Dr. Leela: Welcome back Dr. Barvalia! Quite a few people have read your earlier interview in the Hot seat in April 05, as there is a widespread interest in the Autism Spectrum of Disorders and successful and integrated homeopathic management of these children. I encourage people to read the first interview to get some introductory background as we’re going straight into the thick of discussion now!
I was delighted to hear, talking with you in June this year, of your wonderful plans and futuristic vision for bringing good quality homeopathic treatment to the masses, especially the poor and under-privileged. I’d like to talk in detail about this exciting project a little later.
First, many people I meet online, ask me to recommend reliable online courses where they can also avail of clinical training. I thought I’d find out more about your Global Online Fellowship Course. We mentioned this briefly in the last interview and now it appears you are ready to launch it. Please tell me how you envision this educational initiative.
Dr. Barvalia: Hello Dr. Leela. I’m glad to be in the hot seat again. Thank you for inviting me. Yes at present my focus is in the ‘ambitious’ hospital project at Deonar, Mumbai which has been facilitated over the past year, and developed into a real life possibility! We are thankful for all the support given to us by the Municipal Corporation of Mumbai. I call it ‘ambitious’ because it seems unfathomable at this present time how we will eventually realize the amount of funds needed for its development. But God has been good and blessed us with people only too willing to help who are convinced about our sincerity of purpose. Yes I’d like to talk about this vision more in detail.
You asked about the Global Online course. We have worked out a very comprehensive structure for the total education of the clinical homeopath. Our institute has obtained accreditation from AYUSH, the department of Indian Systems of Medicine & Homeopathy, which is part of the Ministry of Health of the Government of India. It conducts clinical research projects in collaboration with various institutes.
The objectives of the institute will be part of the online course content as well, and are broadly divided into following categories.
Building up a sound conceptual matrix along with advancement in knowledge.
Acquiring the skill & finesse required for an efficient homeopathic practice.
Developing humane aspects within every homeopathic physician.
Evolving the required competencies a physician needs to deal with the basic demands of homeopathic practice.
Cultivating an aptitude in every homeopathic physician for advanced learning, homeopathic research, fellowship, academics & teaching.
I’d like to further elaborate on the importance of further training in the applied aspects of homeopathy for every homeopathic physician which is a central focus in this Fellowship.
Dr. Leela: You mean, how a physician develops his clinical acumen from the homeopathic standpoint?
Dr. Barvalia: Yes, something like that. A physician has to develop an integrated approach to any case present before him using the three tools of Organon and Philosophy, Materia Medica and Repertory to reach a similimum remedy indicated for that point of time. To understand this process of integrated thinking, lets take an illustrative case of an unmarried woman of 49 yrs who worked in a Bank and was diagnosed with a CVA (Cerebral Vascular Accident – Stroke). She was admitted to our Mumbadevi hospital in an unconscious state. She was brought there by her maid as she lived alone and she did not have any close friends. Most of the history we gained was from this maid. She was apparently fine in the morning getting ready to go to work when she suddenly developed weakness of her legs, stumbled and fell. She got up and started having her breakfast. She then told the maid that she was unable to hold her cup as her hand was trembling. A little later she developed a severe headache and fell down unconscious (having suffered a CVA). She had a history of hypertension. Also, she had a history of repeated hospital admissions in the past on flimsy symptoms where nothing was found wrong with her.
The case has to be understood and analyzed based on homeopathic philosophical training. It is an Emergency posing its own challenges for the homeopathic physician. We have to focus and observe the homeopathic symptoms and evaluate them from a philosophical standpoint. This also includes deciding what type of remedy is needed in this situation – an acute, an antimiasmatic or the chronic remedy. Based on this, one has to evaluate the hierarchy of symptoms. A good knowledge of the Materia Medica aids our search for characteristic symptoms that indicate probable remedies. These symptoms converted into appropriate repertorial rubrics enable a repertorial analysis. The choice of a similimum remedy is based on a proper understanding of the Materia Medica of that remedy. All this is done in an integrated fashion in an intuitive process, and not in any predefined stages.
Dr. Leela: I understand what you mean – normally our first response is to rush to the ER and try resuscitation measures without thinking about the symptoms and how they developed in the homeopathic sense. Instead we see a CVA case who is unconscious and we’re desperately trying to ascertain the point of lesion by clinical examination anxiously awaiting the CT scan report. Thus we waste valuable time from the homeopathic perspective.
