Moving Towards Similimum: The Repertorial Route

The pursuit of Similimum for a homeopath has always been like the search of nostrum for the alchemist. Both signify providing Cure of the ills and are hard to obtain but unlike the 'mythical' remedy we homeopaths have strived to obtain the path which promises us the similimum. Each physician has his own basis and experiences of choosing similimum and whatever path one chooses it is the final Cure that matters. To prescribe the similimum from the scores of medicines in our store has been both intriguing and difficult for a new comer in this field. He has to carve his own niche and has to learn from his own experiences. So what are the sources of prescription which we use: 

Sources of Prescription:

1. Materia medica based prescription - most ideal. Here, the totality of symptoms is matched with the information in Materia medica in a holistic manner. Thus we can expect a perfect similimum out of this exercise. But the disadvantage of this method is that it consumes a lot of time for searching the entire Materia medica for the perfect similimum. Also, it is not practically feasible for the physician to remember all the symptoms of all the medicines. Therefore, inspite of being the ideal method for prescription it is not recommended in day to day practice.
2. Therapeutic based prescription - In this method the therapeutic indication of the medicines is given more importance. In it we enlist the therapeutic indications of some prominent medicines which have their action in the particular disease conditions. Whenever we diagnose or define a disease or a condition, we will have a clichéd solution in a few numbers of medicines. The selection of medicine looks easy, simple and time saving by this method. However, the disadvantage is that the similimum may not necessarily be found in each case. This is because irrespective of the disease picture every case has some peculiar symptoms characteristic of the individual.
3. Repertory based prescription - Repertory is an instrument which helps in the matching of the symptoms of the patient with the symptoms of Materia medica. In their Clinical practice the physicians found that, it is very difficult to remember all the hundreds of symptoms of each of the thousands of drugs. So they resorted to the use of repertory which would enlist all the symptoms of medicines in a systematic manner. The physician could use it to simplify his prescription without diluting the essence of homeopathic individualisation. It also avoids the disadvantages of both the above methods. Firstly we will not miss out any medicine and secondly its systematic arrangement makes it handy for use. Therefore the Repertory-based prescription is the most ideal and effective method of prescription.

Utility of Repertory in the Choice of Similimum

Repertorisation may be defined as the application of knowledge of repertory to the symptom totality of the case. For a successful prescription we should have complete knowledge of the methodology of Repertorisation. There are certain steps which are to be passed in regular succession correctly and in chronological sequence, only then can we reach for the similimum. Each of theses phases stands for a specific purpose and has its own significance in Repertorisation. These are:

1. Case taking and case recording: This is the first and the most vital steps of Repertorisation. We know "A Case well taken is half Cured"; as case taking is the step which assists us in conglomerating the data pertaining to what is to be cured in the diseased person. Its importance can be assessed from the fact that any deficiency or carelessness at this step can lead the prescriber astray towards wrong prescription. Proper Case taking does not just mean mechanical registration of all the sentences/symptoms a person ejaculates. It means discernment on the part of physician in weighing the importance and need of each of the symptoms. So, this is not just a mechanical registration but prudent consideration of the facts presented.
2. Enumeration of the symptoms: The patient while case taking narrates to us his complaints and pains, we cannot expect from him to provide us systematic, and concise information. Also it depends on many a factors like his level of intelligence, his perception of his disease, his mode of living etc. that what he feels important and what not. Therefore, now it becomes the responsibility of the physician to judge the correctness and severity of his information. The physician should re-question in order to bridge over any missing links that the patient has left us with. He should also convert the patient's language into the clinical terminology for a meaningful understanding of the case. Thus, this step helps us in proper case synthesis with repertorial view.
3. Proper nosological diagnosis of the case: Some of us may not acknowledge the need of Nosological Diagnosis in Homeopathic Prescribing. But surely it is necessary for us in separating out the pathognomic and non-pathognomic symptoms of the case. For the perfect carving out of the patient's individual picture from his disease picture, it is not just important but vital for the physician to rule out the disease symptoms from the individual case.
4. Identifying the operating school of Philosophy: This is a very crucial step on the way to repertorisation. Now here the physician is subject to many doors, all leading to different pathways. The physician has to assess according to his case which route he decides to tread upon, which school of philosophy he plans to undertake in the particular case. He can follow the Kentian philosophy of Generals and Particulars, the Boenninghausen school of Complete Symptoms, the Causative modalities of Boger or any other school. This step will decide the hierarchy of symptoms, their analysis and evaluation, his choice of repertory and so on. Here his work is simplified by his understanding of the case, the requisites of different schools of philosophy and his knowledge of their application.
5. Analysis and Evaluation of the symptoms: This step pertains to a thorough categorisation and classification of symptoms on the basis of philosophy chosen. It revolves around § 153  of Organon where the Master insists upon the more striking, singular, uncommon and peculiar (characteristic) signs and symptoms  of the case of disease. This involves a prudent segregation of symptoms (Analysis) and their hierarchical listing (Evaluation) according to their importance. In short it is the sieving of the macro-case to get its essence which could be further subject through the instrument of Repertory for obtaining similimum.
6. Repertory selection: The selection of Repertory is the decisive factor for a fruitful exercise. Before finding out the similimum medicine we have to find out the similimum repertory. This can be accomplished by knowing the philosophy of each of the repertories and the need of the case.
7. Repertorisation: The actual procedure of Repertorisation begins only after the above prerequisites are completely and satisfactorily accomplished. It involves:

• Medium of Repertorisation

• Method of Repertorisation

• Selection of Rubrics

• Technique of Repertorisation

• Process of Repertorisation

REPERTORISATION

Medium of Repertorisation: This relates to the number of Repertories we use in our case. It can be :-

1. Unitary medium: When only one repertory is used for the whole data of  symptoms. It is easy and less confusing; only one school of philosophy is consulted for the particular case.

