How to study Boger’s synoptic key in reference to Kent repertory

 How to study Boger’s synoptic key in reference to Kent repertory

Dr Mohan Giri

Abstract;–   Medical science s the branch of science which stands on the pillar of clinical practice i.e. clinical methods and homoeopathy is not an exception. This small books is cream of clinical practice and fruits of whole life struggle of Dr. C.M.Boger and at the same time almost  unknown to the profession.Therefore,I would like to bring the fact in front of you for better understanding and to facilitate the quick selection of ” similimum” through Boger’s unique methods of evaluation of symptoms  

Key-Words;Synoptic-Key, Patients, Organon of Medicine, Repertories.

CYRUS MAXWELL BOGER is the writer of this book and the full name of this book is “A SYNOPTIC KEY OF THE MATERIA MEDICA “

BOGER’S LIFE AND WORK
Dr. C.M Boger was a leading practitioner of U.S.A in the early decades of the twentieth century. He was born in 1861 in Germany and came to U.S.A at quite a young age. He graduated from Philadelphia College of medicine and studied later at Hahnemann Homoeopathic Medical College, Philadelphia.

He came to Parkersbrug, U.S.A in 1888 and had since been engaged in practice of medicine. During his long carrier in medical practice and research Dr. Boger contributed a lot by his writings and successful treatment of incurable cases.

Dr. Boger was in correspondence with Dr. L.D. Dhawale of Bombay, who incorporated his views about pathological generals and strongly advocated their use in treating the patients.

As a practical man he well understood the difficulty faced by the practitioners of his days in finding out a correct correspondence in the materia medica in the shortest possible time. The perceptive mind of this German physician soon discovered that, in spite of the availability of a plethora of literature and clinical experiences, the burning question was how best these could be put to use.

In his time both the Boenninghausen and Kentian school were popular, Boger made a study of both but accepted Boenninghausen’s way of working out of a case.

Dr. Boger, who compiled, edited and augmented Boenninghausen’s Therapeutic Pocket Book has published in 1905 as Boenniinghausen’s Characteristic & Repertory. He accepted the whole concept of Boenninghausen’s , quoted  $ 153 of Organon Of Medicine in his Repertory on the section  “choosing the remedy”, that how the final differentiation depends upon the individualistic or peculiar symptoms. The interpretation of what constitutes a striking or singular symptom in the following seven considerations —

  • Change in personality and temperament
  • Peculiarities of disease.
  • Seat of the disease.
  • Concomitant
  • The Cause.
  • .Modalities
  • Time.

A SYNOPTTIC KEY OF THE MATERIA MEDICA
A synoptic key of the materia medica published in the year 1931. This is a short book, having both repertory and materia medica. After having many years of clinical practice, Dr. Boger has slightly changed his concept of evaluation of symptoms. One can observe this, while going through his article “Some thoughts on prescribing”, given in Studies in the Philosophy of Healing. According to him:—

  • Modalities: – Causation. Time Temperature. Weather. Open air. Posture.  Motion. Eating and drinking. Sleep. If alone Pressure.  Touch. Discharges.                      
  • Mind: — Irritability. Sadness. Fear. Placidity.
  • Sensation: – Burning. Cramping. Cutting. Bursting. Soreness.  Burninging. Thirst.
  • Objective aspect
  • Part affected.

The spirit of the clinical symptom picture is best obtained by asking the patient to tell his own story, whenever this is possible. This account is then amplified and more accurately defined by the questioner, who should first try to elicit the evident cause and course of the sickness down to the latest symptom, to which he will especially add all the things which now seem to interfere with the sufferer’s comfort. Especially should the natural modifiers of sickness — the modalities — be very definitely ascertained? The following are the most vitally important of such influences, Time, Temperature, Open Air, Posture, Being Alone, Motion, Sleep, Eating and Drinking, Touch, pressure, Discharges, etc.

He always emphasizes to elicit the evident cause and course of the sickness and natural modifier of sickness— modalities, which is closely related to the comfort of patients.

A consideration of the mental state comes next in order of importance. Here the presence of Irritability, Sadness or Fear is the ruling factor.

