A Blueprint for Using Homeopathic Philosophy and Organon in Clinical Practice
The three pillars on which the bedrock of homoeopathy is based are:
- Data receiving (gleaned through skillful interview and documentation),
- Analysis (separation of data into its constituent elements) and evaluation (estimation of constituent elements) and
- Synthesis (making a portrait out of the composite totality).
The objective is to perceive the quintessence of the sick individual and identify the real sickness. The process is then to recognize its counterpart in the homoeopathic materia medica and repertory. Totality renders quintessence. We need ideas, concepts, imaginations and fantasies to perceive the multifarious dimensions of totality but they should not be at the cost of throwing away the hard facts! The objective of fathoming the sickness and fishing out the remedy should not be sacrificed in a pseudo-intellectual journey.
An attempt has been made in this article to present the unified approach of objective analysis of data. This is important for the standardization of homoeopathy as a scientific discipline. A lot of prescribing methods are used in homoeopathy and due to lack of unification, a student often gets confused and frustrated. The comments related to each recipe are related more to practical implications that flow from the data.
UNIFIED APPROACH TO DATA PROCESSING
NATURE OF THE DISEASE
- Acute/Per acute/Acute on chronic (exacerbation)
- Mixed/Messed: natural + iatrogenic
- Psycho-somatic mixed/Somato-psychic mixed/Psychiatric/Auto-immune
- Clinical diagnosis
The nature of a disease has to be defined. It is very important for the entire management of a case. The term ‘acute’ may be confused with ‘severe’. However, not all acute diseases are severe. For example, many acute respiratory infections and acute gastroenteritis cases are mild and usually resolve within a few days. The term ‘acute’ is also included in the definition of several diseases, such as severe acute respiratory syndrome, acute leukemia, acute myocardial infarction, acute hepatitis, etc. This is often to distinguish diseases from their chronic forms, such as chronic leukemia, or to highlight the sudden onset of the disease, such as acute myocardial infarct. Diseases are acute or chronic to a homoeopathic physician not by their duration but by their characteristic expressions viz. the mode of onset, intensity of the signs and symptoms, the speed of the progress and the manner in which they terminate.
Per acute, means very acute or violent and it is characterized by very rapid onset and fulminating in nature. Acute on chronic, refers to an acute exacerbation of a chronic condition. It is applied to a variety of conditions, such as liver, renal or respiratory failure, bronchitis etc. Acute on chronic inflammation, is a term used to describe a pattern of inflammation which is a mixture of chronic and acute inflammation. It may be seen in asthma, rheumatoid arthritis, chronic peptic ulcer, chronic periodontitis, tuberculosis, tonsillitis and other conditions. 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 nature or periodical (regular or irregular), interspersed with acute attacks/episodes. Remember, you are treating a chronic disease.
Acute on chronic or acute on chronic inflammation actually require the same way of work for a homeopath; it’s acute of two different chronic situations but at another view they are the same.
Remission refers to a diminution of the seriousness or intensity of disease; this implies the recovery phase. It is a period of time during a serious illness when the patient’s health improves. To exemplify, saying the cancer is in remission, means that it is manageable and not getting any worse. Remission can be temporary or permanent.
Sub-acute is somewhat or moderately acute in nature and it is an intermediate stage between acute and chronic. It is a poorly defined state. Sub-acute endocarditis or sub-acute sclerosing panencephalitis (SSPE) are some of the examples. If the inflammation persists longer than 3 or 4 weeks, it can be called as sub-acute.
Chronic refers to a long-term condition. In chronic diseases, the march of events occurs in a lower key. The chronic disease lasts for a longer period of time and progresses slowly (in a relentless manner) towards destruction, unless aided by the similar force.
Acute versus Chronic: Notable Points
- There is nothing like an acute remedy or a chronic remedy.
- Indications on which the remedy is based matters the most.
- Every remedy has 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 presenting acute totality. Don’t intermingle acute with chronic.
- There is nothing like an acute state and all acutes are a part of expression of constitutional dyscresia. Hence a remedy based on constitutional state can be the same remedy for acute episodes.
- Hence one should try to understand the whole state and on the background of the whole state, understand the acute disease phenomenon.
All these points are correct in their own way but it is the individual instance that determines the relevant application of each of them. To illustrate, a case of bronchial asthma was given Kali carb as a constitutional remedy. The acute exacerbation of bronchial asthma manifested the totality that pointed to the same remedy i.e. Kali carb and it helped in an acute attack.
