Analysis and Evaluation of Symptoms for Repertorization

Every man presents an individual nature different from every other one and as every medicine must be exactly adapted to this individuality in agreement with the symptoms which it is able to produce in the total man.  The spiritual and dispositional individuality of the patient are most important, often almost the only deciding points for the selection of the remedy.

Quibus auxiliis:  Accompanying symptoms.  The accompanying symptoms which alone to be considered in a given case because they are preeminently give its individual character to the whole disease.  These are nothing but the Hahnemannian striking, strange, unusual and peculiar (characteristic) signs.

• The associated symptoms that are to be noted are
• Rarely appear in connection with the leading disease and are therefore, also found rarely among the provings.
• Those that belong to another sphere of disease than the chief ailment.
• Lastly those which have more or less of the characteristic signs of one of the medicines, even in case they have not before been noticed in the present juxtaposition.
• Common accompaniments are less important unless intensified in degree. 

Quomodo:  Ability to produce modifications – aggravation or improvement with the patient

According to Boenninghausen it has got a double importance to Homoeopathy.  Firstly, it was discovered and developed by homoeopaths, and is therefore their indisputable and exclusive property.  Secondly because all the results of provings and of experience without exception, belongs to the more or less characteristic signs of which no one is a matter of indifference, not even those of a negative kind.

Food and drinks have to be given more importance not only as a part of digestive diseases but also in fevers and other internal and external affections.  Its likes and dislikes worsening and better with one or another often give the most important hint for the selection of the medicine.

When the symptoms point out a particular remedy with which modalities do not agree means it is negatively indicated and so the remedy that fir modalities only should select.

Quando:  Time of appearance, time of aggravation or improvement.
The two moments which have an immediate effect on the choice of the remedies are:

• The periodical return of morbid symptoms after a longer or shorter cessation.
• The aggravations and alleviations depending on the time of the day

The general or special modalities referable to the time of the day are of much greater importance for hardly any disease lacks this feature and the provings supply the same peculiarity qualify them for the best and most comprehensive uses.  For example, diarrhoea only during daytime is covered by conium and kali carb, aggravation at 4 to 8 pm indicated Lycopodium and Helleborus

Cur:  the cause of the disease.  The causes are divided into internal and external.
Internal causes refer only to the general natural disposition (proximate cause), which in some cases amounts to a peculiar super-sensitiveness (idiosyncrasy). It is so far as the consequence of a former disease that may have modified the original natural disposition.

The external or occasional cause embraces everything which, where there is such an internal disposition to disease (miasmatic chronic nature), may produce disease.

Ubi:  seat of the disease.
Almost every medicine acts more on certain particular parts of the living organisms and hence it has to be particularly emphasized.  Even if whole body is affected rarely all parts of the organisms affect in the same degree as in some left side will be more affected or the right.

Quid:  nature and peculiarity of the disease.
This is for the diagnosis of a case and is least important as far the homoeopathic therapeutic point of view.

Kent’s gradation of symptoms: Kent has given much importance to the grading of the patient symptoms

General Symptoms – which relates to the patient as a whole that is his bodily reactions to environment, his mental and emotional states, his aversions and desires, his body secretions and discharges

First grade –

• Those symptoms that are rare and peculiar OR
• Those that are characteristics of the remedy
• Symptoms that relate to the will, the loves, the hates, the fears, the desires and aversions, the perversions of understanding and memory.

Second grade –

• Those pertaining to the rational mind and intellect
• The body reactions to the environment
• Physical appetites
• Sexual symptoms
• Body secretions and discharges, because such are elaborated by the organisms as a whole.
• Modalities as to time and conditions of aggravation and amelioration.

Third grade –

• Common symptoms
• Those symptoms common to the proving of many remedies

Particular Symptoms:  Which relate to organs and parts

• High grade – those that are rate and unusual
• Second grade –  the modalities qualifying the particular symptoms
• Third grade – common symptoms relating to particular tissues or organs

Common Symptoms:  Which are common to provings of many remedies or to natural disease conditions?

