Prescribing for acute cases using Repertorization Chart
Prescribing homeopathic medicines for acute conditions poses a challenge to the homeopath. There is no room for error in such situations. The patient wants immediate relief. He is not interested to listen to our theories but is interested in the result. On the other hand, acute cases provide the homeopath with an opportunity to prove the efficacy of the system and his capability decisively. I am of the opinion that it is more difficult to handle acute than chronic cases. One may not be able to cure chronic cases but can find several excuses to keep the patient from leaving him. But it is not so in acute conditions. If the patient does not find relief, say within 24 hours, he consults someone else, preferably an allopath. The fact that there are so many patents for acute than for chronic diseases indicates that homeopaths in general have failed to deal with acute cases effectively.
I have been researching in the field of acute prescribing for more than 20 years. I have tried to evolve a method which is simple and effective. I am going to present my observations in the following article for the homeopaths to examine and apply in their practice. I would like to add that I have repertorised each and every acute case for the last 20 years. I have repertorised the cases using “SPIRO
”, a punched card set designed by me. It takes less than one minute to repertorise the case using “SPIRO
”. Similar result may be obtained by using the commonly available homeopathic software. One should collect all the relevant rubrics from different repertories and store in one place so that the acute cases can be solved quickly. In order to help the homeopath repertorise acute cases quickly, I am providing a ready-to-use repertorization chart, CLICK HERE TO SEE IT
. with commonly found symptoms and commonly indicated remedies with their grading. One can repertorise acute cases within one minute using this chart. One can judge the accuracy of the chart after applying it in practice.
1. In my opinion, non-repertorization of acute cases is the single most important factor for our failure to cure such cases. All acute cases are accompanied by some sensations, concomitants and modalities. The natures of these symptoms are unique to each individual case. Therefore we can consider them as characteristic symptoms. I consider these symptoms to be very important because they are obvious, easy to collect and the result is excellent. These symptoms occur in different combinations and it is impossible for us to arrive at the remedy by mental repertorization. For example if a patient comes with headache, thirst and averse to motion, an experienced homeopath would prescribe Belladonna and affect a cure. But what could be the remedy if the patient complains of ‘head heaviness’, ‘averse to motion’ and ‘thirstlessness’? How many homeopaths can arrive at Gelsemium by mental repertorization? In order to find an excuse for not repertorizing the case we say that repertorization is not required in acute diseases as the remedy is obvious. But I am of the opinion that the remedy is not always obvious if you go deep into the case. A single symptom like ‘desire for warm drink’ may decide in favor of Bryonia even if the case looks like Nux vomica. Again, in order to avoid repertorization, the homeopaths ignore the above three symptoms and go on asking further until some symptom matches a remedy picture in their memory. But the result is poor and we blame homeopathy for our personal failure. Homeopathy has been branded as a slow acting system for such results. I have observed that a single dose of the correct homeopathic remedy acts with a huge curative force. Sometimes the curative force is so powerful that it creates minor problems for the patient; like rise in temperature, dizzy feeling, loose stools etc. These are often positive signals towards an early cure, but this may create problems if the patient is going to sleep or on a journey. Under such situations I give a dose of placebo to be taken at night and ask the patient to take the remedy in the morning. Observing the action of the homeopathic remedies, some patients have wondered if I was prescribing steroids.
2. Most homeopaths do not repertorise acute cases as I have discussed above. They say that repertorization is required only for chronic cases. If so, why are Materia Medicas and Repertories contain thousands of symptoms related to acute conditions?
3. Each case should be considered afresh. Someone has rightly said that a homeopath should take a case with a blank paper and a blank mind. I have found this advice quite useful. One should use his knowledge of Materia Medica to select a remedy from the group of remedies arrived at after repertorization and not before repertorization.
4. The most important part of a homeopathic prescription is case taking and evaluation of symptoms. If this part is done accurately, 75% of the job is done. Anyone, even a computer can do the rest. But none can help if the case is poorly taken. The best method to learn evaluation of symptoms is to analyze one’s prescriptions and compare the successful ones with the failures. Homeopathy is a system based on individualization and one cannot duplicate the results of others. No definite rules can be set to evaluate the symptoms. But following is a guideline to start with.