A case can be a messed / mixed one due to a drug miasm. Here, it is necessary to know the (side) effects of chemical drugs that are increasingly consumed by the patients. One may require to antidote the side effects through the use of tautopathic drugs; these drugs may be interspersed with the constitutional treatment. There is a good rubric, ‘Generalities; intoxication, after; drugs’ in generalities. However, a remedy can be outside this rubric, based on the totality. In a way we have to separate pathognomonic symptoms from non-pathognomonic ones. Now we have also to separate natural disease symptoms from the side effects of the drugs.
If the case has been defined as psycho-somatic mixed, the focus should be more on treatment of the mental state. Unnecessary focusing on trivial and common physical symptoms will not yield results. In the somato-psychic mixed case, it is advisable to focus on type of pathology and location + the supervened mental state. Here, focusing only on mental state has its pitfalls in such cases. In psychiatric disorders, it is necessary to define the problem, and to clinically diagnose the condition. A homoeopath must study both classifications – ICD-10 of WHO and DSM-5 of APA. A good command over personality structure, understanding of remedies and also of rubrics is a must for handling these difficult cases. The recent advances in psychology and psychiatry must be used by a homoeopath for data processing and for selecting the rubrics and the remedy.
Auto-immune diseases pose a problem in the management of a case. Why the immune system can’t recognize the difference between healthy body tissue and antigens and why there is destruction of normal body tissues is a matter of study. Focusing on miasmatic activity (dominant and fundamental) and defining the cause at the mental level and assessment of the state of susceptibility is useful.
Immuno-suppressive agents should not be abruptly stopped if the patient is already on them. No one should underestimate the value of clinical diagnosis, although a homoeopathic physician should not prescribe upon the label of the disease. The rubric of clinical condition itself should not be taken as a crucial rubric. Many homoeopaths take clinical rubrics as a shortcut. Remember, there are no shortcuts in homoeopathy. The evolution of a disease is significant from homoeopathic phenomenology. A simple cold may be an indisposition, or it can be the beginning of a clinical entity like measles or it can be manifestation of a deeper pathology such as malignancy. The evolution helps us know the totality as a unit. Totality is cause and effect merged together. Totality is one spectrum, one unit. Pre-clinical and diagnostic phases of the disease are part of the totality. The stages characterize the time the system takes for Form, Function and Structure – the trinity in which the phenomenon occurs.
PHASE OF THE DISEASE
- Fully developed/Inadequately developed
Pre-clinical or sub-clinical phase is the period preceding clinical manifestations. It is the prodromal stage where diagnosis can only be suspected on the basis of anticipation. Here the illness stays below the surface of clinical detection. Many diseases, including diabetes, hypothyroidism and rheumatoid arthritis are frequently subclinical before they surface as clinical diseases.
Homoeopathy, being a constitutional therapeutic system, has a role to play in the sub-clinical phase of the disease. It is the skill of a homoeopathic physician to find an appropriate remedy in acute or chronic subclinical phases of the disease. The patient may manifest some characteristic symptoms even before the full-blown disease is available and they can help to select the remedy. To exemplify, concomitant symptoms before, during and after fever can be of substantial help to select a remedy.
Clinical phase: Here the disease gets localized and diagnosis becomes a certainty. In other words, an illness becomes a disease. There is a tendency amongst homoeopaths to neglect the clinical entity and to focus only on individualizing features. The experience especially in acute cases, suggests that not all cases do respond to remedies selected on PQRS symptoms that are unrelated to the clinical domain. Many times, a combination of clinical + PQRS symptoms help tide over the crisis.
Functional phase is characterized by absence of organic or structural changes. There are “sensations as if” and investigations yield no pathological changes. It is an observation that patients in the functional phase have some psycho-somatic problem and here treatment of the mental state is more important. Patients having the functional phase of disease are found to be more of psoric and sycotic miasms.
Structural phase is characterized by pathological changes in tissues. The role of investigations is important here for fixing the diagnosis and also in the follow-up of the case. Organotrophic remedies have their place and though constitutional prescribing has an edge in classical homoeopathy, pathological remedies do have their own field of operation. The concept of adequately or inadequately developed phases of the disease is related in homoeopathy to the manifested totality of expressions. It is not only from a clinical standpoint. To illustrate, in a case of primary prostate cancer, one may say that there is metastasis in the liver and vertebrae and yet the cancer is not fully developed as it has yet to spread in all organs of the body. This thinking is not right. Availability of characteristics is the chief criteria to define if it is adequately or inadequately developed. More stimuli, more concomitants and more individualizing symptoms mean that the susceptibility is high and there is a plethora of symptoms to denote that the phase is adequately developed. On the other hand, less characteristics, less concomitants means an inadequately developed phase of the disease.
