Understanding the evolution of concept of concomitant and grand generalisation as proposed by Boenninghausen using materia medica and justifying its representation in the therapeutic pocket book – An exploratory study

INTRODUCTION

Boenninghausen advocated the use of complete symptoms in the formation of totality. Complete symptoms consist of location, sensation and modality. Apart from these three elements of symptoms, Boenninghausen introduced the fourth element, concomitant. The concomitants are accompanying symptoms that were ignored by homeopaths as they do not have any pathological connection other than strict time correlation to the chief complaint. Boenninghausen has emphasised the importance of concomitants in his writing on intermittent fever. Intermittent fevers are difficult to treat, but, if one understands the importance of concomitants and records these symptoms during apyrexia then symptoms of paroxysm it leads to the indicated remedy. Dr. H. A. Roberts described the importance of concomitant by saying that ‘The concomitant symptom is to the totality what the condition of aggravation and amelioration is to the single symptom. It is the differentiating factor’. If we see the representation of the concomitants in Boenninghausen’s Repertory of Anti-Psorics, it is given under a few chapters with separate headings. All these observations have led to the question of how and why Boenninghausen came up with the doctrine of concomitant and grand generalisation.^[1-3] The answer to this has been attempted in the study.

Loknath Behera, in his paper ‘Quibus combitus: The epiphenomenon of concomitants’, concludes that concomitants are of the highest value in prescribing and without concomitants medicine will be palliative. Further concomitants are away from the sphere of the disease, the greater their value in individualising the case.^[4] In a single blind placebo control clinical study to see, the specificity of concomitant symptoms in process of cure in homoeopathic prescribing it has been concluded that prescriptions made on the basis of concomitant symptoms is effective in homoeopathic cure and overall well-being of the patient.^[5] Munjal Thakar in his article ‘Rediscovering the relevance of Boenninghausen and Boger’s Concept-part 1’ analysed three actual cases of Boenninghausen and found out that Boenninghausen has noted concomitants in all his cases especially the changed mental state. He has also considered changes in menstrual pattern and other complaints as a concomitant. Dr. Thakar observed that when Boenninghausen failed to get changed disposition in terms of mental symptoms or state or disposition his prescriptions failed, and he had to reconsider the case.^[6]

Boenninghausen observed that many symptoms are incomplete, either the part of the body or the sensation is not clear. He made observations in the materia medica and also in his case taking of patients that, the same sensations or modalities or concomitants have a tendency to be present in different anatomical locations. He used the concept of analogy and postulated that when one of the elements is missing in a particular area, it can be logically imported from other anatomical location where it is present.^[1,7,8]

This extended view and use of generalisation was not accepted by many including Jahr, Hering, Hempel, Hart, etc. They were of the view that to dismember the essential elements of symptomatology is inappropriate, and they held that in repertory, the symptoms should be kept as they were found in the proving and should not be distorted. Dr. Hering wanted to stick to the character of the symptoms found either in the proving or in the clinical confirmation without any generalisation. Kent’s opposition to the generalisation was that modalities pertaining to the part should not be generalised to the man as a whole. Many times, contradictory modalities are found in general symptoms and in particulars. In his words, ‘Nothing has harmed our cause more than the books that generalise modalities namely, by making a certain aggravation or amelioration fit all parts as well as the general body states’.^[1]

Despite his opposite view to analogy, Jhar conceded that even the most complete repertories available did not satisfy all the exigencies of the practice. He went on to add that in clinical practice, if a physician is unable to get a complete symptom of a location, he can choose based on the expressions in other locations as analogies and further explore with the genius of the likely simillimum of the case. Dr. Kent opposed Boenninghausen’s analogy, but in his, Lesser Writings admitted that many brilliant cures are made from the general rubric when the specific rubric does not help. The specific aggravations are of great help, but such observations are often wanting, and the general rubric must be referred.^[1]

These differences of opinions on analogy confuse homoeopaths even today. Munjal Thakar, in his article ‘Rediscovering the relevance of Boenninghausen and Boger’s Concept-part 1’ with due consideration of criticism from stalwarts, observed, that generalisation can be useful as wider net in process of selection of simillimum as well as expansion of current knowledge of remedies through extrapolation.^[6] While Will Taylor, in his article, ‘On the generalisation of symptom dimensions’ taking in consideration of grand generalisation and its opposition by great minds, found himself at crossroads. He said that instead of asking whether to use generalisation or not, it might be asked when and where this is acceptable.^[9] Lack of logical clarity on sound bases of grand generalisation creates these different opinions and confusions. This paper attempts to define the logical process adopted by Boenninghausen to apply the doctrine of analogy and evolve the concept of grand generalisation. This paper also attempts to define how Boenninghausen may have come up with the concept of concomitant and gave it a place of prominence in clinical practice.

