Dr.Ajit Kulkarni explains in this paper the concept of Monogram with philosophy, abstraction and generalization, correlation with data in Materia Medica and meaning of words coined for monogram. The group monogram of Carbon, Halogen and Mercury are analyzed along with one individual remedy of Opium. Several examples and case illustrations have been provided.
Monogram is a remedy's signature. It unifies the essential threads and renders the fabric of the remedy. The monogram is not just a word, it's not an isolated state; it stands by association, resemblance, identification or convention. Monograms incorporate behavior patterns, identifiable characteristics, habits, traits and trends and prominent dispositions of the person that are exhibited in a wide range of important psychological, clinical, pathological and miasmatic contexts. The study of a remedy through monogram is a more specific way to describe the general manner in which the symptoms express themselves. It conveys precisely and concisely what a drug fundamentally is. The psycho-clinico-patho-miasmatic co-relations can be constructed and perceived well with the concept of monogram, thus helping to see the mental, emotional and pathological layers in integration and how the mind and pathology run parallel in a case.
MM, evolution, limitation of symptoms, keynote symptoms, keynote themes, problems with keynote system, individual remedy, group study, monogram.
(The concept of Monogram was presented in 'Absolute HomeopathicMM', written by Dr. P.I. Tarkas and Dr.Ajit Kulkarni and published by B. Jain Publishers, New Delhi. )
Homeopathic Materia medica is the collection of pathogenic effects of drugs and of the derangements they are capable of causing in the healthy body, by means of which the principle - 'let likes be treated by likes' gets applied at the bedside.
Homeopathic Materia medica originated with Hahnemann who contributed a unique concept of proving on healthy human beings. Hahnemann collected the data from 'provers' and it was recorded 'as it is' in 'Materia Medica Pura'. MM Pura of Hahnemann is a raw collection, though basic. Note that it will be a challenging job for the modern homeopaths to practice if we keep the raw data of MM Pura before them.
Then arrived the colossal work of Encyclopedia of Allen. It contains the protean proving symptoms. Constantine Hering in his mammoth work of 'Guiding symptoms of our MM formulated proper headings and selected those symptoms which had been clinically confirmed. It was Hering who embarked upon the 'mosaic' of symptoms.
EVOLUTION OF MATERIA MEDICA
The evolution of Homeopathic Materia medica is an ongoing process and we have now many methods by which we can study our remedies. The beginning was the proving of the exacting type where the provers – the human beings - expressed their honest experiences with the remedies that were given for the sake of knowing their effects at various levels of operation of the human economy. The symptoms that were painstakingly gathered over months and years were collected together. The collection was pure but raw and there was a need to make it more refined, understandable and of applicable value.
Clinical application of remedies has a big share in evolution. This is, in other words, 'evidence- based remedies' which have enriched the value of MM.
If we see the evolution of MM, every stalwart has tried to make the tool of MM more powerful. There was a need to streamline the scattered raw data in a disciplined way. It was necessary to make headings and subheadings to incorporate the symptoms in a relevant way. It was essential to look at the toxicological data in terms of symptoms and pathology. It was required to throw light on the action of a remedy, how it unfolds on the mental and physical states of the economy. The need was to understand the remedies as living individuals. First evolution occurred in the study of symptoms. The symptoms in MM are variable, profound and ought to be integrated. The concept of totality will have a meaning provided we build up the matrix.
Different homeopathic stalwarts have approached the study of the MM from different perspectives. Hering, Allen, Lippe, Clarke, Boericke, Kent, Tyler, Boger, Dhawale, Pulford, Pathak, Scholten, Coulter, Philip Bailey, Vithoulkas, Sankaran, Farrington, P. I. Tarkas, Ajit Kulkarni etc. have contributed to the shaping of homeopathic Materia medica in their own classical ways.
Anatomy, physiology and pathology were considered as pillars in interpreting data by Boericke, Clarke, Boger and Tarkas-Kulkarni. Handbook of Materia medica and Therapeutics by T.F. Allen, in addition to the hard facts, referred to the clinical side of data and hence, T.F. Allen could be called as a pioneer in clinical co-relation.
Pulford and Allen perceived the keynotes from data which could individualize the portrait of a person or a disease.
Kent's artistic mind perceived meaning from the perspective of personality of drug amongst the data. His reference point was the philosophy of man and his sufferings and it was partly influenced by Swedenborg's philosophy.
Vithoulkas focused on hard data and explained the essence of personality of the remedies.
Scholten dived deep into the periodic table and expounded upon cation-anion relation and developed the personality profiles.
Dr. M. L. Dhawale rendered an integrated meaning to the data by taking the help of various basic sciences.
(The readers are requested to read Preface of Absolute MM to appraise themselves of the contribution of stalwarts towards the evolution of MM).
DR.HAHNEMANN ON SYMPTOMS
"Now, as in a disease, from which no manifest exciting or maintaining cause (causa occasionalis) has to be removed, we can perceive nothing but the morbid symptoms, it must (regard being had to the possibility of a miasm and attention paid to the accessory circumstances, § 5) be the symptoms alone by which the disease demands and points to the remedy suited to relieve it - and, moreover, the totality of these its symptoms, of this outwardly reflected picture of the internal essence of the disease, that is, of the affection of the vital force, must be the principal, or the sole means, whereby the disease can make known what remedy it requires - the only thing that can determine the choice of the most appropriate remedy - and thus, in a word, the totality of the symptoms must be the principal, indeed the only thing the physician has to take note of in every case of disease". - Samuel Hahnemann, Organon of the Medical Art, §7
Hahnemann, while underscoring the importance of the symptoms, has focused on the totality of symptoms.
However, we have to look at the symptoms in many ways. It is to be noted that there are limitations to the symptoms.
LIMITATIONS OF SYMPTOMS
1. SYMPTOMS MAY BE UNOBSERVABLE, HIDDEN OR EVEN ABSENT
'Symptoms are the sole representation of the disease' needs re-consideration.
Symptom or symptoms may be a small part of a big disease portrait.
Symptoms are always there; we are the ones who cannot relate them to what we call a (certain) disease. The immune system performs its responsible job to throw off the warning signals in multiple ways.
Disease is a phenomenon. The law of existence denotes that nothing is without cause and effect. It is rarely found that the disease is present but outward manifestations are absent. Remember, absolute nothingness is a certain type of existence. Even in absolute nothingness, intelligence exists. Hence, it is the duty of an intelligent physician to perceive the true nature of the symptoms.
