ACUTE DISEASES: As per Hahnemann’s clinical classification diseases may be acute or chronic. Acute diseases are Rapid. They are disease processes of the abnormally deranged vital force that have a tendency to finish their course more or less quickly, always in a moderate time, i.e. the disease having a period of progress and a period of decline and there is always a tendency
Acute disease in its very earliest, fertile and virgin soil is the best opportunity for prescribing with the treatment of the entire patient and making the suffering humanity in a perfect balance of health. We observe that the acute phenomena occur in the following ways:
- Produced by an organism (parasite, bacteria, virus) with a perfect picture of nosological tagging like cholera, typhoid, pneumonia, whooping cough etc.
- Or may manifest itself without the pathological tagging.
- Cases of hydra headed manifestation after the vaccination, either alone, repeated or recurrent, ‘taken’ or ‘not taken’.
- several diseases originating from acute poisoning – like , by a constant long standing use of tea, producing a dyscrasia
CLASSIFICATION OF ACUTE DISEASES:
INDIVIDUAL ACUTE DISEASES:
This is acute disease proper where the individual may get suffering of an acute character with tendency to recovery.
For understanding individual acute diseases we ought to be intelligent because it’s the intelligent physician who has got the power of intellect , to understand everything in a perfect way, as has been mentioned by Dr Hahnemann in § 7 , foot note 2 1 .
In any disease if symptoms point out to deficiency of some mineral such as zinc, Selenium, Iron etc., a pathological investigation should be done after which the deficiency should be met with first. If the deficiency of mineral occurred in the body in spite of having a balanced diet, there is defective assimilation due to which in spite of normal intake, the body is unable to assimilate that substance. This needs to be corrected in order to bring back harmony in the living system. Thus, only after improving the deficiency state a medicine should be prescribed to correct the dyscrasia.
Acute diseases are usually a transient explosion of latent miasm present in our body. The factors which trigger this latent miasm are called as exciting cause. For prescribing in acute cases we need to take note of the following:
EXCITING CAUSE: as per Dr Hahnemann, there is not one cause behind any disease but a web of causation. So we ought to find the most probable exciting cause. Here a word of caution is to be added, not to be carried away by a single exciting cause. The probability of a drug should be confirmed through more number of observatory symptoms and logically and sequentially the remedy to should be reached.
for example :
Complaint after getting drenched in rainy weather – Rhus tox is not the only remedy but there are many drugs covering the same as can be seen in Kent’s repertory under chapter
WET Weather : Am-c, Ars, Bad, Calc,Dulc, Nat-h, Nat-s, Nux-m, Puls, Rhod, Rhus-t
These are some of the remedies given as first grade drugs for the same rubric
CAUSATIVE FACTORS can be seen in:
· Allen’s key-notes: for example
§ Complaints caused by exposure to dry cold air, dry north or west winds, or exposure to draughts of cold air while in a perspiration; bad effects of checked perspiration.: Aconitum Napellus
§ For the bad effects resulting from mechanical injuries; even if received years ago: Arnica Montana
§ Ailments from fright, anger, contradictions, mortification, vexation, dread, or reserved displeasure: Aurum Metallicum
§ Ailments: brought on or renewed by change of weather: Chelidonium Majus
§ Bad effects of: coffee, tabacco, alcoholic stimulants; highly spiced or seasoned food; over-eating ; long continued mental over- exertion; sedentary habits; loss of sleep; aromatic or patent medicines; sitting on cold stones; specially in warm weather: Nux vomica
§ Stomach easily disturbed ,especially by cakes, pastry or rich fat foods: Pulsatilla
· Dr M.L.Tyler
§ Complaints from taking cold, when the glands become affected all over the body :
· Kent’s repertory(weather/climate)
Dry weather agg : Asar, Caust, Hep, Nux-v
Windy and stormy weather : Bad, Nux-m, Rhod.
Winter, in : Aur, Fl-ac, Nux-v, Rhus-t
Climate is important and should be noted during prescribing in acute diseases.
· Aggravation – change of weather in spring: Antimonium tart
Mercury : Nit ac
Bryonia : Alum, Bapt, Mur ac
Opium : Hell
Over mental and physical exertion : Cocc
Mental anxiety and worry: Calc
Ovariotomy : Orchitinum
Stiff neck after hair cut :Bryonia
Climacteric disturbances : Oophorinum,
Chronic rheumatism of joints after exposure to x-ray or during climacteric : Oophorinum
Overuse of antibiotics when all indicated remedies fail and no other indicxation can be seen: Rhus tox
Post-operative anaemia : Calc phos
Location was first given importance by Dr Hahnemann and thereafter it was Dr Boenninghausen who emphasized on it in order to obtain a complete symptom. .
