SIGNIFICANCE OF POLARITY ANALYSIS IN

REPERTORISATION USING BBCR, IN THE TREATMENT

OF

BRONCHIAL ASTHMA

By
DR ANU JOSEPH

Dissertation Submitted to
RajivGandhiUniversity of Health Sciences, Karnataka, Bangalore

In partial fulfilment of
the requirements for the degree of

Doctor of Medicine
In
Homoeopathic Repertory
Under the guidance of

DR RITA CHAKRABORTHY

DEPARTM ENT O F CASE TAK ING AND REP ERTO RISATIO N

FATH ER M ULLER H OM O EO PATH IC M EDICAL CO LLEG E, DERALAK ATTE,

M ANG ALO RE.

2012
 RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled“SIGNIFICANCE OF POLARITY

ANALYSIS IN REPERTORISATION USING BBCR, IN THE TREATMENT OF

BRONCHIAL ASTHMA” is a bonafide and genuine research work carried out by me,

under the guidance of DR RITA CHAKRABORTHY MD (HOM), Professor & HOD,

Department ofCase Tak ing & Repert orisat ion, during the year 2009 - 2012, in

partial fulfilment of requirement for the award of DOCTOR OF MEDICINE

(HOMOEOPATHIC REPERTORY).

I have not previously submitted this work (partial or full) to any other university

for the award of any other Degree or Diploma.

Date :

Place : Mangalor e DR ANU JOSEPH

ii
 CERTIFICATE BY THE GUIDE

Thisis to certify that the dissertation entitled“SIGNIFICANCE OF POLARITY

ANALYSIS IN REPERTORISATION USING BBCR, IN THE TREATMENT OF

BRONCHIAL ASTHMA”is a bonafide research work done byDR ANU

JOSEPHunder my guidance and supervision during the year 2009 –2012, in partial

fulfilment of the requirement for the award of the degree of“DOCTOR OF

MEDICINE” (HOMOEOPATHIC REPERTORY).

I have satisfied myself regarding the authenticity of her observations noted in this

dissertation and it conforms to the standards of Rajiv Gandhi University of Health

Sciences, Karnataka, Bangalore. It has not been submitted (partial or full) for the award

of any other Degree or Diploma.

Date: GUIDE
Place: Mangalore
DR RITA CHAKRABORTHY
BHMS,MD (HOM)

Professor and Head of Department

Case Taking & Repertorisation,
Father Muller Homoeopathic
MedicalCollege and Hospital,
Deralakatte, Mangalore.

iii
 ENDORSEMENT BY THE HOD, PRINCIPAL/
HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled “SIGNIFICANCE OF

POLARITY ANALYSIS IN REPERTORISATION USING BBCR, IN THE

TREATMENT OF BRONCHIAL ASTHMA”is a bonafide research work carried out

by DR ANU JOSEPH under the guidance and supervision of DR RITA

CHAKRABORTHYduring the year 2009 – 2012, in partial fulfilment of the

requirement for the award of the degree of “DOCTOR OF MEDICINE”

(HOMOEOPATHIC REPERTORY).

We have satisfied regarding the authenticity of herobservations noted in this

dissertation and it conforms the standards of Rajiv Gandhi University of Health Sciences,

Karnataka, Bangalore. It has not been submitted (partial or full) for the award of any

other Degree or Diploma.

HEAD OF THE DEPARTMENT PRINCIPAL

DR RITA CHAKRABORTHY DR. SRINATH RAO

M.D (HOM) M.D (HOM)
Professor, Professor and H.O.D
Dept. of Case Taking and Repertorisation, Dept. of MateriaMedica
Fr. Muller Homoeopathic Fr. Muller Homoeopathic
Medical College, Medical College,
Deralakatte, Mangalore. Deralakatte, Mangalore

Place: Mangalore Place: Mangalore

Date: Date:

iv
 COPYRIGHT

Declaration by the Candidate

I hereby declare that the RajivGandhiUniversity of Health Sciences,

Karnataka, Bangalore shall have the rights to preserve, use and disseminate this

dissertation / thesis in print or electronic format for academic / research purpose.

Date :
Place : Mangalore DR ANU JOSEPH

© Rajiv Gandhi University of Health Sciences, Karnataka

v
 ACKNOWLEDGEMENT

“I sough t the Lord, and He h eard me; an d delivered me from all my fears”
Psalms 34:4

With immense happiness, I praise and thank God almighty for giving me the
opportunity to aid the suffering humanity and be a part of his healing mission and also
for the mercy and love He has showered upon me throughout my life. It is my privilege
and pleasure to express my gratitude to all those who have been a source of constant help
and encouragement not only in this humble endeavor but through all the good and bad
times of my study life.

Iam deeply indebted to my respected and beloved teacher and guide, DrRita
Chakraborthy, BHMS, M.D (Hom), Head of Department,Case Taking &
Reperto ri sation,for providing me expert guidance, advice, timely support, personal
attention, supervision, encouragement and love throughout my post graduation course
and during this dissertation work. It’s my good fortune to be her student and to do this
work under her guidance.

I am gratefulto the Director of Father Muller Charitable Institutions,.Rev. Fr

Patrick Rodrigues and to the Administrator of Fr. Muller Homoeopathic medical
college, Deralakatte, Rev. Fr Wilfred PrakashD’souza, for their blessings, good wishes
and extending all necessary facilities to carry out this work to my satisfaction in this
reputed institution.

My sincere, heartfelt thanks to Principal DrSrinathRaoBHMS, MD (Hom), Head

of Department of Materia Medica, for the support he provided during of my studies.I
express my sincere thanks to DrShivaprasad,BHMS, MD (Hom), vice principal, Head of
the Department of Organon of Medicine and Homoeopathic Philosophy, former P.G.
Coordinator for all his help.

I extend my sincere thanks to, Dr. M K Kamath,BHMS, MD (Hom), Professor

and Head of Department of Practice of Medicine and Homoeopathic Therapeutics,P G

vi
Coordinator, for all the help, guidance and support he provided me with in my academic
activities.

I would like to thank former principal,DrShashi Kant Tiwari, DMS, DIP – NIH,
MD (Hom).I sincerely thank Dr Sunny Mathew, Medical Superintendent for his help.

I extend my humble gratitude to all my honorable teachers in various

departments, who kindheartedly encouraged and supported me at all times especially, Dr
Praveen Raj, DrRoshan Pinto, Dr N C Dhole, DrGirishNavada& Dr. Sheena Salin.

I thank the staff in the Department of Case Taking & Repertorisation, Dr. Kurian
P J, Dr. Anitha Lobo and Dr. Revan B L for their cooperation and support.

I extend my heartfelt thanks to all my seniors especially Dr. PitambarSahoo and

Dr Sr. Temy Thomas who have guided me in more than just one way.

I also extend my gratitude to all my friends, batchmates

especiallyDrRavikumarJujare and DrA Anbu Raja, and my juniors whose co-operation
and timely help considerably eased my task. A special word of thanks is due to my juniors
in the department of Repertory. I am also thankful to Dr. T Poovai and Dr.
RisadakaPapang for their timely help.

With much pleasure, I thank my dear friend Dr. C.S. Subhapradha, for all the
support, help and love she offered me throughout. A special word of thanks, to friend, Dr.
Praveen Kulkarni, for his timely support and help.

I thank Mrs. Suchurita, forhelping me with the statistical work of my thesis.

I thank all members of Non-teaching staff of FMHMC especially the library as

well as MRD staff Deralakatte for bearing with me always; I thank them for their help
during the study.

I express my sincere thanks to all the Patientson whom the study was conducted. I
also thankA1 solutions, Kankanady for taking pains to complete this work in time.

vii
 Last but not the least; I thank my parents, brother and sister in law for all the
support and love they had for me all throughout my life. I thank them most sincerely for
giving me this opportunity and also for the cooperation throughout. Needless to say, it is
their sacrifices that made me what I am today.

My sincere thanks to all those who directly or indirectly helped me in the

successful completion of this study.

Place: Mangalore
Date: DR ANU JOSEPH

viii
 LIST OF ABBREVIATIONS

A: Absent

ABPA: Allergic Broncho Pulmonary Aspergillosis

Agg/ <: Aggravation

A/F: Ailments From

Amel/>: Amelioration

BBCR: Boger Boenninghausen’s Characteristic Repertory

d.f: Degree of Freedom

Eg: Example

FEV1: Forced Expiratory Volume in 1 second

Grp: Group

H&C: Heat and Cold

HS: HoraSomni (at bed time)

IgE: Immunoglobulin E

Kg: Kilograms

NSAIDs: Non Steroidal Anti Inflammatory Drugs

NV: Nux vomica

PaCO2: Partial Pressure of Carbon dioxide

PaO2: Partial Pressure of Oxygen

PEFR: Peak Expiratory Flow Rate

RT: Rhustox

S: Same

SCR: Standardized Case Record

ix
Sl. No: Serial Number

TPB: Therapeutic Pocket Book

VC: Vital Capacity

W.H.O: World Health Organisation

x
 ABSTRACT

Polarity analysis, a further development of Boenninghausen’sconcept of

contraindications, allows a precisedifferential diagnosis of possible homeopathic

medicines. Increasing the rate of optimalprescriptions by 20%, polarity analysis turned

out to be an efficient modification tocase analysis. This study describes the significance

of this new insight to the treatment of bronchial asthma using Boger Boenninghausen’s

Characteristics and Repertory.

Aims and objectives of this study were to study Boger Boenninghausen’s Characteristics

& Repertory in detail and to study the significance of polarity analysis in repertorisation

using BBCR to select the remedy in bronchial asthma. The first objective, the study of

the repertory explored in detail the practical guide line to locate the rubric and its cross

references as well as the special features of this repertory. To achieve the second

objective, the subjects of this study were selected from the outpatient department of

Father Muller Homoeopathic Medical College and Hospital, as per the inclusion criteria.

Conclusions of the first objective are, this repertory is much useful for treating any case

with its abundant detailing of each symptom with regards to the philosophy of complete

symptom. Also, rubrics on pathological generals, clinical rubrics and chapters on fever

and concordance are much valuable to the Homoeopathic practitioner for a better and

speedy selection of appropriate remedy. Conclusion of the second objective is, the

introduction of polarity analysis for analysing reportorial result helps improve the rate of

improvement of Homoeopathic prescriptions apart from helping the physician to

differentiate between medicines.

Key words: Boger Boenninghausen’s Characteristics & Repertory, Polarity Analysis

xi
 CONTENTS

Sl. No. TOPIC PAGE No.

1. INTRODUCTION 1

2. OBJECTIVES 3

3. REVIEW OF LITERATURE 4

4. METHODOLOGY 74

5. OBSERVATIONS AND RESULTS 77

6. DISCUSSION 90

7. CONCLUSION 94

8. SUMMARY 96

9. BIBLIOGRAPHIC REFERENCES 98

10. ANNEXURE

ANNEXURE – I 101

ANNEXURE – II 103

ANNEXURE – III 118

xii
 LIST OF TABLES

Sl. Page No.

No. DESCRIPTION

1. Polarity analysis showing patient- & opposite-symptoms and 9

polarity difference

2. Chapters with their subsections 21

3. Differential Diagnosis of Bronchial Asthma 63

4. Miasmatic expression of bronchial asthma 67

5. Distribution of cases according to Sex 77

6. Distribution of cases according to Age Group 77

7. Distribution of Cases According to Occupation 79

8. Distribution of Cases According to Approach used in the case 79

9. Distribution of Cases According to the Potency Used 81

10. Distribution of Cases According to the Duration of Illness 81

11. Distribution of Cases According to the Presenting symptoms 83

12. Distribution of Cases According to the treatment outcome 83

13. Distribution of Cases According to Medicines Prescribed 85

xiii
 LIST OF FIGURES
Sl Page No
No. DESCRIPTION
1. Reliability of Symptoms 11
2. Predisposing factors of Asthma 56
3. Etiological factors of Asthma 57
4. Pathophysiology of Asthma 59
5. Diagrammatic Representation of Cases According to Sex 78
6. Diagrammatic Representation of Cases According to the Age Group 78
7. Diagrammatic Representation of Cases According to the Occupation 80
8. Diagrammatic Representation of Cases According to the Approach 80
to the Case
9. Diagrammatic Representation of Cases According to the Potency 82
Used
10. Diagrammatic Representation of Cases According to the duration 82
of illness

11. Diagrammatic Representation of Cases According to the 84

Presenting symptoms
12. Diagrammatic Representation of Cases According to the 84
Treatment Outcome

13. Diagrammatic Representation of Cases According Medicines 86

Prescribed

xiv
INTRODUCTION
 INTRODUCTION

A Homoeopathic physician, who is keenly interested in doing the best for

his patient in the given circumstances, has a very difficult task regarding the choice of

remedies. Luckily, one of the great instruments at his disposal for sifting through the

maze of symptoms of such a large number of remedies in the Materia Medica is,

Homoeopathic Repertory.

The purpose of a repertory is to facilitate the search for the most similar

remedy or remedies corresponding to a given set of symptoms. There are quite a few

repertories, big and small. To use them effectively, their structure, historical and

evolutionary developments have to be thoroughly studied in depth, before we can utilize

them properly.

Boger Boenninghausen’s Characteristics and Repertory is a logico-

utilitarian repertory by C.M Boger. It is an expansion of Boenninghausen’s Therapeutic

Pocket Book. Boger was a keen student of Boenninghausen. Philosophy and concept of

totality adopted by Boger in this work is that of Boenninghausen.

In spite of all that could be said in praise of repertories, they cannot decide

the remedy for us. Repertories are only meant for guiding us to the group oh likely

remedies in the Materia Medica. In such cases, where only reportorial evaluation is used,

one has to be cautious on prescribing the drugs with the highest numerical value, because

some of the polychrests have much greater representations both in proving an MMs and

hence in repertories.

1
 According to a study done by ‘Swiss Association of Homeopathic

Physicians & Institute for Complementary and Alternative Medicine’, the

introduction of ‘Polarity Analysis’ in repertorisation, helped improve the quality of

prescription by increasing the improvement rate. It also helped in selecting the right

choice from the group of medicines.

Polarity Analysis is the modification of the original idea of

contraindications by Boenninghausen. Polar symptom is that which encompasses its

opposite, e.g.: desire to move/aversion to move; thirst/thirst less; warmth

ameliorates/warmth aggravates etc. if in a given polar symptom, the opposite is covered

by a particular medicine in a high grade, whereas the pole exhibited by the patient occurs

only in a low grade, then this medicine, according to Boenninghausen, is contraindicated

and will not cure the patient.

Bronchial asthma is a very common chronic disorder of the airways which

affects the individuals at almost any age and is an important cause of respiratory

morbidity and mortality. The WHO estimate is that there are 15 to 20 million people with

asthma in India and affects 7% of the population and 300 million people worldwide.

Homoeopathy offers a better treatment for this clinical condition than any

other system of medicine. Many studies are done in Homeopathy, regarding bronchial

asthma, following different philosophies. Introduction of polarity analysis in

repertorisation is one of the methods of selecting the similimum which needs further

study. This study is a small attempt to highlight the significance of polarity analysis

method in clinical practise through the study of bronchial asthma.

2
OBJECTIVES
 AIMS AND OBJECTIVES

1. To study Boger Boenninghausen’s Characteristics & Repertory in detail.

2. To study the significance of polarity analysis in repertorisation using BBCR to

select the remedy in bronchial asthma.

3
REVIEW OF
LITERATURE
 REVIEW OF LITERATURE

Every Homoeopath dreams of prescribing the curative remedy in every case of

illness that comes to him so as to attain Hahnemann‟s highest ideal of cure & to find that

remedy easily, quickly & accurately. For this purpose, a thorough knowledge of Materia

Medica is no doubt essential – the more thorough, the better. But how many of us are

gifted with this rare ability? Perhaps one may develop this mastery after a lifetime of

study and practice1.

As the volume of the Homoeopathic Materia Medica expanded and remedies

multiplied, it became a problem to apply this knowledge according to the directions laid

down by Hahnemann2. There are as many points of similarities between the remedies as

there are points of differentiation and to find a way out of this maze and decide which

remedy is most similar to a given case, is difficult in practice and is bound to be uncertain

in results1.

Even Hahnemann had felt in the course of his own practice, the need for an index

to the voluminous symptoms produced by various remedies1. As early as 1805, in his

famous „Fragmenta de Viribus Medicamentorum Positivis‟, he included an index or the

Repertory in the second part2.

If we had nothing but the mass of symptoms as recorded in the Materia Medica to

help in the search for single remedy, it would indeed be a gigantic task and the excuse of

many practitioners that they do not have enough time to practice straight Homoeopathy

would be plausible. But we have in the Repertory, a valuable help along this line, so that

with a little practice & study, the remedy may be found with amazing rapidity3.

4
 No one can know everything and that is why in all honesty, one must admit that

no conscientious Homoeopath can practice Homoeopathy in a serious and really

scientific way without a Repertory. This is why men like Boenninghausen applied their

mind to the discovery of better methods of selecting the similimum2.

To meet the challenge of the ever growing Materia Medica, the Homoeopathic

Repertory was born2.

Dr. Kent: “The use of Repertory in Homoeopathic practice is necessary if one is to do

careful work. Our Materia Medica is so cumbersome without a repertory

that the best prescriber must meet with only indifferent results.”

The term Repertory corresponds to the Latin word “repertorium” which originates

from „reperire‟ – to find; re – again, par ire – to bring forth. It means a place where things

are kept to be brought forth again, an inventory, a table or compendium where the

contents are so arranged that they are easy to find4.

Dr. J N Majumdar: “The Repertory is then essentially a book where we keep our

armamentarium, namely medicines, in an orderly way to be used at

times for fighting diseases in our patients.”

Repertory serves as the dictionary of the language of diseases, being the index of

myriads of clearly depicted symptoms, arranged under a definite order & principle, each

symptom pointing towards a list of remedies with their grades & ranks4. It is a classified

index which adds nothing, changes nothing, but serves merely as a guide to the mass.

5
 Hence basically the Homoeopathic Repertory is an index to the huge mass of

symptoms of various drugs of the Homoeopathic Materia Medica2.

Dr. C M Boger: “It is a book of index of medicines under symptoms. It is well related

with Materia Medica, therapeutics and Organon.”

In spite of all that could be said in praise of repertories, they cannot decide the

remedy for us. There are too many imperfections in our knowledge of the Materia

Medica, case taking, evaluation of symptoms & construction of repertories.

Repertory functions as a distinct system for the purpose of helping the

Homoeopath in the elimination of non indicated drugs. The trouble arises when we abuse

this function of Repertory & let it usurp the functions of the Materia Medica. The

repertories are only meant for guiding us to the group of likely remedies in the Materia

Medica.

There are a number of possibilities which seem to be competing for the place of

honour of the indicated remedy. That is where reportorial evaluations come to our aid. In

such cases where only reportorial evaluation is used, one has to be cautious on

prescribing the drug with the highest numerical value, because some of the polychrests

have much greater representations both in proving & Materia Medicas and hence in

repertories. This precaution is all the more necessary when one is working with

computerised repertories. Of course repertory gives us a suggestive list & brings to our

notice some remedies, but situation arises where it is not possible to be able to think of

the likely similimum.

6
 The changing pattern of sickness, tremendous atmospheric & environmental

changes and use & abuse of potentially toxic drugs have created challenges today which

were not known in Hahnemann‟s time. It is, therefore, tragic if our instruments are not

geared up to these challenges2. This is where the role of polarity analysis arises.

