criteria for the selection of rubrics in a chronic case

7/29/2019 Criteria for the Selection of Rubrics in a Chronic Case

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Criteria for The Selection of Rubrics in a

Chronic Case

Posted by Dr K Saji on June 11, 2010 at 7:14am in Homeopathic-Theory-Philosophy

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Everyone knows that case taking,

evaluation of symptoms and selection of rubrics are the main steps before repertorisation,which may lead to a successful prescription. The advent of Computer software in the

field have changed repertorisation into a mere mechanical process. Ten doctors mayprescribe 10 separate medicines for a single case if taken individually by each of them.

This is an attempt to present criteria for the selection of Rubrics forRepertorisation

properin a chronic case. I know you all will have different opinions on the subject and I

am looking forward to reading what you have to say.

Let me explain what I mean by repertorisation proper

Charting out all the symptoms in a case (confirmed, doubtful, incomplete and the like) for

repertorisation will result in nothing than more confusion. All the symptoms should be

considered, but those which are recurrent, confirmed and more peculiar should be givenmore value. So Repertorisation can be subdivided in two processes.
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(a) Repertorisation proper, considering the most important symptoms and

(b) Analysis of all the remaining symptoms of the case.

Criteria for The Selection of Rubrics and Repertorisation Proper in a Chronic Case

1. The number of rubrics selected should be moderate ( Below 10 for best

results ) 5-10 is the best choice. In cases with minimum number of symptoms, 2

or 3 confirmed symptoms are adequate.

2. Two or more rubrics from the same sphere or chapter should not be taken, unless

unavoidable. If taken, those two should not be considered together for eliminationprocess. Drugs usually have affinity for certain organs and parts. If more rubrics

are selected from a single region, it may lead to prejudiced selection of a drug

with specific action on such a region.

3. Common symptoms should not be considered as such. They may be used in a'synthesized' form. Common symptom means, "Symptoms common to most of the

drugs and most of the diseases." For Eg. Appetite wanting, Thirst increased etc.

Here if you synthesize them to make a characteristic, " Appetite wanting, thirstwith " it becomes valuable. Rubrics related to common symptoms presents with

many medicines in repertory. Those related to characteristic symptoms presents

with moderate number of medicines. Those rubrics with minimum medicines are

reference rubrics. Common and reference rubrics should be avoidedfor repertorisation proper.

4. Fixed and confirmed particulars should be given more value than assumed

causatives and general symptoms - Mental or Physical. An assumed symptom, in

terms of both symptom assumption and rubric assumption - can spoil the result.

5. Symptoms represented in repertory in a scattered manner should not be

considered for repertorisation. Eg. Renal Calculus In Kent's Repertory - Urine,sediment Calculi, Phosphate , Oxalate, Sand, Gravel etc.. all leads to the main

symtom 'Calculus.' All these fractions should be combined to get a considerable

rubric.

6. Surgically treated diseases in the history of past illness should be considered as apart of the present totality. Only for those surgical diseases in which " If surgery

was not done in the past, that symptom might have been present there for

consideration" Eg. Polyps, Fibroids, Deformities etc.


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7. 'Hot and Chilly' fractions, 'Side' and 'Miasmatic' symptoms should be grouped

or synthesized to make a sensible combination. Hot means 'general aggravation

by warmth' and Chilly means the contrary. We consider generalmodalities pertain to weather, bathing, clothing, air, fanning, intake etc to decide

the patients thermal modality. The contradictory points are more valuable than the

others. Logic of side selection and miasm also is the same. Affinity for theregionals are combined to make the general affinity, with a special note on the

contradictory points. I think 'Considering Thermal modality, Side affinity, and

miasm after repertorisation, for medicine selection' is an absurdity.

Analysis of the remaining symptoms.

After repertorisation proper, we will get a few medicines which covers all or almost all ofthe rubrics considered for repertorisation proper ( Repertorial Result ). In analysis of the

remaining symptoms, we should list all the remaining symptoms of the case and shouldrefer for the presence of these medicines in repertorial result under each of them to reach

the similimum. I can show case examples if somebody is interested. There are certain

methods for analysis of the repertorisation result, as well.

Tags: Chronic,Repertory,Rubrics, case

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PermalinkReply by Debby Bruckon June 11, 2010 at 9:01am

Dear Dr K Saji - this is an excellent presentation and I think could easily becategorized under Vera's recent inquiry "Towards Developing A Simple Case-

Take Structure and Check-List"
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Perhaps she will link this in her post.

I do encourage everyone to search the website before writing their discussion andthen to Link to each other. Use the CHAINLINK icon on your menu bar to make

the links. Thank you.

