Homeopathy Papers

Taking the Case: An Insight into Pathological Cases

Last modified on November 18th, 2014

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Sneha Thakkar
Written by Sneha Thakkar

The authors discuss the Synergy method of case taking as practiced by Dinesh and Urvi Chauhan.

A 2-day Seminar by Dr. Dinesh Chauhan at ‘the other song’

 

To treat pathological cases and deliver remarkable results is the real test of a homoeopath. While it is the dream of all homoeopaths to treat such cases successfully, many a times, there are several hindrances that a doctor encounters while treating these cases. Treating pathological cases necessitates an in-depth knowledge of medicine and pathology. It is equally important to know how to tackle acute states and exacerbations in chronic pathologies and cancers. While doing this a homoeopath also has to know what precisely is the scope and limitation of Homoeopathy in such conditions i.e. whether Homoeopathy can treat, palliate a certain condition or the patient might just as well opt for surgery or alternative treatment.

It is often a major cause of concern for most homoeopaths how to get the original unmodified picture of the disease especially in chronic cases with multi-systemic involvement like SLE or psoriatic arthropathy or HIV when there has been suppression with a battery of drugs earlier. How do we judge the prognosis and the posology for the case? How to deal with cases where major organs are involved? These are just a few from amongst a host of questions assailing every physician. To address these questions and to find a solution for such cases, the other song organized a seminar by Dr. Dinesh Chauhan Taking the Case: An Insight into Pathological Cases on the 11th and 12th October on its premises.

Dr. Dinesh Chauhan set the pace of the seminar by explaining about his approach in deep irreversible pathologies, i.e. the synergistic holistic approach, which works on the principle that what is true for one part, has to be true for other parts of the same system. The trio of Homoeopathy is similimum, individualization and holism and these three have to be at the centre of case analysis of every case. Every homoeopathic remedy and every human being has its own individualistic expression, what we generally term as PQRS symptoms, be it at the level of local symptoms, mental generals or physical generals. So when the mind and the body are connected, when the mental and the physical, the general and the particular come together, they form a whole; this phenomenon is holism. Simillimum is selected on the basis of this holistic expression of the individual matching the PQRS symptoms at both the general and the particular level of that remedy. So, the aim of case-taking should be to bring out peculiar symptoms at holistic level. PQRS at holistic level is the key to successfully analyzing any case individually.

The expression of the patient can be understood through the system, the symptoms and also through the genius, the common strand running through the complaints. When all these come together, we get a perfect amalgam, a Synergy. This Synergy of the expressions at a holistic level gives a very peculiar and individual understanding of the patient and his complaints. This combination when matched with the drug forms an accurate understanding, guiding us to the Similimum. So, when doing a case, every physician has to go deeper into the symptoms, so as to elicit them not only on a particular level, but to go beyond the isolated, scattered and meaningless, till they form a common connected thread, a pattern which is seen running through the whole picture, i.e. to form a holistic perspective.

The Sensation Approach founded by Dr. Rajan Sankaran, added a new dimension to the practice of Homoeopathy, giving a clearer and a firmer ground for prescription. Here, the system when used on one hand 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 those 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 Synergy.1

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Dr. Dinesh then talked about his experience with cancer cases. He said that the basic difference in the pathology between cancer (proliferative) and other degenerative diseases is that in cancer, the cells undergo mutation and become some different cells which are not in sync with the body, while in other degenerative diseases the healthy cells die. Though both are deep irreversible pathologies, their pathogenesis and mechanisms are different. Thus there are two things happening; one in itself is the original unmodified state and the other is the pathological state which has developed due to abnormal cell division and mutation. This can be easily compared to a pregnant mother who has two states, one of her own and other of the child she is carrying.

Cancer causes its own superimposed state too; the altered cells arising from the normal tissue represent an altered pattern at the local level. The patient’s central disturbance leads up to this disease, but the disease itself produces a corresponding and a definitive disturbances of the patient. Thus the state created by the disease, cancer is called the present pathological state which runs along with the already existing chronic state.

