Abstract-Repertory from it’s birth till date is not complete.From “The Fragmenta” the subject expands itself, with addition of new rubrics and more and more medicines, through clinical verification. The subject comes into play when the physician, is unable to find a similimum, in any complicated situation or case. There are different repertories available according to the patient’s condition. Master thought the concept of repertory too with the ever increasing symptomatologies of various drugs, along with the span of time.He knew that forming a genuine repertory was more than mere indexing and thus the seed was implanted which has undergone through the process of evolution to the present era of Softwares and various other modern techniques. The book of repertory not only helps in repertorisation, but also has something more to offer, right from the casetaking till the final selection of the medicine or even in 2nd prescription.
Master thought about indexing of symptoms systemically, but was unable to give it a shape. He told his followers Dr Rummel, Dr Ruckert, Dr Staph and even Jahr but none of them could come up with a repertory that could satisfy Dr Hanhemann, until Dr Boenninghausen published the Repertory of the Antipsorics. Mention to be made about the concept of complete symptom of Boenninghausen which was ably supported by Doctrine of Analogy and Doctrine of Concomitants. This thinking of Boenninghausen has been fully supported by the Master as reflected through his preface in the Repertory of the Antipsorics. Master has also praised Boenninghausen for his Repertory of the antipsorics as mentioned in the footnote of 153 in Organon of Medicine. The title of BTPB also reflects its use at the bedside, not only for the sick persons, but also in the study of Materia Medica, as it gives an idea of the of the relative value of each symptom in respect to a particular drug. With the passage of time, there have been different repertories like Jahr’s Symptom Codex, Allen’s Symptom Register, Repertory of Homoeopathic Materia Medica by James Tyler Kent, Boger Boenninghausen’s Characteristic Repertory etc, various other regional repertories, which has enriched the homoeopathic fraternity up to the present era of Software.
Rubric and Repertory consultation
The role of repertory in the recent times, has not only been helping in the mechanical process of repertorisation, but also consulting a repertory in any morbid condition, enriches a physician. Any repertory expresses itself through the language of the rubrics. Unlike materia medica, a rubric is incorporated in repertory only after repeated verification through proving, reproving and/or clinical confirmation, this is the dictum of the repertory. If we consider Kent’s Repertory, a drug present in the rubric in general, as well as in all it’s sub rubrics, sub sub rubrics through various modifications of side, time, modalities or any concomitant, can be called to be a very important symptom of that drug, than those drugs which might have been present in the rubric in general only or in one or two sub rubric or sub sub rubric and due to lack of completeness in the coverage of all the various dimensions of the symptoms or rubrics, the value of the symptom in respect to that one or two particular drugs will be always lesser. It is the repertory which actually gives the idea of relative gradation of the medicines in respect to a particular symptom or rubric———Dr Boenninghausen was the pioneer in this respect. A rubric in general or any sub-rubric generally consist of words that is easily understandable (need not always to be a medical term), so that it can accommodate quite a large number of symptoms. Again it is the repertory which help us to understand the time modalities in a broader and better sense i.e the time span of the morning, forenoon, afternoon or evening, as given in Boger Time Remedies or even the Generalities chapter of Kent’s Repertory. The various sub rubrics or sub sub rubrics under a particular rubric in general, always help us or enhances the art of interrogation. The cross references or similar rubrics also widens the thought process of a physician, helps in proper interpretation of the symptoms of the patient thereby improves the art of interrogation and case taking.
