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10 (a).The remedy selected on the basis of etiology which may or may not be indicated by the present symptoms of the case cures the case.
The selected remedy has in its pathogenesis the present symptoms of the patient, with the addition of an extra indication - 'caused by'. Many of these were noted by Hahnemann himself who made very good use of 'as if or 'aggravation from' to arrive at 'caused by'.

The early homoeopaths prescribed them on the symptoms present, even if they had not enquired about the cause and had not needed it. In their case reports, they did mention the etiology, so that in time, that itself became a separate indication, a clinical rubric valuable by itself.
In many cases the remedy cures without covering the present troubles in its pathogenesis, or without it ever having shown the capacity to produce the condition it causes.

All the best etiological cures take on this principle - the wayward vital force being shunted back to normal health by proper homoeopathic shocks. Its practical utilities are...

1. Once we realize the value of etiology, we shall naturally try to find out the beginning of various complaints of the patient by asking 'when' and 'how' the particular trouble started. Many acute cases get easily cured by this method.

2. By re-arranging the case report chronologically we get a bird's eye view of the progress of the disease, and at what particular point it needs correction. Instead of trying to find one remedy for the whole picture as presented today, we can cure it easily by taking the problems one by one, from the latest to the first cause. All small shocks do not need treatment as the vital force normally manages to re- adjust itself. Think specially of serious and complicated cases.

3. It is the duty of all of us to note the etiologies of cured cases and report these as found under those remedies. Only this way can we continue the tremendous work done by the early homoeopaths and enrich the materia medica.

4. The correct etiological remedy, by directing the vital force on right lines, can cure a case without necessarily having the capacity to produce the present symptoms of the disease. It was the disturbance of the vital force at some previous period of time by some cause or causes that started the pathological condition and the restoration of condition prior to that stage will set right the entire disease including the present symptoms. This enlarges the scope of homoeopathy vastly.

10 (b). Remote causes are found in the past history of illnesses of the patient. These causes produce a morbific influence on the vital influence or the vital dynamics or the power of resistance of the sick individual. On account of their morbific influences the patient fails to adapt, desensitize, immunize or canalize in order to recover completely from his ailments and disease. We give a list of these remote causations of illness and follow it with illustrated cases for the formation and benefit of homoeopaths.

Remote causes may be classified.
1.Traumatic influences.
2.Burns.
3.Cauterizations.
4.Sprains.
5.Stretching of sphincters.
6.Operations.
7.Anesthetics.
8.Drug miasms.
9.Virus diseases.
10.Bacterial diseases.
11.Mycobacterium and spirillum diseases.
12.Blood parasites.
13.Gastro intestinal parasites.
14.Vital drains.

(11). Even some gross errors of diet, taking cold, the appearance of weather especially rough, wet and cold or stormy or even the approach of autumn, if ever so mild, but more yet winter or wintry spring and then some violent exertion of the body or mind, but particularly some shock to the health caused by some severe external injury, or a very sad event that bowed down the soul, repeated fright, great grief, sorrow, and continuous vexation, often caused in a weakened body the reappearance of one or more of the ailments which seemed to have been already overcome; and this new condition was often aggravated by some quiet new concomitants, which if not more threatening than the former ones, which had been removed homeopathically, were often just as troublesome and now more obstinate.

12(a). The past history and the way each sickness leaned are both useful and interesting; for most persons develop symptoms in a distinctive way through the most diverse affections. Such constancies are truly antipsoric and it should be your pleasure to search out the differentiating indications from among them. While their discovery is not always easy, for it involves a recital of every past sickness, the trend of each illness and peculiarities are a part of the sick man's way of doing things and must be known if you wish to do the best work. They will give you a better idea of present and future prospects as well as lay a solid foundation for the prescription that will do much and reveal many things.

12(b). Our task is lightened by being able to find the location of the exciting cause and then differentiate with the aid of modalities and the general picture.

12 (c). We are dealing with the man who uses his organs to guide his internal organs to guide his
internal self; therefore all external injuries have internal effects and external disturbances show themselves by external signs, be the cause moral or physical.