POLARITY ANALYSIS

Polarity analysis is the result of the search for a way to better match the

characteristic patient symptoms with the „„genius symptoms‟‟ of a homeopathic medicine

(i.e., the most characteristic symptoms, of high grade), thereby improving the reliability

of the prescriptions. To this end, Boenninghausen‟s idea of contraindications was

modified5.

Boenninghausen explained the concept of “secondary or alternating effects”,

where the same modality would aggravate as well as ameliorate, in different degrees, in

the same remedy. E.g.: < motion, > motion. Alternating effects were secondary

symptoms of inferior worth, also termed contradictory modalities. These assist in

confirming/rejecting remedies. The grade of the modality when matched with its intensity

in the patient should coincide or else the remedy is contraindicated6.

Even negative signs, so far as they belong to a particular rubric, should not be

neglected. An example will show best what is meant by this: when a patient, for whose

condition Pulsatilla seems suitable according to the five preceding questions (regarding

the location, sensation, causation, concomitant and peculiarities of disease), feels best

while at rest in a warm room, while he feels uncomfortable in the open cool air, and also

is fond of fat foods and bears them well, or offers other peculiarities which are in conflict

7
with the characteristics of Pulsatilla, this would give an urgent cause to doubt the

applicability of it to his case and to look for another remedy which also in these points

corresponds with the symptoms7.

Almost every homeopathic medicine includes a number of polar symptoms. These

are symptoms which also encompass their opposite, e.g., desire to move/aversion to

move; thirst/thirstless; warmth ameliorates/warmth aggravates; etc. A medicine may

exhibit both poles, usually in different grades. According to Boenninghausen, high grade

symptoms (grade three, four and five) correspond to the characteristics of the medicine.

In choosing the medicine for a patient we have to find the one, whose characteristics best

corresponds to the characteristic patient symptoms. All important symptoms of the

patient ought to be covered by the correctly chosen medicine, in as high a grade as

possible.

If, in a given polar symptom, the opposite is covered by a particular medicine in a

high grade, whereas the pole exhibited by the patient occurs only in a low grade, then this

medicine – according to Boenninghausen – is contraindicated and will not cure the

patient. Nux vomica, for example, has aversion to movement in third grade, desire to

move, however, only in first grade. Consequently, Nux-v will likely not cure a patient

who exhibits a strong desire to move, even though it covers this symptom in principle.

Boenninghausen used this method to check his choice of medicines.

Polarity analysis is a further development of this concept of genius symptoms and

contraindications: by summing the grades of all polar patient symptoms for each likely

medicine and subtracting the grades of the corresponding opposite polar symptoms, one

arrives at the polarity difference. For example: a patient suffers from tonsillitis with the

8
following symptoms: <swallowing, <speaking, <cold food, <after waking, >after eating,

thirst increased. All these symptoms are polar and covered by 19 medicines. However,

only three of those are not contraindicated according to Boenninghausen: Natrium

carbonicum, Mercurius solubilise and Magnesium carbonicum. The concept of polarity

difference for these three medicines is illustrated in Table 1.

Table 1: Polarity analysis showing patient- & opposite-symptoms and polarity difference

Nat – C Merc Mag - C Rhus Tox Graphites

Patient symptoms

<Swallowing 1 3 2 3 1

<Speaking 4 1 2 4 3

<Cold food 1 2 1 4 3

<After waking 4 4 3 4 5

>After eating 4 1 1 2 2

Thirst increased 2 4 1 3 1

Total 16 15 10 20 15

Opposite symptoms

>Swallowing 1 2 1 1 2

>Speaking 0 0 0 0 0

>Cold food 0 2 1 1 0

>After waking 1 0 0 0 0

<After eating 3 1 2 4 CI* 3 CI*

Thirstless 1 1 0 2 0

Total 6 6 4 8 5

Polarity Difference 10 9 6 12 10

*CI = Contraindication i.e., patient symptom low grade, opposite symptom high grade.

9
 The polarity difference is the sum of the grades of polar patient symptoms minus

the sum of the grades of polar opposite symptoms. The higher the polarity difference, the

more likely the medicine matches the characteristic symptoms of the patient, provided

there are no contraindications. A negative polarity difference points to remedies which

cover the patient symptoms in an unspecific way, i.e., do not cover all patient symptoms

with their genius symptoms. Such remedies have very little chance of curing the

presenting complaint in the patient.

According to our example, Nat-c exhibits the highest probability to cure, Merc the

second highest. Using this method, the best suited medicine in a repertorisation

containing several medicines, which cover all the patients symptoms, can be more readily

identified5.

The next concern is regarding the reliability of symptoms. According to

Boenninghausen, modalities are the most reliable symptoms. Boenninghausen was

conscious of the value of mental symptoms, but, he had given his own reasons for not

giving in minute details, the particularisation of mental symptoms in his repertory. He

was of the opinion that in a daily practice, it is difficult to extract reliable mentals. Very

often, the psychic state has to be ignored, as it is only a mask for the true mental

symptoms which are exhibited through somatic symptoms. Boenninghausen did not

under rate the mental symptoms but he felt that it was not practical politics2.

At the same time he has given much importance to the modalities narrated by the

patients. The following picture depicts the hierarchy of reliable symptoms. Modalities are

given first place and are the most reliable symptoms in daily practice. Mind symptoms

are listed last as they are the least reliable symptoms in daily practice.

10
Figure 1. Reliability of Symptoms5

Since modalities are considered to be most reliable polar symptoms,

repertorisation using polarity analysis also involves modalities in first place. One such

repertory where modalities are given importance is Boger Boenninghausen‟s

Characteristics and Repertory. While repertorising using this repertory, modalities in first

place method can be used. To use this method under BBCR, we must know the repertory

in detail.

An artisan is only as good as his tools are. Even an able artisan cannot turn out

good work with defective tools. At the same time, without knowledge and the ability to

use them, even the best of tools are useless1.

One must be thoroughly conversant with the underlying principles that have

guided the complier of the Repertory one is using and also with the plan on which it has

been organised. This facilitates quick spotting of the rubrics and the most economical &

11
fruitful way of combining them. It also draws one‟s attention to the drawbacks of the

Repertory. If one is not acquainted with the organization of the material in the Repertory,

it remains a closed book and the hunting of pages through its pages, an arduous task; one

may not be able to find the rubric in question at all8!

Dr. Pierre Schmidt: “You must learn your Repertory by heart almost and know where

to search.”

There are many repertories available today, based on different philosophies by

various stalwarts in Homoeopathy. Boger Boenninghausen‟s Characteristics and

Repertory is one among them with a sound philosophy and careful arrangement of rubrics

in different chapters. Here is a detailed study of this repertory.

BOGER BOENNINGHAUSEN‟S CHARACTERISTICS AND REPERTORY

Boenninghausen‟s Characteristics and Repertory of today is nothing but the

development of earlier repertories by Dr. C M Boger. It is a logical utilitarian type of

repertory based on the concept of particulars to generals. Perhaps, this is one of the

greatest pieces of Homoeopathic literature left by Dr. Boger.

Dr. C M Boger was a leading practitioner of the United States and a keen student

of Boenninghausen. In his time, both the Boenninghausen and Kentian schools were

popular. Boger made a study of both but accepted Boenninghausen‟s way of working out

a case. While translating Boenninghausen‟s „Repertory of Antipsorics‟, he was further

convinced that Boenninghausen‟s basic principles, plan and construction were sound,

comprehensible and hence practicable.

12
 Boger was also aware of the difficulties faced by the practitioners while using

Boenninghausen‟s „Therapeutic Pocket Book‟ as well as the criticism levelled against its

principles and methodology. He undertook the major work of rewriting

Boenninghausen‟s repertory. The outcome was a more useful work enriched with many

new chapters, new rubrics and medicines. He accepted the same basic plan and amplified

it to include the specific concomitants and modalities in various locations. He also

included a section dealing with characteristic symptomatology of each remedy to permit a

ready reference to the Materia Medica.

It was published by Boericke and Tafel in 1905. This work also contains an

excellent and exhaustive index which enables even a novice to locate symptoms more

readily. It lists some rubrics which are not included even in works of the magnitude of

Kent. This work is an attempt to bridge Boenninghausen and Kent9.

Dr. H A Roberts says about the repertory, “The combined observations and logic of

Boenninghausen and the wide observations garnered by Dr. Boger from long years of

study and practice.”

Dr. Dario Spinedi: “I discovered that Boger‟s Boenninghausen‟s Characteristics and

Repertory is a real goldmine for all kinds of symptoms.”

Dr. J H Clarke: “Dr. Boger‟s long work, Boger Boenninghausen‟s Characteristics and

Repertory, contains Boenninghausen‟s characteristic Materia Medica as well as the

repertories of all his work combined into one. It is most valuable compilation.”

PHILOSOPHIC BACKGROUND9

13
Boger while working on Boenninghausen‟s repertory, subscribed to the principle of

totality of symptoms which was originally given by Hahnemann. This work is based on

the following fundamental concepts:

1) Doctrine of complete symptom and concomitant

2) Doctrine of Pathological general

3) Doctrine of causation and time

4) Clinical Rubrics

5) Evaluation of remedies

6) Fever totality

7) Concordances

1. DOCTRINE OF COMPLETE SYMPTOM AND COCOMITANT9,10:

A symptom is not complete even after its exact nature and location are

ascertained. It requires further qualification by its relation or reaction to environmental

conditions, psychical as well as physical. The more a symptoms is qualified by these

factors the more it becomes of leading characteristic value.

A complete symptom is that which consists of Location Sensation, and

Modalities. Concomitants are those unreasonable attendants of the main symptom noticed

in relation to time. They do not have any pathological relation with the chief complaint

and thus helps in individualising a patient.

14
 Boger improved Boenninghausen‟s idea of complete symptom by relating

Sensation and Modalities to specific parts. In the book the complete symptoms are well

arranged and it is seldom necessary to do grand generalization regarding, Sensation and

Modalities. Concomitant are give greater importance by Boger in relation to parts.

2. DOCTRINE OF PATHOLOGICAL GENERALS:

Different systems of the body can be affected at the tissue level at the same time

with a common pathology. This common pattern is called the pathological general.

Pathological generals tell the state of the whole body and its changes in relation to the

constitution. It requires knowledge of pathology, keen observation and careful study of

the symptoms on the part of the physician to detect the pathological generals in a patient

and use it for finding out a similimum. This is an important contribution by Boger. He

emphasized the importance of pathological generals both in his repertory and his book

„General Analysis‟.

Examples for pathological generals: Sensations and complaints in general: discharges,

inflammations, haemorrhage tendency to, rubrics related to constitutions and miasms etc.

3. DOCTRINE OF CAUSATION AND TIME:

From the point of view, causation and time factors are more definitive and reliable

in cases as well as medicines. In his own practice he has successfully employed these

factors to find out the similimum in the shortest possible time.

Boger has given adequate place and importance to causation and time of the

expressions. Each chapter in the book is followed by Time aggravation. The section on

15
aggravation contains many causative factors.. He gave importance to CAUSATION AND

GENERAL MODALITIES (Mental and physical) followed by general sensations

(pathological generals and physical generals) which hold the key in the remedy as well as

in the person. Thus according to Boger they need to be given an adequate place in

repertorisation.

Hahnemann himself has emphazised the importance of causations in the 5th

aphorism of his „Organon of Medicine‟. “Useful to the physician in assisting him to cure

are the particulars of the most probable exciting cause of the acute disease, as also the

most significant points in the whole history of the chronic disease, to enable him to

discover its fundamental cause, which is generally due to a chronic miasm.”11

4. CLINICAL RUBRICS:

Clinical rubrics are those rubrics, corresponding to the clinical conditions or the

diagnosis. They are also known as Diagnostic Rubrics. Though they should be put to a

limited use, they help a physician in cases of advanced tissue changes where he is left

without getting a clear picture because of poor susceptibility. These rubrics are useful to

arrive at a group of medicines that can be further narrowed down with the help of

modalities to select finally the most similar remedy. These are to be used when the case

lacks in characteristic expressions. This helps mainly in finding out a palliative drug or a

drug that is suitable to overcome the patient crisis, when the case does not have any other

choice.

5. EVALUATION OF REMEDIES:

Borger followed the same gradation introduced by Boenninghausen. It is as follows:

16
 CAPITALS 5

Bold 4

Italics 3

Roman 2

(Roman) in parenthesis 1. (Rarely used.)

The gradation is based on the frequency of the appearance of symptoms in the

provers. Thus, five marks medicines are most important and one mark least important.

Higher grade medicines are those which produced symptoms in most of the provers and

had given repeated clinical confirmation. The fourth and third grades, though observed in

proving, less often have received clinical confirmation. The lowest grade, the second and

first, have been confirmed in practise occasionally.

6. FEVER TOTALITY:

This is a unique contribution of Boger. The arrangement of the chapter on Fever

is self-explanatory. Each stage of the fever is followed by Time, Aggravation,

Amelioration and Concomitant. Thus, they help to repertorise any simple as well as

complicated cases of fever. The chapter „Pathological Types of Fever‟ includes rubrics

for various clinical types of fever like typhoid, malaria etc and can be used for reference.

Concomitants are given after each stage in sections from mind to generals.

7. CONCORDANCES:

17
 In this last chapter, Boger has included relationships of different remedies to each

other relating to different parts of the body. It contains a total of 125 remedies. It helps us

to find a close running medicine and also in studying the relationships of remedies at

various levels.

Dr. Boger quotes regarding concordance, “It is notable that most provers develop

a few central effects, around which the other symptoms revolve in a greater or lesser

degree. A collection of these constitutes the essentials of our Materia Medica, especially

as they are thrown into various groupings by clinical application. The concordance is

condensed cross-references of such associated group.”

PLAN AND CONSTRUCTION OF THE REPERTORY

Having found certain difficulties in day to day use of „Therapeutic Pocket Book‟,

Boger tried to modify the structure and content of the book by adding many medicines

and rubrics drawn from his own experience and other sources. While compiling the

repertory Boger followed the basic plan and construction of Boenninghausen‟s

„Repertory of Antipsoric Medicines‟. However, he used the same gradation and the

principles as that of „TPB‟9.

Boger‟s work is mainly divided into FOUR parts: 12

1. Introductory part

2. Materia Medica part with characteristic symptoms of various remedies

3. Repertory proper

4. Concordance part

Introductory part

18
 This is an important contribution by Boger in this work. It is also the

philosophical part of the book. This includes the preface by the author wherein he has

discussed about sources of the book and some philosophical aspects. He also mentions

the 17 new drugs added in this work. The philosophical aspects discussed by Boger

include:

i. On the use of repertory

ii. Choosing the remedy

iii. The repetition of dose

iv. The homoeopathic prognosis

Materia Medica part10

The prime aim of this part is to help the busy practitioners with a ready reference

at the time of repertorisation. This section contains 140 medicines including the 17 new

medicines added by Boger. The sources of the Materia Medica part as mentioned by

Boger in the preface are:

a. „Whooping Cough‟

b. „Domestic Physician‟

c. „Aphorisms of Hippocrates‟

d. „Intermittent Fever‟

Repertory proper10

The repertory part embraces various source books such as:

a. „Boenninghausen's Therapeutic Pocket Book‟

19
 b. The „Apsoric‟ and „Antipsoric‟ repertories

c. „Sides of the Body‟

d. Repertory part of „Whooping cough‟

e. Repertory part of „Intermittent fever‟

f. „Aphorisms of Hippocrates‟.

Plan & construction of repertory part

Boenninghausen had divided his repertory into seven main chapters according to

Hahnemann‟s schema. Boger has followed this plan while compiling the repertory.

Philosophy followed: Particular to General

No. of chapters: 53

No. of medicines: 464

Arrangement of chapters: Each chapter is divided into subsections following

Boenninghausen‟s philosophy of complete symptom. It is described in a tabular form in

the next page.

 Location and Sensation

 Time

 Aggravation

 Amelioration

 Concomitants

 Cross references

20
Table 2. Chapters with their subsections with the number of rubrics in each section10

1.Mind : 369 Aggravation - cross-reference: 11

Time : 8 Amelioration - cross-reference: 1

Aggravation: 163 External – 110

Amelioration: 28 Time: 5

Concomitants: 1 Aggravation: 35

Cross-reference: 286 Amelioration: 9

Agg – Cross Reference: 10 Cross-reference: 15

2. Sensorium : 17 5. Eyes : 169

Aggravation & Amelioration : 40 (Locations & Sensations)

3. Vertigo : 43 Cross-reference: 30

Time: 6 Eyebrows:32

Aggravation: 110 Eyebrows – cross reference: 6

Amelioration: 27 Orbits: 34

Concomitants: 72 Orbits - cross-reference: 3

Agg - Cross-reference: 7 Eyelids: 114

Concomitants - Cross-reference: 3 Eyelids : cross-reference: 18

4. Head : Canthi: Time. Aggravation. Amelioration:164

Internal – 243 Vision: Time. Aggravation. Amelioration:121

Time: 11 6. Ears : (Locations & Sensations): 153

Aggravation: 238 Hearing: 8

Amelioration: 76 Time: 5

Cross-reference: 67 Aggravation: 80

Amelioration: 22

21
7. Nose : Locations & Sensations): 156 10. Mouth : (Locations & Sensations)

Smell: 4 Palate

Time: 5 Throat ( and gullet)

