Objective analysis of the case: Twenty points of data processing

BLUEPRINT TO USE HOMEOPATHIC PHILOSOPHY AND ORGANON INTO CLINICAL PRACTICE

 Introduction

The three pillars on which the bedrock of homeopathy is based are:

• Data receiving (gleaned through skillful interview and documentation of data
• Analysis (separation of data into its constituent elements) and evaluation (estimation of constituent elements) and
• Synthesis (making a portrait out of the composite totality).

The objective is to perceive the quintessence of the sick individual and identify the real sickness. The process is to recognize its counterpart in the homeopathicmateriamedica and repertory.

Totality renders quintessence. We need ideas, concepts, imaginations and fantasies to perceive the multifarious dimensions of totality but they should not be at the cost of throwing away the hard facts! The objective is to fathom the sickness and to fish out the remedy and this should not be sacrificed for running after ‘megacephaly’ travel!

An attempt has been made in this article to present the unified approach of objective analysis of data. This is important for the standardization of homeopathy as a scientific discipline. A lot of prescribing methods are used in homeopathyand often a student gets confused and frustrated.

The comments related to each recipe are related more to the practical implications that flow from the data.

Unified approach to data processing

1. Nature of the disease

• Acute/per acute/acute on chronic (exacerbation)
• Sub-acute/chronic/remission
• Mixed/messed: natural + iatrogenic
• Physical/psycho-somatic/somato-psychic/psychiatric/auto-immune
• Clinical diagnosis

Comments

The nature of disease has to be defined. It is very important for the entire management of a case.

The term ‘acute’ may be confused with ‘severe’. However, not all acute diseases are severe. For example, many acute respiratory infections and acute gastroenteritis cases are mild and usually resolve within a few days.  The term ‘acute’ is also included in the definition of several diseases, such as severe acute respiratory syndrome, acute leukemia, acute myocardial infarction, acute hepatitis, etc. This is often to distinguish diseases from their chronic forms, such as chronic leukemia, or to highlight the sudden onset of the disease, such as acute myocardial infarct.

Diseases are acute or chronic to a homeopathic physician not by their duration but by their characteristic expressions viz. the mode of onset, intensity of the signs and symptoms, the speed of the progress and the manner in which they terminate.

Per acute, means very acute or violent and it is characterized by very rapid onset and progress.

Acute on chronic, refers to an acute exacerbation of a chronic condition. It is applied to a variety of conditions, such as liver, renal or respiratory failure, bronchitis etc.

Acute on chronic inflammation, is a term used to describe a pattern of inflammation which is a mixture of chronic and acute inflammation. It may be seen in asthma, rheumatoid arthritis, chronic peptic ulcer, chronic periodontitis, tuberculosis, tonsillitis and other conditions. Diseases, which appear periodically or as episodic disorders, despite their suddenness of onset and violent expressions, are not acute diseases, but they are acute exacerbations of (a progressive) chronic disorder underlying them. In other words, these are the chronic diseases of a relapsing nature or periodical (regular or irregular), interspersed with acute attacks/episodes. Remember, you are here treating chronic disease.

Acute on chronic or acute on chronic inflammation actually requires the same way of work for a homeopath; it’s acute of two different chronic situations but at another view, they are the same.

Remission refers to a diminution of the seriousness or intensity of disease; this implies the recovery phase. It is a period of time during a serious illness when the patient’s health improves. To exemplify, the cancer is in remission, it means that it is manageable and not getting any worse. Remission can be temporary or permanent.

Sub-acute is somewhat or moderately acute in nature and it is an intermediate stage between acute and chronic. It is a poorly defined state. Sub-acute endocarditis or sub-acute sclerosingpanencephalitis (SSPE) are some of the examples. If the inflammation is persisting longer than 3 or 4 weeks, it can be called as sub-acute.

Chronic refer to a long-term condition. In chronic diseases, the march of events occurs in a lower key. The chronic disease lasts for a longer period of time and progresses slowly (in a relentless manner) towards destruction unless aided by the similar force.

Acute versus chronic: Notable points

• There is nothing like an acute remedy or a chronic remedy.
• Indications on which the remedy is based on matters the most.
• Every remedy has both acute and chronic dimensions in its pathogenesis.
• It may be wrong to believe that acute remedies are superficial.
• Acute can be a different state altogether and it should be treated separately from the constitutional state. The remedy should be selected on presenting acute totality. Don’t intermingle acute with chronic.

• There is nothing like an acute state and all acutes are a part of expression of the constitutional dyscrasia. Hence a remedy based on constitutional state can be the same remedy for acute episodes.
• Hence one should try to understand the whole state and on the background of the whole state, understand the acute disease phenomenon.

All these points are correct in their own way but it is the individual instance that determines the relevant application of each of them.  To illustrate, a case of bronchial asthma was given kali carb as a constitutional remedy. The acute exacerbation of bronchial asthma manifested the totality that pointed to the same remedy i.e. Kali carb and it helped in an acute attack.

