An introduction to Therapeutic Pocket Book

Dr Anoop K K

Baran Climens Martia Fronz Von Boenninghausen was born in Netherlands in west Germany in 1785.He made so many important contribution in to the field of homoeopathy.he was considered as the father of homoeopathic repertories. He was in close touch with Hahnemann until the close of Hahnemann’s life. Among his works Boenninghausen’s therapeutic pocket book was a major one. It was published in the year 1846.

It is a combination of his 4 books as follows               

• Repertory of antipsoric medicines –1832
• Repertory of medicine which are not antipsoric-1835
• Kinship of homoeopathic medicines -1836.
• All the three masterpieces combined to form the therapeutic pocket book.

After his death Dr T F ALLEN added sides of the body (1853) to the text.
The original book was written in German language, which were first time translated to English by a homoeopathic physician whose name is not known. A short time afterwards Hempel translated these books. The literature was handled by Okie, CM. Boger and TF Allen and lastly edited by H.A.Roberts and Annie C Wilson. TFAllen made a lot of additions and deletions. He added the sides of the body and 120 remedies and deleted 4 remedies (126-4+220=342). This book is known as T.F.Allen’s boennninghausen’s therapeutic pocket book because he has left more lasting impression up on his book.
The therapeutic pocket book is based on grouping of symptoms of Hahnemannian teachings based on Boenninghausen’s “doctrines” such as

• Doctrine of concomitants
• Doctrine of generalization
• Doctrine of analogy

Repertory uses: – 
A repertory is an index of symptoms, arranged systematically. The system of arrangement may be founded in turn up on definite guiding principles; or it may be alphabetical or schematic.

Purpose of repertory: –   have got two definite purposes:
1) to serve as a reference and guide in looking up particular symptom that may indicate the simillimum,
2) For careful study of all the symptoms that may appear in a chronic case.
The repertory is not meant for use in those cases where there are clear cut indications for the simillimum. If the repertory is used here it might be used in the manner of a quick reference, to verify leading indications of the remedy, or a slight doubt were felt to, differentiate between those seemingly indicated.
For physicians who have not gained through of materia medica repertory is an important aid in the selection of simillimum.
Useful in chronic cases where several remedies emerge only in shadowy out line from a back ground that is a network of chronic symptoms ever more intricately woven. (Cases after mismanagement after mismanagement superimposed upon circumstantial stress and that again up on hereditary tendencies)

The value of repertory depends up on several elements

• The art of physician in taking the case.
• The knowledge of repertory one attempt to use.
• Its philosophical back ground.
• Its construction.
• Its limitation
• Its adaptability.
• Intelligent use of resulting analysis.

The art of the physician in taking the case
The case: – Combination of subjective and objective symptoms.
The art of case taking embraces the art of physician in securing the confidant of the patient, and drawing out from him those

• Subjective symptoms, of the mind, body and spirit.
• Observation of those observable symptoms
• General atmosphere radiated by he patient.

Doctrine of analogy
Symptoms which existed in an incomplete state in some part of a given case could be reliably completed by observing the condition of other parts of the given case. For E.g.: – it was not possible by questioning a patient to decide what aggravated or ameliorated particular symptoms of the case, the patient would readily express a condition of amelioration of some other symptom. In this condition boenninghausen discovered that condition of aggravation or amelioration are not confined to this or that particular symptoms; but that like the, “Red thread in the cordage of the British Navy” they apply to all the symptoms of the case.

Totality of symptoms and its corresponding simillimum which the homoeopathic prescriber seeks are both based on the same idea. In reality patient is not expressing many symptoms, but only parts of a very few complete symptoms, which the examiner should bring together and complete. Boenninghausen so designed his pocket book that it would enable the physician to bring the symptoms together and complete one part by another.

The perceptible symptoms of the disease are broken up and scattered through different parts of a patient’s organism in much the same way that symptoms are dispersed in the ordinary repertories. The scattered parts must be found and brought together in harmonious relation according to the typical form.
Boenninghausen proceeds up on the Hahnemannian theory that it is the patient who is sick – not his head, nor his eyes, nor his heart. Every symptom that refers to a part may be predicated to the whole man.

If a stitching pain felt in the eyes it belong to the whole man and stitching pain is noted as a characteristic of his complaint in general.

Boenninghausen’s primary and secondary symptoms: – 
The symptoms of the materia medica, like symptoms appearing in sickness, may be reduced to certain fundamental forms, corresponding to the genera and species of biological science, or the generals and particulars of logic. These boenninghausen called the primary and secondary symptoms. These are the elements of symptomatology. In like manner, each particular symptom, primary or secondary, may be reduced to its elements of location, sensation, and conditions.

