Dr Mansoor Ali
Govt. Homeopathic Medical College. Calicut
A symptom can be defined as an external expression of the internally deranged vital force.
The externally expressed manifestation may be observed by the patient himself, his relatives, the doctor or through the laboratory and other mechanically aided investigations.
The word symptom has been derived from the word `symptoma’ which means ` anything that happens’.
According to Doctor Hahnemann “the change in the health of the body and of the mind (morbid phenomena, accidents, symptoms ) which can be perceived externally by means of the senses, that is to say, he notice only the deviations from the former healthy state of the now diseased individual, which are felt by the patient himself, remarked by the those around him and observed by the physician.
You will have to ask many questions in order to elicit a few telling symptoms, and you must be quiet sure that you and your patient means the same Or` It is the outward reflection of the internal essence of the disease, which is the affection of the vital force.
According to Dr.Kent “Every symptom is indicative of a deviation from the normal state of health”
According to Dr.S.Close ” In general a symptom is any evidence of disease or a change of state of health”.
According to Dr.Dewey ” A symptom is the expression of disturbance in a healthy body produced by a drug or some morbid agents”.
According to Dr.Wright ” Symptom to the Homoeopaths are the language of body expressing its disharmony and calling for the similar remedy”.
” Any perceptible change in the body and its functions, either subjective or objective which indicates disease of the kind or the phase of the disease.” _ Websters dictionary.
Sign : These are alterations from the state of health observed or detected by the physician or attendants. All the objective evidence of the disease is identified with the word sign. The signs are of great importance as they are the only available evidence of disease in infants. comatose patients, insane persons etc. The patient may not be aware of the existence of this entity.
Syndrome : A group of symptoms and signs suggestive of particular type of disease or in other words represent a disease.
Elements of a Symptom
CLASSIFICATION OF SYMPTOMS in Brief
- Characteristics _ $ 153
- General & Undefined symptoms _ $ 153
- Lesser accessory symptoms _ $ 95
- Accessory symptoms _ $ 181
- Accidental symptoms
- Determinate symptoms.
- General, Particular, Common
- Eliminating symptom
- Clinical symptom.
3. Dr. S.CLOSE
- Subjective symptom
- Objective symptom
- Keynote symptom
- Negative general.
- Chief complaint / Leading symptom
- Auxiliary symptom / Concomitant symptom
- Subjective symptom
- Diagnostic symptom
- Symptoms of location
- Contradictory symptoms
- Alternating symptom groups.
5. Dr.GARTH BOERICK
- Basic & Determinative symptom
- Clinical symptom
- Curative symptom.
- Common symptom
- Mental symptom
- General symptom
- Objective symptom
- Pathological general
- Eliminative symptom.
1. HAHNEMANN’S CLASSIFICATION.
Hahnemann classified the symptoms as Common And Uncommon symptoms.
COMMON SYMPTOM is the one ,which is common either to a medicine or a disease state.
Pathogenic common symptom.
- Is a symptom that is common to a medicine
- They form the bulk of the drug pathogenesis
- They do not help in remedy selection when found in isolation
- They are important when they are found in harmonious groups or when they are very intense in their expression.
Path gnomic common symptom
- Is a symptom that is common to a disease states
- They may not be of any relationships they are commonly found in many related disease states.
- Help in differential diagnosis.
- These are the symptoms on which prescription has to be based upon, It denote those symptoms which are..
- Peculiar in their nature and character. Which are peculiar to a few patients suffering from similar disease.
- They usually help in the miasmatic understanding of the case.
2. BOENNINGHAUSEN’S CLASSIFICATION
Boenninghausen has seven points to segregate the symptoms for a practical assessment. The points are represented in the forms of maxims.
- QUIS – Personality / the individuality
- QUID – Disease its nature & Peculiarity
- UBI – Seat of disease
- QUIBUS AXILLIS _ Associated symptoms
- CUR-_ Cause of the disease
- QUOMODO – Modifying factors
- QUANDO – Time factor.
3. KENT’S CLASSIFICATION
A. GENERAL SYMPTOMS
- Mental general
- Physical general
B. PARTICULAR SYMPTOMS
- Complete symptom which have sensation, location, modality & concomitants.
