Exploring Rubrics and Keynotes in Clinical Practice

Dr. Pankil Dhruv urges us to look for the SRP symptoms to find the simillimum.

Many times there are instances in the clinic where we have cases with peculiar symptoms which we tend to overlook and those symptoms are mentioned at various places in our keynotes, red line symptoms and in materia medica. On careful study we can highlight those symptoms.  I’m presenting a few snapshot prescriptions where such peculiarities of symptoms helped me to arrive at a remedy with quick results!

Let’s start by understanding the case:

Case 1) A few months back I saw a patient having chronic migraine, mainly left sided and mainly over the orbital region. She had already consulted various physicians but with very little benefit. I asked her to also relax, and when having the acute episode, to do pranayama (breathing exercise) to which she said this is not at all possible. She said “When I close my eyes and try to meditate during exercise my symptoms gets more intense, especially at night. The characteristic symptom was more aggravated by pranayam (breathing exercise) and aggravated when at night. Usually, kind of deep thoughts aggravates him. No other symptoms were more clear, except for repeated cramps in muscles which he gets often. His calcium and vitamin D levels were normal and there was no other pathology.

Now, which remedy has headache < by meditating? If you know this you will crack many cases of migraines and other types of headaches. On looking for it I found a few remedies which cover this symptom:  china, cocculus, Limulus.

I took it as aggravating from meditating (ref: Boericke MM) and < left sided, settles in eye.  Also, cramps in legs on and off.

The remedy which has these symptoms is “Limulus” – Horseshoe Crab.

Sometimes we overlook small remedies which may have very peculiar symptoms. I studied this remedy further and found the properties of this animal.  The blood of limulus is blue in color as it contains copper, which is often indicative of spasms.
We know that cramps and spasms are also a keynote of copper which is the active ingredient in this remedy!

One more close rubric could be: Head pain, attention from too eager- anac., ign,. nux-v., sabad.  And in Clarke’s MM he mentions this in relation to china and cocculus. But the idea of prescribing in this way needed three confirmatory symptoms and the remedy which covers all three.  So it narrowed down to Limulus.

I found that the blue blood of Limulus  is not just ordinary fluid. It evolved in such a way as to fight off infections which it has to live with in marine life. The horseshoe crab has a compound in its blood — LAL, or Limulus Amebocyte Lysate — which immediately binds and clots around fungi, viruses, and bacterial endotoxins. This blood is now used by all labs and as a standard for screening the blood endotoxin levels. The price of one quart of horseshoe crab blood has a price tag of around 15,000!!  Now that’s the reason I feel it is known as King Crab!

Rx: Limulus 30 BD for a week helped her to get rid of her aches and migraine in a short span.

Sometimes these small unnoticed remedies are gems in cracking some complicated cases.

Aug 2016 Pankil Dhruv1

Aug 2016 Pankil Dhruv2
Image
Courtesy:Internet

Finding Peculiar symptoms and making prescriptions
Stuart Close, in his The Genius of Homeopathy, gives the origin of the creation of the “keynote system.” It was taught and practiced by Dr. Henry N. Guernsey in the last half of the 19th Century.

The critical task during the case analysis is aimed towards filtering out the peculiar from the common diagnostic symptoms until we can find the leading keynotes. These keynotes generally pointed to one of the well indicated remedies in our Materia Medica.  It is crucial that we know the remedies really well, because prescriptions have to be made on the spot. The “Bold type” symptoms from Allen’s Key notes, Bhanja’s Homeopathic Prescriber, Boericke and Phatak’s Materia Medica and Nash’s trios are the main resources.

The key to good prescriptions was also about good observation and objective symptoms. What was also interesting was that some of the most peculiar concomitants were elicited during the general examination as objective symptoms.

Eg: Cracks all across the tongue in every direction confirmed Nitric acid.
Hair on the middle phalanges ( hair in abnormal places) is the keynote for Thuja. The exact purple shade of the wound pointed to a Lachesis. Consolidation at the apex of the left lung in an Xray pointed to Sulphur. Linear complaints in eruptions point towards all-c, syph, caust, sep.

Case 2) Justicia Adhatoda

This was a case of a child with cough and coryza, with terrible itching in eyes. The child was restless and had profuse fluent coryza and lachrymation, loss of smell and taste for food. Feverish feeling with difficulty in breathing. The cough was paroxysmal (first observation), tightness was the sensation he felt. Had to hold neck while coughing.  Based on this I had given him Allium cepa but it didn’t work, Lachrymation was increased so I prescribed Euphrasia, but it also failed to work!

This time I thought to prescribe an Indian remedy – Justicia adhatoda 30 BD and to my wonderment I found in Boericke’s material medica – last line of that drug “Seems to come between Cepa and Euphrasia, which compare….” and this remedy helped him in just few hours.

