Understanding the practical application of relationship of remedies chapter of Boenninghausen’s therapeutic pocketbook

Dr Manish Kumar Tiwari

INTRODUCTION
Relationship of remedies means the similarity or dissimilarity between the remedies. Similarity of the remedies can occur at the general level or local/specific location level.

The Therapeutic Pocket Book at the end has a unique section called “the relationship of remedies” which was published in the year 1846 by the father of repertory, Boenninghausen . This repertory is one of the pioneering works, which can be used in the study of materia medica and at the bedside. Dr J.H. Clarke says – “Therapeutic Pocket Book, is in a sense, the parent of all repertories and analysis of the materia medica”.

An attempt is made to form a repertorization sheet exclusively based on relationship of remedies chapter to ease the repertorization process.

SIGNIFICANCE
Boenninghausen in Therapeutic Pocket Book  wrote about the relationship of remedies, which he called as ‘Concordances’. The word concordance means –The inheritance by two related individuals (especially twins) of the same genetic characteristic, such as susceptibility to a disease.

This is a novel and useful idea, as it gave a better understanding of the drug and points of contact with each other with regard to specific spheres, locations, modalities, tissues, etc.,

Working out these relationships, we can find out the remedy which is likely to follow the previous remedy after it has done its job, though partially. Thus we can find out the remedy that would complement the action of the first remedy, with regard to the case in hand and not by any rigid preconceived ideas.

Though the chapter has immense potentiality in its utility, in education and practice, it is yet to be made use in its full capacity. Most of the physicians do not make its proper use, due to want of adequate attention and understanding of the chapter, which seems as a sort of mystery. This part of the pocket book has helped in solving many chronic cases and especially in their search for the second prescription.

HISTORY AND ORIGIN
This idea of  about “relationships of remedies” was envisaged as early as 1836 by Boenninghausen, but later he found many errors and omissions,  which compelled him to discard it. But once again, he incorporated this in the TPB in 1846, he tried to make it as complete and correct as possible. Boenninghausen  wrote in his preface that he hoped that no one would consider this section useless and superfluous. He says “for myself, who for last fifteen years had made the materia medica pura my chief study as one of the most indispensable works of homoeopathy, this concordance has been of extreme importance, not only for recognition of the genius of the remedy but also for testing and making sure of its choice and for judging of sequence of the various remedies, so as to determine the order of their successive exhibition, particularly in chronic diseases”. It was his analytical mind that he was able to weigh the comparative value of remedies in relation to particular symptom groups.

While referring the materia medica, we must have seen that many authors have appended some sort of relationship of remedies at the end of the chapter in a particular drug, but it was Boenninghausen  who was the first to draw our attention to these relationships. Boenninghausen in his preface gives an idea on the method of gathering data; he kept notes for years on various symptoms, their relationship to each other, and the relationship of remedies to symptom groups. He collected the spheres of action of the remedies in different regions, placed them in different relevant sections of particular remedy whose relationships have been detailed. It is the result of comparative action of the various remedies mentioned in the work and an accumulation of practical knowledge of many years of experience. Later when Allen edited Therapeutic Pocket Book he changed the title from “Concordances” to “Relationship of remedies”.

LAYOUT OF THE CHAPTER
The chapter “Relationship of remedies” deals with 142 remedies, which are given as separate sections. Remedies are arranged alphabetically. Each remedy has 12 headings/rubrics, which correspond to the arrangement of the chapters in “Therapeutic pocket book” , with additions of last three headings namely “other remedies”, “antidotes”, and “injurious”.

They are as follows:

  • Mind
  • Localities
  • Sensations
  • Glands
  • Bones
  • Skin
  • Sleep and dreams
  • Blood, circulation and fever
  • Aggravation – time and circumstances
  • Other remedies
  • Antidotes
  • Injurious
  • Under Arnica and other remedies the full list can be seen.
  • Additional rubrics are elaborated as follows

Other remedies – are those remedies, which have general relationship to the remedy under consideration and not to specific subsection. These mostly belong to polychrest remedies

Antidotes – are those similar remedies, which counteract the excess action of the drug. This can be obtained from the clinical experience. For eg: hepar sulph and merc sol, they have a lot of similarity, hence antidote each other.