Aggravation: 44 Saliva

Amelioration: 5 Tongue

Coryza: Time

Time Aggravation

Aggravation Amelioration

Amelioration 11. Appetite : 12

Concomitants Time: 6

8. Face : (Locations & Sensations) 12. Thirst : 2

Lips Time: 10

Lower jaw &Maxillary joints 13. Taste : 107

Chin Time: 7

Time Aggravation: 30

Aggravation Amelioration: 4

Amelioration. 14. Eructation : 70

9. Teeth : (Locations & Sensations) Time: 6

Gums Aggravation: 48

Time Amelioration: 3

Aggravation 15. Waterbrash and Heartburn : 5

Amelioration Time: 6

Concomitants Aggravation: 28

22
16. Hiccough : 1 Cross-reference: 15

Time: 5 21. Abdomen : 214

Aggravation: 23 Time: 9

Amelioration: 2 Aggravation: 143

17. Nausea and Vomiting : 6 Amelioration: 55

Time: 8 Cross-reference: 57

Aggravation: 98 Aggravation : cross-reference: 11

Amelioration: 33 Amelioration : cross-reference: 6

Concomitants: 56 22. External Abdomen: 38

Cross-reference: 3 Aggravation : 6

Aggravation : cross-reference: 10 cross-reference: 10

18. Stomach : 156 23. Inguinal and Pubic region : 68

19. Epigastrium: 103 Aggravation: 1

Stomach & epigastrium cross-reference: 13

Time: 8 Mons pubis: 34

Aggravation: 105 24. Flatulence : 1

Amelioration: 38 Time: 8

Concomitants: 38 Aggravation: 41

Cross-reference: 45 Amelioration: 9

20. Hypochondria : 127 Cross-reference: 2

Time: 5 Aggravation : cross-reference: 1

Aggravation: 47 25. Stool : 146

Amelioration: 18 Concomitants before stool: 57

23
Concomitants during stool: 81 Before Micturition: 22

Concomitants after stool: 72 At beginning of urination: 3

Time: 8 During urination: 43

Aggravation & Amelioration: 112 At the close of urination: 6

Cross-reference: 65 After urination: 35

Concomitants Conditions of urination : 29

before stool : cross-reference: 8 Cross-reference: 18

Concomitants Sediment : cross-reference: 6

during stool : cross-reference: 12 Micturition : cross-reference: 2

Concomitants During urination: cross reference: 5

after stool : cross-reference: 12 After urination : cross-reference: 4

Aggravation and amelioration - cross- 30. Urinary Organs : 1

reference: 2 Kidneys: 49

26. Anus and Rectum : 117 Ureters : 3

Conditions: 34 Bladder: 58

Cross-reference: 29 Urethra: 67

27. Perineum : 47 Meatus: 12

Conditions: 2 Conditions: 30

Cross-reference: 10 Kidneys : cross-reference: 6

28. Prostate gland: 8 Bladder : cross-reference: 7

29. Urine : 56 Urethra: cross reference: 8

Sediment: 43 31. Genitalia : 6

Micturition: 1 Male organs: 58

24
Penis: 44 Concomitants after pollution : cross-

Glans: 58 reference: 3

Prepuce: 42 33. Menstruation : 5

Spermatic cord: 30 Concomitants before menses: 58

Testis: 66 Concomitants at the start of menses: 30

Scrotum: 50 Concomitants during menses: 45

Female organs: 119 Concomitants after menses: 35

Time: 6 Leucorrhoea: 1

Conditions: 72 Concomitants to leucorrhoea: 11

Male organs: cross-reference: 6 Cross-reference: 2

Penis: cross-reference: 6 Leucorrhoea : cross-reference: 9

Glans: cross-reference: 7 34. Respiration : 57

Prepuce: cross-reference: 3 Impeded by: 63

Spermatic cord: cross-reference: 5 Time: 6

Testis: cross-reference: 11 Aggravation: 117

Scrotum: cross-reference: 9 Amelioration: 35

Female organs: cross-reference: 10 Concomitants: 1

30. Sexual impulse : 13 35. Cough : 45

Concomitants of coition: 3 Excited or aggravated by: 177

Concomitants after coition: 31 Amelioration: 34

Concomitants after pollution: 24 Concomitants: 126

Concomitants after coition : cross- Expectoration : 60

reference: 3 Expectoration Taste of : 60

25
Expectoration Odour of: 10 Back proper- Dorsal region: 141

36. Larynx and Trachea : 89 Lumbar region and Small of back in general :

Aggravation: 13 114

37. Voice and Speech : 50 Sacrum and Coccyx: 59

Time: 6 Spinal column and vertebrae: 24

Conditions of voice: 32 Time: 6

38. Neck and External Throat : 93 Aggravation: 79

Nape: 86 Amelioration: 29

Time: 5 41. Upper extremities : 256

Aggravation: 34 Time: 6

Amelioration: 15 Aggravation: 66

39. Chest : Amelioration: 33

Inner: 183 42. Lower extremities : 264

External: 95 Time: 7

Axillae: 40 Aggravation: 94

Mammae: 64 Amelioration: 39

Nipples: 37 43. Sensations and Complaints in general:

Heart and region of: 130 418

Time: 7 44. Glands : 64

Aggravation: 102 45. Bones: 85

Amelioration: 140 46. Skin and Exterior body: 104

40. Back: Aggravation: 11

Scapular region: 98 Time: 2

Concomitants : 131

26
47. Sleep: 9 Mind

Positions during sleep: 6 Head; External head; Eyes; Vision; Ears;

Waking: 2 Nose; Coryza;

48. Dreams: 85 Face; Lips; Teeth; mouth and Throat;

Aggravation: 1 Appetite; Thirst;

49. Fever : Taste; Eructation, Nausea, Qualmishness, and

Pathological types: 27 vomiting

Blood : 1 Stomach, Hypochondria, abdomen; Stool;

Circulation: 2 Urine; respiration; Cough; Larynx; Chest;

Congestion: 6 Back and Lumbar region; Upper extremities;

Palpitation – time : 78 Lower extremities

Heart beat: 1 Skin; Sleep.

Pulse: 1 Heat and Fever in general : 1

Time: 6 Partial Heat; 1

Aggravation: 54 Time: 15

Chill: 3 Aggravation: 61

Partial Chill: 1 Ameliorations: 28

Coldness: 1 Concomitants: 151

Partial coldness: 3 Mind

Shivering: 2 Head; External head; Eyes; Ears; Nose;

Time: 10 Coryza; Face;

Aggravation: 54 Lips; Lower jaw; Teeth and Gums; Mouth;

Amelioration: 15 Chest; Back; Upper extremities; Lower

27
Throat; Appetite; extremities;

Thirst; Taste; Eructation and Waterbrash; Sensations and Generalities;Glands; Skin;

Nausea and Vomiting; Stomach, Bones; Sleep.

Hypochondriae; Abdomen; Flatus; Stool; 50. Compound Fevers :

Urine; Respiration; Cough; Larynx; Beginning with Chill: 2

External Throat and Neck; Chest; Beginning with Shivering: 1

Back; Upper extremities; Lower Beginning with Heat: 1

extremities; Beginning with Sweat: 1

Sensations and Generalities; 51. Conditions in general

Glands; Bones; Skin; Sleep. Time: 11

Sweat: 1 52.Conditions of aggravation and

Partial sweat: 2 amelioration in general: 349

Time: 13 53. Concordances: 125

Aggravation: 52

Amelioration: 16

Concomitants : 140

Mind; Head; Eyes; Ears; Nose; Coryza;

Face; Lips; Lower jaw;Teeth and Gums;

Mouth; Throat; Appetite; Thirst; Taste;

Eructation‟s and Water brash; Nausea and

Vomiting;Stomach;Hypochondriae;

Abdomen; Stool; Urine; Respiration;

Cough; Larynx; External Throat and Neck;

28
ARRANGEMENT OF RUBRICS9

Most of the sections start with the rubric „In General‟. This rubric groups those

prominent medicines, which are capable of producing different types of symptoms in

relation to that organ/ location. This is followed by rubrics relating to locations,

sensations, time, modalities, concomitants and cross references.

Location: Rubrics for location are given in the beginning of each chapter and are

arranged in anatomical order of locations. Location rubrics are followed by further sub

divisions of parts, with each part having rubrics like „side‟ and „extending to‟.

Sensation: After location different sensations are arranged in an alphabetic order. In

most of the chapters, a horizontal line separates the rubrics for locations and sensations.

E.g. Eyes, Ears, Nose, Abdomen, Genitalia etc. Each sensation is a general rubric which

is followed by a group of medicines. It is divided into sub rubrics under which parts are

mentioned (mostly abbreviations) e. g Head, Upper and Lower extremities etc. Rubrics

for pain are further divided into various types of pain, i.e. aching, burning, etc. this is

followed by time, aggravation, amelioration, concomitants and cross reference.

Time: rubrics relating to time are arranged in clockwise order of time. Here the

medicines are grouped under broad divisions of time like daytime, morning, noon, night

etc as patients mention broad divisions of time rather than the exact hour of suffering.

Specific hours are not mentioned except for in a few chapters with a very small group of

medicines. This subsection of time is given at the end of sensations in each chapter and

specifies the aggravation of complaints at a particular time.

29
Aggravation: This subsection contains factors which increase the specific complains of

the part. Rubrics are arranged alphabetically in this section. It also includes the factors

which excite or bring on the complaints, i.e. the causations. Some of the concomitants are

also found in this subsection especially in those chapters which are not followed by a

separate chapter on concomitants. E.g. Eyes, Vision, Nose.

Amelioration: It is found in practise that the patient finds it difficult to present

ameliorating factors. Thus this subsection contains lesser number of rubrics. Thus

ameliorating factors usually help in individualising the case. The rubrics are arranged in

alphabetical order.

Concomitants: This is a major contribution by Boger to the homoeopathic system of

medicine. Most of the concomitant sections are well explained and arranged in an

alphabetical order, but a few subsections have only a group of medicines. Chapter on

fever is extremely rich in concomitants in relation to chill, heat and sweat under different

subheadings. However all chapters do not include this subsection and some of the

concomitants are mentioned under the subsection aggravation.

Cross Reference: This is another important subsection which makes the repertory more

useful and comprehensible. To locate the hard earned characteristic symptoms in the

repertory, we must adequately interpret and convert them into rubrics. This subsection

helps us to do this and also to clear our confusion about similar rubrics. However, all

chapters are not followed by this subsection. Chapter mind is having an extensive section

of cross reference.

30
SPECIAL FEATURES OF CHAPTERS

MIND:8

 This chapter combines the symptoms of mind and the symptoms of intellect

which are arranged alphabetically.

 Rubrics denoting emotional state responsible for the ailments are given in general

section on agg and amel.

 Concomitant section contains a list of remedies having prominent concomitants in

the mental sphere in general.

 Cross reference section in mind chapter is vast and lists many alternative

keywords. If a particular mental symptom is not readily found, refer to this

section and make sure that it is not listed under another heading.

SENSORIUM:

 This section consists of rubrics dealing with a few „Sensations as is‟ and

„Confusion‟ and „Faintness‟. Some of these could have been included in mind or

Sensation & Complaints in General.

 Some of the concomitants mentioned in the agg. and amel.

HEAD:

 This chapter is first sub divided into „Internal and External‟

 INTERNAL :location and sensation are arranged alphabetically

 EXTERNAL: location and sensation of scalp, skin and hair.

31
  Locations are mentioned under the sensation rubrics as sub rubrics in the form of

abbreviations: Forehead (F), Temples (T), Sides of (S), Occiput (O), Vertex (V),

left side (L) and right side (R).

EYES

 Locations of inner eye are listed first followed by their sensations

 After that, this chapter is again divided into sub sections according to different

locations of outer eye: eyebrows, orbits, eyelids and canthi.

 Vision is given as a separate sub section and includes all disorders relating to

vision such as blindness, blurred, indistinct etc. Some of the clinical rubrics found

in this section are: cataract, myopia, presbyopia, photophobia. Paralysis of optic

nerve is also listed in this section.

 „Illusions‟ is a large rubric containing sub rubrics pertaining to altered sense of

vision: illusion of; falling bodies, figures, faces, mist, spots etc. Hemiopia is listed

under this rubric.

 Sub sections canthi and vision are having sub sections for time, aggravation and

amelioration

 All other sections have sub section on cross reference

 Abbreviations are used in different sections: Eyelids; upper – O, lower – U;

Canthi; outer – O, inner – I;

 Alongside the medicines under rubrics, their side affinity is indicated with

abbreviations in bracket: (l) for left and (r) for right, for example: under the rubric

„ foreign body in‟, the remedy alumina is followed by the abbreviation ( l)

32
EARS

 This section starts with the rubric „ right‟ and ends with „vanishing, sudden‟

 Conditions regarding hearing are listed under a separate section as „hearing‟

 The rubric illusions list a number of conditions as sub rubrics for altered sense of

hearing

NOSE

 This chapter is divided into subsections like smell and coryza

 The sub chapter 'smell' contains different type of perversions of smell, and

illusions under the rubric 'illusions of. Whereas chapter coryza contains different

sensations and discharges.

FACE

 The main chapter is followed by lips, lower-jaw and maxillary joints and chin.

 Abbreviations are used such as right (R), left (L), Forehead (F) Temple (T),

Zygoma and malar bones (Z), cheeks (CH).

 Some of the clinical rubrics in this chapter are: acne, boils, herpes, neuralgia,

pimples.

TEETH

 This section starts with the rubric „Side, one‟ and ends with „wrinkled feeling as

if‟.

 Abbreviations are used: right – R, left – L, upper – O, lower – U, incisors – I, eye

teeth – E, bicuspids and molars – J and hollow – H.

33
  Among sub rubrics, many a time these abbreviations are used together to indicate

one condition. For example, page no. 424, under the rubric pain simple, one sub

rubric is J. O. H and this means, pain in the hollow (H) of upper (O) bicuspids and

molars (J).

 There is a sub section on Gums under this chapter to include conditions of gums.

 Under the sub section gums, the abbreviation „I‟ stands for „inner‟, not incisors.

MOUTH

 The section starts with rubric „mouth‟ and ends with „withered‟.

 This is sub divided into palate, throat (and gullet), saliva and tongue

 Some of the clinical rubrics are aphthae and stomatitis in mouth, abscess,

gangrene and oesophagitis in throat, cancer and paralysis in tongue.

 Abbreviations are used in the sub section palate such as, „H‟ for hard palate and

„S‟ for soft palate

APPETITE:

 This section starts with the rubric „appetite‟ and ends with „variable‟

 Has a subsection on time modalities

 This chapter includes different conditions of appetite, hunger and satiety

 Physical generals like desires and aversions are included in this chapter

 Agg. & amel from food and eating are listed in general section on agg & amel

34
THIRST

 This is a short section with two main rubrics „thirst‟ and „thirstlessness‟ which are

followed by many subrubrics

 This section has a subsection on time modalities

TASTE

 This section starts with the rubric „ acid‟ and ends with „wood, as of‟

 This section contains rubrics regarding different conditions of taste such as

„altered in general‟, „lost‟, „dulled, diminished‟ etc

 This also includes particular type of tastes like: bitter, salty, fatty, like bad eggs,

ruinous, sour, nauseous etc.

 This includes subsections on time, aggravation and amelioration

ERUCTATION

 This section starts with „eructations, in general‟ and ends with „watery‟

 Character of eructation is described in detail in this section through various

rubrics such as bitter, disagreeable, foul; offensive, ingesta tasting of, loud

(noisy), salty, sour, watery etc.

 The subsections are listed on time, aggravation, and amelioration.

WATERBRASH & HEARTBURN

 Starts with the rubric „burning‟ and ends with the rubric „water, collecting in

mouth‟

35
  Heartburn is represented directly as „heartburn‟ and waterbrash is represented as

„water, collecting in mouth‟

 Subsections are included on time and aggravation

HICCOUGH

 This is the shortest chapter with only one rubric that is „hiccough‟ itself

 Subsections are: time, aggravation, amelioration

NAUSEA & VOMITING:

 Starts with the rubric „inclination to vomit‟ and ends with „vomiting‟

 Character of vomitus such as bloody, mucous, yellow, fecal matter, green, coffee

grounds like, etc are given as sub rubrics under the rubric „vomiting in general‟

 A few concomitants are also found in this section

STOMACH & EPIGATRIUM

 Section stomach starts with rubric „stomach‟ and ends with „writhing‟

 Section epigastrium starts with the rubric „epigastrium‟ and ends with „ whirling‟

 Although both sections are given separately, sub sections on time, modalities,

concomitants and cross references are given together for both sections at the end

of section epigastrium.

HYPOCHONDRIAC:

 This section starts with the rubric „hypochondria‟ and ends with „wrenching‟

 Contains rubrics related to liver, gall bladder and spleen

36
  Abbreviations used are: „L‟ for liver region, „S‟ means spleen or left and „B‟ for

both sides.

ABDOMEN

 Starts with rubric for „abdomen‟ and ends with „wrenched‟

 Abbreviations used are : A- abdomen in general, U – upper, N – navicular region,

S – sides of, R – right, L – left, H – hips and loin region, M – lower abdomen,.

 Clinical rubrics found in this section are, „tuberculosis, of‟ and „volvulus‟

 Contains rubric relating to the parts or organs in the inner abdomen

EXTERNAL ABDOMEN

 Starts with rubric „abdomen, muscles, walls of etc‟ and ends with zoster

 In this section Boger has arranged rubrics relating to the external parts of

abdomen

 Clinical rubric listed in this chapter is, „hernia, umbilical‟

INGUINAL AND PUBIC REGION

 Starts with „inguinal region‟ and ends with „weakness‟

 Has a subsection on mons pubis

 Clinical rubric: hernia, inguinal

FLATULENCE

 Has only one rubric; „flatus in general‟

 This rubric contains many sub rubrics representing different character of flatus

37
STOOL:

 Starts with „absent‟ and ends with „yellowish green‟

 Characters of stool regarding its odour, colour, consistency etc are mentioned in

this section. Along with this, conditions of stool like constipation, diarrhoea,

dysentery etc are also listed.

 Rubric on „worms‟ contains sub rubrics on types of worms making it much useful

 Concomitants before, during and after stool, are given in detail as different

sections.

 Agg and amel section contains a few concomitants

ANUS AND RECTUM

 Starts with „anus‟ and ends with „worm, as of a‟

 Abbreviations used are: Anus – A, rectum – R.

 Clinical rubrics such as abscess, haemorrhoids, fistula, paralysis and prolapsed are

listed in this chapter

 Modalities are given under the heading CONDITIONS as a sub section instead of

the usual „aggravation / amelioration‟

PERINEUM

 Starts with rubric on „perineum‟ and ends with „varicosis of‟

 Modalities are given as „conditions‟

38
URINE:

 Characters of urine regarding its colour, odour, constituents etc are mentioned in

this chapter

 Concomitants before, at the beginning of, during, at close of and after urination

are listed in detail under corresponding sub sections

 Conditions regarding micturition such as involuntary, urging etc are mentioned

under the sub section „micturition‟

 Modalities are mentioned under the heading „conditions of urination‟ at the end of

„concomitants after urination‟

URINARY ORGANS:

 Different locations and sensations of urinary system included here in anatomical

order

 Subsections are: kidneys, ureters, bladder, urethra, meatus

GENITALIA

 Divided into two main sub sections as „MALE ORGANS‟ and „FEMALE

ORGANS‟

 Section „male organs‟ is again sub divided into penis, glans, prepuce, spermatic

cord, testes and scrotum.

 Female organs section is not sub divided and abbreviations are used to indicate

different parts: V- vagina, U – uterus, O – ovaries.

 Complaints during pregnancy, abortion, parturition and childbed are to be

searched in this section

39
  Some of the clinical rubrics found in this section are: puerperal fever, eclampsia,

herpes, neuralgia, polypi, prolapsed, sub involution etc.

SEXUAL IMPULSE:

 Conditions relating to both sexes are mentioned in this section

MENSTRUATION:

 Character of menses and character of menstrual blood are listed in this chapter

 Details of concomitants before, at beginning of, during and after menses are given

in detail in this chapter.

 Apart from the sub sections on concomitants, this chapter includes a separate

section on leucorrhoea followed by a sub section on concomitants to leucorrhoea

RESPIRATION

 This section includes character of respiration and is followed by a sub section

„impeded by‟ which lists different conditions that impede respiration

 The concomitants section of this chapter contains only one rubric „concomitants‟

COUGH

 This chapter lists rubrics regarding different types of cough

 Aggravating factors are listed under the subsection „excited or aggravated by‟

 Expectoration and type of expectoration are listed in subsection „expectoration‟

 Taste of expectoration as well as colour of expectoration are given under

corresponding sub sections

40
LARYNX AND TRACHEA

 Abbreviations used are: L – larynx and T – trachea.

VOICE AND SPEECH

 Character of voice such as deep base, echoing, hoarse etc and character of speech

such as incoherent, slow, stammering etc are given in this chapter.

 Paralysis of vocal cords can be searched in this chapter

NECK & EXTERNAL THROAT:8

 This chapter combines affections of external throat and neck

 Nape is one sub section in this chapter and Cervical region is to be searched in

this section instead of chapter Back

CHEST

 This section is divided into „inner, external, axillae, mammae, nipples and heart

and region of‟

 Rubrics relating to lungs and heart are found in the section chest, inner.

