or both. Often implies the nervous system is overworked or burnt out. It’s a word of sophistication, not commonly used in clinical conversations.
• The enervated term is suitable for Monogram in neurotic, over-sensitive or burnt-out states.

4. Collapsy

• We have used this word in the monogram of many remedies viz. Amm-c., carbo-v, Veratrum., etc.
• Collapsy should be used when there is a clear sense of inner breakdown – physical, emotional or vital. If the patient says that he feels tired and a physician enters the use ‘collapsy’ in the monogram, it is incorrect. The word should emerge from a state of energetic disintegration, not mere fatigue.

To summarise:

All four can be used depending on the context. ’DEBILITATED’ is the most flexible and widely usable term for both trait and consequence. ‘PROSTRATED’ is good for collapse states, typically pathological. ‘ENERVATED’ is more psychosomatic, suitable for sensitive, neurotic individuals. COLLAPSY indicates inner state of breakdown.

 

 

 

 

 

8.10 RIGID vs. TENSE vs. STIFF

 

            

                   Rigid                                              Tense                                                            Stiff

1. Rigid

• The term refers to something that is completely inflexible, hard and resistant to change or movement. It implies a fixed structure, whether in the body or the mind.
• In psychological terms, a rigid person is unbending, unadaptable and mentally ossified.
• In physical terms, rigidity can be pathological, such as in neurological disorders (like Parkinsonism), where the body resists passive movement. This state is static and implies a deep, structural fixity – both mental and physical.

2. Tense

• The term suggests tightness under strain. It is not as fixed as rigid; rather, it implies a dynamic pressure – something being pulled or stretched, ready to snap.
• Emotionally, a tense person is under stress, anxious or fearful and internally wound up. The tightness can be felt in muscles, but it also applies to atmospheres and relationships (“a tense situation”).
• Tension suggests anticipation and alertness, often related to external threats or internal conflict.

3. Stiff

• The term describes a condition where movement is limited, but not necessarily due to active strain or rigidity. It often implies a mechanical, awkward or rather cold quality – physically or emotionally. A stiff joint may follow trauma, overuse or cold exposure.
• Emotionally, a stiff person might appear formal, inhibited or socially awkward.
• There is a protective quality as well – stiffness may reflect the body or psyche’s attempt to avoid further injury or embarrassment.
• The key difference from ‘rigid’ is that stiffness is not always structural and from ‘tense’ that it is more passive than active.

To summarise:

The three words define the quality of constriction – whether it is dynamic (tense), static (rigid) or defensive/post-traumatic (stiff). All three terms – RIGID, TENSE and STIFF – are suitable for use in Monogram system.

 

 

 

 

 

 

 

 

 

8.11 SLOWED-DOWN vs. DECLINING vs. BROKEN-DOWN vs. RUN-DOWN

 

 

    Slowed-down                     Declining                                                    Broken-down

 

 

            Run-down

 

1. Slowed-down

• The term is used when there is reduction in speed, function or efficiency. It suggests gradual retardation without necessarily implying deterioration.
• Clinico-pathologically, it is seen in aging, chronic fatigue, hypothyroidism or bradykinesia in Parkinson’s disease; also applies to sluggish metabolism, slowed reflexes, or reduced circulation.
• Energetically, indicative of energy conservation, not necessarily pathology at first.
• The term fits well for Monogram as it denotes theme of inertia, dormancy or exhaustion and it describes constitutional sluggishness or a declining functional state without destruction.

2. Declining

• The term is indicative of progressive loss or deterioration in strength, value or health.
• Here, the state involves a downward trajectory, may still be slow but decisively regressive.
• Clinico-pathologically, declining state is seen in progressive degenerative diseases such as Alzheimer’s, MS, cancer cachexia, etc. General wasting or weakening – physiologic systems no longer holding up.
• The term is ideal when the downward change in health leading to loss of vitality is an obvious reality.

3. Broken-down

• The term suggests sudden or complete collapse in function – mental, emotional or physical and advanced deterioration.
• Clinico-pathologically, it is seen in nervous breakdowns, burnouts, organ failure, trauma aftermath. Clinical markers include collapse states, shock, irreparable tissue damage.
• Monogrammatically, best used in extreme, late-stage themes – decompensation, ruin, disintegration. The term should be reserved for end-stage states or when breakdown is central.

 

 

4. Run-down

• ‘Run-down’ describes a state of being overused, exhausted, depleted or worn-out through prolonged strain, illness or stress. Here, recovery can be possible.
• It is not complete broken-down state or collapse, but a condition of lowered vitality where the system lacks the resources to function at its normal capacity.
• Characters: Persistent tiredness despite rest. Susceptibility to minor illnesses. A faded tone in mind and body, without sharp pathology. Looks pale, worn, used-up. Mind is often dull, unrefreshed, low-spirited.
• Clinico-pathologically, it is seen when the vitality is compromised. Can be used to capture states between health and disease – ‘sub-clinical’ or ‘pre-pathological stages.’ The system here is functioning on empty reserves. It is the silhouette of exhaustion before pathology deepens.
• Monogrammatically, to be used when the essence is of fatigue, depleted reserves, poor resistance and lack of bounce-back.

      To summarise:

• Out of four words – SLOWED-DOWN, DECLINING, BROKEN-DOWN and RUN-DOWN, DECLINING is the most balanced and versatile term for Monogram use because it captures the ongoing dynamic of deterioration – physical, mental or emotional.

 

8.12 SEPTIC vs. PUTRESCENT vs. SUPPURATIVE

 

 

Septic                                       Putrescent                                     Suppurative

 

 

Septic

 

1. Septic

• The term is derived from sepsis, indicating infection by pathogenic microorganisms or their toxins. It involves systemic inflammation and toxic response due to microbial invasion.
• Clinico-pathologically, it refers to life-threatening systemic infection (e.g. sepsis, septicemia). Key signs include fever, hypotension, multi-organ failure, shock.
• A toxic internal milieu that is seen in surgical site infections, urosepsis, or postpartum infections.
• Monogram wise, The term can be used in high-grade inflammatory states, decomposition or toxic state and appropriate as a Monogram term when toxicity dominates the portrait.

2. Putrescent

• The term originates from putrefy – to decay or rot, producing foul odour. It reflects tissue decomposition, microbial overgrowth and foul-smelling disintegration
• Clinico-pathologically, it is seen in gangrene, necrosis, ulcerative cancers, deep abscesses, etc. Putrescent discharges are offensive, brownish-green, often suggestive of anaerobic infection.
• Monogram wise, it expresses decay as a process. Putrescence should be used for cases where offensiveness and decay are central themes.

3. Suppurative

·         The term originates from suppurate – to form or discharge pus. The term refers to active pus formation as a result of infection or inflammation.

·         Clinico-pathologically,  suppuration is seen in abscesses, otitis media, empyema or infected wounds. Rather than systemic (like sepsis), it is used for localized inflammation with exudation.

·         Monogram wise,  suppurative should be used when the theme of discharge, elimination, or chronic inflammation is central.

To summarise:

·         For systemic infection with toxic deterioration, use ‘SEPTIC’. For decay, ‘PUTRESCENT’ is most expressive. For localized, eliminative pathology, ‘SUPPURATIVE’ is right. PUTRESCENT is the most appropriate for Monogram because it captures decay, disintegration and stench.

8.13 DROPSICAL vs. FIBRINOUS vs. EXUDATIVE

 

   

                                    Dropsical                              Fibrinous                         Exudative

 

1. Dropsical

• The term is from dropsy and is an old term for oedema – abnormal accumulation of fluid in tissues or body cavities.
• ‘Dropsical’ refers to generalized swelling, bloatedness or fluid retention.
• Clinico-pathologically, dropsy is observed in congestive heart failure, nephrotic syndrome, liver cirrhosis (ascites), severe malnutrition (kwashiorkor). Fluid is usually transudate (low in protein, due to pressure imbalance).
• Monogram relevance: Fits into Monogram as a general energetic or systemic descriptor.

 2. Fibrinous

• The term refers to processes rich in fibrin, a protein involved in clot formation.
• Fibrinous implies sticky, tenacious inflammatory exudates.
• Clinico-pathologically, it is seen in fibrinous pericarditis, fibrinous pneumonia, fibrinous pleuritis, fibrinous colitis, etc. It also suggests acute inflammation where fibrin leaks from vessels and coats surfaces.
• Monogram relevance: Indicates intense inflammatory activity. Good as a Monogram word in cases where stiffness, stasis or clotting dynamics dominate the expression.

 

 

3. Exudative

• The term is from exudate – fluid that leaks from vessels during inflammation, containing proteins, cells and cellular debris.
• ‘Exudative’ implies active inflammation with oozing.
• Clinico-pathologically, it is found in: exudative pharyngitis (diphtheria), exudative tonsillitis, pleural effusion (exudative type), otitis media (exudative), eczema (weeping or exudative), Distinguished from transudate by higher protein/cell content.
• Monogram relevance: It expresses a dynamic, eliminating tendency – things being pushed outward. Exudation is typically a protective mechanism in response to injury, infection or irritation.
• Useful in Monogram for cases where exudative inflammation is present.

To summarise:

• DROPSICAL to be used when there is oedema, congestion and stasis. EXUDATIVE to be used when the inflammation is characterized by exudate which contains proteins, cells and cellular debris. FIBRINOUS to be used when the inflammation is rich in fibrin.

 

 

9. Monogram of AN INDIVIDUAL REMEDY

9.1 opium

 

Insensible. Torpid. Adynamic. Heavy. Paralytic. Epileptic. Deep. Tremulous.  Senile.  Dropsical.  Atonic.  Dry.  Sweaty.  Thrombotic.

 

1. Insensibility

Insensibility is the central feature of Opium.

Opium is one of the most complicated substances of our Materia medica. It contains about 18 alkaloids of which the apomorphine, morphine, heroin and codeine are well known. Besides mucilage, albumen, fat, sugar, and salts of ammonia, calcium and magnesia, it contains alkaloids and two neutral substances, as well as meconic acid” (Brunton).

The poisonous effects of Opium are absolute unconsciousness, complete muscular relaxation, pupils contracted to a pin-point aperture, turgid, bloated, stertorous breathing, pulse slow, asphyxia and death. All these poisonous effects are due to the depressive action.  At the physical level, the insensibility is expressed as loss of reflexes. The reactive pattern is depressed to such an extent that we do not get the response even after intense input. Hence, painlessness is the characteristic of Op. The depressive action of Op. results in nerves ‘on end.’

