PRACTICE OF MEDICINE SHOULD NOT BE AUTOMATED & MECHANICAL

(CRITIQUE OF CLASSICAL HOMEOPATHY-11)

Life is a kaleidoscopic continuum of ever changing scenes, grouping and regrouping of events and happenings. Life cannot be confined in the tight jacket of theories and concepts. Every phenomenon of life, positive—as growth, progress and expansion, and negative—as disease, disorder and destruction, partake of the same dynamics and the flux of life. Mending and remedying the latter phenomena cannot be rectified according to some set theories or edicts or some strict nostrums. This is all true in the practice of medicine. There cannot be any sort of hegemony of any set of routine methods of practice of medicine. With the progress of life and knowledge the therapeutic approaches also get metamorphosed. This the history of medicine abundantly proves.

He is not a physician who cannot creatively manipulate a living and a novel situation. The similimum is not a preordained decree that cannot be violated, or set in abeyance for the time-being. If, by the time you have determined the similimum, another situation is trying to supervene the scenario, and it has grave portents if not immediately attended to, or arrested, forget the similimum, and bring forth your acumen as a skilled and adept clinician to tackle the incumbent situation. A physician should always be a physician first then anything else. He should bring forth his expertise and knowledge and sagacity, and apply it for the betterment of the patient. A dogmatic surveillance of some preconceived theorems or edicts would be a benighted treachery. 

I should adduce a case from practice. A patient, who was never hypertensive in his life, suddenly develops a constant headache with severe congestion of the brain. The condition never ceasing or changing, by day, by night or by sleep. BP was checked and was found 180/95. So the cause of the trouble came to be known. (This, now ubiquitous pathology was never known at the time of inception of homeopathy!) A good physician will not leap at once to find out the indicated remedy. He will first try to understand the situation and find the cause of the trouble. The time was the beginning of winter. The patient tells that he, one day, sat in the sun full day. In the evening the headache began. The concomitant symptom was very frequent urination—which was usual with him every winter. He would urinate some 15 to 20 times in 24 hours. Urges were sudden to make him run for the closet, or he would soil his clothes. Sun-headache and headache from radiated heat was with him always. The case was repertorised for the following symptoms:

• Sun-headache;
• Headache from stove;
• Congestion of head from the above causes;
• Pain in temples and forehead;
• Headache < daytime;
• Frequent Urination;
• Urging to urinate sudden;
• Must hasten to urinate;
• Nape of neck stiff, with headache;
• Thirst normal, but drinking water refreshes him;
• Salt <.

The last symptom I added from myself, as blood-pressure is worsened by the excess of Sodium ions.  

The repertorization brought out Phosphorus as the most indicated remedy. Then Bryonia; then Sepia, Calc., Pulsatilla, etc. Knowing the patient personally that he was not hypertension prone, I decided not to give medicine, expecting to get salutary results by instructing him to bring changes in his lifestyle and daily routine. I instructed him to increase water intake as the frequent urination was dehydrating his system. I asked him to take a glass of water every two hours, and partake of fruits with much water contents—I mean juicy fruits. Reduce salt foods, and relinquish all salty foods for two days. Take a glass of juice of carrots with some fruits twice a day. The patient started feeling well within two days. But a complaint of initial symptoms of piles, with soreness in rectum after defecation, started. Remembering that I had treated him for very complicated attack of piles; and that he was now symptoms free for some 10 years. I, at once, decided to treat him for the pile ere he may come in the grip of full-fledged attack of the disease. Nux-vomica was not among the first 10 remedies in the above repertorised case, but I decided to begin the case with it. Few days’ medication plus the above mentioned regimen, and control over spices and highly seasoned food rounded the patient back to health.

