Dr Mansoor Ali
Govt. Homeopathic Medical College. Calicut
A combined approach using Repertory and Organon of medicine- mainly for beginners and students
Case taking is essentially a social interaction between a physician and a patient under certain pre-determined conditions.
Primary object of case taking is the collection of data, for a prescription on the basis of Homoeopathic philosophy.
The case taking for Homoeopathic management requires background knowledge of various disciplines _ The principles of Homoeopathy, basic medical sciences, clinical subjects and the communication skills.
Aphorism 5,6, 83 -104.
Case taking requires a great deal of experience and training which cannot be acquired from reading books. The reliable way to learn the art of case taking is to actively become involved in the process under the supervision of an experienced and effective Homoeopath. Later the student must become involved in taking case personally.
In case taking the internal state of the person in front of us is gradually revealed. It is just an effort to understand the person in front of you and one can use any technique to suit one’s temperament. Successful case taking supplies the physician all the evidence that is necessary for a proper diagnosis, treatment, and prognosis.
While inquiring in to the state of chronic disease, the particular circumstances of the patient with regard to his ordinary occupation, his usual modes of living and diet and his domestic situations must be well considered and scrutinized to ascertain what tend to produce / maintain the disease.
TO GET A TRUE EVOLUTIONARY PICTURE OF NATURAL DISEASE
- Take in to account of only those symptoms which the patient suffered from before any treatment with the drugs was commenced.
- We may discontinue the treatment for several days and take the remaining symptoms _ with the idea that the effect of already consumed drug must have been eliminated from the system in the meantime.
PRE _ REQUISITES
- You must have your own facilities for recording the case.
- Proper sitting arrangement. Comfortable, adequate sitting accommodation both for the doctor, patient & by slanders.
- Suitable reading materials in the waiting room.
- Adequate arrangement for light, attractive painting…
- Quietness and privacy with sound proof chamber.
- Absolute rest and poise attitude of the physician with no pre conceived ideas nor prejudices.
- Arrangements for drinking water toilet etc,
- Facilities for advance booking
REQUISITES ACCORDING TO HAHNEMANN
- The physician should be free from prejudice.
- He must have sound sense.
- He should be attentive.
- He should faithfully record all the deviations
PRECAUTIONS WHILE TAKING THE CASE.
- All the events and effects should be recorded without any interpolation or deletions.
- Don’t get influenced by the symptoms of drugs recorded in the Materia medica.
- Intensity of the symptoms should be given due consideration while recording.
- Each symptom should be valued properly with the marks against them.
DOS AND DONTS
- Should not hurry a patient in his narrative.
- Do not put leading questions which suggest an answer.
- Do not ask in haphazard manner.
- Do not use complicated technical terms.
- Do not hide anything from the patient.
- Do not rely on patients statement entirely.
- Avoid questions along the line of remedy.
- Never ask alternating questions.
- Never skip from one symptom to another at random
- Never examine a lady in the absence of her relatives or a female nurse.
- Always beware of temptations.
- Ask for all the complaints in detail
- Speak slowly and write methodically.
- Each symptoms should be started in fresh line.
- Symptoms should be noted in chronological order.
- Should be dedicated and unprejudiced.
- Take minimum symptoms of maximum importance.
- Give attention to bystanders
PURPOSE OF CASE TAKING
1. FRAMING THE TOTALITY OF SYMPTOMS . Individualization from the totality of symptoms.
To bring out the symptoms of the patient in such a way as to permit the comparison with the symptoms of the materia medica for the purpose of selecting the similar /Homoeopathic remedy.
2. TO PERCEIVE THE TRUE PICTURE.
Mode of development of the disease.
Chronological sequence with observed changes.
3. FOR PROPER DIAGNOSIS.
A. Nosological Diagnosis : By a proper case taking we can able to separate the symptoms of the patient from the symptoms of the disease.
B. Etiological diagnosis : If the cause is removed, effect go off by themselves. Proper case taking help to prescribe on aetiology, exciting, maintaining or precipitating cause of disease.
C. Miasmatic diagnosis: The fundamental cause/causes of disease condition specially chronic & polymorphic manifestation.
D. Personality diagnosis : Peculiar constitution, temperament & mental behavioural attitude.
E. Therapeutic diagnosis : Individualization from the totality of symptoms.
SOME HINTS ON CASE TAKING
- Ask questions in opposite direction – If you think a person is sad, then doesn’t ask him anything about his sadness. He may straight away say no.