- Cells/ Tissues / Organs/ Systems/Sides
Affinity deals with localities that are accentuated by the deviant energy of a disease. Here we see the anatomical part of the disease. The system may come out with the same tissues being affected though form may be in different systems. The attraction towards organs is related to the biological inferiority concept due to which some tissues or organs become vulnerable and this is determined by the genetic milieu. Even the sides of the body (right, left, right to left or left to right or diagonal) bear the brunt of inferiority. Every human organ has its symbolic language and it can be linked to the emotions and the life of a person. This is an interesting field of application of homoeopathy. In the absence of mental or physical generals, localities do play a vital role. Also, localities and other components make one integrated whole to prescribe upon.
TYPE OF PATHOLOGY
Allergic. Atrophic/Emaciation/Shrivelled/Apoptosis. Benign. Degenerative. Destructive. Dysplasia/Proliferation. Hyperplasia/Metaplasia/Hypertrophy. Induration/Hardening. Inflammation (serous, fibrinous, catarrhal, eosinophilic, granulomatous, pyo-granulomatous, fibronecrotic, lymphocytic, suppurative). Malignant. Embolic. Thrombotic. Caries/Necrosis/Sclerosis. Nodular. Ulceration. Hemorrhagic. Ischemic. Venous. Calcareous. Fibrotic. Rheumatic. Excess/Deficiency.
Pathology is the accentuated and concentric energy of the disease that gets reflected at the tissue level. One of the absorbing aspects of homoeopathy, is the mirrored reflection of pathology in our remedies. It flows directly from the observation of cure by similars – as that which cures directly mirrors that which needs to be cured. The remedy pharmacology and pathology are two inseparable reflections of one another. A result of this direct reflection of the nature of disease in the nature of our remedial substances is that we cannot separate our knowledge of disease – our pathology – from the knowledge of our remedies. Pathological types abound! The causes are legion, including nutritional and assimilative. There are huge metabolic alterations, acquired or genetic. Our materia medica and repertory are replete with them and many times it is necessary to use the relevant rubrics.
There is a class of homoeopaths who uphold that only the mind of the patient has to be treated. Mind is definitely to be treated but body is not only for decomposition when living and must be treated too! Mind and soul stay in the holy temple of the body! Pathology renders the behavior of tissues of a certain pattern and it denotes the individual disposition.
STATE OF PATHOLOGY
The division of pathology into respective states is important from a management point of view. Miasmatic activity can be assessed on the basis of the division. Posology-selection of specific potency and repetition schedule can be planned if we understand the state of pathology. There can be, however, difference of opinion between conventional or mainstream physicians and homoeopathic physicians as to the curability of a case.
PATTERN OF RESPONSE
Sudden. Alternating. Changing. Continuous. Erratic. Regular. Irregular. Paroxysmal. Periodic. Lingering. Shifting. Progressive. Recurrent. Static.
Repetition and periodicity are basic to define the pattern of response in a patient. It is a pattern if it occurs repeatedly and the pattern should not be inferred on the basis of one occurrence. Remember, constituents are not patterns but mere data components. When the system throws out a recurrent set of characteristics or behavioural order of the same type, it is the language of the system and it carries utmost importance in the selection of the remedy. The concept of the pattern is based on the doctrine of generalization. Patterns build up the portrait, the conceptual image of the patient so necessary for selection of a remedy. The pattern emerges out of the self-organizing principle of the system. In pattern lays the essence, lays the threads that bind all essential constituents of the data. With the use of the patterns, a homoeopath follows the system’s behavior and he is not lost in the labyrinth of symptoms.
Explanation of some responses
Continuous is marked by uninterrupted extension in space, time, or sequence. It denotes the ceaseless activity of the disease process.
Progressive means increasing in severity or extent. The response is not only continuous but heading towards more morbidity, more deep affection, investigations are suggesting exorbitant values.
Erratic pattern is marked by unpredictable, variable, inconstant and turbulent response. It denotes not even or regular in pattern.
Lingering means lasting for a long time or slow to end the process.
Irregular means occurring at uneven or varying rates or intervals. The system doesn’t follow the regular or normal pattern.
Shifting means moving from one organ to another.
Changing doesn’t mean only moving from one to another. It means different symptoms, not present earlier. The system comes out with a different set of symptoms as a presentation.
Static is the unmoving state. No change occurs with the indicated remedy(ies). The vitality can’t be aroused. In such cases, the role of intercurrent remedies especially nosodes comes up.
PACE OF THE DISEASE
- Slow. First rapid then slow. First slow then rapid. Moderately rapid. Moderately slow.
