PRACTICE OF MEDICINE

INTRODUCTION
The two-part syllabus has been designed with the objective of delivering to the candidate the entire experience of basic and applied aspects of Homoeopathic health- care applicable to the discipline of General Medicine.
 MD-Part I takes the candidate on the journey from Man in health 4 Man in disease. The ground that he has covered earlier in the undergraduate course is gone over again but from a very different clinical perspective. The integrated approach a clinician needs to adopt will underlie the exposure to these subjects. This will be facilitated since the candidate is simultaneously doing his resident training and is seeing the phenomena of health being transformed into disease in his clinical studies. Having thus re-visited the basic sciences, the candidate is now prepared to undertake the journey deeper into the healing science and art attempting to come into more intimate contact with the principles that Hahnemann identifies as critical for the success of the Operation Cure’.
Hence we should be very clear about the philosophical and conceptual basis of the syllabus, the ground that we need to cover. We should evolve matching methods and techniques that will experientially deliver to the candidate the entire experience of Healing’ in its Hahnemannian sense. We must also remember that unlike in Modern medicine, there can be no standardization of Homoeopathic management of different clinical conditions. All the same, we should be able to define a common approach to the understanding of the condition and it is expected that with the passage of time and accurate documentation (which will follow the establishment of Postgraduate education), an approach will evolve. Till then we will be required to integrate our general understanding of the clinical and pathological phenomena of disease with our knowledge of Materia Medica and apply philosophical concepts to evolve the approach. References to literature is thus, at best, only general and constitute preliminary readings for takeoff. The role of the guide and teacher will be paramount in evolving guidelines.

BASIC CONCEPTS
Part — I has dealt with the following areas: -
(1) Structural basis of health and disease. (Anatomical organization of man and its degeneration into structural pathology)
(2) Functional basis of health and disease. (Physiological organization of man and its degeneration into pathophysiology)
(3) Psychological basis of health and disease and the abnormal psychological processes which initiate abnormal mental and psychophysiological functioning.
(4) The Concept of Man that the clinician needs in order to function in the clinical setting.
(5) The scientific and full use of the extended senses of Clinical Investigations to unravel the hidden, often nascent stage in the evolution of the disease.
(6) Final integration of all of the above with the basic tenets of Homoeopathic Philosophy.

Part—Il will further take the candidate to understand the application of the above knowledge in terms of the following:
(1) Evolving an approach to the Definition of the Clinical Problem
(2) Understanding the crucial role of documentation in the scientific understanding of the clinical l state
(3) Possessing a sound understanding of the Bio-Psycho-Social concept of Aetiopathogenesis and evolution of the disease phenomena.
(4) Evolving clinico-pathological correlations to grasp the essence of the disease phenomena and integrating in terms of the structural, functional and formal correlations
(5) Learning the basics of Classification of Disease and integrating these principles with the Hahnemannian approach
(6) Integrating all of the above in erecting a Hahnemannian Totality
(7) Processing this totality through the appropriate Repertorial I Nonrepertorial  approach
(8) Application in terms of evolving suitable Materia Medica portraits
(9) Understanding the clinical approach to the assessment of susceptibility and its influence in decision-making of Remedy Reaction assessment and Posology
(10) Diagnosing the state of suspended animation and understanding the use of various drugs and other forces to revert this state
(II) Scope & Limitation of the current state of knowledge of Homoeopathy with the demands of Clinical Medicine especially the hyperacute aspects
(12) Finally, the need for the physician to take on the role of the Unprejudiced Observer’ (Aphorism 6) while carrying out all of the above actions.

SYLLABUS
This will follow the four general guidelines as per the PG notification:
(I) GENERAL  MEDICINE INCLUDING TROPICAL MEDICINE:
will include Classification Aetiology, Epidemiology, Pathogenesis & Pathology. Clinical Expression with evolution of Symptoms, Physical Examination, Investigation & Differential Diagnosis. The following would be the broad category of diseases that would be covered in the syllabus.