Injurious remedies – those which are incompatible or inimical with the remedy under consideration. These are developed from the clinical experience. These drugs have will have similarity at the peripheral level but not at the deep acting level. For eg: Apis and rhus tox.

Originally this chapter was compiled with 121 remedies, later Allen added 21 new remedies and thus in Allen’s edition total number of remedies in the relationship chapter are 142. The gradation of remedies in this section is similar to the previous section that is 5 grades. The remedies in parenthesis are for the critical evaluation. Later many authors have not considered this grade remedies

The medicine having  higher marks is said to be more related with the remedy compared to those having less marks. So it can be taken as 5, 4, 3, 2, 1, – in decreasing order of relation of medicines under a particular remedy.

UTILITY OF THIS CHAPTER
It is the most useful section of the Therapeutic Pocket Book. Even Kent who criticized the method of repertorization, has advocated the use of this particular section.

  1. It can be used for studying the relationship of remedies at various levels – mind, parts, sensation, etc.,
  2. The concordance has been of extreme importance, not only for recognition of genius of remedy but also for making sure of choice of the remedy and for judging sequence of  various remedies, especially in chronic diseases.
  3. It is made easier for the beginners, since polychrests present the most points of contact and an intimate acquaintance with these points will enable them to use these drugs easily.
  4. It helps to find a second medicine, if the first one, does not meet with the expectation in a given period of time.
  5. To find a close running medicine, which can be thought of in future follow-ups, if the picture changes.
  6. Sometimes, a deep acting medicine, though indicated should not be given so as to avoid unwanted precipitation of adverse symptoms; in those cases an analogue can be found with the help of this section.
  7. This section helps to study various relationships of remedies. Kent has suggested a close study of sub headings and medicines listed against them. A remedy which runs throughout in higher marks, bears a definite relationship with a remedy, like aconitum with sulphur, pulsatilla with silicea and kali sulph.
  8. For the solving of one sided diseases where symptoms as well as remedies unfold with time.
  9. Experience shows that related medicines act far more curatively, when administered after each other than the unrelated medicine can do.

WORKING METHOD
When the indicated medicine has helped a little and when there is no further improvement without much change in the presentation, this section can be referred to for finding out a close medicine, which would help the patient.

Under the relationship chapter, look for the remedy first prescribed, then refer to the headings or rubric that could be the main complaint of the patient and use it as the first rubric.

Next, take mind and all other headings one after the other.

Repertorisation can be done in two ways that is total addition method or by elimination method. In elimination method there is total elimination or selective elimination. Here only the first rubric is considered for elimination and the remaining is considered for addition process.

In the repertorisation sheet given below, rubrics and medicines are listed. The row above the rubrics has space for mentioning the eliminating rubric for eg: if the rubric gland is selected as eliminating rubric then number  ‘1’ can be mentioned in the row above gland depicting it to be the first rubric followed by other rubrics in order numerically.

A Case – A viral fever case presented with the picture of bryonia. bryonia was prescribed, which relieved constipation, body ache and headache but the temperature continued and oscillated between 101 F to 103 F., after three days, when there was no further improvement, the case was worked out for a second prescription with the help of this section. So here the ‘ BLOOD,CIRCULATION AND FEVER’ was considered as an eliminating rubric followed by other rubrics in addition method.

  1. blood, circulation and fever
  2. mind
  3. localities
  4. sensations
  5. glands
  6. skin
  7. sleep and dream
  8. aggravations – time and circumstances

“One can ignore the rubrics of glands or skin if the symptoms of the patient do not touch on these spheres, as for instance apoplexy, acute fevers or other related syndromes. But as a whole and especially in chronic diseases the whole relationship must be considered. Of course in such comparisons the rubric pertaining to antidotes is not pertinent.” – H.A. Roberts. 

Repertorial result –

  • Sulphur – 34/8
  • Pulsatilla – 33/7
  • Lycopodium – 25/8
  • Nux vomica – 26/7
  • Arsenicum album – 19/6

on further enquiry, It was found that the patient was thirstless, therefore Pulsatilla 200 was prescribed and after few hours the patient was out of fever.

