In interview with Dr.Rajesh Shah : Part II
For part-I of the interview, click here..
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Dr.Rajesh Shah Seminar in UK, USA, India
Q : How often do you change remedy in your practice? Whenever
you do change the remedy, does it not mess up the action of the
previous remedy especially in cases with an acute flare up during
chronic treatment ?
A : While treating the deep seated, chronic disease, once the
remedy is well-selected and administered, it does not require a
change for a long time. The higher potency may be required at a
later date.
The change of remedy is required in three main incidences: One,
if the remedy does not produce any effect, even after
administering a higher potency, it needs a change of remedy
simply because it is not indicated.
Two, the first remedy has done its job using one or more potency,
leading to a change of symptoms and calling for another remedy.
Third, if the patient is confronted with an acute ailment during
the treatment of a chronic disease, he would require the
indicated remedy to combat the acute disturbance.
Whilst treating the acute disease, one may be required to change
the remedy frequently. This is because of the pace of the
disease, the symptoms change and hence the remedy. For instance,
the treatment of Pneumonitis may require, Arsenicum in the early
phase and then may later call for Phosphorus.
There should be a reason for every change of remedy. At the same
time, one should not rigidly stick to the same remedy when it's
no longer indicated. An indicated change of remedy cannot mess up
the case.
Needless to say that no two remedies are ever indicated at the
same time.
Q: How much importance do you give to the miasms? Do you
regularly 'un-block' cases ?
A : Miasms are quite important. They give you an idea about the
depth of the illness, they give an indication about the nature of
the remedy required. It helps you distinguish from superficial
remedy to a more appropriate deep acting remedy. For example, if
you are confronted with a case of lung cancer and the patient has
the typical fears of Aconite. If you give Aconite, it may
help but superficially. There is nothing wrong with it, but you
should be aware that the patient will later need a deeper acting
remedy, maybe Calcarea or Thuja
It was Hahnemann, as you know, who on witnessing frequent
relapses after initial improvement with indicated remedies such
as Belladonna, Pulsatilla and Hepar sulphuricum, came to the
conclusion that many of his cases required a deeper
'miasmatic' remedy for more lasting recovery.
I do not use nosodes to routinely unblock cases. But I have
observed that they are often indicated in many
chronic diseases. In many cases, a dose of the corresponding
nosode, administered at some time during the course of treatment
is part of the constitutional prescribing strategy. Although,
there are plenty of cases which do not require a nosode
throughout the course of treatment.
However, the nosodes can be successfully prescribed as individual
remedies. For instance, we have numerous cases of Tuberculinum,
Carcinosin, Thyroidinum and so forth.
Q : Do you use organ remedies, mother tinctures, bio-chemic
remedies in your practice?
A : I have no experience with organ remedies and mother
tinctures. I feel, it is a crude form of homoeopathy. I may be
wrong...I do not use bio-chemic remedies.
Q: Do you usually go up through the scale of potencies or repeat
the same ?
A: Once the remedy has been selected, I, usually start with a
dose of 200c potency. Many cases may need a repetition at the end
of four to eight weeks. Some may need a higher potency after 2-3
months and even higher on a later date.
All cases are different, some may require just one dose of 200c
and absolutely nothing for over a year. Some may need a dose
every month for about 4-5 months and then a higher potency or
change to a connecting remedy. Some cases may require a
repetition of remedy, say twice a day every day for,as long as
six months ?! It all depends on the case. There are rules for
every step in classical prescribing. One just can not
haphazardly act as per the whims. There should be a logic in
every action. The posology is a methodical science.
Q: Could you tell us in brief about your approach to case
analysis on what you call 'hard-core prescribing ' ?
A : Well, hard-core prescribing, to put it in simple words, is
nothing but the prescription based on the solid, logical, non-
speculative and non-controversial totality of the case. It
should involve a sound method of analysis whereby most
prescribers could come to a similar remedy prescription and the
plan of treatment.
Homoeopathy, as we know, is an art. But, we should not forget
that the art is founded on scientific principles. It is not an
abstract art. In my opinion the homoeopathic principles and
their application should not be based on vague ideas but
rather on hard-core logic and facts.
Q : Do you think that there could be a method in
homoeopathy where all the prescribers could come to a single
remedy ? Is is really possible ?!