He then showed a few cases of degenerative and deep irreversible pathologies where he showed the analysis of the central point in the case as holistic interplay of mind and body. He presented a case of a lady suffering from chronic kidney disease, who had to undergo dialysis every fourth day over the last four months. On studying her life-history, it was seen that she was worried about her husband, her children and their health. This with some other features about her, made Dr. Dinesh think of Causticum for her. However, in such cases, the case-taking has to be a bit different, the difference lying in enquiring about the changes observed at the onset of the kidney disease, which would yield the present predominant pathological state. So here, the doctor asked about the changes seen since the disease started, mentally, physically and emotionally which were not a part of the person originally but came up when the disease started.

When this approach was adopted for the patient, she said that there was intense fear and panic the moment the doctor announced that she had kidney failure. The first experience was of shock, where she had no sense of what was happening around her. This was followed by thoughts of her mother-in-law who passed away from chronic kidney disease. She directly connected to her mother-in-law’s reaction when the doctors declared that her disease was incurable and how she collapsed and died on the spot hearing the doctors say that. This sequence of events was a shock to the patient.

For the patient, everything was burning from inside right from head to toe. She was completely normal except for the weakness and the burning and then suddenly her doctor told her that her kidney had failed. So all this was very sudden for her. When the patient undergoes dialysis, she has a feeling of chilliness externally which is aggravated by draft of air. With this external chilliness, internally there is an intense burning before and after dialysis as if from application of chilies. Since being diagnosed of renal failure, the patient gets a thought as if someone is taking her away when she is in the dark and she suddenly wakes up in shock. When the patient was asked about her likes and dislikes in food, it was found that she had a craving for potatoes.

After this, we have to find out how her original state was, so she was asked about her childhood. Here, the patient observed that she had fear of dark as a child too and would always be frightened that someone would take her away, so she panicked and the experience was again of a shock to her. The patient was aggravated by draft of air even as a child. This is as far as the details were concerned, which were quite apparent in every circumstance of her life, before and after the complaint. However, now we need to understand her complaints at a holistic level, in totality. So we go back to her anxious nature, where the patient is very worried about her family. She is worried if anyone is a trifle unwell and she takes tremendous care of them. This is because if any of them were to develop a serious illness, she would be shocked, which she would be unable to take it.

The centre for this patient is shock, suddenness, burning smarting as if chillies have been applied and chilliness externally which is worse from draft of air. Many remedies like Secale cor, Capsicum, Arsenic, Kali ars can be thought of. But only Capsicum covered the centre of the case i.e. cold agg, burning and the experience of shock in all situations. In this patient we see a lot of sensitivity to every situation, the experience of which is shock. The sensitivity and the reactivity indicate the plant kingdom.

According to the Sensation Approach, the patients’ experience is classified into three kingdoms – the Plant, the Mineral and the Animal kingdom. The main experience or the Vital Sensation of the Plants has to do with sensitivity, of being affected and reacting. The main sensation of the Mineral kingdom is all to do with structure, whether I am lacking, if I have to complete myself, or if I am losing my structure; while the main experience of the Animal kingdom is survival.2

Capsicum belonging to the family of Solanaceae has shock and fright as the centre. The main experience of remedies in the Solanaceae family is shock, anesthetic, stupefied, lack of irritability, faintness, unconsciousness, panic, escape, fight of flight reaction.3 The patient was much better after a year and her need for dialysis tapered off and she was doing much better symptomatically. The experience of shock in all situations had reduced considerably too.

Here we learn the synergy of two systems, the old classical system as well as the new system, we derived the “whole” from theme of plant family Solanaceae and the part i.e. the physical general and particular from old classical materia medica and then combine the two to arrive at our prescription. This coming together of the system and the symptom is termed ‘Synergy’.

Dr. Dinesh then went on to talk about a case of a patient diagnosed with Systemic lupus erthyematosus (SLE), who had very low haemoglobin, despite having frequent blood transfusions. She had married to a boy of her own choice against the wishes of her parents. Later on in her marriage she started feeling helpless, as she had no one to turn to for any help and went on to suppression of her emotions. As a child she had dreams of being pursued either by an animal or a person or a black object or she felt that someone was following her and would feel completely helpless.

