(what is holistic approach)
The following (with a few minor corrections) is an interview which appeared in “The Homoeopathic Heritage” of June 1990. It resulted from a controversy initiated by the editor Dr. S.P. Koppikar, my senior colleague and good friend. The issue he raised was about the practicability of the holistic and psychosomatic approach in homoeopathic prescribing. He went so far as to suggest that prescribing on mentals and generals was just too ideal and not possible to the average (and busy) practitioner. My friend, Mr. Gunavante, was quite upset by this suggestion and felt the need to explain the standpoint of classical Homoeopathy so as to show its logic. He also wanted me to demonstrate through some clinical cases that our fundamental principles are true and sound and that we need to develop our skills to utilize them rather that find unscientific shortcuts.
This interview was much appreciated by several homoeopaths which showed me that doubts still exist about the practicability and soundness of our principles.
Interview with Dr. R. Sankaran by S.M. Gunavante, published in “The Homoeopathic Heritage”, June 1990
In his editorial for February 1990 issue of “The Homoeopathic Heritage”, Dr. Koppikar has raised some fundamental issues in regard to the application of Homoeopathy, which, I felt, needed to be discussed. For this purpose, I felt I could do not better than obtain the views of Dr. Rajan Sankaran whom I know well as an able homoeopathic physician as well as a thinker and teacher. Initially he felt it would be better not to enter a controversy, but on my persuasion that such a discussion is in the interest of Homoeopathy, he agreed to talk. Here is what he said.
I have found Homoeopathy to be a tremendous tool to stimulate vitality and start true curative process. However, if we aim at merely giving relief of some symptoms, we are not exploiting its potential fully. If anyone says he has found
prescribing on local symptoms or prescribing remedies as “specifics” for certain conditions leads to much more curative effect than prescribing on mentals and generals, then our whole philosophy, our understanding of health, disease and cure will have to be changed. But I feel sure it need not, because that approach will not work. Many minor problems are self-limiting; they get well even without medicines. But if an acute problem is serious enough, will it remain a local complaint to be tackled with medicines which have “local” action? Will not the patient be ill as a whole, and need to be treated as a totality?
Anybody who has conscientiously practised Homoeopathy would have felt how frustrating it is to give remedy after remedy and to see nothing really happening until he finds the one remedy which is absolutely correct and fits the patient completely like a glove. Unless this whole philosophy of Homoeopathy, of totality, is grasped and practised faithfully, I am afraid Homoeopathy will not reach its true heights. It has been practised with all kind of combinations, alternations, quick changes in prescriptions and with all kinds of specific and symptomatic treatment. As soon as one hear the word “gas trouble”, one tends to restrict his vision to Lycopodium, China or Carbo vegetabilis. For digestive troubles, we tend not to think beyond Nux vomica, Pulsatilla or Lycopodium. I have seen cases where, if only the practitioner had just seen a little beyond the local complaint, he would have unlocked the whole case, but he did not bother to see. He kept on giving remedies with local action one after the other, giving only temporary relief and sometimes not even that.
The principles of Homoeopathy are clear in stating that there cannot be one remedy for the whole patient and a different remedy for each of his parts. If a drug acts curatively, it will do so by virtue of its covering the mentals and physical generals as well. Only a remedy which acts on the organism as a whole can act curatively on a particular part of the body.
For people with less mastery over particular symptoms of each remedy, it is much safer to rely on mentals and generals. A master might recognize a Tarentula cough, but most of us have not reached that stage and so we need to rely on mentals and generals. This is safer also because the provings and clinical experiences are not as complete in particulars as they are in mentals and generals. One thing certain is that if the remedy does not cover the mentals and generals (with or without our knowing it) and it merely fits particular symptoms, such a remedy often fails. We welcome any experiences to the contrary. However, whenever a characteristic particular is found, we take the trouble to study the remedy to see what its mentals and generals are, especially if no other remedy clearly fits. In this way we are able to exploit even a “small” remedy. Let me make it clear that we do not advocate ignoring the characteristic particular symptoms. On the contrary, we are only asking for a balanced view. But experiences show that mentals and generals often chiefly determine the remedy, and this conviction has proved to be extremely valuable to us.
Why were the masters successful? Probably their knowledge of drugs was so profound that they could identify a remedy by looking at a part of the individual. They could tell the difference in remedies, say, from the tongue of Nitricum acidum or Fluoricum acidum, etc., and prescribe with certainty based on local symptoms. Their identification was so good that they could select the right remedy from looking at the parts, a remedy which unconsciously covered mentals and generals; but our identification not being as good, we choose to rely on mentals and generals. Let me give some experiences, actual cases.
