MODERN CLASSICAL-PRACTICAL PRESCRIBING: METHODOLOGY
NON-SUPPRESSED CASES: CASES WITH CLARITY OF SYMPTOMS:
MTEK is an useful memory aid to arriving at a correct prescription.
M = Miasmatic Totality
T = Totality of Symptoms
E = Essence (should include gestures, postures, behaviours etc)
K = Keynotes (which should encompass PQRS symptoms, refer §153 and §209 of Hahnemann’s Organon)
When the above criteria are considered and the steps below followed, a correct prescription can be made.
Step-I: Make the miasmatic diagnosis of the case, i.e. ascertain the surface miasm.
Step-II: Assess the Totality of Symptoms + Essence + Keynotes and PQRS (if any) of the case and formulate the indicated remedy.
Step-III: Ensure that the indicated remedy covers the surface miasm, as diagnosed in Step I.
Step-IV: Administer the remedy, which encompasses the miasm as well as the Totality of Symptoms.
Make the miasmatic diagnosis of the case, i.e. ascertain the surface miasm. This can be done by:
(a) Head to foot assessment of symptoms (please refer to Miasmatic Prescribing by Subrata K. Banerjea)
(b) Through clinical manifestation of disease, e.g. hypo/scanty/less are psora (e.g. hypotension, atrophy, anaemia etc); hypers are sycotic (e.g. hypertension, hypertrophy, hyperplasia etc.); dyses are syphilitic (e.g. dystrophy, dysplasia etc.) and allergies and haemorrhages are tubercular (e.g. hay fever, menorrhagia etc).
(c) Through psychic essence, nature and character of the individual case (e.g. suspicious, jealous and exploiting in nature represents sycosis; destructive and cruel to animals represents syphilis; stubborn, changeable and impatient natures are tubercular etc.)
(d) We can diagnose the miasm from other, different aspects, e.g. reference to hair falling: alopecia with dry lustreless hair and bran-like dandruff is psora; circular or spotty baldness is sycotic; diffused hair falling is syphilitic, and thick yellow crusts in the hair are tubercular; in reference to taste: burnt is psoric; fishy is sycotic; metallic is syphilitic and taste of pus is tubercular; in reference to pulse: bradycardia is psoric; tachycardia is sycotic and irregular pulse is syphilitic; in reference to bowels: constipation is psoric; diarrhoea is sycotic; dysentery is syphilitic and malaena is tubercular; in reference to pains: neuralgic pains are psoric; joint pains are sycotic; bone pains are syphilitic and pains with exhaustion are tubercular.
(e) Diathesis (tendencies/pre-disposition) can also hint at the miasm: eruptive diathesis is psoric; rheumatic-gouty, lithic-uric acid or proliferative diathesis is sycotic; suppurative-ulcerative is syphilitic and haemorrhagic diathesis is tubercular.
(f) Psoric secretions are watery, mucusy, serous; sycotics are purulent, yellowish; sticky, acrid, putrid and offensive are syphilitic and haemorrhagic secretions/discharges are tubercular.
(g) If you ask your patient what his hobbies are: ‘hunting’ reflects syphilitic taint; ‘travelling’ is tubercular, whereas ‘gambling’ is sycotic.
(h) Ask your patient: ‘If you could take a week off and money would be no object, what would you do?’ Mr. Psora is lazy and will do nothing; Mr. Tubercular will go on a round the world trip! Thereby you understand the innate dyscrasia and miasmatic nature of your patient.
(i) Miasmatic diagnosis can be made from nail appearance; e.g. dry harsh nails are psoric; thick, wavy, ribbed, corrugated, convex nails are sycotic; thin, spoon shaped concave nails are syphilitic and glossy and spotted nails are tubercular.
(j) Miasmatic observation of children: nervous, anxious, constipated children are psoric; restless, hyperactive (ADHD), colicky, diarrhoeic children are sycotic; withdrawn, dull, extremely forgetful, convulsive, dysenteric children are syphilitic and allergic, haemorrhagic, stubborn, impatient children are tubercular.
By such a prescription, which covers the miasmatic dyscrasia of the person, the chances of recurrence are eradicated and the axiom of ‘rapid, gentle and permanent recovery’ (Hahnemann’s Organon §3) is encompassed. In cases of one-sided disease with a scarcity of symptoms, the action of the anti-miasmatic remedy is centrifugal, and by bringing the suppressed symptoms to the surface, allows a proper totality to be framed.
The miasmatic consideration is therefore of great importance as demonstrated in the following example:-
A person is suffering from features of gastric ulcer, which has been confirmed by radiography. As ulceration is syphilitic, the surface miasm is therefore syphilitic also. Let us say that the totality of symptoms (physical, emotional and essence) of the person reflects towards Kali Bichromicum, an anti-syphilitic remedy. The choice of remedy is therefore simple, as Kali Bich covers both the totality of symptoms and the surface miasm of this gastric ulcer case. Kali Bich will peel away the outer layer and reveal a second layer underneath. This second layer may perhaps manifest through the appearance of warts or moles on the face, an indication of suppressed sycosis and the next assessment of the case should include this new surface totality. Following Kentian ideology we now know that there needs to be a change in the plan of treatment, that is, the previous syphilitic plan needs to change to a current sycotic plan, and a new anti-sycotic medicine needs to be selected based on the presenting totality.