- Streptococcal infection without a sore throat
- Myocardial infarction without chest pain
- "Silent" ischemia e.g. in DM due to neuropathy
- Diabetes mellitus without polyuria or polydipsia
- Duodenal ulcer without peptic symptoms
- Viral hepatitis without jaundice
- Atypical hyperplasia of the breasts (typically it doesn't cause symptoms and diagnosis is made on mammogram or biopsy)
2. SYMPTOMS MAY BE ATYPICAL
We as clinicians hinge on typical presentations of common illnesses. Yet, what is often left out from medical training is the frequent occurrence of atypical presentations of illness. These are termed "atypical" because they lack the usual signs and symptoms characterizing a particular condition or diagnosis.
Sometimes the affected anatomical part may not reveal the pain or sensation or discomfort, but it may manifest at a different location.
- Instead of anginal pain, the patient of ischemic heart disease may complain of indigestion.
- Instead of pain in the chest, the patient of myocardial infarction may complain of pain in the jaws.
- Instead of epigastric pain, the patient of duodenal ulcer may present with excessive salivation.
- A change in behaviour or functional ability in an old age patient is often the only sign of a new, potentially serious illness.
3. SYMPTOMS MAY BE NON-SPECIFIC
These symptoms usually do not involve a specific organ or an isolated system. They do not indicate a specific disease or abnormality and can be a feature of many clinical conditions.
Several diseases may represent the same common symptoms and it becomes a difficult task for a physician to make a proper diagnosis and may lead a physician astray.
- Anorexia, nausea and vomiting remind of possible gastrointestinal and hepatic disease, but they may be the presenting features of chronic renal failure, hypercalcemia, digitalis toxicity etc.
- Fatigue is a feature of many medical conditions which may be acute or chronic, physical or mental, primary or secondary. And if a person is fatigued at the end of a hard day or after exertion, it is normal.
- Non-specific somatic symptoms may be clues to changes in emotional well-being.
4. IDENTICAL SYMPTOMS
These may result from conditions which are diametrically opposite to each other and requiring entirely different management.
- Both hypokalaemia and hyperkalaemia may manifest the same symptomatology, muscle weakness and the same physical signs, loss of tendon reflexes and loss of muscle contraction in response to direct percussion.
- Their correct identification is aided by considering the circumstances in which the symptoms occurred: vomiting, diarrhoea and diuretics would provide a setting for hypokalaemia; oliguria and anuria, crush injury and shock would provide one for hyperkalaemia.
5. SOME SYMPTOMS REMAIN UNEXPLAINED
There are many symptoms which remain unexplained.
- Some people have a readiness to explain everything. One must be wary about this attitude while interpreting symptoms and signs because it closes the door the further inquiry.
- It is always good to record an unexplained symptom or an unexplained physical sign as "not understood" so that the mind is still open on the question – for future learning.
Hahnemann emphasized on 'individualization' and naturally, the study of MM got shifted to characteristic symptoms. The distinct difference between common disease symptoms and uncommon individual symptoms was being sought and PQRS symptoms became the influencing essentials. The widespread belief is disseminated that the study of MM means keynote symptoms and for successful practice, there is no alternative but to learn by heart the keynote symptoms of remedies.
Even today, the keynote system is a universal and popular way of dealing with the study of MM and finding a remedy for the patients.
PROBLEMS WITH KEYNOTE SYMPTOMS
However, many issues crop up.
- Keynote symptoms as given by many authors are different. There is no consensus in deciding the authenticity of keynote symptoms. H.C. Allen gives his set of keynotes (Keynotes and characteristics with comparisons of some of the leading remedies of the Materia medica)while Guernsey offers his own (Keynotes to the Materia medica) and he was the first to coin the word 'keynote' during 1868. William Boericke renders his keynotes with emphasis on pathological symptoms. Adolph Von Lippe had a penchant for his characteristics (Keynotes and Red line symptoms). During 1874, Dr. J. H. P. Frost wrote an essay over "On characteristic symptoms" in 'Hahnemannian Monthly'. The quantity of keynote symptoms has been growing and if we make a collective work of amalgamating all keynote symptoms, it could be a big (keynote)MM. Do we need it?
- Selectivity due to favouritism. No logic in selection. Those that are 'uncommon', not connected to the disease symptoms, become keynote symptoms. There are ample uncommon symptoms in provings.
- It is not possible to find keynote symptoms in all cases and at all times.
- The PQRS symptoms may be within the domain of health and may not fall within the domain of a disease. 'What is to be cured in a patient' remains a pertinent question.
- During Hahnemann's time and later on too, the faculties like physiology, anatomy, pathology were not developed. In the light of the knowledge gained in these faculties, we are now in a better position to differentiate between common and uncommon symptoms. Even the field of concomitant symptoms needs to be reviewed at large.
- In many cases, the keynote symptoms and the pathology or the very process of the disease or the type of personality doesn't get covered by the remedy. Even though the keynote symptoms were regarded as the heart or soul of the remedies, the selection of them for the sake of a remedy amounts to one-sidedness of the coverage of the data and then the follow-up becomes a non-disciplined affair.
- Today's keynote symptoms, if not helpful, as due to the failure of the case, become redundant soon and on next follow-up, the job of a physician becomes to select another set of keynote symptoms. In short, the totality is brushed aside, not comprehended well and it becomes a repetitive practice of chasing the keynote symptoms.
- The study of personality type and the advancements in clinical psychology are not taken into account in the selection of keynote symptoms and it deprives the physician of right selection of a remedy and overall management.
The following questions are IMP:
- Is the keynote system of prescribing a self-sufficient method?
- Is the keynote system a 'hit-and-miss' method?
- Can it solve all cases of variable conditions?
- If the keynote system is with lacunae, can we devise a better one?
- Is a keynote system shortcut in clinical practice? And hence popular?
FROM KEYNOTES TO KEY THEMES
Behind the disease, there is a person and there are consistent characters that are unique to the person and they define the very individuality of a person. In spite of the changes that occur in life or in disease, these characters remain unchanged. Hence, they must be a part of totality.
In keynote symptoms, the main theme is to focus on symptoms. In key themes, the focus is on the personality type, some consistent character that is inseparable from the system, some essence which is gleaned from the data and some central points in the data that define the case.
