Dr Felix James V
The concept ‘totality of symptoms ‘ is peculiar to homoeopathy. Homoeopathy teaches us to treat the individual with the disease and not his diseased parts alone. Thus all the signs and symptoms presented by the patient from the former healthy state to the now diseased condition are to be considered before we select the remedy.
Dr.J.N.Kanjilal says that “Totality of symptoms does not means a haphazard conglomeration of all the symptoms of a patient or a drug; it really means a combination of certain groups of symptoms in definite settings with a definite background and certain individualizing characteristics set appropriately on the symptom-complex, so that it can point to the drug having similar peculiar symptom complex.
For drawing a picture of the whole totality of symptoms, one need not pay importance to all the symptoms of the patient or drug, but only to those ones with their characteristic peculiarities which, in their proper setting, help to distinguish the case from all others.”
Let us review our literature to have an idea about, what our master and different pioneers talk about ‘totality of symptoms’
Concept of Samuel Hahnemann:
Our master introduces this concept in his immortal Organon in the aphorism 7 and in many others. Let us review them.
………… and, moreover, the TOTALITY of these its symptoms, of this outwardly reflected picture of the internal essence of the disease, that is, of the affection of the vital force, must be the principal, or the sole means, whereby the disease can make known what remedy it requires – the only thing that can determine the choice of the most appropriate remedy – and thus, in a word, the TOTALITY of the symptoms must be the principal, indeed the only thing the physician has to take note of in every case of disease and to remove by means of his art, in order that it shall be cured and transformed into health.
Fn: In all times, the old school physicians, no knowing how else to give relief, have sought to if possible to suppress by medicines, here and there, a single symptom from among a number in diseases- a one sided procedure, which , under the name of symptomatic treatment, has justly excited universal contempt because by it, not only was nothing gained, but much harm was inflicted. A single one of the symptoms present is no more the disease itself than a single foot is the man himself
The affection of the morbidly deranged, spirit-like dynamis (vital force) that animates our body in the invisible interior, and the TOTALITY of the outwardly cognizable symptoms produced by it in the organism and representing the existing malady, constitute a whole; they are one and the same.
……..after the changes in the health of the patient cognizable by our senses (the TOTALITY of the symptoms) have revealed the disease to the carefully observing and investigating physician as fully as was requisite in order to enable him to cure it.
……..TOTALITY of the disease, the disease itself.
From this indubitable truth, that besides the TOTALITY of the symptoms nothing can by any means be discovered in diseases wherewith they could express their need of aid, it follows undeniably that the sum of all the symptoms in each individual case of disease must be the sole indication, the sole guide to direct us in the choice of a remedy.
But as nothing is to be observed in diseases that must be removed in order to change them into health besides the TOTALITY of their signs and symptoms, …………..for the TOTALITY of the symptoms of the disease to be cured, a medicine must be sought which has a tendency to produce similar or opposite symptoms.
There remains, therefore, no other mode of employing medicines in diseases that promises to be of service besides the homoeopathic, by means of which we seek, for the TOTALITY of the symptoms.
………..the TOTALITY of the symptoms of this morbid state, that is to say, the whole disease present,
The curative power of medicines, therefore, depends on their symptoms, similar to the disease but superior to it in strength, so that each individual case of disease is most surely, radically, rapidly and permanently annihilated and removed only by a medicine capable of producing in the most similar and complete manner the TOTALITY of its symptoms, which at the same time are stronger than the disease.
That everything of a really morbid character and which ought to be cured that the physician can discover in diseases consists solely of the sufferings of the patient, and the sensible alterations in his health, in a word, solely of the TOTALITY of the symptoms, by means of which the disease demands the medicine requisite for its relief;
From all these aphorisms, totality is nothing but the essence of the disease and this has to be matched with the essence of the medicine to select the similar remedy and to facilitate a cure.
Concept of Boenninghausen:
He proceeded on the hypothesis that the totality was not only the sum total of the symptoms, but was in itself one grand symptom – the symptom of the patient; and that whether the individual parts of the symptom were considered or the grand symptom – the totality itself – three factors must be present
1. Locality – the part, organs or tissues involved in the disease process
2. Sensations – the kind of pain, sensation, functional or organic change characterizing the morbid process
3. Conditions of aggravation and amelioration – the circumstances causing, exciting, increasing, or otherwise affording modification or relief of suffering.
