Summary of Patient Management Case Taking Case Analysis Totality of Symptoms Susceptibility Miasmatic understanding Posology First Prescription ( Remedy, Potency and Repetition) Followup (Eliciting Remedy Response) Secondary Prescription. 2008, Shilpa Bhouraskar
PQRS according to Organon The striking, singular, uncommon and peculiar( characteristic) S/S should correspond to the selected medicine for cure. Not the general undefined ones which are common in every disease and every drug. eg loss of appetite, headache, debility, restless sleep etc. The medicine with the greatest number and similarity with symptoms of the natural disease is the most appropriate homoeopathic specific.
In Fevers In intermittent diseases A remedy which matches all the 2 or 3 alternating/intermittent states or the strongest best marked alternating state either cold, heat or sweat with its accessory symptom along with one matching the patient's health during intervals when he is free from fever is chosen.
PQRS or Totality of symptoms as developed by later homoeopaths Kentian mentals, physical generals and particulars Boenning Hausen's Grand Generality and complete symptom Boger's pathological generals Allen's Key notes Sankaran's Central disturbance (PNEI axis)
Totality of Symptoms Mental state General state General modalities reaction to heat, cold, noise, light due to nervous sensitivities Changes in Appetite and Thirst Changes in Cravings and Aversions Sleep and Dream functions Sweating patterns, urine and bowel habits and other normal eliminations. Sexual function, Impulses, menstrual function etc Tendencies eg to catch cold, develop warts, allergies etc
Totality of symptoms(contd) Highly characteristic generals without local organic basis eg burning soles at night without any local pathology are a general nervous manifestation, offensive urine without kidney problems are a general metabolic manifestation. Peculiarities of local pathology eg swollen gland aggravated slightest motion.
Rule out obstacles before assessing patient response. Patient Insensitivity to note minute changes. Concerned only about relief of chief complaint. Oversensitivity and exaggeration of symptoms Homoeopath Lack of observation Faulty conclusion
Responses after the first prescription No change in symptoms Aggravation of some symptoms Amelioration of some symptoms Increase in number of symptoms Decrease in number of symptoms Change in order of symptoms
Types of aggravation Homoeopathic Medicinal Disease
Types of Amelioration Partial Complete Understanding three key aspects Herings Direction of cure, totality of symptoms and Miasm
Partial Relief Initial relief followed by aggravation Due to a partial simillimum or Incurable disease.
Partial relief and Partial Simillimums If the Initial short lived relief is locally or pathologically with no relief in general well being and physical generals( PQRS totality). May be followed by a deeper organ pathology in the future( suppression/reverse Hering's Law) This is when the partial simillimum matches vague, common and local symptoms of the case.
Partial relief and Partial simillimum If the Initial relief is both locally and generally but shortlived and there are frequent recurrances inspite of repititions then the partial simillimum covered symptoms of the disease which were peculiar,distinctive and characteristic Uncommon ones but not the miasm.
Incurable case If the relief is short lived inspite of the remedy covering PQRS and miasm then the disease is incurable with irreversible changes or a surgical suppression and a more palliative approach is possible.
Change in order of Symptoms and Hering's Direction of cure More important to less important Above downwards Inside out Center to periphery Reverse order of appearance of symptoms.
7 layers of suppression ( Vijaykar's chart) 1) Ectodermal derivatives eg skin 2) Endodermal derivatives eg Mucous membranes of RS, GIT, UT etc 3) Mesodermal derivatives ( mesenchymal) eg muscles, tendons, blood cells etc 4)Mesodermal derivatives eg parenchyma of lungs, kidneys, heart, blood vessels etc 5) Neuro endocrinal system eg Thyroid, adrenal, hypothalamus, pituitary etc 6) Nervous system Autonomic and Central nervous system 7) Genetic Code eg homoeostasis of cells, miasmatic traits, tendencies etc.
