CANCER N, Female, 74yrs. From Mahe. A Case of Ca. Ovary who had undergone surgical and radiation treatment a few years back, now with local and distant metastasis. Medicine : Lach 200 on 03-04-06, 14-04-06, 02-05-06 & 01-07-06.
CANCER INVESTIGATION : USG : DATE : 03-01-06 IMPRESSION : –5 cm metastatic nodes in Liver –1 to 4.2 cm multiple metastatic nodes in anterior cardiophrenic fat plane –5.5 x 4 cm irregular mass in pelvic cavity –2 cm lesion in right lateral pelvic side wall –Suspected Lymph node and Rectal involvement. –Prominent PCS on right side.
CANCER INVESTIGATION : USG : DATE : 20-07-06 IMPRESSION : –Ascites –Prominent PCS on right side.
PCO J, Female, 25 yrs, Perambra. USG Follicular Study on 16-12-05 –Multiple small follicles in both ovaries PCO ? –A developing follicle in left ovary. –Re-scan on 21-12-05 : No significant increase in size of follicle. Medicine : Phos CM on 11-03-06 & 22-05-06 USG Follicular Study on 17-06-06 –A developing follicle in left ovary –Re-scan on 21-06-06 : Follicle ( Lt ) 1.5 x 1.3 cm –Re-scan on 26-06-06 : US features suggestive of follicle rupture
PECULIARITIES THE METHOD IS VERY SIMPLE TO UNDERSTAND AND APPLY ONLY THOSE SYMPTOMS WHICH ARE EASILY IDENTIFIED ARE TAKEN INTO CONSIDERATION CLEAR CUT MENTALS ONLY ARE CONSIDERED. ASSUMPTIONS AND BROAD INTERPRETATIONS ARE AVOIDED
PECULIARITIES CONFIRMATION OF EACH PRESENTED OR OBSERVED SYMPTOM IS THE ONLY STRESSING POINT NO NEED OF PHILOSOPHICAL THINKING LESS IMPORTANCE IS GIVEN TO CONFUSING POINTS LIKE HOT AND CHILLY CONSIDERATION AND MIASMATIC DIVISION
PECULIARITIES SELECTION OF MEDICINE IS STRICTLY BY REPERTORISATION CLEAR CUT RULES FOR REPERTORISATION WHICH LEADS EVERY ONE TO A SINGLE SIMILLIMUM EXPLAINS REPERTORIAL RESULT ANALYSIS
THE CONCEPT OF CASE TAKING IS BASED ON HAHNEMANNIAN CASE TAKING ( FROM LESSER WRITINGS- MEDICINE OF EXPERIENCE )
Hahnemannian Case Taking Symptoms which are Constant, Frequent, Strongest, and most troublesome to the patient are the most important ones. Seat, Course and Sensations should be confirmed Confirmation of symptoms by re-questioning after the completion of case taking Omission of assumed etiologies and assumed generals.
Case Taking : Important Points Confirm Each Part of PC Mark Out the Nature, Onset, Progress, and Direction of the Disease in HPC especially in acute diseases Look for Surgically Treated Diseases in HPI, Which Could Be a Prominent Part of Totality. Consider Those Diseases in FH Which Are Considerable for Disease Diagnosis.
HOT OR CHILLY Don’t simply jump into a conclusion whether the patient is hot or chilly You could consider rubrics related to the following points to reach at a conclusion Heat or cold sensation, Clothing, Covering, Air, Fanning, Seasons, Internal & external desires ( Warm or Cold ), Regional thermal modalities.
HOT OR CHILLY If more modalities are directed towards warm, the patient is hot ( < Warm ) else he is chilly ( < Cold ) Even then don’t give undue importance to the thermal factor, and don’t waste much time to define whether the patient is hot or chilly, as it is only a single general symptom Specially note those points which are contradictory – which individualizes the patient
TIME MODALITY Morning:05 AM to 10 AM Forenoon:10 AM to 12 PM Afternoon:01 PMto 05 PM Evening:05 PMto 10 PM Night:10 PMto 05 AM WHAT THE PATIENT POINTS AS NIGHT MAY BE EVENING TIME IN REPERTORY
Difficulties We Face Paucity of Symptoms Many Symptoms Want of Confirmation of Symptoms Time Factor
The Solution Fraction Symptoms in Paucity Synthesize Symptoms in Case of Many Concentrate to Confirm Analyze the symptoms to omit commons. Observe and examine to find out masked fixed symptoms. Investigate to increase the symptom number and to diagnose. Use Every Tool Available to Tackle Time.
