Effective utility of Homoeopathic repertories in Management of acute diseases

Effective utility of Homoeopathic repertories in Management of acute diseases

In our clinical practice we need to come across both chronic as well as acute diseases & some might be of very acute in nature, which need immediate attention. We know well that, the credibility of a homoeopathic doctor depends upon his ability to manage acute diseases well. Because here our prescription must be the accurate one, otherwise it can lead to a failure or may spoil the case to such a worse state & indeed the patient may leave us in time. 

Acute diseases
Hahnemann classified diseases on the basis of their nature into acute & chronic diseases.

Acute diseases are rapid morbid processes of the abnormally deranged vital force, which have a tendency to finish their course, more or less quickly, but always in a moderate time.They lead either to recovery or death. They are produced by an exciting cause or acute miasm.

Classification

• Individual & sporadic – caused by unfavorable conditions & meteoric or telluric influences respectively
• Epidemic diseases – attacks many persons with very similar sufferings from the same cause & generally becomes infectious, when they prevail among thickly congregated masses of human beings 

Sources of information

• The patient himself
• The friends or relatives who have been attending the patient
• The physical environment of the patient- especially in serious acute disease
• Clinical examinations & investigations 

Case taking
According to § 99, it is very easy to take the case in acute diseases because all the phenomena and the deviation from the state of health that has been recently lost are still in the memory of the patient and relatives. The physician certainly requires to know everything, but has much less to inquire into.

Presenting complaints are very prominent and impress our sense quickly. So it requires only few questioning because almost everything is self evident. As they require immediate medical intervention, so one should not waste time in collecting details of constitutional state & should confine to the presentation of disease.

All our stalwarts of field suggests, to limit our inquiry only to the recent deviations from health & not to mix up acute & chronic symptoms together. If the patient doesn’t respond to the acute phase even after careful prescribing and change of potencies or medicines, it’s better to see whether system needs a chronic medicine in acute phase & if, should go on with it. 

ACUTE TOTALITY – INCLUDES

Presenting complaints ( Sector totality )
 With location, sensations, modalities including causation & concomitants or associated complaints

The general features ( Fixed general totality)

• Changes on the physical plane – appetite, thirst, sleep, thermal reaction, respiration, bowel movements etc
• Changes on the mental plane – ie, mental state – irritability, fear, restlessness etc

We can enquire into this format in all 3 types of acute diseases

But in case of epidemic diseases there is a likeness in presentation of cases being reported to him one after another which helps for selecting a ‘genus epidemicus’ on the basis of symptom totality. And in cases of acute exacerbations of chronic diseases, story is different, either we need to manage the case with constitutional medicine at first instance, or we should go up with managing presenting problem with an acute remedy and later followed by a constitutional or inter current remedy

Use of repertory in acute diseases
It’s the habit of many of us to prescribe on one or two prominent or keynote symptoms in acute diseases. But it’s more effective if we could consider a good acute totality & repertorisation done on it to prescribe effectively.

Many are confined with their instant Materia medica knowledge in such acute prescribing, but it can lead us to ‘routine prescribing’. A look on available repertories in such times helps to reach in many more medicines for the required states & its proper application definitely will lead us to a similimum.

Its pretty sure that repertory is one of the most important, easiest and unavoidable tools in the management of acute diseases. Our repertories from the very beginning are well nourished with vast number of useful rubrics to apply them in acute diseases. Our user friendly repertories are either followed anatomical schema or alphabetical schema for the convenience of easy reference. And Clinical repertories followed a region wise or clinical condition wise preparation which helps to confine only with our needs

To use them effectively we should have a good knowledge on its basic construction & adaptation

Majority of the acute clinical conditions we come across are well represented in our repertories with very useful sub-rubrics & a good number of medicines with them.