- Always confirm the symptoms from friends & relatives.
- Observe the expression on the face of person accompanying the patient, while patient is narrating his symptoms.
- Never accept what the patient says at face value. Symptoms provided by the patient should be accepted with interest but with out judgment.
- Look at the hidden expression behind the symptoms.
- The symptoms expressed with spontaneity, clarity and intensity is of highest value.
- Try to confirm the essential parameters of the patient in divers situations of his life.
- Avoid asking the patient directly about his nature.
- Try to lead him through other questions to express it without being conscious of doing so.
- If you want to elicit a characteristic symptom, then look for;
- Characteristics after stressful condition.
- Characteristics of illness before medication.
- If both absent, then characteristics in childhood.
- Many patient bring out the best symptom if you give a pause after the answer.
- The expression of characteristics can often be provoked. Eg .By making the patient wait beyond his time of appointment ie, impatient, mild or rigid.
- The patient should feel that the doctor is someone who cares. where he can trust and to him he can reveal anything.
- If you come to a dead end in case taking and just don’t know how to make the patient talk, just ask him to describe one typical day, his routine from morning to night.
- The patient should be encouraged to tell his story freely to relieve his mind.
- Leave space between the symptoms .Questions are then put in a manner as to complete each symptoms as location, sensation, modality and concomitance.
- Prejudice and doubt may be overcome by reflection, study, self-discipline and auto suggestion by cultivating the scientific spirit.
- The examiner should be constantly on the alert and observing while making an oral examination.
- Look for peculiar, uncommon, characteristics, individual peculiarities from causal expressions of the patient, attitude or gait.
- If the patient is confined to bed, observe his positions in bed, his manner of moving, mental state, turning, skin, color, odor, appearance of excretions, temperature, sensorium, covering, ventilation etc.
- The physical examination will be made thoroughly and systematically and the findings added to the record.
- Note the patients name, age, sex, vocation, the record of the family (Age of the parents, general health, cause of death etc.) We often get a good picture of the hereditary tendencies in this way.
- If you are dealing with an acute condition, limit yourself to dealing with the acute state alone, and do not at the same time attempt to dip in to what has been a chronic state. In an acute explosion the chronic picture will retreat completely.
- Before leaving the case, go over again the family history, the personal history, the mental and physical symptoms, temperament, personality etc. Verify if you have skipped anything.
- Remember that the nature and sensation of symptoms, the time of day, the position and circumstances under which the symptoms appear etc. are the most important modifiers of any given case.
TECHNIQUES OF CASE TAKING
1. OBSERVATION Aphorism 211
Is the most important and useful technique and the one that need to be developed most. It begin right from the time the patient makes the appointment. You observe what is in this person, that make him an individual, what that makes him different from other people. Observation aimed at trying to understand the state of mind of the person.
- General appearance of the patient physical and mental.
- Emotional expressions of the patient sad depressed, quarrelsome etc.
- The way he entering in to the room.
- How the patient speaks, in a low tone, hoarse, brassy etc.
- Condition of pupil dilated or contracted.
- Any discharge from the body Sweating. Increased / decreased, odor, staining, salivation…
- Condition of hair, face and nails with anaemia, paronychia, cyanosis..
- Weakness noticed from the way the patient entering the clinic, the way she get up from the chair etc..
2. MODE OF NARRATION OF THE COMPLAINT – Observe the attitude towards his illness, which may represent his general attitude and his emotional state.
3. Accompaniments to the sufferings.
4. Patients nature as a child.
5. Reactions in life situations.
The true nature comes out in times of stress, whether he is bold or mild, suicidal or depressed. This will reveals an uncompensated state of the person more than at other times.
6. State of mother during pregnancy.
The state of mother/father at the time of conception can give many clues.
7. Patients occupation and area of work.
Important to know whether he has selected the occupation himself /circumstances made him to chose it.
8. The idea in relationship.
Individual, community and social.
A man will form a relationship with a person or a group that is complementary or opposite to his nature. The lock and key will have opposite qualities. This balance is subjective and individual.