Proper interpretation of symptoms through rubrics
The constant use of repertory helps a physician in proper interpretation of the symptoms e.g in Kent’s Repertory in the Mind Chapter in the rubric Death there is a sub rubric ‘predicts the time’ so also under Prophesying there is a sub rubric ‘predicts the time’ and both these rubrics though contain same drugs but one is needed to be very much careful before interpreting these rubrics while treating the sick. So also in the rubrics Blindness pretended, Deafness pretended, Feigning sick and Feigning pregnancy the drug is Veratrum album, thus it can be said that Veratrum album has a tendency to pretend in its symptomatological expressions—this is called analytical use of repertory. Next the rubric, ‘Irritability, sends the doctor home’ has Apis, Arnica,Chamomilla, another rubric ‘Delusion well, think he is’ has medicines Apis, Arnica, Ars, Cinnabaris, Hyoscamus, Kreosote, Mercurius, Pulsatilla, then’ Delirium well, declares she is’ the rubric has Apis, Arnica, Arsenic, further the rubric ‘Obstinate, declares there is nothing the matter with him’ has Apis and Arnica and lastly the rubric ‘Well, says he is, when very sick’ has Apis, Arnica, Ars, Cinnabaris, Hyoscamus, Kreosote, Mercurius, Pulsatilla. The rubrics just discussed are neither cross reference nor similar rubrics. Thus when a patient says that he is well, even though when he/she is suffering, it is very obvious that the physician has to be analytical enough to see the patient’s state, so that he can interpret properly that which will be the right rubric to be considered at that point of time, as just discussed. Dr Vithoulkas has said that the best interpretations come from understanding the situation of the patient which is to be understood in the form of a story or in form of evolution, e.g A boy wants to become an artist. From a very young age he loves to read books related to the arts, he loves to draw ad paint. He is enthusiastic about taking part in art competitions and he loves to visit museum and galleries. Added to this, he has a very dominating father.The father says “ Look you cannot make money by studying at a school of arts. You have to study business so you can get a good job and make lots of money”. Then conflict starts in the mind of the child , regarding his burning desire to be an artist against the restriction of his parents to pursue commercial education.” Now how these symptoms are going to be inter pretated—Here the child wants to do something but the dominating parents restrict him- and ultimately the child surrenders and in this case the rubric in Synthesis Repertory can be, Mind-Contradictory, actions are contradictory to intentions or Antagonism with self or Ailments from domination. Once we decide that which of this rubrics, we must confirm its accuracy with the patient. Only when the patient agrees with the language, then only we should accept it as valid and take it in the analysis. So here again a physician who is well versed with repertory can interprete symptom much more rightly than the physician who uses repertory very little.
Repertory helps in finding the characteristic symptoms and also to understand the evolution of the symptomatologies of some drugs
With regards to repertory consultation, it is also helpful in searching the characteristic symptom for e.g in a case of the O.P.D of Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, where the patient presented with migraine along with excessive thirst, whenever the headache start, the rubric consulted, ‘Thirst with headache’ in Stomach chapter of Kent’s Repertory and was finally prescribed Nat Mur-200, on the basis of the totality, but to get a hint of the uncommon peculiar rubric the repertory has been consulted which paved the way for the final prescription. Another case of O.P.D with the complain of P.C.O.D presented with a peculiar symptom of feeling of nausea whenever he sweats, the rubric consulted in Stomach chapter of Kent’s Repertory, nausea perspiration during, and she was prescribed Graphites-200, after due consultation with materia medica. Thus in both these cases the repertory was consulted for the uncommon, peculiar symptoms. Likewise another case of recurrent boils where the patient was suffering for about 6 months along with brittlness of the nails, the rubric consulted were boils recurring and nails affected in general with the subrubric brittlenails (both these rubrics) fell within the category of Pathological General of BBCR and, finally Sulphur -200 was given on the basis of totality, after consultation with materia medica. Now, as said consultation of Repertory has many aspects i.e one can even learn about the evolution of symptomatology of various drugs through Kent’s Repertory for e,g Baryta Carb, the child is painfully shy (Timidity), and afraid of strangers (Fear, strangers, of), he feels rejected (Delusions, deserted, forsaken) and disapproved of (Delusions, criticized, that he is) and spends his time conscientiously fussing over trifles with great ‘ Dullness, sluggishness, difficulty of thinking and comprehending’. He lives in constant fear of being criticized, laughed at or abandoned, and he hides behind his fears, his mental dullness, his timidity and his perfectionism; from this it should be easy to understand the meaning of the strange delusion that he walks on his knees (Delusions, knees, that he walks’) which is peculiar to the remedy. Again in case of Pulsatilla the individual enjoys being comforted (Consolation amel), in keeping with her great need for company and affection, in her this affirmation reveals her wish to get well quickly, lest the people who care for her should tire themselves out worrying about her and go away (Foresaken feeling). This is what lies behind the silent grief (Grief silent), the ‘Indifference’ and the tears when she talks about her sickness (Weeping, telling of her sickness, when). Again Arnica is oversensitive to all external impressions (Sensitive,external impressions, to all) in that he finds all physical contact painful. His fear of being touched is as great as his fear of being approached (Fear, approaching him, of others). He feels vulnerable, so he withdraws into himself and avoids people; he resents the doctor, once a tried and trusted friend, now an welcome intruder, and sends him packing; he says he is well, when very sick, because in a syphilitic case, he is utterly indiffent to everything( Indifference, everything to), including the state of his health; in a sycotic case, he will say he is well because he refuses to answer (Answer, refuses to), is suspicious and dislikes consolation. So it is not necessary that a Baryta carb patient will always present with timidity, fear of strangers, rather the only presenting complaint at the time of visiting the physician can be a strange delusion of walking on the knee, so also a pulsatilla patient may not always present with a mild affectionate look, always wanting someone to accompany him/her, but rather can present with an indifferent mood, having a silent grief, similarly Arnica patient can present with only indifference or in a state where he refuses to answer anything, with a suspicious look rather than presenting with the oversensitiveness to external impressions—thus a proper anamnesis of every case is very much essential in order to understand the state of the patient, as because every medicine has got various dimensions in its symptomatological expressions and a physician who is well versed with the repertory, can understand the different dimensions of prescription of a medicine in a much better way.
Nosological use of repertory
Now time has also come to use those repertory which are more clinically oriented like Clarke’s Dictionary, Boericke’s Repertory, Pathak’s Repertory or even BBCR, as in these repertories all the clinical or pathological condition are given only after repeated verifications. It is not that Kent’s Repertory is not applicable in such condition, but rather Kent’s philosophy does not go with the concept. As we all know that Kent’s philosophy considers any pathology as the end product of the disease, and then question may arise that why there are pathological rubrics like, Addison’s Disease, Paralysis agitans, Emphysema etc in his repertory, the answer is that he has given only those drugs which he has seen repeatedly found to cure such conditions and if one finds that after repertorisation for a particular morbid condition and then after final selection of the medicine, the same drug is also present in the same nosological rubric , then it only simplifies the selection of the medicine. In case of rachitis, osteoporosis, osteodystrophy, there is a rubric that can be considered in Kent’s repertory – GENERALITIES, Bone brittle. Similarly there is a rubric for sterognosis, which is a disease of the sensory cortex or posterior column e.g MIND,size, incorrect judge of, in the Kent’s repertory. A case of prolactinoma can be presented with rubric interpretation of CHEST,milk, in non-pregnant woman; GENITALIA FEMALE,menses absent, ammenorohoea; GENITALIA FEMALE, menses, irregular; GENITALIA FEMALE, dryness; FACE, eruption, acne; FACE, dryness etc. from Kent’s Repertory . In BTPB or BBCR there is a rubric, PULSE, rate is slower than heart, which is generally found in Atrial fibrillation. These are some of the symptomatologial manifestations of different nosological conditions, as present in repertories and consultation with these rubrics in various morbid conditions, helps the physician to clinically apply repertory in a much better manner. It is a fact that a drug can cure a morbid condition only, when it is similimum both at the level of symptomatology and the pathological state of the patient.
