INTRODUCTION TO A SIMPLE METHOD OF

PRESCRIPTION

Dr.K.SAJI. MD(Hom)

STATISTICAL ANALYSIS OF 279 CHRONIC CASES

EXPECTED CLINICAL RESULT

CASES UNDER STUDY

NO OF CASES

DURATION/REG.NO. CHRONIC % ACUTE %

1000 11-07-06 TO 27-09-06

REG No.25000 TO 25999

579 58 421 42

CHRONIC CASES – FOLLOW UP

FOLLOW-UP CASES PERCENTAGE

ADEQUATE 279 48

MINIMUM 113 20

NIL 187 32

TOTAL CASES : 579

CHRONIC CASES – CLINICAL RESPONSE

TOTAL POSITIVE % NEGATIVE %

279 220 79 59 21

SUCCESSFUL PRESCRIPTION

PRESCRIPTION CASES PERCENTAGE

1ST 190 86

2ND 22 10

3RD 5 02.3

4TH 2 00.9

5TH 1 00.5

No. MEDICINES NO. OF CASES PERCENTAGE

1 SULPH 45 20

2 PHOS 29 13

3 NAT-M 26 12

4 CALC 20 9

5 SEP 17 8

6 GRAPH 6 3

7 LACH 6 3

8 NIT-AC 6 3

9 NUX-V 6 3

10 PULS 6 3

11 BRY 5 2.2

12 SIL 5 2.2

13 CAUST 4 1.8

14 LYC 4 1.8

15 THUJ 4 1.8

16 ARS 3 1.4

17 MEZ 3 1.4

18 OTHERS 25 12

MEDICINES IN 220 CASES WITH POSITIVE RESPONSE

MEDICINES IN CASES WITH POSITIVE RESPONSE

• TOTAL CASES : 220

• TOTAL MEDICINES : 38

MY CASE EXAMPLES

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%

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%

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%

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

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

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

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

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

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%

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

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.

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%

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

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.

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

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

DETAILS OF THE METHOD OF PRESCRIPTION

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

CASE TAKING

CASE TAKING

• 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.

OMISSION OF CONFUSING POINTS

IN CASE TAKING

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 PM to 05 PM• Evening : 05 PM to 10 PM• Night : 10 PM to 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

The Patient represents a single individual

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 Lach2 Phos3 Sep

2.Feet,Numbness Lach Phos3 Sep

3.Female,Cancer, genitalia,bleeding, with Lach

4.Female,Cancer, ovaries Lach2

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 yrs Date : 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 , 5yrs Date : 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

RELATIONSHIP OF REMEDIES

Inimicals

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

Antidotes

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

Complimentaries

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

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 Sulph2

2.Rectum, hemorrhoides, painful : Sep Sulph

RR : RELATED MEDICINES : CASE EXAMPLE

Methods of Analysis of Repertorial Result

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 : Sulph2

2.Food,Pungent, things,desires : Phos Sulph

3.Food,Salt,desires : Phos3 Sulph

4.Coughing,Morning,waking, on : Phos Sulph

VERIFYING RR : CASE EXAMPLE

Reg. No. :25609 Date :18/07/06

Name :R Age :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. :27195 Date :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 Caust2 Nat-m3

2.Nose,Sneezing, general,paroxysmal Nux-v Nat-m2

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

Reg. No. :26481 Date :07/11/2006

Name :S Age :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-c2

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

Reg. No. :26809 Date : 07/12/2006

Name :S Age :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

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.

Repetition of medicine

• Depending on the case

• Depending on the medicine