Homeopathy Papers

Case-taking in Pediatric Cases by Dr. Dinesh Chauhan

Devang Shah
Written by Devang Shah

A Summary of the 2-Day-Seminar Organized at the other song

Homoeopaths treating children have to grapple with numerous issues and problems in the field of Pediatrics. William Wordsworth encapsulated to wisdom of the ages when he said ‘Child is the father of man’. Exploring the mystery and the wonder enshrined at the core of childhood virtually corresponds to a stretch of arduous research or a random adventure for the homoeopath. How to gather case details in children when few of them are at an age to present their case articulately and coherently, is often a burning question for homoeopaths. The case-taking becomes all the more demanding in children suffering from conditions such as ADHD, retardation and autism. In order to address the complexity of case-taking in children, the other song – International Academy of Advanced Homoeopathy had organized a 2-day-seminar conducted by one of their consultant and faculty Dr. Dinesh Chauhan, on its premises on 14th and 15th June, 2014.

Dr. Dinesh Chauhan practices classical Homoeopathy in Mumbai and is well known for his pediatric cases. Insightful and passionate about Homoeopathy, he is one of the most path-breaking figures in the field of Homoeopathy today. He leads seminars in various countries and lectures on courses organized by Homoeopathic Research and Charities, the other song, WISH organization along with Dr. Rajan Sankaran and his team. The focal point of his teaching is the methodology of case-taking process which he characterizes as “the Scientifically Intuitive Case Witnessing Process”. This method is entirely scientific and easy to emulate. He heads the ABJF foundation (Non-profit organization) with his wife Dr. Urvi Chauhan where Indian homoeopaths are taught on no profit basis.

In order to provide a simple solution which could be easily adopted where case-taking in children was concerned, Dr. Dinesh Chauhan divided the seminar into parts so as to enable the audience to internalize the principles thoroughly. He started with an introduction to the general concept of case-taking, then he highlighted the methodology of case-taking in children and followed it up by important ways of how to elicit fears, dreams, delusions from non-verbal children.

He said that the best approach for most cases was Integrative Synergistic Approach which is based on the fact that what is true for one part of the system, has to be true for the whole. Supporting this, Dr. Dinesh emphasized that we can make the best of both the worlds by combining traditional, tried and true wisdom with the newest cutting-edge knowledge. The new is not only a product of the old but also a progression there from. The very founder of Homoeopathy, Dr. Hahnemann affirmed this Synergy by stating in his Lesser Writings, “How often have I wished for the concurrence of some physician of eminence on these points! I always hoped to obtain it believing that observation constructed by really practical minds must eventually unite in truth, as the radii of a circle though even so far asunder at the circumference, all converge in a common centre.”

Dr. Dinesh said that individualism, holism and similimum form the trio on which our prescription is based. But for this, every homoeopath has to understand the connection between individualization and holism. Individualized symptoms can be derived at the level of the locals, physical generals or mental generals. Holism is where all these come together be it at the level of the mind or the body. The role of the homoeopath is to find peculiar symptoms at the holistic level i.e. everything has to be individualized at a holistic level. Similarly, if individualization at holistic level is the perennial truth, then all homoeopaths (traditional, contemporary and classical) must be doing Homoeopathy at this level and they must be converging somewhere.

Dr. Dinesh then expounded Synergy in Homoeopathy conceptualized by Dr. Rajan Sankaran, where the new and the old (the system and the symptom) come together with the genius (the holistic expression running through all symptoms) to form a perfect base for any prescription. The system when used on one hand and with symptoms on the other provides a solid ground for prescription and analysis in most cases. When what we call ‘symptoms’ and ‘system’- left brain and right brain data – come together, it is like a match box and a match stick. You can add these two together – you can toss them into the same bag or drawer – and nothing happens. But when you strike them together it lights a fire. Then it is as if one one is not two; it is as if one one is a thousand. This is Synergy: when two things come together and the result is greater than the sum of its parts. Whether you first pick up the match box and bring it to the match stick, or you first pick up the match stick and bring it to the match box, it does not make a difference. When the two come together, fire is lit, the result is Synergy1.

To demonstrate the methodology which rendered the case-taking simple and practicable for other doctors, Dr. Dinesh presented many cases, some of which are outlined below. Doctor’s understanding has been highlighted in italics and the cases have been edited for brevity.

