Case taking and finding the remedy

Case taking and finding the remedy

The heart of case taking

Case taking involves an application of the principles of Homoeopathy. Our firm grasp of the principles alone can guide us in proper case taking. My purpose here is to explain some of the principles and show how in case taking we should be guided by them.

The purpose and the method

Aphorism 83 of the “Organon” reads:  “The individualizing examination of a case of disease... demands of the healing artist nothing but freedom from prejudice and sound senses, attention in observing and faithfulness in tracing the picture of the disease.”  

See the beauty of this aphorism. In a single aphorism Hahnemann has given the purpose, requisites and method of case taking. He has shown us where to go, how to reach there and what we need to take with us.

The purpose of case taking is “tracing the picture of the disease”. The idea is not to try and fit the patient into some remedy or idea, but to trace out the true picture of the disease. The way to do so this is to bring out the individuality of the patient. In this aphorism, Hahnemann is stating the cardinal principles of Homoeopathy which is that disease is an individual affection, and that each patient is an individual, suffering from his own unique disease. When we want to draw someone’s picture, we first note his individualizing features.

Similarly, “tracing the picture of the disease” requires us to clearly bring out the individualizing features of the case. Only when you bring out the individuality of the patient, can you really claim to have taken the case. Now, we have both the aim of case taking, which is to trace the picture of disease, and the method of case taking, which is to individualize the patient.

What are the requirements for case taking? The only requirements are an unprejudiced mind, an observing mind and a mind that draws a very accurate picture. We must not fit people into slots; instead we have to just let the picture come out, without imposing our own ideas on what we see. We must try to bring out and understand the true feelings of the patient not in terms of remedies, but in terms of human understanding.  

There are two ways we can take the case. The first is to try out various remedies, like a salesman trying to fit shirts on a customer. I heard of a homoeopath who used this method of interview. For example, in dysentery he knew three remedies: Ipecac, Colchicum and Mercurius. To a patient with dysentery he would ask: “Do you have nausea with a clean tongue and thirstlessness?” If the patient said, “Yes”, he would get Ipecac. If he said: “No”, he would ask: “Then do you have nausea at the smell of food? No? Does your urging persist even after stool? No? Then Homoeopathy has no medicine for you!” This kind of fitting of our limited knowledge of Materia  Medica onto a patient is a very deleterious practice. Alternatively we can take all the relevant symptoms of the patient carefully, and then look into the Repertory and Materia Medica for a suitable remedy. This method is much safer and smoother. When the great homoeopath Dr. Pierre Schmidt was asked by a patient if he had treated similar cases before, he remarked: “I hope not!” He meant that each case has to be considered individually, unprejudiced by similar cases we might have seen earlier.

Case taking is the process of perceiving and recording the inner experience of the patient. It is not merely writing down whatever the patient says. This does not mean that we have to theorize or symbolize what we see, but just trace the picture as we see it.  

There is a story that once there was a robbery in the house of the great master Picasso. The police said to him: “Master Picasso, you have seen the thieves and you are one of the greatest artists of the world. Why don’t you paint a picture of the thieves, so that we can easily apprehend them?” Picasso complied, and on the basis of his sketches they arrested a horse, an umbrella and a television set. We should not be Picassos and theorize or symbolize, but let the pure picture emerge as it is, so that the correct remedy can be apprehended.

What is to be cured in disease?

Aphorism 3 of the “Organon” begins with: “If the physician clearly perceives what is to be cured in disease... ” Before we talk about how a case is to be taken, we have to be very clear, exactly what is that we are looking for. We have said that we have to trace the picture of the disease. What exactly does disease comprise of?

One of the easiest ways to find this out is to study our drug provings. After all, drug effects are nothing but artificial diseases. So, when we study our drug provings, we get a good idea about disease. In the proving of Aconitum, no matter who the prover is, or no matter which of his organs are involved, there is a very prominent fear of death. Mental states seem to be common to most provers of a particular remedy. This common mental and general state, produced by that remedy can be called its central disturbance.

Each remedy produces a specific central disturbance

Every remedy produced a specific central disturbance, though different provers will have different organs involvement depending upon their susceptibility. The central disturbance supports or causes these peripheral organ effects. The central disturbance is like a stick which is constant but on which different creepers grow, depending on where it is situated. The stick is responsible for the growth of the creeper, but the same creeper can grow on different sticks. In the same way the central disturbance is responsible for organ pathology but the same organ pathology can occur under different central disturbances. For example, diabetes with its common symptoms can occur under so many remedies that it almost seems to be like a creeper which can hook on to any stick.

