Homoeopathic Management of Anxiety Disorders With the Help o

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HOMOEOPATHIC MANAGEMENT OF ANXIETY DISORDERS WITH THE HELP OF REPERTORIES A Dissertation submitted to the BABA FARID UNIVERSITY OF HEALTH SCIENCES, FARIDKOT, PUNJAB. In partial fulfillment of regulations for the award of Degree Of

DOCTOR OF MEDICINE (HOM.) In HOMOEOPATHIC REPERTORY

Submitted by

DUSHYANT KAMAL DHARI M.D.(HOM.) EXT. STUDENT SESSION 2004-2006

Under the able guidance of Dr. V.C. ACHARYA M.D (Homoeo.) SRI GURUNANAK DEV HOMOEOPATHIC MEDICAL

COLLEGE & HOSPITAL,

CANAL ROAD, BAREWAL, LUDHIANA. (PUNJAB)

Declaration

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I,

Dushyant

Kamal

Dhari,

student

of

MD

(HOM)

in

Homoeopathic Repertory of Sri Guru Nanak Dev Homoeopathic Medical College and Hospital, Canal road, Barewal, Ludhiana affiliated to Baba Farid University of Health Sciences, Faridkot hereby declare that the dissertation entitled “ Homoeopathic Management of Anxiety Disorders with the help of Repertories” submitted by me is not submitted fully or partially, for the award of any other Degree or Diploma in this or any other University by me or copied from any other dissertation work.

I make this statement with the best of my knowledge and ability.

Date: Place: Jammu.

Dushyant Kamal Dhari A student of M.D. (HOM)

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ACKNOWLEDGEMENT It gives me immense pleasure to offer my thanks with gratitude to the following dignitaries who have provided valuable guidance and support, without which this stupendous task would not have come to its proper conclusion. In the first place, my special thanks are due to my revered and honorable guide Dr. V.C. Acharya for his sincere and constant guidance, sharp perceptual scientific suggestions, encouragement and important modifications of my efforts, which enabled me to accomplish this work. Without his supervision and close guidance this work would not have completed. I am indebted to him. I would like to offer thanks full of obligations to Dr. Tejinder pal Singh, Director and Dr. S.C. Chambyal, Principal SGND Homoeopathic Medical college and Hospital, Ludhiana for their special guidance. My thanks are also due to the management, Coordinator and the college staff for their gracious cooperation and facilities in college. Thanks with gratitude from the core of my heart are due to my dear parents and friends for providing me all kinds of support. My special thanks are due to my dearest wife Dr. Ranjana Gupta for her moral support & inspiration this degree. She was a valuable support in my good and bad times. I am grateful to little master Ojas, my only son, who was very co-operative with me during my P.G. Course. A work of this level could not have been completed without the blessings from God.

Date Place: Jammu

Dushyant Kamal Dhari.

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INDEX TOPICS

PAGES

INTRODUCTION

1-3

AIMS AND OBJECTIVES

4-4

REVIEW OF LITERATURE History & evolution of mental disorders Anxiety general

5 - 148 5-6 7 - 12

Physiology of anxiety

13 - 22

Psychodynamic theories of anxiety

23 - 29

Behavioural & Cognitive theories of anxiety

30 - 32

Anxiety in modern medicine Gen

32 - 33

Panic disorder

34 - 37

Phobic disorders

37 - 39

Obsessive compulsive disorders

39 - 41

Generalised Anxiety disorder

41 - 43

Post traumatic stress disorder

43 - 45

Co-morbid depression

45 - 46

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Anxiety disorders in Homoeopathy

46 - 68

Anxiety in repertory general

68 - 73

Kent’s repertory

74 - 77

Anxiety rubrics in Kent’s repertory

77 - 109

Boenninghausen`s repertory

109 - 114

Anxiety rubrics in BBCR

114 - 130

Anxiety rubrics in other repertories

130 - 148

MATERIALS AND METHODS

149 - 161

CASES

162 - 202

DATA ANALYSIS

203 - 208

DISCUSSION

209 - 211

CONCLUSIONS

212 - 212

BIBILIOGRAPHY

213 - 215

APPENDIX

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INTRODUCTION Anxiety has been derived from french word ‘anxieté’. It means ‘the state of feeling nervous or worried that something bad is going to happen.’ The Oxford handbook of psychiatry defines anxiety as “A normal and adaptive response to stress and danger which is pathological if prolonged, severe or out of keeping with the real threat of the external situation. It has two components: psychic anxiety, which is an affect, characterised

by

increased

arousal,

apprehension,

sense

of

vulnerability and unpleasant emotional state; and somatic anxiety, in which there are bodily sensations of palpitations, sweating, dyspnoea, pallor and abdominal discomfort.” Anxiety is the most common psychiatric symptom in clinical practice and anxiety disorders are the commonest disorders found in 15 to 20 percent of patients. These are more common in industrially advanced countries. Anxiety disorders have harmful effects upon physical and mental health. They also impair functional ability and quality of life. The causes of anxiety in modern life are uncertainty, insecurity, time pressures, relationship problems and fears of inadequacy.

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HOLISTIC APPROACH The modern medicine lacks a holistic approach in its treatment for the anxiety disorders. In spite of various advances, the medicines for anxiety in modern medicine are not curative in nature. A risk of dependency is also associated with them. The mind and body work harmoniously in health and in disease. Both of them are considered as a unit in the treatment of diseases. Homoeopathy is a holistic science and has a psychosomatic approach in all diseases. This holistic approach of Homoeopathy gives it an edge in the treatment of affections of the mind. In the Organon of medicine, mental diseases are classified and their treatment is described in detail from aphorism 210 to aphorism 230. Hahnemann was the first to advocate unchaining of the mental patients. He also wrote in detail about the psychotherapy for such patients.

The study of anxiety through homoeopathic perspective No one can deny the role of emotions as causative modalities in the origin and maintenance of innumerable diseases. The provings on healthy human beings has yielded all kinds of emotions that are recorded in materia medica. Anxiety falls in the emotional sphere of mind. In homoeopathy, the symptoms of emotional sphere are of great importance. While evaluating the symptoms, they are considered after the “will” symptoms for the selection of remedy.

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Repertory, as an index to the vast materia medica, helps to narrow down to the similimum more accurately. Thus, the importance of the “emotional” symptoms in homoeopathy and the abundance of “anxiety” patients prompted me to take up “anxiety disorders” as a topic for my dissertation.

In this attempt of mine, I want to highlight the role of repertories in particular in the management of anxiety disorders. This study on anxiety disorders will enlighten me in upgrading my knowledge in the subjects of materia medica, repertory, clinical medicine and overall management of anxiety cases.

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AIMS and OBJECTIVES 1. To understand anxiety in detail. 2. To manage anxiety with the help of Repertory.

3. To prove the utility of Repertory in the management of anxiety.

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History and evolution of mental disorders Ancient world – Era of superstitions In ancient times, mental patients were considered to be in possession of evil spirits. The treatment for possession was exorcism, or the removal of evil through counter-magic. These practices still prevail in many parts of the world including India and western countries.

India Atharva-veda has the oldest written documentation about mental disorders. It describes three mental gunas i.e. Sattva, Rajas & Tamas. Different psychological disorders are believed to occur due to excess of Tamas guna. Detailed description & treatment of various disorders such as Manastap (anxiety), Bhaya (fear), etc. are found in it. Bhagavad-Gita is probably the first recorded evidence of crisis intervention psychotherapy.

Greece In ancient Greece (800 B.C), abnormal behaviour was intercepted as punishment for offences against gods. The treatment took place in temples of Asclepius, the God of healing. Hippocrates (460 - 377 B.C.) stressed that mental disorders were caused by brain dysfunction. He described epilepsy and concluded that it was due to diseased brain.

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Plato (427 - 347 B.C) saw behaviour as a product of totality of psychological processes. He believed that disturbed behaviour grew out of conflicts between emotion and reason. Galen (130 - 200 A.D.), a Greek physician, taught that psychological characteristics were expressions of bodily processes influenced by a balance of the four humors - blood, black bile, yellow bile & phlegm.

The Middle ages During the middle age, contrasting views of mental illness existed. Saint Augustine (354 - 430 A.D), laid the basis for modern psychodynamic theories of abnormal behaviour. He wrote about feelings, mental anguish and human conflict.

The Renaissance Johann Weyer (1525 - 1588), a German physician, emphasised psychological conflicts and disturbed interpersonal relationships as causes of mental disorders. He argued for clinical treatment for the mentally ill rather than religious harassment. William Cullen coined the term ‘neurosis’ in 1777 replacing, ‘illness of nerves’ and meaning any disease of the nervous system without a known organic basis. Sigmund Freud (1856 - 1939) propounded that psychological factors played an important role in the causation of mental disorders. He also highlighted the role of social and cultural factors in causing mental disorders.

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ANXIETY IN GENERAL Anxiety Anxiety is a common emotion and often a normal response to new, stressful, or potentially dangerous situations. In its mild forms, it may be adaptive. It helps one to perform better. A little anxiety, for example helps a student to prepare for his exams. In its extreme forms, it is incapacitating or terrifying. It may cause the same student to lose his concentration, or even his voice. Anxiety becomes a problem only when it is abnormally severe, abnormally prolonged, or if it is present at a level out of proportion to the real threat of the situation. Anxiety often arises in anticipation of danger rather than after a situation has occurred. It is a signal of the approach of danger and a warning to prepare our defenses. It can also indicate an inability to cope with danger. Anxiety is an extremely unpleasant feeling – it can make people feel frightened, uneasy, unhappy and sometimes desperate. Anxiety symptoms vary widely and may even imitate severe physical or mental illness. These symptoms may affect on physical level, thoughts and emotions and the lifestyle of the individual affected.

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The Physical Symptoms of Anxiety Anxiety may present on physical level as:  Breathing difficulties.  Feeling faint / dizzy.  Dry mouth.  Shakiness.

 Pounding heart.

 Muscle aches & pains.

 Headaches.

 Excessive sweating.  ‘Lumps’ in throat.

 Bowel and urinary problems.  Persistent tiredness

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In addition to these, body postures such as crossed arms, crossed legs, clenched fists, clenched jaw with tight facial muscles, head bent, rapid and shallow breathing, frowning / staring expression, and stooped posture also present a picture of anxiety.

Anxiety Posture

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On the mental level:  Fear of variety of things, people or situations.  Negative or unreasonable ideas about themselves or the feared situation.  Increased episodes of crying, being irritable, difficult concentration, worrying and feeling guilty.

Two main reasons for persistent anxiety are avoidance of feared situations and faulty thinking. Avoidance: We may avoid situations which we know will cause us anxiety.

As the symptoms caused in a particular situation are

uncomfortable, we avoid facing it, but each time we avoid a situation, its tendency to cause anxiety in us increases. Faulty thinking: It includes our negative thoughts and irrational beliefs. The negative thoughts make us expect the worst, while the

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irrational beliefs, make us expect too much from others or ourselves. So that leaves us prone to constant disappointment.

The Anxiety trap The lifestyle may be seriously affected by a tendency to avoid situations or escaping them wherever possible. This involves a lots of ‘NOTS’ and ‘CANT’S’ which make a happy and fulfilled existence

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impossible and leads to a poor quality of life. It also affects relationships and work performances.

