Clinical Cases

The Pathology Factor in Remedy Selection

Pathology Factor in Remedy Selection
Written by Ashok Borkar

The author reminds that all aspects of homeopathy may be used along with the Sensation approach. A case is used to illustrate.

Beyond matching the Sensation and the Symptoms of the patient with the remedy, one also has to consider if the Genius matches too. This facilitates healing at the deeper levels and not only relief of symptoms or state of mind.

The Genius includes: Sphere of action, Pathological generals, General Modalities and Sensation: in short the very nature of the patient or the remedy.

While solving a case we need to be flexible in our approach. Each case needs careful evaluation. If one finds in a given case a very strong peculiar symptom, or a very clear sensation and miasm, one can give the remedy even if it is not known for the pathology in the case. After all, the pathological indications of several remedies only came after their clinical use.

It is important that the match between the patient and the remedy should be at several levels, and the Genius, the affinity and pathological tendencies known about a remedy are certainly among the important and sometimes crucial areas that need our attention.

The medical diagnosis, which tells us the pathological process going on in the body, should also be given importance while prescribing the remedy, but only after you have come to a small group of remedies indicated by the Sensation method, the rubrics, the materia medica and the keynotes.

The medical diagnosis helps a lot in the final diagnosis of the remedy and it is a tool which is so easily available to us.

Pathology Factor in Remedy SelectionIn most cases the sensible approach is to consider the peculiar physical generals first because they are more reliable; no interpretation there unlike mental symptoms. For a given mental symptom ten homoeopaths can find ten different rubrics depending on their personal perception. Next you consider those mental symptoms which you are sure of, and then finallytake note of the pathology.

In cases where the pathology is advanced, we have to give more importance to the pathology. All in all, flexibility of the approach is most important to making a good prescription.

When you are analyzing a case, after the history-taking is over, ask yourself: Which approach are you going to take? Are you going to give more importance to rubrics? Or is it the Sensation Method that needs to be applied first in a given case? If the Sensation is clear then you can use it first and later you can see if the rubrics and pathology are also covered. If the Sensation is not clear then use the repertory and materia medica first and arrive at a small group of remedies after which you can use your knowledge of the Sensation method to further narrow down the choice of the remedy. Our final job is to see which of the indicated remedies covers the pathological process going on in the body.

In order to ensure success in every case one must take care that the pathological process going on in the body is covered by the selected remedy. It is an important constituent of the “Genius” of the patient and the remedy. Allow me to validate this point with a case.


Case Example

This is a case of a 37 year old lady who presented with an ovarian mass and menorrhagia. This history was taken in May 2009.

Dr.: Tell me what is your problem?

Pt.: My problem is bleeding.

Dr.: Okay

Pt.: And pain in abdomen and in the legs sometimes. And nothing else and sometimes coughs. That’s it.

Dr.: Bleeding and pain. What else?

Pt.: .That’s the main problem of mine.

Dr.: What other problems do you have? Tell me whatever is happening to you, tell me everything.

Pt.: Only that thing, my bleeding doesn’t stop. It goes on continuously. Shall I start from when it started?

Dr.: Tell me everything.

Pt.: My baby was delivered normally. But the placenta remained inside. So they had to manually take it out. They operated and they gave me an injection in the backbone. And it was taken out. And after 4 months my periods started, and it was normal for 5 days and it stopped. And after 10 days it stated again little by little. Little bleeding was there. Later on it increased a little. And since then I am bleeding.

Dr.: For how many days there has been continuous bleeding?

Pt.: Continuous means continuous, whole month.

Dr.: Whole month?

Pt.: Almost 2 months.

I asked her more about what happens to her and she said that she gets pain in abdomen.

Dr.: How is this pain now?

Pt.: Pain is bearable, means I can walk. It’s just feeling heavy.

Dr.: Heavy means like how is that?

Pt.: Heavy means, if I want to get up I cannot get up and jump .I have to get up slowly.

