(Article published in the souvenir released during the Homeopathic seminar by Dr Amarsinha D Nikam, hosted by The Hahnemann Study Circle, Alapuzha, Kerala )Abstract
We are quite familiar with the prescription on the basis of Causation. Although, this kind of prescription is strongly supported by a number of cases successfully treated so far, we should not be blind in considering causation. It should be noted that, in some cases, the causation could either be a coincidence or a misconception. Hence always weigh its credibility before you consider. Introduction
Among various systems of medicine, Homoeopathy gives great importance to causation. Causation is one of the elements of symptoms, which when strong and genuine, is of much benefit in the remedial diagnosis, and so far we have come across several successful cures made by remedies selected on this basis.
In the field of medicine, the word “Cause” has been used since ages. Physicians knew that there cant be diseases without a cause. Among the physicians of orthodox system, the concept of “Tolle causam” (remove the cause) was prevalent. They believed that by removing the cause of a disease, it could be cured. But later they made the mistake by proposing that bacteria are the only cause behind diseases and by removing the bacteria a cure could be attained. But homoeopathy goes further and propagates that there is a cause in the dynamic level that comes to activity much before the invasion of microbes. This dynamic cause should be removed to cure a patient. As per the concept of homoeopathy, the cause behind every disease is derangement of the vital force by the dynamic noxious influences called miasms. This is the real cause that flows in to effect in the form of sickness. Hence, tolle causam can be related with both orthodox medicine and homoeopathy, but for the former it is about removing the material cause and for the latter it is the removal of a dynamic cause.
Another expression of cause in homoeopathy is causation, which are the factors responsible for a symptom produced in an individual patient. We know that causation, location, sensation, modalities, and concomitants are the components of a symptom. It is not mandatory to have all these components in a given symptom. The causations and modalities mentioned in the materia medica and also in the repertories are the exciting causes that can result in the production of symptoms in a sensitive or susceptible individual. Our body is sensitive to the external world and reacts to any stimuli on the basis of individual sensitivity and susceptibility developed as a result of the miasmatic background. Some external influences can activate the latent psora and the signs and symptoms are manifested externally. Here, the indicated medicine similar to the signs and symptoms of the patient can be given to achieve a cure.Sources of causation
The following are the sources of causation.
1)Details told by the patient
2)Information from the bystanders
3)Understood by the doctor by logical thinking
4)Perceived by clinical examination
5)Impressions from the lab investigations
6)From a second opinion by another doctor Stalwarts on causationHahnemann:
In the Medicine of Experience, he offered several insights into the subject of causation. Later, after several years’ practice he found out the concept of miasms as the real cause of diseases. As per Hahnemann, maisms are diseases having "one and the same cause". He was the first to postulate a complete theory of susceptibility, infection and how they affect our immunity. He understood the fact that miasmic infectious diseases are the basis of all diseases. He also identified the non-miasmatic diseases that can cause prolonged sickness as a result of several internal as well as external factors. If these maintaining causes are removed, the recovery is possible. In aphorism number 73, Hahnemann tells about the acute diseases that affect individually as a result of exposure to injurious influences. Excess or insufficient supply of food, any sort of physical impressions, irritations, emotions etc can act as exciting causes. He says that these external factors actually cause the explosion of the latent psora, which was dormant initially. Beonninghausen:
He proposed the concept of complete symptom and introduced the various components of a symptom such as location, sensation, modalities, and concomitants. In order to give a complete image of a disease Boenninghausen introduced different factors related with a symptom such as Quis, quid, ubi, quibus auxillus, cur, quomodo, quando. In which Cur means the cause of the disease. As per Boenninghausen, causes of diseases can be divided in to internal and external causes. The internal causes refer to general natural disposition (proximate cause) and idiosyncrasy. The external causes are also termed as occasional causes. He emphasized the importance of anamnesis of the case and prescribing on the basis of circumstances or factors that caused the symptoms.C M Boger:
