Dear Colleagues
A couple of weeks ago on MINUTUS we discussed the issue of what is the relevant totality of presenting symptoms.
With kind permission of Dr Farshad Shaddel: Here is an excellent guide
Ranking the Symptoms
1. Defining the problem
We need to evaluate and decide about every symptom whether it is pathological/treatable or not? Every symptom with one of the following characteristics is pathological/treatable and should be considered in Similimum selection:
A. There is a definite pathogen/stress/Precipitating factor
* All related symptoms make an acute disease that should be considered separately from the chronic state. For example when a patient with chronic problems catches cold, we have to consider only the symptoms related to Cold virus effects.
* Check the qualitative and quantitative proportion for each symptom to precipitating factor. Any disproportion between the type (Quality) and severity (Quantity) of symptom with pathogen / stress or Precipitating factor means that symptom is pathologic and must be treated by proper remedy. For example when patient has lost a beloved person some degree of grief and sadness has proportion to stress. Therefore it is not pathologic and cannot be treated.
B. There is no definite pathogen/stress/Precipitating factor
* Such symptoms (without any obvious cause) make the chronic state of a patient and must be inspected for:
I: Patient’s inability to change it.
II: Any mismatch between symptom and cultural or environmental background of patient.
2. Arranging the symptoms
We need to rank the symptoms based on their importance before repertorisation. We have two criteria for ranking them:
A. Severity of symptoms
We need to evaluate the Predominance, Persistency and Presence (PPP) separately for each symptom. The more PPP means the greater severity.
B. Kent’s pyramid
Among the different symptoms with the same severity, the mental symptoms are the most important ones, then the emotional and then general and physical ones respectively.
3. Formulation of the totality
After defining and ranking the symptoms we can extract some new ones by comparing/grouping symptoms with each other, for example if almost all the symptoms affect the right side of body, one can select a general condition – for example in this case ‘General, side, right’.
Finding the central delusion in Sankaran’s system is another example for this section.
Example of arranging symptoms in a real case
Case of IUGR (Intra uterine growth retardation)
27 years old woman, 31 weeks pregnant. She was referred because of IUGR following routine Ultrasound check up.
She suffered from anaemia during pregnancy and was using Iron compounds. She was frequently affected by acute diseases during pregnancy like Shigellosis in the 3rd month and premature contractions during the 26th week. She had used some allopathic medicines during these ailments.
PRESENTING SYMPTOMS
She was irritable and nervous. She breaks things and her head becomes hot when angry. Eruptions and pustules painful to touch has increased during pregnancy.
She also has lost her appetite and 1.5 Kg during pregnancy.
Bleeding gum, Burning in tongue after eating pepper.
Sometimes stool contains undigested food.
Tingling of lower extremities during sleep. Lumbago aggravated while lying.
Dreams of falling, dead persons and disturbing dreams.
Biting nails from childhood.
Sweat of axilla and genitalia smell like urine.
She craved cheese.
Symptoms Arrangement:
For a complete and successful repertorisation of a case, we need to pass 7 steps in order,
4 steps are about ‘selecting important symptoms’:
1.Case Taking - There are good guidelines in the Organon for taking a standard Homeopathic case (Aphorism 83, 86-99).
2.Recording and Interpretation. For finding several useful guidelines in this subject please refer to the Organon (Aphorism 84-85).
3.Defining the problem: Patients say a lot of symptoms but all of them are not pathologic and do not need to be treated. Also they will not be removed even after the initial correct Homeopathic treatment. Furthermore, in different methods for evaluating the patient, one needs to consider some symptoms and omit the others. For example in epidemic conditions one needs to consider common epidemic symptoms and neglect non-epidemic and individual symptoms. (Organon 100-102).
For example Emaciation is not a pathologic symptom here because there is a reason and it is “loss of appetite” and degree of weight loss is proportional to the loss of appetite.
4.Classification & Ranking of Symptoms: It is obvious that all the symptoms are not of the same importance. The Similimum is that which completely covers the most important symptoms.
