CLINICAL APPLICATION OF ANAMNESIS IN PRESCRIBING

Dr. Anju Jethani, M.D. (Hom.)

ABSTRACT: Anamnesis as a tool of case perceiving, based on recalling to memory of the past things, especially the painful, traumatic events and the effect of evolutionary past, served as beacon light of individualization in cases of pre-patellar bursitis and subclinical hypothyroidism. The remedies prescribed in LM potencies in both the cases on the basis of longitudinal case study showed marked clinical improvement. KEY WORDS: Anamnesis, Longitudinal case study, Pre-patellar bursitis, Subclinical Hypothyroidism, Hashimotos thyroiditis, LM potencies. INTRODUCTION: Anamnesis may be defined as medical or psychiatric history obtained from the patient, especially in the patients own words, based on the recollections of events preceding his or her own illness.1 In other words, it is an exposition of ones sickness from the recall to memory of the past occurrences and events. Thus, the essence of the concept of anamnesis is recollection or reminiscence - the faculty of memory.2 Anamnesis is actually a derivative form of Mnemosyne who was the Greek Goddess of memory. Mnemosyne was the daughter of Heaven and Earth (Uranus and Ge) and mother by Zeus of the nine muses of Greek mythology. It is believed that she was personification of memory but was not worshipped. 3 In homoeopathic parlance, anamnesis is also termed as Longitudinal Case Study. It is a mode of perceiving the evolution of presenting complaints and appreciating the effect of past in the development of present illness. Master Hahnemann underscored the importance of this concept of anamnesis or longitudinal case study in 5 of his Organon of Medicine wherein he stated that:

Useful to the physician in assisting him to cure are the particulars of the most probable exciting cause of the acute disease, as also the most significant points in the whole history of the chronic disease, to enable him to discover its fundamental cause,.4 Hahnemann further highlighted the significance of evolutionary case study in his article Medicine of Experience whereby he emphasized that: The internal essential nature of every malady, of every individual case of disease, as far as it is necessary for us to know it, for the purpose of curing it, expresses itself by the symptoms, as they present themselves to the investigation of the true observer in their whole extent, connexion and succession. 5 This paper underlines the usefulness of Hahnemannian concept of evolutionary case analysis through its application in clinical cases. CASE REPORT I: HOUSEMAIDS KNEE (PRE-PATELLAR BURSITIS) A 52 year old male reported with complaint of recurrent swelling of knee with pain and slight difficulty in movement (orthopedic specialist diagnosed it as Housemaids knee). The pain was worse with change of temperature and slightly better with hot fomentation. No significant precipitating factor could be elicited. He had been on allopathic treatment since 4 months with no substantial relief. Evolutionary case study revealed past history of pulmonary Koch for which he had taken due course of ATT. Further, anamnesis of case uncovered strong family history of Pulmonary Koch. On close interrogation, patient gave childhood history of recurrent spasmodic cough with occasional vomiting and redness of face. There were no further prescribing clue in this case. With this strong tubercular background, character of childhood cough and knee involvement, the drug Drosera came foremost to mind. Quoting from Dr. M.L. Tylers Homoeopathic Drug Picture in chapter DROSERA:

I began to realise what Drosera can do in tuberculous disease of bone, of joint and of gland, I was amazed and I started hunting homoeopathic literature for my warrant in so using itBut so far as bone and joints were concerned, I found my justification in black type in the provings of Hahnemann.. How many homoeopaths of our day read Hahnemanns Materia Medica Pura. But I may tell you that Hahnemann gives black type not only to laryngeal symptoms that have made Drosera famous among homoeopaths but he gives the same black type to jointsshafts of long bones and pains in limbs. 6 COURSE & FOLOW-UP: The patient was prescribed Drosera LM1/ twice daily followed by subsequent administration in upto LM5 potencies with marked relief in joint complaint.

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CASE REPORT II: SUBCLINICAL HYPOTHYROIDISM A 53 year old male patient complained of letharginess with feeling of malaise most of the times since 5-6 months. He suffered from hard stool with occasional bleeding per rectum in drops. He had pain in ankle joints off and on (diagnosed as subclinical hypothyroidism as TSH levels were 8.4, FT3/FT4 were within range). The most significant aspect of case

anamnesis was onset of complaint since history of indignation (his own brother had rebuked him on account of some business irresponsibility). He was scolded in front of his own children. Being of sensitive temperament, it hurt him a lot emotionally and since then, he always felt inner anger on seeing his brother. He had Family history of Hypothyroidism (?Hashimotos Thyroiditis). He was a Chilly patient, thirstless and preferred sleeping on right side. The history of indignation, his sensitive sheepish nature and concomitance of thirstlessness provided strong basis for the selection of Staphysagria as the similimum. COURSE & FOLLOW-UP: Patient was prescribed STAPHYSAGRIA LM1/ OD and continued upto LM6 and consequently was symptomatically much better and his thyroid parameters showed remarkable improvement.

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POST TREATMENT CONCLUSION: The forementioned case studies establish the importance of past history, as revealed through anamnesis, in the proper perceiving of the patient as an individual. In both the cases, evolutionary study of the patient could provide rational basis which led to selection of similimum, which was administered in LM potency with significant clinical improvement. ACKNOWLEDGEMENT: Prof. (Dr.) L.M. Khan, Head of Dept. of Organon of Medicine, Homoeopathic philosophy and Psychology, National Institute of Homoeopathy, Kolkata for giving clinical insight into the bedside application of concept of anamnesis. REFERENCES:

1. Encarta World English Dictionary, Macmillan India Pvt. Ltd. 2. Oxford English Dictionary, 2nd edition, Vol. 1, Claredon Press, Oxford, 412. 3. Benet, William Rose. The Readers Encyclopedia, 3rd edition, A & C Black Publications, London, 344. 4. Hahnemann, Samuel. Organon of Medicine, Translated from 5th edition with an appendix by R.E. Dudgeon; with Additions & Alterations as per Sixth edition translated by William Boericke, B. Jain Publishers Pvt. Ltd., New Delhi. 5. Hahnemann, Samuel. The Lesser Writings of Samuel Hahnemann, Compiled by R.E. Dudgeon, Indian Books & Periodical Publishers, New Delhi. 6. Tyler, M.L. Homoeopathic Drug Picture. B. Jain Publishers Pvt. Ltd., New Delhi.

About the author: Dr. Anju Jethani is Senior Medical Officer (H) working at Medical Center, High Court of Delhi & also working as Reader in the Dept. of Organon of Medicine, NHMC & Hospital, Govt. of NCT of Delhi.