INTRODUCTION-
In general symptom is defined as ‘’circumstances or indications which serve as evidence of something’’ where as in pathology it is termed as ‘’which arises due to a particular disease and act as its indication.
The word symptom is derived from a Greek word called “symptoma” meaning “anything that happens”. Any change that takes place in the previous healthy state of the patient is considered a symptom. Symptoms are the language of the vital force; only by the symptoms, the physician can identify the sufferings of the patient.
In sixth edition of organon in aphorism 6 Dr Samuel Hahnemann explained the term ‘’symptom’’ as any change in the health of the organism which is felt by himself, marked by people around him and observed by physician (symptoms are external manifestation of internally deranged vital force).
Also, different authors also explained it in their literature, few important are as follows-
1)Dr H. A. Roberts explained it as ‘’Only representative expression of diseased state’’.
2)Dr Stuart Close also explained it as ‘’In general, a symptom is any evidence of disease or change from state of health’’.
3)Dr Elizabeth Wright defined it as language of body expressing its disharmony and calling for similar remedy.
4)Dr Kent defines it as, “all type of symptom is indication of a deviation from complete normal state of health. All treatable diseases presents themselves to the physician by signs and symptoms all the time”.
It is very important to know the basic difference between ‘sign’ and ‘symptom’ in medical terminology whenever any sensation is subjective (mental as well as physical) and is observed by patient himself like pain and its character while ‘sign’ denotes the observation made by the physician and people around them, eg. Swelling, hemorrhage, any deformity, etc.
Another term is also used very frequently is ‘’Syndrome’’ which denotes a disease with sign and symptom particular to the disease both at the same time as for an example AIDS,down, etc.
SIGNIFICANCE OF SYMPTOMS–
‘’True nature and constitution of a symptom and its complete knowledge is needed to prove or test medicines, also in clinical examination of patients as well as Materia medica study and its application in case study in selection of indicated remedy as per totality of symptom in management of a case’’- Dr Stuart Close.
Symptoms are known as ‘’CRIES OF VITAL FORCE’’ as deranged vital force shows its state through symptoms to be managed to regain again the state of health by physician assistance,so they are also defined as “the external manifestation of the deranged internal state of vital force’’.
Symptoms not only helps in diagnosis of disease but also its management (selection of remedy) and prognosis is based on them , so it is very critical of physician to observe the symptoms not to miss anything important during whole process of case taking.
EXPRESSION OF SYMPTOMS-
They are expressed mainly on 3 planes or spheres, namely-
1)Mental/emotional sphere- emotional state of patient.
2)Physical sphere- all functional or structural change on bodily level.
3)Spiritual/intellectual sphere-it involves intellect, will, understanding, memory, etc.
According to Dr H.A. Roberts they presents themselves in unified order in all the 3 spheres, so complete removal of all symptoms in each sphere is only termed as cure.
Concept of susceptibility and sensitivity plays an important role in symptomatology as every individual show symptoms according to their constitution, it means hypersensitive individual shows high intensity symptoms as compared to a sick persons whose vitality is low often shows symptoms with low intensity. while case taking intensity of symptoms are observed and recorded which helps in formation of totality of symptoms.
CLASSIFICATION-
1)COMPLETE /QUALIFIED SYMPTOM/DISCRIMINATIVE SYMPTOM-
According to Dr. Boenninghausen when a symptom fulfills following criteria then they are classified as complete symptom or grand symptom while case taking, they are as follows-
1)LOCATION– It refers to anatomical location where symptom appears when there is structural changes, it indicates part, organ, etc.
2)SENSATION-It is related to individual subjective feeling as sensed by person themselves which is expressed by individual itself , for an example pain and its type can only be recorded while case taking when patients explains it not by physician observation.
3) MODALITY– It refers to conditions which increases(aggravation) or decreases(amelioration) the suffering of patients (intensity of symptoms), means amelioration or aggravation in case of symptoms.
