Let’s essentially understand symptomatology in detail for all intents and purposes is a very sort of wide topic still we particularly have actually tried to compile it in one generally single topic. Let’s basically start to kind of understand it with a really simple definition of symptoms definition given by our pioneer subtly.
“A symptom which appears trifling to the careless or the superficial examiner may become, in the hands of the expert, the key which unlocks a difficult problem in therapeutics” – Stuart Close.
The oxford medical dictionary defines, “Symptomatology is a branch of medicine that deals with different types of symptoms”.
The word symptom is derived from a Greek word called “symptoma” meaning “anything that happens”. Any change that takes place in the previous healthy state of the patient is considered a symptom. Symptoms are the language of the vital force; only by the symptoms, the physician can identify the sufferings of the patient.
Hahnemann in §6 defines the symptom as, “the deviated state from the former healthy state of an individual, felt by the patient himself, remarked by those around him and observed by the physician”.
Kent defines, “every symptom (subjective or objective), is indicative of a deviation from the normal state of health. All curable diseases make themselves known to the physician by signs and symptoms”.
H.A.Roberts says, “symptoms are the only expression of disease state”.
Stuart Close says, “a symptom is an evidence of disease or change from a state of health”.
Dr. Elizabeth Wright says “symptoms to the homeopaths are the language of the body expressing its disharmony and calling for the similimum remedy.”
In the current context, the word “symptom” is used to signify whereas the subjective sensations felt by the patient. Example: burning pain, stitching pain, etc, whereas the word “sign”, is used to explain the observation made by the physician and also the attendants of the patient. Example: redness of the eye, swelling of the knee, and Kernig’s sign in subarachnoid hemorrhage, bell’s sign in Bell’s palsy, etc.
“Syndrome” is a term used to denote a disease with a group of a particular type of symptoms and signs. Example: Acquired immunodeficiency syndrome [AIDS].
Importance of Symptoms
“Knowledge of the true nature and constitution of a symptom is necessary in proving or testing medicines; in the examination of the patient; in the study of the materia medica and in the selection and management of the indicated remedy” — Stuart Close
Symptoms are the only clues by which a physician can identify the disease. It is the only way to study the deviated state of the vital force. So, symptoms are called “the cries of vital force”. In a healthy condition, the vital force is maintaining the functions of the body perfectly and harmoniously. So, health is a state where there is no symptom of any type. Therefore Health is considered a negative state
Whereas, if vital force is deranged dynamically by the dynamic miasmatic forces it expresses its sufferings in the form of symptoms. The symptom can also be defined as “the external manifestation of the internally deranged vital force”. So, in a disease state, we have symptoms. The disease is in a positive state.
Thus, the intelligent physician tries to understand the disease only by symptomatic study of the disease and not by formulating unnecessary theories. Hence, the study of symptoms is the only way to identify the disease picture. Symptoms are the only evidence of the disease. Symptoms help in determining the prognosis of the disease.
Symptoms help in the nosological diagnosis of the disease. Based on symptoms only it is possible to select the proper homeopathic remedy.
“Disease symptoms show themselves in unified order in the physical, mental and spiritual spheres,” says H.A. Roberts.
These symptoms are expressed by the patient in 3 planes:
i. Mental or emotional sphere: The patient’s feelings explaining the emotional state.
ii. Spiritual or intellectual sphere: The changes in the understanding, thoughts, affections of memory and will.
iii. Physical sphere: All the bodily changes like organic and tissue changes, in functional and structural levels.
The only removal of all the symptoms of the physical, mental, and intellectual plane is called a Cure.
Recording the Intensity of the Symptoms
A person reacts to his surroundings in his own manner. This intensity of reaction changes from individual to individual. One person reacts too much to any given situation, the other too little, or another shows no reaction at all.
For example: when a teacher scolds an entire class of students for their ill behavior, a group of students may feel sorry for it, the other group may overreact and start crying for the mistake they did, whereas another group may not respond and may feel nothing at all. This type of difference in reactions is noticed in different patients for each diseased condition also. Each patient reacts to the disease in his own manner based on his constitution. Based on this level of reactivity, he (the vital force) develops the disease symptoms.
The susceptibility and sensitivity of an individual play a major role in the production of symptoms. Hypersensitive patients exhibit the symptoms in high intensity even to the normal stimuli. On the contrary, sick persons react to any stimulus at a very low level, as a result, symptoms with less intensity are seen. In selecting a homeopathic remedy, symptoms of more intensity are given much importance.
