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Case Study

Study of a Problem Case
NATIONAL JOURNAL OF HOMOEOPATHY 1998 Nov / Dec VOL VII NO 6.
Dr V Sundaram
'Lyco

Dr Guernsey coined the word 'key note'. He states that 'there is only one important note to any piece of music- however complicated. And that note governs all the others, no matter how many variations, trills & accompaniments.

The word keynote indicates that certain peculiar symptoms provide the key, which points straight to a remedy. Prior to the invention of well-developed repertories, our master prescribers used keynotes to help in the proper study of remedies similar to the case. No individuals are exact replicas of another, mentally, physically or as to manner, disposition, speech, action or physical make- up. Each gets sick in his own way and for cure, remedies have to be selected which will be appropriate to that case.

A truly scientific procedure for the selection of proper remedy was laid down by Hahnemann in aphorism 152 of the ORGANON. In this he gives explicit directions for choosing drugs. In aphorism 153, he elucidates further, stating that comparison of the collective symptoms of the natural disease with the list of symptoms of known medicines is to be done to find among the 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 to be kept in view; for it is more particularly to these, that very similar ones in the list of symptoms of the selected medicine must correspond to, in order to constitute it as most suitable for effecting cure.

John Henry Clarke in his master piece 'A Dictionary of Practical Materia Medica' states that in a large proportion of cases, there will be present, some symptoms, which are peculiarly characteristic of the remedy, constituting what are called keynotes. Further he categorically expressed his opinion that practice on keynote symptoms alone is an absurdity, but the right use of keynotes, is immensely labour saving.

H C Allen, in his monumental contribution: 'Keynotes of leading remedies' expresses his view that the differences by which one remedy is distinguished from another are the 'key notes'. Keynote is simply the predominating symptom or feature which directs one's attention to the totality of symptoms through which an individual case is expressed. So its function is merely suggestive. Keynote prescribing is a short cut and a time-saving device, but is often misused. On the one hand, it tries to narrow down the number of likely similar remedies and tries to make a quick job; on the other hand, it is also liable to misfire as it ranks one or two symptoms very high and practically ignores others. We court failure if keynotes are taken as final and generals do not confirm. That's why Dr Taylor, aptly remarked that keynotes are invaluable to give the casting vote.

Dr Harvey Farrington in his book "Homoeopathy and Homoeopathic Prescribing', has, on page 246, presented a problem case, an exercise for repertorisation. This repertorisation has been done with reference to "Synthesis Repertory' edited by Dr Frederick Schroyens and coordinated with Dr John Henry Clarke's 'Dictionary of Practical Materia Medica'.

The ultimate remedy, most suited to this case, is Lycopodium. The various headings, as furnished in the Clarke's dictionary namely Mind [2,I, b]Head [1], throat [2,g] appetite [2,c] stomach [2,a b, g, h] abdomen [2,c,e], stool and anus [2, 1] upper extremities [2,j, k ,o]. lower extremities [2,j, o], urinary organs [2,n], fever [2,m,] characteristics [1,2,c, a,] matches the symptoms accurately. Hence, the most suitable choice for this case is Lycopodium only. Lycopodium keynotes are very pronounced.

·         AGG from 4 to 8 p.m.

·         burning pains in the late after noon [2,k]

·         [R] sided medicine

·         in direction right to left

·         affection of right shoulder and back [2,k]

·         pains in right wrist and right hip [2,o]

·         AGG from cold food and drink

·         thirst for cold water to wash his throat

·         but it causes much pain in stomach

·         frequent and painful eructation, sour eructation

·         Primary action on digestive organs and adjoining glands, on liver and large intestines.

·         Is in the front rank among flatulent remedies.

·         Suffered from dyspepsia for last year [2,a]

·         For two years after eating, spits up food.

·         Hungry, but a few mouthfuls of food seems to fill him up to the throat

·         Much flatulence and rumbling in abdomen [2,e]

·         Belching of gas, immediately after Meals which relieves the distention temporarily [2,b]

·         Food comes up with eructation [2,g]

Therefore as John Henry Clarke has aptly stated, Lycopodium will cure any case in which the totality of symptoms correspond with the symptoms of the remedy.

