Professional Documents
Culture Documents
Dr Mansoor Ali
Govt. Homeopathic Medical College. Calicut
A combined approach using Repertory and Organon of medicine- mainly for beginners and
students
Case taking is essentially a social interaction between a physician and a patient under certain
pre-determined conditions.
Primary object of case taking is the collection of data, for a prescription on the basis of
Homoeopathic philosophy.
The case taking for Homoeopathic management requires background knowledge of various
disciplines _ The principles of Homoeopathy, basic medical sciences, clinical subjects and the
communication skills.
Case taking requires a great deal of experience and training which cannot be acquired from
reading books. The reliable way to learn the art of case taking is to actively become involved in
the process under the supervision of an experienced and effective Homoeopath. Later the
student must become involved in taking case personally.
In case taking the internal state of the person in front of us is gradually revealed. It is just an
effort to understand the person in front of you and one can use any technique to suit one’s
temperament. Successful case taking supplies the physician all the evidence that is necessary
for a proper diagnosis, treatment, and prognosis.
While inquiring in to the state of chronic disease, the particular circumstances of the patient with
regard to his ordinary occupation, his usual modes of living and diet and his domestic situations
must be well considered and scrutinized to ascertain what tend to produce / maintain the
disease.
1. Take in to account of only those symptoms which the patient suffered from before any
treatment with the drugs was commenced.
2. We may discontinue the treatment for several days and take the remaining symptoms _
with the idea that the effect of already consumed drug must have been eliminated from the
system in the meantime.
PRE _ REQUISITES
1. You must have your own facilities for recording the case.
2. Proper sitting arrangement. Comfortable, adequate sitting accommodation both for the
doctor, patient & by slanders.
3. Suitable reading materials in the waiting room.
4. Adequate arrangement for light, attractive painting…
5. Quietness and privacy with sound proof chamber.
6. Absolute rest and poise attitude of the physician with no pre conceived ideas nor
prejudices.
7. Arrangements for drinking water toilet etc,
8. Facilities for advance booking
Aphorism 83
All the events and effects should be recorded without any interpolation or deletions.
Don’t get influenced by the symptoms of drugs recorded in the Materia medica.
Intensity of the symptoms should be given due consideration while recording.
Each symptom should be valued properly with the marks against them.
DON’TS
B. Etiological diagnosis : If the cause is removed, effect go off by themselves. Proper case taking
help to prescribe on aetiology, exciting, maintaining or precipitating cause of disease.
C. Miasmatic diagnosis: The fundamental cause/causes of disease condition specially chronic &
polymorphic manifestation.
1. Ask questions in opposite direction – If you think a person is sad, then doesn’t ask him
anything about his sadness. He may straight away say no.
2. Always confirm the symptoms from friends & relatives.
3. Observe the expression on the face of person accompanying the patient, while patient is
narrating his symptoms.
4. Never accept what the patient says at face value. Symptoms provided by the patient
should be accepted with interest but with out judgment.
5. Look at the hidden expression behind the symptoms.
6. The symptoms expressed with spontaneity, clarity and intensity is of highest value.
7. Try to confirm the essential parameters of the patient in divers situations of his life.
8. Avoid asking the patient directly about his nature.
9. Try to lead him through other questions to express it without being conscious of doing so.
10. If you want to elicit a characteristic symptom, then look for;
Characteristics after stressful condition.
Characteristics of illness before medication.
If both absent, then characteristics in childhood.
Remember
1. Many patient bring out the best symptom if you give a pause after the answer.
2. The expression of characteristics can often be provoked. Eg .By making the patient wait
beyond his time of appointment ie, impatient, mild or rigid.
3. The patient should feel that the doctor is someone who cares. where he can trust and to
him he can reveal anything.
4. If you come to a dead end in case taking and just don’t know how to make the patient talk,
just ask him to describe one typical day, his routine from morning to night.
5. The patient should be encouraged to tell his story freely to relieve his mind.
6. Leave space between the symptoms .Questions are then put in a manner as to complete
each symptoms as location, sensation, modality and concomitance.
7. Prejudice and doubt may be overcome by reflection, study, self-discipline and auto
suggestion by cultivating the scientific spirit.
8. The examiner should be constantly on the alert and observing while making an oral
examination.
