Creating Waves of Awareness
How To Take A Case For The Correct Prescription In Homoeopathy
It is important to take the case completely in it's whole extent to make a correct prescription in Homoeopathy. We should give stress in every level of the patient. We should take the case without fantasy, prejudice and theorising.
I would like to give some indications for case taking. If the cases are taken by these indications almost all the cases have the same prescription by different homoeopaths of good knowledge.
The interrogation of Kent will be added later.
Replies to This Discussion
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Permalink Reply by Dr. Paul Muttathukunnel on -
CASE TAKING
1- Observation
2- Listen the present, past and family history of the patient
3- Interrogation of Kent
4- Physical examination
5- Excretions & secretions
6- Laboratory examinations
7- Modern techniques - Magnetic Resonance, CT Scan etc. if necessary
Observations – it is necessary to observe from the very beginning when we have contact with the patient (eg. When he call or write us for the appointment) Is the patient anxious, sad, anger, fastidious, avarice, curious, suspicious, fearful, cheerful etc? How he is? Tall, lean, fatty, colour of eyes, hair, baldness, how he is sitting, his motion, colour of skin, face and everything?
We should write every observation on our case sheet or Computer.
Listen the patient: - Allow the patient to tell spontaneously his story – and past story with out interruption, just by encouraging him (– anything else, tell me more, then, then etc.) To tell more about him. Often the patient says spontaneously the important things regarding his sickness and may be the key for the case.
Past history – from the childhood onwards, every diseases in the past and the treatment.
(Infancy, puberty, problems of conflicts, grief, shock, accident --- everything in the past)
We should enquire the family history with special stress regarding the diseases in the family.
(diseases of parents, grandparents, and relatives, Tuberculosis, Diabetes, cancer, gonorrhea, syphilis, skin diseases, mental diseases, suicides etc.)
We should write down everything by the words of the patient with enough space to modify and complete the symptoms. Underline the important and striking symptoms.
Then we should Clarify and complete the symptoms with all its modalities ( What? Where, How ? When? Why?) and concomitants.
Never ask direct questions and leading questions in order to get an answer in YES / NONever ask suggestive questions – we must avoid all questions where the patient is obliged to choose between two different alternatives.
We must be always cunning in questioning- all questions should be in global – (tell me about your fears, If the answer is not satisfying or incomplete we should encourage by Eg. (There are different persons have fear of darkness, animals, diseases, devil, death, poverty, happen something to the relatives etc. what about you ?) this is an art!
(Direct question is only for confirming an answer.)
Interrogation of Kent : It is very difficult to arrive a good prescription with out the interrogation of Kent (modified by Dr. Künzli and Dr. Spinedi)
Physical examination: a thorough check up of the patient from head to foot is necessary for arriving a good prescription and some times it is necessary to send the patient to a specialist for further examinations and confirmations of the diagnosis.
Excretions & secretions: We should know details regarding urine, stool, sputum, vomiting matter, nasal discharge, eye discharge, ear discharge and wax, vaginal and urethral discharge, leucorrhoea, sweat etc- the colour, odour, consistency etc. etc.
Often we get important informations from excretions and secretions and that may lead to the correct prescription. An omission of this information may be fatal.
Laboratory examinations: Blood, urine, stool, sputum etc.
Sometimes we get important information from the laboratory, especially regarding the pathological aspect and severity of the disease.
Modern techniques like MR, CT, ultrasonography etc. are also necessary for the diagnosis and prognosis in certain severe diseases like cancer, multiple sclerosis etc.
Analysis of the case
We should collect all the symptoms after taking the case. We must cut layer by layer the case vertically, horizontally and diagonally and analyse and study the case until we have clear picture of this patient. We should analyse the case considering the age, the sex, the location where comes the patient, the religion, the miasmatic situation, the aetiology of the disease, the acute physical and mental symptoms, the chronic physical and mental symptoms etc.
We should know to evaluate the symptoms, the grading of symptoms.