Generalisation of so-called particular symptoms
In another aspect of discussion about repertory, it can be said that after repeated verifications the rubrics like awkwardness, attitude bizarre, ascending aggravation have been generalized by Boger and later on by Dr Phatak and also supported by Dr P Sankaran. Even Dr Phatak has upgraded a rubric to a general level which is present under the rubric Flatulence as ‘Flatus passing up and down, amelioration’ , and used that rubric successfully for the treatment of pain of the lower extremities, from knee, going downwards. Dr Kent has given rubrics such as Discharge, black; Skin, Discoloration, blackish; Skin, Ulcers,black; Skin, Ulcers,discharges,blackish; Genitalia, female, Menses, black; whereas Boger has given them all in one rubric ‘Black’(p 31 of Boger Synoptic Key) . There is a rubric “Greasy, oily, fatty’ (p 37 of Boger Synoptic Key) which one can apply to anything e.g the skin, any discharge, taste etc.. There is another rubric ‘Chronicity,’(p 32 of Boger Synoptic Key) which can be applied to any complaint which has obtained a chronic nature
Conceptual differences in the rubrics of Synthetic Repertory from Kent’s Repertory
Again if we see Synthetic Repertory which is based on Kent’s Repertory, there have been additions of medicines in different rubrics along with incorporation of new rubrics and some of the rubrics here been more self explanatory than Kent’s repertory as the rubric Abusive is presented as Abusive, insult in Synthetic Repertory, which states that the rubric abusive in Synthetic Repertory, is not only meant to abuse others but at the same time also to insult others. In case of rubric sympathetic from Kent’s Repertory if that rubric is again studied from Synthetic it clearly states about the compassionate feeling which relates to the arousal of this sympathiticity, which is absent in Kent’s Repertory. Then stupefaction in Kent’s repertory is presented in superlative degree as stated by stupefaction, intoxicated in Synthetic Repertory. So also, in Vol-II of Synthetic repertory if we see the rubric Haemorrage the number of sub-rubrics are much more then that of in Kent’s repertory. So this type of comparative study between various available repertories increases the clinical acumen of physician.
Repertory consultation during case taking improves the art of interrogation.
Now, totality of symptoms in any case mean qualitative totality & not quantitative totality, which should be ably preceded by a proper analysis and evaluation of symptoms which form the basis of repertorisation, as it is a fact that faulty case taking may lead to wrong drug selection even through repertorisation. This evaluation of symptoms although has been said by different stalwarts like Dr Kent, Dr Boenninghausen, Dr Boger, Dr Boericke, but it is not fixed, it depends on the case, on the present state of the patient. In the totality those symptoms are included, which expresses the individuality of a person and not the common ones. The symptoms included in the totality must have clarity, intensity and spontaneousity in respect to the case. While selecting symptoms to be part of totality in any case, those symptoms should be given importance, which are not contaminated. The uncontaminated symptoms are those physical symptoms, which cannot be contaminated, e.g facial expression, any discoloration of the tongue, the appearance of the nail, the consistency of the hair,the firmness of the musculature etc. The uncontaminated symptoms even if it is a particular, not general, should be given importance because those symptoms are pure. Now in any chronic case where there has been an ideal case taking, there will be hardly 4-6 characteristics symptoms. The repertorial search begins with looking for the respective rubrics i.e the definitive symptoms in a particular repertory much before repertorisation. By looking or consulting for each definitive symptoms/rubrics much before repertorisation, the number of medicines, that will come before us, will be much more than we have actually thought. Thus the questionares or the enquiries to the patient also widens and removes the biasedness or any apriori concept of the physician. Now this is another aspect of Repertory consultation. Any repertory, whether puritan or logiciutilitarian can be consulted as situation or case demands. Thus consultation of repertory, in respect to each characteristic symptoms or rubrics with a particular repertory, widens the thought process of a physician. As a whole the suggestive medicines are much more than he actually thought and now if after repertorisation , the same group of medicines come , then the selection of the medicine become much more easier.
Final selection of medicine after repetorisation
In the process of repertorisation, we can separate the very peculiar symptoms (may be general or particular), consisting of very few drugs, before doing the formal repertorisation from the totality consisting of the other significant symptoms, and then the drug which will be selected after repertorisation will be searched for in those peculiar symptoms also and if the drug is also present in those peculiar symptoms , then the selection becomes more precise and accurate. It may also happen sometimes that a small drug is found to cover all the rubrics taken for repertorisation with respective score of 1 mark for each rubric, on the other some other polycrest drugs are found to cover not all the rubrics, but most of the rubrics (considered for totality). So in this case after repertorisation if both the polycrests as well as the small drug have got the same marks, then the small drug (a drug is small because it is not well proved) may be considered for selection, as because it has made a complete coverage of the totality than the polycrests drugs though at a much lower grade (with respective to each symptom), but obviously with the final consultation of material medica. Sometimes it may so occur, that a drug which has not covered the 2nd and 3rd rubric, in a totality of 6 rubrics, has been selected, after consultation with material medica. If this medicine removes the totality as a whole then the rubrics in respect to which the drug hasn’t been present, the drug can be added in respect to those missing rubrics( clinical addition of any drug in respect to any symptom, can’t be added on seeing once, it requires repeated genuine verifications).