During Drug-proving a medicine develops its own location along with the internal mileu, where it acts most beneficially.
For example: Dulcamara has a strong action on Umblicus as has been mentioned By Dr Tyler.
“We have often successfully employed Dulcamara for pain, or eruptions in the region of the umbilicus – “The hole”, as a wee girl graphically described her pain spot. One first discovered this tip in Boenninghausen years ago. Localities can be important.”
Similarly Sepia affects the Knuckles.
This concept of location was observed by Dr Boenninghausen and references to the same can be seen in his repertory.
We can also find references in Kent’s repertory as well as in Boger Boenninghausem’s repertory.
HEAD ( KENT’S REPETORY)
Forehead : Acon, Am-c, Am-m, Arn, Ars, Bell, Bism, Bry, Caps, Cocc, Dros, Hep, Hyos, Ign, Kali-s, Lac-c, LAur, Merc, Nat-a, Nat-c, Nat-m, Nux-v, Phos, Puls,Sil, Spig, Stann, Sulph
Right side : Prun.
MOUTH(buccal cavity) : BELL, MERC, NUX-V, PHO
Right : MERC
Left : BELL, LACH
A patient is a combination of his ancestral past (From both father and mother), his own past as well as his present. In this scenario, he develops his own constitution and his own deficiency or a disease. Thus, if a disease runs in the family, say Hypertension, then he too has the propensity to suffer from that disease: This has been termed as PATHOLOGICAL GENERAL by Dr Boger. . For example: Hereditary rheumatism : Sel, Sep, Sil.
For eradication of such symptoms, after the acute phase has been overcome with medicines, it’s the best time to start the constitutional medicine so as to remove this disease from the soil of the patient.
Many sensations are mentioned in Therapeutic Pocket Book by Boenninghausen as well as in Kent’s repertory and also in Boger Boenninghausen’s repertory. Many sensations are mentioned along with the chapter on location itself.
STOMACH ( KENT’S REPERTORY):
Coldness : Ars, Camph, Caps, Chin
Constriction : Aesc, Chel, Graph, Guare
Contraction : Ars, Carb-v, Cupr
Death-like sensation : Ars, Cupr.
SENSATIONS AND COMPLAINTS IN GENERAL ( BBCR):
Dry sensation in internal parts : ALU, NUX-M, RHUS-T
A lot of sensations have been marked by Dr M.L. Tyler in her works where she mentions domineering symptom for each drug .for example : BURNING has been mentioned as a domineering sensation in drugs like Arsenic album, Carbo vegetables , and Phosphorus.
CAPSICUM : One notices that the burning pains of Capsicum, which so greatly affects mucous membranes , are the “burnings, as of cayenne pepper, sprinkled on the part.
Then one notices pressing pain in eyes : to protrusion: with burning, redness and lachrymation
Cobweb sensation : Graph, Bor, Brom, Bar-c
Modalities are very important in acute prescription and should be noted with care. For example: a hot patient who is relieved by warmth: Pulsatilla
Chilly patient but nasal symptoms are relieved in open air: Nux vomica
In Kent’s repertory, rubrics are arranged as side, time modalities and extension or radiation.
Modalities have also been explained thoroughly in Boger Boenninghausen’s repertory.
Many concomitants have been given in the Allen’s keynotes. To quote a few examples :
· RHUS TOX : Diarrhoea: with beginning typhoid; involuntary, with great exhaustion; tearing pain down the posterior part of limbs during stool.
· Ipecacuanha: Constant and continual nausea. with tongue clean or slightly coated.
· Digitalis : Clean tongue with slow pulse or heart involvement
Frequent hand washing : Nit-a, Phos ( Lac-c , Med, Syphl)
Pain restlessness of legs with burning : Med
Asthma with nocturnal diarrhea : Kali-c
In cases of acute pain for example Cholecystitis , ask how the different parts of the body respond along with it. His Appetite, Thirst, Desires etc should be inquired into and concomitants can be easily found .