There are 3 different criteria that should be used in choosing and ranking of symptoms:
* Turning-points
* Severity of symptom
* Kent’s pyramid
Turning-points:
Turning points are one or few important accidents or events during the life history of the patient after which a group of symptoms appear. For example: Severe emotional stress like death of parents, puberty, marriage, menopause and pregnancy. These events can be considered as turning-point specially if you observe some deviation in General Modalities like food cravings and aversions, heat and cold, position of sleep, etc. associated with them.
The symptoms which have appeared after the latest turning-point are more important.
Severity of symptoms:
Not all the symptoms of the patient have the same severity and the more severe a symptom, the more important it is. To define the severity of each symptom we should consider 3 criteria: Predominance, Persistence and Presence (PPP).
v Predominance: The symptoms which the patient has complained of them himself and more than any other symptoms.
v Persistence: The symptoms that are constantly present.
v Presence: The symptoms that are present now, not in past history
Kent’s Pyramid: Kent says that Mind and Emotional symptoms (M) are the most important, then are General symptoms (G) and finally the peculiar and particular Physical symptoms (P).
Now, we arrange the symptoms of the case considering these criteria:
A) Turning-point: The pregnancy can be considered as turning-point however we do not have any supportive changing in modalities from this point. The symptoms that have been prior to that point are “Nail Biting” and “Skin eruptions”. The second one has increased after the pregnancy therefore we can consider it as a symptom in current state of patient.
B) Severity of symptoms:
Premature contraction (p, Not persistent, not present),
Irritable (ppp),
Head heat (pp, not persistent),
Break things (pp, not persistent),
Skin, Eruption, painful (ppp),
Skin, Eruption, Pustule (ppp),
Appetite, wanting (ppp),
Bleeding, Gum (pp, not predominant),
Burning, tongue (p, not persistent, not predominant),
Stool ,undigested food (p, not persistent, not predominant),
Tingling, lower limb, sleep during (pp, not predominant),
Back, pain, lying on back agg (ppp),
Dream, falling (p, not persistent, not predominant),
Dream, dead persons (p, not persistent, not predominant),
Dream, disturbing (pp, not predominant),
Biting, nails (pp, not predominant)
Perspiration, odor, urine like (pp, not predominant),
Food, cheese desire (pp, not predominant)
C) Kent’s pyramid:
Premature contraction (P)
Irritable (M),
Head heat (P),
Breaks things (M),
Skin, Eruption, painful (P),
Skin, Eruption, Pustule (P),
Appetite, wanting (G),
Bleeding, Gum (P),
Burning, tongue (P),
Stool ,undigested food (P),
Tingling, lower limb, sleep during (P),
Back, pain, lying on back agg (P),
Dream, falling (G),
Dream, dead persons (G),
Dream, disturbing (G),
Biting, nails (M)
Perspiration, odor, urine like (G),
Food, cheese desire (G)
Final Ranking:
1) Irritable (ppp, M)
2) Appetite, wanting (ppp, G)
3) Skin, eruption, painful (ppp, P)
4) Skin, Eruption, pustule (ppp,P)
5) Back pain, lying agg (ppp, P)
6) Break things (pp, M)
7) Dream, Disturbing (pp, G)
8) Perspiration, odour, urine like (pp,G)
9) Food, Cheese desire (pp, G)
10) Tingling, lower limb, sleep during (pp,P)
11) Head, Heat (pp, P)
12) Bleeding, Gums (pp, P)
13) Dream, Falling (p, G)
14) Premature contraction (p,P)
15) Dream, Dead persons (p,P)
16) Burning tongue (p, P)
17) Stool, undigested food (p, P)
18) Biting, nail (Before turning-point, pp, M)
After repertorizing, Lycopodium was the best remedy covers the most important symptoms. Nit-ac and Sep were the next choices.
I prescribed Lyc LM2 /1 Pill/ 5 shaking/ 2 dilution glasses/ 1 table spoon/ twice a week
The result was dramatic and after only two weeks, the ultrasound reported proper weight of fetus. Most of the symptoms were going and by following the course of treatment, she had a NVD (Normal Vaginal Delivery) with 3.5 Kg birth weight of neonate.
===============
Regards
Soroush
Ranking of Symptoms
-
domenicstanghini
- Posts: 76
- Joined: Thu Jul 21, 2011 10:00 pm