Boger’s gradation of symptoms:
Modalities:  Causation, time, temperature, open air, posture, being alone, motion, sleep, eating and drinking, touch, pressure, discharges, etc.

Mind:  irritability, sadness, fear placidity

Sensation:
Subjective symptoms:  burning, cramping, cutting, bursting, soreness, throbbing, thirst

Objective symptoms:  demeanor, restlessness, nervous excitability, facial expression, torpor, state of secretion, color abnormality odor

Parts affects:  organs, right, left.

Analysis and Evaluation of Symptoms of the case for Repertorization
Lord Bacon once said, “Truth is the daughter of time not of any authority.”  So our interest is to find out truth through appropriate logic of present day context for better analysis and evaluation of symptoms after the case taking.

Analysis of the Case:  It is nothing but the case study about its content for the appropriate treatment by

1. Master Hahnemann’s classification of disease

2. Master Hahnemann’s classification of miasms

Classification of disease i.e. indisposition/dynamic/surgical/one sided/local diseases help in fitting of case for homoeopathy or not.  Acute/chronic/acute exacerbation of chronic diseases diagnosis help in selection of the specific symptoms is to be done to the case fitting for homoeopathy.

Definition of Analysis of Symptoms:  “It is the breakdown of all the symptoms of the case into qualified/characteristic and unqualified/common symptoms and selection of only qualified/characteristic symptoms into various groups, from the case.”  As a result, each symptom can be evaluated for rearranging the only characteristic symptoms to erect the totality/the conceptualization of image of the patient.  Dr. J. N. Kanjilal and Dr. R.P. Patel have shown the way to break the case into:

1. Dr. J. N. Kanjilal in his book “Repertorization” categorize the symptoms as:

1. General

a.  Mental generals                     i.      Rare, Uncommon, Peculiar,  Striking (RUPS)

                                                            ii.      Common

b.  Physical Generals                 i.      Rare, Uncommon, Peculiar, Striking (RUPS)

                                                            ii.      Common

2.  Particular                                 i.      Rare, Uncommon, Peculiar, Striking (RUPS)

                                                            ii.      Common

3.  Common                                    i.      Rare, Uncommon, Peculiar, Striking (RUPS)

                                                            ii.      Common to disease

Dr. M. L. Dhawale in his book “Principles & Practice of Homoeopathy” breaks the symptoms as:

1. Cause
2. Aggravation
3. Ameliorations
4. Unexpected deviations, Craving and Aversions and finally
5. Characteristic particulars (Location, Sensation, Modalities & Concomitants)

After studying all these three stalwarts view, it is my recommendation to classify all general symptoms into Qualified (defined) and Unqualified (Undefined) and Particulars as Characteristic particulars categorization can be done as follows by renovation.

1. Cause (1. Mental & 2. Physical)
2. Aggravations (1. Psycho-social & 2. Physical)
3. Ameliorations (1. Psycho-social & 2. Physical)
4. Unexpected deviations (1. Mental & 2. Physical 3. Pathological Generals by PQRS), Pathological Generals, Cravings and Aversions (Mentally desired for crowd or solitude, work or rest & Physical for work or rest, thermals, foods which should be included by intensity) and finally
5. Characteristic particulars (Locations, Sensation, Pathology, Discharges, Modalities & Concomitants)

On the model format for Analysis of symptoms can be as follows:

Mental Generals:

Will – Peculiarity:       Examples.                    1. Desire of homosexuality,

2. Desire things but soon rejects when offered

            Modality:        Examples.           1. Desire solitude at afternoon

                                                                        2. Desire solitude at work

            Intensity:         Examples.          1. Great desire for Company⁺⁺⁺

                                                                        2. Melancholia

Emotion – Peculiarity: Examples.  1. Consolation aggravates tearfulness/anger etc.

