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The Study of Monogram: From Multitude to Access

Abstract: The concept of monogram was presented in ‘Absolute Homeopathic MM’, written by Dr. P.I. Tarkas and Dr. Ajit Kulkarni and published by B. Jain Publishers, New Delhi. Dr. Ajit Kulkarni deals with the evolution of materiamedica, keynotes, keythemes etc. and then explains the concept with philosophy, abstraction and generalization, correlation with data in MM and case illustrations and meaning of words coined for monogram.

Keywords: MM, evolution, limitation of symptoms, keynote symptoms, keynote themes, problems with keynote system, individual remedy and group study of MM through monogram.

INTRODUCTION

Homeopathic Materia medicais the collection of the pathogenic effects of drugs and of the derangements they are capable of causing in the healthy body, by means of which the principle – ‘Let likes be treated by likes’ gets applied at the bedside.

Homoeopathic Materia medicaoriginated with Hahnemann who contributed a unique concept of ‘proving on healthy human beings’. Hahnemann collected the data from ‘provers’ and it was recorded ‘as it is’ as ‘Materia Medica Pura’. MM Pura of Hahnemann is a raw collection though basic; note that it will be a challenging job for modern homeopaths to practice if they keep the raw data of MM Pura before them. Then arrived the colossal work of the Encyclopedia of Allen. It contains the protean proving symptoms. Constantine Hering in his mammoth work of ‘Guiding Symptoms of our MM’ formulated proper headings and selected those symptoms which had been clinically confirmed. It was Hering who commenced the ‘mosaic’ of symptoms.

EVOLUTION OF MM

The evolution of homeopathic materiamedica (HMM) is an ongoing process and we have now many methods by which we can study our remedies. The beginning was the proving of exacting type where the provers – the human beings – expressed their honest experiences with the remedies that were given for the sake of knowing their effects at various levels of operation of human beings. The symptoms that were painstakingly gathered over months and years were collected together. The collection was pure but raw and there was a need to make it more refined, more understandable and more of applicable value. Clinical application of remedies has a big share in evolution. This is, in other words, ‘evidence based remedies’. And these remedies have enriched the value of MM.

If we see evolution of MM, every sincere stalwart has tried to make the tool of MM more powerful. There was need to make the scattered raw data streamlined in a disciplined way. There was need to make headings and subheadings to incorporate the symptoms in a relevant way. There was need to look at the toxicological data in terms of symptoms and pathology. There was need to focus light on the action of a remedy how it unfolds itself on the mental and physical states of the economy. The first evolution occurred in the study of symptoms. The symptoms in MM are variable, profound and needed to be integrated. The concept of totality will have a meaning provided we build up the matrix.

Different homoeopathic stalwarts have approached the study of the HMM from different perspectives. HERING, ALLEN, LIPPE, CLARKE, BOERICKE, KENT, TYLER, BOGER, DHAWALE, PULFORD, PATHAK, SCHOLTEN, COULTER, PHILIP BAILEY, VITHOULKAS, SANKARAN, P I TARKAS, AJIT KULKARNI etc. have contributed to the shaping of HMM in their own classical ways.

Anatomy, physiology and pathology were considered as pillars in interpretingdata by BOERICKE, CLARKE, BOGER and TARKAS-KULKARNI.

Handbook of Materia Medica and Therapeutics by T.F. ALLEN, in addition to the hard facts, referred to the clinical side of data and hence, T.F. ALLEN could be called as a pioneer in clinical co-relation.  PULFORD and ALLEN perceived the Keynotes from data which could individualize the portrait of a person or a disease.Kent’s artistic mind perceived meaning from the perspective of the personality of the drug amongst the data. His reference point was the philosophy of man and his sufferings and it was partly influenced by Swedenborg’s philosophy.Vithoulkasfocused on hard data and explained the essence of the personality of the remedies. Scholten dived deep into Periodic Table and expounded upon cation-anion relationships and developed the personality profiles.Dr. M. L. Dhawalerendered an integrated meaning to the data by taking the help of various basic sciences.(The readers are requested to read the preface of Absolute MM to apprise themselves of the contribution of stalwarts towards the development of MM).

Dr. HAHNEMANN ON SYMPTOMS

Hahnemann, while underscoring the importance of the symptoms, has focused on the totality of the symptoms.  However, we have to look at the symptoms in many ways. It is to be noted that there are limitations to the symptoms.