A 9-year-old boy, presenting with autistic traits first consulted Dr. Dinesh at the other song clinic. His father said that he was very restless, could not concentrate on anything, did not do any work on his own and so attended a school for special children. Everyone present at the lecture was just told to observe what was holistic in the patient and also note what was really peculiar about him. The child was given ample space and was asked what he liked to which he replied that he liked ice-cream, apple, banana, sherbet (artificial flavored drink), Pepsi, mango, sugar, Chinese food, bhelpuri. Further, the child said that he liked leg piece (chicken) (gesture). When answering, he was smiling and was very happy. It was also apparent that the child was restless.

Every child is restless. The peculiarity lies in defining the restlessness. In this child, the restlessness was mainly obvious in the legs. It is important to observe non-verbal cues as well as pay attention to verbal language. When asked to tell more about himself which was a very general open question, child started talking about likes in food, so we have to be patient and observe. The areas where gestures come up indicate energy and they have to be noted.

What was obvious was the restlessness of legs which was a part of him, and which became more apparent as the case progressed. Dr. Dinesh then took the case further trying to explore other areas, so the child was asked about his hobbies. He said that he was very fond of drawing. He likes drawing house and Ganpati (Hindu deity). The child then spontaneously said that he likes bursting crackers in Diwali (an Indian festival of lights). He also likes making a tattoo (yawning – observation).

When asked another general question, we see that the child spoke of mental state, so here we have to observe with an unprejudiced mind and try to see the connection between the physical generals expressed earlier and the mental symptoms. On observation, we see yawning at regular intervals. This too was very important in the case as it appeared frequently. Giving an example, Dr. Dinesh narrated a case of a child who was given Ferrum sulph and who imagined himself to be a warrior and wanted to learn the art of defense and save people. This child would also yawn every 2-3 minutes. It is observed that in children, this kind of behavior often denotes a defense mechanism.

Then another mental area, i.e. the fears was asked about. The child said that he was scared of horror serials and ghosts.

When children speak about dark, fear of being alone, ghosts, it is not to be considered as peculiar unless strongly present or well defined as most children will have it. The solution is to go deeper and find the uniqueness within the fears.

When asked about these ghosts, the patient replied that ghosts have black blood or red blood and he felt very afraid on seeing them. He did not stay at home and went downstairs to play when scared. When asked about other fears, he said he was afraid of monsters, who may come and hit him (gesture). He spontaneously stated that enjoyed playing in water.

Interesting to note here was that he was being asked about his fears, but from there he spontaneously veers off to areas in which he has fun. It is important to note at such junctures, where the child, despite being asked to describe something, spontaneously goes off to something else. That is perhaps the centre of such cases.

On seeing a paper in front of him, the child then enthusiastically said that he will draw a big house. On being asked to draw something that he was afraid of the child shrieked (excitedly) ‘Mummy, I am afraid of apple! Should I draw that..? I am afraid of rakshas (monster).. No, I am not afraid!’ (Excited laughter). OK, I will draw a rakshas.’

During the case-taking, it is important to remember that the child is everything; he is the director, the actor, the story teller of his other song. So, it is important that we let them take the central role. Our job is like that, of a light boy, to illuminate their other song and let it come to the foreground.

 tos-sep14-image001

Fig 1

 

He drew a rakshas (Fig 1) and said that it scared him. It may hit him on the cheek. The child was then asked about his dreams. He again excitedly gestured here, saying that he did not remember them and he wanted to go home. He said that he is very scared of rakshas as he troubles him a lot (excited laughter). He again asked if he could go home.

Now this is the centre, so we have to focus on that. And not allow the patient to waver as we have to confirm.

When asked to tell more about this rakshas, the child again said that he was scared (laughing) as rakshas troubles him. The physician then asked him whether he should scare him. To this the child exclaimed loudly ‘No!’ (Restlessness of legs, laughing and peeking and making excited noises).

This is when the centre is touched and the restlessness comes up again. We have to take such symptoms and rubric which are connected to the whole. Once the centre is understood, Dr. Dinesh creates an extreme situation of fear to see the experience accompanying it. The resident was asked to show the patient a video with a car running and suddenly a ghost appeared. It was observed that the patient sat expectantly, was startled at the sight of ghost, but then immediately started laughing excitedly and came up to the resident asking to be shown another video.