A case can be a messed/mixed one due to a drug miasm. Here, it is necessary to know the (side) effects of chemical drugs that are increasingly consumed by the patients. One may require to antidote the side effects through the use of tautopathic drugs; these drugs may be interspersed in between with the constitutional treatment. There is a good rubric, ‘generalities; intoxication, after; drugs’ in generalities. However, a remedy can be outside this rubric, based on the totality. In a way we have to separate pathognomonic symptoms from non-pathognomonic ones, we have also to differentiate between natural disease symptoms and the side effects of the drugs.

If the case has been defined as psycho-somatic mixed, the focus should be on treatment of the mental state. Focussing on trivial and common physical symptoms will not yield results.

In the somato-psychic mixed case, it is advisable to focus on the type of pathology and location + the supervened mental state. Here, focusing only on the mental state has its pitfalls.

In psychiatric disorders, it is necessary to define the problem, and to clinically diagnose the condition. A homeopath must study both classifications – ICD-10 of WHO and DSM-5 of APA. Good command over personality structure, understanding of remedies and also of rubrics of repertory is a must for handling these difficult cases. The recent advances in psychology and psychiatry must be used by a homeopath for data processing and for selecting the rubrics and the remedy.

Auto-immune diseases pose a problem in the management of a case. Why the immune system failsto recognize the difference between healthy body tissue and antigens? Why there is destruction of normal body tissues? This is a matter to ponder. Focussing on miasmatic activity (dominant and fundamental) and defining the cause at mental level and assessment of the susceptibility is useful.

Immuno-suppressive treatment should not be abrted abruptly.

No one should underestimate the value of clinical diagnosis, although a homeopathic physician should not prescribe upon the label of the disease. The nomenclature of the clinical condition itself should not be taken as a determinant rubric. Many homeopaths take clinical rubrics as a shortcut. Remember, there are no shortcuts in homeopathy.

The evolution of disease is significant from homeopathic phenomenology. A simple cold may be an indisposition, or it can be beginning of a clinical entity like measles or it can be manifestation of a deeper pathology such as malignancy. The evolution helps to know the totality as a unit. Totality is cause and effect merged together. Totality is one spectrum, one unit. Pre-clinical and diagnostic phases of the disease are part of the totality. The stages characterize the time the system takes for form, function and structure – the trinity in which the phenomenon occurs.

2. Phase of the disease

• Pre/sub-clinical/clinical

• Functional/structural/ end stage disease

• Fully developed/inadequately developed

Comments

Pre-clinical or Sub-clinical phase istheperiod that precedes the clinical manifestations. It is the prodromal stage where diagnosis can only be suspected on the basis of anticipation. Here the illness stays below the surface of clinical detection. Many diseases, including diabetes, hypothyroidism and rheumatoid arthritis are frequently sub-clinical before they surface as clinical diseases.

Homeopathy, being a constitutional therapeutical system, has a role to play in sub-clinical phase of the disease. It is the skill of a homeopathic physician to find an appropriate remedy in acute or chronic subclinical phase of the disease. The patient may manifest some characteristic symptoms even before the full-blown disease is available and they can help to select the remedy. To exemplify, concomitant symptoms before, during and after fever can be of substantial help to select a remedy.

Clinical phase: Here the disease gets localized and diagnosis becomes a certainty. In other words, an illness becomes a disease.

There is a tendency amongst homeopaths to neglect the clinical entity and to focus only on individualizing features. The experience esp. in acute cases, suggests that not all cases do respond to remedies selected on PQRS symptoms that are unrelated to the clinical domain. Many times, a combination of clinical + PQRS symptoms help tide over the crisis.

Functional phase is characterized by the absence of organic or structural changes. There are sensations as if and investigations yield no pathological changes. It is observed that patients of functional phase have psycho-somatic problem and treatment of the mental state is more important. Patients possessing functional phase of the disease are found to be more of psoric (including latent) and sycoticmiasms.

Structural phase is characterized by pathological changes in tissues. The role of investigations is important here for fixing the diagnosis and also in the follow up of a case. Organotrophic remedies have their place and though constitutional prescribing has an edge in classical homeopathy, pathological remedies do have their own field of operation.

The concept of adequately or inadequately developed phase of the disease is related in homeopathy to the manifested totality of expressions. It is not only from clinical standpoint. To illustrate, in a case of primary prostate cancer, with metastasis in liver and vertebrae, one may argue that the cancer is not fully developed as it has yet to spread in all organs of the body. This is not true. Availability of characteristics is the chief criteria to define if the disease is adequately or inadequately developed. More stimuli, more concomitants and more individualizing symptoms mean that the susceptibility is high and there is a plethora of symptoms to denote that the phase is adequately developed. On the other hand, less characteristics, fewer concomitants denote inadequately developed phase of the disease.