9. Look for peculiar, uncommon, characteristics, individual peculiarities from causal
expressions of the patient, attitude or gait.
10. If the patient is confined to bed, observe his positions in bed, his manner of moving, mental
state, turning, skin, color, odor, appearance of excretions, temperature, sensorium,
covering, ventilation etc.
11. The physical examination will be made thoroughly and systematically and the findings
added to the record.
12. Note the patients name, age, sex, vocation, the record of the family (Age of the parents,
general health, cause of death etc.) We often get a good picture of the hereditary
tendencies in this way.
13. If you are dealing with an acute condition, limit yourself to dealing with the acute state
alone, and do not at the same time attempt to dip in to what has been a chronic state. In
an acute explosion the chronic picture will retreat completely.
14. Before leaving the case, go over again the family history, the personal history, the mental
and physical symptoms, temperament, personality etc. Verify if you have skipped
anything.
15. Remember that the nature and sensation of symptoms, the time of day, the position and
circumstances under which the symptoms appear etc. are the most important modifiers of
any given case.
2. MODE OF NARRATION OF THE COMPLAINT – Observe the attitude towards his illness,
which may represent his general attitude and his emotional state.
1. An over view.
IN DETAIL
GENERAL DIRECTIONS
Aphorism 7th. Hahnemann delineated the focus for case taking, the totality of symptoms
alone form the basis of prescription.
Aphorism 83. The qualities of the physician for case taking.
Aphorism 84. Details the manner in which the consultation has to be taken place. This
aphorism has to read with the foot note which cautious against the disruption of the
patients train of narration.
Aphorism 85. Say that every new expression made by the patient or attended has to be
entered in a fresh line. This may help to complete the data’s later and prevent confusion
about the discrimination of symptoms.
Aphorism 86. Narrate the manner in which the incomplete information can be made
complete.
Aphorism 87. Cautious about the don’ts in the case taking. This aphorism has to be read
with the foot note
Aphorism 88. When the case taking come to a dead end, the doctor can engage the
patient in a conversation, makes general suggestions and try to get more information.
Details are given in foot note
Aphorism 89. Narrate the information that the doctor required to seek, once the patient has
completed the narration. This narration has to be read with the foot note .
Aphorism 90. Narrate the necessity to discriminate the symptoms from the attributes of the
patient. This aphorism has to be read with the foot note ,which details the observation the
doctor can make of the patient during consultation.
Aphorism 91. Suggest that to understand the patients state of health before the illness, the
doctor has to discount those expression which were noticed after the medication. This
course of action is advised for c/c disease.
Aphorism 92. Warns that if the disease is of an a/c and fulminate nature no chance should
be taken to keep the patient under observation with out medication, for eliciting the true
nature of the disease. The doctor must try to access the expression previous to
medication.
Aphorism 93. Deals with the doctor to elicit the probable cause for the suffering. The
information can be obtained either from the patient or attendant. This aphorism has to be
read with the foot note ,which elaborate the probable cause for a/c and c/c affections.
Aphorism 94. Asserts that in C/C sufferings, inquiry should be directed towards eliciting
the patients mode of living, daily habits etc. This aphorism has to be read with the
aphorism 5 and foot note ,which details about the information one may seek from the
female patients.
Aphorism 95. Asserts that the details of the expression of c/c cases have to be
investigated thoroughly.
Aphorism 96. Cautious the doctor to be on the guard against such patients who
exaggerate their symptoms. This aphorism has to be read with the foot note .
Aphorism 97. Due to modesty or shame the patient reluctant to speak out. A difficult
situation in case taking.
Aphorism 98. Narrate the attributes of the doctor in conducting the case taking section,
especially of a c/c disease. It say that the doctor should have the qualities of
circumspection, tact, knowledge of human nature, cautions on conducting inquiry and
patience in an eminent degree.
Aphorism 99. Details the projections available in the acute conditions and the mode of
case taking in a/c cases.
Aphorism 100. Case taking in epidemic and sporadic cases.
Aphorism 101_102. An appraisal of several cases in an epidemic reveals a pattern in the
disease expression leads to the genus epidemicus. This aphorism has to read with the
foot note .
Aphorism 103. Details the theme of case taking, also speaks of the data collection.
