Acute Prescribing: Challenges and Solutions

Table of Contents

The need to know philosophy

Evolution of disease

Concept of energy, magnitude & reactive stages

Phase of the disease

Acute versus chronic: Notable points

Miasmatic assessment

Building up acute totality

Module I: CLSMC

Module II: Case taking in acute

Module III: General and sector totality

Module IV: Understanding patterns

Module V: Form, function and structure

Module VI: Energy assessment

Prescribing methods

Nosodes in acute cases

Special cases

Follow-up instructions

Allopathic medication with homeopathy

Some capsule cases

References

“The essence of illness is the freezing of behaviour into unalterable and insatiable patterns”.

– Lawrence S. Kubie

THE Need to know philosophy

Acute diseases have always been challenging to treat since the physician needs to give quick results to the patients. In order to prescribe successfully, one has to understand the philosophy behind acute diseases. Most of the times, prescriptions are made without actually following the guidelines stated by the principles of homeopathy. There are three types of prescribing methods that are usually followed in acute diseases – first based on the clinical and pathological side, second on the classical side and third on characteristic symptoms. The clinical side is required for diagnosis and overall management but brushing aside the philosophy, the principles and selecting the remedy on label of the disease alone is a major mistake made by many physicians.

Homeopathic practice is nothing but applied homeopathic philosophy. When a homeopathic physician begins his practice, he experiences many failures while treating acute conditions. These failures teach the lesson that not following the philosophy of homeopathy results in failures during practice.

For the treatment of acute diseases, the following points are essential.

• One must know the philosophy of acute diseases
• One must know how to form the totality of acute diseases
• Selection of the remedy based on totality of symptoms
• Selection of potency and repetition schedule

These aspects will prepare the base for the scientific application of homeopathy through the artistic use of Materia medica and Repertory.

THE PROCESS OF LIFE

“Life is a process of interiorization and exteriorization proceeding continuously, rhythmically and simultaneously.” –     Dr. J. Jaworoski

Author’s Comments

All diverse forms of life coexisting together include matter and space, movement and stillness, sound and silence, light and darkness.

In integral health, life is rhythmic and in order to maintain the rhythm, the system needs to behave in bipolar ways such as endogenous/exogenous, softness/hardness, anabolism/ catabolism, yin/yang etc.

There must be exteriorization for the sake of internal harmony to be maintained.

Allan Watts has put it beautifully, “Every explicit duality is an implicit unity”.

TIME DIMENSION

Acute

• All attributes of acute diseases are dimensions of time.
• Acute operations in nature last for a shorter duration of time i.e. speed and intensity of natural operations are in inversely proportional to the duration of time.

Chronic

• In chronic diseases, the march of events occurs in a lower key.
• It lasts for a longer period of time and progresses slowly in a relentless manner towards destruction unless aided by the similar force.

Acute diseases in homeopathic parlance   

In Organon of Medicine, Hahnemann has mentioned about acute diseases in the aphorisms 72-82.

The following points are worthy to take into account:

• Mode of onset: Usually sudden
• Intensity: A marked intensity of functional and structural alterations à signs and symptoms
• Pace: Rapid progress; travels at a great speed. Finish their course more or less quickly.
• Termination: Manner in which they terminate; either recovery or death.

Diseases are acute or chronic to a homeopathic physician not by their duration but by their characteristic expressions:

In other words, acute diseases are rapid, morbid processes of the abnormally deranged vital force, which have a tendency to finish their course more or less quickly, resulting in recovery in the course of time or in death, if the vital force is overwhelmed.

Categories

• An isolated episode: An acute ‘miasm’ (individual)
• An acute paroxysm/episode of an intercurrent/periodic disorder, such as malaria, bronchial asthma, epilepsy.
• An acute exacerbation of a chronic progressive disease, such as auto-immune diseases like chronic ulcerative colitis, SLE etc.
• Endemic, epidemic and pandemic diseases like typhoid, exanthematous fevers, cholera, covid-19, etc.

TYPES

• Recurrent/Relapse/Recrudescence /Exacerbation
• Psycho-dynamic
• Somatic
• Psycho-somatic
• Somato-psychic

Evolution of disease in acute CASES

Disease evolves from

Subtle                                      Gross

Functional                                Structural

Physiologic                              Pathologic

Characteristics                          Common

Subjective                                Objective

Traits                                       Patterns

Reversible                                Irreversible

Author’s Comments

The acute disease has its own speed and energy and while it marches onward, it evolves through many stages, phases and transitions making it important to observe this phenomenon as a single spectrum.

The disease evolves from dynamic to post-structural state after taking many intermediate stages. All these stages should be carefully worked out and homeopathic remedies must be applied as per the stages. The field of clinical understanding through physiology, pathology, biochemistry, investigations, clinical features, complications and prognosis of the case has to be thoroughly understood through the evolutionary process of the disease. The whole field of relationship of remedies is based on the concept of evolution. In acute prescribing, the knowledge of Materia medica and that too of relationship of remedies and repertory acquires paramount importance.

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 the manifestation of a malignant pathology.

The evolution helps to know the totality as a unit, as a one spectrum, in which the cause and effect are merged together. Pre-clinical and diagnostic phases of the disease are parts of the totality. The stages characterize the time a system takes for the phenomenon (trinity, i.e. form, function and structure) to occur. The use of remedies is based on the clinical stage at the time of consultation and if there is a change in the stage, a prescriber needs to act accordingly, along with giving importance to fixed general totality (FGT)..

While dealing with acute diseases, two words have marked importance: Energy and Magnitude.

The concept of energy

The concept of energy helps to describe many processes that the disease brings on. The disease potential which is responsible for causing movement in the system at various operations can be easily understood.

Following forms of energy need to be taken into account while one deals with the concept of energy, viz. atomic energy, kinetic energy, gravitational energy, heat energy, elastic energy, electrical energy, chemical energy, electromagnetic energy, nuclear energy, or mass energy. Energy is always conserved in these processes although it may get converted from one form into another. The human system involves all form of energy and energy transformations continue all the time beginning from birth to death.

THE ENERGY ASSESSMENT (MODULE)

Author’s Comments

Intensity, magnitude, speed, stimulation or depression of the system are necessary to define the disease potential and acute illnesses.

