OBJECTIVE ANALYSIS: TWENTY POINTS OF DATA PROCESSING

 A blueprint to use homeopathic philosophy and Organon into clinical practice 

Abstract: Homeopathy is a logistic system based on sound philosophy and scientific experimentation. In view of different schools and cults developed in Homeopathy, it is necessary develop a unified approach to data processing. A 20 points recipe has been developed for the sake of objective analysis of a case.

Keywords: Data processing. Need for unified approach and standardization. Formulation of twenty points and explanation of each point. Fusion of art and science.

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“As to methods, there may be million and then some, but principles are few. The man who grasps principles can successfully select his own methods. The man who tries methods, ignoring principles, is sure to have trouble”.

-Ralph Waldo Emerson, Essayist and Poet

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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).

TOTALITY AND SICKNESS

Totality is not conglomeration of symptoms. It is not hodgepodge. It is not an assembly of symptoms. It is not an aggregate amount.

Totality must represent the system with internal relationships.

Totality means a whole of an entity.

For a homeopath, that entity is sickness. Any totality that portrays the actual sickness is a crucial entity.

Mere interpretation without logic distorts the actuality of sickness embedded within the totality.

Totality is in the beginning; it is in the continuum and is in the end of the phenomenon. This is because the entity of totality does not relate to anything outside of itself. Totality and spectrum are indivisible.

Totality is described by characteristics, properties, rules, patterns, possible states, actions, changes etc. and these define the totality.

 

To perceive the totality, one requires the vision of totality. 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 perceive the quintessence of the sick individual and identify the real sickness. The process is to recognize its counterpart in the homeopathic Materia medica and repertory. The objective is to fathom the sickness and to fish out the remedy and this should not be sacrificed for running after ‘megacephaly’ travel!

In this paper, an attempt has been made 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 homeopathy and often a student gets confused and frustrated.

The comments over each recipe are related 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

Acute/per acute/acute on chronic (exacerbation)

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

Diseases are acute or chronic to a homeopathic physician not just 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.

• 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 leukaemia, acute myocardial infarction, acute hepatitis, etc.
  • 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, asthma, 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) nature, interspersed with acute attacks/episodes. Remember, the motive is in turn to treat the chronic disease.

Sub-acute/chronic/remission

• Remission refers to a diminution of the seriousness or intensity of disease; this implies that, it is the recovery phase. It is a period of time during a serious illness when the patient’s health improves. To exemplify, a cancer is in remission, means it can be managed and is not worsening. Remission can be temporary or permanent. The remission of permanent type is cure.
• Sub-acute is a poorly defined state. It is an intermediate stage between acute and chronic. It may be moderately acute in nature. The acute episode stretches and lengthens with reduction in intensity. Sub-acute endocarditis or Sub-acute Sclerosing Panencephalitis (SSPE) are some of the examples. If the inflammation is persisting longer than 3 or 4 weeks, it is referred to as sub-acute.
• Chronic refers to a long-term condition. In chronic diseases, the march of events occur 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.

The disease taking on the form of chronicity is dependent upon the activity of the fundamental miasm and the triggering factors such as unhealthy life style, toxic inter-personal relationship, mental and physical stress etc. contribute in a big way.

Acute versus chronic: Notable points

• There is nothing like an acute remedy or a chronic remedy.
• Indications on which the remedy is based matters the most.
• Every remedy has both acute and chronic dimensions in its pathogenesis.
• It may be wrong to believe that frequently used remedies for acute conditions 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 the basis of presenting acute totality. Don’t intermingle acute with chronic.

• Another possibility is that an acute state could be a part of expression of the constitutional dyscrasia. Hence a remedy based on constitutional state of the patient can be used for the treatment of acute episodes.
• One should try to understand the whole state and based on its background it, understand the phenomenon of an acute disease.

All the above-mentioned 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-c. as a constitutional remedy. The acute exacerbation of bronchial asthma manifested the totality that pointed to the same remedy i.e. Kali-c. and it helped to resolve the acute attack.

