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INTRODUCTION TO A SIMPLE METHOD OF PRESCRIPTION Dr.K.SAJI. MD(Hom)

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Presentation on theme: "INTRODUCTION TO A SIMPLE METHOD OF PRESCRIPTION Dr.K.SAJI. MD(Hom)"— Presentation transcript:

1 INTRODUCTION TO A SIMPLE METHOD OF PRESCRIPTION Dr.K.SAJI. MD(Hom)

2 STATISTICAL ANALYSIS OF 279 CHRONIC CASES EXPECTED CLINICAL RESULT

3 CASES UNDER STUDY NO OF CASES DURATION/REG.NO.CHRONIC%ACUTE% 100011-07-06 TO 27-09-06 REG No.25000 TO 25999 5795842142

4 CHRONIC CASES – FOLLOW UP FOLLOW-UPCASESPERCENTAGE ADEQUATE27948 MINIMUM11320 NIL18732 TOTAL CASES : 579

5 CHRONIC CASES – CLINICAL RESPONSE TOTALPOSITIVE%NEGATIVE% 279220795921

6 SUCCESSFUL PRESCRIPTION PRESCRIPTIONCASESPERCENTAGE 1 ST 19086 2 ND 2210 3 RD 502.3 4 TH 200.9 5 TH 100.5

7 No.MEDICINESNO. OF CASESPERCENTAGE 1SULPH4520 2PHOS2913 3NAT-M2612 4CALC209 5SEP178 6GRAPH63 7LACH63 8NIT-AC63 9NUX-V63 10PULS63 11BRY52.2 12SIL52.2 13CAUST41.8 14LYC41.8 15THUJ41.8 16ARS31.4 17MEZ31.4 18OTHERS2512 MEDICINES IN 220 CASES WITH POSITIVE RESPONSE

8 MEDICINES IN CASES WITH POSITIVE RESPONSE TOTAL CASES : 220 TOTAL MEDICINES: 38

9 MY CASE EXAMPLES

10 HYPERCHOLESTEROLEMIA K, Male, Age 42, from Perambra Serum Cholesterol on 25-05-06 : 230 mg % Prescription : Lyco CM on 30-05-06 Serum Cholesterol on 03-07-06 : 145 mg%

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13 HYPERCHOLESTEROLEMIA N, Male, Age 58, from Perambra. Serum Cholesterol on 17-02-06 : 227 mg % Prescription : Phos 50M on 17-02-06 Serum Cholesterol on 06-04-06 : 166 mg%

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16 HYPERCHOLESTEROLEMIA S, Male, Age 32, from Paleri. Serum Cholesterol on 22-06-06 : 264 mg % Prescription : Nux-v CM/1d on 22-06-6 & 10-08-06 Serum Cholesterol on 22-08-06 : 198 mg%

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19 UTI S, Male, Age 39, from Perambra. Urine : R/E : Pus cells 45-50 on 30-04-06 Prescription : Sep 10M 0n 30-04-06 Urine : R/E : Pus cells 2-4 on 02-05-06

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22 UTI M, Female, Age 39, Perambra. Urine : R/E : Pus cells 20-30 on 10-06-06 RBC 8-12 Prescription : Sep 1M/1d on 10-06-06 Urine : R/E : Pus cells 5-8 on 14-06-06 RBC 1-2

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25 UTI N, Female, Age 5, from Perambra. Urine : R/E : Pus cells : 8-12, on 18-04-06 RBC : 0-1 Prescription : Nux-v 1M/1d on 18-04-06 Urine : R/E : Pus cells : 0-2, on 22-04-06 RBC : Nil

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28 UTI K, Female, Age 5, Kuttiadi. Urine : R/E : Pus cells : 50-80, on 15-03-07 RBC : 8-12 Prescription : Staph CM/1d on 15-03-07 Urine : R/E : Pus cells : 8-12, on 17-03-07 RBC : 3-5

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30 UTI N, Male, Age 5, Perambra. Urine : R/E : Pus cells : 16-18, on 15-03-07 RBC : 0-1 Prescription : Sars 10M/1d on 15-03-07 Urine : R/E : Pus cells : 2-4, on 17-03-07 RBC : Nil

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33 NEPHRITIS B, Female, Age 64, from Perambra. 11-02-06 : Blood Urea : 49 mg % Serum Creatinine : 1.5 mg% Prescription : Lyco 1M/1d on 11-02-06 23-03-06 : Blood Urea : 30.7 mg % Serum Creatinine : 0.94 mg%

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38 JAUNDICE S, Male, Age 23, from Perambra. Serum Bilirubin 15-11-05 : Total : 2.50 Direct : 0.56 Prescription : Nux-v CM/1d on 15-11-05 Serum Bilirubin 20-11-05 : Total : 0.78 Direct : 0.36

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41 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.

42 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.

43 CANCER INVESTIGATION : USG : DATE : 20-07-06 IMPRESSION : –Ascites –Prominent PCS on right side.

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47 DIABETES MELLITUS B, Male, 29yrs, Perambra. RBS on 03-11-06 : 420 mg% Medicine : Sulph 10M/1d on 03-11-06 PPBS on 08-11-06 : 332 mg% RBS on 22-11-06 : 192 mg% RBS on 07-12-06 : 160 mg% RBS on 22-12-06 : 129 mg% RBS on 20-01-07 : 107 mg%

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54 AZOOSPERMIA J, Male, 33yrs from Thiruvananthapuram Clinical Findings : –Azoospermia. –Bilateral varicocele –Bilateral small testes with atrophic changes –Spermetogenic maturation arrest on testicular biopsy. Medicine : Sepia CM/1d on 05-01-07 Sperm count on 03-02-07 : 3 millions/ml Sperm count on 16-03-07 : 28 millions/ml

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59 CYSTIC OVARY S, Female, 31yrs, Perambra. USG Report on 05-01-07 –Rt Ovarian Cyst. Endometriotic ? –Bilateral Renal calculus with mild hydronephrosis. Medicine : Lach CM/1d on 05-01-07 USG Report on 02-02-07: Normal Study.

