From Sensation to Synergy: a clarification of concepts

It has come to my notice that there is discussion in many quarters that I have swayed away from Sensation method towards a more reportorial approach. Justifiably, many have felt that I might be giving up on something very valuable, which has been of great benefit to all of us.

I am writing to clarify my stand with you all and make amends. I truly do believe that Sensation method is of vital importance to our practices and without this, I could not be working today. But I do also believe that we cannot abandon our original tools like the repertory and Materia Medica – I feel we must integrate it all together.  The result of this integration has been greatly beneficial to me and more importantly, to many, many patients.

Thus, I see my current development as an evolution and strengthening of the Sensation method. What I am doing is nothing new, it is exactly what we all do – we all integrate the repertory and Materia Medica knowledge into our practice. Sometimes, the Sensation Method was somewhat ungrounded and in my practice when this occurred, the repertory and symptoms helped me to ground it even more, and helped in my remedy prescription.

What I am doing now is exactly the same idea that you have all been doing, except a name and nomenclature, ‘Synergy’, has been assigned. It is important to realize that Sensation is an integral part of Synergy; without Sensation, there would be no Synergy. Synergy is bringing people in from all schools of thought, even making believers of those who previously disregarded the Sensation method – it is achieving what we have always wanted to achieve – a unity and solidarity amongst us all.

I would like to say that to those who have understood and grown with the Sensation method, it is impossible to abandon it, as it is the deepest and ultimate truth of the patient. I surely cannot forget it and it will be forever rooted in my practice – if I originated it, I definitely cannot forget it!

It is obvious that different cases require different approaches and I foresee that the development of homoeopathy lies not in a militant difference between the different approaches but in the integration and synergy of the different schools of thought. It is only when we bring together the crucial aspects of the traditional branch of homeopathy and the contributions of the innovators of the present generation, would we be able to establish thorough and definite results.

What I have observed is that many of the followers of various schools or teachers get the impression that a particular method is the only way and best way. They become narrow-minded and adopt a one-tracked, tunnel vision. Conversely, I have seen that the originators, researchers and innovators of the newer ideas are able to learn and integrate other concepts into their practice.

You can say that two things happen here. One is that you integrate different approaches into practice, and the second is that you are able to see the commonality in all approaches and have the understanding that the essence behind all of the approaches is the same. It is like coming to the same point from different paths – a meeting point as such.

I feel that there is a strong need for all of these innovators to come together on one platform so that a strong message of unity amongst diversity is sent to the profession.

I find the Sensation method a wonderful tool, but when used with other techniques, it becomes even more powerful, solid, complete, and balanced. When we are equipped with different tools, we will be able to know which one applies to the case in front of us better.

Consistency of results is really the most important thing in practice. It is the test of any methodology. In homoeopathy, the traditional method of Repertory, Materia Medica and keynotes, with its comparison of the symptoms of a remedy to that of the patient, has led to many beautiful results and has been the foundation for homoeopathic practice.

In the past two decades, newer ideas of classification of the remedy according to kingdom and miasm have emerged. Along with this development, an understanding of the importance of knowing the exact experience of patient in terms of Sensation has been rediscovered. This has reawakened the idea that we can generalise the local sensation: that what is true of the part is true of the whole, as practiced by Boenninghausen. This generalization has been called the Genius.

The discovery that each remedy has the qualities of its Source has given a new dimension to our understanding of our Materia Medica.

Use of this thematic understanding according to Kingdom, Subkingdom and Source information, along with miasms, has been termed the Sensation approach, and it addresses the conceptual side of homeopathy. This approach has appealed to the artistic side of many in the world of homoeopathy, and it has come to be used extensively. However, I have found that the most consistent results come when this artistic side is integrated with the logical, traditional side. In fact, they have always been integral to one another, but we have to be able to see it.

When we see this integration, our prescriptions become more rounded, complete and sure. In remedies that are sufficiently well-known, a third aspect also has to be considered: the genius – the main idea, the flavour, the essence, the grand general of the remedy. When we use these three aspects: the genius; Materia Medica and Repertory, plus the Sensation Approach, then we are using an integrated approach and not a fragmented one. I have found that this integration has given me the best results in thirty years of practice.