Pathogenesis in dynamic doses of Opium demonstrate the depressive action at both mind and body level. At mind level, one gets higher intellectual faculties being depressed, the power of self-control and concentration become lessened, and the judgement is progressively affected. This leads to poor perception, consequently resulting in confusion of mind and fanciful ideas. The senses are perverted including the moral sense, which is expressed at the dispositional level as a ‘knave’ person (dishonest, deceitful;  tricky rascal; rogue; unscrupulous), keeping insensibility to the feelings of others. Insensibility revokes the reality, the sufferings and goes to the extreme polarity of paradise.

It is interesting to note that, at different points in the body, endorphins (natural opiates) are manufactured which intervene to calm fear, pain, and cough, among other things. This state is characterized by a well-feeling even in grave conditions. A person is unable to understand or appreciate his sufferings. He loses the mental grasp of anything and says that nothing ails him. He wants nothing, he is placid and in his own dreamy state as if of  “nirvana” (a transcendent state in which there is neither suffering, desire, nor sense of self).

It is interesting to note that Op. has indifference to both joy and suffering; this indifference is not associated with melancholy (like Natrums) but it is an ‘exalted’ state. It is similar to ‘Anhalonium levii’ but unlike Opium. Anhalonium levii has colourful, brilliant visions, beautiful and varied kaleidoscopic changes and a sensation of increased physical ability. These are however absent in Opium. It is similar also to Cann-i., which has fantastic visions; however, time sense is more disordered in Cann-i. than Op.

Opium is also acute in its manifestations.

Op. has been reputed as a remedy for ‘deep unconsciousness’ where there is no response to superficial or deep reflexes. The unconsciousness may come on due to fright or head injury or even metabolic failure. During the convulsions, the pupils are non-reacting to light. Want of susceptibility to remedy even though indicated is due to the insensibility that results in lack of reaction or adynamia. Here it must be compared with Carb-v., Psor., Sulph., Zinc. etc.

Essence

Opium’s insensibility revokes reality, leading to a transcendent, “nirvana-like” state, characterized by indifference to suffering and joy, and a disconnection from one’s own emotions and surroundings.

Comparative remedies

• Camphor: Collapse with icy coldness; unresponsive; no reaction to stimuli
• Carb-veg: Collapse state; unconscious but wants to be fanned; near-death state with coldness, cyanosis.
• Verat-alb: Collapse with cold sweat; emotional apathy; blank stare during hysteria

2. Torpid

 

               

 

The depressive action of Op. results in sluggishness both at the mind and the body level. The mind loses its perceptive filter capacity. The comprehension is affected, there is a loss of will power and the person loses the go.

At the physical level, the torpidity is expressed as lack of vital energy and reaction, insensibility of the nervous system, painlessness and soporous condition. Op. lessens the voluntary movements.

This torpidity is exhibited at the level of various systems: Sluggishness of the intestines; paralytic atony of bowels; obstipation; no desire to attend to stool; senile. At the urinary system, there is feeble stream which is slow to start. Loss of power or sensibility of bladder. Paralytic atony of bladder; retention of urine; after laparotomy or confinement. At the genital level, there is suppressed menses especially from fright, also suppression of lochia. Uterine inertia with cessation of labour pains with coma is the characteristic feature.

Op. checks all secretions except that of skin.

Torpidity results in general relaxation of the system expressed also as prolapse of uterus, ptosis and paralysis, hernias (more inguinal), hoarseness, slow pulse, heavy, stupid sleep and fever associated with sleepiness.

In short, torpidity runs through and through and is manifested at mental and physical planes.

Comparative remedies

• Gelsemium: Drowsy, dull, sluggish; muscular weakness; mind foggy and torpid
• Helleborus niger: Blank, staring, slow response; torpor of the sensorium and motor function
• Secale-cor: Torpid but paradoxically restless; insensibility with prostration

3. Paralytic

 

             

 

The depressive action of Op. on the nervous system causes paresis and paralysis. Op. has paralysis of painless or painful type; of brain, tongue, bowels, bladder, larynx, limbs, etc.; from fright; from lead poisoning; after head injury; apoplexy; senile; alcoholic; narcotics.

Comparative remedies

• : Paralysis with excessive dryness
• : Paralysis with spasms and twitching
• : Paralysis from lead poisoning
• : Paralysis with numbness and tingling

4. Adynamic

 

                       

 

The torpidity, general depressive action of Op. results in the state of lack of vital reaction. This want of susceptibility gives a poor or no response to even well-indicated remedies. Adynamia indicates the grave condition. The system has lost its power of resistance and the vitality needs to be aroused as a dire necessity. Op. is helpful in acute manifestations chiefly, but it has the usefulness also in chronic ones. To illustrate, if a patient has become unconscious due to CVS, thromboembolic phenomena, or septicaemia, and he is not responding to the indicated remedies, Op. can be given to arouse the vitality and followed by the indicated remedy.

Comparative remedies

• : Reaction; lack of; convalescence, during; in chronic diseases; phagocyte defective, when well-chosen remedies fail to act.
• : Weakness; reaction, with lack of; sudden; with blunted senses, coldness or cyanosis; cardiac; nervous collapse.
• : Painlessness with complaints; complete loss of muscular control or power; loss of physical irritability or response to stimuli.

5. Epileptic

 

 

The convulsions are the toxicological effects during the phase of stimulation.

Emotional triggers: Violent anger or rage; Fright; Insult.

Physical triggers: Puerperium (post-childbirth); Cholera; Suppressed urine; Cessation of labor pains; Apoplectic conditions (stroke); Brain diseases.

The aura begins with congestive headache and convulsions become worse during and after deep sleep, glares of light, heat; of room or bath, from approach of strangers in (children). During convulsions, there is stertorous breathing; coldness of limbs; froth at mouth; eyes half open; pupils dilated and insensible to light; face dark red and hot. Throws limbs about or stretches arms at right angle to the body; stupor between spasms. The attacks are followed by relaxation of muscles and deep sleep.

Op. can be tried in cases of mental retardation with epilepsy. Indolence, stupidity, rashness, recklessness and boldness characterize the Opium children. Op. children are nervous, irritable and there is a tendency to start even at the least noise. Day-dreamer children who are deceptive in nature and are liars. Op. may be tried in spastic children too.

Opium can be compared with Bufo, Tarent. and Tub.

Comparative remedies

• Bufo: Epilepsy with retardation/regression
• : Epilepsy with restless, agitated behaviour
• : Epilepsy with chronic, progressive symptoms

 

6. Tremulous

 

 

Trembling characterizes Op. Fright, anger or rage cause tremors. Twitching, jerking during sleep. Twitching of limbs; after fright. Jerks as if flexors are overacting. Shuffling and trembling gait. One or another arm moves convulsively to and fro. Trembling, twitching of facial muscles.

Op. is one of the chief remedies for a patient who has developed trembling after fright.

Comparative remedies

• : Trembling with weakness and fatigue
• : Trembling with nervous agitation
• : Trembling with numbness and tingling

7. Dropsical

 

Opium poisoning has produced anasarca. Op. has oedema of lower limbs especially feet and of lower eye lids; from uraemia; diabetes mellitus; strokes; of face (red, bloated, swollen, dark suffused, hot).

Comparative remedies

• : Oedema with thirstlessness
• : Oedema with restlessness
• : Oedema with heart failure

8. Dry

 

 

 

Internal dryness typifies Op. paresis and paralyses are the result of dryness of the nerves. There is dryness of mouth (with consequent intense thirst); of eyes (red, burning, hot and dry); of throat (with inability to swallow); of rectum (resulting in obstinate constipation with stools-dry, hard, round, black-balls); cough dry and racking; suppressed discharges (except sweat); dryness of emotions; indifference to pleasure and sufferings.

Comparative remedies

• : Dryness with inflammation
• : Dryness with irritability
• Nux-v.: Dryness with agitation

 

 

 

 

 

 

 

9. Senile

 

The metabolic processes in old age are characterized by torpidity, low susceptibility and degeneration. Op. has all these characters in its pathogenesis. It has at the physical level senile vertigo with lightness of head; senile painless ulcers; slow circulation; tremors; various degenerative disorders of spinal cord; constipation; COPD; oculo-motor paralysis; cardiac diseases; various digestive and kidney disorders; dryness of mucous membranes and of skin; nutrition impairment, etc.

Comparative remedies

• Bar-c.: Senile degeneration with mental weakness
• Calc-c.: Senile degeneration with bone disorders
• : Senile degeneration with nervous exhaustion

10. Atonic

 

 

The system under Op. develops ‘atony’ due to its depressive and torpid action expressed at bowel and bladder in the form of constipation and retention of urine; prolapse of rectum, uterus; abortions; ptosis etc. The causes usually are fright, anger, insult etc. There is inhibition of reflexes. At mind level, one gets indifference, and dullness.

Want of susceptibility to remedies and insensibility are the furtherance of atonic state.

Comparative remedies

• : Prolapse of pelvic floor muscles
• : Atony of digestive system, of intestines
• : Atony from overexertion

 

 

 

 

 

 

 

 

 

 

11. Sweaty

 

 

 

Sweat has a unique character in Opium and hence it is included under monogram. In Op., all secretions are checked except sweat. This produces internal dryness. Skin is usually hot, damp and sweaty.

Characteristics: Hot sweat over whole body except lower limbs; cold perspiration over whole body especially on head and forehead; fever is > without perspiration; sweat without >.

Comparative remedies

• Nux-v: Anxiety; perspiration; with; cold; forehead, on
• : Perspiration; hot; fright, fear agg., delivery, parturition; during
• Bism-n.: Perspiration; hot; vomiting, with

12. Thrombotic

 

 

The reputation of Op. in the unconscious, comatose state allows one to focus on many causes that lead to coma. One of the pathological causes covered by Op. is thrombo-embolic phenomenon. Under Eyes, there is a rubric, ‘Eyes; embolism, arteria centralis retinae’ which contains Op.

Paralytic effects consequent to cerebral thrombosis are covered by the action of Op.

Comparative remedies

• , Crot-h., Lach.: Cerebral thrombosis
• , Ham., Lach.: Venous thrombosis
• Am-c., , Lat-m.: Thrombosis; coronary

13. Heavy

 

 

The word ‘heaviness’ aptly describes the mental and physical characters. The mind is heavy, unable to comprehend. This leads to irresolution, confusion of mind; thus, there is idiocy of mind. Indifference and dullness are also found in Op.

Sensation of heaviness is expressed at many localities.

Comparative remedies

o   Arn.: Confusion of mind with heaviness of head

• .: Heaviness; paralytic
• : Heaviness; painful

To recapitulate:

Op. is a deep-acting, polychrest remedy of a wide range. Its toxic effects are devastating. Op. penetrates deep in the vital economy and causes a severe depressive action over the system. The ‘insensibility’ and ‘wants nothing’, ‘I am fine’, a ‘paradise’ state even with grave illness are actually indicative of deep magnitude of illness. One will naturally expect warning signals through psycho-neuro-immunology in terms of pains through prostaglandin synthesis or of anxiety and conscientiousness through psychogenic defences. But these are absent and the system manifests the deceptiveness. This is due to syphilitic miasmatic dominance.