Dr.: Ha, Hmm

Pt.: But it’s bearable not paining lots.

Dr.: How does it affect you?

Pt.: Little bit not much. Means I can do normal things. But you feel there is pain. You feel the pain.

Dr.: So how do you feel because of the pain?

Pt.: I don’t feel like going out or doing anything. I just want to rest.

Dr.: Don’t feel like doing anything, just want to rest…

Pt.: Yes.

What do we understand about her so far?

Has she given us anything peculiar?

No, but we have understood something important about her.

Her problems are bearable, not severe.

How does this help us?

To understand the degree of desperation.

This helps us to understand the miasm.

Here we can see that there is no desperation which indicates sycosis miasm.

I asked her more about it.

Dr.: How do you feel at that time when you are feeling heavy and don’t feel like doing anything?

Pt.: Just rest and do nothing. Just take rest.

Dr.: Just want to rest. How do you feel at that time?

Pt.: Nothing is happening, I’m walking.

Dr.: No, if you don’t rest how do you feel? Why do you feel you need to rest?

Pt.: If I rest I don’t get the pain and the bleeding is not much. If I do something then bleeding increases.

Dr.: Okay

Pt.: If I walk or go shopping it increases. If I rest then bleeding will be less.

Dr.: If you walk around bleeding increases?

Pt.: Yes

Dr.: What happens when the bleeding is more?

Pt.: Nothing else only that if the bleeding is more then I have to change my pads.That’s it.

Dr.: What else happens? What is the problem because of that?

Pt.: I feel tired.

Dr.: Feel tired and..

Pt.: I just want to sit down somewhere and my legs start pricking. Then I take some rest somewhere.

So what did we get here?

Her bleeding is very less when resting and it increases when she walks about.

The peculiarities of the chief complaint are always important. So try to find out as many peculiarities of the chief complaint as possible.

Dr.: So when you were getting this bleeding. How is the color of the blood?

Pt.: It is red, dark red

Dr.: Is it always like that?

Pt.: Yes

Dr.: Its dark red?

Pt.: Yes.

Then I asked her more about her 2nd pregnancy and she repeated the same things that her bleeding would be better by rest.

I asked her, ‘How is your mood at that time?’

She says, ‘I don’t want to talk. And I take anything which reduces pain. Anything even if you give me poison I will take it. (Laughs)’

I kept asking more about her pain and her mental state at that time and she kept repeating the same things.

So I asked her about her second delivery and she said that she was tensed about it because it was in England. She says there the doctors wait till the last minute to deliver you. They keep asking whether you have pain and only when it is very intense they call you to the hospital. So she lied to them that she is having pain and went early to the hospital because she did not want to wait till her pains increase.

She said, “They kept me for 3-4 days with all those needles in me because they had removed the placenta manually.”

She said that she had a cyst before the second pregnancy.

I asked her about it.                                   

She said that she has been advised operation but she is scared of operation and wants to avoid it.

Then she told me that she avoids cashew nuts, strawberries, mangoes, coke because these things are not good and they cause more bleeding.

I asked her, ‘Do you get good sleep?

She said, ‘I don’t get sleep if the climate is hot because I can’t bear hot climate.’

What do we understand about her now?

Heat affects her.


She wants to avoid operation.

What is her reaction to stressful situations like operations, coke, mangoes, etc.?

Avoid it.

How does it help us?

To understand the miasm this is sycosis.

I asked her about her dreams.

She dreams that her husband has fallen in a pot hole and gets hurt.

Another dream is that she is eating something like raw vegetables or sweets and whenever she gets such a dream she falls sick.

She said something like this before.   

That certain foods are bad for health and she has to avoid those things.

I got the following important symptoms so far

  1. 1.    The bleeding is dark red.
  2. 2.    She  avoids many articles of food thinking that they are bad for her health
  3. 3.    Wants to avoid operations
  4. 4.    Menses are aggravated by walking.