                                                                        2. Burst into laughter in sorrows

            Modality:        Examples.          1. Fearful at evening/morning/night

                                                                        2. Fear of death crows/solitude/disease

            Intensity:         Example.           1. Irritability/Anger⁺⁺⁺/at trifle

                                                                        2. Sobbing/Tearful⁺⁺⁺/at trifle

Intellect – Peculiarity: Example.  1. Understands better in noise

2. Can not understand when taught in silence     & in alone

            Modality:        Example.             1. Dullness at morning/afternoon/evening/night

                                                                        2. Dullness at anxiety/apprehension/with Fear

            Intensity:         Example.            1. Can not understand abstract things.

                                                                        2. Unable to co-relate with other similar Phenomena

                                                                        3. Confusion of one matter to other.

Understanding:

            Peculiarity: Examples.             1. Hallucinations (realization of non Existence) (visual, auditory, tactile,    gustatory, olfactory)

                                                                        2. Illusion (misinterpreting the facts)

                                                                        3. Delusions (Wrong belief)

            Modalities:      Example.            1. Hallucination/Illusions/Delusions at  Specific time.

                                                                        2. Lack of time, place, recoganization at  At specific time

3. The above at fever/sickness/fasting/hard labor

            Intensity:         Examples.                    1. Stupor

2. Lack of time/space orientation all the    times

3. Unable to recognize the friends/kith & kens

Memory:

Peculiarity: Example.          Karsakoff psychosis (forgets recent past) without alcoholism.

Modality: Example.              Forgetful at specific time

                                                      Forgetful at interview/examination/sickness/fasting/noise etc.

Intensity: Example.             Forgetful⁺⁺⁺ at all the times and all the circumstances

Mental general concomitant if any.
These are nothing but the Qualified Mentals

Physical General
Menstruation &           Peculiarity      Example: Vicarious menstruation

Other discharges         Modality:        Example: Agg. during menses           

                                                                       Example: Amel, during menses

                                           Intensity          Example:  No menses or

                                                                        Menstruating twice in month

                                                                       Example: Heavy bleeding/less bleeding

Sex regarding       Peculiarity       Example: Increases sex desire with impotency

                                    Modalities       Example: Aggravation before, during, after coition

                                                                        Amelioration after coition

                                    Intensity          Example: Nymphomania, Sex desire⁺⁺⁺

Aversions                    Peculiarity, Modality, Intensity

Desires                          Peculiarity, Modalities, Intensity

Thermals                      Peculiarity, Modalities, Intensity

• Physical general concomitant if any
• These are nothing but the defined Physical generals.
• Pathological generals if any, with peculiarity, modality and intensity.
• Characteristic Particular

Peculiarity in location: One cheek red, other pale, Head more hot

Peculiarities in Modalities: Pain of hand aggravated by slight touch but ameliorated by pressure.

Differential modalities

            Peculiarity in sensation:          Non-exhausting diarrhoea

            Modalities: Agg. By heat or cold, foods, climate, specific time

                                  Amel. By heat or cold, foods, climate, specific time

            Intensity:   Of pain⁺⁺⁺, radiation, wandering etc.

Particular concomitant if any.

Pathology:      Peculiarity: Example: Painless ulcer

                                Modalities: Example: Relation to heat & cold, foods

                                Intensity: Rapidly growing tumor or ulcer etc.

Discharges: Colour, Odour, Consistency, Mode of Onset.

            Peculiarity: Examples: Changeable colour, absent or required colour

            Modalities: Examples: Aggravation or Amelioration by it.

            Intensity: Examples: Amount⁺⁺⁺, Frequent⁺⁺⁺ or No or less

Utility of Analysis of Symptoms
The answer run parallel to the saying of Computer Application i.e. Garbage In= Garbage Out.  To avoid the Garbage in Erecting Totality, Eliciting Repertorial Syndrome, Selection of Symptoms for PDF, we need the analysis of symptoms.

