Review of a Synoptic Key of the Materia Medica by Dr CM Boger

Dr. Rahul Singh, MD, Senior Research Fellow, Central Council for Research in Homoeopathy; Dr. Divya Taneja, PG Student, Bakson Homoeopathic Medical College and Hospital, Greater Noida,UP

Dr. Cyrus Maxwell Boger a qualified homoeopath is widely known through a large number of books and publications adding to homoeopathic literature. Other than reviving study and interest in Dr Boenninghausen’s works and re-writing and addition to the Boenninghausen therapeutic pocket book as Boger Boenninghausen Characteristics & Repertory ; he added his own experiences in the form of Boger Synoptic key making him an author of considerable eminence. 

His vast knowledge of the homoeopathic science, his comprehension of homoeopathic philosophy and materia medica and his ability in prescribing were thoroughly exhibited and he is rightly looked upon as having attained a position in the knowledge and art of homoeopathic practice that few ever occupied.

Editions of the book

I edition – 1915 

II edition – 1916 

III edition – 1928 

IV edition – 1931 

Augmented edition – 1935 by Dr. Banerjee of Kolkata   

ANATOMY OF THE SYNOPTIC KEY 

• Foreword 
• List of remedies in Materia medica portion 
• Part I – Analysis 
• Part II – Synopsis 
• Part III – Comprises of 4 appendices 
• List of remedies & their abbreviations 

Foreword by C. M. Boger 

Dr Boger details his approach of identification and development of the totality of a patient by a “combination of the analytic and synoptic methods”. 

Subsequent to the patient detailing his/her complaints, the physician needs to elicit and ascertain: 

1. cause and course of the sickness
2. All the things which now seem to interfere with the sufferer’s comfort
3. Modalities – most vital being Time, temperature, open air, posture, being alone, motion, sleep, eating and drinking, touch, pressure, discharges etc. 
4. Next in importance is the mental state, where irritability, sadness or fear is the ruling factor. 
5. Patient’s own description of his/her sensations, especially burning, cramping, cutting, bursting, soreness, throbbing and thirst. 
6. Objective aspect or expression of the sickness, including facial expression, demeanor, nervous excitability, sensibility, restlessness or torpor, state of the secretions, abnormal colouring 
7. Part affected must be determined, which also brings the investigation in touch with diagnosis. 

This is completely in compliance with the Dr Hahnemann’s guidelines of case taking, where the patient is allowed uninterrupted to narrate his / her complaints in as much details as possible; subsequent to which the practitioners asks questions and completes details of the patients symptoms and adds details missed out. Then the practitioner adds his/her observations to the patient’s narration to develop a complete record of the condition.  

PART- I  ANALYSIS 

This part has a short repertory divided into the following 4 sections: 

1. The periods of aggravation 
2. Conditions of aggravations and amelioration
3. Generalities i.e. consideration of drug affinities for the entire organism
4. Regional repertory

Construction of the repertory

• Each page is arranged in two columns 
• Name of the chapter is written on the top of the page in BOLD CAPITAL 
• Rubrics also represented in BOLD CAPITAL 
• Sub rubrics are represented in bold roman letters 
• Synonyms are given soon after the rubric in bold roman letters with the prefix ‘see’ 
• Cross references are given after the medicine in bold roman letters with the prefix ‘comp.’ 

Gradation of medicines

I ORDINARY CAPITALS e.g. ACON 

II Bold roman e.g. Acon 

III Ordinary roman e.g. Acon 

1. The periods of aggravation 

Consists of time periods of aggravations 

Starts with the rubric PERIODICALLY, in general

Time periods are given in the order of 

Morning – 6 am to 12 noon 

After noon – 1 pm to 5 pm 

Evening – 6 pm to 8 pm 

Night – 9 pm to 5 am 

Both day timings and clock timings are given 

Periodically- Daily, agg ; at same hour, agg; Weekly, agg etc 

2. Conditions of aggravations and amelioration

Rubrics arranged alphabetically  from AIR to YAWNING 

Can be taken as causative modalities.