- Common symptoms which are not qualified as regards the elements of the symptoms.
4. GARTH BOERICK’S CLASSIFICATION
- Basic symptoms are the same as Hahnemann’s common symptoms.
- Determinative symptoms are similar to the uncommon symptoms of Hahnemann
- General symptoms of Kent
- Qualified common/local symptoms of Kent
- Complete symptoms of Boenninghausen.
According to G.Boerick ” Basic or absolute symptoms are those that appear on any proving (also in most diseases) and are of a general nature and usually diagnostically important. They are of little value to determine the specific Homoeopathic drug indicated, but taken together furnish a suggestive beginning, Such symptoms are malaise, headache, weariness, anorexia fever and pain “
Basic symptoms are important only when they are signified by personal modification.
Determinative symptoms are the individual or personal ones if found in a patient or a characteristics, keynote or guiding symptom if found in a drug pathogenesis “
Determinative symptom whether encountered in disease or a drug proving are alike and usually consists of: Modalities
Mental symptoms ,Qualified basic or absolute symptoms.
Strange, rare or peculiar symptoms as mentioned by Hahnemann.
BOGER’S CONTRIBUTION TO SYMPTOMATOLOGY
Correct prescribing is the art of carefully fitting the pathogenetic to clinical symptoms. The clinical symptom picture is best obtained by asking the patient to tell his own story.
Try to elicit the evident cause & course of the sickness, to which all the things which now seems to interfere with the sufferer’s comfort.
1. The modalities _the natural modifiers of sickness are most important.
Most vitally important modalities are: Time. Temperature, Open air, Position, Being alone, Motion, Sleep, Eating &drinking, Touch, Pressure, Discharges etc..
2. The mental state come next in order of importance.
Irritability, Sadness or fear is the ruling factor.
Ascertain whether any of the following sensations are present.
Burning, cramping, cutting, soreness, throbbing, bushing & thirst.
4. Entire objective aspect of expressions of the sickness.
They are Facial expression, Demeanor, Nervous excitability, Sensibility, Restlessness, Torpor, State of secretions.
5. Parts affected.
This include investigation & Diagnosis.
By going over the above rubrics in the order named the counter of the disease picture will be easily outlined, and direct towards the similimum.
Types of Symptoms
|1. Common symptom2. Uncommon symptom
3. Pathogenic common symptom
4. Non pathogenic common symptom
5. General symptom
6. Mental general
7. Physical general
8. Particular symptoms
9. Clinical symptoms
10. Basic symptoms
11. Determinative symptoms
12. Totality of symptoms
13. Subjective symptoms
14. Objective symptoms
15. Rare symptom
16. Peculiar symptom
17. Diagnostic symptoms
18. Individualizing symptom
19. Non individualizing symptoms
20. Prescribing symptoms
21. Spurious symptoms
22. Discriminative symptom
23. Grand symptom/complete symptom
24. Concomitant symptom
25. Eliminating symptom
26 Pathogenitic /aetiological
27. Keynote symptom
28. Characteristic symptom
29. Complete symptom
30. Pathological symptom
31. Pathological general
32. Alternating symptoms
33. Negative general
34. Accessory symptoms
35. Lesser accessory symptoms
36. Accidental symptoms
37. Hereditary symptoms
38. Persistent symptoms
39. Withdrawal symptoms
40. Vital symptoms
41. Acute symptoms
42. Chronic symptoms
43. Functional symptoms
44. Miasmatic symptoms
45. Path gnomic common symptom.
46. Generic symptom
47. Schein symptom.
48. Curative symptom
49. Artificial ”
50 Blurred ”
|TYPES OF SYMPTOMS
51. Contrary ”
52. Consecutive ”
53. Contingent ”
54. Deep seated ”
55. Dis-similar ”
56. Distinct ”
57. Disturbing ”
58. Dubious ”
59. Equivocal ”
60. Essential ”
61. Exceptional ”
62. Ext. Guiding ”
63. Fixed ”
64. Frequent ”
66. Genetic ”
67. Heterogeneous ”
68. Imaginary ”
69. Induced ”
70. Invented ”
71. Isolated ”
72. Latent ”
73. Masked ”
74. Morbid ”
75. Mutated ”
76. Mortifying ”
77. Maze of ”
78. Occasional ”
79. Opposed ”
80. Perceptive ”
81. Periodical ”
82. Primary ”
83. Secondary ”
84. Principal ”
85. Progressive ”
86. Psychosomatic ”
87. Recent ”
88. Reflex ”
89. Stable ”
90. Static ”
91. Strong ”
92. Submerged ”
93. Transited ”
94. Ultimate ”
95. Unforeseen ”
96. Unusual ”
97. Variable ”
98. Undefined ”
99. Trifling ”
100.Well defined “.