9. The way the patient follows up.
CASE TAKING – HAHNEMANNIAN VIEW
1. An over view.
- A concise idea about case taking (Aphorism 5)
- General directions ( Aphorism 83 – 93)
- Patient coming directly (Aphorism 83 _ 90)
- Patient coming from other physicians (Aphorism 91 _ 93)
- Chronic case taking ( Aphorism 94 _ 98 )
- Acute case taking ( Aphorism 99 _ 102)
- Appraising the case taken ( Aphorism 103 _ 104)
- Aphorism 7th. Hahnemann delineated the focus for case taking, the totality of symptoms alone form the basis of prescription.
- Aphorism 83. The qualities of the physician for case taking.
- Aphorism 84. Details the manner in which the consultation has to be taken place. This aphorism has to read with the foot note which cautious against the disruption of the patients train of narration.
- Aphorism 85. Say that every new expression made by the patient or attended has to be entered in a fresh line. This may help to complete the data’s later and prevent confusion about the discrimination of symptoms.
- Aphorism 86. Narrate the manner in which the incomplete information can be made complete.
- Aphorism 87. Cautious about the don’ts in the case taking. This aphorism has to be read with the foot note
- Aphorism 88. When the case taking come to a dead end, the doctor can engage the patient in a conversation, makes general suggestions and try to get more information. Details are given in foot note
- Aphorism 89. Narrate the information that the doctor required to seek, once the patient has completed the narration. This narration has to be read with the foot note .
- Aphorism 90. Narrate the necessity to discriminate the symptoms from the attributes of the patient. This aphorism has to be read with the foot note ,which details the observation the doctor can make of the patient during consultation.
- Aphorism 91. Suggest that to understand the patients state of health before the illness, the doctor has to discount those expression which were noticed after the medication. This course of action is advised for c/c disease.
- Aphorism 92. Warns that if the disease is of an a/c and fulminate nature no chance should be taken to keep the patient under observation with out medication, for eliciting the true nature of the disease. The doctor must try to access the expression previous to medication.
- Aphorism 93. Deals with the doctor to elicit the probable cause for the suffering. The information can be obtained either from the patient or attendant. This aphorism has to be read with the foot note ,which elaborate the probable cause for a/c and c/c affections.
94 _ 98 PROTOCOL FOR CASE TAKING IN C/C CASES.
- Aphorism 94. Asserts that in C/C sufferings, inquiry should be directed towards eliciting the patients mode of living, daily habits etc. This aphorism has to be read with the aphorism 5 and foot note ,which details about the information one may seek from the female patients.
- Aphorism 95. Asserts that the details of the expression of c/c cases have to be investigated thoroughly.
- Aphorism 96. Cautious the doctor to be on the guard against such patients who exaggerate their symptoms. This aphorism has to be read with the foot note .
- Aphorism 97. Due to modesty or shame the patient reluctant to speak out. A difficult situation in case taking.
- Aphorism 98. Narrate the attributes of the doctor in conducting the case taking section, especially of a c/c disease. It say that the doctor should have the qualities of circumspection, tact, knowledge of human nature, cautions on conducting inquiry and patience in an eminent degree.
99 _ 102 TAKING A/C CASES
- Aphorism 99. Details the projections available in the acute conditions and the mode of case taking in a/c cases.
- Aphorism 100. Case taking in epidemic and sporadic cases.
- Aphorism 101_102. An appraisal of several cases in an epidemic reveals a pattern in the disease expression leads to the genus epidemicus. This aphorism has to read with the foot note .
- Aphorism 103. Details the theme of case taking, also speaks of the data collection.
- Aphorism 104. Responsibility of the doctor after the case taking, include case analysis, selection of similimum etc.This aphorism has to read with foot note.
- Aphorism 153. States that the selection of the similimum must always depend on the data elicited from the patient, which is more striking, singular, uncommon and peculiar.
In foot note 109 Hahnemann makes a reference to Repertory of Boenninghausen and Jahr.
