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:

Probable remedy: Nux vom, Apis, Veratrum alb

Indicated remedy: Nux vomica

Prescription: Nux Vomica 200 in water x half hourly

Follow-up chart:

F/U	Patient in general	Symptomatic relief	Prescription
6/5/2022	Better	50% pain better No vomiting	Nux Vom 200 x 2 hrly x 1 day
7/5/2022	Better	70% better Can retain food	Nux Vom 200 x TDS x 4day
12/5/2022	Good	95% better Appetite increased, intermittent burning pain > by eating	Nux Vom 200 x BD x 4 days SL 200 x BD x 15 days
28/5/2022	Good	Occ burning pain > eating	Nux Vom 200 sos Sl 200 x BD x 20 days

Discussion:
Patient came with acute abdomen pain and was in panic state. Physician was in dilemma whether to treat or not, as patient was terrorized by sudden onset of pain which looked like an emergency but after knowing cause and observing the sign and symptoms it was diagnosed as acute gastritis. On the basis of observation and listening to patients’ reaction, the case was repertorized and Nux Vom was the only remedy covering not only physical symptoms but also mental symptoms. Thus, Nux Vom was prescribed half hourly in water, which relieved the patient of his panic state within no time.

Summary
Boenninghausen’s approach helps in understanding the case with a different perspective and also gives confidence that with whatever factual data available can be utilized to give results. The result helps in gaining patients confidence.

Boenninghausen never advised to ignore mind but he gave a different way to enter the core of patient.

H A Robert says, “For a brief and comprehensive classification of homeopathic symptomatology for therapeutic purpose, no plan has ever been devised superior or equal to that of Boenninghausen”.

While repertorization of cases using Dr. Boenninghausen’s approach from synthesis repertory the chapter general was extensively made use of because symptoms were generalized. Acc to Dr. Boenninghausen there are no particulars but only generals. Boenninghausen followed the Hahnemannian theory that it is patient who is sick not his head, nor his eyes, nor his heart.

Every symptom that refers to a part may be predicated of the whole man.

Difficulty we face, was only finding the generalized sensations. If not present in general chapter they were referred to particular chapters. Otherwise, synthesis is very user-friendly repertory with constant upgradations which are available online.

The strength of various different methodological approaches, each of which spawned their own repertories, have traditionally led to a prevailing wisdom which stipulates that certain types of case are best suited to certain methods and repertories. For example, a case consisting of mainly mental/emotional and general symptoms suits kent’s approach, a case of physical generals well defined by modalities and concomitants. Boenninghausen’s and a case with lots of physical generals, but not many individualizing features, Boger’s or phatak’s.

The information in a kentian style repertory has the quality of uniqueness, but is more or less limited to complete symptoms drawn from proving, while the information in a Boenninghausen- style repertory is more generalized and not constrained to complete proving symptoms. Prevailing dogma dictates that one should use either one method or the other, but in practical terms there seems little reason why that should be the case or why both approaches – and many other- shouldn’t be incorporated into a single repertory, doing away with the artificial polarizations evident in the perception of different methods. So decided to give it a try.

References

1. Allen F. Boenninghausen’s Therapeutic Pocket Book for Homoeopathic Physicians to use at the bedside and in the study of the Materia Medica. Low priced edition. 2006
2. Von Boenninghausen C.M.F. Lesser writings with Therapeutic Hints translated from the Original German by L.H. Tafel. 1^st Indian Edition New Delhi B. Jain Publishers{p} Ltd. 1979
3. D’Castro J. Benedict. Logic of Repertories. New Delhi B. Jain publishers [P] Ltd. Edition 1994
4. Schroyens Frederik. Synthesis Repertorium Homoeopathicum Syntheticum Edition 9.1. New Delhi, B. Jain Publishers[P] Ltd. Indian Edition 2006
5. Desai Bhanu D. How to Find the similimum with Boger- Boenninghausen’s Repertory, New Delhi B. Jain Publishers Pvt. Ltd. Reprint 1987.
6. Harrison R. Harrison’s Principles of Internal Medicine, Vol-1, 18^th Mc- Graw- Hill. Companies, Inc. 2012
7. Roy S.P. Repertorization of Acute cases with Boger – Boenninghausen’s Repertory. The Homoeopathic Heritage, Pg.- 69,70,71. Feb 1991.
8. RADAR Version