3. Affinity /location/extent of the disease/domain

• Cells/ tissues / organs/ systems/sides (extension, syndrome shifting etc.)

Comments

Affinity deals with localities that are accentuated by the deviant energy of the disease. Here we see the anatomical part of the disease. The system may come out with the same tissues being affected in different systems.

The attraction towards organs is related to biological inferiority concept due to which some tissues or organs become vulnerable and this is determined by the genetic milieu. Even the sides of the body (right, left, right to left or left to right or diagonal) bear the brunt of inferiority.

Every human organ has its symbolic language and it can be linked to the emotions and the life of a person. This is an interesting field of application of homeopathy.

In the absence of mental or physical generals, localities do play a vital role. Also, localities and other components make one integrated whole to prescribe upon.

4. Pathology

A.Type of pathology

• Atrophic.   Benign.   Calcareous/Lithiasis.Cancerous. Caries. Degenerative.  Destructive.  Dysplasia. Emaciation. Embolic. Fibrotic. Gliosis. Hemolysis. Hemorrhagic. Hyperplasia. Hypertrophy. Hardening/Induration. Inflammation (serous, fibrinous, catarrhal, granulomatous, pyo-granulomatous, fibronecrotic, lymphocytic, suppurative). Leukoplakia. Melacoplakia. Metaplasia. Necrosis. Nodular. Proliferation. Sclerosis. Thrombotic. Ulcerative.Venous.

B.Etio-pathogenesis of the disease

• Allergic. Ischemic. Rheumatic. Excess/deficiency.

Comments

Pathology is the accentuated and concentric energy of the disease that gets reflected at the tissue level. One of the absorbing aspects of homeopathy, is the mirrored reflection of pathology in our remedies. It flows directly from the observation of cure by similars – as that which cures directly mirrors that which needs to be cured. The pharmacology and pathology are two inseparable reflections of one another. A result of this direct reflection of the nature of disease vis-à-vis the nature of our remedial substances is that we cannot separate our knowledge of disease – our pathology – from the knowledge of our remedies.

Pathological types abound! The lesions are of innumerable types. The causes are legion, including nutritional and assimilative. There are huge metabolic alterations, acquired or genetic. Our materiamedica and repertory are replete with them and many times it is necessary to use the relevant rubrics esp. in the absence of the mental generals.

There is a class of homeopaths that upholds that only the mind of the patient has to be treated. Mind is definitely to be treated but the body is not just for decomposition; it must be treated too!

Remember, mind and soul stay in the holy temple of the body!!

Pathology renders the behaviour of tissues of a certain pattern and it denotes the individual disposition. It is not a good idea in all cases to hold that consideration of pathology means paying less attention to individualizing features of a case. In many cases, pathology, miasmatic activity and mental state run parallel and a beautiful matrix of them allow select an appropriate remedy.

1. State of pathology

• Borderline
• Reversible
• Irreversible

Comments

The division of pathology into respective states is important from the management point of view. Miasmatic activity can be assessed on the basis of the division. Posology-selection of specific potency and repetition schedule can be planned if we understand the state of pathology.

There can be, however, a difference of opinion between conventional or mainstream physicians and homeopathic physicians as to the curability of a case.

5. Pattern of response

Sudden.   Alternating.   Changing. Continuous.  Erratic.  Regular.  Irregular.  Paroxysmal.   Periodic.   Lingering.    Shifting.   Progressive.  Recurrent. Static.

Comments

Repetition and periodicity are basic to define the pattern of response in a patient. It is a pattern if it occurs repeatedly and it should not be inferred on the basis of a single occurrence. Remember, constituents are not patterns but mere data components. When the system throws out a recurrent set of characteristics or behavioural order of the same type, it is the language of the system and it carries utmost importance in the selection of the remedy.

The concept of the pattern is based on the doctrine of generalization. Patterns build up the portrait, the conceptual image of the patient so necessary for selection of a remedy. The pattern emerges out of the self-organizing principle of the system. In pattern lays the essence, the threads that bind all essential constituents of the data. With the use of the patterns, a homeopath follows the system’s behaviour and he is not lost in the warren of symptoms.

Pattern can be one, two or even multiple. Accordingly, the processing of the data and selection of rubrics will change.

Explanation of some PATTERNS

• Continuous is marked by uninterrupted extension in space, time or sequence. It denotes the ceaseless activity of the disease process.
• Progressive means increasing in severity or extent. The response is not only continuous but heading towards more morbidity, more deep affection, investigations suggesting exorbitant values.
• Erratic pattern is marked by unpredictable, variable, inconstant and turbulent response. It denotes uneven or irregular pattern.
• Lingering means lasting for a long time or slow to end the process.
• Irregular means occurring at uneven or varying rates or intervals. The system doesn’t follow the regular or normal pattern.
• Shifting means moving from one organ to another.
• Changing doesn’t mean only moving from one to another. It means different symptoms, not present earlier. The system comes out with a different set of symptoms as a presentation.
• Static is the unmoving state. No change occurs with the indicated remedy(ies). The vitality can’t be aroused. In such cases, the role of intercurrent remedies esp. Nosodes comes up.

