Author: Rajan Sankaran
The Evolution of Sensation: A Synergistic Approach In Homoeopathic Practice
By: Dr. Rajan Sankaran
head, ‘the other song: international academy of advanced homoeopathy’
The Sensation Method is of vital importance to homeopathic practice but we cannot abandon our original tools like the repertory and materia medica – we must integrate them all to form a whole. The result of this integration has been greatly beneficial to many, many patients.
Thus, the current development of Synergy is not as a regression, but an evolution and strengthening of the Sensation Method. At times, the Sensation Method has potential to be ungrounded and when this occurs, the repertory and symptoms help to ground it even more, and helps remedy prescription.
It is important to realize that Sensation is an integral part of Synergy - without Sensation, there would be no Synergy. Synergy brings people together from all schools of thought, even making believers of those who previously omitted the Sensation Method. Synergy is representative of the unity and solidarity amongst all homeopaths.
While utilizing in depth knowledge in fundamental and traditional tools of homoeopathy like the Materia Medica, Repertory, and the Organon, the Synergy method also values the newer approaches like Sensation, Kingdom, Miasm and Source understanding.
This is a system that is unique – its design can be taught, practiced, and replicated successfully by students and practitioners. This method has brought together both the old and the new approaches in homoeopathy – it has established a universal platform where all approaches in homoeopathy are welcomed and used to aid in the patient’s recovery.
This synergistic approach to studying cases allows us to study a case from three different angles:
1. Symptoms (Local and general)
2. System and Source (Kingdom and subkingdom)
3. Genius (General traits, pace, modalities and nature)
Symptoms include the traditional use of rubrics, keynotes, characteristics, and clinical symptoms. The System includes the newer approaches such as kingdom, sensation and miasm. Finally, the Genius is the common strain or character that runs through every aspect of the case. When looking at these three sides, matching the qualities of the patient to the remedy must always be in the backdrop.
To best understand the nuances of each case, one must study it from all angles and aspects. The goal is to integrate the older and more traditional ways of studying cases with the newer and more contemporary approach in order to get an all-encompassing view.
Looking at a case from many perspectives, you come to a place where everything speaks a similar language. You can then be sure of your knowledge and confidently apply that understanding to the patients.
The Anchor is a tool utilized along side the other three areas and emphasizes the application of complete symptoms (location, sensation, modality, concomitant) along with the very characteristic, sure symptoms to create a reliable repertorization graph, which is free of interpretation or bias. The anchor is the first, clear, sure, definite, concrete thing we see in the case. The primary characteristic of the anchor is that it must be clear and sure. Even more central to this is the degree to which this symptom is unconditional in the patient - the more individual it is, the more dependable it gets. An anchor is a solid and dependable characteristic that goes beyond interpretation. The anchor can come from any aspect of the case, including the pathology, miasm, kingdom/subkingdom, characteristic symptom or rubric.
When trying to understand a patient there must be a solid grasp of the area that is most obvious in that case. It may be the Genius, the Symptoms, the System or the Anchor. By following this clear and definite lead, the other areas will also become evident. It is important to note that in cases sometimes the Symptoms are clear, or the Genius is clear, or the System is clear – however, in order for a successful prescription, all must be reconstructed and utilized in the same way.
When utilizing the idea of “Synergy”, all three sides (Genius, Symptom and System) plus the use of the Anchor tool, must be included in prescription, and ultimately each one will reach the same conclusion and remedy that matches the patient.
Case of Bronchial Asthma and Uticaria
[This case transcript has been summarized for publishing purposes; D = Doctor, P = Patient]
Patient Details: Female, age 40
D: Tell me please, what is the problem?
