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You are viewing:  History & Basis - Repertorisation 1 - Level 2
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to History & Basis - Level 1

Steps to Repertorisation 
 
Repertorisation is not only a mechanical process of counting rubrics and totaling marks obtained by a medicine, it also includes the logical steps to reach the repertory proper and finally   differentiating the remedies with the help of  Materia Medica. Repertory follows the logic of Induction & Deduction. The steps to repertorisation start from  case taking and end by finding out  similimum. They are:-

1)       Case  taking.
2)       Recording and interpretation.
3)       Defining  the problem.
4)       Classifications and evaluation of  symptoms.
5)       Erecting totality.
6)        Selection of repertory and repertorisation proper.
7)       Repertorial result.
8)       Analysis and prescription.

1. Case Taking
Dr. Kent once mentioned  to his followers, There are lot of  symptom, but there is no case. What is the case then ? A case comprises of symptoms which, gives the totality  of a persons suffering. The totality of symptoms, forms a case for the physician. In every event there exists a totality provided an expert can perceive it; likewise, in every alteration  of state of health a totality exists which can be perceived by a physician. 
 
2. Recording and Interpretation
Need of a case record has been emphasized by all the stalwarts for various essential purposes. Every case can be a piece of learning. Therefore, it is imperative to have it recorded properly. Since it is almost impossible to keep all the data intact without any distortion, the necessity of a proper recording has been felt acutely. The purpose of a case record is to keep all the information adequately and accurately recorded for future references. Case record  should communicate the exact picture of  the patient which has been obtained by the physician. This is possible only when  recording is done properly without being hindered by any subjectivity of the physician. While giving directions for investigating the case, Master Hahnemann has greatly emphasized  the necessity of being  unprejudiced and stressed the need of fidelity in tracing the picture to overcome the subjectivity in practice.
Very often it is noticed that all the information of the sick person do not find a place in case record. While the physician might fail to record some information, he might unduly focus on some other. All the events and effects should be recorded without any interpolation or deletions. While recording, beginners are cautioned not to get influenced  by the symptoms of drugs as recorded in the Materia Medica.
Very often the use of technical terms can create confusion, so it should be avoided, but at the same time, physician should apply common sense while noting down the picture in patients own language. In our practice, for instance, we come across many cases where patient shows hypogastruim and says, Doctor, I have got stomach ache. For gas (flatulance) complaints, some patients might say I have got gastric, etc. Whatever the patient is trying to communicate should be properly received and interpreted by the physician. The physician should be careful while interpreting the words of the patient as the prejudices of the physician might crawl in here without his awareness.
Though much is said about prejudice, it is an accepted fact that remaining unprejudiced is not an easy task. Kent once stated It would almost seem impossible to find at the present time one who could be thus described (unprejudiced) To be unprejudiced is to be aware of our own prejudices. Once we are aware of them, the chances of committing wrong interpretations and recording them would be less.
Intensity of symptom should also be given due consideration while recording. Each and every symptom should be recorded by putting marks above it.
 For example:    Salt craving 3 (more intense)
                             Salt craving 2 (intense)
                             Salt craving (moderate)
For effective  repertorisation, precise recording is very crucial for proceeding further with the subsequent steps. Recording is not done independent of interpretation; so both should be done simultaneously.
       
3. Defining the Problem
Once the case is taken well, interpreted, and recorded properly  the physician should be in a position to define the problem precisely. The record should guide him to understand the person and his disease. The sickness of the person gets expressed at his various levels, and to bring all such expressions together to get a whole picture, requires a clear understanding of what Hahnemann stated what is to be cured in a disease, that is to say in every individual case of disease .To define a problem means to define the individual  who is facing the problem. The individual is fully revealed to a physician from the effects of different events associated with the individual as well as from the related data collected from various sources. Diagnosis of the disease, which is of crucial importance, would segregate the peculiar characteristic expressions from the common ones. Thus, only by precisely defining the problem, a physician would be in a position to go ahead further in the right direction. 

4. Classification and Evaluation of Symptoms
 It is a  well-known fact that all the symptoms in a case are not equally important. After taking  the case, a physician faces quite a big number of symptoms which are required to be analyzed, classified, and evaluated  in order to arrange such symptoms hierarchically. Dr. Elizabeth Wright has given a very practical solution to this problem: As soon as the case is taken and the physician sits down to study it, he will find it useful to run down the list of symptoms and mark with M opposite the Mentals, G opposite Generals, PATH opposite the Pathology , P opposite the particular and O for Objectives. For further clarifying , he may under line and peculiar symptoms in red . This exercise undoubtedly is very useful for beginners, but it can prove equally beneficial to all the practitioners. However , the experienced and seasoned practitioners do it mentally.