6. Pace of the disease

Rapid. Slow. First rapid then slow. First slow then rapid. Moderately rapid. Moderately slow.

Comments

The speed with which the disease process evolves is important not only from the prognostic point of view but also from the miasmatic point of view. Every remedy in materiamedica has its own pace. It is the state of susceptibility (under miasmatic activity) of an individual that determines the pace.

To exemplify, Arsenic, Aconite, Belladonna, Phosphorus, Pyrogen etc. have rapid pace while Agaricus, Bryonia, Causticum, Plumbummet etc. have gradually developing pathologies.

When we talk of similarity, it should not only be at symptoms level but also at the level of the pace.

The speed is related to the appreciation of dimensions of time and space. The anamnesis of the case, ODP (Origin, Duration and Progress), the course of the clinical condition, changes in the march of the disease process, pathological investigations, the age of the patient etc. have a place here.

7. Expressions

(+ = scanty, ++ = moderate, +++ = ample)

1. The field of modalities: general particular
2. The field of sensations: general particular
3. The field of symptoms: pathognomonic non-pathognomonic

common               characteristic

1. The field of gestures: common characteristic

Comments

The expressions are grossly classified as common/uncommon, general/particular, pathognomonic/non-pathognomonic etc. It is because of susceptibility that the expressions change and get manifested.

The analysis of expressions helps distinguish between clinical and individualizing symptoms and also assess the state of susceptibility so essential for posology.

8. Miasmatic diagnosis

• Dominant / active
• Fundamental
• Combined

Comments

Every person has all the miasms but their activity variesat that moment in time. At a given time one miasm is preponderant in its activity.

Dominant miasm is to be deducted from prominent expressions of disease at the time of prescribing.

Fundamental miasm is to be arrived at or indicated by the history of diseases in the family tree. The judgment regarding treatment is based on dominant miasmatic phase. Evolutionary disease response is always multi-miasmatic; but at a particular point/time, one of the miasms seems dominant.

Combined miasm: There may be more than one miasm evident at different stages of treatment. Accurate anamnesis and careful analysis are essential for knowing different phases in combined miasms.

Dominant miasm and fundamental miasm may be the same in some cases. In the process of evolution, under adverse environmental stimuli, the basic energy of fundamental miasm may get activated and it can replace the dominant miasm. It is interesting to see how the system is pulled with the basic energy activation.

Criteria for deriving fundamental miasm.

It is difficult to assess the fundamental miasm in an accurate manner. But the following points may help to deduce the fundamental miasm.

Psora

No major illness in the family. All apparently enjoying health. Functional illnesses. Skin disorders. Allergies. No death in the family from serious illness.

Sycosis

Benign growths. Hypertension. Polypus. Fibroids. Cysts. Asthma. Rheumatism. Chronic bronchitis. Neurosis. Diabetes mellitus. Warts. Haemorrhoids. Long continued chronic diseases but no history of sudden death.

Tubercle

Tb/pleurisy. Epilepsy. Ulcerative colitis. Weight loss. Psychopathic personality disorder. Hemorrhagic disorder. Atrophy. Manic-depressive psychosis. Leprosy. Glandular affections. Allergies, severe. Angio-neurotic oedema. Sudden death in the family.

Syphilis

Deformities/anomalies. Cancer. Locomotor ataxia. Syphilis. Stroke. Degeneration. Paralysis. Schizophrenia. Psychosis. Infarction: heart, brain. Pernicious anaemia. Sudden or multiple early deaths in the family due to strong diseases.

9. Sensitivity

• High / moderate / low

• Mind
• Nerves (Body)

Comments

Sensitivity denotes the reactivity of an organism to sensory input (s). It is the capacity of a living organism to feel and respond to any stimulus. Sensitivity has to be assessed at mind and nerves (i.e. body level) through three aspects viz.

Low: Scanty availability of stimuli and poor level of reactivity.

Moderate: Moderate level of reactivity.

High: High level of reactivity to sensory inputs.

Remember, it is healthy to be sensitive. But as a homeopath, we have to decide the altered state of sensitivity. The concept of input and output, the stimulus and reaction are to be studied in the totality of expressions.

10. Susceptibility

• High / moderate / low / static

Comments

Susceptibility denotes the capacity of an individual to react to any form of stimulus. It is by dint of this susceptibility that an organism reacts when a disease (that acts as a stimulus) inflicts the individual who casts out variable expressions.

Low: Scanty availability of expressions and poor level of characteristics; morbid.

Moderate: Moderate level of expressions.

High: Ample characteristics.

Static: Although susceptibility is a dynamic state, it remains at a certain level unmoved and it is observed that such cases respond to certain potency, not above or low. In such cases, an intercurrent remedy interspersed at right time may arouse the vitality and remove the static state.

