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If a chronic case comes to us during its natural remission/ amelioration period, should we start the remedy in this period? e.g. If chronic case of asthma or recurrent bronchitis which has natural remission in summer and  acutes coming up only during monsoon or winter season  which are quite severe and recurrent. Since many years same thing is getting repeated , so should we introduce the constitutional remedy during amelioration period to build up immunity so that further acutes in following seasons can be avoided? Please share your views.

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Dear Beena - This week's BlogTalkRadio show when I discussed alternating symptoms may apply in the type of case you are describing. Dr Herbert Roberts explains how to take the case, observe the totality, realize that what you see in one season is just a part of the totality. Thus, the disease is not truly in 'remission' but only expressing the roots, trunk, branch, leaf, flower of fruit of the whole. If the 'chronic' case, which means it is constant over a long period of time, then I imagine finding the true similimum could be given at any time, even when the system is quiet. 

  • "One of the most difficult problems a physician has to meet, where he has need of acumen and discernment and a complete knowledge of remedy pictures, are such conditions as manifest an alternation of symptom pictures in different seasons of the year, such as summer gastric disturbances and winter rheumatic conditions, the Dr. Jekyll and Mr. Hyde of chronic manifestations. There are a number of these conditions of alternations of symptom groups, and then there are the alternation of sides. When the patient presents himself to you, you may be justified in concluding from his story that his trouble is limited to the disturbed state of which he complains at that time; yet the remedy selected on this group of symptoms alone will often fail to bring relief, or, if the remedy does relieve the symptoms most marked at the time, the man's condition as a whole may not be improved, or indeed it may even be worse, since we have not cured but palliated a part of his symptom picture, obliterating a very valuable part of our symptomatology. If the patient is curable and we have thus obliterated a part of his symptom picture, we have blinded ourselves as to his true state: whereas a complete understanding of his condition over a period of several months would give a sound basis for a successful remedy selection. This is especially true in such conditions as gout, and we have remedies that have just this periodicity. Either for palliation of incurable diseases or for the cure of the curable diseases the symptomatology of the remedy must simulate, in so far as possible, the disease picture in order to bring relief, and where periodicity or alternation is a part of the symptomatology the remedy must have the characteristic feature if we are to expect it to be effective.

  • It is sometimes true, when we have a case with alternating phases or series of symptom groups and we are unable to meet the condition with a remedy that covers all the phases (either because we do not learn of the alternating phases from the patient in the first place or because we do not know of a remedy to meet the condition), that by meeting the symptom groups as they arise in the case itself as we go on, the symptomatology becomes clearer and more distinct so that we more completely meet the conditions as they arise and the patient's condition becomes better as a whole. This is meeting the case by a zigzag process, removing the most pronounced and characteristic symptoms by the remedies most similar in each state, but it takes very careful prescribing or we are apt to hopelessly mix the case. This may be done in emergencies or when we cannot find a better method. It serves better as a palliative measure in incurable states than as a curative measure in curable states, and a failure in any of one of a series of successive prescriptions may mean the difference between possibility and impossibility of eventual cure. There is far more satisfaction and the case is much more complete if we can get a picture of the whole condition and of the single remedy to meet that condition.

  • This may be difficult from two angles. The young physician may find it difficult to do this work carefully because he lacks the knowledge of the materia medica; but he has at his command a wonderful source of help in his repertories, which will often serve his purpose by quick reference, filling in the knowledge that he lacks of the remedy. Another possibility is that of remedy relationship and the relationship of the various inherited dyscrasias to the case; these are large subjects in themselves and will be discussed elsewhere. Again, it is very possible that the remedy covering the case has not been proved fully, or may not have been thought of by the students of materia medica." 

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I agree wholeheartedly. Dr Roberts makes many good points here and they are in accordance with my own experiences in clinic. Until I understood that totality also included the dimension of time (history) I found it difficult to create long term improvement for patients. This is also exactly the observation of Hahnemann and his advice was the same - you must observe the patient over several interview to get a proper view of the whole disease, rather than just using the narrow window offered by the acute flare-up.

The 'quiet' periods are acutally an excellent time for exploring this totality, as the patient's need for a remedy is less urgent and they are more able to sit for a long interview discussing all the various peaks and troughs of their disease. My experience is that despite not being in that urgent state, they are quite able to tap into the feelings, sensations and thoughts that accompany it.

As I had pointed out in my long debate with Hans a few weeks ago, the advantage to examining the case in this way, looking at the 'big picture', is that you can eliminate all the little symptoms that may appear for one short period only and focus on those symptoms that reoccur each time, which are part of that deeper more consistent disease state (which should include the miasm).

It's such a pleasure to have these conversations. Thank you Beena and David.

Thank you Debby and David for your valuable suggestions.Here is a case with me of 1o yr old boy having Adenoid enlargement.So having recurrent pharingitis, adenoiditis, bronchitis etc.The constitutional remedy is Calc. phos and has definitely++ helped the patient in reduction of frequency and intensity of acutes.The acutes which were of help were Merc. sol., Drosera, Spongia etc. as per symptom similarity at that point of time.There are no symptoms at all at present as the Summer has started.So my question is that what should be the posology  to repeat the chronic constitutional remedy in this Summer season  as there are no follow up criteria a there are no symptoms just now?

No symptoms at all? That would be a strange situation for a chronic reoccurring disease - unless of course the chronic remedy is in fact working quite well. However I would say never treat in a symptom-free patient. There must be some kind of indication in the present for the remedy. Was the Calc-phos previously indicated during the less acute phases of their illness?

The characteristic theme of the Acute Miasm is acute episodes interspaced by apparent good health. Perhaps a remedy from this miasm might help resolve this pattern?


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