Analysis and classification give an idea about the case in respect of its nature and the type of symptoms, and therefore, evaluation can be done by different methods.

The schema of the order of importance of symptoms according to Kent is :-

           Mental :          Will  ( Emotion )
                                   Understanding
                                   Intellect

           Physical generals :

           Physical particulars:

           Modalities:       Time, temperature, weather, position, motion, external stimuli, eating,
                                      drinking, sleep, clothing, and bathing 

While Boger specially stresses pathological general, Boenninghausen gives more importance to concomitants and modalities.

 All the three evaluation methods are to help the physician, and not to confuse him. After the case is well taken, evaluation of symptoms according to the case would not be difficult. The case may have different dimensions, which may prove useful to find out the similimum. The objective of all these methods is the same, i.e. to find out a correspondence, but case should be analyzed  and evaluated  by different methods and techniques to facilitate the process of finding out the similimum

 The three standard methods of classification and evaluation propounded by Boenninghausen, Kent and Boger are of practical use in repertorisation.
 
5. Erecting Totality
Totality is not the sum total of symptoms, but it is a logical combination of the symptoms which characterizes the person as well  as individualize the problem. Thus, all the symptoms which are classified and evaluated do not form a working totality of the case.

From the classification  and evaluation, the hierarchy of symptoms is known, but which, among them, should be useful for getting a correspondence are yet to be finalized. Thus, a physician is required to understand the whole symptom and select a few of which can logically represent the whole picture. This logical arrangement must follow a definite principle. If the case has got more generals and a few particulars with rare modalities, it would follow a different arrangement than a case which has vague modalities and striking concomitants, or a pathological general.

Totality should be erected according to the facts collected in the case. There is no hard and fast rule to erect totality in any fixed way. The case alone decides the method to be followed.

6. Selection of Repertory and Repertorisation
After  the totality has been erected, the case becomes clear to the physician. He should look for  one of the following points in the case:-

  1.        Generals : Mentals
                                 Physicals.

  2          Particulars:  Location
                                     Sensation
                                     Modalities
                                     Concomitants

    3          Pathological generals.

If a case is full of generals, Kents repertory would be the best selection. If it has got pathological general, Bogers repertory must be selected. If the case has got particulars with Location, Sensation, Modalities, Concomitants with a few mentals, therapeutic pocket book is preferable; however, Bogers repertory can also be used.

Synthetic repertory can be used for  the Kent method  to refer to more Generals. It has also many pathological generals, but no particulars.

Once the repertory is selected, a major part of analysis and synthesis of the case is done. The next step is to rearrange the totality according to the repertory selected. Rearrangement of the totality in terms of repertory selected  is called Repertorial Totality. Thus, a well arranged totality is worked out.

What follows next is to convert the symptoms into rubrics which requires an acquaintance with the repertory. The symptoms obtained from the patient may not be found in the repertory in the same form; so the physician must know the construction and arrangement of the each repertory.

Rubrics should be arranged according to hierarchy, reason, and page number. The final out come  is written as follows :-

 Symptoms               Rubrics               Reason               Page No.

1                                    -                          -                         -

2                                     -                         -                          -

3                                     -                          -                          -

and  so on.

No, at this stage, the case is referred to the repertory, worked out, and a group of  medicines with markings is arrived at.

7. Repertorial Result
 A group of  close running medicines should be noted down according to  the symptoms covered and marks obtained. For example, if Lycopodium covers seven rubrics and gets 18 marks, it should be written 18/7. A few medicines which are nearer to the first also find place in the repertorial result.

8 Methods of Reperatorisation
 The remedy which gets the highest mark is not necessarily the final remedy in all the cases. Repertorial result should be finally referred to the court of Materia Medica. Marks are important but these does not constitute the final verdict. Further the group has to be referred to the picture of the patient and with the help of Materia Medica, it should be differentiated. Sounding a note of caution, Boenninghausen writes, for this purpose, he should not content himself with repertories that have been prepared, a very frequent  carelessness for these books contain only slight hints as to one or the other remedy that might be selected but can never take the place of the careful reading up of the fountain sources. ( The field which differentiates medicines is called Potential Differential Field )

 Repertory, thus narrows down the group of medicines, and with the help of source books, a final remedy can be found out. The remedy so selected must finally pass through certain criteria such as susceptibility, sensibility, suppression ( if any ), the level of similarity, functional and structural changes, vitality, and miasm to arrive at right potency and doses schedule.
 
