Case processing 1
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Case processing in homeopathy involves analyzing the case, evaluating symptoms, determining the totality of symptoms, performing a miasmatic analysis, and making a homeopathic diagnosis. Analyzing the case involves classifying symptoms as common or uncommon and categorizing them. Evaluating symptoms determines each symptom's significance by ranking different types of symptoms in order of priority. The totality of symptoms reflects the outward picture of the internal essence of the disease based on deviations from the healthy state. It involves considering changes in disposition, mind, physical constitution, and the full symptom picture. Proper case analysis and evaluation are essential for accurately capturing the totality of symptoms and selecting the simillimum remedy.
Case processing 1
- 1. CASE PROCESSING DR. S. FATHIMA MUJAHITHA PG – PART II DEPT. OF REPERTORY
- 2. CASE PROCESSING... • ANALYSIS OF CASE. • EVALUATION OF SYMPTOMS. • TOTALITY OF SYMPTOMS. • MIASMATIC ANALYSIS. • HOMOEOPATHIC DIAGNOSIS.
- 3. ANALYSIS... • Word meaning” examine in order to learn what the separate parts are” • According to Castro” The act of resolving or reducing or breaking the whole in to pieces or groups is called analysis”. • In analysis of the case the value of symptoms must be taken in to consideration on several points. • First the personality, the individuality of the patient must stand out in the picture. • Secondly they should be categorized under subjective, objective, general, common & uncommon symptoms.
- 4. Case analysis is a logical resolving or separating the whole symptomatology into different components and further splitting them into viable units as per their hierarchy. Generally analysis of a case begins with classification of the data collected from the patient into common and uncommon symptoms ANALYSIS OF A CASE – HOMOEOPATHIC VIEW….
- 5. HAHNEMANN’S VIEW… • In the Aphorism 153 states that – ‘ the more striking, singular, uncommon and peculiar (characteristic) signs and symptoms of the case of disease are chiefly and most solely to be kept in view; for it is more particularly these that very similar ones in the list of symptoms of the selected medicine must correspond to, in order to constitute it most suitable for effecting the cure.”
- 6. TO KNOW 1.Whether the case is common or uncommon 2.Can Homoeopathy do something in the given case 3.Whether the case is of indisposition, surgical, acute or chronic 4.Whether the case is curable or incurable 5.Whether the case has more than one or single miasm and requires treatment accordingly. PURPOSE FOR ANALYSIS
- 7. PROCESS IN ANALYSIS… • The symptoms in relation to the chief complaint (s) are put together and should be divided into symptoms which is common to disease and uncommon to disease. • Each component of a symptom has its own importance in relation to the construction of a totality and selection of a remedy. • Therefore, due care is to be exercised while splitting each symptom. • The physician should be able to spot rare, peculiar and striking symptoms in the whole case.
- 8. ON ANALYSING, • The physician can get the following information, • CAUSATION : A/F, PHYSICAL AND EMOTIONAL CAUSATIVE MODALITIES. • GENERAL MODALITIES: AGGRAVATIONS AND AMELIORATIONS, RELATION TO HEAT AND COLD. • CHARACTERISTICS PARTICULARS (MODALITIES, ETC) • RARE, PECULIAR AND STRIKING SYMPTOMS. • CONCOMITANTS. • COMMON SYMPTOMS WITH LOCATION , SENSATION AND MODALITIES.
- 9. HOW TO DO ANALYSIS?? • According to Castro, the symptoms are divided into • common symptoms of disease. • Common symptoms of patient as man. • Uncommon symptoms.
- 10. ACCORDING TO CASTRO, ANALYSIS COMMON SYMPTOM OF DISEASE COMMON SYMPTOMS OF IBS – whitish mucous discharge from anus during stool. COMMON SYMPTOM OF MAN e.g. Weak and anaemic person – irritable, wants to lie down always UNCOMMON SYMPTOMS Weak patient becomes talkative during complaint.
- 11. AFTER PROPER CASE TAKING, ALL THE SYMPTOMS OF THE CASE CAN BE CLASSIFIED INTO TWO GROUPS. SYMPTOMS OF THE PATIENT Symptoms of the disease – PATHOGNOMONIC. Symptoms of the disease helps us to diagnose the disease. Symptoms of the patient – NON – PATHOGNOMONIC. Symptoms of the patient helps us to select proper Homoeopathic medicine or the Simillimum.