Aphorism 104. Responsibility of the doctor after the case taking, include case analysis,
selection of similimum etc.This aphorism has to read with foot note.
Aphorism 153. States that the selection of the similimum must always depend on the data
elicited from the patient, which is more striking, singular, uncommon and peculiar.
In foot note 109 Hahnemann makes a reference to Repertory of Boenninghausen and Jahr.
1. All the information obtained from the patient should be recorded in the patients own words
2. By slanders if anxious do not give correct information
3. The physician should frame the collateral questions and not the leading questions
4. He must be able to collect symptoms with regards to pathology, diagnosis prognosis and
materia medica. Symptoms with respect to materia medica are the key to the prescriptions
5. The physician should know that anything that affect a change in these symptoms Eg.
Drugs, alcohol etc. He should get the original form of the malady
6. The circumstances of the life and habit must be studied with a view to going in to the
slightest particulars
7. Exaggerated and indolent patients do not give a true picture
8. Never consider acute and chronic together
9. Sequel of acute diseases are psoric disorders and must be treated as psora
10. Don’t prejudice by “similar cases” in the past
H.A.ROBERT’S METHOD
He had given much importance to the history of presenting complaints
1. The selection of Homoeopathic remedy is mainly based upon the subjective, conscious
experience perceived by the patient and stated by him to the doctor, his friends or
perceived by the physician himself.
2. The physician should gain the confidence of the patient and relive the tension of the
patient as far as possible
3. The physicians attitude should be calm, dignified, quit and sympathetic
4. The physician should not hurry a patient in his narratives
5. Classify the symptoms as general particular and common
6. Laziness, selfishness and easy conscience are responsible for many failures and sins
7. The physicians senses must be on alert, mind clear, logical faculties acute, sympathies
and prejudices held in abeyance
8. Bring out the symptoms to permit comparison with the materia medica.
1. The homoeopath must know his patient spiritually emotionally mentally physically and
sociologically .
2. The physician must be receptive, must clear his mind of other pre occupations and must
be tranquil and cordial
3. He must allow the patient to tell his own story in his own way without any interruption
4. The personality of the patient his state of mind physical status traits of character should be
noted.
5. The beginner Should not down all the symptoms and later sort it
6. The physician should encourage the patient while narrating his story
7. Beware of loquacious and reticent patients
8. Case may be completed on subsequent appointments if required
9. The physician must make sure that he has questioned the patient on every system and
function
10. The mental symptoms and characteristics of the patient should usually be elicited last
when the patient’s confidence has been more fully gained
11. The patient must get an impression that the physician is interested in his case.
Children :
SEX :
2. PRESENTING COMPLAINT
Note down the complaint in the language of the patient with adequate space in between them.
After completing the history part each symptoms should be qualified by sensation, location,
modality, extension, duration, prodrome, onset, sequence etc.
RUBRICS RELATED :
1 .Etiology
Gen.Measles after
Male. Swelling testes mumps from
Vertigo. Sudden
Gen.Paralysis Gradual
4.PAST HISTORY.
In order to deal intelligently with the present, we must know something of the past.
Ask for the previous illness from childhood down to the present, chronologically, which ages at
which attack appeared, with its nature, symptom, duration, severity and sequence.
2. Diagnosis
Cardiac complaints and joint affections in a patient with a history of recurrent tonsillitis
Chest. Inflammation heart endocardium rheumatic
4.Miasm
Gen.Sycosis
Gen.Syphilis
4. FAMILY HISTORY.
6. PERSONAL HISTORY.
Nature of occupation :
Gen.stone cuttrers
Resp.Asthamatic miners asthma from cold dust
Rectum.Constipation sedentary habits from
Resp.Asthamatic drunkards
Head.Pain tobacco smoking from
Gen.Food alcohol <
Gen.tobacco <
Gen.Narcotics <
7. TREATMENT HISTORY
Must ascertain the treatment already undergone by the patient for the chronic disease, must
understand what medicine have been administered and what effect they produced. The original
picture of the disease must be ascertained in order to understand the progress of the disease
from its original state.
Treatment history help the physician to avoid the administration of medicine used earlier
improperly.