FIGHT \ FLIGHT RESPONSE

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PHYSIOLOGY OF ANXIETY Historical Development Descartes saw the mind & body as different units and noticed the direct effect of emotions on the body reactions. He proposed that pineal body was the main mediating centre between the body and the soul. The Cannon-Baird theory named thalamus as the centre initiating emotional reactions. It was held responsible for receiving sensory information. It also communicated with cortex & body organs to bring about behavioural changes. Cannon also described the characteristic ‘fight / flight’ stress reaction and the role of sympathetic nervous system in it. The modern basis of emotional expression in the biology of the brain began with the work of the American neuroanatomist James Papez. Papez described an "ensemble of structures" in the lower, subcortical areas of the brain (as the hypothalamus, the hippocampus and the amygdala) or the

limbic system as brain sites associated with

emotion. He emphasized the role of hypothalamus rather than thalamus as control centre in initiating emotional response. Recent evidence highlights the role of genetic influences in the causation of anxiety disorders. Studies have shown that the prevalence of anxiety and related disorders is higher among the relatives of affected subjects than among control families.

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THE BRAIN AND ANXIETY Recent studies suggest that three brain sites are responsible for regulating anxiety, i.e. prefrontal area of cortex, amygdala and hypothalamus in sub cortex. ▪ The higher brain or cortex is responsible for: Identifying and interpreting stressors and Initiating / coordinating the voluntary action. ▪ The lower brain or sub cortex is responsible for: Beginning and controlling states of physiological excitement and for involuntary homeostatic functions.

When exposed to stress, following processes happen:

▪The cortex first perceives the stressor. ▪The prefrontal cortex is involved in the cognitive evaluation of the stressor. ▪The subcortical structures are then called into play. ▪The amygdala is responsible for generating the fear response. ▪The hypothalamus regulates the stress response and activates the autonomic and the endocrine systems. It mediates between these two systems and is involved with limbic cortex in regulating emotions.

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A cross section of brain. The Amygdala The amygdala is believed to serve as a communication hub between the parts of the brain that process incoming sensory signal and the parts that interpret them. It signals that a threat is present and triggers a fear response or anxiety. Hippocampus Hippocampus is another brain structure that is responsible for processing threatening or traumatic stimuli. The hippocampus plays a key role in the brain by helping to encode information into memories.

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Studies have shown that the hippocampus appears to be smaller in people who have undergone severe stress because of child abuse or military combat. This reduced size could help explain why individuals with PTSD have flashbacks, deficit in clear memory, and fragmented memory for details of the traumatic event.

The Hypothalamus The hypothalamus helps the body in controlling body temperature. It also contains centres involved with hunger and pleasure. Its main function during stress is to activate and regulate the autonomic and endocrine systems. The

hypothalamus,

on

stimulation

produces

emotional

and

behavioural responses, both autonomic and skeletal. Three main reactions have been observed on experimental stimulation of hypothalamus. They are Alarm, Flight and Rage.

The two lobes of hypothalamus are concerned with the regulation of arousal. The anterolateral lobe inhibits sympathetic nervous system activity and the release of activating hormones from the pituitary. The posteromedial lobe has the opposite effect. It has direct links with the pituitary gland, the limbic structures, the cortex and the thalamus. Neural pathways from hypothalamus also link it to the brainstem and the spinal cord.

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The Autonomic nervous system and anxiety It has an important part in instigation and maintenance of appropriate levels of physiological arousal. It has two main branches – Sympathetic nervous system (SNS). It is responsible for the ‘stress’ response. During ‘stress’ states, the SNS prepares the individual for ‘fight or flight’ response. The flow of blood from digestive organs is directed to the fighting muscles and the heart rate increases. Parasympathetic nervous system (PNS). It is responsible for ‘relaxation’ response. During ‘relaxed’ states, the PNS prepares the individual for digestion, recuperation and sleep. The two branches of ANS work partly in concert. While most organs are under control of both, some sites & symptoms are under the sole control of SNS, i.e. the sweat glands, lung muscles, blood glucose levels and the basal metabolic rate. Others, such as the ciliary muscles of the eye, are under exclusive control of PNS. Individual responses and ANS While the SNS is usually predominant during stress, some individuals may respond to stressors with PNS dominance. It causes a fall in blood pressure and blood glucose levels. Other symptoms may be cold sweating, dizziness, reduced respiratory action and fainting. Lacey proposed that persons do not respond with simple PNS or SNS dominance under stress. It suggested that individuals might react strongly on one physiological measure and very little on another.

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The nature of reaction profile might be determined by the total life experience of the individual as well as genetically determined physiological factors. Several studies on physiological arousal patterns in anxiety neurosis have demonstrated consistent sympathetic hyperactivity. Anxiety disorders have been correlated with a pattern of raised heart rate levels, frontalis muscle tension, forearm blood flow, skin conductance, respiration rates and blood pressure. Each individual has a base line norm of autonomic arousal, or starting point. It has been shown that a high baseline norm will lead to a smaller reaction under stress while a low baseline norm will lead to a larger reaction. The Endocrine system and Anxiety This system has an important role in total stress response. During stress, the ‘master gland’ pituitary is stimulated by hypothalamus to release several chemical messengers to the slave glands directly into bloodstream. These include vasopressin, adrenocorticotrophic hormone (ACTH) and thyrotrophic hormone (TTH). Vasopressin contracts the arteries and causes the blood pressure to rise. ACTH and TTH pass on to adrenal and thyroid glands. They work together to increase circulation and basal metabolic rates.

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The Adrenal glands Adrenalin & noradrenalin from medulla and corticoids from cortex are directly released into blood stream. Adrenalin stimulates the production of glucose from glycogen in liver. The glucose is released in blood increasing the carbohydrate metabolism. It also dilates coronary and skeletal muscle arteries, increases heart rate, blood volume and body temperature. Gaseous exchange is facilitated by bronchial dilatation and shallow breathing results. Smooth (visceral) muscles tend to relax while the sphincters are constricted. Noradrenalin constricts the peripheral arterioles and increases blood pressure. It has been suggested that adrenalin is the major hormone in states of fear while noradrenalin is predominant in anger. Glucocorticoids from cortex tend to raise blood sugar levels and inhibit inflammation. Thyroid gland Thyrotrophic hormone acts on thyroid causing release of thyroxine. The rise of thyroxine in stress conditions causes increased sweating, muscle tremor, heart rate and exaggerated breathing. These effects are similar to adrenalin. Adrenalin tends to predominate in short term stress while thyroxine is released in large quantities in prolonged stress.

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General Adaptation Syndrome Selye used the term ‘stress’ instead of ‘strain’ in its relation to human psychophysiology. He coined the term ‘general adaptation syndrome’ or GAS. GAS has three phases:  Alarm reaction (involving shock and counter shock phases).  Resistance (adaptive response).  Exhaustion. The Alarm phase: In this phase, mobilization takes place following the detection of a stressor. The stressor can either be psychological or physiological in nature. Increase in adrenocortical hormones also takes place in this phase. The Resistance phase: It involves selection of an appropriate organ or system to deal with the particular stressor. Adrenocortical hormones diminish once a specific system is delegated. All the internal resources are then directed towards the support of this system, leaving others susceptible. This may reduce the resistance of the organism to disease. The Exhaustion phase: When the system assigned the job becomes overloaded, the exhaustion phase is reached. At this point, the adrenocortical hormone levels increase again and the alarm phase is induced again. A different system may then be delegated to handle the continuing stress.

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The GAS is useful in mobilising protective resources in emergency situations. In prolonged situations, it may lower resistance. The energy for adaptive reaction to stress is provided by suppressing immune reactions and inflammatory responses to invading pathogens. It is suggested that the ‘weakest link’ or most vulnerable part of the body breaks down first under stress. Therefore, factors including heredity and prior disease may predispose an organism towards a specific somatic disorder. Allergies may also be associated with stress. Allergic reactions involve high levels of inflammatory corticoids for destruction of pathogens. Under stressful conditions the allergic response may be aggravated. Selye based his conclusions on experimental work in which rats were subjected to prolonged stress. It resulted in drastic body changes including irreversible organ damage. The rats showed enlargement of adrenal cortex and atrophy of thymus, spleen and lymph nodes. A severe reduction of white cells and bleeding ulcers in stomach and duodenum were observed. According to Selye, ACTH plays an important role in GAS. In acute stress, adrenalin and noradrenalin from the adrenal medulla are most important. In chronic stress the corticoids are the primary agents. The kidney also plays an important role in GAS, as it is responsible for maintaining a chemical and water balance in the blood and tissues.

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In chronic stress conditions, when corticoids are raised for a prolonged period, blood pressure may rise and damage the kidney. Damage to arteries associated with atherosclerosis may also occur. Continued stress can produce increased hydrochloride acid secretion in stomach leading to formation of ulcers. Selye also added some suggestions on ways of dealing with stress as:  Removal of unnecessary stressors from lifestyle.  Do not allow neutral events to become stressors.  Develop skill in dealing with stressors.  Seek relaxation. Neurotransmitters and anxiety The nerve cells communicate with one another with the help of neurotransmitters. Some of these play a significant role in anxiety and other psychiatric disorders. Examples of these are noradrenalin, adrenalin, serotonin, GABA, dopamine, acetylcholine and histamine. The dysfunction of neurotransmitter activity is the cause of the most psychiatric disorders. The excessive activity may lead to anxiety and psychosis while under activity may cause depression. Recent developments support the view that noradrenalin and serotonin have a central role in mechanisms underlying anxiety in the central nervous system.

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PSYCHODYNAMIC THEORIES OF ANXIETY Sigmund Freud is the forerunner of this school of thought. He defined anxiety as: “a specific state of unpleasure accompanied by motor discharge along definite pathways.” Freud postulated that human anxiety is initiated during birth process, when an infant is expelled from the safe, warm uterine environment into a potentially dangerous one. This anxiety signal is reproduced in a modified form, whenever danger recurs, throughout the life. Defense mechanisms: According to this theory, anxiety is an indication that something is disturbing the internal psychological equilibrium. It is a signal to the ego that an unacceptable drive is pressing for conscious representation and discharge. This is called signal anxiety. This signal anxiety arouses the ego to take defensive action to cope up rationally against the pressures from within. These defenses serve as disguises through which people hide their motives and conflicts from themselves as well as from others. Defenses are used to reduce anxiety arising from ego’s fear of being completely overwhelmed or destroyed by the power of instincts. Thus the role of defenses is to preserve the psychological organization and stability of the individual. The most important & basic defense is Repression. Ideally, the use of repression alone should result in restoration of the psychological

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equilibrium. Repression reduces anxiety by keeping anxiety-laden thoughts and impulses out of person’s consciousness. It is often described as motivated forgetting. It is directed at both, external dangers, such as fear arousing events and internal dangers such as wishes, impulses and emotions that arouse guilt. If the defenses are successful, the anxiety is dispelled or safely contained.

When

repression

fails,

other

secondary

defense

mechanisms are called into play. These include denial, displacement, regression and others. Through these defense mechanisms the drives achieve a partial expression. This expression is disguised in the symptoms of hysteria, phobic disorder or obsessive-compulsive disorder depending on the defense that predominates. If repression fails to function adequately and secondary defense mechanisms are not called into play, anxiety is found only as a symptom. When it rises above the low intensity, characteristic of its function as a signal, it may emerge with the fury of a panic attack. Developmental stages Freud believed that people normally progress through the five stages of psychosexual development. Problems at any stage may retard or arrest development and have long term effect on the life of the person. Oral stage: This is observed during first year of life. The newborn is completely dependent on others for fulfillment of all his needs. During this stage,

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the body pleasure is centered on the mouth. The baby gets satisfaction from sucking, eating and biting in the course of feeding. Anal stage: It is found in the second year of life. It is characterised by a shift in body pleasure to the anus. It is reflected by concern with retention and expulsion of faeces. Freud felt that during this stage of toilet training, a child has the first experience with externally imposed control. The pattern of toilet training may influence the personal qualities and conflicts experienced by the person in his life. Thus, if a person is subjected to very harsh, repressive type of training during this period, it may make the person obsessed with cleanliness during the adult phase. Phallic stage: In this stage the child observes the differences between male and female and experiences what Freud called as Oedipus complex. This occurs at about five years of age. Freud proposed that children develop a desire for opposite sex parent and a wish to displace the same sex parent. This type of attraction leads to serious conflict, which he termed as Oedipus and Electra complex in boys and girls respectively. These two complexes were named after two Greek characters. Oedipus unknowingly killed his father and then married his mother and Electra induced her brother to kill their mother.