Analysis of Symptoms Common Symptom : –Common to most of the diseases and most of the drugs : Rubric with many medicines. Peculiar Symptom : –Peculiar to certain drugs and diseases : Rubric with moderate number of medicines. Reference Rubric : –Rubrics with a minimum number of medicines.
Comparison with Materia Medica Manual Comparison is very difficult because
A Single medicine in materia medica represents many individuals
Comparison with Materia Medica For the same reason, You should not look for Materia Medica symptoms in the patient. Patient symptoms are to be compared with materia medica. Prescription from memory comparison may not yield good result as materia medica is very vast.
Tool for Comparison Repertory –Books. –Software In this method, quick prescription can be made even by book reference as only a few rubrics are taken for repertorisation proper
Steps of Repertorisation Selection of Repertory Rubric Selection Repertorisation Proper Analysis of repertorial result Analysis of remaining symptom
Selection of repertory Selection of repertory on the basis of nature of the disease is an absurdity. Outdated repertories should not be used for repertorisation proper. Special rubrics in each and every authentic repertory could be considered for reference
Modern repertories Synthesis Murphy’s repertory Complete repertory
Rubric selection Number of rubrics selected should be moderate ( below 10 for best result )
Rubric selection Two or more rubrics from the same sphere or chapter should not be taken for repertorisation, unless unavoidable. If selected, two from the same chapter should not be considered for elimination process
Rubric selection Common symptoms should not be considered as such for repertorisation. They may be used in a `synthesized’ form.
Examples of synthesized rubrics Appetite wanting, thirst with Emaciation, general,appetite,good Abdomen, pain,constipation,from Nose, coryza,fever, with Vomiting, general,food,fever,as a concomitant of
Rubric selection Fixed and confirmed particulars should be given more value than assumed causatives and assumed general symptoms( mental or physical )
Rubric selection Symptoms represented in a scattered manner in the repertory should not be considered for repertorisation. ( Eg.. Renal calculi )
Rubric selection Surgically treated symptoms in the past history could be taken as confirmed symptoms. Recurrent regional symptoms should be given more value than presenting regionals.
Nani 73 yrs, Mahe Date : 03-04-06 Rubrics : 1.Female,Bleeding, uterus, metrorrhagia,elderly, women, in 2.Generals,Diabetes mellitus 3.Blood,Hypertension, high blood pressure 4.Skin,Blisters Repertorial Result : Lach : 7/4 Phos 6/4 Sep 5/4 Remaining Symptoms : 1.Hands,Numbness Lach 2 Phos 3 Sep 2.Feet,Numbness Lach Phos 3 Sep 3.Female,Cancer, genitalia,bleeding, with Lach 4.Female,Cancer, ovaries Lach 2 RUBRIC SELECTION : CASE EXAMPLE
Rubric selection `Hot and chilly’ fractions & `side’ symptoms should be grouped or synthesized to make a sensible combination
Rubric Selection in Acute Diseases Every Confirmed part of PC could be considered for repertorisation Symptoms with similar meaning should be omitted Course of the symptoms may easily lead us to the simillimum Relating the disease to the age of the patient and season may help us in cases with paucity of symptoms.
Kunhamina, 46 yrs.Date : 15-03-07 Rubrics : 1.Bladder,Urination, general,frequent,daytime 2.Urine,Sediment,purulent 3.Bladder,Urging, to urinate, sudden,hasten must or urine will escape Repertorial Result : Staph 3/3 ACUTE : CASE EXAMPLE
Nimitha, 5 yrsDate : 18-04-06 Rubrics : 1.Bladder,Urination, general,painful,children, in 2.Urine,Sediment,purulent 3.Urine,Bloody 4.Bladder,Urination, general,painful,fever, as a concomitant of Repertorial Result : Nux-v 6/4 ACUTE : CASE EXAMPLE
Nihal, 5yrsDate : 15-03-07. Rubrics : 1.Urine,Sediment,purulent 2.Urine,Bloody 3.Bladder,Urination, general,painful,children, in 4.Bladder,Urination, general,frequent,daytime,and night Repertorial Result : Sars 6/4 ACUTE : CASE EXAMPLE
REPERTORIAL RESULT Evaluation & Interpretation
CRITERIA OF A GOOD REPERTORIAL RESULT A minimum number of competing medicines Related medicines
Number of medicines Less than five is the best Many medicines with almost similar coverage-results from repertorisation of common symptoms.