I have observed that the following symptoms are important
a) I consider it a great mistake, especially in an acute case, to insist that ‘mentals’ and ‘generals’ are important and ‘common’ symptoms are useless. The point which I would like to put forward is “Homeopathically speaking, a remedy which is incapable of producing common symptoms in its proving cannot cure common symptoms in the patient”. If a patient comes to us for his ‘common cold with sneezing’, we must find a remedy which has that symptom in the proving, even though it is common to find sneezing in a case of common cold. Sometimes I find that even causation may not be important in an acute case.
b) Symptoms spontaneously narrated by the patient are important. The more emphasized or severe, the more important; even if common. If a patient comes to get medicine for his fever and his first complaint is ‘pain in legs’, then I always prefer to select a remedy which is listed under “Pain, leg, fever with”.
c) Straightforward symptoms at the time of prescribing should be considered. I have observed that symptoms which occurred a few hours before may not be important except in few cases.
d) Even if not supplied by the patient, the homeopath should consider the prevailing weather and select a remedy accordingly. The ‘weather’ should not be considered as an eliminating rubric but may be considered as the differentiating factor if several remedies score equal. Some remedies act better in a particular weather. For example cold weather remedies are Ars.alb., nux.v., rhus. tox. etc. and hot weather remedies are Apis.,nat.m., puls. etc. It is my experience that it is easier to prescribe for acute cases during stable weather than when it is changing.
e) The homeopath should preferably see the patient instead of getting symptoms from the attendants. Selecting the remedy often depends on the way the patient enters the room, the way he sits, talks etc. For example, in some acute cases, the patient feels weak suddenly for no apparent reason. His weakness is evident as soon as he enters the consulting room. I find Ars. alb and Bry. to be suitable for such cases. On the other hand I find Puls. to be suitable for cases in which the patient is not so weak. The Puls. children are often active and cheerful in the consulting room. This decision may be made by careful observation only.
f) I have observed that three symptoms are enough to decide the remedy provided that the symptoms are collected and evaluated correctly.
g) The symptoms are not fully developed on the first day of the acute attack. Therefore the remedy acts better if prescribed on the second day, after considering the totality.
A few points about my method
a) I follow a very simple procedure to deal with acute cases. I allow the patient to narrate his feelings in his own words. I never interrupt while he is narrating his symptoms. I invariably find that I can correlate three to five symptoms of the patient with symptoms from the chart and repertorise the case. Some experience is required to select three most important symptoms out of more than ten symptoms supplied by the patient. But it is quite easy. The homeopath has to keep a record and examine the cases which did not yield the desired result and modify his method of observation and evaluation. Some self-study is required to achieve perfection. One should not abandon this method after a few failures. One may have to modify this chart taking into consideration the local conditions. A repertory may be consulted to add new symptoms and remedies.
b) Evaluating effectiveness
: I have learnt from our literature that many great prescribers used only one dose to cure severe acute illnesses. I was doubtful about this in the beginning of my studies. But as my case taking, evaluation of symptoms and repertorization techniques improved, I found that the requirement of dose went on reducing. I considered those cases as my failures that did not produce positive reactions within hours (one to four hours) of taking the dose. The following are some of the positive reactions:
Cases in which this method may fail
- The patient feels much better mentally even though the physical symptoms may sometimes be slightly worse.
- Sometimes there is a rise in body temperature.
- Sometimes discharges set in.
- There is almost 75% improvement within 24 hours and complete cure within 48 hours. I have selected the remedies and symptoms which met these criteria. Cases which took more than 48 hours to cure, I have considered as recovery and not due to the curative action my prescription.
