Keynotes In Homoeopathy

Abstract:
Keynote in homoeopathy is the symptom or group of symptoms which represent the medicine during prescription. Most of the medicines have more than a hundred symptoms but for the sake of prescribing we need to select uncommon, characteristic, peculiar signs and symptoms as far as possible. These signs and symptoms are known as Keynote symptoms which may be found in any sphere of medicine or the case be it chief complaints, mind, physical general, causation, modalities, past and family history etc. These are the important core features of medicines which lead us to their selection for prescribing. There are many ways of homoeopathic prescribing, keynotes prescribing is one of them.

Keywords: Homoeopathy, Keynote, Symptom, Materia Medica.

Introduction:
Through this discourse, the author is going to share his understanding about “Keynotes in Homoeopathy” on the basis of what he has learned from his respected teachers, his understanding from books, literature and clinical practice. Homoeopathy is the science and art of therapeutic based on Similia principle in which such medicine is applied to the sick people which has the capacity to produce similar symptomatology in an apparently healthy person. Whatever may be the case, we need to apply most similar medicine (similimum) in order to cure a patient via matching of symptoms of a patient with the symptoms of the medicine. There are several ways of matching and application of medicines in homoeopathy i.e prescription. At least 37 ways have been found in the homoeopathic literature through which homoeopaths prescribe medicines, for example, prescription based on miasm, constitution, past history, family history, observation, reportorial analysis, past experience, pathology etc.[1] Likewise, prescription based on Keynote symptoms is one of them. All depend upon the nature and presentation of the given case. In this process, available keynote symptoms of medicine are matched with the patient’s symptoms. These few symptoms give the analogy of similarity of maximum symptoms of the patient. In whatever way the doctor prescribes may be the miasmatic approach, maybe the reportorial approach, maybe the constitutional approach, maybe past history approach; ultimately they select 1, 2 or 3 main characteristic symptoms representing the keynotes of the medicine. So, in whatever way homoeopaths prescribe ultimately it is keynotes approach which gives the easy, confident, quick most practical, effective and viable way of homoeopathic practice. In this article, we shall study all about keynotes including its origin, history, character and uses.
Keynote symptoms:
Keynote is the term which relates to music. It is defined as the first note of a musical scale upon which a musical piece’s tonal progression is based and determine the tone of a musical arrangement by setting the starting and ending point for the piece to progress through, and each chord or tone within the piece acts as it relates to that keynote. [2] So the keynote characterizes a piece of music. The same concept has been adopted in homoeopathy. It indicates the identity of the medicine on the basis of which we can individualize and differentiate one medicine from others especially the medicines which are similar in the sphere of action and manifestation. So, the Keynotes of medicine are nothing but its characteristic signs and symptoms. A thorough study of books on keynotes reveals that keynote symptoms can be found in any corner of the given case starting from generalities, causations, modalities, particulars, suppressions, bad effects, past history, family history etc. indicating keynotes are not confounded to a particular sphere of the case rather may belong to any sphere of the case/medicine from head to foot.
Evolution of Keynotes in Homoeopathy:
After the discovery of homoeopathy by Master Hahnemann in later part of the 18th century, he faced the challenge in terms of scarcity of instruments i.e. Proved symptoms. The scientific process of knowing the pathogenetic power or disease-producing power of a drug is known as drug proving which is the main source of our materia medica. He started experimenting and proving of substances which were known to have some medicinal effect. Gradually, he involved many people including his disciples, followers, well-wishers, and friends etc. Proving of medicines started all over the world and eventually, more and more symptoms were discovered in respect of each drug. As the time progressed more and more homoeopathic practitioners came forward who contributed in the shaping up of a present form of our materia medicas which includes proving symptoms, toxicological symptoms, clinical symptoms etc. covering both mental and physical aspects of the body. Ultimately a huge number of symptoms were discovered in each medicines esp. in polychrests. In “Materia Medica Pura” only the proved symptoms in each polychrest medicine are around one thousand (Table-1) [3],[4] so, it is practically quite difficult to remember the so many symptoms of these medicines but the conception of few Keynotes will give the applied picture of these medicines.
Table -1
S.No. Name of Medicine No. of Symptoms
1. Sulphur_______________ 816
2. Ignatia _______________ 794
3. Merc Sol ______________1265
4. Nux Vomica __________1299
5. Thuja __________________633
6. China _________________1143
7. Pulsatilla _____________1154
8. Veratrum Album ____716
9. Rhus Tox _____________975