If we are to see the case, we see some themes running through and through the case, one is of excitement, the other is fear and the third theme running through the case is of restlessness of lower limbs. So, we should select a remedy with excitement at the centre and having fear and restless legs as equally important components. The sphere of action should be nervous system as the child is diagnosed of ADHD. This theme of excitement is the theme of the plant family Labiatae. According to the Sensation Approach, the main sensation of the Labiatae family is excitement: vivid, pleasant, tremulous, excitement, rush of ideas, loquacity, vivacity, enjoyment, fright, anxiety, unpleasant surprises2. To match exactly the remedy from this family, each remedy from this family was scrutinized till Scutellaria laterifolia was studied and found to be matching very closely for this case.

 

Scutelleria – References2:

Boger – Sleeplessness from nervous excitement

Boericke – Nervous sedative, where nervous fear predominates. Nervous irritation and spasm of children.

Restless sleep must move about. Night terror.

Vermeulen

Sphere of action – nerves, A/f – emotional excitement, nightly restlessness, sudden wakefulness, frightful dreams. Fear at night in children. Nervous explosion, chilly

 

The child was given Scutellaria 1M. In his follow-up after a year, where he was given infrequent doses of Scutellaria, the child did much better. His restlessness was better. His attention had improved a lot, and it was apparent through his improved results in the examination. The parents were very happy with the results. He did most of his work himself and his talk was much more comprehensible. His behaviour was almost normal, so the parents and teachers were thinking of shifting him to regular school.

Dr. Dinesh then went on to demonstrate the case-taking techniques in children from age 3-16 years through approaches such that the holistic aspects of the child emerge upfront. He said that this can be achieved in most cases with an integrated, simple, scientific case-taking technique in children even with paucity of symptoms. He describes his journey along this path of establishing this technique over 8 years ago, an arduous journey which culminated in wonderful results compiled in his book, ‘A Wander with a Little Wonder’ which elaborates different case-taking approaches in children.

The basic aim of the case-taking is to elicit the PQRS (peculiar, queer, rare and strange) symptoms. Besides, the case-taking technique should also be integrative, simple, scientific, human centric and reproducible. When he was thinking how this would be possible in child cases, he stumbled across Law of Three by Gurdjieff, which stated that it is the basic for the Universe we know. And if we go deep we will find, we are bound to find that everything will be reduced to three. The whole Human consciousness, in whatsoever dimension it works, comes to ‘The Law of Three’.

 

Every learning, every phenomena in and around us takes 3 steps:

Step 1 – where you put lots of open ended scientific efforts but the outcome is scattered, not connected, isolated, not coordinated.

Step 2 – where things begin to co-ordinate, and get connected.

Step 3 – where all expressions get connected, coordinated effortlessly till the holistic level.

 

He then realized that the same thing also applied to Homoeopathy, where during the journey of case-taking, initially, we have to put open-ended, scientific, persistent efforts and in the end the whole journey becomes intuitively effortless. This happens everywhere. So, to make the approach more systematic, he divided the process of case-taking into 3 parts and named the whole process as ‘The Scientifically Intuitive Case Witnessing Process: the Journey of Three Steps.’

The first step of this journey, Step 1 is the Passive Case Witnessing Process (Open-ended scientific effort, PQRS not connected and coordinated). In this step, the child is given open, free-floating attention. The child is allowed to just be himself and express himself with ease, with minimal general interruption from the physician. You go with the natural flow and see what comes up. The emphasis is on ‘not altering the flow’. Give free floating attention.

The aim of this process is to note all the verbal and non verbal expressions that are out of place, out of order, out of content, out of proportion, out of knowledge, out of patient’s knowledge and out of any time zone. Secondly, it is also to note down all PQRS symptoms verbal as well as non verbal at physical particular, physical general and mental level. It is important to pay attention to what is common at all levels, where the two are connected, where the child is putting up defenses, or is aggravated – these become the focus. Once that is achieved, we have to start with Step 2.

The Step 2 or the Active Case Witnessing Process should be scientifically intuitive and human centric. This is the step where the peculiar symptoms from the case start coming together. E.g. in earlier case, when excitement was explored, the fear and the restlessness start coming up together. In this, the verbal and non-verbal symptoms start coming together. Here, the child may start erecting defenses as the painful part is touched. We may also notice an aggravation of physical or general state. E.g. when fears are tapped, the child may get urge for urination or may have dilation of pupils. This is the first step towards zooming into his core.