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Latency stage: This stage follows phallic stage and in this stage there is very little explicit or overt concern with sexuality. The child represses his or her memories of infantile sexuality and forbidden sexual activity. Genital stage: During this stage the person attains maturity in psychosexual development. The person becomes capable for genuine love for other people and can achieve adult sexual satisfaction. He or she may relate to others in a heterosexual fashion. The Structure of Personality It refers to a person’s unique and relatively stable qualities that characterise behaviour patterns across different situations and over a period of time. The personality consists of three dynamic structures i.e. Id, Ego and Superego. They are used as strong psychological forces and not physical locations in brain. Id: Desire: This part of personality deals with immediate gratification of primitive needs, sexual desires and aggressive impulses. It is totally unconscious and follows the pleasure principle. Thus, Id seeks the discharge of tension arising out of biological drives. Its main concern is ‘need gratification’ in any manner. An infant’s mind is conceived as all Id.

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Ego: Reason: It develops out of Id. It works on ‘reality principle’. It tries to maximise pleasure and minimise pain. The ego emerges in childhood and is the personality which moderates the desires of Id.

Freud’s concept of dynamic structures of personality. Super Ego: Conscience: It deals with the ideals. It represents the societal demands and ideals. If a person falls short of societal norms & ideals, then superego creates the feelings of guilt and punishes the person. It provides judgements on what behaviours are ‘acceptable’ and which are ‘bad’.

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Categories of anxiety Freud broke down his concept of anxiety into three types: Reality, Moral and Neurotic anxiety. All three are involved with the ego’s response to actual, or potential, helplessness when threatened with overwhelming psychic danger. The function of ego is of mediation between instinctual demands to ensure that some gratification is achieved, while still preserving its own integrity. If such an outcome becomes impossible, pathological anxiety results. The reality anxiety is due to real external threat. In this the ego’s aim is to expedite the gratification of instincts without making the organism vulnerable to anger, e.g. ‘I must have / do this, but I must avoid having physical harm in the process’. If the ego is uncertain how to achieve this aim, fear related anxiety results. The moral anxiety is due to id-superego conflict. In this the ego’s aim is to preserve its sense of its own goodness while at the same time placating the instincts, e.g. ‘If I am good and worthy, I cannot allow myself to have / do this’. Shame / guilt related anxiety results if ego fails to meet the moral demands of the superego. The neurotic anxiety is due to id- ego conflict. In this the ego’s aim is to protect its own identity and structure while an uncharacteristic and powerful instinctual drive threatens to overwhelm it, e.g. ‘I long to have / do this, but I cannot allow myself to perceive that I am the

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one who has/ does this’. Neurotic anxiety results when ego cannot satisfy these conflicting aims.

Freud writes that, “In some cases the characteristics of reality anxiety and neurotic anxiety are mingled. The danger is known and real but the anxiety in regard to it is over-great, greater than seems proper to us.”

While differentiating neurosis from psychosis, he says that for neurosis the decisive factor would be the predominance of the influence of reality, whereas for psychosis, a loss of reality would necessarily be present.

BEHAVIOURAL AND COGNITIVE THEORIES OF ANXIETY Behavioural theory John Watson, the father of behaviourism, proposed that neuroses arouse out of traumatic learning situations and then persist to influence behaviour throughout life. ‘Stimulus – response’ concept of anxiety, which emerged from this, posits that certain stimuli when associated with fear could show up an anxiety response. For e.g. if a dog bites a child, the child will respond with anxiety the next time he sees a dog. This response will occur

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even if the dog does not actually bite him again. Thus anxiety has a protective function here. This anxiety could become a reaction to a danger signal that was recognised to forebode a harmful situation. So, anxiety is viewed as an unconditioned inherent response of the organism to painful or dangerous stimuli. In anxiety and phobias, this becomes attached to relatively neutral stimuli by conditioning. Systematic desensitization: The principle of reciprocal inhibition (i.e. anxiety and relaxation cannot coexist) is the core of this. Systematic graded exposure to the source of anxiety is coupled with the use of relaxation techniques (the ‘desensitisation’ component). Flooding/implosive therapy: The high levels of anxiety cannot be maintained for long periods, and a process of ‘exhaustion’ occurs. By exposing the patient to the phobic object and preventing the usual escape or avoidance, there is extinction of the usual anxiety response. Anxiety and Cognitive performance The cognitive model of anxiety postulates that anxious individuals invariably exaggerate the level of threat in a given situation. So, there is evidence of selective information processing (with more attention paid to threat related information), negative automatic thoughts and perception of decreased control over internal and external stimuli. Cognitive behavioural modification or CBM developed from this approach helps in treatment of anxiety resulting from inadequate

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coping skills. It aims to ‘change the way you feel, by changing the way you think’. Anxiety and rational thinking Albert Ellis developed a treatment technique based on rational thinking in 1955. Several research studies have confirmed the relationship between anxiety and negative / irrational thinking. The RET (Rational emotive therapy) belief holds that individual’s own thoughts and beliefs about difficulties create negative emotions as anxiety. The individual’s reaction towards a situation is based on his set of beliefs and attitudes. So, the patients are taught to identify, challenge, and change their irrational beliefs which maintain and justify their anxiety. After all, anxiety, by definition is not attributable to sources of real danger and is as such irrational.

ANXIETY IN MODERN MEDICINE Anxiety, defined as a subjective sense of unease, dread, or foreboding, can indicate a primary psychiatric condition or can be a component of, or reaction to, a primary medical disease.

Anxiety has two components: ▪ Psychic anxiety – an unpleasant affect in which there is subjective tension, increased arousal and fearful apprehension; and

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▪ Somatic anxiety – bodily sensations of palpitations, sweating, dyspnoea, pallor and abdominal discomfort. The sensations of anxiety are related to autonomic arousal and cognitive appraisal of threat which are adaptive primitive survival reactions.

The primary anxiety disorders are classified according to their duration and course and the existence and nature of precipitants. The national prevalence rates of anxiety disorders in India are 15 per 1000 for rural and 16 per 1000 for the urban population. When evaluating the anxious patient, the clinician must first establish whether the anxiety antedates or postdates a medical illness or is due to a medication side effect. Anxiety symptoms may be present at a more or less constant level – generalized anxiety; or may occur only episodically – panic attacks.

Anxiety symptoms may or may not have an identifiable stimulus. Where a stimulus can be identified it may be very specific, as in simple phobia (e.g. fear of cats or spider); or may be more generalised, as in social phobia and agoraphobia. In phobias of all kinds there is avoidance of the feared situation. As this avoidance is followed by a reduction in unpleasant symptoms, it is reinforced and is liable to be repeated.

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The repetition of behaviours in order to achieve reduction in the experience of anxiety is also seen in the symptoms of obsessions and compulsions. Here, the patient regards the thoughts (obsessions) and/ or actions (compulsions) as purposeless, but is unable to resist thinking about them or carrying them out. Resistance to their performance produces rising anxiety levels, which are diminished by repeating the resisted behaviour.

PANIC DISORDER: ‘Panic’ derives its meaning from the Greek god ‘Pan’ who was in the habit of frightening humans and animals ‘out of the blue’. Panic attack: It is a period of intense fear characterized by a group of symptoms (given below) that develop rapidly, reach a peak intensity in about 10 minutes, and generally do not last longer than 20-30 min (rarely over 1 hr). Attacks may be either spontaneous (‘out of blue’) or situational (usually where attacks have occurred previously). Sometimes attacks may occur during sleep (nocturnal panic attacks), and rarely, physiological symptoms of anxiety may occur without psychological component (non-fearful panic attacks). Panic disorder: The recurrent panic attacks, which are not secondary to substance misuse, medical conditions, or another psychiatric condition. There are distinct episodes of intense fear and discomfort

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associated with a variety of physical symptoms. The frequency of occurrence may vary from many attacks a day, to only a few attacks a year. There is usually the persistent worry of having another attack or the consequences of attack (which may lead to phobic avoidance of places or situations) and significant behavioural changes related to attack. Epidemiology: In India the prevalence rate of panic disorder in psychiatry clinics is around 3 %. Panic disorder without agoraphobia is more or less equal among males and females, but panic disorder with agoraphobia is more among females. It develops in early adulthood, the mean age of onset being around 25 years.

Aetiology and Psychopathology: The exact etiology of panic disorder is unknown but appears to involve a genetic predisposition, altered autonomic responsivity, and social learning. Panic disorder has a moderate heritability of around 30 – 40 %. Most studies suggest that vulnerability is genetically determined, but critical stressors are required to develop clinical symptoms. Intravenous infusion of sodium lactate can evoke an attack in about two-thirds of the panic disorder patients, as do yohimbine and carbon dioxide inhalation.

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Neuroanatomical model of aetiology suggests that panic attacks are mediated by ‘fear network’ in brain that involves the amygdale, the hypothalamus and the brain stem centres. Psychoanalytic

model

suggests

that

panic

attacks

are

the

consequences of parental deprivation in early childhood. Clinical features: The diagnosis of panic disorder is based on the following criteria:A separate period of intense fear or discomfort in which four (or more) of the following symptoms are developed abruptly and reach the peak within 10 minutes (in order of frequency of occurrence): 1. Palpitations, pounding heart, or accelerated heart rate. 2. Sweating.

3. Trembling or shaking.

4. Sense of shortness of breath or smothering. 5. Feeling of choking.

6. Chest pain or discomfort

.7. Nausea or abdominal discomfort. 8. Feeling dizzy, unsteady, light-headed, or faint. 9. Derealisation (feelings of unreality) or depersonalization (being detached from oneself). 10. Fear of losing control or going crazy.

11. Fear of dying.

12. Paresthesia (numbness or tingling sensations). 13. Chills or hot flushes.

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In some individuals, anticipatory anxiety develops over time and results in a generalized fear and a progressive avoidance of places or situations in which a panic attack might recur. Researches suggest that individuals with panic disorder had a significantly higher rate of supporting gastrointestinal symptoms, including those typically associated with irritable bowel syndrome, than those with other or no psychiatric diagnosis. Differential Diagnosis: A wide variety of conditions can present as panic disorder. a. Substance or alcohol misuse / withdrawal. b. Mood disorders/other psychiatric disorders secondary to medical conditions. C.Medical conditions presenting with similar conditions e.g. hyperthyroidism, hypoglycaemia, anaemia, mitral valve prolapse, atrial tachycardia, coronary heart disease, epilepsy, asthma etc. PHOBIC DISORDERS: A phobia is a marked and persistent fear resulting in conscious avoidance of a specific feared object, activity or a situation. The patient avoids the phobic stimulus, and this avoidance usually impairs his occupational or social functioning. The affected individual is aware that the experienced fear is excessive and unreasonable to the given circumstances, but cannot help it

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Agoraphobia is the fear of public places; the patient tries his best to avoid such places or situations where escape may be difficult. The patient avoids crowds, public places, traveling away from home or alone. Agoraphobia is usually associated with panic disorder, but there exists a subgroup without panic disorder.

