Keynote and the Pathogenesis
NATIONAL JOURNAL OF HOMOEOPATHY 1998 Nov / Dec VOL VII NO 6.
Dr Mirza Anwer Baig
'Lach / Gels / Stram

Keynotes are actually like a bowl in which the entire ocean of our Materia Medica can be immersed. In other words, keynote is a key, which unlocks the treasure of our Materia Medica. We say Homoeopathy is holistic; so we have to study the patient as a whole, ie his generals, his particulars, his peculiar, strange, rare and uncommon or characteristic symptom. The prescription on mentals alone is not enough many a time and may only give a palliating effect to the minds of the patients, leaving the patient and his prescriber both in delusion that patient is cured. Hence, it is important for the Keynotes of a particular remedy to match with its pathogenesis. The author of the "Keynotes" Dr H C Allen emphasizes this particular point in his preface: the student must compare pathogenesis of the remedy with the recorded anamnesis.

Dr Guernsey has called them Peculiar Symptoms, while Dr Lippe calls them Characteristic/Redline Symptoms. None of them recommend to use them solely or wholly or to strike blindly. Dr B K Sarkar, in his foreword to the Indian edition of Allen's Keynotes, published in 1964 warns: "One thing must be noted here, that this book should not be taken as a substitute for Homoeopathic Materia Medica, but as an indispensable supplement or complement to the latter, to make our work precise & quick."
Keynote may be a better tool for a Homoeopath, but he should not leave his crease and strike blindly for a six.

Case 1:
The patient, my childhood friend, now a surgeon & settled abroad, came to Mumbai two months back, with his family, to settle property matters. We had a family get-together and he cut many jokes. He wanted to leave soon, because of his indifferent health due to Diabetes. After a week, he consulted me saying, "I am in a very bad state. I have developed a very bad carbuncle on the nape of my neck. I have not taken any anti-biotic, since in the past, I had been treated with strong immuno-suppressive medicines. This time I thought you should treat me." On further inquiry, he said he had burning pain with pustular discharge, mild fever and weakness. These details were not enough for me for a prescription. I had to confirm between Lachesis, Hepar-sulph or Arsenic. So, I kept on asking him about his generals and particulars. He replied "The fan is off, as I do not like it and it bothers me. The discharge of pus is large and I want some relief for now". The copious discharge led to Arsenic-album 30 and ruled out Lachesis.

Next morning, he said that the medicine had helped him a little but I could see his agony was the same. When I examined it, it was certainly a carbuncle with scanty purulent oozing, which he had mistaken as a profuse discharge. It was greenish with a bluish, dark and purple congestion around the carbuncle, indicative of a serious kind of infection. A dose of Lachesis 200 was administered immediately and he became felt well the same day. Lachesis aborted the carbuncle and after profuse and purulent discharge, the wound healed in two days without necessitating surgery or antibiotics.

In this case the Keynote was "sensitiveness to touch" that even a draft of air (from the fan) was not tolerable. Other points: his sense of humour and non-stop jokes, one leading to another. Third keynote in this case "wants to talk all the time; jumps from one idea to another, one word leading to another story."
The pathogenesis of Lachesis are abscess, carbuncle, gangrene, etc.

Case 2:
A young boy of 20 yr was brought by his parents from Bhiwandi, with the history that the boy had been for an outing with his friends and was roaming the whole day in the city. When he returned home he was very tired and had a severe headache: ascending from the nape of the neck to the head. He could not hold even a glass of water, which fell down. He could not stand on his legs, started trembling and had to lie down. He was terribly afraid of his condition. The parents consulted a local MD at Bhiwandi and that doctor advised to consult a neuro-surgeon and immediate hospitalization. The parents wanted to consult me before admitting him. I had earlier treated one of their relations.

Actually my wife, Dr Shahida, attended the case and after consulting me, the patient was given a single dose of Gelsemium 200, based on the key symptoms- headache extending to the head, his fright and nervousness, lack of muscular coordination, trembling and weakness. Actually the pathogenesis of Gels is Pseudo-bulbar-palsy; ie its signs and symptoms are exactly similar to the symptomatology of Gels.

Case 3:
A 13-year-old boy consulted me for an undiagnosed and mysterious ailment, not heard in the medical history before.
He was earlier seen by a senior neuro-surgeon, who declared him incurable. On case taking, it was noticed that the boy wanted to talk but was unable to speak. He stammered and exerted himself to speak, twitching his right arm, rubbing his face, as if he wanted to remember something. Then laughed or suddenly got up, as if inclined to walk; he walked fast but trembled. He gave a blank look and laughed or became angry. His mouth drooled with saliva and he did not complain of any pain.

The history revealed that the boy was treated for malaria a month ago and was all right 15 days back. On the day of falling sick, he was lying on the floor when his father commanded him to go down for some purchase. He obeyed his father and again lay down. Later during tuition he made silly mistakes as if he had forgotten everything and then his behaviour became funny. He started putting his legs into the sleeves of his shirt and indulged in various other abnormal behaviour. The boy was treated unsuccessfully by a psychiatrist and then referred to a neuro-surgeon.

I analyzed the case and prescribed Stramonium 1M single dose. The parents were asked to report the next day. The follow-up was encouraging: the boy started walking on his own and his speech was also clearer.
His first MRI taken on 12-6-98 revealed "extensive, ill-defined, non-enhancing white matter lesion in the brain stem and both the cerebral hemispheres as described. Ill-defined, diffuse, hyper intense lesions in the pons, mid-brain and the middle cerebral peduncles. In addition, few more ill defined areas seen in the Lt occipital posterior region. There is no mass effect, no middle shift. The ventricular system is normal."

The Impression: "The possibility of Dysmyelination/ Demyelination is likely. Further Evaluation is necessary."
His serological reports conducted on 16-6-98 at Hinduja Hospital including Gram stain, Myelin Basic Protein, CSF Electrophoresis etc were also normal. MRI Brain, carried out again on 19.6.98 at Jaslok Hospital, revealed; "Diffuse Bilateral fronto-parieto-temporal asymmetric white matter hyper intense lesions with associated Brain stem and corpus callosum hyper intensities, exact aetiology undermined. The possibilities to be considered are:

1. Disseminated encephalomyelitis,
2. Progressive myelo leukodystrophy,
3. SSPE (Subacute Sclerosing Pan Encephalitis)
4. Diffuse vasculitis of undetermined aetiology.

1. History of malarial fever a month back, and the neurological symptoms started about four weeks after the attack of acute bacterial/viral illness.
2. The protein content markedly remained normal throughout first ten days of illness, after the onset of neurological complaints.
3. There was no rise in cell count in his CSF.
4. History of acute onset and his age.

The pathogenesis of Stramonium is that it produces acute Mania. The features continually change from grief to joy and astonishment. If our neurophysicians will study the symptomatology of Stramonium alone, they may get answer of their failures in such conditions. Homoeopathy is for all.
The Keynote in this case was characteristic painlessness throughout.

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