How To Classify And Grade Symptoms- A New Approach Proposed By Dialectical Homeopathy
In accordance with the scientific understanding and explanation of homeopathic therapeutics provided by Dialectical Homeopathy, we have to re-examine the whole protocols of Case Taking, Classification and Grading of Symptoms, selection of similimum and its therapeutic application.
To be capable of following the logic behind the new method of classifying and grading of symptoms proposed by Dialectical Homeopathy, one should be familiar with its basic premises regarding the understanding of ‘similia similibus curentur’ and homeopathic therapeutics.
Since the perception of Dialectical homeopathy about the mechanism underlying the processes of disease and cure fundamentally differs from that of ‘classical homeopathy’, its ways of application are also bound to differ.
Dialectical Homeopathy explains ‘similia similibus curentur’ on the basis of modern biochemistry and molecular biology. According to this view, diseases are deviations in biochemical pathways caused by material level molecular errors in the organism. Apart from those of genetic abnormalities and nutritional deficiencies, these molecular errors are caused by inhibitions of essential biological molecules resulting from binding of molecules of exogenous or endogenous origin. These molecular level deviations are primary factors of diseases, which expresses through diverse groups of objective and subjective symptoms. Symptoms are actually the expressions of molecular errors as reflected in the consciousness of the person himself, or perceived the observers.
An individual may be same time having diverse types of pathological molecular errors in him, caused by diverse types of molecular inhibitions originating from genetic, miasmatic, nutritional, infectious, environmental, emotional, metabolic, iatrogentic and various such factors. Symptoms expressed by an individual actually represent such diverse types of pathological molecular errors happened in different biochemical pathways. More over, molecular inhibitions have a cascading effect, errors in one pathway leading to new errors in associated pathways. Diseases progress to new stages through this cascading mechanism. That shows, disease cannot be dealt with as a singular entity in the concerned organism.
According to Dialectical Homeopathy, potentization involves a process of ‘molecular imprinting’, by which three-dimensional artificial binding agents are prepared in water/alcohol medium, that can later bind to the pathogenic molecules having configurational similarity to original drug molecules. These ‘molecular imprints’ are the actual active principles of potentized homeopathic drugs. When these ‘molecular imprints’ are introduced into the organism according to the therapeutic law of ‘similia similibus curentur’, they would specifically bind to the pathological molecules having configurational affinity, thereby relieving the biological molecules. This is the molecular mechanism of homeopathic therapeutics.
We should understand ‘drug proving’ and materaia medica in a new light. Drug proving actually involves the study of ‘molecular errors’ that could be created in a healthy organism by introducing crude drug substances. When drug substances are introduced into the organism, independent constituent molecules contained in the drug substances interact with biological molecules and create molecular inhibitions amounting to artificial pathological conditions. These ‘molecular errors’ are expressed through diverse groups of objective and subjective symptoms, and systematically compiled in our material medica texts. The most important insight Dialectical Homeopathy introduces regarding ‘drug proving is that drugs are never ‘proved’ as ‘single’ entities. It is not the drug substances that interact with biological molecules, but the independent constituent molecules of drugs. Materia medica actually represents a collection of symptoms produced by the diverse types of molecular errors caused by diverse types of individual drug molecules being part of the drug substance. As such, a drug substance can not be considered as ‘single’ entities as ‘classical’ approach perceives. They are ‘proved’ as constituent molecules, potentizaed as individual molecules, and the potentized drugs act as therapeutic agents in capacity of individual ‘molecular imprints’.
According to Dialectical Homeopathy, ‘similia similibus curentur’ should be explained in the light of this new understanding regarding disease and cure. Meaning of ‘similia similibus curentur’ now becomes, “pathological molecular errors can be removed using molecular imprints of drug molecules that were proven to be capable of producing similar molecular errors in organism in capacity of their configurational similarity of their functional groups or moieties”. This ‘similarity of molecular errors’ and similarity of ‘molecular configurations’ are determined in homeopathy by a very practical way of ‘similarity of symptoms’.
Now, we clearly understand the importance of ‘symptoms’ and ‘similarity of symptoms’ in the application of homeopathic therapeutics.
The exact molecular errors underlying a state of pathology and the biochemical deviations arising there from could be determined and compared with that of drug substances only by a careful and judicious observation and analysis of ‘symptoms’. Subjective and objective symptoms are the only indicators by which we can identify the molecular errors underlying a pathological condition.
Classifying and grading of symptoms is a very important step in homeopathic case study and selection of similimum. So far, homeopaths were taught to classify symptoms first into ‘physical’ and ‘mental’, considering ‘mentals’ as decisive factors in selecting similimum. This method of classification is based on the theory that diseases originate in the level of ‘vital force’, and the concept that ‘mind’ is primary to ‘body’. Dialectical Homeopathy thinks just the opposite. Material ‘body’ is ‘primary’, and ‘mind is ‘secondary’. Disease and cure are material phenomena, drugs are material, therapeutics is a ‘material art’, not a ‘spiritual’ one. Diseases and cure happen at molecular level, not ‘spiritual’ level.