A : I think we must have a method whereby if not all, most
prescribers could come to a similar conclusion after the case
analysis. I understand that it is difficult, but I am sure it
is not impossible. What is more important is that it is
necessary to have some kind of standardization in case taking,
case analysis and the planning, without which our science can not
advance.
What happens in our field is that you attend the seminar with
the same teacher on the forth occasion but could not solve a
single case during the forth teaching encounter !
I am aware that the homoeopathy is quite individualistic.
However, I do not believe in escaping from the reality that many
of our methods fairly are un-standardized. This, I think, is
mainly
because we tend to prescribe largely on the variable data. We
need standardization which, in my opinion, is possible with
hard-core prescribing.
Q : Do you propose some specific method when you talk about such
hard-core prescribing ?
A : I think whichever method you choose to analyse your cases,
should have sound logic and a hard-core totality. You may
choose to go Kentian or may prescribe on the essence or using
the key-notes, or a combination of approaches, as the case may
demand.
Q : You are often talking and teaching about the concept of
Facets ? What is it exactly and is it not a new theorising ?!
A : The concept of Facets I talk about is something based on
logic. It is simply based on the drug proving. I assure you that
it is no new toy for theorising !
Q : What exactly do mean by the 'Facets of the remedy' ?
A : I believe that every remedy has multiple facets. It depends
on what we see in a patient at given time and how we compare that
with the remedy. I believe that it is possible to use every
polychrest more widely. We cannot restrict the applicability of
our remedies to any single idea, for instance, Pulsatilla for
timidity or Lycopodium for cowardice. Cowardice or timidity are
nothing but some prominent facets of the said remedies.
The facets is like a symptom-syndrome, like a group of
inter-related symptoms in a remedy and proven together, in the
same prover.
The concept of facets widens the application of our materia
medica. We have so many Pulsatilla cases which are not mild
or yielding but rough and rash.
Q : How do you decide or recognise the facets of remedies ?
A : Strictly from the drug proving. I do not believe in any
source other than the drug proving as far as basic remedy
appreciation is concerned.
Q : What about the clinical provings, i.e. symptoms cured after
giving a remedy which does theoretically cover those symptoms...
A : No! I do not believe in adding those symptoms to my
repertory which are cured after administering the remedy. This is
simply because, I expect the remedy to do a lot more than what it
has been known to prove in the drug proving And, whatever it can
remove as a similimum, cannot be presumed as what it can produce
as a symptom.
Q : Can you further explain 'the facets' with some example ?
A : Yes. As I told you, my understanding of the facets of any
remedy comes from the drug proving. The interesting thing is that
I try to see what kind of emotions have been produced together in
the same prover.
For example. You know that sadness is produced in over 400 drugs.
Similarly cowardice is produced in the drug provings of 80. If
you have a patient who has these two prominent two features i.e.
sadness and cowardice. What will you do ? You will probably
repertorise to see which are the common drugs producing these
symptoms, I will look at it in a slightly different manner.
My search will be for a remedy which has the capability to
produce cowardice and sadness,at the same time, in the same
prover...
Q : Is there any remedy like that...?
A : Yes, there is. It is Sulphur. Sulphur is probably the only
remedy in the entire materia medica which has produced these two
important mental attributes in the same prover. This is the facet
of Sulphur. Likewise Sulphur has some other facets. Most remedies
can be studied this way...
Q : Sounds interesting. How do you get this idea at the first
place to study the facets...
A: Frankly, I can not recall how it happened. It was around nine
years ago when it occurred to me, that it is important to see
which symptoms were being produced together in the drug proving.
Constant study of the drug proving and the repertory allowed me
to identify this unique concept which I have thereafter
repeatedly applied to check if it works. On applying it on
numerous cases,I could see it's application as well as the
limitations... Many medicines have been studied and evaluated
with this idea and it has helped me tremendously in my practice.
Q : Is it only the combination of the mentals, the emotions that
you look for or the physicals as well ?
A : It is not only the mentals. When you look into the source
books with the idea of such group of symptoms you will find
amazing things.
There was a case of hemorrhoids who has an irritable
temperament.