I was recently called to see a case which was diagnosed as pneumonitis. This lady had had a continuous temperature for the past three weeks and the temperature was not going down despite antibiotics and several homoeopathic remedies. I was taken to see her by a homoeopathic doctor who had already prescribed various medicines. There was a patch on the lungs, though the febrile symptoms resembled a malarial paroxysm. I was not able to get any characteristic symptoms of the fever or paroxysms. Therefore, I was forced to rely solely on her constitutional symptoms. She was a school teacher, and was very anxious to get back to work. She was talkative and quite humorous, was known as “the life and soul of the party”. She was a very hot patient, liked to take very long walks and enjoyed going out in the open air. She would get anxious about various matters concerning her family. If we take the symptoms, “Loquacity with jesting” (Synthetic Repertory), “Ameliorated by walking in the open air” and “Hot patient” with “Anxiety”, we come to Kalium iodatum. I gave it, two doses in 1M and 10M potencies, twelve hourly. After the second dose she had profuse perspiration. Two months have passed now, and she is in good health.
This kind of result is not exceptional. Cases treated earlier with local remedies (prescribed purely on local symptoms, which are usually quite common to any illness) usually failed. When we prescribed Kalium iodatum on generals such as “Loquacity with jesting”, even in a case of severe leucoderma, we have been very successful, even though “White spots on skin” is not covered by this remedy. What do we mean by holistic treatment? What is the idea of giving Kalium iodatum in leucoderma, or a case of pneumonia or pyrexia of unknown origin? The idea of giving it is that what we are trying to treat is not leucoderma, nor is it pyrexia. The concept of disease in Homoeopathy is that disease is a total affection of the body and mind. There are no local diseases. That is what Hahnemann has emphasized repeatedly in the “Organon”, that disease is nothing but a disorder of the vital force. He never says that in typhoid we have to treat typhoid, or in pneumonia we have to treat pneumonia. We have always to treat the person, that is his disordered vital force, as represented by the totality of signs and symptoms, not merely local signs and symptoms.
In a case of cholera, we will certainly not sit down and ask about the patient’s nature from childhood. In a case of cholera, as in any acute case, what we are going to see is the present totality. When a person is dying and breathing hard, has anxiety, fear of death and restlessness, we will consider those remedies which have these symptoms in a high degree. We need not always ask whether before he developed this state he was dictatorial or mild. That is immaterial if the present picture itself is complete and clear. Each time, what has to be treated is the present illness as a whole. If we forget this principle and start treating parts without the remedy covering the whole, then there are two possibilities: either the remedy will not work at all, or it will work partially. If it works partially, it is going to suppress, and
suppression always leads to harm. This is pure logic, and it does not change, no matter how many prescribers follow this practice.
Tell us one more case. I know you have numerous cases to draw upon.
It is not merely numerous cases, but every single case we treat is on this basis. A recent case: a lady was complaining of very severe headache, which would start and go down with the sun. They would be brought on by missing a meal. They were quite intense. She was taking around twelve tablets of Aspirin every day. I asked her why she is taking twelve tablets. She said: “Doctor, some of them are for my headache surely, but nowadays I have started liking to take the medicine. Even if I do not require them, I get pleasure out of swallowing the pills, I have some sweating after that, and get a nice feeling. If I require six tablets, I take twelve. And you also, please do not give me one or two doses a day; give me six doses, or eight.” This struck me so much that I looked up the rubric in Synthetic Repertory, “Medicine, desire to
swallow large doses of”, and I found only Cactus, which also fits her headache symptoms. Her aggravation with the sun, and worse from missing a meal were also found in Cactus. Cactus 200 completely relieved her headaches.
I will give you another case. A person came with fever since over one week. Temperature was around 102 ºF. He was an old man of seventy plus. He came to my clinic with his son. My female assistant was also there. He was not so neatly dressed. He sat down and said: “Doctor (in quite a commanding tone), I know that this fever is due to the cracks on my penis (he meant the foreskin). It is due to that. This is the infection that has created the fever. You treat that and I will be okay. I know that. Don’t try to handle anything else.” In this I could see three prominent symptoms: firstly, “Egotism”, second, “Theorizing” and the third was cracks on the prepuce, which had nothing to do with the fever even though he insisted that fever was due to the cracks. When you take “Theorizing”, “Egotism” and cracks on to the prepuce, you get only Sulphur. The way he said it in presence of the female assistant and of his son, showed a kind of “Indifference to his own personal appearance”. He did not bother how it looked. It was not actually shameless behaviour but a kind of indifference to appearance which is not just the clothes. It is Sulphur who says: “I don’t care a damn what they think of me”, or “I will do what I wish to.” On this basis, I gave him a dose of Sulphur 1M. Very soon the fever and everything subsided. You don’t have to give many doses. When you prescribe like this, one or two doses are enough. Look at the state at that time. It is not that he was Sulphur even ten years ago. He was Sulphur right then, even during his fever. Any other remedy given at that time either will do nothing or it can suppress. You have to appreciate one thing, that is: disease is a dynamic affection; only one affection can exist at a time. If his affection is Sulphur, it is Sulphur and nothing else. A man can be only in one state at a time.
Is there any possibility that after several months he may come with a complaint about which the doctor will take a different view?
