MODERN CLASSICAL-PRACTICAL PRESCRIBING: METHODOLOGY
NON-SUPPRESSED CASES: CASES WITH CLARITY OF SYMPTOMS:
MTEK is an useful memory aid to arriving at a correct prescription.
M = Miasmatic Totality
T = Totality of Symptoms
E = Essence (should include gestures, postures, behaviours etc)
K = Keynotes (which should encompass PQRS symptoms, refer §153 and §209 of Hahnemann’s Organon)
When the above criteria are considered and the steps below followed, a correct prescription can be made.
Step-I: Make the miasmatic diagnosis of the case, i.e. ascertain the surface miasm.
Step-II: Assess the Totality of Symptoms + Essence + Keynotes and PQRS (if any) of the case and formulate the indicated remedy.
Step-III: Ensure that the indicated remedy covers the surface miasm, as diagnosed in Step I.
Step-IV: Administer the remedy, which encompasses the miasm as well as the Totality of Symptoms.
Make the miasmatic diagnosis of the case, i.e. ascertain the surface miasm. This can be done by:
(a) Head to foot assessment of symptoms (please refer to Miasmatic Prescribing by Subrata K. Banerjea)
(b) Through clinical manifestation of disease, e.g. hypo/scanty/less are psora (e.g. hypotension, atrophy, anaemia etc); hypers are sycotic (e.g. hypertension, hypertrophy, hyperplasia etc.); dyses are syphilitic (e.g. dystrophy, dysplasia etc.) and allergies and haemorrhages are tubercular (e.g. hay fever, menorrhagia etc).
(c) Through psychic essence, nature and character of the individual case (e.g. suspicious, jealous and exploiting in nature represents sycosis; destructive and cruel to animals represents syphilis; stubborn, changeable and impatient natures are tubercular etc.)
(d) We can diagnose the miasm from other, different aspects, e.g. reference to hair falling: alopecia with dry lustreless hair and bran-like dandruff is psora; circular or spotty baldness is sycotic; diffused hair falling is syphilitic, and thick yellow crusts in the hair are tubercular; in reference to taste: burnt is psoric; fishy is sycotic; metallic is syphilitic and taste of pus is tubercular; in reference to pulse: bradycardia is psoric; tachycardia is sycotic and irregular pulse is syphilitic; in reference to bowels: constipation is psoric; diarrhoea is sycotic; dysentery is syphilitic and malaena is tubercular; in reference to pains: neuralgic pains are psoric; joint pains are sycotic; bone pains are syphilitic and pains with exhaustion are tubercular.
(e) Diathesis (tendencies/pre-disposition) can also hint at the miasm: eruptive diathesis is psoric; rheumatic-gouty, lithic-uric acid or proliferative diathesis is sycotic; suppurative-ulcerative is syphilitic and haemorrhagic diathesis is tubercular.
(f) Psoric secretions are watery, mucusy, serous; sycotics are purulent, yellowish; sticky, acrid, putrid and offensive are syphilitic and haemorrhagic secretions/discharges are tubercular.
(g) If you ask your patient what his hobbies are: ‘hunting’ reflects syphilitic taint; ‘travelling’ is tubercular, whereas ‘gambling’ is sycotic.
(h) Ask your patient: ‘If you could take a week off and money would be no object, what would you do?’ Mr. Psora is lazy and will do nothing; Mr. Tubercular will go on a round the world trip! Thereby you understand the innate dyscrasia and miasmatic nature of your patient.
(i) Miasmatic diagnosis can be made from nail appearance; e.g. dry harsh nails are psoric; thick, wavy, ribbed, corrugated, convex nails are sycotic; thin, spoon shaped concave nails are syphilitic and glossy and spotted nails are tubercular.
(j) Miasmatic observation of children: nervous, anxious, constipated children are psoric; restless, hyperactive (ADHD), colicky, diarrhoeic children are sycotic; withdrawn, dull, extremely forgetful, convulsive, dysenteric children are syphilitic and allergic, haemorrhagic, stubborn, impatient children are tubercular.
By such a prescription, which covers the miasmatic dyscrasia of the person, the chances of recurrence are eradicated and the axiom of ‘rapid, gentle and permanent recovery’ (Hahnemann’s Organon §3) is encompassed. In cases of one-sided disease with a scarcity of symptoms, the action of the anti-miasmatic remedy is centrifugal, and by bringing the suppressed symptoms to the surface, allows a proper totality to be framed.
