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A CLINICAL RESEARCH-ORIENTED STUDY ON THE EFFICACY OF CAUSAL PRESCRIPTION IN HOMOEOPATHY
Dr. Atul B. Modi, Dr. D. B. Sharma
PRESCRIPTION
Definition: A prescription is the written statement of the suggestion of a remedy. As far as homoeopathic system of medicine is concerned, a prescription should aim at the patient and his individual reaction to the disease. But there are practical difficulties in obtaining the totality of symptoms.

The immediate cause of the present illness, if determinable or its exciting factor will be a great aid in the administration of the remedy but this factor is responsible for exciting the probable fundamental cause of the chronic disease. This, Dr. Hahnneman teaches in aphorism 5 and in footnote of aphorism 206. Causes of a much more important character than these remembered noxious influences must lie at the root of the initiation and progress of a serious, obstinate disease of long standing, the assigned causes could only rouse in to activity, the latent chronic miasm. Every patient has a primary cause and the exciting cause (factor) is the secondary cause. Exciting cause is the secondary cause and is responsible for arousing the fundamental (primary) cause.

Exciting causes are different for the same fundamental causes and symptoms are precipitated by exciting cause. The symptoms start from the excitation of corresponding miasm by the exciting cause. We can diagnose the fundamental cause by the nature of response of the individual to the exciting cause. e.g.: A patient with no complaints in dry weather & asthmatic in humid weather, sycotic miasm is excited. There are different types of exciting factors for different miasmatic diseases. Each miasm will be excited by corresponding exciting factors. So treating exciting cause means treating an expression of fundamental cause.

Aim of the Study:
The aim of the study is to evaluate the efficacy of causal prescription in homeopathic treatment. Even if the results of causal prescription are seen, a scientific study in the matter, based on statistical data has not been undertaken so far. This is an attempt to do a scientific study based on statistical data.
    • Aetiology has been defined as a study or theory of the causation of any disease; the sum total of the knowledge regarding causes. Aetiology does not concern itself with synthesis of causative factors in the pathogenesis of a disease to enable an observer to form a comprehensive picture of the development of the disease in all its stages.
    • The knowledge of etiology depends necessarily on the understanding of the various physical and biological phenomena that man has observed and is exposed to, in nature.
    • Dr. Hahnemann always emphasized the importance of the causative factors in the environment – both physical and emotional, which could be held responsible for the development of illnesses. He advises the physician to remove the cause first whenever it is feasible. But, at the same time, he cautioned the physician against the dangers of armchair theorizing and speculating on the ultimate cause or mechanism of disease. He cautions the true homoeopathic physician to remove all obstacles to cure before proceeding with the administration of the similar remedy. In a case, the causative factors form the core of the image of the patient in his illness. Their identification or the incorporation in the image is therefore imperative if the prescription is to prove homoeopathic and hence curative.
  2. The Physician should first try to elicit the evident cause and course of the sickness, and then consider all other factors, which now seems to interfere with the sufferer's comfort,
  3. It is self evident truth that the cause of the disease or the symptoms representing the cause, are most important as indications for treatment.
  4. Almost all diseases have relations of some kind to the various accidents and conditions of ordinary life. Their symptoms are made worse or better by heat or cold, rest or motion, by night or by day, or other circumstances or conditions. Many remedies are related to the effects of certain conditions. This is not just the same thing as aggravation, though allied to it and sometimes identical with it. For instance Arnica removes morbid conditions (apart of course, from surgical injuries such as broken bones) caused by falls; Ruta relieves the effects of bruised bones. It is not correct in either case to describe these as aggravations. Although causations and aggravations are not the same, they are closely allied. Rhus tox is related to the effects of damp weather, and appears in the list of remedies having this causation, but it also having this causation, but it also has its symptoms, when not caused by damp, aggravated in a supreme degree by conditions of damp. Therefore the prescriber who uses this list of causes as a rough list of aggravations also will not go far wrong and may find no little help from it in some of his cases.
  5. The diseases are not 'just happened .Their origin may be from an event or series of events, extending over many years. Sometimes the cause is an inherited constitutional fault, or it may be a progressive accumulation of toxic material in the organisms created by defective elimination. Other causative factors are bad hygiene, over indulgence in bad habits, over-eating or malnutrition. Ailments often appear as a result of a severe mental shock such as grief, prolonged anxiety, or great disappointment. It will be seen, therefore, that the fundamental cause of disease spring from two main sources:
    i. Inherited - the type of constitution.
    ii.Acquired - direct contamination, physical or emotional shocks, hygiene or dietetic lapses

    Inherited Causes:
    They will be dealt later as they are most important in our treatment of chronic ailments.