The study of Opium through the monogram themes renders the essence of this important drug.

10.GROUP MONOGRAMS

10.1 Carbon group

 

Devitalized. Adynamic. Degenerating. Venous. Scorbutic. Putrescent. Ulcerative. Cachectic. Cancerous. Senile. Flatulent. Offensive. Burner.

 

1. Devitalized

 

The make-up of the carbon group of remedies is an anaemic, broken-down constitution. Persons below par, used up people, by debauchery or from consuming mal-nourished food. Carbon group is indicated in decrepit old people. Defective oxidation and incomplete combustion give rise to the low state of vitality. Hence ‘devitalized’ is the character.

Comparative remedies

• : Out of imperfect assimilation and defective nutrition; great nervous debility
• Pic-ac.: Neurasthenia; tired from least exertion; cancerous cachexia
• Crot-h..: Exhausted vital force; a genuine collapse; deathly sick; rapid decomposition

2. Adynamic

 

Lack of reaction is the central character of the carbon group. Because of low vitality, they do not respond quickly. They have delayed repair process, or no repair occurs. They are the chief remedies for slow recuperative process. Because of their adynamic character, remedies like Carb-v. or Carbn-s. are interpolated for the sake of arousing the vitality.

Comparative remedies

• : Collapse: Cholera, dysentery, puerperal fever; sudden
• : From exhausting diseases, loss of vital fluids; exhausting discharges
• Mur-ac.: Decomposition; septic condition; slides down in bed

3. Degenerating

                                                   

The carbon group primarily acts on degenerative conditions. The source of Carb-v., for example, is charcoal, a product formed after combustion, symbolizing its affinity for decay and breakdown processes.. Fatty degeneration is also covered by carbon group. Senility is characterized by a process of degeneration and carbon group has slant for elderly people. Out of all carbon remedies, Carbn-s. has a pronounced affinity for the nerves.

Comparative remedies

• Arg-nit.: Fatty of liver, kidneys, glands; softening of brain; sclerosis; of nerves and remaining tissues
• Merc-sol.: Out of syphilis miasm; sclerosis; demyelination of neurons; necrosis
• Fl-ac.: Of fatty organs, liver, kidneys, bones, brain, mind; slowly progressing degenerative pathologies

4. Venous

 

The group has venous constitution. It is indicated for varicose veins, varicose ulcers and bleeding haemorrhoids. Notably, Carb-v. is associated with large, protruding, blue haemorrhoids. In essence, when the venous system is predominantly affected, carbon group is indicated.

Comparative remedies

• : Engorged and large hemorrhoidal veins; many symptoms due to reflex from

        hemorrhoids

• : Veins: Relaxed; varicose; varicocele; inflamed; phlebitis; diminished motility
• : Subject to venous congestion, esp. of the portal system; < standing; varicose

         eczema, ulcer

5. Scorbutic

 

Bleeding (and swelling) of gums is found in carbon remedies. Because of deficiency of vitamin C or malnourishment in general, scorbusis is developed. Scorbusis may be a precursory indication of metabolic disorders like diabetes mellitus.

Comparative remedies

• Kali-chl.: Bleeding and softening of gums; easy hemorrhage; stomatitis; apthous and gangrenous; grey based ulcers
• Nit-ac.: Bleeding ; ulceration: of tongue, deep, irregular; tough, ropy mucus; acrid saliva; splinter-like pains
• : Bloody erosions on inner surface of cheeks; breath: offensive, cadaverous, garlicky; burning; metallic taste

 

6. Putrescent

 

Low vitality, impaired repair processes and a lack of reaction, all of which contribute to decomposition within the body. This is reflected in offensive, muco-purulent discharges, underscoring the putrescent nature of these remedies.

Comparative remedies

• Carb-ac.: Tendency to destruction of tissues; breaking off (Crot-h.) breaking down of tissues; sloughing; rapid decubituos.
• Hippoz.: Destructive, quasi-malignant tendency to tissue decomposition; purulent infiltrations; gangrene
• Pyrog. : Lack of resistance and vital response, due to hangovers of (i.e. latent) pyogenic states. Disturbed metabolism with lack of absorption or complete disintegration

7. Ulcerative

 

On the background of low vitality and sluggish repair processes slow, ulceration develops. . This includes conditions such as varicose ulcers, indolent ulcers, chronic phagedenic ulcers, and ulcers that may progress to cancer or gangrene. Additionally, senile ulcers are also commonly observed.

Comparative remedies

• Syph: Suppurative tendency; stubborn; chronic; offensive; destructive; rodent-burrowing
• Hydr: Destructive tendency; internal; aphthous; fungoid; fistulous; leprous; false granulations.
• Kali-bi.: Punched out edges; dry; oval; bright red areola; base hard, corroding; becoming deeper; tenacious exudation;

8. Cachectic

 

Devitalized character coupled with adynamia and iatrogenic diseases which tell upon the economy make the constitution cachectic. The system breaks down under the sway of conditions like malignancy, metabolic and degenerative disorders.

Comparative remedies

• Iod: Stemmimg from tubercular disposition; malarial; quinine; cancerous; rapid
• Uran-n: From assimilative derangements; diabetic; rapid; cancerous; with dropsy; lupus
• Cad-s: Cancerous; due to chemotherapy; with prostration; gastric cancer

9. Cancerous

 

 

Carbon remedies esp. Carb-an., Carbn-s., Graph. and Kreos. are indicated in malignant conditions. The syco-syphilitic miasmatic activity produces the diathesis of cancer.

Comparative Materia medica

• Carc: Family history of cancer; the cancerinique; cancers of softer variety; rapid or slow cancers; based on deprivation and rejection in life
• Rad-br: From exposure to radiation; great prostration and languor; melanoma; epithelioma; with pains
• Alumen: All repair at standstill; non healing due to atony; epithelioma; scirrhus; lupus; lung cancer with haemoptysis; from lead poisoning

10. Flatulent

Carbon remedies assume a very important place in acid peptic syndromes. Slow digestion and torpid vitality are chiefly responsible. Food putrefies before it digests; food turns to gas and even the simplest food distresses. This is why ‘dyspeptic’ and ‘flatulent’ terms are included in the monogram of carbon remedies.

Comparative materia medica

• Raph: Incarcerated; with anxiety and deathly feeling; rises up in abdomen, into chest or even to head; during sleep
• All-s: Flatulent colic; incarcerated; causing twinges in pre cordia; < pressure > lying down; inguinal flatulent hernia
• Asaf: Hysterical; with spasmodic contraction of stomach and oesophagus; with reverse peristalsis; great difficulty in bringing up wind

11. Offensive

 

 

The processes of decomposition, disintegration, imperfect oxidation and putrescence give rise to the offensiveness of discharges, flatus and other bodily excretions.

Comparative Materia medica

• Bapt: All discharges offensive (fetor, stool, sputum); rapid decomposition; putrescence
• Pyrog: All discharges horribly offensive; septic; rapid decomposition
• Tub: Septic conditions; rapid decomposition; peculiar foetid odour of discharges

12. Burner

 

Charcoal, a product of combustion and imperfect oxidation embodies this characteristic. Just like ash, internal burning but external coldness is marked. Pains of burning character. Additionally, it leads to the ‘burning’ of tissues through processes like decomposition, cachexia and emaciation.

Comparative remedies

• : Burning of decay and despair; burning pains, cachexia with great debility, emaciation and anxiety; conditions involving gangrene, ulcerations and putrefactive processes.
• Phos: Fiery disintegration and extroverted consumption; rapid tissue breakdown, hemorrhages and inflammation that spreads like fire; burning sensations
• : Fiery archetype of the combustive vital force; burning pains, of palms and soles; burns-out quickly; rapid emaciation

 

 

 

 

10.2 Halogen group

 

Concreting. Glandular. Malignant. Warm-blooded. Agile. Syco-syphilitic.

1. Concreting

 

It is the tendency of the system to cause concentric pathologies. To illustrate, Calc-fl. has hardness due to its concreting property. Instead of open cancer (this is more for Acid-fluoric), Calc-fl. has more concentric hardness. The process of coalescence is the basis to give the character of concreting to the halogen group and hence its inclusion in the monogram.

2. Glandular

Remedies from the halogen group exhibit a marked affinity for the glands. Glandular pathologies can range from simple inflammation to more severe conditions such as ulceration, hypertrophy, atrophy, calculus formation, or even malignancy. The six  key features to note are: glands may become enlarged, inflamed, indurated, suppurated, atrophied, or cancerous

3. Malignant

 

Flourine, Chlorine, Bromine and Iodine have a tendency to malignancy. The halogen remedies specifically affect the Reticulo-Endothelial System (RES) and through its disturbance trigger malignant changes. Glandular malignancies are particularly common within the halogen group, or ulcerations may become chronic and eventually malignant. The syco-syphilitic miasmatic background fosters this process, cultivating conditions that lead to cancer.

4. Warm-blooded

Thermally, halogen group of remedies are found to be warm-blooded. They have a low tolerance for warmth in general, including hot weather or air. Many disease conditions are aggravated due to above modalities. It is as if the system is drained by heat. Being a strong physical general and being applicable to all halogen remedies, the thermal state has been included in the monogram.

5. Agile

 

 

The activity index of the halogen group is very high. They are mentally as well as physically very active and it is due to this activity that we find rapid development of grave diseases such as tuberculosis, hyperthyroidism, cancer and various auto-immune disorders. Mentally, individuals requiring halogen remedies tend to be restless, active, and hurried in nature, which, over time, can lead to destructive tendencies.

6. Syco-syphilitic

Halogen remedies are poised for organic or structural changes. The illnesses are found more in the structural zone rather than the functional zone. The syco-syphilitic miasmatic dimension which is actively operational over the system produces a lot of chronic, metabolic, endocrinological and other inveterate disease conditions.

11. CLINICAL Illustration

A female/65 years.

Medical history

Known case of rheumatoid arthritis for 20 years

Varicose veins

Hypertension for 10 years

Lichen sclerosus (LS) for 10 years

Diabetes mellitus for 17 years

Complaints

DM: Neuropathy resulting in tingling and numbness of lower limbs due to. Coldness of hands and feet. One left great toe was amputated 1.5 years back due to gangrene. Indolent, painless ulcer on the left foot for the past three months, with a fear it might turn gangrenous.

Rheumatoid arthritis: Deformities of the fingers and toes for the past four years. Lightning like, tearing pains in joints. Stiffness++, < morning and at the beginning of motion.

GIT: Chronic hyperacidity. Reflux oesophagitis. Heartburn. Regurgitation.