Social phobia is the specific fear of social or performance situations in which the individual is exposed to unfamiliar individuals or to possible examination and evaluation by others. This is different from agoraphobia where the patient is not bothered about the reaction of other people. Examples include having to converse at a party, use public restrooms, and meet strangers. Simple phobias are specific phobias not covered by social phobia and agoraphobia. It is further sub-divided into five types: animals, aspects of natural environment, blood/ injection/ injury, situational and ‘other’. Common examples of simple phobia are fear of heights, fear of closed spaces (claustrophobia), fear of flying, fear of animals, fear of lightning and thunderstorm, fear of darkness, fear of blood, fear of crossing streets, etc. Aetiology and Psychopathology: Both genetic and environmental factors play a role in the aetiology. According to psychoanalysis school, phobias are the result of traumatic experiences in childhood such as separation anxiety

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(separation from mother) and unconscious conflict, which has been repressed and displaced into phobic symptoms. The unconscious anxiety is displaced to a neutral object or activity or situation.

Clinical Manifestations: Onset is typically in childhood to early adulthood. The cardinal feature of phobic disorders is severe anxiety when the patient is exposed to specific object or situation or activity. Both mental and somatic symptoms of anxiety are present. To prevent the onset of anxiety, the patient avoids these objects or situations or activities. Most of the patients are able to live normal lives in spite of the phobic disorder because the phobic object or situation or activity is easily avoidable, but this avoidance usually impairs occupational or social functioning. Panic attacks may be triggered by the phobic stimulus or may emerge spontaneously during the course of the illness. To get relief from anxiety, the patient may resort to abuse of alcohol or drugs. He may also develop features of depression. OBSESSIVE-COMPULSIVE DISORDER (OCD) Obsessions are persistent, recurring ideas accompanied by a subjective feeling of compulsion which the patient tries to resist but cannot get rid of. Compulsions are irresistible urges to carry out irrational activities.

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The patient knows about the irrationality of these obsessions and compulsions, but cannot prevent them. When he tries, the emotional tension mounts and he becomes miserable and exhausted. These obsessions and compulsions restrict the social activities and interpersonal relationships of the patient. Epidemiology: About 1 % of the patients attending a psychiatry clinic may have this disorder. The peak age of onset is around early adulthood, and both males and females are equally affected. Aetiology and Psychopathology: Though some genetic or constitutional factors may be involved in production of an obsessive type of personality, environmental factors are of primary importance in the causation of the symptoms. It often has a sudden onset (e.g. after stressful ‘loss’ event). According to psychoanalysis school, patients with obsessive compulsive disorder have a disturbed development commonly around the anal phase of psychosexual development. Anxiety associated with sexuality is displaced to neutral ideas or acts. Neuroimaging studies have demonstrated a decrease in caudate nucleus volume and abnormalities in frontal lobe white matter. The caudate nucleus seems particularly involved in the acquisition and maintenance of habit and skill learning.

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Clinical Manifestations: Patients with obsessive compulsive disorder usually have a particular type of personality which is characterized by ritualistic, rigid, perfectionist and meticulous tendencies. Patients often conceal their symptoms, usually because they are embarrassed by the content of their thoughts or the nature of their actions. Specific questions regarding recurrent thoughts and behaviors are to be asked, particularly if physical clues such as chafed and reddened hands or patchy hair loss (from repetitive hair pulling) are present. Tics are sometimes associated with OCD. In all cases, obsessive-compulsive behaviors take up more than 1 hour per day & are undertaken to relieve the anxiety triggered by the core fear. There are four major symptom patterns. ▪Most common one is an obsession of contamination followed by washing. ▪Second most common is obsession of doubt followed by a compulsion of checking. ▪Third form is one with merely intrusive obsessive thoughts without a compulsion. Such obsessions are usually repetitious thoughts of some sexual or aggressive act that is reprehensible to the patient.

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▪Fourthly, there is obsessional slowness in which the obsession and compulsion seem to be united into slow carrying out of daily activities. Such patients can take hours in bathing, eating, shaving etc. Most of the patients show features of depression because of the inconvenience and embarrassment caused by the symptoms. The patient realizes that the above symptoms are irrational, but cannot prevent them. GENERALISED ANXIETY DISORDER (GAD) This is a chronic (longer than 6 months) disorder characterized by excessive anxiety and worry about various life circumstances. Patients who have generalized anxiety disorder are pathologically anxious about everything. They are generally mistrustful of their own general level of competence and basic merit. They have a low threshold for anxiety and find it difficult to handle even the normal anxietyprovoking situations. Epidemiology: It is estimated that about 2 % of the general population suffer from generalized anxiety disorder. Onset is usually before age 20, the peak age group is 20-25 years. A history of childhood fears and social inhibition may be present. Women are more prone. Aetiology and Psychopathology:

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Though there may be genetic predisposition to develop this disorder, environmental factors are more important in the aetiology of GAD. Emotional conflicts in early childhood interfere with normal development of personality, especially when there is genetic predisposition. When this abnormal personality is confronted with the everyday stresses of life, the defense mechanisms which are used to anxiety normally become inadequate and fail. Clinical features: Patients with generalized anxiety disorder have persistent, excessive, and/or unrealistic worry associated with other signs and symptoms, which commonly include muscle tension, impaired concentration, autonomic arousal, feeling "on edge" or restless, and sleep disturbances. Patients with GAD readily admit to worrying excessively over minor matters with clinically significant distress or impairment in social, occupational or other areas of functioning. The common symptoms are palpitation, trembling / shaking, excessive sweating, and dryness of mouth, breathlessness, chest pain, abdominal pain, headache, and heaviness of head, dizziness and unsteadiness, frequency of micturition, diarrhoea and disturbances of sleep. Other general symptoms include hot flushes / cold chills; numbness or tingling sensations. Common Signs are: Elevation of blood pressure, tachycardia, increased respiratory rate and sweating etc.

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A person with GAD has tense, anxious, apprehensive appearance. Increased muscular tension is shown in his facial expression, and it produces tremors and aches in various parts of the body. He is irritable, forgetful, and complains of tiredness and lack of concentration. The person finds it difficult to control the worry. Differential diagnosis: Thyrotoxicosis has to be ruled out. Thyroid swelling, exophthalmia, and abnormal thyroid function tests suggest thyrotoxicosis. Cold and moist hands are common in GAD in contrast to warm and moist hands in thyrotoxicosis. POST TRAUMATIC STRESS DISORDER (PTSD) This condition develops in persons who have experienced extremely traumatic emotional or physical stress with either actual or threatened death or injury to oneself or another. Such traumas include combat experience, natural catastrophes such as earthquake, rape, and disasters such as fires in buildings. In World War 1, the syndrome was called ‘shell shock’. Similar features were observed in survivors of Nazi concentration camps & atomic bombings of Japan in the Second World War. Epidemiology: More than 50 % of the survivors of a disaster can develop PTSD. Women are more vulnerable. Though it can occur in any age group, it is most prevalent in young adults.

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Aetiology: Many factors can precipitate this disorder. The most important one is the stressor. The other factor is the personality characteristics of high neuroticism and extroversion of the subject. The third factor is social support. When there is strong social support, an individual may not break down even when there is major stress. Risk factors include a past or family history of psychiatric problems, low education and previous traumatic events (including childhood experiences). Clinical Manifestations: There is a triad of symptoms in this disorder. These are: Re-experiencing of the trauma through dreams and waking thoughts. Emotional numbing to other life experiences Associated features of autonomic instability, depressive ideas, poor concentration and panic attacks. These disturbances cause clinically significant distress or impairment in social, occupational, or other areas of functioning. These above symptoms have to be present for at least one month for a diagnosis of PTSD to be made. Patients often actively avoid stimuli that precipitate recollections of the trauma and demonstrate a resulting increase in vigilance, arousal, and startle response. Patients with stress disorders are at increased risk for the development of other anxiety, mood and substance-related disorders

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ANXIETY DISORDERS COMORBID WITH DEPRESSION Anxiety is closely related to depression. In a clinical situation, the symptoms are often difficult to differentiate. In a meta-analysis, the prevalence of anxiety disorder in patients with depression has been estimated at 57 %. A new diagnostic category – ‘mixed anxietydepression’ is being proposed for further study. Anxiety far more commonly precedes depression than vice versa and that particular episodes of depression may begin with anxiety symptoms. Social anxiety disorder and simple phobia are more likely to precede depression. The comorbidity of depression and anxiety has been associated with more severe symptoms and worse prognosis. A classical theoretical distinction is that anxiety is associated with ‘helplessness’ while depression is characterised by ‘hopelessness’. Also uncertainty about the ability to control important outcomes may be associated with anxiety, whereas helplessness together with certainty about negative outcome may be associated with depression. Furthermore, anxiety disorders are characterized by anxiety / fears about future events and avoidant behaviour, whereas depression involves loss of pleasure and thoughts about past events. Anxiety involves an attentional bias for threatening information. Thus, when given both threatening & non-threatening cues, anxious patients attend selectively to threatening cues. On the other hand, depression

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involves a memory bias, with depressed subjects showing bias to recall negative information, particularly when it is self referential.

ANXIETY DISORDERS AND HOMOEOPATHY Mental health is a growing area of concern in our society and times. It needs to be understood and treated on an individual level. Every person is unique and has his life story full of joys, disappointments, and vicissitudes of life in some shape or form. Homoeopathy is defined as a system of drug-therapeutics based on the law of similars. This law states that ‘a drug, acts as a curative agent when it is capable of producing in a healthy person a diseased-state exactly similar to that observed in a diseased person.’ As drug provings show that the actions of a drug manifest themselves on the body and the mind. So that, in every fully proved drug picture, there are corporeal symptoms along with alterations of thoughts, feelings, affections and intellect, memory etc. The successful application of law of similars depends upon the concept of individualization and susceptible constitutions. The concept of individualization takes into consideration the total response of the organism to the unfavorable environment. This unfavorable response is seen through signs and symptoms on three planes: Emotional, Intellectual and Physical, where the life force manifests itself.

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On this emotional level arise anxiety, anger, anguish, irritability, fears, phobias, depression and many emotions. Emotionally disturbed states tend to revolve around the issues of personal comfort, personal survival and personal expression. Emotions as maintaining causes When a patient has some harmful emotions, these emotions may act as maintaining causes for illness. The homoeopathic medicines boost the energy of a person to adapt with the energy of his own emotions and as a result to cope with varying types of environments. The physician is the best person for this because the patient can talk freely with the physician. Also the physician can better understand the emotional problems and co-relate them better with the physical problems. The physician also has to evaluate that whether the anxiety is reasonable to circumstances or the patient is over-anxious. General treatment of mental diseases During Hahnemann`s time, mental asylums were usually run in connection with prisons. The mentally ill were crowded in close quarters with insufficient food, were chained, flogged and teased for the amusement of visitors. The physicians also abandoned them believing that insanity was contagious. Hahnemann founded an asylum in Georgenthal where Duke Ernst of Gotha put one of the wings of his castle at Hahnemann`s disposal in 1792. He had only one patient Klockenbring from the beginning to the end. Klockenbring was cured of his illness. Hahnemann evolved a

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humane approach to mentally sick patients. He advocated unchaining of the mental patients. His principles for treatment of insane were new to the psychiatry of that time, but are today universally acknowledged as the chief factor in the treatment of insane. He introduced treatment to the mentally sick patient with kindness. While describing his experience on the treatment of insane, he writes – “I never allow any insane person to be punished by blows or other painful corporeal inflictions, since there can be no punishment where there is no sense of responsibility, and since such patients only deserve our pity and cannot be improved, but must be rendered worse by such rough treatment.” He further instructs the physicians attending the mental patients as – “The physician of such unfortunate creatures ought to behave so as to inspire them with respect and at the same time with confidence; he should never feel offended at what they do, for an irrational person can give no offence. The exhibition of their unreasonable anger should only excite his sympathy and stimulate his philanthropy to relieve their sad condition.” Ahead of times, as Hahnemann was, he has coded some ethical approach to mental patients, which he describes in § 228 of the Organon.