A GLOSSARY OF SYMPTOMS
1. TOTALITY OF SYMPTOMS.
A purposeful totality of symptom needs a well-directed and meaningful case taking procedure.
According to Dr.Hahnemann`Outwardly reflected picture of the internal essence of the disease”.
According to S.Close” It means all the symptoms of the case which are capable of being logically combined in to harmonious and consistent whole, having form coherency and individuality,”
According to H.A.Robert.` The totality is that concrete form which the symptom take when they are logically related to each other and stand forth as an individually recognizable form.”
SOURCE OF TOTALITY
- From the patient himself
- From his attendance and relatives
- From the observation of the physician & the examination findings
- From the past ,personal, social history, habits & family back grounds.
To arrive at the totality of symptoms is an exercise in analyzing the symptoms as individualizing and non-individualizing symptoms, from the data obtained after case taking.
Numerical totality or symptom totality includes each and every signs and symptom to present a complete picture of patient or drug. But totality of symptom in real sense is the logical totality as said by S.Close
These are those type of symptoms which can be experienced by the patient under emotional, intellectual and sensorial aspect of the patient (desires, aversions, temperaments attitudes etc. ). They are ranked highest among during evaluation for selection of remedy as they are symptoms belongs to psychic and mental sphere. These are the only means to reach the inner subtle nature of the disease.
According to Hahnemann ` the expression of the disease in the sensations and functions of the side of the organism exposed to sense of the physician and bystanders. So objective symptom means observing symptoms including the physiological findings and lab investigations. Totality of symptom include both objective and subjective symptoms.
A general symptoms is the one that refers to the individual as a whole.
Value of General symptoms.
- They relate to the highest esteem of self which represent the ego.
- They help in forming a totality and also help in the individualization
- If these are strange, rare & peculiar they help in the selection of the similimum.
Source of General symptom.
- From the patient himself
- From the observation of the physician
- From the past, personal & family history
- From his attendance & relatives
- From the examination by the doctor.
A. MENTAL GENERAL
All the symptom related the mental sphere are termed as mental general. They are the symptoms which reflect the inner self, the inner most part or the ego of the individual.
- Will and emotions.
- Intellect and understanding
- Memory components.
- External will is usually voluntary and responds to the external influences, tempting the person to do things.
- Internal will is the conscience which is the deepest of all and is unchanged by the medicine.
- Emotions provide the greatest driving force to an individual.
The emotional states manifest itself in various ways
- Direct expression _ through appropriate feelings
- Indirect expression through..
- Voluntary nervous system
- Autonomic nervous system
- Endocrine system.
Intellect & Understanding determine the individual capacity of the person and the emotions determine the free expression.
Functions of the intellect
- Perception of environment
- Formulation of ideas thoughts and concepts
B. PHYSICIAL GENERAL
These are the symptoms of the physical plane of the person as a whole.
These symptoms can be ;
- General reaction _ thermal, atmosphere, seasonal
- Ailments from _ Circumstantial, dietary, physical
- Laterality of the affections
- Sleep & its disturbances
- Appetite, thirst, desires and aversions.
- Mental & sexual complaints
- Tendency to pathological changes
- Of these symptoms, the expressions, which have a pathological basis are called as Pathological generals.
- Eg. Tumors, warts etc.
- The term `corroboration’ means `support or strengthen by further evidence’.
- In Homoeopathy, Corroborative symptoms form a part of the concomitant symptoms.
- Concomitants which have no direct pathological or physiological association to the chief symptoms are called Corroborative symptoms.
