Utility of time modality in clinical practice Boger’s approach

Dr Asma Munir Sheikh

ABSTRACT
Modalities are the most prominent expressions that patient narrates to the physician during case taking. The time modality is more important than the aggravation and amelioration. It may be general modality or may affect a particular part of the body. In some repertory ailments also comes under causative modality which is key to prescription. Modality play a major role in the differentiation of the medicine as well as reaching to similimum.

KEYWORDS- modalities , Concomitant, similimum, Moon phases

DEFINITIONModality is the circumstances and condition that affect or modify a symptom. It can be-

AGGRAVATION: Aggravation means worsening of the patient due to any circumstances. It is denoted as using symbol “<” or the abbreviation “agg”.

AMELIORATION: Amelioration which gives relief or reduced the intensity of symptoms. It is denoted as using the symbol “>”or abbreviation “ amel”. [1]

The idea of complete symptom was introduced by Dr. Boenninghausen. Modalities are one of the most important components of complete symptoms.[2]. We must consider everything that tends to increase and diminish the equilibrium. Thus being an important component of complete symptoms play a major role in formulating individualization of the patient and selection of medicine.[1]

IMPORTANCE OF MODALITIES AND JUSTIFICATION – Totality of symptom with accompanying factors which modified or which changes to the patient’s equilibrium. “ The modalities is the sole guide to the choice of remedy”. All the modalities help to the individualizing and help to the selection of remedy. [3]

Dr. Boger rearranges the repertory part by giving modalities in each chapter and at the end there is a separate chapter on modalities, conditions of aggravations and ameliorations in this chapter Dr. Boger given the modalities in very detailed manner. While working on BogerBoenninghausen’s Characteristics and Repertory he followed the principle of the totality of symptom which was previously followed by Dr. Hahnemann. Dr. Boger was fully agreed with the idea of what constitutes a complete symptom .

  • Locations                                                                                                                                         
  • Sensation                                                                                                                                        
  • Modalities                                                                                                                                    
  • Concomitant[1]

REVIEW OF LITERATURE:
Modalities are one of the most important aspects of choosing a remedy. They are an essential criterion that enables us to differentiate between remedies. Modalities are the modifying and qualifying factors of a remedy. i.e. what makes someone’s symptoms-Better or worse.

Modality can be assessed in following ways-[7] may apply to weather, movement, activity, time  colour and consistency of discharges, the patient’s sensations, mood, condition; desires and aversions, to foods, thirst, etc

  • ABOUT MODALITIES

Modalities include Causation, Time, Temp, Open Air, Posture, Being Alone, Motion, Sleep, Eating and Drinking, Touch, Pressure, Discharges etc.

 In practice too, one can observe that patient do not mention the relieving factors but always describe the aggravating factors[1].

In Boger’s concept of totality, he gives 1st importance to modalities.

In Boenninghausen’s concept of totality he gives importance to modalities, he evaluates modality as QUOMODO and QUONDO[8].

Boger Says in BBCR- all experienced homoeopaths pay great attention to modality.

Cravings and aversion to various foods furnish some of the most important points in deciding upon the remedy[9].

 H.A Robert says in chapter drug proving we must consider everything that tends to increase or diminish the equilibrium[4].

Boger says in BCR- general or special modalities to the time of day or much importance.

According to M.L. Dhawale amongst the modalities causative factors, predisposing as well as precipitating rank first.[10]

From the standpoint of individualization, modalities assume the highest importance.[1]

  • ABOUT MODALITIES- 

CAUSE

 A full and detailed consideration of causative factors in the genesis of illness is imperative to its control and eradication. Causative factors could be grouped under- 

1) Predisposing, 2) Precipitating and 3) Maintaining[6.].

AGGRAVATION

Aggravating factors at emotional sphere are all- important.

Next in importance are the factors which could be considered to be in the general sphere.

The particular aggravations come last in this group.

AMELIORATION

Ameliorations are considered last as very often the patient has few observations to make on this point, his attention is mostly focused on the aggravating or causative factors. The absence of modalities will suggest to the physician a purely psychic basis for the complaint (provided non-observation is ruled out)[6].

  • RUBRICS ARRANGEMENT IN CHAPTER MODALITY

Under each section (modality for the particular section) are given.

 In chapters modalities along with sensation and locations are given. In many rubrics sensations, conditions and modalities are given in parenthesis. 

E.g- page.no’s- 16,25,50,65,74,81, etc. Causative modalities are also given E.g page no 15,38[1]

  • SPECIAL FEATURES OF MODALITY CHAPTER IN BBCR 

Cases with more modalities can be referred to this repertory.

 Modalities in regards with all types are mentioned.

Each rubric contains sensations and locations apart from modality.[1]

  • MOON PHASES  Dr. Boger became widely known through a large number of learned contributions to homoeopathic literature. German authors and his indefatigable labour in Fever cases with more modalities can be referred to. As it’s taken from Hering’s Condensed Materia Medica This work is authenticated. research work – Times of remedy ,Moon phases , the synoptic key of materia medica. In 

The Times of  Remedies” was mainly based upon Dr. Boger’s own practical observations and long clinical experience.  Dr.Boger has emphasized the importance of “ TIME FACTOR” and “THE MOON PHASES ’’ in the action .[5]

CONCLUSION – Medicine can be selected on the basis of modalities. modalities vary from individual to individual. Boger pays prime importance to Time modalities in the homoeopathic totality of symptoms. In Boennighausen’s characteristic repertory time modalities are present separately in each section.

REFERENCES- 

1.Dr.Boger,C.Conditions of aggravation and amelioration–Boger Boennighausen’s Characteristics and Repertory. Newdelhi: B jain Published pvt.Ltd;Reprint edition 1993

2. Dr.Close,S, Symptomatology.The genius of homoeopathy lectures and essays on homoeopathy philosophy.New Delhi: B jain Published Pvt. Ltd; in 1924 

3. Dr.  Hahnemann S. Organon of medicine 6th edition,Newdelhi;  B jain Published Pvt.Ltd ;1833.

4.Dr. Robert, H.  Drug Proving-The principle and art of cure by homoeopathy ,New Delhi; B jain Published Pvt.Ltd; 1936.

5.  Dr. Boger . Times of remedies and moon phases. New Delhi; B.jain publisher Pvt.Ltd;1996

6.  Dr.Worecester, S. Repertory to the modalities. New Delhi; B. jain publisher pvt Ltd;  1996

 7.    Edwin a. Netby and Thomas and George. An index of Aggravation and Amelioration. New Delhi;B.jain publication Pvt.Ltd; 1993.

8.   Dr. Boenninghausen’s .Therapeutic pocket book; Noida, UP; B jain publisher Pvt.Ltd; 1846

9.DrPhatak,S. Concise repertory of homoeopathic medicine;New Delhi; B jain publisher Pvt.Ltd. Reprient edd.1994                                   

10 .Dr. Dhawale M.  Principles and Practice of Homoeopathy; New Delhi; B jain publisher Pvt.Ltd.1967 

Dr Asma Munir Sheikh
MD Scholar, Department  of  Repertory, Dr. M.P.K  Homoeopathic Medical College, Hospital &Research Centre, Homoeopathy University, Jaipur.

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