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Dr Mansoor Ali
Govt. Homeopathic Medical College. Calicut
A symptom can be defined as an external expression of the internally deranged vital force.
The externally expressed manifestation may be observed by the patient himself, his relatives, the doctor or
through the laboratory and other mechanically aided investigations.
The word symptom has been derived from the word `symptoma’ which means ` anything that happens’.
According to Doctor Hahnemann “the change in the health of the body and of the mind (morbid phenomena,
accidents, symptoms ) which can be perceived externally by means of the senses, that is to say, he notice only the deviations from the former healthy state of the now
diseased individual, which are felt by the patient himself, remarked by the those around him and observed by the physician.
You will have to ask many questions in order to elicit a few telling symptoms, and you must be quiet sure that you and your patient means the same Or` It is the
outward reflection of the internal essence of the disease, which is the affection of the vital force.
According to Dr.Kent “Every symptom is indicative of a deviation from the normal state of health”
According to Dr.S.Close ” In general a symptom is any evidence of disease or a change of state of health”.
According to Dr.Dewey ” A symptom is the expression of disturbance in a healthy body produced by a drug or some morbid agents”.
According to Dr.Wright ” Symptom to the Homoeopaths are the language of body expressing its disharmony and calling for the similar remedy”.
” Any perceptible change in the body and its functions, either subjective or objective which indicates disease of the kind or the phase of the disease.” _ Websters
dictionary.
Sign : These are alterations from the state of health observed or detected by the physician or attendants. All the objective evidence of the disease is identified with the
word sign. The signs are of great importance as they are the only available evidence of disease in infants. comatose patients, insane persons etc. The patient may not
be aware of the existence of this entity.
Syndrome : A group of symptoms and signs suggestive of particular type of disease or in other words represent a disease.
Elements of a Symptom
Location
Sensation
Character/color/odor
Aggravation
Amelioration
Concomitants
Causation
Duration
Extension
Alternation
Miasm.
1.Dr.HAHNEMANN
Characteristics _ $ 153
General & Undefined symptoms _ $ 153
Lesser accessory symptoms _ $ 95
Accessory symptoms _ $ 181
Accidental symptoms
Determinate symptoms.
2. Dr.KENT
3. Dr. S.CLOSE
Subjective symptom
Objective symptom
Keynote symptom
Negative general.
4. Dr.H.A.ROBERT
5. Dr.GARTH BOERICK
6. Dr.E.WRIGHT
Common symptom
Mental symptom
General symptom
Objective symptom
Pathological general
Particulars
Eliminative symptom.
IN DETAIL
1. HAHNEMANN’S CLASSIFICATION.
Hahnemann classified the symptoms as Common And Uncommon symptoms.
COMMON SYMPTOM is the one ,which is common either to a medicine or a disease state.
UNCOMMON SYMPTOMS
These are the symptoms on which prescription has to be based upon, It denote those symptoms which are..
Peculiar in their nature and character. Which are peculiar to a few patients suffering from similar disease.
They usually help in the miasmatic understanding of the case.
3. KENT’S CLASSIFICATION
A. GENERAL SYMPTOMS
Mental general
Physical general
B. PARTICULAR SYMPTOMS
Basic symptoms are important only when they are signified by personal modification.
Determinative symptoms are the individual or personal ones if found in a patient or a characteristics, keynote or guiding symptom if found in a drug pathogenesis “
Determinative symptom whether encountered in disease or a drug proving are alike and usually consists of: Modalities
Try to elicit the evident cause & course of the sickness, to which all the things which now seems to interfere with the sufferer’s comfort.
3. Sensations
Ascertain whether any of the following sensations are present.
Burning, cramping, cutting, soreness, throbbing, bushing & thirst.
5. Parts affected.
This include investigation & Diagnosis.
By going over the above rubrics in the order named the counter of the disease picture will be easily outlined, and direct towards the similimum.
Types of Symptoms
1. Common symptom2. Uncommon symptom3. Pathogenic common symptom TYPES OF SYMPTOMS51. Contrary ”
99. Trifling ”
100.Well defined “.
A GLOSSARY OF SYMPTOMS
SOURCE OF TOTALITY
To arrive at the totality of symptoms is an exercise in analyzing the symptoms as individualizing and non-individualizing symptoms, from the data obtained after case
taking.