KENT’S METHOD OF CASE TAKING
- All the information obtained from the patient should be recorded in the patients own words
- By slanders if anxious do not give correct information
- The physician should frame the collateral questions and not the leading questions
- He must be able to collect symptoms with regards to pathology, diagnosis prognosis and materia medica. Symptoms with respect to materia medica are the key to the prescriptions
- The physician should know that anything that affect a change in these symptoms Eg. Drugs, alcohol etc. He should get the original form of the malady
- The circumstances of the life and habit must be studied with a view to going in to the slightest particulars
- Exaggerated and indolent patients do not give a true picture
- Never consider acute and chronic together
- Sequel of acute diseases are psoric disorders and must be treated as psora
- Don’t prejudice by “similar cases” in the past
He had given much importance to the history of presenting complaints
- The first requisite is the case record
- Absolute rest and poise attitude of the physician with no pre conceived Idea or prejudices
- The physician should not fail to obtain a detailed a family history
- Special care is to be taken while recording the past history of a patient to inquire about his recovery from each illness.
- The source of information must always be scanned with a great deal of circumspection and he must weigh the integrity of the source as being worthy of consideration
- While dealing with an acute condition do not dip in to the chronic state at the same time
- A clear picture of the chronic state is obtained at the end of an acute attack
- The physician should not interrupt a patient in his narration
- Cross examination is required in many of the cases
STUART CLOSE’S METHOD
- The selection of Homoeopathic remedy is mainly based upon the subjective, conscious experience perceived by the patient and stated by him to the doctor, his friends or perceived by the physician himself.
- The physician should gain the confidence of the patient and relive the tension of the patient as far as possible
- The physicians attitude should be calm, dignified, quit and sympathetic
- The physician should not hurry a patient in his narratives
- Classify the symptoms as general particular and common
- Laziness, selfishness and easy conscience are responsible for many failures and sins
- The physicians senses must be on alert, mind clear, logical faculties acute, sympathies and prejudices held in abeyance
- Bring out the symptoms to permit comparison with the materia medica.
ELIZABETH WRIGHT’S INSTRUCTIONS
- The homoeopath must know his patient spiritually emotionally mentally physically and sociologically .
- The physician must be receptive, must clear his mind of other pre occupations and must be tranquil and cordial
- He must allow the patient to tell his own story in his own way without any interruption
- The personality of the patient his state of mind physical status traits of character should be noted.
- The beginner Should not down all the symptoms and later sort it
- The physician should encourage the patient while narrating his story
- Beware of loquacious and reticent patients
- Case may be completed on subsequent appointments if required
- The physician must make sure that he has questioned the patient on every system and function
- The mental symptoms and characteristics of the patient should usually be elicited last when the patient’s confidence has been more fully gained
- The patient must get an impression that the physician is interested in his case.
AN OUTLINE OF CASE TAKING
(A practical repertorial Approach – Utilise the rubrics related )
1. DETAILS OF THE PATIENT
Name, age, sex, occupation, address, phone religion, marital etc. of patient & relatives.
Utilise the rubrics related :
AGE : New borns :
- Resp.Asphyxia childrens new born
- Rectum Constipation children new born
- Bladder Retention children New born
- Skin. Discoloration yellow children new-born
Babies : Mind. weeping children babies
Infants : Eye. inflammation children infants
- Resp Asthmatic children
- Rectum.diarrhoea children
- Rectum Prolapses children
- Sleep. sleeplessness children
Adolescence : Bladder Urination invol night adolescence
Puberty : Gen puberty ailments in
Ext throat.gioter puberty
Young people: Head Hair baldness young people
Menopause : Female Menopause
Gen.Heat flushes menopause
Old people : Resp.Asthmatic old people
- Mind. Memory weakness of facts,recent facts for old people
- Female.metrrohagia old women in
- Eye.Catract senile
- Prostate gland Enlargement senile
- Boys : Bladder.urination invol night boys in
- Girls : Head pain school girls
- Female : Eye.catract women in
2. PRESENTING COMPLAINT
Note down the complaint in the language of the patient with adequate space in between them. After completing the history part each symptoms should be qualified by sensation, location, modality, extension, duration, prodrome, onset, sequence etc.
3.HISTORY OF PRESENTING COMPLAINT.
Specially deals with the aetiology behind the onset of disease. How the disease progressed along with the appearance of the symptoms in a sequential order.
