Dr. Sneha Vyas, Resident Doctor and Editor, the other song
Dr. Ruchita Shah, Publication Team, the other song
Consistency of results is one of the most important requisite in practice. It is the test of any methodology. In Homoeopathy, the traditional method of Repertory, Materia Medica and Keynotes, with its comparison of the symptoms of a remedy to that of the patient, has led to many beautiful results and has been the foundation for homoeopathic practice. In the past two decades newer ideas of classification of the remedy according to Kingdom and miasm have emerged. Along with this development, an understanding of the importance of knowing the exact experience of patient in terms of Sensation has been rediscovered. This has reawakened the idea that we can generalise the local sensation, that what is true of the part is true of the whole, which was practiced by Boenninghausen.
The discovery that each remedy has the qualities of its Source has given a new dimension to our understanding of our Materia Medica. Use of this thematic understanding according to Kingdom, Subkingdom and Source information, along with Miasms, has been termed the Sensation Approach, and it addresses the conceptual side of Homoeopathy. This approach has appealed to the artistic side of many in the world of homoeopathy, and it has come to be used extensively. However, I have found that the most consistent results come when this artistic side and the logical, traditional side are integrated. In fact they have always been integral to one another, but we have to be able to see it.
When we see this integration, our prescriptions become more rounded, complete and sure. In remedies that are sufficiently well-known a third aspect also has to be considered: the genius – the main idea, the flavour, the essence, the grand general of the remedy. When we use these three aspects: the Genius; Materia Medica and Repertory; and the Sensation Approach concepts, then we are using an integrated approach and not a fragmented one. I have found that this integration has given me the best results in thirty years of practice.1
The basis to a good prescription always lies in skillful case-taking which goes a long way in understanding the case. A good case history is the result of patience, unprejudiced observation and skilled attention on the part of the homoeopath and more often than not is enriched by experience of the practice. It is a quest of all successful and flourishing physicians to refine their case-taking so as to understand what the deepest experience of the patient is. One question that haunts many a senior homoeopath too is how to go to the experience of the patient, to understand that what stands true to the patient as a whole, that which defines him and on which the similimum can be based. How does one choose the entry point to enter deeper towards experience of the patient? Let us see this through a case.
This is a case of a 52-year-old female seen at the other song 2 ½ years ago. The patient was diagnosed of having spasmodic dysphonia (a voice disorder characterized by involuntary movements or spasms of one or more muscles of the larynx). She complained of severe hoarseness of voice and difficulty in speech over the last 6 months. She had to strain to speak, and was better when speaking in a high pitch. The hoarseness was worse in morning, on waking up. It was also noticeably worse in evening due to constant use of voice over the day. Strangely, she reported that her voice was better when singing. Besides this, she also had difficulty in sleeping and had to take sedatives for the same.
The patient was a trained classical singer and she has a deep love for singing. She had been singing for the past 30 years, but had to stop singing due to the hoarse voice. When narrating this, she broke down and said, “Singing is something different from my daily routine. It really gives me pleasure. Singing is something special to me. It is like some achievement; it gives me immense happiness and satisfaction.” The patient was silent and sad for a while. She then said, “I had taken her voice for granted; it was something that I always relied on. I had never thought that it would be taken away from me.”
This is something characteristic, when describing about her complaint, the patient directly went to her passion for singing and how not being able to sing affected her. Also, the way she described her voice as something that could always be relied upon was characteristic. This comes up when it was the least expected and since the patient wept, to me it signified an intense emotion or an energy, so I decided to explore this further. This became the entry point – something that she relied on, being taken away from her. Here, we see that the entry point lies in the narration of her effect due to complaint.
The entry point is an important juncture in the case-taking, it is the point which can make or break the case. Of the many things that a patient speaks, it is important that a homoeopath knows at which point to enter deeper into the case. There may be various junctures from which we can reach the deepest experience, but the skill lies in selecting the right one, so as to directly reach the core experience.
The most obvious and traditional way would be to start with the complaint of the patient and ask her to describe it. And then to observe not only the description of her complaint but the whole of her demeanour: her attitude; pace; desperation; history; way of talking, who is accompanying her – everything that we can observe about who she is. This is a kind of listening without asking questions. Just feeling or observing the phenomena in this way is the ideal start. Once this is done, we have a fair estimate of the whole case. Once the case is scanned and the initial talking done, then the entry point can be chosen.