The word ‘integrate’ means to make integral. Integral means that all the parts of a system are both interlinked and essential to its full function, to its completion. Sensation, symptoms and genius are the three integral parts of remedy selection, and all three are essential to its completion.

Thirty-five years of clinical practice, along with deep grounding in Materia Medica, provings and Repertory, has brought with it an on-going evolution and refinement in my approach of practice. I know that the Sensation idea holds true but I am not rigid about the approach of case-taking. I believe that we should go as deep as the patient will let us. Pushing beyond that can be counterproductive, causing us to go off on a tangent, chasing one expression and missing the core of who the person really is.

Some practitioners and students, who observe my case-taking in the clinic or in a seminar, are surprised that I do not use the “Sankaran’s approach” in my cases. They see me take different approaches in different cases.

In one recent live case demonstration a student asked me how I came to a remedy despite the patient not showing any hand gestures. These queries come from the delusion that the “Sankaran’s approach” is totally divorced from traditional homoeopathy and is a very fixed way of taking cases. Sometimes, I need to tell them that I do not fully believe in Sankaran!

The knowledge of the Kingdoms and Subkingdoms is derived from the study of provings, Repertory and Materia Medica of the various remedies within each group. I do not see the new and the traditional knowledge as separate but as complementing each other in a natural evolution of traditional practice. The symptoms and system speak of the same thing from two angles. They are like two sides of the same coin. To see both sides is definitely better than seeing only one side. I use both approaches in parallel during case-taking and analysis. In fact, the two approaches inform and deepen each other.

After some time, the clues become clear. You may hear very strong indications for the Kingdom, Sub-kingdom or miasm. Then, you will want to see that all of the other features of the given Sub-kingdom or miasm are found in the case. You may locate characteristic symptoms and then zoom in on or confirm the remedy. Sometimes, the most prominent feature of the case is one or more characteristic symptoms. The remedy that emerges from these symptoms should be explored and compared to the features of the Subkingdom and miasm evident in the case. The symptoms and the Sensation are intertwined.

A much more serious issue to be addressed is that practitioners feel the need to choose between the traditional approach, using Repertory and Materia Medica, and the Sensation Approach, using analysis according to Kingdoms and miasms. I often found that Sensation Approach practitioners did not even feel the need to use Repertory or Materia Medica, analyzing the case solely according to Kingdom and family themes, hopeful that the patient would spontaneously reveal the name of the remedy.

The formula for success is to be flexible and to vary the case-taking style to suit each patient, while at the same time keeping in mind the destination – knowledge of what is to be cured.

When an idea is developed or learned, it should not be put into a rigid box. As useful as that idea may be, we need to be able to think beyond that structure, too, and not be confined to it. This is true of any system. In homoeopathy, I believe it is also true for any approach or technique, whether it is repertorisation, keynote prescription, or any other ‘school’.

We should not even box ourselves into homoeopathy. We can be flexible. Our flexibility should allow us to entertain different possibilities, to think broadly. In each case, we need to be open to see what will really help an individual patient.

Sometimes, the diversity of classical homoeopathy has brought confusion and division. In my practice I use many approaches, in an attitude of openness and acceptance, with the goal that these will converge, enhance, and empower one another.

The last three decades as a practitioner and teacher have been eventful years. I have seen homoeopathy evolve to heights not imagined before; however, developments are a double-edged sword. On the one hand, we see many improved results in practice; on the other hand, they have caused a schism in the profession between traditionalists - those who viewed these new ideas with much skepticism and spoke fiercely against them - and ‘post-modern’ homoeopaths, who embraced the ideas with such enthusiasm that they ignored the solid fundamentals of Classical homoeopathy. Both these extreme positions have helped neither the practitioners nor the profession.

The basis of the split is to view remedies either traditionally as individual entities, or within the framework of a group. In my practice, I see no division between the old and the new; rather, they are two sides of the same coin, like seeing the same thing from two different angles. Understanding and practising homoeopathy with this insight has been my personal secret of success, as well as that of many of my colleagues.