For using a repertory effectively and to derive maximum benefit, one must thoroughly acquaint himself with it . Hence the need for  its constant handling and frequent use.

Every repertory follows its own philosophy and construction  suitable for different types of cases. Methods have been evolved as per the given philosophy underlying each repertory. Hence a case must be handled keeping in mind, first and foremost, the particular philosophy and the construction of each repertory, and not just its method.

It is commonly found that many practitioners use just one repertory for working out all cases. Such a practice is not all too desirable. Every case has its own dimension which decides the selection of repertory, and every repertory has its own methods of repertorisation.

Dr. B.K.Sarkar in his book Lectures in Homoeopathy ( 1956 ) has described the following methods of working out the cases :

  1)      Hahnemann and Boenninghausens method  = where complete symptoms are available.

  2)      Kents method = Where Generals ( mental and physical ) and particulars are available.

  3)      Third method =     Where mental symptoms are lacking. Here one  starts with physical generals; next mental symptoms and then particulars.

  4)      Fourth Method =    Where Generals are lacking. Selection of a striking, peculiar as a key symptom, and then medicines are differentiated with the help of other symptoms.

  5)      Fifth Method    =     Where the case presents only common symptoms or pathology. Here physician makes use of every means at his command , including

(a)     Patients personal and family history ,

(b)     Temperament,

(c)     Complexion, color and texture  of skin,

(d)      Particular organs and tissues affected,

(e)     Location, character and physical aspect of lesions, and

(f)      Probable etiological factors.

    (6)     Sixth Method = Technical nosological terms are selected as main headings.

The methods described above have their own advantages and disadvantages.
 
  
10. Techniques of Repertorisation

(1) Old methods : ( using plain paper sheet )

In this method, rubrics are arranged according to the hierarchy, and medicines are listed against them. All the medicines with their grades are written by hand against the symptom. At the end, common medicines which cover all the rubrics are found out. The are further differentiated with reference to Materia Medica.

The advantage of  this method  is that while writing the symptoms, referring to the rubrics and noting down the medicines, one learns to use repertory in a better way. It leaves a lasting impression on the users memory. As a result, acquaintance with the repertory and knowledge of Materia Medica  considerably improves. The only disadvantage  is that it consumes more time in working out a case.

(2)     Modern Method ( using repertorial sheet ) :

Repertorial sheet used contains a list of medicines alphabetically arranged and also a number of  longitudinal and horizontal columns for noting down the marks against rubrics.

Whether we use old or new  method, two basic logical processes are involved. They are :-

a)  Total addition process, and

b)  Eliminating process.

a)   Total addition process :- All the medicines against all the rubrics are noted down and finally total marks against medicines  are calculated. Medicines obtaining higher marks are further differentiated. The advantage is that the possibility of omission is less. However, it takes more time.

b)    Eliminating  process :- Select the most important symptom  in the person without which we can not think of  a prescription, preferably generals. Now, this symptom should be placed on the top and the rest of the symptoms are placed below it according to hierarchy. While repertorizing, take only those medicines  which cover the first symptom. Further rubrics can be referred to and marks added to those medicines only.

 Some prefer to use the second rubrics also, while others even the third.. There are also who use all the rubrics till the end for eliminating purpose. This process is called continuous eliminating process. A few cautions may be borne in mind, namely,

1)       If evaluation of symptom is not strictly practiced, eliminating process would prove disastrous.

2)       Hierarchy of symptoms should be adequately accurate.

3)       However important the rubrics may be, do not take it for the use of eliminating process if it has only one or a few medicines.

4)       Preferably generals should be used for the purpose.

 If  the above cautions are followed properly, eliminating process will be the most suitable working method for the purpose of  repertorisation. It is time saving, less confusing  and easy to practice.

 There are several other working techniques which are suggested by busy practitioners, but the above two methods are generally used for systematic working out a case.

11.Recording & Interpretation
 
Case taking is the first step, and the outcome of treatment entirely depends upon the success  of this first step. Any mistake committed here would certainly interfere in the selection of drugs and planning of the treatment.