The third step concerns the estimate to be put upon the patient’s own description of his sensations. This is a very vital point and in order not to be misled it is always well to ascertain whether any of the following primary sensations are present. Burning, Cramping, Cutting, Brushing, Soreness, Throbbing and Thirst. There may be many others, but the presence of any one of these often overshadows them, especially such as may be due to the play of the imagination; which feature is in itself often of more importance than the particular thing imagined.

Next in order comes the entire objective aspect or expression of the sickness: This should especially include the Facial Expression, Demeanor, Nervous Excitability, Sensibility, Restlessness, or Torpor, State of the secretions and any abnormal colouring that may be present.

Lastly the part affected must be determined; which also brings the investigation in touch with diagnosis.

It is seen very clearly from the above study that the concept of evaluation of symptoms has under went some changes. He gives more importance to Causation and General Modalities (Mental and Physical) followed by General Sensations (Pathological and Physical generals), which hold key in the remedy as well as in the person.

In the foreword of this book Dr. Boger has mentioned that the aim of this book to simplify and introduce method into this work, so that the truly homoeopathic curative remedy may be worked out with greater ease and certainty. For this purpose a combination of the analytic and synoptic methods has been thought best.

Keeping in mind the evaluation of symptoms given in synoptic key, the construction of synoptic key can be better understood.

Construction of a synoptic key of the Materia Medica 

Dr.Boger has given the evaluation of symptoms in the foreword written to synoptic key. This book can be divided into three parts:

  • Part I: – ANALYSIS (Repertory).
  • Part II: – SYNOPSIS (Materia Medica).
  • Part III:-  It consists of –
  1. a) Table of the Approximate Duration of Action of Remedies.
  2. b) Complementary Remedies.
  3. c)  Antagonistic Remedies.
  4. d) Supplemental Reference table i.e. a valuable additional table for ready  reference to the repertorial portion in the text.                                              

 Construction of ANALYSIS part:
Part I: Analysis: This part is a short repertory containing sections:

A: – The Periods of Aggravations (TIME)

B:-Conditions of Aggravations and Ameliorations.

C:-Generalities. I.e. consideration of drugs affinities for entire organism.

D:-Regional Repertory.

Thus the section in the analysis part is also arranged according to the evaluation of symptoms written in the foreword. The time aggravations and causative modalities are given first preference in the construction of the book and parts affected are given last preference, under the heading Regional Repertory.

The repertory part is printed in two columns in each page and pages have been numbered.

The rubrics are printed in CAPITAL BOLD (e.g.: ANEURISM)

The sub rubrics are printed in roman bold (e.g.: WIPING: Agg, Amel)

Cross reference is given after the remedies are given for that rubric or sub rubric. This is written as Comp.

 For examples-In sub-section MIND –

  • ALTERATIONS—Comp—Changing.
  • COWARDALY— Comp—Anthropo phobia.

                                                                 Gradation of remedies

CAPITAL BOLD 1st grade.
Roman bold 2nd grade.
Ordinary roman 3rd grade.

Total number of remedies in analysis part is 489 & in Synoptic part are 323.

A. The Periods of Aggravations–. Under this section, we have rubrics like—

                                                               PERIODICALLY, in general aggravation, daily aggravation etc.

                                                               MORNING, and hours of aggravation related to morning,

                                                               AFTERNOON, and hours of aggravations related to afternoon,

                                                                EVENING, and hours of aggravation related to evening,

                                                                NIGHT, and hours of aggravation related to night.

The drugs given under each part of the time have either aggravated the symptom during that time or produced the symptoms during that time at the period of drug proving. There is no amelioration rubrics and sub rubrics.

If we go through Boger’s “TIMES OF THE REMEDIES AND MOON PHASES”, we will find that Boger has given much importance on time modality. According to him time factors is more definite and more reliable in case as well as in medicine. He emphasized that the particular time when medicine manifests its full therapeutic action is often decisive importance e.g.

