Understanding Keynote System of Prescribing


students (7)Dr  Ajit Kulkarni M.D.(Hom)                                                    

Multi-dimensional aspects of a human medicine i.e. homoeopathy, involve utilization of homoeopathic remedies on the basis of Similia. As the collective and selective approach has to be implemented in an individual instance, keeping at the core the tenet of individualization, homoeopathy envisages a lot of avenues – the prescribing methodologies. It is therefore imperative for a physician to perceive them completely before applying them.

Out of several methods of finding the similimum, the Keynote system of prescribing has assumed its own place in Homoeopathic practice. It has won both, laurels and invited failures. A thorough understanding of its base and surroundings will help utilize this wonderful system in a better way.

A. THE WORD “KEY” has several meanings. Relevant to the Homoeopathic theme are the following:

  1. An implement designed to open a lock
  2. Any means of control or possession
  3. An essential ingredient or requisite
  4. An explanation of a set of symbols or abbreviations
  5. A set of answers to a test or puzzle
  6. Anything that serves to explain or interpret

7.   In (or out of) key: In (or out of) tune with other factors – To bring into tune or harmony; coordinate.

 Prime or crucial element
An underlying or prevailing tone, spirit or idea.
A significant word or quality.

Based on these meanings, selection of the drug is based on a prime or crucial element available in the data of the case. That crucial element includes the core, the nucleus or the essence of the case and it will unlock it.

The data elicited during case taking in its raw form is a sort of pot pourri of various incongruous components or symptoms. The data will have to be re-organized in a logical sequence to refine the data so as to be useful for prescribing. The nucleus of the case should be the main coordinator around which the rest of the data is attached.

Homoeopathy propounds the concept of Totality. To perceive the totality, one requires the vision of wholeness of the case. This is not merely a quantitative approach. We have to define ‘quality’ in the data. The problem is that we are swayed by the parts very easily. If some parts are influencing, we hold on to them. These could be dominant factors but not essentially crucial factors. Dominant factors can be subjective and hence these could lead to wrong or inadequate perception. The crucial factors, on the other hand, are related to hard facts and hence significant and without them you can’t go for a synthetic view.

When we consider totality, there is one ‘organizing principle’ structured within it. This principle binds all components together; it defines the interrelations present in the data. We are able to perceive clearly, then, all the attributes of the data, the cause-effect relationship and the phenomenon. The whole can’t be without parts, but whole is not merely parts together. The vision of wholeness makes every part, every component alive! We are able to see the universality and the commonality that exist in various parts and beyond these parts there is something subtle, something imperceptible that can’t be put in words.

It is through the process of ego loss that one can achieve the perception of wholeness. This is a very intricate problem of human beings. How one can go for ego loss? I think that the ‘unprejudiced observer’ as the demand of Hahnemann has basically to deal with ego loss. In ego loss, we do not add anything of our own. We are just passively active spectators trying to dig out the expressions, trying to look at the expressions through synthesis, and trying to develop a portrait.

It is used in many contexts, basically denotes “a whole composed of related parts.”

This definition, however, raises many questions:

  1. Can something be regarded more or less a whole or as a whole for some purposes but       not for others?
  2. Can a whole be also part of another whole or even of several other wholes?
  3. Regarding relation between whole and its parts, can we debate whether –
  4. Could a ‘whole’ be more than the sum of its ‘parts’ and if so how?
  5. Is it apparent that every whole must necessarily be both more and less than the sum of its parts? It is less because its parts are constrained by being organized. This then, relates wholeness with organization. The whole has to be so organized that it is able to act as a whole on its surround. For  it is composed of parts, which may or may not be willing and able to combine in joint action, to act “as a whole.” The parts lose their quality in their unorganized state. To cite an example, the constituents of a dead body are free to combine in other forms, once the discipline of the living organism is relaxed. But they are also more than the sum, because when organized they can do what they could not do alone or as an unorganized aggregate.

The prime requisite hence is to make the data ‘organized’; bringing into play complex, artistic part of Homoeopathy.

E. Ultimately, the system consists of relationships. Parts / components / objects / entities support these relationships; but one has to understand that relationships are basic than the entities. Rather there are entities in the system to be related. Are they elusive to a physician?

