Understanding the practical application of relationship of remedies chapter of Boenninghausen’s therapeutic pocketbook

Dr Manish Kumar Tiwari

INTRODUCTION
Relationship of remedies means the similarity or dissimilarity between the remedies. Similarity of the remedies can occur at the general level or local/specific location level.

The Therapeutic Pocket Book at the end has a unique section called “the relationship of remedies” which was published in the year 1846 by the father of repertory, Boenninghausen . This repertory is one of the pioneering works, which can be used in the study of materia medica and at the bedside. Dr J.H. Clarke says – “Therapeutic Pocket Book, is in a sense, the parent of all repertories and analysis of the materia medica”.

An attempt is made to form a repertorization sheet exclusively based on relationship of remedies chapter to ease the repertorization process.

SIGNIFICANCE
Boenninghausen in Therapeutic Pocket Book  wrote about the relationship of remedies, which he called as ‘Concordances’. The word concordance means –The inheritance by two related individuals (especially twins) of the same genetic characteristic, such as susceptibility to a disease.

This is a novel and useful idea, as it gave a better understanding of the drug and points of contact with each other with regard to specific spheres, locations, modalities, tissues, etc.,

Working out these relationships, we can find out the remedy which is likely to follow the previous remedy after it has done its job, though partially. Thus we can find out the remedy that would complement the action of the first remedy, with regard to the case in hand and not by any rigid preconceived ideas.

Though the chapter has immense potentiality in its utility, in education and practice, it is yet to be made use in its full capacity. Most of the physicians do not make its proper use, due to want of adequate attention and understanding of the chapter, which seems as a sort of mystery. This part of the pocket book has helped in solving many chronic cases and especially in their search for the second prescription.

HISTORY AND ORIGIN
This idea of  about “relationships of remedies” was envisaged as early as 1836 by Boenninghausen, but later he found many errors and omissions,  which compelled him to discard it. But once again, he incorporated this in the TPB in 1846, he tried to make it as complete and correct as possible. Boenninghausen  wrote in his preface that he hoped that no one would consider this section useless and superfluous. He says “for myself, who for last fifteen years had made the materia medica pura my chief study as one of the most indispensable works of homoeopathy, this concordance has been of extreme importance, not only for recognition of the genius of the remedy but also for testing and making sure of its choice and for judging of sequence of the various remedies, so as to determine the order of their successive exhibition, particularly in chronic diseases”. It was his analytical mind that he was able to weigh the comparative value of remedies in relation to particular symptom groups.

While referring the materia medica, we must have seen that many authors have appended some sort of relationship of remedies at the end of the chapter in a particular drug, but it was Boenninghausen  who was the first to draw our attention to these relationships. Boenninghausen in his preface gives an idea on the method of gathering data; he kept notes for years on various symptoms, their relationship to each other, and the relationship of remedies to symptom groups. He collected the spheres of action of the remedies in different regions, placed them in different relevant sections of particular remedy whose relationships have been detailed. It is the result of comparative action of the various remedies mentioned in the work and an accumulation of practical knowledge of many years of experience. Later when Allen edited Therapeutic Pocket Book he changed the title from “Concordances” to “Relationship of remedies”.

LAYOUT OF THE CHAPTER
The chapter “Relationship of remedies” deals with 142 remedies, which are given as separate sections. Remedies are arranged alphabetically. Each remedy has 12 headings/rubrics, which correspond to the arrangement of the chapters in “Therapeutic pocket book” , with additions of last three headings namely “other remedies”, “antidotes”, and “injurious”.

They are as follows:

• Mind
• Localities
• Sensations
• Glands
• Bones
• Skin
• Sleep and dreams
• Blood, circulation and fever
• Aggravation – time and circumstances
• Other remedies
• Antidotes
• Injurious
• Under Arnica and other remedies the full list can be seen.
• Additional rubrics are elaborated as follows

Other remedies – are those remedies, which have general relationship to the remedy under consideration and not to specific subsection. These mostly belong to polychrest remedies

Antidotes – are those similar remedies, which counteract the excess action of the drug. This can be obtained from the clinical experience. For eg: hepar sulph and merc sol, they have a lot of similarity, hence antidote each other.