Disease is a phenomenon which needs to be studied from the energy point of view. Pace defines the speed with which the disease travels. Intensity defines the degree; the quality of being intense Magnitude defines the depth and the extent.

One also has to define if the system is stimulated or depressed. To exemplify: Bell. is stimulated while Gels. is depressed.

The concept of magnitude

The word ‘magnitude’ denotes perception of deepness, immensity, dimension, strength, vastness, or extent of the disease process. To illustrate, “The amount of energy released by an earthquake is measured on Richter scale. This measure actually signifies the magnitude.” Another example by which it is apparent that scientists are assessing the consequences or damage of the explosion states, “scientists are trying to predict the magnitude of the explosion.”

The investigations include the parameters of knowing the magnitude of harm made by the energy of the disease to the tissues.

The concept of miasms helps to know the energy and magnitude in a synthetic way.

The reactive stages

There are two important reactive stages. Whether the system is stimulated or depressed? What has been manifested by the system on the screen? Does the disease produce the delirium or mania or rambling talk and has the patient become euphoric or is the system so depressed that the patient is lying in the bed without any reaction?

The remedies can be categorized on the basis of the reactions.

Examples

Mind

Rubric 1

Mind; excitement, excitable; fever, during: ACON alum anthr APIS ars ARS-H bac BELL bov bry caps carb-ac CHAM chin-s cina COCC COFF coff-t CON elaps FERR ign ip kali-c LACH lachn LYC m-arct mag-c mag-m mosch mur-ac NUX-V op PETR ph-ac puls RHUS-T ruta sabin SARS sec SEP stram sulph tarent tela TEUCR thuj VALER verat

Rubric 2

Mind; cheerfulness; fever, during: acon clem coff ferr-p harp mosch nat-c OP petr plat sabad SARS thuj verat

Rubric 3

Mind; dullness; fever; during: am-c ang arn ars BAPT bell bry cadm camph caps CARB-V cinch-s COLCH cupr eup-per gels guare HELL HYOS ip kali-c lach laur LYC malar nat-c NUX-V ph-ac phos PODO rhus-t ruta sep STRAM SULPH term-c VALER verat v

Body

Rubric 1

Generalities; restlessness, physical; fever heat, during: ACON ARN ARS BELL BOV cham HYOS lach LYC MERC MOSCH MUR-AC nux-v op phos RHUS-T sil staph stram sulph

Rubric 2

Mind; dullness; fever; during: am-c arn BAPT bry camph CARB-V  cic COLCH cupr  gels HELL HYOS laur LYC malar nat-c NUX-V ph-ac PODO STRAM SULPH term-c VALER

Rubric 3

Generalities; collapse; fever, during: ail antipyrin ARS CAMPH CARB-V chin crat crot-h hyos hyosin LAUR merc-cy mur-ac sec verat

START HERE

The phase of the disease

The phase consideration denotes defining any distinct or characteristic stage of development in a sequence of events. It depends on the availability of characteristics and not only on the basis of clinical features and pathological alterations. In acute diseases, the constitutional symptoms of the patient are thrown into the background and the vital force under the impact of the environmental force brings the acute symptomatology to the forefront. Hence identifying the phase of the disease becomes absolutely essential.

Fully developed

This has two angles: Clinical and Homeopathic. When the disease is diagnosed due to its clinical features, it is called fully developed. When the characteristic symptoms are available at the physical and mental level, the phase is called fully developed in homeopathy. PQRS symptoms are available due to increased susceptibility.

Inadequately developed

One gets pathognomonic or common disease symptoms and individualizing or PQRS symptoms are very scanty or absent.

Acute exacerbation

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 or periodical type (regular or irregular), interspersed with acute attacks/episodes. One must remember that he is treating a chronic disease.

Remission

The period during which the symptoms of a disease abate or subside is termed  remission. Deep-acting constitutional remedies and nosodes are to be given during the phase of remission unless otherwise indicated in the definitive manner.

Clinical phase of THE disease response

Prodromal stage

• Where diagnosis can only be suspected on the basis of anticipation.
• For example, in epidemics, signs and symptoms, by themselves, are insufficient to establish a definitive diagnosis.
• It is also called the ‘pre-localization’ phase of the disease.

Diagnostic stage

• Where disease gets localized and diagnosis becomes a certainty.
• Illness becomes a disease. If not treated judiciously, it may develop into complications.

REQUIREMENTS

The following states must be considered while dealing with acutes.

• Requiring no treatment/indisposition
• Requiring wait and watch until the full-blown picture has emerged (however, if the moderate form of acute is present).
• Requiring definitely the treatment
• Requiring immediate attention and treatment in view of the overwhelming state

When a homeopathic physician gets confronted with an acute ailment, it becomes necessary to define in which state the patient falls into, which is dependent on the stage of disease at the time of consultation.

For example, Pneumonia has four stages: Consolidation, Red hepatization, Grey hepatization and Resolution. Consolidation occurs in the first 24 hours and is marked by coughing and deep breathing. Red hepatization occurs in 2-3 days after consolidation. At this point, the consistency of the lungs resembles the consistency of the liver (hence called red hepatization). The lungs become hyperaemic during this stage. Grey hepatization stage occurs in the 2-3 days after red hepatization. This is an avascular stage and the lung appears gray-brown to yellow because of fibrino-purulent exudates, disintegration of red cells, and hemosiderin. The resolution stage is characterized by resorption and restoration of the pulmonary architecture.

NOTABLE points: ACUTE VERSUS CHRONIC

• There is nothing like an acute or a chronic remedy.
• Indications, according to which the remedy is prescribed, matters the most.
• Every remedy possesses both acute and chronic dimensions in its pathogenesis.
• It may be wrong to believe that acute remedies are superficial.
• Acute can be a different state altogether and it should be treated separately from the constitutional state. The remedy should be selected on the presenting acute totality. Acute should not be intermingled with chronic.
• There is nothing like an acute state and acute episode is an expression of constitutional dyscrasia. Hence a remedy based on constitutional state can be the same remedy for acute episodes.
• Hence one should try to understand the whole state as well as the acute disease phenomenon and on the background of the whole state.

Note: All these points are correct in their own way, but it is the individual instance that determines the relevant application of each of them.

