What else is life, if not relationships? Could you conceive of yourself without any relationship whatsoever? In fact, you are relationships. If you remove all these relationships, where are you?
Relating means trying to get acquainted. First there is the introduction to each other, then many facets of the other’s personality are seen. Then one tries to penetrate deeper into the realm of inner feelings, into the deep recesses of another’s being. Relation doesn’t mean relationship. Relationship is an added quality in terms of connection, association, link, correlation, correspondence, parallel, alliance, bond, ties, interrelation, interconnection, kinship, affinity, lineage, emotions, liaison etc. etc. Relationship is the constitution of our identity and experience. It is a shared identity. It is an objective embodiment. It is mirroring and exploring of oneself, of others, of all concerned.
Remedy relationship (RR) is nothing but the various relations that are shared between remedies in many aspects, facets, dimensions, levels, phases and sectors. Every remedy is related to every other remedy in one way or other. How the remedy is related has to be studied and how it could be practically applied in clinical practice is a matter of concern. RR is ‘recognizing’ and ‘being recognized by’ as a process of consciousness, as a process of applying wisdom to a patient under question.
The subject of relationship of remedies is one of the intriguing, yet neglected aspects in homoeopathic prescribing. Its utility in clinical practice is profound in terms of discrimination required for the sake of arriving at the simillimum out of the vast list of remedies and their protean indications and also in terms of follow-up of a case where a physician has to use a wide armamentarium given:
a) Environmental inputs out of inter-action
b) Disease potential exerting its influence over the individual
c) Remedial functionality
To fathom relations in their depth and extent, a homoeopathic physician must have the following requisites:
- The concept of similarity: degrees and levels; the qualitative aspects of similarity. The relationship section in materia medica has the very basis of the law of similars. It is the similarity in one way or the other that determines the type and the value of RR, the way in which the remedies share their attributes at many levels of their operation. In other words, the concept of relationship is a corollary of the concept of similarity
- The in-depth knowledge of materia medica: perceiving the portrait in its totality,
- The conceptual understanding of data in materia medica vis a vis hard facts
Conceptual Portrait <—> Original Data Base
- The knowledge of anatomy, physiology, biochemistry, psychology, psychiatry, biology: botany/zoology, physics, chemistry etc.; co-relations of concepts arriving out of these allied faculties with materia medica and repertory
- The knowledge of logical and philosophical faculties
- The knowledge of universal laws
- The knowledge of miasms, sensitivity, susceptibility, disease potential in terms of phases, stages and sequelae etc.
All this knowledge is necessary, for the study of materia medica is the study of the universe. From the application point of view, the study of MM encompasses within its domain the study of a human being in totality, in all of his fields, dimensions and ramifications. Each remedy is a treasure of thousands of symptoms and there are thousands of remedies, which collectively represent the vast gamut of human suffering. The enormous number of symptoms at emotional, intellectual and physical levels coupled with clinical information forms an unending resource for a physician. This resource becomes the foundation to explore the innumerable relationships that get developed. However, the cumbersome and omnifarious symptoms have to be put into some module, some methodology for the sake of application. Otherwise, a physician will be lost in the jungle of symptoms.
As a matter of fact, RR is about ‘second’ prescription (note that second is not a digital number but concerns with the follow up of a case). It is keeping track of what is happening to the vital force during treatment. It concerns with the ebbs and flows, peaks and troughs of the vital force. Hence, trying to understand the ‘movement’ that occurs after the administration of the remedy and what it all means constitutes the follow up and it is inseparably linked to RR. RR doesn’t mean just selecting the remedy out of the relevant type and giving to the patient!