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Herein, in addition to Antipsoric treatment, he stresses upon psychotherapy with regulated mode of life and instructions for a good behaviour towards the patients by physician and attendants as: ▪ Raving madness should be met by calm fearlessness & firm resolution. ▪ Painfully disconsolate melancholy should be assuaged by silent compassion expressed through gestures and looks. ▪ Loquacity should be listened to in silence. ▪ Indecent behaviour and obscene languages are to be totally ignored. ▪ In destructive mental tendencies, things should be kept out of reach of the patient to prevent mischief. ▪ Absolute avoidance of torture and other corporeal punishments. ▪ All exciting factors, which may influence the mind of the patient, should be removed. ▪ Contradiction, arguments, rude correction etc. are to be avoided. ▪ The physician and the attendant should pretend to believe the patient in everything. In the footnote to § 229, Hahnemann also recommends that the treatment of violent insane maniac and melancholic patients can take place only in an institution specially arranged for their treatment, but not within the family circle of the patient. He believed that the patient must be left alone and must not be excited or distracted by other people; as this hindered his recovery.

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Hahnemann on mental diseases Hahnemann describes mental diseases under One-sided diseases. In §172 he writes, “A similar difficulty in the way of cure occurs from the symptoms of the disease being too few – a circumstance that deserves our careful attention, for by its removal almost all the difficulties that can lie in the way of this most perfect of all possible modes of treatment (except that its apparatus of known homoeopathic medicines is still incomplete) are removed.” Mental diseases are one-sided diseases affecting the whole psychosomatic entity where the symptoms of derangement of mind and disposition are increased while the physical symptoms decline. § 210- 230 The § 210 to 230 of the Organon describe in detail different types of mental diseases and their treatment. In §210, he attributes Psora as the cause of one-sided diseases and mental diseases are also a part of it. He stresses for psychic condition of the patient to be noted along with the totality of symptoms in order to treat these successfully with homoeopathic medicines. In § 211, he stresses the importance of the psychic condition of the patient in selection of a remedy, putting them as characteristic symptoms and these cannot remain hidden from a careful physician.

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In § 212, he highlights the fact that medicinal substances alter the mind and disposition of the provers during its proving and every medicine does so in a different manner. In § 213, he advises to pay attention to mental symptoms even in acute cases and that unless the mental and emotional picture does not match with the remedy, positive results are not possible. He explains this in the footnote of § 213 as “Thus Aconite will seldom or never effect either a rapid or permanent cure in a patient of a quiet, calm, equable disposition; and just as little will Nux vomica be serviceable where the disposition is mild and phlegmatic, Pulsatilla where it is happy, gay and obstinate, or Ignatia where it is imperturbable and disposed neither to be frightened nor vexed.” In § 214, he starts to tell us that a patient with a mental-emotional disease must be perceived the same way as other patients i.e. with a remedy, a disease agent capable of producing in body and psyche of healthy people symptoms as similar as possible as those of the case. In § 215, he specifies that most mental and emotional diseases are extensions of physical disease. So in the mental disease it starts on the physical level, and then slowly it progresses into the mental level until you have almost no more symptoms of the physical level and finally the disease transfers itself (almost like a local malady) to the invisibly subtle mental and emotional organs.

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CLASSIFICATION OF MENTAL DISEASES: Hahnemann has arranged mental diseases into following four types: 1. Mental diseases appearing with the decline of corporeal disease which threatens to be fatal --- Somato - Psychic. Hahnemann refers this type of mental disease in § 216. In this type of diseases there is quick and dramatic transference of physical disease, becoming mental disease. In this type of mental disease, the so-called physical disease declines with a rapid increase of the psychic symptoms. Finally, the physical symptoms become insignificant and improve almost to perfect health and the person is no more in the danger of death. So in this way, the physicals or the affections of grosser corporeal organs become transferred to the spiritual, mental and emotional organs. Examples: - A suppuration of lungs gets transferred into insanity. 2. Mental diseases appearing suddenly as an acute disease in patient’s ordinary calm state caused by some exciting factor: Hahnemann refers to this type of mental disease in § 221. In this type of diseases, an insanity or frenzy that suddenly breaks out as an acute disease from the patient's usually quiet state may be occasioned by fright, vexation, drinking alcohol, etc., but it almost without exception springs from internal Psora.

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He further says that during acute phases deep acting remedies are not needed but mainly the remedy that corresponds to the acute picture only. So, it must first be treated with medicines such as Aconite, Belladonna, Stramonium, Hyoscyamus, etc. in a high potency. This will control the acute flare-up to such an extent that the Psora returns to its previous, almost latent state, whereupon the patient appears to recover. 3. Mental diseases of doubtful origin: Hahnemann refers to this type in § 224. In this he refers to certain type of mental diseases where it is difficult to ascertain the cause of them. It is not sure here whether these diseases are from physical affections or some psychological factors. Various causes proposed by Hahnemann are fault of education, bad practices, and corrupt morals, neglect of mind, superstition or ignorance. 4. Mental diseases arising from prolonged emotional causes – Psycho-Somatic: Hahnemann refers this type to § 225. In comparison with the first type of diseases, there are few emotional diseases that have not developed from physical diseases. These diseases originate from emotional causes such as: Persistent anxiety, worry, vexation, abuse, frequent fear and fright. This is in contrast to the first type. In this the body is little affected in the beginning but as the disease progresses, it affects the physical health to a great degree.

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While Hahnemann did not make a difference between psychosis and neurosis, he differentiated between physical disease extending into mental disease or Somato-psychic disease and a psychological condition extending into physical disease or Psycho-somatic disease.

TREATMENT OF MENTAL DISEASES: Hahnemann had no other aim in sight except to cure. He challenged the theories of the treatment of disease of his time. He taught us that the remedies should be chosen according to the symptoms of the patient and that physician should always be governed by what is certain and safe, not by that which is more or less uncertain and unsafe. He further instructs that because a remedy has helped us before this is no reason why it should help again in a similar disease i.e. the symptoms of the patient and not the name of the disease are to point out the remedy. He, as an experimenter laid the foundation for a scientific medicine which had no scope for speculations and opinions.

A. Mental diseases arising from physical diseases: In the § 217, 218, 219 & 220 Hahnemann describes the treatment for these mental diseases. In § 217, he stresses that totality of the case should be taken into consideration with importance being given to the mental and emotional symptoms.

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Sometimes, in a mental disease, it could be a very strong physical symptom that will be your chief symptom to find the remedy. That is why a complete case is needed, to match a remedy on the physical as well as mental and emotional levels. He further guides in § 218 about the evolution of disease from physical to mental level, to be studied. For this, the accurate description of the entire phenomenon of the previous corporeal diseases before it degenerated into a one-sided mental disorder should be learned from the patient’s attendants. In § 219, the remaining symptoms of the physical plane or the physical symptoms present during the remission of mental / emotional state are to be used to complete the physical picture of the disease. In § 220, Hahnemann recommends that the physician should accurately observe the present mental and emotional symptoms of the patient and attendant’s observations are added to it. In this way, the complete picture of the disease is constructed.

The medicine is

selected on the above basis and it should be a strong Antipsoric remedy.

B. Mental diseases appearing suddenly: These cases should be firstly treated acute medicines such as Aconite, Belladonna, Hyoscyamus and Stramonium in potentised form that have similar states in their proving.

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In § 222, he emphasizes that after the acute state has subsided, these patients should never be regarded as cured. It should be followed up by anti-psoric treatment in order to prevent its recurrence. In § 223, he warns that if this Antipsoric treatment is not done, then a worse attack from a much slighter cause is bound to follow and this will be more difficult to cure.

C. Mental diseases of doubtful origin. In § 224, Hahnemann provides us with a method of distinguishing the cause of the disease as follows: A. If the mental affection is based on psychological causes, it will diminish and improve by “sensible, friendly exhortations, consolatory arguments, serious representations and sensible advice.” B. If the mental malady is dependant on some bodily disease, it would be aggravated by the same measures. Thus, depressive type of patients will be still more depressed, plaintive, disconsolate & retiring; the maniac type would become more embittered; the silly prattler will become more foolish than ever.

If the cause of mental affection is of psychic origin, then the treatment should be as per the treatment of Psycho-somatic diseases.

If the cause of mental affection is of bodily origin, then the treatment is same as per the Somato-psychic diseases.

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D. Mental disease arising from prolonged emotional causes – Psychosomatic. In § 226 he describes the treatment for these mental affections which are of psychic origin. For these he recommends ▪ Psychotherapy. He writes that these types of mental affections may be rapidly changed into a healthy state of mind by psychical remedies such as display of confidence, friendly exhortations, and sensible advice, often with a well disguised deception. ▪ Appropriate diet and regimen

▪ Antipsoric treatment

He also tells us that if the psycho-somatic diseases are not cared for in its milder form then it will progress into serious physical diseases. In § 227, he again stresses upon Psora being the fundamental cause in mental diseases and that these patients should be treated with Antipsorics at the earliest to prevent recurrence. In § 228, Hahnemann also describes the mode of administration of homoeopathic medicines. He recommends that medicines are to be administered to the patient without his knowledge in his drink so that all compulsion is unnecessary. As the small dose of the medicine does not upset the taste, it is easy. In the footnote to § 228, Hahnemann also wonders at the hardheartedness of contemporary doctors, who, without attempting to discover the efficacious mode of homoeopathic treatment are content with cruel some methods of treatment for the mentally sick.

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In § 229, he discusses the importance of psycho-social and physical environment needed to help the patient to recover. He advocates removal of all kinds of external disturbing influences on the senses and dispositions of the patients. In § 230, he confidently asserts from great experience, the superiority of homoeopathic system of medicine over other systems and emphasizes that only through homoeopathy cure of these patients is possible. At a time when insanity was believed to contagious & incurable, Hahnemann was first to assert the curability of mental illness. He differentiated organic from functional mental illness. He advocated early treatment of these and with non-violent methods. He inculcated on the mental symptoms for completing the totality of a case and left us with numerous remedies that work just as well as they did in his days. HOMOEOPATHIC APPROACH TO MENTAL DISEASES: Homoeopathy considers disease as an affection of both mind and body. As existence of life is not possible with mind and body separately, involvement of it is also not possible individually. Nevertheless, each affection of vital force is manifested by a set of physical and mental symptoms. Health is considered as a state of harmony of sensations and functions of both physique and mind. Even in case of a drug proving, we get series of symptoms in mind and body. The provings on healthy human beings has yielded

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variegated symptomatology at three levels - physical, mental and spiritual. CASE TAKING Case taking should be more careful in one-sided diseases. In cases of mental disease, an effort should be made to locate any physical symptom or involvement of any other part of body. Some of the physical symptoms may appear quite vague and trivial, but it is more important to build up the totality. Like, in disease on a physical plane, any mental symptoms should be given maximum importance and vice versa.

