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Case Study

The Value Of Repertorisation In Practice
Dr Yogesh R Vashan

The various components of totality of case taking, Organon, Materia Medica, and Repertory are interlinked hence it is impractical to discuss one in isolation of others. 

As newer medicines were proved, it became increasingly difficult to memorise symptoms. The repertory came into use to aid the prescriber. They brought about a better understanding of the various components of the totality, as well as the parts of the symptom ie location, sensation, modality, extension etc. Repertories also highlighted the incompleteness of the vast number of symptoms of the MM, Boeninghausen was the first to scientifically describe and overcome this hurdle by his doctrine of analogy. His method entailed a numerical construction of totality. Later Kent, building upon Boenninghausen's concept but highlighting the extreme specificity came up with his Repertory, which has stood the test of time and formed the basis of all future repertories. 

All in all the limitations are fewer than the advantages.. Repertorisation has been blamed for giving the same drugs over and again. The fault lies not in the repertory but the incorrect use of this valuable tool. To overcome this, one must do a prior work up on the case, the most essential steps being a thorough case taking, accurate analysis and evaluation to collect the most important elements of the case along with an understanding of the construction of the repertory to be used. Last but not the least the final selection comes after the appropriate references from the Materia Medica the proving records. 

A repertory forms a bridge between the Materia Medica and the patient. The classic examples by Dr E B Nash highlight the value of repertory. Nash had a case of severe autumnal dysentery where the usual medicines like Acon, Ipec, Nux -vomica, Merc,Sulph, etc did not help. The patient had one characteristic symptom: Nausea eminently AGG by smell of food." He started reading stomach symptoms beginning with Aconite and found the symptom under Colchicum. One can imagine what would be the plight of the physician if the remedies have to be found in this way for most of the patients, if he has to consult various Materia Medica of which no single one is complete. 

The following case is but one sample in my practice where the repertory proved indispensable. 

Case: Forty eight-year-old lady came with a complaint of fever, the three classical chill, heat and sweat stages were noted. She had already received anti malarial and anti typhoid line of treatment from her G.P without benefit. Now each subsequent paroxysm was worse than the earlier one. The characteristic feature of chill is the time of occurrence ie 10.30 -11 am. The fever touches 103 ~ maximally.
The other complaints were as follows:
a] Cervical spondylitis pains, bilaterally
b] Head pain from the temples to the occiput < 2 11 am
c] Ankle pain since her last pregnancy
d] Distention of abdomen with the constant sensation of being pregnant [test negative] due to movements felt inside.

The two marked generals were her craving for sweets 2, salted cashew nuts 2, sweet-lime2, ice-creams2 and especially bitter things3. Thermally chilly since the fever began; otherwise she is markedly a hot patient. 

Her sleep is easily disturbed by noise and she always wakes up early 4.30 pm with an urge for stools since one year. 

Her life has been very good as far as family, children and finances are concerned. Still constantly feels that her husband might leave her. The husband works on a ship and is away for three months at a stretch followed by three months at home and the cycle keeps repeating thus. She knows her fear is baseless as the husband is very loving, honest and God-fearing but her feeling still persists. Even her dreams constantly reflect this theme. She loves to be alone in the house [children are grown up and work abroad] because then she can sing or listen to music. When young, she was an excellent athlete and a classical dancer. She loves horror films and detective stories. She gets offended very easily and describes herself as hot headed. People consider her as a soft-spoken person because she does not show her anger easily. She wants to look smart so she exercises regularly even at this age. She takes a lot of effort to dress up well. She does all this, just for her husband. She is well known for her desire for absolute cleanliness. 

Her dreams are recurrent and almost always about,
1] Her husband deserting her
2] She is bathing and suddenly realises that the roof and the walls of the bathroom are missing. Everyone is watching her which makes her feel extremely embarrassed and exposed.

The sensitivity at the level of mind exhibited by her feeling offended easily. Her desire to be alone and sensitivity to music and uncleanness coupled with her craving for bitter things and the time modality of chill [10 to 11 am]
- all pointed to Nat-mur the constantly false feeling of being neglected by husband is also covered by Nat-mur.
The drug given did not have the desired effect and the fever though low key [101 degrees F] persisted even 4 days after repetition.
At this juncture I took recourse to the repertory and started looking for the other features of the case. The dreams of being exposed, the sensation of movements in Abdomen [SS -697] along with early morning diarrhoea pointed to 

Natrum-Sulphuricum : The feeling of delusion being naked which was the most peculiar and characteristic feature of case unlocked the case. This is in addition by George Vithaulkas vide Jan Scholten Pg 84. The patient improved on all levels dramatically with a single dose of 200 potency. This case illustrates how one should avoid prescribing on fixed remedy images and should resort to the bridge between vast Materia Medica, repertory and the patient.

The repertory has guided me to think of other remedies in many other cases where the seemingly indicated medicines appeared to be a strong match. It may not lead to the similimum, but gives suggestions, which after proper references from the Materia Medica help us to arrive at the similimum. The repertory thus provides a compass to drive safely through the vast ocean of the Materia Medica.