Actually, second prescription is all about timing. Timing in clinical practice is the biggest thing! It focuses on perspective and prospective vision. Without deep study of all concerned aspects, it is difficult to use RR with appropriate timing. Many times central structural similarity is not achieved, instead, peripheral formal similarity is only corresponded. To understand this statement, the concept of nucleus and periphery has to be understood first. Only covering some symptoms of a diseased part does not imply that one has given the simillimum. The disease expresses through various forms and a homoeopathic physician engages himself mostly in giving a remedy based on these forms. The remedy must cover the center, nucleus, core, kernel or the essence, and the sickness is comprehended at the essence through the process of generalization. Essence is perceived through totality. The remedy based on ‘essence’ with totalistic vision covers the similarity in a far better way.
The word structural, which is used in the statement, is not from anatomical or organic origin but from the point of view of the base/foundation. RR deals with the essence and it should not be used only for chasing the forms.
An attempt has been made in this article to understand the concept and to see how RR could be used as a powerful tool in clinical practice through expanding the themes related to RR.
EVOLUTION OF THE CONCEPT – HAHNEMANN
It is from Hahnemann that the concept of relationship of remedies began. In his books ‘Organon of Medicine’ and ‘Chronic Diseases, Their Nature and Cure’, Hahnemann has dealt with the subject of RR. In aphorism 249, there is statement of Hahnemann about antidotal relationship, “Every medicine prescribed for a case of a disease which in the course of its action produces new and troublesome symptoms not appertaining to the disease to be cured, is not capable of effecting real improvement, and cannot be considered as homoeopathically selected; it must, therefore, either, if the aggravation be considerable (after a medicine) be first partially neutralized as soon as possible by an antidote before giving the next remedy chosen more accurately according to similarity of action.” In aphorism 250, “If patient’s state is growing worse from hour to hour by the occurrence of new symptoms and suffering, it is not only allowable for him, but it is his duty to remedy his mistake, by the selection and administration of a homoeopathic medicine not merely tolerably suitable, but the most appropriate possible for the existing state of the disease”. Hahnemann gives advice about giving a ‘tolerably suitable’ medicine for the ‘existing state’ of the disease. It is clear here that Hahnemann focuses on the current active state operating over the system. It is to be noted that Hahnemann writes about RR in only two aphorisms in Organon of Medicine.
Boenninghausen represented the concept of RR in a systemic way and he should be regarded as a pioneer of the concept of RR. He introduced the concept of RR through the seven and last section of his Therapeutic Pocket Book (BTPB) under ‘concordance’. Boenninghausen gave more importance to comparative value of remedies in relation to particular symptom groups. We all know that each remedy has some attributes of every other remedy to some extent. It would hardly be possible to select two remedies so different from each other that they would not touch at some point. They were having some symptoms which were common and some that were differentiating features. This gave rise to comparison of two remedies in relation to symptom groups. Similarity at some points implies dissimilarity at some other points. Thus the whole concept of RR in the form of comparative study of Materia medica was evolved.
CONTRIBUTORS FROM A MATERIA MEDICA PERSPECTIVE
If we analyze the literature of our predecessors, we find FARRINGTON, BOGER, KENT, MILLER, HERING, WRIGHT, BOERICKE, etc. casting relations in their own way. Clinical experience and the data of materia medica are the major sources of the relations. However, if we focus on their relations, most stalwarts have tried to present the remedy relations under the following headings: Collateral, Similar, Complementary, Inimical, Incompatible, Remedy antidotes, Remedy antidoted by, Remedy follows well, Remedy followed well by, Analogous etc.
The meaning of these relations gets overlapped. All these relations center around three aspects – Complementary, Inimical and Antidote. These relations do not satisfy the growing need of homoeopaths who have to deal with today’s challenging patients. The subject of RR is very vast and to limit this to the above three aspects severely affects applicability. RR is the least understood and hence least used tool because not enough study has been conducted. There is some confusion as the same drug is found to be in Complementary, Inimical and Antidotal relationship. The wrong notion that one single remedy (and also a single magic dose) is enough to completely cure the disease also prevents a student from studying and utilizing the concept in clinical practice.