12 (d). In ordinary parlance we speak of the etiology of the disease, but for us these old school ideas are far too narrow because the radius from which we draw our information is wide and may include any influence whatsoever. Things in themselves apparently very trivial may become of the greatest import when related to the beginning of the disease. Sickness arises from extrinsic as well as autogenic causes. The former arc in a general way more accessible and therefore more accurately defined. They embrace the susceptibility to certain external influences, which pervert the vital force, injuries, the state of the weather, heat, cold, dampness, physical exertion, etc.
Autogenic causes often have mental states as their starting point; the effects of grief, worry or fright arc good examples. Emotional states may be the beginning of a long train of untoward manifestations for which the similimum cannot be perceived until they are given a proper place in the pedigree of the disease and as the mind does not always readily disclose such things, they may be difficult to discover. Whether the causes come from without or arise from within, the homoeopathic simillimum cannot be chosen with safety without taking them fully into account.

(13), The physician's first duty is to inquire into the whole condition of the patient: the cause of the disease, his mode of life, the nature of his mind, the tone and character of his sentiments, his physical constitution, and especially the symptoms of his disease...according to the rules in the organon.

1314(a). Dr. P. Sankaran tried to select a remedy which fitted in with and covers the symptom totality of the patient as well as the cause, but he took the cause as the starting point as well as the most important symptom of the case.

14(h). And the homoeopath also finds that giving due consideration to these emotional causes and the mental symptoms of each patient in the selection of the remedy leads to success.

14(c). While taking the case. Dr. P. Sankaran invariably tried to find out from a patient the cause, source or origin of the illness or the circumstances in which it started. In the earlier years of his practice when he used to enquire about this, his patients used to reply either that they did not know the reason or that the illness had started without any apparent exciting cause. And he used to accept this and be satisfied by this answer. But later he - found that by persistent questioning about this point he was able to uncover and expose in about 75% of the cases, a definite cause, source, origin and or circumstance from which the disease had taken shape. And he usually gave very great importance to this etiology. And generally he tried to select a remedy, which covered both etiology and symptomatology. Sometimes he based his prescription mainly or solely on this etiology and he cured many cases this way. For instance if the suffering had started after an injury, he might consider Arnica: if after an operation or mortification, Staphysagria, after getting wet,  Rhus tox;after suppressed skin condition. Sulphur; after a suppresseddischarge, Lachesis; if after suppressed sexual desire, Conium; after a shock or grief, Phos-acid, Ignatia etc; aftera fright, Opium; after a bad vaccination, Thuja; after a wounded pride, Platina and so on. Of course, he tried to select a remedy, which fitted in with and covered the symptom - totality of the patient as well as the cause but he took the cause as the starting point as well as the most important symptom in the case.

MATERIALS
The materials for this study were collected from the in-patient department of Government Homoeopathic Medical College Hospital, Calicut, from 1 February 1999 to 30 April 1999.

METHODS
Cases presented with a specific etiology only are taken up for study. Detailed history was taken in each case with special reference to previous history, family history, occupational history, physical generals and mental generals. Systemic examination was done in all cases. Age, Sex, Socio-economic and occupational status were considered as attributes. The method of approach was a clinical study without the use of control.

In the present study, materia medica has not been included because causative modalities and the aggravations are intertwined in material medica and also being a vast area of study, it far exceeds the sphere and scope of this analysis.

It is the repertory synthesis9 that is resorted to for the purpose of this study. The old masters (Boenninghausen's, Boger, Alien etc...) has not been included because the repertory 'Synthesis9 encompasses them too. Causations are taken generally not taken particularly for this study.

The selection of medicine for each case was decided upon a strictly etiological basis, using all repertories and materia medica depending on the type of cases. Each case was reviewed on one week, two weeks and four weeks time. Each case was followed up for a minimum of two months from the beginning of treatment.

Medicines were repeated only were quantitative increase in the symptoms and other clinical features of the diseases were noticed. In between the period of medication all patients were kept under blank tablet continuously.

DIET AND REGIMEN
All patients were directed to continue with the same diet as earlier. All of them were directed to stop the use of all the medicines prior to the start of this treatment.

EFFECTIVENESS
Effectiveness of the treatment was assessed on the basis of relief from symptoms, clinical improvement and changes in the score taken before and after the end of the treatment.

ANALYSIS
Various facts obtained during this study were treated according to statistical principles.
This study to evaluate the efficacy of etiological prescription in homoeopathy provides evidence to say that there is enhanced success if the mode of etiological prescription is followed in homoeopathic treatment. Therefore this mode of treatment is effective.
In homoeopathic practice, for prescriptions other than etiological, no research findings are available. Even in other etiological studies made, a statistical analysis is not attempted. Hence a comparison of the present study with them is not possible.
In this study, the effectiveness of etiological prescription in homoeopathic treatment is evaluated. The evaluation is based on the relief from symptoms, clinical improvement and on the changes in the score taken before and after 2 months of homoeopathic treatment.