Final selection of medicine when 2 or 3 drugs get same marks after repetorisation with same symptom coverage
Now, the point comes if after repertorisation, 2 or 3 drugs are found to cover same number of symptoms, even with same intensity and the total score of all the 2 or 3 drugs are also same. In such condition there are some ways out, in order to select the similimum, firstly the sequential appearance of the symptoms i.e the medicine which is graded high in the last appearing symptoms can be considered. Secondly, another aspect of consideration for final selection of medicine, after repertorisation, are those symptoms which are restricting his/her goal of life, and thereby considering that medicine, which covers these symptoms with highest grade and coverage. Lastly to be considered those symptoms, which are the cry of the vitality, particularly in incurable cases i.e symptoms covering the vital organs necessary for the life. Here the medicine getting the highest grade and coverage of these symptoms related to the vital organ, is to be considered.
Repetorisation is more than a mechanical process
Now, repertorisation is a more mechanical process, keeping in mind about the philosophical background of different repertories, where some suggestive group of medicines are available at hand, particularly in difficult situation. Now it is the art of the physician to meticulously select a medicine among the medicines which have come through the process of repertorisation. It is worthy to mention that the drugs which come from first to last, in a repertorial sheet are somewhat related to each other, and in any sickness of the individual those latter drugs may be required, thus correct repertorisation also gives an idea of remedy relationship. In this regard, some light should be also thrown on the concept of 2nd prescription through BTPB or BBCR also. This idea of 2nd prescription through the relationship chapter of BTPB is an unique concept in itself which has been praised by different stalwarts like Dr Kent, Dr Hering. Both BTPB and BBCR are the only repertories where there is a separate chapter of relationship or concordance, in order to help the physician for 2nd prescription. Other general repertories like Kent’s Repertory, Jahr’s Symptom Codex, Allen’s Symptom Register, none of them has this orientation in their chapter arrangement. Unlike, Dr Kent’s concept of 2nd prescription which has a philosophical background, 2nd prescription through BTPB or BBCR is a more mechanical process, where a physician has to repertorise a case,to get the next following medicine.
So, the book of repertory, is more than mere indexing of symptoms. A meticulous study of different types of repertory, not only increases the physician’s knowledge but also widens his ability as a physician. Though, some of the homoeopaths due to their lackadaisical attitude denies to use the repertory, but to be a genuine physician one need to use more and more repertory in clinical practice as Dr Boger said that ‘ Repertory is a necessary evil, like a husband’. The above mentioned thoughts, are just some areas of discussions on repertory which can be increased more and more with due inputs from various corners of homoeopathic fraternity
A Special acknowledgement to Dr Sahida Khatun, Lecturer, Dept of Gynae and Obs and Dr. Ardhendu Sekhar Chakraborty, H.O.D, Case taking and Homoeopathic Repertory, Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Howrah, Govt of West Bengal, for their valuable advices.
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- Dr Amit Bikram Basu, M.D(Hom) [The West Bengal University of Health Sciences]Homoeopathic Medical Officer in West Bengal Homoeopathic Health Service, working as a lecturer on detailment in the Dept of Case taking and Homoeopathic Repertory, Mahesh Bhattacharyya Homoeopathic Medical College and Hospital,Howrah, Govt of West Bengal.
- Dr Soumendranath Ghosh, PGT, 3rd Year, Dept of Case Taking and Homoeopathic Repertory, Mahesh Bhattacharyya Homoeopathic Medical College and Hospital,Howrah, Govt of West Bengal.