There are three comparative materia medica books authored by FARRINGTON, GROSS and ROBERTS. They give the comparisons through symptoms of remedies under study in a tabular form. For symptomatic comparisons, these are invaluable works. However, their limitations should also be considered. The concept of giving RR in tabular form got momentum with Gibson Miller. Then J. H. CLARKE published the compilation of Remedy Relationships. He made a twofold division of the relationship—the natural relationship and the clinical relationship. According to Clarke, knowledge of these relations is all-important to those who aim at accurate prescribing. His compilation of natural relationships showed at a glance how a remedy stood in its mineral, vegetable or animal relationship to other remedies. Many books on Materia medica now available, are based on this. The second section of clinical relationship has been given in tabular form and it represents the chief clinical relations of all remedies of the Materia medica so far as they have been noted. P. SANKARAN and CHITKARA also took efforts to compile RR through tabular form.
I must mention some outstanding contributors about RR. First is DR. ABDUR REHMAN. His stupendous work (though not known to many Indian homoeopaths) is published as ‘Encyclopedia of Remedy Relationship in Homeopathy.’ Dr. Rehman meticulously collected, collated and culled many aspects of remedy relations and for every entry he mentioned authors, abbreviating with numbers. However, his book doesn’t provide any analysis about why such a relationship has been written by the stalwarts. As the stories of remedies and living MM concept developed, many authors started discriminating between remedies at personality level-dispositions, characters, behavioural responses, etc. M. L. DHAWALE and K. N. KASAD’s exemplary writings in ‘ICR Symposium’ volumes over many remedy relations guide how one should delve deep in the subject of RR. KENT in his distinctive manner compares many remedies in ‘Lectures on Homoeopathic Materia medica’. He gives more specialized classes of complementary remedies of ‘acute complements of chronic remedies’.
CATHERINE COULTER through ‘Constitutional Types’, PHILIP BAILEY through ‘Homeopathic Psychology’ and CANDEGABE E. F. through ‘Comparative Materia Medica’ deal with the subject of RR in an elaborate way, focusing on the psychological and behavioural patterns of human beings. I must mention three scholarly articles written by S.P. KOPPIKAR on RR, which are published in his book, ‘70 years in clinical practice.’ ‘A Select Homoeopathic Materia medica’ by P. I. TARKAS and AJIT KULKARNI have offered many new relations and suggestions at the psychological, clinical, and pathological levels. They have coined many new words of RR and tried to come out of the restricted field of RR of complementary, inimical and antidotal.
FROM REPERTORIAL PERSPECTIVE
Repertory is nothing but Materia medica in different outline, in different format. Repertory is one of the best tools to compare and contrast the remedies. GASKIN A. through ‘Comparative Study on Kent’s Materia Medica’, DOCKX AND KOKELENBERG through ‘Kent’s Comparative Repertory of the Homoeopathic Materia Medica’ and LUIS DETINIS through ‘Mental Symptoms in Homeopathy’ have shown how materia medica symptoms and reportorial rubrics could be integrated to know the remedial functionality through RR.
In fact, repertory is a vast collection of relationships. Each rubric in the repertory gives a group of remedies that are inter-related at the point of their therapeutic potential.
THE VALUE OF RELATIONSHIP
The relationship section is not a product of proving, as proving yields raw/discordant/incongruous/inconsistent/paradoxical and divergent symptomatology. They have a suggestive value, based on experience and interpretation of the remedial action. The relations, which are shared or the statements under relationship are not solid facts, incontrovertible as of proving.
A homoeopathic physician should find justification of every relation and this will occur only if a physician has dived deep into the core of our remedies and has deduced the relations logically out of remedial functionality.
No physician can get adequate success in his clinical practice if he doesn’t possess the knowledge of relationship of remedies. The final choice of simillimum is through the processing of data – of the patient and of the remedy in the materia medica. A thorough grasp over ‘differential world of materia medica’ will help a physician in organizing the follow-up in a meticulous and disciplined manner. The working, thorough knowledge of relations will allow a physician to release the remedial function as per the demand of similarity after observing the ‘movement’ that will occur after the administration of the remedy.
