Beware Remedy of Bias
NATIONAL JOURNAL OF HOMOEOPATHY 1996 Nov / Dec Vol V No 6.
Kulay F M.
Cases.
` Cad-s / Puls / Bell
What should be the approach to a case of sickness should seem to be a question easily answered by the principles or theory of a particular therapy. In the Homoeopathic context, however, the question about approach can be truly baffling. Students of Homoeopathy especially the earnest ones, get easily disheartened by the failures of prescribers they never. They even become skeptical about the efficacy of remedies, more so in acutes. There seem to be so many mysteries about interpreting and evaluating symptoms, selecting a remedy, deciding what potency to use, when to repeat or change the remedy or perhaps most importantly, when not to prescribe. Lurking in the mind is also the question of discovering the unity in the apparent diversity found in the ways of arriving at the simillimum such as Boger- Boenninghausen method, Kentian method, causation as the basis of prescribing, or even one stimulating allopathic method. Bell, for high fever, Puls for diarrhoea, Nux-vomica for constipation, various corruptions such as mixing remedies, excessive repetition of doses and so forth.
One wonders if all is really fair in war and love and in Homoeopathy. This is not to cast aspersions on those with whom one may disagree, or whom one may even condemn. In actual practice, the gap seems to widen between theory and its application.
According to theory, the simillimum has to be identified. This is often difficult it not impossible, even in CURABLE cases. We may fail to elicit meaningful information, because that is not always easy! We may fail to understand, let alone appreciate, what a patient may be trying to communicate. This may happen due to many reasons, the worst being our prejudice during case-taking in favour of a particular remedy. This prejudice which focuses our attention on only justifying symptoms and blinds us to others, the symptoms that contraindicate the remedy-of-bias or point to another is a real and frequent obstacle. It is very important to be always on the alert to check this tendency. Given below are two recent cases to highlight this point.
Case 1:
A doctor called me on phone - his daughter had severe menstrual colic. The blood was black, the girl was chilly and anxious. Arsenic he thought and SAW only Arsenic and he almost made me also think of it. On further enquiry, I learnt that she was not restless: she was in fact lying still. One dose of Cadm sulph 200 was suggested. She slept off in ten minutes, woke up after an hour or so and was well. Cadm sulph which has prostration, chilliness, anxiety, black vomit stood like Arsenicum though not known for black menstrual blood but distinguished from Arsenic by absence of restlessness, and amelioration by lying still.
Case 2:
An intelligent amateur prescriber described a 20 months old babys case on the phone. The baby was subject to recurrent attacks of cold and fever. He gave me such details as would make anyone think of Calcarea-carb. He then asked me if it appeared to be Calcarea case. I said yes. Knowing his limitation, he generally refrained from using deeper remedies or handling cases that appear difficult to him. He fixed an appointment with me and brought the child and her parents to me. The child undoubtedly had a few Calcarea symptoms, including the desire for egg. As I went into details while he was listening, it was found that the mother had severe anaemia during the pregnancy and had consumed lot of iron. The child was quite warm, had no particular thirst, two to three pasty stools daily. Before I could write Pulsatilla 1M, single dose in my case diary, he exclamation, Oh you think its Puls! Mark his exclamation, amateur though, I have called him because his profession is not medicine, he could recognise Pulsatilla. This shows he did not miss Pulsatilla because of poor study, but because of his prejudice in favour of Calcarea. He knew Pulsatilla but could not see it. One needs a mystics detachment and a scientists objectivity during case-taking as well as after.
Approach to a case does not end with taking a case well. In fact, the approach begins then, for a well taken case provides only a sound basis for the decisions that follow in treating a patient perhaps over a long time. Principles of Homoeopathy establish the indubitable scientificity of this unique and most reliable system of therapeutics. Grasping the essence of the principles constitutes the first preparatory shaping of a would-be Homoeopaths mind. This scientific grounding has to be made as the foundation of the massive edifice of his subsequent activities as a physician. This knowledge of and insight into the principles, is first reflected in well-taken Homoeopathic case. Other preparatory medical disciplines Anatomy, physiology, Pathology, etc. are essential for a Homoeopath-in-the-making, but they are common basics of all the therapies. Homoeopathy is distinguished from other therapies by its principles.
The practice of medicine represents an art, Homoeopathic prescribing and management of disease is likewise an art. Even in this sphere, a Homoeopaths activity demands a lot of subtlety in observing, data-collecting, evaluation and follow-up. On the level of this art, one can adhere to the rules of the game, knowledge of drug pathogenesis, similimum, minimum dose, prognostic observations determining subsequent medication using repertories intelligently etc. and achieve good results. There is scope for improving this ability until the art of prescribing becomes a fine art as reflected in some of the case reported by masters. .
