Abstract
Background: Uncommon use of common medicine: prescribing on concomitant is to consider for those symptoms which is not mostly known to the profession. The most characteristic symptoms but which are not common as we have found in “Keynotes and characteristics with comparison of some of the Leading Remedies of the Materia Medica with Bowel Nosodes” by H.C. Allen and “Leaders in Homoeopathic Therapeutics” by E.B. Nash etc. My subjects consider those characteristics symptoms which are not commonly used rather they are folded under the non observation of profession. I consider many more symptoms which are most characteristic symptoms of a common medicine, polychrests medicine, but mostly not known to the profession. Importance of concomitant symptoms in homoeopathic prescribing was very much stressed by different homoeopathic stalwarts. Different authors though wrote a book on a particular organ, location, and area but they consider for prescribing concomitant symptoms
i.e. away from the disease. Concomitant symptoms utilised since Hippocrates in treatment of human being. Hippocrates used concomitant symptoms for prognosis of disease2. Different Materia Medica and repertories are available which can give us uncommon symptoms, less known symptoms to the profession, characteristics symptoms, concomitant symptoms, symptoms away from the disease of common medicine.
Material and Methods: An observational study was conducted at the National Institute of Homoeopathy for a period of more than one year. Sample was fixed at 30, in randomized single blind placebo control method, 15 patients were in the trial or experimental group and 15 patients were in the placebo control group,one case was dropped out during study. Uncommon symptoms –less known symptoms of common medicine which is concomitant symptoms of that common medicine collected from different Materia Medica, Therapeutics and Repertories. Uncommon symptoms-less known symptoms of common medicine, – Concomitant symptoms-symptoms away from the disease were selected for our study. Standard parameters were fixed to assess the effect of treatment.
Result: Study shows that more number of patients improved (16) that is 53.33% than not improved patients (14) that is 46.67%.
Conclusion: The study shows that common remedies, polychrest, selected on the basis of uncommon symptoms – folded under the non observation of profession, less known symptoms to the profession, which is concomitant symptoms of common medicine, i.e. symptoms away from the disease, was a unique, effective and successful avenue for prescribing. These uncommon symptoms–less known symptoms of common medicine are real gem and characteristic of common medicine, at the same times exploring full Materia Medica/symptoms awareness for profession.
Introduction
1- Prof. L. M. Khan in his book “Pleasure of Prescribing” cited that “More than two thousand years ago, Hippocrates and school of Cos taught- ‘‘not the disease but individual”, and recognition of the individual symptom, deviating from the average course of disease. School of Cnidus believed on classification of diseases and treatment of the disease stressing more on diagnosis and typing of diseases by name, and using remedies routinely, exhausting themselves in details of localizing the pathology. Hippocrates–said, ‘‘I, however, consider it right to see the whole”1.
As per Bernie Siegel, was born in Brooklyn, NY, a surgeon at Yale New Haven Hospital, West Haven Veteran’s Hospital and the Children’s Hospital of Pittsburgh, In 1989, Bernie retired from Yale as an Assistant Clinical Professor of General and Pediatric Surgery2,in his book “Love, Medicine, Miracles” states “Sir Willium Osler,the brilliant Canadian Physician and Medical historian was echoing Hippocrates, who said he would rather know what sort of person has a disease than what sort of disease a person has”3. As per Bernie Siegel, in his book “Love, Medicine, Miracles” states “There are no incurable diseases, only incurably people”4.
Erwin A. Ackerknecht in his book “A Short History of Medicine” states that Hippocratic physician treat the individual, not a disease and treat the whole body, not any part of it5. Hippocrates held the belief that the body must be treated as a whole and not just a series of parts6.
2-This is concept reflected in “Organon of Medicine’’.6 Homoeopaths carry the best and original legacy of Hippocrates; for Hahnemann prescribed the medicine for person as whole; not for diseases and diseased parts. As in his“ Organon of Medicine’’ Samuel Hahnemann states in § 1‘The physician’s high and only mission is to restore the sick, to health, to cure, as it is termed’7.
David Bohm (20 December 1917 – 27 October 1992 ), an American theoretical physicist, in his book “Wholeness and the Implicate Order” states that word ‘health’ in English is based on an Anglo-Saxon word ‘hale’ meaning ‘whole’.Which is, I think, roughly the equivalent of the Hebrew ‘shalem’. Likewise, the
English ‘holy’ is based on the same root as ‘whole’. All of this indicates that man has sensed always that wholeness or integrity is an absolute necessity to make life worth living”8.
