Analysis & Evaluation of Symptoms for Repertorization

Dr S S Moharana

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 excerbation of chronic diseases diagnosis help in selection of the specific symptoms for totality. After the Analysis of the case, Analysis of the symptoms is to be done to the case fitting for Homoeopathy.

Defination of Analysis of Symptoms: “It is the breakdown of the all 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:

                        General                                              Particulars of Local

Uncommon                Common                    Uncommon                Common

Peculiar,                      (Basic, Primary)          Peculiar,                      (Basic, Primary)

Charecteristic,             1^st Grade                     Characteristic,             1^st Grade

Individualising,           2^nd Grade                     Individualising,           2^nd Grade

(Determinative,           3^rd Grade                     (Determinative,           3^rd Grade

Secondary)                                                      Secondary)

1^st Grade                                                         1^st Grade

2^nd Grade                                                         2^nd Grade

3^rd  Grade                                                        3^rd Grade

Dr. R. P. Patel in his book “The Art of Case Taking and Practical Repertorisation” classifies the symptoms as:

1. General

• i) Mental Generals a) Rare,Uncommon,Peculiar, Striking (RUPS), b) Common
• ii) Physical Generals:a) Rare,Uncommon,Peculiar, Striking (RUPS), b) 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:

• i)   Cause
• ii)  Aggravations
• iii) Ameliorations
• iv) Unexpected deviations, Cravings and Aversions and finally
• v)  Characteristic particulars (Location, Sensation, Modalities & Concomitants)

After studying the all these three stalwarts view, it is my recommendation to classify all general symptoms into Qualified (defined) and Unqualified (undefined) and Particulars as Characteristic and Common and then selection of all qualified (Defined) Generals and 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 (Location, Sensation, Pathology, Discharges, Modalities & Concomitants)

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 mense

                                        Intensity:         Example: No mense or Menstruating twice in month

                                                            Example: Heavy bleeding / less bleeding

Sex regarding              Peculiarity       Example:Increased 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 diarrhea
• 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 of 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 Computor 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 instructions help us for Analysis of symptoms. While case taking Master Hahnemann in aphorism 84 instruct us not to intrupt 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, Mater instructs us to consider the physical constitution, moral and intellectual character, social and domestic relations, occupation, habits etc. but simultaneously warn us to be alert in taking the characteristic symptoms in mental, physical and behavioural level in the aphorism 153 of 6^th edition of Organon  while praising Boenninghausen is as follows:

“The more general & 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 its Undefined Generals and Qualified Generals, Common Particulars and Characteristic particulars, then classify the Qualified generals to the category 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 into 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 kinds 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 of  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. Dhawle

1. Causative Modalities: Emotional, Intellectual, Physical.
2. General Aggravations : Emotional, Intellectual, Physical.
3. General Ameliorations : Emotional, Intellectual, Physical.
4. Physical Generals : Sensations and Complaints.
5. Concomitants.
6. 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

                        Understaning              2^nd grade mental

                        Memory                       3^rd  grade 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 Generalisation of Particulars

PDF: Charecteristic 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 wife’s Insomnia, irritated & astonished Dr. Kent.

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

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

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

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

Mental  Itch → Vital force → Mind → Body.

Derrangement of Vital Force by pollution of Mind.

Behaviour is altered (Mind of Latent Psora)

Physical reaction to environment is altered. Then only Full pledged Latent Psora causes the disease later to the 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 criticised by Kentian school for his doctrine of grand generalisation & generalisation of concomitants and Kent was also criticised by Overgeneralisation mind, & over particularisation of extrimities. Both the schools had been claiming their accuracy through clinical case studies through the publications in journals, magazines etc.
3. In stead of supporting the one school, he studied the original German literature of Boenninghausen & also literature of Kent.
4. Boger took best from both the schools & eliminated the criticised concept. Thus Kentian Concept fitted to Bonninghausen’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 repertorisation.
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 Generalisation was eliminated & Kent’s Limited Generalisation was used in repertorisation.
10. Generalisation 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 Modernisation in Repertorisation 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 Boennighausen Philosophy, Kentian Philosophy and Boger’s Philosophy differ. Thus in case of the cross – repertorisation, 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. 

References:

1. Dhawale, M/L., Principles & Practice of Homoeopathy, Part-1, Third Edition 2000, Institute of Clinical Research, Mumbai, page 85-88
2. Kanjilal, J.N., Repertorization, Reprint edition 2002, B.Jain Publishers (P) Ltd., New Delhi, page 38.and 20
3. Patel, R.P., The Art of Case Taking and Practical Repertorisation in Homoeopathy, 6^th edition, 1998, Sai Homoeopathic Book Corporation, Kerala, Page 37 and 57.
4. Sarkar, B.K., Hahnemann’s Organon of Medicine, Reprint Edition 2004-05, Birla Publications Pvt. Ltd., New Delhi, page 116, 169, 201.
5. Bidwell, G.I., How to use Repertory, Reprint Edition, 1994, B.Jain Publishers (P) Ltd., New Delhi, Page 38 – 40.
6. Boger, C.M., Studies in the Philosophy of Healing, Second Edition, 1999, B, Jain Publihers Pvt. Ltd., New Delhi, page 40-42. 

N.B.  The paper “Analysis and Evaluation of symptoms of the Case for Repertorization”is presented at Father Muller Homoeopathic Medical College and Hospital in Repertory Re – Orientation Training Program 3^rd module of AYUSH, Ministry of Health & Family Welfare, Govt. of India, on 28^th March, 2009.     

Dr S S Moharana M.D(Hom), M.A., M.F.HOM(Malaysia)
Professor & HOD, P.G. Guide Dept. of Repertory
Dr.B.D.Jatti Homoeopathic Medical College and Hospital
P. G. and Research Center, Dharwad, Karnataka.
E-Mail : ssmoharana62@yahoo.co.in