January 2014

The synergistic approach in homoeopathic practice

by Rajan Sankaran, Sneha Thakkar, Rishi Vyas

A contemporary approach in homoeopathy, termed Synergy, has evolved over the last thirty years. It has proved to be advantageous when utilized in homoeopathic practice, and is overall a clinically successful method. While utilizing the fundamental and traditional tools of homoeopathy, such as the Materia Medica, the Repertory, and the Organon, the Synergy method also values the newer approaches, such as 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 triangle figure represents the Synergy concept in homoeopathy.

                                                                                                                          synergy

The peak of the triangle is the Genius. Genius here means the prevailing spirit or distinctive character of something – this applies to the patient and also to the remedy, as coined by Dr. C.M. Boger. In the preface to Boger’s Synoptic Key, he states: “The strain which runs through every pathogenetic symptom complex has been called the genius of the drug.” The first few lines about each remedy in Boger’s Synoptic Key usually give a very good idea of the remedy’s genius. This general quality of the patient and of the remedy has also been called, by various authors in homoeopathy, the essence, keynote, soul, red line, or the grand generals.

GENIUS

                                                                                                                      genius

The sides of the triangle, Symptoms and System, complement each other, and when they are used together the best results ensue. Symptoms include the use of rubrics, structured repertorization, keynotes, provings, characteristics, and clinical symptoms. The System includes kingdom, sensation and miasm.

When the System areas are used synergistically and in complete unison with traditional methods of analysis, the view of the case and of the remedy is widened. This allows for the greatest understanding of what is to be cured in disease, and what is curative in a remedy.

The Anchor is a tool utilized alongside the Synergy Triangle 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.

When utilizing the idea of “Synergy”, all three sides of the triangle (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.

Each side of the Synergy Triangle and other additional tools will be examined further with representative figures. 

When looking at the Genius of remedies, the Genius of the patient and of the remedy must always be in the backdrop when trying to match the two together. Some examples:

–        Baryta carbonicum – slow development, torpid, dwarfish, early senility, scrophula, vascular softening, takes cold easily, slow, inept and backward.

–        Stannum – extreme weakness, paralytic heaviness, profuse mucus secretions

–        Cuprum – intermittent, spasms, cramps, jerking, violence, nerves affected

–        Ignatia– erratic, spasmodic effects, twitches, jerks, hysteria, oversensitive

–        Helleborus – dark, dusky remedy, dark face, sooty nostrils, dark lips, hands etc.

–        Plumbum– slow, insidious processes, having violent side symptoms, often of a very changeable or incoherent character, coming in single parts.

–        Stramonium – remedy of terrors but lacking in pain, with suppressed excretions, passing neither urine or stool, dreads darkness, horror of glistening objects, fearful, desires company or escape.  Further, if we look at the fright and terror of Stramonium, it is there in the system understanding, in the symptoms, and in the genius. It is centre part of all three.

SYSTEM

                                                                                                         system

The System side of the triangle includes many piece of the patient. The System of the patient can lead to Kingdoms, Sensation, Miasm, or Source.

When we examine the System area in a given case, it is a Right Brain Experience. This is the artistic side, creative, holistic, concepts, and perception.

SYMPTOM

                                                                                                         Symtom

When talking about the Symptom side of the triangle, Rubrics and Structured Repertorization, Materia Medica, Keynotes, Provings, Characteristics, and Clinical Symptoms are critical to prescription.
When investigating the Symptom area in a patient, it is a Left Brain Experience, which is the side of science, analytic, math, logic, and grammar.

                                                                                                           generals

The key to success is flexibility and keen observation skills. In any given case there can be very clearly marked Symptoms and rubrics. Sometimes in a given case there can be a very clear System or sensation – homoeopaths must be able to delineate betweenthese, yet merge all together to ensure they each come to the same conclusion. This is the art of case-taking, and therefore will allow the homeopath to see that no matter which area the case starts in, the other areas must follow closely behind (Genius, Symptoms or System).

THE ANCHOR

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, as illustrated below.

                                                                                                            anchor

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.