But I could not understand her vital sensation. I continued asking her about her operation which was a stressful issue in her life.

Dr.: You were saying that you want to avoid operation, what is your fear in this?

Pt.: They told me that they will have to remove the ovary and might be the uterus as well. I am just thinking that if the problem is with the ovary, then why they have to remove the uterus. Because I don’t have any problem in the uterus. So I am just thinking why. And I just avoid pains. I don’t like pains, or just cutting things, I don’t like. I try to get things better with medicines. I can take medicines anytime, even 10 tablets if you tell me to take I am ready to take. But I am not ready for this operation. I don’t want the operation.

Dr.: What is the reason?

Pt.: I have fear of pain. I am frightened of pain. I don’t like pain.

Dr.: Explain this again,‘fear of pain’.

Pt.: Means I try to avoid pain. If someone is in pain I am not scared. Even if I am in pain I am not scared. But I avoid pain, means I don’t like pain for anyone. If someone is in pain I cannot see him in pain. I can see blood. But I can’t see anyone in pain. Any pain, any type of pain. Not only cut or wound, some emotional problem also in some people, I can’t see that. I feel like crying.

We can see her sensitivity clearly now.

What is she sensitive to?


Pt.: I don’t know what happens to me. I don’t know. I can’t feel anything but I just don’t want anyone in pain. Just no one in pain. Everyone should be happy. If the person dies I don’t feel pain. But if he is alive and in pain, that I can’t see. If the person dies I don’t mind. But I can’t see the person living and in pain. Even for myself I don’t like pain.

Dr.: What is it about pain that makes you really uncomfortable?

Pt.: Means not that extreme type of pain. You cannot see it, you just have to turn around and walk. Can’t see that person in pain. You try to do whatever you can or just avoid pain.

Dr.: Tell me about your childhood. How was your childhood, what do you remember?

Pt.: Everything was fine means I used to play. I didn’t fall down or anything. I would take care of myself.

Pt.: I would take care means; I would look for a hole and I would not go there. I knew if I go there I will fall down. So I walked carefully like. If someone else was going there I would tell them not to go there.

Dr.: But what was the feeling? Why would you say don’t go.

Pt.: because it will hurt if the person falls in that thing.

In childhood also we see the same sensitivity. Now we can see the sensation and miasm.

Dr.: Hurt means.

Pt.: If they put fingers in the electric thing and they get shock. If they go somewhere and they will fall. If something is broken and you jump on that. They will fall or they will get hurt.

Dr.: And what will happen if they got hit, shock or hurt

Pt.: It will pain. So they’ll get pain. I can’t see them in pain so I tell them don’t go.

Dr.: You said that before delivery you were quite tensed. What was the tension in that?

Pt.: Means, will they do the operation? Main thing was operation. I don’t want operation.

Dr.: What was the fear of?

Pt.: Operation

Dr.: In that what was the fear?

Pt.: Means in operation you get pain. So I don’t want pain.

Dr.: What happens if you get pain? What is the fear?

Pt.: If you get pain it will hurt. Whether the baby will be okay if they do operation? That they will take out (hand gesture), you know…

Dr.: Take out what?

Pt.: When the baby comes out I don’t know in the operation what they do? They take the baby’s head out with the tongs or something like that.

Dr.: So.

Pt.: I was just worried about that I didn’t want an operation.

Dr.: No they will take the baby’s head out with the tongs, so what?

Pt.: It will hurt the baby that way, the head. I was just worried about this.

Pt.: The baby will be in pain whole life and they won’t be able to do anything. And I couldn’t see that.


End of case

Follow up after two years:

After a single dose of the remedy, the patient’s bleeding stopped immediately. She never got pain in the abdomen again. Her frequent cold and cough problem stopped. Her sensitivity to pain became less and she said that now other people’s pains do not bother her. In addition to this, she started eating all of the foods that she used to avoid before. The ultrasonography report showed that the ovarian mass had disappeared. The ovarian cyst was still the same.