Examples A. Let us take the case of a boy. He is sensitive, delicate, born premature, is falling sick often and he can't bear any criticism. He becomes nervous and tears soon start streaming from his eyes. He is affected easily when exposed to cold air or any stimulus of an unusual type brings on the deleterious effect.
By analyzing the data of the boy, we can draw the key theme of being 'fragile'.
- Let us take another example. I was consulted for a case of a boy aged 15 years who has recurrent tonsillitis, rhinitis and dermatitis. They are ever-present one after another and parents are exhausted as the boy is constantly ill and has to be given anti-inflammatory, antibiotics and steroids. The boy is rebellious, doesn't want to follow the norms and quarrels with everyone and if his wishes are not fulfilled, takes everyone as an enemy. He likes the games of war and is addicted to them and this has been a big problem as he may even skip school. Here, we get the key theme of body and mind being at war. He is fighting at body level through inflammation and there is enough evidence that the mind has the set-up of war. We can't think of any remedy without the concept of war in this case. There is a rubric which epitomizes his key theme "mind; fight, wants to" and IMP remedies are androc., aster., aur., carc., caust., hyos., lac-eq., lac-f., lac-leo.,lach., lyss., med., merc., nux-v., scorp., tub., uran.
- The extroverted or introverted types point towards the key themes that these personalities represent through their basic dispositions.
- The study of a patient through temperament focusses on the basic traits.
Let it be clear that themes do not stand alone for themselves in prescribing. One theme (no matter how major) does not hold a case alone. It must be a part of the totality, along with the general symptoms-physical, mental and pathological and also the physical particulars.
THE STUDY OF MONOGRAM: MAGNIFICENCE OF DATA
- The data in MM is multifaceted.
- There are multiple hearts and nuclei of each remedy.
- How to shape the data in a concrete whole?
- How to connect a network of paths and hedges out of the puzzle through which a homeopath has to find a way?
- How to make a meaningful portrait out of the maze of symptoms?
- Which symptoms fall in the category of connections and which symptoms fall in their quality of being redundant?
- The concept of monogram is developed out of the need for integration.
- Without integration, the data will be just the quantity of components.
- Integration renders quality to the data.
- Integration defines the nature of components and opens up many new frontiers, new directions and new meanings hidden hitherto.
WHAT IS MONOGRAM?
The word monogram is used in two contexts:
- Design: In design, we think of pattern, image, decoration, shape, ornamentation and logo.
- Theme: Theme is related to idea, concept, topic or subject.
In homeopathy, both contexts are used with the concept of monogram.
The monogram is a remedy's signature. It is like a piece of art for adorning the esteem of a remedy. It unifies the essential threads and renders the fabric of the remedy. The monogram is not just a word, it's not an isolated state; it stands by association, resemblance, identification or convention.
The monogram is the center from which we can enter into the periphery and we can create the monogram by using the components of the periphery.
Monogram is like the genetic encoding of a remedy where the information of characters of a remedy is programmed. It is like nucleus/essence/core/kernel/central idea which encompasses disturbances at mental, emotional and physical levels.
The study of a remedy through monogram is a more specific way to describe the general manner in which the symptoms express themselves. This is the mode where the procedure itself takes place. It bestows an impression. It conveys precisely and concisely what a drug fundamentally is!
Generalization is the process of identifying the symptoms of the totality, as belonging to the whole. The symptoms, completely unrelated may be brought together as a group by establishing a common relation between them. Generalization is the formulation of general concepts from specific symptoms by abstracting common properties. Generalization is the essential basis of all valid deductive inferences.
The study of monogram conforms to the concept of pathological general (Boger), but we have furthered the concept with pattern, pace and miasmatic activity. Thus, it helps to see mental, emotional and pathological layers in integration and how mind and pathology run parallel in a case. In other words, psycho-clinico-patho-miasmatic co-relations can be constructed and perceived well with the concept of monogram.
Monogram words are not merely pedantic rules. They are like building blocks. They incorporate behaviour patterns, identifiable characteristics, habits, traits and trends and prominent dispositions of the person that are exhibited in a wide range of important psychological, clinical, pathological and miasmatic contexts. The study of monogram is a way to conceptualize and assess both stability and variability in behavioural patterns.
Monogram study is the measurement of undercurrent between mind and body. It measures the degree of the recurrent and consistent patterns of 'behaviour' of certain physical and mental characters.
An individual can be analyzed using monogram to come up with the key indicators of how he/she tends to behave according to certain tendencies. While the keynote/key theme involves personal interpretation of the factors and as a result, can be influenced by the subjectivity of the physician; monogram projects the hard facts in an objective manner.
COMPONENTS OF MONOGRAM
- Essence of the system following the concept of generalization
- The essential threads that run through and through
- The character evolved after the deductive inference
- Patterns (behavioural, tendencies, often repeated phenomena)
- Pathological generals
- Miasmatic state
MONOGRAM OF OPIUM
INSENSIBLE. TORPID. ADYNAMIC. HEAVY. PARALYTIC. EPILEPTIC. DEEP. TREMULOUS. SENILE. DROPSICAL. ATONIC. DRY. SWEATY. THROMBOTIC.
Insensibility is the central feature of Opium.
Opium is one of the most complicated substances of our Materia medica. It contains about 18 alkaloids of which the apomorphine, morphine, heroin and codeine are well known. Besides mucilage, albumen, fat, sugar, and salts of ammonia, calcium and magnesia, it contains "17 or 18 alkaloids and two neutral substances, as well as meconic acid" (Brunton).
The poisonous effects of Opium are absolute unconsciousness, complete muscular relaxation, pupils contracted to a pin-point aperture, turgid, bloated, stertorous breathing, pulse slow, asphyxia and death. All these poisonous effects are due to the depressive action. At the physical level, the insensibility is expressed as loss of reflexes. The reactive pattern is depressed to such an extent that we do not get the response even after intense input. Hence, painlessness is the characteristic of Op.The depressive action of Op. results in nerves 'on end.'