On inquiring about her chief complaint, she said that due to her complaints, she was easily exhausted and even a small walk would drain her. She developed oedema all over her body on walking and because of this she could do no activity, like teaching (which she was passionate about). She feels helpless and stuck in the house all the time. On being asked to describe this feeling of helplessness, she said, “I feel as if I don’t belong to this family, as if they have disowned me. I cannot go and become a part of them again. No important decisions are taken with my opinion as they consider me a child. I feel as if I am tied in the house just doing household work day in and day out. I feel as if I am separated from my mother. I feel alone and forsaken.”

She dreams that people are chasing her away. She feels aggravated in a closed and narrow room and cannot tolerate milk since she has been ill. Lac defloratum as per Phatak has all the symptoms of the case but the feeling of being helpless and forsaken is not given in Phatak. Here, taking the help of the system, if we refer to Dr. Sankaran’s proving of Lac defloratum, we find dreams of being pursued. Lac def belongs to the malarial miasm, and we see that the patient has a feeling of being stuck, which indicated malaria miasm again.

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(Complete Repertory, copyright @Roger van Zandvoort, from MacRepertory 8.2.01, Professional)

After the administration of the remedy, even when haemoglobin went up to 5, the patient would remain asymptomatic. Though the pathology remained, the patient started experiencing wellness at a general level. It took 6 months for her to reach haemoglobin of 11 and then the patient required no further transfusion. She went on to study and to fulfill her ambition of becoming a teacher. After around a year of commencing the treatment, SLE autoimmune marker has became negative for her.

Posology is a very critical topic of discussion in treatment of pathological cases as we have many different views by our masters. Stuart Close advises the use of higher potency like 10M and CM in frequent repetition in cases of deep irreversible pathologies. Others recommend infrequent repetition in such cases, and there are physicians who also believe in administering only one dose and then waiting and watching. The question here is what to believe and what to practice, so we again come to individualization saying it differs from patient to patient. Thus the selection of posology should depend on the basis of whether PQRS are elicited at local, general or holistic level.

Levels of experience according to the Sensation Approach also help to decide the posology. As we potentize the remedy, we are moving from a lower level of experience of the drug to a higher level which means moving to higher level of PQRS. This confirms (as correctly mentioned by Dr Sankaran), higher the level experience of the patient, higher the potency and vice versa irrespective of the pathology.

According to the Sensation Approach, every patient expressed his experience at seven different levels, namely:

 

Level 1: Name – Here, the patient expresses his complaint only as a diagnostic condition, e.g. I suffer from rheumatoid arthritis.

Level 2: Fact – The experience of the patient is in the form of local sensation or phenomena, which make him experience his ailment as a local symptom only. e.g.: I have immense joint pain due to this condition which is more at night.

Level 3: Emotion – The experience of the patient due to the complaint is more at an emotional level, the emphasis of expression being on an emotional plane. e.g.: I get very irritated and extremely restless due to these pains.

Level 4: Delusion – The patient’s experience of any ailment will be in terms of imagination. So, he talks of what it feels like rather than what he feels about it. e.g.: The pains are just killing me, they are not letting go of me and not allowing me to rest in peace. Fears and dreams also belong to this level of experience.

Level 5: Sensation – This is the deepest level for a person as all fears and actions boil down to this basic theme. So this is the main Sensation / Experience. Sensation is a level deeper than that of delusion and it encompasses the mind and the body. e.g. – a person feels restricted due to his pains, and on exploring that restriction further, he says that he feels limited, hedged in, as if tightly bound, unable to move. This becomes the main Sensation, and since it manifests at the level of both mind and body, it is also called the Vital Sensation.

Level 6: Energy – The experience of the ailment or complaint will be in the form of an energy pattern.