“The aggravation or amelioration of a drug are the Pathognomonic symptoms of drugs in Materia medica- Dr. Boericke’’.
VARIETY OF MODALITY-
1.General Modality– Those modalities which affects as a whole. Example- better in open air is general modality as it affects individual as a whole, etc.
2.Particular Modality– These affects particular organ or system not as a whole to the organism. Example- headache or toothache or any other particular symptom involves any modality then it is termed as particular modality.
3.Positional Modality– It refers to the position of body in which any symptom is ameliorated or aggravated. Example in case of Sulphur individual standing is the worst position, etc.
4.Environmental Modality-It is concerned with environmental conditions and their changes. Example in case of Rhus tox thunderstorm aggravates, etc.
2.SUBJECTIVE AND OBJECTIVE SYMPTOM
A) Subjective symptoms- Those symptoms which are expressed by the individual himself. Especially mental symptoms are subjective as it is the sensation or feeling of the patient which is expressed by patient himself during case taking, as well as bodily sensation like pain and its type are subjective in nature. Subjective symptoms are vital in homoeopathic case taking and mentals are very important to form totality of symptoms.
Significance-
1) Indicator of inner nature of the patient as they are related to mental as well as psychological state of the individual.
2) They are early indicator of diseases as functional changes even though not observed by others or physician but they are present and felt by the patient themselves.
3) It helps in formation of symptom totality and in selection of constitutional remedy.
B) Objective symptoms-Those symptom which are observed by others and physician himself is termed as objective symptoms. They are termed as ‘SIGN’ in medical practice.
Example- Swelling, lesion, etc. is visible as change by others and physician too, etc.
Significance
1)It is very useful in cases where subjective symptoms are less or hard to obtain, in cases of infants, comatose as well as insane patients, etc.
2)Helpful in nosological diagnosis than forming totality of symptoms.
3. COMMON (GENERAL) AND UNCOMMON SYMPTOMS
A) Common symptoms- It is called as ‘general symptoms’ by Dr. Hahnemann (he classified into general and uncommon symptoms) as they are present in many patients suffering from certain disease as well as produced in abundant during drug proving, they are spurious in nature so also called as ‘spurious symptoms’. Example- rashes in measles,etc.
It is of no significance in homoeopathic remedy selection, but they are very helpful in nosological diagnosis and its management.
B)Uncommon symptoms
Those symptoms that are special to the patient or the drug, like strange, peculiar, and individualizing symptoms, are called the Uncommon symptoms. These are helpful from a homeopathic point of view, but useless in diagnostic view. Most of the uncommon symptoms are unexplainable, absurd, or paradoxical from the pathological point.
Example: i. Coryza relieved by cold bath ii. Moist tongue with great thirst iii. Thirstless during fever iv. Burning sensation relieved by heat v. Asthma aggravated in summer
4. BASIC AND DETERMINATIVE SYMPTOMS- Both terms are used in book named ‘The Principles of Homoeopathy’ by Dr. Boericke, he explains them as follows-
A) BASIC/ABSOLUTE SYMPTOMS– They are basically the most general symptoms (which is termed as common symptom ) present in every proving during drug proving. So they have significance in nosological diagnosis, management and prognosis but they have no significance in homoeopathic remedy selection.
It must be noted that Dr. Boericke’s basic symptom is same as Kent’s common symptom and Hahnemann’s general symptoms.
Example-weakness, fever,etc.
B) DETERMINATIVE SYMPTOMS–
In every case individualization is the aim to obtain similimum , which is aided by the symptoms which helps in determination, personalization (to distinguish every case apart from another case ). Example- modalities, desires, mental symptoms, etc., such symptoms are called as ‘Determinative symptoms’ by Dr. Boericke.
It must be noted that Dr. Boericke’s determinative symptom is same as Kent’s general & qualified particular symptom and Hahnemann’s uncommon symptoms.
5.CHARACTERISTIC SYMPTOMS- Any symptom which is ‘PECULIAR, UNUSUAL, DISTINCTIVE’ in a case and is related to the individual not to the disease is known as Characteristic symptoms.