 Clinical rubrics in the whole chapter are: pleurisy, pneumonia, bronchitis,

hydrothorax, aneurysm

BACK

 This chapter is subdivided into scapular region, back proper – dorsal region,

lumbar region – small of back in general and spinal column and vertebrae.

41
UPPER EXTREMITIES

 Different locations are listed first in general and then under specific complaints.

 Abbreviations are used for different locations: A – means the entire muscular and

fleshy part of the arm, unless otherwise specified the entire arm is understood, Sh

– shoulder, O – upper arm, U – forearm, H – hands, F – fingers, T – thumbs, J –

joints in general , J.Sh – shoulder joint, J . E – elbow joint, J . W – wrist joint, J. F

– finger joints, B - bones

LOWER EXTREMITIES:

 Abbreviations used are: The entire muscular and fleshy part of limb denotes

(M).Loin (Hip) region (H), Thigh (U) leg (L), Tendo-achilles (T. A), Foot (F),

Toes (T) joints in general (J) with other sub parts of foot, limb and fingers.

SENSATIONS & COMPLAINTS IN GENERAL:

 This is a very important section where in general sensations included

 Some of the clinical rubrics are: epilepsy, marasmus, polypi etc.

 Some of the pathological generals are: emaciation, haemorrhage etc

 The rubric „constitution‟ contains different sub rubrics for various constitutions as

well as miasms: carbo – nitrogenous, hydrogenoid, litahemic etc and psoric,

sycotic and syphilitic

 The rubric „infants‟ contain different subrubrics involving conditions of infants

and is very useful especially in paediatrics practice.

42
GLANDS

 Starts with the rubric „glands in general‟ and ends with the rubric „urging

outward, as if‟.

 It represents the affections of glands of whole body in general.

BONES

 Starts with the rubric „abscess of‟ and ends with „weakness, sense of‟.

 Some clinical rubrics found in this section are: abscess, caries, fracture, ganglion,

osteo – myelitis, tuberculosis, of etc.

 Different clinical conditions of bones and general sensations regarding them are

represented in alphabetical order.

SKIN AND EXTERIOR BODY

 Starts with the rubric „skin in general‟ and ends with „zoster‟.

 Some of the clinical rubrics mentioned in this chapter are: abscess, boils, corns,

figwarts, gangrene, keliod, miliaria, nettle rash, pimples, polypi, sarcoma, scarlet

fever, small pox, varicella, warts, zoster etc.

 The chapter aggravation and amelioration has a cross reference for the rubric

„injuries‟ to the this chapter and the rubric in this chapter is „wounds‟ (injuries in

general, falls, bruises, blows, contusions). This rubric is used when „ailments from

injury‟ is to be used in a case as a causative modality.

 Different colour of skin is mentioned under the rubric „color‟

43
  General sensations of skin like: biting in skin, burning of skin, formication,

itching, gnawing, prickling etc are mentioned.

 Conditions affecting nails are given in this chapter under the rubric „Nails‟.

 Urticaria is represented by two rubrics, „urticaria‟ and „nettle rash‟ both of which

are cross referred to „eruptions, urticarious‟.

 There are two subsections for this chapter; aggravation and time.

SLEEP:

 This section is dealt with somewhat differently from the usual arrangement.

Sensations & Complaints, modalities, concomitants etc are all mixed up.

 No. of rubrics : 17

 Starts with the rubric „yawning‟ and ends with „sleeplessness‟.

 Important rubrics are : yawning; falling to sleep, late; sleepiness; sleep; during

sleep; waking and sleeplessness

 Two subsections are present; positions during sleep and waking

 Character of sleep like anxious, restless, sound (deep), stupor etc are mentioned

under the rubric „sleep‟

 Conditions during sleep such as twitching of eyelids, motion of limbs, legs

crossed etc are mentioned under the rubric „ during sleep‟

 The rubric „sleeplessness‟ contain different conditions causing sleeplessness.

 The rubric‟ sleepiness‟ starts with time modifications such as sleepiness during

day, in morning etc and then the conditions associated are mentioned.

44
DREAMS

 Starts with „dreams in general‟ and ends with „wrong of, doing‟.

 No. of rubrics : 85

 Different types of dreams in general, for example: anxious, confused, unpleasant,

unremembered, etc are included.

 Particular types of dreams are also represented : Fruit ,of; teeth falling out, of;

fishes, of; flying; singing etc

 All rubrics represent different type of dreams.

 This chapter has only one subsection, aggravation, with only one rubric, „lying on

left side‟.

FEVER:8

 This chapter is enriched with maximum number of concomitants

 Various chapters like pathological types, blood, circulation, palpitation, heartbeat,

chill, partial chill, coldness, partial coldness, shivering, heat & fever in general,

partial heat, sweat, partial sweat etc are included

 Chill, heat and sweat stages are followed by time, aggravation, amelioration and

concomitant.

 Concomitants are given elaborately under headings starting from mind to general

modalities

COMPOUND FEVERS:8

 This chapter deals with instances of fever wherein all the three stages are not seen

45
CONDITION IN GENERAL

 This section contains aggravations in general related to time factor.

 Time is arranged in clockwise order.

 Specific hour of time is not mentioned in this chapter

CONDITIONS IN GENERAL:8

 Should be read as conditions of agg and amel in general.

 General modifying conditions are arranged alphabetically under agg and amel in

general.

CONCORDANCES:8

 A total of 125 remedies are discussed

 Each remedy is further divided into rubrics that are generalised as symptom

groups

 The rubrics in each remedy section is arranged from mind through blood and

circulation to aggravation

 At the end of each remedy, a rubric on „related remedies‟ is included as „other

remedies‟

 Remedies are arranged in alphabetical order

METHODS OF WORKING OUT A CASE9

Boenninghausen‟s Characteristics and Repertory has got its own advantages over

the other repertories. It is well arranged, well explained follows a definite plan and

construction and is based on a sound philosophy. Boger has given great importance to

46
causation, time dimensions, modalities and pathological generals. The repertory can be

used by the following methods according to the availability of data in different cases.

1. Using Causative modalities in first place

This method can be useful in cases which have definitive causative

modalities. The hierarchical arrangement of rubrics is as follows:

 CAUSATIVE MODALITIES (Ailments from)

Mental: fear, excitement etc

Physical: getting wet, cold exposure etc.

 OTHER MODALITIES

Aggravations: mental & physical

Ameliorations: mental & physical

 PHYSICAL GENERALS

 CONCOMITANTS

 LOCATION & SENSATIONS

2. Using Modalities in the first place

Some cases may not present with causative modalities but have other

general as well as particular modalities in abundance. Such cases can be

repertorised using this method where the arrangement of rubrics is in the

following order.

 MODALITIES: mental & physical

 CONCOMITANTS

 PHYSICAL GENERALS

 LOCATION & SENSATIONS

47
3. Using Concomitants in the first place

Boger stressed the importance concomitants in selecting a similimum and

mentioned many concomitants in each chapter. This method of repertorisation can

be followed for cases which have clear concomitants.

 CONCOMITANTS

 MODALITIES

 PHYSICAL GENERALS

 LOCATIONS & SENSATIONS

4. Using Pathological Generals in first place

Pathological generals are unique contribution by Boger and he has given

much importance to it especially in cases which lack in characteristic expressions.

The hierarchical arrangement of rubrics is:

 PATHOLOGICAL GENERALS

 PHYSICAL GENERALS

 CONCOMITANTS

 MODALITIES

5. Using Diagnostic or Clinical Rubrics in First Place

Boger has included many clinical conditions in his repertory which can be

used for cases that have no other choice, mainly to find out a palliative drug.

Arrangement of rubric is:

 CLINICAL RUBRIC

 AGGRAVATIONS

48
  AMELIORATIONS

 WEAK CONCOMITANT

 PHYSICAL GENERALS

6. Following Robert‟s Method

In this method, locations and sensations are used in the first place. Here,

sensations and modalities are first referred to the parts concerned. In case the

particular sensation or modality is absent they can be referred to the general

chapter. If they are represented well in general chapter, they should be used for

repertorisation. Arrangement of rubrics:

 LOCATIONS & SENSATIONS

 MODALITIES

 CONCOMITANTS

 PHYSICAL GENERALS

7. Fever Totality

In a fever case if all stages are distinct, the following order would be

preferable. If some stage is not available in the case, then the next stage can be

considered for repertorisation.

 CHILL

o Type / Partial Chill / Coldness – Partial / Shivering

o Time

o Aggravation

o Amelioration

o Concomitant

49
  HEAT

o Type / Partial

o Time

o Aggravation

o Amelioration

o Concomitant

 SWEAT

o Type / Partial

o Time aggravation

o Amelioration

o Concomitants

Pathological types of fever mentioned in the repertory can be used for

reference and final selection of the drug. Sometimes these rubrics can be used for

repertorisation following the fifth method mentioned earlier.

8. Use of Concordance Chapter

The chapter concordance solely deals with the relationship of remedies. It can

be used for studying the relationships of remedies at various levels of mind, parts,

sensations and modalities. It can be used to find out close running medicine to

make second prescription when needed.

Method of Working

Under the medicine in first prescription, refer the subheading which is the

main complaint of the patient and use it as first rubric. Next take mind and all

other subheadings one after another. The first rubric can be used as an eliminating

rubric also.

50
MERITS OF THE REPERTORY9,10

Complete Symptom: Boger has completed each chapter with all components of a

complete symptom. Each location is followed by particular sensations, modalities and

concomitants. Therapeutic Pocket Book by Boenninghausen was lacking this type of

complete arrangement.

Pathological Generals: Boger has included many pathological generals in his repertory

which are valuable for repertorisation and selecting the similimum. Detail about

pathological generals is mentioned earlier.

Clinical Rubrics: We find many diagnostic clinical rubrics mentioned in each chapter

with a group of medicines. These medicines have been used in the conditions mentioned

and found to be useful in majority of cases.

Constitution: Boger has mentioned different types of constitutions with a group of

medicines in the chapter „Sensations & Complaints in General‟. It helps in finding out the

similimum easily.

Separate Concomitants: Boger made his repertory more useful by attaching

concomitants section to each chapter. This section is followed after modalities subsection

in most of the chapters.

Rubric – infant affections of: This is a big rubric with many sub rubrics in the chapter

„Sensations & Complaints in General‟. This is very useful for repertorising cases of

children.

51
Fever Chapter: This is a unique work of Boger. Each stage of fever is represented well

in this chapter with details. Concomitants in relation to each stage given under different

headings are really valuable. This is one of the best repertories for fever cases.

Cross Reference: This sub section given under each chapter helps us to find the

appropriate rubric. In some cases, a particular rubric may not be found and in such cases

we can refer this section and find out the appropriate rubric given in the repertory. It also

helps in studying similar rubrics.

Menstruation Chapter: This is well arranged and followed by concomitants in the

following order:

Before menses

At the start of menses

During menses

After menses

With this repertory, all these can be found at one place. Similar arrangement is also found

in chapters stool, leucorrhoea, micturition etc.

52
LIMITATIONS OF THE REPERTORY9,10

1. Though it is said that all chapters follow the arrangement in the form of complete

symptom, many chapter do not have all components as sub sections. Many

chapters lack in the sub section of concomitant. In many chapters, concomitants

are given under aggravation.

2. The sub section concomitants in the chapter MIND is not much useful as details

are not mentioned. It is a general rubric with a group of medicines. No sub rubrics

are included. Thus it does not convey a very useful meaning.

3. Though the chapter concordance is very useful, it contains only 125 remedies in

it. Also the number of remedies under each heading is less. Hence, it falls short

for practical purposes.

4. Boger has used similar rubrics in different sections which may create confusion.

For example, the rubric „faintness rising on‟ is mentioned under chapter

„Sensorium‟. Similar rubric „faintness on rising‟ is mentioned under chapter

„sensations & complaints in general‟.

5. There are some misplaced rubrics in the repertory

6. Although it is one of the latest repertories, the remedial representation is poor.

Many rubrics contain single or a few medicines.

7. Under certain rubrics, many important medicines are missing. For example: under

the rubric „sentimental‟, the medicine „Natrum Mur‟ is missing. Similarly, under

the rubric „faintness rising on‟ the remedy „Cocculus‟ is missing. Also, under the

rubric „dreams of snakes‟ the medicine „Lachesis‟ is not included.

8. Nosodes are not represented well in this repertory.

53
 BRONCHIAL ASTHMA

Bronchial asthma is a condition affecting many individuals in the society today.

Cases diagnosed to be Bronchial asthma are frequently visited in our outpatient department

daily. Hence this condition was thought of easily, to be included in this study. Another

point of advantage is that, cases with bronchial asthma, usually report many modalities

which are well represented in the repertory as well. It supports the study this was as the

study involves polarity analysis where modalities are of prime importance.

DEFINITION

Asthma is defined as the chronic inflammatory disease of airways that is

characterised by increased responsiveness of the trachea bronchial tree to a multiplicity of

stimuli.

It is manifested physiologically by a widespread narrowing of the air passages

which may be relieved spontaneously or as a result of therapy, and clinically by paroxysms

of dyspnoea, cough and wheezing. It is an episodic disease with acute exacerbations

interspersed with symptom free periods13.

The term „asthma‟ in Greek means „breathless‟ or „breathe with open mouth‟14. The

word first appears in Homer‟s “Iliad”. Hippocrates was first to use it in reference to the

medical condition in 450 BC. In the 17th century, „Bernardino Ramazzini‟, noted a

connection between asthma and organic dust. The use of bronchodilators started in 1901,

but not until 1960‟s that inflammatory component of asthma was recognized15.

54
EPIDEMIOLOGY

It is suggested that 300 hundred million people worldwide suffer from asthma and

an additional 100 million may be diagnosed with asthma by 201516. About one half of the

cases develop before the age of 10 and another third occur before the age of 40. In

childhood, there is 2:1 male/female ratio preponderance, but the sex ratio equalizes by age

30. In India, asthma has been found to be around 6% in the majority of the surveys17.

TYPES OF ASTHMA17

1. ATOPIC

2. NON ATOPIC

ATOPIC ASTHMA

This type usually starts at an early age and is provoked by allergens in addition to

other triggers. Such patients usually have allergic ailments of skin, nose and eyes. Family

history of allergic disease is common. Such patients form IgE antibodies when they come

in contact with common allergens. This type is also known as EXTRINSIC or EARLY

ONSET ASTHMA.

NON ATOPIC ASTHMA

This type usually starts at adult age. It is usually not provoked by allergens. In such

patients, family history of allergic disease is uncommon. This type is also known as

INTRINSIC or LATE ONSET ASTHMA.

55
AETIOLOGY

Aetiological factors of asthma can be divided mainly into two; inducing factors and

provoking factors.

Inducing factors17

These are factors which cause initial development of asthma. They include genetic

factors, tobacco smoke, maternal smoking during pregnancy or infancy, viral infection

(rhinosyncitial virus infection) during infancy and exposure to high concentration of

allergens during infancy.

Figure 2. Predisposing factors of Asthma16

Provoking factors17

These are factors which provoke an episode in predisposed individuals. It includes:

A. Allergy: exposure to house dust mite, pollens, molds, animal dander, cockroaches

etc.

B. Drugs: beta blockers, prostaglandins, cholinergic drugs, NSAIDs, aspirin etc.

56
C. Food: egg, milk, food colouring agents, preservatives etc. are sometimes observed

to be trigger factors for asthma. However, Indians are reported to be more sensitive

to ice and cola drinks.

Figure 3. Etiological factors of Asthma16

D. Environment: aggravation of asthma on cold and dry days especially when there is

strong wind is observed. Traffic pollution and environmental tobacco smoke are

also contributing factors.

E. Occupation: Chemicals related to different occupations such as isocyanates,

platinum, chrome, nickel, reactive dyes, pharmaceutical agents, wood dust, cotton

dust etc are some of the major trigger factors.

57
 F. Exercise: Vigorous exercise is noted to cause bronchospasm.

G. Psychological factors: Stress may rarely provoke an episode of asthma.

H. Infection: It is well recognised that viral infections commonly cause attacks of

asthma. Secondary bacterial infection is widely held to occur and perpetuate the

inflammatory reactions which give rise to prolonged airway narrowing.

I. Gastro-oesophageal reflux disease: reflux of the gastric contents in the lower third

of oesophagus can provoke asthma.

J. Sinusitis18: 50% of asthma patients are observed to have concurrent sinus disease

which is an important exacerbating factor.

K. Obesity18: some study findings have shown a statistically significant association

between asthma, obesity and abnormal lipid and glucose metabolism.

PATHOPHYSIOLOGY

Pathophysiology of asthma is complex and involves the following components18:

- Airway inflammation

- Airflow obstruction

- Bronchial hyper responsiveness

Local cellular events in the airways have important effects on lung function. As a

consequence of the airway inflammation, smooth muscle hyperresponsiveness, and airway

narrowing, airway resistance increases significantly. Thus, where under normal physiologic

circumstances the small-calibre peripheral airways do not contribute significantly to airflow

resistance, these airways now are the site of increased resistance. This is worsened by the

superimposed mucus hypersecretion and by any additional bronchoconstrictor stimuli.

58
Bronchial neural function also appears to play a role in the evolution of asthma. Cough and

reflex bronchoconstriction mediated by vagal efferents follows stimulation of bronchial

irritant receptors19.

Figure 4. Pathophysiology of Asthma20

59
PATHOLOGY21

Grossly

 Lungs are over distended due to over inflation

 Occlusion of bronchi and bronchioles by viscid mucous plug

Microscopically

 Mucus plugs contain normal or degenerated respiratory epithelium forming twisted

strips (whorls) called Curschmann’s spirals.

 Sputum usually contains numerous eosinophils and diamond shaped crystals

derived from eosinophils called Charcot – Leyden crystals.

 Thickening of basement membrane

 Sub mucosal oedema with inflammatory exudates

 Hypertrophy of sub mucosal glands as well as of bronchial smooth muscles.

CLINICAL PRESENTATON OF BRONCHIAL ASTHMA

Asthma is characterised by difficulty in breathing, wheezing, chest tightness and

cough. The frequency of asthma symptoms is highly variable22. History of recurrent

episodes caused by one or more provoking factors is important17.

Dyspnoea: shortness of breath is one of the cardinal symptoms of asthma. The patient may

be restless, agitated, sweating and breathing through pursed lips with a prolonged

expiration.

60
Wheeze: The high velocity of flow through narrowed large airways produces wheeze

which is often first audible to the physician. Expiratory wheeze heard all over the chest is a

diagnostic feature. Its absence should not exclude the diagnosis.

Chest Tightness: This is one of the characteristic symptoms of asthma. It is likely that this

sensation reflects the excessive activity of the vagal receptors, known to be a fundamental

feature of asthma23.

Cough: Cough may be ineffective with only very scanty and tenacious mucoid

expectoration. It may disturb sleep in some patients14.

The symptoms show a characteristic pattern of diurnal variability of worsening

during night and early morning specially between 3am and 4am16,17,22.