Some important rubrics : 

Anticipation <; Breakfast <; Dust, feathers etc <; Emotions <; Females <; Foods drinks, <; Mental exertion<; moon phase, full moon <; moon light, <; Vaccination <; Position<; Rising from sitting <; Sea, <; Seasons <; Smoke<; Sleep<; woollens<.  

3. Generalities

It consists of the consideration of the drug affinities of the entire organism 

Rubrics are arranged in alphabetical order ACHING to YELLOW.

Rubrics include locations in general like bones, joints; sensations; complaints; pathological generals; clinical rubrics; mental rubrics 

4. Regional repertory

Given as sub-chapters 

Starts with INTELLECT & ends with SWEAT 

Each subchapter is separated from others by a horizontal line 

These sub-chapters are : Intellect, mind, head, external head, bones and scalp, eyes, vision, ears, hearing, nose and accessory cavities, face, teeth, gums, palate, tongue, mouth and throat, saliva, taste, appetite, aversions, thirst, cravings and desires, water brash, heart burn, qualmishness, hiccough, nausea, regurgitation, retching and gagging, vomiting, eructations, epigastrium, stomach and abdomen, external abdomen, hypochondria, flatulence, groins, anus and rectum, perineum, stool, micturition, urine, sediment, urinary organs, genitals, male organs, female organs, sexual impulse, menstruation, leucorrhoea, respiration, cough, larynx and trachea, voice and speech, external throat, neck, chest and lungs, external chest, axillae, mammae, nipples, heart, circulation and pulse; back, spine and cord (scapular region, dorsal region, lumbar region, sacrum), upper limbs, lower limbs, skin, sleep; chill, chilliness, coldness etc.; heat, sweat. 

Comparing rubrics in A synoptic Key with those in The Repertory of Homoeopathic Matera Medica by Dr JT Kent

Some rubrics which are not found in the repertory by Dr JT Kent 

• ASSOCIATED effects (p.30),
• FORCED through narrow opening, as if (p.36),
• POMPOUS(p.53), 
• BREAKFAST agg (p.20), 
• DINNER agg (p.22), 
• HERE AND THERE (p.38), 
• INTERNAL affection (p.39),
• LOOSE as if(p.39), 
• LUMPY effects (p.39), 
• SHORT as if too(p.44), 
• VENOSITY(p.48),
• WALK impulse to(p.48),
• ABSORVENT ACTION(p.355), 
• ACIDOSIS(p.356), 
• CONICAL FORMATION(p.367) 

Drugs in rubrics 
At many places Dr Boger has taken drugs almost as it is from Dr Kent’s repertory. Often he takes all the bold type drugs, leaving the others, sometimes the ones in ordinary type also. From some rubrics he has left out drugs and in some he has added new ones.

For example:

1. In the rubric ‘Activity fruitless’(p.356) Dr Boger has given Ap., bor., cal-c., stan., ther., whereas in Dr Kent’s repertory only Stan. is present.
2. Under rubric ‘Wild feeling’ (p.95) Dr Kent has given Bapt., lil-t., med. While Dr Boger (p.54) has given Amb., cimi., lil-t. 
3. Under ‘Sighing’ (p.80), Dr Kent has given Arg-n in ordinary type and Cal-p in bold, while Dr Boger (p.53&422) omits Cal-p , takes Arg-n and adds Apoc.