Mixed/messed: natural + iatrogenic

• 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 with the use of tautopathic/homeopathic drugs which can be interspersed in between the constitutional treatment and with detox diet. There is a good rubric, ‘Generalities; intoxication, after; drugs’. However, a remedy can be outside this rubric and 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. The offending drug agent, which is often suppressive in nature, needs to be slowly weaned with alert monitoring while the condition improves with homeopathy. The detox diet should also be used.

Physical/psycho-somatic/somato-psychic/psychiatric/auto-immune

• If the case has been defined as psycho-somatic mixed, the focus should be on treatment of the mental state. The constitutional remedy coupled with counselling often helps. 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. A good command over personality structure, understanding of remedies and also of rubrics of the repertory are a dire pre-requisite for handling such cases. The recent advances in psychology and psychiatry must be used by a homeopath for data processing and for selecting the relevant rubrics and the remedy.
• Auto-immune diseases pose a problem in the management of a case. Why the immune system fails to 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 aborted abruptly.

Clinical diagnosis

Although a homeopathic physician should not prescribe upon the label of the disease, one should not underestimate the value of clinical diagnosis. 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 trinity of form, function and structure develops in transitions, phases and stages during the phenomenon of the disease.

2. Phase of the Disease

• Pre/sub-clinical/clinical

• Functional/structural/ end stage disease

• Fully developed/inadequately developed

Pre/sub-clinical/clinical

• Pre-clinical or Sub-clinical phase is the period 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 observed to be sub-clinical before they surface as clinical diseases. Homeopathy, being a constitutional therapeutic system, has a role to play in the 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/structural/ end stage disease 

• Functional phase is characterized by the sensations as if and absence of organic or structural changes. Investigations yield no evidence of underlying pathology. 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 sycotic miasms.
• 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 pace of evolution of disease in terms of the structural changes helps in determining the prognosis or prediction of the course of illness in given time frame and determines institution of appropriate and proactive posology and the role of intercurrent remedies.
• Fully developed/inadequately developed
• 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 a 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, and 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.)

• 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 of the deviant force of the disease towards the 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

Type of pathology

• Atrophic.   Benign.   Calcareous/Lithiasis. Cancerous. Caries. Degenerative.  Destructive.  Dysplasia. Emaciation. Embolic. Fibrotic. Gliosis. Haemolysis. Haemorrhagic. Hyperplasia/Anaplasia/Metaplasia. Hypertrophy. Hardening/Induration. Inflammation (serous, fibrinous, catarrhal, granulomatous, pyo-granulomatous, fibro necrotic, lymphocytic, suppurative). Leucoplakia. Melacoplakia. Necrosis. Nodular. Proliferation. Sclerosis. Thrombosis. Ulcerative. Venous.

Aetio-pathogenesis of the disease

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

Pathology is the accentuated and concentric energy of the disease that gets localized and 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 the Law of 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 Materia medica 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 reside 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.

State of pathology

• Borderline
• Reversible
• Irreversible

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.

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. Patterns 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 especially nosodes comes up.

6. Pace of the Disease

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

• 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 Materia medica has its own pace. It is the state of susceptibility (under miasmatic activity) of an individual that determines the pace.
• To exemplify, , Acon., Bell., Phos., Pyrog., etc. have rapid pace while Agar., Bry., Caust., Plb. etc. have gradually developing pathologies.
• While talking of similarity, it should be at the level of not only symptoms but also 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. – all have a place here.

7. Expressions

(Scale: + = 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 concomitants Common       Characteristic
2. The field of body language Common                  Characteristic

• 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 assess the state of susceptibility so essential for posology.

8. Miasmatic Diagnosis

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

• 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.

Criteria for deriving fundamental miasm

It is difficult to assess the fundamental miasm in an accurate manner. But the following points may help to evaluate 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 any serious illness or no premature death in the family from a dynamic disease.

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.

Tubercular

Tuberculosis/pleurisy. Epilepsy. Ulcerative colitis. Weight loss. Psychopathic personality disorder. Haemorrhagic 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

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 must 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. Normal sensitivity denotes the state of health. But a homeopath has to study the altered state of sensitivity through the concept of input and output and the stimulus and reaction in the totality of expressions.