Level 7: Seventh level – The experience at this level is of the space that supports the energy level, or which houses the energy pattern.5

 

According to the Sensation Approach, 30th potency is the level of name and fact. 200th potency is very effective for patients who are at the level of emotions. 1M potency is given to patients who are at the level of Delusion. 10M potency patients will give peculiars at local and general, mental general all speaking the same language. This is the PQRS symptom at the holistic level and the patient is at the level of Sensation or Experience. 50M potency is the level where the patient goes to every area not only giving the peculiar symptom at holistic level but also the energy level.

CM potency is useful for patients who within the first 15 minutes cover all different areas and we see the holistic picture emerging everywhere, so clearly that it clearly points to the remedy picture. MM potency, this is the level where the person sees the entire altered pattern in them as a 3rd observer; he separates his being from the altered pattern in him. It is close to nothingness.

When a patient is experiencing level of experience locally only in a passive case taking, we can use LM or, from mother tincture to 12C. This depends on whether there is functional/ structural reversible pathology where mother tincture to 12 C can be used or in the case of structural irreversible deep pathology where LM should be used. In cases at local name and fact only – mother tincture can be used.

  • Local name and fact – 3C
  • Local feelings and modalities – 6C
  • Local perception – 9C
  • Local sensation with energy pattern – 12C

Deep irreversible pathology with local symptom – LM potency (in cases where the pathology is progressively increasing)

  • Name – LM 1,2
  • Fact – LM 3,4
  • Feeling – LM 5,6
  • Delusion – LM 7,8
  • Sensation – LM 9,10
  • Energy pattern – LM 11,12
  • The seventh – LM 13,14

Repetition should be done when the state is coming back, local or general. Start with a minimum dose, say one dose or three doses, and then wait for fifteen days, then inquire about the patient at the local, general and mental level and accordingly decide the repetition. The repetition of doses should be based on the patient’s reactivity.

Sometimes in deep irreversible pathology we decide the potency as per the level of experience, but at the same time, we also give a lower potency of the same remedy repeatedly which takes care of the structural changes and the higher takes care of the whole state. This is still on an experimental basis and based on clinical experience.

As discussed earlier about the present predominant pathological state developed by the disease along with the constitutional state of the patient, the patient may require two remedies, one specific to the state and the other constitutional, where we need to take the case in a different way, firstly to explore the entire disease picture and then go to the state of the patient before the onset of the disease. This leads us to two possibilities in the end. Either the present pathological state is same as the constitutional state or there are two different states; this helps us decide whether two remedies are required or not, irrespective of any protocol. In cancer cases, where the part and the whole are speaking two different languages, we generally administer two remedies. Posology can be decided according to the level of experience.

Dr. Dinesh discussed a case of a young girl having germ cell tumor of the ovary. On asking her to talk she did not say anything for 15mins. When she was asked direct questions, she started answering about her facts at a general level. The patient was scared of loud noise, like when a mother beats her child. She got dreams about this and she would wake up scared. She further said that when her mother worked with a needle, she would be scared of getting pricked by a needle as it would hurt and draw blood.

On asking about her fear as a child, she said that she was scared of needles then too. She was also scared if the teacher banged the book on the table, fearing that it would hurt her. She would get some noise in her ear, which she could not tolerate. She was afraid of falling from a bicycle and was very afraid that her mother would burn her fingers when cooking. She had various dreams, namely bleeding from her mother’s leg, someone being killed, some insects climbing on someone’s body. The scariest dream was of a boy cutting a girl’s hand with a blade and putting it in water. The boy then kills the girl with a gun.

Thus the centre of the case is injury and the level of experience is the fact level. In the second interview she complained of having pain in the ear as if something is pricking like a thorn; while talking about this she started to draw thorns. Here the choice of the remedy was made considering the whole with the disease with injury at the centre. So the remedy she received was Bellis per 30. Bellis per belongs to the Compositae and the main sensation of the family Compositae is injured, hurt or insulted, shocked, burnt or scalded, fear to be touched, hurt, approached, numb, anaesthetic, stupor, catalepsy.6 She developed an acute state after a few months and during this too, she described her pain as pricking. Thus the level of experience being higher, she was given 10M potency at that time repeatedly. She was otherwise on 30th potency for 9 months and her cancer was cured and she is living a healthy life now and is studying in 12th grade.