Hahnemann says sick in aphorism 1 i.e. means disease is not located to the part, pathology is not going to established as diagnosis, this none diagnostic area where patients as a whole is involve, sickness never found in the part or place rather sickness is found in whole.
In his “Organon of Medicine’’ Samuel Hahnemann states in §6 that “…..he notices only the deviation from the former healthy state of the now diseases individual, which are felt by the patient himself, remarked by those around him and observed by the physician, all these perceptible signs represent the disease in its whole extent………”9
In my humble effort during tenure of post graduate training in National Institute of Homoeopathy
working under my guide. I found that from the Organon of Medicine Hahnemann consider characteristics including following factors:
1. More striking
2. Singular
3. Uncommon and
4. Peculiar
Above Sign and symptoms are characteristics. I learn to study every factor are not to be related to the disease rather away from the disease but present with the synchronicity of pathological condition, disease diagnostic tagging. Therefore these are concomitant. Logically if characteristics are concomitant therefore concomitants are also characteristics.
Calvin B. Knerr in his book “The Conversation, Talks, Life and Times of Hering” cited that “Guernsey admits that he got his idea of practising by the keynote system, from Jeanes.”10 The resource of concomitant from Organon of Medicine in the §6 as Hahnemann described “………………..which are felt by the patient himself, remarked by those around him and observed by the physician. (See Figure 1)
Aims and Objectives
1. Use of concomitant symptom in homoeopathic prescribing:
Use concomitant symptoms in homoeopathic prescribing begins since in hand of our master Samuel Hahnemann and got exploration in hands of Boenninghausen and H A Roberts.
Figure 1
2. Characteristic symptoms used as concomitant symptom:
During citing the characteristics of concomitant symptoms, Boenninghausen in his lesser writing, mention third the character of concomitant is that, those which are more or less of the characteristics sign and symptoms of one of medicine, is the concomitant of that medicine. For examples Lycopodium has 4 to 8 p.m aggravation, desire for sweets and warm food, complaints go from right to left, these are characteristics symptoms of Lycopodium. According to third character of concomitant as per Boenninghausen concept.These are the concomitant symptoms of Lycopodium medicine.
3. Individualisation on the basis of concomitant symptom:
H A Roberts cited that “The concomitant symptom is to the Totality what the condition of aggravation or amelioration is to the single symptom. It is the differentiating factors.”
4. Searching and utilization of concomitant symptom in different dimension and its skillful consideration in
prescribing: The main object of anamnesis is to individualize or differentiate a patient from all the other patients suffering with a disease having the same nosological diagnosis. Anamnesis helps in finding out the striking, singular, uncommon, and peculiar (characteristic) feature in patient whose diagnosis of the disease is same as many other patients. It distinguishes the uncommon features of the patient from the common features of the disease.
5. To know the prognosis of case with the help of concomitant symptom: Absence of concomitant symptoms indicates that the case is incurable from homoeopathic prescribing point of view. If in advanced and terminal cases, concomitant symptoms are present then it indicate that best palliation will be possible.
Review of Literatures
Dr. C.M.F. Von Boenninghausen (1785- 1864) in his “The Lesser Writings” cited that“ every disease has its recognizable phenomena, more or less numerous group of symptoms, and it is only their totality which presents its complete image”11. He further stated that “First of all, those symptoms which are found in almost all disease may be left out at our count unless they manifest themselves in a striking manner. All those attendant symptoms should be carefully noted which-
1. Rarely appear in connection with the leading disease, and are therefore, also found rarely among the proving.
2. Which belong to another sphere of disease than the chief ailment.
3. Which have more or less of the characteristic signs of one of the medicines.
Lastly mentioned symptoms are included among those which Hahnemann, calls “striking, strange,unusual and peculiar (characteristic) signs,” and which are “almost alone to be considered” because they pre-eminently give its individual character, to the whole disease.”12 These symptoms are considered as Quibus Auxiliis/Quibus sociis/ Quibus comitibus /accompanying symptom.
