Keynote or its Substitute?
NATIONAL JOURNAL OF HOMOEOPATHY 1998 Nov / Dec VOL VII NO 6.
Dr P R Varma
'Ars-alb

My dear Brothers & Sisters,
For the noble cause of our mission,
Let us put our minds and strengths together.

Most patients, who come to us, have had enough experience of all-modern diagnostic and therapeutic skills. Taking up such a case under Homoeopathic Management and succeeding in curing it, is a real thrill. This thrill stimulates one to go for 'repeat performance' and that is a chain that links one with goodwill and success. Here one learns to concentrate on one's objective - to cure the sick and not to bother about theories and their advocates. We know that we can cure by selecting a wonder drug [similimum] for every curable case. Since the advent of Homoeopathy, practical difficulty in its selection was realized and attempts were made to find a short cut.

Remember that we are devoted to 'ideal cure' and we must compare efficiency of every method on the basis of superiority of its results. Then we can rightly claim to have various paths of helping our patients within the framework of Homoeopathic system of therapy. Prescribing on the basis of keynotes is one of the most effective, practical shortcuts advocated by great masters. But we must stress it strongly that IT MUST BE AN OPTION AND NOT A ROUTINE. I believe that consideration of the following case will help in explaining my view clearly.

Case:
Mrs KM, aged 53, was seen on 7/7/97. She was a relative of a reputed Ayurvedic Physician, who had done his best to control the diseases she had. Why only control was aimed at? Simply because it was well-documented recognition of ancient and modern science that each of her diagnoses is INCURABLE. She was a case of Hypertension since last 11 years, plus Diabetes since 6 yrs. and hyperacidity since a long time. For approximately one year she was also having Psoriasis. So you will also appreciate the logic of control. Thinking in terms of modern medicine, she was best controlled so far as hyperacidity, hypertension and diabetes were concerned but failure to control Psoriasis brought her under Homoeopathic treatment.

First let us be clear as to what control should mean. Disease progress stopped or at least slowed down i.e. there should be no regular need to increase the dose or addition of a new drug or a change to more effective drug, and known complications of diagnosed condition should not develop or their development is retarded. Keeping this idea in mind the case under consideration was really well controlled but in terms of our approach the patient as a whole was deteriorating in health with addition of diseases; the disease was progressing invisibly. To put it more clearly we can say disease was progressing under five star supervision of modern therapeutic skill.

We Homoeopaths do not diagnose diseases and treat brands but we diagnose a patient as an individual to find his symptomatic match in an individual drug. So far as brand hyperacidity is concerned it will have some common presentation in the form of heartburn, waterbrash, abdominal or thoracic discomfort, change in appetite, flatulence etc and recording these common symptoms does not serve the purpose of case taking or finding the curative remedy. This is equally true of any other diagnosis as well. So Hahnemann rightly and emphatically advised to observe the disposition of the patient. This is the PURPOSE of case taking so that we can individualize our patient a, b c +- conditions knowing the perceptions and performance of both the schools will help everyone to choose the best.

She initially told about her psoriasis, and showed the lesions on head, hands, breasts and buttocks and associated itching, burning, and bleeding with expressions suggesting her suffering and tension. On further inquiry, she revealed Hyperacidity, hypertension, diabetes and headache. She then told about her tensions, a young widowed daughter, whose remarriage is to be arranged, and husband's cardiac problems; about her irritability and her desire to keep quiet. All the while her face was telling about her dislike for my interrogation. When I asked about her expectation she said "Please stop this itching and burning at the earliest. I am fed up." 
Here I stopped digging, as the picture was clear to select her wonder drug: her individualistic features were her monosyllable speech, irritability and taciturnity.

Rubrics:
Quiet, wants to be.
Anxiety about others and
Reasonableness of her objective.
To stop her itching and burning in light of her knowledge about incurability of Psoriasis is a reasonable objective, which indicated in favour of Ars-alb....

The objective of this case, as in others, is to emphasize unprejudiced case taking and an attempt to use our skills in the best of interests of the patient. So diagnosis cannot decide curability of patient but from analysis we can be optimistic.

On 7 July 1997 she received a single dose of Ars-alb 200 and she was asked to stop antihypertensives and to continue diabetic diet which included Tab Glucomap 1 B D and second wonder drug S L one dose daily.

During follow up on 21/7/98, patient seemed at ease and reported slight relief in itching and burning & requested speeding up her recovery.
Here she willingly told about her intolerance to heat so much so, that she feels hot by merely looking at the sunlight!

We all know this to be against the important PHSYICAL GENERAL of Ars-alb. Kent in his Lesser Writings upon the USE OF THE REPERTORY indicates priority of mentals when he says there is no need to write out the remedies not in the mental group. From his teaching we know that the direction of cure from centre to periphery is expressed mostly on face and this patient has shown general improvement so I neglected the heat and continued with S.L. Asked her to stop Tab Glucomap and bring fresh blood sugar reports.

11/8/97: Better acidity, headache, mood, itching, and burning, but request for speedy relief was still there. The tests revealed blood sugar [F] 205 mg% and [PP] 260 mg % but rise in blood sugar was expected form withdrawal of Glucomap S.L.
Till December she continued to improve steadily with occasional AGG of itching and burning but better in disposition and sleep. Acidity, headache and hypertension were not the problems. She had an abscess near [R] ankle that was associated with fever and pain, which burst open on day 5 and was allowed to discharge without medicine. Her blood sugar was within normal limits even after diet schedule. Thereafter patient gradually became careless about medicine but continued to come and receive SL till 13th May 1998, when skin was spotless, blood sugar F 139 mg% and PP 175 mg%.

This case is specially selected for Keynote issue to remind the IMPORTANCE OF MIND above all other symptoms [including physical keynotes] and simplicity of management including due waiting for second prescription. So what a beginner should learn is to believe in simplicity of our pathy. And, more importantly, to put it in practice. It also evaluates diagnosis, as it has no influence on selection of similimum. Even if this patient had had piles, eczema or migraine she would require Ars-alb and you could have prescribed it equally effectively.