The concomitant symptoms was added by him emphasizing that the doctrine of the totality of the case which must include the concomitants.
He says that the concomitant symptoms is to the totality what the condition of aggravation or amelioration is to the single symptom.
Concept of James Tyler Kent:
Dr. J.T.Kent further expands and explains this concept based on the teachings of our master.
§ 17 – removal of the totality of the symptoms is actually the removal of the cause.
Unless causes are removed from beginning to end the disease can reproduce itself. This includes the first proposition of Hanhemann as to the cure of disease, which means permanent removal of the totality of the symptoms; thus removing the cause and turning disorder into order, and as a consequence the results of the disease are removed. The totality cannot be removed without removing the cause.
The totality of symptoms is a wonderful broad thing. It may be considered to be al that is essential of the disease. it is all that is visible and represents the disease in the natural world to the eye; the touch and the external understanding of man. It is all that enables the physician to individualise between diseases and between remedies. The entire representation of a disease is the totality of the symptoms and the entire representation of a drug is the totality of symptoms.
If the patient has nothing to conceal he will delineate his symptoms cheerfully, but if he has something to conceal it becomes a hard matter to obtain the totality of symptoms.
Every symptom must be examined to see what relation it sustains to and what position it fills in that totality in order that he may know its value (evaluation), whether it is a common symptom, or whether a peculiarly characteristic symptom.
Concept of Boger:
Similar to that of Boenninghausen and re-emphasised the following seven points
1. Changes in personality and temperament
2. Peculiarities of disease
3. The seat of disease
5. The cause
Concept of Stuart Close:
Dr. Stuart Close further elaborates this concept and has presented it with more clarity.
Totality is the true and only basis for every homoeopathic prescription. § 6 – the ensemble or totality of these available signs or symptoms, represents in its full extend the disease itself; that is, they constitute the true and only form of which the mind is capable of conceiving
He states that
1. Totality of symptoms means, first the totality of each individual symptom – location, sensation, modality
2. Totality of the symptoms means all the symptoms of the case which are capable of being logically combined into a harmonious and consistent whole, having form, coherency and individuality.
Totality must express an idea
1. Diagnostic idea (totality): when studying a case from the diagnostic stand point, for example, certain symptoms are selected as having a known pathological relation to each other, and upon these is based the diagnosis.
2. Therapeutic idea: totality of symptoms considered as the basis of a homoeopathic prescription represents therapeutic idea
The totality means the sum of the aggregate of the symptoms. It is the numerical aggregate + the idea or plan which unites them in a special manner to give them its characteristic form.
The true totality is a work of art, formed by the mind of the artist from the crude materials at his command, which are derived from a proving or from a clinical examination of the patient.
Points that obscure totality:
1. Error arising by placing much emphasis upon a single symptom
2. Error arising in attempting to fit a remedy to a mass of indefinite, unrelated or fragmentary symptom by mechanical comparison of symptoms – superficial symptom coverer
3. ‘Pathological prescribers’ – empirically base their treatment upon a theoretical pathological diagnosis and end in prescribing sedatives, stimulants, combination tablets and other crude mixtures.
From the above studies we can say that, understanding the concept ‘totality of symptoms forms the basis of a successful homoeopathic prescription. All the peculiarities of the patient are to be collected and arranged in such a way that a logical comprehension of the case becomes feasible. The drug also has to be selected considering all the parameters used to form the totality. So we find nothing to grumble about the meaning, connotation and scope of the totality of symptoms, as described by Hahnemann in his Organon.
1. Organon of Medicne – Dr. Samuel Hahnemann (5th edition) translated by R.E.Dudgeon
2. Lectures on Homoeopathic Materia medica – J.T.Kent
3. Boenninghausen’s Therapeutic Pocket Book – Boenninghausen
4. Boenninghausen’s characteristics and repertory – C.M.Boger
5. Writings on Homoeopathy – J.N.Kanjilal
6. Genius of Homoeopathy – Stuart Close
Dr. Felix James. V BHMS,MD(Hom)
Medical Officer,Department of Homeopathy. Govt. of Kerala