VALUE OF OBSERVATIONS IN HOMOEOPATHIC PRACTICE

Dr Pramod K
Chief Medical Officer, NFSG
Dte of ISM & Homoeopathy, Govt of NCT of Delhi

“If the Homoeopathic Physician is not an accurate observer, his observations will be indefinite,
and his observations are indefinite, his prescribing is indefinite” Kent (1900)

Observation means the act or instance of noticing a condition, perception, the faculty of taking notice,
the accurate watching and noting of a phenomenon. (Oxford Dictionary) When a patient comes for
consultation a medical practitioner is likely to take note her/his sex, apparent age, constitution, posture,
state of nutrition, facies, manner of dress, talking and other similar features. Many at times, observation
along with the other symptomatology stated by the patient determines the remedy. As such, good
observational skill remains to be one For Kind attention:
of the requisite qualities of a Observation is an integral part of case taking and follow up
homoeopathic practitioner. treatment in Homoeopathy. This faculty can be used to
manage patients in busy OPDs and confirm the accuracy in
S Hahnemann emphasizes the prescription. I would like to appeal my seniors and colleagues
importance of observation in clinical to send cases based on observations for discussion.
practice. Observations often exposes
the peculiarity of the patient and therefore demands making summary of such observations after noting
the symptoms expressed by the patient. In Organon of medicine the place of observation in the
examination of a case is stated as “The state of the disposition of the patient often chiefly determines
the selection of the homoeopathic remedy, as being a decidedly characteristic symptom which can least
of all remain concealed from the accurately observing physician.” Hahnemann (1833)

THE ROLE OF OBSERVATION

1. OBJECTVE SYMPTOMS

The objective symptoms are considered as the signs of pathological changes and have little value in
prescribing if not peculiar in nature. Usually it includes physiological findings, laboratory findings and the
observations of the physician. The objective symptoms that are not diagnostic of a pathological state or
disease turn out to be important in prescribing. These symptoms become more important while dealing
with infants, comatose, mental disease, uncooperative patients, imbeciles etc.

Good observational skill enables to notice the objective component of many subjective symptoms and is
useful in individualization. For eg. Lying with face buried in pillow in intense photophobia (Psor),
chilliness or sensitiveness to cold air is manifested as wearing a fur cap, overcoat or shawl even in
hottest summer(Psor), patient is constantly rubbing and shaking the region of liver with his hands in
abdominal complaints (Podo), repugnance to cold or cold air, chilly when uncovered and feels better by
covering the whole body (Nux vom), burning sensation of a part, feels better by applying the cold things
or exposing that part to open air, pain in abdomen causing the patient to bend double or flexion of
thighs over abdomen(Colocynth), constant tendency to blow the nose even without discharge (Sticta.p),
sits sideways in chair to avoid pressure against spine(Theridion c) wearing loose clothing because of
great sensitiveness to touch (Lach) [Allen (2002); Boericke (1927)]

Objective symptoms are of more value when they occur while in sleep. These symptoms can be taken
note of especially in cases of IPD patient or if possible, by visiting them at their residence.

Various postures/position adopted during sleep such as lies on abdomen, position of arm, curled up like
a dog, head inclined forward /backward, limbs crossed, drawn up, spread apart, lies on sides, restless
sleep, restlessness and kicks off cloths, singing ,talking and walking during sleep etc. are of great value
for a homeopathic medical practitioner. Observation of perspiration during sleep, mouth open or half
open, eyes half open during sleep all lead to specific remedies.

In case of skin complaints the morphology of the lesions usually suggests the diagnosis of the disease
but we can individualize the case by seeing the peculiarity of nature of the disease such as location, side
or laterality, extension, color, distribution, consistency.

Observation Medicine
Styes, chalazae on eye lids or upper eye lids one after another Con, Staph, Thuja
leaving hard nodosities in their wake
Eruptions only on covered parts, sweat only on uncovered parts Thuja

Tendency to small painful boils one after another, extremely sore Arnica
small boils in crops Sulph
Eczema-no itching, exudation forms into hard lemon colored crust Cicuta vir
Keloids-old cicatrices become red around edges and threaten to Acid Fluor, Caust, Graph.
become open ulcers
Folliculitis -in recurring or chronic boils particularly when located Calc. pic.
on parts thinly covered with muscle tissue as on shinbones, coccyx,
auditory canal
Herpetic eruptions about anus and on borders of hair at nape of Nat mur
neck
Herpetic eruptions on end of the nose Aeth cyn

Affects especially the mucus outlets of the body where skin and Acid nit.
mucus membrane join; mouth, nose, anus, urethra, vagina
Sore raw spots on feet , especially heel from friction Allium cepa
Panaritia, with red streaks up the arm Allium cepa. Bufo r

Source: Allen (2002); Boericke (1927)

These show evidences of how even the objective symptoms become the indication for a remedy as the
observational skill is used effectively.
2. IN DIAGNOSIS OF MIASM

The Homoeopathic physician must have a comprehensive knowledge of the three miasm for enabling
her/him in treating chronic disease with good results. The attention in observation itself will give an idea
of miasmatic trait in the individual. The miasmatic features from the patients can be traced out using
observational skill.