Even after a long study there was no clarity. You have
cases where you have a long history written before you but it
does not click ! In this case, we tried to search for possible
combinations. It was interesting to find that Nux vomica has
proved irritability in the prover where it also proved
hemorrhoids. And we could see Nux vomica covered the totality and
curing it.
With the facet idea, many less important symptoms also become
valuable guideline for prescribing, we have consistently
observed.
Q : Why do you think a combination of symptoms in the same
prover is more important than a compilation of symptoms in more
provers ?
A : Well, when you study the source books and the repertory, you
find a huge mass of data, enough to get lost in. Just
imagine,3000 plus symptoms of Sulphur, over 1100 symptoms of
Carbo vegetalis !
In practice, for a case with seven symptoms. Instead of
considering remedies, that have produced the seven in separate
provers, it's more logical to consider, the one remedy that has
produced three of the interrelated symptoms ,if not all seven at
the same time in the same prover. For example, a remedy capable
of producing mortification at the mind level, neuralgic pain in
the lower limb and a wart like growth on the skin in a single
prover is more important rather than the remedy which produces
mortification in one prover, warts in another, and the neuralgic
pain in the third.
Q : Which is the remedy...and did you have a case...
A : Yes, a couple of cases. It was Staphysagria...
Q: Does this concept of facets, always work in practice ?!
A : One should not hesitate to doubt any new ideas. In fact, one
must ! I too was skeptical about its efficacy in the beginning.
But now, I can say confidently that it aids greater understanding
of the remedies and in selecting the prescription. There are some
rules and criteria that one must follow. This concept facilitates
case-analysis and case-individualisation, whenever applicable.
Q : You have introduced another approach to case analysis, which
you call 'The Phenomenological Approach '. Can you give some
brief idea...
A : The Phenomenological approach per se is not new but it's
application in homoeopathy is original. The Phenomenon idea is an
extension of the Facet concept. It is the consecutive event of
symptoms in a patient being compared with the drug proving. The
drug proving is not just the conglomeration of dissociated
symptoms. If you closely examine, there are so many symptoms
occurring in a chain form. For instance, the Lycopodium proving
has sadness leading to anxiety, eventually leads to irritability.
Very basic symptoms but very important because they follow each
other in a definite sequence. This is what I understand by
phenomenon.
The study of phenomena reveals, the individual's characteristics
enabling us to perceive the true portrait of patient's
personality. The Phenomenon, I have observed, reflects the
intricate nature of the inner man in a decipherable manner. This
is important.
Our drug proving sources are full of such phenomena and it is
extremely interesting to study them and apply in practice. It has
opened up new avenues for me in practice.
I think this concept can best be illustrated with the help of
cases.
Q : How do you perceive such phenomena in the patients and in
the remedies ?
A : Whilst taking a case, you have to find how how does the
patient behave on experiencing a strong emotion. Many times
patients tell us quite spontaneously.
To identify the phenomenon in the materia medica, as I told you,
you have to go back to the drug proving and the repertory. You
will be amazed to find that our repertories have such phenomena
listed almost on every page !
Q : What is your experience with the newly proved drugs and new
drug proving ?
A : I am somewhat conservative with regards new provings.
Although, it would be good idea to have new entries in our
materia medica. In my opinion, we have enough remedies, over
3000 already ! I prefer to handle my cases with a couple of
hundred remedies, which have a well described proving and well
proved efficacy. I am unhappy about learning, teaching and
proving new remedies which can not be made available in the
pharmacy for the use of the homoeopathic community at large. My
proposal is to re-prove some of the century old polychrests in
the modern light. Sometimes, I wonder, are we using the same
Tuberculinum which was proved in 1878, and is the source of that
Tuberculinum the same as one made today ?
Q : Can you share with us some of your successful cases...
A : I would rather talk about the failures in practice of
which which are plenty ! The nature of homoeopathy, gives every
homoeopath, irrespective of their background, his share of
failures. And at times, one has terrible failures. You prescribe
a remedy for acute hyperpyrexia or a small patch of vitiligo, and
nothing happens.
I tell you that every failure in practice is an opportunity for
introspection, offering an opening to learn, to find out where
you went wrong. I call failures ego breakers, They keep you on
your toes. As there is a system of having a death-conference in
hospital practice, we homoeopaths should have a kind of failure
conference...
For part-I of the interview, click here..
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