  • 4 to 8 p.m. agg of Lycopodium.
  • Chill appearing at 3 p.m.—Apis mellifica.
  • Eczema which is moist during the increasing moon but dries up during waning moon – Clematis erected.
  • Daily colic in infant about 5 A. M.—Kali-Brom.
  • Fever paroxysm at 7 A. M. with  great loquacity during  chill and heat—Podophyllum

B. Conditions Of Aggravations and Ameliorations—under this section we have all the aggravating factors. Causative factors are included in this section. All the rubrics & sub rubrics arranged alphabetically

There are mental as well as physical general rubrics included, which can either Agg.or Amel, disease conditions i, e-

  • AIR, cold dry Agg.
  • BATHING, cold applications, Amel.
  • BLEEDING, Amel.
  • ANTICIPATIONS, Agg.
  • COMPANY, Crowds etc, Agg and Amel.
  • EMOTIONS, mental excitement Agg.

In Kent’s repertory also the rubrics arranged as S.T.M.E.

The M stands for modality which includes

  • Ailments from
  • Alternating with
  • Modifying factors e.g. agg. and amel, including concomitants.

So this part almost same as Kent’s repertory.

C  Generalities– For the better understanding this section can be divided into following sub-section i, e,–

  1. Generalities i.e. .-physical generals.
  2. Mind.
  3. Intellect.
  4. Vertigo.

1-Physical General— In this section the drugs, which have the capacity to affect the whole organism which related to physical generals, only are included. For example:-

The drugs under the rubric “ACHING” have produced this kind of sensation in the body and so can cure the same.

The drugs given in rubric “ALBUMINOUS” have produced this kind of discharge. This rubric can be applied to any discharge like nasal discharge, leucorrhoea or pus etc. when they are white. Before applying this rubric, one should rule out this kind of discharge from the regional repertory section.

SUPPURATION- the sub rubric is bone, glands, fibrous parts, etc.

HAEMORRHAGE, Bloody discharge etc- the character of haemorrhage are also given here like – bright, dark, slight, etc.

The way of construction of this section in this book is totally different from the “General” chapter of Kent Repertory.

2.  Mind—in this sub-section all the mental rubrics are given .The rubrics are arranged alphabetically. The mind rubrics starts from the rubrics ABSENCE OF, abstracted etc, and ends the rubrics WORK-DREADS or Dislikes for

3.  Intellect—there is the list of remedy which is having general affinity on the intellect only.

4.  Vertigo—there is list of drugs which is having general tendency for vertigo, after that rubrics and sub-rubrics are given.

D.   Regional Repertory

There are 71 sub sections which also including – 

  • Thirst,
  •  Sexual Impulse,
  • Menstruation,
  • Sleep,
  • Chill, Chilliness, Coldness.
  • Sweat etc.

 The function of the organs in Regional Repertory given just after the regions is just as like in Kent’s Repertory e.g.

  • EYE ———- VISION
  • EAR ———- HEARING
  • MOUTH & THROAT ———– SALIVATION, TASTE
  • LARYNX & TRACHEA ——– VOICE & SPEECH

The construction of this section is almost same of that of Boenninghausen’s Characteristics & Repertory.

The arrangement of the sub sections in Regional Repertory almost follows the Hahnemannian’s schema and starts from the chapter Head and ends the chapter Sweat. The sub sections are as follows: —-

1. HEAD 37. STOOL
2. EXTERNAL HEAD BONES &  SCALP 38. MICTURITION
3. EYES 39.URINE
4. VISION 40. SEDIMENT
5. EARS 41. URINARY ORGANS
6. HEARING 42. GENITALS
7. NOSE & ACCESSORY CAVITIES 43. MALE ORGANS
8. FACE 44. FEMALE ORGANS
9. TEETH 45. SEXUAL IMPULSE
10. GUMS 46. MENSTRUATION
11. PALATE 47. LEUCORRHOEA
12. TONGUE 48. RESPIRATION
13. MOUTH & THROAT 49. COUGH
14. SALIVA 50. LARYNX & TRACHEA
15. TASTE 51. VOICE & SPEECH
16. APPETITE 52. EXTERNAL THROAT
17. AVERSIONS 53. NECK (NAPE)
18. THIRST 54. CHEST & LUNGS
19. CRAVINGS & DESIRES 55. EXTERNAL CHEST.
20. WATERBRASH 56. AXILLAE
21. HEARTBURN 57. MAMMAE
22. QUALMISHNESS 58. NIPPLE
23. HICCOUGH 59. HEART CIRCULATION & PULSE
24. NAUSIA 60. BACK SPINE & CORD
25. REGARGITATION 61. SCAPULAR REGION
26.RETCHING & GAGGING 62. DORSAL REGION
27. VOMITING 63. LUMBAR REGION
28. ERUCTATIONS 64. SACRUM
29. EPIGASTRIUM 65. UPPER LIMBS
30. STOMACH & ABDOMEN 66.  LOWER LIMBS
31. EXTERNAL ABDOMEN 67. SKIN
32. HYPOCHONDRIAE 68. SLEEP
33. FLATULENCE 69. CHILL, CHILLINESS, COLDNESS..
34. GROINS 70. HEAT
35. ANUS & RECTUM 71. SWEAT
36. PERINEUM