I want to share this with the profession, to address interested practitioners from both sides of the divide and those in the middle, to discuss the reality of everyday practice: the cases, difficulties, mistakes, techniques, remedies and systems. I feel that sharing this, in an organized way over two years, would put to rest some of the controversies and provide homoeopaths with practical examples and an understanding of the development and integration of these approaches.

None of us hold the truth; we hold only parts of the truth. In order to hold the full truth, we must integrate. I believe that the future of homoeopathy is golden and it lies in the form of synergistic integration of the old and the new. Once we have accomplished this, our perceptions will expand and we will have reached a stage of maturity, wisdom and responsibility. Also, if we are able to use all these tools synergistically, our confidence and our results will rise exponentially.

Case of Nephrotic Syndrome

D: So tell me, what is happening?

P: Now, I am in remission, I am getting frequent relapses of pedal oedema, facial oedema, diabetes and nephrotic syndrome. My creatinine levels are currently at 1.6.

D: Tell me how it started?

P: I was studying my second year of homoeopathic school. I went for a holiday and it started at that time, with no other complaints.

D: Tell me a little about your nature as a child?

P: I had a joint family; my grandfather’s youngest son died, so my father was the eldest. He wanted to study but he was put into farming. My grandfather was very strict so there was lot of tension and we grew up in that atmosphere; there was fear  about everything, like going out and doing anything.

D: Describe this fear a little more?

P: Fear that somebody will scold me or will beat me. I have a fear of death.

Comment: right away in the case, we see his fears. This is one area where more probing is necessary to help individualize him.

D: What was the fear of death?

P: I have this since childhood, or I have a fear I will get a grave disease and die. For example, if I saw a movie or read about a disease, I feel I’ll get it and I’ll die. I saw a film, so I thought I’ll get cancer. I also had a fear that when an airplane was going above me that it would throw a bomb on me, so I used to go home running. I had a fear that people will laugh at me, fear of failure in exams or losing my first rank in my class. I was coming first in the class and felt others would overtake me.

Comment: here, we see hints of the kingdom. Firstly, the patient narrated all of his fears, which are extensive: being scolded, beaten, or laughed at, fear of death, severe disease, cancer, airplanes, bombs, death, failure in exams and losing his first rank in class.

D: Dreams as a child?

P: I don’t remember, but I used to wake up shouting. I used to be so scared that people had to hold me. I used to breastfeed until fourth grade, it was like an addiction. Now, I am getting dreams of a hostel and flying parallel to sea level.

Comment: the main story that we see so far is about fear from basically anything from the outside, causing him to run home. However, here we see a very interesting piece, even at age nine he was breastfeeding. As he says: “It was like an addiction.”

D: Describe this a little more?

P: I am in a hostel, I have to complete my journal so I sit on a horse and I go somewhere. When I get there, I am in the slums and I forget my way. Then, I sit in a rickshaw but there is no place to move, so the driver folds his rickshaw, but nothing happens to me. Randomly, I see a bungalow and an eagle, then I go ahead and I see a cliff. There, the rickshaw stops. The driver then climbs into the water below and gets caught in quicksand. I left him and came back but he was dead. I felt so much guilt that he drowned and I could not do anything.

D: Describe the other dream.

P: It is like flying parallel to sea, up and down, next to the sea. It is a totally soothing feeling with no fear. I feel good in the dream and I have no fear of falling in water. It is like I am sitting in a see-saw or a giant wheel.

D: Describe this feeling of being in a see-saw or a giant wheel?

P: My heart is pounding, it is a bubble-like feeling; it is good. I enjoy the thrill. When the giant wheel is coming down, air is going in my chest and I am enjoying that.

Comment: the dreams are also important. Note the theme of up and down movement in the flying dream, or the giant wheel or see-saw.

D: Tell me other dreams you remember?

P: I had a dream of marriage and I have noticed if I have a bad dream then something bad happens with me, like financial loss.

D: What is the effect of this loss on you?

P: At first, I feel bad but then I get adjusted.

D: What is the experience?

P: I become panicked and get fullness in chest. I get palpitations, as if my blood is going to my head. My ears and palms become hot, my palms sweat, and I have a general feeling of heat.

Comment: the next thing that is peculiar is the warmth of the palms and soles, with a rush of blood to the head when he encountered this financial loss.