We can safely conclude from the affirmation case histories that the doctor’s attitude, approach and observation has to be properly attuned to the tenets of Homoeopathy. Confidence itself is a form of knowledge which derives itself as much from external phenomena as from internal faculties too. One can experiment with methodology, choice of medicine and dosage so as to calibrate the response of the patient. Insight is a byproduct of sight with exemplary sensitivity and sharpness.

Bibliography:

1 – Rajan Sankaran, Synergy, The Synergy in Homoeopathy – An Integrated Approach to Case-taking and Analysis, First Edition, 2012, Homoeopathic Medical Publishers, Mumbai, Page 47.

2 – Rajan Sankaran, Vital Sensation and the Kingdoms, Sensation in Homoeopathy, Reprint 2009, Homoeopathic Medical Publishers, Mumbai, Page 289.

3 – Rajan Sankaran, An Insight into Plants, Volume 2, Solanaceae, Second Revised Edition, 2005, Homoeopathic Medical Publishers, Mumbai

4 – Rajan Sankaran, An Insight into Plants, Volume 2, Ranunculaceae, Second Revised Edition, 2005, Homoeopathic Medical Publishers, Mumbai

5 – Rajan Sankaran, An Introduction to the Levels, Sensation in Homoeopathy, Reprint 2009, Homoeopathic Medical Publishers, Mumbai, Page 225.

6 – Rajan Sankaran, An Insight into Plants, Volume 1, Compositae, Second Revised Edition, 2005, Homoeopathic Medical Publishers, Mumbai

 

About ‘the other song: International Academy of Advanced Homoeopathy’:
‘the other song’ is a world class premium medical centre which puts good health and well being at the core of an academic culture dedicated to complete patient care. Situated in Mumbai, this institute is one of its kind where a team of 35 doctors headed by Dr. Rajan Sankaran (the pioneer of the Sensation Approach in Homoeopathy) come together and practice Homoeopathy. At the Academy, the students and practitioners are trained in advanced Homoeopathic practices, using new methodologies in combination with the traditional approaches, all with the use of state-of-the-art technologies. The Academy is also a meeting point for different schools of thought in Homoeopathy, where renowned homoeopaths – national and international are invited, to share their knowledge and experience, so that there is a constant flow of ideas on a common platform

 

About Dr. Dinesh Chauhan:

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.

About the author

Sneha Thakkar

Sneha Thakkar

Dr. Sneha Thakkar, M.D (Hom) has had rich experience in treating varied
cases homeopathically in her practice over the past decade. Keen observation, patience and persistence are the key values she adheres to professionally and personally. Her homoeopathic knowledge has been enriched working along renowned homoeopaths like Dr. Rajan Sankaran, Dr. Sujit Chatterjee, Dr. Jayesh Shah and Dr. Shekhar Algundgi at ‘the other song’ clinic and academy, Mumbai. She also has specialized clinical training in the fields of pediatrics and dermatology. An avid reader and an articulate writer, she has authored and helped edit many publications for different homoeopathic journals. Currently based in Toronto, Canada, she has also been associated with the Ontario College of Homoeopathic Medicine, in the capacity of lecturer and clinic supervisor.

About the author

Ruchita Shah

Dr. Ruchita Shah, B.H.M.S.

1 Comment

  • DEAR SIR,

    INSIGHT INTO PATHOLOGICAL CASES REQUIRES TO ASSESS THE PATHOLOGY IN A DISEASE IT IS NECESSARY TO KNOW THE NATURE, CAUSE AND STAGE OF THAT DISEASE. TO ENABLE THE DR TO KNOW THE NATURE AND THE STAGE OF THE DISEASE CERTAIN LAB TESTS ARE NECESSARY, WHICH DO NOT FIND ANY IMPORTANCE IN THE ARTICLE.
    THE ARTICLE IS VERY GOOD
    THANKS

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