The Step 3 or the Active – Active Case witnessing Process is an Individualized or Designer’s approach to case- taking. This stage involves confirmation of the already spotted holistic symptoms through very specific questions which bring out the whole state or the experience. Once the whole is explored, in it lies everything – miasm, symptoms, source, sensation, etc. If we hold on to the thread which is common and follow it, everything gets connected.

 

Dr. Dinesh presented another case of a girl, of 14 years of age, athlete and a 100-metre running champion, who approached him with the complaints of recurrent damage to ligaments and hypothyroidism since childhood. She had also developed a patch of alopecia areata and had a vitiligo patch on her left temple.

Going according to the Step 1, the Passive Case witnessing Process, the child was just asked to speak about herself and the doctor waited patiently to see what peculiar things came up in the history.

The patient said, ‘I try to be the best at what I do… I try to be at the top…. I work best under pressure….I have allergy to strawberries and get cough from strawberries….(Slow talk)… I like coffee.. I like cats and dogs… and I like black colour.’ (All this was said at a slow pace, with long pauses).

‘I like listening to fast paced songs, where the beat is fast…. I used to dance but now I don’t. (Pause – thinking, eyes turned upwards.. So we have to patiently wait. After every pause something deeper comes up). I cough throughout the year… (pause)… I do not like snakes.’

About the author

Devang Shah

Devang Shah

Dr. Devang Shah graduated from D.S. Homoeopathic Medical College and has been practicing homoeopathy for the last three years in Pune. He feels blessed to have studied under Dr. Sunil Anand, Dr. Dinesh Chauhan and other teachers of the Bombay School of Homoeopathy. His goal in each case is to reach deeply and find the root from where the branches of disease originate. "May we reach the depth so that the spirit arises. Silence is the opening of an infinite world within each of us."

About the author

Sneha Vyas

Dr. Sneha Vyas, M.D. (Hom), Resident Doctor, the other song

4 Comments

  • Pediatric casetaking some of the most difficult to take. I worked a month as a mentor to an MD in Bangkok at an Allopathic/homeopathic pediatric clinic saw only children. Some not very expressive/or verbal due to partly autistic tendency. Having them draw is a big help but you have to be able to understand their drawings,What helps is “drawings before’ remedies were given and then ‘after remedies’ during the follow up consultation.You will notice a change as the child progresses in wellness. I would also like to mention that most often with very wealthy children the mother and father do not take care of their own child,the nanny does- if you have both parents in front of you there is no response to any casetaking questions. I got a lot of replies like…. “oh you know average like all the other kids”…..(meaning the parents have no clue on what to answer due to the sad fact they have no connection to their own children) . IN these cases their caretakers often the babysitter/nanny/grandparent needs to be at the appointment.

  • a particular combination of symptoms is unique to each remedy. every successful homeopath has or develops his own individual method of extracting that information from patients. the variations in such methods depend on the needs of individual homeopaths considering the strength & weaknesses of individual homeopaths. Again such variations remain within certain permissible limits too. Whether these methods are useful to each & every homeopath is not guaranteed the same way a method adopted by one person to accomplish a task may not be the best method for another person who is also good at accomplishing the same task.
    Apart from demonstrating the possibility of designing individual methods of case taking, I fail to understand how this method is superior to the already existing classical methods of case taking and translating the language of the patient to the uniform language of the comparison tool ie, whichever repertory or materia medica the homeopath is coversant with.

  • DEAR DR,
    WHAT EVER METHODS, YOU HAVE APPLIED APPEARS TO ME VERY LENGTHY AND CUMBERSOME. YOU HAVE STATED THAT CHILD STARTED YAWNING. YAWNING IS A SIGN OF MONOTONY AND BOREDOM. CHILD DOES NOT WANT TO REPLY FURTHER AND BECOMES RESTLESS. A CHILD WHO CAN SPEAK SHOULD BE ASKED TWO QUESTIONS ONLY. WHAT HE LIKED MOST AND WHAT HE HATED MOST. HE MAY BE ASKED HIS 2ND OR 3RD LIKES OR HATES. I THINK THIS GIVES US SUFFICIENT CLUE TO SELECT CORRECT REMEDY.
    THANKS

  • I agree with Dr. CSGupta. Further complicating a system is easy& everyone who knows the system can do it. What is needed is simplification & we can see the stalwarts have done only that.

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