Injurious remedies – those which are incompatible or inimical with the remedy under consideration. These are developed from the clinical experience. These drugs have will have similarity at the peripheral level but not at the deep acting level. For eg: Apis and rhus tox.

Originally this chapter was compiled with 121 remedies, later Allen added 21 new remedies and thus in Allen’s edition total number of remedies in the relationship chapter are 142. The gradation of remedies in this section is similar to the previous section that is 5 grades. The remedies in parenthesis are for the critical evaluation. Later many authors have not considered this grade remedies

The medicine having  higher marks is said to be more related with the remedy compared to those having less marks. So it can be taken as 5, 4, 3, 2, 1, – in decreasing order of relation of medicines under a particular remedy.

UTILITY OF THIS CHAPTER
It is the most useful section of the Therapeutic Pocket Book. Even Kent who criticized the method of repertorization, has advocated the use of this particular section.

1. It can be used for studying the relationship of remedies at various levels – mind, parts, sensation, etc.,
2. The concordance has been of extreme importance, not only for recognition of genius of remedy but also for making sure of choice of the remedy and for judging sequence of  various remedies, especially in chronic diseases.
3. It is made easier for the beginners, since polychrests present the most points of contact and an intimate acquaintance with these points will enable them to use these drugs easily.
4. It helps to find a second medicine, if the first one, does not meet with the expectation in a given period of time.
5. To find a close running medicine, which can be thought of in future follow-ups, if the picture changes.
6. Sometimes, a deep acting medicine, though indicated should not be given so as to avoid unwanted precipitation of adverse symptoms; in those cases an analogue can be found with the help of this section.
7. This section helps to study various relationships of remedies. Kent has suggested a close study of sub headings and medicines listed against them. A remedy which runs throughout in higher marks, bears a definite relationship with a remedy, like aconitum with sulphur, pulsatilla with silicea and kali sulph.
8. For the solving of one sided diseases where symptoms as well as remedies unfold with time.
9. Experience shows that related medicines act far more curatively, when administered after each other than the unrelated medicine can do.

WORKING METHOD
When the indicated medicine has helped a little and when there is no further improvement without much change in the presentation, this section can be referred to for finding out a close medicine, which would help the patient.

Under the relationship chapter, look for the remedy first prescribed, then refer to the headings or rubric that could be the main complaint of the patient and use it as the first rubric.

Next, take mind and all other headings one after the other.

Repertorisation can be done in two ways that is total addition method or by elimination method. In elimination method there is total elimination or selective elimination. Here only the first rubric is considered for elimination and the remaining is considered for addition process.

In the repertorisation sheet given below, rubrics and medicines are listed. The row above the rubrics has space for mentioning the eliminating rubric for eg: if the rubric gland is selected as eliminating rubric then number  ‘1’ can be mentioned in the row above gland depicting it to be the first rubric followed by other rubrics in order numerically.

A Case – A viral fever case presented with the picture of bryonia. bryonia was prescribed, which relieved constipation, body ache and headache but the temperature continued and oscillated between 101 F to 103 F., after three days, when there was no further improvement, the case was worked out for a second prescription with the help of this section. So here the ‘ BLOOD,CIRCULATION AND FEVER’ was considered as an eliminating rubric followed by other rubrics in addition method.

1. blood, circulation and fever
2. mind
3. localities
4. sensations
5. glands
6. skin
7. sleep and dream
8. aggravations – time and circumstances

“One can ignore the rubrics of glands or skin if the symptoms of the patient do not touch on these spheres, as for instance apoplexy, acute fevers or other related syndromes. But as a whole and especially in chronic diseases the whole relationship must be considered. Of course in such comparisons the rubric pertaining to antidotes is not pertinent.” – H.A. Roberts. 

Repertorial result –

• Sulphur – 34/8
• Pulsatilla – 33/7
• Lycopodium – 25/8
• Nux vomica – 26/7
• Arsenicum album – 19/6

on further enquiry, It was found that the patient was thirstless, therefore Pulsatilla 200 was prescribed and after few hours the patient was out of fever.