The galaxy of luminaries in Homoeopathy have left behind Unique historical records preserved meticulously, to report both successes and failures. These laborious and rewarding exercises of learning from the Masters clearly flash certain signals. Next to the principles, the most important preparation of a Homoeopathy is to feel palpably the remedies he has studied and would use. Repertory, of course, is a great help. But its role is that of a refresher-guide, a guide to what was known, was dormant and needed a reviving or refreshing of memory. It does not replace the prescriber. Arsenic Secale, Pulsatilla Cyclamen, Lycopodium Alumina, Phosphorus Bismuth, Colocynth Gnaphalium, Cina Granatum, Natrum mur Calc phos, Lil-tig. One must know the remedies palpably as personalities and not miss Cyclamen for Pulsatilla.
Roughly Secale is a warm Arsenic. Cyclamen is a giver rather than a receiver of attention or sympathy, besides being chilly; Phosphorus retains cold water until it becomes warm, Bismuth vomits it immediately. Alumina is too difficult to picturise and is confused with Lyco, but Alumina would begin to totter if stood with eyes closed. One know Colocynths importance in sciatica and ignores numbness because one does not know or recall Gnaphalium, Granatum, as many others, is a warm-remedy; not only Cina. Lil. tig. is worse consolation like Nat-mur, so is Calc-phos. Prunnis sp. can be missed by Bry. Sinapis is opposite of Coloc in colic, worse bending double, and the list can go on. Ledum is below upward in rheumatism and arthritic complaints, while Kalmia is above downward.
The digression into remedy-difference is made only to highlight the difficulty of grasping remedy-essences and remembering them. ACquiring a remedy-image and fixing it in the mind by principle of Repetition reading again and again even seemingly simple or well-known remedies is the only way, and a repertory comes in only as a refresher.
So, the approach to a case is governed by two preparatory stages:-.
- Knowledge with understanding of principles, and
- As good a knowledge as possible of remedial images. The test of prescribing ability lies in dealing with acutes. An old friend of mine who is no more, a better prescriber than whom I have not met, used to say. Our fresh graduates should deal with chronic cases and the senior man being the more experienced, should tackle only acutes. This is not an exaggeration, really. Truth excites, and make Archimedes run (with its and his) nakedness. Allopathic general practitioners attend the acute of their area and send serious cases acute or chronic to specialists. In the Homoeopathic approach, every step as always, is opposed to the allopaths. Here, prescribing for acute calls for greater expertise or specialist.
But, why so? Time and again I learn of a spoiled case hospitalised. There are reports also of some Homoeopaths directing acutes to allopaths, some from their own limitation, and others camouflage that they deal with more serious matters. It is a travesty that Homoeopaths hold erroneous beliefs themselves;" that Homoeopathy is harmless, that homoeopathy is slow.
A ten years old case of asthma is cured by a Homoeopath in two years. It beats my knowledge of arithmetic how a period of ten years of non-curative treatment is shorter than two years which cured.
A young man comes with high fever, heavy eyelids, and pleads. "Do something quick tomorrow is my paper of LLB" you give him something, he returns in ten minutes. You are alarmed what now?.
He says he came to congratulate you. But why? You have performed magic. I am so well. What can be quicker? My elder daughters toes were stiffly turning inwards. She was in pain. Mag phos 6X - 4 tabs. She was better in 3-4 minutes. Younger daughter was in agony with pain in throat agg. by empty swallowing, could eat solids, agg. drinking. Repertorial analysis took less than two minutes.
- Pain. Throat, empty swallowing Bell (2)
- Pain. Throat, solids amel Bell (0)
- Pain. Throat, liquids agg. Bell (3).
Bell 1M 1 dose relieved her in 8 minutes.
Equally true is the fact that when we fail, we fail miserably and Homoeopathy is laughed at. As hinted earlier, the reason lies in the weakness of the second stage of preparation Drug-study if not both principles and drug-Pathogenesis. That takes one to the problem of studying drugs before using them as remedial weapons.
TO RECAPITULATE : Every step of a Homoeopathic approach must be guided, firstly by the principles which must never be sidetracked: From case taking to prescribing to effecting cure - these principles help. Secondly, a very reliable understanding of remedy images like the principles also, guides every step of a Homoeopaths career. To acquire this ability to spot the remedy, correctly without being influenced by a remedy-of-bias, one has to have as large a remedy-repertoire from the extensive Homoeopathic materia medica as possible. This labour of love is never lost, it help prescribing fast, especially in acutes.