LIMITATIONS OF SYMPTOMS

  1. Symptoms may be unobservable, hidden or even absent

Symptoms are the sole representation of the disease and may always be present or correct. Symptom or symptoms may be a small part of a big disease portrait. Symptoms are always there, but we are the ones who cannot relate them to what we call a (certain) disease. The immune system performs its responsible job to throw off the warning signals in multiple ways.

Disease is a phenomenon. The law of existence denotes that nothing can’t ‘BE’ without cause and effect.It is rarely found in clinical practice that the disease is present but outward manifestations are absent. Remember, absolute nothingness is a certain type of existence. Even in absolute nothingness, intelligence exists.Hence, it is the duty of an intelligent physician to perceive the true nature of the symptoms.

Examples

  1. Symptoms may be Atypical

We as clinicians hinge on typical presentations of common illnesses. Yet, what is often left out from medical training is the frequent occurrence of atypical presentations of illness. These presentations are termed “atypical” because they lack the usual signs and symptoms characterizing a particular condition or diagnosis. Sometimes the affected site may not reveal the pain or sensation or discomfort but it may have a different location.

Examples

  1. Symptoms may be Non-specific

These symptoms usually do not involve a specific organ or isolated body system. They do not indicate a specific disease or abnormality and it can be a feature of many clinical conditions. Several diseases can represent themselves through the common symptoms and it becomes a difficult task to make a proper diagnosis and may lead a physician astray.

Examples

  1. Identical symptoms

These may result from conditions which are diametrically opposite to each other and requiring entirely different management.

Examples

  1. Some symptoms remain Unexplained

There are many symptoms which remain unexplained.

Examples

KEYNOTE SYMPTOMS

Hahnemann emphasized ‘individualization’ and naturally the study of MM got shifted to characteristic symptoms. The distinct difference between common disease symptoms and uncommon individual symptoms was being sought and PQRS symptoms became the influencing essentials. The widespread belief is disseminated that the study of MM means keynote symptoms and for successful practice, there is no alternative but to learn by heart the keynote symptoms of remedies. Thus, the keynote system became a universal and popular way of dealing with patients.

Problems with keynote symptoms

However, many issues crop up.

Do we need it?

(1)Is keynote system of prescribing a non-self-sufficient method and there are lacunae with it?

(2)Did it became popular just because it isa shortcut in clinical practice?

(3)Is the keynote system a ‘hit-and-miss’method?

FROM KEYNOTES TO KEY THEMES

Behind the disease there is a person and there are consistent characters that are unique to the person and they define the very individuality of the person. In spite of the changes that occur in life or in disease, these characters remain unchanged. Hence they must be a part of totality. In keynote symptoms, the main theme is to focus on symptoms. In keythemes, the focus is on the personality type, some consistent character that is inseparable from the system, some essence which is gleaned from the data, some central points in the data that define the case etc. etc.

Examples

By analyzing the data of the boy, we can draw the keytheme of being ‘fragile’.

Let it be clear that themes do not stand alone for themselves in prescribing. One theme (no matter how major) do not hold a case alone. It must be a part of the totality, along with the general symptoms-physical, mental and pathological and also the physical particulars.

THE STUDY OF MONOGRAM

Magnificence of data

What is Monogram?

The word monogram is used in two contexts –

In homeopathy, both contexts are used with the concept of monogram.

The monogram is a remedy’s signature. It is like a piece of art for adorning the esteem of a remedy. It unifies the essential threads and renders the fabric of the remedy. The monogram is not just a word, it’s not an isolated state; it stands by association, resemblance, identification or convention. The monogram is the center from which we can enter into periphery and we can create the monogram by using the components of the periphery. Monogram is like the genetic encoding of a remedy where the information of characters of a remedy is programmed. It is like nucleus/essence/core/kernel/central idea which encompasses disturbances at mental, emotional and physical levels.

The study of a remedy through monogram is a more specific way to describe the general manner in which the symptoms express themselves. This is the mode where the procedure itself takes place. It bestows an impression, not just on impresser. It conveys precisely and concisely what a drug fundamentally is! It is like a genetic code of an individual that contains its unique information and will display its characteristic pattern in the form of behaviour!

Generalization is the process of identifying the symptoms of thetotality, as belonging to the whole. The symptoms, completely unrelated may be brought together as a group, belonging to the whole by establishing a common relation between them. Generalization is the formulation of general concepts from specific symptoms by abstracting common properties. Generalization is the essential basis of all valid deductive inferences. The study of monogram conforms to the concept of pathological general (Boger), but we have furthered the concept with pattern, pace and miasmatic activity. Thus, it helps to see mental, emotional and pathological layers in integration and how mind and pathology run parallel in a case. In other words, psycho-clinico-patho-miasmatic co-relations can be constructed and perceived well with the concept of monogram.