Example : In a case of headache from excitement, which is relieved by bilious vomiting, the medicine coming up on reference to Kent’s Repertory is Argentum Nitricum. But the evidence of an Argentum nitricum symptom in any other region of the case strengthens our selection. It may be a desire like that for salt, or may be a fear like that of high places and the like.
Here, bilious vomiting is the immediate associate of the presenting complaint . But the distant associate( Corroborative symptom ) gives us further evidence that the selection is correct.
Both symptoms are concomitants of the chief symptom, when we consider the entire symptom picture as a single disease.
Hahnemann’s `Lesser accessory symptoms’ ( aphorism.95 ) are a type of corroborative symptoms. In that case the patient becomes so accustomed to his prolonged suffering that he considers these `greater or lesser deviations from the healthy state’ as not related to his principal malady and thus not worth mentioning.
- These are the symptoms which belongs to a particular part, organ or functions of the body.
- These symptoms tend to disturb the patient most and seeks consultation for them only. Thus the prescription of acute necessity will be based on these particulars.
- It should be understood that the generals help in the delineation of the outline, whereas the particulars furnish the details to differentiate the remedy.
Symptom may be Complete or Incomplete.
A complete symptom is the one where all the elements of a symptom are found in complete functional harmony. An incomplete symptom is the one that lack one of the elements.
Importance of particular symptoms.
- At times a strong particular may point to a small group of remedies and this help a quick prescription.
- According to Boenninghausen they provide a base for the evolution of generals.
- When particular symptom is expressed at more than 2 places, it behave as a general and become important.
- Particulars furnish the details to differentiate the remedies.
These are the symptoms which are linked to the disease and expressed by a large number of patients or provers. They are of little value in the selection of the remedy. They do not help the prescriber to individualize.
PATHOGENIC COMMON SYMPTOM
It is a symptom that is common to medicines. These symptoms form the bulk of the drug pathogenesis. These are of importance when they are found in harmonious groups or when they are very intense in their expression.
PATHOGNOMIC COMMON SYMPTOM
Are symptoms which are common to a disease state? They are commonly found in many related disease states and not are of any diagnostic help, but help in differential diagnosis. If they get modified by uncommon modalities they become important.
Eg. Constipation before and during menses, Trembling before stool.
- These are the symptoms, on which prescription has to be based upon.
- It denote those symptom which are ;
- Peculiar in their nature & character
- Where no explanation is possible
- Which are peculiar to few patients suffering from similar disease
- Their basis cannot be explained on the basis of pathology
- They have their basis in the constitutional make up that determine the psychic of the individual
- They usually help in the miasmatic understanding of the case.
WHY TO ANALYS THE TWO
- To individualize the case
- For the selection of the similimum
- For framing an altogether different totality.
- These symptom can be analyzed only if one has complete knowledge of case taking, symptomatology, evaluation and synthesis of case. This essentiality requires the complete knowledge of the medicine, and of the disease, the expertise by which the symptom belonging to the patient and those of the disease can be differentiated and analyzed.
These symptom may be pathogenic or pathognomic. These are of high value in individualization for a Homoeopathic prescription.
See also uncommon symptom
See rare, uncommon symptom
These are the symptoms upon which a nosological diagnosis made. These are of value in differentiating the common/uncommon symptoms or symptoms of the patient from symptoms of the disease. These are common symptoms which are found in harmonious groups to suggest a common diagnostic entity.
See uncommon symptom
NON INDIVIDUALISING SYMPTOM
See common symptom
These are the symptoms upon which a prescription is to be made. A prescription cannot be made without these symptoms. The high grade of prescribing symptoms are called the Eliminating symptoms.
These are vague symptoms, also known as the common symptoms of the disease present in the proving of all most all medicines. They are of no use either for the purpose of prescribing or for the purpose of diagnosis of the disease.
These are qualified or complete symptom containing all the elements such as Sensation, Location, Modality and Concomitants.
According to Dr.Boenninghausen the totality of symptom is not only the sum total of the symptoms but it is itself one Grand symptom, the symptoms of the patient. For marking a symptom as Grand symptom or totality itself 4 factors must be present. Symptom which is clearly defined by the elements of location, sensation, modality and concomitants is called a Complete symptom.
- Location : It points to the exact situation or localization of the complaint.