Attaching labels to ‘entities’ and thus exaggerating them may pose a problem. It is important to draw a distinction between the (internal) relations, which enable any assembly to sustain its form and those, which enable it to acts a whole on its surround.

Synthesis, however, goes beyond mere assembly, for the parts may be integrated with each other to make a ‘functioning’ whole. “Human synthesis in human design for a human purpose” is the very basis of Homoeopathic science. Design and synthesis involve doing something or making something happen. At the end of which something is produced which was not there at the beginning. Synthesis and design overlap in this matter. There has to be a desired purpose, and if the matter is dealt with thoroughly and logically with reasoning faculty, the purpose is served.

Most of our thinking is concerned with fitting things into the patterns, which we create and continue to use. Fitting wrong things into right patterns or right things into wrong patterns result in failures. As a matter of fact, if we have perfect fit between what we want and what we get, we do not bother about priorities. The priorities are obviously included in the perfect fit. However, it is worthwhile to check out the priorities, as the human mind is easily carried away by the temptation. In the other words, once perception has triggered emotion then emotion leads to perception.

Perception is the trickiest and the most fascinating aspect of mind. The brain acts as a superb pattern-making system, which allows experience to organize itself into patterns. Once the patterns are formed they direct attention and organize the perception of the present. Awareness of the rigidity of the pattern and the perception is essential especially to a Homoeopathic physician in view of the need of flexibility. Or we can become trapped by our dexterity!

Whether the structure is making things more difficult than they need be? Whether the fault lies with the structure? If the structure is evolved with reference to one part rather than the whole, the operating thrust of different parts of the structure will not be aligned. To be truly effective the structure needs to be designed to cope with a wide range of data. It should be flexible, not in ability to change but in being broad enough to channel different types of data in the required direction. After all, one designs the structure for success. Needless to say that for a Homoeopathic physician, total design is much more satisfying than tinkering.

A large amount of our thinking and information – exploration is concerned with linking things together. We come across isolated pieces of information and link them to already existing data in the brain. To link things, we have to act on the information, rather than wait for the information to act on us. Significance is by no means obvious. It has to be ‘squeezed’ out of isolated items.

The ‘squeezing’ out of only isolated components is not the keynote system of prescribing; the squeezing has to be in the form of extract which has to be gleaned through the totality. Extract is not like picking a brick out of a wall but of creating the shape of a brick in a concrete wall. Extraction is thus pattern recognition but with the ability to cut across interfering patterns.

The ability to extract is rare and it is here that the problems of a Homoeopathic physician are maximum – to pick out the important keys from the flak. He has to think a priori, a posteriori and in concreto.

The keynote system of prescribing is a skillful art. To reduce this wonderful methodology to a mere workout of the manifestations (and not of the state) is an injustice. The substance that this system carries, is lost if we approach the data from the reductionist point of view.

With right analysis and synthesis, a Homoeopathic physician will be able to process the data and derive the extract. In the course of analytical activity, the mind advances from the complex to the simple, from the fortuitous to the necessary, from multiformity to identity and unity. The purpose of analysis is cognition, breaking-down of the parts to basic elements of a complex whole. Whereas Synthesis is the process of uniting into a single whole, parts, properties and relations isolated by means of analysis. Going from the identical, the essential, to the different and varied, synthesis combines the common and the individual, unity and variety, into a concrete living whole. Synthesis complements analysis and is in indissoluble unity with it.

Reductionism is favored out of favoritism, temptation, with a pecuniary accent and involves no brain-fag. But it invites failures and poses a problem as to the assessment of ‘movement’ that occurs after the administration of the remedy. The keynote system affects the follow-up in a negative way, creates the confusion as to the next prescription and creates a zig-zag path, unlikely to reach Hahnemannian cure, if vision used is narrow.

Keynote through totality is the need, and is the right path.

We are, what we repeatedly do. Excellence, then, is not an act, but a habit” wrote Aristotle. Each physician has to introspect where he stands.

Dr  Ajit Kulkarni M.D.(Hom.)
Email : dr_ajitkulkarni@rediffmail.com