Case Analysis - Hints from Masters
Kasivishwanathan T K.
General Topics / Cases.
` Fago / Caust/ Form
"In analysis of a case, the value of symptoms must be taken into consideration on several points. First, the personality, the individuality of the patient, must stand out predominantly in the picture. While the generals rank the highest in evaluating the case and without generals we cannot find the simillimum, the mental and emotional characteristics have a high value, since these are the true reflections of the man himself. Objective symptoms, those that are seen by the careful observer have more importance in child life than in adult life because through them we see the expression of the childs disposition and desires. We must next take into consideration the nature of the disease and its peculiar types.".
Dr. Roberts
"Selection of the remedy on the basis of the diagnosis may, and probably will fail completely. However the symptoms of the patient are an infallible guide and the more serious the condition, the clear cut are the indications for the remedy. If we allow ourselves to be guided by these symptoms, we shall probably save the patient, even though the remedy selected on the basis of the symptom totality may never have been used under like diagnostic conditions before. The symptoms of location frequently furnish quite characteristic symptoms and they deserve particular attention since every remedy acts more and more decidedly on certain organs. These differences enter into consideration of certain local manifestations, like furunculosis, but it also enters into those types of diseases that localise in certain parts. like gout of the great toe and yet are of systemic origin. These symptoms are pertaining to localization in the right or left side of the body or of certain organs of the body are particularly valuable.".
Dr. H.A. Roberts
Concomitants
"We must gain the knowledge of the concomitant symptoms if we would prescribe Homoeopathically".
Dr. Roberts
"As a group, the concomitants contain many anomalous and peculiar symptoms. They are often so distinctive of a remedy as to render the name of the disease of little moment. Sometimes the affected organ seems overwhelmed by the impact of the disease and the vital powers can find expression through the concomitants only; then they become of supreme importance as the almost sole guide for the selection of that remedy".
Dr. Boger
Dr. Roberts observed "A peculiar and unusual deduction from these concomitant symptoms is that they often illuminate remedies that have never been thought of before in this relationship to the individual case." The concomitants are:-.
"(a) Those attendant symptoms which rarely appear in connection with the leading disease and therefore are found rarely among the provings. (b) those which belong to another sphere of disease than the principal ailment and (c) those which have more or less characteristic signs of the medicine even though they have not before have been noticed in the present relationship or diagnostic group" these should be carefully noted.
H.A. Roberts
"Besides the concomitant symptoms there should be one in which the genius of the remedy should be plainly and definitely portrayed so that it would be immediately noticeable. In considering the strange, rare and peculiar symptoms we must remember the words of Dr. Sherlock Holmes "that which is out of the common is usually a guide rather than a hindrance. That while seemingly confuses the case is the very thing that furnishes the clue to its solution.".
H.A. Roberts
Modalities.
"We must note that every symptoms of note has modifying conditions of aggravation and amelioration as to time of the day, the time of season, the time of the moon: the aggravation or amelioration from thermic conditions; from motion or rest, of the part affected or of the condition as a whole; from lying down or sitting or standing and the positions taken during such conditions, waking or sleeping and the aggravations and ameliorations from such positions and circumstances; the various positions in motion that aggravate or ameliorate; the desires and aversion to eating and drinking, especially in feverish conditions; aggravations from certain foods and drink.".
H.A. Roberts
"I bear in mind the famous lecture of Constantine Hering in which he sets forth the theme how to trace the picture of the disease, his rules being summed up in four words:-.
To listen, to write, to question, to coordinate Dr. Pierre Schmidt in his Art Of Interrogation.".
Chief complaint and auxiliary symptoms.
"Almost every case presents two distinct parts as it were: the part comprising the symptoms of which the patient complains, those which are most annoying to him and most outstanding in his recognition (chief or entrance complaint); secondly those symptoms which he does not recognise as symptoms or which he does not consider worth reporting or does not consider the totality of the symptoms and in order to do so he must give more weight to the other part probably unexpressed without some encouragement from the physician, which is an even more necessary part of the case than the chief complaint because it is that part which manifests more clearly the individuality of the patient and individuality of the remedy to cover the case.