Numerical totality or symptom totality includes each and every signs and symptom to present a complete picture of patient or drug. But totality of symptom in real
sense is the logical totality as said by S.Close
Subjective Symptoms
These are those type of symptoms which can be experienced by the patient under emotional, intellectual and sensorial aspect of the patient (desires, aversions,
temperaments attitudes etc. ). They are ranked highest among during evaluation for selection of remedy as they are symptoms belongs to psychic and mental sphere.
These are the only means to reach the inner subtle nature of the disease.
OBJECTIVE SYMPTOMS
According to Hahnemann ` the expression of the disease in the sensations and functions of the side of the organism exposed to sense of the physician and bystanders.
So objective symptom means observing symptoms including the physiological findings and lab investigations. Totality of symptom include both objective and
subjective symptoms.
GENERAL SYMPTOMS
A general symptoms is the one that refers to the individual as a whole.
They relate to the highest esteem of self which represent the ego.
They help in forming a totality and also help in the individualization
If these are strange, rare & peculiar they help in the selection of the similimum.
CATEGORIZATION
A. MENTAL GENERAL
All the symptom related the mental sphere are termed as mental general. They are the symptoms which reflect the inner self, the inner most part or the ego of the
individual.
1. External will is usually voluntary and responds to the external influences, tempting the person to do things.
2. Internal will is the conscience which is the deepest of all and is unchanged by the medicine.
5. Endocrine system.
Intellect & Understanding determine the individual capacity of the person and the emotions determine the free expression.
Perception of environment
Formulation of ideas thoughts and concepts
Discrimination
Action.
B. PHYSICIAL GENERAL
These are the symptoms of the physical plane of the person as a whole.
CORROBORATIVE SYMPTOMS
Example : In a case of headache from excitement, which is relieved by bilious vomiting, the medicine coming up on reference to Kent’s Repertory is Argentum
Nitricum. But the evidence of an Argentum nitricum symptom in any other region of the case strengthens our selection. It may be a desire like that for salt, or may be
a fear like that of high places and the like.
Here, bilious vomiting is the immediate associate of the presenting complaint . But the distant associate( Corroborative symptom ) gives us further evidence that the
selection is correct.
Both symptoms are concomitants of the chief symptom, when we consider the entire symptom picture as a single disease.
Hahnemann’s `Lesser accessory symptoms’ ( aphorism.95 ) are a type of corroborative symptoms. In that case the patient becomes so accustomed to his prolonged
suffering that he considers these `greater or lesser deviations from the healthy state’ as not related to his principal malady and thus not worth mentioning.
PARTICULAR SYMPTOMS.
These are the symptoms which belongs to a particular part, organ or functions of the body.
These symptoms tend to disturb the patient most and seeks consultation for them only. Thus the prescription of acute necessity will be based on these
particulars.
It should be understood that the generals help in the delineation of the outline, whereas the particulars furnish the details to differentiate the remedy.
At times a strong particular may point to a small group of remedies and this help a quick prescription.
According to Boenninghausen they provide a base for the evolution of generals.
When particular symptom is expressed at more than 2 places, it behave as a general and become important.
Particulars furnish the details to differentiate the remedies.
COMMON SYMPTOMS
These are the symptoms which are linked to the disease and expressed by a large number of patients or provers. They are of little value in the selection of the remedy.
They do not help the prescriber to individualize.
UNCOMMON SYMPTOMS
RARE SYMPTOM
These symptom may be pathogenic or pathognomic. These are of high value in individualization for a Homoeopathic prescription.
See also uncommon symptom
PECULIER SYMPTOM
See rare, uncommon symptom
DIAGNOSTIC SYMPTOM
These are the symptoms upon which a nosological diagnosis made. These are of value in differentiating the common/uncommon symptoms or symptoms of the
patient from symptoms of the disease. These are common symptoms which are found in harmonious groups to suggest a common diagnostic entity.
INDIVIDUALISING SYMPTOM
See uncommon symptom
PRESCRIBING SYMPTOM
These are the symptoms upon which a prescription is to be made. A prescription cannot be made without these symptoms. The high grade of prescribing symptoms
are called the Eliminating symptoms.