Monogram words are not merely pedantic rules. They are like building blocks. They incorporatebehaviour patterns, identifiable characteristics, habits, traits and trends, and prominent dispositions of person that are exhibited in a wide range of important psychological, clinical, pathological and miasmatic contexts.The study of monogram is a way to conceptualize and assess both stability and variability in behavioural patterns.Monogram study is the measurement of undercurrent between Mind and Body. It measures the degree to the recurrent and consistent patterns of ‘behaviour’ of certain physical and mental characters. The consistencies would be found in distinctive but stable patterns of “if-then” Context <——>Behaviour relationship that form the individual signatures.An individual can be analyzed using monogram to come up with the key indicators of how he/she tends to behave according to certain tendencies. While the keynote/key theme involves personal interpretation of subjective factors and as a result, can be influenced by the subjectivity of the physician, monogram projects the hard facts in an objective manner.

MONOGRAM OF AN INDIVIDUAL REMEDY

OPIUM

Insensible – Torpid –Adynamic  – Heavy Paralytic – Epileptic – Deep –

Tremulous-  Senile –  Dropsical –  Atonic –  Dry –  Sweaty –  Thrombotic

  1. Insensibility

Insensibility is the central feature of Opium.

Opium is one of the most complicated substances of our Materia medica. It contains about 18 alkaloids of which the Apomorphine, Morphine, Heroin and Codeine are well known. Besides mucilage, albumen, fat, sugar, and salts of ammonia, calcium and magnesia, it contains “17 or 18 alkaloids and two neutral substances, as well as meconic acid” (Brunton).

The poisonous effects of Opium are absolute unconsciousness, complete muscular relaxation, pupils contracted to a pin-point aperture, turgid, bloated, stertorous breathing, pulse slow, asphyxia and death. All these poisonous effects are due to the depressive action, which culminates asity. At the physical level the insensibility is expressed as loss of reflexes. The reactive pattern is depressed to such an extent that we do not get the response even to intense input. Hence, painlessness is the characteristic of Opium. The depressive action of Opium results in nerves ‘on end.’

The depressive action is available at both mind and body level in Opium pathogenesis with dynamic doses. At mind level we get higher intellectual faculties being depressed, self-control and power of concentration is lessened, judgement is progressively affected. This leads to poor perception, consequently confusion of mind and fanciful ideas. The senses are perverted including the moral sense, which is expressed at the dispositional level as a ‘knave’ person (unprincipled, crafty man, a rogue, a scoundrel), keeping insensibility to the feelings of others. Insensibility revokes the reality, the sufferings and goes to the extreme polarity of paradise. (It is interesting to note that, at different points in the body, we manufacture endorphins, natural opiates which intervene to calm fear, pain and cough, among other things). This state is characterized by a well- feeling even in grave conditions. A person is unable to understand or appreciate his sufferings. He loses the mental grasp of anything and says that nothing ails him. He wants nothing, he is placid and in his own dreamy state as if of “nirvana”.

It is interesting to note that Opium has indifference to both joy and suffering; this indifference is not associated with melancholy (like Natrums) but it is an ‘exalted’ state. It is similar to ‘AnhaloniumLevii’ but unlike it. Anhalonium has colourful, brilliant visions, beautiful and varied kaleidoscopic changes and a sensation of increased physical ability. These are however absent in Opium. It is similar also to Cann-i., which has fantastic visions; however, time sense is more disordered in Cann-i.

Opium has been reputed as a remedy for ‘deep unconsciousness’ where there is no response to superficial or deep reflexes. The unconsciousness may come on due to fright or head injury or even metabolic failure. During the convulsions the pupils are non-reacting to light. Want of susceptibility to remedy even though indicated is due to the insensibility that results in lack of reaction or adynamia. Here it must be competed with Carb-v, Psor, Zinc, Sulph, etc. Opium is, however, also acute in its manifestations.

  1. Torpid

The depressive action of Opium results in sluggishness both of mind and body.. The mind loses its perceptive filter capacity. The comprehension is affected, there is loss of will power and the person loses the go.At the physical level the torpidity is expressed as lack of vital reaction, insensibility of the nervous system, painlessness and soporous condition. Opium lessens the voluntary movements.This torpidity is exhibited at the level of various systems: sluggishness of the intestines; paralytic atony of bowels; obstipation; no desire to go to stool; senile. At urinary system there is feeble stream and slow to start. Loss of power or sensibility of bladder. Paralytic atony of bladder; retention of urine; after laparotomy or confinement. At the genital level there is suppressed menses especially from fright, also suppression of lochia. Uterine inertia with cessation of labour pains with coma is the characteristic feature.