Dr. Barvalia: Clinical diagnosis is equally important in homeopathic prescribing. In fact it can be crucial especially in life threatening situations. But we have our own homeopathic applications of it. That is what I mean when I say it is an “applied aspect“. What is important in these situations is sound observation, the right quest to identify ‘PQRS’ (Peculiar, Queer, Rare, Striking/Characteristic) symptoms and an ability to make proper correlations.
In this case we observe the progression of symptoms from the homeopathic philosophical basis; legs >> to hands >> to head. This is interpreted in homeopathic terms as “Ascending Paralysis” which is found in the Materia Medica of Conium. The Hypertension was attributed to Atherosclerosis. Since the patient was a spinster, the possibility of sexual suppression existed. Her repeated hospital admissions of the past point to a probable ‘hysterical’ element. Now bereft of a good history in an unconscious patient, we are able to formulate a picture for a prescription based on one central reliable symptom, the ascending paralysis, and further supported by other observations.
We were able to be fairly confident that Conium was the remedy she needed and started her on this before any investigations were completed. She did very well on it, regained consciousness and recovered. No other treatment was required.
Dr. Leela: I looked up Complete Repertory for Ascending Paralysis and here are the rubrics and remedies:
Generalities; PARALYSIS; General; landrys ascending paralysis, acute idiopathic polyneuritis (4) : aconin., con., lyss., vip.
Generalities; PARALYSIS; General; extending; upward (22) : aconin., agar., alum., Ars., bar-acet., bar-c., Con., gels., hydr-ac., Kali-c., karw-h., lath., led., lyss., mang., Ox-ac., phos., pic-ac., plb., sec., sulfon., vip.
Conium is in both rubrics!
Dr. Barvalia: 🙂 Modern medicine has its own severe limitations in such situations. If we put on our Homoeopathic caps instead, we can begin the curative treatment long before all investigations are done.
As a hospital in-patient we could monitor the case around the clock. My MD friend from modern medicine was at our beck and call, in case any grave situation arose.
Dr. Leela: You have repeatedly stressed about developing one’s Homoeopathic perspective. Can you elaborate on it a little more?
Dr Barvalia: It is our ability to perceive individuality in any phenomenon that makes us resourceful homoeopathic clinicians. Equipped with this ability, trained through rigorous disciplined practice, we can acquire a perspective to perceive the ‘Homoeopathicity’ in the phenomenon under observation.
We are fortunate to have various masters whose teachings have helped us to find a pathway to similimum within a real maze. One such master is Dr. C.M. Boger, whose unique contribution is his Synoptic Key which is an instrument par excellence in sharpening a physician’s analysis and synthesis. Boger’s approach to totality was not centered on pathology but on pathogenesis. We need to grasp this difference accurately. His focus was on the ‘pathogenetic’ potential of a remedy which was manifested at various planes: Physical, Mental, Pathological.
He stated: “Correct prescribing is the art of carefully fitting pathogeneticity to clinical symptoms, and thus in a present situation requires a special aptness in grasping the essential points of symptom images; through great drudgery in mastering a working knowledge of our large Materia Medica or through the most skillful use of many books of reference”. The focus here is on the physician: his skills and faculties that need to be cultivated.
Dr. Leela: Words of Wisdom, that we will need to have spelled out for us 😉
Dr. Barvalia: I’ll oblige. Here is a small example from my practice which will demonstrate the way I perceive Boger’s thinking: A junior physician in the Out Patient Dept. handles a case of acute Upper Respiratory Infection. The patient presents with a severe pain in throat, fever, backache and bodyache. The thermal state is chilly, thirst unchanged. He was prescribed Rhus tox 200 and later 1M without any relief.
The junior asks for a senior’s help. The consultant finds the patient in a state of physical distress. The throat congestion is quite severe. Elongated tortuous violet blood vessels are visible on throat examination. On further questioning we find out that excruciating BACKACHE with fever was present since day one. On these indications, AESCULUS 200 was prescribed, which brought about prompt and total relief with 2 doses.
Now, AESCULUS is well known for its applications in Haemorrhoids. Tortuous, purplish elongated veins in rectum, would easily make us think of AESCULUS. But in Homoeopathy, similarity is not in pathology, but in pathogenesis. AESCULUS has a tendency to produce tortuous, purplish, elongated veins; not only in the rectum but also in the throat, abdomen etc. It has pain in lumbo-sacral region as an important concomitant.