P: It started with the throat 3-4 years back. I had an infection in my throat, continuous since then, and discharge comes from my left nostril. Last year in July I had a bronchitis attack. In June I was expecting. In December again I got an attack and I had to be hospitalized for 3-4 days. After that I delivered my baby in February. Also, now I have this urticarial thing, which has started, small red patches. It goes to the full body, and I get full body itching. There is also a burning sensation there, sometimes face and lips also swell, since January. Sometimes my lips swell up since the last 6 months. I am also taking medicine from your student for 3 months, but it is still continuing. Bronchitis and breathing problems are what I also have. I am taking Senega. It increases in at 2pm in the afternoon and I am up all night until I take my inhaler. I had this nose congestion problem also. I was operated for a fibroid in December 2008, a missed abortion happened and antibiotics were given at that time. This problem started in 2002 when we moved, the problem started the very first day we went there.
D: From where did you all move?
P: From Goa, the very 1st day the problem started. It was a little there, but now the problem of choking of the throat, but it has increased in the last 3-4 years, there is very severe problem. I always swallow. There is also nasal congestion. In the chest also, the breathing problem started after that, in afternoon increases in afternoon and I feel heavy in the chest. Also coughing is there, night when I lie down, I have to take out congestion at least 2-3 times. Then I sleep. The congestion has been there for 3-4 years and these red patches start in the evening and increases in the night, but it decreases after bath. In the morning, it is little there, but night its horrible – from 1-2 am. When my lips and face get swollen, I become very restless. Sometimes I am not able to breathe also. Initially they were daily but now the eruptions have gone because the doctor changed the medicine, but since then my breathing problem have increased particularly at 2 in the afternoon. If the rashes go, then the breathing problem starts. If rashes go then breathing starts, that’s what I have observed.
Commentary: What one has to look for from this point is for characteristic symptoms. Her most important and main characteristic from this dialogue would have to be her symptom of uticaria alternating with breathing problems and asthma. We can look in the repertory in the chapter Skin to find a matching rubric. In the repertory, the following rubric is a summary of this symptom, SKIN; ERUPTIONS; uticaria alternating with asthma.
This is a characteristic and sure symptom, one that is not left for interpretation and is very clear. When we look at this rubric, we see that there are only 4 remedies – Apis, Caladium, Croton tig and Graphites. This is her main symptom and it is very characteristic so if we can find a remedy that has this symptom, then there can be sureity. Of course, since this rubric has only 4 remedies, one must look elsewhere in the repertory to find a better representation.
We can also investigate other similar rubrics such as RESPIRATION; Asthmatic alternating with eruptions. Again, we have remedies like Apis, Graphites, Croton tig, and Caladium in this rubric. Either rubric we decide to select will represent the strange, rare and very characteristic symptom in this patient.
This symptom can be our first symptom in the Symptom part of the Synergy triangle. We can also consider this as the Genius and Anchor of the patient –thus, we have to find a remedy that has this exact symptom as its main idea and match it with the patient.
D: When the rashes come the breathing gets better?
P: Yes but last week both things were there suddenly at 2-3 in night.
D: When you get the rashes, what helps?
P: Nothing actually I sit, nothing actually. I sit at one spot and then I come out of it. I can’t shout also, I can’t speak loud also, or else I choke. Looks like it’s because of weather. The urticarial type of infection was more there.
D: Tell me of more symptoms. Are there any other complaints?
P: I cannot sit in a/c, and I work in an office with a/c. I get suffocation more discharge. My nose runs from the a/c, and the discharge is thick. It is not yellow, but not runny, it is transparent. I also got worse after I moved from Goa to Mumbai.
Commentary: The second very strong symptom in her case is her aggravation by change of weather – particularly the aggravation in damp weather. The patient had moved from Goa to Dehli (both dry places) to Mumbai, where the weather is much more damp. In this dampness her symptoms aggravate, like her nasal discharge and pains.
For this symptom we can look in the repertory in the generals chapter. We can look at the rubric GENERALITIES; WEATHER; damp weather agg.
This second rubric can also be used to contribute to the Symptom part of the triangle.
D: What dreams do you get?
P: Actually I dream of the daily work I do. Earlier I used to have dreams of small babies. In childhood before results I used to get dreams that I was failing. I used to always stand 1st. I never had frightful dreams but if I was in a deep sleep and someone woke me I would get up suddenly. I am fond of sleeping and eating, if I am hungry I become restless. I sleep soundly. I get restless, so I have to eat. Nowadays I get a dream, and I am giving an exam, I am in a classroom and giving exam, lectures. Even my husband says I like to eat and that I like to sleep. I always have to call my husband if I am feeling anxiety or tension. I need to talk to him when I feel this way – and I feel better when I talk to her.