I think the best entry point is the one on which the patient himself puts an emphasis. It may be the sensation in the chief complaint: “There is a burning pain,” or any other peculiarity that he describes such as a dream or a disturbing situation. Then you can take that peculiarity as your initial focus. If the patient says, “It disturbs my routine,” or “It disturbs my work,” you can say, “Talk about ‘It disturbs my work.’” So the entry point shifts, in different cases, according to the significance given by the patient. If he emphasizes an exciting factor after which his complaint started, then you go with that as an entry point.2
Many times when a patient is talking, he will give you fifteen or twenty symptoms, speak about their emotions, about their job, and about a number of intense situations in their life. In the course of such a listening process it is tough to choose the entry point. The energy in the case could be intense either in the chief complaint, in some emotional aspect, and in several other places in their story. In this case, it was the emphasis that the patient laid on her singing and the fact that the voice which she relied on and took for granted, was suddenly taken away from her, struck me as characteristic. Hence, I chose to explore it further.
The patient was then asked to talk more about ‘relied on’. Describing this, she said, “It was always there for me, even if anyone else was there or no.” The patient then spontaneously went on saying, “You cannot rely on others, nothing is permanent, you cannot trust your husband or kids to be with you forever; you cannot depend on them.”
Here, the issue of reliance, trust and dependence were apparent. She speaks of her inability to rely or trust someone as no one would be always with her. As there is energy here, this was explored further and the patient was asked about depending. She said, “Depending is depending on someone emotionally, to love and support when you need them, have faith in them. The faith should not be broken.” I then asked her about ‘faith being broken’ to which she replied that it could be through any physical thing, which cannot be taken for granted, like the voice, which can get worse anytime or can be taken away anytime.
She was hopeful about her recovery, knew that this was just a phase and that it would pass away. She liked Sufi songs and they touch her heart. She particularly liked one song, whose lyrics comprised of an earnest request to God asking him to improve everyone’s destiny. She had great inclination to music and poetry and was sentimental while reciting or listening to them. Besides, she also liked Indian devotional songs and well composed classical songs. These songs evoked emotions like tenderness, love, devotion and romance in her.
As a teenager, she wrote poems, and also liked to write on philosophical subjects. She felt very hurt when someone spoke to her in a derogatory fashion or if someone does not care for her feelings. She was also very sensitive to being contradicted or being shown in a bad light. These made her feel as if she was not cared for and that she was not important enough for the husband / household. This again hurt and made her feel isolated.
The patient is fond of nuts like pistachio and almonds, chocolates and sweets, fish, garlic, pepper and bread and butter. She also likes bitter food like bitter cucumber.
The patient has sudden hoarseness of voice, which is aggravated exertion of voice and is better by singing. For her singing is a pleasure, a serious hobby. Voice was something she relied on and it was suddenly affected. To her, relying is having trust, care, love, support and something which she could depend on. These are the issues of Mineral Kingdom where the person feels incomplete or lacking and depends on someone. These are all pointers to a mineral remedy – where the core issue is of one’s structure and need to fulfill all the functions required to maintain that structure. This creates either a lack or loss of abilities which are required to fulfill a particular function. The issues are ‘Am I capable or not?’ This is very well represented in the seven rows of the periodic table, where each row represents a stage of development of human life.
On confirming the mineral kingdom, the next step is to determine the row. The prime issues of the seven rows of the periodic table are:
Row 1: Existence
Row 2: Separation
Row 3: Identity
Row 4: Security and task
Row 5: Creativity and performance
Row 6: Responsibility
Row 7: Disintegration3
The patient compares the relying upon to be dependent on husband and children for trust, care, love, support. Her voice becoming hoarse is like emotional support, faith – which has now been broken. So from all this we understand that the patient needs a salt from Row 3. The main issues of Row 3 of the periodic table are love, care, affection, identity, nurture, nourishment, forsaken, alone etc.