The philosophical background
Hahnemann himself compiled a short repertory of some of his leading symptoms; this was printed in Latin. Later he developed the repertory ideas still further, but these later repertories are still in manuscript form, never having been published.
Boenninghausen was a close friend and student of Hahnemann, and it was with the encouragement of Hahnemann that Boenninghausen developed his his first repertory, Repertory of antipsorics, published in 1832. In 1835 Boenninghausen published his Repertory of medicines which are not antipsorics; in 1836 his attempt at showing the relative kinship of homoeopathic remedies. Ten years later he published his therapeutic manual for homoeopathic physician.
In constructing his therapeutic pocket book Boenninghauens based his grouping of symptoms on Hahnemann’s teaching that the homoeopathic physician prescribe on the totality of the case.

According to boenninghausen totality was not only the sum total of the symptoms, but was in itself one grand symptom- the symptom of the patient. the grand symptoms – the totality itself – three factors must be present
1. Locality: the part, organs, or tissue involved in the disease process.
2. Sensation: the kind of pain, sensation, functional or organic changes characterizing the morbid process.
3. Condition of aggravation or amelioration of the symptoms: the circumstances causing, exciting, increasing, or decreasing the suffering.

“ Warp of the fabric.”
This term is used to express the leading symptom of a chronic case. These appear in every chronic case, and often to a marked degree. These are always leading symptoms, and these may be defined as those symptoms for which there is clear pathological foundation; or the symptoms that are most prominent and clearly recognizable; or the symptom which first attract the attention of the patient or the physician; or which cause the most suffering; or which indicate definitely the seat and nature of the morbid process.
In the leading symptoms alone, there is nothing particularly characteristic from the standpoint of the prescriber.
For e.g.: – we have so many remedies having cerebral congestion, inflamed liver, inflamed lung etc. any one of these may become a leading symptom, yet inflammation of any organ is not a fact of great value in leading the prescriber to the simillimum.

Boenninghausen in the plan of his repertory, emphasized the value of complete symptom (location, sensation, conditions) but he added the fourth requirement, equally imperative to the first three, this was the concomitant symptom, and the repertory is founded on the doctrine of concomitant symptom.
The word concomitant means existing or occurring together; attendant;
The noun means attendant circumstance.
In nearly every case we may find one or more concomitant symptoms, these symptoms seemingly no relation to the leading symptoms from the standpoint of theoretical pathology. They are the symptoms, which we find no reason for their existences in the individual. We might almost term them as “ unreasonable attendance “.
These symptoms are important in finding out the simillimum because they exist at the same time, in the same patient.
One could prescribe successfully up on one symptom by following the plan laid down in the pocket book, provided that one symptom should be complete.
The concomitant symptoms to the totality what the condition of aggravation or amelioration is to the single symptom.
The foundation of Boenninghausen’s therapeutic book is the doctrine of concomitants.

Construction of the repertory 
One of the outstanding features of boenninghausen’s repertory construction is that he embodied the variation in sizes of type, signifying the varying importance of the symptom-rubric to the various drug listed.

In Allen’s edition we find five types

• CAPITAL (5)
• Bold face  (4)
• Italics    (3)
• Roman (2)
• (roman) (1)

“The fifth place the last of all, contains the doubtful remedies, which require critical study, and which occurs most seldom…”
While constructing a repertory the plan must be elastic enough to allow the separated part of a remedy or a symptom to be brought together in such form as would correspond to any group of symptoms that might arise in practice. The symptoms should be separated in such a manner it would not destroy the individuality nor restrict the integrity.

The problem was a difficult one, but the fine analytical mind of the  “Sage of Munster” solved it. He conceived the figurer of a great all inclusive symptom totality, made up of the cardinal points of location, sensation, condition of aggravation and amelioration, and concomitants, under which all the symptoms of materia medica, and all the symptoms of the disease as well should be covered.

An anonymous person made this book to English the first translation. This work contains so many typographical errors and obsolete phrasing. Then the translation was done by Hempel these early editions divided in to seven parts. Other translators were Okei, Boger, T.F.Allen etc.T.F.Allen has left a more lasting impression up on the pocket book, because it was he who added many of the eye symptoms, and combined Boenninghausen’s repertory of sides of the body with the original pocket book.

The seven parts in the early editions were as follows,
1. Mind and intellect.
2. Parts of the body and organs.
3. Sensation and complaints
a) in general
b) of glands
c) of bones
d) of skin.
4. Sleep and dreams
5. Fever

• circulation of blood
• cold stage
• coldness
• heat
• perspiration
• compound fevers
• concomitant complaints.

6. Alteration of the state of health
Aggravations according to time
Aggravation according to the situation and circumstances.
Amelioration by position and circumstances
7. Relationship of remedies.

Mind and intellect
There are very few rubrics under this section, which have been criticized by many competent homoeopaths. Boenninghausen based his work on the value of concomitants and he never wanted to reflect the picture through mental and his stand was to show the totality through foursquare foundation and mental symptoms were deliberately neglected.