Master Hahnemann’s instruction helps us for Analysis of symptoms.  While case taking Master Hahnemann in aphorism 84 instruct us not to interrupt in middle while the patient  is telling his story which may break the flow of thought and if broken the second time the flow of thought may come in different manner.  Again in aphorism 85 he tells to give a demarcation line at the end of every symptom and some space before the demarcation line so that the unrevealed problems can be completed asking the questions.  So the case is having full important and unimportant symptoms for homoeopathic prescription out of which we have to choose only the characteristic symptoms as per the aphorism 5 and 153.  In aphorism 5, master tells us to consider the exciting causes in acute diseases and fundamental causes in chronic diseases which are nothing but the chronic miasms.  In chronic cases, matter instructs us to consider the physical constitution, moral and intellectual character, social and domestic relations, occupation, habits etc. but simultaneously warns us to be alert in taking the characteristic symptoms in mental, physical and behavioral level in the aphorism 153 of 6^th edition of Organon while praising Boenninghausen is as follows:

“The more general and undefined symptoms; loss of appetite, headache, debility, restless sleep, discomfort, and so forth, demand but little attention when of that vague & indefinite character, if they can’t be more accurately described, as symptoms of such a general nature are observed in almost every disease & from almost every drug.”

So in analysis of symptoms we first break down the case to the Undefined Generals and Qualified Generals, Common Particulars and Characteristic particulars, then classify the Qualified generals to the catefory of 1^st, 2^nd grade and 3^rd grade mental generals and physical generals to 1^st, 2^nd grade and 3^rd grade physical generals, and lastly particulars to 1^st, 2^nd and 3^rd grade particulars.  The 1^st grade mental generals are the qualified mental symptoms of Will and Emotion, the 2^nd grade mental generals are the qualified mental symptoms of Intellect and Understanding, the third grade mental symptoms are the qualified mental symptoms of Memory.  The mental symptoms are qualified by 1. Peculiarity, 2. Modality, 3. Intensity.  Similarly 1^st grade physical generals are the qualified physical symptoms of menstruation and sexual sphere, the second grade physical generals are the qualified physical symptoms of reaction to environment e.g., thermals, foods. The third grade physical generals are desires and aversions in relation to food and climate, and any abnormal functioning in relation to urination, bowel habit, thirst, and appetite as per the Dr. Bidwell.

The analysis of particular symptoms should be considered after breaking the particular symptoms in to causation, pathology with or without discharges, sensation, Location, Modalities and concomitants as per the instruction of Boenninghausen.  The 1^st grade particulars are the pathology with or without discharges/sensation with peculiarity, the 2^nd grade particulars are the pathology with or without discharges/sensation with causations or modalities and the 3^rd grade particulars are the pathology with or without discharges/sensation with intensity.

Evaluation of symptoms
View of the different stalwarts for defining evaluation of symptoms:

1. Dr. R. P. Patel:  The principles of grading or ranking of different kind of symptoms in order of priority which are to be matched with the drug symptoms in order to cover the characteristic totality in a natural disease condition with that of the drug disease.

2. Dr. J. N. Kanjilal:  Assessing the relative values of each item of vast collected materials.

3. Dr. M. L. Dhawale: “The classification that he accepts will indicate this evaluation”.  The example of the classification is given in analysis of symptoms.

Thus it is the grading by priority of the characteristic symptoms with comparison to other characteristic symptoms as per the school o philosophy.

Boenninghausen’s Evaluation as per Dr. Robert

• Concomitant if any is highest as it decides the totality (Fever, Menstruation)
• A complete symptom is the grand symptom.
• Grand generalization is done.
• No differentiation is made among general concomitant to particular & general complete symptoms to particular complete symptoms.
• PDF:  Mental symptoms are kept for differentiation.

Among the components of symptom

• Causation/Modality is prime importance.
• The intensified specific sensations.
• The specific Location values last.