Dr. Boger rightly focuses on venosity; purple puffy parts: as an essence of Aesculus. A homoeopath who grasps this concept will not limit AESCULUS as a local remedy for piles, but will fully exploit its potential to deal with any number of diseases where the above mentioned Aesculus state exists.
Do read Boger’s essay “The Language of Disease” as it brings out, in his unique, concise and precise style the essence of philosophy.
Dr. Leela: Aesculus for fever and sore throat – imagine that! I’m going to read that inspirational essay as soon as I can lay my hands on it!
Dr. Barvalia: In order to manage critical cases, this perspective and ability to synthesize helps immensely. I would explain this with another illustration:
Mrs. S.D., a 41 year old female, presented with an acute excruciating pain in the limbs and back. She was from a Jain family and had 2 sons. Her husband was a clerk in a company. She was a case of ‘Beta’ Thalassemia and sickle cell trait. She would come down with a severe exacerbation of sickle cell crises leading to intense pains, mild fever and had become almost bedridden. I was called to see her during one such acute exacerbation.
The following evolution of her disease was available:
She was diagnosed with this illness 12 years back. She would have frequent acute episodes of pain – once every 2 months. During this time, her Hemoglobin would fall to 6 or 7 gms%. Each episode lasted for 15 days. Twice she was given a blood transfusion. She remained weak and frail. Each episode tended to precipitate suddenly. This time it began with intense pain in right shoulder followed by severe pain in left hip. After a few hours it was left shoulder followed by right hip. The pains were excruciating making her bedridden within a day of onset. Allopathic medication would give her comfort only for 6 days.
The pains were worse on slightest touch with pain in shin of her right tibia being very intense. She was thirstless, chilly and had a bitter taste in the mouth. Her pains were so intense, she was in hardly any mood to speak. The PQRS that stood out were:
Diagonal affection: Direction of pains and symptoms
Shin (bone) of Tibia….. intense pain
Thirstless and chilly
When we correlate these characteristics, along with sensitive bone pains and anemia caused by ischemia and haemolysis, MANGANUM comes up. This remedy covers the tubercular – syphilitic pathogenesis of the bones as well. MANGANUM 200 4 hourly promptly relieved her pains and she started walking within 2 days! Later on, her constitutional state of NATRUM MUR became apparent and was administered. She needed a few doses of TUBERCULINUM during remission. Her Hemoglobin became stable and stayed at around 10 gms% and gradually the Serum Ferrittin level reduced to normal.
After 2 years the acute phase changed, she developed chills, fever with an episode of Urinary Tract infection. A SEPIA picture was evident and it cured the Urinary infection. Her other biochemical parameters showed a tremendous improvement despite her Sickle Cell Hemoglobinopathy. She required Natrum mur. periodically while the Manganum phase of Sickle Cell crisis returned only twice over those 6 years of follow up.
This case demonstrates how an effective clinico-pathalogic-miasmatic correlation when philosophically made, can be applied in practice.
Dr. leela: In simple words, in serious cases, one must perceive the presenting picture of PQRS symptoms for a prescription, and then understand why a remedy is indicated at a particular point of time as similimum. This is not only based on its PQRS indications, but also on the understanding of its pathological and/or anti-miasmatic scope in a particular disease.
Dr. Barvalia: Yes, perceiving the Manganum totality, the use of Tuberculinum and posology used; all this was dependent on the understanding of the nature of illness and miasmatic state in the pathology of Haemolytic Anemia. An integration of the miasmatic totality is crucial in the Anamnesis of cases with genetic disorders.
Revisiting this area of disease from the Homoeopathic perspective will be immensely helpful to the entire homeopathic medical fraternity, enabling us to handle many serious genetic disorders where very little can be done by Modern Medicine. NOSODES are the most potent, deeper forces of our remedy armamentarium that can play decisive role in the cure of these diseases. This will demand a whole hearted acceptance of Hahnemann’s miasmatic doctrine in the Theory of Chronic Diseases, while keeping our analytical faculty open, agile and active. Any ambivalence to our own philosophy will be disastrous and self-destructive.
Dr. Leela: Truly, homeopathic clinical acumen in serious diseases along with understanding the role of miasms and pathogenesis is an area of advanced learning that is necessary among homeopaths today. I understand the Fellowship you offer includes not only international students, but Indian homeopaths from various parts of the country as well.