Yes, you have to change the remedy if the mentals and generals change. What do we mean by mentals and generals? By that we mean those things that are totally dissociated from pathological and pathognomonic symptoms. Now, these can be keynotes also. What is a keynote? It is something which does not relate to disease pathology. If you are going to take something that belongs to disease pathology as a keynote, you are courting trouble. But, if you are going to select symptoms that are characteristic for that particular patient, that will differentiate one patient from another, then your keynotes will be useful. Naturally, the keynotes should fit in with the mentals and generals. You cannot have a patient with a keynote of Bryonia and the mentals of Rhus toxicodendron; or a keynote of Sulphur and the mentals of Veratrum. They have to be the same. You can either approach from keynotes or from mentals and generals, but the circle must be complete. Some people find it easier with keynotes, but those who think they can prescribe on local symptoms or keynotes or on pathognomonic symptoms are badly mistaken. Naturally, if I examine a Sulphur patient, he might have aggravation from covering his feet at night. He may also have intolerance of hunger, as well as aggravation from standing. These are all keynotes which are written in three marks in Allen’s “Keynotes”. What are those keynotes? They are all symptoms that are removed from the pathological process. Thirst during fever is not a keynote.
Keynotes are uncommon symptoms. Uncommon symptoms indicate the general state, the nature of disturbance of the vital force, and hence the mentals and generals. There is no disagreement about them. But they have to fit in together. If we are able to confirm the keynotes with mentals and generals, the prescription becomes one hundred percent confirmed; and then our case cannot go wrong. We insist on mentals and generals because here there is no chance of mistaking pathognomonic and non-pathognomonic symptoms. “Egotism”, “Theorizing” and “Indifference to personal appearance” can, by no stretch of imagination, be a part of the fever. By no stretch of imagination in a predominantly physical case, can a mental or general symptom be a part of the pathology. That is why reliance on mentals and generals is much safer. But if one is very good at perceiving what is characteristic and what is not, he can definitely use those local symptoms. Hahnemann said in Aphorism 153 that the uncommon, peculiar symptoms are most important. But how many prescriptions are made on this basis? If one gives Arsenicum sulphuratum flavum again and again for vitiligo, are we prescribing on something uncommon? But that is what many homoeopaths are doing. If we prescribe in every case of cervical spondylosis one or two particular remedies, is this the legacy of Hahnemann? And the question is asked: Was Hahnemann holistic? Certainly, he was holistic. Can we find one word in Hahnemann’s writing where he said: “Do not prescribe on
characteristics; do not prescribe on mentals”?
On the contrary, in Aphorism 211 he says: “This holds true to such an extent that that state of disposition often chiefly determines the choice of the remedy.” In fact, Hahnemann came to his conclusions after several years of experience. Anyone who says that Aconitum is good for fever, Cantharis for urinary troubles, Rhus toxicodendron for joint pains, Mercurius for dysentery, etc., is talking of absolute pathology. He does not follow Hahnemann and ignores the teaching of the more successful practitioners who followed him.
Last month, I had a case of iridocyclitis for whom I prescribed Iodum. Why? Because the patient was hungry every three hours and he had a kind of anxiety that made him walk around. He must walk fast in the open air to get rid of his anxiety.
He felt extremely hot. He was told that he would become blind if he does not take Cortisone. Yet, he got totally well with Iodum 200, I did not even care to see if Iodum has got any eye symptoms.
You can prescribe with absolute certainty if mentals and generals agree. Everything else is a matter of chance. That is why from Hahnemann downward, to Boenninghausen, Boger, Kent, Sir John Weir, Margaret Tyler – all these great names are known; the one true method of prescribing on totality, understanding the mind and generals of the patient, his
peculiarities and the individuality of his being – only this method really has stood the test of time, because every other method is a chance.
I treated a case of fibroid of uterus with Arsenicum album 200, and that tumour went away. And Arsenicum album is not mentioned, even in single grade, for fibroid. Why? Because the patient was fastidious, had a compulsive neurosis, was extremely anxious about health, very chilly, very lean. All the symptoms of this patient fitted into Arsenicum album except fibroid. If I had started with the remedies known for fibroid, this lady would never have got well. Nowadays we have the good (or bad) fortune of treating many patients coming after taking innumerable homoeopathic medicines. Sometimes they were given the right remedy, but it was quickly changed. This is what happens when we try to treat symptoms one after the other. Even if they have hit the right remedy, there is no faith in it. They prescribed on some symptoms, and when the symptom has not improved, they change. But, if they knew that the remedy fitted the mentals and generals, they would not have changed and that remedy would have ultimately cured.
I can give some more examples in which mentals symptoms alone led to the curative prescription. A case of pituitary tumour was taken for operation. The patient, a Minister in West Bengal government, developed symptoms of heart failure every time he was taken to the operation theatre, and hence he had to be taken home. On the basis of fear causing heart failure, Dr. B.N. Chakravarty told us he prescribed Gelsemium. “Cowardice”, “Anticipatory anxiety”, “Fear, of operation”