Opium checks all secretions except that of skin. Torpidity results in general relaxation of the system expressed also at prolapse of uterus, ptosis and paralysis, hemias (more inguinal), hoarseness, slow pulse, heavy, stupid sleep and fever associated with sleepiness. In short, torpidity runs through and through and is manifested at mental and physical planes.

  1. Paralytic

The depressive action of Opium on the nervous system causes paresis and paralysis. Opium has paralysis of painless or painful type; of brain, tongue, bowels, bladder, larynx, limbs, etc.; from fright; from lead poisoning; head injury after; apoplexy; senile; alcoholic.In paralysis, Opium should be compared with Caust, Alum, Plb, Gels and Zinc.

  1. Adynamic

The torpidity, general depressive action of Opium results in the state of lack of vital reaction. This want of susceptibility gives a poor or no response to even well indicated remedies. Adynamia indicates the grave condition. The system has lost its power of resistance and the vitality needs to be aroused as a dire necessity. Opium is helpful in acute manifestations chiefly but it has the usefulness also in chronic ones. To illustrate if a patient has become unconscious due to CVS, thromboembolic phenomena, or septicemia, and he is not responding to the indicated remedies, Opium should be given to arouse the vitality of a person and then again the indicated remedy should be prescribed.

  1. Epileptic

The convulsions are the toxicological effects during the phase of stimulation. The causes are: after violent anger or rage; after fright; insult; puerperium; after cholera; from suppressed urine; when labour pains are ceased; apoplectic; brain diseases.The aura begins with congestive headache and convulsions are worse during and after deep sleep, glares of light, heat of room or bath, from approach of strangers (children). During convulsions – stertorous breathing; coldness of limbs; froth at mouth; eyes half open; pupils dilated and insensible to light; face dark red and hot. Throws limbs about or stretches arms at right angle to the body; stupor between spasms. The attacks are followed by relaxation of muscles and deep sleep.Opium can be tried in cases of mental retardation with epilepsy. Indolence, stupidity, rashness, recklessness and boldness characterize the Opium children. Such children are nervous, irritable and there is a tendency to start even at the least noise. These are the dreamy children who are deceptive in nature and are liars. Opium should be compared with Bufo, Tarent., and Tub. Opium should be tried in spastic children.

  1. Tremulous

Trembling characterizes Opium. Fright, anger or rage cause tremors. Twitching, jerking during sleep. Twitching of limbs; after fright. Jerks as if flexors are overacting. Shuffling and trembling gait. One or other arm moves convulsively to and fro. Trembling, twitching of facial muscles.Opium is one of the chief remedies for a patient who has developed trembling after fright.

  1. Dropsical

Opium poisoning has produced anasarca. Opium has oedema of lower limbs especially feet, and of lower eye lids. Oedema: uremia; diabetes mellitus; strokes; of face (red, bloated, swollen, dark suffused, hot).

  1. Dry

Internal dryness typifies Opium paresis and paralyses are the results of the dryness of the nerves. We get the dryness of mouth (with consequent intense thirst); of eyes (red, burning, hot and dry); of throat (with inability to swallow); of rectum (resulting in obstinate constipation with stools-dry, hard, round, black-balls); cough dry and racking; suppressed discharges (except sweat); dryness of emotions; indifference to pleasure and sufferings.

  1. Senile

The metabolic processes in old age are characterized by torpidity, low susceptibility and degeneration. Opium has all these characters in its pathogenesis. It has at the physical level senile vertigo with lightness of head; senile painless ulcers; slow circulation; tremors; various degenerative disorders of spinal cord; constipation; C.O.P.D.; occulo-motor paralysis; cardiac diseases; various digestive and kidney disorders; dryness of the mucous membranes and of the skin; nutrition impairment; etc.

  1. Atonic

The system under Opium develops ‘atony’ under its depressive and torpid action expressed at bowel and bladder in the form of constipation and retention of urine; prolapse of rectum, uterus; abortions; ptosis etc. The causes usually are fright, anger, insult etc. There is inhibition of reflexes. At mind level we get indifference, dullness. Want of susceptibility to remedies and insensibility are the furtherance of atonic state.

  1. Sweaty

All secretions are checked (except sweat) in Opium. This produces the internal dryness. The characteristics of sweat are: 1. Hot sweat over whole body except lower limbs. 2. Cold sweat over whole body (esp. on head and forehead). 4. Fever is > without perspiration. 5. Sweat without >. 6. Skin is usually hot, damp and sweating.

