Understanding the concept and utility of structuralisation in homoeopathic practice: A conference report

Institute of Clinical Research (ICR) Symposia have always striven to be case-based learning cauldrons! Whatever be the topic of these continued educational programmes, knowledge and opinions churn through till ‘amrut’ (nectar) emerges! The symposia either explore clinical themes, delve into various aspects of homoeopathic philosophy, or discuss thematic Materia Medica. Rarely, they have tried to revisit repertorial approaches to evolve a finer understanding and their application in the current scenario. The Golden Jubilee National Symposium organised in Mumbai (12^th–14^th September 2025) was unique. It was devoted to decoding Structuralisation, an approach to the case originated by Dr. M. L. Dhawale (1927–1987) himself. The ICR Literature, especially the celebrated Symposium Volumes, has extensively used this method to present a variety of knowledge – philosophical concepts, clinico-pathological correlations, psychological facets and most important of all, polychrest remedies, we commonly use in our daily practice. Not many have been able to master the technique of even interpreting these charts, let alone constructing them! It was but fitting that the team of Dr. Anand Kapse, a seasoned teacher of Homoeopathic Philosophy and Dr. Nikunj Jani, a master communicator and a Repertorian, had undertaken the onerous responsibility of unravelling this theme in the Golden Jubilee of the ICR.

The questions posed by Dr. Nikunj at the beginning were relevant: What is the concept and methodology of standardisation? How do we apply it in our clinical and educational practice? What advantages does it give us in understanding the illness, the patient and the remedy? What are the firm indications for using it? Why do we generally find it difficult? What are the common errors and the limitations of its use? How can we build on what our teacher has given us through his numerous writings?

The 12 cases, which were to provide answers to the above questions, were as varied as were the teams presenting them, hailing from different centres of the Institute. The case selection team had performed an excellent job of curating the case material to afford us a glimpse of all aspects of the theme. What was common was the undoubted evidence-based outcome in all the detailed cases with clinical data circulated in advance, which allowed the 200 participants to apply their minds to the precise directives provided. A number of attendees had come prepared and had submitted their workings in advance to the presenter (guide) of the case. This helped the guide focus on the difficulties and plan and conduct the discussion. This format of an ICR Symposium is very apt to achieve the specific objectives of learning from each case and to deepen the understanding of the theme. What follows are brief pointers on how each physician approached the case and what it taught us about the theme and about the dos and don’ts.

A young female homoeopath presented with migraine, IBS and leucorrhoea – all with characteristics. Her brief colourful life indicated a strong-willed, egotistic and unforgiving nature. She was also very fearful. Standard repertorisation brought Nat Mur, which did not cover the physical characteristics nor the finer nuances of the mind. We learnt how to evolve the different blocks, connect them and then refer to the material medica to yield Kreosote. The differential images of Nitric acid, Cenchris and Nat mur now fitted the pattern.

Another young female who was unable to build sufficient human choriogonadotrophin levels to sustain pregnancy also had an unquenchable need for appreciation. Her remarkable oversensitiveness to neglect, coupled with pride, nonplussed the husband and the marriage was on the rocks. Here too, the blocks of the theme (want of appreciation) along with the relationship patterns in her maternal and married home, allowed Palladium to be closely differentiated from Platina, Lac can, Pulsatilla and Sepia. The patient conceived and successfully delivered.

The other infertile woman was her polar opposite. Right from the very controlled expression in her short history, this efficient female manager was shaped by the Bhuj earthquake, which destroyed her home but hastened her maturity and allowed her to internalise disciplined conduct. Her responsibility and anxiety towards establishing a home for her elderly parents overrode all other concerns. The evolving image of Carcinosin was perceived through distinct evolutionary personality patterns. Conception occurred during the first month of treatment. She needed the support of homoeopathic medicines to deal with placenta praevia, antepartum haemorrhage and poor labour pains-all chosen with the pathological blocks in the forefront.

However, another female who had contracted a late marriage presented with perimenopausal dysfunctional uterine bleeding and hypertension. She had delayed her marriage due to financial responsibilities at her maternal home and then continued to shoulder these even though times had changed. The differing family pattern after marriage unsettled her and the strain showed in her state of chronic exhaustion and depression. She had a limited interest in discharging the standard female role and the typical Sepia thinking-feeling-behaviour pattern helped to identify the remedy.

