Saturday, August 31, 2013

Is there a need to rewrite the textbook of Practice of medicine according to the need of homeopaths ?

Is there a need to rewrite the textbook of Practice of medicine according to the need of homeopaths ?
Prof G R Mohan,
Principal, Devs Homeopathic Medical College,
Ankireddipalli, Keesara Mandal, -501301
R.R.District, AP

A Teacher is a performer like an actor- the only difference is that the teacher expects learners to perform

Samuel Hahnemann states  in The third aphorism in the Organon :
If the physician clearly perceives what is to be cured in diseases, that is to say, in every individual case of disease (knowledge of disease, indication), if he clearly perceives what is curative in medicines, that is to say, in each individual medicine
Basic objectives of education and training in a Homoeopathic institution is to prepare a competent Homoeopathic Physician who is capable of functioning independently and effectively under Rural and Urban set ups (CCH)
According to C C H syllabus there are three papers for practice of medicine examination which is scheduled in the final year of B H M S course. Two papers are mainly concerned to homeopathic therapeutics. In true sprit a teacher in the Department of medicine has to refer text book of medicine along with material medica  and Organon books to deliver a lecture to satisfy the examination modalities. How far is this practicable? Majority time of 85% is spent on medicine proper; in reaming fifteen percent of time only homeopathic treatment is discussed in the class. Even for students it becomes difficult to collect information with this cumbrous syllabus.
Present day there is a criticism that newly passed out graduates are not able to give correct prescription. How far is it correct ? It is a question to be answered by every teacher in homeopathic medical college. Is it the fault of the teacher ? Can it be the student? Or non  availability of Homoeopathic oriented books ?
Late Prof. John Mitchell & his team have shown that :80% of the accurate final diagnosis & 100% of the management strategies, could be arrived at the end of reading the referral letter and carefully listening to the patient. This clinical accuracy could only be 4% more refined by all the physical examination and only 8% more refined by all the investigations including PET scan.
Elizabeth Hubbard said : A through physical examination and routine laboratory investigations has to be done, so that the physician is thoroughly scientific.
Stuart  Close said : Hahnemann devoted  twenty two paragraphs in the ‘Organon’ on examination of the patient ( 83-105)
Really there are no  good homeopathic oriented  text books  for practice of medicine are available but  they are quite good number text books  in allopathic oriented practice of medicine  which naturally impress on the student‘s mind the allopathic approach. Medicine books are written by allopathic oriented authors with mechanical-materialistic approach and outlook. Very little attention paid to the dynamic vitalistic aspect of all these subjects .The disease is described more from nosological diagnostic point of view less from the angle of dynamic vitality and individualistic concept. Prognosis not described according to the homeopathic point of view.    
 Medicine is essentially a practical science and can be more learnt at the bedside than in a classroom. Care should therefore be taken to impart an intensive clinical training to the students during the later part of their study in the college.

Therapeutic method of study consists of studying a remedy in relation to its action in different disease conditions.  For example
Nat.mur-               Eczema, Headache etc.
Pulsatilla-              Mumps, Measles, Haemorroids etc.
Iris Tenax-            Appendicitis.
As teachers  we have to discuss  the predominant site of action drugs which are mentioned  in Materia Medica  with the knowledge of Practice of medicine e.g.:  Cheledonium- Liver, Ceanothus- Spleen, Sabal ser- Prostrate , Ruta-   Periosteum, Hypericum- Nerves. Digitalis – Heart, Euphrasia – Eye and Iodum- Thyroid.  
The modern physiologist reflects the theory that the vast majority of human ills are related in some degree to endocrine imbalance. Every drug in Materia Medica should be studied in relation to the affection of endocrine glands.
Iodum- Hyperthyroidism.
Graphites- Hypothyroidism, Hypogonardism. 
Fucus Vesiculosus- Nontoxic Goiter.
Nat. Mur- Addision’s Disease. Hyperthyroidism
In therapeutics explanation should be more scientifically like :Hardness of hearing> by riding in carriage or train is seen in Otosclerosis (medicine), this symptom is present in Nit. Acid, Graph (materia medica) Enlarged glands.  Hodgkin’s Disease. Seen in  Scrophularia. N.
Even in Materia Medica books contains a vast number of medical terms with many nosological names of disease. So it is difficult to understand Materia Medica without knowing the meaning of the term or signs and symptoms of the disease.
Wen-                     Sebaceous cyst.
Paralysis agitans- Parkinsonism.
Somnambulism-    Sleep Walking.
Hive-                     Urticaria.
Zona-                    Herpes zoster.
The knowledge about the diagnostic symptoms i.e. the pathognomonic symptoms helps in determining the individual characteristic symptoms which form the basis of the prescription in homeopathic practice according to the concept of the totality of the symptoms. It aids prescription by giving information about the location and nature of pathological changes present – pathological generals. It determines whether the pathological changes are far advanced and have affected any of the vital organs. Diagnosis gives indication to use of deep acting constitutional remedies like Silicea, Lycopodium, and Sulphur etc.
Administration of the superficially acting related remedy, Use of high potencies frequent repetition of similar deep acting remedies in acute diseases, the clear diagnosis helps in the differentiation of a natural disease process from other disturbances in the health, E.g.: Asiatic cholera from Arsenic poisoning, cholera from Camphor poisoning .The clinical diagnosis helps the physician in instituting the prophylactic measures (Genus epidemicus) at the time of epidemics. It also makes possible the comparative assessment of the therapeutic results, it also helps to know, to which stage of disease, the drug is more similar. So helps in - Speed prescribing, - Prescription in case of the paucity of symptoms- Comatose patient. 
In reality patients come to teaching hospitals either acute , psedochronic and chronic type, but when a teacher in the practice of medicine has to teach according to the above said classification so that for the plan of the treatment. A teacher who is senior can tackle but for junior teacher it becomes difficult , because no book covers the above problems.
Lastly even after introduction of post graduation in the practice of medicine there is no improvement,  even in  examinations also when the student writes the long or short case , he fails to mention the classification of diseases , fundamental cause exiting cause,  answering blunders in Viva, Performing Very poor clinical examination, writing very few remedies in therapeutic part, no mention of diet nor mentioning general management . Views of a cross section of Homoeopaths  who don’t know about the difficulties in teaching comment like, No Homeopathic orientation,  Poor clinical skill, no filtering in examinations and  on teacher’s attitude
The practice of medicine , Orgonon and materia medica are interrelated , when discussing about  a remedy it should not be theoretical oriented better it should be clinically oriented  material medica to students. Twelve observations of Kent are not shown at the bedside in some of the institutions. Majority of homoeopathic hospitals admission strength is coming down as there is no special care for admitted patients compared to out patiently treated patients. It becomes difficult to demonstrate a good clinical case (successfully homeopathically treated case).
It is for young dynamic teachers of this great system,to come out with a book on the practice of medicine which cover all above said deficiencies.

*** article is published in Medicina Futura homoeopathica,  vol :1 issue :9 Sept 2013