10. Susceptibility

Susceptibility denotes the capacity of an individual to react to any form of stimulus. It is by dint of susceptibility that an organism reacts when a disease (that acts as a stimulus) afflicts 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, neither above nor low. In such cases, an intercurrent remedy interspersed at right time may arouse the vitality and remove the static state.

To determine the selection of a remedy and posology, similarity has to be achieved at the level of not only the expressions but also sensitivity and susceptibility

It must be noted that susceptibility is inclusive of sensitivity.

Pathology: 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 before, during and after the treatment is a good criterion to assess if the case is steering towards the right direction or not.

11. Suppression

A lot of confusion prevails amongst the homeopaths about the concept of suppression. It is known that the immuno-suppressive agents used by allopathic 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 you prescribe on the basis of the Law of Similars when you are practising homeopathy. If someone is not following the Similia, how can it be a therapeutic science of homeopathy? For example, a patient’s acute urticaria is better with the hot application and a homeopath is prescribing Apis-mel, it is difficult to call Apis-mel as a homeopathic remedy in the true sense in this case.

If it is to be believed that Homeopathy suppresses, does it mean that the name of “Homeopathy” should be changed to “Homeo-anti”pathy?

Confusion as to relief, palliation and suppression needs to be resolved.

Palliation

The term palliation comes from a Greek word which means “to hide or disguise”. Palliation “hides” the symptoms and disguises the patient (and the doctor) by the impression that he is getting cured.

Palliation offers rapid relief of symptoms, even though it will not correct the underlying problem that has caused them.

Palliation can be achieved by medicines, therapies, or treatments. Let us take a few examples: The pain in joints of a chronic rheumatoid arthritis is temporarily relieved by an analgesic; constipation  is relieved by laxative; eczematous dermatitis is reduced by cortisone, etc.

Palliation offers a “quick fix” but the symptoms return once the treatment has been stopped or the medicine wears off. Let us take an example from the homeopathic side. A patient of urticaria 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. In palliation, there may be relief but not in the right order. If the patient was on Sulphur 200 daily and if the symptoms return after missing one or two doses, it is palliation.

Differentiation between Suppression and Palliation

Suppression is similar to palliation in the sense that it provides relief in symptoms but never fixes the underlying problem. Suppression differs from palliation in that suppression completely stops the return of symptoms and they get driven inward and a new set of symptoms is manifested at a deeper level. With palliation, immediate symptoms are relieved, leading to the long-term detriment of health. Suppression will only lead to further deterioration in health as it damages and weakens the immunity. A vicious cycle of progressive use of suppressants is set up if antipathic treatment is instituted resulting in worsening of health and quality of life.

Hence, palliation or suppression are the matters of concern.

Notions about suppression

Suppression is when the presenting signs and symptoms are replaced by the stronger and more dangerous symptoms or syndrome than before. One can apply the concept of suppression if one has evidence that a deeper layer of the vital system (through the affliction of the vital organs and deep pathologies) has been affected and it is confirmed through cause à effect 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. It’s just an exhausted action of a given remedy. It is necessary to view them in the light of Hering’s suggestions.

Some patients prove every remedy due to their high sensitivity. This should not be linked to suppression. Such patients are uncommon on the planet. They should be given low potency as a single dose to begin with and repetition should be done cautiously in such cases.

Notions about relief, palliation and suppression are based on the fundamental knowledge of the disease entity-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 used for drug miasm.

12. General Vitality

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

The transitional march from Psora à 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 judging 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 in day-to-day life, and availability of PQRS symptoms and if the system is able to marshal 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 status of the 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.

Vitality has to be assessed at three levels – low, moderate and good.

13. Monogram

(The readers are requested to read the article on ‘Monogram: From Multitude to Access’ published in Homeopathy through Harmony and Totality Vol II)

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

Let us understand it through a case.

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

Monogram of the above case is

Rheumatic. Allergic. Venous. Glandular. Dyspeptic. Cachectic. Cancerous. Chilly.

14. Study of the Mind

“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. One then doesn’t engage in just the maze of symptoms, but looks at the patient through the holistic lens.

(Refer article “The study of dispositions in Homeopathy” from Homeopathy through Harmony and Totality Volume 1)

15. Body Language

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 (Birdwhishtell). 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 gesture cluster. 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. 1 Defence Mechanisms

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.