This is how the insight of a physician can bring back a complicated and a grave case to health with least medication, by only instructing changes in the patient’s life-style: treating some diseases and not treating some others with medicines. Medicine is not a proviso in every case of disease; nor is having found the similimum, it is necessary to apply it at once, or giving it without thinking its real justification. It is just possible that you may prefer selecting the 3^rd. or 5^th. medicine in the list of indicated remedies. And what about this fact that many times you are compelled to prescribe another medicine after having employed the similimum!  This shows that the similimum is only a symptoms similimum, not the patient similimum. The patient is a bigger universe than the ‘symptoms complex ’. Your choice of the symptoms complex, revealing—as you think, the personality of the patient, is, at best, arbitrary. Man is a very big universe, with many dark and mysterious sides, aspects and regions to it, that are impossible to encircle, for mortals like me and you. Let me enlarge a bit on this point:

WHAT IS THE SIMILIMUM

SIMILIMUM is a rare species, and, as the medical knowledge is growing and science expanding, it is becoming an endangered species—soon to be obliterated from the face of the earth. The modern patient is a queer phenomenon not ever found in the whole history of medicine. He has averagely four or five major disabling diseases but is not disabled. He is actively doing his business, and attending all the functions of life and society actively in a normal way. Take a person X, in his sixties, a magnate of a large business concern, having 20 years old Diabetes, CHF— (congestive heart failure)—for the last 7 to 8 years;  Arthritis, for 5 years, and so many other minor ailments. He is living a fully active life, attending to the minutiae of his business and moving in society. Another patient Y, in his fifties or early sixties, an old diabetic, and on dialysis for the last six or so years, and a professor in a university, delivering lectures and speeches, with a commanding voice and mental acumen.  Again a lady, a head-mistress of a school, in her fifties, having undergone hysterectomy ten years ago, quite obese, having asthma using inhaler for some seven years, dealing and attending  school and family affairs admirably.  Another patient, Mr. Z, an industrialist, in his late seventies, having installed a Pace-maker, for the last 12 years; now doctors thinking to renew his battery, aggressively attending his industry affairs. Examples can be adduced ad infinitum.

The point at discussion is how these people with such grave pathologies of the major systems are spending a successful life with integrity. Miracles of modern therapeutic handling of cases! Now think one such person comes to you for some minor or major complaint, where will you find the similimum? And how will your similimum wipe away the incumbent pathologies and bestow him the pristine health? All concepts of similimum will prove to be an incongruous utopia.

The fact is that people of all the four examples may come to you for one ailment or another. We can serve them admirably if we shed our idealism, and behave as a matter of fact physician—homeopathic physician, indeed. To be true, we do serve such people in our daily practice, and they are much satisfied. You tell them or allow them to go on taking their ‘finely adjusted’ prescription of medicines. Never try to destabilize them by changing their allopathic medication and regimentation.

Yes! Do try to find the similimum, if it is at all possible; but don’t apply it mechanically, in a routine fashion. It is possible that you may feel or think that the most indicated remedy should be held back, and the remedy second in order or third one is more practical to be used first. As it is practical, before felling a big tree, a gardener feels it advisable to lop down some unduly expanded and grotesquely grown branches—á la Drainage Therapy. After such pruning and unburdening the vital force from superfluous symptoms or intruding complaints the path for the curative action of the similimum becomes smooth, as done by the masters of the art by first prescribing some organ affinity drugs, in drop-doses or in low potencies, before radically striking down with the most indicated remedy (or the so-called similimum). First pruning then uprooting to avoid damage and shock.

The similimum is an elusive concept.  It is taken by the classical homeopaths as more psychic than somatic: that is, more ‘personality’ related than the disease related. The personality they consider is a sum-total of personal qualities or traits, liking and disliking, mental trends and psychic make-up. Evidently it is an elusive bargain. What is ‘bravery’ in one person’s mind may be a treachery in another person’s mind; what is sinful for one person may be quite innocuous for some other.  Psychological field is a fertile ground for misconstruing the symptoms as to their real intent and purpose. Depth of mind is unfathomable. Innocuous words can sometimes bring the vilest catastrophe. I have abundantly talked on this subject in my previous articles.

Seeing the stage of advancement of medical sciences and technology, it seems imperative that the Similimum be squarely based on pathology, corroborated by laboratory techniques. It is the need of the hour that the materia medica is based on pathology. Every pathologic entity—I mean the disease, should have many remedies in the materia medica, similar to the pathology of that disease. This will give us a scope of similar remedies for that disease. The similmum will be determined with the help of ‘fine-tuning’ chapters of the Repertory—as I have explicitly laid down in my previous article, viz., FINE-TUNING SYMPTOMS. That will be the future approach in homeopathic practice.