Follow up after three years:

The patient has been in very good health overall, and the latest ultrasonography report revealed that the cyst has also disappeared.

Her USG reports done in 2009, 2011 and 2012 respectively are printed here.

The Pathology Factor in Remedy Selection





Case analysis:

The miasm in this case is quite clear. The patient anticipates problems and avoids them. There is no desperation and the pain is not severe. The miasm here is sycosis.

What was the main issue coming up and what was the sensation when we investigated the patient’s stress, fears and childhood?

The issue that ran through and through this case was sensitivity to pain.

What is the kingdom?

The remedy chosen came from the plant kingdom, as only one sensation came up in all areas.

Which plant family?

Some of my colleagues who saw this case felt that this patient needed a remedy from the Ranunculaceae, Compositae, or Papaveraceae family.

In Ranunculaceae, the issue is ‘extreme sensitivity to pain’. The pain is not extreme and it may be physical or emotional pain.

In Compositae, the main issue is injury.

The main issue in the Papaveraceae family is, ‘extreme pain or agonizing pain, like hell’.

From close analysis of all the families mentioned it appears that this patient needs a remedy from the Ranunculaceae family.

The sycosis miasm remedy in the Ranunculaceae family is Pulsatilla.

How can we be sure of the remedy?

You will see that this remedy also covers the peculiarity of the chief complaint.

Pulsatilla covers the following rubrics:

  1. Menses, dark red
  2. 2.    Menses < walking

From Phatak’s Materia Medica:

  • ‘Haemorrhages, passive, blood dark, easily coagulating.’

What is the sphere of action in our patient?

In this patient, the main sphere of action is the uterus. In the remedy Pulsatilla, the uterus is an important area of affinity.

What is the mode of action of Pulsatilla?

Pulsatilla as a remedy produces menstrual disorders. It causes dark red bleeding. And the bleeding is passive. It is not profuse bleeding.

In Phatak’s Materia Medica, under ‘Mind’ the following symptom is given:

‘Imagines that certain articles of food are not good for the human race.’

One dose of Pulsatilla 200 was given to her.

The dose has not been repeated in the last three years.

Also, it is interesting to note that in Pulsatilla, Phatak’s Materia Medica further mentions:

‘Post- partum secondary haemorrhages from retained placenta.’

In this case we can see that the prescription of Pulsatilla was supported by the kingdom, the miasm, the rubrics and the materia medica. Besides this the pathology was also covered by the remedy. Hence a good result was a foregone conclusion.

About the author

Ashok Borkar

DR. Ashok Borkar graduated from the C.M. P. Homoeopathic Medical College in Mumbai. His desire to serve rural India made him start his practice in a remote village of Goa in 1991. Today his clinic is an institution where young homoeopaths hone their skills under his guidance. He teaches classical homoeopathy in Goa, Karnataka and Maharashtra. He is a teacher at ‘the other song: International Academy of Advanced Homoeopathy’, Mumbai. His desire for consistency in producing good results in ‘cases with structural changes and advanced pathology’ led him to a study of all his cases and this study has been published in his book “Pathology Factor in Remedy Selection”.


  • Does sensitivity belong to only plants? Phosphoric acid, Silicea and a host of others are sensitive to noises, voices etc. May be some other approach would have led to the same medicine. Sorry if I am wrong.

    • Medicines from all kingdoms have sensitivity.

      The “Sensation” which we talk about when choosing the kingdom; is the experience of the delusion.

      In plant kingdom cases, we notice that after exploring (7 levels of experience) all the areas of the patients life (emotional state, fears, dreams, childhood, physical complaints, hobbies), the same sensation is observed as the experience of the delusions.

      For more clarity, please read “The sensation in homoeopathy” and “The other song” by Dr. Rajan Sankaran

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