SIGNS

 Audibly harsh respiration

 Prolonged expiration

 Tachypnoea

 Tachycardia with mild systolic hypertension and paradoxical pulse13

 Hunched shoulders and use of accessory muscles of respiration

 Nasal mucosal swelling

 Increased nasal secretions and nasal polyps22

 Flaring of alae nasi during an episode17

 Obscured breath sounds with added sounds such as ronchi

 Percussion note may be unaltered or hyper resonant

 In chronic cases the chest may be pigeon shaped24

61
INVESTIGATION

Blood: Eosinophilia, increased serum total IgE17

Sputum: Eosinophilia, Cruschmann‟s spirals and Charcot- Leyden crystals17

X-ray: May show hyper inflation17

Arterial Blood Gas Analysis (ABG)17

o In severe chronic asthma: PaO2 is decreased but PaCO2 may remain normal

o In acute severe asthma: PaO2 decreases and at the same time PaCO2 increases

Pulmonary Function Tests16

 Peak flow meters: PEF may be reduced. A diurnal variation in PEF (the lowest

values typically being recorded in the morning) of more than 20% is considered

diagnostic.

 Spirometry: FEV1 and VC are reduced. Measurement of FEV1 and VC by

Spirometry allows the demonstration of airflow obstruction. It confirms the

diagnosis when a 15% improvement in FEV1 is noted following the administration

of a bronchodilator.

 Exercise Challenge Test: in positive cases, there is a decrease in FEV and PEFR

indices after physical exercises.

 Skin Prick Test: in this the allergen is introduced in minute doses to the skin by

pricking the skin. In positive cases, a wheal is seen at the sight 20 to 40 minutes

after the introduction of the allergen.

62
DIFFERENTIAL DIAGNOSIS

Table 3. Differential Diagnosis of Bronchial Asthma22

System Selected Diseases

Cardiovascular Coronary artery disease, heart failure, valvulopathy,

pulmonary hypertension, pulmonary embolism
Infectious Pneumonia, particularly atypical organisms, acute
bronchitis
Neoplastic Lung cancer, carcinoid
Other pulmonary disease Chronic obstructive pulmonary disease. ABPA,
Idiopathic pulmonary fibrosis, bronchiectasis,
pulmonary eosinophilia, cystic fibrosis, pulmonary
manifestations of connective tissue diseases,
hypersensitivity pneumonitis, sarcoidosis, asbestosis
Gastroesophageal Gastroesophageal reflux disease
Hematologic Anemia, systemic mastocytosls
General Deconditioning, obesity
Psychiatric Anxiety, vocal cord dysfunction
Note: It is important to remember that although many of these disease processes may
mimic asthma, they (or their treatments) may also coexist with and contribute to the
severity of asthma.

COMPLICATIONS22

Complications of asthma include exhaustion, dehydration, airway infection, cor

pulmonale, tussive syncope etc. It may rarely cause pneumothorax. Acute hypercapnoeic

and hypocapnoeic respiratory failure may occur in severe diseases. Acute attack may lead

to hypoxemia, acidosis and can include emphysema, bronchiectasis, pneumothorax and

atelectasis.

PROGNOSIS17

Prognosis of acute severe asthma is good. Very rarely, mortality occurs. About one

half of the adolescent children with early onset asthma tend to improve with prolonged

63
remission. However, the disease usually adopts a chronic course in patients with late onset

asthma. Usual death rate attributed to asthma is 1-2 per million populations per annum.

MANAGEMENT

AIMS OF TREATMENT25

 Abolish symptoms

 Restore normal or best possible lung functioning

 Reduce risk of severe attacks

 Enable normal growth to occur in children

 Minimize absence from school/employment

 Patient education about asthma

Since bronchial asthma is a chronic condition with acute exacerbation, treatment

requires a continuous care to avoid unwanted aggravation.

Therefore, in management of asthma, there are two aspects: include patient

education regarding control of extrinsic factors and drug therapy26.

Patient education16:

Patient education should begin at the time of diagnosis and be revisited in

subsequent consultations. Patients (or their carers) should be taught about the relationship

between symptoms and inflammation, the importance of key symptoms such as nocturnal

waking, the different types of medication and the use of PEF to guide management

decisions. Written action plans may prove helpful in developing these skills.

64
Avoidance of aggravating factors16:

This is particularly important in the management of occupational asthma, where

removal of the offending agent is one of the few instances when asthma may be cured or

substantially improved. Similarly, the identification of sensitisation to a household pet

suggests that asthma control may be improved by removing the animal from the home,

although it may take several years before dander levels fall substantially. House dust mite

exposure may be minimized by replacing carpets with floorboards and using mite-

impermeable bedding. Measures to reduce fungal exposure and eliminate cockroaches may

be applicable in specific circumferences and medications known to precipitate or aggravate

asthma should be avoided. Patients should be advised not to smoke16.

HOMOEOPATHIC APPROACH

Homoeopathy recognises Asthma as a Hereditary susceptibility in which abnormal

sensitivity to outside influences causes a periodic constriction of the breathing tubes with

wheezy and difficult breathing. These disease condition being mostly chronic in nature, the

management is also same as that of chronic disease, as per the direction laid out by Dr.

Samuel Hahnemann.

The fundamentalist school of Homoeopaths does not generalize and term it as

asthma. They are abhorrent, of naming any disease. They insist that disease is the result of

the psycho physical disturbances of the individual.

John H. Clarke puts the Homoeopathic view of asthma, in a nut shell. He says, “An

attack of asthma, may look and generally does look, like an isolated events in a patient‟s

history. But, enquiry will probably discover the same. Patient has, at a former period

65
suffered from a skin eruption, a diarrhea or some other affection. All these are not many

diseases, but varied expressions, of one morbid taint27.

“Susceptibility” can be defined as the reaction of the organism to external and

internal influences. It is an inherent capacity in all living things to react to stimuli in the

environment and represents a fundamental quality that distinguishes the living from the

non-living. We see very frequently the susceptibility to climate conditions, as well as all

other phases of environment. One person will thrive in a vigorous climate where another

will become seriously ill8.

„Stuart-close‟, in his lectures the „Genus of Homoeopathy‟ says, by susceptibility

we mean the general quality or capability of the living organism of receiving impression;

the power to react to stimuli28.

As told by Dr. Kent, “It is man that is sick and to restored to health, not his body,

not the tissues. The tissue could not become sick unless something prior to them had been

deranged and so made them sick. The real sick man is prior to the body”. The external

disease is outward expression of internal disease. In any disease not only the organs /

systems, but the patient as a whole is affected, which is true for the “asthma” also. The

balance between the environment and the individual is disturbed29.

With our treatment, we try to replace the balance between the environment and the

individual. Detailed case taking is essential for constitutional treatment. Our chief concern

during a case receiving is to bring out an individualizing feature and the remedy selected is

based on “Characteristic symptoms” and not on the disease symptoms. “And this can be

ascertained only by the fundamentalist approach”27.

66
Table 4: Miasmatic expression of bronchial asthma.24

PSORA SYCOSIS TUBERCULAR SYPHILITIC

1. Cause Suppression of skin Suppression of Repeated upper Family history

eruptions discharges respiratory of alcoholism or
from mucous infections alcoholic parents
membrane

2. Presentation / Less secretion more Cough scanty Cough excessive Cough one (or)
Sensation of spasms sudden difficult expectoration two distinct
Asthmatic breathe holding expectoration purulent barks like a dog
symptoms
spasms. mucopurulent whatever the
Expectoration Thick greenish bloody cause when
scanty mucous yellow color expectoration. irreversible
tasteless. cannot breathe Rapid change occur in
through the changeability in lung parenchyma
Allergic asthma is nose. severity, duration miasm pre
manifestation of and frequency of dominating is
psora. attacks. syphilis.

3. Provocating Emotional Getting wet - Cold air, Viral, Cold air.

factors psychological Rainy season. Bacterial infection
condition.

4. Modalities Amelioration On Amelioration Amelioration Aggravated in

reappearance of Dry weather or Better as day morning.
skin eruption and Re advances.
on treating skin establishment
complaints. of discharge

5. Concomitants Alternation of skin Musculo- Fever Other systemic

complaints with skeletal manifestation.
episodes of asthma manifestation Enlarged lymph
or Asthmatic myalgias nodes
episodes in arthritis.
eruptive disease.

67
 PSORA SYCOSIS TUBERCULAR SYPHILIS

6. Mentals irritable, anxious, Sluggish slowness Fear Fear, Irritable,

excitable, psoric poverty of ideas. anxious,
personality excitable,
destructive

Antimonium Tartaricum:

There is will be sub crepitates rales all through the chest, marked wheezing when

the patient breathes the cough sounds loose and yet the patient cannot raise it30.

Aralia racemosa:

Dry cough coming on after first sleep, about middle of night. Asthma on lying down

at night with spasmodic cough; worse after first sleep, with tickling in throat. Constriction

of chest; feels as if a foreign body were in throat31.

Arsenicum album:

It is useful for asthma with restlessness and anxiety. Asthmatic attacks after mid

night. During the attack, the patient cannot lie down but has to sit with head bend forwards.

Attack subsides after 3-4 a.m32.

Aspidosperma:

The digitalis of the lung. “Want of breath” during exertion33.

68
Blatta orentalis:

It is usually given at the commencement of an attack. Attacks are usually

aggravated from lying down and in rains. Patient complaints of cough with dyspnoea and

mucous pus like mucous.

Carbo vegitabilis:

Patient sits up and gasps for breath. He wants to be fanned – patient appears to be

hungry for air – Remedy often used for asthmatic attacks after long spasmodic coughing

spells worse after eating or talking and in evening24.

Dulcamara:

Acute asthma from cold loose ratting cough with copious sputum < during wet

weather < night31.

Grindelia robusta:

Asthma, with profuse tenacious expectoration, which relieves. Stops breathing when

falling asleep; wake with a start, and gasps for breath. Must sit up to breathe. Cannot

breathe when lying down33.

Ipecacuanha:

There is constant constriction in chest, asthma, early attacks of difficult breathing,

continued sneezing, coryza with wheezing, the cough is incessant and violent with every

breathe. There is constant nausea, which is a characteristic symptom of Ipecac34.

69
Kali carbonicum:

Has sensation of no air in the chest, and the worse time in 2 to 3 am, is better sitting

upright, slightly forward, bending over the table or knees relieved by rocking. Lying down

is impossible, worse by drinking and motion30.

Lobelia inflata:

Dyspnoea from constriction of chest, sensation of pressure or weight in chest. Better

by rapidly walking. Feels as if heart would stop34.

Moschus:

Moschus can assist when the patient experiences intense anxiety and fear combined

with a smothering sensation. It suits those of a highly organized nervous, sensitive

temperament.

Natrum sulphuricum:

Tendency to develop chest catarrh and any increase in dampness in the weaker can

cause severe chest congestion with difficulty to breath. Aggravation time is 4 to 5 a.m.

Cough with thick ropy greenish expectoration.

Nux Vomica:

Tearing cough and pharyngeal scraping. Gastric cases or from alcoholic excess.

Neurotic, irritable subjects with distention of the stomach, acidity and constipation30.

70
Justicia Adhatoda:

Constrictive pain in the lungs; severe dyspnea and shortness of breathing; asthmatic

attacks; patient can‟t endure a close warm room33.

Pulsatilla:

Pulsatilla is indicated if wheezing starts after a person eats rich food or gets too

warm. Tightness in the chest tends to become worse during the evening and at night, and is

relieved by fresh, cool air, coughing brings up yellow colored mucous.

Spongia tosta:

Spongia tosta is strongly indicated by a barking cough during an asthma attack.

Labored breathing has a sawing sound and little mucous is produced. The person may feel

best when learning forward or when sitting up and tilting the head back. There is

aggravation from cold drinks30.

REPERTORIAL APPROACH

KENT‟S REPERTORY

Respiration – asthmatic: 3 marks – Ambr, Arg.n, Ars, Ars.i, cupr, Ip, Kali ars, kali nit,

lob, puls, samb, sil, spong, stram, sulph.

Respiration – difficult: Anac, Ant.t, Apis, Ars, Bry, Cact, Carbv, Caust, Chel, Chin,

Chlor, Cina, crot-t, cep, Cupr-ars, Ferr, Hep, Ip, Kali-c, Kali ar, Kali-I, Lach, Lobi, Meph,

Merc Naja, Nux-m, Nat-s, Nat Phos, Puls, Sel, Sil, Spong, Squill, Stann, Stry, Sulph,

Tarent, Verat.

71
Respiration impeded – obstructed: 3 marks – Cina, Nit-acid35.

BOENNINGHAUSEN‟S THERAPEUTIC POCKET BOOK

Respiration-oppressed: Acon, Ars, Ant Ars, Bell, Bry, Cact, Carb V, Chlorum, Colch,

Crot t, Cupr, Ferr, Ign, Iod, Ip, Lob, Nux V, Phos, Puls, Sep, Squi, Stan, Sulph, Verat A,

Verat V7.

Boerickes: ‘Materia Medica and Repertory’

Respiratory system, Type, Hay asthma: Aral., Ars., Ars.i., Chin.a., Ipec, Lob.i., Naph.,

Nat.s., Nux.v., Sauad., Sang., Sticta., Sul.i.,

Periodical: Ars., Chin.a., Cinchona., Ipec,

Proceeded by coryza: Aral. Naja.., Nux.v,

Proceeded by rose cold: Sang.,

Concomitants with bronchial catarrh: Aeon., Ant.t., Ars., Blatta.a., Bry.,

Cupr.ac, Eriod., Eucal., Grind., Ipec, Kal.i., Lob., Nat.s., Oniscus., Sabal., Sul33.

Robin .Murphy, ND. „Homoeopathic Medical Repertory’

This is one of the latest alphabetical repertories available to the field of

homoeopathy.

Lung : Asthma: Allergic: Hay fever with: ALL.C, ARS., IOD., THUJ., Ars.i., Badi.,

Car.v., Care, Dulc, Euphr., Ipec, Kal.i., Lach., Lobe., Med., Najo., Nat.s., Nux.v.,

72
Opium., Sabad., Sili., Sin.n., Stict., apis., aral., arum.t., chin.a., chlor., linn.u., naphtin.,

ol.an., phle., sang., sep., svil.i., sulp., tub.,

Asthma, Dust, from inhaling: Blatta., Ipec, Sili., ictod., kal.c, pot.a.., poth36.

73
METHODOLOGY
 METHODOLOGY

Source of Data:

“Significance of Polarity Analysis in Repertorisation Using BBCR, In the

Treatment of Bronchial Asthma” a clinical study was conducted in the outpatient

department of Fr. Muller's Homoeopathic Medical College and Hospital.

Inclusion criteria:

a. Patients of both sexes and 15-75yrs of age group were included in this study.

b. 30 patients were selected for the study after fulfilling the diagnostic criteria.

c. Cases which were already diagnosed and who are on any other treatment

(allopathic) will also be taken into consideration.

d. Diagnostic criteria are mainly based on clinical presentation, like breathlessness,

wheezing, cough, expectoration, ronchi etc.

Exclusion criteria:

a. The samples below 15 and above 75 years are not included in the study.

b. Patient with severe complication like Status asthmaticus who are critically ill are

excluded

c. Patient with severe illness like cardiac asthma, chronic bronchitis and emphysema

are excluded.

Method of collection of Data:

The data has been collected by purposive sampling method. Two groups were

74
formed each of which received a total of 15 patients selected randomly. Hence a total of

thirty cases were studied.

Materials:

The study has been conducted by analyzing 30 cases with regular follow – ups.

These case studies have been recorded in a logical manner utilizing Standardized Case

Record (SCR).

SCR

The standardized case record helped in collecting the data, processing it and

instituting a definite therapeutic plan. A detailed record of the follow up is maintained

which determined further management of the case. All data were collected in the SCR.

Methods:

1. Case taking

2. Recording And interpretation

3. Defining the problem

4. Classification and evaluation of symptoms

5. Erecting the totality

6. Repertory selection and forming reportorial totality

7. In case of group A, a totality of patient’s opposite symptoms formed for polarity

analysis.

8. Reportorial result.

75
9. In group A, reportorial result was obtained after analyzing the polarity difference

of medicines using patient symptom totality and the opposite symptom totality.

10. The prescription was arrived at by analyzing the medicines from reportorial result

using Boger Boenninghausen’s Characteristics and Repertory and consulting

Materia Medica.

11. The potency selection and repetition of doses were done according to the demand

of the case, with the consideration of potency selection criteria such as

susceptibility, sensitivity, vitality, changes in structural and functional level and

the degree of correspondence to the remedies selected.

12. Majorities of the patients were reviewed, on a fortnightly basis to assess the

subjective and objective changes. Each case was followed of the minimum of 4-6

months from the commencement of treatment.

13. Effectiveness of the treatment was assessed on the basis of

A) Clinical improvement-Disappearance or relief of symptoms, Improvement in

general health and reduction in frequency of the attacks.

B) For an effective assessment and evaluation, disease intensity scores were also

given to every patient. After completion of treatment the post treatment disease

intensity scores were compared with the pre treatment disease intensity scores.

Note: For disease intensity scores refer appendix: 1

C) Group A and group B were compared statistically, in terms of improvement,

using Chi Square test of significance to assess the significance of polarity analysis

in repertorisation.

76
OBSERVATION AND
RESULTS
 OBSERVATION AND RESULTS

Thirty patients with a diagnosis of bronchial asthma were included in this study.

All these thirty cases were followed up for a minimum of six months and were

considered for the statistical study. This section contains the description of data collected

from 30 cases using tables and charts.

Table 5. Distribution of cases according to Sex

Sex No. of Cases Percentage

Male 16 53.33%
Female 14 46.67 %
Total 30 100 %

Out of 30 cases studied, 16 (53.33 %) were male patients and 14 (46.67 %) were

female patients.

Table 6.Distribution of cases according to Age Group.

Age Group No. of Cases Percentage

15 - 30 11 36.67%
31 - 45 9 30 %
46 – 60 5 16.67 %
61 – 75 5 16.67 %
Total 30 100%

In this study maximum number of 11 patients was found to be within the age

group of 15 – 30 (36.67%) and 9 patients in the age group of 31 – 45 (30%). This is

followed by 5 patients each in age groups of 46 – 60 (16.67%) and 61 – 75 (16.67%).

Here, the peak incidence is observed in young and middle aged people.

77
Figure 5. Diagrammatic Representation of Cases According to Sex

14
16

male female

Figure 6. Diagrammatic Representation of Cases According to the Age Group

12

10

8
No.Of Cases

6
No. of Cases
4

0
15 - 30 31 - 45 46 – 60 61 – 75
Age Group

78
Table 7. Distribution of Cases According to Occupation

Occupation No. of Cases Percentage

Students 4 13.33 %

Teachers, office workers 2 6.67 %

Fishermen, Coolie worker 3 10%

Agriculture, Business, Sales 9 30%

Beedi rolling, driver 5 16.67%

House Wife 7 23.33%

Total 30 100%

Out of 30 cases, 9 patients belonged to the field of agriculture/business/sales

(30%). There were 7 housewives (23.33%). 5 patients had an occupation of beedi rolling/

driver (16.67%). 4 patients out of 30 were students (13.33%). 3 patients belonged to the

category of fishermen/coolie workers (10%). Remaining 2 patients belonged to the

category of teachers/office workers.

Table 8. Distribution of Cases According to Approach used in the case

Sl No: Approach Used No. of Cases Percentage

1 ACUTE 3 10%

2 CONSTITUTIONAL 26 86.67%

3 MIASMATIC 1 3.33%

Total 30 100%

Out of 30 cases, 26 cases received constitutional medicine (86.66%), 3 cases

received acute medicine (10%). Only one patient received miasmatic treatment (3.33%).