Example:  ‘Identity loss’ as a defence mechanism

This mechanism projects a dependent personality and is characterized by the excessive and constant necessity for care and help. Such a person uses the technique of extreme yielding and servile conduct. There is a fear of losing support and hence, there is clinging behaviour. The emotional content of this personality includes forsaken feeling (delusional), discontentment with self, feeling of being unfortunate, incompetent, helpless and anxious about trifles. Concept of self is of a weak, helpless, insufficient person, with necessity of constant support, low confidence and inferiority feeling. Positives are delicate, caring, cooperative and compassionate.

During childhood, this person was under continuous excessive guardianship, wardship, guidance even in trifles. Due to parents’ anxiety or to child’s diseases, or for the sake of security, the child’s will power was substituted by the parents’ will and the child was devoid of independent and autonomic activity and decisions. Obedience and passivity were stimulated and implanted by all means – so the personality grows with the firm belief that some figure will always be near to fulfil all wishes.

Rubrics for ‘identity loss’ could be

Confusion of identity, dependent, helpless, yielding/submissive disposition, holding or being held desires to be, clinging. Fear alone of being, servile. Will, loss of.

Some of the remedies for ‘identity loss’

Alumina, Bar-carb, Bismuth, Borax, Calc-carb, Lac-can, Kali-carb, Phosphorus, Pulsatilla, Sanicula etc.

(Readers are requested to read Dr Alexander Martushev’s article on Defence mechanisms.)

17. RepertoriSation

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 Materia medica. Hence it encompasses the wisdom of Materia medica. The repertory is an indexed micro-filming of kaleidoscopic Materia medica. However, although retaining the essence of the symptomatology of kaleidoscopic Materia medica, 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’s emphasizing on the pathological generals are the three fundamental approaches of repertorisation. 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 ‘Patanjali Yoga sutras.’ Each word contains enormous information. Similarly, each rubric has a deep meaning and it can be elaborated in many ways.

Important (but neglected) rubrics related to data processing

The list of the following important rubrics

• 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

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 has two sides to look upon–first hard facts and conceptualization of them (science) and second, practical application (art). A homeopath has to blend both science and art and be competent to apply his armamentarium on the basis of the Law of Similars.

A big problem with imaginations is that they go berserk!

19. Selection of remedy(ies)

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

Single dose of a single remedy

Many homeopaths hold that a single dose of a single remedy is what it cures and finishes off the disease! That a single remedy helps the patient at all situations, at all times and it is this remedy that is unchanged throughout the life of the patient. Mostly this is a delusion. Very occasionally, however, a single dose of a similimum 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.

Individualization is the central tenet in homeopathic 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 a patient is not better with the remedy that has been given, one must try for the same remedy in ascending or descending scale or 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!

Similarity should be the basis of selection of the remedies and not only the conceptual basis.

20. 20. Posology and outcome assessment

Many homeopaths hold that it is the remedy that is important and not the potency. If one wants to fulfil Hahnemann’s criteria, ‘gently, rapidly and permanently’, one should give not only the right remedy but also the right potency in right repetition.

Nine fundamental concepts on which posology is based are as follows.

• Disease potential
• Sensitivity
• Susceptibility
• Etiological factors
• Miasm
• Vitality
• Suppression
• Type of the patient and
• Similarity

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 one must act according to the patient’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, and functional or structural. It can be at the level of sector, physical general, 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 important 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.

(Read Dr Ajit Kulkarni’s book on ‘Homeopathic Posology’)

 A STRUCTURAL DIAGRAM REPRESENTING OBJECTIVE ANALYSIS

 

TABLE OF ANALYSIS

1. Nature of the disease

·        Acute/Per acute/ acute on chronic (exacerbation) ·        Sub-acute/Chronic/Remission Mixed / Messed: natural + iatrogenic Psycho-somatic Somato-psychic ·        Auto-immune ·        Clinical diagnosis

 

2. Phase of the disease

·        Pre/Sub-clinical/Clinical Functional Structural Fully developed Inadequately developed

 

3.  Affinity/Location

Cells/ Tissues / Organs/ Systems/Sides/Extension/Syndrome shifting

 