This section contains those prominent remedies which have the regional affinity. That is first the remedies having affinity for whole location, followed by the remedies having affinity for the parts of location.  Following this, different sensations are given with remedies; generally sensations are given after one horizontal line. The modalities and concomitants after each location are not given as that of Boenninghausen’s Characteristics & Repertory, except for leucorrhoea, respiration, stool, and sediment – remedies are given under the heading “concomitants”

In the leucorrhoea and respiration sub-section, there is only list of drugs under concomitant heading, but no concomitant symptoms are there.

Costruction of SYNOPSIS part 

SYNOPSIS:   Dictionary meaning — Concise statement – General view, Abstract etc.

An exposition of the important and characteristic feature of the most important remedies of the Homoeopathic Materia Medica with their physiological sphere of activities, modalities and relationships.

Synopsis part of this book contains genius of remedies given on first parts of each drugs. After that there are few dots is followed by mental symptoms, then the symptoms are given according to the Hahnnemanian schema from head to foot as per the evaluation of symptoms. Dr Boger has mentioned prominent objective aspects as well as the sensation whenever they are applicable in each and every drug. He has also maintained the gradation of symptoms as in the repertory parts of this book, I, e, Capital bold, Roman bold, and ordinary roman.

Under each remedy, the regions affected by that remedy are given on the left side and modalities on the right side, followed by the symptoms produced by that remedy. The complimentary and related remedies are given at the end of each drug picture.

Part III: It consists of:

a) Table of the Approximate Duration of Action of Remedies –There is a list of remedy with possible duration of action mentioned in week.

In Organon of Medicine in section 246 master Hahnemann has pointed out three most important points which is essentials in the path of recovery i.e.

I) – the medicine selected with utmost care should be perfectly homoeopathic — Similimum.

II) – It should be given in the minute dose, so as to produce the list possible excitation of vital force, and yet sufficient to effects the necessary changes in it

III) – The minute yet powerful dose of the best selected medicine should repeat at suitable interval.

In section 246 foot note master has also advised that a single dose of a well selected homoeopathic medicine should always be allowed first fully to expand its action before a new medicine is given or the same one repeated.

Dr. Boenninghausen has also advised that as long as old ailments reappear or are worse, without the appearance of essentially new symptoms which lie outside of its sphere of action, we should guard against a repetition of the remedy, or changing to a new one.

According to Herring: — Symptoms appearing last in a proving have the highest value.

b) Complementary Remedies:—Lists of 114 drugs with others drugs.

c) Antagonistic Remedies:—Lists of 35 drugs with others drugs.

d) Supplemental Reference Table i.e. a valuable additional table for ready reference to the reportorial portion in the text – Dr. C. M. Boger has given the special foreword for the Supplemental Reference Table and wrote that — the “Supplementary Reference Table” has-been enlarged considerably, especially by transferring most of the comparisons to it from the text of the respective remedies. This makes for clearness and facility of reference                                      

 Points to be remembered 

During the study of Boger’s Synoptic Key we may face following difficulties –

1. We know that causation is given more importance by Dr. Boger, but nowhere causations are given. For causation, one should refer “Conditions of aggravations and ameliorations”. Aggravating factors can be taken as causation also.

2. When under any particular part of location under Regional Repertory, a sensation is not given; one should refer the section “Generalities”.

3.  Always refer the “Supplemental Reference Table”, one may find the sensation or location under this table which is not given in the repertory part.

4. Always refer the list of complementary remedies, because in this list new remedies or extra remedies are added which are not given under Synoptic part.  For example: In synopsis part, under Abrotanum, there are no complementary remedies, but in “Complementary remedies list”, under Abrotanum- Bry, Kali-bich, and Lyc are given.