I. Introduction to Principles & Practice of Clinical Medicine
2 .Symptomatology of diseases / disorders.
3.Interpretation & analysis of clinical history, clinical signs & investigative approaches, diagnostic & therapeutic approaches to diseases. Special reference shall be made to nutrition and dietetics disease wise.
4. Acid-Base — Water/electrolyte disturbances;
5.Tropical diseases Infectious diseases, & infections (Bacterial Viruses, fungal parasitic rickettsial, spirochetes).
6. Cardiovascular System -
7. Respiratory System
B. Neurology
9. Hepatobiliary system. Pancreas & GIT.
10. Bone & Joints disorders; connective tissue diseases.
1I. Immunology
12. Haematology
13. Oncology
14. Venereo - leprology & Demiatology relevant to Gen. Medicine
15. Toxicology (insect bites, stings, poisonings.)
16. Nephrology
17. Endocrine/metabolic diseases
18. Geriatrics
19. Genetics
20. Health Economics
21. National Health programmes
22. Emergency Medicine— Intensive care
23. Occupational health — Basics/common problems
24. Preventive Medicine— Basics/vaccines and the role of Homoeopathy (See (d) below).
25. HIV &AIDS
26. Nutrition related Health Problems both undernutrition and overnutrition.
27. Substance abuse and related medical emergencies
28. Psychosomatic Medicine
29. Current National / International Research/Trials on common diseases e.g. DM. HT. IHD. CVA.
30. Special reference shall be made to recent advances in all the fields stated above.

Special attention shall be given to inculcation of humanitarian approach, and attitudes in the students towards patients, their relatives & their behavior towards professional colleagues in and out of work places.
Rural aspects, NHP and clinical epidemiological approach, aspects related to public health, and health education shall be taught in all sessions. lnterdepartmental/lintegrated teaching programs at PG levels shall form a regular/periodic features in which some of the subjects stated above can be covered in a better manner. (e.g. Genetics, Bone and jts, Hepatobiliary, Haematology etc.)

(II) MIASMATIC STUDY OF MEDICINE:
Application of Knowledges acquired in Part-I in terms of ClinicaL Pathological. Immunological, Functional, Structural, changes in a cell—tissue-organ—system to understand the Miasm taking into consideration Evolutionary aspect of a particular disease, specifically in terms of Psora — Sycosis — Tubercular— Syphilis. Application of this knowledge to understand the susceptibility and its implication in defining Posology, Remedy reaction, Course of Disease, use of remedies & Prognosis.
c) Diagnostic procedures in view of latest technology:
Knowledge about indication, interpretation implications in terms of Diagnosis & differential Diagnosis, Prognosis, Susceptibility, Posology, Remedy reaction, course of diseases & use of remedies. The investigative procedures - will range from the routine clinical skills to perform the basic investigative procedures & collection of sample needed to be acquired along with basic bedside procedures to sophisticated techniques. Below are outlined the list which should not be treated as all-inclusive.

(A) Profession related clerical Skills:
Proper history taking, presentation! writing/ maintaining Bed Head Ticket (BHT), writing informed consents, death /birth discharge certificates and referred notes. Notes in legal cases, and their reporting, etc.

(B) Psychomotor aspects:
Putting & securing IV linings, monitoring therapies of drugs, fluids, electrolytes caloric requirements etc., putting CV- linings. Observing aseptic precautions in indoor procedures (catheterization) passing tubes doing paracentesis and tissue fluids examination in side lab. Lumbar puncture, urinalysis, tissue biopsies and GM aspiration. Ability to use instruments and equipments like, glucometers, ECG machine, defibrillator, monitors, ventilators, etc. Ability to pass endo-tracheal tube. Prevention of bedsores, exposure keratitis in comatose cases & several other aspects of patient care.

(C) Cognitive aspects:
Learning (by reading, questioning, discussion) the scientific basis for interpretation, & analysis of clinical features and diagnostic approaches interpretation of microscopic slides ,Blood films, etc.

(D) Behavioral aspects (Attitudinal):
The student shall be able to interact with professional colleagues, teachers, seniors, juniors, patients, patient’s relatives in a respectful manner. He shall be able to create atmosphere conducive to patient care, motivate relatives for donating blood, clinical autopsy etc. Supervised management of the common medical emergencies and initial treatment of complicated cases shall be learnt at all levels of PG course.