Related medicines Rr containing inimical medicines is the best Rr containing complimentaries is next Rr with antidotes is last Rr with unrelated remedies- least
First method By studying the symptomatology of each and every medicine under the repertorial result in the Materia medica and finding out the most similar one based on the symptoms present in the case.
Demerits Tedious and Time consuming. Each case presents a fraction of symptoms of a medicine. Comparing the whole medicine as found in Comparative materia medica is very easy but comparing fractions seem difficult Reading the drug pictures of similar medicines yields nothing but confusion.
Second method By preparing a list of all the remaining symptoms of the case other than those taken for repertorization and analyzing the repertorial result by referring for these symptoms in the repertory or materia medica.
Merits Takes less time Yields a confident result.
Verifying rr One among the medicines in rr will cover all or almost all of the rubrics under the list of remaining symptoms. If not, it reveals that there occurred some error in our repertorisation. ( Rubric selection error, Interpretation error, repertory error or mechanical error )
Biju 29 yrs.Date : 03-11-06 Rubrics : 1.Generals,Diabetes mellitus 2.Coughing,Chronic 3.Mouth,Saliva,frothy 4.Food,Appetite, general,increased, hunger,weakness with Repertorial result : Phos 8/4 Sulph 7/4 Remaining Symptoms : 1.Eyes,Inflammation,general,recurrent : Sulph 2 2.Food,Pungent, things,desires : Phos Sulph 3.Food,Salt,desires : Phos 3 Sulph 4.Coughing,Morning,waking, on : Phos Sulph VERIFYING RR : CASE EXAMPLE
Reg. No. :25609 Date :18/07/06 Name :RAge :23 Rubrics : 1.Stomach,Pain,general,fasting, while 2.Rectum,Urging,eating after 3.Vision,Dim,evening 4.Food,Salt,desires Repertorial Result : Anac 5/3 Nit-ac 5/3 Caust 4/3 Sulph 3/3 Remaining Symptom : 1. Vision, dim right : Sulph VERIFYING RR : CASE EXAMPLE
Reg. No. :25609 Date :23/08/06 Name :R Age :23 Rubrics : 1.Stomach,Pain,general,fasting, while 2.Eyes,Pain,general,rubbing,amel 3.Rectum,Urging,eating after 4.Food, salt, desires Repertorial Result: Caust-6/4 Remaining Symptoms: 1.Eyes,Pain,general,pressure,amel Caust2 2.Eyes,Pain,sand, as from,general Caust3 3.Eyes,Pain,side,right VERIFYING RR : CASE EXAMPLE
Repertory Errors Inclusion errors : Non inclusion of medicines under sub-rubrics in the main rubric. Duplicate representation of rubrics in different chapters with different medicines Representation of symptom in fractions
MEDICINE SELECTION In Chronic diseases, unless the situation is very acute and demands an acute remedy, the constitutional medicine is the best medicine of choice. For Eg. In a case of asthma, the medicine which covers the symptoms of acute phase may not give you the desired result.
Reg. No. :27195Date :13/01/2007 Name :A Age :5 Rubrics : 1.Food,Pungent, things,desires 2.Nose,Sneezing, general,morning 3.Nerves,Convulsions, general,fever, during the Repertorial Result: Caust-6/3 Nux-v-6/3 Nat-m-5/3 Sep-4/3 Ars-3/3 Remaining Symptoms: 1.Food,Salt,desires Caust 2 Nat-m 3 2.Nose,Sneezing, general,paroxysmal Nux-v Nat-m 2 Prescription : Nat.m CM/1d 13-01-07 13-02-07 Dyspnoea >, Pain in thigh-right severe, since 1 day Coloc 30 sos MEDICINE SELECTION : CASE EXAMPLE