Eg- fever (Fever chapter), diarrhea (Rectum), renal colic (Kidney,pain) dyspnea (Respiration/Breathing,difficult) etc

Our latest repertories are putting their best efforts to represent them more & more ‘practically applicable’ one. Advent of computer software programmes lessens our tasks much easier too.
To prescribe in an acute case, to follow the ‘acute totality’ for repertorisation is the convenient one

Representation in repertories
Erecting a sector totality

Location

• Repertories prepared on the basis of anatomical schema like Kent, BBCR, Synthesis etc & prepared on alphabetical idea like Murphy& Phathak makes our task easy
• Regional repertories helps to confine to them Eg -Allen’s intermittent fever, Berridge’s eyes, Morgan’s urinary organs etc
• By clinical examination & investigations we can confirm the exact location too
• And successful prescriptions can be made alone by prescribing on them
• Eg- Patient with severe abdominal pain, on examination appendicitis
• Rubric- Kent – Abdomen, Inflammation- Appendix/appendicitis
• Similarly liver, spleen, intestines, prostate etc & many more also available

Sensations or complaints
 Different sensations like pain, numbness & complaints like fever etc are well represented in our repertories under different chapters with lot of sub rubrics. We need to get exact sensation on which patient suffers & should go in particular rather going too general.

IN KENT & SYNTHESIS – These sensations follows classical side, time, modality, extension pattern which helps to narrow them according to the case.

              IN MURPHY – they too arranged alphabetically

              IN BBCR– well represented along with separate sections for them

1. Modalities – Well represented in all repertories

Causative modality/ Aetiology
Causative modality or aetiology alone can be a prescribing tool. They are very important in acute diseases because if the cause is removed the effect goes off by them 

Common examples of practice

1. Patient with cold after getting wet in rain

              Kent– Nose -coryza, wet, after getting- Sepia.

              Murphy– Nose – CORYZA, general – wet, after getting- Sep

              Synthesis– NOSE – CORYZA – wet, after getting

2 mark-  Puls. Sep

NOSE – CORYZA – wet, after getting – head – Rhus-t [2 mark]

              BBCR– CORYZA – Aggravation – wet getting –PULS, Ant.c, Sep

Sepia gives good results when prescribed

2. Pain in ankle from a false step

               Kent– Extremities- Pain, Ankle, step from a false– Ledum

               Murphy– Ankles – PAIN, ankles – step, from a false -2 mark –Ledum

Similarly Ledum gives best results here 

Aggravation & amelioration

• Both physical & mental, should consider
• Time modality- hour, day, night, midnight etc, Periodicity, Seasons, Moon phases
• Temperature & weather – chilly or warm blooded in present illness; Dry, cold, wet or hot weather
• Thunder storm – before, during, after;
• Wind, open air, warm room, warmth of bed, covering & uncovering etc
• Bathing, local applications
• Rest or motion
• Positions – standing, sitting, stooping, lying, leaning, unusual positions
• External stimuli – touch, pressure, rubbing, light, noise etc
• Food & drinks – eating & drinking in general
• Sleep – in general, before, during, after, first sleep, waking etc
• Menses- before, during, after; sweat & other discharges; Coition, masturbation etc

In very acute diseases we can make prescriptions based only on it. In conditions like renal colic, acute dyspnea & severe backache etc we can manage them well if we know where to look them in repertories

In Kent, synthesis, & Murphy
Chapter Kidneys- pain, provides a bunch of modality sub-rubrics which are very practicable in dealing with renal colic in clinical practice.  Similarly, Chapter Back-pain, Respiration-difficult & much more

Modalities are well arranged under many sensation rubrics in these repertories under appropriate chapters & can seek the help of ‘generalities/generals’ chapter too for the same purpose

In BBCR – Very useful construction to get them, as many of the chapters provides separate sections for them. And with a chapter as ‘agg. & amel. in general’.  These rubrics from BBCR, are very valuable in clinical practice to handle even a critical acute condition & conditions of acute exacerbations of chronic conditions

Eg – Patient with severe acute dyspnea, only > sitting & bending forward

BBCR- Respiration, amelioration, sitting, and bent forward, with-    4- Lach : 3- Acon, Aur ; 2- Bufo, Spong

