Here’s a detailed road map that will guide you with your detective work.
Did you know that the Repertory contains rubrics for each of the following eight steps or entry points?
1. Observation
2. Journey of Disease
3. Physicals and Generals
4. Causative Factors
5. Mental Make-Up
6. Key Sensitivity
7. Subject
8. Rubrics / Kingdom Theory
Steps 1 to 3 relate to the WHAT of a case, that is, the description of the patient’s disease. Steps 4 to 6 deal with the WHY of the case, that is, how and why the disease process developed.
Case taking begins at the point of contact. It begins well before the actual, initial consultation. Following are touch points to guide the practitioner’s observation of their patient.
This step pertains to chronologically tracing the patient’s physical history. This tells the practitioner WHAT exactly needs to be tackled. It is about tracing the journey of disease and its various symptoms from birth to the present day. This process must be thoroughly understood. It also helps you understand the direction of cure after treatment begins because, often, old symptoms recur while you reverse disease.
While assessing the journey of disease, there are two aspects you must bear in mind: Dr Praful Vijayakar’s Chart of Suppression, which shows the progress of disease from one (embryonic) layer to another; and Miasmatic Theory, to understand how the patient’s disease has shifted ‘gears’ from one Miasm to another.
It is important to note the precise chronology of the journey of disease, preferably noting dates so that you can perfectly correlate it with the patient’s mentals and, later, Key Sensitivity. I cannot stress enough how very crucial this correlating is to piecing the jigsaw together and to accurate prescribing.
Generals are very important in pathological cases. Patients often exhibit cravings, which are peculiar symptoms. These striking symptoms are strong pointers to the right remedy and may include a strong desire for, say, fried food or sour food, a desire to chew pencils and chalk. These markers indicate a very peculiar constitution. Sometimes, it is very difficult to secure a mental history of the patient. In these cases too, generals prove excellent pointers.
Watch out for:
Speed of Constitution: This refers to the pace at which his disease progresses: ‘Fast’ and ‘slow’ constitutions.
Shifting Gears: Turning points that make the patient switch gears from one Miasmatic state to another.
How To Find Constitutional ‘Speed’: Select Rubrics
Thermals Pathology Peculiar, Queer, Rare Symptoms General Modalities Discharges Concomitants Appetite, Cravings / Aversions Thirst Sexual function Time / Season effects
This refers to the WHYs of a case. Why has the constitution fallen sick? What has caused the patient’s immunity to falter? Why has the patient contracted a certain disease or grown weak at the physical and mental levels?
Factors:
Life Situation: What are the patient’s thought processes as traced from their childhood, as well as their family dynamics at the time. By assessing this, we can also find the Miasm the patient was born into. This stage provides nothing less than a thorough understanding of the constitution and lays the foundation for the progression of disease in adulthood.
Nature and reaction to situations
Mode of Living: Ups and down
Education Profession Economics
Status Sexual Life (Married / Single)
Review of Accompanying Person
Changed Disposition: At present after sickness
What Is Key Sensitivity: The Eight-Step approach is akin to peeling an onion, whose scaly, outermost layer protects a soft and sensitive core. It is when you understand the patient’s core – his most painful and sensitive issues – that you arrive at the patient’s Key Sensitivity, which, in turn, leads you to the right rubrics and right remedy.
These key and core issues are expressed in the patient’s disposition and behaviour, of course, always through the prism of his Miasm. But to arrive at these all-important issues, the practitioner must probe ever deeper, listening to what the patient is NOT as much as he is saying, and reading between the lines, always guided by two key questions – What is the issue that the patient is most sensitive to? And how has he coped with it?
When you have a clear and solid understanding of the patient’s Key Sensitivity, you must find out why the constitution has turned indifferent (Sycotic Miasm) or gone out of control (Syphilitic Miasm). In other words, if you find out ‘what makes the patient tick’, you’ve found the key that will open the case!
How To Find Key Sensitivity: If the patient’s history reveals why the constitution has fallen sick, his Key Sensitivity will reveal exactly how he has coped; why he has turned indifferent (Sycotic Miasm) and / or what went out of control (Syphilitic Miasm) or what he is compensating for. Critically, his Key Sensitivity will link effect with cause.
After determining the patient’s Key Sensitivity, we must observe its expression at all Miasmatic levels, and how and why he progressed from one Miasmatic state to the other. This is where we come to Tri-Miasmatic Drug Pictures.
The patient’s sensitive issue can be found in different ways. I always begin with Dr Rajan Sankaran’s Kingdom Theory.
There are certain specific sets of rubrics you can use to find the patient’s Key Sensitivity. Here, I would like to stress that it is important to pinpoint what the patient is indifferent to. This is how we often get to his Key Sensitivity because, being painful, it is that issue to which he has turned indifferent. Was it his family, marriage, his job, performance at work, his appearance, etc?
‘Subject’ is the category to which the patient’s Sensitive Issue belongs. Subject is a clue to the Kingdom and Sub-Kingdom according to which we can classify the patient. This is later confirmed by rubrics from the Repertory according to the patient’s Miasmatic state.
It is at this point, after corroborating, checking, re-checking, collating and distilling all the information gathered so far that you arrive at the Right Remedy.
This stage can serve a dual purpose. One, as with the other steps, it too can provide an entry point to the case. However, if you have already arrived at a remedy and are confident of it, use this step to cross-check your rubrics.
Rubrics: Will: Moral, Intellect, Sensitivity, Attachments, No Attachments, Peculiarities / Abnormalities
Before I arrived at my Eight Step Method, I had followed Dr Sankaran’s Kingdom approach and Dr Vijayakar’s Rubrics method very closely. And even though I found both methods very valid, I believed there was something missing.
Thus, I began to observe the common thread in all the cases I solved, as I worked my way through thousands of patients. It took a few years before I realised that Key Sensitivity was indeed the key to solving any case, regardless of patient, disease or how challenging it was. It is what gets you to the very source of disease – and sets your patient free.
