The evolution of Sensation: a Synergistic approach

The Sensation Method is of vital importance to homeopathic practice but we cannot abandon our original tools like the Repertory and Materia Medica – we must integrate them all to form a whole. The result of this integration has been greatly beneficial to many, many patients.

Accordingly, the current development of Synergy is an evolution and a strengthening of the Sensation Method. At times, the Sensation Method has the potential to be ungrounded and when this occurs, the repertory and symptoms help to ground it even more, and help remedy prescription.

It is important to realize that Sensation is an integral part of Synergy: without Sensation, there would be no Synergy. Synergy brings people together from all schools of thought, even making believers of those who previously omitted the Sensation Method. Synergy is representative of the unity and solidarity amongst all homeopaths.

While utilizing in-depth knowledge in fundamental and traditional tools of homoeopathy, like the Materia Medica, Repertory, and the Organon, the Synergy method also values the newer approaches like Sensation, Kingdom, Miasm and Source understanding.

This is a system that is unique – its design can be taught, practiced, and replicated successfully by students and practitioners. This method has brought together both the old and the new approaches in homoeopathy – it has established a universal platform where all approaches in homoeopathy are welcomed and used to aid in the patient’s recovery.

This Synergistic approach allows us to study a case from three different angles:

1. Symptoms: local and general
2. System and Source: kingdom and subkingdom
3. Genius: general traits, pace, modalities and nature

Symptoms include the traditional use of rubrics, keynotes, characteristics, and clinical symptoms. The System includes the newer approaches, such as kingdom, sensation, and miasm. Finally, the Genius is the common strain or character that runs through every aspect of the case. When looking at these three sides, matching the qualities of the patient to the remedy must always be in the background.

To best understand the nuances of each case, one must study it from all angles and aspects. The goal is to integrate the older and more traditional ways of studying cases with the newer and more contemporary approaches, in order to get an all-encompassing view.

Looking at a case from many perspectives, you come to a place where everything speaks a similar language. You can then be sure of your knowledge and confidently apply that understanding to the patients.

The Anchor is a tool utilized alongside the other three areas and emphasizes the application of complete symptoms (location, sensation, modality, concomitant), along with the very characteristic, sure symptoms to create a reliable repertorization graph, which is free of interpretation or bias. The Anchor is the first clear, sure, definite, concrete thing we see in the case. The primary characteristic of the Anchor is that it must be clear and sure. Even more central to this is the degree to which this symptom is unconditional in the patient - the more individual it is, the more dependable it gets. An Anchor is a solid and dependable characteristic that goes beyond interpretation. The Anchor can come from any aspect of the case, including the pathology, miasm, kingdom/subkingdom, characteristic symptom or rubric.

When trying to understand a patient, there must be a solid grasp of the area that is most obvious in that case. It may be the Genius, the Symptoms, the System or the Anchor. By following this clear and definite lead, the other areas will also become evident. It is important to note that in cases sometimes the Symptoms are clear, or the Genius is clear, or the System is clear – however, for a successful prescription, all must be reconstructed and utilized in the same way.

When utilizing the idea of “Synergy”, all three sides (Genius, Symptom and System) plus the use of the Anchor, must be included in the prescription, and ultimately each one will reach the same conclusion and remedy that matches the patient.

Case of bronchial asthma and urticaria

This case transcript has been summarized for publishing purposes; RS = Rajan Sankaran; P = Patient

Forty-year-old woman

RS: Tell me please, what is the problem?
P: It started with an infection in my throat three or four years ago; it's been continuous since then, and I have discharge from my left nostril. Last year in July, I had a bronchitis attack. In June, I was pregnant. In December, I got an attack again and I had to be hospitalized for 3-4 days. After that, I delivered my baby in February. Now, I also have this urticarial thing: small red patches. It goes over my whole body, and I start  itching all over. I have a burning sensation and sometimes, my face and lips swell too, since January. I also have bronchitis and breathing problems. It increases at 2pm in the afternoon and I am up all night, until I take my inhaler. My nose is also congested. I was operated for a fibroid in December 2008, I had a missed abortion and antibiotics were given. This problem started in 2002, the very first day that we moved home.

RS: From where did you move?
P: From Goa. The problem of choking in my throat was there a little bit beforehand, but it has increased in the last 3-4 years. Now, it is a very severe problem. I always swallow and I have nasal congestion. I feel heavy in my chest; the breathing problem increases in the afternoon. I also cough at night, when I lie down; I have to release the congestion at least two to three times before I can sleep. These red patches start in the evening and increase in the night, but they decreases after a bath. In the morning, it is a little there, but at night it's horrible – from 1-2 am. When my lips and face get swollen, I become very restless. Sometimes, I am not able to breathe. Initially, the attacks were daily but now the eruptions have gone because the doctor changed the medicine. Since then, my breathing problem have increased, particularly at 2 in the afternoon. If the rashes go, then the breathing problem starts.

Commentary: From this point on, one loooks for characteristic symptoms. Her most important and main characteristic would have to be her symptom of urticaria alternating with breathing problems and asthma. In the Repertory, the following rubric is a summary of this symptom, SKIN; ERUPTIONS; urticaria alternating with asthma.

This is a characteristic, sure, and clear symptom; one that is not open to interpretation. When we look at this rubric, we see that there are only four remedies: Apis, Caladium, Croton tiglium, and Graphites. This is her main symptom and it is very characteristic, so if we can find a remedy that has this symptom, then there can be certainty. Of course, since this rubric has only four remedies, one must look elsewhere in the repertory to find a better representation.

We can also investigate other similar rubrics such as RESPIRATION; Asthmatic alternating with eruptions. Again, we have remedies like Apis, Graphites, Croton tig, and Caladium in this rubric. Either rubric we decide to select will represent the strange, rare and very characteristic symptom in this patient.

This symptom can be our first symptom in the Symptom part of the Synergy triangle. We can also consider this as the Genius and Anchor of the patient – thus, we have to find a remedy that has this exact symptom as its main idea and match it with the patient.

RS: When the rashes come, the breathing gets better?
P: Yes, but last week both things were there suddenly at 2-3 am.

RS: When you get the rashes, what helps?
P: Nothing, actually. I sit in one place and then I come out of it. I can’t shout and I can’t speak loud; I choke. It feels like it’s because of a change of weather.

RS: Do you have any other complaints?
P: I cannot sit in air conditioning, but I work in an office with airco. I get suffocation from having more discharge. My nose runs, it's a thick discharge. It is transparent, not yellow and not runny. I got worse after I moved from Goa to Mumbai.

Commentary: The second very strong symptom in her case is her aggravation from change of weather – particularly the aggravation in damp weather. The patient had moved from Goa to Dehli (both dry places) to Mumbai, where the weather is much more damp. In this dampness, her symptoms aggravate, like her nasal discharge and pains.

For this symptom, we can look at the rubric GENERALITIES; WEATHER; damp weather agg.

This second rubric can also be used to contribute to the Symptom part of the triangle.

RS: What dreams do you get?
P: I dream of the daily work I do. I used to have dreams of small babies. In childhood, before getting my exam results, I used to dream that I was failing. I used to always be first in the class. I never had frightful dreams but if I was in a deep sleep and someone woke me, I would get up suddenly. I sleep soundly. I am fond of sleeping and eating; if I am hungry, I become restless. I get restless, so I have to eat. Even my husband says I like to eat and that I like to sleep. Nowadays, I get a dream: I am in a classroom and giving exam, lectures. I always have to call my husband if I am feeling anxious or tense. I need to talk to him when I feel this way; I feel better when I talk to him.

Commentary: The third most interesting thing in the case comes from her description of herself, which is confirmed by her husband. The patient says she likes to sleep and eat. This is representative of the phase in life where the patient is: she is like a baby, she likes to sleep and eat, and she is very dependent on her husband. She says that she only likes to talk to him and that he is the only one who does everything for her, so there is a very strong dependence.

This symptom fits into the System part of the Synergy triangle – it is more based on kingdom. Here, we see that the mineral kingdom is well represented – she is very dependent on her husband for everything, and it is evident that although she is an adult, she is stuck at a very early developmental stage (baby-like).

RS: Tell me about exams…what are you feeling? Is it like you are not prepared?
P: I used to get cold palms and little bit of sweat.

RS: What was the fear like?
P: I wonder what type of question will come, because I wanted to get good marks. I wanted to become something better in life because I was career oriented. I cannot sit idle, I am always doing something, maybe a computer course. I am doing a Vastu course now, so I always keep busy. I get interested in it and then, I want to keep enhancing my skills. I left my office 3-4 years ago because my baby was small. I always want to do these things because I become very restless. I am afraid that if I sit and don't update myself, then everybody will get ahead and they will do better than me.

Commentary: Note that there is an apparent kind of restlessness. She cannot sit in one place, she must move. There is a rubric in the repertory in the mind section that represents her restlessness: MIND; FIDGETY; she must be occupied, cannot sit in one place. We can also look at the rubric, MIND; FIDGETY; work at.

This is an important mind symptom which we can place in the Symptom part of the triangle.

RS: If you don’t update, then what will you feel in this situation?
P: Depressed and wanting to cry. If I am busy then I am ok. When I leave the office and am alone, I call my husband, otherwise I don't feel better. I need someone to share my feelings with. I feel better when I cry and when I talk with my husband. Now, when I cry, that discharge comes, so I always start coughing; it becomes difficult.

RS: What things make you very tense or nervous?
P: If am going for an interview, or if I am doing something for the first time and I'm not familiar with the subject. Speaking in public makes me a little nervous. Once I become comfortable, I am okay. If I'm in contact with someone I don't like, I get tense.

RS: Anything more about your nature?
P: If I rely on someone, then I trust that person very well, but if I don't like them then I refuse to even meet them. I make a picture of  someone and I do not change my mind. I'm afraid that if I meet them I will feel bad. I don’t feel comfortable: my heart beats fast, my hands and feet get cold and I get sweaty on my nose and chin.

RS: What is the fear of at that time?
P: The fear is that they will hurt me. I won’t feel comfortable with that person, in that environment. I am tense. The opposite is that I get relaxed, my hands are not cold and heart beats normally. I have a peaceful mind.

RS: What is the opposite?
P: The opposite is when everything comes into my mind, like when I am alone. I want to be busy and I want to divert my mind.

RS: Tell me about this, wanting to be busy?
P: When I am not busy, I think about negative things. I get tension, I don’t feel nice, so I call my husband and mother for emotional support. They tell me: "You should do this and that."

RS: What is emotional support?
P: Emotional support means they give me suggestions. They console me and say things like: "You are at home because of  the baby." I already know this and I want to be consoled. They tell me that I can study something, even though I know this, but I need to be consoled.

RS: What is the experience to be consoled?
P: I feel good, to have somebody there and I am not alone. It’s a good emotional support.

RS: What is the experience of this support, how does it feel inside you? What is the sensation?
P: My breathing becomes normal. My hands and feet become warm, knowing that I have started work.

Commentary: Again, we see that her main modalities include being ameliorated by support and consolation, in addition to amelioration from expressing herself.

We also notice that she reiterates her desire to keep busy or diverted. From this, we can conclude that this restlessness comes in more than one area in the case and can be taken into the repertorization.

RS: What situations earlier in your life caused you a lot of stress?
P: My education, studies, exams, and sometimes, since my marriage financial things, and kids too.

RS: How are you at making decisions in general?
P: Making decisions is difficult. I always discuss that with my husband because I feel I will make the wrong decision. I am always thinking that maybe this is right, then maybe it is not. This mainly happens for small things, because when we wanted to buy a house eight years ago, I took the decision to buy it and pay if off in loans. I can take that kind of decision, but not on small things.

RS: Like?
P: Things that are related to me. For example, my career is like my second baby, but we were thinking for a long time before having one. Maybe when the decisions are related to me, if it affects me personally, then I become nervous.

RS: What is the fear?
P: I have a fear of the future. I have fear about my children, their future, and what it will be like for us economically.

RS: What are your interest and hobbies?
P: Right now, I am reading astrology; whenever I read, I go deeply into it and I don't like to leave it. Before I used to play table tennis, badminton, even running. In childhood, I used to do more physical activity. In the 11th grade, I wanted to go to join the army because I was tom-boyish, so I wanted to be an officer. I see Mom making chappati (Indian bread), and so I told my Mom I don’t want to make chappati. I feel like girls can do everything. I feel confident.

RS: The opposite?
P: The opposite is feeling down low, depressed and low key.

Commentary: What is interesting is that there are two sides to this patient. One is a fantasy side, the girl who is capable of doing everything, a girl who can go out, a girl who can be in army. This is her fantasy, the opposite of that is what she really is. She is very under-confident, always needing somebody and wanting support. This is her inner state, and her fantasy is being in the army.

RS: What skin problems have you had in the past? Does your skin dry anytime? Cracks?
P: I am sensitive to the sun and I get rashes. Sometimes, I have cracks in my feet.

RS: How do you react to sudden sound?
P: I do not like it.

RS: What about climate?
P: In terms of climate, dry is better. I get a headache if I am in the sun for an hour, not very severe. I used to be comfortable in cold weather; when I was in Gwalior and in Goa, I used to like winter, but since I have come to Bombay, I can’t tolerate it.

RS: Do you like the windows open or closed?
P: Open or else I feel suffocated, that's the breathing problem. I also get a heaviness in my hands, so when I open the windows I feel better.

Commentary: When we examine the System part of the triangle and we see the exact opposite of her fantasy, we understand there are many Carbon symptoms.

Carbon symptoms include the startling from noise, startling when woken from sleep, suffocation inside a closed room and desire for open air. We also see an affinity for the skin in this area.

These are also specific symptoms of the remedy Graphites, which is apart of the Carbon group of remedies.

RS: Does this cough and urticarial disease disturb you very much?
P: Yeah, it makes me upset. I feel it should not come again and I wish to get better. My eyesight is also weak.

RS: Generally your mood remains good?
P: Since being married, I have become more tense, earlier I was very cheerful. When I am alone, I feel depressed. I want to discuss something with somebody.

RS: What do you like to eat?
P: Salty. I like dahiwada (yoghurt and dumpling, Indian specialty food).

Commentary and important observations: The patient is a forty-year-old woman, nevertheless, she brought her husband with her into the consultation room. She wanted to make him say everything and would probe him to say more. Halfway through the case taking, I even tried to stop him from talking, but she kept encouraging him to talk about her. In my understanding, this in itself is very strange – she is quite old for doing this and it shows her obvious dependency on her husband.

Case Analysis

By utilizing a balanced, structured and synergistic approach where a triangulation between Genius, Symptoms and System occurs, it will lead not only to great depth of results but to highly consistent prescribing.

In this case, all of the symptoms that were established were sure, clear and exact. Most importantly, they were characteristic to the patient, which meant we had to have a remedy that matches these characteristics.

The following rubrics were selected for this case:

1. RESPIRATION; asthmatic alternating with eruptions
2. RESPIRATION; DIFFICULT
3. SKIN; ERUPTIONS; urticaria alternating with asthma
4. GENERALITIES; AIR; open; amel.
5. GENERALITIES; AIR; open; desire
6. GENERALITIES; WEATHER; damp weather agg.
7. MIND; FIDGETY; work at
8. MIND; FIDGETY; she must be occupied, cannot sit in one place
9. MIND; IRRESOLUTION; indecision
10. MIND; NOISE; agg.
11. MIND; SENSITIVE; oversensitive; noise to
12. MIND; STARTING; startled; sleep, during

If we examine the Symptoms of the case, we see that there are many characteristic general, particular, physical and mind symptoms that can be reproduced in the form of rubrics from the repertory.

From the System point of view, we can see the kingdom quite clearly. The patient fits into the mineral kingdom when there is a lot of dependence, need for constant support; her development is in the early stages.

When we look at the particular themes of the Carbon family, we see themes of dependency, wanting and valuing the opinions of others, a sense of childishness and smallness, irresolution and skin problems. These people do not want to enter the world. They want to find a way to escape from their environment because it is difficult to cope. There is a great dependency and desire for support.

Graphites is a fundamental Carbon remedy. The keynote symptom in Graphites is irresolution. They will ask others opinions before acting. In this case, the patient depended heavily on her husband for support. These patients also cannot deal with a crisis or new situation, and often develop tremendous anxiety and panic attacks.

Prescription: Graphites

Follow-up after ten months

RS: How are you doing?
P: I am much, much better than I was since the first time I came in September but the same nasal congestion is there. Discharge still comes out at any time, about 4-5 times a day. My throat is better than before and the chest pain is only once a month, very little actually. It felt like it might happen again, but it didn't. It isn’t acute, and the frequency is also reduced.

RS: Frequency is reduced?
P: Yes. Even for my chest pain and cervical pain. I have stopped coughing.

RS: How is your sleep?
P: My sleep is good now. Energy-wise I am also much better. Emotionally, I am also much, much better now. I am not feeling uncomfortable and I am busy with my work.

RS: You have started to work?
P: In the morning, I go teach at a school for three to four hours per morning. My son is in a play group too, and when I am busy, it is the only time which is comfortable for me. I am not crying as much and I don't feel alone anymore. I used to cry because there was lots of responsibility with my baby son and my daughter. 

RS: How about when you were alone and you couldn’t manage, how is the feeling now?

P: Now, I can manage. I am not even tense about issues in my family. I am not afraid at all, only a bit when family members I don't know come to visit: I fear that something might happen.

RS: So, how is this fear now? Is it same, it is more, it is less, how would you see that?
P: Now, there is no fear so I am okay. Eventually, it might come, so I don't know. Maybe I will feel much better. The anxiety levels are better than before, so much better. Overall, I say I am 80% better.

Conclusion

In most cases, it is vital to integrate the old and new approaches in homeopathy: use both System and Symptom. The System will give 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, and vice versa.

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

Further explanation with cases illustrating this idea can be found in my latest book: The Synergy in Homoeopathy, published by Homoeopathic Medical Publishers (www.rajansankaran.com). I strongly recommend learning to use this approach through observation of good practitioners taking cases. This is possible at “the other song academy” in Mumbai, India (www.theothersong.com).

Photos: Shutterstock
Woman who has caught a cold; karuka
Female army officer; Cameron Whitman