H.A. Roberts
Case 1:
A young woman complained of tension, stiffness of the neck, lameness of her back, particularly between the shoulders and in the nape of the neck, the stiffness causing a pulling sensation of the muscles even into the cheeks. She could not turn her head without distress; bending the body or raising the arms, especially the left, aggravated the condition. It is clear that many remedies cover this chief complaint and it is not enough on which to base your prescription. Upon further enquiry it transpired that she also had leucorrhoea. This symptom is also covered by many remedies and hence in itself it has no value as differentiating symptom. On careful questioning the patient volunteered that her leucorrhoea comes only when sitting; she is absolutely free from it as soon as she gets up on her feet either standing or walking. There is only one remedy which in its provings has developed this characteristic symptom and that is Fagopyrum. We find the other symptoms of the chief complaint are covered by this remedy. In this case the outstanding and peculiar concomitant symptom that apparently bore no relationship to the chief complaint was the leucorrhoea > while standing or walking but < sitting defined the choice of the remedy.".
Roberts
Methods of case analysis.
Dr. Morrison of USA, who studied under Dr. Vithoulkas, has outlined several approaches taught by Dr.vithoulkas with case illustrations under each category to take care of different situations. "In any case there are three types of information available: essence, totality, and keynotes. Essence is three dimensional living image of a patient type which is distinct from other remedies. Totality means mathematical evaluation from a repertory; each symptom is repertorised to find the remedy which covers these symptoms most completely. Keynote is that symptom which when stated by a patient emphatically makes us automatically consider a particular remedy. In any case there may or may not be clear information in any of these areas. We may, for example have a clear totality (which is to say that one remedy clearly covers the symptoms of the case better than any other remedy) but no keynotes or essence. Or in some cases the information may conflict, for example, we see a clear essence of Phosphorus but the totality is equally strong for Sulphur. For this reason it is necessary to have a hierarchical structure to evaluate the cases. That is to say that when we take the information. Or put another way, we must decide which parts of the information in the case we should weigh most strongly in deciding upon the remedy. The major approaches are:-.
- ETK (essence, totality, keynote). Obviously it is the best of all worlds if the case has an essence, totality and keynotes, all pointing to same remedy. This is rare and it is the only one per cent of the cases; when such a case is found results are almost 100 percent curative.
- ET or EK "it is far more common to find a situation in which the essence is confirmed not by both the totality and keynotes but only by one or the other. Such cases are still easy to diagnose and the results are nearly as reliable as when all three types of information point to the same remedy. The cure rate is still 95 percent.".
- TK (totality & keynote).
"A large number of cases fall under this category in which all data point to one remedy and there are keynotes to support that remedy. "There is however nothing distinctive in these cases from the standpoint of essence. The results are still quite favourable with cures in approximately 85 percent of cases. - Essence (E).
"In as many as 20 percent of cases we find a clear essence of a remedy but no confirmation from the data at all. The results are less reliable but still curative in approximately 80 percent of cases". - Totality.
When no essence is found in a case it may still be possible to have the data repertorised to a specific remedy. Results in these cases are curative in only 60 - 70 percent of the cases. - Elimination.
When the totality of a case has been analysed carefully of the most reliable symptoms in the case, two questions can be asked : Which symptoms can I absolutely depend upon? or which symptoms can I eliminate without changing the essential nature of the case? We may eliminate vague or too general symptoms and repertorise the others to arrive at the remedy. - Main complaint.
When a careful analysis does not lead to a satisfactory remedy through the essence, totality or reliable symptoms classification, we may focus on the main complaint of the patient. For example, if the main complaint is headache, we may repertorise the symptoms thoroughly and the remedy emerging therefrom may not fully cover the case. It will give a good beginning to the case and after a period of time the indications for a second and deeper remedy may become apparent. - (a) Recent symptoms.