According to Dialectical Homeopathy, symptoms should be first classified into ‘subjective’ and ‘objective’.
Many people confuse with the terms ‘subjective’ and ‘mental’. They think both terms mean the same, and use these terms in similar meaning. But, if you logically think over it, you will understand ‘subjective’ does not mean ‘mental’. There are many ‘subjective’ symptoms that are not ‘mental’. Same way, there are many ‘mental’ symptoms that are not at all ‘subjective’. Without resolving this confusion, it would be difficult to follow what I say regarding classification of symptoms.
‘Subjective Symptoms’ are the symptoms ‘felt’ or experienced’ by the individual, without the involvement of sense organs. The micro-level pathological molecular errors are first experienced subjectively, by the faculty of ‘consciousness’ of the individual, without the involvement of sense organs. The cascading effects of even minute molecular and cellular level deviations would be transmitted to the associated brain centers through the mediation of internal signaling system and neuro-endicrine system. This mechanism initiates certain molecular processes in the brain, which is ‘experienced’, ‘felt’ or ‘sensed’ by the consciousness as diverse groups of ‘subjective symptoms’. As such, study of ‘Subjective Symptoms’ can be used as an effective way of understanding the exact molecular errors underlying the pathological deviations.
Subjective symptoms may appear much before objective manifestations of pathology. Diseases with same objective manifestation may be accompanied with different subjective symptoms, indicting that they differ in some molecular level processes in the individual, demanding different similimum. Obviously, ‘subjective symptoms’ are the most reliable guides in our search for an appropriate similimum.
For example, most ‘aggravations’, ‘ameliorations’, ‘sensations’, ‘desires’, ‘aversions’ and ‘concomitants’ accompanying ‘physical’ symptoms are ‘subjective’ but not ‘mental’. ‘Itching’ , ‘burning’, ‘pain’, and all such symptoms are ‘subjective physical’, not ‘mental’. ‘Aggravation by cold application’, ‘pain amel by rest’, ‘pain amel by motion’ etc are also ‘subjective physicals’.
Whatever method we use for grading of symptoms and repertorization, ‘Subjective Symptoms’ will come on top rank.
Subjective Symptoms are classified into ‘Subjective Mentals’ and ‘Subjective Physicals’.
Subjective Mental Generals are those symptoms ‘general mental symptoms’ that could be ‘experienced’ by the patient only. Many hallucinations and delusions belong this group. ‘Grief’, ‘anxiety’ etc are ‘subjective mental generals’.
‘Subjective Mentals’ can be further divided into ‘Subjective Mental Generals’ (SMG) and ‘Subjective Mental Particulars’ (SMP)
‘Subjective Physicals’ can be further classified into ‘Subjective Physical Generals’ (SPG) and ‘Subjective Physical Particulars’ (SPP).
‘Objective Symptoms’ are those ‘observed’ by the patient himself, or by the onlookers, with their sense organs aided or un-aided by accessory means. Observations through physical examinations and laboratory investigations also belong to this class. ‘Objective symptoms’ also represent the ‘pathological derangements’, but only those which have advanced into gross observable magnitude. Hence, ‘objective symptoms’ cannot reflect the exact ‘molecular basis’ of pathology. In most cases, ‘objective symptoms’ may also be associated with certain ‘subjective symptoms’, which give real indications to the actual micro-level processes behind. Observing objective symptoms along with associated subjective symptoms help us to identify the exact molecular errors, which is necessary for selecting appropriate similimum. Such objective symptoms, appearing with related subjective symptom can be classified as a subjective symptom. Here lies the importance of sensations, modalities, concomitants, desires and aversions appearing in association with objective symptoms. Objective symptoms, in the absence of associated subjective symptoms are not of much importance in deciding similimum. When we observe an objective symptom, he should look out for ‘how it is felt’ by the patient.
‘Objective Symptoms’ are classified into ‘Objective Mentals’ and ‘Objective Physicals’
‘Objective Mentals’ can be further divided into ‘Objective Mental Generals’ (OMG) and ‘Objective Mental Particulars’ (OMG).
‘Objective Physicals’ can be further classified into ‘Objective Physical Generals’ (OPG) and ‘Objective Physical Particulars’ (OPP).
Classification and grading of ‘General Symptoms’:
In the classical way of homeopathic case analysis, ‘mentals’ and ‘physical generals’ are considered to be most important in the selection of similimum. Normally, while describing ‘general symptoms’, the patient would use the prefix ‘I’, and others would use the prefix ‘He’.
According to the new method of case analysis proposed by Dialectical Homeopathy, ‘general’ symptoms are classified into four categories:
1. Subjective Mental General. 2. Subjective Physical General.
3. Objective Mental General. 4. Objective Physical General
A ‘general symptom’ may be either ‘physical’ or ‘mental’. Further, ‘mentals’ are classified into ‘subjective and ‘objective’. ‘Physical generals’ are also classified into ‘subjective’ and ‘objective’.
‘General physical symptoms’ that could be ‘experienced’ only by the patient, such as ‘General weakness’, ‘chilliness’, ‘hot patient’, ‘hot flashes’, etc are ‘subjective physical generals’.
