David Owen has been practicing medicine and integrated complementary and alternative medicine for 30 years. He has proposed five models in his book, “principles and practice of homoeopathy” to explain process of analysis in different cases1. Case taking plays a very important role in homoeopathy. The information that we receive and record during case taking helps us to find the most similar medicine, understand the constitutions, diathesis, miasmatic forces or tendencies, susceptibility etc2. Hahnemann has provided a comprehensive plan for homoeopathic case taking in the organon of medicine. The directions are recorded in aphorisms 83 to aphorism 104.
In our day to day practice, we have seen many homoeopaths who prescribe considering complete symptoms
(Boennighausen’s method); giving more importance to general symptoms, especially mind symptoms
(Kentian school of philosophy); followed by particular, considering pathological generals or common symptoms in pathologically advanced cases (Boger’s school of philosophy), considering only keynotes symptoms present in the case and so on.
A man is constantly acts and reacts with surroundings and tries to strike a balance in order to remain healthy. Hence, while understanding the case, a physician should also explore the various environments of a patient and should be able to find out the reasons for the imbalance causing the sickness3. It is difficult to find all the symptoms like mental symptoms, pathological symptoms or complete symptoms in a single case. So each case is different and case itself demands the way, a physician should consider history taking and analysis. When we give undue importance to any of the elements like mental symptoms during history taking will misguide the physician landing with wrong remedy.
These models help a physician to consider and analyze health and disease in 5 different ways. These 5 ways are to be 5 different models which help a physician from taking case history to analysis of the case and arriving at simillimum. These models are not exclusive and are used in combination as case demands during clinical practice. This combined strategy helps a physician to understand a patient’s illness in different perspectives.
The five models as stated by David Owen are as follows:
1. Pathogenic model
2. Biological model
3. Holistic model
4. Holographic model
5. Relational model
Pathogenic model :
- This model sees illness in terms of effects by external causes. In this model health is the ability to withstand causes of illness.
- It concerns itself with the causation of patient’s problem using many different modalities including simple lifestyle changes. For example, avoiding acidic foods in indigestion.
- This theory is based on the fact that once the cause is removed, treatment or recovery will follow it. It is more effective when there is a single causative factor.
- It is the level of much conventional disease treatment today, such as treating an infection by killing the infective organisms.
- Once a disturbance is caused by a external cause, the organism will be attempting to re balance itself in response to the cause.
- If, despite treatment, the cause is maintained then, although treatment may give relief, the illness may remains or resurfaces later as recurrence.
- Causation includes predisposing and precipitating or provoking factors.
- A homoeopathic treatment using causation may be chosen on the trigger event, on the factors that proceed the patient’s illness. Following things can be considered in this model .they are as follows :
- Trigger event or etiology
- Maintaining cause
- Never well since rubric
- Ailments from etc.
- The question to be asked by the homoeopath in these cases will be ,
“What is the cause?”
- This model can be used especially in acute cases, where one can relate illness to the causation and causation can be from both mental and physical plane.
A pediatric known case of asthma, 8year old male had an acute attack of breathlessness in school and brought home by his parents. Sudden fits of cough and breathlessness since one day. When asked about the causation, mother revealed he consumed roadside chats like Gobi Manchurian, which he craves for with his friend the day before the attack. And mother also confirmed that whenever he consumes Gobi Manchurian, he ends up with breathlessness on same day.
So, as the case was acute and there was a need of remedy which covers the causation was in need and a remedy which covers acute totality was in need. In special repertory of HOMPATH, this below rubric was found:
(ASTHMA) difficult ailments from: CABBAGE – PETROLEUM
The only remedy present in this rubric was petroleum. Petroleum 200 thrice a day was given and relieved his symptoms.
Biological model :
- The biological model considers health as effects of causation on the organism that is, capability of an organism to rebalance itself after a threat or cause.
- This can be related to auto regulation or homoeostasis.
- This model explains relationship between cause and effects as linear one, as always cause is followed by effects.
- So, this model explains illness as reaction of the body for causation as set of signs and symptoms.
Clinical application :
- Here a homoeopath should try to elicit cause behind the cause and also effects of the cause.
- It can be used both in acute and chronic cases, but more in acute one where the cause and effects are clear and analysis is not complicated.
- A homoeopath can use following questions using this model for eliciting history from patients :
- Why has this happened now?
- Why has this caused these particular symptoms?
- What was your response to the cause?
- What is the disease process that has ensued?
- Why even when the cause is removed, have things not improved ?( in chronic cases , a homoeopath should also consider maintaining causes along with exciting one)
- As we know that, a single cause or even multiple causes can lead to diseases, it is duty of homoeopath to elicit information in cases with multiple causes also and also consider the dynamicity between the patient and situation they are in.
- Factors which helps a homoeopath in prescription while adopting biological model are as follows :
- Single main symptoms
- Single keynotes or PQRS (peculiar, queer, rare symptom)
- Complete symptom
- Local or clinical prescribing symptoms.