A divorcee from a backward community with a long-standing, recurrent atopic dermatitis had an unfortunate childhood with early loss of mother and a disrupted family. She acquired an alcoholic husband, from whom she separated. In spite of this misfortune, she persisted in the quest for individuality, completed her post-graduation and refused to give up her quest for independence and settling in a retail trade. Sepia had to be closely differentiated from Natrum mur – again from the characteristic features in the blocks of the skin and of the person. All the above female patients, when seen from the perspective of the distinct behavioural patterns to their circumstances, when correlated to the concomitant areas of expression, allowed us to appreciate the distinct remedies.

A child with corticosteroid-dependent nephrotic syndrome fixed the group with contradictory behavioural patterns that increased after the birth of a sibling. He endeared himself to the physician in the consulting room but was reported to be aggressive, hyperactive and irritable, ‘cruel’ to pets while also being morbidly oversensitive to being criticised and fearful. The context of a chronically ill child displaying adverse effects of steroid therapy needed to be decoded. He gave clear indications of precocity. Medorrhinum was difficult to distinguish from Lachesis, Kreosote and Iodum without connecting the different blocks of the evolving traits. The child raised quite a storm amongst the group of sensitive mothers and fathers, learners. This remedy is represented in the Atlas of the Symposium volume.

A finance professional with a presentation of Trigeminal neuralgia and an underlying cerebro-pontine AV malformation posed questions of accepting the case for homoeopathic treatment. The contribution from a group member of pain amplification syndrome showed a way forward – at least, we would be able to dampen the sensitivity and manage the pain. The clue to the personality was the sticky-stingy aspect. An inveterate worrier with an ability to trounce remarkable personal limitations, although paying the cost by developing obesity, diabetes mellitus and hypertension, allowed Kali bich to be perceived. The response has been consistent and definite.

A different application of the process of structuralisation was seen in the process of synthetic prescription. The lady was getting incapacitated by an increasingly debilitating obsessive compulsive disorder, although she had come to get relieved of tonsillar. The physician was unable to find an exact similimum and therefore decided to bring together the cation of Calcarea and anion of Arsenicum. This was an instance of structuralisation through erecting two distinct blocks and then marrying them to yield Calc ars.

We had three very unusual examples of employing the method of structuralisation and each of these yielded a very different learning. A 45-year-old hemiplegic from a poor social background wanted help almost a year after the episode. He could not afford physiotherapy. What benefit can accrue with any treatment after such a long lapse? The personality of the patient afforded the answer. His remarkable sensitivity, studied evolutionarily, gave a glimpse of the profound effect of anxiety and fright from early childhood persisting to date. The block of the mind with the location and pathogenesis helped to prescribe Gelsemium with striking results. The power almost returned to 5/5 and the man was able to resume his physical labour! The case emphasised the relevance of the study of Boger to arrive at the origin of the concept of structuralisation.

We have been taught that the bond of the mother and the newborn is close till time gradually separates them and the infant establishes its independent equation with the environment. We saw this phenomenon in action when the definition of the mother’s remedy (Sepia) helped to treat impending neonatal sepsis in her pre-term twins (Phos) and how the relationship of remedies was effectively utilised. The success struck all the more when other neonates admitted around the same time did not make it. The parents had refused permission for homoeopathic treatment. This was yet another extension of the concept of structuralisation, which dealt with the mother-infant as a unit.

ICR has taught us that we need to structure our understanding of the patient’s problem in a holistic way so that resolution follows suit. Our standardised case record carries this representation and it has entered our DNA. However, we witnessed this phenomenon on a grand scale when a young girl of Schizoaffective disorder under psychotropic medication with polycystic ovarian disease and Obesity had to be managed in the bio-psycho-social framework, dealing with a number of factors, with multiple interventions over a prolonged period. The management was implemented in phases with infinite patience! Casting the whole process in the format of structuralisation was indeed an extension of the concept in hitherto uncharted territory.

What was taught (and Dr. Shirish Phansalkar was one of the ablest articulators of the teaching) was that we arrange blocks of cause and effect in an evolutionary manner. Individualising characteristic features of a patient constitutes the central block of the structure. Each remedy has its own individuality manifested in the evolutionary structure. An accurate identification will reduce the confusion as to which remedy will best fit the patient. We would be missing the remedy if we placed the same facts differently. Thus, we would find it possible to identify and differentiate different remedy structures through employing this method.

Learning is a continual process. Learners from Mumbai, Pune, Gujarat, Bangalore, Raipur, Kolhapur and Jaipur have learnt the basic ropes of structuralisation through the symposium. It is for us to now delve deeper into the ICR literature to deepen our understanding. What Boger started, Dr. Dhawale has carried forward. Our learning and contributions in the ICR symposium on understanding structuralisation have laid the foundation for the long journey before us.