    Acquired Causes:
    Endemic is the term applied to disease which exists in particular localities or amongst certain races. For example cholera is an endemic disease of certain parts of Asia. Epidemic is the term applied to a disease which affects a large number of people in a particular locality at one time. This type of disease is therefore infectious from person to person. Direct contamination covers the epidemic diseases. Many epidemic diseases occur at certain regular seasons. For example typhoid fever begins to show itself in August, increases during autumn months and gradually decreases during the spring. Measles produces two epidemics- one in midsummer and one in December. Physical and emotional shocks which may be the root cause of a patient's disorder will be revealed when the patient is questioned by the practitioner; from this questioning any hygienic or dietetic lapses should also become evident. It should be noted that all curable diseases created by these causes could be removed, or greatly modified, by correct homoeopathic treatment. In simple or acute cases, the correct remedy produces almost an instantaneous effect. A demonstration of this rapid action will be seen when arnica is given for shock and bruising in an accident. In chronic cases, one may have to wait for weeks or even months, but improvement will follow providing the disease has not ultimate itself in gross pathological changes.

  6. The external causes or occasional causes embrace everything where there is such an internal disposition to disease which may produce disease. To this belong- After effects of acute diseases, medicinal diseases and poisoning, contusions, sprains, burns and the like, exposure to cold, infectious diseases, etc. These are anamnestic and are of special importance.

    • As regards acute diseases, the exciting cause being injurious influences to which the person was particularly exposed. Aphorism 73 explains the various factors responsible for exciting the latent psora into individual expressions of an acute kind which spontaneously return to their dormant state if the acute diseases were not of too violent a character and were soon quelled.

    • The causes, (either a cold caught many years ago, or a former fright, a sprain, a vexation) are much too insignificant to develop a chronic disease in a healthy body, to keep it up for years, and to aggravate it year by year, as it is the case with all chronic diseases from developed psora. Causes of a much more important character than these remembered noxious influences must lie at the root of initiation and progress of a serious, obstinate disease of long standing; the assigned causes could only rouse into activity the latent chronic miasm.

    • The chronic miasms are the fundamental causes of the acute miasms; if there are chronic miasms there would be acute miasms also. It is the very nature of a chronic miasm to predispose man to acute diseases and the acute diseases are as fuel added to an unquenchable fire. Acute diseases then exist from specific causes co-operating with susceptibility. If there is no chronic miasm there would be no susceptibility. Indisposition from external causes mimic the miasms, i.e., their group of symptoms is an imitation of a miasmatic manifestation, but the removal of the external cause is likely to restore the patient to health. The active cause is within and the apparent cause is without.

  8. a) Pathological explanations and speculations are too far removed from our entirely practical method to have any great value in a therapy and cure. Diseases are logically divided into internal and external. The former arise from the natural disposition, which is sometimes highly susceptible (idiosyncrasy). The latter can excite disease principally by means of external impressions, when there is already a natural predisposition thereto. The modified natural tendency to disease depends, according to Habnemann, upon the un-eradicated miasms of psora, syphilis, and sycosis. When it does not originate in these, it is mostly composed of remnants and sequel of the acute affections which so largely go to make up drug diseases and poisonings, but we do not see both factors combine to undermine the health, thus presenting a proportionately deeper rooted disease just that much harder to combat. In such cases anti psoric remedies very much excel all others in efficiency. (The scrofulous diathesis - psora - is constantly being extended by the practice of vaccination; our view of the matter receives confirmation from the fact that in very many cases of such diseases which are essentially acute in character it is only by the administration of our so called anti-psoric remedies that rapid and durable cures can be effected). Whether or not we believe the psoric theory, the fact remains that the best selected remedy is often ineffectual unless preceded by the proper anti-psoric, anti-sycotic or anti-syphilitic as the case may be, but because of their almost identical symptom list it is generally chosen with difficulty by differentiating and searching out the few true characteristics. Drug diseases and poisonings do not differ in their health destroying power. The drug taken should be ascertained and properly antidoted. Simple poisons are easily detected by their effects, but a drug disease is generally a compound result which fails to show a clear and accurate picture, hence knowledge of the contents of former prescriptions taken is a necessity and lightens the labour. Practice has extracted and rendered the anamnestic symptoms ease of access, thus greatly restricting the list from which the selection is to be made so that attention to but a few characteristics quickly determines an accurate choice. This is especially true of sprains, bruises, burns etc. Colds are more complicated because of the diverse manner in which they are contracted and the different parts which they affect that point to different remedies, e.g., it makes a great difference whether they are contracted while sweating, by exposure of a part, being drenched all over or partly etc. Various remedies must be considered, according to whether the symptoms localize themselves internally (stomach, chest, abdomen etc.) or externally (head, feet, back etc.). Such remedies are to be too readily thrown aside unless certainly found dissimilar in other respects. So much depends upon the knowledge of the cause (Anamnesis) of disease, that without it the choice of homoeopathic remedy cannot be made with safety.