Gradual weight loss.

History of hysterectomy at age 42 due to 3rd-grade uterine prolapse; now has an umbilical hernia but refuses surgery.

Mind: Despair of recovery; helplessness.

Life space

Born into a wealthy family, lived a life of luxury, and accustomed to having demands fulfilled.

Personality traits

Suspicious and self-centered, with a tendency to believe her perceptions as absolute truth.

Haughty, selfish and demanding, particularly in terms of material needs.

Has had two divorces, the most recent due to loss of libido, sexual dysfunction and an ever-demanding nature.

Extravagant in spending, insists on buying only expensive items and refuses to wear ordinary clothes. Wears an exclusive saree daily.

Former journalist, highly critical of the ruling government, now boasting of her political connections.

Current status

Dependent on others for daily activities; cannot function independently without support.

Monogram of the case

 

Rheumatic. Stiff. Atonic. Senile. Gradual. Degenerating. Atrophic. Sclerotic. Ulcerative. Dyspeptic. Venous. Progressive. Syphilitic.

 

Repertorization

 

 

Short analysis of the case

In this case, RA, DM and LS are all auto-immune diseases. You get Lichen sclerosus as a pathology. Diabetes mellitus is basically a degenerative disorder. You get deep pathologies at almost every disease – RA is with deformities, so there is caries of bones and loss. History of amputation is again a loss. Hence, the dominant miasm is syphilitic. These pathologies are present in one indivisible individual.

By combining the characteristics identified through the monogram with the mental and physical portrait provided by the case, it is possible to narrow down to Plumbum metallicum as a likely remedy.

Note that in the absence of local/particular symptoms, the module of monogram helps us select the remedy based on the overall pattern of the case. Plumbum metallicum fits the broad profile, addressing the degenerative, stiff, atonic and progressive nature of the condition, as well as the underlying syphilitic miasm and associated mental traits.

12. THE SYNERGY BETWEEN MONOGRAM AND REPERTORY

The monogram and repertorization are two essential aspects of homeopathic practice that work in tandem to enhance the effectiveness of remedy selection. Remember, Monogram does not replace repertorisation – it complements, deepens, serves to explain and refine the process. It helps the homeopath select the right symptoms and weave them into a unified understanding of the patient’s totality. Without a monogrammatic approach, repertorisation risks becoming a mechanical process of fragmented symptoms, lacking cohesion.

When rubrics are studied through the lens of the Monogram, they reveal the dynamic flow of the organism’s inner life. In essence, the Monogram is about discerning the modes and patterns upon which the organism exists and expresses itself.

While many rubrics in the repertory relate to the concept of Monogram, the true need of the hour is a reliable and expansive repertory explicitly grounded in the Monogram framework.

13. PACE AND EVOLUTION AS DETERMINANTS OF MONOGRAMMATIC ANALYSIS

EXAMPLE: CARBO-VEG

Monogram of the carbon group has already been given. But it is reproduced here for easy reference and how the concepts of pace and evolution define the interconnections between Monogram themes.

 

Devitalized. Adynamic. Degenerating. Venous. Scorbutic. Putrescent. Ulcerative. Cachectic. Cancerous. Senile. Flatulent. Offensive. Burner.

Systematic elucidation of interrelationships

Let us apply the concept of pace and evolution to the Monogram of the Carbon Group. Each word in the Monogram is connected to other words in one way or the other. This group evolves progressively through four levels: functional decline à early degeneration à progressive break-down à terminal depletion à devitalization.

This analytical framework facilitates systematic elucidation of interrelationships among monogram key themes, enabling precise mapping of the trajectory of pathological processes. It provides a structured basis for delineating miasmatic dynamics, enhances the accuracy of prognostic assessment and supports evidence-informed approaches to patient counselling and posological strategies.

Carbon group remedies represent the waning phase of life, where the pace of vital processes becomes slow, stagnant and declining. Energy production, mobilization and utilization are markedly reduced, leading to progressive deterioration of tissue vitality. Physiologically, mitochondrial inefficiency, impaired oxygen utilization, lowered basal metabolism are affected. We get reduced cellular renewal, poor venous return and low oxygen saturation. The evolution of disease reflects a chronic, insidious and degenerative trajectory, culminating in states of structural breakdown, putrescence and decay, where systemic integrity is gravely undermined.

Pace: Slowed metabolic processes à sluggish reaction à stasis, congestion, early tissue deterioration à sluggish and imperfect repair à inability to restore à eventual structural decay à tissue destruction and putrescence.

To summarise:

The Carbon group illustrates a progressive decline of life-force. The pace is slow and insidious at first (Devitalized, Adynamic), shifting into a stasis-driven degenerative phase (Degenerating, Venous). From here, the process accelerates into destructive and septic breakdown (Scorbutic, Putrescent, Ulcerative) and culminates in terminal depletion and malignant states (Cachectic, Cancerous, Senile). Throughout, the organism shows impaired metabolism (Flatulent), foul decay (Offensive), and combustion of remnants of vitality (Burner).

14. THE MONOGRAMMATIC WORDBOOK

To enhance clarity, selected word meanings are contextualized as they appear in remedies, offering better understanding of their therapeutic implications. The remedies are taken from Absolute Materia Medica, authored by Dr P. I. Tarkas and Dr Ajit Kulkarni, as the Monograms of these remedies have already been provided.

 

Acetic acid

• Vulnerable: It refers to a state of being susceptible to harm, injury, or disease. It can be: Physical (fragile health, weak immunity), Emotional (sensitive to hurt or criticism), Genetic or constitutional (inherited weaknesses), Situational (age, disease, or socioeconomic risk factors). Vulnerability is deeply associated with the constitutional state and miasmatic predisposition. It refers to how susceptible a person is to disease, emotionally or physically, and how resilient their vital force is.
• Calcareous: Deposition. Lithemic. Cholelithiasis. Nephrolithiasis.

• Cachectic: Malnutrition and wasting.
• Haemorrhagic: Pertaining to or marked by haemorrhages.
• Tubercular: Related to the tubercular miasmatic activity. Lymphadenopathy, emaciation, hectic fever, profuse bleeding etc. are some of the characters.
• Cancerous: Relating to malignant growth of cancer.

Agaricus

·         Agitated:

• Refers to excessive restlessness, marked by heightened mental and physical activity.
• Characterized by tremors.
• Severe motor restlessness, typically non-purposeful, often accompanied by anxiety.
• Unstrung: Refers to an emotionally upset state, leading to passivity or lack of reaction.

Aletris farinosa

• Allergic: Pertaining to or characterized by sensitivity to an allergen.
• Dysthrepsia/athrepsia: Refers to digestive failure.
• Dystrophy: A disorder caused by defective nutrition or metabolism.

Allium sativum

• Herpetic: Pertaining to vesicular eruptions.
• Dyspeptic: Characterized by imperfect or painful digestion.

Alumen

• Indurating: Referring to the process of hardening of tissue.

Aluminium silicata

• Congestive: Characterized by an excessive amount of blood or tissue fluid in an organ or tissue.
• Constrictive: Referring to the narrowing of vessels or a sensation of being restrained or narrow.
• Neurasthenic: Person with unexplained chronic fatigue and lassitude with nervousness, irritability, anxiety, depression, headache, insomnia and sexual weakness.
• Ulcerative: Relating to the formation of ulcers.
• Ataxic: Characterized by defective muscular incoordination.

Ambra grisea

• Nervo-billious: Pertaining to stress-induced bilious temperament.
• Shaky: Unsteady.

Ammonium carbonicum

• Plethoric: Pertaining to or characterized by over fullness of blood vessels or of the total quantity of fluid in the body.
• Torpid: Sluggish, lacking vigour.
• Anoxic: Lacking oxygen, resulting in a sub-normal oxygen level in  the blood.
• Scorbutic: Concerning or affecting with scurvy.
• Toxic: Relating to illness caused by intense infection or septicaemia.

Anhalonium lewinii

• Ecstatic: A state of heightened exhilaration or trance like euphoria.
• Extra-sensory perceptions: Pertaining to forms of perception not dependent upon five primary senses.

Argentum metallicum

• Insidious: Characterized by a deceptive development of a disease (lacking in symptoms or the patient is unaware of it or gradual development of a disease
• Proliferative: Pertaining to the reproduction by cell division
• Malignant: Growing worse; resisting to treatment, said of cancerous growth. Tending or threatening to produce death; harmful.

Argentum nitricum

• Catarrhal: Of nature of or pertaining to inflammation of mucous membranes.
• Neuralgic: Severe sharp pain along the course of a nerve.
• Neurotic: One suffering from neurosis.
• Tense: Tight, rigid, and anxious, especially under mental stress.

Aristolochia clematis

• Festering: Becoming suppurated or infected with pus.

Arnica montana

• Sore: Tender or painful, especially in ulcer or lesion of skin or mucous membrane.
• Venous: Pertaining to the veins or blood passing through them.
• Soporous: Characterized by abnormally deep sleep.
• Stuporous: Marked by or resembling deep sleep or coma.

Asterias rubens

• Toxaemia: Distribution throughout the body of poisonous products of bacteria growing in the focal or local sight thus producing generalized symptoms like fever; diarrhoea; vomiting; pulse and respiration weakened or depressed; shock.

Aurum muriaticum

• Lymphatic: Of or pertaining to lymph or lymph vessel
• Sclerotic: Pertaining to sclerosis i.e., hardening or induration of an organ or tissue (especially from excessive growth of fibrous tissue)
• Scrofulous: Pertaining to scrofula, a variety of tuberculous adenitis.

Beryllium

• Lithic: Related to the formation of calculi and concretions.
• Neurotic: Pertaining to neurosis i.e., unpleasant mental symptoms in an individual with intact reality.
• Epileptic: Concerning epilepsy, involving seizures.
• Deprived: Being not rendered the rights.

Bryonia alba

• Composed: Calm and contented.
• Steady: Stable and consistent.

Calcarea silicata

• Atrophic: Pertaining to wasting; a decrease in the size of organ or tissue.
• Incompetent: Not competent, not able or not in a position to act.

Carlsbad

• Atonic: Without normal tension or tone of strength.
• Tremulous: Trembling or shaking.

Causticum

• Atrophied: Wasted, affected with atrophy.
• Sickly: Pertaining to sickness.
• Fissured: Pertaining to fissured i.e., ulcer or crack like a sore.
• Standstill: Still; not moving

Conium maculatum

• Chronicity: A state of long duration, designating a disease showing little change or of slow progression.
• Depressed: Low in spirit; dejected. Decreased level of function.

Crataegus

• Gluttons: Food lover.

Crotalus horridus

• Destructive: Causing ruin or destruction.