  1. Thrombotic

The reputation of Opium in unconscious, comatose state has brought to the fore the pathological condition of thromboembolic phenomenon. Under eyes we get ‘embolism of central artery’. Paralytic effects consequent to cerebral thrombosis come within the range of Opium.

  1. Heavy

The word ‘heaviness’ aptly describes the mental and physical characters. The mind is heavy, unable to comprehend. This leads to irresolution, confusion of mind; finally, we get idiocy of mind. Indifference to mind, dullness is also found in Opium. Torpidity at physical level explains heaviness at physical level.

  1. Deep

Opium is a deep-acting, polychrest remedy of wide range. Its toxic effects are devastating. Opium penetrates deep in the vital economy and causes a severe depressive action over the system. The ‘insensibility’ and ‘wants nothing’, ‘I am fine’, a ‘paradise’ state even with grave illness is actually indicative of deep magnitude of illness. One will naturally expect the warning signals through psycho-neuro-immunology in terms of pains through prostaglandin synthesis or of anxiety and conscientiousness through psychogenic defenses. But warning signals are absent and the system manifests the deceptiveness. This is reflective of syphilitic dominance.The study of Opium through above characters i.e. through monogram renders, in a nutshell, the essence of this important drug.

THE MONOGRAM OF GROUPS

  1. MERCURY

Congestive.  Catarrhal.  Exudative.  Ulcerative.  Suppurative.  Destructive.

Glandular.  Scrofulous.  Scorbutic.  Anemic.  Rheumatic.  Offensive.

Sensitive.  Tremulous.  Dropsical. Agile.  Chaotic.  Debilitated.  Syphilitic.