Reply

PermalinkReply by Hans Weitbrecht on June 13, 2010 at 10:33am

Dear Dr K. Saji

There is an easy and fast way to get to the NOW needed remedy:

Materia medica Knowledge.

All it needs is to do the homework first before going out to do the job.

Doing it the other way around means: every time , at the final analysis of a case tostudy a few remedies entirely, which is fairly time consuming.

Having a good MMP knowledge, there is no need for repertorisation anymore, nomore insecurity if the symptoms expressed can be found in MMp, or if rubrics are

found to match them,-- no more too much information, or too little.

you come to that point, where you are woken by the phone from your deepest

sleep, you listen to the problem, you ask few questions, you tell the remedy and

dosage and fall asleep again, not remembering a thing next morning, until the

phone goes again , and someone is very thankful that the problem is resolved.

As the case emerges, the most suitable remedies appear before the inner eye,

alongside the individual differences, -- which at the end of case taking can beasked.

In chronic cases a case history is helpful,-- not so much for the selection of theremedy to start out with, but in determining which remedies will follow and also

how quick, and in assessing the overall progress of treatment.

Boenninghausen was a master in speeding up recovery by giving series ofremedies in quick succession. this method still works amazingly fast, much faster

than the kentian single dose high C-potency wait and see operation.

Sincerely

Hans Weitbrecht
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I remember Kent teaching: you could have pages of symptoms and still no disease

- picture .

Reply

PermalinkReply by Dr K Saji on June 15, 2010 at 4:04am

Dear Dr Hans

With due respect to your suggestions, I strongly disagree with you.

Even Dr.Hahnemann who proved the initial drugs was thinking of the need of an

index - a repertory and he himself created one at the time when the proved

medicine number was a meagre 27 ! ( Fragmenta de viribus...... 1805 ) He is the

man who did more 'homework' than all of us !

Now it has grown to thousands and how can one remember the symptomatology,

or the characteristics of atleast the polychrests ?

"Doing it the other way around means: every time , at the final analysis of a case

to study a few remedies entirely, which is fairly time consuming. "

For this i have to explain ' Analysis of Repertorial Result'

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

1.Tedious and Time consuming.

2.Each case presents a fraction of symptoms of a medicine. Comparing the whole

medicine as found in Comparative materia medica is very easy but comparingfractions seem difficult3.Reading the drug pictures of similar medicines yields nothing but confusion.

Second Method

By preparing a potential differential field ( PDF ), by finding out all the symptoms

of the case other than those taken for repertorization and analyzing the repertorial
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result by referring for these PDF symptoms in the repertory or materia medica

Merits

1.Takes less time

2.Yields a confident result

So reference of Materia Medica after Repertorisation do not mean - reading frommind to relationship section of the medicines in the Repertorial result. It is a

search for those symptoms found in the case which are not found under the

available repertory.

How can somebody say that memorising the whole Materia Medica is more easier

than refering a few symptoms under a few drugs !

"Boenninghausen was a master in speeding up recovery by giving series of

remedies in quick succession"

I think giving series of medicines in every case do not fit with the theories of

Dr.Hahnemann.

Sincerely

Saji

Reply

PermalinkReply by DR. ARINDAM DUTTA on June 15, 2010 at 1:49pm

Dear Dr. K Saji,

So you want to routinize the process of repertorization through certain guiding

rules.

Sorry Dr. Saji, I beg to differ from you, and that too pretty strongly.

Let me explain it to you where I differ.

Repertory itself is an instrument, and repertorization is the application of thatinstrument to get best out of it.

Screw-driver is an instrument and an efficient use of it in the hands of a carpentercan only produce the excellent results. The use of it depends on the nature of the

surface you are handling with- whether it is wood or glass or aluminium panel or

venyle surface,... and so on. The efficient carpenter knows it very well and act to
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7/19

fit with the situation accordingly. If we try to routinize the technique the whole

thing will be in a mess.

Likewise, the technique of repertorization depends solely on the presentation of

symptoms.... how the patient is presenting himself to us with his signs and

symptoms.Here, if we try to routinize the process of analysing a case withoutgiving much importance to each individual patient, surely we will be biased, we

will be much more attentive to maintain the guiding schema by ignoring the

essence of the case.

Homoeopathy is a science as well as an art. It becomes more evident when we are

repertorizing. I think it wont be irrelevant here, if I try to make a schema below in

this way-

# Case taking following Organon;

# Analysis of the case in hand;

# Repertorization proper (the tabulation and computation part);

# Selecting the similimum.

Among these four areas the first, second and the fourth should be performed in an

artistic approach, whereas the third one - the computation part is entirely dependsupon the science.