MIASMS AND ANXIETY DISORDERS The term miasm comes from the Greek word ‘miasma’, meaning ‘pollution, taint’. In general ‘miasm’ means – a heavy vaporous exhalation formerly believed to cause disease; obnoxious influence or atmosphere; polluted material; putrid vegetable matter. Hahnemann observed that though the acute diseases were rapidly and completely cured by medicines but chronic diseases always had a tendency to replace in a more or less varied form with new symptoms. This he stated as “Its start was pleasing, the continuation less favorable, and the outcome hopeless.” After prolonged observations and laborious experimentations for twelve years (1816 – 1828), he realized the obstacles to cure in the

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chronic diseases. He attributed the origin of all chronic diseases to chronic Miasms, namely PSORA – the non – venereal miasm and SYCOSIS and SYPHILIS – the venereal miasms. Each miasm produces its own characteristic symptoms on the human body and these must be recognised to be able to remove them accordingly. PSORA – The Universal Miasm According to Hahnemann, Psora is the only fundamental cause and producer of all (acute and chronic) diseases of non-venereal nature. It is the most ancient miasm which produces seven-eights of all chronic diseases. It is the most infectious of all chronic miasms. This lead him to declare, “Psora is that most ancient, most universal, and most destructive and yet most misapprehended chronic miasmatic disease which for many thousand years has disfigured and tortured mankind…” Hahnemann writes in ‘Chronic Diseases’ “-- diseases of the mind and of the soul, from imbecility up to ecstasy, from melancholy up to raging insanity – in short, thousands of tedious ailments of humanity called by pathology by various names, are, with few exceptions, true descendants of this many-formed Psora alone.”

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He further writes “So great a flood of numberless nervous troubles, painful ailments – consumptions and cripplings of soul, mind and body were never seen in ancient times when the Psora mostly confined itself to its dreadful cutaneous symptoms leprosy. Only during the last few centuries has mankind been flooded with these infirmities, owing to causes just mentioned.” He further makes observations about the disappearance of itch as “It often disappears through unlucky physical or psychical occurrence, through a violent fright, through continual vexations, deeply affecting grief – and the results in such case are just as mischievous as if the eruption had been driven away externally by the irrational practice of physician.” In another foot note he writes, “ I have never either in my practice, nor in any insane asylum, seen a patient suffering from melancholy, insanity, or frenzy whose disease did not have Psora as its foundation, complicated at times, however, though rarely, with syphilis.” In the Organon also, Hahnemann attributes the cause of all mental diseases to Psora alone. Kent writes that, “The miasms that are at the present day upon the human race are complicated a thousand fold by allopathic treatment. Every external manifestation of the miasm has in itself a tendency to straighten mankind, but the human race is being violently damaged

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and diseases are being complicated for the reason that these outward expressions are forced to disappear by the application of some violent or stimulating drug.” According to Ortega - Anxiety is eminently psoric. Its sycotic equivalent is Fear and has syphilitic color in Panic. Anxiety is conceived as the outcome of man’s first sensation after birth, when it abandons the maternal enclosure in which it lives with practically no effort. When he passes to outside and there he must work steadily to exist – from oxygenating his blood to taking in food, digesting it, secreting it, submitting himself to various movements; all this combined with the aggressiveness of external environment, stamps on him a feeling of worthlessness, of relative incapacity, which is translated in anxiety or existential anxiety. It will be constantly present in our minds, ready to come forth in various forms, especially if the stimulus is one of the elements which most profoundly affect the maintenance of that existential insecurity (an insecurity which we all feel because of the expectation of death and possibility of harm from many elements around us, including our fellow human beings), it gives rise to fears: fear of darkness, of being alone, of ghosts, of people, of evil. If this existential anxiety grows within us, it becomes Anguish – which is more destructive and has a markedly syphilitic tinge. But all these symptoms – Anxiety, Fear and Anguish have a psoric base –

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turning into “Fear” when it has a sycotic admixture, and into “Anguish” with a syphilitic one.

If our fear is externalized and

increases, it then becomes a Panicky terror that has a syphilitic base. Hering in his foreword to the ‘Chronic Diseases’ writes “Hahnemann inculcates with so much care the important rule to attend to the moral symptoms, and to judge of the degree of homoeopathic adaptation, existing between the remedy and the disease, by the improvement which takes place in the moral condition and the general well being of the patient.” J.P. Gallavardin has exclusively treated psychic symptoms, when present as a manifestation of latent psychic state or as the symptoms of an individual temperament. He cites numerous cases wherein defects of the character and intelligence were cured with the help of homoeopathic medicines. He lays down certain conditions essential for the success of psychic treatment:▪ He preferred to use the medicines without the knowledge of the patient. He felt that the curative effects of the medicine are developed better in this way. ▪ He advises not to reproach the patients & nor to give them any advice.

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He further states that these psychic conditions may be some symptoms of the manifested or latent diseases, or they may be the cause of stoppage of some development. Jahr does not promise much hope in chronic mental diseases with a family history of the same. He advises us to be cautious in promising too much in these cases. For success in mental and psychical derangements, he shortlists the following requirements: ▪ Knowledge with physician about the characteristic indications of remedies. ▪ Use of smallest possible dose. ▪ Exciting cause should be extensively traced & considered.

Farrington also endorses Hahnemann`s views about treatment of insanity as, “Hahnemann, with his incomparable astuteness, touched the very keynote, when he bid us treat the insane, as though they were not insane. By assuming a state harmonizing with that of my patient, opposing him in nothing, I gained what else might have been impossible. ” Kent declares that the symptoms of the mind are the most important symptoms in a remedy as well in the disease. He stresses the Hahnemannian thought ‘Mind is the Key to Man’ and advises that the mind symptoms should not be overlooked.

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Talcott puts forward “The Insane Diathesis” for the conditions which tend to start and develop mental disorders. He further writes that, “Mental abnormality is always due to either imperfect or eccentric physical development, or to effects of inborn or acquired physical disease, or to injurious impressions, either ante-natal or postnatal, upon that delicate and intricate physical structure known as human brain.” His simple and brief classification of insanity is as follows:1. Melancholia, which includes all forms of mental depression. 2. Mania, which includes all forms of mental excitement. 3. Dementia, which includes all forms of mental weakness or failure, except idiocy and imbecility. 4.General paresis, which is a distinct form of mental disease having certain characteristics which demand that it shall be classified separately. Risquez writes “Emotions guide energy either through the nervous system, producing feelings, affection, thoughts, etc., or through the somatic system, producing alterations in the immune system, the blood circulation, and the hormones: somatic alterations. ” Edward Whitmont in the introduction to ‘Psyche and Substance’ writes that “while it is certainly true that a hopeless or pessimistic outlook on life, repressed psychological conflicts and tensions do

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result in organic pathology, and that positive imaging helps in restoring as well as maintaining health, it is equally true that no one alive can wholly avoid tension, stress, conflict, repressions, depressions and disappointment. Indeed, psychological complexes and crises are building stones of personality. Frustration and repression are the unavoidable conditions of ego-building no less than approval, success, satisfaction and joy.” He further writes that “mental and physical symptoms are largely interchangeable. Emotional suppression leads to physical disorder; physical suppression (e.g. menses, lochia etc.) may produce hysterical and even psychotic states. In psychiatry even the term “conversion” state is used to denote somatic manifestations of mental or emotional disturbances.” Vithoulkas puts people with anxiety as difficult cases. He says, “As they are excessively anxious about their health – These people tend to relate a tremendous volume of minute symptoms that cannot be valued highly by a homoeopath because of these patients tendency to exaggerate.” He further writes that symptoms of such patients should be chosen with caution and perhaps only after confirmation of these by objective co-workers or relatives.

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Homoeopathic medicines help people attain a calmer state of mind, greater vitality and better physical health. Even the word "dis-ease" means (on either mental or physical level) that the individual is "ill at ease" with himself or some aspect of their daily life (relationships, their sexuality, family, work etc.). Usually a trauma or a series of bad life experiences (e.g. a traumatic childhood, loss, disappointment in love etc.) leave a person with disturbed thoughts and emotions and for a homoeopath, the mind is the starting point for all types of health problems (psychological or physical) of the man.

HOMOEOPATHIC REPERTORY “All who know how to use a repertory succeed, and not one has ever discarded it.” – Kent in ‘The language of repertory’

REPERTORY The

word

Repertory

“REPERTORIUM”

has

originated

from

Latin

word

which means ‘an inventory; a table or a

compendium, where the contents are so arranged that they are easy to find’. Basically, the homoeopathic repertory is an index to the huge mass of symptoms of various drugs of the Materia medica, the record of scientific provings, which is reproduced and arranged in a practical form with relative gradation of medicines to facilitate the quick

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selection of the remedy. Along with Materia medica and Organon it forms the Triad of Homoeopathy.

Evolution of repertory Hahnemann in his own life time had become conscious about the need for suitable index to the growing materia medica. He realized the limitation of human mind to remember all symptoms and felt the need for an aid to retrieve the facts.

His famous book ‘Fragmenta de

viribus medica mentorum positivis’ published in 1805 contained two parts. The first part contained symptoms which were observed in the provers and the second part formed the index or the repertory. Hahnemann`s pupil, Gross compiled two volumes of a repertory, which never appeared in print. Another pupil, Ruckert was appointed

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by Hahnemann to compile a repertory. After working hard on it for eight years, in 1830 he prepared one, but it was not found up to the mark. Thereafter Hahnemann employed Jahr for compiling a repertory. Jahr`s repertory was finally published in 1835 in German language. It was in three volumes. In 1832, Boenninghausen published a ’Repertory of Antipsoric medicines’ with a preface by Hahnemann. This repertory of 256 pages became a foundation stone for all later repertories. Though technically, Hahnemann was the first repertorian, the credit of publishing the first repertory goes to Boenninghausen and he is called as the “Father of repertory”. Purpose of repertory H.A. Roberts says that a repertory has two definite purposes: ● To serve as a reference and guide in looking up a particular symptom that may indicate the similimum or that may make the necessary distinction between two or more similar remedies in any given case. ● For careful study of all the symptoms that may appear in a chronic case. He also adds that the repertory is not meant for use in those cases where there are clear indications for the similimum. In these cases, it might be used in the manner of a quick reference, to verify the leading indications for the remedy, or if some slight doubt were felt, to differentiate between those seemingly indicated.

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According to P. Schmidt, “No one can know everything and this is why in all honesty one must admit that no conscientious homoeopathic doctor can practice homoeopathy in a serious and really scientific way without a repertory.” Kent writes in ‘How to use the repertory’ that, ‘the use of repertory in homoeopathic practice is a necessity if one is to do careful work. Our materia medica is so cumbersome without a repertory that the best prescriber must meet with only indifferent results.’ He advises us as,” The physician must read over and over the rubrics in the repertory in order to learn what is in it and how symptoms are expressed.” Value of Repertory The value of any repertory depends upon several elements: ▪ The art of the physician in taking the case. ▪ The knowledge of the repertory one attempts to use

and

▪ Intelligent use of the resulting analysis. The aim of repertory is not to replace the materia medica but to help in narrowing down to the similimum. It is like a bridge link between the materia medica and the case. TYPES OF REPERTORIES Repertories are divided into two main groups: 1. Traditional or the book form 2. Mechanical.

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1. Traditional or the book form is further subdivided into A. General repertories. B. Particular repertories. A. General Repertories consist of following types: ● Repertories according to Hahnemannian anatomical schema. ▪ Concordance e.g. Knerr`s repertory; Gentry’s repertory ▪ Systematic e.g. Kent’s repertory; Boenninghausen`s repertory; Synthesis; Complete repertory. ● Alphabetical ▪ Section wise e.g. Murphy’s repertory ▪ Rubric wise e.g. Phatak`s repertory.

B. Regional (Particular) ● Disease wise e.g. Bell’s diarrhoea; Allen’s intermittent fever; Robert’s Rheumatic medicines. ● Part wise e.g. Berridge`s Eye; Minton’s uterine; Hering`s analytical repertory of mind; Synthetic repertory.