• Generalization of rubrics 

Dr Boger has generalized some rubrics from Dr Kent’s Repertory. For example, 

1. Dr Kent’s  repertory has different  rubrics for ‘Discharge, black’, ‘Skin, Discoloration, blackish’, ‘Skin, ulcers, black’, Menses black  etc. whereas Dr Boger has given all in one rubric ‘BLACK’(p.31)
2. Remedies given under the rubric OFFENSIVENESS (p.41) can be expected to have offensiveness in general including offensiveness of any discharge such as expectoration, leucorrhoea, menses, urine, sweat etc. But if patient has offensive stool or urine it is better to look also under the rubric ‘Stool, bad odour’(p.80), ‘Urine odour foul’(p.83) etc for additional remedies covering this particular symptom.
3. There is rubric ‘Greasy, oily, fatty’(p.37) which can be apply to anything e.g. skin, any discharge, taste etc

• Wider meaning rubrics 

Some rubric headings given by Dr Boger have wider application e.g

• The rubric ‘Ascending agg’ includes remedies which are < by ascending in the air as in flying or ascending in a lift or ascending on the mountain or ascending up the stairs.
• The rubric ‘Abortion’ gives not only all the remedies indicated in actual abortion but also those which cover the after-effects of abortion and tendency for habitual abortion.
• The rubric ‘Forced through a narrow opening, as if’ can be apply to such varied conditions as hernia, stricture, stenosis, feeling as if food is obstructed in oesophagus, cardiospasm, proptosis etc. 
• Kent has given a rubric ‘Attitude bizarre’ in Mind chapter but Boger has transferred this to the Generalities chapter so that it becomes both a mental and physical symptom.

PART –II SYNOPSIS
This part comprises of an exposition of the Important and Characteristic Features  of the most important remedies of the Homoeopathic materia medica, with their physiological spheres of activities, modalities and relationships. This part comprises of the General expression or genius of each remedy; for which Dr Boger advises that their proper place in the prescription should be the ideal of every prescriber.  

Medicines 

Comprises of 323 remedies from Abrotanum to Zinc valerianate with gradation of symptoms, using similar 3 gradations used in the repertory part 

Construction of synopsis

Name of the medicine written on the top of the page in BOLD CAPITALS  followed by 2 columns – Right & left 

• In left column – REGION i.e., sphere of action of the remedy 
• In Right column – modalities as WORSE & BETTER

This is followed by characteristic features of the remedy as a single paragraph with the most nearly affiliated remedies after some of the symptoms in brackets. 

Lastly, other medicines which are Antidotes; Complementary & Related (not seen in every medicine) are given. 

PART III APPENDICES 

1 : Table of Approximate Duration of Action of Remedies

Number of medicines: 127 from Aconite to Zincum 

Duration given in weeks as superscript e.g. E.g Phos⁵ – 5 weeks. 

Duration is given as approximate minimum duration of action of 127 remedies by weeks followed by 2 directions by Dr Boenninghausen and Dr Hering as follows: 

• As long as old ailments reappear or are worse, without the appearance of essentially new symptoms which lie outside of its sphere of action, we should guard against a repetition of the remedy, or changing to a new one – Boenninghausen
• Symptoms appearing last in a proving have the highest value – Hering

2: Complementary remedies

Number of medicines: 114 from Abrotanum to Zincum with their complementary remedies with gradations as bold roman & ordinary roman. 

Gradation in the complementary relationships is a unique concept

E.g. : ASAFOETIDA– Caus., Puls

BARYTA CARB – Ant-t

CONIUM- Phos, Sil

NATRUM CARB – Sep 

3: Antagonistic remedies

Number of medicines: 35 from from Acetic acid to Zincum with their antagonistic remedies (inimical relationship) without any gradations 

E.g. : APIS -Rhus tox

COLOCYNTH- Caust

LYCOPODIUM- Nux mos

MERCURIUS- Lach. Sil

PHOSPHORUS- Caust

SEPIA-  Lach.

4: Supplementary reference table

A supplementary refereance table of rubrics is given with a foreword by Dr Boger. He mentions that it has been enlarged considerably, especially by transferring most of the comparisons to it from the text of respective remedies. 

Features: 

• Rubrics arranged alphabetically, with sub rubrics.
• Many rubrics are provided with page number against them for easy reference as an index to analysis part with gradation of medicines.
• The additional sub-rubrics & medicines mentioned in this section should be used in combination with those in the analysis part.
• Clinical conditions pertaining to various parts of body are vividly described under specific part.