1° symptoms- rare & peculiar - § 153
2° symptoms – clear mental & emotional symptoms
3° general symptoms - not only hot& chilly or thirst & thirstless, we have so many generals.
4° symptoms – cause of the disease- trauma, grief, lack / excess of sex, abuse of drugs etc.
5° local symptoms
Sometimes a local symptom may become a 1° grade symptom (ex. a wart on the tip of nose is a local symptom, but it is 1° grade symptom because of it’s peculiarity) Some times the aetiology may become a 1° grade symptom (ex. A patient of Sepia, Lycopodium or any other constitution has developed carcinoma on the breast after a trauma of the breast – then CONIUM is necessary to cure the patient, then the mentals or generals have no values in the prescription of the remedy. Later the constitutional remedy is necessary to complete the cure.
So it is important take the case completely.
So, for that we can use our Repertory – now it is easy to use the repertory in computer...
We should be able to measure the vital energy and the energy of the disease in a patient, in order to give an adequate potency from mother tincture to CM and also LM.
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Permalink Reply by Dr. Paul Muttathukunnel on
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Dear Dr. Gary,
§ 153
"In this search for a homeopathic specific remedy, that is to say, in this comparison of the collective symptoms of the natural disease with the list of symptoms of known medicines, in order to find among these an artificial morbid 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. The more general and undefined symptoms: loss of appetite, headache, debility, restless sleep, discomfort; and so forth, demand but little attention when of that vague and indefinite character, if they cannot be more accurately described, as symptoms of such a general nature are observed in almost every disease and from almost every drug."
Without much theory and explanation we can understand what dr. Hahnemann wrote in these paragraph of Organon. We should give a remedy similar to the symptoms of natural disease, for a permanent cure. We can recognize immediately Charlie Chaplin from a caricature of Chaplin, where his mustache and hat are characteristics and striking features. Same is the situation of the remedy picture and the disease picture of the patient.
Without those characteristic, striking features it is difficult to recognize Chaplin.
Dr. Kent wrote in the chapter XXXII of lectures of Homoeopathic philosophy “ you have plenty of symptoms but you have no case “ you have not taken your case properly and you have failed to get anything that characterizes your case. If we say that we can’t find anything characteristics, rare , uncommon, striking and peculiar symptom in a case means we have not taken the case properly.
Constitutional remedy:After taking, analyzing and repertorising the case we can find a clear picture of the patient from head to foot, from mental general to physical general , from A to Z of every symptoms, that is totality of symptoms which corresponds to the picture of remedy and that is the constitutional remedy.
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Permalink Reply by vimal kumar dhawan on -
dear dr good morning
i think it is only for chronic case not for acute what you say in acute patients
dr. dhawan
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Permalink Reply by Dr. Paul Muttathukunnel on
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dear Dr. Dhawan,
The long case taking is for chronic cases. The modalities and Concomitants are very much important in acute cases. Acute physical symptoms and Acute mental symptoms with all modalities and concomitants will lead to the correct prescription in acute cases.
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Permalink Reply by Debby Bruck on -
Dear Dr Paul Muttathukunnel - A very clear presentation of case-taking. It is good to learn step-by-step. Thank you, Debby
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Permalink Reply by Dr. Paul Muttathukunnel on
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Dear Debby,
thank you, i hope so.
this is only a little bit of guidlines for case taking.
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Permalink Reply by Dr. Wequar Ali Khan on -
Dear Dr Paul and Dr Gary,your debate is interesting and informative.It gives us a moment to reflect on the Aphorism and the underlying meaning and then its application to a particular case.
It is appreciated that such intellectual debate is taking place,which beside being informative is also educative.I also give credit to Debby that a lively platform on homeopathy that HWC has become,has come into being where such debate can take place in a lighthearted intellectual atmosphere.
It will be appreciated if you both or any one else who would join the debate,continue to shed light on these intricacies of Homeopathic prescribing and keep on enlightening us which we can seldom get in class rooms or rarely in real life situation.I thank you both.