Concomitants / accompaniments

• Often very valuable alone & represented almost well in our repertories
• As they present mostly as a separate entity, we could consider them as a separate rubric in our reportorial totality if they are not available as exactly we want
• Especially BBCR is useful here, provides separate section for them under many chapters
• Eg- ‘Heat & fever in general’ chapter, concomitants given in general & in different locations from ‘Head to Sleep’, proves efficacy of BBCR in working out a acute fever case well
• In Kent, Synthesis & Murphy we need to correlate them under appropriate chapters, and also under chapter like Generalities/Generals. Eg- faintness, numbness, weakness etc 

FIXED GENERAL TOTALITY
As we are giving importance for patient’s suffering in acute diseases we should not get stuck with them in prescribing. We should have a look on general changes observed on patient’s physical or mental plane, they should consider with priority in our repertorial totality

• Changes on the physical plane  – appetite, thirst, sleep, thermal reaction, respiration, bowel movements etc
• Changes on the mental plane – ie, mental state -irritability, confusion, fear, restlessness etc

Appetite & thirst

In Kent’s repertory

• – Appetite & thirst – well represented in ‘stomach’ chapter
• – We can consider general sub-rubrics like Appetite – diminished/easy satiety/ increased/insatiable/ravenous/relish without/wanting etc in our totality

Or can narrow them as

• Appetite, increased, fever, during
• Appetite, increased, headache with etc
• Appetite, increased, pain in stomach with etc
• Similarly Thirst – burning/extreme/large quantities for/small quantities  for/ unquenchable/violent
• Thirst-vomiting, before – Eup.perf
• Thirstless – heat, during etc

In synthesis – Similar rubrics with more no. of sub rubrics & medicines

In Murphy – Under ‘food’ chapter

In BBCR
Separate chapters as appetite & thirst
Similarly other changes in physical plane can work out from appropriate sections

MENTAL STATE (changes in mental plane)

• Important criteria for prescription
• Even with our Materia medica knowledge we can think of Ars. Alb or Aconite for a patient with much fear or anxiety or restlessness during a fever or such other acute conditions
• But repertories help to expand remedial knowledge further

In Kent

• Mind, anxiety, chill during
• Mind, anxiety, Fever, during
• Mind, delirium, hemorrhage after
• Mind, fear, death of
• Mind, fear, death of, heart symptoms during
• Mind, irritabilty, headache during
• Mind, irritabilty, sends the doctor home, says he is not sick- Apis, Arn, Cham
• Mind, Fear, disease, of impending
• Mind, sadness, errors of diet -Nat –c
• Mind, sensitive, chill during /heat during/perspiration during 

In BBCR

Under mind chapter-in general

• – Fear, incurable being
• – Intoxicated as if
• – Memory, poor, injuries head after
• – Thinking affected
• – Thought vanishing of

Under Mind chapter– sections aggravation gives good notes on mental disturbances in some acute ailments like

• – Abdominal complaints with
• – Gastric disturbances with
• – Headache during
• – Heart pains in
• – Hemorrhages after
• – Stomach disordered after etc

In Synthesis & Murphy
Better presentation more no.of rubrics & medicines

Role of clinical examinations
Physical examinations are unavoidable in acute diseases & helps to correlate the symptoms we get by case taking

Like general appearance, examination of nail, teeth, tongue, hair, eyes, Vital signs [ pulse, blood pressure, respiratory rate] , palpable lesions, respiratory difficulty, murmurs, bruises, friction rubs, bowel sounds, neuralgic signs etc & much more

• – Many of them are well represented in our repertories
• – In many cases, we can rely on them for prescription 

KENT
Patient with severe abdominal pain, can be renal colic or appendicitis, here if symptoms & clinical examinations corresponds we can get

Kidney- Pain, Ureters, Vomiting with – Ocimum canum (3 mark)