Difference between relationship chapter in BTPB and BBCR

BTPB

BBCR

Number of remedies – 142

Originally titled as concordances, but later Allen changed it into relationships of remedies

Additions made by Allen

Sub headings – 12

1. mind

2. localities

3. sensations

4. glands

5. bones

6. skin

7. sleep and dreams

8. blood, circulation and fever

9. aggravation – time and circumstances

10. other remedies

11. antidotes

12. injurious

Time and aggravation mentioned together

Number of remedies  -125

Compiled by Boger, title – concordances 

Sub headings – 13

  1. mind
  2. localities
  3. sensations
  4. glands
  5. bones
  6. skin
  7. sleep and dreams
  8. blood, circulation and fever
  9. time
  10. aggravation
  11. related remedies
  12. antidote
  13. inimical given occasionally under antidote

instead of other remedies – related remedies

time and aggravation is mentioned separately

Occasionally remedies in ordinary roman with question mark as 6th grade. Eg: under marum –cam?

As the repertory doesn’t include a list of remedies, the repertorization sheet below is prepared by going through the remedies listed in most of the rubrics in Therapeutic Pocket Book and added. There Is also provision for writing numbers which indicate the hierarchy of rubrics selected for repertorization in a case. 

PATIENT NAME                                    AGE

GENDER        

OPD NO.                                                 IPD NO.     

FIRST PRESCRIPTION –
Rubricselected
Medicines Mind Location Sensation Glands Bones Skin sleep and dreams Blood, circulation and fever Aggravation, time  and circumstances Other remedies Inimical Antidotes Total
Abrot
Ab. C
Abs
Ac.ac
Acetum
Acon
Aesc
Agar
Agn
Ail
All c
Aloe
Alum
Ambr
Am. Carb
Am m
Amyl
Anac
Ant cr
Ant t
Apis
Apoc c
Arg
Arg n
Aran
Arn
Ars
Ars iod
Arum t
Asaf
Asar
Atrop
Aur
Aurum
Bapt
Bar ac
Bar c
Bar m
Bell
Benz ac
Berb
Bism
Bor
Bov
Brach
Brom
Bry
Bufo
Cact
Calad
Calc ac
Calc c
Calc f
Calc p
Calend
Camph
Cannabi
Cannb s
Canth
Caps
Carb ac
Carb an
Carb v
Caul
Caust
Ced
Cham
Chel
Chin
Cic
Cimic
Cina
Cinnab
Clem
Coca
Cocc
Cod
Cop
Coff
Colch
Coloc
Com
Con
Corn c
Coral
Croc
Crotal
Croton t
Cup
Cur
Cyc
Dig
Dios
Dros
Dulc
Dol
Eup per
Euphorb
Euphr
Fer
Fer phos
Fl ac
Form
Gel
Glon
Graph
Guai
Hell
Helo
Hep
Hyd
Hydroc
Hyd ac
Hyper
Hyos
Ign
Iod
Ip
Iris v
Jug c
Kali c
Kali chl
Kali b
Kali brom
Kali carb
Kali nit
Kalmia
Kreo
Lach
Laur
Led
Lil t
Lith
Lob i
Lyc
Mag c
Mag m
Mang
Mar
Meli
Meny
Merc
Merc d
Merc I r
mez
Millef
Mos
Mur ac
Myr
Naja
Nat c
Nat m
Nit ac
Nux m
Nux v
Oleand
Onos
Op
Osm
Oxalic ac
Oxyt
Par
Petrol
Phos
Phos ac
Phyt
Pic ac
Plant
Plat
Pb
Pod
Pru
Pso
Puls
Ran b
Ran s
Rheum
Rhodo
Rhus t
Rumex
Ruta
Saba
Sabi
Salac
Samb
sang
Sars
Sec c
Sele
Seneg
sep
Sil
Spig
Spo
Squ
Stan
staph
Still
Stram
Stro
Sul ac
Tab
Tan
Tar
Tarent
Tell
Thea
Ther
Thuj
Urt
V aler
Verat a
Verat v
Verb
Vio
Vio o
Vio t
Vip
Zinc

LIST OF REMEDIES IN RELATIONSHIP OF REMEDIES CHAPTER OF BTPB (main headings)