- 12. ANALYSIS OF CASE… COMMON SYMPTOMS Symptoms ,which are common to a disease state. Pathognomic common symptom • Is a symptom that is common to a disease state. • They may not be of any relationships they are commonly found in many related disease states. • Help in differential diagnosis. • Eg. Constipation before and during menses, Trembling before stool. UNCOMMON SYMPTOMS These are the symptoms on which prescription has to be based upon. It denote those symptoms which are.. • Peculiar in their nature and character. • peculiar to a few patients suffering from similar disease. • Their basis cannot be explained on the basis of pathology. • They have their basis in the constitutional make up that determine the psychic of the individual. • They usually help in the miasmatic understanding of the case.
- 14. SIGNIFICANCE OF ANALYSIS… • To individualize the case. • For the selection of the Simillimum. • For framing an altogether different totality. • Product of analysis used for the synthesis of a case. • These symptom can be analyzed only if one has complete knowledge of case taking, symptomatology, evaluation and synthesis of case. • This essentiality requires the complete knowledge of the medicine, and of the disease, the expertise by which the symptom belonging to the patient and those of the disease can be differentiated and analyzed.
- 15. CASE PROCESSING… • ANALYSIS OF CASE. • EVALUATION OF SYMPTOMS. • TOTALITY OF SYMPTOMS. • MIASMATIC ANALYSIS. • HOMOEOPATHIC DIAGNOSIS.
- 16. Evaluating of symptoms implies the principle of grading or ranking of different kinds of symptoms in order of priority, which are to be matched with the drug – symptoms. Evaluation of symptoms is a process that determines the significance and importance of expressed symptoms- an external manifestation of the internal essence of the disease. EVALUATION OF SYMPTOMS….
- 17. • The evaluation of symptoms is, perhaps the most important part of the homoeopathic technique and for a beginner, one of the most difficult. • It is a well known fact that all the symptoms in a case are not equally important. After taking the case, a physician comes across quite a large number of symptoms which have to be evaluated in order to arrange them hierarchically. • Basically symptoms are ranked according to their intensity, how deeply they reach into the organism (mental – will and emotional symptoms being considered most important) and according to their degree of peculiarity
- 18. GENERAL RULES TO BE CONSIDERED: • Generals > Particulars • Mental Generals > Physical Generals • Modality > Sensation > Location • Characteristic Symptoms > Common symptom • Causative Modality > Aggravation > Amelioration • Physical General Modality > Physical General > Sensation.
- 19. PHYSICAL GENERAL SENSATIONS AND COMPLAINTS: • Deviations from psycho- physiologic- biologic urges and norms – especially of recent origin. • “Sensation as if” – because of the characteristic nature. • Negative Generals. • Cravings and Aversions – especially recent deviations from the previous norm • Constitution / Diathesis • Sexual Generals • Pathological Generals
- 20. • Predisposing Causes are of a greater value in chronic prescribing. • Precipitating causes are of greater value in acute prescribing. • A strong / characteristic general rule out any number of weak particulars. • Conversely, a characteristic particular/ keynote > any number of weak generals. • A characteristic discharge has an immense prescribing value. • Deviations from normal biological urges, drives, impulses and instincts are of the highest value. • Qualified Mentals > Common Mentals • Concomitants are of the highest value in prescribing.