Commentary: The third most interesting thing in the case comes from her description of herself that is confirmed by her husband. The patient says she likes to sleep and eat – the husband agrees. This is representative of the phase in life where the patient is – she is like a baby, she likes to sleep and eat and she is very dependent on her husband. She said that she only likes to talk to him and said that he is only who does everything for her, so there is a very strong dependence seen.
This symptom fits into the System part of the Synergy triangle – it is more based on kingdom. Here, we see that the mineral kingdom is well represented – she is very dependent on her husband for everything, and it is evident that although she is an adult, she is stuck at a very early developmental stage (baby-like).
D: Exams meaning…what are you feeling? Is it like you are not prepared?
P: I used to get cold palms, and little bit sweat.
D: What was the fear like?
P: What type of question will come, because I wanted to get good marks. I wanted to become something better in life. Because I was career oriented. I cannot sit idle, I am always doing something, maybe a computer course, I am doing a Vastu course now, so I always keep busy. I get interested in it and then I want to keep enhancing my skills. I left my office 3-4 years ago, because my baby was small. I always want to do these things because I become very restless. Some fear is there, that if I sit and don't update myself, then everybody will go ahead, and they will do better than me.
Commentary: Also note that in the case there is an apparent kind of restlessness. She cannot sit in one place, she must move. There is a rubric in the repertory in the mind section that represents her restlessness: MIND; FIDGETY; she must be occupied, cannot sit in one place. We can also look at the rubric, MIND; FIDGETY; work at.
This is an important mind symptom which we can take apart of the Symptom part of the triangle.
D: If you don’t update, then what will you feel in this situation?
P: Depressed and wanting to cry. If I am busy then I am ok. When I leave the office and am alone, I call my husband. Until I do this, I don't feel better. I need someone to share my feelings with during that time. I feel better when I cry and when I tell my husband. Now when I cry that discharge comes, so I always start coughing, it becomes difficult, and it started 3-4 months back.
D: What are the things that make you very tensed or nervous? In which situation you get tensed and nervous?
P: If am going for an interview, before and after I am ok. Or, if I am doing something for the 1st time, I don’t have knowledge of subject. Speaking in public makes me nervous a little. Once I become comfortable I am okay. If the person I don't like comes in contact with me I get tense.
D: Anything more about your nature?
P: If I rely on the person, then I trust the person very well, but if I don't like them then I will not even meet them, I refuse. I make a picture of person and do not change my mind. I have a fear if I meet then I will feel bad. From inside I don’t feel comfortable, heart beats fast, hands and soles get cold, I get sweat on my nose and chin.
D: What is the fear of at that time?
P: The fear is that they will hurt me basically. I won’t feel comfortable with that person, that environment. I am in tension. The opposite is that I get relaxed, my hands are not cold and heart beat normal. I have a peaceful mind. The opposite is having everything coming in my mind. When I am alone this happens. I want to be busy, and I want to divert my mind.
D: Tell me about this, I want to be busy?
P: When I am not busy I think about negative things I don’t like. I get tension, I don’t feel nice, so I call my husband and mother for emotional support. They tell me you should do this and that.
D: What is emotional support?
P: Emotional support means they will usually give suggestions. They console me and say things like you are home because of baby. I already know this and I want to be consoled. They tell me that you can study something, even though I know this too but I need to be consoled.
D: What is the experience to be consoled?
P: I feel, good actually. That somebody is there, and I am not alone. It’s a good support. Actually, good emotional support.
D: What is the experience of this support, how does it feel inside you? What is the sensation?
P: Breathing is normal. Hands and soles are all normal knowing that I have started work.
Commentary: Again, we see here her main modalities include being ameliorated by support and consolation, in addition to amelioration from expressing herself.