He introduced the Doctrine of causation into Homoeopathy and gave due importance to causation, time and general modalities and according to him this approach is more practical and proved. Boger proposed that, causation and time factors are more definite and reliable in cases as well as in medicines. As per Boger, cause could be miasmatic cause and exciting cause. In his synoptic key, he emphasizes that “while taking the case we should first try to elicit the evident cause and course of sickness and all which now to interfere with the patients comfort”. Even though there is no separate section on causation in his repertory, the subsection Aggravation also includes the factors that excite or bring on the symptoms. O E Boericke:
In his repertory, each rubric, when extensive in scope, is presented in the order of cause, type, location, character of pain, concomitants and modalities. Since the cause is given separately, it is useful for quick prescription.J H Clark:
In his clinical repertory, there are five main chapters in which the second one is Repertory of causation. This is very useful in clinical practice.Burnet:
He gave much importance to prescription on the basis of pathology. Hence his way of approach can be followed for cases that can be explained in terms of pathological causes.Vithoulkas:
As per Vithoulkas there are various ways of looking at a case, i.e. by looking at the essence, the totality of symptoms, keynotes & peculiars, and at the causation. Further he says, “If a patient tells that her skin eruption started after her child died or his stomach problems started after losing his job, then this is the causation. These causation symptoms can be considered very strongly. They are the starting points to finding the remedy and a remedy must often be given that fits that causation even if it means ignoring other symptoms”. He gives an example of a man who had impaired hearing since a fall that took place 20 years ago. Later he also developed duodenal ulcer. On the basis of aetiology Arnica was given, which improved not only his hearing but also cured the stomach problems that actually developed 5 years after the fall. With the example of this aetiological prescription, he says, “It does not matter that it took much longer for the stomach symptoms to develop as a result of the fall as the fall is still the primary causation”. General repertories:
In other repertories like Kent’s Repertory, Synthesis etc. causation is scattered. Causations mentioned in Boericke repertory:
1.Ailments from mental &emotional causes:
Anger, fright, grief, sorrow, jealousy, joy, vexation, nostalgia, mortification, discords, mental work, sedentary life, luxury, hysteria, tension, thinking, hastiness, hurry, worry, emotional excitement, loss of social position, insults, away from home, misdeeds of others, rape, disappointed love, hypochondriacs etc.
2.Ailments from history:
History of diseases like gonorrhea, syphilis, diphtheria, malaria, scarlet fever, influenza, pneumonia, eczema, intermittent fever, chickenpox, typhoid, zoster, whooping cough, measles etc. History of suppression of symptoms, sexual desire, eruptions, exanthemata, suppression of coryza, perspiration, milk, lochia etc. Family history of alcoholism, any diseases like cancer, diabetes etc.
3.Complaints related with age or life situation:
Old age, climacteric, children, dentition, pregnancy, puberty, nursing, senile decay, lactation, after confinement, after marriage, puerperal, post partum etc.
4.Ailments due to errors in body functions:
Menses, sweating, unnatural discharges, vital loss, sexual excess, bleeding, masturbation, onanism, unsatisfied stools, impacted bowels, loss of sleep, night watching, debility.
5.Complaints as a result of diathesis and temperament:
Bilious, uric acid, rheumatic, gouty scrofula, tubercular etc.
6.Ailments due to individual sensitivity:
Allergies, sensitiveness to noises, odors, odor of food, putrid odors, smoke, dust, flowers, noxious effluvia, visual disturbances, artificial light, glare, looking at moving objects, sea sickness, sight of food, bright objects, working under gas light, woolen clothe, hat etc.
7.Ailments due to organ involvement:
Reflux symptoms from organs, gastric origin, cerebral origin, pelvic origin, cardiac, decayed teeth, renal, torpor of rectum, atony of rectum/bladder, prostrate hypertrophy etc.
8.Complaints due to overuse:
Overuse of organs, eyes, muscles, throat, public speaking, physical exertion etc.
9.Ailments due to any pathology:
After acute/chronic disease, fungal growth, worms, epilepsy, anemia, fibrosis, septic, shock, anaphylaxis, hypertrophy, atrophy, neuritis, abscess, sclerosis, degeneration, edema, inflammation, foreign bodies, proliferation, thrombosis, ischaemia, tumors, spasm, arterial spasm, congestion, flatulency, neuralgia, gout, irregular peristalsis, dryness, increased mucus, fever, toxemia, jaundice, calculus, suppuration, retained placenta, paresis, paralysis, opacity of lens, sluggish circulation etc.
Weather changes, rain, heat, sun, high altitude, wind, fog, dampness, open air, fanning, snow, lightning, fire, getting wet, sea bathing, washing cloths, draughts, ice, bathing, feet wet, autumn, moon, spring, sunstroke, mining, working in clay.