The speed with which the disease process evolves is important not only from a prognostic point of view but also from a miasmatic one. Every remedy in the materia medica has its own pace. It is the state of susceptibility (under miasmatic activity) of an individual that determines the pace. To exemplify, Arsenic, Aconite, Belladonna, Phosphorus, Pyrogen etc. have rapid pace while Agaricus, Bryonia, Causticum, Plumbum met etc. have gradually developing pathologies. When we talk of similarity, it should not be only at the symptom level but also at the pace level.
(+ = scanty, ++ = moderate, +++ = ample)
- The field of modalities: General Particular
- The field of sensations: General Particular
- The field of symptoms: Pathognomonic Non-pathognomonic
- The field of gestures: Common Characteristic
The expressions are grossly classified as common/uncommon, general/particular, pathognomonic/non-pathognomonic etc. It is because of susceptibility that the expressions change. The analysis of expressions helps to distinguish between clinical and individualizing symptoms and also to assess the state of susceptibility so essential for posology.
- Dominant / Active
All miasms are present in everyone but they vary in their activity at any moment in time. But at a given time one miasm is preponderant in its activity. The dominant miasm is to be deduced from prominent expressions of the disease at the time of prescribing.
The fundamental miasm is to be arrived at or indicated by the history of diseases in the family tree. The judgment regarding treatment is based on dominant miasmatic phase. Evolutionary disease response is always multi-miasmatic; but at a particular point / time, one of the miasms seems dominant.
Combined miasm: There may be more than one miasm evident at different stages of treatment. Accurate anamnesis and careful analysis is essential for knowing different phases in combined miasms. The dominant miasm and fundamental miasm may be the same in some cases. In the process of evolution, under adverse environmental stimuli, the basic energy of fundamental miasm may get activated and it can replace the dominant miasm. It is interesting to see how the system is pulled with the basic energy activation.
Criteria for deriving fundamental miasm.
It is difficult to assess the fundamental miasm in 100% manner. But the following points may help to deduce the fundamental miasm.
No major illness in family. All apparently enjoying health. Functional illnesses. Skin disorders. Allergies. No death in family from serious illness.
Benign growths. Hypertension. Polypus. Fibroids. Cysts. Asthma. Rheumatism. Chronic Bronchitis. Neurosis. Diabetes mellitus. Warts. Hemorrhoids. Long continued chronic diseases but no history of sudden death.
TB/Pleurisy. Epilepsy. Ulcerative colitis. Weight loss. Psychopathic personality disorder. Hemorrhagic disorder. Atrophy. Manic-depressive psychosis. Leprosy. Glandular affections. Allergies, severe. Angio-neurotic oedema. Sudden death in the family.
Deformities/Anomalies. Cancer. Locomotor ataxia. Syphilis. Stroke. Degeneration. Paralysis. Schizophrenia. Psychosis. Infarction: Heart, Brain. Pernicious anemia. Sudden or multiple early deaths in the family due to strong diseases.
- High / Moderate / Low
Sensitivity denotes the reactivity of an organism to sensory input (s). It is the capacity of a living organism to feel and respond to any stimulus. Sensitivity has to be assessed at mind and nerves (i.e. body level) through three aspects viz.
Low: Scanty availability of stimuli and poor level of reactivity.
Moderate: Moderate level of reactivity.
High: High level of reactivity to sensory inputs.
Remember, it is healthy to be sensitive. But as a homeopath, we have to decide the altered state of sensitivity. The concept of input and output, the stimulus and reaction are to be studied in totality of expressions.
- High / Moderate / Low / Static
Susceptibility denotes the capacity of an individual to react to any form of stimulus. It is by dint of this susceptibility that an organism reacts when a disease (that acts as a stimulus) inflicts the individual who casts out variable expressions.
Low: Scanty availability of expressions and poor level of characteristics; morbid.
Moderate: Moderate level of expressions.
High: Ample characteristics.
Static: Although susceptibility is a dynamic state, it remains at a certain level unmoved and it is observed that such cases respond to certain potencies, not above or below. In such cases, an intercurrent remedy interspersed at the right time may arouse the vitality and remove the static state. Similarity has to be achieved not only at the level of expressions but also at the sensitivity and susceptibility level. It must be noted that susceptibility includes sensitivity.
Path: The direction and movement of an illness indicate the way sensitivity and susceptibility develop e.g. if a disease process is evolving from the functional to the structural zone with a concomitant diminution in characteristics, the path of sensitivity and susceptibility are indicated as Heightened —-> Moderate —–> Low. Appreciation of susceptibility when a homoeopath begins the treatment and during the treatment is a good criterion if the case is steering towards the right direction.