4.  Pathology

Allergic Atrophic Benign Degenerative Destructive. Dysplasia/ Proliferation Hyperplasia / Metaplasia / Hypertrophy Induration / Hardening Inflammatory (serous, fibrinous, catarrhal, eosinophilic, granulomatous, pyogranulomatous, fibro-necrotic, lymphocytic, suppurative). Leucoplakia. Melacoplakia Cancerous Necrosis / Sclerosis Nodular Ulcerative Haemorrhagic Ischemic Thrombotic Venous Calcareous/Lithemic Fibrotic Rheumatic

 

 

State of pathology

Reversible Borderline Irreversible

 

5. Pattern of the response

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

 

6. Pace of the disease

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

 

7. Expressions

(Scale: += scanty, ++ = moderate, +++ = ample) The field of modalities: General   Particular The field of sensations: General   Particular The field of symptoms:  Pathognomonic   Non-pathognomonic Common           Characteristic ·        The field of Concomitants ·        The field of Body Language

 

8. Miasmatic diagnosis

Dominant / Active Fundamental Combined Psora     Sycosis    Tubercle    Syphilis

 

9. Sensitivity

High Moderate Decreased At Mind level: At Nerves (body) level:

 

10. Susceptibility

High Moderate Decreased

 

11. Suppression

Mind Physical

 

12. General vitality

Good Moderate Low

 

13. Monogram

·        Essence of the system following the concept of generalization ·        Essential threads that run through and through ·        Traits and dyscretic states that identify the essence ·        Character evolved after the deductive inference ·        Patterns (behavioural, tendencies, often repeated phenomena) ·        Pathological generals ·        Miasmatic state

 

14. The study of the mind

Dispositions/Temperament/Personality traits Ailments from Dreams Delusions Sensations Behaviour Emotional and intellectual state

 

15. Body language

Totality of all elements of body language Characteristic gestures and postures Vital signs BL and its co-relation with personality

 

16. Defence mechanisms

(Read Alexander Martusheve’s article on Defence Mechanisms and Homeopathy)

     

17. Repertorisation

Rubrics ·        Essential / crucial / determining characters ·       Accurate selection of rubrics to define the disease, the person and the stage

 

18. Themes, if any

An abstract understanding (which should be ideally supported by logic, Doctrine of Signature and facts).

 

19.. Selection of Remedy/Remedies

·        Acute ·        Constitutional ·        Intercurrent ·        Organ ·        Miasmatic ·        Sarcode ·        Nosode ·        Mother tincture ·        Tautopathic

 

20. Posology and outcome               assessment

Selection of potency on the basis of fundamental nine concepts 1.      Disease potential 2.      Sensitivity 3.      Susceptibility 4.      Etiological factors: Pre-disposing. Exciting. Maintaining. Fundamental. 5.      Miasmatic assessment 6.      Similarity: Degree and Level 7.      Suppression 8.      Type of the patient 9.      Vitality The schedule of repetition versus Individualization Follow up assessment

 

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.

“The only people who see the whole picture are the ones who step outside the frame”, wrote Salman Rushdie. It is time to step outside the comfort zone and utilize the blueprint of twenty points to widen the horizon and help the patients with the salubrious therapy of homeopathy.

I thank Dr Yogesh Niturkar for constructing the structural diagram and Dr Hitesh Shah for his valuable suggestions.

About Author

Dr AJIT KULKARNI M.D. (Hom.)

• Director, Homeopathic Research Institute, Pune
• A veteran homoeopath, an academician and a famed international teacher
• A classical Homeopathic physician practicing since the last 35 years
• Co-Author: Absolute Homoeopathic Matera Medica

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

Author:   Body Language and Homeopathy

Homeopathy through Harmony and Totality (Three volumes)

Law of Similars in Medical Science

Homeopathic Posology

Kali Family and Its Relations

Homeopathic Covidoscope (published by Amazon)

More than 100 publications on various aspects of homeopathy

Many papers and books translated in several languages

• Award of ‘Excellence in Homoeopathy’
• Award of ‘Homoeo-Ratna’
• ‘Life achievement Award’
• ‘Dr B. Sahni Memorial Award’
• Member, Editorial Board, National Journal of Homeopathy, Mumbai