79
Figure 7. Diagrammatic Representation of Cases According to the Occupation

No. of Cases
10
9
8
No. of Cases

7
6
5
4
3
2
1 No. of Cases
0

Occupation

Figure 8. Diagrammatic Representation of Cases According to the Approach to the

Case

Percentage
100%
90%
80%
70%
No. of Cases

60%
50%
40%
Percentage
30%
20%
10%
0%
1 2 3

Approach to the Case

80
Table 9. Distribution of Cases According to the Potency Used

Potency Used No. of Cases Percentage

30 4 13.33%

200 19 63.33%

1M 3 10%

0/1 4 13.33%

Total 30 100%

200th potency was found to be prescribed in maximum number of cases, i.e. 19

(63.33%). 0/1 and 30th potencies were prescribed for 4 cases each (13.33%). Remaining 3

patients received 30th potency.

Table 10. Distribution of Cases According to the Duration of Illness

Duration of Illness No. of Cases Percentage

Since childhood 4 13.33%

> 20 years 3 10%

10 – 20 years 3 10%

1 – 10 years 15 50%

6 months – 1 year 4 13.33%

<6 months 1 3.33%

Total 30 100%

Out of the 30 patients, 15 patients suffered from asthma since 1 – 10 years (50%).

4 patients suffered from asthma since childhood (13.33%) whereas another 4 patients

suffered since 6 months to 1 year (13.33%). It was observed that 3 patients suffered since

more than 20 years and at the same time, another 3 patients suffered with asthma since 10

– 20 years. 1 patient was observed to be suffering since less than 6 months.

81
Figure 9. Diagrammatic Representation of Cases According to the Potency Used

No. of Cases

4 4
30

3 200

1M

0/1

19

Figure 10. Diagrammatic Representation of Cases According to the duration of

illness

16

14

12
No. of Cases

10

8
No. of Cases
6

0
Since > 20 10 – 20 1 – 10 6 months < 6
childhood years years years – 1 year months
Duration of Illness

82
Table 11. Distribution of Cases According to the Presenting symptoms

Symptoms No. of cases Percentage

Breathlessness 30 100%

Wheezing 30 100%

Cough 30 100%

Expectoration 28 93.33%

Ronchi 30 100%

On allopathic treatment/inhalers/bronchodilators 10 3.33%

Out of 30 cases, all 30 cases presented with breathlessness, wheezing, cough and ronchi

(100%) each. 28 cases presented with expectoration(93.33%). 10 cases were on allopathic

treatment/inhalers/bronchodilators (3.33%).

Table 12. Distribution of Cases According to the treatment outcome

Results No. of cases Percentage

Grp A Grp B Grp A Grp B

Markedly improved 14 7 93.33% 46.67%

Improved 0 7 0% 46.67%

No improvement 1 0 20% 0%

Dropped out 0 1 0% 20%

Total 30 100

Out of two groups in the study, group A showed marked improvement in 14 out of 15

cases (93.33%) whereas group B showed marked improvement in 7 out of 15 cases

(46.67%). Improvement was shown by 7 out of 15 cases in group B (46.67%) and it was

nil in group A. One case in group A showed no improvement (20%) and one case in

group B was dropped out as patient discontinued treatment (20%).

83
Figure 11. Diagrammatic Representation of Cases According to the Presenting

symptoms

No. of cases
35
30
25
20
15
10 No. of cases
5
0

Figure 11. Diagrammatic Representation of Cases According to the treatment

outcome

14
12
10
8
6
No. of cases Grp A
4
No. of cases Grp B
2
0

84
Table 13. Distribution of Cases According to Medicines Prescribed

Medicine Prescribed No. of Cases Percentage

ARS ALB 9 30%

PULSATILLA 7 23.33%

BRYONIA 3 10%

NUX VOMICA 2 6.67%

SULPHUR 2 6.67%

LYCOPODIUM 1 3.33%

NATRUM SULPH 1 3.33%

CACTUS 1 3.33%

RHUS TOX 1 3.33%

KALI CARB 1 3.33%

TUB BOVINUM 1 3.33%

SILICEA 1 3.33%

TOTAL 30 100%

Out of the 30 cases included in the study, 9 cases received ArsAlb (30%), 7 cases

received Pulsatilla (23.33%) and 3 cases (10%) received Bryonia. Nux Vomica and

Sulphur were prescribed in two cases each (6.67%). Remedies Lycopodium,

NatrumSulph, Cactus, RhusTox, Kali Carb, Tub Bovinum, Silicea were prescribe in one

case each (3.33%).

85
Figure 13. Diagrammatic Representation of Cases According to the Medicines

Prescribed

Percentage
SILICEA

TUB BOVINUM

KALI CARB

RHUS TOX

CACTUS

NATRUM SULPH

LYCOPODIUM Percentage

SULPHUR

NUX VOMICA

BRYONIA

PULSATILLA

ARS ALB

0% 5% 10% 15% 20% 25% 30% 35%

86
STATISTICAL ANALYSIS

THE TEST APPLICABLE

1. There are three rows and two columns and the data is in whole numbers.

2. The data is on curability which shows it is qualitative

3. The samples are drawn independently for the two groups

4. There are cells containing less than 5 frequencies and hence Yate’s correction is

applicable.

5. So the statistical test applicable is Chi Square Test which can be calculated as

X2 = Σ[ |O – E | - ½]2/ E

QUESTION TO BE ANSWERED

A. Null hypothesis

There is no association between polarity analysis and cure rate

B. Research Hypothesis (alternative hypothesis)

There is association between polarity analysis and cure rate

Results Group A Group B Total

Markedly improved 14 7 21

Improved 0 7 7

No improvement 1 0 1

Dropped Out 0 1 1

Total 15 15 30

87
X2 = Σ[ | O – E | - ½]2/ E

O = observed frequency E = expected frequency

O 1 = 14 O2 = 7 O3 = 0 O4 = 7 O5 = 1 O6 = 0 O7 = 0 O8 = 1

C= column total R = row total G = grand total

E 1 = [C 1 x R 1 ] / G = [15 x 21] / 30 = 10.5

E 2 = [C 2 x R 1 ] / G = [15 x 21] / 30 = 10.5

E 3 = [C 1 x R 2 ] / G = [15 x 7] / 30= 3.5

E 4 = [C 2 x R 2 ] / G = [15 x 7] / 30 = 3.5

E 5 = [C 1 x R 3 ] / G = [15 x 1] / 30 = 0.5

E 6 = [C 2 x R 3 ] / G = [15 x 1] / 30 = 0.5

E 7 = [C 1 x R 4 ] /G = [15 x1] /30 = 0.5

E 8 = [C 2 x R 4 ] /G = [15 x 1] / 30 = 0.5

X2 = Σ[ | O 1 – E 1 |2 / E 1 ] + [ | O 2 – E 2 |2 / E 2 ] + [ | O 3 – E 3 |2 / E 3 ] + [ | O 4 – E 4 |2 / E 4 ]

+ [ | O 5 − E 5 |2 / E 5 ] + [ | O 6 - E 6 |2 / E 6 ] + [ |O 7 – E 7 |2 / E 7 ] + [ |O 8 – E 8 |2 / E 8 ]

88
 = [ |14 – 10.5|2 / 10.5] + [ |7 – 10.5|2 / 10.5] + [ |0 – 3.5|2 / 3.5]

+ [ |7 – 3.5|2 / 3.5] + [ |1- 0.5|2 / 0.5] + [ |0 – 0.5|2 / 0.5] + [ |0 – 0.5|2 /0.05]

+ [ |0 – 0.5|2 /0.05]

= [12.25/ 10.5] + [12.25/ 10.5]+ [12.25/ 3.5] + [12.25/ 3.5] + [ 0.25 / 0.5]

+ [ 0.25/ 0.5] + [ 0.25/ 0.5] + [ 0.25/ 0.5]

= 1.17+ 1.17 + 3.5 + 3.5 + 0.5 + 0.5 + 0.5 + 0.5 =11.34

Degrees of freedom (d. f) = (C – 1) x ( R – 1)

C = No. of columns = 2

R = No. of rows = 4

d.f. = (2 -1) x (4 – 1) = 1 x 3 = 3

X2 table value at 5% level for degree of freedom 3 = 7.82

INFERENCE

Since the calculated value of Chi Square (11.34) is greater than the table value at

5% level for d.f. 3 (7.82), test is significant statistically and the null hypothesis is

rejected and research or alternative hypothesis is accepted. That is, there is association

between polarity analysis and the cure rate.

89
DISCUSSION
 DISCUSSION

This study was conducted on patients attending outpatient department of Father

Muller Homoeopathic Medical College and Hospital, as per the inclusion criteria. A total

of 30 cases were selected. Two groups were formed and 15 cases were assigned to each

group randomly from the 30 cases.

BogerBoenninghausen’s Characteristics and Repertory was studied in detail. The

arrangement of chapters following the philosophy of complete symptom is found to be

much useful as one symptom can be searched for in the same chapter regarding all its

components. The clinical rubrics listed in various chapters of this repertory helps in

treating difficult cases where characteristic impressions are lacking. Cross references are

given in the chapters as well as at the end of chapters and they help a physician in

selection of appropriate rubrics. Various methods of repertorisation using this repertory

help in treating any kind of cases easily.

Cases in group A received treatment according to the analysis of reportorial result

after polarity analysis. Group B received treatment according to conventional reportorial

result. BogerBoenninghausen’s Characteristics and Repertory was used for

repertorisation and the method applied was ‘modalities in first place’ method.

30 cases included in the study were recorded in standardized case record.

Assessment of each case was done through follow ups at regular intervals. Scoring was

done before and after the treatment to assess the improvement of the patient.

The study was conducted to know the “Significance of Polarity Analysis in

Repertorisation Using BBCR, In the Treatment of Bronchial Asthma”. It is to

introduce to practitioners of Homoeopathy, the method of polarity analysis and to help

90
them, especially who does not know about polarity analysis, in repertorisation using

polarity analysis.

Out of two groups in the study, group A showed marked improvement in 14 out

of 15 cases (93.33%) whereas group B showed marked improvement in 7 out of 15 cases

(46.67%). Improvement was shown by 8 out of 15 cases in group B (53.33%) and it was

nil in group A. One case in group A showed no improvement (20%) and one case in

group B was dropped out as patient discontinued treatment (20%).

Out of 30 cases studied, 16 (53.33 %) were male patients and 14 (46.67 %) were

female patients. In this study maximum number of 11 patients was found to be within the

age group of 15 – 30 (36.67%) and 9 patients in the age group of 31 – 45 (30%). This is

followed by 5 patients each in age groups of 46 – 60 (16.67%) and 61 – 75 (16.67%).

Here, the peak incidence is observed in young and middle aged people.

Out of 30 cases, 9 patients belonged to the field of agriculture/business/sales

(30%). There were 7 housewives (23.33%). 5 patients had an occupation of beedi rolling

/ driver (16.67%). 4 patients out of 30 were students (13.33%). 3 patients belonged to the

category of fishermen/coolie workers (10%). Remaining 2 patients belonged to the

category of teachers/office workers.

Out of the 30 cases included in the study, 9 cases received ArsAlb (30%), 7 cases

received Pulsatilla (23.33%) and 3 cases (10%) received Bryonia. Nux Vomica and

Sulphur were prescribed in two cases each (6.67%). Remedies Lycopodium,

NatrumSulph, Cactus, RhusTox, Kali Carb, Tub Bovinum, Silicea were prescribe in one

case each (3.33%). 200th potency was found to be prescribed in maximum number of

91
cases, i.e. 19 (63.33%). 0/1 and 30th potencies were prescribed for 4 cases each (13.33%).

Remaining 3 patients received 30th potency.

Some of the cases in group B received multiple prescriptions through various

follow ups as the complaints were not relieved with the first prescription. E.g. Case no:

17, 18, 23 and 25.

Some cases in group B were analyzed after many follow ups to find the reason for

the patient not improving markedly despite the relief they reported. It was found that the

remedy prescribed was contraindicated. E.g. Case No: 26. In this case, patient’s

symptoms of breathlessness were aggravated by lying down. The remedy prescribed was

Nux Vomica. When polarity analysis was done for the purpose of reviewing the case,

Nux Vomica was found to be contra indicated as this remedy covers the opposite

symptom, > by lying down, in high grade. Since this case was in group B, polarity

analysis was not applied in the repertorisation of the case.

LIMITATIONS

 Since this is a time bound study, cases could not be followed up for a longer period.

Some good cases couldn’t be considered in this study because of discontinued

treatment in between the study period.

 In most of the cases even though time modalities were prominent, they could not be

considered for polarity analysis as the ameliorations with regards to time are not well

represented in this repertory.

 The symptom < from dust, could not be taken as a polar symptom even though it is a

modality and was prominent in many cases, because the exact opposite of this

symptom, > from dust, could not be found in the Homoeopathic literature.

92
 Since the sample size is limited to 15 cases alone in study group and control group (a

total of 30), generalizing the result and conclusions of this study need to be done

cautiously.

 This study would have been still better if blinding method would have been included.

Considering the time and sample size it was not followed in the study.

 No much extensive investigation procedures were used in the study.

 Few of the cases follow up were not regular so assessment of drug action could not be

controlled well.

 Some follow ups were taken by various physicians at various times; hence, proper

recording of the symptoms with intensity was difficult.

 Certain variables like quality of medicine, method of dispensing the medicine, good

habits of the patients and placebo effect could not be controlled well.

 Extensive data is not available regarding polarity analysis and the analysis of polarity

difference was done manually which may have caused some shortcomings.

RECOMMENDATIONS

 Bigger sample with extended time of research would provide better results.

 Peak flow meters, spirometry, and Immunoglobin assay, and skin prick test studies if

done simultaneously during the course of study would provide valuable data

regarding the changes taking place in the drugs.

 Universal standardized scale should be used, so that evaluation of outcome of the

study would become precise.

93
CONCLUSION
 CONCLUSION

There were a total number of thirty cases taken up for the study. Conclusions

were arrived at after statistical analysis of patients with bronchial asthma.

Conclusion of first objective

• Boenninghausen’s philosophy of complete symptom is maintained in the book. It

was elaborated by adding sections on locations, sensations, modalities and

concomitants to each chapter.

• Many cross references are given especially in the mind chapter which enables the

physician for quick finding of appropriate rubrics.

• The chapter on fever, a unique contribution by Boger, is very useful in all type of

cases of fever. Elaborate concomitant section in each stage of fever helps the

physician find remedy quickly in cases of fever.

• Many clinical rubrics included in the book enable the physician to find out a

remedy in cases where characteristic features are missing.

• When a case presents with many modalities, BogerBoenninghausen’s

Characteristics & Repertory is much useful with its ‘modality in first place’

method of repertorisation.

• Pathological generals introduced by Boger are very useful in finding the

similimum in an easy and quick manner when patient is affected by same

pathology at different systems.

• The chapter ‘concordances’ helps to arrive at a second prescription much easily.

94
Conclusion of Second Objective

• Out of 30 cases, marked improvement was shown by 21 cases (70%),

improvement by 7 cases (23.33%) and no improvement by 1 case (3.33%).

• Group A showed 14 cases with marked improvement (93.33%) whereas Group B

showed 7 cases with marked improvement (46.67%).

• The improvement rate of cases after administering the remedy selected after the

analysis of reportorial result, using the polarity difference of medicines, is higher.

• Polarity analysis can be successfully used in repertorisation of any cases that have

a number of polar symptoms.

• Polarity analysis can be introduced in any type of diagnosed cases.

• Boenninghausen’s idea of contraindications is validated by this study.

95
SUMMARY
 SUMMARY

A thorough study on BogerBoenninghausen’s Characteristics & Repertory,

concept of Polarity analysis etc were done with this work under the topic “Significance

of Polarity Analysis in Repertorisation Using BBCR, In the Treatment of Bronchial

Asthma”. Special features of the repertory were studied completely. Cases were selected

on the basis of inclusion and exclusion criteria. These cases were followed regularly and

at the end of the study, certain conclusions were arrived at.

Out of 30 cases, cases showed marked improvement (%). Cases showed moderate

improvement (%) and mild improvement was shown by cases (%). Among the 30 cases,

1 case was dropped out as the patient did not continue treatment.

In this study, maximum patients were found to be in the age group of (%) & by

occupation. Sex distribution in this study is observed to be more or less equal. Pulsatilla

and ArsAlb were prescribed for maximum number of patients, & respectively. 200th

potency was observed to be used in maximum number of cases in this study (%).

In the two groups made for the study, Group A that included repertorisation using

polarity analysis, showed maximum number of cases with marked improvement

(%).Statistical analysis was made to assess the treatment outcome.

The result of this work shows that adding polarity analysis, a modification of

Boenninghausen’s idea of contraindications, to repertorisation, increases the rate of

improvement by Homeopathic prescriptions. Thus polarity analysis should be

recommended in the daily practice of homoeopathic physicians.

96
BIBLIOGRAPHIC
REFERENCES
 BIBILIOGRAPHIC REFERENCES

1. Desai Bhanu. How to Find the Similimum with BogerBoenninghausen’s

Repertory. Reprint ed. New Delhi: B. Jain Publishers (P) Ltd; 1987.p.1 – 4.

2. Kishore Jugal. Evolution of Homoeopathic Repertories and Repertorisation.

1sted. New Delhi: Kishore Cards Publication; 1998. p. 1 – 4,11,16

3. BidwellIrving Glen. How to use repertory. Reprint ed. New Delhi: B. Jain

Publishers (P) Ltd; 1998.p.27

4. Kanjilal J N. Repertorization. Reprint ed. New Delhi: B. Jain Publishers (P) Ltd;

1998.p.5, 40, 42.

5. HeinerFrei. Polarity Analysis, a new approach to increase the Precision of

Homeopathic Prescription. Homoeopathy – the Journal of the Faculty of
Homeopathy. 2009 Jan. 98(1).p.49-55
6. www.google.com

7. Bradford L Thomas. The Lesser Writings of CMF Boenninghausen. Reprint ed.

New Delhi:B.Jain Publishers Pvt Ltd;1994.p.119.

8. Dhawale.M.L. Principles and practice of Homoeopathy.Vol-1. 3rd ed. Mumbai:

I.C.R Publications; 2000. p.139-156.

9. TiwariShashikant. Essentials of Repertorization. 4thed. New Delhi: B. Jain

Publishers (P) Ltd; 2003.p.209 – 210, 225 – 231, 246 – 250, 277 – 279, 287 - 289

10. Boger C.M. Boenninghausen’s Characteristics MateriaMedica and Repertory

with word index. Reprint ed. New Delhi: B.Jain Publishers Pvt Ltd; 1997.

p. 690.

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11. Hahnemann Samuel. Organon of medicine. 6thed. New Delhi: B.Jain Publishers

Pvt Ltd.1996. p.94

12. Khanaj R Vidyadhar. Reperire. 4thed. New Delhi: Indian Books & Periodicals

Publishers; 2007.p.589

13. Kasper Dennis L, Braunwald E, Fauci A. S, Hauser S. L, Longo D. L, Jameson

L. J.Harrison’s Principles of Internal Medicine.16th ed. New york: McGraw-Hill

Companies, Inc; Vol., 2.2005.p.1508, 1509.

14. Das Krishna K.V. Textbook of medicine.5thed. New Delhi:Ajanta

offset&packagings Ltd;2008.p.917.

15. Fishman Alfred.P. Pulmonary Diseases& Disorders.1st ed. U.S.A: McGraw-Hill

Companies, Inc; Vol., 2.1980.p.562-563.