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Permalink Reply by Dr. Paul Muttathukunnel on
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Small Interrogation of Kent
Where the patient’s spontaneous narrative and our questions in this regard do not give us enough information, then it is useful to ask the small interrogation of Kent.
As far as I’m concerned I have to say that a few cases where I could make a safe prescription only on the basis of patient’s spontaneous narrative.
We can formulate our questions in various modes; important is to understand the patient clearly. Avoid direct and suggestive questions. We can ask our questions by giving small examples.
1. Certain persons can’t tolerate the heat the others can’t tolerate the cold, some others can’t tolerate both heat and cold, then how are you with heat and cold?
2. Certain people feel heat or cold in the body for e.g. on head, feet, palms, chest etc. then what is the situation in your case?
3. How do you feel after a hot, warm and cold bath?
4. Certain people like to eat and drink only hot food and hot drinks, others only cold and some others only warm food and drinks… then tell me regarding you?
5. How do you tolerate the various seasons, summer, winter? How do you feel during the change from one season to other?
6. How does the different weather and weather changes on you... the rainy weather , the hot, the cold, dry hot , dry cold, wet warm, wet cold, the wind, the snow ,the cloudy, the thunder storm etc ?
7. How do you tolerate the various types of wind, the north, the south etc.?
8. How do you tolerate the sun, the sun bath?
9. How do you feel in the sea, in the mountains? Are there any problems during the stay on these places?
10. How do you tolerate the air draft, the air condition?
11. In which way do you react the heat temperature in general – the heat of bed, the heat of the room, and the heat of the radiator?
12. How is your reaction on the extreme heat and extreme cold?
13. In which place do you want to live if there is a possibility for that?
14. When you get cold/ (coryza), how many times in a year, in which season?
15. How do you feel if you should have to stay in a room without fresh air?
16. How do you after a physical exertion, like running, trekking, dancing or any other physical activity?
17. In which position do you feel discomfort? Standing, sitting, lying?
18. Do you have any problems with travelling, in a car, by ship/ boat, the airplanes?
19. How do you with travelling in general, vacations?
20. Tell me about your appetite, any particularities, when you feel hungry?
21. How do you with various types of food and drinks?
22. How do you with meat, fish, milk, ice cream, bread, cheese, eggs, vegetables – cabbages, cauliflower, beans and peans, onions, garlics, various types of fruits?
23. How is the thirst? What about your habits of drinking, water, beer, alcohol? How do you drink a glass of water? The temperature?
24. How is with different tastes? Vs. Sweet, bitter, salt, sour, piquant, spicy?
25. Smoking?
26. Any food or drinks that you can’t tolerate or that you don’t like, or make problems?
27. Do you anything regarding the vaccinations you have taken and the eventual reactions after that?
28. How do you feel with dressing, tight dress, loose, woolen?
29. How do tolerate the cloth on various part of your body?
30. How does with small wounds, the heeling process, the bleeding?
31. Any type allergy vs.….
32. Tell me regarding you, your character, your personality, what do you think about you? (We can give different examples – like optimistic, pessimistic, introverted, extroverted, affectionate etc.)
(Depends on the mental situation of every patient we should enquire in various ways to understand the mental state of the patient and the relation of that mental state and the disease.)
33. How do you feel? What do you think about your sickness?
34. Do you have any idea why you are sick – any physical or psychological factors?
35. In which situation do you weep/ cry?
36. How do you feel after weeping?
37. How do you react or feel if someone near to you trying to consulate you in a sad situation?
38. How do you prefer to be in a bad situation? Alone, in company, with friends, with family, by praying?
39. Tell me about your fears, anxiety, preoccupatins etc.
40. (Give several examples of fears, anxiety etc.)
41. In which situation do you feel Jealous? What about your reactions in that case?
42. In which situation you feel angry, your reactions?
(We must be careful of certain types of question ex. Suicidal disposition, sexuality etc. Don’t hurt the patient)
43. How do you spiritually, do you believe in God, how is religiously?
43. Is anything changed in your believe or spirituality after the diagnosis of your disease.
44. What do you think about the death?
45. Certain people thinks that it is useless to live or better to die etc. when they have difficult problems of life, diseases etc. what about you?