A lot of confusion prevails amongst homoeopaths as to the concept of suppression. It is known that the immune-suppressive agents used by mainstream medicine, suppress and cause deeper affections. There is a belief that homoeopathy also suppresses. I do not approve of the idea as homoeopathy is based on the fundamental natural curative principle of similia. I agree that antipathy may suppress. But if you are using “Homoeo”- pathy, it is difficult to agree. It is expected to prescribe on the basis of law of similars when you are practicing Homoeopathy. If someone is not following the similia, how it can be a therapeutic science of Homoeopathy? For example, if a patient’s acute urticaria is better with hot application and a homoeopath is prescribing Apis mel, it is difficult to call it homoeopathic in the true sense. Should we change the name of “Homoeopathy” to “Homoeo-antipathy” if we believe that homoeopathy suppresses?
Confusion as to relief, palliation and suppression needs to be resolved. Palliation is when the symptoms return to their normal chronic state immediately after the removal of the continued treatment. Let us take an example. A patient is given a dose of Sulphur 200 and he is symptom free for three months. Is it palliation? No. It is the action of a remedy, which lasted for three months. Relief of right order is not palliation. If the patient was on Sulphur 200 daily and one day he forgot to take it and symptoms returned and we just go on repeating- that is palliation.
Suppression is when after the administration of a remedy, presenting signs and symptoms are replaced by stronger and more dangerous symptoms than before. If we have full evidence that a deeper layer of the vital economy (through affection of vital organs, deep pathologies) has been affected and it is confirmed through cause—effect relation through time dimension, then it is suppression.
A return of old chronic symptoms after the previously successful administration of a remedy should not be viewed as failure or suppression or removal of a layer. It is just a return of symptoms due to the action of a given remedy being exhausted. Some patients prove every remedy due to their high sensitivity. This should not be linked to suppression. Such high sensitivity patients are rare on the planet.
Knowledge of clinical conditions and clinical features, evolution, stages and complications is fundamental to examining our notions about relief, palliation and suppression. It is unfortunate that the natural evolution of a disease process is regarded as suppression if the apparently indicated remedies don’t help the case. It is our experience that in cases of suppression, more doses of antidote of suppressive agents and even of constitutional remedy are required.
- Good / Moderate / Low
Vitality represents strength possessed by the system, the ability to resist the morbific force, to tolerate the onslaughts and respond to the medicinal force. Each individual is unique in its reservoir of energy, determined by hereditary and environmental factors. The transitional march from Psora – -> Sycosis – – –> Tubercular – – -> Syphilis demonstrates a progressive depletion of energy; the disease evolving from the functional to the structural zone; structural changes then progressing from reversibility to irreversibility. Practically every function in the human body has been shown to exhibit circadian rhythmicity. We all know that vital signs are measurements of the body’s most basic functions and the four main vital signs routinely monitored are Body temperature, Pulse rate, Respiration rate (rate of breathing), and Blood pressure. They are no doubt useful for physiological status, more in critical conditions. But the concept of assessment of vitality in homoeopathy is related to overall immunological status, to the strength and vigour and if the system is able to mobilize itself against the morbific forces. The various investigations in clinical practice are the parameters for knowing how far the damage has occurred at the cellular level; how far functioning has been affected. All these eventually give us the status of general vitality, which the system possesses. Hence the importance of investigations in homoeopathic practice. This study is useful not only for clinical assessment but also for determining the potency and repetition schedule.
- Pathological generals
- Intertwining elements
- The consistent behavior of tissues or system
The monogram is a remedy’s signature. It is a piece of art for adorning the esteem of a remedy. The monogram is the essence. It unifies the essential threads and renders the fabric. The monogram is like the genetic encoding where the information of a remedy is programmed. It is a pattern developed out of the same repeated behaviour of the system.
Monogram is based on the concept of generalization. It was developed and made popular by Boenninghausen and Boger. We have tried to make the concept more refined and user-friendly. Deriving the monogram helps to see beyong the known dimensions of a case, of a remedy or of a group.
Let us understand through a case.
A female, aged 38 years. A diagnosed case of Rheumatoid arthritis. < winter; since 10 years. Eggs & chocolates = eruptions and itching. Varicose veins, since 8 years. Recurrent tonsillitis, < winter, since childhood. Chilly. Recurrent attacks of acidity and gastralgia, since 6 years. Distension of abdomen with flatulence. Currently, lost 8 kg. weight within 3 months. Investigated —– Hodgkin’s lymphoma.