Eucalyptus globulus

• Grippy: Pertaining to acute infectious disease marked by fever, prostration, pain in head and back and upper respiratory tract symptoms such as cough and nasal congestion; synonym influenza.
• Hyperaemic: Pertaining to congestion or an unusual amount of blood in a part or a form of macula; red areas on skin that disappear on pressure.
• Malarious: Affected with malaria. Causing or resembling malaria.

Hydrastis canadensis

• Dyscretic: Pertaining to dyscrasia or miasmatic constitution.

Hydrocyanic acid

• Algid: Cold, chilly.
• Cyanotic: Of the nature affected with or pertaining to slightly bluish greyish slate like or dark purple discolouration of the skin due to presence of abnormal amount of reduced haemoglobin in blood.

Iodum

• Glandular:  Pertaining or of the nature of gland.
• Toxic: Pertaining to, resembling or caused by poison. Synonym: poisonous.

Kali arsenicosum

• Skinny: Pertaining to thin, slender constitution.

Kali carbonicum

• Trepid: Marked by tremors.

Kali iodatum

• Vegetative: Having the power to grow or regenerate.

Lachesis mutus

• Haphephobic: Phobia of touch.
• Phthisic: Pertaining to tuberculosis.

Lactrodectus mactans

• Neurotoxic: Poisonous to nerve cells.
• Hyperaestheic: Pertaining to increased sensitivity to sensory stimuli, such as pain or touch.
• Spastic: Resembling or of the nature of spasms or convulsions
• Apoplectic: Pertaining to apoplexy (cerebro-vascular accident).

• Effusion of blood into an organ.
• Sudden loss of consciousness followed by paralysis caused by hemorrhages into brain; formation of an embolus or a thrombus that occludes an artery or rupture of an extra-cerebral artery casing sub-arachnoid haemorrhages.

• Syncopic: Pertaining to transient loss of consciousness due to inadequate blood flow to the brain.

Naja tripudians

• Nervous: Characterized by anxiety or excitability.

Natrum muriaticum

• Hydric: Pertaining to, or characterized by considerable moisture.
• Chlorotic: Affected by iron deficiency anaemia.
• Halophilic: Craving for salt.

Nux moschata

• Inebriate: To intoxicate or become drunk.

Pituitarium posteriorum

• Spasmodic: Involuntary sudden movement of muscular contraction

Pothos foetidus

• Erratic: Wandering; having an unpredictable or fluctuating course or pattern.

Pulsatilla nigricans

• Fitful: Erratic; irregular

Pyrogen

• Run-down: To lose power, to grow gradually weaker.
• Spoilt: Decomposed; destroyed; decay.

Raphanus sativus

• Amative: Related to sexual desire or activity

Rhus radicans

• Periodic: Recurring at definite intervals.

Sabina

• Gouty: Of the nature of or related to gout

Secale cornutum

• Thermophobic: Fear of heat.

Sumbul ferula

• Paretic: Affected with or concerning partial or incomplete paralysis.

Syphilinum

• Stunted: Underdeveloped

• Obsession: uncontrollable preoccupation with an idea or emotion.

Thuja occidentalis

• Hyperplasic: Excessive proliferation of normal tissue, especially in organs.

Tuberculinum

• Psychoneurotic: Pertaining to emotional mal-adaptation due to unresolved unconscious conflicts, leading to disturbances in thoughts, feelings and behaviour.

15. FINAL REFLECTIONS

15.1 UTILITY OF MONOGRAM: LOGIC, PATTERNS AND EVOLUTION OF DISEASE

The concept of the monogram enables a deeper view of the remedy, not solely through individual symptoms, but through the ‘totality’ that weaves through them. It broadens the clinical perspective, facilitating a more integrated understanding of the mind-body relationship. Even, the interconnections between various pathologies become more apparent, allowing the clinician to grasp the entire matrix of disease more clearly. In essence, the monogram aids in discerning the multiple domains a person must navigate, particularly when deviating from the harmonious flow of vital energy.

The Monogram approach honours the integration: it recognizes the usefulness of keynotes but weaves them into the broader web of threads, themes and essential traits. In this way, prescribing moves from the superficial and fragmentary to the profound and individualised, staying faithful to Hahnemann’s directive that the totality alone is the basis for cure.

 

The monogram concept serves as a critical objective tool for evaluating the portrait of the patient, which represents more than just a collection of symptoms. It opens up the fields of logic, philosophy, pathology, patterns, integration of the intertwining characters and if these characters are understood in their genuineness, a physician is able to see the movement of the disease (under the miasmatic activity) in a better way. A physician endowed with prognostic ability is a better homeopath and can be more proactive and aggressive in his management of thwarting the miasmatic influence, apart from deeper correspondence of the totality being painstakingly built up by a conscientious homeopathic physician. This approach goes beyond mere symptom relief; it involves harmonizing the vital force and addresses health at a deeper, energetic level, fostering a proactive path toward sustained well-being.

 

While abstraction reduces complexity by hiding irrelevant details, generalization reduces complexity by making a coherent whole.  A single construct of monogram thus unifies the raw and scattered data and convincingly puts before the homeopath the roadmap intended for fishing out the most similar remedy, to perceive what is to be cured in a case and to monitor the direction a homeopath is riding.

The ability to abstract and generalize is an essential part of any intellectual activity. Abstraction and generalization are fundamental to philosophy on which the concept of monogram is based.

Remember, it is also possible that the remedy may not cover the monogram characters of the patient but yet can be useful if the symptoms correspond. This occurs due to the layers; the presenting surface layer may be superficial, and the system is yet in a process to develop the pathological generals and behavioural patterns. The utility of monogram concept is tremendous in pathological cases when the PQRS symptoms are scanty. Combining mental expressions, dispositions and mental state with the monogram words (keywords, keythemes, behaviour, pattern) allows the physician to see the parallelism, to see the movement and to assess the miasmatic energy that is operating at various levels of the system.

Monogram in contemporary Homeopathy

• The Monogram as conceived by the author is not merely a clinical tool – it is a new paradigm of perceiving the remedy, the patient and the disease as a unified energetic system. It emerges as an evolution beyond keynotes, beyond layers and beyond isolated symptomatology.
• The Monogram is not just a concept – it is an applied methodology for developing remedy intelligence.
• The monogram encompasses both philosophical vision and clinical traction.
• The monogram is a milestone contribution that resonates with both classical roots and modern sensibilities.
• The monogram is a practical roadmap, a philosophical compass and a diagnostic mirror. The layered components (essence, threads, traits, temperament, constitution, characters, dispositions, patterns, generals, miasmatic state, etc.) help the physician in mapping the whole.

Monogram: Bridging modules, prognosis and patient persuasion

• Logical and philosophical approach, offering a structured and systematic framework

• Understanding pathology and patterns, helping a homeopath to track the movement of the disease and to assess the miasmatic activity
• Identification of patterns, defining the individuality
• Integration of intertwining characters at mental, emotional and physical levels
• Perception of deviant energy paths
• Deeper correspondence of totality
• Offering a preventive approach
• Prognostic ability, combining pathologies, their interconnections and influence over the system as a whole, defining the pace and the miasmatic activity and thus allowing a homeopath to intervene early for thwarting the miasmatic influence
  management of acute and chronic cases on a standardized basis
• Enhances homeopathic practice by enabling the homeopath to access the components of the totality through a broader, integrative vision
• Convincing the patients about the broader, integrative approach
• Developing entry points for envisioning the probable remedies in a row

Conclusion

The concept of Monogram is rooted in the principle of generalization. It is as if one precisely and concisely denotes the character which defines the problem, highlights the exactness of the problem and streams down to the essence out of the maze of symptoms. The concept gives justice to the pathology, which is nothing but an accentuated, concentric and objective form of energy of the disease.

‘Action’ section in the ‘Absolute Homeopathic Materia medica’ is a natural continuation of the monogram teaching. It explains the rhythm, pace, order and directions of the monogram themes. The blend of monogram and action paves the way for a better grasp of the potential remedy under consideration.

The application of miasmatic analysis to each element of the remedy or patient within the Monogram structure offers a lucid representation of the systemic economy – facilitating diagnostic direction, tracing the trajectory of disease evolution, and supporting reliable prognostication.

The Monogram is more than a tool – it is a philosophical and conceptual framework that guides the homeopath toward a deeper and integrated understanding: to study the disease potential in its essence, to perceive the afflicted individual with all his unique patterns and dynamics, to view remedies in their totality, to grasp rubrics in a holistic perspective and to create meaningful correspondences based on the Law of Similars – nay, the ultimate aim of the Monogram is to arrive at the most similar remedy, one that is precisely tailored to the patient Remember, a single Monogram word may be insufficient to find an appropriate remedy.

ACKNOWLEDGEMENT

The author gratefully acknowledges the valuable contributions of his colleague, Guy Tydor and Alexander Martuishev for their insightful inputs. Readers are encouraged to explore their compelling articles,  “The monogram concept in homeopathy: Exploring the golden key of Dr. P. I. Tarkas and Dr. Ajit Kulkarni” and “Monogram: Offering meticulous analysis of clinical approach”.  

 

**********

 

REFERENCES   

 