Art is always variable and it should be so.

As far as the case taking, case analysis and similimum selection are concerned,

we should react according to the patient's representation of his symptoms, ourunderstandings of the case and our skill to apply the drug knowledge to the

disease knowledge, respectively.

So all these steps will vary with their own merit for each and every individualcase.If we try to manage all these three sectors in a schematic format, we cannot be unprejudiced enough to make a successful homoeopathic prescription.

But as far as the tabulation and computation part is concerned, it is purely

mathematics i.e. science, completely a mechanical job. If I can rely upon my

memory-.... there was an old journal writing of Dr. M. Tyler, where she told usthis computation part is the most boring as well as an essential part for

repertorization.

........................................ARINDAM


8/19

Reply

PermalinkReply by Dr K Saji on June 15, 2010 at 2:08pm

Dear Dr Arindam

Very Happy to read your idea on the subject.

Can you please give me a better explanation of the last three steps. I mean

Analysis, Repertorisation and Selection of Similimum. What i want to know ishow do you manage those steps exactly. It is better if you explain it with an

example.

Learning different ideas can correct my prejudices no ?

Saji

Reply

PermalinkReply by DR. ARINDAM DUTTA on June 16, 2010 at 8:57pm

Dear Dr. Saji,

My intention is not to continue this discussion only on theoretical base. Asphysicians we must contribute here from our little or vast experiences to enricheach other in particular and to make our Homoeopathy wealthier in general.

In my last post I had mentioned about the four areas for repertorization-

# Case taking following Organon :

On this subject so much learned discussions are going on at this moment here inHWC. So we don't require any repetition of them here. The only thing to mention

here is- We should follow the rules & regulations laid down in Organon regarding

CT. This is the primary and the basic criteria. Even by following this criteria wesee in practice, there are different approaches from different practitioners toward

this case taking event. I think it is obvious, because the whole thing depends on

the skill and experiences from the physician's part. e.g.- to get the portrait of acase a novice practitioner has to wait till the end but an experienced practitioner

can get many clues by studying patient's attitude, body language, dress code, etc.

through his expert clinical eye.

Its like the difference between the amature detective and Sharlock Holmes....LOL.
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9/19

# Analysis of the case in hand :

On a practical basis we may subdivide this event.

Picking up of characteristics-We have already taken the full case. Now to initiate the analysis, we have to

identify the symptoms. What the patient has told us, all of them may not be the

symptom.e.g.- patient may complain about nausea in the morning whenever he tries to clean

his tongue base by touching it with his fingers. Is it a symptom? No, obviously

not. This is physiology.

Again our patient may give us plenty of symptoms. We have to chose only thosesymptoms which characterize or individualize the patient from others. That is to

say making the portrait of the case.

Evaluation-We have to categorize the characteristics of the patient according to the intensity

of them in the case. There are different philosophical concepts to do it. Which onewe have to adopt depends upon the presentation and the merit of the case in hand.

Here also I think a bit elaboration is needed. Suppose we have adopted Kentian

way, because the case in hand is full of strong generals and peculiar particulars.The case has mentals .... but they are not so strong enough in comparison with

physicals. Should we give priority to these vague mentals only because they are

mentals? No. Here we have to evaluate the symptoms according to their strength

of presentation in the case.

Repertory selection-

As soon as the evaluation is done, the selection of the philosophy of repertory isover. Now it is our turn to select our favorite repertory backed by that chosen

philosophy.

Conversion into rubrics-

Here our skill and acquaintance with the selected repertory are needed. Proper

understanding of the rubrics' meaning is essential.

# Repertorization :

Repertory searching-We should have a through knowledge about the plan of construction of the

selected repertory.

Repertorization proper (Tabulation & computation)-

This step is truly mechanical. Only plain calculation is needed. In different

notebooks authors tried to present various techniques of achieving it, but they are

only theoretical. The essence of this step is to calculate mechanically which drugs


10/19

cover all or most of the rubrics of the case along with how much ranks they have

scored. Here lies the scope of softwares which can calculate the whole

mathematics flawlessly in fractions of a second.

Repertorial result-

Accurate calculations will give us the result which consists of a small group ofdrugs similar to the case in hand.

So from the discussions above in the area of Repertorization it is quite clear thatthe whole process is purely a mechanical job and has no scope of applying

Homoeopathic skill or art.

# Selecting the similimum :

Similimum selection by consulting Materia Medica-

We have to match the portrait of the patient with the portrait of the drug. Themost closer similar medicine to the case may be selected as similimum. Dr.