The miasmatic consideration is therefore of great importance as demonstrated in the following example:-
A person is suffering from features of gastric ulcer, which has been confirmed by radiography. As ulceration is syphilitic, the surface miasm is therefore syphilitic also. Let us say that the totality of symptoms (physical, emotional and essence) of the person reflects towards Kali Bichromicum, an anti-syphilitic remedy. The choice of remedy is therefore simple, as Kali Bich covers both the totality of symptoms and the surface miasm of this gastric ulcer case. Kali Bich will peel away the outer layer and reveal a second layer underneath. This second layer may perhaps manifest through the appearance of warts or moles on the face, an indication of suppressed sycosis and the next assessment of the case should include this new surface totality. Following Kentian ideology we now know that there needs to be a change in the plan of treatment, that is, the previous syphilitic plan needs to change to a current sycotic plan, and a new anti-sycotic medicine needs to be selected based on the presenting totality.
Assess the Totality of Symptoms + Essence + Keynotes and PQRS (if any) of the case and formulate the indicated remedy.
Totality of symptoms:
(1) Each of the symptoms must be complete with regard to its location, sensation, modality and concomitant (Subrata’s addition : Cause and onset, duration of the suffering and treatments he/she had in the past.)
(2) The symptoms should have a chronological order of development and progression.
(3) Environmental, occupational and other exogenous influences on the case must be evaluated.
(4) Then the background of the case from (a) the past history (with special reference to various forms of suppressions) and (b) the family history (inherited miasmatic influences), must be in the purview.
(5) The qualitative totality of all the symptoms (outwardly reflected picture of the internal essence of the disease) is the sole indication for the choice of the remedy.
i) Acquaintance with the psychic essences and personification of ‘Drug Pictures’ [e.g. Mr. Lycopodiums are teachers, doctors, successful dictators, and politicians; and their personality characteristics reflect they are careful; cautious; conscientious; conservative; courteous; contained; avoid risk and commitments – Mr. Safe; Mr. Nux Vomicas are CEO, share brokers, salesman, and their personality characteristics reflect they are ambitious, impatient, arrogant, charismatic, aggressive, independent, confident, courteous, workaholics, perfectionists; Mrs. Pulsatillas are nursery teachers, nurses, caregivers and their personality characteristics reflect they are emotional-tearful, moody, changeable, pleasing, perceptive, affectionate, caring, forsaken, worriers; and Miss Phosphorus’ can be artists, actors, receptionists, maitre d’hotel, politicians, and their personality characteristics reflect they are expressive, emotional, social, artistic, impressionable, gregarious, sympathetic and sensitive. period], with modern interpretations of old proving symptoms.
ii) To ascertain a clearer picture for the constitutional medicine ask about the innate nature of the person, for example ‘Give ten words to describe yourself’ and when patient says I am COMPASSIONATE: – e.g. Arg-nit, Bell, Calc, CalcareaPhos, Carcin, Caust, Coccul, Graphites, Ign, Lach, Nat-c. Nat-m, Nit-ac, Nux-v, Phos, Pulsatilla, Sulph; DUTIFUL :- Calc, Calc-I, Carcin.,Cocculus, Ignatia, Kali-ars., Kali-c, Kali iod., Lyco, Nat-m, Puls; EASY GOING :- Ars, Calc, Carc, LiliumTig., Lyco, Mag Mur., Nat-m, Nux-v, Phos-ac, Phos, Puls, Rhus Tox, Sepia, Silicea, Sulph, Thuja; FAMILY ORIENTED :- Acet-ac, Anacardium, Ars, Baryta C., Calc, Calc-I, Calc-sil, Carcinocin, Graphites, Hep, Ignatia, Iodium, Kali Br., Kali Nit., Kali phos., Lyco.,Mag Carb., Nat Carb., Nat Mur., Petr, Phos, PhosphorusAc., Puls, Psorinum, Rhus-t, Sulphur etc. These are modern extensions/ interpretations of old proving symptoms and not found in the Repertory books and Subrata has developed an extensive Repertory of Personality Characters.