Psora Mental activity -quick, active

Weeps without cause and Weeping palliates
Easily frightened often by trivial things with trembling and shaking of the body.
Anxious, apprehensive, sad and Changeable mood
Psoric patients become dizzy and faint in a crowd or when they meet strangers or
any unusual ordeal is to take place.
They are sensitive to many impressions such as odors of flowers, cooking food
atmospheric changes, bad news or joy etc.
A chronic complainer never satisfied with conditions in life.
Philosophical out look
“Sensation as if” without pathological changes
Skin symptoms-history of suppression, the cause of present complaints
Aggravation –morning ,standing, heat exertion ,worries
Amelioration- lying down, sleep, rest ,scratching, open air

Sycosis Suspicious, confused, jealousy, deceitful, quarrelsome, cruel cunning persons are
sycotics. They will do harm to others and have lack confidence and suicidal
tendencies but fears. They are slow in thinking and doing.
Serous, fibrous tissue and muco-cutaneous margin are usually involved
All symptoms are relieved by abnormal/pathological discharges.
Aggravation-cold, rainy weather, damp places, thunderstorms, thinking of
complaints, daytime
Amelioration-stretching , lying on abdomen, moving.

Syphilis Mentally dull, obstinate, stubborn, idiotic, suspicious thinks of suicide and
commits it, impulsive, close mouthed persons are coming under syphilitic miasm.
The parts of the body involved are: mucus membrane with destruction and
ulceration, bones blood vessels, nervous system.
Aggravation –night ,summer, heat ,rest, exertion
Amelioration –cold application, day time, motion

Source: Patel (1996); Speight (1994)

3. PHYSICAL EXAMINATION OF THE PATIENT

Physical examination is the most important part of the case taking. This helps the medical practitioner
reach in provisional diagnosis and enables to see the indication of remedies.
General examination

Appearance: Observation Refer to

dirty, filthy Allen key notes

Old looking Kent Repertory Face-expression,

Gen. old age
Wrinkles Kent Repertory Face

edema Gen.swelling

Awkwardness Extremities- Awkwardness

Built-dwarf Gen - dwarfishness

Obese Gen - obesity

Emaciation Gen
Tall Arg.nit, Phos, Tub
Thin Secale.cor
Gait Extremities
Other physical deformity-stoop Gen
shouldered
Discoloration –pale Gen. Aneamia
Icteric Skin
Cyanosis Gen
Examination Perspiration General/particular, odor
Lymph nodes Gen-indurations, swelling glands
Pulse Gen
B.P
Temperature Fever
Respiration Respiration
Behaviour Anxious , fearful , quarrelsome, Mind
indifferent, talkative
Expression Face- expression

 Systemic examination

Reveals the underlying pathology as well as the remedial indications

Examples:
fear of being touched or approached Arnica
Aversion to be touched or approached Anti.curd, Anti.tart
Dullness in right upper lobe lung in pneumonia lyco
Rattling rales heard from a distance Anti.Tart
Rales with full of mucus but does not expectorate- Ipecac

4. Observation of Sick room

At times the arrangement of the articles in the sick room signifies the peculiarity of the patient. But this
must be verified with appropriate enquiry.

If windows are open even in winters or cold weather may indicate the desire for open air or intolerance
of closed room. Observation of patient sitting facing towards fan even in normal temperature has
therapeutic value.

A child rests comfortably while lying on the shoulder of his mother but become irritable and peevish
when lying down expresses her/his peculiar nature which should be noted.

Dim or shaded light in the room, darkness and preference of solitude provide important therapeutic
hints to the medical practitioner.

Likes wise, various types of odors such as putrid, decayed, sour, fish-brine will give clue regarding the
remedy as well as disease diagnosis.

Keeping some “Smelling bottle” and if patient explains frequency of its usage is an observable feature
that can lead to prescription of remedy.

The temperature chart usually gives the exact time modality which is useful to know about the nature of
illness and in the selection of remedy.

IMPROVING THE OBSERVATION- Suggestions

1. Drug proving

2. Study of Homoeopathic repertory giving stress to rubrics

3. Reading the pure homoeopathic materia medica

BARRIERS TO OBSERVATION

1. Lack of time for a proper case taking.

2. Improper clinical training .

References

Hanhemann,Samuel (1833) Organon of Medicine, B Jain Publishers, New Delhi

Allen, HC (2002) Keynotes and Characteristics with comparisons of some of the leading remedies of the
Materia Medica with Bowel Nosodes, B. Jain Publishers, New Delhi

Boericke, William (1927) Pocket Manual of Homoeopathic Materia Medica, B. Jain Publishers, New Delhi

Patel Ramanlal (1996) Chronic Miasms in Homoeopathy and their cure, Hahnemann Homoeopathic
Pharmacy, Kerala

Speight Phyllis (1994) A comparision of the Chronic Miasms, B. Jain Publishers, New Delhi

Kent James Tyler (1945) Repertory of the Homoeopathic Materia Medica , B. Jain Publishers, New Delhi