1. Organon of Medicine, 6^th Edition, Samuel Hahnemann, B. Jain Publishers, New Delhi,1983
2. Symposium Volumes, Second Edition, ICR, Mumbai, 1994
3. Lectures on Homeopathic Philosophy, J T Kent, B. Jain Publishers (P) Ltd., 2002
4. The Philosophy and Psychology of Personal Identity, Jonthan Glover, Penguin group, 1988
5. On Characteristic Symptoms, Dr J. H. P. Frost, Hahnemannian Monthly, 1874
6. The Genius of Homeopathy, Stuart Close, B. Jain Publishers (P) Ltd., 1924
7. Kali Family and Its Relations, Dr Ajit Kulkarni, IBPP, New Delhi, 2002
8. Body Language and Homeopathy, Dr Ajit Kulkarni, B. Jain Publishers, New Delhi, 2010
9. Harmony in Totality Vol. I, 2^nd revised edition, Dr Ajit Kulkarni, B. Jain Publishers, New Delhi, 2022
10. Harmony in Totality Vol. II, 1^st edition, Dr Ajit Kulkarni, B. Jain Publishers, New Delhi. 2023
11. Harmony in Totality Vol. III, 1^st edition, Dr Ajit Kulkarni, B. Jain Publishers, New Delhi. 2024
12. Harmony in Totality Vol. IV, 1^st edition, Dr Ajit Kulkarni, B. Jain Publishers, New Delhi. 2024
13. Homeopathic Posology, Dr Ajit Kulkarni, 2nd edition, Soham Prakashan, Satara, 2005
14. Absolute Homeopathic Materia Medica, Tarkas P. I., Kulkarni, Ajit, B. Jain Publishers, New Delhi, 2019
15. A Manual of Materia medica, M. Bhattacharya & Co. Calcutta, 1945
16. The Encyclopedia of Pure Materia Medica, TF Allen, Jain Publishers, Re-printed 1988
17. The Guiding Symptoms of Our Materia Medica, C. Hering, Jain Publishers, Re-printed 1982
18. Clinical Materia Medica, E. A. Farrington, B. Jain Publishers, New Delhi, 1887
19. Homeopathy and Homeopathic Prescribing, Harvey Farrington, B. Jain Publishers, New Delhi, 1987
20. Lotus Materia Medica, Robin Murphy, B. Jain Publishers, New Delhi, 1996
21. Concordant Materia medica, Frans Vermeulen, B. Jain Publishers, New Delhi, 2011
22. Kent’s Comparative Repertory of HMM, Dockx & Kokelenberg, B. Jain Publishers, New Delhi, 1921
23. Dictionary of Homeopathic Materia medica, O. A. Julian, B. Jain Publishers, New Delhi, 1984
24. The Homoeopathic Prescriber K. C. Bhanja, Published by Dr K. C. Bhanja, Culcutta, 1959
25. Homeopathic Psychology, Philip m. Bailey, B. Jain Publishers (P) Ltd., 2002
26. Portarits of Homeopathic Medicines, Vol 1 & 2 Catharine Coulter, Publisher North Atlantic Books, U.S., 1988
27. Synthesis Repertory 9.x, Dr Frederik Shroyens, B. Jain Publishers, New Delhi, 2007
28. Homeopathic Medical Repertory, Robin Murphy, B. Jain Publishers, New Delhi, 1993
29. Complete Repertory, Roger Van Zandvoort, IBPP, New Delhi, 2011
30. Collected Seminars, Roger Morrison (II), Nancy Herric, Jain Publishers (P) Ltd., 1999
31. A Textbook of Pathology, Willaim Byod, Lea and Febiger, Philadelphia, 1938
32. Research in Homeopathy, Boiron, 2005
33. Homeopathy and Mental Health Care, Editors, Christopher K. Johannes & Harry van Zee, Home Links Publishers, 2010
34. Identity and Individualism, V session, Dr Massimmo Mangialavori, Oct-Nov 2004
35. From Medication to Meditation, Osho, Saffron Walden, The C. W. Daniel Company Limited, England, 1995
36. The Turning Point Science, Society and The Rising Culture, Fritjof Capra, Bantam Books, 1983
37. The Web of Life, A new synthesis of Mind and Matter, Fritjof Capra, Flamingo, London, 1997
38. the hidden connections, Fritjof Capra, Flamingo, London, 2002
39. The Systems View of Life, Fritjof Capra & Pier Luigi Luisi, Publisher Cambridge University Press, 2016
40. Psychoneuroimmunology: The Interface between Behaviour, Brain and Immunity, Maier, S. F., Watkins, L. R., & Fleshner, M, American Psychologist, 1004-1017, 1994
41. Emotions, Morbidity and Mortality: New Perspectives from Psychoneuroimmunology, Kiecolt-Glaser, J. K., Mcguire, L., Robles, T. F., & Glaser, R., Annual Review of Psychology, 53, 83-107, 2002
42. Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process, Nancy Mcwilliams, 2nd edition, Guilford Press, 1999
43. Personality disorders in Modern life, Theodore Millon Et al., second edition, Wiley, 2004
44. The Tao of Psychology, Nirmal Kumar, Bhartiya Vidya Bhavan, 1993
45. A Guide to Physical Examination and History Taking, 4^th Edition, Barbara Bates, Harper International Edition, 1987
46. Merriam-Webster’s Dictionary, Encyclopaedia Britannica, Revised edition, 2022
47. Problem-Oriented Medical Diagnosis, Editor: H. Harold Friedman, Little Brown and Company, Boston, 1987
48. What Doctors Don’t Get To Study In Medical School, B. M. Hegde, Paras Medical Publishers, 2019
49. Clinical Science and Clinical Research, R.D. Lele, Sajjan sons, 1993

Softwares

1. Complete Dynamics software program (complete dynamics.com)
2. Radar Opus, Homeopathic software
3. Mac Repertory and Reference Works, Synergy Homeopathic
4. Hompath Zomeo software

 Journals

54. Homeopathic Links
55. Homeopathy International, England
56. National Journal of Homeopathy, Mumbai
57. Homeopathic Heritage, B. Jain Publishers, New Delhi
58. Homeopathy Plus Newsletter
59. Interhomeopathy, International Homeopathic Internet Journal

Internet websites

1. tamiflu.com
2. en.wikipedia.org
3. Hpathy.com
4. similima.com
5. childdevelopmentinfo.com
6. pediatrics.about.com
7. aap.org
8. naturalnews.com
9. google.com
10. https://chat.openai.com

 

AUTHOR’S INFORMATION

*Dr AJIT KULKARNI

M.D. (Hom.)

• Director, Homeopathic Research Institute, Pune
• A Veteran Homeopath, an Academician and a Famed International Teacher
• Co-Author: Absolute Homeopathic Materia Medica

Five Regional Repertories: AIDS, DM, Thyroid, HTN and Trauma

Author:  Homeopathy through Harmony and Totality Vol I-IV
Law of Similars in Medical Science

Homeopathic Posology

Kali Family and Its Relations

Body Language and Homeopathy English)
Body language (Marathi)

Homeopathic Covidoscope (published by Amazon)

More than 100 publications on various aspects of homeopathy

Numerous books translated into multiple languages

26 books in Russian language

• Award of ‘Excellence in Homoeopathy’
• Award of ‘Homoeo-Ratna’
• ‘Life achievement Award’
• Member, Editorial Board, National Journal of Homeopathy, Mumbai
• Address: Kachare Classic, Erandwane, near New Karnataka High school, Pune
• Website: www.ajitkulkarni.com
• E-mail ID: [email protected]/[email protected]

 

___________________________________________________________________________

 

 

 

 

 

 

REFLECTIVE INSIGHTS

 

1. THE MONOGRAM CONCEPT IN HOMEOPATHY:
   Exploring the Golden Key of Dr. P. I. Tarkas and Dr. Ajit Kulkarni

 

Guy Tydor, RCHom Homeopath

Principal, Remedy College of Homeopathy, Israel

 

INTRODUCTION

Every homeopath carries within him a personal story, a unique journey that leads him or her into the arms of homeopathy. Most of us can vividly recall the very spark that set us upon this path. It might have been the healing of a loved one, the wonder of a seemingly miraculous cure, a personal health crisis, the inspiration of a mentor, or the teachings of a spiritual guide. For some, even a simple reading or a passing story about the marvels of homeopathy can be enough to set the wheel in motion. In my own case, it was a few lines I encountered ‘by chance’ in the Organon. They touched something profound within me, awakening the realization that “love at first sight” is not merely a phrase, but an authentic experience.

But I’m not someone who believe in beginnings or endings. I believe our existence unfolds as an infinite continuum of sequences. The wheel of homeopathy had begun turning in my direction long before I encountered those lines. I arrived at homeopathy, not by an accident, but through the world of philosophy. The lines I read in my aunt’s living room in Tel Aviv only gained meaning because I was immersed in the study of philosophy at that moment. There are no true coincidences. My consciousness was ripe for that initial encounter with Hahnemann’s thought. The familiar saying “everything is connected” may sometimes sound pseudo-spiritual, yet it holds a profound truth. Had it been any other time, I might have glanced at the book, dismissed it with a roll of the eyes, and simply walked away.

My continuum carried me further and in the early 2000s it led me to Dr. Ajit Kulkarni. I had originally planned to meet another well-known homeopath in India, yet sequences unfold as they must, and I found myself instead in the presence of a classical homeopath whose clinical work is grounded more in deep understanding than in mere subjective experience. It was no accident – my path directed me to Dr. Ajit Kulkarni, a physician whose teachings themselves acknowledge the very existence of sequences in human health.

Dr. Ajit Kulkarni, together with his teacher Dr. P.I. Tarkas, chose a mode of teaching that felt both true and profoundly resonant to me. They approached the study of the Materia Medica not in isolation, but in parallel with philosophy, weaving the two into a unified discipline. From this vision emerged what has come to be known as the golden key of homeopathy: the ‘Monogram’ – a cornerstone in the study of Materia medica worldwide. After the passing of Dr. Tarkas, the responsibility of carrying this work forward became the central mission of Dr. Ajit Kulkarni and his dedicated team.

In this article, I hope to share with my fellow homeopaths a fresh perspective on studying remedies through the Monogram and to explore its relevance in applying the foundational principles of homeopathy.

HOLISM AND THE TOTALITY OF SYMPTOMS

The Law of the Totality of Symptoms stands as a core principle at the heart of homeopathy, embodying the very essence of holism in practice. Among all the laws presented by Hahnemann in the Organon of Medicine, it is the most frequently emphasized, consistently applied, and repeatedly insisted upon. This does not lessen the significance of other laws—particularly the Law of Similars – but it does highlight the centrality of totality in case analysis. What remains essential, however, is clarity in addressing certain recurring issues that arise in its understanding and application.

The Law of the Totality of Symptoms stands as a central principle at the very heart of homeopathy – an embodiment of holism within our practice. Of all the laws set forth by Hahnemann in the Organon of Medicine, it is the most frequently cited, the most consistently applied and the one he underscores above all others. This, however, in no way diminishes the importance of the remaining laws, particularly the Law of Similars. Yet in applying these principles, clarity becomes indispensable for resolving the recurring challenges that often arise in interpretation and practice.

Understanding holism is an essential stage in the evolution of every homeopath. The term holism was coined by Jan Smuts in 1926, born of his observation that science had become increasingly fragmented – hollowed by an overemphasis on isolated parts, detached from the environment and context in which they function. Yet, long before Smuts, the Organon speaks repeatedly to this principle. Hahnemann sought to convey the same truth: the necessity of perceiving the whole – the totality of disease as the complete manifestation of symptoms (§6, gesammte Erscheinung der Symptome). This understanding of wholeness is the true gateway into homeopathy and anyone who aspires to practice with integrity must pass through it—eyes open, heart open.

Holism is the recognition of phenomena in their very suchness – the understanding that all elements, with their countless components, are inseparably interconnected, just as every phenomenon is bound to those around it. As the saying goes, “the whole is greater than the sum of its parts.” No phenomenon can be truly understood by analyzing its fragments in isolation; it must be perceived within its full context, as a living system in which every part interacts, shapes, and is shaped by the others.