The depressive action is available at both mind and body level in Op. pathogenesis with dynamic doses. At mind level we get higher intellectual faculties being depressed, self-control and power of concentration are lessened, judgement is progressively affected. This leads to poor perception, consequently confusion of mind and fanciful ideas. The senses are perverted including the moral sense, which is expressed at the dispositional level as a 'knave' person (unprincipled, crafty man, a rogue, a scoundrel), keeping insensibility to the feelings of others. Insensibility revokes the reality, the sufferings and goes to the extreme polarity of paradise. (it is interesting to note that, at different points in the body, we manufacture endorphins, natural opiates which intervene to calm fear, pain, and cough, among other things). This state is characterized by a well- feeling even in grave conditions. A person is unable to understand or appreciate his sufferings. He loses the mental grasp of anything and says that nothing ails him. He wants nothing, he is placid and in his own dreamy state as if of "nirvana".
It is interesting to note that Op. has an indifference to both joy and suffering; this indifference is not associated with melancholy (like Natrums) but it is an 'exalted' state. It is similar to 'Anhaloniumlevii' but unlike it. Anhaloniumlevii has colourful, brilliant visions, beautiful and varied kaleidoscopic changes and a sensation of increased physical ability. These are however absent in Opium. It is similar also to Cann-i., which has fantastic visions; however, time sense is more disordered in Cann-i.
Op. has been reputed as a remedy for 'deep unconsciousness' where there is no response to superficial or deep reflexes. The unconsciousness may come on due to fright or head injury or even metabolic failure. During the convulsions, the pupils are non-reacting to light. Want of susceptibility to remedy even though indicated is due to the insensibility that results in lack of reaction or adynamia. Here it must be competed with Carb-v., Psor., Sulph., Zinc. etc. Opium is also acute in its manifestations.
The depressive action of Op. results in sluggishness both at mind and body level. The mind loses its perceptive filter capacity. The comprehension is affected, there is a loss of will power and the person loses the go.
At the physical level, the torpidity is expressed as lack of vital reaction, insensibility of the nervous system, painlessness and soporous condition. Op. lessens the voluntary movements.
This torpidity is exhibited at the level of various systems: Sluggishness of the intestines; paralytic atony of bowels; obstipation; no desire to go to stool; senile. At the urinary system, there is feeble stream and slow to start. Loss of power or sensibility of bladder. Paralytic atony of bladder; retention of urine; after laparotomy or confinement. At the genital level, there is suppressed menses especially from fright, also suppression of lochia. Uterine inertia with cessation of labour pains with coma is the characteristic feature.
Op. checks all secretions except that of skin. Torpidity results in general relaxation of the system expressed also at prolapse of uterus, ptosis and paralysis, hernias (more inguinal), hoarseness, slow pulse, heavy, stupid sleep and fever associated with sleepiness. In short, torpidity runs through and through and is manifested at mental and physical planes.
The depressive action of Op. on the nervous system causes paresis and paralysis. Op. has paralysis of painless or painful type; of brain, tongue, bowels, bladder, larynx, limbs, etc.; from fright; from lead poisoning; after head injury; apoplexy; senile; alcoholic.
In paralysis, Op. should be compared with Alum., Caust., Gels., Plb. and Zinc.
The torpidity, general depressive action of Op. results in the state of lack of vital reaction. This want of susceptibility gives a poor or no response to even well-indicated remedies. Adynamia indicates the grave condition. The system has lost its power of resistance and the vitality needs to be aroused as a dire necessity. Op. is helpful in acute manifestations chiefly, but it has the usefulness also in chronic ones. To illustrate, if a patient has become unconscious due to CVS, thromboembolic phenomena, or septicemia, and he is not responding to the indicated remedies, Op. should be given to arouse the vitality of a person and then again, the indicated remedy should be prescribed.
The convulsions are the toxicological effects during the phase of stimulation. The causes are: after violent anger or rage; after fright; insult; puerperium; after cholera; from suppressed urine; when labour pains are ceased; apoplectic; brain diseases.
The aura begins with congestive headache and convulsions are worse during and after deep sleep, glares of light, heat; of room or bath, from approach of strangers (children). During convulsions – stertorous breathing; coldness of limbs; froth at mouth; eyes half open; pupils dilated and insensible to light; face dark red and hot. Throws limbs about or stretches arms at right angle to the body; stupor between spasms. The attacks are followed by relaxation of muscles and deep sleep.
Op. can be tried in cases of mental retardation with epilepsy. Indolence, stupidity, rashness, recklessness and boldness characterize the Opium children. Such children are nervous, irritable and there is a tendency to start even at the least noise. These are the dreamy children who are deceptive in nature and are liars. Opium should be compared with Bufo, Tarent., and Tub. Op. should be tried in spastic children.
Trembling characterizes Op. Fright, anger or rage cause tremors. Twitching, jerking during sleep. Twitching of limbs; after fright. Jerks as if flexors are overacting. Shuffling and trembling gait. One or other arm moves convulsively to and fro. Trembling, twitching of facial muscles. Op. is one of the chief remedies for a patient who has developed trembling after fright.
Opium poisoning has produced anasarca. Op. has oedema of lower limbs especially feet, and of lower eye lids; from uremia; diabetes mellitus; strokes; of face (red, bloated, swollen, dark suffused, hot).
Internal dryness typifies Op. paresis and paralyses are the results of the dryness of the nerves. We get the dryness of mouth (with consequent intense thirst); of eyes (red, burning, hot and dry); of throat (with inability to swallow); of rectum (resulting in obstinate constipation with stools-dry, hard, round, black-balls); cough dry and racking; suppressed discharges (except sweat); dryness of emotions; indifference to pleasure and sufferings.
The metabolic processes in old age are characterized by torpidity, low susceptibility and degeneration. Op. has all these characters in its pathogenesis. It has at the physical level senile vertigo with lightness of head; senile painless ulcers; slow circulation; tremors; various degenerative disorders of spinal cord; constipation; C.O.P.D.; occulo-motor paralysis; cardiac diseases; various digestive and kidney disorders; dryness of the mucous membranes and of the skin; nutrition impairment; etc.
The system under Op. develops 'atony' under its depressive and torpid action expressed at bowel and bladder in the form of constipation and retention of urine; prolapse of rectum, uterus; abortions; ptosis etc. The causes usually are fright, anger, insult etc. There is inhibition of reflexes. At mind level we get indifference, dullness.
Want of susceptibility to remedies and insensibility are the furtherance of atonic state.