5. There are lists of antagonistic remedies which are not given in the synoptic part except in few remedies like Sulphur.

6. We have to always depends upon the General Modalities because there is no Particular Modalities in the Regional Repertory, or if they are, very few and occasional.

At last this is a short handy book and most important things is that there is a rational compilation of Boenninghausen’s and Kent’s concepts on one place. Which may be more helpful for quick prescription?                                                                                             

CASE STUDY
C
ase 1 

MR A. Prasad aged about 50 years of a middle class family came to my clinic with a rheumatic troubles for about 7 years. On careful questioning to the patients and on observation the following characteristics were obtained:-

  1. Aching pain on back especially whole length of spine < on hard pressure.
  2. Aching pain in lower extremities > by cold application.
  3. Whitish discoloration of lateral margin of foot.
  4. Hunger intolerable.
  5. Craving bitter sweet and warm food.
  6. Intolerance egg.
  7. Stool –unsatisfactory urging for.
  8. Thermal reaction –ambithermal.
  9. Perspiration –profuse on whole body.
  10. Irritable, gets angry easily.
  11. Hasty wants to do works in hurried manner.
  12. Prefer company.

Evaluation as per Boger Synoptic-Key 

  1. Cold application > the complaints.
  2. Pressure < the complaints.
  3. Prefer company.
  4. Intolerance egg.
  5. Irritable, gets angry easily
  6. Aching pain on back especially whole length of spine and lower extremities.
  7. Hasty wants to do works in hurried manner.
  8. Hunger intolerable.
  9. Craving bitter and sweet and warm food.
  10. Stool –unsatisfactory urging for.
  11. Perspiration –profuse on whole body
  12. Complaints of spine and lower extremities.

Conversion of Symptoms to Rubrics with Page No Of Synoptic-Key 

  • 1.   Cold, becoming, Amel………………………………..20.
  • 2.   Pressure, Agg.…………………………………………27.
  • 3.    Company, Amel, desire for etc………………………21
  • 4.    Food & Drinks, eggs, Agg …………………………..23
  • 5.   Aching…………………………………………………..30
  • 6.   Anger…………………………………………………….49.
  • 7.   Hurry, impatience………………………………………51.
  • 8.   Hunger…………………………………………………..73.
  • 9.    Bitter……………………………………………………74.
  • 10.   Sweets and dainties…………………………………74.
  • 11.   Hot things………………………………………………74.
  • 12.   Stool insufficient……………………………………….81.
  • 13.   Sweat, in general, easy tendency to………………104
  • 14.   Lower limb……………………………………………..96.
  • 15.   Back, spine and cord…………………………………94.

Repertorisation and Results

Repertorisations done with the help of synoptic-key and repetorial results are as follow-   Lyco 18/8, Nux-vom 16/8, Sulph 15/8, Calc carb 12/8Lach10/6 etc.

Final selection can be made with the consultation of materia medica.

 Case 2 

Smt R Molla aged about 30 year of a middle class family came to my clinic with a respiratory troubles for about 3 years. On careful questioning to the patients and on observation the following characteristics were obtained:-

  • 1.   Breathing difficulty < at night, < on lying while,> by sitting erect.
  • 2.   Recurrent attacks of dry cough with frank bleeding from the mouth.
  • 3.   Chest pain < during cough.
  • 4.   Cough < at night.
  • 5.   Tendency to catch cold easily.
  • 6.   Thermal Reaction-Cold intolerance.
  • 7.   Appetite-Good but easily satisfy from food.
  • 8.   Craving-sour.
  • 9.   Craving-warm food.
  • 10. Thirst-less only during eating.
  • 11.  Bowel-hard irregular 2-3 days interval.
  • 12.  Frequent urging for urination.
  • 13.  Sleep-less.
  • 14.  Dream-dead person, and falling from high places.
  • 15.  Irritable temperament gets anger easily and beat the child.
  • 16.   Weeping disposition < during anger.
  • 17.   Desires to be alone.
  • 18.   Memory weak.
  • 19.   Forgetful. 