Dr. Barvalia: Yes, we organize 2 workshops per year where international online students will be expected to participate in order to gain the essential clinical application they require. Students taking the course will be divided into 2 categories:
Basic Foundation Course of 1 year for those with very minimal exposure to clinical homeopathy, but have a basic acceptable homeopathic qualification. This course will take them through the fundamental principles of homeopathy, the art of perceiving the case and its analysis to reach a remedy. Further, through appropriate case management in order to evaluate not only remedy response, but also to consider what other ancillary measures are needed in each individual case to assist with healing.
Advanced Fellowship Course of 1 year with detailed modules specifically in the fields of HIV and Child Care. Each of these subjects encompasses a wide variety of cases which have specialized structures of management that include the study of the pathology of disease and other ancillary support needed. We integrate this study with tools available in Modern Medicine today, that are a necessary part of evaluating management and healing. All this needs to be taught to homeopaths. Of course, the basic principles here are applicable in various other clinical cases. But our work so far has built up a wide range of reliable documented evidence on Child Care and HIV and hence it seems appropriate to start with fellowships in these two areas first.
Those who have a homeopathic qualification and are of paramedical or medical background will be able to complete the first course in 6 month period, before embarking on the fellowship course. In India of course, the basic qualification is a DHMS or BHMS degree.
Dr. Leela: What I find exciting about the course you have planned is that it also includes the clinical workshops necessary for developing the confidence and clinical acumen needed to handle a variety of patients. This really widens the scope of homeopathy for these practitioners.
Dr. Barvalia: Yes, since we have experienced homeopaths with well developed practices on the faculty, students are able to experience first-hand clinical management. Besides this, there are the ongoing research projects and patient groups with the Spandan initiatives in Tb, HIV, Autism and other hyperactive disorders, thyroid disorders, developmental disabilities in children, patients with various other Neurological Disorders, etc. These cases are all well documented along with qualified medical opinions on their progress, from neurologists, psychiatrists, etc who are part of our team. We also include cases cured from various types of clinical pathology like renal failure, pancreatitis, nephrotic syndrome, cardiac diseases, including various cases of viral and bacterial infections as well.
Our homeopathic faculty comprises of very senior and competent homeopathic consultants who have a rich out-patient/in-patient and research experience. Dr C.B Jain, Dr Amit Daftary, Dr Shankar Chawala to name a few, part of this team. All of us have been working together for last 20-25 years!
Dr. Leela: That speaks of true commitment!
Dr. Barvalia: The workshops in Mumbai twice a year are especially for international students. But we also conduct smaller workshops held in various parts of the country throughout the year in order to enable Indian homeopaths in the fellowship programme to participate. I travel 3-4 times a year to these areas, as do the other members of the faculty. We’re busy! But what remains a central focus right now is progressing with the plans for the Multi Specialty Homeopathic Hospital in Deonar, Mumbai.
Dr. Leela: I’m excited to hear more, as this has always been my core interest in homeopathic management. I have had the opportunity to work in allopathic hospitals for about 6 years, both as a homeopath and as a medical officer. One year I worked as Homeopathic Medical Officer at Holy Family Hospital, Okhla, New Delhi and that experience was tremendously inspiring – in terms of the potential scope of integrated medical work with other medical and paramedical professionals competent in their field of work. This, in addition to the tremendous scope homeopathy has to offer in the emergency hospital situation.
Tell us more about this ‘ambitious’ project as you call it.
Dr. Barvalia: Let me explain to you my vision for this hospital. As you know in-patient work is not new to us. I attended for 16 years, the Mumbadevi hospital where you worked, as well as the Dhawle foundations’ various projects/hospitals. People with so called ‘serious diseases’ in all these places have been cured with homeopathic management. Beyond that I have also been called on innumerable occasions, to handle serious medical and surgical cases for relatives of my patients who were under the care of MD’s in various allopathic hospitals. Homeopathy was considered their last hope. We have been successful and saved people’s lives. This has been a strong motivation to establish a fully equipped hospital on a larger scale where homeopathy becomes the central therapeutic modality.
The need of the hour today is for homeopaths to understand the scope of multidisciplinary care and its operational implications in healing. In India we are fortunate that we have a large number of well qualified MD’s, MS’s and Super-Specialist’s in modern medicine who have a keen interest in homeopathy and support our treatment protocols. They add to this their much-needed and experienced opinion on the pathological status of the case. Like our master homeopaths, Kent, Hering, Boenninghausen, Boger, etc, these MD’s have all personally or through their patients, experienced the curative capacity of homeopathic remedies and are ever willing to support such major projects especially in their professional capacity.