D: In what other situations have you seen this happen other than loss?

P: During fear and when I am composing a tune.

D: Describe composing a tune.

P: While working on my harmonium, when I work up a tune and have to replay it so I get a good tune. I feel impatient, I want to go ahead or I will forget it.

D: What is the feeling?

P: Feeling of heat and restlessness. I forget everything else when I make a tune. I become restlessness in the sense that I go out and walk to and fro. I beat my head like that and I get restless until I get the tune.

D: What is the feeling of restless inside you?

P: As if like there is a dam and the flow has been stopped. As if there is something like a delicate cloth stopping it and if I pierce it, then the water will come.

Comment: here we see an example, a metaphor: “As if there is a dam and the flow has been stopped…” This is symbolic of the patient’s delusion.

D: So what is the experience there?

P: As if I get to have a new experience.

D: Describe the words ‘new experience’.

P: Like discovering something new, like the new tune I am discovering. I have a fear of death, but I feel that death will also be a new experience. There is a curiosity: ‘What will be after that?’ When composing a poem, if I don’t get a word I become restless until I find the word.

Comment: at this time, we get the experience of the patient: “As if I am discovering something new.” Also, we see here that he feels that even though he has a fear death, “death will also be a new experience.”

D: What are the other symptoms do you have?

P: Burning heat in the soles, then palms, then earlobes. I feel it particularly in the month of September and whenever I sit free. The heat is more when I have not slept or when I try to sleep after I get up. This heat prevents me from sleeping. I get annoyed by the heat. Sometimes, I feel even the bed has become warm, so I have to change the cushion.

Comment: there are more interesting and peculiar physical general symptoms – warmth in the bed causes restlessness; heat in general aggravates him, and again he speaks about heat extending upwards to his earlobes.

D: Tell me a little bit about your nature and temperament?

P: I am emotional. For example, I saw on the news that a woman delivered a child on the road and left him on the road and went away. I was crying the whole night.

D: What was your feeling?

P: I also have a small daughter, so I was comparing what must be happening with the child.

D: What will happen?

P: The innocent child will die, how did this happen?

Comment: again, note his sensitivity to life and death in a different situation.

D: To what other matters are you sensitive?

P: When diseases happens to family members, like when my nephews are ill. I feel I cannot treat them and they should get better as soon as possible. Also, I have farm land, so when the laborers come I feel bad about their lifestyle, about their poverty. I pay for their work completely. When I go shopping, I feel guilty because they get so little money while I am spending my money on small things. I am also sensitive to when people do not look after their parents. I feel like crying when alone. I don’t want to show my emotions because people will laugh at me and I will feel bad.

D: What are your interests and hobbies?

P: Music and reading books. I read so I can know many things and while talking, I can give people references to convince them of my thoughts. I like to read new things. I was always first in school and wanted to keep that position.

D: Why is it important to convince others of your thoughts?

P: I have an inferiority complex.

D: What is it?

P: I cannot convince people, I cannot put forth my ideas.

Comment: here, we see an important part of his personality. His hobbies and interests include music, reading books, and reading new things. More interestingly, we see a concept of this ‘inferiority complex’ resulting from not being able to put forward and convince others of his thoughts; this is also something to consider when looking at his individuality.

D: Anything more about yourself?

P: I am religious. I know that when I get a disease, I will die. I thank God for my achievement.

D: What achievement?

P: When I got married, I thanked God. I went on my honeymoon and I thanked God again. I thought I would never get this. I have no fear of God, I take Him as a friend. I can share everything with Him.

Comment: also, the patient is admittedly religious – another important facet to his whole picture. 

D: Generally how is your appetite?

P: It is good, I get hungry between 11-12pm and in the evening around 7pm.

D: Do you sweat much or little?

P: I sweat more on axillary areas, palm and soles, it is quite smelly.

D: What illnesses have you had in the past?

P:  I was operated for haemorrhoids. It was a precipitating infection.

D: When you have to speak on stage do you have anxiety?

P: Yes, in the beginning. I am physically weak, so I get hurt and nervous when someone is a big shot or something. At that time, I become angry.

D: You have made a drawing, tell me what comes to your mind?

P: I am trapped and I am trying to come out.

D: Describe this – what is the experience to feel trapped?

P: Uneasy, like I am smothered. It is difficult to breath and it feels like somebody is pulling me.

Comment: this last experience of being trapped, feeling smothered, difficult to breathe, and someone is pulling, is another delusion.

D: How often do you get this oedema?

P:  For the last three to four years.

Final Analysis

To start the case analysis, we have to look at what systematically occurred in the case.

The entry point in the case was his fears: he fears of been beaten, scolded, death, a serious disease like cancer, a bomb, airplanes, that something will come, and the reaction to these fears is that he has to go running home. Next, we have fear of people laughing at him, failure and losing his first position. These are all of his fears, which are very important. These are very intense fears, very panic-like.

One of the main, peculiar things about the patient, however, is his clinging or holding. This is the strongest in him – until the age of nine, he was still breast-feeding. Again, he says: “It was like an addiction.”

On investigation of his dreams, you firstly see that there are so many dreams, and in one of them he is flying. We see up and down movements, even in the dream with the rickshaw driver, who is sinking into quicksand, going down. So this sensation of up and down movement is coming again in his dreams.

When you combine this clinging aspect to the up and down sensation of the dreams, fears and panic, it points you towards the second row of the Mineral kingdom. The remedy one can think of is Borax.

However, I did not choose this remedy because there was something else very essential. When I asked about the financial loss, he said: “I become panicked. I get fullness in chest. I get palpitations, as if blood is going to my head. My ears and palms become hot, there is sweating on palms, and a feeling of heat and general body.” I found this fascinating and knew that these are sure symptoms that can be found in the repertory.

So, when we traveled into the area of the case where he composes his music he says: “There is a dam and the water is stopped and you have to pierce it and then water has to come out…and therefore, you have a new experience.”

This is an exact description of the labor process. He is in a stage of labor where the amniotic sac has to burst and he needs to come out.

As a result, we then see there are two aspects of the case: one side is clinging, holding on, and cannot let it go, and on the other hand, you see the need to burst the sac, come out and have a new experience.

Once you can see both of these polarities, then you come to the remedy Carbon.

In Carbon you have two sides: one is the clinging side and the other side is the wanting to come out. He does not know where he is – inside or outside of the womb – thus, these are the two sides of Carbon.

Similarly to our patient, a stage of Carbon would also have the fear of death, but the death is also a new experience because one does not know what will come. Again, we see that on one side there is a holding on and on the other side a desire to let go, and to go for new experiences. This is very peculiar as well.

We conclude that his remedy has to something to do with Carbon, and once we establish this, then we need to examine further.

So now, which Carbon does he need?

Here, I only depend on the symptoms to confirm. 

His main peculiar symptom is burning heat, burning heat of palms, soles and ears. What is peculiar is that this burning and heat is more while in bed and it prevents him sleeping.

Let us take the rubrics:

1. Sleep; SLEEPLESSNESS; warmth agg. (14)
2. Generalities; HEATED, warmed, hot, becoming; agg. (221)
3. Generalities; HEAT; extending; upward (46) 

From the above repertorization of these peculiar symptoms, the only two remedies we get are Sulphur and Carbo animalis.

Therefore, I thought of giving him Carboneum sulphuricum.

I thought of Sulphur because of the string of elements of this remedy that resemble the patient including embarrassment, his desire gain knowledge, to know many things, so he can discuss with many people. These are all the symptoms of Sulphur.

After matching the sensation and the symptoms, I see the remedy Carboneum sulphuricum in the Materia Medica:

-          Delusion, he is falling in a hole

-          Delusion, he will received injury (as he said his first fear was that people will beat him)

-          Delusion, talking about money – this is another important symptom, he talks about how he fears poverty and about money

-          Religious affections is in Sulphur

-          And the whole thing of inferiority complex is in Sulphur

-          Perspiration offensive, again is a strong indication for Sulphur

Lastly, you come to the patient’s drawing, which again indicates the labor process experience: “Something is holding me, not letting me; I feel smothered and it is difficult to breathe. I am trapped and I need to come out.” This is typical of Carbon. So, in the drawing, he again takes you back to confirm Carbon.