  1. Congestive: Merc is basically an inflammatory group. Every inflammation begins with congestion and Merc has it forcefully in its pathogenesis. This congestive character has to be differentiated from Aco, Bell or Ferr-p. These three drugs have congestion in their first stage of inflammation. Merc presents a furtherance of activity where suppuration has supervened. An abscess in Merc is of spreading type-more congestion, more redness, more painful, more throbbing and with adjacent lymphadenopathy.
  2. Catarrhal: Merc causes inflammation of mucous membranes resulting in profuse, thin, slimy, acrid, burning, foul or thick greenish-yellow discharges. Merc covers simple to malignant catarrhs in its pathogenesis.
  1. Exudative: Exuding the ichorous fluid, pus etc. through affected lesions like boils, abscesses, carbuncles, sinuses, fistulae etc. is the characteristic of Merc. The exudation is usually offensive in nature.
  1. Ulcerative: Merc has ulcerations of the mucous membranes, esp. of mouth and throat. The syphilitic miasmatic activity is responsible for recurrent and non-healing ulcerations; ulcers based on deep pathologies, or metabolic basis. Syphilitic, phagedenic (necrotic ulceration with prominent tissue destruction) ulcers.
  1. Suppurative: Inflammation in Merc doesn’t stop at the level of congestion. Inflammatory action is intensely acute and violent and rapidly tends to septic disorganization. It is as if little resistance is offered by the system. Defective mesenchymal system and phagocytosis turns the condition into suppuration. Merc has tendency to pus formation and the pus is thin, green, putrid; streaked with blood. Suppuration in glands, ulcers or even internal vital organs like lungs (e.g. empyema) or kidneys (e.g. peri-nephric abscess or pyelonephritis) comes within the range of Merc.
  1. Destructive: Merc transformshealthy cells into decrepit, inflamed and necrotic wrecks. Merc is destructive both at body and mind levels. Its lesions resemble those of syphilis. Merc’s action is similar to that of the toxins of infectious diseases. Inflammations of malignant types and often they are associated with prostration. Appropriate Merc salt can be thought of in cases where perforation threatens.
  1. Glandular: Merchas increased glandular activity, esp. of salivary and mucous glands. Merc has concomitant lymphadenopathy with skin lesions like boil, abscess, ulcer etc. The Syphilitic miasm is responsible for even malignant glandular affections and fevers. Based on scrofulous diathesis, it also covers tubercular glandular affections. Chronic suppurating glands; cold abscesses are dealt with Merc.
  1. Scrofulous: Tuberculous diseases of lymphatic nodes and of bone, with slowly suppurating abscesses. Merc decomposes the blood, producing profound anemia. It thus affects the nutrition and prepares the ground for scrofulous affections. Syphilitic activity further leads to cachexia.
  2. Scorbutic: Merc has spongy and bleeding gums. When the general condition is impaired and metabolism gets affected because of malnutrition, scorbusis may get developed. Scorbusis may be a precursor of metabolic diseases like DM
  3. Anemic: Merc through decomposition of blood, and through bone-narrow depression causes profound or aplastic anemia. Hemorrhages, metabolic disorders, hepatic and renal toxicity are some of the causes of anemia. Hence Merc constitution is emaciated, pale with dark rings around eyes.
  1. Rheumatic: Rheumatic diathesis is one of the features of Merc group. It has both acute and chronic dimensions. Mercs are sensitive to both heat and cold (human barometers) and they come down with acute joint swellings and pains consequent to weather changes. ‘Redness’ and swelling and throbbing pains characterize Merc.
  1. Offensive: Merc is filthy, mentally as well as physically. All discharges smell horribly; the decomposition, the debris, the slough, the suppuration; smell emanates from the body. Mercs are, hence, recognized to an observant physician.
  1. Sensitive: Mercs are very sensitive to weather changes, hence termed as ‘human barometers’. The inflamed part is very sensitive and depicts all characters of inflammation. The reactivity pattern is exhibited well. Sensitivity attracts environmental stimuli; hence modalities or sensory stimuli / inputs are usually available. Sensitivity is also present at mind level.
  1. Tremulous: ‘Trembling’ is a marked characteristic of Merc. Paralysis agitans – Parkinsonism -come under pathogenetic action of Merc. Syphilitic expressions with a lot of pathologies at nerves, spinal cord and brain resulting in incoordination are responsible for tremulousness.
  1. Dropsical: Dropsy due to anemia, hepatic, renal or cardiac affections are covered by Merc. Edematous swellings in the affected parts characterize Merc.
  1. Agile: Merc is basically an‘active’ group. We get rapid development of symptoms leading to destruction. When the active disease processes are present, Merc group is indicated. It is less indicated for remnants or for exhaustion stage. That work is allotted to other groups like Carbon etc. Usually full-blown acute or chronic diseases are found in Merc group because of increased sensitivity and susceptibility.
  1. Chaotic: The aberrant immune response as expressed in autoimmune disorders give the character of chaos. Under severe infection, the system becomes prey and behaves in an eccentric way. Tubercular miasma actively dominates the scene. The agile character allows the system to go into chaos.
  1. Debilitated: The sway of disease process under tubercular and syphilitic miasmatic activity depletes the energy. The system can’t continue for long and succumbs. Anemia and malnourishment add to the state of debility. Discharges produced do not ameliorate and further deplete the energy.
  1. Syphilitic: Merc and syphilis are knot together since antiquity. Merc has in its pathogenesis all stages of syphilis-primary, secondary and tertiary. Low states and phagadenic condition from syphilitic poison. Destructive effects on nerves. It covers both acute and chronic phases. Discharges (which system develops as defense) do not help and syphilitic march is continued.
  1. CARBON GROUP
Devitalized –Adynamic – Degenerating – Venous-Scorbutic – Putrescent – Ulcerative – Cachectic Cancerous – Senile- Flatulent – Offensive – Burner

1.Devitalized: The make-up of the carbon group of remedies is an anemic, broken-down constitution. Persons below par, used up people, by debauchery or from consuming mal-nourished food. Carbon group is indicated in decrepit old people. Defective oxidation and incomplete combustion give rise to low state of vitality. Hence ‘devitalized’ as the character.