Remember, similarity has to be achieved not only at the level of expressions but also at the level of sensitivity and susceptibility.

It must be noted that susceptibility includes sensitivity.

Path: The direction and movement of illness indicate the way sensitivity and susceptibility develop e.g. If a disease process is evolving from the functional to the structural zone with a concomitant diminution in characteristics, the path of sensitivity and susceptibility are indicated as heightened à moderate à low.

Appreciation of susceptibility when a homeopath begins the treatment and during the treatment is a good criterion to assess if the case is steering towards the right direction or not.

11. Suppression

• Mental
• Physical

Comments

A lot of confusion prevails amongst homeopaths as to the concept of suppression. It is known that the immune-suppressive agents used by mainstream medicine, suppress and cause deeper affections. Some people think that homeopathy also suppresses. I do not approve of the idea as homeopathy is based on the fundamental natural curative principle of similia. I agree that antipathy may suppress. But if you are using “homeo”-pathy, it is difficult to agree. It is expected that to prescribe on the basis of Law of Similars when you are practisinghomeopathy. If someone is not following the similia, how it can be a therapeutic science of homeopathy? For example, a patient’s acute urticaria is better with the hot application and a homeopath is prescribing Apismel, it is difficult to call it as a homeopathicremedy in the true sense.

Should we change the name of “Homeopathy” to “Homeo-antipathy” if we believe that homeopathy suppresses?

Confusion as to relief, palliation and suppression needs to be resolved. Palliation is when the symptoms return to their normal chronic state immediately after the removal of the continued treatment. Let us take an example. A patient of urticarial is given a dose of Sulphur 200 and he is free from urticarial symptoms for the last three months. Is it palliation? No. It is the action of a remedy, which lasted for three months. Relief of right order is not palliation. If the patient was on Sulphur 200 daily and if the symptoms return after missing one or two doses, it is palliation.

Suppression is whenthe presenting signs and symptoms are replaced by the stronger and more dangerous symptoms than before. We have full evidence that a deeper layer of the vital economy (through the affection of vital organs, deep pathologies) has been affected and it is confirmed through cause àeffect relation.

A return of old chronic symptoms after the previously successful administration of a remedy should not be viewed as failure or suppression or removal of a layer. Its just an exhausted action of a given remedy. It may be a positive signal in view of Hering’s direction of cure.

Some patients prove every remedy due to their high sensitivity. This should not be linked to suppression. Such patients are rare on the planet. They should be given low potency as a single dose and repetition should be cautious.

Notions about relief, palliation and suppression are based on our fundamental knowledge of the clinical condition-clinical features, evolution, stages, and complications. It is unfortunate that natural evolution of a disease process is regarded as suppression if the apparently indicated remedies don’t help the case.

In cases of suppression, frequent doses of the tautopathic drugs, the interpolation of an intercurrent remedy and even of constitutional remedy are needed. The rubrics ‘Generalities; intoxication, after; medicaments and Generalities; reaction; lack of and rubrics related to suppression should be studied.

12. General vitality

• Good / moderate / low

Comments

Vitality represents strength possessed by the system, the ability to resist the morbific force, to tolerate the onslaughts and respond to the medicinal force. Each individual is unique in his reservoir of energy, determined by hereditary and environmental factors.

The transitional march from Psoraà Sycosis à Tubercle à Syphilis demonstrates a progressive depletion of energy; the disease evolving from the functional to the structural zone; structural changes then progressing from reversibility to irreversibility.

Practically every function in the human body exhibits circadian rhythmicity. We all know that vital signs (measurements of the body’s most basic functions)routinely monitored are body temperature, pulse rate, respiration rate (rate of breathing) and blood pressure. They are no doubt useful for the physiological status in critical conditions. In addition to vital signs, the concept of assessment of vitality in homeopathy is also related to overall immunological status, to the strength and vigour and availability of PQRS symptoms and if the system is able to mobilize itself against the morbific forces.

The various investigations in clinical practice are the parameters to gauze the damage that has occurred at the cell level. All these eventually give us the status of general vitality possessed by the system. Hence there is a definite place of investigations in homeopathic practice. This study is useful not only for clinical assessment but also for determining the potency selection and repetition schedule.

13. Monogram

• Pathological generals
• Intertwining elements
• The consistent behaviour of tissues or system

Comments

(The readers are requested to read my article on ‘Monogram: From Multitude to Access’.)

The monogram is a remedy’s signature. It is a piece of art for adorning the esteem of a remedy. The monogram is the essence. It unifies the essential threads and renders the fabric. The monogram is like the genetic encoding where the information of a remedy is programmed. It is a pattern developed out of the repeated behaviour of the system.

Let us understand it through a case.

A female, aged 38 years. A diagnosed case of rheumatoid arthritis. < winter; since 10 years. Eggs & chocolates = eruptions and itching. Varicose veins, since 8 years.  Recurrent tonsillitis, < winter, since childhood. Chilly. Recurrent attacks of acidity and gastralgia, since 6 years. Distension of abdomen with flatulence. Currently, lost 8 kg. Weight within 3 months. Investigations à Hodgkin’s lymphoma.