When a ‘subjective physical general’ is associated with a ‘subjective mental general’, it should be graded top in the list, as a ‘subjective mental general’.
If a ‘mental general’ symptom could be observed by others, it becomes a ‘objective mental general’. ‘Laughing immoderately’, ‘wandering on streets’, ‘absence of personal hygiene’, ‘walking hurried’, ‘eating in a hurry’ ‘abusive’, ‘aversion to answer’, ‘bemoaning’, ‘plays antics’, ‘idiotic’, ‘crawling on the floor’ etc are ‘objective mental generals.
‘Objective physical generals’ are ‘physical generals’ that could be observed by others. ‘Obesity’, ‘leanness’, ‘emaciation’, ‘chorea’, ‘chlorosis’, ‘collapse’, ‘fainting’, ‘convulsions’, ‘color of discharges’, ‘dwarfish’, ‘flabbiness of skin’, ‘stoop-shouldered’, ‘anasarca’ , ‘trembling’, ‘positions in sleep’, and such symptoms belong to this group.
If an objective physical general is associated with a symptom belonging to subjective physical general or subjective mental general, it should be ranked top in the list.
After classifying and grading ‘general’ symptoms systematically, we can find an appropriate ‘constitutional similimum’ using all subjective and objective generals.
Grading of Symptoms:
Once we classify the symptoms into 8 groups as proposed by Dialectical Homeopathy, its practical application requires a perfect system for ‘Grading of symptoms. This grading ultimately decides the selection of similimum. Once grading of all rubrics are set and weightage marks assigned accordingly, we can use any of the three ‘methods of grading’ we already discussed, such as ‘subjective-objective’, ‘menetal-physical’ and ‘general- particular’ for our repertorization work.
I. Subjective-Objective Method:
1. Subjective Mental Symptoms. 2. Subjective Physical Symptoms. 3. Subjective Mental Particulars. 4. Subjective Physical Particular. 5. Objective Mental General. 6. Objective Physical General. 7. Objective Mental Particular. 8. Objective Physical Particular
II. Mental-Physical Method:
1. Subjective Mental General. 2. Subjective Mental Particular. 3. Objective Mental General. 4. Objective Mental Particular. 5. Subjective Physical General. 6. Subjective Physical Particular. 7. Objective Physical General. 8. Objective Physical Particular.
III. General-Particular Method:
1. Subjective Mental General. 2. Subjective Physical General. 3. Objective Mental General. 4. Objective Physical General. 5. Subjective Mental Particular. 6. Subjective Physical Particular. 7. Objective Mental Particular. 8. Objective Physical Particular
I would suggest following system of ranking for repertorization:
1. ‘Subjective Mental Generals’ and ‘Subjective Physical Generals’ should be given equal ranking and placed on the top.
2. ‘Subjective Mental Particular’ and ‘Subjective Physical Particulars’ should be considered of equal rank and placed second in weightage.
3. ‘Objective Mental Generals’ and ‘Objective Physical Generals’ can be considered equals in importance and given third place in ranking
4. ‘Objective Mental Particulars’ and ‘Objective Physical Particulars’ can be considered equals and placed in fourth rank.
If you are repertorizing using ‘totality method’, weightage marks can be given accordingly. If you repertorize using ‘elimination method’, always use top-ranking ones as ‘eliminating symptoms’
By placing in low rank, it does not mean a symptom is un-important and totally ignorable. All classes of symptoms have their own relevance and should not be ignored.
Grouping of symptoms into ‘Symptom Complexes’:
For those who are not averse to using multiple drugs if necessary, symptoms can further be grouped into ‘Symptom Complexes’. I have already explained through my earlier articles, my concepts of similimum that differs from accepted classical approach.
If we minutely and systematically study the whole symptoms expressed by the patient belonging to the eight different classes discussed above, we can see that each symptom exists as part of a larger unit or ‘symptom complex’ by associating with two or more other subjective or objective symptoms normally called as locations, sensations, modalities and concomitants. A ‘symptom complex’ normally represents a specific train of pathological derangements caused by a particular molecular error in the organism. There may be diverse types of molecular errors existing in the organism caused by diverse types endogenous or exogenous pathogenic agents belonging to genetic, environmental, infectious, miasmatic, metabolic, emotional, iatrogenic and such other factors. Hence, especially in chronic constitutional conditions, we should always expect more than one unrelated ‘symptom complex’ existing in a patient. It would be an ideal condition if we could find a single drug that contains all ‘molecular imprints’ that cover all the different ‘symptom complexes’ existing in the patient. In many cases, each individual ‘symptom complex’ may demand a separate similimum containing appropriate ‘molecular imprints’ capable of removing that particular molecular error it is representing. In such cases, instead of trying to match the totality of whole symptoms expressed by the patient with a ‘single drug’, we will have to address each ‘symptom complex’ by matching them with similar ‘symptom complexes’ in the materia medica of different drugs. Physicians should always try to identify such ‘symptom complexes’ by carefully observing and analyzing the associations and relationships between various symptoms, and find appropriate similimum for each individual symptom complex, to ensure a TOTAL CURE for his patient.