As our job at the bedside is to match patient’s symptoms with the medicinal symptoms, it is practically unviable rather impossible to exactly match the thousand symptoms of medicines with patient’s symptoms, moreover, all symptoms are not presented by the patient at a given time. Here lies the importance of keynotes prescribing. During early days repertory was not so advance and less in verity. There was an urgent need of adopting an easy, simple quick method to choose similimum or near to similimum. Dr H.N. Guernsey (1817-1885), an American homoeopath, observed certain symptoms in each medicine which were present in most of the provers or cases and were the main stem of the medicine around which all symptoms revolve. He started collecting those symptoms and found practically very useful in prescribing. The concept of the keynote was first used by Dr Jacob Janeas (1800-1877), an American homoeopath, but the term “keynote” was not used by him. The term “keynote” was first popularised in homoeopathic literature by Dr H. N. Guernsey when he published his renowned and very important book on materia medica viz-“Keynote to the Materia Medica” in 1875. It was the compilation of his lecture delivered to the students of “Hahnemann Medical College of Philadelphia” during the year 1871-1873[5]. In the words of Dr Willium Burt, he is “The originator of the characteristic, or “Key Note” System for the choice of remedies in disease, brought out in his “Treatise on Obstetrics,” the most reliable work ever written on the science of Medicine.” [6] In the introduction to the famous book viz. “Application of Principles of Homeopathy to Obstetrics”, he stated the basic preliminary idea of keynote and its relation with the characteristic symptom. The plan of treatment may seem to some rather novel and perhaps on its first view, as objectionable, as much as it may seem like prescribing for single symptom; whereas such is not the fact. It is only meant to state some strong characteristic symptom, which will often be found the governing symptom, and on referring to the Symptomen Codex, all the others will surely be there if this one is. Since then the concept of keynote prescribing was very widely and readily accepted by homoeopathic fraternity and the same was transcended to the coming generations of homoeopaths. Master Hahnemann has pointed out in the “Organon of Medicine,” “In order to find among these an artificial morbific agent corresponding by similarity to the disease to be cured, the more striking, singular, uncommon and peculiar (characteristic) signs and symptoms of the case of disease are chiefly and most solely to be kept in view; for it is more particularly these that very similar ones in the list of symptoms of the selected medicine must correspond to, in order to constitute it the most suitable for effecting the cure” (§153). [7] Characteristic symptoms are important for prescribing and cure can only be achieved by matching of characteristic symptoms has been told by our Master but how to identify what are the characteristic symptoms in each medicine was explained by Dr H. N. Guernsey in a most practical and elaborate way. Different stalwarts have understood the importance of keynotes of homoeopathic materia medica in prescribing. They have highlighted this concept in their practice and philosophy but through various names such as “Genius of the remedy” [8], Red strand of the medicine, PQRS (peculiar, queer, rare and strange) symptoms, “Bacon light symptoms”. Determinative symptoms, Three-legged stool[9] Being inspired by this idea a good number of books have been published.