Difference between relationship chapter in BTPB and BBCR

BTPB

BBCR

Number of remedies – 142 Originally titled as concordances, but later Allen changed it into relationships of remedies Additions made by Allen Sub headings – 12 1. mind 2. localities 3. sensations 4. glands 5. bones 6. skin 7. sleep and dreams 8. blood, circulation and fever 9. aggravation – time and circumstances 10. other remedies 11. antidotes 12. injurious Time and aggravation mentioned together

Number of remedies  -125 Compiled by Boger, title – concordances  Sub headings – 13 mind localities sensations glands bones skin sleep and dreams blood, circulation and fever time aggravation related remedies antidote inimical given occasionally under antidote instead of other remedies – related remedies time and aggravation is mentioned separately Occasionally remedies in ordinary roman with question mark as 6th grade. Eg: under marum –cam?

As the repertory doesn’t include a list of remedies, the repertorization sheet below is prepared by going through the remedies listed in most of the rubrics in Therapeutic Pocket Book and added. There Is also provision for writing numbers which indicate the hierarchy of rubrics selected for repertorization in a case. 

PATIENT NAME                                    AGE GENDER         OPD NO.                                                 IPD NO.

FIRST PRESCRIPTION –

Rubricselected

Medicines

Mind

Location

Sensation

Glands

Bones

Skin

sleep and dreams

Blood, circulation and fever

Aggravation, time  and circumstances

Other remedies

Inimical

Antidotes

Total

Abrot

Ab. C

Abs

Ac.ac

Acetum

Acon

Aesc

Agar

Agn

Ail

All c

Aloe

Alum

Ambr

Am. Carb

Am m

Amyl

Anac

Ant cr

Ant t

Apis

Apoc c

Arg

Arg n

Aran

Arn

Ars

Ars iod

Arum t

Asaf

Asar

Atrop

Aur

Aurum

Bapt

Bar ac

Bar c

Bar m

Bell

Benz ac

Berb

Bism

Bor

Bov

Brach

Brom

Bry

Bufo

Cact

Calad

Calc ac

Calc c

Calc f

Calc p

Calend

Camph

Cannabi

Cannb s

Canth

Caps

Carb ac

Carb an

Carb v

Caul

Caust

Ced

Cham

Chel

Chin

Cic

Cimic

Cina

Cinnab

Clem

Coca

Cocc

Cod

Cop

Coff

Colch

Coloc

Com

Con

Corn c

Coral

Croc

Crotal

Croton t

Cup

Cur

Cyc

Dig

Dios

Dros

Dulc

Dol

Eup per

Euphorb

Euphr

Fer

Fer phos

Fl ac

Form

Gel

Glon

Graph

Guai

Hell

Helo

Hep

Hyd

Hydroc

Hyd ac

Hyper

Hyos

Ign

Iod

Ip

Iris v

Jug c

Kali c

Kali chl

Kali b

Kali brom

Kali carb

Kali nit

Kalmia

Kreo

Lach

Laur

Led

Lil t

Lith

Lob i

Lyc

Mag c

Mag m

Mang

Mar

Meli

Meny

Merc

Merc d

Merc I r

mez

Millef

Mos

Mur ac

Myr

Naja

Nat c

Nat m

Nit ac

Nux m

Nux v

Oleand

Onos

Op

Osm

Oxalic ac

Oxyt

Par

Petrol

Phos

Phos ac

Phyt

Pic ac

Plant

Plat

Pb

Pod

Pru

Pso

Puls

Ran b

Ran s

Rheum

Rhodo

Rhus t

Rumex

Ruta

Saba

Sabi

Salac

Samb

sang

Sars

Sec c

Sele

Seneg

sep

Sil

Spig

Spo

Squ

Stan

staph

Still

Stram

Stro

Sul ac

Tab

Tan

Tar

Tarent

Tell

Thea

Ther

Thuj

Urt

V aler

Verat a

Verat v

Verb

Vio

Vio o

Vio t

Vip

Zinc

LIST OF REMEDIES IN RELATIONSHIP OF REMEDIES CHAPTER OF BTPB (main headings)