Some homoeopaths don’t bother about the use of RR, because they do not care nor comprehend about rules and regulations of the follow up of a case. I would like to quote Kent, “If you talk with a great many physicians concerning the observations you have made after giving the remedy, you will find that the majority of them have only whims or notions on this subject and see nothing after the prescription is made.” Compromise at quality and use of shortcuts are basic causes of failure. No homoeopath can get good and consistent results if he does not possess adequate knowledge of RR. When a homoeopath is in RR, he is in a case; he is with the case and he flows according to the needs and stages of the case, thus following the principle of individualization. It can be decisively said that the application of RR paves the way for individualization.
The relationship of remedies concerns the huge field of operation of homoeopathic remedies. It’s not only about studying a single remedy through various symptoms. It’s not only about knowing some keynotes, PQRS and pathogenetic action of a remedy under study but about the abundant features that get explored. This exploration should go for the paraphernalia that get developed out of relational database. Relational database should act as an information technology organization that should be capable of delivering new applications of remedies in the shortest time and with clarity. To make this possible, organizations must introduce new words / ideas / concepts / methods / relations alongside the older, traditional ones necessary for a wider field of application.
A large coverage of remedies with their core / nucleus / essence / kernel and with their peripheral expressions should be the basis of methodological development of relationship of materia medica. However, the wider ‘field’ should not deter a homoeopathic physician from the vast study. The study of RR is all about quality and not quantity. A high quality system is one that meets a physician’s needs, is reliable, is flexible enough to meet future needs, and enhances physician’s efforts in clinical practice and hence a qualitative, refined methodology developed out of raw and haphazard data is the most important.
UNDERSTANDING OLD RELATIONS AND DEVELOPING NEW RELATIONS
An attempt has been made to explain the old terms of RR. We have coined many new relations and some of them have also been given. We admit that they overlap, but they are presented in order to highlight many mysterious and missed links, which often confront a conscientious homoeopathic physician. Readers are requested to ponder them, use them in their clinical practice and send their feedback.
- Acute/Chronic analogues
- Counterpart/ Mutual C.
a) That which bears an analogy to something else.
b) An organ or structure that is similar in function to another kind , but is of dissimilar evolutionary origin.
c) Similar or equivalent in certain respects, close enough to be compared (syn. Akin, Cognate).
- Calc, Caust, Con, Lach, Lyc, Puls are analogues of Argentumn.
- Analogues of Lyc are Alum, Ph-ac.
- Ars, Bapt, Echin and Ter are nearest analogues of Eucal.
- Vegetable analogues of Arg-n: Gel (Ign is of Nat-m).
- Con’s non-traumatic analogue: Hydr.
- Bar and Calc are nearest analogues.
Similarity is the base of this RR. The subject of remedy analogues in the animal, vegetable and mineral kingdoms has been but little studied and offers a fruitful field. Analogue relations are of many types viz. acute, chronic, nearest, vegetable, chemical, mineral etc. Acute intercurrent, acute of chronic constitutional remedy, acute complementary remedies etc. also come under analogous relationships. Consideration of the dominant phase and looking at the phase through totalistic vision helps to select an acute remedy to tide over the acute crisis. A chronic constitutional remedy should then be the follow up.
A single group consisting of many analogous remedies is formed out of analogical remedial functions or characters as given in example three. The basis of this group is infection, inflammation, toxicity and debility. The RR gets developed out of commons symptoms, themes, concepts related to kingdom study and the process of generalization helps deduce the RR. Note that no kingdom is solo or mono. Every kingdom contains attributes/chemicals of every other kingdom. The relationship of remedies according to their chemical constituents is an interesting idea and this study will throw more light on RR. Let us take the example of Lyc. Chemically, the oil globules extracted from the spores contain “Aluminium” and “Phosphoric acid.” We find striking similarity in the proving symptoms and clinical conditions of Lyc, Alum and Ph-ac. Retrospectively, it shows that source material and symptoms are connected with each other.