A list of classical books[10],[11], [12], [13]based on Keynotes are given below for ready reference:
1 Application of the Principles and Practice of Homoeopathy to Obstetrics and the disorders peculiar to women and young children. 1897 by Dr H.N. Guernsey.
2 Key-Note to The Materia Medica- 1887 by Dr H.N. Guernsey.
3 Keynotes and characteristics with comparisons of some of the Leading Remedies of the Materia Medica with Bowel Nosodes- 1898 by Dr H.C Allen.
4 Leaders in Homoeopathic Therapeutics With Grouping and Classification-1899 by Dr E.B. Nash.
5 A Synoptic Key of the Materia Medica- 1931 by Dr C.M Boger.
6 Characteristic Materia Medica by William Burt.
7 Keynotes and Redline Symptoms of the Materia Medica by DrAdolph Von Lippe.
8 Keynotes of Homoeopathic Materia Medica, Vol. 1 &2 CCRH, Min. of AYUSH, Govt. of India.
9 Politics of prescribing-2017 by Dr L.M.Khan.
10 W. Burt
11 Nplex Homoeopathic Materia Medica Study Guide Themes, Keynotes and Confirmed Symptoms by Dr Steve Olsen ND.

Apart from the above list, further rearranged, reorganised or augmented editions of different classical books on Materia Medica especially on Keynotes have been published by different authors and publishers. Few of them are very famous, widely used and has become household names among the homoeopathic fraternity.

How to Use Keynotes:
Master Hahnemann has referred homoeopathy as a simple way of therapeutic but the incomprehensive, immature, unscientific approach of homoeopath makes it complex but keynote prescribing makes this task easy. In my opinion, the proper utilization of keynote prescribing depends on two points-
A) The proper knowledge of Keynote symptoms of medicines and applied Materia Medica-
We should have a thorough knowledge of various materia medica books based on keynote symptoms as mentioned above. Each materia medica has its own specific structure, makeup, philosophy, style and presentation etc. The fearless and confident approach of administration of medicine in maximum numbers of cases is essential to recognize and to have the pragmatic utility of keynote symptoms. In newcomers and budding homoeopaths, there is a kind of hesitation or fear in applying homoeopathic medicine arising out of there suspicion regarding the choice of medicine whether the selected medicine will act or not. This fear can only be coped with the frequent application of medicines and observation of their effects. The experience may be good or bad but in the long run, this experience gives us the practical idea regarding the effectiveness of a particular symptom of medicine and its application. By this process, our mental eye gradually becomes conversant with keynotes and how to identify in other medicines. For this, we can take the help of well-experienced teachers, practitioners because it is the Guru who teaches what is to be looked for and how. Dr H. C. Allen has suggested to the homoeopaths as to what should be our approach to the subject, “A homoeopathic physician must develop habit of constant comparison and differentiation of pathogenesis and symptomatology of drugs to gain the knowledge of the individuality of the remedy something that is peculiar, uncommon or sufficiently characteristics of the remedy, it is called Keynotes or characteristic or red strand of the rope” [14]. By developing the concept of keynotes of various medicines we make the prescribing easy and fruitful. New researchers term theses symptoms as a prognostic factor. [15] Which give us an idea about the likelihood of recovery of the case.
B) Possession of techniques to get indications from the patient and erect Totality of symptoms-
It has been said that “A well-taken case taken is half cured.” We may get the indication of the case from different spheres to be it mental, physical, disposition, behaviour, past history, family history, gesture, posture etc. Master Hahnemann said, “In these investigations, the ascertainable physical constitution of the patient (especially when the disease is chronic), his moral and intellectual character, his occupation, mode of living and habits, his social and domestic relations, his age, sexual function, &c., are to be taken into consideration”(§5). [7] So a homoeopath should have knowledge of various field apart from course syllabus such as psychology, anthropology, sociology etc. We should try to complete the symptoms taking into account the location, sensation, modalities, causation and concomitant. Completeness of a symptom makes it unique. Master Hahnemann very elaborately discussed case taking in “Organon of Medicine” whose each and every point is essential. Our target should be to gather indications i.e. characteristic signs and symptoms by using tact, friendly exhortations etc. Gaining the confidence and faith of the patient is very important for eliciting the true picture of the given case.