  1. Adynamic: Lack of reaction is the central character of the carbon group. Because of low vitality, they do not respond quickly. They have delayed repair processes or no repair occurs. They are the chief remedies for slow recuperative process. Because of their adynamic character, remedies like Carb-v. or Carbn-sul. are interpolated for the sake of arousing the vitality.
  1. Degenerating: The carbon group acts on degenerative conditions. The source of Carb-v., for example, is charcoal which is the product after combustion. Fatty degeneration is also covered by carbon group. Senility is characterized by a process of degeneration and Carbon group has slant for old people. Out of all carbon remedies, Carbon-sulph. has more affinity for nerves.
  1. Venous: The group has venous constitution. It is indicated for varicose veins, varicose ulcers and also for bleeding hemorrhoids. Large protruding blue hemorrhoids are found in Carboveg. In other words, when the venous system is predominantly affected, Carbon group is indicated.
  2. Scorbutic: Bleeding (and swelling) of gums are found in carbon remedies. Because of deficiency of vitamin C or malnourishment in general, scorbusis is developed. Scorbusis may be a precursory indication of metabolic disorders like Diabetes Mellitus.
  3. Putrescent: Low vitality, lack of repair process, lack of reaction result in decomposition. Discharges are offensive and muco-purulent. Hence putrescent as the character.
  4. Ulcerative: On the background of the low vitality and repair process slow, there is development of ulceration. We find varicose ulcers; indolent ulcers; chronic phagadenic ulcers; ulcers turning in cancer or gangrene, senile ulcers etc.
  5. Cachectic: Devitalized character coupled with adynamia and iatrogenic diseases which tell upon the economy make the constitution cachectic. The system breaks down under the sway of conditions like malignancy, metabolic and degenerative disorders.
  1. Cancerous: Carbon remedies esp. Carb-an.,Carbn-sul., Graph. and Kreos. are indicated in malignant conditions. The syco-syphilitic miasmatic activity produces this diathesis.
  2. Flatulent: Carbon remedies assume a very important place in acid peptic syndromes. Slow digestion and torpid vitality are chiefly responsible. Food putrefies before it digests; food turns to gas and even the simplest food distresses. Hence ‘Flatulent’ included in the monogram.
  3. Offensive: The process of decomposition, disintegration, imperfect oxidation and putrescence produce offensiveness of discharges, flatus etc
  4. Burner: Charcoal, a product of combustion and imperfect oxidation produces this character. Just like ash, internal burning but external coldness is marked. Pains of burning character. Also, it causes ‘burning’ of the tissues through decomposition, cachexia and emaciation.

III. HALOGEN GROUP

ConcretingGlandular Malignant – Warm blooded Agile -Syco-syphilitic

1.Concreting: It is the tendency of the system to cause concentric pathologies. To illustrate, Calc-fl. has the concreting pathology of hardness. Instead of an open cancer (this is more for Acid-fluoric), Calc-fl. has more concentric hardness. The process of coalescence is the basis to give the character of concreting to the halogen group and hence its inclusion in the monogram.

2.Glandular: The remedies in the halogen group have affinity for glands. Pathologies of glands range from simple inflammation to ulceration, hypertrophy, atrophy, calculus formation or even malignancy. There are 6 points to mention: Glands get enlarged, inflamed, indurate, suppurate, become atrophied and cancerous.

3.Malignant: All – Flourine, Chlorine, Bromine and Iodine have tendency to malignancy. The halogen remedies act on the reticulo-endothelial system (R.E.S.) and through its disturbance cause malignant changes. Glandular malignancies are more common in the halogen group; or an ulceration may become chronic and then malignant. The miasmatic background of syco-syphilis cultivates the process to develop the cancerous conditions.

4.Warm-blooded: Thermally halogen group of remedies are found to be warm-blooded. They can’t tolerate warmth in general, summer, or hot air. Many disease conditions are aggravated due to above modalities. It is as if the system drains away with heat. Being a strong physical general and being applicable to all halogen remedies, this has been included in the monogram.

5.Agile: The activity index of the halogen group is very high. They are mentally as well as physically very active and it is due to this activity that we find rapid development of grave diseases like tuberculosis, hyperthyroidism, cancer etc. Mentally halogen remedies are restless, active, hurried in nature and in the long run, they may become destructive.

6.Syco-syphilitic: Halogen remedies are poised for organic or structural changes. The illnesses are more found to be in the structural zone rather than in the functional zone. The syco-syphilitic miasmatic dimension which is actively operational over the system produces a lot of chronic, metabolic, endocrinologic and other inveterate disease conditions.

ILLUSTRATION

A case of rheumatoid arthritis with lichen sclerosus, varicose veins, HTN and DM :

Age 65 years.

RA since 20 years. Deformities of the fingers and toes since four years.

Lightning like, tearing pains in joints. Stiffness++, < morning, beginning of motion.

LS since 10 years.

DM since 17 years. Tingling and numbness of lower limbs due to neuropathy. Coldness of hands and feet.

Dependent. Daily activities not possible without support.

One left great toe was amputated 1.5 years back due to gangrene.

Chronic hyperacidity. Reflux oesophagitis. Heartburn. Regurgitation. Gases.

Is gradually losing weight.

Recently an ulcer has developed on left foot since three months and and fears that it will turn into gangrene. It is painless and indolent.

Was operated for hysterectomy due to 3rd grade uterine prolapse at 42 years. Now has umbilical hernia and she refuses the surgery.

Despair of recovery. Feels helpless.

Belongs to the rich family. Whole life in luxury. Demanding. Fulfill my demands now. Suspicious. Thinks that she is unwanted at home and others want to kill her. Haughty. Selfish. Restless and anxious. Rigid. What she says and holds is only the right and truth.