Monogram of this case is
Rheumatic. Allergic. Venous. Glandular
Dyspeptic. Cachectic. Cancerous. Chilly
Let us draw the monogram of Carbon group.
Devitalized. Adynamic. Degenerating. Venous. Scorbutic. Putrescent.
Ulcerative. Cachectic. Cancerous. Senile. Flatulent. Offensive. Burner.
- Temperamental/personality traits
“This holds good to such an extent, that the state of the disposition of the patient often chiefly determines the selection of a remedy, as being decidedly a characteristic symptom which can least of all remain concealed from the accurately observing physician” – Dr. Hahnemann.
Disposition is a basic quality/attribute/character/temperamental trait. It can be inborn or evolved in circumstance repeatedly throughout symptoms under stress. It is consistent, persistent, and it has a sort of permanence. Dispositions are the natural tendencies of each individual to take on a certain position in any field. It is the skill of a physician to derive the dispositions of an individual out of the data that has been elicited. Matching the dispositions of a patient with that of a remedy in M.M. (with or without the use of repertory) makes the homeopathic practice personalized. You are then not only after a maze of symptoms, after the form but after the personality.
- Totality of all elements of body language
Body language is a confluence of mind and body. It represents a living synthesis, which integrates the functioning of mind and body in dynamis. The mind dominates because it is powerful in strength and speed. The mind dictates and the body obeys. Body language is a unique physical discipline and entity in which emotional, psychological, spiritual, intellectual and creative energies are unified and harmonized. Our body feels, thrills, speaks, memorizes, expresses and communicates effectively through various movements. And still unfortunately, body language is one of the least used and least understood forms of human communication. Our bodies are ambassadors of our inner self. They convey more than what our tongues do. Research has shown that 35% of the messages are conveyed verbally while 65% of them non-verbally. The concept of totality will be redefined if we include the study of body language in analysis, evaluation and synthesis of data. A remedy should not be selected on the basis of an isolated gesture but on gesture-cluster. It is necessary to focus on modes of body language, consistent and transition gestures, patterns and vital signs.
- One of the promising tools of data processing
The use of the defense mechanisms for the sake of data processing is a promising field. Defense mechanisms are the techniques of coping mechanisms that reduce anxiety or suffering in general that are generated by threats from unacceptable or negative impulses. Defense mechanisms may result in healthy or unhealthy consequences depending on the circumstances and frequency of the mechanism used. When the unhealthy responses become pathological, the system becomes more morbific.
Note that the evolutionary totality of the patient through the time and space dimension is required for using the tool of defense mechanism.
The following fifteen defense mechanisms have been studied in detail and every homoeopath must know their characters. 1. Omnipotence. 2. Idealization-devaluation. 3. Isolation. 4. Projection. 5. Introjection. 6. Denial. 7. Turning against self. 8. Isolation of affect. 9. Undoing. 10. Regression. 11. Repression. 12. Acting out. 13. Displacement. 14. Withdrawal. 15. Identity loss.
Let us explain ‘identity loss’ as a defense mechanism. This mechanism projects a dependent personality and is characterized by excessive and constant necessity for care and help. Such a person uses the technique of extreme yielding and servile conduct. There is fear of losing support and hence, there is clinging behaviour. Emotional content of this personality includes a forsaken feeling (delusional), discontentment with self, feeling of being unfortunate, incompetent, helplessness and anxiety about trifles. Concept of self covers position of a weak, helpless, insufficient person, with necessity of constant support, low confidence and inferiority feeling. Positives are delicate, caring, cooperative and compassionate. During childhood, this person was under continuous excessive guardianship, wardship, guidance even in trifles. Due to the parents’ anxiety or to the child’s diseases, or for the sake of security, the child’s will power was substituted for the parents’ power and the child was devoid of independent activity and decisions. Obedience and passivity were stimulated and implanted by all means – so the personality grows with the firm belief that some figure will always be near to fulfil all wishes.
Rubrics for ‘identity loss’ could be
Confusion of identity, Dependent, Helpless, Yielding/submissive disposition, Holding or being held desires to be, Fear alone of being, Servile. Will, loss of. The remedies that are indicated are Alumina, Bar-carb, Bismuth, Borax, Calc-carb, Lac-can, Kali-carb, Pulsatilla, Sanicula etc.
- Rubrics: Essential/crucial/determining characters
The homoeopathic Repertory is a qualitative tool. It is not a mere quantitative compilation of symptoms or rubrics with related homoeopathic remedies. It is an instrument of ‘refined’ wisdom. The homoeopathic repertory originated from materia medica. Hence it encompasses the wisdom of materia medica. The repertory is a micro-filming of materia medica. However, although retaining the essence of the symptomatology of materia medica, it has its own individuality and characteristic form. It helps to fulfill various pitfalls which diverse patients present to a homoeopathic physician.