We have already been fortunate to have respected senior MD’s working on our team in Spandan over the last 8 years. This team experience has resulted in a phenomenal quality of clinical work. I believe that this documented evidence will serve as a ‘Research Tool’ for the future, in all such hospital ventures by the homeopathic community worldwide. This team work I term “Interdisciplinary Management” and “Multidisciplinary Management”. I am keen that our colleagues in America and Europe experience this first-hand with us, and are able to replicate the same in their own countries, once legislation is in place to support these types of projects there.
We have already had a team here from Europe which was extremely impressed with our strategy and functioning. Europe may be ready to launch into the holistic hospital multidisciplinary concept of homeopathic management. The US will not be far behind, I assure you. They only need adequate legislation put into place.
Dr. Leela: Yes I do think this will be the beginning of a worldwide phenomenon. Please tell us what is your vision of the Interdisciplinary Management and Multidisciplinary Management in a Homeopathic setup.
Dr. Barvalia: Yes I have identified 3 different groups of patients that require hospital level management:
Inveterate Chronic Diseases
Complex chronic disorders with or without sequelae requiring Multidisciplinary Intervention
This classification is based on the clinical presentation and the pathology of a given case. Making these classifications help us decide for hospital admission, and, at the time of admission, the management required for the case. This assessment has to be based on how we perceive the case with our homeopathic principles, and not what is the present perception of the same in Modern Medicine.
Dr. Leela: You know Dr.Barvalia, I think this is an education that is required by the homeopathic community as a whole. I believe it is those practitioners who develop a deep faith in the reliability of core homeopathic principles, who then have tremendous clinical success in handling serious pathological problems.
Besides, people have been given such a fatalistic impression of emergencies, with depressive prognosis of some “incurable” diseases by Modern Medicine today, that they remain in a state of panic when faced with these conditions. I have seen this both in patients and practitioners. I too felt the same way till not so long ago and I realized it was simply a state of mind that needed working on with support from someone with strong ideals, committed to the principles of practice.
Dr. Barvalia: Yes I think this education starts first with the homeopathic practitioners themselves. They have to understand that perceiving a case has to be based on the way we perceive disease in The Organon and Theory of Chronic Diseases. This tri-fold classification has to be perceived when a patient arrives in the ER, in the private clinic or at the hospital for treatment. On admission, the homeopath has to be able to understand how to co-ordinate the involvement of various experts and their opinions for the best care of the patient in the homeopathic hospital infrastructure.
Dr. Leela: Please explain to us, Sir, how you visualize this classification in practical terms from the homeopathic standpoint.
Dr. Barvalia: Yes I would like to do so. Lets talk about Emergency Care first. When a patient arrives in the ER, one needs to have an immediate qualified and experienced medical opinion about the status of the case. Then investigations required for monitoring the development of the case have to be decided. Ancillary measures and supplementary measures have to be considered in case the patient requires life saving management. We have to be aware that a patient may deteriorate to a situation of suspended animation that requires their vital force to be strengthened in other ways in addition to the similimum remedy. When this support is available, the homeopath instead concentrates on a good homeopathic prescription by observing the homeopathic characteristics in the case, the rest being taken care of by other experts. These are cases of Trauma, Cardiac Emergencies, CVA’s, Poisonings, Obstetric Emergencies, etc, to name a few. The basis for this care is explained in The Organon Aphorism 67 and its footnote.
The next area of homeopathically classified hospital cases are the Inveterate Diseases. Hahnemann makes a reference to these in The Organon Aphorisms 51, 206 and in the Introduction. This group of cases includes all diseases that are termed “incurable” by Modern Medicine. Often these patients come to us after being on symptomatic prescription drugs for years. Cases like SLE (systemic lupus), Rheumatoid Arthritis, long standing Bronchial Asthma, are in this category because they come for homeopathic treatment after having taken painkillers and steroids, for extended periods of time. They become heavily immuno-suppressed. They present with structurally advanced pathology while the disease is still in an ‘active’ state. At this point they are in a dangerous state of susceptibility as any small attempt at withdrawal of the allopathic drugs results in a severe exacerbation of the chronic complaint. These patients cannot be treated on an Out-Patient basis. They need continuous close monitoring over a period of months dealing with these acute exacerbations and changing symptom pictures, before they are stable enough to be seen as Out-patients. During this period of hospitalization, they are tapered off the prescription drugs and reach a point of stability on the homeopathic similimum prescription, before they are sent home