Back to basics and beyond: Repertorisation as a concept and a tool for clinical decision-making

‘The use of the repertory in homoeopathic practice is a necessity if one has to do careful work. Our Materia Medica is so cumbersome without a repertory that the best prescriber must meet with only indifferent results’. - Dr. James Tyler Kent^[1]

A homoeopathic repertory is not just a collection of mere symptoms and their corresponding remedies. It is one of the three pillars of homoeopathic practice, the other two being Homoeopathic Philosophy and Materia Medica. Our Founder, Dr. Hahnemann, rued the lack of a suitable one till Dr. Jahr came to the rescue, followed by the revered Boenninghausen. We are still in the throes of this magnificent thinker and logician who impressed Hahnemann too, with his brevity and brilliant use of the Principles of Generalisation and Analogy. The ‘Therapeutic Pocket Book’ never fails to impress and becomes a compulsory entry of every homoeopathic student to the process of repertorisation. The works of Kent and Boger extended and completed this project, leading to the distinct triad of Repertorial approaches so lucidly espoused by Dr. Dhawale.^[2]

A celebrated collection of papers related to this subject appeared in 1975 in the ICR Symposium on Hahnemann Totality, where again a triad (Dr. Jugal Kishore, Dr. K.N. Kasad, and Dr. P. Sankaran) in a majestic sweep tied up all loose ends and evolved an integrated approach to constructing the Homoeopathic Totality and then applied the Principles and Practice of Repertorisation to this refined data.^[3] This was one of the first comprehensive attempts to demonstrate the application of Repertory through the use of scientific methods that would aid decision-making at the bedside. Numerous case illustrations are an evocative demonstration of the way in which the student needs to grasp the core principles and apply these correctly to practice.

It has always puzzled any insightful practitioner that the academicians of yore never thought it fit to introduce the homoeopathic student to the study of Repertory until they began the 4^th year! Perhaps the penchant for keynotes played a key role in denigrating the early introduction of this subject. Thanks to the boldness and perspicacity of the National Commission of Homoeopathy, it broke with tradition and decided that it was time to respect the third pillar and introduce it during the 1^st year itself. The move was so revolutionary that even many teachers of Repertory looked askance at ‘burdening’ the fresher with essentials of the subject!

Technology has a way of capturing our attention; sure enough, the advent of computers enabled the capturing of vast data from numerous repertories, leading to the proliferation of software. The hitherto laborious process was reduced to a work of a few minutes. However, did we solve our problem of making reasoned and logical decisions that would aid patient care? Did the software developers understand that the repertory was more than a mere dictionary of symptoms and was constructed on a unique appreciation and application of homoeopathic philosophy? It was not uncommon to witness the phenomenon of ‘more the merrier.’ Include as many symptoms as you can gather in a case and look for the remedy that scores the highest. The enterprise raised more troubling questions than provided sensible answers.

We are in the era of Evidence-Based Medicine, where all the processes of clinical decision-making need a support base that can be clearly deduced from clinical data with the underlying logic outlined. Homoeopathy has been fortunate in acquiring reputed teachers and practitioners who delved deeply into their clinical successes/failures and gave us heuristic rules for prescribing. We are fortunate to have a policy paper on this issue that builds bridges between our traditional model and the one that is in current use as a Clinical Decision Support System. This thoughtful article by Dr. Ahmed raises relevant questions for us as teachers of repertory and as practitioners of homoeopathy to reflect on the way that we have been underutilising our precious legacy.^[4] It is a wake-up call which we may ignore at our own peril.

We complete our diet of Repertory with the fulsome work of Dr. C. M. Boger. In the world of homoeopathy, very few people have been as impactful and transformative as Dr. Boger. His contributions to homoeopathic philosophy, clinical practice, homoeopathic materia medica, and homoeopathic repertory have been phenomenal and have shaped the course of modern clinical homoeopathy. Boger was way ahead of his time: The application of his concepts to the clinical practice still remains an enigma for a vast section of homoeopaths. Dr. Dhawale was one of the rare souls who understood the essence of Boger and effectively portrayed it in his little book on ‘General Analysis.’^[5] Dr. Kasad worked on decoding Boger’s abstractions, revealing to us the considerable extensions he made to Boenninghausen’s understanding after almost seven decades.^[6] Over the years, there has been a renewed zeal to understand Boger-his concepts, philosophy, Materia Medica, and his repertories. Before one understands the creation, it is very important to understand the man behind these creations. In this issue, we have reviewed two books on Boger focusing on his legacy and, most importantly, his Synoptic Key repertory. These reviews will surely help our readers in the process of rediscovering Boger.

In continuation with our emphasis on evidence-based scientific homoeopathy, we have an original research paper based on an open-label, prospective, non-controlled, and pre-post-comparison clinical trial which demonstrates the efficacy of homoeopathy in the treatment of hyperuricaemia.^[7] These evidence-based case series and case reports help demonstrate the efficacy of homoeopathy in several clinical conditions.

How does one go on rediscovering the basic concepts, concepts which we have long learnt, which have always been there but now not noticed by us? In our quest for learning newer and newer concepts, have we taken the liberty of ignoring and forgetting the basic principles of homoeopathic philosophy and their application to all aspects of our work? The answer to this can be found in Dr. J. T. Kent’s statement, ‘The cry for liberty has been a grievous error, as liberty is and has been shamefully abused. It is liberty that has driven out of use, or limited the use of, the Repertory that all the old healers so much consulted. If Boenninghausen used a repertory with the limited remedies then proved, how much more do we need to consult it’.^[1] To be better clinicians, it is time for us to rediscover how strongly our repertories and concepts of repertorisation are founded on our philosophy.