RUBRICS RELATED :
- Gen.Measles after
- Male. Swelling testes mumps from
2. Diagnosis Gen.Paralysis apoplectic
3. Nature of the disease
- Rectum. Constipation chronic
- Throat Inflammation tonsils recurrent
- Eye. Inflammation acute
4. Onset and progress of the disease
- Vertigo. Sudden
- Gen.Paralysis Gradual
5.Extention and alternation
- Gen.Paralysis ext upwards downwards etc
- Gen Side symptoms on one,Rt then Lt etc
- Nose. Obstruction alt sides
- Resp.Asthmatic alt with eruption
In order to deal intelligently with the present, we must know something of the past.
Ask for the previous illness from childhood down to the present, chronologically, which ages at which attack appeared, with its nature, symptom, duration, severity and sequence.
- Very important in finding the miasmatic background of the patient.
- Ask for the history of the any pronged illness in the past,r/c attacks etc.
- Birth history – It include prematurity, post maturity, truma, congenital defect etc.
- H/O of developmental mile stones, normal / abnormal.
- H/O of vaccination with or without any outward reaction.
- H/O of any surgical interference, exposure to radiation etc.
- Details of domestic circumstances, negligence, attitude of the parents, over protection, relationship between father and mother.
- Details of accident, mechanical injuries / mental shock..
PAST HISTORY MAY GIVE A CLUE ABOUT :
- Resp.Asthmatic eruption after suppressed
- Cardiac complaints and joint affections in a patient with a history of recurrent tonsillitis
- Chest. Inflammation heart endocardium rheumatic
3. Development of the disease
Surgically or mechanically corrected disease in the past history could be considered as presenting complaint in the concept that they would have been present there if surgical intervention has not been made. Examples are surgically treated Hernia,fibroids.haemerrhoids,catract,deformities,fistulae,tumors etc..
4. FAMILY HISTORY.
- Help in deciding the miasmatic background.
- Helps in tracing consanguinity
- Ask about any miasmatic disease in the family including parents, grandparents, siblings with paternal and maternal relations. Eg : T.b,Schizophrenia,Eczema…..
- H/O disease, cause of disease, cause of death..
- Pre disposition and tendency to disease.
- Individual peculiarities of all the relatives.
- This will create a feeling in the patient that “doctor knows all about them” that he is not only interested in them and their families, personally and professionally, but that he takes pains to learn and keep in touch with all their individual peculiarities.
6. PERSONAL HISTORY.
- For personal identity of the patient.
- Ask about the occupation, habit, diet, regimen, exercise…
- Habit of smoking, alcoholism, extra marital relations..
- Born and brought up, job, study, status of children, mode of living…
- Marital status, no.of children.
- Antenatal and post natal development.
- Economic circumstances .
RELATED RUBRICS ARE :
Delayed mile stones :
- Mind.Talk slow learning to
- Extr.Walk late learning to
Nature or conditions of the dwellings :
- Chill.Exposure tropical countries
- Resp.Difficult mountains in
Nature of occupation :
- Gen.stone cuttrers
- Resp.Asthamatic miners asthma from cold dust
- Rectum.Constipation sedentary habits from
RUBRICS RELATED TO HABITS :
- Resp.Asthamatic drunkards
- Head.Pain tobacco smoking from
- Gen.Food alcohol <
- Gen.tobacco <
- Gen.Narcotics <
RUBRICS RELATED TO MARRIAGE :
Mind. Marriage idea of marriage seems un endurable
- Genit.F Sexual desire increased in widows
7. TREATMENT HISTORY
Must ascertain the treatment already undergone by the patient for the chronic disease, must understand what medicine have been administered and what effect they produced. The original picture of the disease must be ascertained in order to understand the progress of the disease from its original state.
Treatment history help the physician to avoid the administration of medicine used earlier improperly.
RELATED RUBRICS :
- Gen Irritability When too much medicines have produced…
- Fever. Changing paroxysm after Homoeopathic potencies
- Chest .Inflammation lungs abuse of aconite after
8. DEVELOPMENTAL LAND MARKS.
- Gen. Developement arrested
- Mind Talk slow learning to
- Extr Walk Late learning to
1. Time modality.
- Morning ,evening ,periodicity, moon phase…
2. General modality.
- Any anxiety, physical or mental trauma etc.
