Pitfalls of Keynotes
NATIONAL JOURNAL OF HOMOEOPATHY 1998 Nov / Dec VOL VII NO 6.
Dr Velamkunnel Jinson
'Lyco / Calc-c
Editor's Introduction: These two cases were brought to me directly by Dr Velam Kunnel Jinson. He came in to my clinic carrying a Repertory issue. Why was he carrying this issue I asked him? He told me that he is a PG student and his thesis is on repertory. He found this issue as the best reference point. This was, to me, fulfilling the purpose NJH was born for. Then he inquired if he could submit 2 cases for publication. I read them right away and was able to see their usefulness to demonstrate the Keynotes- advantages and pitfalls. I modified them to demonstrate this effectively.
Case 1: Corns
A 42-year-old businessman, Mr P N consulted me on 28/07/97, for a corn on the [L] heel since 2 years, so painful that he could not even wear shoes.
| Pain | > by walking < pressure > warm application |
On examination: a 3-cm raised conical, uniform & tender plaque of hyperkera- tinisation. No discharge or ulceration.
No other symptoms, except restlessness of hands and feet; constantly moving them.
Occasionally constipation with hard stools, taking long to pass. He was not willing to give more information about his family background, business or other related matters. He said he was a hard working person. At that time, he did not appreciate the importance of mental symptoms in prescribing and resisted giving detailed information.
On 28/07/97, Antim-crud.30, a specific for corns given OD/7 days:
[Editor: Antim-crud = corn, has been fixed in our minds from time immemorial. To fight fixity, we sometimes go to the other extreme! I still remember a case, which has been given in the NJH earlier, where I took the full history, gave the constitutional and all kinds of remedies, while the patient went about screaming with pain, and finally in desperation I gave Antim-crud and lo and behold! The corn disappeared! So sometimes when we do too much jugglery and fail, the words of our seniors come home to us: why do you hunt around for esoteric prescriptions when the simple prescriptions stare you in the face!]
Here in this patient there were 3 symptoms: corn, collaborated by the modality: < walking and constipation. But this was not the right 3-legged stool, and I failed, as seen from the follow-up.
Follow-Up
| Date | Symptoms | Treatment |
| 13/8/97 | Not much change; pain slightly reduced | Ant-crud 30 OD X 7 |
| 27/8/97 | No marked improvement; pain same | Ant-crud 200 OD X7 |
| 05/9/97 | Not much improvement; thinking of discontinuing the treatment |
Life Situation:- He was the second child of a middle class family. He has an elder sister and a younger brother. Both married, and stay separately. His father was a businessman, but never flourished in his business because of his unaccountable expenditure. At the age of 18, he took up his fathers business and made a steady progress. He was in love with a girl, but later he distanced himself because he did not want to marry her. She was from a poor family and also belonged to another caste. He did not have the courage to face the consequences of such a marriage. Later he married another girl. His relation with his wife has been very cordial. He has two sons and one daughter.
He contested for municipal corporation elections 4 times. All the times he lost but he said; "I want to win. I want the power. Nowadays nobody respects you if you dont have money and power. One day I will become municipal Chairman, then I will show these people what I am".
He plans everything in advance. He presumes that everything will go smoothly and his work will be done. But later on he will end up in loss and then depression. He lost so much of money in such pursuits. Once he paid Rs 15000/- as advance for a plot, presuming that he might get Rs2 lakh rupees from another business partner. But he could not manage the money and lost the advance. It happened to him so many times.
Physicians Observations- Apparently, he talks nicely to others but I found him showing a type of rude behaviour. He talked as if I was his subordinate and never showed any kind of respect to others or me in the hospital. -a kind of superiority complex: as if it was his birthright to have the right kind of treatment.
He was always restless; moving his hands and legs constantly. He liked sweets. He had a perpetual frown, whenever faced with difficult questions.
Analysis and Evaluation: Aurum-met, Platina, Silicea, Lycopodium and Phosphorous were the drugs which came to mind after completing the case. But after analyzing the case I felt his over -calculations and mis-calculations were landing him into trouble as well as his superiority behaviour. His love for power was also very marked. So the following rubrics were taken for Repertorisation.
| K 69 | Power, love of : Lyco(1) |
| K 57 | Insolent: Plat(3), Verat(3), Graph(3), Lyco (3), Nux-vom (2) |
| K 69 | Presumptuous: Lyco (1) |
| K 50 | Frown disposed to Hell(1), Mang(1), Lyco(1), Nux-v(1), Stram(1) |
| K 1326 | Stem Hard like Callosities: Sep(3). Graph(3), Ant-c(2), Sil(2), Lyoc(1) |
Now the remedy was clear. A reference to Materia Medica confirmed the drug considering the life situation of the patient. So on 06/09/97 Lyco 1M/1 dose and SL 200/TDS/7 days were given.
Follow-Up:
| Date | Symptoms | Remedy |
| 14/9/97 | GC - better; Corns - pain same, sleep good, appetite good Bowels-regular |
Sac lac 30/tds/15d |
| 24/9/97 | GC - better Pain reduced, Corn turned softer. Sleep good, Appetite good |
Sac lac 30/tds/15d |
| 30/9/97 | Miraculous improvement Skin almost clear. Sleep good, Appetite good | Sac lac 30/tds/15d |
| 7/10/97 | Constipation restarted Sleep good, appetite good. | Lyco 1 M/1 dose Sac lac 30/tds/15d |
| 14/10/97 | Marked improvement in all respects. Difficult to identify that there ever was a corn in his leg. Sleep good, appetite reduced. | Sac lac 30/tds/15d |
Patient was only on placebo for another 2 months, but no recurrence.
Discussion: This case started with a local specific remedy because of the paucity of symptoms, which did not give much relief to the patient. Later, when his mental symptoms were explored, I could select the right constitutional remedy for him. It was given in high potency because the remedy selection was based more on mental plane rather than on particular symptoms.
Impression: As Lycopodium is the chronic constitutional and it is a slow, but deep acting remedy it was repeated cautiously. This case shows that the right constitutional remedy is the choice of drug even if it is a localized condition.