16. Boon Micholas A, Colledge M. R, Walker B. R, Hunter John A.A.Davidson’s

Principles & practice of medicine.20th ed. U.S.A : Churchill Living

stone;2006.p.673,675.

17. Shah Siddharth N. Dr, Anand P.M.API Text book of Medicine.7th ed. Mumbai:

The Association of physicians of India; 2003.p.291 - 295.

18. http://emedicine.medscape.com/pulmonology

19. Mcphee Stephen J, Papadakis, Hammer D Gary. Pathophysiology of disease. 6th

ed. U.S.A : McGraw-Hill Companies, Inc;2005.p.

20. Lawlor Glen J, Fisher T. J,Adelman D. C. Manual of Allergy and

Immunology.3rd ed.U.S.A.:Little brown and Company;1995.p.124.

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21. Mohan Harsh. Text book of pathology. 5thed. New Delhi: Jaypee Brothers

Medical Publisher (p) Ltd; 2000.p.492.

22. Mcphee Stephen J, Papadakis M. A. Current medical diagnosis & treatment.47th

ed. U.S.A : McGraw-Hill Companies, Inc;2008.p.206,208.

23. Weiss Earle B,SegalM.S,SteinM.Bronchial asthma, Mechanisms and

Therapeutics.2nded . U.S.A: Little, Brown and company; 1985. p.2, 410, 310,

311,349.

24. Nanda DhirajDr.PracticalHomoeo Treatment of Asthma. 1st ed. New

Delhi:Pratap Medical Publishers;1626. p.27-37,58,62-63,69,76-78,88-91

25. Clarke & Kumar. Clinical Medicine.6th ed. U.S.A: Elsevier Saunders Inc; 2005.

p.912,917,918.

26. ShaikhWiqarA.Allergy&Asthma,A Tropical view. 1st ed. New Delhi: An IJCP

Group publication (p) Ltd;2001.p.1,168.

27. Sivaraman M.S. Dr. Homoeopathic treatment of Asthma. Reprint ed. New Delhi:

B. Jain Publishers Pvt Ltd;1995.p.14-22

28. Close Stuart.The Genius of Homoeopathy. New Delhi: B.Jain Publishers Pvt

Ltd;.p.112,113.

29. Kent James Tyler. Lectures on Homoeopathic Philosophy.New Delhi: B. Jain

Publishers Pvt Ltd; Reprint Edition 1998.p.1.

30. Homoeo Times. Chennai: A.K.P. Homoeopathic Clinical Research Centre;Vol-

6,Issue-6,June 2009.p.19,20.

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31. Gatchell. C.H. Disease of the lungs& pleura. 1st ed. New Delhi: B.Jain

Publishers Pvt Ltd; 1996. p.42.

32. Nanda Dhiraj Dr. Homoeopathic Therapy for living with allergies. 1st ed. New

Delhi: Shivanson Health Series; 1995. p.27, 15, 31, 109, 114-117.

33. Boericke William. Pocket Manual of Homoeopathic MateriaMedica and

Repertory. Reprint ed. New Delhi: B.Jain Publishers Pvt Ltd; 1996. p.94, 1066,

883.

34. Palsule S.G. Homoeopathic treatment for asthma and blood pressure.1st ed. New

Delhi: B.Jain Publishers Pvt Ltd; 1999. p.3.

35. Kent J.T.Repertory of the Homoeopathic MateriaMedica Reprint ed. New Delhi:

B.Jain Publishers Pvt Ltd; 2007 .p.763, 766, 773.

36. Murphy Robin N.D.Homoeopathic Medical Repertory. New Delhi: IBPS;

1994.p.945, 946.

100
ANNEXURES
 ANNEXURE – I

DISEASE INTENSITY SCORING CHART FOR BRONCHIAL ASTHMA

1. Gradation on Intensity of Breathlessness

No breathlessness = 0
On Unaccustomed work = 1
On accustomed work = 2
On exertion = 3
At rest = 4
2. Gradation on Wheezing
No Wheezing = 0
Mild Wheezing = 1
Moderate wheezing = 2
Severe wheezing = 3
3. A)Gradation on Cough 3.B) Expectoration

No cough = 0 No expectoration = 0
Occasional = 1 Scanty expectoration = 1
Severe Cough = 2 Profuse expectoration = 2
4. Gradation on Rhonchi
No Rhonchi = 0
Occasional = 1
Unilateral = 2
Bilateral = 3
5. Gradation on Drug dependence
No Dependency = 0
On Bronchodilators = 1
On inhalers = 2
On Steroids = 3

101
IMPROVEMENT CRITERIA USING SCORES AFTER TREATMENT

IMPROVEMENT SCORES

Markedly improved 1–3

Improved 4–7

Not improved >7

102
 ANNEXURE – II

CASE PROFORMA

Preliminary Data

Name:

Age:

Sex:

Religion:

Education:

Occupation:

Address:

Chief Complaint

Patient’s complaints for which he/she came.

LOCATION SENSATION MODALITY CONCOMITANT

History of presenting complaint

Past History

Significant past history

Family History

Significant history of family members

Treatment History

Treatment taken for same and/or past complaints

103
Patient as a Person

Appearance:

Appetite:

Thirst:

Craving:

Aversion:

Perspiration:

Stool:

Urine:

Sleep:

Dreams:

Menstrual Function:

Obstetric History: Pregnancies: Gravida: Para:

Particulars of each pregnancy:

Thermal State:

Life Space Investigation

1. Emotional State (causation, characteristics/intensity):

2. Intellectual State (capacities & performance):

 Memory:

 Motivation, will, drive:

 Comprehension:

 Performance:

 Thinking:

 Confidence:

104
 3. Reaction: A.F. <, > state effects

Reactions: Physical factors

Desires:

Prefers:

Bathing:

Season:

Relation to H & C

General Physical Examination

Built & Nourishment:

Orientation with time, place and person:

Weight:

Signs of pallor, cyanosis, clubbing, icterus and oedema:

Lymph Nodes:

Vital Signs:

Temperature:

Pulse:

Respiratory rate:

Blood presuure:

Systemic Examination

Respiratory System

Cardiovascular System

Abdomen

Central Nervous System

105
Provisional Diagnosis

Differential Diagnosis

Analysis and Evaluation of Symptoms

COMMON SYMPTOMS UNCOMMON SYMPTOMS

Totality of Symptoms

Mental generals

Physical generals

Characteristic Particulars

Repertory selection and reportorial totality

Reportorial result

Analysis of reportorial result

First prescription

Follow up criteria

106
 MAIN CASE

PRELIMINARY DATA:

NAME: Mr. GP S. C. R. No. 17889

AGE : 43 years Dr: P.K

SEX : Male Dat e: 10.06.10

OCCUP ATION: Aut o driver

RELIGION: Hindu

ADDRESS: Ko naje

LOCATION SENSATION MODALITY CONCOMITANT

Respiratory System Breathlessness3 <talking 3 Dryness of throat3

Since 10 months, Cough – dry 2 <exertion3 Itching of throat

increased since one Feels to clear throat <lying 3

week constantly < night3

Wheezing1 >home remedies

chest pain

History of presenting complaint

Patient was apparently well 10 months back when he gradually developed

difficulty in breathing. Breathlessness was gradual in onset and was more during night,

exertion, while lying and talking. Patient also complained of wheezing along with

breathlessness. During the complaints patient also had much dryness of the throat with

itching and cough. Patient used to get a feeling to clear the throat but there was no

expectoration. Patient also complained of occasional chest pain. Patient was relieved only

by taking some home remedies. Patient had similar complaints in the childhood.

107
 Patient did not complain of any increased perspiration, nausea, vomiting,

palpitations or fever along with the breathlessness.

Past History

Asthma in childhood

Family History

Patient’s mother is suffering from Hypertension.

Treatment History

Patient has taken allopathic treatment for the same complaints.

Patient as a Person

Appearance: Lean

Appetite: Good

Thirst: Decreased, 3 glasses/day

Craving: Tea1

Aversion: vegetables 1

Perspiration: neither decreased nor increased

Stool: 2 times /day, satisfactory

Urine: 4 times/day, once at night, no complaints

Sleep: disturbed

Dreams: unremembered

Thermal State: Hot

Life Space Investigation

Patient hails from lower financial set up and belongs to Hindu religion. He did not

study much as he was not interested. His childhood was uneventful. He got married at the

108
age of 26. He is much attached to his family. He has a younger sister who is handicapped

and he is tensed about her future. Patient is mild in nature, shares all his tensions with his

wife.

1. Emotional State (causation, characteristics/intensity):

Mild patient

2. Intellectual State (capacities & performance):

 Memory: Average

 Motivation, will, drive: Good

 Comprehension: Good

 Performance: Good

 Thinking: Active

 Confidence: Adequate

3. Reaction: A.F. <, > state effects

Likes to share tensions and likes consolation

Reactions: Physical factors

Desires: Fan

Prefers: Open Air

Bathing: once/day, cold water

Season: likes winter and monsoon

Relation to H & C: Hot patient

General Physical Examination

Built & Nourishment: Moderately built and nourished

Orientation with time, place and person: well oriented

109
Weight: 51 kg

Signs of pallor, cyanosis, clubbing, icterus and oedema: Absent

Lymph Nodes: Normal, NAD

Vital Signs:

Temperature: Afebrile

Pulse: 62 beats/ min

Respiratory rate: 17 / min

Blood pressure: 140/90 mm of Hg

Local examination

RESPIRATORY SYSTEM

Inspection: trachea seems to be centrally placed.

Chest is bilaterally symmetrical

No dilated veins. No visible pulsations. No scar marks.

Movements of the chest are equal in both sides.

Palpation: trachea is slightly shifted towards the right side

There is no local rise of temperature.

No tenderness.

Tactile vocal fremitus: equal on both sides

Percussion: resonant notes heard.

Auscultation: occasional expiratory ronchi heard all over the lung field

CARDIOVASCULAR SYSTEM

S1S2 heard. No murmur.

110
ABDOMEN

No abnormalities detected.

CENTRAL NERVOUS SYSTEM

No abnormalities detected.

Provisional Diagnosis

BRONCHIAL ASTHMA

: Difficulty in breathing

: < exertion , lying down

: Cough

: Wheezing

: Ronchi heard on examination

Differential Diagnosis

INTERSTITIAL LUNG DISEASE:

Difficulty in breathing

<exertion

Wheezing

Cough

Analysis and Evaluation of Symptoms

COMMON SYMPTOMS UNCOMMON SYMPTOMS

difficulty in breathing3 Dryness of throat3

< night , exertion, talking Itching of throat

< lying down Appearance: lean

Cough with no expectoration2 Thirst: decreased

111
 Thermally: Hot

Mildness, Likes consolation

Totality of Symptoms

Characteristic Particulars

Difficulty in breathing 3 : < night3, exertion2, lying down2, talking 3

Cough with no expectoration2

Dryness of throat3 with itching

Physical generals

Appearance: lean

Thirst: decreased

Thermally: hot

Mental generals

Mild in nature

Likes to share everything with wife

Likes company

Repertory selection and reportorial totality

Since this case has marked modalities and doesn’t have marked mental generals

or physical generals, modalities in first place method is used for repertorisation using

BogerBoenninghausen’s Characteristics and Repertory.

112
Sl Symptom Rubric Chapter Comment

no:

1. Breathlessness Respiration – time – night Respiration Physical

< night Modality

2. < talking Respiration – agg – talking, Respiration Physical

speaking Modality

3. < exertion Respiration – agg – exertion – Respiration Physical

physical Modality

4. < lying down Respiration – agg – lying – Respiration Physical

when Modality

5. Decreased Thirst – thirstlessness Thirst Physical

thirst General

6. Dryness of Mouth – throat (and gullet) – Mouth Concomit

throat dry ant

7. Difficulty in Respiration – difficult Respiration Location

breathing &

sensation

113
Reportorial result

Patient Rhustox Sulph Arsalb Nux Phos Puls Bell Calc lach sabad
Symptom v
Totality
Respiration – 2 2 4 4 1 4 1 3 2 1
time – night
Respiration – 1 4 - - - - - - - -
agg – talking,
speaking
Respiration – 1 - 1 - - - - - -
agg –
exertion –
physical
Respiration – 1 1 1 3 3 1 1 1 2 2
agg – lying –
when
Thirst – 2 2 3 2 2 4 3 1 1 3
thirstlessness
Mouth – 3 4 2 4 4 3 4 3 1 2
throat (and
gullet) – dry
Respiration – 2 4 4 2 4 2 4 2 4 2
difficult
Total 12/7 17/6 15/6 15/5 14/5 14/5 13/5 10/5 10/5 10/5
Opposite
Symptom
Totality
Agg&amel in 1 - - - - - - - - -
general –
talking,
speaking –
amel
Agg&amel in 3 - - - - - - - - -
general –
exertion –
physical –
amel
Respiration – - - - 3 - - - - - 1
amel – lying
– when
Thirst – thirst 3 4 4 4 4 2 4 3 1 2
Total 7 4 4 7 4 2 4 3 1 3

Polarity 5 CI 13 CI 11 CI 8 CI 10 12 9 CI 7 CI 9 7
Difference CI

114
CI = Contra Indicated
Pulsatilla = 12

Lachesis = 9

Sabadilla = 7

115
Analysis of reportorial result

After the polarity analysis, Pulsatilla is scoring high marks. In first repertorisation

in the conventional method, Pulsatilla came at 6th position. But with polarity analysis, the

remedies before Pulsatilla were found to be contraindicated. Further reference to the

MateriaMedica confirmed the choice of selection of this remedy. 200th potency was

selected considering patient’s age, pathology and seat of disease.

First prescription

Rx 1.Pulsatilla 200 (IP) H. S

2. No. ii pills, 4 – 0 – 4 for two weeks

Follow up criteria

1. Breathlessness

2. <night

3. <exertion

4. Cough

5. Occasional chest pain

6. Dryness of throat

7. Thirst

8. Ronchi

Follow Ups : 03/07/10

1 2 3 4 5 6 7 8

S S S S > > S S

116
Rx 1.Pulsatilla 200 (1P), H.S

2. No ii Pills 4 – 0 – 0 for two weeks

3. 3 grain tab 0 – 1 – 0 for two weeks

14/08/10

1 2 3 4 5 6 7 8

> S > > > > S >

Rx 1.Pulsatilla 200 (1P), H.S

2. No ii Pills 4 – 0 – 4 for two weeks

3. 3 grain tab 0 – 1 – 0 for two weeks

18/09/10

1 2 3 4 5 6 7 8

>+ > > >++ >++ >+++ > >+

Rx 1.Pulsatilla 200 (1P), H.S

2. No ii Pills 3 – 3 – 3 for two weeks

09/10/10

1 2 3 4 5 6 7 8

>++ >+ >++ A A >+++ >++ A

Rx 1.Pulsatilla 200 (1P), H.S

2. No ii Pills 4 – 0 – 4 for two weeks

3. 3 grain tab 1 – 0 – 1for two weeks

117
27/11/10

1 2 3 4 5 6 7 8

>+++ >+++ >+++ A A A >+++ A

Rx 1. Sac Lac (1P), H.S

2. 3 grain tab 0 – 0 – 1for two weeks

3. No ii Pills 4 – 0 – 4 for two weeks

08/01/11

1 2 3 4 5 6 7 8

A A >+++ A A A >+++ A

Since 2

months

Rx 1. Sac Lac (1P), H.S

2. No ii Pills 4 – 0 – 4 for two weeks

Summary of the Case

Patient named Mr. GP aged 43 yrs, male, Auto driver by occupation, hailing from

Konaje came with the complaints of breathlessness especially at night, during exertion,

while lying down and talking. He also complained of dry cough with dryness of throat.

The case was diagnosed as “Bronchial Asthma”. Case was taken in detail and

repertorisation was done using modalities in first place method of

BogerBoenninghausen’s Characteristics and Repertory. Polarity analysis was done for the

reportorial result and Pulsatilla was selected as the remedy. With this prescription patient

was completely better of his complaints.

118
 ANNEXURE III MASTER CHART

1. Mr. M A Patient Symptom Totality Opposite Symptom Totality NV: 17/8, Sulph: B A
Age: 51 yrs Respiration- time – morning Respiration – amel – lying 17/8, Ars: 16/8 ArsAlb 6 months Markedly
Sil:16/7, Phos: 15/7 200 8 2 improved
Sex: Male Respiration – agg – dust, stone cutters when
Religion: Respiration – agg – lying when Respiration – amel – eating After Polarity
Muslim Respiration – agg – eating after Respiration – amel – cold Difference
Occupation: Respiration – agg – cold drinks drinks
business Conditions of agg&amel in general – Conditions of agg&amel Sulphur: 16
Derelakkatte winter in – agg in general – summer – ArsAlb: 15
SCR No: 20952
Face – sweat on warmweather in – agg
Appetite – aversion – milk Appetite – desire – milk
Respiration – difficult
2 Ms. L A Respiration – agg – dust, stone cutters Respiration – amel – walking Sulph:18/6, ArsAlb 6 months
Age: 27 yrs Respiration – agg – walking – when Respiration – amel – Phos:14/6, Ars: 30, 200 11 1 Markedly
ascending, when 12/6, Puls:12/6, Sil: improved
Sex: Female Respiration – agg – ascending
14/5
Religion: Hindu Respiration – amel – sitting, uprightwhen Respiration – agg – sitting
After Polarity
Occupation: Thirst – thirst Thirst – thirstlessness Difference
shopkeeper Appetite – desire – condiments, piquant, Appetite – aversion - Sulph: 16, Sil: 14,
Someshwara appetizingthings condiments Ars: 12
SCR No: 20244 Cough – expectoration - whitish
3. Ms. NA A Respiration – time – night Respiration – amel – Ars : 18/7, Carbo Pulsatill 1 year and
Age: 16 yrs Respiration – agg – lying – when lyingwhen V: 17/7, Nux V: a 30, 5 months 9 1 Markedly
Respiration – agg – sitting 16/6, Puls: 16/6, 200 improved
Sex: Female Respiration – amel – sittingupright, when
Sulph: 15/6
Religion: Conditions of agg&amel in general – air – Appetite – desire - meat
Muslim cold, in – agg After Polarity
Occupation: Appetite – aversion – meat Difference
Student Menstruation- concomitants after menses- ArsAlb: 17
Kallapu leucorrhoea Sulph: 14
SCR No: 16418 Respiration – difficult NuxVom: 12

118
Sl. Preliminary Gro Reportorial Totality Reportorial Result Remedy Duration Scores Remarks
No. Data up of
A/B Treatment
4. Mr. AKM A Patient Symptom Totality Opposite Symptom Totaty NV: 20/8, Sil: 18/7, B A
Age: 60 yrs Respiration – time – evening Respiration – amel – walking AA:18/6, Bell:17.8, ArsAlb 7 months
Respiration – time – morning Agg&amel in general – Puls: 17/7 1M 11 8 Mildly
Sex: Male
Respiration – agg – dust, stone cutters summer, warm weather, in the improved
Religion: After Polarity
Respiration – agg – walking, when – agg
Muslim Agg&amel in general – winter in – agg Agg&amel – food – cold – Difference
Occupation: Agg&amel in general – food – cold – agg amel
Business Agg&amel in general – drinks cold – agg Agg&amel in general – drinks Nux Vom:18
Kotekar Head – external – sweat on – cold- amel Ars Alb:17
SCR No: 20395 Respiration - difficult Sil:14
5. Mrs. SM A Respiration – time – night Respiration – amel – lying Puls: 16/8, Sulphur
Age: 45 yrs Respiration – agg – lying when when RhusTox: 16/7, 200 9 1 Markedly
Respiration – amel – sitting- upright, when Respiration – agg – sitting Carbo V: 15/7, improved
Sex: Female
Agg&amel in general – food – cold – agg Agg&amel in general – food – Sulph: 14/7, Nux V:
Religion: Agg&amel in general – drinks – cold agg cold – amel 16/6
Muslim Agg&amel in general – weather – cold, Agg&amel in general – drinks
Occupation: wet – agg – cold – amel After Polarity
Beedi rolling Face – sweat on Agg&amel in general – Difference
Konaje Cough – concomitants – urination – weather – hot – agg RT: 14
SCR No: 16646 involuntary Calc: 9
Respiration difficult Sulph: 12