Our job is not to cut the creepers but to remove the stick that support them. If you cut only the creepers and leave the stick intact, some other creeper can grow on that stick.

 Case taking is one of the most important aspect of homoeopathy from the view point of patient and doctor, because every thing which leads to the selection of the remedy depends on the information obtained there of. If the information is precise and exact, definitely it will lead us to cure. Hence, it is rightly said that a well-taken case is half solved. 

Many doctors prepare themselves to a premeditated style of case taking; some give Performa to be filled in by the patient, and some other do an exhaustive inquiry so as to bring out the inner man out. At times, the process becomes so lengthy and exhaustive that the patient becomes bored. 

The first and foremost thing is that we have to be very clear about what we are going to search in a patient and how to reach there. Then the cumbersome process of case taking can be cut short and the meaningful information can be spotted easily. 

Let's first understand what Dr. Hahnemann has instructed to do. In the early year of his practice, when he tried to find the similibus and the affinity for that particular organ or disease, the Master faced failure. Then after deep thinking about the matter for a long time Hahnemann came to conclusion that what is taken for prescription is a mere fragment of the real sickness. It needs further and more reliable information so as to choose the right indicated medicine. What was that? - It is the man which has to be taken into consideration, not the organs or the diseases. After this experiment, it really brought the revolution in the field of his practice. 

It means, the whole journey of the case taking is to understand the man who is in question at the moment. Every case needs a full exploration to understand to prescribe. Now, the question which is very pertinent here is, 'What MAN?' Many people misunderstand it and start compiling the symptoms from head to foot, aggravations / ameliorations,  concomitants and all that. 

It is not a mechanical or mathematical sum of the symptoms the master had spoken of, but it is that scientific, logical information or the group of symptoms which establishes the individuality of the patient. it is the particular individual who is to be treated, and nothing other than that. The aim of case taking is to reach to this individual. Once the set of symptoms found, which establishes the individuality, it will give us the perfect similibus.  

Dr. Hahnemann has given utmost importance to that mental state of the patient, which he used us a decisive phenomenon, so as to select a remedy. No doubt, Master Hahnemann and his followers had also used physical symptoms very well to prescribe. But, Dr. J. T. Kent has written that Homoeopathy treats the man and man is in the mind. It is the mental state which establishes the individuality very precisely. Prescribing on mental state means directly touching the deepest layer of the man which uproots the disorder from the root. 

Agreed that Dr. J. T. Kent also used physicals, but, it was very clear in his mind that 'Homoeopathy treats the man and man is in the mind'.  To understand the mental state of the patient is not an easy task. Even the most experienced man in the profession can be misled. It was Dr. Kent who stressed most on the mentals, but his literature shows that he used physicals also to a great extent. To bring out the mentals in each and every case is again a very tedious task, not possible for a new comer to the profession. So what happened? The mental section remained unused to great extent. 

I would like to tell you that the most significant and most important thing i.e. the state of mind, which we need to prescribe on, patient gives us very vividly. But if we are not vigilant enough, it passes without our notice. We need not to do any premeditation or pre-assignments to make some exhaustive inquiry. What we need is to be alert and receive information from all the sources, as it is.  In the early days of my practice, i use to wonder, why some patients behave rudely with the physician, sometime very nicely and some others very impatiently, irritated, angrily, dictatorial etc.

Why a patient touches your feet whereas others quarrel. Many a time, patient quarrels with the doctor, which is really an embarrassing situation for any doctor. Why someone cries and other laugh in your clinic. Mind it! All these are very important. HOW and WHY, are two things which take you to your destination, to work out for the similibus.  

Taking a case is very pleasurable job. The most you can do about it, is to vacate your mind before meeting a patient. Accept the things as they are coming to you, never color them. Don't paint them with your knowledge. Don't try to make a judgement which is very scientifically supportive. The only thing required in the part of physician is to have a pure OBSERVATION.  Everything, every experience of the past is true, but what is happening before you at the moment of encounter with patient, is the only fact and most valuable in regard of that particular individual. When a patient approaches you, it is very important to know that what made the patient feel like coming to you and to seek your help. Many a times, very decisive and eye opening aspects are explored very tactfully, to bring out the inner feeling of the man.  

Following two lines are very precious: 

v  What the patient says?          How he says?

v  What he does?       How he does?

Wherever we are in doubt, we should go ahead with the help of these above two lines, asking queries to the patient in the perspective of clearing our doubts.

Please don't forget that during the whole discussion with the patient, utmost care should be given to the tone and intensity of language and words used. Many times, patients use a particular sentence time and again. What is the meaning of that in the patient's point of view? It is the most significant line in case taking and all the emphasis should be given to the patient's view point.