11.Complaints due to food and drinks:
Indigestion, defective nutrition &assimilation, overeating, fasting, hasty eating and drinking, bottle feeding, artificial food, breakfast, beer, tea, bread, butter, cabbage, cheese, cold/hot drinks, egg, fish, meat, fruits, melons, mushroom, onion, oyster, pastry, pork, potato, salt, sausage, soup, coffee, lemonade, spices, milk, fat, acids, decayed food, sour food, sweets, starchy food, strawberries, farinaceous food, seasoned food, vegetables, vinegar, vine, veal, impure water, flatulent food, cucumber, unripe fruits, indigestible items.
12.Complaints due to treatments:
Medicines, vaccination, tonics, laxatives, vegetable medicines, sedatives, purgatives, anesthesia, surgery, amputation, injection, tooth extraction, dental work, cauterization, curettage, local tar application, abuse of enemas, abdominal operation, lithotomy, pessary, abortion, spinal injection, catheterization.
13.Complaints due to poisoning:
Narcotics, stimulants, tobacco, alcohol, smoking, drug abuse, debauchery, mercury, arsenic, war gas, toxins, lead, copper, camphor, cantharis, chamomilla, colchicum, digitalis, ptomaine poisoning, quinine, occupational hazards.
14.Ailments from activity:
Exertion, working, running, walking, night watching, dancing, singing, over lifting, eye strain, sewing, haircut, brushing, ironing, traveling (car, boat, rail), climbing mountain.
15.Ailments from injury:
Falling, concussion, traumatism, postmortem wound, puncture wounds by splinters, sharp objects, contusion, cuts, abrasion, laceration, sprains.
16.Complaints without any identifiable cause:
Functional, habitual, idiopathic, no ascertainable cause.Beware of causation
Though the prescription on the basis of causation has helped us a lot and is still working for many cases, we should not be blind in considering the causation for a remedial diagnosis. In many of the cases, the causation could be a coincidence or a misconception. Some times the patient may tell that so and so factor is responsible for his ailments but may not be the real cause. Hence we should not give over importance to anything unless we confirm by asking about the repeated history of the same complaint after exposing to any particular stimuli. Or else, we will be misguided. Of course, confirmation of causation is not that easy and may not be possible in certain cases. However maximum care has to be taken while weighing each and every word told by the patient.
There is a trend among many of us to get prejudiced in the remedial diagnosis, when the prescription is given on the basis of causation. For example: Arnica for injury, Rhus tox for physical exertion, Natrum mur for grief. If we refer repertory, we can see that there are many drugs indicated for the above causations. Hence, if we follow the prejudiced way of prescription, we may miss some other drug that may also cover the same causation and may be much more similar to the whole case.
As per the concept of homoeopathy, if the cause of a symptom or a component of a symptom can be explained medically, it is least important for a remedial diagnosis. Example: Vertigo due to high BP is least important, whereas vertigo from grief (calc carb) is more important. However, as a rule, in the case-paper we should write down what the patient says, without thinking about the scientific cause behind each symptom, and without changing the words expressed. But it doesn’t mean that we should believe or consider it completely. Once a patient came to me and said, “Doctor my left kidney is swollen since many years”. I noted down his complaints in his own words. When I asked for the USG report, he said, “This is the first time I am consulting a doctor”. I felt great respect for the patient who has diagnosed enlarged kidney without a doctor’s help. Out of curiosity, I asked the way he diagnosed the kidney swelling. Immediately he exposed his genital area and showed the swollen left testicle. For an illiterate man like him, kidney and testis are synonyms! Always remember: we learn so many things from our patients; at the same time they can also misguide us, if we are not that cautious.Conclusion
True that we have cured many cases on the basis of causation, even for cases failed to respond to a “well-selected remedy”. But we should always try to confirm the causation and consider its intensity. We know that there are different ways to arrive at a group of similar drugs, but only one way to reach the similimum, i.e. the highest level of similarity with the qualitative totality of the case. Hence always consider the whole individual rather than considering one or two symptoms.Bibliography:
1.Organon of Medicine – Dr Samuel Hahnemann – B Jain publishers, New Delhi
2.The Lesser writings – Dr Boenninghausen – B Jain publishers, New Delhi
3.Boericke’s New Manual of Hom. Materia Medica – Dr W. Boericke – B Jain, New Delhi
4.Reference to Repertories – Dr PV Siju – B Jain publishers, New Delhi
5.Essentials of Repertorisation – Dr S K Tiwari – B Jain publishers, New Delhi
6.A Synoptic key of materia medica – Dr C M Boger– B Jain publishers, New Delhi
7.Hompath software – Dr Jwahar Shah, Mumbai.
8.Radar, B Jain, New Delhi.