Conclusion

I believe that most cases, approximately 90% of them, can be done in 15-20 minutes. The remaining 10% will take little more time. This is because the obvious thing, the most central thing in the case, should be found and investigated. If you have to search and search in a case, then it is not a central focus!

You have to use the old and new things together – use both System and Symptom. The System will give you 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.

My advice is to learn thoroughly and slowly, and this will be good for a new homoeopath. In the following case, you have to think what is central – and now we know that the one string that ran through and through in her case it is fear.

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.

Illustrative Case Example of the Synergistic Approach

Case of Meige’s Syndrome

This is a case of an elderly male patient who came to me with a diagnosis of Meige’s Syndrome. His daughter accompanied him to the appointment because at times, the syndrome made his speech unclear. Medically, this disease causes a spasm in the face (eye and mouth areas). Generally, the only solution or treatment in the allopathic field is using botox.

For this patient in particular, his left side of the eye goes into spasm, he is unable to speak properly, his jaw and tongue goes into spasm, and he has to clench it again and again.

The patient is of a higher class and is known for being a successful and important figure and public speaker in the entertainment industry.

On observation, his feet were constantly moving and he appeared to be restless during the case taking.

D: Tell me please, what is the main problem?

P: I am not able to speak because of this Leigh’s Syndrome. My major problem is eating and speaking. My eyes forcibly close anytime, when talking or at anytime. I have a severe speech problem and I have to exert a lot for speaking. My muscles get stiff. Like I have to speak and I cannot speak, I feel stiffness. I cannot sleep properly because of this either. Also, in the mouth, there is total dryness.

D: One problem is a spasmodic closure of eyes, and then stiffness around mouth that prevents you from pronouncing words?

P: Eating also is a problem. I have to chew, but I am not able to. There is no control of my facial movement. It is not all the time now, but when it started it was continuous. It comes between 12-3 pm and after 6pm-9-10 pm.

D: These two times of the day the problem is more?

P: Particularly more, but it comes anytime.

D: Anything more about this problem? Can you give details?

P: My left side of the eye goes into spasm. It shuts suddenly and I cannot see. I am also unable to speak properly and this bothers me most. My jaw and tongue goes into spasm, and I constantly have this clenching motion.

Commentary: from this point in the case, we know the patient’s diagnosis and pathology. Also, we can look in our repertory for the peculiar characteristics and symptoms that he displays. The rubrics we can examine are in the eye chapter, where the eyes close involuntarily and there is spasmodic and convulsive action.  Also, we should look in the mouth chapter for spasms of the mouth and tongue. We can anchor ourselves on these symptoms because they are concrete, sure, 100% reliable, and not interpreted.

D: Any other symptoms or troubles you have?

P: Just cold and cough. I cannot sit in air conditioning or I cannot sit under a fast fan. The smallest draft of air aggravates me and all of my problems increase.

D: Tell about your cough and cold?

P: In the cold, I have lots of phlegm coming out through my nose.

P2 (Patient’s daughter): Every month he gets a cold and thick discharge comes out from his nose. He even gets fever from this. He cannot go to a cold environment because that makes this condition worse. 

When he is eating, food comes out of his nose. He is famous for his speech but since the disease has started he has gotten worse. Sometimes he has to hold his face and speak. Only we can understand what he says.

Commentary: at this point in the case, we have a strong modality of being aggravated by cold, aggravated by a draft of air and fanning.

D: So his speech becomes indistinct and unclear?

P2: Yes. He cannot enjoy food either and gets embarrassed because he cannot eat properly.

D: You said he is famous for his speech?

P2: He studied in the entertainment industry and he was a good speaker. He even received an award for it.

P: My job was in consulting but now my speech has gone. So now I am in total frustration. This disease harms my work, and in what I am earning. I only earn from my speaking.

D: What is your nature of work?

P: I have to go to actors and directors, convince them about a project, do all the castings, attend and do speeches at many various award functions, and sometimes I even design the whole show.

D: What are the qualities needed?