Keynote symptoms of few medicines: [14], [16], [17]
Few keynotes of some polychrest medicines from Allen’s Keynotes and other materia medica are given below which I have found very effective in my clinical practice are given below-

1. Aconite :
-Complains caused by exposure to dry cold air, dry north or west winds.
-Great fear and anxiety of mind.
-Fever; skin dry and hot; intense nervous restlessness, tossing about in agony.
-Cough; from dry, cold winds or drafts of air.
2. Aloe socotrina :
-Mucous in jelly-like lumps.
-Diarrhoea; has to hurry to closet immediately after eating and drinking; with want of confidence in sphincter ani; driving out of bed early in the morning(pso, rum,sulph).
-Haemorrhoids, like a bunch of grapes.
3. Antim tart :
-Face cold, blue, pale, covered with cold sweat.
-asphyxia: mechanical, as apparent death from drowning; from mucus in bronchi; from impending paralysis of lungs; from foreign bodies in larynx or trachea; with drowsiness and coma.
4. Arnica montana :
-Sore, lame, bruished feeling all through the body, as if beaten.
-Heat upper part of body; coldness of lower.
-Gout and rheumatism, with great fear of being touched or struck by persons coming near him.
5. Bryonia alba :
-Great thirst; excessive dryness of mucous membranes of entire body, great thirst for large quantities at long intervals.
-Aggravation from any motion, relief from absolute rest, either mental or physical.
-Constipation; inactive, no inclination, large, hard dark, dry, as if burnt.
-Mammae heavy, must support the breasts.
6. Belladonna :
-Rush of blood to head and face, headache, congestive, with red face, throbbing of brain and carotids.
-skin;of a uniform, smooth, shining scarlet redness, dry, hot, burning.
-violent delirium
7. Berberis vulgaris :
-Burning and soreness in region of kidneys; stitching, cutting pain from left kidney following course of ureter into bladder and urethra.
8.Chamomilla :
-Child exceedingly irritable, fretful, quiet only when carried.
-Diarrhoea from anger, chagrin; during dentition; stool greenish, hot, very offensive, like rotten eggs.
9. Nux vomica :
-Disposed to be quarrelsome, spiteful, malicious, nervous.
-Must be covered in every stage of fever.
10. Natrum muriaticum :
-Great emaciation; losing flesh while living well.
-Headache; beginning with blindness
-Mapped tongue
-Excessive use of salts.
-Dreams of robbers in the house.
11. Lachesis :
-Climacteric ailments; haemorrhoids, hot flushes and hot perspiration.
-Diseases begin on the left and go to the right side-left ovary, testicle, chest.
-Menses at regular time, too short, pains all relieved by the flow, always better during menses.
-< After sleep.
12. Sulphur :
Standing is the worse position for sulphur patient, they cannot stand, every standing position is uncomfortable.
-Dirty, filthy people, prone to skin affection (psor)
-Cannot bear to be washed or bathed. Always < after a bath
-Complaints that are continually relapsing.
-Sensation of burning, constant heat on vertex.
-Diarrhoea, driving out of bed early in the morning.
-For lean, stoop-shouldered persons who walk and sit stooping.
13. Hepar sulph :
-The slightest injury causes suppuration (Graph.Merc)
-Extremely sensitive to cold air, imagines he can feel the air if a door is opened in the next room.
-Cough, croupy, choking, strangling; from exposure to dry west wind.
14. Argentum nitricum :
-Acute or chronic diseases fro unusual or long-continued mental exertion
-Apprehension when ready for church or opera, diarrhoea sets in (Gels.)
15. Hyoscyamus niger:
-Lascivious mania; immodesty, will not be covered.
16.Thuja occidentalis :
-Fixed ideas.
-Sweat; only on uncovered parts.
-Snoring.
17. Carcinosin :
-Café-Au lait complexion.
-Enjoys watching a thunderstorm.
-Cravings for or aversion to butter, eggs, fat meat, fat bacon, fruits, milk, salt, sweets.
18. Lycopodium :
-Affects right side, or pain goes from right to left.
-Avaricious, greedy, miserly, malicious, pusillanimous.
-Excessive accumulation of flatulence.