CONTAMINATED DRUG DEPENDENT CASES: CASES WITHOUT CLARITY OF SYMPTOMS:
i) In drug dependent cases placing emphasis on Lesser Known Medicines can succeed when well selected remedies fail. E.g. Franciscea, Ginseng, Pimpenella, Stellaria, Viola etc. to open the steroid dependant arthritic cases with few uncontaminated symptoms and absence of clear modalities can prove beneficial; such lesser known organopathic medicines have the capacity to alleviate symptoms to a certain extent, thereby giving the chance to wean off the conventional medication, and experience shows that after 40-50% weaning off, uncontaminated symptoms of the natural disease surface and give scope for constitutional prescribing.
ii) In drug dependent asthma cases, when the patient is on an inhaler and/or steroids; in such cases it is very difficult to get a clear picture of the case. The artificial chronic disease is superimposed on the original natural disease (Aphorsim 91, Organon), therefore symptoms are contaminated or suppressed and the patient cannot give a clear picture e.g., modalities, etc. In such cases, homoeopathic bronchodilators e.g., Aralia Racemosa, Blatta Orientalis, Aspidosperma, Cassia Sophera, Eriodictyon, Pothos Foetidus etc., can be prescribed on the basis of few available symptoms (according to §173–§178, Ref. Organon of Medicine) and gradually the conventional allopathic bronchodilator is withdrawn. Subrata asks the patient to sip the homoeopathic bronchodilator medicine prescribed on the basis of few available symptoms in those drug-dependant asthma cases, therefore considering the partial symptomatic similarity in accordance with §173–§178. So when the patient is out of breath and in need of conventional bronchodilator, he takes the homoeopathic medicine and tries to defer the conventional medicine as much as s/he can. In this way, a steroid dependent patient who used to take steroid/inhaler 8 hourly can, with the help of homoeopathic medicine now defer the steroids to 12 hourly, then 24 hourly and so on. In this way the conventional medication/inhaler etc is gradually weaned off.
EIGHT HOMOEOPATHIC BRONCHO-DIALATORS: TO WEAN-OFF CONVENTIONAL MEDICATION:
1) AMYL. NITROSUM:
(i) Asthmatic dyspnoea with angina.
(ii) Chest: (a) Oppression, (b) Fullness, (c)Suffocation.
(iii) Anxiety: must have fresh air.
(iv) Cough: (a) Spasmodic, (b) Suffocative, (c) Paroxysmal.
(v) Constriction: (a) Throat, (b) Chest, (c) Larynx.
(vi) Manifestation: (a) Pulsation, (b) Oppression, (c) Constriction.
Miasmatics: Psora (++)-Sycotic (+)- Syphilis (+)- Tubercular (+)
Potency of Choice: 1x, 6 C.
2) ARALIA RACEMOSA:
A = Asthma with wheezing.
R = Right lung: affected
A = Agg. at 2 A.M.
L = Lying agg.
I = Inspiration is difficult
A = A f.b. (foreign-body) sensation.
(i) Wheezing in throat. Constriction in chest and throat with a sensation of foreign body in the throat.
(ii) Inspiration is difficult than expiration.
(iii) Cough < after lying, < 2 A.M. (iv) Expecto-ration is salty and hot.
Miasmatics: Psora (++)-Sycotic(++)- Syphilis (+)- Tubercular (++)
Potency of Choice: Q, 6 C; 1M.
(i) Want of breath during exertion is the guiding symptom.
(ii) Useful in Cardiac asthma.
(iii) It is the Digitalis of the lungs : broncho-dilatation.
Miasmatics: Psoric (++)- Syco(++).
Potency of Choice: Q, 30 C ;1M.
4) BLATTA ORIENTALIS:
(i) Doctrine of Signature: Cockroach lives in cracks and crevices; in damp shady places, therefore it is a wonderful medicine for Asthma for people who live or work in damp basements, cellars, etc. Aggravation from damp and rainy weather.
(ii) Asthma with bronchitis, especially indicated after Arsenic when this is insufficient.
(iii) Acts best in stout, or corpulent persons. Seem to act on patients who have a tendency to obesity.
(iv) Much pus-like mucus.
(v) After the spasm, for the remaining cough use higher potency, stop with improvement.
Miasmatics: Psora (++)-Sycotic (+++).
Potency of Choice: Q, 30 C ; 1M.
5) CASSIA SOPHERA:
(i) Skin diseases (like dandruff, eczema, itching, ringworm etc.) are associated with bronchial troubles.
(ii) More the cough (in asthmatic patients) and the more it is a painful and distressing cough, the better it is indicated.
(iii) Asthmatic symptoms with rattling of mucus in the throat but not much expulsion.
(iv) Aggravates during rainy and winter season,
(v) < later part of the evening and past mid-night, towards early morning, better by sitting up. Note: Cassia sophera is antidoted by smoking or chewing tobacco, so patients, should avoid them during medication.