Monogram of this case is

Rheumatic. Allergic. Venous. Glandular.

Dyspeptic. Cachectic. Cancerous. Chilly.

Monogram is based on the concept of generalization. It was developed and made popular by Boenninghausen and Boger. We have tried to make the concept more refined and user-friendly. Deriving the monogram helps to see beyond the known dimensions of a case, of a remedy or of a group.

14. Dispositions

• Temperamental/personality traits

Comments

“This holds good to such an extent, that the state of the disposition of the patient often chiefly determines the selection of a remedy, as being decidedly a characteristic symptom which can least of all remain concealed from the accurately observing physician” – Dr.Hahnemann, § 210-212, Organon of Medicine.

Disposition is a basic quality/attribute/character/temperamental trait. It can be inborn or evolved as a response to the environment when the system has to sustain the perpetual stress. It is consistent, persistent, and it has a sort of permanence. Dispositions are the natural tendencies of each individual to take on a certain position in his life.

It is the skill of a physician to derive the dispositions of an individual out of the data that has been elicited. Matching the dispositions of a patient with that of a remedy in MM (with or without the use of repertory) makes the homeopathic practice personalized. You are then not only after the form of symptoms, but after the personality.

15. Body language

• Totality of all elements of body language and then finding the essence

Comments

Body language is the confluence of mind and body. It represents a living synthesis, which integrates the functioning of mind and body in dynamis. The mind dominates because it is powerful in strength and speed. The mind dictates and the body obeys.

Body language is a unique physical discipline and entity in which emotional, psychological, spiritual, intellectual and creative energies are unified and harmonized. Our body feels, thrills, speaks, memorizes, expresses and communicates effectively through various movements. Yet, body language is one of the least used and least understood forms of human communication.

Our bodies are ambassadors of our inner self. They convey more than what our tongues do. Research has shown that 35% of the messages are conveyed verbally while 65% of them non-verbally. The concept of totality will be redefined if we include the study of body language in analysis, evaluation and synthesis of data.

A remedy should not be selected on the basis of an isolated gesture but on cluster of gestures. It is necessary to focus on modes of body language, consistent and transition gestures, patterns and vital signs. Remember, verbal language is understood better when one combines non-verbal language with it.

16. DefenCe mechanisms

• One of the promising tools of data processing

Comments

The use of defence mechanisms for the sake of data processing is a promising field. Defence mechanisms are the techniques of coping mechanisms that reduce anxiety or suffering in general that are generated by threats from unacceptable or negative impulses. Defence mechanisms may result in healthy or unhealthy consequences depending on the circumstances and frequency of the mechanism used. When the unhealthy responses become pathological, the system becomes more morbific.

Note that the evolutionary totality of the patient is required for using the tool of defence mechanism.

Following fifteen defence mechanisms have been studied in depth in psychology and every homeopath must know their characters. 1. Omnipotence. 2. Idealization-devaluation. 3. Isolation. 4. Projection. 5. Introjection. 6. Denial. 7. Turning against self. 8. Isolation of affect. 9. Undoing. 10. Regression. 11. Repression. 12. Acting out. 13. Displacement. 14. Withdrawal. 15. Identity loss.

Letusexplain ‘identityloss’ as a defencemechanism.

Identityloss

Thismechanismprojects a dependentpersonalityandischaracterizedbytheexcessiveandconstantnecessityforcareandhelp. Such a personusesthetechniqueofextremeyieldingandservileconduct. Thereisa fearoflosingsupportandhence, thereisclingingbehaviour. Theemotionalcontentofthispersonalityincludesforsakenfeeling (delusional), discontentmentwithself, feelingofbeingunfortunate, incompetent, helplessandanxiousabouttrifles. Conceptofselfisof a weak, helpless, insufficientperson, withnecessityofconstantsupport, lowconfidenceandinferiorityfeeling. Positivesaredelicate, caring, cooperativeandcompassionate.

Duringchildhood, thispersonwasundercontinuousexcessiveguardianship, wardship, guidanceevenintrifles. Duetoparents’ anxietyortochild’sdiseases, orforthesakeofsecurity, thechild’swillpowerwassubstitutedbytheparents’ willandthechildwasdevoidofindependentandautonomicactivityanddecisions. Obedienceandpassivitywerestimulatedandimplantedbyallmeans – sothepersonalitygrowswiththefirmbeliefthatsomefigurewillalwaysbeneartofulfilallwishes.

Rubricsfor ‘identityloss’ couldbe

Confusionofidentity, dependent, helpless, yielding/submissivedisposition, holdingorbeinghelddesirestobe, clinging. Fearaloneofbeing, servile. Will, lossof.