This is the System understanding in the case. It gives us a clear hint of what the patient requires. We know that the patient belongs to the Mineral kingdom and requires a salt of Row 3. Now we understand the characteristic symptoms of the case and repertorize them. The patient likes listening to music, likes romantic poetry and also composed poetry and philosophical writings in her teenage years. When her husband says something against her she feels she is not loved and feels forsaken. So what comes up is the issue of emotional support, faith which is suddenly broken by husband and by her voice, after which she feels sad and forsaken, not loved. So Nat mur comes up as the remedy. Also her cravings for bitter, bread and butter, sour, sweet, nuts, garlic are covered by Nat mur.
(Roger van Zandvoort, Complete Repertory, Mac Repertory, 8.2.01, Professional, Kent Homoeopathic Associates)
On one hand we see the traditional approaches of the Repertory and the Materia Medica together indicating a remedy, whereas on the other hand, we see the understanding from the Sensation Approach complement the result through the traditional approach. This confluence of the old and the new, not only deepens our understanding, but also gives us added confidence in our analysis and prescription. This coming together of the old and the new is what I term as Synergy – which means a creation of a whole that is greater than the simple sum of its parts.
The patient was given Nat mur 0/6, as she was at level 3, the level of emotion and the complaint was slowly progressive and lacked a particular causative modality. According to Sensation Approach and the understanding of the levels of experience, the patients at Level 3 are most helped by 200 potency in the centesimal scale and 0/6 potency in the LM scale.
Thus in this case, it was her effect due to the complaint, which served as an entry point. Once this choice was made aptly, it provided many key words which when asked about further, directly led to a clear understanding of the patient’s state and her symptoms.
After a year of treatment, the patient did quite better. The hoarseness of voice had considerably reduced, so she could resume singing. This gave her great joy that she could again start relying on her voice. Though her voice was not back to its original pitch, daily exercise helped her improve her voice. Her temperament also improved and she was now able to trust people easily. The cold and cough, which she recurrently suffered from, but had forgotten to mention earlier also abated to a great extent. Overall she was better by 70%. She was on daily doses of Nat mur 0/6, with intermittent doses of Nat mur 200, for acute episodes of cold and cough which responded well to the medicine.
A successful case demands utmost skill on the part of the homoeopath. It is of utmost importance to know which points to tap so as to reach central experience of the patient, which is unique to the individual. The ultimate test of a homoeopath lies in skillfully eliciting the case and then judiciously applying his knowledge, the old and the new, to successfully analyze the case so as to come to the similimum.
More so, the point I would like to drive home is the importance of the synergistic approach to cases; which is an amalgam of the classical understanding and the newer advances. Sensation and Synergy approaches are advancements I have made in my practice, similarly some of my colleagues have also made significant advancements in approaches to case solving, which are beyond the Sensation method. Therefore we are all coming together to present our ideas, comprising of our journey beyond the Sensation. the other song has organized Sensation and Beyond: Latest Advanced in Homoeopathic Practice, a 3 day intense learning experience on 8th, 9th and 10th January, 2016 in Mumbai, where senior and international homeopaths and experts in the ‘Sensation Method’ will put these new ideas into practice. The main purpose of this event is to highlight the advances made beyond the Sensation method, which have helped treat difficult and challenging cases.
1, 2 : Rajan Sankaran, Synergy, The Synergy in Homoeopathy – An Integrated Approach to Case-taking and Analysis, First Edition, 2012, Homoeopathic Medical Publishers
3 : Rajan Sankaran, Row 3, Structure: Experiences with the Mineral Kingdom – Volume 1, First Edition 2008, Homoeopathic Medical Publishers, Mumbai
About the other song:
‘the other song’ is a world class premium medical centre which puts good health and well being at the core of an academic culture dedicated to complete patient care. Situated in Mumbai, this institute is one in its kind where a team of 35 doctors headed by Dr. Rajan Sankaran (the pioneer of the Sensation Approach in Homoeopathy) come together and practice Homoeopathy. At the Academy, the students and practitioners are trained in advanced Homoeopathic practices, using new methodologies in combination with the traditional approaches, all with the use of state-of-the-art technologies. The Academy is also a meeting point for different schools of thought in Homoeopathy, where renowned homoeopaths – national and international are invited, to share their knowledge and experience, so that there is a constant flow of ideas on a common platform.
On what basis did you decide to administer Nat.m daily for a year?
I also have question about the potency.