Sweat has a unique character in Opium and hence it is included under monogram. In Op. all secretions are checked except sweat. This produces internal dryness. The characteristics of sweat are: hot sweat over whole body except lower limbs, cold perspiration over whole body especially on head and forehead, and fever is > without perspiration; sweat without >. Skin is usually hot, damp and sweaty.
The reputation of Op. in the unconscious, comatose state has brought to the fore the pathological condition of thrombo-embolic phenomenon. Under eyes, we get 'embolism of central artery'. Paralytic effects consequent to cerebral thrombosis come within the range of Op..
The word 'heaviness' aptly describes the mental and physical characters. The mind is heavy, unable to comprehend. This leads to irresolution, confusion of mind; finally, we get idiocy of mind. Indifference to mind, dullness is also found in Op..
Op. is a deep-acting, polychrest remedy of a wide range. Its toxic effects are devastating. Op. penetrates deep in the vital economy and causes a severe depressive action over the system. The 'insensibility' and 'wants nothing', 'I am fine', a 'paradise' state even with grave illness is actually indicative of the deep magnitude of illness. One will naturally expect the warning signals through psycho-neuro-immunology in terms of pains through prostaglandin synthesis or of anxiety and conscientiousness through psychogenic defenses. But warning signals are absent and the system manifests the deceptiveness. This is reflective of syphilitic dominance.
The study of Op. through above characters i.e. through the monogram, renders, in a nutshell, the essence of this important drug.
MONOGRAM OF MERCURY, CARBON AND HALOGEN GROUP
CONGESTIVE. CATARRHAL. EXUDATIVE. ULCERATIVE. SUPPURATIVE. DESTRUCTIVE. GLANDULAR. SCROFULOUS. SCORBUTIC. ANEMIC. RHEUMATIC. OFFENSIVE. SENSITIVE. TREMULOUS. DROPSICAL. AGILE. CHAOTIC. DEBILITATED. SYPHILITIC.
Merc is basically an inflammatory group. Every inflammation begins with congestion and Merc has it forcefully in its pathogenesis. This congestive character has to be differentiated from Aco, Bell or Ferr-p. These three drugs have congestion in their first stage of inflammation. Merc presents furtherance of activity where suppuration has supervened. An abscess in Merc is of spreading type-more congestion, more redness, more painful, more throbbing and with adjacent lymphadenopathy.
Merc causes inflammation of mucous membranes resulting in profuse, thin, slimy, acrid, burning, foul or thick greenish-yellow discharges. Merc covers simple to malignant catarrhs in its pathogenesis.
Exuding the ichorous fluid, pus etc. Through affected lesions like boils, abscesses, carbuncles, sinuses, fistulae etc. is the characteristic of Merc. The exudation is usually offensive in nature.
Merc has ulcerations of the mucous membranes, esp. Of mouth and throat. The syphilitic miasmatic activity is responsible for recurrent and non-healing ulcerations; ulcers based on deep pathologies or metabolic basis. Syphilitic, phagedenic (necrotic ulceration with prominent tissue destruction) ulcers.
Inflammation in Merc doesn't stop at the level of congestion. Inflammatory action is intensely acute and violent and rapidly tends to septic disorganization. It is as if little resistance is offered by the system. Defective mesenchymal system and phagocytosis turn the condition into suppuration. Merc has a tendency to pus formation and the pus is thin, green, putrid; streaked with blood. Suppuration in glands, ulcers or even internal vital organs like lungs (e.g. Empyema) or kidneys (e.g. peri-nephric abscess or pyelonephritis) comes within the range of Merc.
Merc transforms healthy cells into decrepit, inflamed and necrotic wrecks. Merc is destructive both at body and mind levels. Its lesions resemble those of syphilis. Merc's action is similar to that of the toxins of infectious diseases. Inflammations of malignant types and often they are associated with prostration. Appropriate Merc salt can be thought of in cases where perforation threatens.
Merc has increased glandular activity, esp. of salivary and mucous glands. Merc has concomitant lymphadenopathy with skin lesions like boil, abscess, ulcer etc. Syphilitic miasm is responsible for even malignant glandular affections and fevers. Based on scrofulous diathesis, it also covers tubercular glandular affections. Chronic suppurating glands; cold abscesses are dealt with Merc.
Tuberculous diseases of lymphatic nodes and of bone, with slowly suppurating abscesses. Merc decomposes the blood, producing profound anaemia. It thus affects the nutrition and prepares the ground for scrofulous affections. Syphilitic activity further leads to cachexia.
Merc has spongy and bleeding gums. When the general condition is impaired and metabolism gets affected because of malnutrition, scorbusis may get developed. Scorbusis may be a precursor of metabolic diseases like dm.
Merc through decomposition of blood, and through bone-marrow depression causes profound or aplastic anaemia. Haemorrhages, metabolic disorders, hepatic and renal toxicity are some of the causes of anaemia. Hence Merc constitution is emaciated, pale with dark rings around eyes.
Rheumatic diathesis is one of the features of Merc group. It has both acute and chronic dimensions. Mercs are sensitive to both heat and cold (human barometers) and they come down with acute joint swellings and pains consequent to weather changes. 'redness' and swelling and throbbing pains characterize Merc.
Merc is filthy, mentally as well as physically. All discharges smell horrible; the decomposition, the debris, the slough, the suppuration; smell emanates from the body. Mercs are, hence, recognized to an observant physician.
Mercs are very sensitive to weather changes, hence termed as 'human barometers'. The inflamed part is very sensitive and depicts all characters of inflammation. The reactivity pattern is exhibited well. Sensitivity attracts environmental stimuli; hence modalities or sensory stimuli/inputs are usually available. Sensitivity is also present at the mind level.
'Trembling' is a marked characteristic of Merc. Paralysis agitans – parkinsonism-come under pathogenetic action of Merc. Syphilitic expressions with a lot of pathologies at nerves, spinal cord and brain resulting in incoordination are responsible for tremulousness.
Dropsy due to anaemia, hepatic, renal or cardiac affections are covered by Merc. Edematous swellings in the affected parts characterize Merc.
Merc is basically an 'active' group. We get rapid development of symptoms leading to destruction. When the active disease processes are present, Merc group is indicated. It is less indicated for remnants or for exhaustion stage. That work is allotted to other groups like carbon etc. Usually, full-blown acute or chronic diseases are found in Merc group because of increased sensitivity and susceptibility.