2. Mechanical repertories. ● Card repertories e.g. Field’s cards; Kishore cards; Sharma’s card repertory. ● Softwares e.g. Radar; Hompath; Cara; Organum etc.

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Value of symptoms The homoeopathic materia medica has pathology of its own. The symptoms which the pathologist would exclude as accidental and meaningless are usually the symptoms which decide the choice of the homoeopathic remedy. It actually has a vital relation to the case.

Limitations of Repertory: Repertory provides us with hints about the probable remedy. It leads us to a group of remedies of which the similimum is to be found with the help of materia medica, the final authority. It is only in the materia medica that we will find the exact description of what our patient is telling us. No repertory is complete. With growing clinical experiences, new drugs and remedy confirmations, the materia medica is expanding. This growth of materia medica is not being updated into the repertory at that pace, so the repertory is not complete. Boenninghausen warns us about this in his article, “Warning, namely, the selection of the right remedy” as he writes, “for this purpose he should not content himself with the repertories that have been prepared, a very frequent carelessness, for these books contain only slight hints as to one or the other remedy that might be selected, but can never take the place of the careful reading up of the fountain sources.”

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KENT`S REPERTORY History Dr

Kent’s masterpiece “A repertory of homoeopathic material

medica” better known as Kent’s repertory is a literature which is popular

in homoeopathic

system for

over 100 years. Dr

Boenninghausen is the one who initiated repertory as a system of logical concept while Kent put in strength, vigor & vitality to this system. J.T. Kent used Lippe`s repertory for a number of years but was not satisfied with the rubrics and the number of medicines used. Kent was a great advocate of the use of important generals and individualization in the treatment of patients. So, he took up the task of producing an exhaustive repertory. Taking Lippe`s plan as its base, he expanded it by adding clinical symptoms which he had recorded. The clinical symptoms which were consistent with the provings were added, while those which were contradictory to the provings were rejected. His repertory was first published in 1897. Philosophy Kent believed that Hahnemannian totality demanded study of man as a whole and puts it as, ‘If we believe an organ is sick and alone constitutes the disease, we must feel that if we could remove the organ we would cure the patient.” He further continues this as “The organs

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are not the man. The man is prior to organs. The man is the will and understanding, and the house which he lives in, is his body.” Kent advised beginners as, “Treat the patient and not the disease.” He explains this as, “the symptom that is seldom found in a given disease is one not peculiar to the disease, but peculiar to the patient.” These peculiarities must be looked into for the individualization of the patient. Kent laid much emphasis on the importance of generals. His repertory is based on the principle of Generals to Particulars. So, mental generals followed by physical generals including modalities forms the basis of repertorisation by Kent’s repertory. Arrangement of Chapters: Kent’s repertory is divided into 37 chapters. The arrangement of chapters is on the anatomical schema with certain exceptions such as Mind, Vertigo, Vision, Hearing, Stool, etc. The chapters are as follows: 1. Mind.

19. Kidneys.

2. Vertigo.

20. Prostate Gland.

3. Head.

21. Urethra.

4. Eyes.

22. Urine.

5. Vision.

23. Genitalia Male.

6. Ear

24. Genitalia Female.

7. Hearing

25. Larynx and Trachea.

8. Nose

26. Respiration.

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9. Face

27. Cough.

10. Mouth.

28. Expectoration.

11. Teeth.

29. Chest.

12. Throat

30. Back.

13. External Throat.

31. Extremities.

14. Stomach

32. Sleep.

15. Abdomen

33. Chill

16. Rectum.

34. Fever.

17. Stool

35. Perspiration

18. Bladder.

36. Skin. 37. Generalities.

Under each chapter, the symptoms are arranged in the following order: 1. Location. 2. Sensations in general, unmodified or having modalities. 3. Sides of body or organs. 4. Time modalities. 5. Other modalities arranged alphabetically. 6. Extension of sensation etc. from the specified location to other areas, arranged alphabetically. In Kent’s repertory, Anxiety as a rubric under the section Mind is given on page 4. The main rubric of anxiety is followed by 205 sub

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rubrics. It has 203 drugs in the main rubric of which 37 drugs are in first grade, 89 drugs in 2nd grade and 77 drugs are in 3rd grade. In addition to this, there are 36 more remedies found in the subrubrics that are not found in the main rubric of Anxiety. In mind section more rubrics of anxiety are found under main rubrics of Cautious, Delirium, Indifference, Laughing, Restlessness, Starting and Talking in sleep. Anxiety is quoted as a cross-reference in rubrics Fear & Horror.

REPERTORIAL REFERENCES IN KENT`S REPERTORY SYMPTOMS MIND – ABSENTMINDED MIND - ABSORBED, buried in thought MIND - ABSORBED, buried in thought, as to what would become of him MIND - ANGER - ailments after anger with anxiety MIND - ANGER - ailments after anger with fright MIND - ANGUISH MIND - ANGUISH - daytime MIND - ANGUISH - daytime - 5 a.m. to 5 p.m. MIND - ANGUISH - morning MIND - ANGUISH - forenoon MIND - ANGUISH - evening MIND - ANGUISH - night MIND - ANGUISH - night - 4 a.m. MIND - ANGUISH - chill, during

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MIND - ANGUISH - driving from place to place MIND - ANGUISH - eating, while MIND - ANGUISH - heat, during MIND - ANGUISH - menses, before MIND - ANGUISH - menses, during MIND - ANGUISH - open air amel. MIND - ANGUISH - perspiration, during MIND - ANGUISH - stool, before MIND - ANGUISH - stool, during MIND - ANGUISH - walking in open air MIND - ANTICIPATION, complaints from MIND - ANXIETY MIND - ANXIETY - daytime MIND - ANXIETY - daytime - 5 a.m. to 5 p.m. MIND - ANXIETY - morning MIND - ANXIETY - morning - rising, on MIND - ANXIETY - morning - rising, on - amel. MIND - ANXIETY - morning - waking, on MIND - ANXIETY - forenoon MIND - ANXIETY - forenoon - 11 a.m. MIND - ANXIETY - noon MIND - ANXIETY - noon - till 3 p.m. MIND - ANXIETY - afternoon MIND - ANXIETY - afternoon - 3 to 6 p.m. MIND - ANXIETY - afternoon - 4 p.m. MIND - ANXIETY - afternoon - 4 to 5 p.m. MIND - ANXIETY - afternoon - 4 to 6 p.m. MIND - ANXIETY - afternoon - 5 to 6 p.m.

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MIND - ANXIETY - afternoon - until evening MIND - ANXIETY - evening MIND - ANXIETY - evening - amel. MIND - ANXIETY - evening - until 11 p.m. MIND - ANXIETY - evening - bed; in MIND - ANXIETY - evening - bed; in - amel. MIND - ANXIETY - evening - bed; in - closing eyes, on MIND - ANXIETY - evening - bed; in - uneasiness and anguish; must uncover* MIND - ANXIETY - evening - exercise, from violent MIND - ANXIETY - evening - twilight, in the MIND - ANXIETY - evening - 6 p.m. MIND - ANXIETY - evening - 7 to 8 p.m. MIND - ANXIETY - evening - 8 p.m. MIND - ANXIETY - night MIND - ANXIETY - night - waking, on MIND - ANXIETY - night - midnight, before MIND - ANXIETY - night - midnight, before - on waking, amel, on rising MIND - ANXIETY - night - midnight, before - 11 p.m. MIND - ANXIETY - night - midnight, after MIND - ANXIETY - night - midnight, after - on waking MIND - ANXIETY - night - midnight, after - 1 to 3 a.m. MIND - ANXIETY - night - midnight, after - 2 a.m. MIND - ANXIETY - night - midnight, after - 2 a.m. - until 2 a.m. MIND - ANXIETY - night - midnight, after - 3 a.m. MIND - ANXIETY - night - midnight, after - 3 a.m. - after MIND - ANXIETY - night - midnight, after - 4 a.m. MIND - ANXIETY - air, in open MIND - ANXIETY - air, in open amel

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MIND - ANXIETY - alone, when MIND - ANXIETY - alternating with indifference MIND - ANXIETY - anger, during MIND - ANXIETY - anticipating an engagement MIND - ANXIETY – apparition, from horrible, while awake MIND - ANXIETY - ascending steps, on MIND - ANXIETY - bathing the feet, after MIND - ANXIETY - bed, in MIND - ANXIETY - breakfast, after MIND - ANXIETY - breathing deeply, on MIND - ANXIETY - breathing deeply, amel MIND - ANXIETY - business, about MIND - ANXIETY - chagrin, after MIND - ANXIETY - children, in MIND - ANXIETY - children, about his MIND - ANXIETY - children, when lifted from the cradle MIND - ANXIETY - chill, before MIND - ANXIETY - chill, during MIND - ANXIETY - chill, after MIND - ANXIETY - church bells, from hearing MIND - ANXIETY - closing eyes, on MIND - ANXIETY - coffee, after MIND - ANXIETY - coition, after MIND - ANXIETY - coition - thought of (in a woman) MIND - ANXIETY - cold, becoming, from MIND - ANXIETY - cold drinks, amel MIND - ANXIETY - company, when in MIND - ANXIETY - conscience, of (as if guilty of a crime)

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MIND - ANXIETY - continence prolonged, from MIND - ANXIETY - conversation, from MIND - ANXIETY - cough, before MIND - ANXIETY - cough, before the attack of whooping cough MIND - ANXIETY - coughing, from MIND - ANXIETY - crowd, in a MIND - ANXIETY - cruelties, after hearing of MIND - ANXIETY - dark, in MIND - ANXIETY - dinner, during MIND - ANXIETY - dinner, after MIND - ANXIETY - dinner, after, amel MIND - ANXIETY - dreams, on waking from frightful MIND - ANXIETY - drinking, after MIND - ANXIETY - eating, before MIND - ANXIETY - eating, while MIND - ANXIETY - eating, warm food MIND - ANXIETY - eating, after MIND - ANXIETY - eating, after amel MIND - ANXIETY - emissions, after MIND - ANXIETY - eructations amel MIND - ANXIETY - excitement, from MIND - ANXIETY - exercise amel. MIND - ANXIETY - exertion of eyes MIND - ANXIETY - expected of him, when anything is MIND - ANXIETY - fear, with MIND - ANXIETY - fever, during MIND - ANXIETY - fever, prodrome, during MIND - ANXIETY - fits, with

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MIND - ANXIETY - flatus, from MIND - ANXIETY - flatus, emission of, amel MIND - ANXIETY - flushes of heat, during MIND - ANXIETY - foot bath, after a MIND - ANXIETY - friends at home, about MIND - ANXIETY - fright, after MIND - ANXIETY - future, about MIND - ANXIETY - headache, with MIND - ANXIETY - health, about MIND - ANXIETY - health, about, especially during climacteric period MIND - ANXIETY - hot air, as if in MIND - ANXIETY - house in MIND - ANXIETY - house, in amel MIND - ANXIETY - house, on entering MIND - ANXIETY - hungry, when MIND - ANXIETY - hypochondriacal MIND - ANXIETY - ineffectual desire for stool, from MIND - ANXIETY - looking steadily MIND - ANXIETY - lying, while MIND - ANXIETY - lying amel MIND - ANXIETY - lying - must lie down with anguish MIND - ANXIETY - lying - side, on MIND - ANXIETY - lying - side, on, right, from flatulence MIND - ANXIETY - lying - side, on - left MIND - ANXIETY - manual labor, from MIND - ANXIETY - menses, before MIND - ANXIETY - menses, during MIND - ANXIETY - menses, during - amel.