Boenninghausen’s concept of grand generalization, Kent’s stressing the polarity of specification and Boger’s emphasizing the pathological generals are the three fundamental approaches to repertorization. With their logical and coherent approach, they carved out the quintessential tool of repertory for the homeopathic physician. He was able to blend his exemplary knowledge of pathology with his precise, concise and artistic way of presentation. Now homoeopaths use more alphabetical repertories that lack the very philosophical basis. This affects the results. With the increasing use of psychology, psychiatry and other allied branches, it has now become easy and possible for us to define the rubric, explain it and use it practically. Understanding ‘rubrics’ in the repertory is just like understanding ‘Patanjali Yogasutras.’ Each stanza contains enormous information. Similarly each rubric has a deep meaning and it can be elaborated in many ways.
THEMES, IF ANY
Apart from what has been given above, a homoeopath can have a wide platform to dance. Every case contains a lot of themes, ideas, imaginations, concepts, connections, logic, universe, doctrine of signatures, symbolism, energy, etc. etc. A homoeopath can travel with his mental make-up, experience and knowledge and try to perceive the true sickness in a patient. He can use several modules as developed in the science and see which one fits the case. But remember, every module/method has its scope and limitations. He can overstretch any concept from location, sensation, pathology, modalities, concomitants, etiology, dreams, delusions, body language etc. etc. and look upon a case. But the real beauty of fishing out a remedy is deriving the quintessence out of totality and prescribing thereupon.
Homoeopathy as a science has two sides to look upon. First, hard facts and conceptualization of them and second, practical application. A homoeopath has to be skilled in both. He has to respect both science and art. A big problem with imaginations is that they go berserk!
- Selection of potency based on nine fundamental concepts
- The schedule of repetition versus Individualization
- Follow up
Many homoeopaths hold that it is the remedy that is important and not the potency. This is not correct. If you want to fulfill Hahnemann’s criteria, of healing ‘gently, rapidly and permanently’, you need to give not only the right remedy but also the right potency, in the right repetition. Nine fundamental concepts on which posology is based are Disease potential, Sensitivity, Susceptibility, Etiological factors, Miasm, Vitality, Suppression, Type of patient and Similarity. Unnecessary repetition is wrong but failure to repeat is also one of the causes of failure in practice. There is science behind repetition or no repetition and we have to behave according to the individual’s needs.
In the follow up of the cluster of complaints, the treatment result has to be assessed. It differs according to the case. Either it is acute or chronic, curable or incurable; one-sided or fully developed. It can be at sector level, physical general level, or psychodynamic level or a combination of all. Follow up criteria is selected by considering complaints, pathology, deviation at general level and local level – where we expect the result. Generals, like appetite, weight, eliminations, sleep and energy level are IMP parameters. Laboratory investigations also have a big share in assessing the result of the treatment.
The mantras of follow up in homoeopathy are opening and exploring possibilities, generating alternatives, extracting concepts, connecting and linking up and releasing right action at the right time.
IMPORTANT RUBRICS RELATED TO DATA PROCESSING
The list of the following rubrics (from complete repertory and our own unpublished repertory), we hope will be of considerable help.
Generalities; violent complaints
Generalities; progressive diseases
Generalities; sudden manifestations
Generalities; chronic diseases, chronicity
Clinical; auto-immune diseases
Generalities; change; complaints, of, constant
Generalities; alternating states
Generalities; contradictory and alternating states
Generalities; reaction; lack of
Generalities; vitality decreasing
Generalities; wandering complaints
Generalities; radiating, spreading complaints
Generalities; complaints; acute, recurrent
Generalities, complaints, constant
Generalities, complaints, gradual
Generalities; relapse of complaints
Generalities; complaints; group; recur
Generalities; groups, complaints appear in
Generalities, slow processes
Generalities; complaints; reappearance of old/Clinical; sequelae
Generalities; history, personal
Generalities; suppression of
An attempt has been made through the 20 points recipe to structuralize the data for the sake of perceiving the segments in their true character. It is unfortunate that no standard protocol is followed for data processing and the increasing use of imagination and fantasies make the scientific discipline of homoeopathy crazy and chaotic.
Individualization doesn’t mean freedom unlimited; it doesn’t mean exemption from control; it doesn’t mean releasing the action without restraint. Artistic prescribing doesn’t mean burying the science. Remember, art is subjective while science is objective. Art is more focused on the perception of the individual and is based on personal experience, opinions, emotions etc. Science, on the other hand, is very systematic.