P: Total knowledge of the industry. Talent. Creativity. Marketing ability. You have to understand the market position and you have to study the marketability. Market research and the capacity to execute everything are important. Talent is definitely needed for this. Also, one should have good relationships and contacts, and be successful at thinking out of the box and planning. For me, every day is a new day at work. I cannot apply a formula of one project to another. I need to design and tailor the program for each project. You need to be able to speak, but now I cannot and that is what I am lacking. My presentation is lacking even though I am an expert. Now, I am losing. I am confident but it still affects me. My daughter is the number one actress in Gujrat. She is taking after me, her father, so she has become quite famous and big. I liked it when people told me that I sounded good and my voice was clear. I liked when they complimented me for my speech. I had to perform in front of so many in the industry and everyone liked my speaking. I felt special when this used to happen to me. Now, I am losing it all.

D: Do you have any dreams?

P: No. I sleep soundly.

D: Were you nervous before this disease, when you spoke?

P: I was very affected, but I was confident, damn confident! I am always ready for a speech. If in any function I was asked to speak instantly and impromptu, I could speak – and I could speak very well. I was unique and an inspiration to many in my field. Now, I have this challenge.

Commentary: from here, we see a glimpse of the System side of the triangle. This is a patient who believes he is someone special, not average. He is longing for good opinion of others, and his whole life he has been a speaker and has had to perform. The patient describes his field and explains that he is creative and must be capable of doing research and planning to be successful. He prides himself on his talent (of public speaking) and he is now losing this talent.

All of these themes can be classified into the Mineral Kingdom, where the patient has achieved so much, but now is lacking or losing his own ability. More specifically, this patient can be put into the fifth row of the Periodic Table, where the common themes include creativity, talent, show, performance, challenge, uniqueness, admiration, ambition, voice, and inspiration.

D: Are there any other physical complaints?

P2: He has had 3 blocks in his heart and has been taking allopathic medicine for 20 years. I have a feeling that the medicine has caused this problem.

D: Do you like singing or not?

P: No. I do not. I do not like dancing, I don't like parties. I am more a homey person.

D: How are you about order?

P: I am very well organized. I am very much disciplined. I like to do everything in a very planned way. I am also very punctual. I am famous for my discipline.

P2: He was very short tempered, but not now. Generally, he is a very soft spoken person but very well spoken. He feels scared at night to drive or walk ever since his eyes forcibly got closed.

D: This problem, it comes and goes, does it?

P: Yes, it is like an attack.

D: What do you like most in food and drink?

P: I eat all food, vegetarian and non-vegetarian. I like fish but I don’t have it now because everyone is vegetarian in my family. So, when I go out for food, I have fish. 

D: Do you like sweets?

P: Yes, I love to have sweets. I used to have it every day, but now, my wife doesn’t give them to me because of my health problems. I also love spicy food but I control this.

Commentary: the food craving is very important in case-taking. It can confirm the remedy we are thinking. In this case in particular, the patient craves sweets and wanted them every day.

D: Your feet remain really restless?

P: Yes, they do.

D: Is there any problem with your voice. Does your voice become hoarse?

P: Yes. My voice often becomes harsh and hoarse because of this problem. I am losing my ability to speak clearly.

D: How was his original speech?

P2: His speech was so clear and so nice. Now he is not speaking his original speech. His voice was like pearls. Every word he spoke was beautiful. People would understand him clearly and could tell it was his voice right away. He loved to perform. He was so famous for his speech and I hear many people in the industry say that his speech was so clear. People say that I have his voice too even, and they appreciate it. He was working all over India, in radio, television and film, and he even was interviewing actors.

Commentary: the theme of speaking, show and performance is very prominent in this patient. His voice is also something that is instantly recognizable and now he is unable to showcase his talents because of this disease.

D: Did this problem start slowly or suddenly?

P: This problem suddenly came one day, and I realized it was a big problem. All of a sudden one day, I couldn't open my eyes.

D: Okay, we will give you a medicine.

Final Commentary and Case Analysis

From this short case example, we can utilize the synergistic approach. We see that the patient believes he is someone special and not average; he is creative and enjoys performing and showcasing his talent and ability. He is longing for a good opinion from everyone in the industry but his main issue is this disease, which is challenging his ability to perform, showcase himself, and be creative. This shows the System Side of the triangle.