We also notice that she re-iterates her desire to keep busy or diverted and from this we can conclude that this restlessness comes in more than one area in the case and can be taken in repertorization.
D: What are the situations in your life earlier that caused a lot of stress in your life?
P: My education, studies, exams, and after marriage sometimes financial, kids too.
D: Generally how are you at taking decisions?
P: Taking decisions are difficult. I discuss always with my husband because I feel I will make the wrong decision. All the time I am in 2 options that maybe this is right, and maybe it is not. This happens for small things, because when we wanted to buy house 8 years back, I had taken the decision that we will buy it and pay off loans. I can take that kind of decisions, but not on small things.
P: What is related to me, then. For example my career like my second baby, but we were thinking for long. Maybe when the decisions are related to me, if it affects me personally then I have a fear.
D: What is the fear?
P: I have a fear of the future. I have fear about my children, their future, and what it will be like for us economically.
D: What are your interest and hobbies?
P: Right now I am reading astrology, whenever I read I go deep when I am sitting I don’t like to leave it. Before I used to play table tennis, badminton, even running. In childhood I used to do physical activity more, in 11th grade I wanted to go to join the army because I was tom boyish, so I wanted to be an officer. I see mom making chappati (Indian bread), and so I told my mom I don’t want to make chappati. I feel girls can do everything. I feel confident and the opposite is feeling down low, depressed and low key.
Commentary: What is also interesting is that there are two sides of this patient. One is a fantasy side, the girl who is able to do everything, a girl who can go out, a girl who can be in army. This is her fantasy and the opposite of that is what she really is. She is very under confident, always needing somebody, and wanting support. This is her inner state but her fantasy is being in the army.
D: Tell me what earlier skin problems have you had? Does the skin dry anytime? Cracks?
P: I am sensitive to the sun and get rashes, no other things. Sometimes. I also have cracks in my feet.
D: How do you react to sudden sound?
P: I do not like it.
D: What about climate?
P: In terms of climate, dry is better. I get a headache if I am in sun for an hour, not very severe. Earlier I was comfortable in cold weather, when I was in Gwalior and in Goa I used to like winter but since I have come to Bombay can’t tolerate it.
D: Do you like windows open or closed?
P: Open, or else I feel suffocated. That the breathing problem, in hands I also feel some heaviness is there, so when I open the windows I feel better.
Commentary: When we examine the System part of the triangle in this case when we see the exact opposite of her fantasy, we understand there are many carbon symptoms.
Carbon symptoms include the startling from noise, startling when waken from sleep, the suffocation inside the closed room and desire for open air. We also see an affinity for the skin in this area.
These are also specific symptoms of the remedy Graphites, which is apart of the Carbon group of remedies.
D: Does this cough and urticarial disease disturb you very much?
P: Yeah it makes me upset. I feel it should not come again and I wish to get better. My eyesight is also weak.
D: Generally your mood remains good?
P: After marriage I have been more tense, earlier I was very cheerful. When I am alone, I feel depressed. I want to discuss something with somebody.
D: What are the things that you like to eat?
P: Salty. I like dahiwada (yogurt and dumpling Indian specialty food).
Commentary and Important Observations: The patient was a female of age 40. However, what was most characteristic was that she brought her husband with her into the consultation room. She would want to make him say everything and would probe her husband to say more. Halfway through the case taking I even tried to stop him from talking, but she kept on encouraging him to talk about her. In my understanding, this in itself is very strange – she is quite old for doing this and it shows her obvious dependency on her husband.
By utilizing a balanced, structured and synergistic approach where a triangulation between Genius, Symptoms and System occurs, it will lead not only to great depth of results but to highly consistent prescribing.
In this case, all of the symptoms that were established were sure, clear and exact. Most importantly, they were characteristic to the patient – which meant we had to have a remedy that matches these characteristics.