DR. Cyrus Maxwell Boger (1861- 1935) define concomitant symptoms in his “Materia Medica and case taking” that as a group concomitants contain many anomalous and peculiar symptoms. They are often as distinctive of a remedy as to render the name of the disease under which a peculiar symptom may occur of little moment. Nevertheless the modalities, mental accompaniments and duration of unusual symptoms govern its position. When these go to make up a harmonious picture it becomes a true characteristic, otherwise it has only a negative value13. C M Boger cited in his “Studies in the Philosophy of Healing” that “Such symptoms belong to those which Hahnemann called striking, extraordinary, and peculiar (characteristic) and are to receive our almost exclusive attention because they lend their individuality to the totality”14.
Dr. Herbert A. Roberts (1868-1950) define concomitant symptoms in his “The principles and Art of Cure by Homoeopathy” in the following way “These are the symptoms which the pathologist would exclude as accidental and meaningless, but they have actually a definite relationship to the case, because they occur in the same patient, and at the same time or in definite relationship of time, as the other symptoms which are considered the chief complaint. The auxiliary or concomitant symptom or group of symptoms seldom has any definite relationship to the leading symptoms from the standpoint of theoretical pathology. If they do not fit into the theories of pathology, they have an even greater individual value in the case; it is a group of auxiliary or concomitant symptoms which limit the choice of the simillimum”15
Dr. M. L. Dhawale (14.07.1927- 16.01.1987) defines the concomitant symptoms in his “Principles and Practice of Homoeopathy” in this manner “symptoms that accompany the chief complaint are known as concomitants. The concomitants beer no other relationship to the chief complaint than this time association.
They are also known as associated symptoms16. These cannot be explained on the basis of a diagnosis of the disease as they represent the individual reactions of the patient”.
Dr. Jugal Kishore define the concomitant symptoms in his text “Evolution of Homoeopathic
Repertories and Repertorisation” in following way–“The Concomitant are the accompanying symptoms which may seem to have no relation to the patient’s main complaints, save that they appear at the same time”17.For example,
A child with diarrhoea, who at the same time, has a nose bleed; and coldness with numbness of heels; or diarrhoea with overpowering sleepiness; involuntary urination while coughing etc,.
The accompanying symptoms or secondary symptoms18 which are usually ignored by us are sometimes the most valuable because these do not seem to have any connection with the pathology and are typical of the individual’s reactions. There are certain criteria which can be considered as the selection of the Concomitant symptoms.
1. A common sign or well-known accompanying symptoms, may be as concomitant if they occur in an extraordinary degree or in a singular manner19 i.e. fever with thirst is a common accompaniment, but fever with thirst for small quantity of water at frequent interval is extraordinary, hence become concomitant.
2. Common symptoms when occur in unusual combination20 i.e. inflammation without pain(Stramonium), fever with coldness of body (Arsenic alba- Kent repertory/1284).
3. Two common symptoms become uncommon when they have definite relationship21 i.e. Coryza ending in diarrhoea (Selenium). Cough ends in sneezing (Belldonna).
Cough accompanied by blood shot eyes (Arnica montana). Pain (Rheumatic) with Nausea (Ipecac.).
4. When we not able to explain its existence22. Vomiting without nausea (except central nervous disease) (Apoc.). Painlessness of ulcers (opium). Fever without thirst (Pulsatilla)
5. Coexistence of rarer and more strange symptom with the main symptoms.23 Eructation when pressing painful parts (Borax). Pain in opposite breast as child nurses (Borax).
6. Dr. Jugal Kishore in his “Evolution of Homoeopathic Repertories and Repertorisation” cited that
“According to Boenninghausen, Aggravation or presence of certain complaints and symptoms, say, before menses, could be consider associated or concomitant symptoms.”24 Headache before the stool (Merc).
Observations
Table -1
Sex Distribution
In Study Sample
H0 = there is no difference between experimental group and placebo group in assessment of result.
Row total for the row of that cell X Column total for the column of that cell
Expected frequency of any cell
= ______________________
Grand total
OA=13
OB =3
OC =2
OD=12
EA = 8, 15×16/30= 8
EB =8, 15×16 /30 = 8
EC =7, 15×14/30=7
ED =7, 15X 14/30=7
OA – EA =13-8 = (5)
OB – EB =3-8 = (-5)
OC – EC =2-7 = (-5)
OD – ED=12-7=(5)
(OA – EA) 2 = (5)2 =25
(OB – EB)2 =(-5)2 =25
(OC – EC)2 = (-5)2 =25
(OD – ED)2 =(5)2= 25
(OA – EA) 2/ EA= 25/8
(OB – EB)2/EB=25/8
(OC – EC)2/ EC= 25/7
(OD – ED) 2/ED= 25/7
25/8+25/8+25/7 + 25/7=350+400/56
=13.39
Degree of freedom= (No. of row-1)
X(No. Of column)
=(2-1)X(2-1)
=1X1
=1
When degree of freedom is 1 then tabulated value of chi square at P= 0.05 is 3.84 then above calculated value(13.39) is more than tabulated value(3.84) there is H0 is rejected. This signifies that there is marked difference between result of experimental group and Placebo group as calculated value(13.39) is much more than 3.84. Here from statistical point of view there is highly significant difference between the proportions of success in the group treated with Placebo and group treated with common homoeopathic medicine.