- 21. TAKE THE MINIMUM SYMPTOMS OF MAXIMUM IMPORTANCE… - DR. WEIR. • MENTAL SYMPTOMS AGGRAVATED OR AMELIORATED BY PHYSICAL GENERAL SYMPTOMS ARE OF VERY HIGH RANKING OR RARE, UNCOMMON, PECULIAR AND STRANGE. • E.G., MENSES < / > ; SLEEP < / >. • LOW GRADE MENTAL SYMPTOMS AGGRAVATED OR AMELIORATED BY PHYSICAL GENERAL SYMPTOMS ARE OF HIGHER VALUE OR GRADE THAN COMMON MENTAL SYMPTOMS. • E.G., MENSES < / > ; WEATHER < / > ; TIME < / > • PARTICULAR SYMPTOMS HAVING AGGRAVATION OR AMELIORATION BY ANY MENTAL GEENRAL SYMPTOMS ARE PHYSICAL GENERAL SYMPTOMS ARE OF HIGHER GRADE THAN PARTICULARS ONLY AND SAME GOES WITH COMMONS. • E.G., HEAT OF FACE ; MENSES < / >, LYING < / > ; WEATHER OR SEASON < / > , ANXIETY DURING ; DIARRHOEA, INDIGNATION FROM ; ANGER AFTER, PAIN IN STOMACH. • ALL PHYSICAL GENERALS < / > BY MENTAL GENERALS ARE OF HIGHER VALUE THAN ONLY PHYSICAL GENERALS. • E.G., APPETITE, WANTING , VEXATION, AFTER.
- 23. DIFFERENT AUTHORS VIEW: • KENT • BOENINGHAUSEN • SPALDING • WHITMAN • ML TYLER • HUBBARD • BOGER
- 24. KENTIAN VIEW: • Prime importance to mental generals • Physical generals including modalities • Characteristic particulars for final stage of differentiation
- 25. SCHEME OF EVALUATION…. GENERAL SYMPTOMS a) Mental general • 1st grade mental _ will (abnormal thinking) / Emotions (abnormal feeling). • 2nd grade - Intellect / understanding (abnormal perception / perceiving). • 3rd grade - Memory. b) Physical generals • 1st grade _ Referring to sexual sphere including menstrual general. • 2nd grade – Symptoms referring to appetite, desires etc. • 3rd grade _ Things affecting the entire physical body, they are off greater importance and may be used as eliminating symptoms. E, g. weather, climate ,bathing etc.
- 26. SCHEME OF EVALUATION… PARTICULAR SYMPTOMS: The symptom which are related to a particular part or organ or functions of the body. • Top grade particular : Which are peculiar, uncommon. unexpected & un accountable e.g. Inflammation with out pain • 2nd grade particular: particulars with marked modality • 3rd grade particulars: Common particulars without any appreciative modality, having diagnostic value only.
- 27. SCHEME OF EVALUATION…. • COMMON SYMPTOMS: This symptoms are common to a particular disease or are found in several patients as a common factor. They are usually of secondary importance and do not play much role in the selection of Simillimum, unless they have peculiar modalities.
- 28. BOENNINGHAUSEN’S VIEW…. Boenninghausen has narrated seven verse or rubrics required to get the complete image of the disease. They are in hierarchy given below: • QUIS (Change in disposition of personality or individuality) • QUID (Nature of the disease) • UBI (Seat of the disease) • QUIBUS AUXILIS (Accompanying symptoms) • CUR (Cause) • QUAMODO (Modalities) • QUANDO (Time) • Boger recommends this totality in BBCR.
- 29. BOGER’S VIEW…. 1. Modalities • Causation, time, temperature, open air, posture, being alone, motion, sleep, eating and drinking, touch, pressure, discharges etc. 2. Mind: • Irritability, sadness, fear, placidity (A feeling of calmness) 3. Sensations: • Subjective symptoms: • Burning, cramping, cutting, bursting, soreness, throbbing, thirst • Objective symptoms: • Demeanor, restlessness, nervous excitability, facial expression, torpor, state of secretions, color abnormality, odor. 4. Parts affected: • Organs, right, left
- 30. SPALDING…. • MENTAL GENERALS. • PHYSICAL GENERALS. • DREAM • SPECIAL SENSES. • DESIRES AND AVERSIONS • MODALITIES. • STRANGE RARE PECULIARS. • PARTICULARS. • OBJECTIVE OR PATHOLOGY.
- 31. HUBBARD…. • PHYSICAL GENERAL • MENTAL GENERAL
- 32. WHITMAN… • MENTAL GENERAL • PHYSICAL GENERAL WITH MODALITIES. • FOOD, DESIRE AND AVERSION • MENSES • STRANGE RARE PECULIAR • PARTICULAR.