During the case-taking process, the intensity of the symptoms is indicated by the numbers 1, 2, 3 in the upper right corner of each symptom. The symptom of high intensity is marked with the digit “3”, and the symptom of medium intensity is marked with the digit “2” while and the symptom of less intensity is marked with the digit “1”.
For example: if a patient says he has a severe throbbing type of headache and this subjective feeling of throbbing is more severe in intensity, then the physician marks the symptom as throbbing ³.
During the analysis and evaluation of the case, the physician gives much importance to this symptom. Some physicians mark the intensity by using symbols + or + + or + + +. This they do instead of using the 1, 2, and 3 numberings by marking the + on the upper right corner of the symptom in the ascending order of the severity of the symptom.
Different Types of Symptoms in Homeopathy
1. Complete symptom (Also called as Qualified symptom / Grand symptom / Discriminative symptom)
Every symptom has to be studied to its whole extent to understand its meaning properly. Dr. Boenninghausen, with his extensive research and experience, has formulated this grand symptom. According to him, a symptom is called a complete symptom only if it fulfills the following criteria. Every symptom told by the patient has to be elaborately enquired.
During the process of case taking the physician has to enquire about the following details without fail to make each symptom a grand symptom.
i. Location: It indicates the localization of the disease or the exact anatomical site of the symptom. It indicates the exact part, organ, tissue, or the fraction of the body where the lesion is located or the symptom is expressed.
ii. Sensation: The subjective feeling, felt by the patient regarding the symptom. It is most important in homeopathic prescribing, as Sensation is the subjective individual expression of the vital force. Example: The type of pain felt by the patient, whether the nature of the pain is burning, bursting, boring, shooting, or throbbing, etc.
iii. Modalities: Those circumstances or conditions that ameliorate or aggravate the sufferings of the patient are called the modalities. Dr. William Boericke says, “The modalities of a drug are the Pathognomonic symptoms of the Materia Medica.”
Modalities can be of two types:
a. Aggravation: Condition or the position that increases the intensity of the symptoms.
b. Amelioration: Technically, it is the condition or the position that gives relief or diminution of the intensity of the symptoms.
Modalities can be of many varieties:
1. General Modality: The modality that affects the patient as a whole. Example: patient generally feels better in wet air, complaints worse while thinking of them, etc.
2. Particular Modality: Modality that applies to an organ or a system in particular. Example: headache better by urination, coryza worse in the open air, etc.
3. Positional Modality: The position of the body of the patient based on which the severity of the symptoms is altered. Example: breathlessness ameliorated by sitting in the knee-chest position, pain in the leg aggravated by hanging the limbs, standing is the worst position, etc.
4. Environmental Modality: Changes in the conditions of the atmosphere, room, or season can alter the intensity of the suffering of the patient. Example: complaints aggravated by the north cold wind, thunderstorm aggravates, coryza aggravated in a closed room, etc.
2. Subjective and objective symptoms
Symptoms that are felt or expressed by the patient alone are called Subjective symptoms. Subjective symptoms do not have external indications. These symptoms belong to the mental or psychic sphere of the patient; hence, bear much importance in homeopathic prescription. Master Hahnemann gave much importance to the subjective symptoms. Modern medicine does not identify the importance of these symptoms.
Example: varieties of subjective sensations like burning, throbbing, dragging, tearing, and stitching pains, desires and aversions, and modalities.
Importance of subjective symptoms:
i. They help in understanding the inner nature of the patient, i.e. the psychological state.
ii. Most physicians consider them as the functional disturbances of the organism or the earlier indications of the diseases.
iii. They help in the individualization of the patient and selecting the constitutional remedy.
Those symptoms that can be observed by the physician, or the attendants without the expression of the patient are called the Objective symptoms. These are commonly known as “Signs”. Hahnemann defines them as “the expression of the disease in the sensations and functions of that side of the organism that is exposed to the senses of the physician and by-standers”.
Example: i. Swelling of the knee joint. ii. Discoloration of the skin. iii. The laboratory findings like the temperature of the body, E.C.G., radiological findings.
Importance of objective symptoms:
i. They are very important in the nosological diagnosis of the disease.
ii. Their importance in finding the homeopathic remedy is less.
iii. They are useful in conditions where collecting subjective symptoms becomes difficult. Like in the case of infants, animals, comatose and insane patients, etc.
3. Common symptoms and Uncommon symptoms
Those symptoms that are found in many patients, in many sufferings, and are produced in many during drug proving are called the Common symptoms. Hahnemann called them the general symptom. They are also called spurious symptoms. Basically, Hahnemann classified symptoms into general and uncommon symptoms.