30 patients of the age group 0 - 100 with a specific etiology for the complaints were studied. The maximum representation was from the age group 40 " 49(13,33%), The male female ratio was 1:1. 47% of the patients were from lower middle class. In this study maximum patients were housewives (43%). 80% of the cases presented was with less than 5 years duration in presenting complaints.

In 8 cases, (27%) with injury as cause, 6 cases (75%) reported complete relief from symptoms and 2 cases (25%) showed no change in presenting complaints after 2 months of homoeopathic treatment based on etiology. 7 cases (23%) were with tobacco smoking as cause. Among these, 6 cases (86%) reported complete relief from symptoms and one case (14%) reported aggravation after 2 months of homoeopathic treatment based on etiology. 5 cases were (16.33%) presented with grief as cause and all the 5 cases (100%) reported complete relief after 2 months of etiological homoeopathic treatment. In six cases out of which two had fatty food, 2 had death of loved ones and 67 the other two who had climatic change as causes respectively, complete relief from symptoms was noticed after two month's homoeopathic treatment based on etiology. One case each with vaccination, dust exposure and emotional excitement as causes showed complete relief from symptoms after two months of similar treatment. One case, in which childbirth was the cause, showed no change after two month's etiological homoeopathic treatment.

The effectiveness of etiological prescription in homoeopathy was evaluated by statistical analysis. On analysis, the calculated value is 1.8 is less than the tabled value at 1% level. This indicates there is reduction in the presenting complaints after homoeopathic treatment on the lines of etiological prescription. Therefore the treatment is highly effective.

In this study the medicines were selected on the basis of reportorial totality along with the etiology. The medicines for etiology were selected from the repertory specially prepared which is included in this work.

In this study, treatment started with low potency.The potency was changed if it was necessary. After treatment on etiological basis there was significant reduction in the presenting complaints.

Clinically all the patients were examined for any untoward reaction to the drug. There was no side-effect seen during the treatment. From the forgoing results it is evident that the etiological prescription is effective and homoeopathic medicines are non-toxic.
This study to evaluate the efficacy of etiological prescription in homoeopathy provides evidence to say that there is a convincingly high success rate if the above method is followed. Therefore the treatment is effective,

REFERENCES
1.Principles APractice of Homoeopathy Part 1. M.L.DhawaleM.D, Second edition, (la -pg 29, Ib -pg 30, Ic -pg 131)
2.A Synoptic key of the materia medica.C.M.Boger. Pg-8.
3.Constitutional therapeutics by A. W. Woodward. M.D, B - Jain Publishers, Reprint edition: 1993, pg: 19.
4.A Clinical Repertory to the dictionary of MateriaMedica. J. H. Clarke, B - Jain Publishers, Reprintedition. Pg: 137.
5.A Study Course in Homoeopathy. By Phyllis Speight.B-Jain Publishers;Reprint Edition : 1995. Pg: 11 & 12.
6.The lesser Writings of C.M.F, Von Boennighaussencompiled by Thomas Lindsey Bradford M.D; FirstIndian Edition:1979. Pgs 114,115,116,117.
7.Organon of medicine. Hahnemann.S. 7(a) aphorism 73,7(b) Foot note of aphorism 206.
8.lectures on Homoeopathic philosophy. J,T. Kent.Reprint edition 1977. 8(a) pg-47, 8(b) pg-61.
9.Boenninghausen's Charecteristics Materia Medica Repertory.IBPS Publishers. Reprint edition 1996. Pg: 15.
10.Some reflectionsns on Aetiology in Homoeopathy byDr. S.P. Kopikar, Indian Journal of HomoeopathicMedicine, Vol. April -June, 1967, No:2 10(a) Pgs: 76-81, Pg:280.
11.The Chronic Diseases, their peculiar nature & their homoeopathic cure. Hahnemann. S. Jain PublishingCompany 1982 edn; Pg: 24.
12. The Study of Materia Medica and taking the case. C.M. Boger. M. D. 12(a) pgs: 4&5, 12(b) pgs: 7, 12(c)pg: 11 , 12(d)pgs: 16 & 17. i
13. Hahnemann on Homoeopathic Philosophy. John Weir,pg - 12.
14. The selection of similimum and the management of the patient.Dr.P.Sankaran.(a)Pg:l, (b)pg:4, (c)pg:10.

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