Miasmatic assessment

Master Hahnemann, while dealing with the miasms, has emphasized that acute disease occurs due to acute miasm which constitute two types, namely, recurring and non-recurring. Acute disease is regarded as the transient explosion of latent psora, which spontaneously returns to its dormant state if the acute disease is not violent in character and is soon quelled.

While elaborating latent psora, Stuart Close has mentioned, “The disturbance is located in the central life mechanism, which is manifested through the perceptible sensorial and functional changes of the organism as a whole.” Stuart Close has explained about the central life mechanism, i.e. vital force which he called central as it governs and rules the system. The derangement of vital force is manifested through sensations and functions at all levels i.e. organism as a whole, thus emphasizing the concept of totality.

It is to be remembered that Psora is the basic miasm, the sensitizing miasm and hence it possesses hypersensitivity as well as hyperactivity. Therefore, more emotive stimuli, more physical stimuli, more inputs, more modalities, more functional zone, more sensations and more concomitants are being observed.

However, every acute disease is not psoric in nature.  Each acute or chronic disease should be categorized in any of the four miasms viz. Psora, Sycosis and Syphilis by Master Hahnemann and Tubercle by Dr Allen. Simple influenza of mild type is psoric in nature but the one having definite Covid-19 with pneumonia is tubercular in nature, which if left untreated could lead to the dominance of syphilitic miasm. There is certainly a differentiation between pain in the throat due to mild viral infection or diphtheria. Unless the clinico-pathological co-relations are defined well, the concept of miasm can’t be applied adequately.

MODULE ONE: BUILDING UP THE ACUTE TOTALITY

Five pillars

Author’s Comments

The complaints of a patient with acute disease need to be categorized into five pillars in order to develop the totality in an accurate and adequate way.

CAUSATIVE FACTORS

• Pre-disposing
• Exciting/Precipitating
• Emotional
• Dietetic
• Weather etc.

Examples

• Ailments from concussion: Arn., Nat-s.
• Ailments from grief: Ign.
• Ailments after sea bath, cold: Ant-c.
• Ailments from mortification: Staph.

Case

Diagnosis: Acute unstable angina pectoris

Ailments from disappointment in love, severe constriction in left side of chest, pain < lying on left side and feeble pulse. Lovesick for one year. Contemptuous behavior with everyone in the hospital. The patient (an allopathic doctor himself) said, ‘I feel I am dying.’ The author further inquired, ‘So you have fear of death?’ The reply was, ‘No, I don’t feel fear of death, I feel that I am dying.’

Cactus grand helped within a short period of time.

The cause can be a crucial element in the initial phase but one shouldn’t stretch it beyond a certain limit as the evolving totality may point to a remedy that may not cover the cause, and as the disease will evolve, the individual contribution will continue to increase resulting in a modified picture.

Case

A 15 years old boy developed rhinitis on exposure to cold with chills, fever, tickling in larynx, hoarseness of voice and wet cough. Hepar sulph in 30 potency every six hours for two days didn’t help. Then, Rumex was given as a follow-up remedy as it covered the cause, i.e. exposure to cold air as well as other features. However, on the fifth day, patient developed pain in the right side of chest while coughing, persistent fever, thirst for large quantity of water, dryness of lips, which pointed towards right lobar pneumonia and the remedy chosen was Bryonia which cured the patient.

Lesson: If a homeopath would have stuck to the cause of exposure to cold even on the fifth day neglecting the totality, he might have avoided giving Bryonia.

LOCATION

• Includes side, extension or radiation of pain, sensation and pathology; diagonal; alternating.
• Affinity: Cells / Tissue / Organ / System
• Assumes great importance in acute prescribing especially when characteristic indications are scanty.
• Location as a concomitant

Examples

A. Locality

• Right scapula: Chelidonium
• Left scapula: Chenopodium
• Right sciatic nerve: Lachesis
• Sacroiliac joint: Aesculus hip
• Solar plexus: Argentum nitricum
• Unstriped, muscular fibers: Pituitarium posteriorum

B.Extension

• Headache up to base of tongue:
• Headache from neck rising up to the head: Gels., Sep
• Pain in heart region extending down the left arm: Kalm.

Case

• A case of acute appendicitis with fever having temperature of 39⁰C; < during and after sleep. Fever, with shivering. Acute pain in right iliac fossa < touch, > pressure
• Lachesis resolved the case.

SENSATION AND COMPLAINTS

• Peculiar sensation may be vital, denoting the inner core of the patient.
• Outstanding sensation at the level of affected organ often gives a clue to the simillimum.
• Peculiar sensation could be a concomitant of characteristic type.
• Pathology is also included under this heading.

Examples

• Enlarged, expanded sensation: Apis, Arg-n.
• Pain in spots: Ign., Kali-bi.
• Constricting pains: Cact-g., Lach.
• Shaking like electric shocks: Arg-m., Bar-m.
• As if the heart is hung by a thread: Kali-c., Lach., Lil-t.
• Sensation of an eye lash in the eye: Puls.
• As if the tongue is very wide: Nat-m.
• Sharp stones in stomach rubbing against each other: Cocc.

Case

• An old man of 62 years with acute influenza symptoms. , Bry. didn’t help.
• While examining him on the table, patient was found muttering ‘Snehal, Snehal.’ The author thought that Snehal was probably the name of his wife. Casually the author asked his wife if her name is ‘Snehal.’ She laughed and said that her husband had a disappointment in a love affair when he was 22 years old. Whenever any illness developed, he used to mutter like this.

Nat-mur 200 relieved him soon.

MODALITY: CIRCUMSTANCES OF < AND >

• A modality is the most important element of a symptom.
• A modality of an outstanding nature may unlock a case. It can reflect the inner individuality if we perceive its importance.
• The modality is studied in two ways: Aggravation and amelioration.
• A modality common to the chief complaint and the concomitant may often give clue to the remedy.
• The concept of ‘General’ and ‘Particular’ modalities.
• Contradictory modalities

Examples

• Watery stool after perspiration: Bell.
• Yellow discharge, evening: , Sulph.
• Vertigo on entering a dark room: Agar., Arg., Nit-ac., Stram.
• Diarrhoea during dentition: , Dulc., Sulph.
• Nausea amel. by cold drinks: Bism., Phos., Puls.

