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.