The following rubrics were selected for this case:
1. RESPIRATION; Asthmatic alternating with eruptions
2. RESPIRATION; DIFFICULT
3. SKIN; ERUPTIONS; uticaria alternating with asthma
4. GENERALITIES; AIR; open; amel.
5. GENERALITIES; AIR; open; desire
6. GENERALITIES; WEATHER; damp weather agg.
7. MIND; FIDGETY; work at
8. MIND; FIDGETY; she must be occupied, cannot sit in one place
9. MIND; IRRESOLUTION, indecision
10. MIND; NOISE; agg.
11. MIND; SENSITIVE; oversensitive; noise, to
12. MIND; STARTING; startled; sleep, during
If we examine the Symptoms of the case we see that there are many characteristic general, particular, physical and mind symptoms that can be reproduced in the form of rubrics from the repertory.
From the System point of view we can see the kingdom quite clearly. The patient fits into the mineral kingdom where there is lots of dependence, need for constant support, and development is in the early stages.
When we look at the particular themes of the Carbon family, we see themes of dependency, wanting and valuing the opinions of others, a sense of childishness and smallness, irresolution, and skin problems. These people do not want to enter the world. They want to find a way to escape from their environment because it is difficult to cope. There is a great dependency and desire for support.
Graphites is a fundamental carbon remedy. The keynote symptom in Graphites is irresolution. They will ask others opinions before acting. In this case, the patient depended heavily on her husband for support. These patients also cannot deal with a crisis or new situation and often develop tremendous anxiety and panic attacks.
Follow-Up After 10 months
D: How are you doing?
P: I am much, much better than I was since the first time I came in September but the same congestion is there. The nasal congestion is still there – again discharge comes out at any time, about 4-5 times a day. My throat is better than before and the chest pain is only once a month. It’s very little actually. The only thing was that the feeling was there that it will happen but no it did not happen. It isn’t acute, and the frequency is also reduced.
D: Frequency is reduced?
P: Yes. Even for my chest pain and cervical pain. Some nasal congestion is there and it is not going away. The discharge is white and not very yellowish. It is a white color. However, my coughing has not been present. The frequency of the chest pain has now reduced, it only comes once a month but even if it comes, it is very little.
D: How is your sleep?
P: Sleep is good now. Energy wise I am also much better. I am feeling like the same energy as I had before actually. Emotions wise I am also much, much better now. I am not feeling discomfort and now I am also busy with my work.
D: You have started to work?
P: Actually in the morning I used to go teach at a school as a visiting faculty I have joined there but for only 3-4 hours in morning time. My son is in a play group too, and when I am busy, it is the only time which is comfortable for me. I am not crying and I am not feeling like tears. Now I am not feeling alone or something like that. I am very much busy in my work, and I am not crying also nowadays. I am feeling good. I used to cry because there was lots of responsibility. My baby son was there and my daughter is also there so it was lots of responsibility. Sometimes I felt that I am alone, but now that is not there.
D: What is that when you were alone you couldn’t manage, how is the feeling that now?
P: Now I can manage. I feel, no I can manage so I am managing actually. I even am not tensed about issues in my family. There is also no fear actually. Only when the family comes who I don't know I get a little fear. I get a fear like something will happen.
D: So how is this fear now? Is it same, it is more, it is less, how would you see that?
P: So now, there is no fear so I am okay. Eventually they will come, so I don't know. Maybe I will feel much better. Anxiety levels are better than before, so much better.
Overall, I say I am 80% better.
In most cases, it is vital to integrate the old and new approaches in homeopathy together – use both System and Symptom. The System will give the crux and the Symptom(s) will give you the hard facts, the inarguable data. Suppose you come through rubrics and repertorizing to the remedy, you then have to see is that the sensation and the experience also matches, and vice versa.
The Synergy approach to homeopathic case-taking provides a much needed integration and unification between the old schools of thought and the new. The advantages of this approach are that it is highly reproducible and provides homeopaths with a newfound confidence in their clinical practice.
Further explanation with cases illustrating this idea can be found in my latest book: The Synergy in Homoeopathy, published by Homoeopathic Medical Publishers (www.rajansankaran.com). I also strongly recommend learning to use this approach through observation of good practitioners taking cases. This is possible at the other song academy in Mumbai, India (www.theothersong.com).