(E) Clinical Investigations
Apart from the routine haematological, biochemical and radiological investigations which are a part of undergraduate studies, the postgraduate must be conversant with a host of detailed and sophisticated investigations which further the understanding of the disease in its depth and extent. Given below are representative samples of these. These are not exhaustive nor are they a ‘must know’ for the candidate in all their details. However, he must have a nodding acquaintance with all of these and the place that they hold in the diagnostic and prognostic work

 GIT INVESTIGATION:
  Gastric acid secretary studies
 Schilling test of vitamin B12 metabolism
 Barium studies
 Endoscopy
 Radionuclide imaging
 Angiography
 USG
 CTscan

 RESPIRATORY SYSTEM:
 Trans tracheal aspiration
 Gastric lavage
 Serological test
 CTscan
  MRI
  Bronchography
  Pulmonary angiography
  USG
  Radio isotope lung scan
  Fibro optic bronchoscopy
  Broncho-alveolar lavage
  Mediastinoscopy
  Thoracocentacic and pleural fluid examination
  Pleural biopsy
  Lung biopsy
  Thoracoscopy
  PFT
  Arterial blood gas

 CVS:
 EGG
 Stress test
 2 D ECHO , CT scan
 MRI
 Nuclear cardiology
1.Myocardial function: _ 1st past radionuclide angiography
                                   _ Equilibrium blood pool imaging
                                   _  Radio nucliide ventriculography
2. Myocardial perfusion imaging
3. Myocardial metabolism imaging
4. Myocardial infarct imaging
5. Myocardial innervations imaging
4 Cardiac catheterization
  Angiocardiography

 HEPATOBILIARY:
 Viral markers
 Immunological markers
 Tumour markers
 Alfa feto protein
 Aminopyrin breath test
 Needle biopsy
 Hepato biliary imaging

 PANCREATIC:
 Serum immunoreactive - trypsin/trypsinogen
  Tumourmarker
  Imaging
  Pancreatic secretory function test
  Dual labile schilling test -
 Others: foecal chymotrypsin/ plasma pancreatic polypeptide
 USG
 Endoscopic USG
 Interventional USG , CTscan
 MRI
 Oral cholecystography
 Endoscopic retrograde cholangio-pancreatography
 Percutaneous trans hepatic cholangiography
 Angiography
 Laproscopy

 RENAL:
 GFR
 Insulin clearance
 Creatinine clearance
 24- hour Protein estimation
 Para-aminohippuric acid excretion test
 Tubular function
 USG
 IVP
 Renalscan
 Antegrade/retrograde pyelography
 Renalarteriography
 CTscan
 Biopsy
 CNS: .
 CTSCAN
 MRI
 Echoencephalopathy
 Doppler study of cerebral vessels
 Radio isotope brain scan
 Radio nuclide angiography
 Single photo emission CT scan
 Positron emission tomography
 Neuroimaging of the spine
 Plane radiography of spine
 Myelography
 Radio nucleiod scanning
 Neuro USG
 Spinal angiography
 EEG

HAEMATOLOGY
 Bone marrow examination

ENDOCRINE:
 Plasma hormonal estimation
 Urinary determination
 Dynamic endocrine test
 Receptor studies and antibodies
 Endocrine imaging

OSTEOLOGY:
 Bone isotope scanning
 Measurement of bone mass and bone density
 Total body calcium
 Histopathology and histomorphometric analysis of bone
 Steroid suppression test
 P hormone infusion test

 INFECTION:
 Detection method- biological signals
 Detection system
 Amplification
 Direct detection: microscopy! staining of macroscopic antigen detection Culture
 Identification method: classic phenotyping/ gas liquid chromatography! nucleic acid probe
 Susceptibility testing
 Automation of microbial detection in blood
 Detection of the pathological agents by serological methods

 IMMUNE DISORDERS
 Serum immunoglobulin Ievels-IgM, lgG, IgA, gE

 Quantification of blood mononuclear populations
 T cells: CD3, CD4, CDS, TCRαß,  TCRγß
 B cells: CD19, CD2O, CD2I, Ig Roitt, Brotoff a (μ,∂,γ,α,κ,λ)Ig associated molecules( α,ß)
 NK cells: CDI6
 Monocytes: CD15

Activation markers: HLA-DR, CD25, CD8O (B cells)
 T cell functional evaluation
 B cell functional evaluation
 Complement evaluation
 Phagocyte function
 Histocompatibility gene complex
 Autoantibodies ANA, anti-dsDNA etc.
 Serological Tests