- 33. MARGERET TYLER… • MENTALS : WILL, UNDERSTANDING, MEMORY. • STRANGE, RARE, PECULIAR : MAY OCCUR AMONG MENTALS, GENERALS OR PARTICULARS. • PHYSICAL : SEXUAL PERVERSIONS – STOMACH RELATED. • PHYSICAL GENERALS – RELATING TO CLIMATE, POSITION, ETC. • CHARACTER OF DISCHARGES. • PARTICULARS.
- 34. CASE PROCESSING… • ANALYSIS OF CASE. • EVALUATION OF SYMPTOMS. • TOTALITY OF SYMPTOMS. • MIASMATIC ANALYSIS. • HOMOEOPATHIC DIAGNOSIS.
- 35. TOTALITY OF SYMPTOMS… • Some considered Totality of symptoms means all the symptoms of the patient, but Hahnemann used the term “Totality of symptoms” something deeper than that. • Totality of the symptoms in an acute condition is entirely different from that which constitute the totality of symptoms in a chronic condition.
- 36. DR. HAHNEMANN’S VIEW… • “Totality of symptoms is the outward reflected picture of the internal essence of the disease, that is, of the affection of the vital force.” • Hahnemann , in the aphorism § 6 of Organon of medicine, wanted us to perceive the patient in a new perspective. The physician should note only the deviations from the healthy state of the now diseased individual ,which felt by the patient himself, remarked by the those around him and observed by the physician (including the signs) together they form the true portrait of the disease.
- 37. APHORISM § 7… • In aphorism § 7, Hahnemann states that the totality of these symptoms which are the outwardly reflected picture of the internal essence of the disease ,that is, of the vital force must be the sole means by which the disease can be known what remedy it requires. • Hahnemann in his initial practice has taken the entire expression of the patient for the totality and this whole picture should match with that of the similar expression in the MM.
- 38. HAHNEMANNIAN TOTALITY…. • In case of chronic disease, § 210 says – “….. so called corporeal diseases the condition of the disposition and mind is always altered; and in all cases of disease we are called on to cure the state of the patient’s disposition is to be particularly noted, along with the totality of the symptoms, if we would trace an accurate picture of the disease, in order to be able there-from to treat it homeopathically with success.”
- 39. HAHNEMANNIAN TOTALITY…. In addition to this § 94 – “In these investigations, the ascertainable Physical constitution of the patient (especially when the disease is chronic), his moral and intellectual character, his occupation, mode of living and habits, his social and domestic relations, his age, sexual function, etc., are to be taken into consideration.”
- 40. HAHNEMANNIAN TOTALITY…. • § 88 quotes: “ If in these voluntary details nothing has been mentioned respecting several parts of functions of the body or his mental state, the physician asks what more can be told in regard to these parts and these functions, or the state of his disposition or mind; but in doing this he only makes use of general expressions, in order that his informants may be obliged to enter into special details concerning them.”
- 41. Conclusively, The CHRONIC TOTALITY of a true chronic disease becomes clear. That is: Change in Disposition Mind Physical Constitution Totality of Symptoms
- 42. POINTS TO BE CONSIDERED - TOTALITY OF SYMPTOMS… • Take the case not only for the diagnostic purpose, but to bring forth the SYMPTOM PICTURE OF THE SICK similar to the corresponding drug picture in the Homoeopathic Materia Medica. • We must mediate mostly on the GENERALITIES rather than the particulars, so as to consider the uncommon symptoms and the sick individual rather than the disease. • PERSONALITY AND PSYCHOLOGY OF THE PATIENT. • SYMPTOMS WHICH MAKE HIM DIFFERENT FROM OTHERS AND WHICH IS PECULIAR TO HIM. • EACH INDIVIDUAL HAS TOBE KELT IN MIND IN HEALTH, DISEASE AND IN CURE.
- 43. TOTALITY OF SYMPTOMS… • In practical sense, After evaluating the symptoms of the patient, i.e., arranged according to the patient’s symptoms hierarchy, the symptoms are arranged and considered for the selection of the medicine including the constitution, temperament , diathesis , miasm and thermal of the patient. • After arranging the symptoms, all the symptoms of the patient are considered for the totality of the symptoms. • According to the symptoms that were considered for the totality of the symptoms are lead us to next level of case processing to the selection of the medicine. • The selection of the medicine can be repertorial and non – repertorial according to the symptoms of the patient.
- 44. THANK YOU…