Evaluation as per Boger Synoptic-Key

  • 1.   Complaints < at night < lying while > sitting erect.
  • 2.   Tendency to catch cold easily.
  • 3.   Irritable temperament gets anger easily and beat the child.
  • 4.    Weeping disposition < during anger.
  • 5.    Recurrent attacks of frank bleeding from the mouth.
  • 6.   Chest pain < during cough.
  • 7.    Craving- sour.
  • 8.   Thirst-  less only during eating.
  • 9.    Dreams of dead person, and falling from high places.
  • 10.    Breathing difficulty
  • 11.   Dry cough
  • 12.   Affection of chest and lung. 

Conversion of Symptoms to Rubrics with Page No Of Synoptic-Key

  • 1.   Night, Agg.………………………………………18.
  • 2.   Lying, Agg………………………………………24
  • 3.   Position, sitting erect, Amel………………….. 27
  • 4.   Cold, Agg, easily chilled, lacks heat…………20
  • 5.   Emotion, mental excitement etc, Agg………..22
  • 6.   Haemarrhage, bloody discharges, etc……….38.
  • 7.   Weeping…………………………………………54.
  • 8.   Stitches, burning in muscle……………………45
  • 9.   Craving & Desire-sour thing…………………..74.
  • 10.   Thirst, absent, to water……………………….73.
  • 11.   Respiration, difficult, suffocative, etc………  86.
  • 12.   Cough, dry, expectoration without…………   87.
  • 13.   Sleep, dreams…………………………………103.
  • 14.   Chest and lung……………………………………….90 

  Reprtorisation and Results

Repertorisation done with the help of synoptic-key and repetorial results are as follow-Puls 23/9,Phos 17/9,Ars 17/8,Nux-vom 15/7,etc.

Final selection can be made with the consultation of materia medica.

According to Dr S.R.Phatak “Prescribing in Homoeopathy is both science and art”, But it is a difficult art. Good case-taking, sound knowledge of Materia Medica and skilful use of the reference books are the three prerequisites.”

Repertory is a book which contains symptoms index of materia medica and repertorisation is a technique which totally depends upon the quality of the physician. Whatever may be the repertory, evaluation of symptoms is essential (except few condition) and if we are giving the relative value of symptoms then sometimes and even always needs to do eliminating process of repertorisation for wanted as well as required results for a particular cases.

 Bibliography 

  1. Boger C.M. “A Synoptic Key to the Materia Medica”. “Jain Publishers (P) Ltd”.       New Delhi. Aug. 2002.
  2. Hahnemann S. Organon of Medicine,” B. Jain Publishers (P) Ltd”. New Delhi.         1970.
  3. Das A.K.,” Fundamentals of Homoeopathic Repertory” Books $ Allied (P) Ltd. Calcutta, January 2003, P.P. – 366-67.
  4. Harinidhan K.” Principles and Practice of Repertory”.P.P.137-40.
  5. Boger C.M.”Times of the Remedies and Moon Phases. “B. Jain Publishers (P) Ltd”. New Delhi. 1990.
  6. Boger C.M. Studies in the Philosophy of Healing. “Some Thoughts on Prescribing,” B. Jain Publishers (P) Ltd”. New Delhi. 1991. P.P.37-42.
  7. Tiwari S.K.” Essentials of Repertorization,” B Jain Publishers (p) Ltd”, New Delhi.P.P. -75.
  8. Allen H.C.,” Keynotes and characteristics with comparisons” B. Jain Publishers (P) Ltd”, New Delhi. 1990,
  9. Boger C.M.”Bonninghausen’s Characteristics $ Repertory”. “B. Jain Publishers (P) Ltd”. New Delhi. reprint edit 2001.
  10. Kent J.T. “Repertory of the Homoeopathic Materia Medica”, B.Jain Publishers (P) Ltd, New Delhi reprint edit 1993.

Dr.Mohan Giri.
B.Sc (Hons) Bhms (Hons) M.D (Hom).NIH
Lecturer Dept Of Practice Of Medicine.MBHMCH..Howrah..
Ex-Research Fellow.Nih..Ex-Lecturer Nshmch.Bhopal
CELL – +91-9903849895
mail :  drmohan.2010@ rediffmail.com

3 Comments

  1. Dr. Mohan Giri
    Thanks for such an extensive work on the master piece of Dr. Bogar. Congratulations for brilliant explanations.

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