Dhawale of I.C.R., Bombay, India coined the term PDF ( Potential DifferentialField) to describe all the symptoms of the case other than the evaluated ones and

taught us that this pdf plays a vital role for the similimum selection after

consulting Materia Medicas.

Cross repertorization-

Sometimes to gain the firm conviction over our prescription we may re-

repertorize the same case with different repertories, provided the case in hand hasa wide dimension to be fit in for any type of analysis.

Prescription.-Now the selected similimum is to be prescribed. The potency, dose, repetition

schedule are to be finalized on the basis of susceptibility, level of similarity,

functional and structural changes, underlying miasms, etc.

While performing the above mentioned steps at the time of repertorization

we have to be versatile with each and every case separately according to their

merit. If we try to fix any strict rule as you have mentioned under the

heading Criteria for The Selection of Rubrics - for Repertorisation Proper

- in a Chronic Case I think the whole thing will be spoiled for the sake of

maintaining the routine and ignoring the patient as a separate individual.

..................................ARINDAM

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11/19

PermalinkReply by Dr K Saji on June 17, 2010 at 8:35am

Dear Dr Arindam

Now i can point out where exactly my subject fits into.

We too had been taught in the same manner, the same steps and every one knowthat these are the essential points; but

After Case taking, Analysis of Symptoms, Evaluation of symptoms, Selection of

Repertory and Conversion of symptoms into rubrics we should decide what

rubrics are to be considered for Repertorisation proper -And that is the subject i

am trying to discuss.

We all know that repertorisation of all the rubrics in a case will not yield a good

result. After evaluation of the totality, the physician have to decide which are the

rubrics to be cosidered for Repertorisation proper.

In my opinion, there are 10 points in Homoeopathic case study.

1. CASE IDENTIFICATION :

An immediate identification, an overall assessment, whether the case is acute,

sub-acute, chronic, intermittent etc., because, the next steps depend on the nature

of the case.

2. CASE TAKING3. ANALYSIS AND EVALUATION OF SYMPTOMS

4. RUBRIC SELECTION

5. REPERTORISATION PROPER

6. ANALYSIS OF REPERTORIAL RESULT

7. ANALYSIS OF REMAINING SYMPTOMS ( PDF )8. MEDICINE SELECTION

9. POTENCY & DOSE SELECTION10. FOLLOW UP

RUBRIC SELECTION is the part i was trying to explain.

"Repertorial result-

Accurate calculations will give us the result which consists of a small group of

drugs similar to the case in hand."
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12/19

For this let me give my idea on

REPERTORIAL RESULT : Evaluation & Interpretation

Criteria Of A Good Repertorial Result

1. A Minimum Number Of Competing Medicines

Less Than Five Is The Best :Many Medicines With Almost Similar Coverage-

Results From Repertorisation Of Common Symptoms

2. Related Medicines

Repertorial Result Containing Inimical Medicines Is The Best

Repertorial Result Containing Complimentaries Is Next

Repertorial Result With Antidotes Is LastRepertorial Result With Unrelated Remedies- Least

For this it is good if we have a look into the symptomatic relationship of therelated medicines.

Inimicals : Those with maximum Similarity becomes inimical.

Eg.

Rhus-t, ApisPhos, Caust

Calc-c, Bar-c

Psor, SepBell, Dulc

Merc sol, Sil.

Antidotes : Those with moderate Similarity

Eg.

Bell, Hep

Borax, Cham

Canth, ApisGraph, Nux

Ipecac, Ars

Nat mur, Phos


13/19

Complimentaries : Those which are similar with cotradictory modality

Eg.

Rhus-t, Bry

Ars, PhosLach, Lyc

I had mentioned about the Methods of Analysis of Repertorial Result in my

previous post

Verifying Repertorial Result :

One Among The Medicines In the Repertorial Result Will Cover All Or Almost

All Of The Rubrics Under PDF. If Not, It Reveals That There Occurred SomeError In Our Repertorisation. ( Case taking error, Evaluation Error, Symptom to

rubric conversion error, Selection Error , Repertory Error Or Mechanical Error )

NB : That Sherlock Holms comparison is a Classic one !! LOL

Sincerely

Saji

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PermalinkReply by dipesh k vyason December 10, 2010 at 12:33am

thank you sir I would like to learn more about rubrics

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PermalinkReply by Vasiliki Zora on September 2, 2012 at 7:41am

Dr K. Saji. I do like and I agree with this method of repertorization and analysis.

In addition I would be appreciated if you could give us some more case examples.