His main physical symptoms include the peculiarities of the spasm pathology in the disease itself and also the emphasis on his voice and public speaking. He is in the process of losing his ability, but wants to maintain this position.

Rubrics Chosen:

1)      GENERALS, COLD, agg.

2)      EYE, EYELIDS, closure, involuntary

3)      EYE, CLOSING THE EYES, spasmodic closure

4)      EYE, COMPLAINTS OF EYES, left

5)      EYE, OPENING THE LIDS, unable to

6)      NOSE, DISCHARGE, thick

7)      NOSE, DISCHARGE, mucus

8)      NOSE, DISCHARGE, copious

9)      LARYNX AND TRACHEA, VOICE, hoarseness

10)    MOUTH, SPASMS

11)    MOUTH, SPASMS, tongue

12)    MOUTH, SPEECH, difficult

13)    MIND, ANXIETY, anticipation from

14)    MIND, TIMIDITY, public about appearing in

Prescription: Argentum metallicum 200C

I chose the remedy Argentum Metallicum for this patient because it was clear. The System side of the triangle was confirmed (kingdom and row), and the characteristic Symptoms were also confirmed.

When it comes to deciding the right column, we have to understand the level of stress. This patient is stressed because he doesn’t feel he has lost the position he was in, he simply feels that this spasm acts as a challenge to his position. He is questioning himself – do I have the capability at the moment that this disease occurs? He wants to maintain his position. He still believes he is on top but is wondering if he will maintain his position there. Speech is a very critical and important feature of the remedy Argentum, which falls in the 11th column of the Periodic Table, where the main themes of this column include maintaining, conserving, and sustaining his or her position.

The Genius of the remedy is also represented. The main site of action for this remedy is on the larynx. There is a loss of power in the patients needing this remedy.

Argentum (silver) belongs to the second line of metals in the Periodic Table, where it lies between copper and gold. Like other metal remedies, Argentum metallicum sees his survival in performance and defence. The metals of the second line are concerned with show. Silver is a showy metal, a shiny metal, a showpiece of human society. A good orator is called silver-tongued. Funnily enough Argentum metallicum has the symptom: "Tongue has a silver coating". It is said "Silence is golden, speech is silver". Silver is not the noble one but always the showy one. There is a strong intellectual component in Argentum metallicum. Kent says it singles out mainly the intellectual faculty, it scarcely affects the emotion. The Argentum metallicum situation is one where the person has to perform intellectually and express himself through speech, singing, writing, etc., and also has to defend himself by intellect, speech and words.

In Argentum metallicum, one of the most important symptoms is aggravation from using voice, aggravation from speaking, singing and mental exertion. He can argue and fight very strongly and hard, not only for himself but also for others. He has the ability to convince others and win over the opposition with intellect; hence, the Argentum metallicum person would make a very good lawyer or salesman.

Physical symptoms of this remedy include spasms, convulsions and cramps.

Follow-ups

One month later

D: Tell me please, how are you?

P: I am good. Overall, I feel like I was 25% better after the first month. Mentally, I was feeling good and confident because my spasms reduced. The frequency of the spasms was much less, and if I did get a spasm it improved. But now, I feel the disease is getting worse again.

Commentary: this is a good example of how potency selection can make all the difference in homoeopathic prescription. We know that the remedy acted in a positive way because of the 25% improvement in symptoms, however, the improvement was not lasting. Thus, we can conclude that this patient needs a continuous dosage and a lower potency. I gave him 30 potency, twice daily for a month.

Three months later

D: Tell me, how have you been since the last time?

P: To be honest doctor, I am feeling much better. I can even hear my speech improving. People are saying that it is clearer. I feel overall 50% better.

Commentary: after understanding the posology, we see that the patient is doing much better and continues to improve. He was given Argentum metallicum 30 again.

This case has been previously published in VOICE: e magazine of the other song http://theothersong.wordpress.com/

 

 

Categories: Cases
Keywords: synergy, genius, anchor, system, Meige's syndrome, spasms, loss of speech, performance
Remedies: Argentum metallicum

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