The aberrant immune response as expressed in autoimmune disorders give the character of chaos. Under severe infection, the system becomes a prey and behaves in an eccentric way. Tubercular miasma actively dominates the scene. The agile character allows the system to go into chaos.
The sway of disease process under tubercular and syphilitic miasmatic activity depletes the energy. The system can't continue for long and succumbs. Anaemia and malnourishment add to the state of debility. Discharges produced do not ameliorate and further deplete the energy.
Merc and syphilis are knot together since antiquity. Merc has in its pathogenesis all stages of syphilis-primary, secondary and tertiary. Low states and phagedenic condition from syphilitic poison. Destructive effects on nerves. It covers both acute and chronic phases. Discharges (which system develops as defense) do not help and syphilitic march is continued.
MONOGRAM OF CARBON GROUP
DEVITALIZED. ADYNAMIC. DEGENERATING. VENOUS. SCORBUTIC. PUTRESCENT. ULCERATIVE. CACHECTIC. CANCEROUS. SENILE. FLATULENT. OFFENSIVE. BURNER.
The make-up of the carbon group of remedies is an anaemic, broken-down constitution. Persons below par, used up people, by debauchery or from consuming mal-nourished food. Carbon group is indicated in decrepit old people. Defective oxidation and incomplete combustion give rise to the low state of vitality. Hence 'devitalized' as the character.
Lack of reaction is the central character of the carbon group. Because of low vitality, they do not respond quickly. They have delayed repair processes or no repair occurs. They are the chief remedies for slow recuperative process. Because of their adynamic character, remedies like Carb-v. or Carbn-s. are interpolated for the sake of arousing the vitality.
The carbon group acts on degenerative conditions. The source of Carb-v., for example, is charcoal which is the product after combustion. Fatty degeneration is also covered by carbon group. Senility is characterized by a process of degeneration and carbon group has slant for old people. Out of all carbon remedies, Carbn-s. Has more affinity for nerves.
The group has venous constitution. It is indicated for varicose veins, varicose ulcers and also for bleeding haemorrhoids. Large protruding blue haemorrhoids are found in Carb-v. In other words, when the venous system is predominantly affected, carbon group is indicated.
Bleeding (and swelling) of gums are found in carbon remedies. Because of deficiency of vitamin C or malnourishment in general, scorbusis is developed. Scorbusis may be a precursory indication of metabolic disorders like diabetes mellitus.
Low vitality, lack of repair process, lack of reaction result in decomposition. Discharges are offensive and muco-purulent. Hence putrescent as the character.
On the background of the low vitality and repair process slow, there is development of ulceration. We find varicose ulcers; indolent ulcers; chronic phagedenic ulcers; ulcers turning in cancer or gangrene, senile ulcers etc.
Devitalized character coupled with adynamia and iatrogenic diseases which tell upon the economy make the constitution cachectic. The system breaks down under the sway of conditions like malignancy, metabolic and degenerative disorders.
Carbon remedies esp. Carb-an.,Carbn-s., Graph. and Kreos. are indicated in malignant conditions. The syco-syphilitic miasmatic activity produces this diathesis.
Carbon remedies assume a very important place in acid peptic syndromes. Slow digestion and torpid vitality are chiefly responsible. Food putrefies before it digests; food turns to gas and even the simplest food distresses. Hence 'flatulent' included in the monogram.
The process of decomposition, disintegration, imperfect oxidation and putrescence produce offensiveness of discharges, flatus etc.
Charcoal, a product of combustion and imperfect oxidation produces this character. Just like ash, internal burning but external coldness is marked. Pains of burning character. Also, it causes 'burning' of the tissues through decomposition, cachexia and emaciation.
MONOGRAM OF HALOGEN GROUP
CONCRETING. GLANDULAR. MALIGNANT. WARM-BLOODED. AGILE. SYCO-SYPHILITIC.
It is the tendency of the system to cause concentric pathologies. To illustrate, Calc-fl. has the concreting pathology of hardness. Instead of open cancer (this is more for Acid-fluoric), Calc-fl. has more concentric hardness. The process of coalescence is the basis to give the character of concreting to the halogen group and hence its inclusion in the monogram.
The remedies in the halogen group have an affinity for glands. Pathologies of glands range from simple inflammation to ulceration, hypertrophy, atrophy, calculus formation or even malignancy. There are 6 points to mention: Glands get enlarged, inflamed, indurate, suppurate, become atrophied and cancerous.
All - flourine, chlorine, bromine and iodine have a tendency to malignancy. The halogen remedies act on the reticulo-endothelial system (RES) and through its disturbance cause malignant changes. Glandular malignancies are more common in the halogen group, or ulceration may become chronic and then malignant. The miasmatic background of syco-syphilis cultivates the process to develop the cancerous conditions.
Thermally halogen group of remedies is found to be warm-blooded. They can't tolerate warmth in general, summer, or hot air. Many disease conditions are aggravated due to above modalities. It is as if the system drains away with heat. Being a strong physical general and being applicable to all halogen remedies, this has been included in the monogram.
The activity index of the halogen group is very high. They are mentally as well as physically very active and it is due to this activity that we find rapid development of grave diseases like tuberculosis, hyperthyroidism, cancer and many auto-immune disorders. Mentally halogen remedies are restless, active, hurried in nature and in the long run, they may become destructive.
Halogen remedies are poised for organic or structural changes. The illnesses are more found to be in the structural zone rather than in the functional zone. The syco-syphilitic miasmatic dimension which is actively operational over the system produces a lot of chronic, metabolic, endocrinologic and other inveterate disease conditions.
ILLUSTRATION THROUGH CASE STUDY
A case of rheumatoid arthritis with Lichen sclerosus, Varicose veins, HTN and DM.
Age 65 years.
RA since 20 years. Deformities of the fingers and toes since four years. Lightning like, tearing pains in joints. Stiffness++, < morning, beginning of motion.
LS since 10 years.
DM since 17 years. Tingling and numbness of lower limbs due to neuropathy. Coldness of hands and feet.
Dependent. Daily activities not possible without support.
One left great toe was amputated 1.5 years back due to gangrene.
Chronic hyperacidity. Reflux oesophagitis. Heartburn. Regurgitation. Gases.
Is gradually losing weight.
Ulcer has developed on left foot since three months and she fears that it will turn as gangrene. Ulcer is painless and indolent.