Someoftheremediesfor ‘identityloss’

Alumina, Bar-carb, Bismuth, Borax, Calc-carb, Lac-can, Kali-carb, Pulsatilla, Saniculaetc.

17. Repertorization

• Rubrics: Essential/crucial/determining characters

Comments

Homeopathic repertory is a qualitative tool. It should not be regarded as a mere quantitative compilation of symptoms or rubrics with related homeopathic remedies. It is an instrument of ‘refined’ wisdom. Homeopathic repertory has originated from materiamedica. Hence it encompasses the wisdom of materiamedica. The repertory is a micro-filming of materiamedica. However, although retaining the essence of the symptomatology of materiamedica, it has its own individuality and characteristic form. It helps to fulfill various pitfalls which diverse patients present to a homeopathic physician.

Boenninghausen’s concept of grand generalization, Kent’s stressing on the polarity of specification and Boger’semphasizing on the pathological generals are the three fundamental approaches of repertorization. With their logical and coherent approach, they carved out the quintessential tool of repertory for the homeopathic physician. Boger was able to blend his exemplary knowledge of pathology with his precise, concise and artistic way of presentation.

Now homeopaths use more alphabetical repertories that lack the very philosophical basis. This affects the results.

With the increasing use of psychology, psychiatry and other allied branches, it has now become easy and possible for us to define the rubric, explain it and use it practically.

Understanding ‘rubrics’ in the repertory is just like understanding ‘PatanjaliYogasutras.’ Each stanza contains enormous information. Similarly, each rubric has a deep meaning and it can be elaborated in many ways.

Important rubrics related to data processing

The list of the following rubrics (from Complete repertory and our own unpublished repertory), we hope, will be of considerable help.

• Generalities; violent complaints
• Generalities; progressive diseases
• Generalities; sudden manifestations
• Generalities; chronic diseases, chronicity
• Clinical; auto-immune diseases
• Generalities; change; complaints, of, constant
• Generalities; alternating states
• Generalities; contradictory and alternating states
• Generalities; reaction; lack of
• Generalities; vitality decreasing
• Generalities; metastasis
• Generalities; wandering complaints
• Generalities; radiating, spreading complaints
• Generalities; complaints; acute, recurrent
• Generalities, complaints, constant
• Generalities, complaints, gradual
• Generalities; relapse of complaints
• Generalities; complaints; group; recur
• Generalities; groups, complaints appear in
• Generalities, slow processes
• Generalities; sensitiveness
• Generalities; complaints; reappearance of old/clinical; sequelae
• Generalities; history, personal
• Generalities; suppression of

18. 18. Themes, if any

Comments

Apart from what has been given above, a homeopath can have a wide platform to dance.

Every case contains a lot of themes, ideas, imaginations, concepts, connections, logic, universe, doctrine of signatures, symbolism, energy, etc. A homeopath can travel with his mental make-up, experience and knowledge and try to perceive the true sickness in a patient. He can use several modules as developed in the science and see which one fits in with the case. But remember, every module/method has its scope and limitations. A homeopath can overstretch any concept from location, sensation, modalities, concomitants,pathology, aetiology, dreams, delusions, body language etc. and look upon a case. But the real beauty of fishing out a remedy is deriving the quintessence out of totality and prescribing thereupon.

Homeopathy as science has two sides to look upon–first hard facts and conceptualization of them and second, practical application.  A homeopath has to be skilled in both. He has to respect both science and art.

A big problem with imaginations is that they go berserk!

19. Selection of remedy(ies)

• Chronic constitutional remedy
• Acute remedy
• Intercurrent/Miasmatic remedy
• Organ remedy
• Sarcodes/Hormones
• Mother tinctures

Comments

Many homeopaths hold that a single dose of a single remedy is what cures and finishes off the disease! This single remedy helps the patient at all situations and at all times and it is this remedy that is unchanged in the life of the patient. Mostly this is a delusion. Very occasionally, however, a single dose of a simillimum may be sufficient to steer the patient towards final recovery and consequent permanent restoration of health. But such cases are rare and they should not deter a homeopath from testing many remedies with many avenues of prescribing.

We all know that individualization is the central tenet in prescribing. The natural corollary to individualization is that several remedies may be indicated in one disease and one remedy may be useful in several diseases. So when your patient is not better with the remedy that you have given, you have to try for another remedy and this is in line with the tenet of individualization. Of course, it doesn’t mean that a homeopath should go on changing the remedies on and on, one after another in every follow-up!

20. 20. Posology

• Selection of potency based on nine fundamental components
• The schedule of repetition versus individualization
• Follow-up

Comments

Many homeopaths hold that it is the remedy that is important and not potency. This is not right. If you want to fulfill Hahnemann’s criteria, ‘gently, rapidly and permanently’, you need to give not only the right remedy but also the right potency in right repetition. Nine fundamental concepts on which posology is based are disease potential, sensitivity, susceptibility, etiological factors, miasm, vitality, suppression, type of patient and similarity. (Read Dr. Ajit Kulkarni’s book on ‘Homeopathic Posology’)

Unnecessary repetition is wrong but failure to repeat is also one of the causes of failure in practice. There is science behind repetition or no repetition and we have to behave according to the individual’s needs.