3. Temperature and weather.
- Summer, winter., chill or warm blooded, weather changes, thunder storm, open air, uncovering, clothing…
- Hot or cold, local applications…
5. Rest or motion.
- Exertion, walking, car and sea sickness…
- Standing, sitting, stooping, lying on sides, head high/low, rising from lying, leaning head backwards, unusual positions .
7. Exertion stimuli.
- Touch, hard or light, pressure, rubbing ,jar, stepping noise, odour ,light etc.
8. Relation with eating.
- Weather before, during or after meals, desires and aversions, picca, any food < or >,salivation, taste, appetite etc.
9. Thirst _ quantity, frequency, hot or cool etc.
10.Sleep In general,before,during and after, position, dreams, eye movements, difficulty in getting sleep, somnambulism, snoring, restlessness etc..
The sleep symptoms are very important because when we are asleep, we don’t know what we are doing.
11. Sweat _ In general,hot/cold,foot sweat, partial or suppressed, Profuse,scanty,odor,staining,< or > before, during or after.
12.Bowels _ Regular / not, satisfactory or not,frequency,time, complaints before during or after,nature,color,odor, consistency bleeding,masses,worms etc.
13. Urinary _ Complaints before, during and after,nature,color, odor ,consistency,frequency,incontinance etc..
14.Other discharges _Bleeding,coryza,diarrhoea,vomiting,symptoms from suppression, symptoms alternating with.< or >from dhg. nature,course,color,odor etc..
15. Objective symptoms if any.
16. Pathology which applies to the patient as a whole. Tendency to tumors,cyst,warts. Individual and family tendencies to certian diseases. Weakness of specific region / tissues.
17. Ailments from..
Emotions, suppressions. From exposure to cold, wet sun.. From mechanical conditions eg. injury, over eating.
18. Gynaecological history.
- Menarche,duration,chter.,abnormality in cycle
- Leucorrhoea, post coital complaints..
- Abnormal discharge,s upression, odor,c olor, clots…
19. Obstetrical history.
- Number of conceptions.
- All trimesters normal or not.
- Picca or aversion during pregnancy.
- H/O jaundice, bleeding ,UTI during..
- Normal or caesarean.
- History of puerperal infections.
- Breast feeding for normal duration or not.
RUBRICS RELATED ARE:
- Genit. Female Abortion tendency to
- Genit. Female Sterility
20. Sexual complaints.
Sexual complaints are more difficult to ask.
Never begin with this. If we know how to handle human hearts and human beings, they will tell their complaints very easily, especially their sexual complaints, that they will hide from every body else.
RUBRICS RELATED TO PHYSICAL GENERALS ARE…
- Gen.cold <
- Gen.Warm <
- Gen.Uncovering <
- Gen.warm wrapps <
- Gen.Heat sensation of
- Gen.Eating < & >
10. MENTAL GENERALS.
a) Will _ Love,hates and emotion.
b) Understanding. _
Delusion, delerium, hallucinations. time sense..
C) Intellect _ Memory,concentration,mistakes
Important information about mental state can be obtained from his friends and relatives.
Head to foot including skin.
A. General examinations.
- Degree of illiness
- Chtics of movements.
- Skin _ Pallor. yellow, cynosis, pigmentation, eruptions.
- Neck _ Lymphatics and salivary glands, thyroid,veins.
- Tounge,edema,hands and feet,breast,axilla
- Temperature,pulse,blood preassure,respiratory rate
B. Systemic examinations.
- Mental state
- System examinations.
14. PROBABLE DIAGNOSIS WITH D/D.
15. ANALYSIS OF SYMPTOMS.
1. Disease diagnosis
2. Constitutional diagnosis.
16. EVALUATION OF SYMPTOMS.
17. MIASMATIC EXPRESSION.
18. REPORTORIAL TOTALITY.
19. IMAGE OF THE PATIENT.
Acute, constitutional, intercurrent.
Medicinal _ Potency, repetition.
21. OBSERVATION AND FOLLOW UP.
Date, basis of selection, prescription, observation.
22. ADVICE ON DISCHARGE.
CASE TAKING IN ACUTE DISEASES
Aphorism 99,152_ 153
1. It is very easy to take a case in acute disease, because all the phenomena and the deviation from the health that has been recently lost are still in the memory of the patient and relatives.