  1. Aconitum

40. Carbo veg

79. Laurocerasus

  1. Aesculus

41. Causticum

80. Ledum

  1. Agaricus muscarius

42. Chammomila

81. Lilium tig

  1. Agnus

43. Chelidonium

82. Lithium

  1. Allium cepa

44. China

83. Lycopodium

  1. Aloe

45. Cicuta

84. Magnesia carbonica

  1. Alumina

46. Cimicifuga

85. Magnesia muriatica

  1. Ambra grisea

47. cina

86. Manganum

  1. Ammonium carbonicum

48. Clematis

87. Marum verum

  1. Ammonium muriaticum

49. Cocculus

88. Menyanthes

  1. Anacardium

50 Coffea

89. Mercurius vivus

  1. Antimonium crudum

51. Colchicum

90. Mezereum

  1. Antimonium tart

52. Colocynthis

91. Moschus

  1. Apis

53. Conium

92. Muriaticum acidum

  1. Argentum

54. Croccus

93. Natrum carbonicum

  1. Argentum nitricum

55. Crotalus

94. Natrum muriaticum

       17. Arnica

56. Cuprum

95. Nitrum acidum

       18. Arsenicum album

57. Cyclamen

96. Nux moschata

       19. Arum triphyllum

58. Digitalis

97. Nux vomica

       20. Asafoetida

59. Drosera

98. Oleander

       21. Asarum

60. Dulcamara

99. Opium

       22. Aurum foliatum

61. Euphorbium

100. Paris

       23. Baptisia

62. Euphrasia

101. Petroleum

       24. Baryta carbonica

63. Ferrum

102. Phosphorus

      25. Belladonna

64. Gelsemium

103. Phosphoricum acidum

      26. Berberis

65. Glonine

104. Phytolacca

      27. Bismuthum

66. Graphites

105. Platina

      28. Borax

67. Guaicum

106. Plumbum

      29. Bovista

68. Helleborous

107. Podophyllum

      30. Bryonia

69. Hepar sulfuris Calcareum

108. Pulsatilla

      31. Cactus

70. Hyoscyamus

109. Ranunculus bulbosus

      32. Caladium

71. Ignatia

110. ranunculus sceleratus

      33. Calcarea carbonica

72. Iodium

111. Rheum

      34. Camphora

73. Ipecacuanha

112. Rhododendron

      35. Cannabis indica

74. Kali bichrome

113. Rhus tox

      36. Cannabis sativa

75. Kali carbonicum

114. Ruta

      37. Cantharis

76. Kali nitricum

115. Sabadilla

      38. Capsicum

77. Kreosotum

116. Sabina

      39. Carbo animalis

78. Lachesis

117. Sambucus

118. Sangunaria

127. Squilla

136. Valerina

119. Sarsaparila

128. Stannum

137. Veratrum album

120. Secale cornutum

129. Staphysagria

138. Veratrum viride

121. Seleneium

130. Stramonium

139. Verbascum

122. Senega

131. Strontium

140. Viola odorata

123. Sepia

132. Sulphur

141. Viola tricolor

124. Silicia

133. Sulphuricum Acidum

142. Zincum

125. Spigelia

134. Taraxacum

126. Spongia

135. Thuja

CONCLUSION
Knowledge of Relationship of remedies is very important in homoeopathy. Most of the cases require more than one remedy for their cure, especially in chronic diseases. Experience shows that when related remedies are prescribed we are surer of a cure than when unrelated remedies are given. Boenninghuasen realizing this fact, collected all the required data from the many homoeopathic literature of his time and also his many years of experience in homoeopathic practice compiled a section on relationship of remedies in the Therapeutic Pocket Book. Physicians should devote more time, so that they can use this section for their benefit in practice.

REFERENCES

  1. Tiwari S. Essentials of Repertorisation. 5th ed. New Delhi: B. Jain; 2012.
  2. Siju. P.V. A Reference to Repertories for Homoeopathic students. 1st ed. New Delhi: B. jain publishers; 2007
  3. Boenninghausen: Edited by Allen T.F. Boenninghausen’s Therapeutic pocket book for homoeopathic physicians to use at the bedside and in the study of materia medica. Reprint edition. New Delhi: B. Jain Publishers; 1999.
  4.  R Ahmed Munir. Fundamentals Of Repertories Alchemy Of Homeopathic Methodology. Bangalore: i-Line Publisher; 2016.
  5. Kishore J. Evolution of homoeopathic repertories and repertorization. 1st ed. New Delhi: Kishore cards publication; 1998

Dr Manish Kumar Tiwari
M.D Part II
Department of Repertory and Case taking
Under the guidance of Dr Munir Ahmed R
Government Homoeopathic Medical College and hospital, Bangalore

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