RELATED RUBRICS :
9.PHYSICAL GENERAL
1. Time modality.
2. General modality.
Summer, winter., chill or warm blooded, weather changes, thunder storm, open air,
uncovering, clothing…
4. Bathing.
5. Rest or motion.
6. Position.
Standing, sitting, stooping, lying on sides, head high/low, rising from lying, leaning head
backwards, unusual positions .
7. Exertion stimuli.
Touch, hard or light, pressure, rubbing ,jar, stepping noise, odour ,light etc.
Weather before, during or after meals, desires and aversions, picca, any food < or
>,salivation, taste, appetite etc.
16. Pathology which applies to the patient as a whole. Tendency to tumors,cyst,warts. Individual
and family tendencies to certian diseases. Weakness of specific region / tissues.
Emotions, suppressions. From exposure to cold, wet sun.. From mechanical conditions eg.
injury, over eating.
Menarche,duration,chter.,abnormality in cycle
Leucorrhoea, post coital complaints..
Abnormal discharge,s upression, odor,c olor, clots…
Number of conceptions.
All trimesters normal or not.
Picca or aversion during pregnancy.
H/O jaundice, bleeding ,UTI during..
Normal or caesarean.
History of puerperal infections.
Breast feeding for normal duration or not.
Gen.cold <
Gen.Warm <
Gen.Uncovering <
Gen.warm wrapps <
Gen.Heat sensation of
Gen.Seasons
2.FOOD
Obstinacy,contradiction,loquacity.
Sexual perversion,impatients..
b) Understanding. _
C) Intellect _ Memory,concentration,mistakes
Important information about mental state can be obtained from his friends and relatives.
11. REGIONALS
12.PHYSICAL EXAMINATIONS.
A. General examinations.
Degree of illiness
Intellegence,attitude,
Gait,ht,weight
Chtics of movements.
Skin _ Pallor. yellow, cynosis, pigmentation, eruptions.
Neck _ Lymphatics and salivary glands, thyroid,veins.
Tounge,edema,hands and feet,breast,axilla
Temperature,pulse,blood preassure,respiratory rate
B. Systemic examinations.
Mental state
System examinations.
13. INVESTIGATIONS.
1. Disease diagnosis
2. Constitutional diagnosis.
20.MANAGMENT.
General
1. It is very easy to take a case in acute disease, because all the phenomena and the deviation
from the health that has been recently lost are still in the memory of the patient and relatives.
2. Physician wants to know everything in such cases also, but he has much less to inquire into.
3. In acute disease the presenting complaints are very prominent and impress our sense quickly,
so much less time is required for tracing the full picture of the disease.
6. Any known causative factor for the explosion of latent psora is to be ascertained.
9. Possible nosological diagnosis should be kept in mind for diet and regimen, mgt. etc.
Aphorism 94_99,205_209
1. In chronic disease the symptoms take a slow evolutionary pace covering months and years.
3. It must cover the past as well as the presenting conditions of the patient and even tracing the
family history on both paternal and maternal side of the individual concerned.
Aphorism 103.
The whole array of symptoms belonging to a miasmatic chronic disease, can only be ascertained
from observation of very any single patients affected with such a chronic disease, and with out a
complete survey and collective picture of these symptoms the medicines capable of curing the
whole malady Homeopathically cannot be discovered, this medicines are at the same time, the
true remedies of the several patients suffering from such chronic affections.”
The three c/c miasmatic affections always retain their essential nature in all individual patients.
To know the complete picture of each miasmatic disease large number of patients are to be
investigated.
Each individual represent only a part of totality of miasmatic affections, By gathering the totality
from large number of patients medicines suitable for such a chronic affection can be determined.
These remedies are indicated in several patients suffering from such a c/c disease. These cases
should be minutely investigated for selecting a proper anti miasmatic remedy.
Between he acute and chronic there is a bridge, called as acute exacerbation of the chronic case
which sometimes flare up. Here take the case first in the acute disease then comes or follows the
c/c one.
When the individual has an acute case the case taking is limited to the symptoms of the moment,
of acute symptom that has been before him, not to take in to consideration that the patient has
had any c/c disease, the tendency of the family,mother,father etc.
We had to pay little attention to the c/c symptoms in taking an a/c case because ;
1.A/c disease has their own marked period of onset, progress and decline and although they are
an a/c explosion of psora but the exciting cause play an important role.