These symptoms characterize both disease as well as remedy.
They are broadly classified into mental and physical characteristic symptoms.
Example- In constipation when it is dry sweat at stools it indicates alumina,etc.
6.NEGATIVE GENERAL SYMPTOMS– These are those symptoms which are meant to be present as a symptom of a nosological disease but they are not present in the case. Common or general symptom of a nosological disease is not present then it become the negative general symptom of the case.
7. GENERAL, COMMON AND PARTICULAR SYMPTOMS– These are explained by Dr. Kent in his book “The lectures on Homoeopathic philosophy”. These are as follows-
1) GENERAL SYMPTOMS– For any symptom when a patient uses the first person pronoun “I”, then it belongs to general symptom. It is related to patient as a whole. It expresses the individuality of the patient.
These are classified into two types ( kent’s classification)-
1)MENTAL GENERAL–
These are subjective feelings of the patient, also termed as inner expression of one being related to mind, intellect, understanding and emotions. It is very important in remedy selection in homoeopathy.
2)PHYSICAL GENERAL–
These are symptoms related to physical suffering of the patient as a whole not only to one part of the body.
Example- General modalities that aggravate or ameliorate the patient’s suffering as whole, appetite, thirst, constitutional type, etc.
2) COMMON SYMPTOM–
All those symptoms which are common during drug proving, many patients too and to the disease. These are of least important to homoeopathic remedy selection, because if prescription is merely based on common symptoms leads to palliation. They are very important in nosological diagnosis, management and prognosis of any case.
Example- rashes in measles, etc.
3)PARTICULAR SYMPTOMS–
These are related to particular part or organ of the body (anatomical organ not the whole person is involved). It is given importance after general symptoms in any case. It is called as “my” in any case taking by the patient. Example- my back is very painful, etc.
8.GUIDING SYMPTOMS-According to Dr. Constantine Hering Characteristic symptoms are called as ‘Guiding symptoms’. They act as torch light (guide) in the selection of homoeopathic remedies.
9.KEYNOTE SYMPTOMS– As we know keynote in terms of music is the fundamental note or tone of which complete music piece is accommodated, in the same way it is the symptom which makes the symptom totality and differentiate the remedies to obtain the similimum. According to Dr. Stuart Close this analogy is shown in the use of other musical terms in medicine, but still in many cases it is not suitable to prescribe solely on keynote symptoms by ignoring general symptoms as it can lead to failure in several cases. Under this symptom as per Dr. Hering , he suggests his ‘three legged stool concept’, means at least 3 keynote symptoms are needed to make any remedy selection successful.
10. CHIEF SYMPTOMS– Main or presenting complaint of the patient for which they go to physician for treatment. It denotes the prime symptom which needs to be removed in order to provide relief to the patient.
11.CONCOMITANT (ALONG WITH) SYMPTOMS– These symptoms are present along with main complain of any case, they are also a part of complete symptom, Dr. Boenninghausen used this term for first time and explained it.
Example- in drug picture of capsicum, involuntary urination is present along while coughing with pain in hips.
12. ACCESSORY SYMPTOMS–
These are of two types-
1)ACCESSORY SYMPTOMS OF THE DISEASE (APHORISM 95)– These are those which are ignored by the patient while case taking although patient suffers from it for a long time, because of their chronicity it makes them think that they are not part of disease but they are habit, so it do not need to be treated in urgency. These are very helpful in treatment of one-sided disease.
2)ACCESSORY SYMPTOM OF MEDICINE (APHORISM 163,167,180,181)- Once the treatment starts in any case but is partially suitable homoeopathic remedy (imperfectly selected remedy) is administered which leads to some new symptoms which are not the part of disease in patient, then they are termed as ‘accessory symptom of medicine’. If these symptoms are of more serious nature then remedy change is considered by including new as well as existing symptoms, but if it is mild then no change is adviced.
