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
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:
|General||Particular or Local|
|(Basic Primary)1stgrade2nd grade
|(Basic Primary)1stgrade2nd grade
Dr. R.P. Patel in his book “The Art of Case Taking and Practical Repertorization classify the symptoms as:
a. Mental generals i. Rare, Uncommon, Peculiar, Striking (RUPS)
b. Physical Generals i. Rare, Uncommon, Peculiar, Striking (RUPS)
2. Particular i. Rare, Uncommon, Peculiar, Striking (RUPS)
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:
- Unexpected deviations, Craving and Aversions and finally
- 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.
- Cause (1. Mental & 2. Physical)
- Aggravations (1. Psycho-social & 2. Physical)
- Ameliorations (1. Psycho-social & 2. Physical)
- 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
- Characteristic particulars (Locations, Sensation, Pathology, Discharges, Modalities & Concomitants)
On the model format for Analysis of symptoms can be as follows:
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+++
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.
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
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
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.
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 6th 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 1st, 2nd grade and 3rd grade mental generals and physical generals to 1st, 2nd grade and 3rd grade physical generals, and lastly particulars to 1st, 2nd and 3rd grade particulars. The 1st grade mental generals are the qualified mental symptoms of Will and Emotion, the 2nd 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 1st 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 1st grade particulars are the pathology with or without discharges/sensation with peculiarity, the 2nd grade particulars are the pathology with or without discharges/sensation with causations or modalities and the 3rd 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
- Causative Modalities:
- Emotional, Intellectual, Physical
- General Aggravation:
- Emotional, Intellectual, Physical
- General Amelioration:
- Emotional, intellectual, Physical
- Physical Generals: Sensation and complaints
- Mentals: For reference & differentiation
Evaluation of qualified symptoms as per Kentian School
1. Qualified Mentals by Peculiarity, modality and Intensity:
- Will 1st grade mental
- Understanding 2nd grade mental
- Memory 3rd mental
2. Defined Physical General by Peculiarity, Modality and Intensity:
- Other Discharges 1st grade Physical general
- Sex regarding 1st grade Physical general
- Gen. Agg. 2nd grade Physical general
- Aversions 3rd grade Physical general
- Desires 3rd grade Physical general
3. Limited Generalization of particulars
PDF: Characteristic Particular
- PQRS 1st grade particulars
- Modalities 2nd grade particulars
- Highly intensified sensation 3rd 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
- Dr. Cyrus Maxwell Boger was a allopath by profession and was German in origin and had been settled in America
- 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.
- Instead of supporting the one school, he studied the original German literature of Boenninghausen and also literature of Kent.
- Boger took best from both the schools & eliminated the criticized concept. Thus Kentian Concept fitted to Boenninghausen’s Format.
- He illustrated it in the hierarchy form in FOREWARD of Synoptic Key and in Studies in the Philosophy of Healing.
- Unlike the Boenninghausen, he gave qualified mental symptoms high value and kept for repertorization.
- Like the Boenninghausen, he followed his format of giving high values to Causation & Modality of Mental symptoms than mental state.
- Similarly General Modality was given high value than Gen Sensation.
- Boenninghausen’s Grand Generalization was eliminated & Kent’s Limited Generalization was used in Repertorization.
- Generalization of concomitant was also rejected.
- 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:
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
- Thermals, Fever with concomitants if any
3. Limited generalization of particulars can be done to upgrade into Generals
4. Characteristic Particulars:
- Particular concomitant
- PQRS symptoms
- 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’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 of
Modalities, Evaluation of
Principle of Grand
modality) present in
one part is
predicated to be a symptom of the whole.
|Doctrine of Complete Symptoms,Doctrine ofConcomitants and
Causation and Time,
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 as
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.),
Mentals are used for differentiation and the final selection of the remedy.
chill, heat, sweat as to Type/partial, Time, Aggravation, Amelioration, Concomitant.
|Strange, rare andpeculiar symptomsMental Generals
Symptoms have to be graded according to their value.
|Adaptability||For Casesrepresenting:Complete symptoms, prominent
marked sensations and modalities,
when generals are lacking or strongly marked mentals are not available,
suffering in few parts but no modalities for all the suffering parts
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,
one-sided diseases (if the totality of the state can be filled out),
objective symptoms and pathological
cases without many mental symptoms,
useful to get related remedies by working on the chapter on Concordances
|Cases having generals and characteristicparticulars,when mental symptoms or physical general
symptoms 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,
Boger’s repertorization methods.