Case

• A case of acute angina pectoris was given Lat-m., Ox-ac., Kali-c. etc. resulting in partial relief.
• Re-totality: Pains < 2-3 am, lying on left side, exertion; extending to left arm, shoulder. Concomitants: choking and dry cough, > lying on right side, chilliness.
• Naja 200 repeated at an interval of 5 minutes relieved the angina pains.

CONCOMITANTS

• Dr Boenninghausen has presented the unique Doctrine of Concomitants
• The further a concomitant is removed from the sphere of the disease, the greater its value in the diagnosis of the remedy.
• Physical concomitants in a mental case and vice-versa are important.
• The concomitant symptom may be preceding, in tandem or after the episode is over. For example, aura before seizure is a preceding concomitant, unconsciousness during seizure is a now concomitant and involuntary urination after the seizure is an after

Examples

• Pain in the right hip while coughing: Caust.
• Burning coryza, bland lachrymation: All-c.
• Vertigo with yawning: Agar., Petr.
• Nausea with foul breathe: Ipec.
• Sensitive to fresh air before stools: Mez.

Case

• A case of acute pericarditis was prescribed , Bry., Spig., Kali-c. etc. without much avail.
• A group of concomitants existing from the beginning was overlooked. They   were related to urinary system. A few doses of Cantharis 30 saved the case (J. N. Kanjilal).

MODULE TWO: CASE TAKING IN ACUTE DISEASES

Important seven stages

(Fever is taken as an example but we can apply this to all acute cases

1. Anamnesis

• Without anamnesis and the evolutionary totality, the case taking in acute cases is inadequate.
• Strict adherence to date and time is a way to success.
• Record every deviation in a chronological way.
• Evolutionary totality helps to assess the miasmatic state.

2. Analysis in stages

1. Prodome

• Concentrate on Origin, Duration and Progress (ODP)
• Onset: Sudden, gradual, slow then rapid, rapid then slow
• Symptoms during prodrome and apyrexia, though grossly incomplete, have been listed only in Allen’s Intermittent fevers.
• Most of the prodrome symptoms in Kent have been listed under ‘Before Chill’ in appropriate sections.

2. Fever types with meaning

• Continuous: Temperature constantly elevated
• Intermittent: Characterized by intervals of normal temperature.
• Ladders: Continuous and a characteristic step-ladder pattern, a step-wise increase in temperature with a high plateau.
• Remittent: Elevated body temperature showing fluctuation each day, but never falling to normal.
• Swinging: An intermittentfever in which the daily oscillations are very large, often associated with severe chills and sweats.
• Hectic: A fever that recurs each day, with profound sweating, chills, and facial flushing.
• Simple: Elevated body temperature (>8° C orally or > 38.2° C rectally)
• Compound: A continual hot burning putrified fever.
• Undulating: A persistent human brucellosis, especially marked by remittentfever

3.Fever Proper

Stages in fever

1. Chill
2. a. Partial

… May start from location

1. b. General

… May start from the whole body

1. Heat
2. a. Partial

… May start from location

1. b. General

… May start from the whole body

1. Sweat
2. a. Partial

…May start from location

1. b. General

… May start from the whole body

4. Apyrexia phase

• Concentrate on the general symptoms.
• Sweat, thirst, weakness, activity and energy pattern.
• Dr A. Charge (as quoted by Allen) has mentioned, “Study the patient during apyrexia to form an exact idea of the functional action, regular or otherwise, of all the organs.”

5. Physical Examination

• Systemic examination
• Local examination
• The characteristic observations are recorded and used for clinical and homeopathic purposes.
• Objective signs are extremely important.

 6. Investigations: Clinical/Pathological filter

 7. Diagnosis: Clinical, of the phase of the disease and focus on real sickness

MODULE THREE: GENERAL AND SECTOR TOTALITY

1. FIXED GENERAL TOTALITY (FGT)

• The generalized disturbance manifests as General Totality, being thrown up by the constitution of the patient.
• It remains fixed, stable, with minor alterations, whatever sectors get involved subsequently.
• Hence it is termed FGT in relation to variable sector totality (S.T.)

Components of FGT

• Ailments from: Precipitating, mental and physical.
• < and > in general sphere.
• Physical General sensations and complaints (e.g. thirst) inclusive of pathological Generals; incorporation of time dimension.
• Mental state.
• Fever totality

2. SECTOR TOTALITY

Components of ST

• Location
• Sensation and pathology
• Ailments from (Causation)
• < and > in the sector
• Concomitants in the sector, with their time relationship
• Evolution: Onset, speed/pace, course of disease: direction, manner and extent

ACUTE TOTALITY = F.G.T + S.T.

• In the evolution of the acute disease, F.G.T. precedes S.T. in linear dimension of time.
• ‘Aborting’ the disease is possible if F.G.T. is perceived before S.T. becomes manifest.
• Both F.G.T. and S.T. are dynamic with relative fixity of F.G.T.

MODULE FOUR: UNDERSTANDING PATTERNS

Patterns are basic to the inner individuality. Patterns are based on repetition and periodicity. Each remedy has its own pattern of response which has to be understood at many levels. The patterns of the remedy get manifested through time modalities, body language, postures, sensations and feelings, pathological states, concomitants etc.

Patterns as understood through origin, duration, progress (ODP) combined with speed (pace) help to select the simillimum.

Fever: Patterns

• Study the patterns first
• Note down the relevant rubrics from Boger-Boenninghausen’s repertory (Compound fevers, pages 1099-1102)
• Note down the relevant rubrics from Kent’s repertory (fever chapter, pages 1290-1292)

(a) Remedies of sudden onset

acon, ail, all-c, am-c, ant-t, ars, ars-i, arum-t, brom, cor-r, eucal, ferr-p, hep, iod, lob-s, merc, nat-ars, nux-v, penic, phos, pyrog, ran-b, rumx, sabad, squil, solanaceaae family (bell, sol-n, dulc, hyos), spira, spong, tub

(b) Remedies of gradual onset

agar., am-m., ant-ar., arg-m., arg-n., aur-m., bry., carbon group (carb-v., carbn-s., graph., kreos.), chin., ferr-i., ferr., fl-ac., gels., hippoz., kali group (caust., kali-ar., kali-c., kali-m., kali-s., kali-bi., kali-i.), naja, nat-s., plat., puls., raph., sang., sil, seneg., stict., stann., stront-c.., teucr., thuj.