ONCOLOGY
 Tumor markers
 Screening Tests for common variety of cancers -

a) Practice of Homoeopathy In general medicine including Tropical medicine:
Case Receiving, Examination, Recording and Processing the Homoeopathic Case as applicable to general medicine cases while meticulously following the directions given in the ‘Organon of Medicine. Knowledge acquired in M D Part-I along with (a) to (c) of Part-Il will form a platform for the practice of Homoeopathy in general medicine. Understanding the basic disease process in terms of Clinico—Pathologic--lmmunologic--Miasmatic understanding, symptom classification and evaluation, erection of the totality, repertorial approach & reference & its application through differential Materia Medica. Definition of susceptibility, Posology & remedy reaction along with scope & limitation of Homoeopathic remedies will lead to further application in terms of understanding Therapeutics while keeping the Clinico—Pathologic—lmmunologic—Miasmatic understanding in the background. The study of remedies through the concept of relationships (Boger-Boenninghausen) so that differentiation gets established at the bedside should be the aim. Also application of the knowledge of disease classification & its evolution in terms of acute, chronic, sub-acute phases for defining the type of remedies in terms of acute - chronic— intercurrent — constitutional becomes clinically useful.

COURSE OUTLINE
1. The course of study would be for a period of three years. Part I examination will be held at the end of I 1/2 years and Part I after three years. The teaching of the specialty subject will begin from the first year itself.
2. Them would be regular internal evaluation in the form of evaluation of written assignments, presentation at seminars and journal clubs and maintenance and processing of case records and clinical activities like acquisition of skills and ward work on the standard format.
3. The examination will be held after three years, the details of which are appended below.
4. Guidelines for thesis are also appended separately.

Reference Readings:

Homoeopathy books:
1. Hahnemann S.: Organon of Medicine
2. Hahnemann S.: Lesser Writings. Pub: Swaran Publishing House, New D&hi
3. Dhawale M. L.: ICR Symposium Volume on Hahnemannian Totality 5 Volumes
                   Pub: ICR Symposium Council, Mumbai
4. Kent J. T.: Lesser Writings
5. All standard repertories
6. All available commentaries on Materia Medica and Therapeutics

SCHEME OF EXAMINATION
A. Theory
A. 1 Theory examination shall comprise 2 written papers; each of 100 marks (Total 200 marks). Passing shall be separate for theory.
A.2 Each paper will be divided into two parts of 50 each and shall consist of two patterns of questions.
(a) SAQs              (b) LAOs in the ratio 30:40

Each part will have
      SAQ shall  be 03 each of 5 marks = 15
      SAQs shall be 03 each of 5 marks = 15
      LAQs shall be 02 each of 10 marks = 20
       Total Marks    =50
Time duration for each paper shall be 3 hours.
A.3. Three examiners (Out of which at least 2 are external) shall value the papers
A.4. ‘Passing’ shall be considered as score of 100 more marks out of total 200.
Passing shall be separate for theory.

Paper I
Section I: General Medicine including Tropical Medicine. Section II: Miasmatic Study of Medicine:
Paper II
Section I: Diagnostic procedures in view of latest technology
Section II: Practice of Homoeopathy in general medicine including Tropical medicine
B. Practical
B. 1) 3 Examiners out of which 2 are External
8. 2) Clinical Long Case = =60 Marks (1 hr.) = Short Case I 40 Marks (1 hr.)

C. Viva Voce:
Amongst 3 examiners the marks shall be equally divided under four heads covering all the aspects of general medicine as described in syllabus above. They can be broadly divided into four heads as below:

C.1                                   C.2                                      C.3                                                  C4
Electro diagnostics   Instruments Equipments          Therapeutic radiological                                            Radio diagnosis                                                                                                            Research aptitude
                                   Procedures                              Immunological Genetic etc,            including thesis
                                                         Charts                                                                                         Affective do main                                                               Attitudes Knowledge   about recent           advances in medical   field                         

 (10 min)                                           (10 min)         (10 min)                            (10 min)

Marks max. 25         25                                               25                                              25

Viva & practicals: 50%marks are allotted for homoeopathic application
Total marks: Cases 100 Viva 100 = 200 marks
Separate passing in individual heads A B & C is essential to pass in Examination.