Common symptoms are of no use in homeopathic prescriptions. If a prescription is based on this symptom, it leads to palliation. They are useful only in diagnosing the disease and advising the general management like diet and regimen of the patient, etc.
Example: rice water stool in cholera, stitching pain in pneumonia, rashes in measles, and symptoms like anorexia, cough, etc.
Those symptoms that are special to the patient or the drug, like strange, peculiar, and individualizing symptoms, are called the Uncommon symptoms. These are helpful from a homeopathic point of view, but useless in diagnostic view. Most of the uncommon symptoms are unexplainable, absurd, or paradoxical from the pathological point.
Example: i. Coryza relieved by cold bath ii. Moist tongue with great thirst iii. Thirstless during fever iv. Burning sensation relieved by heat v. Asthma aggravated in summer
4. Basic and determinative symptoms
These terms were used by Dr. Garth Boericke in his book “The Principles of Homeopathy”. Boericke basically divided the symptoms into Basic and Determinative symptoms.
Basic or absolute symptoms are those symptoms that appear in every proving and are of a general nature. There are usually of diagnostic importance. So, they are nothing but common symptoms, only useful in the diagnosis and general management of the case and not in the selection of the homeopathic remedy. Example: headache, fever, weakness, etc. Kent’s common symptoms and Hahnemann’s general symptoms are Boericke’s basic symptoms.
Concerning basic symptoms, Boericke had used this symptom. Determinative symptoms help in determination, individualizing, or personalizing one patient from the other. They are valuable in homeopathic prescription. Example: the mental symptoms of the patient, modalities, desires, aversions, strange, rare, peculiar symptoms, etc. Kent’s generals and qualified particulars, Hahnemann’s uncommon symptoms are Boericke’s determinative symptoms.
5. General, common and particular symptoms
Dr.J.T.Kent in his book “The lectures on Homeopathic Philosophy” under the chapter “The value of symptoms” has mentioned these types of symptoms. The symptoms exhibited by the patient can be divided into three groups according to him. They are i. General symptoms ii. Particular symptoms iii. Common symptoms
i. General symptoms: Those symptoms that relate to the patient as a whole are called general symptoms. When a patient uses the first pronoun “I” to explain his sufferings, we can call them the “General symptoms”. But it is not mandatory every time.
For example: when a patient says “I am thirsty, I am weak, I feel sleepy” etc, the physician can think that the patient is explaining the symptom with his inner feelings as a whole. So, these symptoms can be grouped under Kent’s general symptoms.
General symptoms are very important as they are expressing the individuality of a patient. They help in differentiating one patient from the other.
General symptoms of Kent are of two types:
a. Mental generals: Those symptoms that explain the inner self or the expressions of the mind, intellect, and emotions can be grouped under this heading. These symptoms are important for prescribing because they reflect the patient as a person.
b. Physical generals: The sufferings of a person that are referring to the physical body as a whole and are not limited to only one part of the anatomical body, can be classified under this heading. Example: General modalities that aggravate or ameliorate the patient’s sufferings as a whole, sexual perversions, sleep and dreams related information, craving, and aversion, hunger, appetite, thirst, symptoms related to the special senses, menstrual problems in females, constitutional type, periodicity of the appearance of symptoms, etc, are important physical generals.
ii. Particular symptoms
Symptoms that are related to the particular part or organ of the body are called Particular symptoms. Dr.J.T.Kent says, “If you are examining any part alone, you are only examining the particulars.” Usually, the patient expresses them by the term “my”. Example My throat is burning, my back is paining, my hands are weak, etc. Particular symptoms are given importance only after the general symptoms because they exhibit the sufferings of only one part of the body. They are related to the anatomical organ and not to the whole person.
iii. Common symptom
Those symptoms that are found in many patients, in many sufferings, and are produced in many during drug proving are called the Common symptoms. Common symptoms are of no use in homeopathic prescriptions. If a prescription is based on this symptom, it leads to palliation. They are useful only in diagnosing the disease and advising general management, like the diet and regimen of the patient, etc. Example: rice water stool in cholera, stitching pain in pneumonia, rashes in measles, and symptoms like anorexia, cough, etc.
6. Negative Generals Symptoms
If a common or general symptom of a nosological disease is not present in a case, it becomes a Negative General symptom. Example: hunger without appetite, coldness with an aversion to being covered, fever without thirst, etc.