2. Multiple mediums: In it more than one repertory is consulted for the whole exercise of repertorisation. The medium can either be comparative or integrated in nature:

• Comparative medium: In it, same case (with same set of symptoms, perhaps with altered hierarchy suiting the philosophy of repertory) is repertorised using different repertories. It is used in cases where appropriate school of philosophy cannot be ascertained. It is more often an academic exercise and is not preferred in cases where quick repertorisation is needed.

• Integrated medium: This method is used when the operating school of  philosophy is vague or when the required rubrics are not found in a single repertory. While using this method the grading of the Primary or Basic repertory should be considered standard and accordingly the grades of other medicines should be adjusted. When more than one school of philosophy is indicated, the Dominant Philosophy is determined  (on basis of nature of symptoms). The choice of Repertories thus chosen can be:

• Base Repertory and Accessory Repertory: The Repertory whose philosophy is the dominant is known as the Base Repertory while the other one is known as Accessory Repertory.

• Primary Repertory and Secondary Repertory: In cases where both repertory follow the same philosophy, the repertory which affords the major share of rubrics is called as the Primary Repertory while the other one is called as Secondary Repertory.

• Accessory Repertory: If some symptom has to be assessed from a    repertory not belonging to the same school of philosophy as the primary repertory, such a repertory is called as Accessory Repertory.

Methods of Repertorisation: Chiefly there are two methods of Repertorisation:

1. Aggregation Method or Scientific Method: In this method all the analysed symptoms are included for repertorisation. The medicines indicated under each rubric (symptom) are included and their Repertory value is calculated. The advantage of this method is that no symptom however insignificant it may seem is neglected while the drawback is that it is much time consuming. There is also no discrimination between chief symptom (severe in intensity) and associated complaints (not much troublesome), as both are accorded the same status.
2. Elimination Method or Artistic Method: This system was introduced by Margaret Tyler. The theme of this method is to exclude those medicines in the first round itself which are outside the orbit of eliminating symptom. These are those symptoms which should be of the highest rank in hierarchy and must have sufficient number of remedies under it. The advantage of this method is that it drastically cuts the huge work of repertorisation, but if the rubric is wrongly chosen it can point towards wrong medicine. The elimination mode can be of two ways:
   • - Single-step Elimination: In this method the elimination is done only once and that too in the beginning. The medicines which fall in the orbit are now chosen for further repertorisation.
   • - Cascading Elimination: In this method repeated elimination is done at each step for whole case. The symptoms are arranged in decreasing hierarchy of importance and each symptom becomes eliminating for the next symptom.

Techniques of Repertorisation These are the various techniques we use for actually performing Repertorisation. It can be:

1. Paper-Pencil Usage: In this method all the symptoms along with their indicated remedies are noted on a paper and their relative values are assessed accordingly. This is a cumbersome process and there are more chances of human-error.
2. Repertory-Grid method: In this method, a Repertory grid or chart (Repertorisation Sheets) consisting of names of medicines with columns for filling the relative gradations are used. It is highly useful in aggregation method of repertorisation.
3. Book-Mark Technique or Thumb finger technique: In it, we bookmark the pages where selected rubrics are present and visually choose the most frequently occurring medicine. It is useful in cases where the number of rubrics is less and the chance of human error is highest in this method.
4. Cards Technique: This method has been used in the construction of Card Repertories. In it the cards signifying related symptoms with punches for medicines are chosen and arranged together. The most radiolucent punch indicates the remedy.
5. Computer Usage: This is the most widely preferred and used method in the modern practice. The patient data (symptoms) are loaded on the computer which processes it and instantaneously display the repertory value of all medicines repertorised. The advantages of this method are limitless but the drawback is the need of basic knowledge about computers.

Process of Repertorisation : It is the mechanical method of calculating the value of medicines under consideration for repertorisation. There are two types of processes:

1. Universal Selection : In this process all medicines indicated under rubrics are given equal importance in repertorisation. Though it removes the bias but the disadvantage is that the polycrests have better representation in the repertory. So they overshadow the smaller medicines and interfere with the choice of similimum.
2. Preferential Selection: In this method, we select only the medicines with higher grades from each rubric for assessment. This not only saves time and labour but also if pursued logically can produce better results.

Materia medica is the Final Court of Justice: We should remember that Repertory is the tool which tapers our choice of medicines, but nowhere does it actually point towards the remedy. In the choice of similimum, Materia medica is the final overruling body. After repertorisation bespeaks few remedies topping the charts, we compare the picture of patient in each of these from medicine picture in Materia medica. It is then that we ascertain the similimum and prescribe it to the patient.

Thus, we conclude that it is the thorough knowledge and judicious use of Repertorisation which is the surest and most effective path in the selection of Similimum. The technique though at times appears cumbersome and drudgery but definitely promises the final win.