(c) Gradual then sudden onset

am-c., ars., bapt., bry., kali-ar., kali-c.

(d) Sudden then gradual onset

Agar., ant-ar., arg-m., arg-n., bry., fl-ac., kali-ar., kali-m., merc-c., nat-m., stann., sulph.

(e) Succession of stages

1. Chill, accompanied by heat
2. Chill, alternating with heat
3. Chill, followed by heat
4. Chill, followed by heat then perspiration
5. Chill, with perspiration
6. Chill, heat without
7. Chill, followed by heat with perspiration
8. Chill followed by perspiration, intervening heat without
9. Heat with perspiration
10. Heat without perspiration
11. Heat alternating with perspiration
12. Perspiration alternating with chilliness

Author’s Comments

The succession of stages denotes the individualistic pattern and hence it is important in clinical practice. Management of fever cases (acute cases) is easy if one follows the succession of stages. Assortment of appropriate rubrics based on succession of stages pave the way for selection of a right remedy.

MODULE FIVE: TRAINGLE OF FORM-FUNCTION-STRUCTURE

                                                                                                                  

Author’s Comments

Form

The manifestations of the disease in the projection of symptoms is the form. Form is a group of symptoms one can see in the totality of Location, Sensation, Modality and Concomitant.

There are two aspects of the form – fixed and changeable.

Fixed form can be at the level of sector or general and is consistent in spite of evolution that is occurring as a part of progression of the disease process. In spite of many changes that occurred in the system at various levels, if some symptoms or patterns remained the same, they are reflective of individuality and therefore, assume crucial position in evaluation.

Changeable forms are tricky because they need a careful differentiation between clinical symptoms and individual symptoms.

Function

The deviant disease force causes change in the function. The physiological processes get disturbed affecting the functionality of the organ or the system being affected. The organ can’t function properly, and the normal activities of the patient get hindered. It is seen that the change in function is dependent upon the form that gets manifested. In other words, form follows function.

Structure

Anatomical and structural changes follow in the system as the disease evolves. Organic, structural changes occur in the cellular structure whose evidences can be seen through various investigations. The change in architecture is known through many devices and techniques and tests and one can get objective, pathological symptoms and signs.

Inter-relationship between Form-Function-Structure

According to cell biology, the form and shape of a body structure is related to the purpose or function of that structure. This shows that the structure and function go hand in hand and a disruption in one of the components can lead to failure of another. In other words, the function of a body part dictates the form of that body part.

A change in form can cause a change in structure. In other words, change of activity sooner or later leads to a change in structure. Functional disturbances in organs precede their morphological distortions.

A change in structure leads to a distortion of the function.

Example

Case of chronic rhinitis. The form is sneezing, running nose, < exposure to cold air, obstruction of nose, itching of palate, ears and eyes and with lachrymation. The function of smell is affected and the patient has developed anosmia. The patient has a nasal polyp with enlarged turbinates and deviated nasal septum which is related to structure.

In an acute or chronic case, if one takes the totality of trinity of form-function-structure, he can have a broad vision for the management.

MODULE SIX: ENERGY ASSESSMENT (described above)

If the above six modules are applied thoroughly, it is possible to increase the rate of success in clinical practice.

REMEDY SELECTION

• Acute phase remedy
• Organotrophic remedy
• Intercurrent remedy
• Chronic constitutional remedy

Prescribing methods

• Totality of symptoms
• Keynote prescribing
• Etiological prescribing
• Miasmatic prescribing
• Nosodes in acutes
• Pathological prescribing
• Objective signs
• Organ remedies
• ‘Anticipation’ method
• Intuition
• Chronological method
• Alternation of remedies
• Remedy relationship
• Constitutional prescribing
• Tautopathic prescribing
• Preventive prescribing
• Genus epidemicus

AUTHOR’S COMMENTS OVER SOME PRESCRIBING METHODS

Totality of symptoms

• This is the best method. Note that it is not only the aggregate of symptoms, but all the aspects discussed in this chapter.
• Repertorization of all symptoms often helps to select the right remedy.

Keynote prescribing

• PQRS symptoms are more important in acute cases.
• A single keynote is only a pointer to a small group of remedies.
• A single symptom, however PQRS, hardly ever determines the simillimum; rather, it is a group of keynotes that clinches the remedy.

Examples

• A case of Infective Hepatitis (B), where Bry. followed by Chel. failed to benefit the patient.
• Liver function tests were exorbitantly high. Pyrogen selected on high grade fever, temperature–pulse discrepancy, continued chilliness and associated concomitant of rheumatic pains, brought back to the normal within two days. LFT performed a fortnight later showed normal values.
• A case of hyperthyroidism, developed acutely, with marked weight loss, was helped by Iodum selected constitutionally on the key-themes
• Rapidity: Action, disease process, metabolism
• Thermally hot
• Agitational anxiety

Remedy relations

• Boenninghausen, Allen, Gibson Miller, Kent, Hering, Boger, Abdul Rehman, P. I. Tarkas, Ajit Kulkarni, Sunirmal Sarkar etc.
• Discrimination as the necessity for arriving at simillimum
• Complementary
• Collateral
• Symbiotic
• Analogue
• Intensified

(Note: Read Remedy Relations from Absolute Homeopathic Materia Medica)

Examples

• A young boy aged 17 years sustained a blow to the ribs. Arnica helped only partially, then Bellis per given on the basis: ‘greater or deeper Arn’., ‘affection of deeper tissues (than Arn.)’ and ‘pain > motion’ entirely relieved the pain.
• One more case of similar type with constricting pain was relieved by Cactus grand.
• 1M repeated ½ hourly at the onset of labour helped a Sepia woman with breech presentation in quick delivery. Puls. is an acute of Sep. during labour.

Pathological prescribing and specifics

• Resorted to in cases with striking pathology and especially when no definite pointers to the remedy exist in terms of mentals, physical generals and particulars.
• Pathological general (Boger)
• Both location and Pathology together make the choice easier.