Boenninghausen’s Evaluation as per Dr. M.L. Dhawale

1. Causative Modalities:
2. Emotional, Intellectual, Physical
   1. General Aggravation:
   2. Emotional, Intellectual, Physical
      1. General Amelioration:
      2. Emotional, intellectual, Physical
         1. Physical Generals:  Sensation and complaints
         2. Concomitants
         3. Mentals:  For reference & differentiation

Evaluation of qualified symptoms as per Kentian School

1. Qualified Mentals by Peculiarity, modality and Intensity:

• Will                             1^st grade mental
• Understanding      2^nd grade mental
• Memory                   3^rd mental

2. Defined Physical General  by Peculiarity, Modality and Intensity:

• Menstruation
• Other Discharges     1^st grade Physical general
• Sex regarding            1^st grade Physical general
• Gen. Agg.                     2^nd grade Physical general
• Aversions                    3^rd grade Physical general
• Desires                         3^rd grade Physical general

3. Limited Generalization of particulars

PDF:  Characteristic Particular

• PQRS                                                1^st grade particulars
• Modalities                                       2^nd grade particulars
• Highly intensified sensation   3^rd grade particulars 

Evolution of Kent’s Concept of Totality:

Dr. Phelan’s irrelevant interrogation unrelated to disease for his wi9fe’s Insomnia, irritated and astonished Dr. kent.

1) How the physical & mental aspect of the person unrelated to the disease help in cure in the treatment of Homoeopathy?

2) He developed an earnest desire to learn truth behind those so irrelevancy used in Homoeopathy

3) He learned Homoeopathy, Dr. Hahnemann’s portrait of disease formulation by Mental & Physical characteristic symptoms ( § – 5, 7 & 153), the miasm portrait & Sweden berg’s hierarchy of decedent of Aura in the hierarchy of Soul → Mind → Body.

4) Then he gave his own theory of disease formation as follows:

Mental Itch → Vital force → Mind → Bodyt.

↓

Derangement of Vital Force by pollution of Mind

↓

Behavior is altered (Mind of Latent Psora)

Physical reaction to environment is altered.  Then only Full pledged Latent Psora causes the disease later to that organ which is weak.

The Evolution of Boger’s Concept

1. Dr. Cyrus Maxwell Boger was a allopath by profession and was German in origin and had been settled in America
2. He learned Homoeopathy at the juncture when Boenninghausen school was criticized by Kentian school for the doctrine of grand generalization and generalization of concomitants and Kent was also criticized by overgeneralization of mind and over particularization of extremities.  Both the schools had been claiming their accuracy through clinical case studies through the publications in journals, magazines, etc.
3. Instead of supporting the one school, he studied the original German literature of Boenninghausen and also literature of Kent.
4. Boger took best from both the schools & eliminated the criticized concept.  Thus Kentian Concept fitted to Boenninghausen’s Format.
5. He illustrated it in the hierarchy form in FOREWARD of Synoptic Key and in Studies in the Philosophy of Healing.
6. Unlike the Boenninghausen, he gave qualified mental symptoms high value and kept for repertorization.
7. Like the Boenninghausen, he followed his format of giving high values to Causation & Modality of Mental symptoms than mental state.
8. Similarly General Modality was given high value than Gen Sensation.
9. Boenninghausen’s Grand Generalization was eliminated & Kent’s Limited Generalization was used in Repertorization.
10. Generalization of concomitant was also rejected.
11. The Concept of Pathological General was introduced by reasoning out the structural deviation at tissue level.  One step ahead than the Miasm.

Boger’s School of Evaluation (The era of Modernization in Repertorization by bridging Kent and Boenninghausen schools: Kentian  Concept in Boenninghausen’s format)

1. Causations & Modalities:

Pathological Generals

            Mental Causation/Modalities

            Physical Causation/Modalities

2. Generals

            Qualified Mental state by Concomitant, Peculiarity, and Intensity.