A HIGH-QUALITY RED WINE: EVERYTHING MATTERS

In our universe, nothing exists as a wholly self-defined entity. Every “thing” is shaped by its components, the components of those components, and the conditions that surround them. A fine glass of red wine, for instance, carries within it not only the grapevine that bore the fruit, but also the soil that nourished it, the sun that ripened it, the season of its harvest and the age and roots of the vine itself. The winemaker’s character, sensibilities, and skill leave their imprint as well. Even something as subtle as the meal the vintner shared with his family the evening before harvest might, in some delicate way, become part of the wine’s story.

Thus, every sip is not just fermented grape, but a confluence of countless influences woven together. Change any one element – soil too dry, a season too wet, a weary or joyful winemaker – and the wine becomes something different. So too, the homeopath perceives the patient: not as an isolated symptom or organ, but as a living system in which every part and circumstance resonates with the whole.

The uniqueness of homeopathy extends beyond the Law of the Totality of Symptoms to the deeper principle of the individuality of the patient. Each unique person’s totality is unlike any other, composed of details and experiences that belong solely to them. It is this singular constellation of traits, sensations and responses that defines the individual – a living, unrepeatable wonder in the fabric of existence.

Like wine, every person lives and unfolds according to patterns uniquely their own. To truly recognize a wine, the sommelier must understand not only the grape variety, but also the soil that nurtured it, the season that shaped it and the hand of the vintner who guided it. A discerning sommelier considers all of these elements together, perceiving not isolated traits but the full character of each drop.

The skilled vintner and a good sommelier know each vine intimately: its lifespan of each plant, the length of its budding phase and the subtle influences that may alter its fruit. They recognize the rhythms of every variety, and even of each individual vine within the vineyard.

Likewise, the homeopath must perceive the patient in their wholeness. It is not enough to note scattered symptoms; he must grasp the underlying patterns and structures of the patient’s existence, while also holding in view the dynamic spectrum of symptoms inherent in each remedy. Both patient and remedy extend far beyond a mere inventory of complaints or indications. They are not shopping lists, but living movements – a continuum of expression and response.

It is precisely here that the Monogram reveals its purpose.

At the beginning of each remedy in the Tarkas-Kulkarni Materia Medica appears a square containing words that capture the remedy’s patterns of existence. This is the Monogram – a symbol of the remedy’s totality. It serves as a lens through which we compare the essence of the remedy with the living image of the patient.

When studying a patient’s Monogram, we do not dissect each symptom in isolation. Instead, we examine the symptoms in relation to one another, tracing the threads of connection that reveal a deeper coherence (examples to follow). Our purpose is singular: to perceive the true, complete picture of the patient in front of us.

Likewise, when studying a remedy, we always seek the relationships among all the symptoms that are gathered. We try to understand what led to what and how each element is interconnected. Only then does the complete picture emerge. If I were to describe this pictorially, I would say that sometimes we need to unfocus our vision or take a step back, in order to perceive the full image – the outline of the patient. Each word within the Monogram contributes to this total image of the patient or of the remedy.

THE SILHOUETTE

The Monogram serves as a primary tool for approaching both the patient and the remedy. It does not replace the ‘story’ of the remedy, as it appears in classical Materia medica texts like those of Kent, Vithoulkas and others, nor does it replace the list of symptoms organized by body systems. Rather, the Monogram serves as the golden key that opens the door to our first encounter with the image of the disease. This key provides a framework for action – sketching the general silhouette (dark, solid shape of somebody) of the case and capturing the essential traits and energy patterns of the individual, beyond superficial symptoms. Once this outline is established, we can begin to discern the Mode of Action (MoA) through which the individual operates in health and disease.

Just as we can instantly recognize the silhouette of a giraffe, a hippopotamus, a lotus, or a diamond, so too must we learn to perceive the characteristic structural pattern of each individual and each remedy. Every symptom and anecdote we gather—whether from a patient or from a proving—must ultimately fit within this broader outline, enriching it with depth, tone, and nuance. Only then can we practice homeopathy in its true spirit.

At this relatively early stage in the evolution of homeopathic medicine—where only a limited number of remedies have been thoroughly investigated, owing to the absence of a systematic and reliable framework for high-quality provings – the Monogram approach provides the essential structure and boundaries needed for our work.

THE MONOGRAM AND MIASMS

As mentioned, at the start of each remedy entry in Tarkas-Kulkarni’s Absolute Materia Medica, there is a Monogram square containing words that encapsulate the essence of the remedy. These words highlight the recurring, characteristic patterns of the remedy; outlining both the nature of its influence and the type of vital force disturbance it addresses within the dimensions of time and space. Collectively, they portray the image of the patient’s disease. When these words are connected and their relationships understood, they reveal the underlying miasm uniting them.

In forthcoming editions of the Monogram, each Monogram square will also include a summary of the dominant miasm associated with the remedy.

The Monogram clusters together the words that define the remedy’s mode of action. When the name of the miasm is placed alongside this cluster, it “colours” each word with the context of that miasm, allowing us to grasp more clearly the significance of each word in relation to the patient. What does this mean in practice?

For example, consider the word Destructiveness appearing in a remedy’s Monogram. If the Monogram is summarized with the word Syphilitic, we understand that this destructiveness is syphilitic in nature—deep-seated, terminal, and with little likelihood of returning to baseline or achieving recovery. In contrast, if the same word appears alongside Tubercular, we recognize a tubercular form of destructiveness. Though still damaging, it is generally less consuming—whether of the organs or the mind—and carries a higher potential for partial healing or return to baseline, in keeping with the qualities of that miasm. Such distinctions are of great importance for us as homeopaths.

During case-taking, it is highly advisable to jot down key words in a side column as they come up, parallel to the flow of information. A bird’s-eye view of these recurring words often reveals the core characteristics of the case, functioning like a spontaneous Monogram. This simple practice also brings to light the miasm underlying the patient’s functional patterns, reflected in expressions such as sluggish, congestive, destructive, ulcerative, and so on.

This is profoundly powerful. For us as homeopaths, the ability to identify the dominant miasm shaping a patient’s functional patterns is an invaluable gift. It illuminates the pathology in process, helps us craft a more precise prognosis and enables us to set appropriate expectations following the prescription of a remedy (an example will be presented later).

THE MONOGRAMMATICAL THINKING

The seeds of the Monogram—if my colleagues and teachers will kindly pardon me for saying so—were sown long before Dr. Kulkarni and Dr. Tarkas nurtured them into the sturdy tree we now lean on in case analysis. I would even go so far as to say that many experienced homeopaths, knowingly or not, already engage in a kind of “monogrammatic thinking” when solving a case. They list the symptoms, look for a guiding thread and seek out the remedy. Long before these two masters formalized and refined this method into what is now called the “Monogram,” it was Bœnninghausen and Boger who recognized that general symptoms and the generalization of keynote symptoms, are essential tools for perceiving the complete picture of the patient, or of the remedy).

I first began studying Tarkas-Kulkarni’s Materia Medica in its earlier edition in 2003. Yet the true importance of the Monogram within that work revealed itself to me only five years later, largely through a deeper engagement with Hahnemann’s instructions on case-taking and the proving process.

At first glance, many of us may see Hahnemann as a rigid, old-fashioned figure, preoccupied with minute details. Over time, however, I came to realize that the structure he demands in both clinical practice and research is not rigidity for its own sake, but rather an expression of the profoundly spiritual worldview held by the German master.

In James Tyler Kent’s canonical book, Lectures on Homeopathic Philosophy, he explains Hahnemann’s approach as follows:

“In fact, we ought to regard the pure image of each prevailing disease as a thing that is new and unknown and study the same from its foundation, if we would really exercise the art of healing.”

A great deal depends upon a physician’s ability to perceive what constitutes the miasm.
If he is dull of perception, he will intermingle symptoms that do not belong together.
Hahnemann seems to have had the most wonderful perception, he seemed to see at a glance.

Hahnemann was skillful in this respect because he was a hard student of Materia Medica and because he proved his Materia Medica daily. He had examined the remedies carefully, he saw them, he felt them, he realized them.

“We ought never to substitute hypothesis in the room of observation, never regard any case as already known.”

Now we see why it is that it does not make any difference with a physician whether he has seen such diseases before or not.

The homoeopathic physician is acquainted with the signs and symptoms of the man, and a different disease is only a change in the combination of them, only a change in their manner, form and representation.

There is order, perfect order, in every sickness that presents itself, and it rests with the physician to find that order.

The homoeopathic physician need never be taken unaware (From Lectures on Homeopathic Philosophy, Chapter 26).

And that is precisely the point in the sentence: “and a different disease is only a change in the combination of them, only a change in their manner, form and representation.”
Hahnemann repeatedly emphasized the need to understand the nature of the vital force and its mode of action. To perceive the modus operandi, to grasp the nature of the person – this is the very essence of homeopathy.

Homeopathy is not a mere compilation of symptoms.

Nor is it confined to the mind alone, or reducible to a handful of keynotes while disregarding the wider totality.

Homeopathy is the medicine of wholeness – the one truly holistic system – seeking to capture the complete image of the patient as a living phenomenon within nature.

This is precisely what the Monogram was created to support.

HOW TO BEGIN AND KEEP APPLYING MONOGRAM

When constructing a Monogram, we are, in essence, sketching the outline of a remedy. Rather than compiling long lists of symptoms, we employ words that capture the characteristic patterns of the remedy’s—and the patient’s—mode of functioning. These may be terms such as slow, sudden, destructive, offensive, catarrhal, senile, degenerant, calcareous, and many others. Each word in the Monogram expresses how the patient manifests his illness – physically, emotionally and mentally.

• Take the word “Slowness”: this applies when pathologies develop gradually, when the vital force operates at a sluggish pace in managing the pathology. Naturally, this monogrammatic word also applies when the patient’s thinking is slow, when cognitive processes are delayed. In essence, it denotes the diminished pace of the vital force’s functioning in this state.
• The word “Destructive” denotes pathologies marked by cellular degeneration, as in diabetes, or by processes that erode and damage tissue, often reflecting syphilitic tendencies. It also extends to the mental sphere, where destructive or harmful patterns of thought and behavior become evident. In this sense, Destructive serves as a fitting monogrammatic descriptor whenever such tendencies manifest, whether in localized disease or throughout the entire organism.
• The word “Offensive” refers to foul odors arising from bodily discharges, infections, or ulcers, and equally to offensive states of mind or behavior (as we see, for instance, in Mercurius).
• The word “Senile” is used when a patient exhibits pathological signs of aging disproportionate to their biological age or when their mental state and behavior resemble that of advanced old age. It conveys a sense of decline and decadence.
• The word “Congestive” denotes a tendency toward accumulation, where the system gathers but cannot adequately eliminate. This may manifest physically – through fluid retention, fat deposition, pathological excretions, or mineral build-up – as well as emotionally, in the form of unexpressed or withheld feelings.
• The word “Paralytic” signifies a tendency to initiate or terminate processes with paralysis. This state may present physiologically, emotionally, or mentally, reflecting stagnation or loss of function across different levels of the organism.