From the above statistical calculation it is significant that proper use of common homoeopathic medicine produced much more effect than the Placebo.
Discussion
The present study was conducted on the patients, attending O.P.D.and I.P.D. of National Institute of Homoeopathy, Block-GE, Sec–lll, Salt lake, Kolkata-700106, suffering from various complaints with the
help of common medicines by consideration of those symptoms which are folded under the non observation of profession in homoeopathic prescribing.
Present study is observational, Randomized single blind, placebo controlled study which is conducted from July 2012 to December 2013 on the patients, who attending the O.P.D. and admitted in I.P.D. of National Institute of Homoeopathy.
Main objective of the study is to find out way of utilization of concomitant symptom in homoeopathic prescribing, characteristic symptoms utilized as concomitant symptoms, individualisation on the basis of concomitant symptoms, searching and utilization of concomitant symptoms in different dimension and its skilful consideration in prescribing. Role of concomitant symptoms to know the prognosis of cases.
Present study consists of 30 cases having various complaints. At first for every selected case, complete case history were taken according to the ‘Case Taking Performa’ (as per Appendix ‘A’).
The enrolled patient was shown the ‘Patient Information Sheet and a written informed consent were taken as per Informed Consent Form (as per Appendix ‘B’). The collected cases are divided into two groups according to received type of medicine. Patients of experimental group got polychrests, common homoeopathic medicine where as 2nd group – placebo group got placebo. One case is dropped out and which has no impact on result of study and not considered in statistical analysis. I prefer 50 Millesimal potency in my dissertation for two purposes-I found in OPD under my guide a great success in bedside. I like to confirm the LM potency utility, efficacy and got success in both levels. The medicines were dispensed from the dispensary of National Institute of Homoeopathy, with proper advice with respect to healthy lifestyle measure like nutrition; hygienic modifications and exercise were given. Minimum 3 follow up was done for 3 months.The interval between the two follow ups were usually 16- 30 days. No supplementary or intermittent therapy was adopted for any type of causalities or adverse or undesirable symptom –spectra during the treatment span, as these might affect the quality of study. The outcome measures were assessed on the basis of the clinical parameters and by improvement of the patient as a whole. On feedback reporting, the cases were followed up properly and result were evaluated on the basis of enquiry about the present state of health, physical and mental general symptoms as well as physical examination, investigation as per consent of patient and existing infrastructure of the hospital and improvement of the patient as a whole. For the assessment of the improvement, evaluation has been grouped according to the nature of improvement.
1. Marked improvement- Complete disappearances of both subjective and objective symptoms with a sense of well being. It is represented by Grade-I
2. Moderate improvement- Many of symptoms subsided but still some symptoms remain and the patient is still continuing the medicine with a sense of well being. It is represented by Grade-II.
3. No improvement- It is represented by Grade-III. It is classified into two types 1) Standstill-No change in the symptoms of the patient.2)
4. Aggravation -Disease, medicinal, and homoeopathic aggravation are considered in this group.
5. Dropped out –Patient those who discontinued the treatment or did not turn up after one or two visits.The result is assessed with the help of chi-square test. In the study between the both sexes it was found that the number of male (19) is more than female (11) and equal number of patients belongs to Hinduism and Islam religion.
In this study it has been observed that maximum no. of patients belonged to age group 31-40 (10 patients) followed by age group 51-60 (7 patients), age group 11-20 (5 patients), age group 21-30 (4 patients), age group 41- 50 (2 patients), age group 61-70 (1 patient), age group 71-80 (1
patient).
In this study it is observed that maximum number of patients belongs to rural area (28) than urban area(2). It has been also observed that the patients belong to lower socioeconomic status (21) was more than the patients belongs to middle class (9) socio-economic status.