- Sensation : Any altered perception of mind regarding the disease. It is manifested either in the form of pain or any discomfort felt both physically as well as mentally.
- Modality : Anything which modifies a symptom for better or worse is called the modality. It can be in terms of time, place, climate or any circumstances.
- Concomitants : The symptom associated with the chief complaint is called a concomitant symptom.
Dr.Boerick has defined Clinical symptom as one which does not appear in the proving of a drug yet nevertheless has been inadvertently relieved by that same drug, given for another purpose.
Eg. Stitching pain in the chest are constantly relieved by Bryonia which failed during proving.
These are the symptom which could not be ascertained and included in drug pathogenesis while proving of a drug but always relived the same symptom when encountered in a patient.
According to other school : These are those symptoms of the patient which he ascertain in the clinic either with his sense or with the help of instruments.
Dr.Boenninghausen was the first to realize the importance of the concomitants in prescribing and constructing his repertory. Dr.Boger developed the idea fully in Boger’s repertory with additions and modifications.
The word concomitant means – existing or occurring together also known as associated symptoms.
The symptom that accompany the chief are called concomitant symptom.
The concomitant bear no relation to the chief complaint than the time association. When these symptoms cannot be explained by pathology they become the characteristic symptoms.
Concomitant arise from the inherent constitutional aspects and tend to remain constant with a patient irrespective of the nature of the disease.
- Rarely found combined with the main affection, here also infrequent under the same condition in the proving.
- All these belongs to the another sphere of the disease than that of the main one.
- Finally those which bear the distinctive marks of some drug, even if they have never before noted in the preceding relation.
ACCORDING TO BOGER..
Concomitant means accompanying or co-existing The more it belongs to another sphere of the patients health than the chief complaint _ they become a unreasonable attendant.
The peculiar strange rare symptoms are indeed concomitants. They cannot be explained on pathology ,yet they occur at the same time with the chief complaint.
When a marked peculiar symptom belonging to the disease proper,makes the choice of remedy difficult, a concomitant will decidedly indicate the drug.
Concomitants may far outrank the other symptom of the chief complaint, such sympton tend individuality to the totality.
Totality being the sum total of the characteristic symptom, due attention to concomitants help in finding the similimum more easily ,and with an assurance of accuracy. So concomitants are characteristic symptom peculiar to the individual patient.
A concomitant having the same modality as the grand symptom, represent a high characteristic feature of the remedy and is of great import ants.
Mental concomitant in physical ailments and physical concomitants in mental ailments are an unfailing guide to the similimum.
In introduction to TPB HA.Robert says ” The concomitant symptom as to the totality what the condition of < & > is to single symptom, it is the differentiating factor”.
Are those symptoms which through of all the medicines that are not needed for the patient and brings only those medicines which are required for the patient.
Margret Tyler first introduced this method for facilitating an easy Repertorisation. The method of repertorisation using the eliminating symptom is called as the eliminating method.
IT IS SELECTD ON THE BASIS OF
- The schools of philosophy
- Intensity of expression
- Characteristics /uncommonness of the symptom.
Precaution while taking an eliminating symptom
- Make sure that the symptom chosen will cover the man & not only the superficial symptoms.
- Eliminating symptoms are selected always from the symptoms of the man and in absence of symptoms of man the general symptoms of the physical being is considered.
- The symptom selected should be real & marked intensity, expressing the inner need of the patient.
- The symptoms should be arranged in the order of important so that the peculiar, uncommon symptoms can be selected.
METHOD OF ELIMINATION
All the symptoms which are peculiar, uncommon and most expressive of all should be selected. This symptom is placed on the top and rest of the symptom below it. The medicines that ate not covered by the first symptom, the one placed at the top will be eliminated from the rest of the symptom.
- Safe short cut to the prescription
- Labor and time consumption is significantly reduced.
- Fails if one is not thorough & efficient in structuring the hierarchy of the symptoms for repertorisation.
- You cannot eliminate symptoms dependent on a disease which you have not diagnosed.
- Don’t risk missing your remedy for an ill marked mental or a very small rubric . This is easy but often fatal.
PATHOGENETIC OR AETIOLOGICAL SYMPTOMS.