2. The acute diseases are so violent, that they give no time for a detailed case taking.
When an individual has an a/c disease the case taking is limited to the symptoms of the case
only. Not to take into consideration that the patient had any chronic disease.
Take the case regarding the a/c complaint only, and prescribe on that with out considering the
c/c disease.
We have to pay little attention to the chronic symptoms, because a/c disease have sudden onset
and decline and they are so violent and they give no time for a detailed case taking.
Eg.R/C Asthma
Eg.Vitiligo
Individual vary from each other and even the generic picture of the epidemic disease may vary
from year to year. As Hahnemann said ” In investigating the totality of the symptoms of epidemic
and sporadic disease it is quiet immaterial whether or not some thing similar has ever appeared
in the world before under the same or other names.
In epidemic disease the disease cause might be same or a fixed miasm,giving rise to a general
picture of the disease to which all the patient confirm to ,but each individual patient adds his
quota to this general symptom complex to make each patient unique and different from others.
So investigate each sporadic and epidemic disease as a new and unknown case and select
medicine according to its symptom similarity. No disease is fully manifest through symptoms in
one individual case.
In epidemic disease a complete picture of the disease is apparent to the physician only when he
observe a number of cases during the epidemic.
Every epidemic disease in many respect a phenomenon of a unique character ,differing vastly
from all previous epidemics. The complete picture of an epidemic disease is grasped through
observation of a good many person falling victims to that epidemic disease.
Intermittent diseases are those that occurring at certain periods. Alternating diseases are those
in which certain symptom _ syndrome alternate at uncertain intervals with symptom _ syndrome
of a different kind.
Both this diseases fall under the category of c/c case taking.
INTERMITTENT FEVER
While case taking ,to acquire totality of symptoms, consider the symptoms during any of the
alternating states and during the interval between the two paroxysm. The guiding symptom
should be those present during the interval period when the patient is free from the fever.
The most appropriate remedy would be that which is Homoeopathic to the symptoms of the
patient during the interval between the successive paroxysmal stage.
The case taking should help to find the remedy which capable of producing whole paroxysm as
found in the case.
First conduct an acute case taking, followed by a case taking for a deep acting antipsoric.
All the individuals affected by such an epidemic fever show almost invariably the same totality of
symptoms. The totality is obtained after going through a number of cases.
Aphorism 172.
One sided diseases are those diseases which seems to have very few perceptible symptoms
and belongs to the class of chronic diseases.
These diseases usually appear one-sided due to lack of observation of the physician. A
physician well versed with the art of case taking is capable of finding many significant symptoms
in such cases giving totality of the disease. So in one sided diseases a thorough case taking is
essential which may require more than one sitting with the patient.
We can able to select a most similar remedy guided by these few symptoms alone, this may
produce cure provided the symptoms are characteristics, rare and uncommon. Take the case
again after the exhaustion of action of the most similar, and administer next suitable remedy.
Thus successive re-examinations of the patient and the successive administration of the most
similar Homoeopathic remedies are to be considered.
In cases of the selecting and administration of the partially similar antiphonic remedy the same
procedure is to be followed as recommended for a/c diseases in which partially similar was not
available due to paucity of symptoms.
Mental diseases are one sided diseases which are chronic in nature and psoric in origin.
There is no absolute gap between body and mind. In natural diseases the physical disturbance
are often found associated with their mental counterpart.
In mental diseases we must take very carefully the past history and should try to detect the
physical symptoms which precede the present condition ( may be long ago) and try to get the full
picture of disease comprising physical and mental symptoms on the totality of which a
“similimum” can be found out.
These corporeal symptoms may not be disappeared completely though obscure and make
appearance during the lucid interval. The symptoms of previous corporeal disease should be
learned from the friends and relatives of the patient and should be carefully considered.
The maintaining cause of these diseases are to be traced out by a skilful case taking. Trace out
all kind of external disturbing influences on the mental state of the patient.
3. Mental diseases appearing suddenly.
Mental diseases after sudden fright, grief, abuse of spirituous liquors etc. Find out the cause give
acute medicine followed by a deep acting anti psoric.
CONSULTED WORKS.