Study shows that more patients were markedly improved (09) followed by moderately improved (04) and not improved (02) in experimental group. In this study it is observed that only 1 patients markedly improve, 2 patients moderately improved where as maximum patients not improved (12) in Placebo group.
Study shows that 3 patients got Centicimal Potency whereas maximum number of patientsgot 50 Millesimal potency (12) in experimental group. In this study it is observed that maximum utilised medicine to cases are Ignatia amara (3) followed by Arnica montana (2) and Sulphur (2), Agaricus m. (1),Argentum nitricum (1), Drosera rotundifolia (1), Gelsemium semperrens (1), Natrum mur (1),Nitric acid (1), Nux vomica (1), Phosphorus (1).
Study shows that more number of patients improved (16) that is 53.33% than not improved patients (14) that is 46.67%. Homoeopathic medicines vary from patient to patients, as it depends upon individualization and every case is a new one for the physician. The study continued from July 2012 to December 2013 which was also very less for the total eradication of whole condition. The study must be conducted for longer duration for proper follow up of the cases. Though most of the cases got better results but cannot claim that patients are cured completely.
Regarding statistical test done during study, data is shown in the chapter observation for finding effectiveness of common homoeopathic medicine for various kinds of illnesses. Assessment of the result is done by chi-square test, which confirms the effectiveness of common homoeopathic medicine prescribed on the basis of concomitant symptoms in the cases.
Summary / Conclusion
Assessment of the result was verified statistically, and it signifies the effectiveness of uncommon use of common homoeopathic medicine: prescribing on concomitant in various complaints.
Scope of Homoeopathy is increased only because Hahnemann’s homoeopathy have no iatrogenesis, no addition, no complication of medicine rather homoeopathic medicines without creating any side effects only giving honey –a nutritious sweet.We as a homoeopathic physician have ample opportunity to prevent development of disease by art of medicine. This art we apply before the development of disease or when we have cooperation from patient to treat him with under careful guidance of artistic constitutional prescribing by these uncommon uses of most common polychrests medicine to prevent many- many known and unknown disease.
By this study it is confirmed that a common homoeopathic medicine has better scope in the treatment of various illnesses. It would be much better proved if more number of cases and prolonged time was given for the study.
The entire dissertation proved the efficacy of homoeopathic medicines in relation to the
uncommon use of common medicines on the basis of the concomitant that is uncommon, rare, strange, and characteristic symptoms to establish the cure in the system of medicine.
I conclude my subject of dissertation that is “Uncommon use of Common medicine:
Prescribing on Concomitant”. These common medicines having some uncommon indications
which is not less than common characteristics available in Materia Medica. Research of these polychrests, common medicines in depth in writing of different authors especially H.N. Guernsey give conclusion for my dissertation that as we study more, we get more treasures of prescribing.
Limitations and Recommendations
In spite of the most sincere approach maintained in this study the efficacy of homoeopathic treatment in cases in which prescription was done on the basis of uncommon use of common medicine prescribing on concomitant some limitation were evident in the study. As no work is free from limitations, this work is also not exception to this rule.
This study therefore demands reconfirmation. This work had many limitations like:
• A noble subject, I choose for dissertation but I not fully satisfied due to limitation of works in time and duration.
• The period of study was too short to access the actual utility of these symptoms on patients.
• Placebo control and medicine study was very small for drawing any conclusion.
• Most of the subjects come from poor socioeconomic level which puts query on the generalization of the results.
• The main drawback with the study was the paucity of the samples (30) in outpatient department.
• Few other obstacles on the patient’s part are also quite considerable. For example, not being able attends to the OPD in proper time for consultation, unavoidability of maintaining factors, irregular intake of medicine. These obstacles were curved the path of achieving the desired result. Although the present study comes to an end but, in fact any study still is incomplete unless further study is done extensively on following aspects:
• The time of study is conducted on a limited numbers of cases, more extensive study in this regard are to be conducted to reach at more rational and genuine conclusion to reestablished the truth.
• The time of the study was limited and results would have been better result if the time of the study would have longer.
• Patients having a voluntary inclination to be included in the study may to be encouraged in more numbers.
• Large number of control study should be taken.
• Various modern investigations should be carried out during the study.
• As my study deep more and more subject of dissertation. I got many different avenues for knowing some unknown characteristic features of prescribing due to scarcity of time. I limit myself which I hope in future may work hard to develop and express gigantic angle and art of prescription in future course of my academic extension.
References
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