Examples

• A case of Diabetes. The patient developed right wrist drop (radial nerve palsy, carpel tunnel syndrome). selected on pathological basis restored the patient.
• A case of gangrene with severe inflammation, with sloughing, affected part hot, was given Crot-h. on pathological basis which helped avert surgery.

Objective signs

• Signs are of great value when subjective symptoms are lacking, or cannot be elicited. Body language is also an objective sign.
• Helpful in: Infants and children; the insane, the imbecile, the idiot; the comatose; uncommunicative; language barrier; animals etc. as well as and in the pathological cases.

Examples

• Open mouth with stertorous breathing and constricted pupils in a comatose patient.
• Thick, yellow coating on posterior third of the tongue with acute tonsillitis: Merc-i-f.
• X-ray chest: Left lower pneumonia. This confirmed the diagnosis of Phosphorus which was otherwise confusing to the physician owing to inadequate data.

Anticipation

• Before the full-blown disease portrait is developed, one has to learn to anticipate homeopathic remedies.
• ‘Sensing’ the remedy would cut short the course of illness, or even abort it.
• In some cases, to wait for too long prove to be dangerous.

Examples

• A case of enteric fever with high-grade temperature gave the indications of which was given in 1M and then 10M potency without much relief. Patient was drowsy and had a strong aversion to motion.
• Anticipating the toxic state, 1M every two hours was given which cured the case.
• Note: Bapt’s early prostration should not be mistaken for the aversion to motion of Bry. and drowsiness of Gels. (Refer Absolute Materia medica)

Alternation of remedies

Hahnemann:

• and Rhus-t. in typhoid

Nash:

• Rhus-t. and in typhoid

Tyler:

• and Spong. in croup

Nosodes in acutes

Two views

• The French School (Cartior): It favours using nosodes in the acute phase e.g. Tub. in acute, active tuberculosis.
• General consensus: In favour of using nosodes in the sequelae and complications of acute infections, when apparently indicated remedies have failed to cure. Also, for persistent ill- health after acute illness in the past etc.
• A nosode can be used as an acute, chronic, as an intercurrent or as a miasmatic remedy.
• It should be usually given in an infrequent manner.
• The aggravation caused by frequent repetitive doses of nosodes may exhaust the vital force and damage the tissues by causing excessive elimination. Rarely, it may lead to ‘killer’ aggravation.
• Constitution must be able to support the deep reactions which the nosodes may initiate.
• Sometimes one has to take the risk of giving nosodes as acutes.
• As a prophylaxis.

Examples

1. A case of post-influenzal depression/apathy responded to , another to Ph-ac., yet another to Aur.
2. A case of cholera; The child was on the brink of death, failed to respond to remedies like , Verat., Ars., etc. The collapse state suggested Carb-v. but it didn’t help. In desperation, information about family history was asked and it revealed gonorrhea in father. A few doses of Med. 200 cured the child (Dr. J. N. Kanjilal)

A case of Influenza

• An old lady of 67 years.
• Rhinitis since 15 days which started with influenza symptoms. Profuse, watery nasal catarrh and chilliness. While traveling she exposed herself to cold air and drenched in heavy rains. She had almost shattering chills, not better by heavy blankets.
• A course of anti-histamines, antibiotics and anti-malarial drugs. Fever reduced but profuse catarrh, chilliness and profound weakness were persistent since the beginning. Cough with laryngeal tickling and scraping. Feels as if a ball is stuck in the larynx. Cough ends in sneezing; < draft of cold air.
• Agaricus 30 every four hours, for two days. But no relief.

Additional data

• Doesn’t want to take bath out of chilliness. Goes in the sun. Sleeps with two blankets and wears two sweaters.
• She is so much prostrated that she doesn’t want to move at all, does not want to talk. Prefers hot drinks.
• Appetite: reduced. Nasal discharge thin, profuse and offensive. No bath since 4 days. Offensive odour emanates from the body.
• Tip of the nose: Red.

Selection of the remedy

• Psorinum

Result

• Remarkable improvement within hours.

Organ remedies in Acute Illness

• As a palliative when paucity of symptoms is present and there are no pointers to a remedy.
• No cure may follow with the exclusive use of organ remedies.
• The constitutional remedy should follow after the acute phase is over.

SPECIAL CASES

1. ‘INTERNAL SYMPTOMS’ IN PERIODIC STATES

• In conditions marked by periodicity

Regular or irregular-like

– intermittent fevers

– asthma

– headache

– neuralgias etc.

 2. ACUTE ILLNESS DURING CONSTITUTIONAL TREATMENT

Confusing issue

• Whether to treat or delay treatment?
• Acute disorders are considered to be independent of the constitutional state of the patient. Is it so?
• Defense reaction àcleansing process?
• Acute of what type? Its intensity/magnitude?
• Acute in which organ?
• Etiology of acute: Precipitating/exciting?
• Is everything in the follow-up related to remedial force?

Author’s Comments

• No acute   for   years (deeper disease process) and acute only after constitutional à return   to higher level of health à treat only if necessary; better to keep the hands off.
• If the vitality is good, acute will disappear within a few days (3-4 days).
• If acute lingers for long, general status of health is likely to be low.

3. CONSTITUTIONAL REMEDY DURING ACUTE ILLNESS

• Not common.
• Generals are called into play by the system.
• May represent the urgent situation.
• Are the sector, fixed general and chronic totalities keeping their autonomous fields intact?
• No definitive pointers to the acute remedy exist.
• Chronic constitutional remedy of the patient is known.

Action

• The case may need intercurrent remedy.
• See whether it is really elimination?
• Access miasmatic dimension.
• Elimination through which route?
• Don’t meddle with the charged vitality.
• Keep your hands off as long as elimination continues.
• What is the final assessment?

4.RECURRENT EXACERBATION OF CHRONIC DISEASE

• Treat the acute if the totality is clear and separate from the chronic remedy’s acute totality. But treating acute flare-ups helps temporarily and in the long run more damage can occur to the system if the underlying miasmatic condition is not addressed.
• Deeper constitutional treatment is necessary.
• Study pattern, intensity, interval and changes.