Pain with chill-Pulsatilla
Pain with shuddering- Sepia
Pain with fainting-Hepar sulph
Pain with numbness- Chamomilla, Coffea Gnaphalium
Pain with micturition- Apis Mel, Sarsaparilla, Cantharis
Heat on top of head, flushes in face, feet cold-Sulphur
Better in Knee-elbow position- Med., Sepia, Lycopodium, Calcarea phos, Carcinosin
Desire for
Sugar- Argentum nitricum (Nash)
Milk- Rhus tox.
Fish-Natrum Mur, Phosphorus, Natrum Phos.
Refreshing things- Phosphoric Acid, Veratrum Album
Gall bladder colic- Calcarea carb 30 (Repeated dose)
Intense pain along the sciatic nerve, following its larger ramifications; sometimes numbness takes the place of pains- Gnaphalium

Conclusion:
In Homoeopathy, medicine is prescribed on the basis of symptoms similarity. We need to match the maximum symptoms of the case with the symptoms of medicine as far as possible. The keynotes in homoeopathy represents the strain, spirit, genius, individuality and characteristics of the medicine. Our literature and experiences of different stalwarts of homoeopathy propose the maximum similarity between the symptomatology of the case and medicine when we prescribe on the basis of keynotes. In whatever way we execute a homoeopathic prescription we select some core symptoms either signs, symptoms or rubrics eventually they are nothing but the keynotes of the medicine.

Acknowledgement:
I express my sincere thanks to Dr Hasina Sultana, BHMS, Program Assistant, Peripheral Pharmacovigilance Centre, RRI(H), Guwahati, for helping in the compilation of this work.
References:
Sarkar S, Chunawala A, Jain P. Keynotes in Homoeopathic practice. The Homoeopathic Heritage.Nov.2017; Vol.43(08): p. 46-49.
https://www.liveabout.com/keynote-definition-2701641.
Hahnemann S,. Materia Medica Pura, 1st Edn: Translated by Dudgeon R.E, B.Jain Publishers (p)LTD: Kuldeep Jain.1830,Vol.I.
Hahnemann S, Materia Medica Pura, 1st Edn: Translated by Dudgeon R.E, B Jain Publishers (p)LTD: Kuldeep Jain.1833,Vol. II.
http://www.homeoint.org/site/deepak/principles_of_homeopathy.htm#7
Burt H.W (n.d.) Characteristic Materia Medica. 2nd Edn., B. Jain Publishers(p).LTD: 
Hahnemann S, Dudgeon R.E (ed.). Organon Of Medicine. 5th Edn: B. Jain Publishers(p) LTD:1970.
Boger C.M. A Synoptic Key to the Materia Medica. 8th Edn.: B. Jain publishers (p) LTD: Kuldeep Jain. 1915.
http://www.homeoint.org/books4/guernsey/preface.htm
https://www.google.com/search?q=all+keynotes+books+in+homoeopathy&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjF2dPu94bkAhWg7nMBHUFSA2UQ_AUIESgB&biw=1366&bih=657
Guernsey H. N. Application of the Principles and Practice of Homoeopathy to Obstetrics and The Disorders Peculiar to Women and Young Children. 2nd Edition, Boerick and Tafel, New work: 145, Grand Sr. Philadelphia: 635 Arch. St. England; 1874.
https://archive.org/details/keynotescharact00alle/page/n6
https://en.wikipedia.org/wiki/
Allen H. C. Keynotes and Characteristics with Comparisons of Some of the Leading Remedies of the Materia Medica with Bowel Nosodes, 8th Edn.: B. Jain Publishers (P) Ltd; 1898.
Rutten L. Prognostic factor research in Homoeopathy. Indian J Res Homoeopathy 2016;10:59-65.
Khan L. M. Politics of Prescribing. 1st Edn., Indian Books & Periodicals Publishers: Mayur Jain; 2018.
Foubister.D. Tutorials On Homoeopathy. 1st Edn., Beaconsfield, Bucks, England: Beaconsfield Publishers LTD; 1989.
*Research Officer (Homoeopathy)/Scientist-1, Officer-In-Charge, Regional Research Institute for Homoeopathy, Guwahati-28, under CCRH, Ministry of AYUSH, Govt. of India.
Contact no. – 9883203656