• 18 rubrics in mind section.
• 18 rubrics in intellect
• 17 rubrics in the section aggravation under the rubric emotional excitement.

Boenninghausen based his work on the concept of the whole man. Placing the balance of the emphasis on the value of concomitant symptoms and modalities; it is not his intention to reflect the picture of whole man through his mental reactions. It was his stand that the solid basis of the four square foundation was the only method of securing the totality of the case.

Parts of the body and organs  

• Based on the anatomical schema used by Hahnemann.
• This part run from the page 24 to142

Internal head —-> external head —-> sides of the head.
Eyes ( various location of eye) —-> Vision.
Face ( the objective symptoms observed in the face —->location of sensation in
Abdomen (locations) —-> flatulence —–> stool
Urinary organs —-> urine
Sexual organs —->Menstruation —->Leucorrhoea
Respiration —-> cough —> expectoration —-> Air passages ( specific
location, voice )
Under these chapters devoted to parts of the body and organs , we find a few aggravations and rubrics related to sensation and complaints.

Sensations and complaints
Allen’s edition puts the name sensation and complaints. In earlier editions the heading was sensations.
Contains three types of rubric

• Subjective symptoms
• Complaints ( or conditions )
• Objective symptoms and also few locations

Subjective symptoms,
Desire for open air, aversion to open air, intolerance of clothing, inclination to lie down, aversion to motion, desire for motion restlessness, sensitive to pain, inclination to sit, illusion of touch etc.
The symptoms of direction
Generalized or directional as follows
Symptoms of one side, left side, right side ,crosswise, left upper and right lower and crosswise etc
The symptoms covering complaints
Apoplexy, consumption, convulsions, dropsy, emaciation, tendency to take cold, nervous excitement, hemorrhage, frozen limbs, apparent death, induration, inflammation, paralysis etc. appear under this section even though they are not sensations.

Objective symptoms
Blackness externally, carphology, clumsiness, cracking of joints, cyanosis etc.
Sleep and dreams
This section covers symptoms like yawning, sleepiness, sleeplessness, and position in sleep and dreams.

Fever
There are seven subsections
In the old edition s there where 7 subsections in this part of the book. In this edition the sub heads have been removed but the same general outline in followed, with a single exception which will be noticed.

The original outline is
1. Circulation of blood
2. Cold stage
3. Coldness
4. Heat
5. Perspiration
6. Compound fevers
7. Concomitant complains

The first division has
Anaemia, congestion, objective and subjective symptoms of blood vessels and pulse.
Second division formerly called cold stage is what we term the chilly stage. The rubrics are the modifications of chilliness.
The third and fourth divisions are reversed in Allen’s edition.

In this book we find

•  Circulation
•  Chilliness gen.
•  Heat
•  Coldness in general, with shivering
•  Sweat in general.

The rubrics devoted to perspiration follow in the old order, with their modifications.
Then the rubric dealing with compound fever.
The old seventh section concomitant complaints are scattered more or less through the part. Thus we find
Heat with associated symptoms
Sweat with associated symptoms,
Before fever, During fever, after fever, etc.

Alteration in the state of health
Aggravation according to time
Aggravation according to the situations and circumstances
Amelioration by position and circumstances.
Allen has removed the headings of the subsections and has left the
Aggravations and ameliorations.
The section aggravations covers number of conditions, while the section devoted to amelioration is comparatively small, which are usually not reported by the patient. Allen detected the ameliorations, which are suggested by Boenninghausen and put them, in under the contrary state, thus the rubric > heat has been presented as < cold and it was Allen’s idea to make the book even less cumbersome.

Relationship of remedies 
The work on relationship of remedies was published in 1836. In the earlier editions the chapter was called as concordance of remedies but Allen comprehend the title as relationship of remedies in therapeutic pocket book. this has become a masterpiece for majority of homoeopathic physicians.
The chapter relationship is divided in to sections, each section being devoted to a remedy, in alphabetical order. Each of these remedy section is divided in to rubrics, as all are general section in the book, but in this chapter we find the rubrics are not particularized as symptoms, but are generalized symptom group.This is divided into twelve sections which correspond to materia medica part.
1. Mind
2. Localities
3. Sensations
4. Glands
5. Bones
6. Skin
7. Sleep and dreams
8. Blood, circulation and fever
9. Aggravation, time, circumstances
10. Other remedies
11. Antidotes
12. Injurious

We find that each rubric in this chapter of the book correspond to a general section heading in the first part of the book. To this added one, two, or three additional rubrics. The important one is the “other remedies” the general relation ship of remedies (other than the one heading this particular section of the chapter relationship) to the remedy heading in this particular section.this rubric other remedies covers all those symptoms which do not fall into such regular groups like mind, localities etc. The other two rubrics Antidotes and injurious are easily comprehended

Dr Anoop K K
Medical Officer, Department of Homoeopathy
Govt. of Kerala