Some rubrics under Supplementary reference table

ASTHMA –86 

bronchial – Terb; catarrhal – Calad., Caps; with coryza – Just; dry weather – Cham; of hay fever – Aru-t, Chlor; from hives – Apis; humid – Cann. 

BACK – 94

acne – Rumex; cyst on – Phos; mental exertion – Pic-ac; stiffness ascends – Ars.

BONES–31. 97. 98

exostoses – Sulph iod, Syph; weather changes agg. –20 Am-c. 

BURNS –32

Urt-u.

CALCULI –32

Coc – c.

DUODENUM – Pod, Uran-n.  

X-RAY BURNS – Calc fl.

LIST OF REMEDIES AND THEIR ABBREVIATIONS

Number of medicines: 489 medicines from Abies canadensis to Zizia aurea with their abbreviations used in repertory. 

SCOPE OF THE SYNOPTIC KEY

• Simplified practical application of combining philosophy of Dr Boenningausen with that of Dr Kent
• Synopsis of medicines i.e. the whole sphere of action of drugs is presented in a nut shell.
• Modalities are given which are helpful for prescription. Time and conditions of aggravation and amelioration is a highly useful.
• Sphere of action of drug are given which will help physician to study or classify the drugs in a group which in turn will help clinician in quick prescribing.
• Complementary and related medicine given at the end that will help physician in second prescription 
• Concept of materia medica & repertory together, helps for easy reference
• Gradation of symptoms in synopsis is very valuable 
• It is a quick bed side reference 
• Part III, supplementary reference tables are the highlights of this book 

LIMITATIONS 

• Limited number of medicines 
• Number of the related medicine is less
• Limited number of rubrics 

CASE

1. Mr K. A. L. ,35yrs old male, an engineer by profession started vomiting at nights. He was hospitalised and investigated, Ba meal and X-rays showed N.A.D. Gastric analysis revealed hyperchlorhydria. He was treated for this with allopathic med. with little relief.At the moment he had heaviness of stomach with dull pain starting half an hour after food and lasting an hour; with the pain he had headache;and become very irritable and impatient. The pain was agg. by heavy food , starchy food , spices, tea and exertion and was much relieved even by a very short nap.If the pain was very sever, he induced vomiting which ameliorated.He preferred eggs, hot food and drinks. Otherwise there was nothing worth reporting.The case was repertorised using Boger Synoptic key and rubrics chosen are:

Sleep amel(p28) +  Discharge amel(p21)=Ars,Nux-v,Pul,Sep,Zn

Sourness(p45)=Nux-v,Pul,Sep

Hurry, Impatience(p51)=Nux-v

Anger, irritability(p49)=Nux-v

The only remedy which comes through was Nux-v so one dose of Nux-v 1M was prescribed. There was an immediate and very gratifying response to the remedy and pt. felt competely well in one week’s time. However there were slight  relapses. And the remedy had to be repeated twice but with the last dose the whole condition cleared up completely.

2.  A child about age of 11 months. He developed itching eruptions all over the body.The father was very well-to-do and was impatient that his son should be cured quickly.The symptoms of the child besides the eruption were that he was obese and had whitish stools.And the most peculiarsymptom was the thought he might be lively and playful the whole day, as soon as he started feeling sleepy he would scream his head off. Following rubrics were consulted from Synoptic key:

Sleep before, agg (p28) + Stool white (p81)=Ars, Cal-c,Merc.,Pho

Children (p32) =Calc-c., Merc.

Obesity (p41) = Calc-c

Calc-c  1M gave immediate relief though he had relapses after some time and medicine was repeated at intervals upto DMM potency to cure him completely.

Bibliography

• A Synoptic Key of the Materia Medica by Dr CM Boger 
• Times of the Remedies and Phases by Dr CM Boger 
• Repertory of Homoeopathic Materia Medica by Dr JT Kent 
• Introduction to Boger’s Synoptic Key by Dr P Sankaran
• Essentials of repertorization by Dr SK Tiwari