2. Physician wants to know everything in such cases also, but he has much less to inquire into.
3. In acute disease the presenting complaints are very prominent and impress our sense quickly, so much less time is required for tracing the full picture of the disease.
4. Requires only few questionings almost everything is self-evident.
5. Evolution of symptoms are very quick in a/c diseases and the patient remember all of them.
6. Any known causative factor for the explosion of latent psora is to be ascertained.
7. The total s/s should take down.
8. Physical examinations and laboratory findings be noted.
9. Possible nosological diagnosis should be kept in mind for diet and regimen, mgt. etc.
SPECIAL INVESTIGATION IN TAKING A CHRONIC DISEASES
1. In chronic disease the symptoms take a slow evolutionary pace covering months and years.
2. The case taking must be detailed and painstaking.
3. It must cover the past as well as the presenting conditions of the patient and even tracing the family history on both paternal and maternal side of the individual concerned.
4. Here the symptoms are much more difficult to be ascertained.
METHOD OF IDENTIFICATION OF CHRONIC MIASMATIC DISEASE
The whole array of symptoms belonging to a miasmatic chronic disease, can only be ascertained from observation of very any single patients affected with such a chronic disease, and with out a complete survey and collective picture of these symptoms the medicines capable of curing the whole malady Homeopathically cannot be discovered, this medicines are at the same time, the true remedies of the several patients suffering from such chronic affections.”
The three c/c miasmatic affections always retain their essential nature in all individual patients. To know the complete picture of each miasmatic disease large number of patients are to be investigated.
Each individual represent only a part of totality of miasmatic affections, By gathering the totality from large number of patients medicines suitable for such a chronic affection can be determined.
These remedies are indicated in several patients suffering from such a c/c disease. These cases should be minutely investigated for selecting a proper anti miasmatic remedy.
CASE TAKING IN CHRONIC DISEASE WITH ACUTE EXACERBATION
Foot note to Aphorism 208 – 230.
Between he acute and chronic there is a bridge, called as acute exacerbation of the chronic case which sometimes flare up. Here take the case first in the acute disease then comes or follows the c/c one.
When the individual has an acute case the case taking is limited to the symptoms of the moment, of acute symptom that has been before him, not to take in to consideration that the patient has had any c/c disease, the tendency of the family,mother,father etc.
We had to pay little attention to the c/c symptoms in taking an a/c case because ;
1.A/c disease has their own marked period of onset, progress and decline and although they are an a/c explosion of psora but the exciting cause play an important role.
2. The acute diseases are so violent, that they give no time for a detailed case taking.
Eg. R/C tonsillitis.
CASE TAKING IN ACUTE DISEASE WITH A CHRONIC BACKGROUND
When an individual has an a/c disease the case taking is limited to the symptoms of the case only. Not to take into consideration that the patient had any chronic disease.
Take the case regarding the a/c complaint only, and prescribe on that with out considering the c/c disease.
We have to pay little attention to the chronic symptoms, because a/c disease have sudden onset and decline and they are so violent and they give no time for a detailed case taking.
C/C DISEASE WITH OUT A/C EXACERBATION
As in the case of natural chronic disease.
A/C DISEASE WITH A DIFFERENT C/C BACKGROUND
Consider only the acute totality.
Eg. Chicken pox in an IHD patient
CASE TAKING IN EPIDEMIC AND SPORADIC DISEASE
Aphorism 100 – 103
Individual vary from each other and even the generic picture of the epidemic disease may vary from year to year. As Hahnemann said ” In investigating the totality of the symptoms of epidemic and sporadic disease it is quiet immaterial whether or not some thing similar has ever appeared in the world before under the same or other names.
In epidemic disease the disease cause might be same or a fixed miasm,giving rise to a general picture of the disease to which all the patient confirm to ,but each individual patient adds his quota to this general symptom complex to make each patient unique and different from others.
So investigate each sporadic and epidemic disease as a new and unknown case and select medicine according to its symptom similarity. No disease is fully manifest through symptoms in one individual case.
In epidemic disease a complete picture of the disease is apparent to the physician only when he observe a number of cases during the epidemic.
Every epidemic disease in many respect a phenomenon of a unique character ,differing vastly from all previous epidemics. The complete picture of an epidemic disease is grasped through observation of a good many person falling victims to that epidemic disease.