MATERIAL AND METHODS

Methodology adopted is as under [Figure 1]. As an illustration, Natrum Mur has been given below.

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Figure 1:

Methodology flowchart.

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Mental symptoms of Natrum mur is demonstrated in Table 1.^[10] Physical symptoms of Natrum Mur were divided into location, sensation, modalities and concomitants as demonstrated in Table 2.^[10]

The synchronous application of concomitants observed in different anatomical locations in materia medica from the study of six remedies and also seen in Boenninghausen’s Repertory of Anti-psoric remedies and his write – up of Brief Directions for Forming a complete image of a disease for the sake of homoeopathic treatment is demonstrated in Table 3.^[3,10-12]

The process adopted and demonstrated in Tables 1 and 2 for Natrum Mur was applied for all the other five remedies. From the ‘concomitants separated’ column [E.g. Tables 1 and 2], frequently appearing concomitants across the anatomical locations identified from each remedy. The representation is shown in Table 4.

Comparison of frequently coming concomitants from study of materia medica [Table 4] with that of the rubrics in the therapeutic pocket book (TPB) (where concomitants have been generalised) is represented in Table 5 with gradation of the remedy.^[10,11,13]

RESULTS

In materia medica, there are many symptoms which can be identified as symptom accompanying location, sensation and modality which Boenninghausen considered as fourth element of complete symptom and named it as concomitant symptoms [Tables 1 and 2].

A complete symptom demands the presence of all the four elements. In his first repertory, Repertory of the Anti-psorics he has mentioned concomitants in more or less every anatomical position when comparing the symptoms represented in the Materia medica. However, in some sections in Repertory of Anti-psorics like mind, eye and vision, mouth/throat, nausea and vomiting, stomach, abdomen and sleep, we do not observe the concomitants [Table 3].

The logic of generalisation of concomitants in grand scale in his TPB can be observed with corresponding representation in materia medica [Tables 4 and 5].

The observations in Table 6 which is based on Table 5, demonstrate that most of the rubrics are generalised. Moschus being ill – proved, it has few symptoms and, hence, the concomitants too are few. With growing knowledge of Moschus, this may be explored in future.

DISCUSSION

Stalwarts recognised the importance of concomitants in clinical practice and generalisation of symptoms as well. However, Boenninghausen’s logic for identifying concomitant and to generalise it, were not clear to many, resulting in confusion and controversy. Furthermore, the reason for this study was also to illustrate the method of studying the concomitant and generalisation to the students of homoeopathy.

The study began with the materia medica’s present then and now and compared the symptoms with the rubrics in TPB. It was found that the presence of accompanying symptoms in many symptoms firmly establishes Boenninghausen’s doctrine of concomitants and evolution of the concept of complete symptom. When we further studied the representation of symptoms, we appreciated the presence of similar concomitants in multiple symptoms (different anatomical locations), they were either physical or mental generals. Hence, the grand generalisation observed in TPB too is justified.

We conclude this as a genius remedy and, hence, can be applied with any complaints as concomitant if it presents in patients, though it is not represented in materia medica. This will be in accordance with Boenninghausen’s own writing on contribution to the judgement concerning the characteristic value of symptoms, in hexameter under heading Quibus Auxiliis. He also compared these symptoms to striking, strange, unusual and peculiar as mentioned by Dr. Hahnemann. He said that this type of symptoms demands more prominent place than the common one, because on them chiefly though not exclusively the similitude depends.^[14]

This study attempts to indicate to current day practitioners to freely use both these concepts as they are logically thought and presented by Boenninghausen. A study of more remedies will enhance the credibility of the concept and its application in clinical practice.

CONCLUSION

The study though was done on only six remedies, two each from Mineral, Animal and Vegetable kingdom justifies the doctrines of concomitants, complete symptoms and grand generalisation. This study demonstrates the probable methodology that was applied by Boenninghausen to give us the doctrine of concomitants and generalisation on the grand scale.