5.ACUTES COMPLICATED

• Patient on immune suppressive agents like steroids, chemotherapy, radiation, etc.
• Opportunistic infections
• Toxic, fulminating infections
• Focus on investigatory parameters
• Give preference to the use of LM scale

6.NOTABLE POINTS

• Some chronic patients get better if the acute disease develops; but not all the patients become better.
• Don’t get addicted to the notion that every acute illness is due to constitutional treatment.
• Pulse, blood pressure and general status help assess the reaction after the remedy.

FOLLOW-UP INSTRUCTIONS

CATEGORY I

• The virulence and intensity of the acute illness/infection is diminished during homeopathic treatment (as compared to the previous status of health).

Inference

• Immunity good.
• Most probably Psora is the dominant miasm.
• Usually functional zone of the illness is predominant.

Action

• Withhold the acute prescription. However, after 3-4 days if the acute condition is progressing, give an acute corresponding remedy based on the totality (it should be complementary to the chronic and to the previous remedy).
• If pushing the acute for 2-3 days doesn’t help the patient, think of
• Giving the acute remedy in high potency and in frequent repetition schedule.
• Reverting back to the constitutional remedy.
• Giving a different remedy (deeper acting than the earlier one).

CATEGORY II

• The patient is falling sick frequently since homeopathic constitutional treatment, but the general status/energy of the system has improved.

Inference

• A good reaction but the immunity is not as strong as Category I.
• The system is weak to develop acute illness, because the influence of the chronic disease is overwhelming.
• The system is improving with the chronic remedy; so it is better to persist with it.
• If the acute is severe, treat it, don’t keep the hands off.
• A patient is moving from the deep disease layer to the superficial one. In order to infer this, focus on generals: Mental and Physical. Observe Hering’s suggestions.

Examples

• A patient of schizophrenia develops an acute influenza (which he never had before).
• A patient of multiple sclerosis develops acute sinusitis.

CATEGORY III

• The development of acute exacerbations is a regular pattern (unchanged) even after homeopathic treatment.

Inference

• This occurs in cases such as otitis media, cystitis, bronchitis etc.
• There is a respite only for a few days and the acute infection revisits.
• Persist with the chronic remedy (but make sure that it covers the sector totality as well) in LM scale with daily repetition.
• The chronic remedy may be wrong. Make a new prescription.

CATEGORY IV

• The intensity of the acute disease is the same, the chronic disease is not responding, and the level of health is low.

Inference

• The resources of the system are poor.
• The disease is incurable.
• The previous remedies were inappropriate.
• There may be inability of the physician to find the correct remedy.
• Try hard to find the right remedy and think of interpolating a nosode/anti-miasmatic/ tautopathic remedy.

ALLOPATHIC MEDICATION DURING HOMOEOPATHIC TREATMENT

• Drugs can make homoeopathic treatment difficult.
• Homoeopathic totality may be confusing and there is great possibility of complications or problems which may not come under control.

Three groups

• Medications that are essential for the patient: For example, Insulin, cardiac drugs, anti-hypertensives. Allopathic medications for this group should not be stopped abruptly (sometimes not at all).
• Medication that is necessary for the patient’s comfort: For example, painkillers. This group can be stopped.
• Medication that is necessary for family or social purpose: For example, major psycho-active medication. This group can be decreased only in certain circumstances.

Can we give homeopathy with allopathic drugs (chemicals)?

• Homoeopathic remedies can be given with allopathic medication. A correct remedy will always give amelioration.
• Depending on the amelioration of the complaints, some allopathic medication can be reduced.
• Obviously, the reaction of the homoeopathic remedy will last for less time when more or stronger allopathic medication is being taken.

Anti-hypertensives

• Define first the type of hypertension. Is it mild, moderate, severe or malignant?
• Anti-hypertensives drugs can be reduced if blood pressure is maintaining normal after homeopathic treatment. It usually occurs in mild and moderate varieties of hypertension.
• Anti-hypertensives does not usually pose any problem for homoeopathic treatment.
• In all cases of severe and malignant hypertension, don’t stop anti-hypertensives.

Cardiac drugs

• These drugs cause no problems to homeopathic treatment.
• If there is a good amelioration after homeopathic treatment, one can allow the cardiologist to decide whether the medication can be stopped or reduced.

Cortisone

Possible situations

1. The disease is chronic and the patient has been on systemic cortisone therapy: If the totality is clear and patient’s vitality is strong, give the required homeopathic remedy in low potency and in successive doses. If there is >, taper off the cortisone gradually.
2. If the totality is not clear and the patient’s vitality is strong: Wait along with homeopathic treatment, try to reduce the cortisone first by replacing it with other allopathic medication. Examples: Asthma: Theophylline and Inhalers. Colitis: Salazopyrine. Rheumatoid arthritis: NSAIDs.

• If the totality remains unclear, try the most suitable remedy in a low potency but in frequent repetition.
• If the picture has become very clear in the subsequent follow-up, give the remedy in a higher potency.

Aggravation in the follow-up with Cortisone

• Aggravation is of three types: Disease, Medicinal and Homeopathic.
• Differentiate between < from withdrawal of cortisone and < from homeopathic remedy.
• If there is a serious < after homeopathic remedy and during this aggravation, the patient is given more cortisone, one has to judge afterwards whether the remedy has acted or not.
• If the patient feels better after <, the remedy is correct.
• If the patient produces less severe or shorter crisis after the <, his organism has become stronger.
• If the patient shows the same crises as before the <, the remedy was not correct.
• In a case of serious <, allow the patient to take his allopathic medication. Even if this is not favourable to the treatment, one can avert legal problems and in future, help the patient in a better way.
• There is crisis but the allopathic medicines have been reduced which means homeopathy is working.

Psychiatric medication

• One can reduce the doses of tranquillizers and keep the patient on homeopathic remedies.
• Neurosis is treated in a curative way with homeopathy.
• Panic attacks can be managed with homoeopathy. There is no need to give tranquillizers during acute panic attacks.
• Anti-psychotic drugs may pose problems. Don’t reduce them abruptly. Be careful. If the patient develops acute suicidal impulse or an attack of insanity, refer to a psychiatrist.
• Don’t give up in psychotic patients. Homeopathy helps.