Was operated for hysterectomy due to 3rd grade uterine prolapse at 42 years. Now has umbilical hernia and she refuses the surgery.
Despair of recovery. Feels helpless.
Belongs to the rich family. The whole life in luxury. Demanding. Fulfill my demands now. Suspicious. Thinks that she is unwanted at home and others want to kill her. Haughty. Selfish. Restless and anxious. Rigid. What she says and holds is only the right and truth.
Two divorces. The last one due to her loss of libido and sexual dysfunction + her ever demanding nature.
Extravagant in spending money. No compromise in price, will purchase only expensive items. Wears daily an executive saree and keeps it throughout the day.
Worked as a journalist and was always critical of ruling government. Now boasts of her political connections.
MONOGRAM OF THE CASE
RHEUMATIC. STIFF. ATONIC. SENILE. GRADUAL. DEGENERATING. ATROPHIC. SCLEROTIC. ULCERATIVE. DYSPEPTIC. VENOUS. PROGRESSIVE. SYPHILITIC.
A SHORT ANALYSIS OF THE CASE
Combining the characters (as we get through the exercise of monogram) with the mental portrait as we receive from the case, it is possible to clinch Plumbum metallicum. Note that in the absence of local/particular symptoms, the module of monogram is very useful to select an appropriate remedy.
MONOGRAM WORD MEANINGS
Some word meanings as they appear in remedies have been given for more understanding.
- Calcareous: Deposition. Lithemic. Cholelithiasis. Nephrolithiasis.
- Cachectic: Malnutrition and wasting.
- Hemorrhagic: Pertaining to or marked by haemorrhages.
- Vulnerable: Easily injured or wounded. Predisposed.
- Exudative: Having pathology of oozing of fluids, result of inflammation.
- Fibrinous: Pertaining to a whitish filamentous protein formed by thrombin or fibrinogen i.e. fibrin.
- Tubercular: Relating to the tubercular miasmatic activity. Lymphadenopathy, emaciation, hectic fever, profuse bleeding etc. are some of the characters.
- Debilitated: Pertaining to weakness.
- Cancerous: Pertaining to malignant growth.
- Dropsical: Pertaining to oedema.
- Collapsy: State of falling into sudden and extreme prostration resembling shock.
- Agitated: 1. Pertaining to excessive restlessness, increased mental and physical activity. 2. The tremor 3. Severe motor restlessness, usually non-purposeful, associated with anxiety.
- Unstrung: Emotionally upset but becoming passive.
- Allergic: Pertaining to, sensitive to, or caused by an allergen.
- Dysthrepsia/athrepsia: Digestive failure.
- Dystrophy: Disorder caused by defective nutrition or metabolism.
- Herpetic: Pertaining to indicate vesicular eruptions.
- Dyspeptic: Affected with imperfect or painful digestion.
- Indurating: Pertaining to the act of indurations that is hardening of tissue.
- Congestive: Pertaining to presence of an excessive amount of blood or tissue fluid in an organ or tissue.
- Constrictive: Pertaining to narrowing of vessels. Functional sensation of being restrained or narrow.
- Neurasthenic: Person with unexplained chronic fatigue and lassitude with nervousness, irritability, anxiety, depression, headache, insomnia and sexual weakness.
- Ulcerative: Pertaining to an ulcer.
- Ataxic: Pertaining to or marked by defective muscular incoordination.
- Nervo-billious: Pertaining to stress-induced bilious temperament.
- Shaky: unsteady.
- Senile: Pertaining to old age. Cross reference: aged.
- Plethoric: Pertaining to or characterized by over fullness of blood vessels or of the total quantity of fluid in the body.
- Torpid: Not acting vigorously, sluggish.
- Anoxic: Lack of oxygen and characterized by a generally sub-normal oxygen tension of the blood.
- Scorbutic: Concerning or affecting with scurvy.
- Toxic: The state of sickness due to the intense influence of infection or septicemia
- Rheumatic: Pertaining to rheumatism.
- Stiff: Rigid, firm, inflexible.
- Ecstatic: Pertaining to a state of exhilaration, trance like condition or a state of exalted delight.
- Extra-sensory perceptions: Pertaining to forms of perception not dependent upon 5 primary senses
- Insidious: Deceptive development of a disease (lacking in symptoms or the patient is unaware of it).
- Proliferative: Pertaining to reproduction by cell division
- Malignant: Growing worse; resisting to treatment, said of cancerous growth. Tending or threatening to produce death; harmful.
- Catarrhal: Of nature of or pertaining to inflammation of mucous membranes.
- Flatulent: Affected with or caused by gas in alimentary tract.
- Neuralgic: Severe sharp pain along a course of nerve.
- Neurotic: One suffering from neurosis.
- Tense: Tight, rigid, and anxious, under mental stress.
- Festering: Becoming suppurated.
- Sore: Tender, painful, any type of tender or painful ulcer or lesion of skin or mucous membrane.
- Venous: Pertaining to veins or blood passing through them.
- Degenerative: Pertaining to or accompanied by deterioration or impairment of an organ or part in structure of the cell and the substances of which they are part.
- Septic: Pertaining to pathologic state, usually febrile, resulting from the presence of microorganisms or their poisonous products in the blood stream.
- Soporous: Characterized by abnormally deep sleep.
- Stuporous: Marked by or resembling sound sleep or coma.
- Concreting: Condensing, hardening or solidifying.
- Toxemia: Distribution throughout the body of poisonous products of bacteria growing in the focal or local sight thus producing generalized symptoms like fever; diarrhoea; vomiting; pulse and respiration weakened or depressed; shock.
- Lymphatic: Of or pertaining to lymph or lymph vessel
- Sclerotic: Pertaining to sclerosis i.e. hardening or induration of an organ or tissue (esp. from excessive growth of fibrous tissue)
- Scrofulous: Pertaining to scrofula that is a variety of tuberculous adenitis.
- Lithic: Pertaining to formation of calculi and concretion.
- Cancerous: Pertaining to malignant growths.
- Neurotic: Pertaining to neurosis i.e. unpleasant mental symptoms in an individual with intact reality.
- Epileptic: Concerning epilepsy, individual suffering from attacks of epilepsy.
- Deprived: Being not rendered the rights.
- Composed: Calm and contented.
- Steady: Stable.
- Atrophic: Pertaining to wasting; a decrease in the size of organ or tissue.
- Incompetent: Not competent, not able or not in a position to act.
- Atonic: Without normal tension or tone of strength.
- Tremulous: Trembling or shaking.
- Atrophied: Wasted, affected with atrophy.
- Sickly: Pertaining to sickness.
- Fissured: Pertaining to fissured i.e. Ulcer or crack like a sore.
- Devitalized: Pertaining to destruction or loss of vitality.
- Declining: Pertaining to progressive disease.
- Standstill: Still; not moving
- Chronicity: A state of long duration, designating a disease showing little change or of slow progression.
- Depressed: Low in spirit; dejected. Decreased level of function.
- Gluttons: Food lover.
- Putrescent: Decay; rottenness.
- Destructive: Causing ruin or destruction.
- Suppurative: Producing or associated with generation of pus.
- Grippy: Pertaining to acute infectious disease marked by fever, prostration, pain in head and back and upper respiratory tract symptoms such as cough and nasal congestion; synonym influenza.
- Hyperemic: Pertaining to congestion or an unusual amount of blood in a part or a form of macula; red areas on skin that disappear on pressure.
- Malarious: Affected with malaria. Causing or resembling malaria.
- Pyemic: Related to or affected with blood poison.
- Dyscretic: Pertaining to dyscresia or miasmatic constitution.
- Algid: Cold, chilly.
- Cyanotic: Of the nature affected with or pertaining to slightly bluish grEyish slate like or dark purple discolouration of the skin due to presence of abnormal amounts of reduced haemoglobin in blood.
- Glandular: Pertaining or of the nature of gland.
- Toxic: Pertaining to, resembling or caused by poison. Synonym: poisonous.
- Skinny: Pertaining to thin, slender constitution.
- Trepid: Marked by tremors.
- Rhoeo-rhematic: Various forms of rheumatism.
- Vegetative: Having the power to grow.
- Tactophobic: Phobia of touch.
- Phthisic: Pertaining to tuberculosis.
- Neurotoxic: Poisonous to the nerve cells.
- Hyperestheic: Pertaining to increased sensitivity to sensory stimuli, such as pain or touch.
- Spastic: Resembling or of the nature of spasms or convulsions
- Apoplectic: Pertaining to apoplexy - 1. Copious effusion of blood into an organ. 2. Sudden loss of consciousness followed by paralysis caused by haemorrhages into brain; formation of an embolus or a thrombus that occludes an artery or rupture of an extra -cerebral artery casing sub arachnoids haemorrhages.
- Syncopic: Pertaining to transient loss of consciousness due to inadequate blood flow to the brain.
- Nervous: Anxious, characterized by excitability. Pertaining to the nerves.
- Hydric: Pertaining to, characterized by, or requiring considerable moisture.
- Chlorotic: Of the nature of or afflicted with a form of iron deficiency anaemia.
- Salophilic: Craving for salt.
- Inebriate: To make drunk or to become intoxicated.
- Spasmodic: Involuntary sudden movement of muscular contraction which occurs as a result of some irritant or trauma.
- Erratic: Wandering. Having an unpredictable or fluctuating course or pattern.
- Fitful: Erratic; irregular
- Run down: To lose power, to grow gradually weaker.
- Spoilt: Decomposed; destroyed; decay.
- Amative: Sexual
- Periodic: Recurring after definite intervals.
- Gouty: Of the nature of or related to gout
- Thermophobic: Fear of heat.
- Paretic: Affected with or concerning partial or incomplete paralysis.
- Stunted: Underdeveloped
- Obsession: Pertaining to neurotic state of having an uncontrollable desire to dwell on an idea or an emotion.
- Hyperplasic: Excessive proliferation of normal tissue arrangement of an organ.
- Psychoneurotic: Pertaining to emotional mal-adaptation due to unresolved unconscious conflicts. This leads to disturbances in thought, feeling, attitudes and behaviour.
The concept of monogram is an objective tool for evaluating the portrait, that the patient draws. It opens up the fields of logic, philosophy, pathology, patterns, integration of the intertwining characters and if these characters are understood in their genuineness, a physician is able to see the movement of the disease (under the miasmatic activity) in a better way.
The concept of monogram is based on the principle of Generalization. It is as if one precisely and concisely denotes the character which defines the problem, highlights the exactness of the problem and streams down to the essence out of the maze of symptoms. The concept gives justice to the pathology which is nothing but an accentuated form of energy of the disease.
The concept of monogram allows to view the remedy under consideration not only by the symptoms but the 'totality' through the symptoms. It also allows the study of the patient through a broader vision as the mind-body co-relation is better understood.
While abstraction reduces complexity by hiding irrelevant details, generalization reduces complexity by making a coherent whole. A single construct of monogram thus unifies the raw and scattered data and convincingly puts before the homeopath the roadmap intended for fishing out the most similar remedy, to perceive what is to be cured in a case and to monitor the direction a homeopath is riding.
The ability to abstract and generalize is an essential part of any intellectual activity. Abstraction and generalization are fundamental to philosophy on which the concept of monogram is based.
Remember, it is also possible that the remedy may not cover the monogram characters of the patient but yet can be useful if the symptoms correspond. This occurs due to the layers, the presenting surface layer may be superficial and the system yet in a process to develop the pathological generals and behavioural patterns. The utility of monogram concept is tremendous in pathological cases when the PQRS symptoms are scanty. Combining mental expressions, dispositions and state with the monogram words allows the physician to see the parallelism, to see the movement and to assess the miasmatic energy that is operating at various levels of the system.
In 'Absolute MM, we have given the 'Action' section. It is a natural continuation of the monogram teaching. It explains the rhythm, pace, order and directions of the monogram themes. The blend of monogram and action paves the way for a better grasp of the remedy under consideration.
Remember, monogram does not replace the repertorization; it rather explains it. The monogram allows to select the right symptoms and connect them to one and whole existence. Without a monogramic understanding of the repertorization, we deal with separated and fragmented symptoms. The study of the rubrics with the monogram makes a homeopath conscious of the flow within the system. In other words, monogram is about recognizing the modes upon which the organism exists.
There are many rubrics (related to monogram) in our repertory. But a reliable and big repertory of monogram is the need of the hour. The author of this paper is working over the project of repertory of monogram.
I thank my colleague, Guy Tydor, Israel, for his valuable suggestions.