Assess the Totality of Symptoms + Essence + Keynotes and PQRS (if any) of the case and formulate the indicated remedy.
Totality of symptoms:
(1) Each of the symptoms must be complete with regard to its location, sensation, modality and concomitant (Subrata’s addition : Cause and onset, duration of the suffering and treatments he/she had in the past.)
(2) The symptoms should have a chronological order of development and progression.
(3) Environmental, occupational and other exogenous influences on the case must be evaluated.
(4) Then the background of the case from (a) the past history (with special reference to various forms of suppressions) and (b) the family history (inherited miasmatic influences), must be in the purview.
(5) The qualitative totality of all the symptoms (outwardly reflected picture of the internal essence of the disease) is the sole indication for the choice of the remedy.
i) Acquaintance with the psychic essences and personification of ‘Drug Pictures’ [e.g. Mr. Lycopodiums are teachers, doctors, successful dictators, and politicians; and their personality characteristics reflect they are careful; cautious; conscientious; conservative; courteous; contained; avoid risk and commitments – Mr. Safe; Mr. Nux Vomicas are CEO, share brokers, salesman, and their personality characteristics reflect they are ambitious, impatient, arrogant, charismatic, aggressive, independent, confident, courteous, workaholics, perfectionists; Mrs. Pulsatillas are nursery teachers, nurses, caregivers and their personality characteristics reflect they are emotional-tearful, moody, changeable, pleasing, perceptive, affectionate, caring, forsaken, worriers; and Miss Phosphorus’ can be artists, actors, receptionists, maitre d’hotel, politicians, and their personality characteristics reflect they are expressive, emotional, social, artistic, impressionable, gregarious, sympathetic and sensitive. period], with modern interpretations of old proving symptoms.
ii) To ascertain a clearer picture for the constitutional medicine ask about the innate nature of the person, for example ‘Give ten words to describe yourself’ and when patient says I am COMPASSIONATE: – e.g. Arg-nit, Bell, Calc, CalcareaPhos, Carcin, Caust, Coccul, Graphites, Ign, Lach, Nat-c. Nat-m, Nit-ac, Nux-v, Phos, Pulsatilla, Sulph; DUTIFUL :- Calc, Calc-I, Carcin.,Cocculus, Ignatia, Kali-ars., Kali-c, Kali iod., Lyco, Nat-m, Puls; EASY GOING :- Ars, Calc, Carc, LiliumTig., Lyco, Mag Mur., Nat-m, Nux-v, Phos-ac, Phos, Puls, Rhus Tox, Sepia, Silicea, Sulph, Thuja; FAMILY ORIENTED :- Acet-ac, Anacardium, Ars, Baryta C., Calc, Calc-I, Calc-sil, Carcinocin, Graphites, Hep, Ignatia, Iodium, Kali Br., Kali Nit., Kali phos., Lyco.,Mag Carb., Nat Carb., Nat Mur., Petr, Phos, PhosphorusAc., Puls, Psorinum, Rhus-t, Sulphur etc. These are modern extensions/ interpretations of old proving symptoms and not found in the Repertory books and Subrata has developed an extensive Repertory of Personality Characters.
CONTAMINATED DRUG DEPENDENT CASES: CASES WITHOUT CLARITY OF SYMPTOMS:
i) In drug dependent cases placing emphasis on Lesser Known Medicines can succeed when well selected remedies fail. E.g. Franciscea, Ginseng, Pimpenella, Stellaria, Viola etc. to open the steroid dependant arthritic cases with few uncontaminated symptoms and absence of clear modalities can prove beneficial; such lesser known organopathic medicines have the capacity to alleviate symptoms to a certain extent, thereby giving the chance to wean off the conventional medication, and experience shows that after 40-50% weaning off, uncontaminated symptoms of the natural disease surface and give scope for constitutional prescribing.
ii) In drug dependent asthma cases, when the patient is on an inhaler and/or steroids; in such cases it is very difficult to get a clear picture of the case. The artificial chronic disease is superimposed on the original natural disease (Aphorsim 91, Organon), therefore symptoms are contaminated or suppressed and the patient cannot give a clear picture e.g., modalities, etc. In such cases, homoeopathic bronchodilators e.g., Aralia Racemosa, Blatta Orientalis, Aspidosperma, Cassia Sophera, Eriodictyon, Pothos Foetidus etc., can be prescribed on the basis of few available symptoms (according to §173–§178, Ref. Organon of Medicine) and gradually the conventional allopathic bronchodilator is withdrawn. Subrata asks the patient to sip the homoeopathic bronchodilator medicine prescribed on the basis of few available symptoms in those drug-dependant asthma cases, therefore considering the partial symptomatic similarity in accordance with §173–§178. So when the patient is out of breath and in need of conventional bronchodilator, he takes the homoeopathic medicine and tries to defer the conventional medicine as much as s/he can. In this way, a steroid dependent patient who used to take steroid/inhaler 8 hourly can, with the help of homoeopathic medicine now defer the steroids to 12 hourly, then 24 hourly and so on. In this way the conventional medication/inhaler etc is gradually weaned off.