Case 3) Phytolacca Decandra

A case of pain in foot and difficulty in walking barefoot.  A homeopath had referred this case to me, which was treated earlier with Bryonia, Rhus tox, Arania etc. but nothing had helped her for a long time. Along with this she had follicular tonsillitis due to cold drinks along with aphonia.  This was enough data to arrive at prescription a prescription of Phytolacca D 30 BD for 1 week. In a month’s time she was remarkably better!
Boericke mentions : this is a glandular remedy with effects on fibrous and osseous tissues, fascie, muscle sheath, scar tissue. Syphilitic remedy.
Allen writes in his book on keynotes: Rheumatic diathesis, occupies a position between Bryonia and Rhus tox; cures when these fail though apparently well indicated.

START
Exploring rubrics from repertory in a clinical sitting

Short excerpt from a case:  I had a case of an old woman with the chief complaints of forgetfulness and depression. She tends to forget while speaking. Now in such a case while looking for rubrics we check mainly at two places:

1) Mind: fortgetful             2) Mind: memory- weakness

While working out with the case, I came across some interesting rubrics below:

1) FORGETFUL, words, of, while speaking:

They are having a conversation and do not find the right word.  Eg: “Doctor Dhruv, you know what, last night I forgot to take that….. what?  That round thing what we called na… what?  I’m not getting that word but you give that every time…”

I said did you mean big sized pills? Medicines?…. “Yes”

Every paragraph she needs our input to recollect.

2) sub rubric: Forgetful, something, feels constantly as if he had: Constant feeling that he is forgetting every now and then.
CAUSTICUM:  Here the reason is a type of paralysis of his memory.

3) Another interesting sub-rubric: FORGOTTEN things, come to mind in sleep:
SELENIUM: He is forgetful the whole day through. When he sleeps peacefully, he remembers everything, for example in a dream. It is also a symptom of sclerosis of the brain.

4) Forgetful, purchase; goes off and leaves the: forgets to take along the bag of shopping which she purchased or left out while travelling in busses and trains.
We came across this common saying from patients.

Thus, exploring more rubrics and understanding how it would be expressed in patients helps us to be more exact during our case taking and acute prescriptions.

T conclude, it’s not just a random collection of symptoms we select but one which is peculiar and characteristic of the remedy and that same if found in patient, then it creates wonderful results.  We strive to exploring our materia medica and repertory and get exactness of symptoms.

About the author

Pankil Dhruv

Pankil Dhruv

Dr. Pankil Dhruv (BHMS, CCAH) graduated in 2012 from CMP Homoeopathic Medical College, Mumbai and later did post-graduation studies (CCAH, FCAH) in Advanced Homoeopathy. He runs a busy private practice in the suburbs of Mumbai and provides online consultation to overseas patients. He is associated with the other song - International Academy of Advanced Homoeopathy as an academic team faculty and web media consultant. He has been instrumental in initiating and developing a unique e-learning course known as “Essential Homoeopathy” with Dr. Rajan Sankaran. He has always had a keen interest in Metaphysical sciences and is a degree holder in FengShui from Malaysian masters. He conducts a yearly workshop on the importance of Homoeopathy and Fengshui for maintaining health. www.Homenhealth.in www.thefengshuiacademy.com

6 Comments

  • Good insight and an open mind is demonstrated by Dr. Dhruv to arrive at the lesser known remedies. Kudos to Dr. and he has doe good job in case analysis as well as looking into what the General world has as features from Nature of the the substance/creature, that he eventually uses as the remedy. Thanks

  • Regarding some more information about this symptom on “meditating”:

    worse from meditating i had referred from boreicke’s materia medica mentioned in Head section under remedy Limulus. this symptom has cocculus and china as a reference from bucks regional and kents reverse repertory.
    but limitation of repertory i wanted to point out through this, likewise other features of the case matched through materia medica symptoms from clarke’s materia about this remedy and then i prescribed it.
    Thus, the knowledge of materia medica can sometimes help to clinch the exact remedy and helps a base for successful prescription.

    Hope this helps!
    feel free to share your queries.

    Best regards,
    Dr.Pankil Dhruv
    [email protected]

  • Thank you Pankil for these pithy case examples.
    A great reminder of what has always been in our literature and we don’t see, unless we are really looking. It’s time to take Boericke to bed again!

  • it seems to me that- homeopathy is an artistic science,not just a science.
    -human life is not enough to master homeopathy
    if you know all reperotories by heart ,you will miss the limulus case.
    -i think keynote prescribing is wonderful for acute case.
    it may help chronic cases if we have something really peculiar and it makes a good match with a remedy .
    thank you Dr. Pankil for sharing your articles.

  • thanks sir for these cases. because we tend to overlook these small remedies and indian remedies, and if at all we read them, we cant see in patients, if one has not keenful sight.

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