2 - Present complaints: a] has suffered from dyspepsia for the past year. Gradually getting worse.b] For two years, after eating, spits up food but its not acid. 661676702667 StomachDyspepsia, indigestionStomach spitting up food [see eructation, vomiting]eructation: food eating two hours after 341341 StomachStomach Slow digestion

Symptoms

Synthesis Repertory

J H Clarke's Dictionary of Practical Materia Medica

 

Page

Symptoms

Page

Location

Symptoms

1 - A stone mason aged 47 brown hair partially bald, grey eyes, spare of built slightly stoop shouldered with scrawny neck and thin arms. Has led the ordinary life of a working man.

241

Head, hair, baldness, falling of hair

339

Head

Baldness, the hair falls out, first on the vertex, later on the temples. Feeble muscular developments, upper body wasted lower semi dropsical.

2 - Present complaints: 

661

Stomach

341

Stomach

Slow digestion

a] has suffered from dyspepsia for the past year. Gradually getting worse.

676

Dyspepsia, indigestion

 

 

 

b] For two years, after eating, spits up food but its not acid. 

702

Stomach spitting up food [see eructation, vomiting]

 

 

 

 

667

eructation: food eating two hours after

341

Stomach

Vomiting after a meal, with salivation.

c) He is hungry, but a few mouthfuls of food seems to fill him to the throat

657

Stomach appetite wanting fullness, from sense of

341

Appetite

Loss of appetite, sometimes with the first mouthful.

 

 

 

 342

Abdomen

Has a great appetite but a small amount of food fills him up.

 

 

 

 332

Characteristics

Canine hunger, but as soon as a morsel of food is swallowed there is distension and fullness of the throat, preventing him form eating any more.

d) He drinks two cups of coffee during each meal.

1605

Generals Coffee AGG

 

 

 

e) Much flatulence and rumbling the abdomen

725

Abdomen flatulence eating after

342

Abdomen Characteristics

Great deal of noisy flatulence in the abdomen.

781

Rumbling

332

 

Lycopodium is in the front rank about flatulent remedies. Sometimes much rumbling of wind.

f) Belching of gas immediately after meals which relieves the distention temporarily

660

Stomach Distension eating after eructation do not ameliorate

341

Stomach

The pains in the stomach manifest themselves, after a meal.

   

341

Stomach

Sour eructations.

g) Food comes up with eructation

661

Stomach food Eructation-regurgitation

341

Stomach

Sour regurgitation of food.

h) Thirst for cold water, to wash his throat, but it causes much pain stomach.

625
687

Throat dryness
Stomach
Pain after
Cold drinks

340

341

Throat

Stomach

Dryness of throat.

Pain in stomach after a slight chill.

i) He complaints of forgetfulness; uses wrong words in speaking [he did so in addressing a doctor]

119


164

Mind
Forgetful
Mind-mistakes
speaking misplacing words.

338

338

Mind

Mind

Memory weak Inability to remember what is read.
Inability to express oneself correctly misapplication of words and syllables.

j) He is fidgety and keeps moving or walking about to quiet his nerves motion.

118

Mind fidgety

345

Upper extrem

Involuntary trembling of the hands.

k) On coming home from work he has his wife rub his right shoulder and back to relieve burning pains, which come on in the late afternoon.

1258

Extremities Pain shoulder right

345

Upper extremi-Ties

Rheumatic tension in right shoulder joint

l) Due to his habits, he is constipated.
He frequently has ineffectual urging to stools

790

791

Rectum constipation

Rectum ineffectual urging and staining.

342

Stool and anus

Constipation of long standing; hard stools with ineffectual desire to evacuate.

m) He perspires normally while working

1515

Perspiration during slight exertion.

348

Fever

Sweat principally in face, easily excited during the day by slight exercise

n) The urine is sometimes highly colored and burns slight on voiding

865

Urethra burning during urination

348

Urinary organ

Smarting when urinating Urine deep coloured

o) On rising from supper table he notices pains in his right wrist and right hip, esp. if the room is cold

1257


1265

1265

Extremities pain, wrist, right

Pain hip 

Chill, during

345


345

Upper limbs


Lower limbs

Pain as from a sprain in right wrist joint Rheumatic tension in left hip. Pain as form a sprain in hip. Tearing, beneath right hip, in left hip joint.
Tearing in legs and knees, extending to tibia and instep, esp., in evening and at night.

p) He is inclined to irritability and is depressed over his inability to do work as well as formerly

141

89

188

Mind

Depressed

[sadness]

338

338

Mind

Mind

Irritability and susceptibility with tears.

Silent, melancholy, and peevish humour. Melancholy and disposition to weep.