A physician should be clear about his job in the beginning itself and must possess a clear understanding  about the case. For Homoeopathic physician, expressions at all levels, mental,  physical, general and  particular, are required to individualize the person as well as to diagnose the condition. If this is clear in the beginning, case taking will be on the right lines. It is a unique art of getting  into conversation, of serving and collecting data from patient as well as from the bystanders to define the patient as a person and disease. The purpose is to understand both the person and the disease. This particular method and approach is different from other  systems of medicine

There has been much discussion on case taking by many stalwarts and this subject has been dealt-with at length but still many make mistakes while applying this art in practice. This being an art, the individual skill plays an important role in applying the rules of case taking. It is difficult to apply a uniform standard in all the cases and in respect of all physicians. In case taking, physician applies his ability and skills of communication keeping in view his objective. As case taking is individualized in approach, there are several suggestions offered and numerous models of case taking forms are available to the practioners. Some are in the form of questionnaires, some in the form of multiple choice questions, and so on. Dr Dhawale has devised a Standardized Case Record which has a fixed form, structure and function. It can be most useful to the profession if used properly.

Dr  Hahnemann has described the necessary guidelines  which should  be taken into consideration while taking a case, in aphorisms 83-104 of Organon of Medicine. Throughout the process of case taking, the patient should be cooperative. He should be assured of the confidentiality of data. If patient narrates well and fully, the task becomes easier for the physician. Apart from the collection of data, case taking has got its own therapeutic value in certain type of cases, if not all. Personal experience in certain cases has  convinced the author about the therapeutic value of it. Many patients ventilate  certain experiences unexpressed for years which keep on disturbing them and giving rise to very many  physical and  mental symptoms. Very often  after the case taking, the patient says, Doctor, I feel much relieved after talking to you", and then  a similimum completes  its job. It should be  a free exchange  between the patient and  the physician. Both verbal and non-verbal communication of the physician can either encourage or discourage the patient in opening up  various  events and their effects on him. It is a very delicate, yet dynamic situation, where the physician  should remain attentive so that  disclosures are properly received.  Physician should be aware of is own problems of communication  to gain more from this highly dynamic process. In some cases, even if one thread is missed, arriving at the totality would become difficult. Nothing else should keep the  physician occupied other than the case taking. To understand the feelings properly, a physician should be expert in role playing. He should acknowledge the feelings of the patient, but empathy should replace sympathy while dealing with sensitive cases. At the end of the interview with the patient, physician should have a clear definition of the problem. This is not always easy to achieve. If physician remains in confusion at the level of case taking, further steps in repertorisation would become intractable. A shaky foundation would certainly mar even the best of the superstructure.
  
Need of a case record has been emphasized by all the stalwarts for various essential purposes. Every case can be a piece of learning. Therefore, it is imperative to have it recorded properly. Since it is almost impossible to keep all the data intact without any distortion, the necessity of a proper recording has been felt acutely. The purpose of a case record is to keep all the information adequately and accurately recorded for future references. Case record  should communicate the exact picture of  the patient which has been obtained by the physician. This is possible only when  recording is done properly without being hindered by any subjectivity of the physician. While giving directions for investigating the case, Master Hahnemann has greatly emphasized  the necessity of being  unprejudiced and stressed the need of fidelity in tracing the picture to overcome the subjectivity in practice.

Very often it is noticed that all the information of the sick person do not find a place in case record. While the physician might fail to record some information, he might unduly focus on some other. All the events and effects should be recorded without any interpolation or deletions. While recording, beginners are cautioned not to get influenced  by the symptoms of drugs as recorded in the Materia Medica.

Very often the use of technical terms can create confusion, so it should be avoided, but at the same time, physician should apply common sense while noting down the picture in patients own language. In our practice, for instance, we come across many cases where patient shows hypogastruim and says, Doctor, I have got stomach ache. For gas (flatulance) complaints, some patients might say I have got gastric, etc. Whatever the patient is trying to communicate should be properly received and interpreted by the physician. The physician should be careful while interpreting the words of the patient as the prejudices of the physician might crawl in here without his awareness.

Though much is said about prejudice, it is an accepted fact that remaining unprejudiced is not an easy task. Kent once stated It would almost seem impossible to find at the present time one who could be thus described (unprejudiced) To be unprejudiced is to be aware of our own prejudices. Once we are aware of them, the chances of committing wrong interpretations and recording them would be less.

Intensity of symptom should also be given due consideration while recording. Each and every symptom should be recorded by putting marks above it.

 For example:     Salt craving 3 (more intense)

                             Salt craving 2 (intense)

                             Salt craving (moderate)

For effective  repertorisation, precise recording is very crucial for proceeding further with the subsequent steps. Recording is not done independent of interpretation; so both should be done simultaneously.
 ___________________________________
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