WRONG REMEDY Does not act New symptoms coming up Accessory Symptoms One sided/non onesided diseases Disease symptoms Partial relief, Quick shortlived > followed by relapse of original or worse symptoms. Local relief Both local and general relief
RIGHT REMEDY, WRONG POTENCY Does not act New symptoms come up Prolonged aggravation Final decline/ Killer's aggravation Slow recovery
RIGHT REMEDY, RIGHT POTENCY No <,just > Quick short <,followed by rapid improvement.
When the second prescription is a repetition of the first. If the remedy does not act,re examine case and give another prescription,first Prescription is the prescription that first reacts.. When first prescription is chosen on PQRS, then it acts beneficially and these guiding symptoms are obliterated with only trivial symptoms left. Wait and watch for the action of the remedy to be over. Look for the return of the same original guiding PQRS symptoms.
How long to wait? Depending on the developmental timeline of the disease we must wait an appropriate amount of time to see if the remedy is acting. In an acute injury or emergency this could be only a few minutes, in an acute disease it could be a few hours, and in a chronic disease a certain number of days. In general when treating a chronic disease we must wait at least 7 to 14 days, or more, to see if the dose is acting. David Little
When to Repeat dose? Every striking reaction to the first dose of a homoeopathic remedy precludes the repetition of the remedy until this dramatic response slows down or there is a slight relapse of symptoms. If the dramatic effect lasts for 14 days, and then slows down, the remedy should be repeated every 12 or 13 days just before the relapse of symptoms. If there is only a slow improvement the remedy may have to be repeated at more rapid intervals to speed the cure. In slowly moving cases the remedy may have to be repeated daily or every other day. If there is a moderate reaction the remedy may have to be repeated every 3, 4 or 5 days. In cases that are progressing rather well the remedy may have to be repeated only 1 time a week or so. Some individuals may only need the remedy very occasionally whereas others will need it quite often.
When to change the potency? If case reaches a standstill with guiding original symptoms still covered by this remedy well then this prescription is further repeated at necessary intervals through a range of potencies securing the good from each potency before passing on the next.
When to change the remedy after beneficial first prescription? If the PQRS symptoms have changed in the direction of cure and now new symptoms have emerged not covered by the same remedy. Then this needs a new complementary remedy covering the presenting symptom picture.
Complementary remedies Kent Suppose a little four or five year old child, a large headed, bright, blueeyed boy, is subject to taking cold, and every cold settles in the head with flushed face and throbbing carotids, etc., you say give him Belladonna and Belladonna relieves, but it does not act as a constitutional remedy. He continues to have these headaches, which are due to a psoric constitution, and the time comes when Belladonna will not relieve them ; but upon a thorough study of the case, you find that when his symptoms are not acute, when he does not have this cold and fever, he does not have the headache and you see an entirely different remedy indicated. You study over the flabby muscles, and you find his glands are enlarged ; that he takes cold with every change in the weather, like enough he craves eggs, and you decide that the case calls for Calcarea. Do not give Calcarea during the paroxysm, but after the wire edge has been rubbed off by Belladonna, give him that constitutional remedy that is complementary to Belladonna, which is Calcarea.
Possible reasons for succession of complementary remedies ( Zig Zag cure) Lack of adequate knowledge of remedies. One sided cases which do not unfold before us from the start Multimiasmatic cases where one miasm is submerged under the other and when one is removed the other appears.
Examples of complementary remedies Bacillinum Psorinum Calcarea Belladonna Puls Nat mur Bell Tub Nat mur Calc Nat mur Aurum Calc puls rhus tox calc rhus tox thuja caust kali carb nat mur/lyc lach lyc ars mag phos bell calc med calc phos med thuja ars med thuja nat sulph phos sulphur tub puls graph sil puls sulph tub/thuja
Complementary remedies contd sepia lach lyc sep nat mur lach sep nat mur phos sil puls fluoric acid staph caust coloc staph ignatia plat sulphur calc lyc tub med calc/nat mur tub med thuja calc puls thuja coloc mag phos stannum nat mur aurum carc plat ip staph plat lil tig nux vom staph sil sepia syph aurum nit ac
RIGHT REMEDY, RIGHT POTENCY Partial relief, Quick short > followed by relapse of original symptoms. Local and general Local Does not act