Case 2: A case of 27years female came with excessive vomiting during pregnancy. Aggravation morning and smell of food. She was in 24th week of gestation, and still morning sickness was persisting. She has consulted her gynecologist and taken antiemetic, which was of no use. The only PQRS found in the case was, aversion to water since pregnancy, that she was a thirsty person who turned out to be thirst less after pregnancy.
Analysis: By considering above case, only PQRS symptom in the case was found under the rubric indicating single remedy in Phatak repertory was-Aversion, dislikes water, pregnancy during (see thirst less) –PHOSPHOROUS.Phosphorous 200 (2doses) helped the patient in 2days where nausea and vomiting reduce.
Holistic model :
- Holistic model recognizes that any single cause may in different people, have a different effects. This model also believes that any individual can produce similar symptoms from diverse causes.
- In this model, we should think about susceptibility of a person that is his sensitivity or degree of response given by the organisms to the causes as signs and symptoms.
- The susceptibility of a person can be considered at both physical and mental level.
- Question be asked by a homoeopath while dealing with the case which can be analyzed by holistic model is ,
“What are you sensitive to?”
- So in this model, it’s not only about external cause and reaction of those organisms, here local causes, local symptoms, psychological and general symptoms are also considered.
- Here a homoeopath, should be able to form totality of the case by following things :
- Physical symptoms
- Mental symptoms
- General symptoms
- So, here the overall effect of the disease on the patient as a whole will be considered and can be understood as the person’s susceptibility to the disease.
Case 3: A case of 29year old female had complaints of dysmenorrhea since 2years and sudden weight gain of 8kgs since 2years,, whose complete case history was taken and following totality was formed :
Physical appearance: obese
- Quarrelsome , menses before
- Rectum, diarrhea menses before
- Discharges , loss of vital fluids : acid excoriating (pathological general )
- Thermals chilly, cold in general aggravation.
- Abdomen, pain, aching dull pain : menses during
Investigations revealed: USG (Abdomen and Pelvis)
- Mild Fatty infiltration of liver
- Both ovaries are bulky and demonstrate multiple small peripherally arranged follicles
- Bilateral renal microliths
- Left sided extra renal pelvis
- Isolated dilatation of lower pole calyces of right kidney
Above case was reportorized using HOMPATH and AMMONIUM CARB 200 was given monthly one dose for 7months follow-up with relief of all symptoms.
Investigation after treatment revealed: GRADE 2 fatty infiltration of the liver.
Holographic model :
- When a case is partially treated and advancement in the pathology and deceleration in general well being takes place, there will be only few symptoms that are expressed and most of the symptoms are masked due to advancement. So these fewer symptoms act as source for forming totality.
- When case only presents with fewer symptoms and most of the symptoms are overshadowed and masked, one can think of using this model to solve the case.
- Here a homoeopath tries to find an essence or themes which are expresses by the patients in all phases or circumstances. This theme runs in their both mental and physical plane.
- Here physician asks for, the order or pattern being expressed or revealed by the patient.
- This can be related to different kingdom theory to differentiate the individual as plant remedy, animal remedy and mineral remedy.
Case 4: Case by name x, 36 years, male who has come for the treatment for infertility. When he was advised to undergo semen analysis, it was shown as Oligospermia. So below mentioned qualities in the case are considered to form totality:
1. Basically he was a shy and timid man, who always wants his wife to go along with him outside and avoids going out alone.
2. Since childhood, he doesn’t talk much in school or even public meetings or family gatherings.
3. Very slow in doing work, but does with extra care and perfection.
4. Wife takes all decisions of home as he becomes indecisive and asks for her suggestions for every matters related to home.
5. He is very dull person since his childhood and needed extra tuitions to study as mentioned by his mother, also now he cannot learn new things soon and needs extra time than average learning people.
6. Very anxious about health matters and feels “what people think of him “for same matter.
By considering above mentioned theme, which runs all over the case is slowness, dullness, being imbecile for some things, retarded growth at mental level for his age, Baryta carbonicum was selected considering his thermals and thirst.
After 3months follow-up for every month, a dose was repeated. His reports were redone after treatment which came out normal and couple conceived and blesses with a baby girl.
- This model has broader sense of connecting the living organism with its surrounding. It believes that the patient is at all times projecting on to the surrounding people and environment; and people and the environment will be constantly projecting on to the patient.
- This model can be called as reflective approach from physician who tries to apply psychodynamic methodologies to assess the case. Here the dynamic nature of the relationships between the homoeopath and client reveals important aspects of the case.
Clinical application :
- Applicable in one sided cases where most of the picture is masked.
- It requires lot of experience to use this model in day to day practice.
- This model requires homoeopaths to reflect carefully about their mental and physical reactions to the clients and to know themselves well.
- Cases which come with reports and investigations lacking in general symptoms can be well treated using this model by experienced homoeopaths.
This model is used only by experienced homoeopaths who can analyze the case with their clinical experience and knowledge by intuitive methods.
- David owen, principles and practice of homoeopathy: copy rights Elsevier ltd 2007 : published by similbis india.
- Munir ahmed R, Fundementals of repertories : published by I line publishers and distributors pvt ltd.
- Shashi kanth tiwari , essesntials of repertorization : published by B Jain publishers ltd.
Department of repertory
Government homoeopathic college