In the follow-up, the cluster of complaints has to be studied in depth and result of the treatment has to be assessed. The follow-up differs according to the case either it is acute or chronic, curable or incurable; one-sided or fully-developed. It can be at the levels of sector, physical general or psychodynamic or combination of all. Follow-up criteria are selected by considering the mental state, complaints, pathology, deviation at general and local level. Generals like appetite, weight, eliminations, sleep and energy state are IMP parameters. Body language is a great parameter to assess the progress in a case. Laboratory investigations also have a big share in assessing the result of the treatment.

The mantras of follow-up in homeopathy are opening and exploring possibilities, generating alternatives, extracting concepts, connecting and linking up and releasing the right action at the right time.

Conclusion

An attempt has been made (through the 20 points recipe) to structuralize the data for the sake of perceiving the segments in their true character. It is unfortunate that no standard protocol is followed for data processing and the increasing use of imaginations and fantasies make the scientific discipline of homeopathy crazy and chaotic.

Individualization doesn’t mean freedom unlimited; it doesn’t mean exemption from control; it doesn’t mean releasing the action without restraint. Artistic prescribing doesn’t mean burying the science. Remember, art is subjective while science is objective. Art is more focused on the perception of the individual and is based on personal experience, opinions, emotions etc. Science, on the other hand, is very systematic.

Balancing the art with science will go a long way in making the salubrious therapy of homeopathy much more powerful.

Dear friends, send your feedback by applying the recipe. The author will feel happy if this recipe is followed at the undergraduate and postgraduate level. I appeal the teachers of homeopathy to ponder over the recipe and implement it for logical application of homeopathy.

IN A NUTSHELL

 Data processing 

1. Nature of disease

• Acute/per acute/ acute on chronic (exacerbation). Sub-acute. Chronic/ remission. Mixed / messed: natural + iatrogenic. Psycho-somatic. Somato-psychic. Psychiatric. Auto-immune. Clinical diagnosis.

2. 2. Phase of the disease

• Pre/sub-clinical. Clinical. Functional. Structural. End-stage disease. Fully developed. Inadequately developed.

3. 3. Affinity/location/extent of the disease/domain

Cells/ tissues / organs/ systems/sides (extension, syndrome shifting etc.)

4.Pathology

Type of pathology

• Atrophic.   Benign.   Calcareous/Lithiasis.Cancerous. Caries. Degenerative.  Destructive.  Dysplasia. Emaciation. Embolic. Fibrotic. Gliosis. Hemolysis. Hemorrhagic. Hyperplasia. Hypertrophy. Hardening.  Induration. Inflammation (serous, fibrinous, catarrhal, granulomatous, pyo-granulomatous, fibronecrotic, lymphocytic, suppurative). Leukoplakia. Melacoplakia. Metaplasia. Necrosis. Nodular. Proliferation. Sclerosis. Thrombotic. Ulcerative.Venous.

Aetio-pathogenesis of the disease

• Allergic. Ischemic. Metabolic. Rheumatic. Excess/deficiency.

State of pathology

• Borderline. Reversible. Irreversible.

5. 5. Pattern of response

• Sudden.   Alternating.  Changing. Continuous.  Erratic.  Regular.  Irregular.  Paroxysmal.   Periodic.   Lingering.    Shifting.   Progressive.  Recurrent. Static.

6. 6. Pace of disease:

• Rapid.  Slow.  First rapid then slow.   First slow then rapid.  Moderately rapid. Moderatelyslow.

7. 7. Expressions:

(+ = scanty, ++ = moderate, +++ = ample)

• The field of modalities: general+   particular +
• The field of sensations: general ++  particular ++
• The field of symptoms:  pathognomonic ++  non-pathognomonic +

common  ++           characteristic

8. Miasmatic diagnosis

• Dominant / active. Fundamental. Combined.

9. 9. Sensitivity

• High.  Moderate.  Decreased.

• Mental
• Physical

10. 10. Susceptibility

• High. Moderate.  Decreased.

11.suppression

• Mind. Body.

12. 12. General vitality

• Good. Moderate. Low.

13. 13. Monogram

• Pathological generals. Intertwining elements. The consistent behaviour of tissues or system.

14. 14. Dispositions

• Temperamental /personality traits

15. Body language

• Totality of all elements of body language

16. DefenCe mechanisms
17. Themes, if any
18. 18. Repertorization

• rubrics: essential/crucial/determining characters

19. 19. Selection of remedies

• Constitutional, acute, intercurrent, organ, miasmatic, sarcode, mother tincture, etc.

20. Posology

• Selection of potency based on nine fundamental concepts
• The schedule of repetition versus individualization
• Follow-up