CASE TAKING IN INTERMITTENT & ALTERNATING DISEASES
Aphorism 231 – 234.
Intermittent diseases are those that occurring at certain periods. Alternating diseases are those in which certain symptom _ syndrome alternate at uncertain intervals with symptom _ syndrome of a different kind.
Both this diseases fall under the category of c/c case taking.
At one time only one group of symptom is dominant.
1. Sporadic or epidemic intermittent fevers.
Each individual suffering from intermittent fever presents individual, unique features which differentiate him from other cases. As each case of intermittent fever is different from another the most similar homoeopathic remedy is selected according to the totality of symptoms exhibited by each individual.
While case taking ,to acquire totality of symptoms, consider the symptoms during any of the alternating states and during the interval between the two paroxysm. The guiding symptom should be those present during the interval period when the patient is free from the fever.
The most appropriate remedy would be that which is Homoeopathic to the symptoms of the patient during the interval between the successive paroxysmal stage.
The case taking should help to find the remedy which capable of producing whole paroxysm as found in the case.
First conduct an acute case taking, followed by a case taking for a deep acting antipsoric.
2.Epidemic in non marshy areas.
Come under a/c case taking and have a simple acute paroxysm.
All the individuals affected by such an epidemic fever show almost invariably the same totality of symptoms. The totality is obtained after going through a number of cases.
3. Pernicious intermittent fever in non marshy areas.
First consider an acute case taking, to select an acute remedy to begin the treatment. How ever the well selected remedy fails and recovery not ensue in few days, a detailed chronic case taking is required.
4. Endemic in marshy areas.
Trace out the maintain cause and remove it. But in spite of the well regulated diet and regimen, many individual suffering from intermittent fever requires a detailed c/c case taking to prescribe an antiphonic remedy.
CASE TAKING IN ONE SIDED DISEASES
One sided diseases are those diseases which seems to have very few perceptible symptoms and belongs to the class of chronic diseases.
These diseases usually appear one-sided due to lack of observation of the physician. A physician well versed with the art of case taking is capable of finding many significant symptoms in such cases giving totality of the disease. So in one sided diseases a thorough case taking is essential which may require more than one sitting with the patient.
We can able to select a most similar remedy guided by these few symptoms alone, this may produce cure provided the symptoms are characteristics, rare and uncommon. Take the case again after the exhaustion of action of the most similar, and administer next suitable remedy. Thus successive re-examinations of the patient and the successive administration of the most similar Homoeopathic remedies are to be considered.
In cases of the selecting and administration of the partially similar antiphonic remedy the same procedure is to be followed as recommended for a/c diseases in which partially similar was not available due to paucity of symptoms.
CASE TAKING IN MENTAL DISEASES
Aphorism 215 – 216.
Mental diseases are one sided diseases which are chronic in nature and psoric in origin.
There is no absolute gap between body and mind. In natural diseases the physical disturbance are often found associated with their mental counterpart.
In mental diseases we must take very carefully the past history and should try to detect the physical symptoms which precede the present condition ( may be long ago) and try to get the full picture of disease comprising physical and mental symptoms on the totality of which a “similimum” can be found out.
1.Mental symptoms appearing with the decline of corporeal symptoms
The totality to be taken for prescribing in such cases must include past corporeal symptoms along with mental and emotional state. Past history is a must in these type of cases.
These corporeal symptoms may not be disappeared completely though obscure and make appearance during the lucid interval. The symptoms of previous corporeal disease should be learned from the friends and relatives of the patient and should be carefully considered.
2. Mental disease with out corporeal diseases.
Certain mental diseases are psychogeneses in origin. originate from emotional cause, continued anxiety, worry etc. The fundamental cause of these diseases are psoric miasm.
The maintaining cause of these diseases are to be traced out by a skilful case taking. Trace out all kind of external disturbing influences on the mental state of the patient.
3. Mental diseases appearing suddenly.
Mental diseases after sudden fright, grief, abuse of spirituous liquors etc. Find out the cause give acute medicine followed by a deep acting anti psoric.
4. Mental diseases due to psychological factors.
Mental disease arise due to faulty way of living, over protection etc. Take the case on individual peculiarities, on constitutional nature.
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