Miasmatics: Psora (++) -Syco(+++) – Syphilitic
Potency of Choice: Q, 30 C;1M.
6) ERIODICTYON GLUTINOSUM:
(i) Bronchitis followed by tubercular cough. Past history of recurrent bronchitis, pneumonia when the lung vitality is really low and patient coughs and coughs to bring the expectoration; finally when the expectoration comes, s/he feels so much better.
(ii) Profuse nocturnal sweat and spasm > by expectoration.
(iii) Cough after influenza.
Miasmatics: Psora (++)-Sycotic(++)- Syphilis (+)- Tubercular (+++)
Potency of Choice: Q, 30 C.
7) POTHOS FOETIDUS:
(i) For asthmatic complaints, which are caused and are made worse from inhaling any dust. Allergic broncho-spasm.
(ii) Difficult, troublesome respiration; oppression with perspiration. Anguish with oppression.
(iii) Asthmatic symptoms are better by passing stool.
(iv) Deep acting Syco-Psoric remedy
Miasmatics: Psora (++)-Sycotic(++)- Tubercular (+)
Potency of Choice: Q, 30 C ; 1M ( For Allergic Broncho-spasm).
8) SOLIDAGO VIRGA:
(i) Periodical asthma with nightly dysuria.
(ii) 15 drops doses promotes expectoration in bronchitis and bronchial asthma, in old people.
(iii) Expectoration:- (a) Profuse, (b) Blood stinged.
Miasmatics: Psora (++)-Sycotic(++)- Syphilis (+)- Tubercular (+++).
Potency of Choice: Q, 30 C.
Dispensing of the dose of Homoeopathic broncho-dialators:
When the patient is out of breath and in need of a conventional broncho-dilator, patient can take any of the above homoeopathic medicines (or any other homoeopathic organopathic medicine, in accordance with the few symptomatic similarity) and tries to defer the conventional medicine as much as s/he can. In this way, a steroid dependent patient who used to take steroid/inhaler 8 hourly can, with the help of homoeopathic medicine now defer the steroids to 12 hourly, then 24 hourly and so on. In this way the conventional medication/inhaler is gradually weaned off.
In the same way, for pain killer dependent migraine cases, the artificial chronic disease is superimposed on the original natural disease, therefore symptoms are contaminated or suppressed and the patient cannot give a clear picture for a constitutional medicine. The modalities of the pain are masked. Therefore, the following medicines can be selected on the basis of few available symptoms, e.g., Acetanilidum, Anagyris, Bromium, Chionanthus Virginica, Epiphegus,
Ferrum Pyro-Phosphoricum, Indium, Iris Versicolor, Kalmia Latifolia, Lac Defloratum, Melilotus, Menispernum, Menynanthes, Oleum Animale, Onosmodium, Saponin, Usnea Barbata, Yucca Filamentosa. Accordingly the conventional allopathic painkiller is gradually withdrawn and after approximately 50% weaning off of the conventional medicine, suppressed symptoms surface and now the patient can give much clearer modalities. This will lead to making a change in the plan of treatment and on the basis of `MTEK’ a constitutional prescription can now be made.
Similar example for Drug Dependent Hypertensive cases where the following medicines (Allium Sativa, Crataegus Oxyacantha, Eel Serum, Ergotinum, Lycopus Virginicus, Rauwolfia Serpentina, Spartium Scoparium, Strophanthus Hispidus) are capable of gradually weaning off the conventional medication.
iii) In my experience after the patient has weaned off approximately 50% of the conventional medicine, suppressed symptoms surface and the patient can give much clearer modalities. This will lead to making a change in the plan of treatment and on the basis of `MTEK’ a constitutional prescription can be made. Through this approach, not only does the patient gain immediate confidence that homoeopathy is acting, but has also weaned off the conventional medication to a certain extent.
The patient is often aware of the side effects of the chemicals of the conventional medicine and wants to stop or reduce the dose. Using this method the conventional medicine is gradually reduced. I give full control to the patient who often consults with the conventional medical doctor. Reducing the conventional drugs in this way empowers the patient and gives him confidence in the process. The involvement in this process assists in raising the patient’s energy level. I do not advise exactly how much to wean-off, because that should be guided by the G.P/ Doctor. As I put the control in the hand of the patient, therefore, it is wise to get a disclaimer signed by the patient.
Dr. Subrata K. Banerjea,
GOLD MEDALIST, B.H.M.S.
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