THE MONOGRAM AND THE CO-MORBIDITY

Each word within the Monogram acquires its true significance only through its relationship with other words that accompany it. The context in which a particular action appears – whether in a remedy or in a patient—shapes and defines its meaning. Take the example of Paralysis. Its import shifts depending on the surrounding descriptors. When paired with a word like Neuralgic, it suggests a clinical picture of neurological disturbance culminating in paralysis, as seen in remedies such as Causticum. When combined instead with terms like Debility, Congestive, or Weakness, it conveys a different functional sequence – one of exhaustion and loss of muscular control, as in Gelsemium. Thus, the same word may bear entirely different significance in entirely different contexts.

When we, as homeopaths, recognize these contextual sequences, we are putting into practice the very principle of holism. Hahnemann’s instructions on remedy correspondence—and indeed the very essence of homeopathy—find concrete expression in the Monogram. Here we perceive the patient’s patterns of action as a living phenomenon; this is the language of nature itself, and its significance cannot be overstated.

This tool, as developed and refined by the master duo Dr. Tarkas and Dr. Kulkarni, is, by far, the most accurate, meaningful and objective tool we possess for representing the holistic nature of both remedy and patient.

Once we have drawn the outline of the patient by identifying his characteristic patterns and modes of action, we have, in effect, constructed the silhouette, the initial sketch of the patient’s image, being combined with disease potential. From this foundation, we can then turn to the specific symptoms and case details, gradually filling in the picture with its true colours and finer nuances.

Hahnemann did not randomly refer to homeopathy as “the art of medicine”.

CASE EXAMPLE

A 37-year-old woman, 163 cm tall and weighing only 42 kg, presented with a long-standing inability to gain weight, persisting for the past ten years. She is markedly emaciated, with wasted musculature and pronounced weakness. Her health has remained fragile since her remission from uterine cancer.

She suffers from a chronic inflammatory condition of the intestines, characterized by extreme bowel activity with explosive diarrhea, nausea and vomiting.

Notably, all her illnesses and crises have followed episodes of nervous breakdown.

The patient is profoundly exhausted, saying she “barely gets through the day because of fatigue.” She repeatedly emphasizes that she has no energy.

“Every event brings me to my knees, and I can’t recover from it,” she explains. She becomes not only tired and depressed, but also reactive and hysterical, concluding with despair: “I can’t live like this.”

Before delving into the finer details of the case, it is essential to discern the patient’s fundamental patterns of action. This is precisely what Hahnemann emphasized in his doctrine of holism. I must observe the patient as a whole, along with the complete narrative I have recorded. I highlight the key lines, and in the margin I note the recurring words that characterize her essence. Then I ask myself: what are the governing laws of this phenomenon we call “her”?

This is just one example of how a case can be “framed.”

At this stage, I turn to the top of my case-taking sheet. On every intake form, there is a blank space reserved for noting the words that capture the patient’s functional nature.

For this patient, the words I have written to describe her vital dynamics are:

 

 

 

In this way, I construct the general framework of the case before me. There must, of course, be a clear correspondence between the patient’s mode of action, her functional patterns, and those of the selected remedy.

In this instance, the Monogram keywords unmistakably indicate the Tubercular miasm in transition toward the Syphilitic. The patient is hysterical, highly reactive and subject to periodical pathologies; she is emaciated and weak. Her chronic intestinal inflammation, persisting over years, is heading in a bad direction.

When I examine the Monograms of different remedies, I attend not only to the individual words but also for the connections between the sequences. For example, many remedies carry the descriptor “hysterical” in their Monogram, such as Pulsatilla, Ignatia, Tabacum, Sumbul, Nux moschata and several others. Yet in this case, I must focus only on those remedies where hysteria leads directly into exhaustion and neurasthenia, for that is the sequence of events evident in this patient. Consequently, most of the remedies mentioned above can be excluded.

The same logic applies to all other Monogram descriptors. At this stage, we must determine whether the patient’s functional patterns are not only present in the remedy, but also appear in the right order, with the correct emphasis and within the right miasmatic context. For example, we recognize that Psoric hysteria does not culminate in nervous exhaustion or collapse; its expression remains far more superficial.

The very idea of looking beyond the simple black-and-white printed word, whether on paper or screen, is something that can be very difficult for those unfamiliar with the deep teachings of Dr. Hahnemann and his successors to grasp. This is precisely why we call our profession the art of healing. We do not merely read words; we perceive them in their living manifestations, through a multidimensional lens.

In accordance with the patterns, I have outlined as characteristic of this patient, I found in the Absolute Materia Medica the following monogram under the remedy Vanadium.

 

 

Vanadium was the remedy prescribed for the patient. Its action stimulates the vital force for only a brief span—what is often, though mistakenly, referred to as a “short-acting remedy.” Yet this was precisely what was required: a means of gently nudging her out of the vicious cycle of stagnation – stagnation born of weakness and lack of strength, weakness arising from collapse and collapse itself triggered by hypersensitivity… and so on the cycle perpetuates.

She was given the remedy for two months in gradually increasing LM potencies.

Two months later, the next prescription—Calcarea Hypophosphorosa (Calc-hp)—was administered, and it fostered an impressive recovery.

MONOGRAM: BEYOND A SURFACE LAYER

Symptoms, the primary tool that guides us toward the correct remedy, are only the surface layer. They represent but one facet of a larger whole, and in truth, they remain meaningless unless viewed in light of the sequence and the connections that bind them together.

For what is homeopathy, if not the practice of medicine rooted in a profound understanding of holism, the recognition of existence as an indivisible whole and of the infinite interdependence of its parts?

What is homeopathy, if not the wondrous practice of holism in its purest form and the understanding of holism within that incredible phenomenon we call the human being?

And how are we to grow into better human beings, and better healers, if not by shedding misguided perceptions, filling ourselves with clarity and refined insight, and learning to observe phenomena as they truly are?

(The readers are requested to refer to the chapter “Monogram: From Multitude to Access” from “Homeopathy through Harmony in Totality Second Volume” authored by Dr Ajit Kulkarni. There is also a revised version of the chapter.)

___________________________________________________________________________

 

2. MONOGRAM CONCEPT IN HOMEOPATHY: METICULOUS ANALYSIS OF CLINICAL APPROACH

 

Alexander Martuishev M.D. Ph.D. M.F. Hom. Moscow, Russia

Clinical approach

The most remarkable merit of Dr. Ajit Kulkarni’s article on the Monogram lies in its profound and meticulous analysis of the clinical approach – particularly in highlighting its limitations. This critical evaluation is invaluable, since the clinical approach constitutes an essential instrument in homeopathic methodology and understanding both its strengths and drawbacks is vital for any meaningful application.

Homeopathy’s clinical approach stands in marked contrast to that of allopathy. While the latter tends to localize its understanding of disease – focusing narrowly on the affected organ or system – the homeopathic perspective embraces a holistic vision of the human being, integrating body, mind and vital force into a unified whole. Dr. Kulkarni’s exposition rightly underscores the inadequacy of relying exclusively on symptomatic diagnosis or laboratory data. True comprehension, he reminds us, emerges only when we consider the entire organism as an interconnected system.

An important insight raised in the article is the distinction between diagnosis and disease. Modern medical practice often equates the two, but as Dr. Kulkarni (and classical homeopathy assert), not every disease bears a diagnosis and not every diagnosis captures the essence of disease. This conceptual clarity serves as a necessary corrective to reductionist tendencies in clinical reasoning.

Keynote approach

I particularly appreciated the author’s discussion of the keynote approach. Although it holds a certain pragmatic appeal, Dr. Kulkarni astutely observes that excessive reliance on keynote prescribing risks fragmenting our understanding of the patient. The keynote method, while expedient, may divert both physician and patient from perceiving the totality of symptoms essential for identifying the true similimum. Nevertheless, its potential to hasten provisional relief (even if through partial similimum) is acknowledged and respected.

Dr. Kulkarni’s presentation of the Monogram concept is nothing short of pioneering – a genuine innovation in the study and teaching of Materia Medica. The Monogram offers a synthetic and integrative framework for exploring remedy relationships, thematic connections and clinical correspondences. It provides an invaluable means to penetrate deeper into the Materia Medica, enabling a homeopath to perceive interlinkages among remedies, remedy sections and clinical entities.

Need for Monogram repertory

However, for the Monogram method to achieve its full potential, practical implementation is indispensable. One promising direction would be the creation of a Monogram Repertory, in which each rubric represents a Monogram term, accompanied by the remedies that share this Monogram attribute. Establishing cross-references with existing repertories such as Complete or Synthesis could further enrich this tool, offering insights into remedy relationships during case-taking and analysis. Through such cross-linking, additional Monogram attributes might surface, revealing subtle connections otherwise overlooked.

This proposed repertory could evolve into a powerful aid for refining remedy selection – helping physicians to identify or hypothesize the similimum through distinctive constellations of Monogram attributes. Such a development would not only advance the practical utility of Dr. Kulkarni’s concept but also deepen our collective grasp of remedy essence and its dynamic manifestations.

In his analysis of the clinical approach, Dr. Kulkarni also raises significant epistemological questions regarding the concept of disease. Though his discussion remains more suggestive than definitive, it opens an avenue for further elaboration. To enhance conceptual clarity, the notion of “disease” may be revisited through the Hahnemannian framework as outlined in the Organon of Medicine (Aphorisms 3, 6, 11 and Preface).

The concept of disease

According to Hahnemann’s view:

Disease as change

Disease is a deviation from the former harmonious state of sensations and functions – a dynamic alteration discernible only through observation or patient sensation. What remains constant (such as temperament, habitual desires or constitutional tendencies) is not considered morbid in itself and thus lies outside the sphere of curative action.

Disease as dynamic process

The morbid state is inherently dynamic – ever in motion and subject to change. The manifestations of disease vary with time, circumstances and modalities – physiological, physical or environmental. These modalities (for instance, sensitivity to temperature, touch, weather or water) are vital indicators of altered susceptibility and must be comprehended in their evolving context.

Disease versus disease products

Disease, in Hahnemann’s terms, is distinct from its material consequences or “products.” Pathological deposits, discharges and tissue changes are not the disease itself but rather its secondary expressions. They neither sustain nor produce the disease process and should not distract a physician from addressing the dynamic disturbance at its source.

These fundamental principles illuminate Dr. Kulkarni’s reflections on the clinical approach and affirm the Monogram’s value as a tool for synthesizing the dynamic, totalistic view of disease. His contribution thus marks a significant step toward restoring the holistic integrity of homeopathic thinking and practice.

___________________________________________________________________________