Here is a brief case of headache, demonstrating the practical utility of Boger’s philosophy of totality.
The Logic of Dr. Boger:
The venerable Dr. Boger, in his article “Some Thoughts on Prescribing” instructs a physician to give importance to symptoms in the following order:
- First, the evident cause and course of sickness down to the latest symptom
- Second, comes the modalities and effect of such influences as time, temperature, open air, posture, being alone, motion, sleep, eating, drinking, touch, pressure, etc.
- Third, the entire objective aspect of the sickness, including the state of secretions [sensations]. Here, also consider the mental state in order of importance.
- Lastly, the part affected [location] must be determined which also brings the investigation in touch with diagnosis.
A new practitioner would find it helpful in following this logic. The prime reason is that in the process of case taking, a young practitioner usually finds it more comfortable to elicit the modalities and the sensations relating to the particular complaints compared to the alterations in the physical generals. Further, the changes in the mental generals are still more difficult symptoms to elicit, observe and interpret accurately without prejudice.
Why this order of priority to symptoms?
Our material medica is a compilation of symptoms noted from the healthy human drug provings. In this process, among the various symptoms, the sensations and modalities related to the particular symptoms were observed and described by the provers with much precision and accuracy. Hence, the characteristic modalities and the sensations are the most reliable symptoms of highest degree.
Further, it is not unusual that the locations mentioned under a remedy are most frequently a result of a clinical cure and are not noted while proving the drug. For example, the physician is prone to limit his choice of remedies if he considers the rubric ‘skin-spots-whitish’, which would mislead him to select a remedy from a mere handful of drugs. It is to be remembered that the remedies under this rubric have not produced the particular symptom during drug proving. Rather, they are considered as a result of their more frequent need in those particular clinical cases.
Caution must be exercised in valuation of the symptoms and in forming the characteristic totality of the case in hand. The ideal dictum in framing the logical totality is to take the location, sensation, modalities and concomitants together without distinction, as well as the mentals, if strong and well-marked. However, the modalities are the most decisive modifiers of the characteristics, according to Dr. Boenninghausen.
- A young, otherwise strong 23 year old male had complaint of headache for the last 8 weeks. He first consulted me on 28/12/2018. The intensity and frequency of the headache was gradually increasing that later it was troubling him on a daily basis with more severity.
- During every episode, the pain started from the right occipital/parietal region and extended forward to be located over the frontal region of the same side just above the eyebrows.
- The pain was increasing in intensity and every passing day he had severe attacks more than the day previous.
- The pain was not of a continuous type. More pain was felt during the morning when waking up. Then after a little relapse it would recur until noon. Following a relief in the afternoon, the pain recurred in the late evening. Lately, he started to suffer from the pain severely during sleep, disturbing him from getting good sleep.
- There is an aversion to milk/ dairy products of all sorts. It is an aversion even to the smell of milk.
- Refrigerated water is preferred over ordinary water. Even during winter, the desire for refrigerated water is obvious.
- Has had complaints in passing his stool for many years. There is an unsatisfied feeling along with straining at stool. The colour and texture appears normal.
- As mentioned before, his sleep at night was disturbed due to the headache.
- When a certain incident happened in his daily life, suddenly he remembered that he had visualized that exact incident in a dream, a few days prior to the particular incident. In this way he described that he was having ‘sort of clairvoyant dreams’. When I inquired about his personal nature, he described himself as an obstinate guy with tendency to get angry with others when they did not listen to what he was saying. During anger, he would react by striking others. Later he would be worried by the way he reacted before. He said he had a fear of dark places and of ghosts, especially at night. Further, there was a tendency to constantly dwell on sexual thoughts.
After failure from some single-symptom prescriptions that included Lachesis, Kali bi and Nux vomica, I did a more systematic analysis. Following the logic described above, the following list of rubrics was prepared [BBCR, 47th impression 2018, by B. Jain publishers]:
|S.no||Rubrics||Page no||Type of symptom|
|1.||Head, internal, agg., sleep, disturbed, by||289||[Modality]|
|2.||Head, internal, agg, awaking on||282||[Modality]|
|3.||Head, internal, time, forenoon||280||[Modality]|
|4.||Appetite, desire for, cold liquids, water, etc.||476||[General]|
|5.||Appetite, aversion to, milk||474||[General]|
|6.||Head, internal, half of, one, right||253||[Location]|
|8.||Mind, presentiments, premonitions, forebodings, etc.||213||[Mental]|
|9.||Mind, anger, crossness, etc.||192||[Mental]|
The next step that would largely minimize the valuable time of the physician is to follow the repertorisation by elimination method. Accordingly, symptom-1 was taken as the eliminating rubric considering its prominence in this case.
From the subsequent groups, those remedies covering the eliminating rubric are listed along with their marks. Also, a remedy is discarded if it is not under the eliminating rubric, whatever its totality mark is.
The symptoms 8 and 9 are considered for confirmation of the remedy. It is to be noted that some symptoms date back much prior to the main complaint. They serve as the clues for further understanding the constitution and the underlying miasms in the case.
Prescription and follow up:
A single dose of Cinchona off. in the 200th potency was prescribed with complete relief and no recurrence for about 40 days now.
The aim of this brief article is to elaborate the practical utility of Boger Boenninghausen’s Characteristics and Repertory by mentioning the most essential logical ideas behind it. By ardently following this logical guidance I am convinced that success in homeopathy is accessible not only to the masterminds but to any sincere working physician.
“The proficiency of the physician’s daily work, rather than the flash of genius which makes an occasional brilliant cure, is the final measure of the successful practitioner.”
-Dr. C.M. Boger
The following works were referred to:
- How to Find the Simillimum with BBCR by Dr. Bhanu D Desai
- Preface to BBCR by Dr. C. M. Boger
- A Commentary to BBCR by Dr. S. K. Tiwari