Balancing the art with science will go a long way to make the salubrious therapy of homeopathy much more powerful. Dear friends, send your feedback on applying the recipe. The author will feel happy if this recipe is followed at undergraduate and postgraduate levels. I appeal to the teachers of homoeopathy to ponder the recipe and implement it for the logical application of homoeopathy.
In a nutshell
- Nature of disease
- Acute/Per acute/ acute on chronic (exacerbation). Sub-acute. Chronic/ Remission. Mixed / Messed: natural + iatrogenic. Psycho-somatic mixed. Somato-psychic mixed. Psychiatric. Auto-immune. Clinical diagnosis.
- Phase of the Disease
- Pre/Sub-clinical. Clinical. Functional. Structural. Fully developed. Inadequately developed.
- Cells/ Tissues / Organs/ Systems/Sides (extension, syndrome shifting etc.)
- Type of Pathology
- Atrophic/Emaciation/Shrivelled/Apoptosis. Benign. Degenerative. Destructive. Dysplasia/Proliferation. Hyperplasia/Metaplasia/Hypertrophy. Induration/Hardening. Inflammation (serous, fibrinous, catarrhal, eosinophilic, granulomatous, pyo-granulomatous, fibronecrotic, lymphocytic, suppurative). Malignant. Embolic. Thrombotic. Caries/Necrosis/Sclerosis. Nodular. Ulceration. Hemorrhagic. Ischemic. Venous. Calcareous. Fibrotic. Rheumatic. Excess/Deficiency.
- State of pathology
- Irreversible. Reversible.
- Pattern of response
- Alternating. Changing. Continuous. Erratic. Regular. Irregular. Paroxysmal. Periodic. Lingering. Shifting. Progressive. Recurrent. Static.
- Pace of disease:
- Slow. First rapid then slow. First slow then rapid. Moderately rapid. Moderately slow.
(+ = scanty, ++ = moderate, +++ = ample)
- The field of modalities: General+ Particular +
- The field of sensations: General ++ Particular ++
- The field of symptoms: Pathognomonic ++ Non-pathognomonic +
Common ++ Characteristic
- Miasmatic diagnosis
- Dominant / Active. Fundamental. Combined.
- Moderate. Decreased.
- Nerves (body)
- Moderate. Decreased.
- General vitality
- Moderate. Low.
- Pathological Generals. Intertwining elements. The consistent behavior of tissues or system.
- Temperamental /Personality traits
- Body language
- Totality of all elements of body language
- Defense mechanisms
- Themes, if any
- Rubrics: Essential/crucial/determining characters
- Selection of potency based on nine fundamental concepts
- The schedule of repetition versus Individualization
- Follow up
- Symposium volumes, ICR, Mumbai
- A Select Homoeopathic Materia medica, Dr. P. I. Tarkas & Dr. Ajit Kulkarni
- Homoeopathic Posology, Dr. Ajit Kulkarni
- Body Language and Homoeopathy, Dr. Ajit Kulkarni
- Defense mechanisms and Homoeopathy, Alexander Martushev
- A Textbook of Pathology Structure and Function in Disease, William Boyd
- Complete Repertory, Roger van Zandvoort
After carefully reading Dr. Ajit Kulkarni’s 20 points recipe, I can’t keep myself away from making my comments.
‘Recipe’ sounds as something for eatable and digestible but this one by Dr. Kulkarni sir is for quenching the cerebral appetite, full with multi- variety, multi-ingredients, multi-taste, multi-enjoyment & multi-dimensional information, nothing left out, thought-provoking blue print of
Such type of writing is possible only when one follows systemic and scientific approach. Homeopathy is a science but only when it is applied in a rational way. Dr. Kulkarni has mentioned that each doctor follows his way but no uniform method of data processing and this results in confusion.
Each heading and sub-heading has been meticulously presented by the author with lucid description. Some doubts about ‘Acute’, ‘Sub-Acute’ and ‘Chronic’ disease have been cleared. Notable points about acute bring more clarity.
Phase of disease, Affinity, Type of pathology, State of pathology, Pattern of Response, Pace of disease, Expressions, Miasmatic diagnosis, Sensitivity, susceptibility, suppression, general vitality, Monogram, Disposition, Body language, Defense mechanism, Repertorisation, Posology, etc. are logical basic components of this paper and I think they are indisputable.
The 20 points recipe has been very authentically produced by the learned author. Author’s appeal to homoeopaths and teachers to use this recipe is the need of the hour.
S N Ojha
Post Scriptum: Dr. Kulkarni, it would be better if you comment 15 Defense mechanism tools.