Aconitum	40. Carbo veg	79. Laurocerasus
Aesculus	41. Causticum	80. Ledum
Agaricus muscarius	42. Chammomila	81. Lilium tig
Agnus	43. Chelidonium	82. Lithium
Allium cepa	44. China	83. Lycopodium
Aloe	45. Cicuta	84. Magnesia carbonica
Alumina	46. Cimicifuga	85. Magnesia muriatica
Ambra grisea	47. cina	86. Manganum
Ammonium carbonicum	48. Clematis	87. Marum verum
Ammonium muriaticum	49. Cocculus	88. Menyanthes
Anacardium	50 Coffea	89. Mercurius vivus
Antimonium crudum	51. Colchicum	90. Mezereum
Antimonium tart	52. Colocynthis	91. Moschus
Apis	53. Conium	92. Muriaticum acidum
Argentum	54. Croccus	93. Natrum carbonicum
Argentum nitricum	55. Crotalus	94. Natrum muriaticum
17. Arnica	56. Cuprum	95. Nitrum acidum
18. Arsenicum album	57. Cyclamen	96. Nux moschata
19. Arum triphyllum	58. Digitalis	97. Nux vomica
20. Asafoetida	59. Drosera	98. Oleander
21. Asarum	60. Dulcamara	99. Opium
22. Aurum foliatum	61. Euphorbium	100. Paris
23. Baptisia	62. Euphrasia	101. Petroleum
24. Baryta carbonica	63. Ferrum	102. Phosphorus
25. Belladonna	64. Gelsemium	103. Phosphoricum acidum
26. Berberis	65. Glonine	104. Phytolacca
27. Bismuthum	66. Graphites	105. Platina
28. Borax	67. Guaicum	106. Plumbum
29. Bovista	68. Helleborous	107. Podophyllum
30. Bryonia	69. Hepar sulfuris Calcareum	108. Pulsatilla
31. Cactus	70. Hyoscyamus	109. Ranunculus bulbosus
32. Caladium	71. Ignatia	110. ranunculus sceleratus
33. Calcarea carbonica	72. Iodium	111. Rheum
34. Camphora	73. Ipecacuanha	112. Rhododendron
35. Cannabis indica	74. Kali bichrome	113. Rhus tox
36. Cannabis sativa	75. Kali carbonicum	114. Ruta
37. Cantharis	76. Kali nitricum	115. Sabadilla
38. Capsicum	77. Kreosotum	116. Sabina
39. Carbo animalis	78. Lachesis	117. Sambucus

118. Sangunaria	127. Squilla	136. Valerina
119. Sarsaparila	128. Stannum	137. Veratrum album
120. Secale cornutum	129. Staphysagria	138. Veratrum viride
121. Seleneium	130. Stramonium	139. Verbascum
122. Senega	131. Strontium	140. Viola odorata
123. Sepia	132. Sulphur	141. Viola tricolor
124. Silicia	133. Sulphuricum Acidum	142. Zincum
125. Spigelia	134. Taraxacum
126. Spongia	135. Thuja

CONCLUSION
Knowledge of Relationship of remedies is very important in homoeopathy. Most of the cases require more than one remedy for their cure, especially in chronic diseases. Experience shows that when related remedies are prescribed we are surer of a cure than when unrelated remedies are given. Boenninghuasen realizing this fact, collected all the required data from the many homoeopathic literature of his time and also his many years of experience in homoeopathic practice compiled a section on relationship of remedies in the Therapeutic Pocket Book. Physicians should devote more time, so that they can use this section for their benefit in practice.

REFERENCES

1. Tiwari S. Essentials of Repertorisation. 5th ed. New Delhi: B. Jain; 2012.
2. Siju. P.V. A Reference to Repertories for Homoeopathic students. 1^st ed. New Delhi: B. jain publishers; 2007
3. Boenninghausen: Edited by Allen T.F. Boenninghausen’s Therapeutic pocket book for homoeopathic physicians to use at the bedside and in the study of materia medica. Reprint edition. New Delhi: B. Jain Publishers; 1999.
4.  R Ahmed Munir. Fundamentals Of Repertories Alchemy Of Homeopathic Methodology. Bangalore: i-Line Publisher; 2016.
5. Kishore J. Evolution of homoeopathic repertories and repertorization. 1^st ed. New Delhi: Kishore cards publication; 1998

Dr Manish Kumar Tiwari
M.D Part II
Department of Repertory and Case taking
Under the guidance of Dr Munir Ahmed R
Government Homoeopathic Medical College and hospital, Bangalore