SPURIOUS SYMPTOMS
These are vague symptoms, also known as the common symptoms of the disease present in the proving of all most all medicines. They are of no use either for the
purpose of prescribing or for the purpose of diagnosis of the disease.
DISCRIMINATIVE SYMPTOMS
These are qualified or complete symptom containing all the elements such as Sensation, Location, Modality and Concomitants.
COMPLETE SYMPTOMS
According to Dr.Boenninghausen the totality of symptom is not only the sum total of the symptoms but it is itself one Grand symptom, the symptoms of the patient.
For marking a symptom as Grand symptom or totality itself 4 factors must be present. Symptom which is clearly defined by the elements of location, sensation,
modality and concomitants is called a Complete symptom.
2. Sensation : Any altered perception of mind regarding the disease. It is manifested either in the form of pain or any discomfort felt both physically as well as
mentally.
3. Modality : Anything which modifies a symptom for better or worse is called the modality. It can be in terms of time, place, climate or any circumstances.
4. Concomitants : The symptom associated with the chief complaint is called a concomitant symptom.
CLINICAL SYMPTOMS
Dr.Boerick has defined Clinical symptom as one which does not appear in the proving of a drug yet nevertheless has been inadvertently relieved by that same drug,
given for another purpose.
Eg. Stitching pain in the chest are constantly relieved by Bryonia which failed during proving.
These are the symptom which could not be ascertained and included in drug pathogenesis while proving of a drug but always relived the same symptom when
encountered in a patient.
According to other school : These are those symptoms of the patient which he ascertain in the clinic either with his sense or with the help of instruments.
C0NCOMITANT SYMPTOMS
Dr.Boenninghausen was the first to realize the importance of the concomitants in prescribing and constructing his repertory. Dr.Boger developed the idea fully in
Boger’s repertory with additions and modifications.
The word concomitant means – existing or occurring together also known as associated symptoms.
The symptom that accompany the chief are called concomitant symptom.
The concomitant bear no relation to the chief complaint than the time association. When these symptoms cannot be explained by pathology they become the
characteristic symptoms.
Concomitant arise from the inherent constitutional aspects and tend to remain constant with a patient irrespective of the nature of the disease.
Rarely found combined with the main affection, here also infrequent under the same condition in the proving.
All these belongs to the another sphere of the disease than that of the main one.
Finally those which bear the distinctive marks of some drug, even if they have never before noted in the preceding relation.
ACCORDING TO BOGER..
Concomitant means accompanying or co-existing The more it belongs to another sphere of the patients health than the chief complaint _ they become a
unreasonable attendant.
The peculiar strange rare symptoms are indeed concomitants. They cannot be explained on pathology ,yet they occur at the same time with the chief complaint.
When a marked peculiar symptom belonging to the disease proper,makes the choice of remedy difficult, a concomitant will decidedly indicate the drug.
Concomitants may far outrank the other symptom of the chief complaint, such sympton tend individuality to the totality.
Totality being the sum total of the characteristic symptom, due attention to concomitants help in finding the similimum more easily ,and with an assurance of
accuracy. So concomitants are characteristic symptom peculiar to the individual patient.
A concomitant having the same modality as the grand symptom, represent a high characteristic feature of the remedy and is of great import ants.
Mental concomitant in physical ailments and physical concomitants in mental ailments are an unfailing guide to the similimum.
In introduction to TPB HA.Robert says ” The concomitant symptom as to the totality what the condition of < & > is to single symptom, it is the differentiating factor”.
ELIMINATING SYMPTOM.
Are those symptoms which through of all the medicines that are not needed for the patient and brings only those medicines which are required for the patient.
Margret Tyler first introduced this method for facilitating an easy Repertorisation. The method of repertorisation using the eliminating symptom is called as the
eliminating method.
Make sure that the symptom chosen will cover the man & not only the superficial symptoms.
Eliminating symptoms are selected always from the symptoms of the man and in absence of symptoms of man the general symptoms of the physical being is
considered.
The symptom selected should be real & marked intensity, expressing the inner need of the patient.
The symptoms should be arranged in the order of important so that the peculiar, uncommon symptoms can be selected.