 Defined Physical generals by Concomitant, Peculiarity, and Intensity

• Sexual Impulse
• Menstruation &
• Other discharges with concomitants if any
• Aversion
• Desires
• Thermals, Fever with concomitants if any
• Thirst
• Appetite

3. Limited generalization of particulars can be done to upgrade into Generals

4. Characteristic Particulars:

• Particular concomitant
• PQRS symptoms
• Modalities
• Intensifies sensation   

Differentiation:  Any rubric can be differentiating factor as per high value.
The General concomitant if any can decide the similimum remedy from totality in chronic case management and particular concomitant if any can decide the similimum remedy from sector totality in acute case management.

Conclusion: Proper Evaluation of symptoms is necessary for the erecting totality as per the philosophy of Repertory the case is adapted to.  Even with the same set of symptoms, totality/conceptual image by Boenninghausen Philosophy, Kentian Philosophy and Boger’s Philosophy differ. Thus in case of the cross-repertorization, without changing the totality and again the erection of totality as per the philosophy of that repertory is required through the evaluation for comparative study.  

Boenninghausen	Boger	Kent
	Boenninghausen’sTherapeuticPocket Book (BTPB)	Boenninghausen’s Characteristics and Repertory (BBCR)	Kent’s Repertory of Homeopathic Materia Medica
The philosophical background is based on the following conceptsAll methods have their origin in the Organon and prescription is based on the Totality of Symptoms.	Doctrine of Complete Symptoms,Doctrine of Analogy,Doctrine ofConcomitants and Modalities, Evaluation of Remedies, Concordances, Principle of Grand Generalization, i.e. each symptom (sensation and modality) present in one part is predicated to be a symptom of the whole.	Doctrine of Complete Symptoms,Doctrine ofConcomitants andModalities, Pathological Generals, Causation and Time, Clinical Rubrics, Evaluation of Remedies, Fever Totality, Concordances, Principle of Generalization (if sensations or modalities are present in more than three parts).	From Generals to Particulars, with highest emphasis on the Mental Generals and strange, rare and peculiarsymptoms.Particular symptoms are used for further differentiation and the final selection of the remedy. They must be qualified.The place of Generalization and Concomitants is very limited in Kent’s view of the totality.
Arrangement of symptomsThe evaluation of symptoms is a must in all methods, and depends upon their value.All methods  emphasize the prime importance of characteristic, unusual, uncommon, strange, rare and peculiar symptoms aswell as symptoms of the Mind.	LocationSensationModalitiesConcomitants Mentals are used for differentiation and the final selection of the remedy.	The arrangement depends on the availability of data and their peculiarity:Causative modalities,Other modalities(agg. and amel.), Concomitants, Physical generals, Locations and Sensations, Pathological Generals, Clinical rubrics Mentals are used for differentiation and the final selection of the remedy. Fever totality: chill, heat, sweat as to Type/partial, Time, Aggravation, Amelioration, Concomitant.	Strange, rare andpeculiar symptomsMental GeneralsPhysical Generals Characteristic Particulars Symptoms have to be graded according to their value.
Adaptability	For Casesrepresenting:Complete symptoms,  prominentconcomitants, marked sensations and modalities, when generals are lacking or strongly marked mentals are not available, cases having suffering in few parts but no modalities for all the suffering parts or scattered modalities, one-sided diseases with paucity of symptoms (if the totality of the state can be filled out), useful to get related remedies by working on the chapter on Concordances	Cases rich inparticulars with marked modalities and concomitants,pathological generals,clinical symptoms, one-sided diseases (if the totality of the state can be filled out), objective symptoms and pathological symptoms (with absence of characteristic symptoms), cases without many mental symptoms, fever cases, useful to get related remedies by working on the chapter on Concordances	Cases having generals and characteristicparticulars,when mental symptoms  or physical generalsymptoms are marked, useful in treating mental or emotional disorders, In cases with lacking Mentals, the Physical Generals and Characteristic Particulars will make the totality. If Generals are lacking, Characteristic Particulars should be used for repertorization, or, Boenninghausen’s or Boger’s repertorization methods.