Abdomen – inflammation, appendicitis

Others

• Mouth – discoloration, tongue, white/black/yellow
• Mouth – dryness, thirst with
• Mouth – froath, foam from
• Fever – coldness, external with
• Fever – intense heat, of the head & face, body cold
• Skin – ulcer, bleeding, touched when
• Skin – ulcer, offensive
• Generalities –pulse -febrile
• Generalities – pulse -Frequent, accelerated, elevated
• Generalities – Pulse – slow/ imperceptible /irregular/weak etc 

LABORATORY & OTHER INVESTIGATIONS

• They are another helping tool in acute prescriptions
• Usually they are helpful to a physician in effective diagnosis but thorough knowledge in correlating them with our Materia medica is a brilliant effort helps the prescription especially when symptoms are lacking
• Our repertories lends a helping hand in this, some examples are 

In Kent

Urine

• Albuminous
• Alkaline
• Bloody
• Casts -blood, epithelial,granular,hyaline, etc
• Sediment -albuminous,phosphates,purulent,renal calculi,gravel etc
• Specific gravity-increased, decreased
• Sugar etc

Chest

• Abscess, lungs
• Hepatization of lungs- right, left
• Inflammation, bronchial tubes
• Inflammation, lungs- right, left

Generals -anaemia

Similar rubrics are available in BBCR, Murphy & synthesis 

In addition

In BBCR

• Kidneys -calculi
• Urine -saccharine

In Synthesis

A rubric as ‘laboratory findings’ in ‘generals’ chapter with more no. of useful sub-rubrics

In Murphy

In ‘clinical’ chapter- under rubric ‘blood’ sub-rubrics like Eosinophilia, RBC cells, WBC cells etc & under rubric ‘blood vessels’ & as some as some general rubrics in ‘clinical’ chapter

And findings of other investigations like x- rays, ECG, Echocardiography etc are also available in our repertories if we know how to correlate them well, especially with latest editions of Synthesis & Murphy 

CLINICAL RUBRICS/DIAGNOSTIC RUBRICS
Those are habituated or forced into making their prescription on acute clinical conditions also gets their help from our repertories as ‘clinical rubrics’

Kent- Chest-angina pectoris

Chest–stenocardia

Acute diseases complicated by allopathic drugs
Here original disease symptoms may be mixed with the drug symptoms. Here physician can apprehend the complete picture of disease in its actual condition, thus a conjoint malady can be formed by the medicinal & original disease & can prescribe for it.

Our repertories generally provides a different set of rubrics in light of after effects of allopathic & other medications Eg-

Synthesis

• GENERALS – HISTORY; personal – antibiotics; of use of
• GENERALS – MEDICINE – allopathic – abuse of
• GENERALS – MEDICINE – allopathic – oversensitive to – influenza; medicine against

Murphy

• Toxicity – DRUG, overdose
• Toxicity – DRUGS, general – abuse
• Toxicity – DRUGS, general – abuse – herbal
• Toxicity – DRUGS, general – overacts, without curing

Genus epidemicus

• In case of an epidemic disease we can reach into a genus epidemicus by preparing a totality which has derived only after observing a number of cases
• This totality can be effectively worked out by a good repertory
• Importance of repertories can never be push aside in reaching a effective genus epidemicus & in prophylaxis in an acute epidemic disease

Second prescription
Section like ‘Relationship of remedies’ provided with repertories are useful in selecting a second prescription in an acute disease after the first remedy is acted positively or failed

Conclusion
It conveys that repertories are the best tools in management of acute diseases, as they provide us a vast ocean of acute symptomatology with proper & handy construction to deal effectively with them when in need. But the immense knowledge in all aspects of all acute diseases we come across is essential for a better outcome.

References : 

1. Organon of medicine- Dr Samuel Hahnemann
2. Essentials of Repertorisation -Dr.Shashi Kant Tiwari
3. Chronic Disease, its cause and cure – P. Banerjee
4. Collected seminars &various journals
5. similima.com
6. Hpathy.com