7. Characteristic symptoms
Those symptoms which are peculiar, unusual, and distinctive are called the Characteristic symptoms. These symptoms characterize the individuality of a patient. According to Stuart Close “The characteristic symptoms are the symptoms peculiar to the individual patient, rather than the symptoms common to the disease”.
Dr. P.P.Wells says “Characteristic symptoms are those which characterize both the disease and the drug”. Dr. Adolph Lippe says “The characteristic symptoms will consist in the result obtained by deducting all the symptoms generally pertaining to the disease with which the patient suffers, from those elicited by a through examination of the case.”
Characteristic symptoms may be classified into physical or mental symptoms. They are produced in very few provers during drug proving and are seen in very few patients during diseases.
i. Along with the common symptoms of dysentery like bloody mucus and painful tenesmus if, “cold water produces chill, and it is followed by hurried stool” is seen, then it indicates the drug “Capsicum”.
ii. Complaints aggravated by motion and ameliorated by rest and the patient is thirsty for a large quantity of water at long intervals is characteristic of “Bryonia.”
8. Guiding symptoms
Dr. Constantine Hering called the Characteristic symptoms the “Guiding symptoms”. He explained it in his book “Hering’s Guiding Symptoms” which appears in 10 volumes. Hering says “every stool must have atleast 3 legs, if it is to stand alone”.
He advises selecting the remedy at least by using three characteristic symptoms. Guiding symptoms guide in the selection of homeopathic remedies.
9. Keynote symptoms
Dr.Guernsey taught and practiced the keynote prescription. Keynote symptoms are those prominent features that draw our attention towards symptom totality. In music generally “keynote or tune” is used to accommodate the whole music. It is the fundamental note or tone of which the whole piece is accommodated. So, keynotes in materia medica are features distinguished by one remedy from the other similar remedies.
Dr. Tyler comments “The keynotes are invaluable often to give the casting vote”. Prescribing purely based on the keynote symptoms is not recommended because it tries to cut down the other important symptom to make a quick job of selecting the remedy. If they are used by neglecting the general symptoms, failure will be the result.
The term ‘keynote’ is merely suggestive as used in this connection. The reference is between the analogy between materia medica and music. “This analogy is shown in the use of the other musical terms in medicine.” says Stuart Close.
There should be at least three keynote symptoms to make a successful prescription, as suggested by Hering in his three-legged stool concept. Example: “Tension” is the keynote of Aconite, but Aconite is not the only medicine in our materia medica which covers the tension. So when we prescribe Aconite based on this keynote, the result will be uncertain.
10. Chief symptoms
They are also called the Presenting symptom or Presenting complaint. Chief symptoms are those symptoms for which the patient seeks relief and for which the patient consults the physician.
11. Concomitant symptoms
The word ‘Concomitants’ means “That which is occurring together” or “Along with”. Concomitant symptoms always follow the chief symptoms. Dr. Boenninghausen for the first time used this term to explain the symptomatology. Concomitants cannot be explained by the physician either on physiological or pathological grounds but they are helpful in homeopathic prescription.
i. Pain in different parts of the body while coughing is a symptom of “Capsicum”.
ii. Involuntary urination while coughing with pain in the hips is the symptom of “Causticum”.
12. Accessory symptoms
Accessory symptoms are of 2 types:
i. Accessory symptoms of the disease (Explained in §95)
Accessory symptoms are those symptoms that the patient is suffering for a long period and forgets to mention to the physician during case taking. This is because he thinks that they are his habits and are not related to his disease. These symptoms are helpful to the physician in treating one-sided diseases.
Example: A patient visits the toilet more than 4 times a day he is habituated to it. He might not mention this symptom during the case taking but it is useful to the physician in prescription.
ii. Accessory symptoms of the medicine (Explained in § 163, 167, 180, and 181)
While treating a case with a partially suitable homeopathic remedy, some new symptoms can be observed by the patient which he never felt in his life before. These symptoms can be called the accessory symptoms of the medicine. Only an imperfectly selected remedy produces accessory symptoms.
If such symptoms are noticed, those symptoms have to be considered as the symptoms of the disease itself. After prescribing a not so well selected homeopathic remedy, accessory symptoms of medicines may be noticed.
If accessory symptoms of the medicines are severe in nature and if such a condition is seen during acute diseases, a new remedy has to be selected considering the original disease symptoms as well as the newly developed accessory symptoms of the medicine as a totality. But if accessory symptoms of the medicine are mild in nature, then there is no need to change the medicine.