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14/19

PermalinkReply by Dr K Saji on September 3, 2012 at 3:09pm

CASE 1.

R - Female 36yrs, Housewife.

PC :

1. Knee pain Right : 4-5 months duration

Intense pain

< 3-4 days.

< walking, rising from sitting, ascending stairs

2. Pain in finger joints vague pain, with mild stiffness.

< Morning

3. Pain in wrists - occasional

HPC : Had temporary relief with pain killers at the beginning. The case wasdiagnosed as RA by an Post Graduate (GM) doctor. He referred the case to

Homoeopathy.

HPI : Skin eruption 10 yrs back On dorsum of feet for about 3-4 yrs. Had

AGN in the course of

treatment. Both relieved with allopathic medication.

FH :

Twin sister Eczema - RA
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15/19

Mother - DM

Father* - HTN

PH :

Husband Auto driver

two children ( 5,1)

Generals :

Heat sensation of

Appetite : diminished.

Desires sour

Unsatisfactory stools.

Regionals :

Perspiration of face (Observed Symptom)

Itching between thighs, with discolouration and desquamation7-8 yrsduration-recurrent

Brittle finger nails, Shapeless. 2-3 yrs duration

Ingrowing nails toes 4-5 yrs duration


16/19

Back pain lumbar menses during.

Mind :

Husband was a bit handicapped. He corrected his complaint recently witha surgery. Now

she is living in her house with her mother for the last 5-6 months. She

never mentioned

anything about her family problem.

Investigation : Before : 20/08/11.

RA Factor - Positive : 86 IU/ml.

Rubrics :

1.Extremities; ingrowing toenails

2.Extremities; eruptions; feet; back

3.Extremities; inflammation; chronic; joints

Repertorial Result :

Caust

SilThuj

Hep

( Sil and Thuja - Complementary; Sil and Hep - Antidote )

Remaining symptoms :

1. Extremities; pain; knees; ascending stairs agg. : Thuj.

2. Extremities; pain; knees; right : Caust., Thuj.3. Extremities; pain; fingers; joints : Caust., Sil., Thuj., Hep.

4. Extremities, pain, rheumatic, knees : Caust., Thuj.


17/19

5. Skin; eruptions; suppressed : Caust., Sil., Thuj., Hep.

6. Generals, Heat, sensation in body : Caust., Thuj.

7. Generalities; food and drinks; sour, acid; desires : Thuj., Hep.8. Rectum; constipation; insufficient, incomplete, unsatisfactory stools : Sil.,

Thuj., Hep.

9. Face; perspiration : Sil., Thuj., Hep.10.Extremities; excoriation; thighs, between : Caust., Thuj.,Hep.

11.Extremities; brittle; nails : Caust., Thuj., Hep.

12.Back; pain; lumbar region, lumbago; menses; during : Caust., Thuj.

Prescription : Thuja CM/1d + Placebo.

Investigation : After : 27/10/11.

RA Factor - Negative

CASE 2 :

J-Female, 25 yrs.

Date : 11/03/06

PC : Infertility, primary, 3 yrs duration.

HPC : Consulted a Gynaecologist for late menses and he diagnosed the case asPCO. Advised some anti-diabetic tablets, hormone supplements and regular

exercise. Patient tried this for about 4 months. Menses was regular during the

treatment period but, became irregular again when she discontinued the hormonesupplements.

HPI : Hypotension

Recurrent painful oral ulcers.


18/19

FH : Father is diabetic.

Generals :

Appetite increased.

Profuse sweating

MH : Late (2-3 months) protracted, profuse menses.

Irritable before menses, Constipation during menses, Pain in lower limbs

during menses.

BP : 100/70 mm of Hg

Investigation before : Follicular study : 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.

Rubrics :

1. Mind; irritability; menses; before (70)

2. Abdomen; degeneration; fatty; liver (62)3. Clinical; hypotension (76)

4. Mouth; ulcers; painful(67)

Repertorial result :


19/19

Nat-m

Phos

Remaining rubrics :

1. Extremities; pain; lower limbs; menses; during -Phos

2. Female, Infertility - Nat-m, Phos

3. Rectum; constipation; menses; during - Nat-m, Phos4. Female; menses; late, too; profuse, and - Phos

5. Female; sterility; menses; early, and too; late, or too - Phos

Prescription (11/03/06) : Phos CM/1d.

Investigation after : Follicular study : 17/06/06.

A developing follicle in left ovary

Re-scan on 21-06-06 : Follicle left 1.5 x 1.3 cm

Re-scan in 26-06-06 : US features suggestive of follicular rupture

criteria for the selection of rubrics in a chronic case

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