46. Now I want to ask some personal questions. It is very important for me to understand you. Reply only if you want--- tell me about your sexual life, are you feeling good, any problems, lack/ excess of sexual life?
47. ( we can also discuss regarding the homosexuality etc. depending on the situation of the case)
48. For female patients: it is very important to enquire everything regarding menses ,the age of first menses, physical and mental problems before ,during and after menses, during climacteric period, during pregnancy, delivery, vaginal infections and discharges.
49. How about your sleep, in which position, which type of bed?
50. Any activities during sleep, talking, laughing, weeping, grinding the teeth, somnambulism, open mouth, open eyes, salivation etc.?
51. Tell me about your dreams? (We should try to understand the sensations and feeling of the patient from these dreams)
52. Clairvoyance dreams, repeated dreams, continued dreams, many dreams, nightmares?
53. What do you want to change in your character if there is a possibility for that? Why?
54. What do you want to do if there is a magic stick? Tell me everything? Why?
Depends on the answer of the patient we should enquire further and further until every symptom are clear.
We can ask several other questions regarding
Infection of venereal diseases
Disappointment / grief
Humiliation
Embarrassment
Superstitious
Imperfection of genital organs / body parts
Special care in case of a child.
Problems during pregnancy..delivery, during lactation , milk crust,
Mouth and eyes open during sleep.. etc.
When comes first teeth, any problems during dentition ( like diarrhea , fever etc.) grinding of teeth during sleep, sweating of head – during sleep , or beginning of sleep, sweating on which part of the head, sweating of other part of body, obese, capricious , affectionate etc.
Position of sleep, desire and aversion of food ..
We can extend this interrogation until everything is clear regarding the case...
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Permalink Reply by Dr. Wequar Ali Khan on
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One personal experience in to days world.A patient approached me through a common acquaintance,to gives some help in their health problem.I had tried to avoid doing any treatment as i was not present in person.But they insisted that i help them at least guide them.
Since one to one case taking was not possible being in two different countries i suggested that i will send a list of questionnaire (Kent's).I had briefed them that it was long and probing type question.They agreed to this also.
They were happy up to this point.The case was of Itching and rash appearing and the patient was a female.
The questionaire was sent,but after that i was not approached any further.In another case where pain on big toe was involved with some other problem,In this case a young man,it met the same fate,
The point i wish to make is often times these long probing questions,when given in type of a form are deterrent to patient who feel insecure to answer them in writing,and would probably feel comfortable if these were slowly asked in a few sittings as treatment would continue and the patient start's feeling more secure.
Yes case taking is art and science.Knowledge of human psychology can be added advantage.
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Permalink Reply by Dr. Paul Muttathukunnel on
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Dear Dr. Wequar,
thank you vey much your coments. It is not a proper way to treat a person online or by sending questionnaire. A patient and the physician must look each other on the eyes. We have never two similar cases and we have never two similar case taking. Atleast for the first time we should see the patient and we must use all our senses to understant and try to cure the patient.
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Permalink Reply by Dr. Wequar Ali Khan on
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Thank you Dr Paul.
There are occasion when you are compelled to do on line case taking,depending on nature of the case whether acute or chronic.What i wrote was my personal experience,and i have now decided to be very restrictive in such cases.If i am not mistaken even Hahnemann and many master's of the past did do treatment by correspondence.If i am not mistaken Kent's questionnaire was out come of such circumstances where treatment was resorted to correspondence.
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Permalink Reply by Dr. Ravi Singh on -
Dear Dr.Wequar
This is true, I often give online consultation through my website http://www.homoeopathic-cure.com/gettreatment.htm and often get quarry from India and abroad, but once comes the question of filling the long form patients often either become reluctant, feels boring and sometimes reply only in short( may be due to they are not aware about the exact value of trifle details.) while during direct conversation at Clinic they are rather impressed that Doctor u have given me so much time that nobody has given me.
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