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The Art of Case Taking

Contents
Introduction
Vital Force
Fundamental Laws
Analysis of the Case
Drug Proving
Second Prescription
Susceptibility
Suppression
Classification of diseases
Miasms(Psora)
Miasms(Syphilis)
Miasms(Sycosis)
Homoeopathic Case Taking


Objects for taking the case:
1. For Diagnosis:The object of the homoeopathic physician in making diagnosis is to classify the symptoms into different groups. Homoeopathic physician as other school of medicine doesn't depend on diagnosis for therapeutic purpose. Irrespective of diagnosis the patient as a whole is treated i.e. as an individual.

2. To differentiate the true symptom picture of the patient

Purpose of recording:
The whole picture is preserved in case record cards, without omiting the important symptoms. Keeping the record is very important for first prescription and for making subsequent prescriptions. The case record assures the physician whether the prescription was given correctly by observing the sequence of disappering of the symptoms and comparing them with recorded sequence of appearance of symptoms.

Attitude of the Physician while taking the case:
The physician should be in state of absolute rest with clear mind. He should not have any prebiased ideas, specially about the remedy the patient would require. He should be in a state to listen all the symptoms narrated to him.

Method of Case Taking:
First it is important to note down the Name, Age and Sex of the patient. The Address of the patient and the Occupation should also be recorded. If the patient carries out other works other than his occupational one, then it should be noted down.

Present Complaints:The patient is now ready to express in his own words regarding his illness, including how he became ill. When patient starts narrating about his illness, every symptom is recorded leaving space inbetween each symptom, to fill answer to questions put afterwards regarding details of those symptoms. One important point is that, the patient is never interrupted when he is expressing his symptoms because by doing so we may break his chain of thoughts and miss some important points. If he comes to point of hesitation, he is questioned "what else?", so as to continue his explaination.

Details of Present Complaints:When the patient has fully exhausted telling his story, then the case is reviewed by asking him questions about each symptoms about which he has given a fair description, or were found to be incomplete. These symptoms are completed in respect of time of its appearance, its location, the type of sensation felt, the kind of uncomfortableness, all the modalities(Aggravating and Ameliorating factors),the probable cause of appearance of symptom. The most important, the emotional aspect is taken into consideration. The only object in extracting the above particulars is to get the whole picture of the diseased individual.If necessary the aid of the relatives and friends or the nurse is taken for their observations regarding the patient.

While dealing with the acute diseases the symptoms related to acute conditions are only taken into consideration, leaving those of chronic state of the patient. If the chronic symptoms are also recorded, confusing picture is obtained.

All the symptoms are recorded which are expressed in the chronic state of patient.Their history is unearthed as far as possible. Their sequence of appearance is also noted.In a chronic patient when an acute outbreak occurs, the symptoms of the chronic state will dimnish. During this time only the symptoms of acute outbreak are considered as totality. After the ceseation of the acute outbreak, the underlying chronic condition shows itself clearly never as before, making easier for the physician to record the chronic picture.

The most improtant among the symptoms are the general symptoms i.e. the symptoms that pertain to the patient as a whole. Then comes the aggravations and ameliorations. Among the generals, the mental symptoms rank very high, as they represent the man himself.

Personal history:After completing the recording symptomatology of the patient, the physician should note down the personal history of the patient. His habits, temperament and personality are considered. The general aggravations i.e. weather aggravations as to sun, wind, cold, dry, wet, fog; changes of weather as before, during or after storms, rain, snow; tendencies such as taking cold, sore throat, headaches; reaction to open air and indoors; conditions of appetite and craving or aversions; aggravation from certain foods; the effect of vaccination; effects of altitude; seashore; the thermal reaction; dryness or moistness of the skin; perspiration under which conditions, its character, its relation to chill; thirst and its relation to chill, heat or sweat; type of sleep and dreams; the position of body during sleep; sexual function. These are the essential part of case taking, which can be grouped under the personal history.

Family history:The physician is often helped by recording the family history i.e. the age of parents, their general health, cause of death if deceased. This should also include the brothers and sisters. Clear picture of the ailments they are suffering from is recorded to know the heriditary tendencies running in the family.

Past illness:The past illness of the patient is recorded with details as regards to name of illness, time, his recovery from each illness, whether fully recovered or not well since the onset of illness, the treatment received.

Mental Symptoms:Now the physician arrives at the most essential part of case taking, the recording of mental symptoms. By this time the physician would has gained the confidence of his patient as they would express without any hesitation. Clear record as to their subjection to hallucination; if having any fixed ideas: fears; irritability; variable disposition; jealousy; presence of mind; sadness; reaction in presence of others; solitude; memory; concentration; understanding, are recorded.Ailments arising from grief, vexation and sudden joy should be noted.

Physical examination:Lastly a thorough physical examination of the patient from every angle is carried out. The objective symptoms should be elicited and recorded. Vital signs like pulse, B.P. should be noted down. Any tendencies like warts, growth of tumors etc. are noted. The expression on the face, gait give important clues.The pathological diagnosis will guide during the prognosis of the disease of the patient.

What we must not do when taking the case:
1. Avoid all leading questions i.e. the questions which suggest answers to patient, as some patients are anxious to answer questions suggested to them.
2. Direct questions should not be asked, which may be answered with a direct affirmative or negative.
3. Alternating questions should not be asked.
4. While dealing with one symptom, physician should not skip to another symptom randomly unless the prior one is completed.
5. Questioning along the line of the remedy should not be made.

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