Anti-diabetic medication

• In Juvenile diabetic patients, never stop Insulin. One can reduce Insulin but can’t stop them. A homeopath can help the patient to improve at many levels such as mental, physical as well as dealing with complications.
• In Diabetes mellitus type II, hypoglycemic agents can be stopped. But careful monitoring of BSL and Glycated hemoglobin (HbA1c) is necessary.

 CASE

• An old man, aged 68 years.
• Persistent abdominal pain.
• A known case of hypertension with Diabetes type II. A cigar smoker since many years.
• Investigation: Abdominal aneurysm of aorta.
• Symptoms: The pain radiating from abdomen to back. Conscious of abdominal pulsations.
• Constantly changing position, which gives him very slight relief.
• Hospitalized and kept under observation. Examination was done in the hospital.
• Observation: Restless and literally crying due to pains.
• Palpation: Tender mass felt.
• In view of sudden onset, a rapidly expanding abdominal aneurysm was suspected. In such a situation, there is always a danger of rupture of aneurysm.

Totality of the case

• Pain, abdomen, extending to back
• Pain, abdomen, > cold application
• Pain, abdomen, > bending double
• Numbness, with pains
• Restlessness, with pains
• Aneurysm of aorta

SELECTION OF THE REMEDY

Secale cor

• The concomitant symptoms of numbness and tingling were the entry points for Secale cor. Secale cor also covered the modalities and threatened shock state.
• A few doses of Sec-cor 30 repeated every 15 minutes, relieved the patient within 3 hours.

SOME CAPSULE CASES

Management of acute conditions in homeopathy has always been a matter of concern. A physician has to give rapid results in a case and if a right remedy is given, the results are apparent and known within hours.  Some cases are cited here from author’s clinical practice.

TUBERCULINUM AS AN ACUTE

There was a case of a middle-aged man who developed right tennis elbow. The pain was severe, excruciating and was only partially responding to painkillers and also to remedies like Bry., Rhus-t., Caust., etc. The pain was of aching type and used to appear and disappear suddenly. Further history revealed that, the patient also had the tendency of wandering pains in many parts of body, although at present, it was more felt at the right elbow. The patient gave past history of tuberculosis of lungs – 4 years back and also the family history revealed tuberculosis.

From the data, Tuberculinum Bovinum Kent 1M, in a single dose was prescribed and the patient was asked to report after a week. To my amazement, this single dose worked miracles within a day and when the patient woke up in the morning, there was no pain at all in right elbow. Since then the patient has remained pain-free.

INSTANTANEOUS RELIEF WITH CANTHARIS IN A CASE OF BURN

It is said that homeopathy acts slowly and that there are no painkillers in homeopathy. Contrary to these disbeliefs, the author has shared an interesting case. While cooking, hot water splashed over the hands and the patient sustained severe burn injuries. The skin was scalded. There was very severe burning pain and the patient was extremely restless. She was crying loudly due to pains. When she entered in the clinic there were many relatives along with her and it became necessary to show that she gets instant relief from the pain.

I immediately put Cantharis 1M pills on her tongue and she was asked to repeat every 10 minutes. Within 5 minutes after the administration of Canth. 1M, the patient started feeling better. It was a huge relief to the author too!

QUICK RESPONSE TO GLONOINE

A girl of 10 years of age complained of severe headache. The history was that when she exposed herself to sun and after returning home, she started complaining of headache. She complained of heaviness and throbbing pain, aggravated by shaking the head slightly. She didn’t want to move at all because any sort of motion was a strong aggravating factor. Her face was red, and she was even finding it difficult to open her eyes and answer the questions.

Glonoine 30 was given to her every 15 minutes. Within an hour, the pain subsided almost 100%.

Glon. is a chief remedy in homeopathic therapeutics for sun stroke. It is like Bell. in action but more intensified than Bell.

A CASE OF GASTRO-ENTERITIS

Once there was a very bad case of gastro-enteritis due to food poisoning. The patient took some stale cheese and developed sudden high fever with diarrhoea and vomiting. He was restless and a very offensive smell was emanating from his body. There was thirst for small quantities of water at small intervals. The remedy choice was between Arsenic-album and Pyrogen.

Pyr. was selected as her fever was 104⁰F, her pulse was only 100/min. Pyr. 1M was given every hour, along with ORS. Within few hours, she responded nicely. Her vomiting and diarrhoea stopped and there was no fever too. Hospitalization was also avoided in this case.

CONCLUSION

Accurate and adequate data is the foremost requirement. Any compromise at this level leads to failure. Six modules have been presented.

• Building up the acute totality (Five pillars: Cause + LSMC)
• Case taking in acute diseases (Anamnesis, Analysis in stages, Fever proper, Apyrexia phase, Physical examination, Investigations, Diagnosis)
• Concept of Totality (FGT+ST)
• Understanding Patterns
• Form, Function and Structure
• Energy assessment (Pace, intensity, Magnitude, System stimulated or depressed)

The author hopes that the modules presented in this chapter will aid the homeopaths in their clinical work when they are treating acute cases. Some instructions about follow-up are given through categories of the patients.

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REFERENCES

• Symposium Volumes. ICR publications; Mumbai
• Kasad, K.N. Acute Prescribing. British Homeopathic Journal
• Ghegas, Vassilis, Med. The Classical Homeopathic lectures, Homeo-study, Belgium
• Tarkas P.I., Kulkarni Ajit. Absolute Homeopathic Materia Medica, B. Jain Publishers, New Delhi, 2019
• Kulkarni Ajit. Homoeopathic Posology, tailoring the dose to the patient. Soham Prakashan, Satara, 2005
• Kulkarni Ajit. Homeopathy through Harmony and Totality, Volume I. B. Jain Publishers, New Delhi, 2020
• Kulkarni Ajit. Homeopathy through Harmony and Totality, Volume II. B. Jain Publishers, New Delhi (unpublished)
• Kulkarni Ajit. Objective analysis of the case: 20 points recipe: A blueprint to use Homeopathic Philosophy and Organon into clinical practice. National Journal of Homeopathy, Mumbai
• Vermeulen Frans. Concordant Materia Medica. Emryss bv Publishers, 1997
• Complete Repertory. Roger Van Zandvoort
• Radar Opus. Homeopathic software