    Homoeopathic prophylactics are tested and sure. The very remedies, which cure the fully developed disease, will protect exposed persons. This is very important for the reason that incipient diseases are generally very lacking in the characteristics, which determine the choice.

    Its practical utilities are:
    • Once we realize the value of aetiology, we shall naturally try to find out the beginning of various complaints of the patient by asking 'when' and 'how' the particular trouble started. Many acute cases get easily cured by this method.
    • By re-arranging the case report chronologically we get a bird's eye view of the progress of the disease, and at what particular point it needs correction. Instead of trying to find one remedy for the whole picture as presented today, we can cure it easily by taking the problems one by one, from the latest to the first cause. All small shocks do not need treatment as the vital force normally manages to re- adjust itself. Think specially of serious and complicated cases.
    • It is the duty of us all, to note the aetiologies of cured cases and report these as found under those remedies. Only this way can we continue the tremendous work done by the early homoeopaths and enrich the materia medica.
    • The correct causal remedy, by directing the vital force on right lines, can cure a case without necessarily having the capacity to produce the present symptoms of the disease. It was the disturbance of the vital force at some previous period of time by some cause or causes that started the pathological condition and the restoration of condition prior to that stage will set right the entire disease including the present symptoms. This enlarges the scope of homoeopathy vastly.

    b) Remote causes are found in the past history of illnesses of the patient. These causes produce a morbific influence on the vital influence or the vital dynamics or the power of resistance of the sick individual. On account of their morbific influences the patient fails to adapt, desensitize, immunize or canalize in order to recover completely from his ailments and disease. We give a list of these remote causations of illness and follow it with illustrated cases for the benefit of homoeopaths.
    Remote causes may be classified:
    1. Traumatic influences.
    2. Burns.
    3. Cauterizations.
    4. Sprains.
    5. Stretching of sphincters.
    6. Operations.
    7. Anesthetics.
    8. Drug miasms.
    9. Virus diseases.
    10. Bacterial diseases.
    11. Mycobacterium and spirillum diseases.
    12. Blood parasites.
    13. Gastro intestinal parasites.
    14. Vital drains.