METHOD OF ELIMINATION
All the symptoms which are peculiar, uncommon and most expressive of all should be selected. This symptom is placed on the top and rest of the symptom below it.
The medicines that ate not covered by the first symptom, the one placed at the top will be eliminated from the rest of the symptom.
Advantage
Disadvantages
Fails if one is not thorough & efficient in structuring the hierarchy of the symptoms for repertorisation.
You cannot eliminate symptoms dependent on a disease which you have not diagnosed.
Don’t risk missing your remedy for an ill marked mental or a very small rubric . This is easy but often fatal.
Kent says ” The great trouble with key note is that they are misused, the key notes are often characteristic symptoms, but if the key notes are taken as final and the
generals don’t confirm there will come failures.”
CHARACTERISTIC SYMPTOM
Are those symptoms which are uncommon, peculiar unusual and striking symptoms find in few patients and in the proving of few medicines. These symptoms are
unexplainable on the basis of pathology. These symptoms characterize and individualize and help in the differentiation of remedies.
Kent says ” Get the strong strange peculiar symptoms, and see that there are no generals in the case that oppose or contradict. “
Margaret Tyler says ” Many c/c cases may be worked out on mental generals only and the particulars will be found to fit ,in a marvelous way.
VITAL SYMPTOMS
According to Dr.Dunham, these are the symptoms related to the vital force.
The action of the drug on the vital power, correlative of the above, the symptoms of the nervous system given conjointly with the symptoms of the various organ to
which the different parts of the nervous system are distributed.
The sensorium _ of which the symptoms are found chiefly under the rubrics head and disposition.
The general sensibility
The general mobility _ The symptoms of the tissues to which the nerves of the sense and motion are distributed.
The special sensibility _ Exhibited in the symptoms of the organs of special senses.
The sympathetic system _ Exhibited in the symptoms or organ containing involuntary muscles _ in the intestinal tract and all the sphincters.
PATHOLOGICAL SYMPTOMS.
The symptoms directly produced by the pathological changes, these are the common symptoms of the disease.
PATHOLOGICAL GENERAL
Pathological general are the expressions of the person which are known by a study of the changes at the tissue level.
Eg. Tumors,warts…
ALTERNATING SYMPTOMS
These symptoms that recur at uncertain intervals with morbid state of different kind.
In U.colitis, diarrhoea alt. with rheumatism.
NEGATIVE GENERAL
ACESSORY SYMPTOMS
Symptoms produced after the administration of a partially similar remedy.
Occur in
These symptoms are not previously observable in the disease, but at the same time symptoms of the disease itself, although they may have been rarely perceived.
ACCIDENTAL SYMPTOMS
These are the symptoms which are evanescent, un genuine produced by the medicines last used.
HEREDITARY SYMPTOMS
Symptoms that is present as a part of hereditary disease which are present both in parents and offspring’s.
PERSISTENT SYMPTOMS
Any symptoms which are continuously present for a long time in an individual.
WITHDRAWAL SYMPTOM
These are symptoms which are produced after the withdrawal of non-homoeopathic drugs which are capable of producing dependence.
ACUTE SYMPTOMS
Symptoms usually of short duration with severity and sharpness.
CHRONIC SYMPTOMS
Symptoms occur in an individual for a long duration/period of time as in c/c disease.
FUNCTIONAL SYMPTOM
Usually it means to indicate the symptoms which are produced before the structural damage is affected. Usually indicative of symptoms produced during early bio
physical or bio chemical changes.
May be an early pathogenesis.
MIASMATIC SYMPTOMS
Symptoms which indicate the miasmatic expression of an individual.
QUALIFIED SYMPTOM
Symptom which is clearly defined by the elements of sensation, location & modality.
SCHEIN SYMPTOMS
These are the apparent symptoms caused by the excessive Homoeopathic medicines as a result of frequent repetition. The dose in that case must be reduced &
repeated in longer intervals and possibly stopped several days.
GENERIC SYMPTOM
These symptoms are produced by the dynamic generic action of the drug. These symptoms are common to many drugs of a particular genesis or class.
CURATIVE SYMPTOM
Start out like the clinical symptom, but subsequently disappears due to the drug taken in.
REFERENCES