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62 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

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67 CONDUCTIVE DEAFNESS Danish 11yrs, Perambra. Audiogram :21-11-05 :PTA Rt :41,Lt :36 Medicine : Merc sol 50M/1d on 03-12-05, 09-02-06. Audiogram :26-01-06 :PTA Rt :38,Lt :38 Audiogram :11-04-06 :PTA Rt :21,Lt :23

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74 DETAILS OF THE METHOD OF PRESCRIPTION

75 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

76 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

77 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

78 CASE TAKING

79 THE CONCEPT OF CASE TAKING IS BASED ON HAHNEMANNIAN CASE TAKING ( FROM LESSER WRITINGS- MEDICINE OF EXPERIENCE )

80 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.

81 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.

82 OMISSION OF CONFUSING POINTS IN CASE TAKING

83 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.

84 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

85 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

86 Difficulties We Face Paucity of Symptoms Many Symptoms Want of Confirmation of Symptoms Time Factor

87 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.

88 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.

89 Comparison with Materia Medica Manual Comparison is very difficult because

90 The Patient represents a single individual

91 A Single medicine in materia medica represents many individuals

92 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.

93 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

94 Steps of Repertorisation Selection of Repertory Rubric Selection Repertorisation Proper Analysis of repertorial result Analysis of remaining symptom

95 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

96 Modern repertories Synthesis Murphy’s repertory Complete repertory

97 Rubric selection Number of rubrics selected should be moderate ( below 10 for best result )

98 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

99 Rubric selection Common symptoms should not be considered as such for repertorisation. They may be used in a `synthesized’ form.

100 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

101 Rubric selection Fixed and confirmed particulars should be given more value than assumed causatives and assumed general symptoms( mental or physical )

102 Rubric selection Symptoms represented in a scattered manner in the repertory should not be considered for repertorisation. ( Eg.. Renal calculi )

103 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.

104 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

105 Rubric selection `Hot and chilly’ fractions & `side’ symptoms should be grouped or synthesized to make a sensible combination

106 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.

107 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

108 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

109 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

110 REPERTORIAL RESULT Evaluation & Interpretation

111 CRITERIA OF A GOOD REPERTORIAL RESULT A minimum number of competing medicines Related medicines

112 Number of medicines Less than five is the best Many medicines with almost similar coverage-results from repertorisation of common symptoms.

113 Related medicines Rr containing inimical medicines is the best Rr containing complimentaries is next Rr with antidotes is last Rr with unrelated remedies- least

114 RELATIONSHIP OF REMEDIES

115 Inimicals Maximum similarity. Eg. –Rhus-t, Apis –Phos, Caust –Calc-c, Bar-c –Psor, Sep –Bell, Dulc –Merc sol, Sil.

116 Antidotes Moderate similarity eg. –Bell, Hep –Borax, Cham –Canth, Apis –Graph, Nux –Ipecac, Ars –Nat mur, Phos

117 Complimentaries Similar with cotradictory modality eg. –Rhus-t, Bry –Ars, Phos –Lach, Lyc

118 Jinuraj 33yrs, Date : 05-01-07. Rubrics : 1.Male,Varicocele, spermatic cord 2.Sleep,Position,side, on,left 3.Rectum,Constipation general,chronic 4.Nails,Discoloration,fingers,white,spots 5.Hands,Warts,back of hand Repertorial Result : Sep 6/5, Sulph 6/4 Remaining Symptoms : 1.Sleep, Snoring : Sep Sulph 2 2.Rectum, hemorrhoides, painful : Sep Sulph RR : RELATED MEDICINES : CASE EXAMPLE

119 Methods of Analysis of Repertorial Result

120 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.

121 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.

122 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.

123 Merits Takes less time Yields a confident result.

124 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 )

125 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

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127 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

128 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

129 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

130 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.

131 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

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133 Reg. No. :26481Date :07/11/2006 Name :SAge :40 Rubrics : 1.Lungs,Asthma, general,dust, from inhaling 2.Blood,Hypertension, high blood pressure 3.Face,Discoloration,colors,brown,spots Repertorial result : Kali-c 4/3 Remaining symptoms : 1. Generals, Convalescence, pneummonia Kali-c 2 Prescription : 07-11-06 : BP 129/98 Kali-c 50M/1d 05-12-07 : BP 124/98 Itching eruption on lower limbs. 16-12-06 : BP 141/95 10-01-07 : Kali-c 50/1d 09-02-07 : Eruption > BP : 105/78 27-03-07 : BP 119/82 MEDICINE SELECTION : CASE EXAMPLE

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135 Reg. No. :26809Date : 07/12/2006 Name :SAge :26 Rubrics : 1.Nerves,Trembling, general,hungry when 2.Nose,Coryza,asthmatic, breathing, with 3.Breathing,Wheezing, 4.Generals,Emaciation, general,appetite,good Repertorial result : Iod 9/4 Calc 4/3 Sulph 4/3 Phos 3/3 Prescription : Iod 50M/1d on 07-12-06, 06-01-07,.09-04-07 MEDICINE SELECTION : CASE EXAMPLE

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137 Potency selection In chronic diseases, higher the similarity, higher the potency. In acute diseases, more the case is acute, less the potency to be administered.

138 Repetition of medicine Depending on the case Depending on the medicine


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