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Case Study

My Approach Towards Repertorisation
Dr Rama Marathe
'Nat-c / Lyco

I still remember the day when I was a proud recipient of GCEH. I had topped the list. My father insisted that I should practice Homoeopathy exclusively. I was in love with Homoeopathy because of its principles-principles like the Holistic approach, treating the person as a whole and not the disease, etc. At the same time, I was worried and tense because I had yet to master the art. Repertorisation was a time consuming and laborious job, especially without computers. But individualization was almost impossible without it. I was searching for an easy way out. 

Then some years ago, I bought a computer and Lamnia Hom software. Now Repertorisation was fun. I got addicted to playing with the repertory. Not only did it make my work easy, but whenever I had free time. I used to browse through the different symptoms, remedies selected, their relationships with each other, etc.
From the beginning, I have been using the classical method of Repertorisation. And when I get an good symptomatology form a sensitive and intelligent patient, I feel that Kent's Repertory is the best. 

Sometimes, it is difficult to get the characteristic symptoms especially in chronic conditions or with advanced pathology. Here, what we get is nosological diagnosis and common symptoms. Sometimes, it so happens that with classical Repertorisation, only polychrest remedies float up. 

In such conditions, one has to take the help of clinical repertories.
I do not restrict myself to any particular repertory or method of repertorization. Since every repertory and method has its own advantages and limitations, I select the repertory and method of repertorization suitable for a specific case according to the symptoms available and selected. Sometimes I even refer to various repertories for a single patient.
I make it a point to carry the result of repertorization to Materia Medica. I take the help of books, which are like clinical repertories. This confirms remedial diagnosis.
To bring out an ideal cure, relationship of remedies, duration of action, needed effect at that moment, aim of selection, coverage of pathogenecity, of nosological diagnosis etc are considered. 

To check out the repertorization, four perspectives of treatment are considered:
1. Main remedy
2. Accessory remedy
3. Constitutional and Intercurrent remedy.
Working in this fashion for many years I chanced upon some novel and special ways of using repertories for eg.:

·         Forming a small clinical repertory for specific conditions

·         Coining the most characteristic rubrics and trying to find them in the available repertory.


Formation Of Small Clinical Repertory
With rapid advances in clinical knowledge and disease diagnosis, newer and newer data is available. Repertories, which were compiled long ago, may not have the exact rubric or disease signs. For eg. Secondary Lactose intolerance is a relatively new entity, of which hardly any mention is found in Materia Medica or Repertory. 

Hence considering all characteristic symptoms of important disease, a small clinical repertory is formed with the help of computer. ADVANTAGES of this Repertory are:
a] It makes prescription easy
b] Remedies covering major, important and particular symptoms are known.
c] Study of these remedies regarding sphere of action, type of action, concomitants, modalities, relations with each other, gives a bird's eye view of the disease and remedial options.
d] With this type of prior knowledge individualization becomes easy and correct. Of course principles of Homoeopathy are followed strictly in all remedial diagnosis. 

Let me make this point clear with one example:
A leading Pediatrician referred Baba G N, aged 11 months, to me for diarrhoea, not responding to treatment. On admission, the child was severely dehydrated. IV fluids were started on an emergency basis and later history taken in detail. He had had diarrhoea for the previous 5 days. 

Stools: frequent, every half an hour or so. Large, watery, yellow with gas, projectile in nature with characteristic sour smell.
His mother asked me "Doctor with IV Fluids the child is better, but as soon as I give him little milk, explosive diarrhoea starts". With this diarrhoea he has become weak and cranky and nothing pleases him. He used to love music, but now hates it. 

On Examination
Weight - 6.750 kg
Dehydration - Gr III
Abdomen -gaseous distension
Stool report-no pus cells. Reducing substance present [+++]
Diagnosis - Secondary lactose intolerance. Construction of clinical repertory, covering symptoms peculiar to Lactose Intolerance, Nat-carb stands very high and in this particular case it also covers two important mental symptoms:
KENT: MIND sensitive to music [78] Nat-carb, Nux-vom.
KENT: MIND sensitive to noise [79] Nat-carb-2 points
KENT: RECTUM: diarrhoea, [614] Calc, Mag-m, Nat-a, Nat-carb
KENT: STOOL: Frequent [637] Nat-carb
1 mark
KENT: STOOL: Forcible, sudden, gushing [637] Nat-carb 1 mark
KENT: STOOL: Forcible, sudden, gushing [637] Crot, T Elat, GratJatr, Nat-c, Nat-m, Verat.
KENT: STOOL: watery, yellow [643]
KENT: STOOL: odour, acid [sour] [640]
Nat-c 2 marks.
Repertorial analysis showed
Phos 21/10
Calc 22/9
Nat-c 20/9
Sepia 20/9
Cham-ars 18/9
Sulph 17/8

Study of MM showed that although Phos carries highest marks it misses the important symptom ie Diarrhoea, milk after.... and patient did not belong to Calc group. Nat-carb 6 was prescribed every ½ hr on these two clear indications. Within 36-hrs patient improved significantly by way of reduction in quantity of stools, disappearance of sour smell and better hydration. But the frequency persisted. Perineal area had become raw, red and painful with multiple ulcers around anus. The Child cried during and after passing motions. Nit-acid was given as indicated. Locally hot water fomentation along with Calendula application was advised. Patient improved very well thereafter. He was put on milk diet gradually on 6th day, till then he was on MRD ie rice kanji, ORS, dal water, rawa kheer, khichdi etc. 
Underweight and restless child, with past history of repeated loose motions, and tendency for respiratory infections Ars-alb 200 was prescribed as constitutional remedy. Bacillinum 200 was prescribed as intercurrent remedy.