The symptom pertaining to the etiological or exciting feature of the disease.
Eg. Exposure to dry cold air.
KEY NOTE SYMPTOMS
These are rare, singular, peculiar uncommon symptoms defying their explanation by pathology.
Kent says ” The great trouble with key note is that they are misused, the key notes are often characteristic symptoms, but if the key notes are taken as final and the generals don’t confirm there will come failures.”
Are those symptoms which are uncommon, peculiar unusual and striking symptoms find in few patients and in the proving of few medicines. These symptoms are unexplainable on the basis of pathology. These symptoms characterize and individualize and help in the differentiation of remedies.
Kent says ” Get the strong strange peculiar symptoms, and see that there are no generals in the case that oppose or contradict. “
Margaret Tyler says ” Many c/c cases may be worked out on mental generals only and the particulars will be found to fit ,in a marvelous way.
According to Dr.Dunham, these are the symptoms related to the vital force.
The action of the drug on the vital power, correlative of the above, the symptoms of the nervous system given conjointly with the symptoms of the various organ to which the different parts of the nervous system are distributed.
He considered these symptom under 5 heads.
- The sensorium _ of which the symptoms are found chiefly under the rubrics head and disposition.
- The general sensibility
- The general mobility _ The symptoms of the tissues to which the nerves of the sense and motion are distributed.
- The special sensibility _ Exhibited in the symptoms of the organs of special senses.
- The sympathetic system _ Exhibited in the symptoms or organ containing involuntary muscles _ in the intestinal tract and all the sphincters.
The symptoms directly produced by the pathological changes, these are the common symptoms of the disease.
Pathological general are the expressions of the person which are known by a study of the changes at the tissue level.
These symptoms that recur at uncertain intervals with morbid state of different kind.
In U.colitis, diarrhoea alt. with rheumatism.
- Absence of path gnomic symptom in a particular disease or condition or case.
- It is an indirectly derived general.
- Eg. Dry cholera in camphor
- Absence of eruption in measles.
Symptoms produced after the administration of a partially similar remedy.
- One sided disease
- Paucity of medicines.
These symptoms are not previously observable in the disease, but at the same time symptoms of the disease itself, although they may have been rarely perceived.
LESSER ACESSORY SYMPTOMS
In chronic disease the patient get accustomed to their sufferings and may not feel the necessity of narrating those symptoms with which they had lived for a long, which are important for the choice of medicine. They do not consider that these symptoms have anything to do with the prescription that has to be made for the presenting trouble.
These are the symptoms which are evanescent, un genuine produced by the medicines last used.
Symptoms that is present as a part of hereditary disease which are present both in parents and offspring’s.
Any symptoms which are continuously present for a long time in an individual.
These are symptoms which are produced after the withdrawal of non-homoeopathic drugs which are capable of producing dependence.
Symptoms usually of short duration with severity and sharpness.
Symptoms occur in an individual for a long duration/period of time as in c/c disease.
Usually it means to indicate the symptoms which are produced before the structural damage is affected. Usually indicative of symptoms produced during early bio physical or bio chemical changes.
May be an early pathogenesis.
Symptoms which indicate the miasmatic expression of an individual.
Symptom which is clearly defined by the elements of sensation, location & modality.
These are the apparent symptoms caused by the excessive Homoeopathic medicines as a result of frequent repetition. The dose in that case must be reduced & repeated in longer intervals and possibly stopped several days.
These symptoms are produced by the dynamic generic action of the drug. These symptoms are common to many drugs of a particular genesis or class.
Start out like the clinical symptom, but subsequently disappears due to the drug taken in.
- Hahnemann : Organon of medicine
- Sarkar.B.K : Organon with commentary
- Robert.H.A : Principles & art of cure by Homoeopathy
- Close.S : The genius of Homoeopathy
- Boerick.G : Principles & practice of Homoeopathy
- Dunham : Science of therapeutics
- Dhawle.M.L : Principles & practice of Homoeopathy
- Munir Ahmed : Introduction to Repertorisation
- Gupta : Organon of medicine.
- Dudgeon : Lesser writings of Hahnemann
- Kent : Lectures on Homoeopathic philosophy
- Kent : Lesser writings.