6. Mr. LD A Respiration – agg – dust, stone cutters Agg&amel in general – Sulph: 19/7, Phos: RhusTox 4 months
Age: 20 yrs Agg&amel in general- weather – cold, wet weather – hot – agg 14/6, Ars: 13/6, Sil: 1M 12 1 Markedly
– agg Agg&amel in general – lying 12/5, Rhustox: 13/4 improved
Sex: Male
Agg&amel in general- lying - on back – – on back – amel After Polarity
Religion: agg Agg&amel in general – Difference
Christian Agg&amel in general – breathing – breathing – inspiration – amel ArsAlb: 12
Occupation: inspiration – agg Appetite – aversion - meat RhusTox: 12
Student Appetite – desire – meat
Konaje Respiration - difficult
SCR No: 22444

119
Sl. Preliminary Gro Reportorial Totality Reportorial Result Remedy Duration Scores Remarks
No. Data up of
A/B Treatment
7. Mr. AA A Patient Symptom Totality Opposite Symptom Totality Ars: 15/6, Puls: B A
Age; 18 yrs Respiration – time – midnight Respiration – agg – sitting 13/6, RhusTox: ArsAlb 5 months
Respiration – amel – sitting; upright, when Respiration – agg – walking 13/6, Bry: 11/6, 0/1 8 1 Markedly
Sex: Male
Respiration – amel – walking when Calc :10/5 improved
Religion: Agg&amel in general – running – agg Agg&amel in general – After Polarity
Muslim Agg&amel in general – weather – cold, running – amel Difference
Occupation: wet – agg Agg&amel in general –
Hotel worker Agg&amel in general – drinks – cold, agg weather – hot – agg ArsAlb: 15
Asaigoli Agg&amel in general – food – oil – agg Agg&amel in general – drinks Rhus Tox:12
SCR No: 18387 Respiration – difficult – cold - amel
8. Mr. NN A Respiration – time – night Respiration – amel – walking N V:20/6, CV:16/6, Bryonia 8 months
Age: 65 years Respiration – agg – walking - when Respiration – agg – lying – Sulph:16/6,Bry:15/ 200 7 1 Markedly
Sex: Male Respiration – amel – lying – when when 6, China:11/6 improved
Religion: Hindu Agg&amel in general – rest, repose – amel Agg&amel in general – rest, After Polarity
Occupation: Appetite – appetite – want of repose – agg Difference
Farmer Cough – expectoration – whitish Appetite – appetite- increased
Bantwal Respiration – difficult Carb V: 12
SCR No: 14815 Bry: 11
9. Mr. SN A Respiration – time – morning Respiration – agg – lying, Nux V: 26/10, Calc: ArsAlb 7 months
Age: 64yrs Respiration – time – night when 23/9, Ars Alb:22/9, 0/1 7 1 Markedly
Sex: Male Respiration – agg – dust, stone cutters Agg&amel in general – rest, Sulph: 21/9, China: improved
Religion: Hindu Respiration – agg – exertion – physical repose – agg 16/9
Occupation: nil Agg&amel in general – weather – cold, Agg&amel in general –
Mudipu wet – agg exertion – physical – amel After Polarity
SCR No: 15586 Agg&amel in general – ascending – agg Agg&amel in general – Difference
Respiration – amel – lying when weather – hot – agg
Agg&amel in general – rest, repose, amel Agg&amel in general – Ars: Alb: 17
Appetite – appetite – want of ascending – amel
Appetite – desire – sweet, dainties etc Appetite - appetite –
Respiration – difficult increased
Appetite – aversion - sweets

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Sl. Preliminary Gro Reportorial Totality Reportorial Result Remedy Duration Scores Remarks
No. Data up of
A/B Treatment
10. Mr. S A Patient Symptom Totality Opposite Symptom Totality Puls: 18/7, Ars: B A
Age: 19 yrs Respiration – time – evening Respiration – amel – lying – 17/7, Phos: 14/7, Pulsatilla 4 months
Sex: Male Respiration – time – night when Bell: 12/7, Sulph: 200 8 2 Markedly
Religion: Respiration – agg – lying – when Respiration – amel – air- 15/6 improved
Muslim Respiration – agg – dust, stone cutters open, in After Polarity
Occupation: Respiration – amel – air, open Respiration – agg – sitting Difference
Student Respiration – amel – sitting – upright, Thirst - thirst
Salethur when Puls: 14
SCR No: 15532 Thirst – thirstlessness
Respiration – difficult
11. Mrs. S A Respiration – time – evening Respiration – amel – walking Sulph: 17/6, Bell: Pulsatilla 7 months
Age: 55 yrs Respiration – agg – walking – when Agg&amel in general – 13/6, N V:13/6,Ars: 200 8 1 Markedly
Sex: Female Respiration – agg – exertion – physical exertion – physical – amel 13/5, Puls: 13/5 improved
Religion: Hindu Respiration – agg – dust, stone cutters Agg&amel in general – sun – After Polarity
Occupation : Agg&amel in general – sun (heat of) – in light – amel Difference
Housewife the – agg Sweat – sweat, sweatiness – Puls: 11
Mangalore Sweat – sweat, sweatiness – in general absent ( inability to sweat) Ars: 11
SCR No: 14831 Respiration – difficult NV: 11
12. Mr. GP A Respiration – time – night Agg&amel in general – RT:12/7,Sulph:17/6 Pulsatilla 6 months
Age: 43 yrs Respiration – agg – talking, speaking talking, speaking – amel ,Ars: 15/6NV: 15/5, 200 7 2 Markedly
Sex: Male Respiration – agg – exertion – physical Agg&amel in general – Phos: 14/5 improved
Religion: Hindu Respiration – agg – lying – when exertion – physical – amel After Polarity
Occupation: Thirst – thirstlessness Respiration – amel – lying – Difference
Auto driver Mouth – throat (and gullet) – dry when
Konaje Respiration – difficult Thirst – thirst Puls: 12
SCR No: 17889

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Sl. Preliminary Gro Reportorial Totality Reportorial Result Remedy Duration Scores Remarks
No. Data up of
A/B Treatment
13. Mrs. AD A Patient Symptom Totality Opposite Symptom Totality Puls:24/9, NV: B A
Age: 63 yrs Respiration – time – night Respiration – amel – lying – 25/8, RT: 20/8, Pulsatilla 5 months
Sex: Female Respiration – agg – lying – when when Bell: 19/8, Carbo 200 9 2 Markedly
Religion: Respiration – amel – sitting – upright, Agg&amel in general – V: 18/8 improved
Christian when and bent forward with After Polarity
sitting bent over – agg
Occupation: Agg&amel in general – food – oil – agg Difference
Beedi rolling Appetite – appetite – want of Thirst – thirst
Mangalore Thirst – thirstlessness Appetite – appetite- Puls: 16
SCR No: 17658 Face – sweat on excessive
Respiration – difficult
14. Mrs. NA A Respiration – time – morning Respiration – amel – lying – Sulph: 19/8, ArsAlb 4 months
Age:64 yrs Respiration – agg – lying – when when Ars:14/8, Puls: 200 9 1 Markedly
Sex: Female Respiration – agg – eating after Respiration – amel – eating 13/7, NV: 12/7, improved
Religion: Agg&amel in general – weather – cold, Agg&amel in general – Phos: 16/6
Muslim wet – agg weather – hot – agg After Polarity
Occupation: Appetite – desire – condiments, piquant, Appetite – aversion – Difference
Housewife appetizingthings condiments
Bantwal Appetite – desire – sweet, dainties etc Appetite – aversion - sweets Ars: 12
SCR No: 17579 Sweat – sweat, sweatiness – yellow Phos: 13
Cough – expectoration – yellow
Respiration – difficult
15. Mr. H A Respiration – time – night Agg&amel in general – drinks Ars: 12/6, Sil: 11/5, Silicea 4 months
Age: 52 yrs Respiration – agg – dust, stone cutters – cold – amel Phos: 9/5, Sulph: 200 9 1 Markedly
Sex: Male Agg&amel in general – drinks – cold – agg Respiration – agg – sitting 12/4, Hepar: 11/4 improved
Religion: Hindu Agg&amel in general – cold – in general – Agg&amel in general –
Occupation: agg warmth – in general – agg After Polarity
Auto Driver Respiration – amel – sitting – upright, Sweat – sweat, sweatiness – Difference
Kuthar when odourless Ars: 15, Sil: 14,
SCR No: 17981 Sweat – sweat, sweatiness – odorous Hep: 14, Phos: 8
Respiration – difficult

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Sl. Preliminary Gro Reportorial Totality Reportorial Result Remedy Duration Scores Remarks
No. Data up of
A/B Treatment
16. Mr. N B Respiration – time – night RT: 15/7 ArsAlb 200, 0/1 1 year and B A
Age:20 yrs Respiration – agg – lying – when Puls: 14/7 4 months
Sex: Male Respiration – amel – sitting – upright, when Carb V: 13/7 9 2 Markedly
Religion: Respiration – amel – walking Ars: 15/6 improved
Muslim Agg&amel in general – food – cold – agg Lyco: 13/6
Occupation : Agg&amel in general – weather – cold, wet – agg
Student Chest – external – sweat on
Mangalore Respiration – difficult
SCR No: 18165
17. Mrs. A B Respiration – time – night Ars: 20/9 NuxVom 200 4 months
Age: 27 yrs Respiration – agg – dust, stone cutters Puls: 21/8 Sulphur 200 8 6 Mildly
Sex: Female Respiration – agg – lying – when NV: 19/8 ArsAlb 200 improved
Religion: Respiration – amel – sitting – upright, when Sulph: 19/8 Kali Bich 200
Muslim Respiration – amel – sitting – upright, when – and bent Carb V: 18/8
Occupation: forward with
Housewife Thirst – thirstlessness
Konaje Appetite - aversion – milk
SCR No: 18522 Face – sweat on
Mouth – dryness
Cough – expectoration – scanty, suppressed etc
Respiration – difficult
18. Mrs. CM B Respiration – time – midnight – after Ars: 17/6 ArsAlb 200 11 months
Age: 52 yrs Respiration – time – morning NV: 15/6 NuxVom 200 11 6 Mildly
Sex: Female Respiration – amel – lying – side on Puls: 15/6 improved
Religion: Agg&amel in general – food – cold – agg Sulph: 14/6
Christian Agg&amel in general – food – vegetables – agg Verat: 14/6
Occupation: Face – sweat on
Housewife Larynx & Trachea – constriction – larynx
Kuthar Cough – expectoration – copious
SCR No: 16322 Respiration – difficult

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Sl. Preliminary Gro Reportorial Totality Reportorial Result Remedy Duration Scores Remarks
No. Data up of
A/B Treatment
19. Mrs. NZH B Respiration – time – evening Ars: 17/9 Bryonia 200 4 months B A
Age: 22 yrs Respiration – agg – dust, stone cutters Bell: 15/7
Sex: Female Agg&amel in general – drinks – cold – agg NV: 12/7 8 5
Religion: Respiration – agg – cold – taking after Sulph: 18/6
Muslim Head – internal – aching, undefined pain etc – temples Puls: 15/6
Occupation: Appetite – aversion – eggs
Housewife Appetite – desires – condiments, piquant, appetizing things
Cough – expectoration – yellow
Ullal
Respiration – difficult
SCR No 22449
20. Mr. JJ B Respiration – time – night Ars: 18/8 Nat Mur 200 1 month
Age: 36 yrs Respiration – agg – dust, stone cutters Sulph: 20/7 10 Dropped out
Sex: Male Respiration – agg – exertion – physical Calc: 18/7
Religion: Agg&amel in general – smoke, agg Phos: 18/7
Christian Agg&amel in general – weather change of , agg NV: 16/7
Thirst – thirst
Occupation: Bar
tender Appetite – desire – salty things
Sweat – sweat, sweatiness – odorous
Kasaragode
Respiration difficult
SCR No:22136
21. Mrs. SS B Respiration – time – night Ars: 19/8 Nat Sulph 200 5 months
Age: 32 yrs Respiration – agg – dust, stone cutters Phos: 16/7 7 4 Moderately
Respiration – agg – lying – when RhusTox: 14/7 improved
Sex: Female
Respiration – agg – exertion – physical NV: 18/6
Religion: Hindu Respiration – amel – sitting – upright, when Calc: 16/6
Occupation: Agg&amel in general – winter in – agg
Beedi rolling Thirst – thirst
Thalapady Respiration difficult
SCR No:20907

124
Sl. Preliminary Gro Reportorial Totality Reportorial Result Remedy Duration Scores Remarks
No. Data up of
A/B Treatment
22. Mrs. J B Respiration – time – night Sulph: 24/9 Cactus 30 4 months B A
Age: 31 yrs Respiration – time – morning Ars: 21/9
Sex: Female Respiration – agg – dust, stone cutters NV: 22/8 8 3 Moderately
Religion: Respiration – agg – cold – taking after Puls: 17/8 improved
Muslim Respiration – agg – walking – when China: 15/8
Occupation: Agg&amel in general – food – milk – agg
Housewife Appetite – appetite - want of
Appetite – desires – condiments, piquant, appetizing things
Derelakkatte
Appetite – aversion – sweets
SCR No:21963
Respiration – difficult

23. Mrs. Ds B Respiration – time – night Sulph: 20/7 Pulsatilla 30 8 months

Age: 26 yrs Respiration – agg – lying – when Ars: 17/7 Nat Sulph 30, 200 7 2 Markedly
Respiration – amel – sitting – upright, when – and bent Puls:17/7 ArsAlb 200 improved
Sex: Female
forward with Calc: 15/6
Religion: Hindu Agg&amel in general – drinks – cold – agg Phos: 15/6
Occupation: Agg&amel in general – food – eggs – agg
Teacher Agg&amel – in general – food – milk – agg
Asaigoli Thirst – thirst
SCR No:20391 Appetite – desires – condiments, piquant, appetizing things
Respiration – difficult

24. Mrs. RRS B Respiration – time – night Ars: 18/6 Pulsatilla 0/1 9 months
Age: 28 yrs Agg&amel in general – ascending (steps) – agg Sulph: 16/6 7 3 Moderately
Agg&amel in general – talking, speaking – agg Puls: 14/6 improved
Sex: Female
Agg&amel in general – winter, in – agg Phos: 13/6
Religion: Hindu Appetite – desires – condiments, piquant, appetizing things NV: 16/5
Occupation: Respiration – difficult
Office worker
Mudipu
SCR No:20265

125
Sl. Preliminary Gro Reportorial Totality Reportorial Result Remedy Duration Scores Remarks
No. Data up of
A/B Treatment
25. Mr. OJD B Respiration – time – night Ars: 20/9 ArsAlb 200 11 months B A
Age: 46 yrs Respiration – agg – lying – when Sulph: 19/8 NuxVom 200
Agg&amel in general – drinks – cold – agg Lach: 16/8 Lycopodium 200 9 3 Moderately
Sex: Male
Agg&amel in general – food – fruit – agg Sep: 16/8 improved
Religion: Agg&amel in general – draft of air – agg Phos: 15/8
Christian Thirst – thirstlessness
Occupation: Appetite – aversion – sweets
Fisherman Stool – hard
Mangalore Cough – expectoration – difficult
SCR No:20157 Respiration – difficult
26. Mr. MA B Respiration – time – night Ars: 20/9 NuxVom 200 7 months
Age: yrs Respiration – agg – lying – when NV: 19/7 11 5 Moderately
Respiration – agg – dust, stone cutters Bell: 16/7 improved
Sex: Male
Respiration – agg – exertion – physical RhusTox: 13/7
Religion: Respiration – agg – cold – taking, after China: 12/7
Muslim Agg&amel in general – cold – agg, when becoming
Occupation: Thirst – thirstlessness
Mangalore Cough – expectoration – scanty , suppressed etc
SCR No: 21144 Respiration – difficult
27. Mr. FD B Respiration – time – night Calc: 23/9 Kali Carb 200 6 months
Age: 40 yrs Respiration – time – morning Ars: 20/9 11 4 Moderately
Respiration – agg – dust, stone cutters Sulph: 20/9 improved
Sex: Male
Respiration - agg – lying – when NV: 18/8
Religion: Respiration – agg – exertion – physical Phos: 17/8
Christian Agg&amel in general – weather – cold, wet – agg
Occupation: Agg&amel in general – drinks – cold – agg
Farmer Agg&amel in general – food – sweets, sugar etc – agg
Mangalore Head – external – sweat, on
SCR No:19118 Appetite – desires – condiments, piquant, appetizing things
Respiration – difficult

126
Sl. Preliminary Gro Reportorial Totality Reportorial Result Remedy Duration Scores Remarks
No. Data up of
A/B Treatment
28. Mrs. S B Respiration – time – midnight Ars: 16/8 Bryonia 200 5 months B A
Age: 30 yrs Respiration – time – morning Sulph: 17/7
Respiration – time – evening Puls: 11/7 9 1 Markedly
Sex: Female
Respiration – agg – lying – when Phos: 13/6 improved
Religion: Respiration – aggravation – talking, speaking RhusTox: 11/6
Muslim Agg&amel in general – weather – cold, wet – agg
Occupation: Respiration – amel - sitting – upright, when
Housewife Neck & external throat – sweat
Ullal Appetite – desires – condiments, piquant, appetizing things
SCR No:21888 Respiration – difficult
29. Mr. IK B Respiration – time – night Ars: 17/6 Lycopodium 200 , 4 months
Age: 41 yrs Agg&amel in general – winter in – agg Sulph: 17/6 1M 8 1 Markedly
Agg&amel in general – drinks – cold – agg Phos: 14/6 improved
Sex: Male
Agg&amel in general – summer, warm weather in the – Spong: 9/6
Religion: amel Puls: 17/5
Muslim Thirst – thirstlessness Carbo V: 14/5
Occupation: Appetite – aversion – sweets Lyco: 12/5
Salesman Cough – expectoration – whitish
Bantwel Respiration – difficult
SCR No:21733
30. Mr. RM B Respiration – agg – exertion – physical Ars: 23/9 Bryonia 200 , 1M 4 months
Age: 60 yrs Respiration – agg – eating – after Sulph: 26/8 11 5 Moderately
Respiration – agg – lying – when NV: 24/8 improved
Sex: Male
Respiration – agg – dust, stone cutters RhusTox: 19/8
Religion: Hindu Agg&amel in general – food – cold – agg Sil: 21/7
Occupation: Agg&amel in general – drinks – cold – agg Bry: 18/6
Coolie Woorker Agg 7 amel in general – drinking – after – agg
Manjanady Appetite – appetite – want of
SCR No:19638 Thirst – thirst
Respiration – difficult

127