Analogous RR should prepare a ground for comparative study of remedies too.
Let us study Baryta and Calcarea. They share huge similarity. But the study through comparisons allows us to focus on qualified attributes. Baryta is retarded, below average while Calcarea is average. Baryta’s dullness is more constant and impenetrable. Calcarea wants company, enjoys company though he may be withdrawn and morose at home due to parental aggression. Both Baryta and Calcarea are shy but Calc’s shyness is not to the same extent as Bar; Bar is very shy and bashful and this gets revealed through the body language. Baryta doesn’t keep eye to eye contact, avoids looking at strangers or a physician and the eyes are looking down at the floor! Asking questions in various ways doesn’t change BL nor does it yield any substantial information. Calcarea’s BL is minimal eye to eye contact and he may look at the physician at least while answering. A tactful persuading can bring some information on the floor. Baryta harbors a strong delusion of being ‘ridiculed’; he has a strong feeling that he is made a mockery by the others. This is due to his stupidity and inferiority complex.
2. CYCLIC OR SEQUENTIAL
The portrait of a disease is heterogenous, non-descript, messed-up and hence confusing to a physician as to the selection of a single remedy. With an orderly analysis, one can go in for a cycle of remedies in a consecutive/successive manner.
- A patient with abdominal colic requiring Caust —- Coloc —- Staphysagria in succession if the totality is not distinctly covered by a single drug.
- The well-known trio of Sul —– Calc —– Lyc is a good example of cyclic or sequential relationship.
This relationship is about ‘remedies in a series’ and it has a basis of similarity between many remedies. The remedies must be in harmony with each other. Here the sequential remedy must have the quality of a complementary type and the subsequent remedy must be deeper-acting than the earlier remedy so that the system steers towards recovery or cure. The remedies are to be used according to an order and should not be used in an opposite way. This relationship is not related to only three remedies as we see in ‘trio’ relation.
In cyclical relation we define the stage in operation at the present juncture and the way in which it is now evolving in the next phase. This relationship is seen more in the context of a clinical situation, which is evolving, so more in acute cases. The data is indistinct and it is difficult to find the most similar remedy. You select a remedy but it exerts no action or gives only partial relief to a case and ultimately you have to select the other remedy. It’s like finding an order in the disorderly data and trying to respect the clinical evolution and then covering the totality with many remedies to be administered according to the need. Don’t interpret that this RR is polypharmacy. It is not about giving several remedies at one time.
To sum up cyclical RR, see the similarity, concentrate on the evolving stages of a clinical condition, define also action of related remedies and then prescribe according to the need. In the example of Caust-Coloc-Staph, it could also be possible that Staph could also be followed by Caust again and at this stage it may be with a less intensified portrait, as the system might have used the defenses according to the Hering’s suggestions of cure.
If the status quo is maintained and a case comes to a standstill, a remedy interpolated/ interposed in between, rouses the vital force for the sake of directing the deviant energy towards restoration of health.
- 1. Tub in a case of pneumonia with delayed resolution or in a case of recurrent pneumonia.
- Thyr in a case of urticaria with a family h/o thyroid disorder.
- DNA in a case of inveterate psoriasis.
Hahnemann himself observed that occasionally constitutional treatment might need to be complemented by the administration of an intercurrent remedy, which is intended to treat miasmatic obstructions and suppressions and thus remove obstacles to the cure. We presume that the previous remedy helps a case only partially and the system now needs a shake up. However, we have to define the system as a whole with its state in terms of sensitivity, susceptibility, genetic/basic energy, clinical condition etc. A relevant polychrest, a sarcode or an isopathic remedy can also be given as an intercurrent. It need not be a nosode always.
Readers are requested to read a separate article on intercurrent prescribing.