Thuja Occidentalis: Pain with frequency of micturation
In acute disease, the Chief symptom strikes us and becomes evident to the sense more quickly, and hence much less time is requisite for knowing the picture of the disease and much fewer questions are required to be asked.(§ 82).The worst the acute disease, the more numerous and striking are the symptoms. So the art of the physician is to take the “PROJECTIVE SYMPTOM” at the moment; as for example the desire and aversions, thirst, the change in the mental behavior and the mode of onset of the disease with its pace whether it is slow in progress or rapid in onset, etc.
Hyperpyrexia with red face – Bell
In most of the cases, climate plays an important role as trigger factor. In such cases Pointers by Dr M.L. Tyler is an important reference as for example
COLD . Worse cold air : All c, Ars, Dulc, Hep, Nux, Phos
cold dry weather : Acon, Bry, Hep, Nux, Caust
cold wet : Calc, Dulc, Rhus, Nat-s
inhaling cold air : All c, Hep, Phos, Rumex
draught : Ars, Bell, Hep, Nat c, Nux, Sul, Dulc, Merc.
POTENCY: 6, 12 and 30 – frequent repetition
LM potency – Olfaction ( especially in Advanced Pathology)
The higher the intensity of the symptom, more frequent should be the repetition.
EMOTIONAL CAUSES : fear, fright, insult feeling
Insult with pain > hard pressure : Colocynth
Insult with pain < touch : Staphysagria
Pain > hard pressure : Colocynth
Pain > pressure and especially by warmth : Mag phos
Acute pains are usually of stones ( as in cholelithiasis or renal stones ) or are due to Dysmenorrhoea.
- During menstruation; the more profuse the flow the greater the pain : Actaea Racemosa.
- Pains accompanied with constant chilliness; the more severe the pain, the more severe the chill : Pulsatilla
- Severe Dysmenorrhoea with cold sweat on the forehead : Veratrum album
The bold symptoms of Allen’s keynotes are important as they develop along with the main symptom . for example :
- A thick milky-white coating on the tongue, is the red strand of the remedy; Antim crudum.
- Acute pain with thirstlessness : Nux moschata
- Thirstlessness with drowsiness : Opium, Antim tart
- Fear of downward motion along with hot, profuse discharges : Borax
- Thirstlessness with nearly all complaints : Pulsatilla
HOW TO OBSERVE A PATIENT:
Observation plays a major role in selecting a remedy and thus a proper observation should be made from head to toe. In certain cases like loss of consciousness, good observation is of utmost importance as we cannot have the subjective symptoms of the patient.
First we should observe the HAIR of the patient followed by FOREHEAD followed by EYEBROWS and EYELASHES. Then EYE- CORNEA, PUPIL and so on should be observed. After we have observed the patient through our sense of sight we should next touch and feel them so as not to miss out on important indications of medicines Example :
Forehead warm feet cold : Arnica Montana
Breasts cold as ice to touch , especially the nipples, rest of the body warm ( during menss) : Medorrhinum
Kent’s repertory and Boger’s synoptic key are useful in locating the observatory symptoms
What is the smell of the body ?
Sour smell of the whole body; child smells sour, even after washing or bathing: Rheum
What is the condition of inspired or expired air. Is it cold/ warm?
If it is cold : Carbo vegetables
Inquiry should be made as to whether the sweat is on the part lain on or on uncovered parts as for example :
· Sweat: only on uncovered parts; or all over except the head (rev. of Sil.); when he sleeps, stops when he wakes (rev. of Samb.); profuse, sour smelling, fetid at night. Persipration, smelling like honey, on the genitals: Thuja
Time and location of sweating : during sleep or waking hours ;on forehead or head or neck etc
- Sweat day and night, as soon as one sleeps, or even when closing the eyes: Conium Maculatum
Some important observations giving indications to the drugs
Brown moles ( Carc) : Thuj
Lies with hand over the head : Aesc, Carc, Puls
Fidgety feet : Cupr
Pointed warts : Med
Old, slow tired man with weak bradyarrythmia : Crat
Slow and irregular beat, especially every fourth beat missing: Apoc
Eruption on wrists : Psor
Modalities of the patient should be matched with the presenting complaint as well as the concomitant of the patient. If suppose a patient comes and says headache < motion along with Dysmenorrhoea during which she tries to sit quietly – Bryonia
Pneumonia with constant rubbing of the liver region : Podophyllum
Sometimes, even the constitutional medicine can be prescribed frequently to overcome the acute symptoms. Example in a case of fibroid if bleeding P/V occurs; the constitutional medicine can be prescribed frequently and beneficially.