13.CLINICAL SYMPTOMS– It includes those symptoms which are relieved during clinical prescription but they are not present during drug proving, as for an example in case of Broynia during drug proving pricking type of pain in lungs are not present during drug proving but get resolved while prescribing. These are well defined by Dr. Boericke , they are included in materia medica by Dr. Hering which is opposed by Dr. Hughes but later accepted them .Their significance is management of acute cases
14.PATHOGONOMONIC SYMPTOMS (DISEASE NAMING) –Symptoms those are helpful in nosological (diasease) diagnosis as well as differential diagnosis. Objective symptoms are pathogonomonic symptoms. Example-cough and its characteristics like yellow,bloody,etc. are considerd as pathogonomic as they can be used for diagnosis of tuberculosis as well as differential diagnosis in diseases of lungs including T.B. itself.
In homeopathic remedy selection they play a very little role but they are very helpful in disease diagnosis as well as its management and its prognosis.
15.PATHOGENETIC SYMPTOMS/ETIOLOGICAL SYMPTOMS ( DISEASE PRODUCING) – It is related to drug proving, those symptoms which are produced during proving including objective as well as subjective symptom. This process is known as pathogenesis and they are recorded in materia medica.
16. ALTERNATING SYMPTOMS- It includes set of symptoms that appear and disappear alternatively, especially in cases of chronic diseases. Most important point to be remember is that one symptom is present is at a time, means other symptom returns only when former is not present in the patient. Example – Diarrhea alternates with headache, skin affection alternates with joint pain, etc.
17. RARE SYMPTOMS– It refers to those symptoms which are not present all during proving but only found in highly sensitive and susceptible subjects, they are of greater value as well as characteristic in nature.
18. GENERIC SYMPTOMS– It includes symptom specific to one group or genera of drugs .
Example- Hemorrhagic tendency is generic symptom to all Ophidia group remedies.
19. ELIMINATING SYMPTOMS– They play an important role in individualization and remedy selection in homoeopathy by eliminating all those remedies which are not needed based in totality of symptoms during process of repertorization. Symptoms like general modality, an uncommon, peculiar symptom can be used as eliminating symptoms. Dr. Tyler introduced these in repertorisation.
20. RECENT AND OLD SYMPTOMS–
A) RECENT SYMPTOMS– In case of chronic diseases, on the basis of time and progress of symptom, those who came up ( on surface) in a later part of disease is known as recent symptoms. It is very helpful in remedy management.
B) OLD SYMPTOMS– These are guiding symptoms at beginning of the case taking for selection of similimum. It helps in understanding of disease picture, it helps in constitutional prescription for complete cure.
Both recent and old symptoms are important for prognosis of disease.
21. DIAGNOSTIC (PATHOLOGICAL ULTIMATES) SYMPTOMS– Those symptoms which are guiding symptom for disease diagnosis, they are classified as common symptoms, which are not useful in homoeopathic remedy selection.
22. RECURRENT SYMPTOMS– It is indicator of constitutional dyscrasias which represent the miasmatic background of the individual which return every infrequent intervals.
23. PERIODICAL SYMPTOMS– It is related to the time and interval when a symptom appears or disappear, as many symptoms returns at a fixed and definite time interval is termed as periodical symptoms. They are very helpful in remedy selection in homoeopathy as it is characteristic in nature for each remedy.
24. PARADOXICAL SYMPTOMS–
Symptoms that are self-contradictory and of opposite nature but always appear together are called Paradoxical symptoms. They are also called contradictory symptoms. Example: sleepy but cannot sleep, throat pain better by swallowing solid food, etc.
25. ACCIDENTAL SYMPTOMS- They are not part of symptom totality but they are resent while case taking . They are present in the individual but they are not fit to be in totality.
26. PATHOLOGICAL GENERAL SYMPTOMS- When pathological /structural changes are present in two or more than two anatomical site or locations then such symptom is classified as pathological general under physical general symptoms according to Dr. Kent.
HAPPY LEARNING
Contributor- Dr. Apurva Varangi