Miasms are the morbid constitutions that make the system vulnerable and develop certain traits, tendencies, diatheses etc. Hence, a structural fault has to be corrected at the constitutional level with the appropriate anti-miasmatic treatment. The miasmatic block acts as an obstacle against recovery.
- Each layer is an entry unto itself.
- Each layer interacts with other layers.
- Time dimension plays a major role in the formation of layers.
- Gels is a psoric Kali-c.
- Arg-m is a sycotic Silicea
- Calc-sil is a sycotic Silicea
- Caust is a psoro-sycotic (like Sul); or a psoro-syphilitic (like Psor); or a syphilo-sycotic (like Plb, Zinc).
- Aur has syphilis grafted on a scrofulous background. Aur-m-n has syphilis grafted on sycosis (like Fl-ac).
- Aur-s, Kali-i, Merc-i-f, Sul-i, and Syph are ‘syphilitic Sul.’, just as Medorrhinum and X-ray are ‘sycotic Sul.’
- Ran-b is a sycotic remedy of the Bry group.
The patient and the drug in materia medica represent Psora —Sycosis —Tubercular — Syphilis. The remedy must cover not only the manifestations but also the underlying miasmatic state. Hence, miasmatic relations are extremely important. They give an assessment of layers and follow-up guidance. Let us take the statement ‘Calc-sil is sycotic Sil.’ The meaning of this statement is that when a Sil patient represents the functional and structural pathologies of the sycotic miasm, it is better to consider Calc-sil. This is because Calc-sil has a dominant Calc element as manifested by: Physical: Mildly and slowly developing disease processes. Hydrogenoid constitution. Torpor: Slow/impaired function of organs and glands (digestion, liver, bowels, evacuation). Catarrhal discharges: Copious, thick, yellowish green. Gouty nodes. Renal stones. Mental: Fear of poverty, of an incurable disease. Bashful timidity. Wants to be magnetized. Sensitive to reprimands. Dreams of: dead, death, vexatious, horrible, business etc. Sil represents more tubercular and syphilitic miasms while Calc-sil represents more of sycotic miasm.
Let us elaborate upon the statement, “Arg-m is sycotic Silicea” It means first it is like Sil and then a sycotic Sil. What are the resemblances between Arg-m and Sil? At physical level: Slow, deep, low-grade processes (like t.b., cancer); they come on lingeringly, insidiously, but progress steadily (Silicea). Broken down, emaciating progressively. Make-up: Tall, thin, pale, chilly, nervous, irritable, faggy, hollow-eyed, weak-chested. Indicated for brainworkers, students and readers. Both are rejuvenators of the system. Infiltrations. Thickenings. Indurations. Ulcerations. Nerves: Deep-seated troubles of nerves; growing increasingly sensitive to surroundings. Action on cartilages and bones in terms of degeneration and destruction. Mental level: Profound nervous breakdown. If a Sil patient presents with sycotic miasmatic expressions, it will be better not to neglect Arg-m.
a) Mostly similar but opposite in some respects.
b) One that exactly resembles another as in function or relation.
c) A person or thing, which has the same purpose as another in a different place or organization.
d) Natural complement.
e) One of two parts that fit and complete each other e.g. seal and its impressions.
Lycopodium is a counterpart of Arg-n and Causticum Arg-n is a counterpart of Kali-c and Causticum This connects Arg-n, Causticum and Lycopodium with Kali-c.
Rad-br is counterpart of Sul.
Bar-c is chronic counterpart of Bufo.
Lachesis and Fl-ac are mutual counterparts.
The statement ‘The Indian Prime Minister met his counterpart British Prime Minister’ is appropriate to understand the meaning. The counterpart relation basically deals with similarity at the prime components. It means that the similarity is available at the general level, both at mind and physical levels with the most characteristic pattern. It may be at the pathogenetic action level (pathological general) or it may be also at the particular level. In the counterpart relation, it is to be noted that there are some opposite symptoms also. So the total similarity is not available, while in nearest analogous relation or inversion relationship, there are no opposites, at least strong opposites are not available.