  9. Even some gross errors of diet, taking cold, the appearance of weather especially rough, wet and cold or stormy or even the approach of autumn, if ever so mild, but more yet winter or wintry spring and then some violent exertion of the body or mind, but particularly some shock to the health caused by some severe external injury, or a very sad event that bowed down the soul, repeated fright, great grief, sorrow, and continuous vexation, often caused in a weakened body the reappearance of one or more of the ailments which seemed to have been already overcome; and this new condition was often aggravated by some quiet new concomitants, which if not more threatening than the former ones, which had been removed homeopathically, were often just as troublesome and now more obstinate.
    • The past history and the way each sickness leaned are both useful and interesting; for most persons develop symptoms in a distinctive way through the most diverse affections. Such constancies are truly antipsoric and it should be your pleasure to search out the differentiating indications from among them. While their discovery is not always easy, for it involves a recital of every past sickness, the trend of each illness and peculiarities are a part of the sick man's way of doing things and must be known if you wish to do the best work. They will give you a better idea of present and future prospects as well as lay a solid foundation for the prescription that will do much and reveal many things.
    • Our task is lightened by being able to find the location of the exciting cause and then differentiate with the aid of modalities and the general picture.
    • We are dealing with the man who uses his organs to guide his internal organs to guide his internal self; therefore all external injuries have internal effects and external disturbances show themselves by external signs, be the cause moral or physical.
    • In ordinary parlance we speak of the etiology of the disease, these old school ideas are far too narrow because the radius from which we draw our information is wide and may include any influence whatsoever. Things in themselves apparently very trivial may become of the greatest importance when related to the beginning of the disease. Sickness arises from extrinsic as well as autogenic causes. The former arc in a general way more accessible and therefore more accurately defined. They embrace the susceptibility to certain external influences, which pervert the vital force, injuries, the state of the weather, heat, cold, dampness, physical exertion, etc. Autogenic causes often have mental states as their starting point; the effects of grief, worry or fright arc good examples. Emotional states may be the beginning of a long train of untoward manifestations for which the similimum cannot be perceived until they are given a proper place in the pedigree of the disease and as the mind does not always readily disclose such things, they may be difficult to discover. Whether the causes come from without or arise from within, the homoeopathic simillimum cannot be chosen with safety without taking them fully into account.
  11. The physician's first duty is to inquire into the whole condition of patient: the cause of disease, his mode of life, the nature of his mind, the tone and character of his sentiments, his physical constitution, and especially the symptoms of his disease as per Organon.
    • Dr. P. Sankaran tried to select a remedy which fitted in with and covers the symptom totality of the patient as well as the cause, but he took the cause as the starting point as well as the most important symptom of the case.
    • The homoeopath also finds that giving due consideration to these emotional causes and the mental symptoms of each patient in the selection of the remedy leads to success.
    • While taking the case, Dr. P. Sankaran invariably tried to find out from a patient the cause, source or origin of the illness or the circumstances in which it started. In the earlier years of his practice when he used to enquire about this, his patients used to reply either that they did not know the reason or that the illness had started without any apparent exciting cause. He accepted this initially, but later he found that by persistent questioning about this point he was able to uncover and expose in about 75% of cases, a definite cause, source, origin and or circumstance from which the disease had taken shape. He usually gave very great importance to this etiology and tried to select a remedy, which covered both etiology and symptomatology. Sometimes he based his prescription mainly or solely on this etiology and he cured many cases this way. For instance, if the suffering had started after an injury, he might consider Arnica; if after an operation or mortification, Staphysagria; after getting wet, Rhus tox; after suppressed skin condition, Sulphur; after a suppressed discharge, Lachesis; after suppressed sexual desire, Conium; after a shock or grief, Phos-acid, Ignatia etc; after a fright, Opium; after a bad vaccination, Thuja; after a wounded pride, Platina; and so on. He obviously tried selecting a remedy which fitted in with and covered the symptom - totality of patient as well as the cause, but he took the cause as the starting point as well as the most important symptom in the case.


MATERIALS
The materials for this study were collected from the in-patient department of Dr. D.Y. Patil Homoeopathic Medical College Hospital, Pimpri, Pune, from 1 February 2010 to 30 April 2010.
METHODS
Cases presented with a specific etiology only are taken up for study. Detailed history was taken in each case with special reference to previous history, family history, occupational history, physical generals and mental generals. Systemic examination was done in all cases. Age, Sex, Socio-economic and occupational status were considered as attributes. The method of approach was a clinical study without the use of control.

In the present study, materia medica has not been included because causative modalities and the aggravations are intertwined in material medica and also being a vast area of study, it far exceeds the sphere and scope of this analysis. It is the repertory ‘Synthesis 9’ that is resorted to for the purpose of this study. The old masters (Boenninghausen’s, Boger, Allen, etc.) have not been included because the repertory 'Synthesis 9’ encompasses them too. Causations are taken generally not taken particularly for this study. The selection of medicine for each case was decided upon a strictly causal basis, using all repertories and materia medica depending on the type of cases. Each case was reviewed on one week, two weeks and four weeks’ time. Each case was followed up for a minimum of two months from the beginning of treatment. Medicines were repeated only were quantitative increase in the symptoms and other clinical features of the diseases were noticed. In between the period of medication all patients were kept under blank tablet continuously.
DIET AND REGIMEN
All patients were directed to continue with the same diet as earlier. All of them were directed to stop the use of all the medicines prior to the start of this treatment.
EFFECTIVENESS
Effectiveness of the treatment was assessed on the basis of relief from symptoms, clinical improvement and changes in the score taken before and after the end of the treatment.

