Importance of Boenninghausen’s Approach using Synthesis Repertory in Management of Acute cases

Dr Mona Whatkar

Dr Boenninghausen’s Approach

According to Dr. Boenninghausen a complete symptom has 4 aspects i.e., location [ ubi- seat of disease], sensation, modalities [quomado], and concomitant [ quibis auxilus]

Dr. Boenninghausen’s greatest contribution has been raising particulars sensation and modality to general by analogy on the basis that ‘Man as a whole’ is sick-only expresses through parts [ locations] thus in one stroke he raised all particulars to general level. This was his concept of GRAND GENERALISATION. By this he helped to complete incomplete symptoms in Materia medica as well as in cases. His second important contribution has been the concept of CONCOMITANTS. Concomitants are those symptoms which come along with chief complaint but doesn’t have any relation with chief complaints except time relation.

Following features characterize his approach.

  1. Generalization on grand scale
  2. Prime importance to modalities
  3. High evaluation of concomitants
  4. Importance of physical generals
  5. Use of mentals for

As usually perceived, it is not that Dr. Boenninghausen gave any less importance to mind. In fact, in his lesser writing, he deals extensively on this subject. Acc to him, he preferred not to break them, as they are highly specific. He smartly uses them at the end to clinch the choice of similimum. He also stressed that it is not easy to find mentals in many cases, esp for novice. Mind is also subject to interpretation; hence he relies on FACTS, which are not likely to be modified by interpretation. Factual data is easy to find at physical level.

This ensured safety and reliability, in landing at similimum esp for novice and in difficult cases.

SYNTHESIS REPERTORY
Synthesis has been the most favored repertories of the modern era ever since it first appeared on horizon. The repertory which started its journey as an updated kent’s repertory has now become so much more. Synthesis now included information on nearly all new medicines, clinical information from a variety of established sources, data from works of Hahnemann, Boenninghausen, boger, phatak and many others.

Case

Preliminary data

Name: XYZ Age: 40 yr Sex: male

DOC: 05/05/2022

Marital status: Married Occupation: Construction worker

Chief complaint: Pain in stomach since 4 hrs

Patient was apparently alright 4 hrs back, suddenly started with complaint of severe burning agony in stomach since morning. Patient approached clinic shouting { potat aag lagli ahe, me marto ki kay ata}. Also since morning frothy vomiting twice with constant nausea and sour bitter eructation’s. Unable to retain water n food. On further enquiry got to know patient has consumed deshi daru {alcohol} without food yesterday night. Pain slight better after eating n drinking water.

Associated complaint: Nothing specific Past history: Typhoid at age of 20 yrs. Family history: Mother – diabetic Personal history:

Appetite- normal Thirst- normal

Urine – normal Bowel – once a day Thermal – chilly

Perspiration – Profuse

Mind – Patient was terrorized by suddenness of complaints. Fear of disease, shouting as if he is going to die.

Classification of disease– Acute disease

General examination / local examination:

Poorly built, lean, dark complexion Temp- Afebrile

Pulse- 90/min

Bp- 110/70 mmhg RR- 20/min

Systemic examination:

CNS- conscious and oriented

P/A- Inspection- umbilicus centrally, no distention, no scar or pigmentation. Palpation- mild tenderness at epigastric region, no organomegaly.

Percussion- tympanic except liver dullness Auscultation – peristalsis increased 3-4 /min RS- AEBE clear

CVS- S1S2 heard

Diagnosis: Acute Gastritis Investigation: USG abdomen Analysis:

Location Sensation modality concomitant
stomach Burning as if there is fire2+.

Frothy vomiting

A/F-

Abuse of

Alcohol

Shouting as if he is going to die.

 

Sour bitter

eructation’s

>eating after
Mind/ general Fear of disease2+ Terrorized by suddenness of complaint2+
Profuse perspiration

Evaluation and Repertorial totality:

Evaluation Type/ reason Rubrics
1.    Shouting as if going to die2+ Characteristic mental concomitant with 2 mark intensity Mind – shrieking

Mind – delusion -dying he is

2. A/f – abuse of alcohol Causative factor General – food and drinks- alcoholic drinks- ailments from
3. Sensation burning in stomach as if there is fire2+ Characteristic SENSATION with 2 mark intensity General – pain- burning- as from a burn
4. Terrorized by suddenness of complaints2+  

Common mental symptom with 2 mark intensity

 

Mind – fear – terror

5. Fear of disease2+
 

6.    Frothy vomiting

 

7.    Sour bitter

eructation’s

Common sensation with

2 mark intensity Physical particular

 

Physical particular

Mind – a disease of

impending Stomach- vomiting- type of – frothy

Stomach- eructation’s; type of – bitter sour

Repertorization: