Clinical Application of Anamnesis in Prescribing: Some Case Studies

CLINICAL APPLICATION OF ANAMNESIS IN PRESCRIBING: SOME CASE STUDIES
Senior Medical Officer (H) Medical Center, High Court of Delhi; Reader, Dept. of Organon of Medicine, NHMC & Hospital, Govt. of NCT of Delhi. Email:[email protected] Abstract Anamnesis as a tool of case perceiving is used in homoeopathy in a broader sense than just medical history as it involves recalling of all the past happenings especially the painful and traumatic events. This tool guided successful treatment of cases of prepatellar bursitis and primary hypothyroidism. Key words: hypothyroidism Anamnesis, homoeopathy, prepatellar bursitis, primary
Dr. Anju Jethani, M.D. (Hom.)
Introduction Anamnesis may be defined as medical or psychiatric history obtained from the patient, especially in the patients own words, based on the recollections of events preceding his or her own illness.1 In other words, it is an exposition of ones sickness from the recall to memory of the past occurrences and events.2 Anamnesis is etymologically a derivative form of Mnemosyne who was the Greek Goddess of memory.3 In homoeopathic parlance, anamnesis is also termed as longitudinal case study. It is a mode of perceiving the evolution of presenting complaints and appreciating the effect of past in the development of present illness. Master Hahnemann underscored the importance of this concept of anamnesis or longitudinal case study in 5 of his Organon of Medicine wherein he stated that, Useful to the physician in assisting him to cure are the particulars of the most probable exciting cause of the acute disease, as also the most significant points in the whole history of the chronic disease, to enable him to discover its fundamental cause,.4 Hahnemann further highlighted the significance of evolutionary case study in his article Medicine of Experience wherein he emphasized that, The internal essential nature of every malady, of every individual case of disease, as far as it is necessary for us to know it, for the purpose of curing it, expresses itself by the symptoms, as they present themselves to the investigation of the true observer in their whole extent, connection and succession. 5 We share the usefulness of this concept with the help of two clinical cases. Case Report I: Prepatellar bursitis (Housemaids knee) A 52 years old male reported with complaint of - swelling of right knee with pain and slight difficulty in movement (orthopedic specialist diagnosed it as housemaids knee with sub-acute idiopathic mono-arthritis). The pain was worse with change of temperature and slightly better with hot fomentation. No significant precipitating factor (like injury) could be elicited as he led a sedentary lifestyle with his
occupation being judicial assistant. He had been on allopathic and homoeopathic treatment since 4-5 months with no relief. Keeping in view the fact that the previous homoeopathic prescriptions were based on presenting symptoms alone and were of no help; the need for thorough anamnesis of the case became imminent. Evolutionary case study revealed past history of pulmonary koch for which he had taken due course of ATT. Further- anamnesis of case uncovered strong family history of pulmonary koch. On close interrogation, patient gave childhood history of recurrent spasmodic cough with occasional vomiting and redness of face. Case Analysis With this strong tubercular background, character of childhood cough and right knee involvement, the drug Drosera came foremost to mind. Quoting from Dr. M.L. Tylers Homoeopathic Drug Picture in chapter DROSERA: I began to realise what Drosera can do in tuberculous disease of bone, of joint and of gland, I was amazed and I started hunting homoeopathic literature for my warrant in so using itBut so far as bone and joints were concerned, I found my justification in black type in the provings of Hahnemann.. How many homoeopaths of our day read Hahnemanns Materia Medica Pura. But I may tell you that Hahnemann gives black type not only to laryngeal symptoms that have made Drosera famous among homoeopaths but he gives the same black type to jointsshafts of long bones and pains in limbs. 6 Prescription & Folow-up The patient was prescribed Drosera LM1/ twice daily followed by subsequent administration in upto LM5 potencies with marked relief in joint complaints (both pain and swelling diminshed within a period of about 2 months).
PRE-TREATMENT
POST-TREATMENT
Case Report II: Primary hypothyroidism A 53 years old male patient, diagnosed with primary hypothyroidism consulted for letharginess with feeling of malaise for last 5-6 months. He passed hard stools with
occasional bleeding per rectum in drops. He had pain in ankle joints off and on. Though he had been advised Thyronorm 25 by allopathic physicians but he preferred to take homoeopathic treatment on account of his previous satisfactory experiences. On reviewing his case, the most significant aspect of case anamnesis was perceived to be the onset of complaints since history of indignation (his own brother had rebuked him on account of some business irresponsibility). He was scolded in front of his own children. Being of sensitive temperament, it hurt him a lot emotionally and since then, he always felt inner anger on seeing his brother. He had family history of Hypothyroidism. He was a chilly patient, thirstless and preferred sleeping on right side. Case analysis The history of indignation, his sensitive sheepish nature and concomitance of thirstlessness provided strong basis for the selection of Staphysagria as the similimum. Prescription & follow-up Patient was prescribed STAPHYSAGRIA LM1/ once daily and continued upto LM6. symptomatically his thyroid serology showed remarkable improvement within three months. He also reported marked relief in his complaints of letharginess and constipation with single of bleeding per rectum. His joint pains also improved slightly. He is still being followed up.
PRE-TREATMENT
POST TREATMENT Discussion & Conclusion The fore-mentioned case studies highlight the importance of anamnesis, in the proper perceiving of the patient as an individual, which could provide rational basis for selection of indicated homoeopathic remedy. Acknowledgement Prof. (Dr.) L.M. Khan, Head of Dept. of Organon of Medicine, Homoeopathic philosophy and Psychology, National Institute of Homoeopathy, Kolkata for giving clinical insight into the bedside application of concept of anamnesis. References 1. Encarta World English Dictionary, Macmillan India Pvt. Ltd. 2. Oxford English Dictionary, 2nd edition, Vol. 1, Claredon Press, Oxford, 412. 3. Benet, William Rose. The Readers Encyclopedia, 3rd edition, A & C Black Publications, London, 344. 4. Hahnemann, Samuel. Organon of Medicine, Translated from 5th edition with an appendix by R.E. Dudgeon; with Additions & Alterations as per Sixth edition translated by William Boericke, B. Jain Publishers Pvt. Ltd., New Delhi. 5. Hahnemann, Samuel. The Lesser Writings of Samuel Hahnemann, Compiled by R.E. Dudgeon, Indian Books & Periodical Publishers, New Delhi. 6. Tyler, M.L. Homoeopathic Drug Picture. B. Jain Publishers Pvt. Ltd., New Delhi.

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CLINICAL APPLICATION OF ANAMNESIS IN PRESCRIBING: SOME CASE STUDIES

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