ANALYSIS
Various facts obtained during this study were treated according to statistical principles. This study to evaluate the efficacy of causal prescription in homoeopathy provides evidence to say that there is enhanced success if the mode of causal prescription is followed in homoeopathic treatment. In homoeopathic practice, for prescriptions other than causal, no research findings are available. Even in other causal studies made, a statistical analysis is not attempted. Hence a comparison of the present study with them is not possible. In this study, the effectiveness of causal prescription in homoeopathic treatment is evaluated. The evaluation is based on the relief from symptoms, clinical improvement and on the changes in the score taken before and after 2 months of homoeopathic treatment.

30 patients of the age group 0 - 100 with a specific etiology for the complaints were studied. The maximum representation was from the age group 40 - 49(13, 33%). The male: female ratio was 1:1. 47% of the patients were from lower middle class. Maximum female patients were housewives (43%). 80% of the cases presented were with less than 5 years duration in presenting complaints. In 8 cases (27%) with injury as cause, 6 cases (75%) reported complete relief from symptoms and 2 cases (25%) showed no change in presenting complaints after 2 months of homoeopathic treatment based on aetiology. 7 cases (23%) were with tobacco smoking as cause. Among these, 6 cases (86%) reported complete relief from symptoms and one case (14%) reported aggravation after 2 months of homoeopathic treatment based on etiology. 5 cases were (16.33%) presented with grief as cause and all the 5 cases (100%) reported complete relief after 2 months of causal homoeopathic treatment. In 6 cases, out of which, 2 had fatty food, 2 had death of loved ones and of the other 2 who had climatic change as causes respectively, complete relief from symptoms was noticed after 2 months homoeopathic treatment based on aetiology. 1 case each with vaccination, dust exposure and emotional excitement as causes showed complete relief from symptoms after 2 months of similar treatment. 1 case, in which childbirth was the cause, showed no change after 2 months causal homoeopathic treatment. The effectiveness of causal prescription in homoeopathy was evaluated by statistical analysis.

CONCLUSION
The above analysis indicates there is reduction in the presenting complaints after homoeopathic treatment on the lines of causal prescription. Therefore the treatment is highly effective. In this study the medicines were selected on the basis of reportorial totality along with the aetiology. The medicines for aetiology were selected from the repertory specially prepared which is included in this work. The treatment started with low potency. The potency was changed if it was necessary. After treatment there was significant reduction in the presenting complaints. Clinically all the patients were examined for any untoward reaction to the drug. There was no side-effect seen during the treatment. From the foregoing results it is evident that the causal prescription is effective and homoeopathic medicines are non-toxic. This study to evaluate the efficacy of causal prescription in homoeopathy provides evidence to say that there is a convincingly high success rate if this method is followed. Therefore the treatment is effective.

REFERENCES
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  10. Some reflectionsns on Aetiology in Homoeopathy by Dr. S.P. Kopikar, Indian Journal of Homoeopathic Medicine, Vol. April -June, 1967, No: 2 10(a) Pgs: 76-81, Pg: 280.
  11. The Chronic Diseases, their peculiar nature & their homoeopathic cure. Hahnemann. S. Jain Publishing Company 1982 edition; Pg: 24.
  12. The Study of Materia Medica and taking the case. C.M. Boger. M. D. 12(a) pgs: 4&5, 12(b) pgs: 7, 12(c)pg: 11 , 12(d)pgs: 16 & 17. i
  13. Hahnemann on Homoeopathic Philosophy. John Weir, pg - 12.
  14. The Selection of Similimum and the Management of the patient, Dr.P.Sankaran.(a)Pg:l, (b)pg:4, (c)pg:10.



Dr. Atul B. Modi
Professor and Head of Department
Department of Organon and Homoeopathic Philosophy
Dr. D. Y. Patil Homoeopathic Medical College and Research Centre, Pimpri, Pune-18
Dr. D. B. Sharma
Principal,
Professor and Head of Department
Department of Forensic Medicine and Toxicology
Dr. D. Y. Patil Homoeopathic Medical College and Research Centre, Pimpri, Pune-18.
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