:Some cases like measles, chicken pox, jaundice, tubercular cases, cases complicated by other treatments do not react as per the above way. But such cases are few. Diet and accessory treatments are very important for a speedy cure of an acute case. For some unknown reason I find that consuming rice during fever interferes with cure in my area. Some people in my area cure themselves of fever by avoiding rice only. The food items to be avoided during an illness depend on several factors, like food habits of the person, nature of disease etc. In general, the diet should be light and natural. Sometimes an acute case may not be cured by considering the present totality but by considering the causation. A person falls ill by the action of several causative factors and it is often difficult to pinpoint as to which one is the real cause. Causation is ambiguous but present totality is obvious.
About the CHART
i) The data included in the chart are collected from standard Repertories. I have not included a single data from my experience or the experience of recent authors.
ii) Remedies and symptoms most frequently used in acute conditions are included. The remedies and symptoms for the chart are so chosen that more than 70% of acute cases coming to a homeopath can be solved by this chart. I have found that the success rate of an average homeopath (rapid and gentle cure) is less than 40 %. Therefore I am of the opinion that many homeopaths can improve their success rate by using this chart.
iii) First three symptoms are useful for cases of fever only. But most other symptoms can be considered in any acute case whether it be cold, flu, viral fevers, tonsillitis or any other condition. These symptoms are especially useful to treat viral fevers for which there is no allopathic remedy. One dose of the correct homeopathic remedy has been found to cure the case within a day.
iv) I have chosen the rubrics and remedies based on local requirement. The chart may have to be modified taking into account the local conditions.
How to use the Chart : One can make copies of the chart and use one copy for each case. The sheets can be filed for further study. The homeopath should select three to five symptoms and draw lines horizontally on the row on each symptom. The marking left by the line should be transparent so that the grading can be added up. A marker pen or a sketch pen of suitable color should be used to draw the line so that the row is highlighted. The marks covered by the line should then be added up vertically and the total entered at the box provided below. If the symptoms are selected correctly, one can prescribe the remedy scoring the highest mark straightaway. Sometimes other lower scoring remedies may be considered and prescribed, but most frequently the highest scoring remedy is the similimum. One dose of the remedy in 30c potency may be prescribed.
Aconite nap=Aco, Apis mel=Aps, Arnica mont=Arn ,Arsenic alb=Ars, Belladonna=Bel, Bryonia =Bry, Eupatorium perf=E.pf, Gelsemium=Gel, Ipecac=Ip, Merc sol=Merc, Natrum mur=Nat.m, Nux vom=Nux v, Pulsatilla = Pul, Rhus tox=R tox.
Aggravation ( Becoming worse) = Agg
I am giving an example of practical use of the chart. This case of intermittent fever is from the book ‘Clinical Therapeutics’ by Temple S. Hoyne. Page 357.
The case is as follows
Chill, without thirst, at 10 or 11 a.m.; shaking chill, felt as though water was running down the back, blue surface, shrunken skin; burning fever, great thirst, drinking little at a time, but often, marked prostration, dry parched tongue; little or no sweat, irritable and melancholy…
Dr. T. D. Stow.
I always consider symptoms ‘During, heat’ in cases of all fevers. To solve this case using the chart, put colored lines on the rows ‘Mouth, dryness’. ‘Thirst’ and ‘Weakness with’. Now add up the figures vertically (Click Here for the Figure
). The reading in the ‘Total’ box is Aco.-4, aps.-1, arn.-2, ars.-11, bel.-6, bry.-7, e.pf.-4, gel.-2, ip.-2,Merc.-2,nat.m.-6,nux.v.-6,puls.-4 and rhus. tox.-5. The remedy selected by the author was Ars. Alb 30.
Repertorization was not done by earlier homeopaths as the process was difficult. Even the repertory was not easily available in the market. Therefore, it is possible that some senior homeopaths still do not use or encourage the use of computers. The present generation of homeopaths is lucky to have computers and homeopathic software at their disposal at an affordable price. It is a pity that few homeopaths are using computer to select the remedy.I request all homeopaths to use computers and see the difference it makes in their success rate. All homeopaths following other methods do produce miraculous cures occasionally. But the homeopath prescribing on the basis of the reportorial result produces miraculous results consistently. I do not like to put forward theories to support my view. I can only say that “The proof of the pudding is in the eating