INTRODUCTION-
Classical homoeopathy aims to find a single remedy at any given time in the case that will act as a holistic stimulus to the organism, prodding it towards health. It includes the use of a Hahnemannian or more modern view of miasmatic theory. It follows and respect ‘Hering law of cure’ at the same time uses single remedy at a time, it puts a very high emphasis on the psychological and emotional symptoms of the patient.
CONCEPT OF CONSTITUTIONAL REMEDY-
Constitutional remedy can be defined as a medicine that has clearly acted as a positive holistic stimulus in a patient, improving the health generally as well as give at least some relief to the present symptoms. Often it is selected on the totality of symptoms (both physical and psychological).
Other features of the constitutional remedy may include-
1)A medicine that will help the patient on more than one occasion in his life (it must be distinguished from nosodes used in the ‘never well since an acute disease’ situation which also capable of acting as powerful holistic stimuli but seldom on more than one occasion in the same patient).
2) Improving the patient’s health by removing symptoms in order of herring law of cure.
3) Improving the psychological wellbeing of the patient as well as relieving physical symptoms.
ART OF CASE TAKING –
It is vital to record a full picture of as many as possible of the patient’s symptoms, past and present as well as physical and psychological, which is of the utmost importance in helping us find the constitutional remedy in any case.
In case history taking it is always done in a particular way and order which is very important approach in order to ensure that the physician does not omit to ask about certain vital areas of the patient’s health.
Each point of case taking has dual significance-pathological/diagnostic and homoeopathic.
Standard guidance for case taking follows the following set and its salient features are as follows-
1)History or interrogation of the patient–
a) Particulars of the patient-It includes
1)Name
2)Age-It is very important in order to rule out diseases as well as to focus on certain diseases in particular age group, also from homoeopathic view point, there are some medicines which are indicated in certain age groups (child remedies, old age, etc.) and to determine the potency of the medicine based on susceptibility.
3)Sex-As male and female are susceptible to different diseases like ‘haemophilia’ is exclusively for males, etc., also there are some medicines which are more indicated in females than males and vice-versa.
4)Address- It is important especially in case of endemic diseases (a disease regularly found in a particular place or among a particular group of people and difficult to get rid of) like-malaria and kala-azar in West Bengal as well as Orrisa, etc.
b) Present complaints-It is advisable to allow patient to express their complaints in their own words without any interruptions, after that physician should revert to each particular symptoms and elicit more precise information under heading of –
1)location/Sensation/Modality/Concomitants
2)Duration/Mode of onset/Probable cause/Treatment already taken and results.
In Organon footnote to aphorism 84- ‘Every interruption breaks the train of thoughts of the narrator & all they would have said at first does not again occur to them in precisely the same manner after that’.
c) History of present complaints-It has its importance in knowing the course of the disease, its evolution, type , causation or any modification of the original symptoms following treatment and its consequences.
d)Past history- It has significance in two ways –
1)Diagnostic/ pathological -There may be some correlation of the past disease, for an example we know that heart valve diseases usually follow rheumatic fever, etc. also it helps in determine the susceptibility of the patient.
2)Homoeopathic- It helps in miasmatic diagnosis as well as in selection of the remedy.
e) Family history-It has following importance vin case taking-
1)Diagnostic- Sometimes a communicable disease e.g.T.B., etc. may be present in the family, this could be important both in making diagnosis and in management. Secondly, genetic history among family members helps in disease diagnosis too.
2)Homoeopathic- It also helps in understanding the miasmatic background of the patient. Sometimes it helps in the selection of the medicine as well as to determine the prognosis of the case ,a purely genetic disease is difficult to cure, rather incurable.
f) Personal history– It is to be considered due to following reasons-
1)To discover the causation (exciting/maintaining).
2)To find out the miasmatic cause in a chronic case.
3)For the selection of homoeopathic medicine.
It includes-
1)Addictions
2)Occupation (important to rule out any occupational disease)
3)Accommodation/Housing- It helps in discovering the exciting/maintaining cause, e.g. -when a patient lives in a damp basement and is presenting symptoms, we can choose remedy with such causation like – Natrum sulf., etc.
4)Diet-For better management and prevention in certain cases like – diabetes, anemia or allergic cases.
5)Sexual history -It is important in cases of sexually transmitted diseases, infertility cases, etc.
g) Homoeopathic generalities– It includes –
a) Physical generals –
1)Appearance.
2)Appetite (including taste of mouth).
3)Desires & Aversion including intolerance (Food/Drinks)
4)Natural Discharges- It includes salivation, stool, urine, sweat type, etc. (abnormal discharges from any outlet like vagina, ear, nose, etc.)
5)Menstrual history.
6)Sleep (dreams too)
7)Thermals
8)Increased susceptibility.
9)Bathing/Clothing.
10)General modalities/sensations/tendencies.
b) Mental generals- The patient is asked to describe his personality in general terms. When he has finished speaking, open ended questions may be asked about anxiety ,fears, phobia, emotional states, jealousy ,ability to express emotions like grief , anger ,etc. It includes will, understanding and intellect in general.
2)Physical examination of the patient– Its significance is enhanced when they confirm a functional or structural change already suggested by patient’s history, individual peculiarity of the patient from physical examination is to be determined for totality of the symptoms. It includes-
a) General survey- It includes B.P., temp., pulse , weight, nutrition, jaundice ,etc.
b) Systemic examinations.
3)Provisional clinical/ nosological diagnosis.
4)Laboratory investigation-It should be done, if necessary in order to confirm the diagnosis.
5)Confirmed clinical / nosological diagnosis-Although the diagnosis of the disease is not the sole basis of selection of homoeopathic similimum, but it is helpful in better management of the different cases.
6) Miasmatic diagnosis-It has to be done in almost every case, it includes 4 categories-
1)Only Psora/Sycosis/Syphilis.
2)Psora + Sycosis.
3)Psora + Syphilis.
4) Psora + Sycosis + Syphilis.
7) Analysis and evaluation of symptoms–Classification of symptoms in different categories is known as analysis of the symptoms. When the record of the case is completed then next step is the to interpret them and evaluate them as all symptoms are not of equal value, hence they are to be evaluated through any one of the following methods to decide the basis of the nature of the case at hand,they are-
1)Hahnemannian method.
2) Kent method.
3) Boenninghausen’s method.
4)Boger’s method.
8) Totality of symptoms– The evaluated symptoms forms the totality of the case which will be the chief guide in the selection of the remedy in the case.
9) Selection of the medicine (with/ without the help of repertory)- It depends on formed totality in the case at hand in consultation with materia medica.
Happy Healing
Contributor- Dr. Apurva Varangi
👍
Thanks for sharing 🙂