Overall, we see that there are strong symptoms of both Sulphur and Carboneum sulphuricum.

Prescription: Carboneum sulphuricum 200C. He received this potency because he is at Level 3, the level of emotions.

Rubrics:

1. Sleep; SLEEPLESSNESS; warmth agg. (14)
2. Generalities; HEATED, warmed, hot, becoming; agg. (221)
3. Generalities; HEAT; extending; upward (46)
4. Mind; DELUSIONS, imaginations; injury; receive, will (19)
5. Mind; DELUSIONS, imaginations; falling; he is; hole, in a (4)
6. Mind; DELUSIONS, imaginations; money; talks of (4)
7. Mind; RELIGIOUS affections (139)

I believe that in most cases, you have to use the old and new together, both System and Symptoms. The System will give you the crux and the Symptom(s) will give you the hard facts, the inarguable data. Suppose you come through rubrics and repertorizing to the remedy, you then have to see if the sensation and the experience also match.

In this case, you have think what is central – clinging, fears, dreams, panic, holding on and letting go from the System side – indicating a Carbon remedy, along with the embarrassment, need for knowledge, inferiority complex, general aggravation from heat, heat ascending upwards, and the burning of the soles, palms and earlobes from the Symptoms side – indicating the Sulphur component.

The Synergy approach to homeopathic case-taking provides a much needed integration and unification between the old schools of thought and the new. The advantages of this approach are that it is highly reproducible and provides homeopaths with a newfound confidence in their clinical practice.

Follow-ups

Follow-up 1: six months later

D: How are you feeling?

P: Calm, fresh and much more energetic.

D: Very good reports, creatinine has gone down to 0.9 from 1.2. Tell me, how are you?

P: Joyful, better. Getting interest in those things, which before I was not interested in, poetry, musical instruments. I also practice.

D: What is the difference?

P: Before, I used to feel very tired, but now I wait to go to the clinic. I handle stressful situations better. Last night, I went to a marriage, and the bridegroom had peptic acid complaints, so I did my homeopathy properly, without my usual skepticism and lack of confidence. My way of thinking has changed.

D: In what way?

P: I used to think, how will I examine someone in front of so many people, what if people laugh at me if I forget something? I used to neglect text messages, but now I feel my creativity level has also increased. I reply in poetry. I feel I should reply creatively.

D: How is the feeling?

P: Pleasant feeling, like flying in the air parallel to the ground. I am happy, and I am spreading the happiness. My heart is filled with joy, like filled with water, and sometimes, like waves. If I get a subject, then I write about it.

D: What about all those anxieties?

P: The anxieties have decreased. But I feel I’ll get diabetes. There is no disturbance, if there is disturbance I pass that and fly. Cool feeling. For example: the cool oil you put on your head and then I sit below the fan. I feel relaxed, weightless. I feel like I am in my own world. I have no sad feelings.

D: How is your sleep?

P: I sleep soundly.

D: How much do you feel better?

P: 60 % better.

D: We will repeat the same medicine.

P: I am with this doctor who will help taper the medicine. She said my spleen and liver are no longer palpable.

Prescription: Carboneum sulphuricum 200C

Follow-up 2: one year later

D: How are you now?

P: I am more energetic now. I am doing things which didn’t do in the past, like playing  music. I feel better. I feel lightness, weightlessness.

D: Where do you feel it?

P: In my entire body. Like the fear.

D: Tell me a little more?

P: I’m going slowly with the air. Cool. The burning which I used to get has improved, I feel cool there now. When I got this disease, I had seen a song which I used to avoid playing, but now I have the courage play it.  I was thinking that I would get the fear again, together with the heat.

D: What is the change?

P: Now, I can see that song and reason with it. I feel more courageous and enthusiastic. I used to feel anxious that someone could feel bad with what I said but now I can manage that. My energy level has increased despite traveling long distances.

D: How is your sleep?

P: Sound; my dreams have also decreased.

D: Earlier you used to get anxious and fearful?

P: Yeah, my fears have decreased. I can talk to people with more courage.

D: Your creatinine levels also normal. I’ll give you another dose of the remedy, and assess the creatinine again.

Prescription: Carboneum sulphuricum 200C