13. Clinical symptoms
These are the symptoms that do not appear during drug proving, but successfully relieve the same symptoms when prescribed clinically based on other symptoms. Example: pleural pricking type of pain of Bryonia was not produced during its proving. But it successfully helps to remove the same pricking pain in patients when administered.
Dr. Boericke supported and defined these symptoms. Dr. Constantine Hering included these symptoms in the materia medica. Dr. Richard Hughes and his followers initially opposed their inclusion into the homeopathic materia medica. These symptoms have less practical importance but are much helpful in managing acute diseases.
In other schools, clinical symptoms are those which the physician understands at the bedside of the patient without the help of diagnostic procedures.
14. Pathognomonic symptoms (Pathos= disease, gnomonic= naming)
Pathognomonic symptoms are those that are helpful in the nosological diagnosis and differential diagnosis of a disease. Most of the objective symptoms are pathognomonic symptoms. Example: cough with bloody sputum, loss of appetite and weight, evening rise of temperature and fine crepitations in the lungs are pathognomonic symptoms of tuberculosis. These symptoms are very useful in the allopathic management of diseases but are less important in the homeopathic method.
15. Pathogenetic symptoms (Pathos=disease, genetic= producing)
Those symptoms that are produced during the drug proving are called the pathogenetic symptoms of that drug. These include the Subjective and Objective symptoms and Toxicological symptoms. These are also called Etiological symptoms.
When the medicine is administered in physiological doses or crude form, or even in the dynamized medicinal form to a prover, he produces these pathogenetic symptoms. This process of producing the symptoms is called pathogenesis. Materia Medica is the record of such pathogenetic symptoms produced on the provers.
16. Alternating symptoms
Alternating symptoms are those symptoms that appear and disappear alternatively in the patient. If one symptom is present, the other symptom will not be exhibited in that person. These symptoms help in understanding the true nature of the chronic disease. Example: i. Diarrhea alternates with headache ii. Rheumatism alternates with diarrhea.
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17. Rare symptoms
Those symptoms that appear only in highly sensitive and susceptible people during drug proving are called rare symptoms. These symptoms will have greater value and curative effect.
18. Generic symptoms (Generic=special)
Those symptoms which are very special to one group or genera of drugs are called Generic symptoms.
i. All Kali group drugs have a weakness as the generic symptoms
ii. All Ophidian groups have a hemorrhagic tendency as the generic symptom
19. Eliminating symptoms
Eliminating symptoms are those symptoms that exclude all medicines that are not needed for the patient and helps in individualizing the patient. Kent’s general symptoms of high rank are usually considered eliminative symptoms.
The general modality, an uncommon, peculiar symptom, which is most striking in the patient, can be used as the eliminating symptom. This is one of the repertorial processes. Dr.M.Tyler introduced these symptoms in the repertorisation.
20. Recent and old symptoms
Recent symptoms are those symptoms that have surfaced in a chronic case in a later part. They can be identified based on the time and progress of such symptoms in the chronic long-standing case. They are extremely helpful in remedy management.
Old symptoms are those symptoms that guide the physician at beginning of the case, in the selection of similimum. Most of the old symptoms are not easily ascertainable as they remain hidden and neither the physician nor the patient can understand their significance.
Old symptoms help the physician in understanding the original picture of the disease. They also help in constitutional prescription. The study of recent and old symptoms helps in understanding the prognosis of the disease.
21. Diagnostic symptoms
Those symptoms which help in diagnosing or naming the disease are called diagnostic symptoms. They are also called pathological ultimates, or common symptoms, they are not useful in homeopathic prescribing and selection of remedies.
22. Recurrent symptoms
Symptoms that return infrequent intervals are called Recurrent symptoms. These are indicative of the constitutional dyscrasias and also suggestive of the miasmatic background.
23. Periodical symptoms
Symptoms that return at a fixed and definitive interval are called Periodical symptoms. They are helpful in selecting the remedy.
24. Paradoxical symptoms
Symptoms that are self-contradictory and of opposite nature but always appear together are called Paradoxical symptoms. They are also called contradictory symptoms. Example: sleepy but cannot sleep, throat pain better by swallowing solid food, etc.
25. Accidental symptoms
Those symptoms are very clearly present in a patient but do not fit into the totality. They are present only by chance and do not help in forming the totality and it is always better to neglect such symptoms after thoroughly interrogating them.
26. Pathological generals
When any pathological feature is present in a patient, either two or more than two anatomical locations, it can be called as Pathological general. This symptom is very important for prescription according to Dr.Boger. Kent considers this symptom under physical general.
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