Two divorces. The last one due to her loss of libido and sexual dysfunction + her ever demands.

Extravagant in spending money. No compromise in price, will purchase only expensive items. Wears daily an executive saree and keeps it throughout the day.

Worked as a journalist and was always critical of ruling government. Now boasts of her political connections.

Monogram of the case

Rheumatic – Stiff – Atonic – Gradual – Degenerating Atrophic- Sclerotic – Venous – Progressive – Ulcerative Senile – Dyspeptic – Syphilitic

Short analysis of the case

Combining the characterswe get through the exercise of monogram with the mental portrait as we receive from the data, it is possible to clinch Plumbummetallicum. In the absence of local/particular symptoms, the module of monogram is very useful.

MONOGRAM WORD MEANINGS

Some word meanings as they appear in remedies have been given for more understanding.

Acetic acid

Agaricus

Aletrisfarinosa

Allium sativum

Alumen

Aluminiumsilicata

Ambragrisea

Ammonium carb

Angusturavera

Anhaloniumlewinii

Argentum met

Argentum nitricum

Aristolochia

Arnica montana

Asterias rubens

Aurum mur

Beryllium

Bryonia

Calcareasilicata

 

Carlsbad

Causticum

Conium

Cratagus

Crotalushor

Eucalyptus globulus

Hippozenium

Hydrastis

Hydrocyanic acid

Iodum

Kali ars

Kali carb

Kali iod

Lachesis

Lactrodectusmactans

Naja

Natrum mur

Nuxmoschata

Pituitariumposteriorum

Pothosfoetidus

Pulsatilla

Pyrogen

Raphanus

Rhus radicans

Sabina

Secalecor

Sumbul

Syphilinum

Thuja

Tuberculinum

CONCLUSION

The concept of monogram is an objective tool for evaluating the portrait, the patient draws. It opens up the fields of logic, philosophy, pathology, patterns, integration of the intertwining characters and if these characters are understood in their genuineness, a physician is able to see the movement of the disease process under the miasmatic activity in a better way.

The concept of monogram is based on the principle of Generalization. It is as if you precisely and concisely denote the character which defines the problem, highlights the exactness of the problem and you stream down to the essence out of the maze of symptoms. The concept gives justice to the pathology which is nothing but an accentuated form of energy of the disease.

The concept allows one to view the remedy under consideration through not only symptoms but the ‘totality’ through the symptoms. It also allows the study of the patient through a broader vision. The mind-body co-relation is better understood.

While abstraction reduces complexity by hiding irrelevant details, generalization reduces complexity by making a coherent whole.  A single construct of monogram thus unifies the raw and scattered data and convincingly puts before the homeopath a roadmap intended for fishing out the most similar remedy, to perceive what is to be cured in a case and to monitor the direction a homeopath is riding. The ability to abstract and to generalize is an essential part of any intellectual activity. Abstraction and generalization are fundamental to philosophy.The concept of monogram is based on fundamental principles of abstraction and generalization.

Remember, it is also possible that the remedy may not cover the monogram characters but can be of use if the symptoms correspond. This occurs due to the layers.The presenting surface layer may be superficial and the system is yet in a process to develop the pathological generals and behavioral patterns. The utility of the monogram concept is tremendous in pathological cases when the PQRS symptoms are scanty. Combining mental expressions, dispositions and state with the monogram words allows the physician to see the parallelism, to see the movement and to assess the miasmatic energy that is operating at various levels of the system.

In ‘Absolute MM’ we have given the ‘Action’ section. It is a natural continuation of the concept of monogram. It explains the rhythm, pace, order and directions of the monogram themes. The blend of Monogram and Action paves the way for a better grasp of the remedy under consideration.There are many rubrics already in our repertory. But a reliable repertory of monogram is the necessity of hour and the author of this paper is working over the project.

I thank my colleague, Guy Tydor,Israel,for his valuable suggestions.

REFERENCES

  1. ‘Absolute Homeopathic Materia Medica’, Dr. P.I. Tarkas and Dr. Ajit Kulkarni, B. Jain Publishers, New Delhi
  2. ‘On Characteristic Symptoms’, Dr. J. H. P. Frost, ‘Hahnemannian Monthly’, 1874
  3. ‘Perceiving crucial symptoms’, S. M. Gunvante
  4. ‘Key-note system of prescribing, some random thoughts’, Dr. Ajit Kulkarni, National Journal of Homeopathy, Mumbai