Here we look at only the recent symptoms. The patients in such a case often complaint that I have not been well since. There may have been a surgery or serious emotional stress or shock which has led to profound change of the symptoms leading to grafting of a new remedy picture to the case. If this has happened we must carefully outline the details of the pathology and be repertorising only those symptoms one can arrive at the remedy.
(b). We can do just the opposite of 8 (a) by focusing attention on a past clear remedy image if the present picture is confusing. - Keynotes.
Three keynotes from different areas of the case. We may come across a case where the totality is confusing, the essence is uncertain, and the most reliable or recent symptoms do not give an answer. In such a situation one can take three keynotes from three different areas, say from food cravings, from pathology and one mental.
Case 2:
Mrs. E. M. aged 35 consulted Dr. Morrison for following complaints :-.
(a) 14 years of terrible allergies in spring. (b) nasal obstruction; (c) very sleepy from fullness in the head and has lost work from sleepiness. (d) amel in open air and in wind (e) mouth gets very dry and the tongue sticks to the roof of the mouth. (f) back pain agg. sitting, caused by ruptured disc 8 months ago. (g) craves beef, chocolate, salt, spicy meat, fruit (h) averse to damp and rainy weather. Puts the feet out of covers and salivates during sleep. (i) rebellious and cant stand injustice (j) major focus on relationships and her unhappiness about not finding the right partner. (k) sex desire high. (i) fears moth and dark.
Analysis.
One sees the symptoms of Causticum and Ignatia but there is nothing to confirm these prescriptions :- for example the patient is worse in damp weather but in Causticum she should be ameliorated; she craves fruit whereas Ignatia patient is averse to it.
However there are certain peculiar symptoms which have to be reckoned while arriving at the remedy. One is the extreme sleepiness and the other is the marked dryness of the mouth and the tendency of the tongue to stick to the roof of the mouth. With these characteristic keynote we are led to prescribe Nux moschata.
It was prescribed and a 2 month follow-up showed that it was the correct prescription. She was less tired, head clear, no sinus trouble, no such sleepiness, mental clarity better, mouth and tongue no longer dry. Emotionally more positive.
Dr. Morrison
10 Keynote essence.
In these cases one sees that the pathology is expressed so strongly in one certain area that it outweighs all other aspects of image presented by the symptomatology. In such case it is only keynote prescribing which will work. Usually the indicated remedy may be a small remedy or unusual substance which has as its main indication a particularly intense and specific type of pathology.
Case 3:
A 61 years old female came for treatment of her arthritis. For the past two years suffered from inflammatory arthritis. It all began with a weakness of grip and suddenly the legs became painful. Could not rise from chair and started dropping things. Wandering joint pains; the painful joint becomes red, hot and swollen lasting for about one day and resolves nearly completely but the process is repeated in another joint. Agg from any movement. She had also chronic pain in the knees and shoulders worse from exertion and while descending stairs but ameliorated from slow motion. She develops swollen lumps on skin which migrates down the limb over the days; these are painful and these occur once or twice a month. The patient is chilly and agg from cold weather. The right eye is bloodshot and swollen and nearly closed much of the time. Sleeps on abdomen and sleep is okay and wakes up refreshed. Craves chocolate, ice cream, fat and sour. Thirsty and averse to sun. Reserved, fears robbers, heights and insects.
Blood report showed markedly elevated ANA but rheumatoid factor was negative.
The patient has a particular form of migratory arthritis not fitting Puls, Kali bich, or Berberis which are best known remedies for wandering arthritis. There is, however, a small remedy which has this precise form of arthritis involving single joints at a time and comes and goes exactly as the patient experienced. That is Formica rufa which was prescribed in 200 potency twice over a 2 month period. The arthritis and vasculitis (skin lesions) and conjunctivitis were resolved and the patient was asymptomatic over 5 years after that.
Dr. Morrison
Sources :-
- Principles and Art of Cure by Homoeopathy -Dr. H.A. Roberts
- Studies in Philosophy of Healing - Dr. Boger
- Methods of Case Analysis - Dr. Roger Morrison - Quarterly Homoeopathic Digest, Dec. 92.
