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Aphorism case taking

1) Case taking is an art that involves conversation, observation, and collecting information from the patient and others to understand the patient and their disease. 2) Hahnemann provides detailed guidance on case taking for acute vs chronic diseases, diseases from other physicians, difficulties assessing chronic diseases, and recording information. 3) Key aspects of case taking include not leading the patient, understanding lifestyle factors, assessing specific symptoms, and accurately documenting the patient's description of their condition in their own words.

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CASE TAKING - § 83 -104 Dr Aiswarya M.S P.G PAEDIATRICS
Case taking By Master Samuel Hahnemann
Case taking is a unique art of getting into conversation, observation and collecting information from patient, as well as from bystanders to define the patient as a person and the disease.
§83-90 : general instructions §91-93 : patients coming from other physicians. §94-98 : difficulties in chronic case taking. §99: acute case taking. §100- 102 : epidemic and sporadic diseases. §103 : chronic miasmatic maladies. §104 : record keeping.
§ 81-why do we get sick? • congenital • Acquired(aphorisms 74,75,76,77) • Life itself(81 footnote)-climate, physical character of the place, physical and mental training of youth. • Diet and regimen. • passions, manners, habits and customs.
Genetic predisposition Secondary symptoms of psora(acquired) due to lifestyle or allopathic medicines. Acute or Chronic diseases Incurable allopathic treatment chronic incurable and Genetic disease.
§82-Individualisation • Strict personal care by careful casetaking is must. • Acute -chief symptoms, less time, fresh in memory. • Chronic –more time.
§ 83- Demands of the physician • freedom from prejudice • sound senses • attention in observing • fidelity in tracing the picture of the disease.
§ 84 • He writes down accurately all that the patient and his friends have told him in the very expressions used by them. • The physician sees, hears, and remarks by his senses what there is of an altered or unusual character about patient. Fn :Every interruption breaks the train of thoughts.
§ 85 He begins a fresh line with every new circumstance mentioned by the patient or his friends § 86 When the narrators have finished what they would say of their own accord, the physician then reverts to each particular symptom and elicits more precise information
§ 87 ✓Should not ask YES or NO question ✓Should not ask any leading question that itself suggest an answer Fn – tend to seduce patient to give a false answer.
§ 88 The physician asks- functions of the body and the state of his disposition or mind. Fn 88, master advices to note the character of stool, urine, sleep, state of his disposition, his humour, memory, thirst, taste, food and drinks, unusual taste, anything about head, limbs or abdomen .
§ 89 The physician asks- more precise, more special questions. Fn 6th edition of 89, master advices to note the character of menstruation and other discharges etc.
§ 90 • Physician has to note down his own observations about the individual peculiarity of the patient in disease and health. Fn eg –behavior of patient, speech, colour of face and eyes, skin, degree of liveliness, nature of tongue, breathing, smell from mouth, hearing, character of pulse, condition on abdomen, position of sleep.
Patient comes from other physician • 91-chronic cases……….what to do? Stop medications to get uncontaminated symptoms and furnish pure picture of the disease. Give placebo. • 92- acute cases……….. what to do? Just form an apprehension of the complete picture of disease and prescribe as you cannot wait/delay.
• Treat and save life. • Medicinal disease with severe side effects by use of inappropriate drugs. • Severe acute diseases. • Conjoint malady
• 93-obvious cause……chronic/acute …..what to do? How to get private H/O from relatives/ friends. •Psychiatric cases. •Pediatric cases. •Comatose/ICU cases 93 fn: Any causes of disgraceful character - by skillful framing of questions or by private information.
Fn 93 93 fn: major disappointing events, attempting suicide, unnatural debauchery, family worry, grief, injured pride, masturbation, infection with venereal diseases, extra marital affairs, unfortunate love, jealousy, sexual perversions, superstitious fear, hunger, imperfection in private parts .
§ 94 -maintaining causes While inquiring into the state of chronic diseases, the particular circumstances of the patient with regard to his occupations, his usual mode of living and diet, his domestic situation, and so forth, must be well considered.
§ 94 fn Female case taking- 7 points •Pregnancy • sterility • sexual desire • miscarriages • suckling •state of menstrual discharge • leucorrhoea
§ 95 How to underline or give intensity to the symptoms of patient? •PREGNET WITH MEANING!! •CREATE A TIMELINE IF A CLEAR TOTALITY IS NOT AVAILABLE in chronic disease. •Difficult to get PQRS or accessory symptom in case of chronic disease, because of •Patient has FORGOTTEN in suffering. •MODIFIED due to treatment. •Symptoms have become their part of life.
§ 95 About lesser accessory symptoms. Symptoms which are often pregnant with meaning, very useful in determining the choice of remedy and regard them as most necessary part of their condition, the real feeling of which they have well forgotten and can scarcely believe that these greater or lesser deviations from healthy state, can have any connection with their principal malady.
§ 96 hypochondriacs and other persons of great sensitiveness and impatient of suffering. FN : physician gives placebo but we must deduct something from their exaggeration, the strong character of their expressions to their excessive sensibility.
§ 97 • partly from indolence, partly from false modesty, partly from a kind of mildness of disposition or weakness of mind, refrain from mentioning their symptoms. • Open patient • Closed patient • Intellectual patient. • Ask Leading questions
§ 98 QUALTIES OF HOMOEOPATH IN CHRONIC CASE TAKING • As certainly as we should listen particularly to the patient's description of his sufferings and sensations, and attach credence especially to his own expressions wherewith he endeavors to make us understand his ailments - because in the mouths of his friends and attendants they are usually altered and erroneously stated.
§ 99 • Investigation of acute diseases is much the easiest for the physician. • All phenomena and deviations are fresh in the memory of patient.
§ 100-102 • epidemic disease • In investigating totality of symptoms of epidemic and sporadic disease it is quite immaterial whether or not some thing similar has ever happened in the world before under the same or other names. • Totality of its signs and symptoms collected by close observation of several cases.
§ 103 •Whole array of symptoms belonging to such a miasmatic , chronic disease and especially to psora can only be ascertained from the observation of very many single patients affected with such a chronic disease and without a complete survey and collective picture of these symptoms the medicine cannot be discovered.
§ 104 • When the totality of the symptoms that specially mark and distinguish the case of disease or, in other words, when the picture of the disease, whatever be its kind, is once accurately sketched, the most difficult part of the task is accomplished. The physician has then the picture of the disease