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MIND - ANXIETY - menses, after MIND - ANXIETY - menses, after - which prevents sleep MIND - ANXIETY - mental exertion MIND - ANXIETY - motion, from MIND - ANXIETY - motion amel MIND - ANXIETY - motion downward MIND - ANXIETY - music, from MIND - ANXIETY - night watching, from MIND - ANXIETY - noise, from MIND - ANXIETY - noise of rushing water MIND - ANXIETY - others, for MIND - ANXIETY - pains, from the MIND - ANXIETY - paroxysms MIND - ANXIETY - periodical MIND - ANXIETY - playing piano, while MIND - ANXIETY - pressure on chest MIND - ANXIETY - pursued when walking, as if MIND - ANXIETY - railroad, when about to journey by, amel, while in train MIND - ANXIETY - reading, while MIND - ANXIETY - riding, while MIND - ANXIETY - riding down the hill MIND - ANXIETY - rising, after MIND - ANXIETY - rising, from a seat, on MIND - ANXIETY - rising, from a seat amel MIND - ANXIETY - salvation, about MIND - ANXIETY - salvation, about - morning MIND - ANXIETY - sedentary employment, from MIND - ANXIETY - sewing

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MIND - ANXIETY - shaving, while MIND - ANXIETY - shuddering, with MIND - ANXIETY - sitting, while MIND - ANXIETY - sitting, amel MIND - ANXIETY - sitting, bent MIND - ANXIETY - sleep, before MIND - ANXIETY - sleep, before - evening MIND - ANXIETY - sleep, on going to MIND - ANXIETY - sleep, during MIND - ANXIETY - sleep, loss of sleep MIND - ANXIETY - sleep, menses, after MIND - ANXIETY - sleep, on starting from MIND - ANXIETY - sleep, partial slumbering in the morning, during MIND - ANXIETY - soup, after MIND - ANXIETY - speaking, when MIND - ANXIETY - speaking, in company MIND - ANXIETY - standing, while MIND - ANXIETY - standing amel MIND - ANXIETY - stool, before MIND - ANXIETY - stool, during MIND - ANXIETY - stool, after MIND - ANXIETY - stool, while straining at MIND - ANXIETY - stooping, when MIND - ANXIETY - stooping amel MIND - ANXIETY - storm, during a thunder MIND - ANXIETY - strangers, in the presence of MIND - ANXIETY - sudden MIND - ANXIETY - suicidal

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MIND - ANXIETY - supper, after MIND - ANXIETY - thinking about it, from MIND - ANXIETY - thoughts, from MIND - ANXIETY - time is set, if a MIND - ANXIETY - tobacco, from smoking MIND - ANXIETY - trifles, about MIND - ANXIETY - urination, before MIND - ANXIETY - urination, during MIND - ANXIETY - urination, after MIND - ANXIETY - vexation, after MIND - ANXIETY - voice, on raising the MIND - ANXIETY - waking, on MIND - ANXIETY - walking, while MIND - ANXIETY - walking - in open air MIND - ANXIETY - walking - in open air, amel MIND - ANXIETY - walking - rapidly MIND - ANXIETY - walking - rapidly - which makes him walk faster MIND - ANXIETY - warm bed yet limbs cold if uncovered MIND - ANXIETY - warmth, from MIND - ANXIETY - warmth amel MIND - ANXIETY - weeping, followed by MIND - ANXIETY - weeping amel MIND - ANXIETY - work, during manual MIND - AVARICE MIND - AVERSION, approached to being MIND - BAD news, ailments from MIND - BROODING MIND - BUSINESS, averse to

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MIND - CAREFULNESS MIND - CARES, full of MIND - CARES, full of - ailments, from MIND - CARES, full of - domestic affairs, about MIND - CARES, full of - trifles, about MIND - CARRIED, desires to be MIND - CAUTIOUS MIND - CAUTIOUS - anxiously MIND - CLINGING to persons or furniture MIND - CLINGING - child awakens terrified, knows no one, screams, clings* MIND - COMPANY - aversion to MIND - COMPANY - aversion to - avoids the sight of people MIND - CONCENTRATION - difficult MIND - CONFIDENCE, want of self MIND - CONFUSION of mind - concentrate the mind, on attempting to MIND - CONSCIENTIOUS about trifles MIND - COUNTING continually MIND - COWARDICE MIND – DARKNESS, agg. MIND - DEATH, desires MIND - DEATH, presentiment of MIND – DEATH, sensation, of MIND - DEATH, thoughts of MIND - DELIRIUM - anxious MIND - DELIRIUM - frightful MIND - DELUSIONS - crime - as if he had committed MIND - DELUSIONS - danger, impression of MIND - DELUSIONS - disease has incurable

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MIND - DELUSIONS - fail, everything will MIND - DELUSIONS - happen, that something terrible is going to MIND - DELUSIONS - heart disease, is going to have, and die MIND - DELUSIONS - images - frightful MIND - DELUSIONS - images - frightful - sleep, preventing MIND - DELUSIONS - insane, that she will become MIND - DELUSIONS - murdered, that he would be MIND - DELUSIONS - neglected his duty, that he has MIND - DELUSIONS - poisoned, that he was about to be MIND - DELUSIONS - poor, thinks he is MIND - DELUSIONS - pursued, by enemies MIND - DELUSIONS - sick, imagines himself MIND - DELUSIONS - succeed, that he cannot, does everything wrong MIND - DELUSIONS - troubles, broods over imaginary MIND - DELUSIONS - wrong, fancies he has done MIND - DESPAIR MIND - DESPAIR - health, of MIND - DESPAIR - recovery MIND - DESPAIR - religious (of salvation, etc) MIND - DESPAIR - social position, of MIND - DESPAIR - trifles, over MIND - DISCOURAGED MIND - DISGUST MIND - DOUBTFUL - recovery, of MIND - DOUBTFUL - soul’s welfare, of MIND - DULLNESS, sluggishness, difficulty of thinking and comprehending MIND - DWELLS on past disagreeable occurrences MIND - ESCAPE, attempts to

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MIND - EXCITEMENT - anticipating events, when MIND - EXCITEMENT - emotional, ailments from MIND - EXCITEMENT - horrible things, after hearing MIND - EXCITEMENT - hurried, as if MIND - EXCITEMENT - nervous MIND - EXCITEMENT - perspiration, during MIND - EXCITEMENT - trifles, over MIND - FANCIES - exaltation of - frightful MIND - FASTIDIOUS MIND - FEAR MIND - FEAR - daytime, only MIND - FEAR - morning MIND - FEAR - morning - rising on MIND - FEAR - morning - until evening MIND - FEAR - morning - waking, on MIND - FEAR - forenoon MIND - FEAR - noon until 3 p.m. MIND - FEAR - afternoon MIND - FEAR - afternoon - 4 p.m. MIND - FEAR - afternoon - 5 p.m. MIND - FEAR - evening MIND - FEAR - evening - amel. MIND - FEAR - evening - bed, in MIND - FEAR - evening - bed, in - amel. MIND - FEAR - evening - twilight, in MIND - FEAR - evening - walking, while MIND - FEAR - night MIND - FEAR - night - waking, after

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MIND - FEAR - night - midnight MIND - FEAR - night - midnight, after MIND - FEAR - night - midnight, after - 3 a.m. MIND - FEAR - abdomen, arising from MIND - FEAR - accidents, of MIND - FEAR - air, in open MIND - FEAR - air, in open - amel. MIND - FEAR - alone, of being MIND - FEAR - alone, of being - evening MIND - FEAR - alone, of being - night MIND - FEAR - alone, of being - lest - he die MIND - FEAR - alone, of being - lest - he injure himself MIND - FEAR - alternating with mania MIND - FEAR - animals, of MIND - FEAR - apoplexy, of MIND - FEAR - apoplexy, of - night at, with feelings as if head would burst MIND - FEAR - apoplexy, of - palpitation, with MIND - FEAR - apoplexy, of - stool, during MIND - FEAR - apoplexy, of - waking, on MIND - FEAR - approaching him, of others MIND - FEAR - approaching him, children cannot bear to have anyone near* MIND - FEAR - approaching him, delirium, in MIND - FEAR - approaching him, lest he be touched MIND - FEAR - approaching him, of vehicles MIND - FEAR - bad news, of hearing MIND - FEAR - bed, of the MIND - FEAR - behind him, that someone is MIND - FEAR - betrayed, being

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MIND - FEAR - bitten, of being MIND - FEAR - black, everything MIND - FEAR - brain, of softening of MIND - FEAR - brilliant objects, looking glass, etc, of, or cannot endure MIND - FEAR - burden, of becoming a MIND - FEAR - censured, of being MIND - FEAR - chill, during MIND - FEAR - cholera, of the MIND - FEAR - church or opera, when ready to go MIND - FEAR - closing eyes, on MIND - FEAR - coal scuttle, of the MIND - FEAR - coition - at thought of coition in a woman MIND - FEAR - cold, of taking MIND - FEAR - confusion, that people will observe her MIND - FEAR - consumption, of MIND - FEAR - corners, to walk past certain MIND - FEAR - creeping out of every corner, of something MIND - FEAR - crowd, in a MIND - FEAR - crowd, in a - public places, of MIND - FEAR - cruelties, report of, excite MIND - FEAR - cutting himself when shaving MIND - FEAR - danger, of impending MIND - FEAR - danger, of impending - going to sleep, on MIND - FEAR - dark MIND - FEAR - dawn, of the return of MIND - FEAR - death, of MIND - FEAR - death, of - morning MIND - FEAR - death, of - evening

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MIND - FEAR - death, of - night MIND - FEAR - death, of - alone, when MIND - FEAR - death, of - alone, when - evening in bed MIND - FEAR - death, of - die, fear he will, if he goes to sleep, after night-mare MIND - FEAR - death, of - heart symptoms, during MIND - FEAR - death, of - heat, during MIND - FEAR - death, of - labor, during MIND - FEAR - death, of - menses, before MIND - FEAR - death, of - menses, during MIND - FEAR - death, of - pain, from MIND - FEAR - death, of - perspiration, during MIND - FEAR - death, of - predicts the time MIND - FEAR - death, of - pregnancy, during MIND - FEAR - death, of - soon, that she will die MIND - FEAR - death, of - sudden, of MIND - FEAR - death, of - vexation, after MIND - FEAR - death, of - vomiting MIND - FEAR - death, of - waking, on MIND - FEAR - death, of - walking, while MIND - FEAR - destination, of being unable to reach his MIND - FEAR - devil, being taken by the, of MIND - FEAR - devoured by animals; of being MIND - FEAR - dinner, after MIND - FEAR - disaster; of MIND - FEAR - disease, of impending MIND - FEAR - disease, of impending - night, in bed MIND - FEAR - disease, of impending - worse walking in open air MIND - FEAR - dogs, of

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MIND - FEAR - downward motion, of MIND - FEAR - drawn upward, of being MIND - FEAR - driving him from place to place MIND - FEAR - drowned, of being MIND - FEAR - eating, of MIND - FEAR - eating, after MIND - FEAR - eating, of - when hungry MIND - FEAR - emission, after an MIND - FEAR - epilepsy MIND - FEAR - epilepsy - in the morning MIND - FEAR - evil of MIND - FEAR - evil of - morning, on waking MIND - FEAR - evil of - afternoon MIND - FEAR - evil of - evening MIND - FEAR - evil of - evening - walking in open air, while MIND - FEAR - exertion, of MIND - FEAR - exposure night in bed, of MIND - FEAR - extravagance, of MIND - FEAR - failure, of, in business MIND - FEAR - fainting, of MIND - FEAR - fall upon him, high walls and building MIND - FEAR - falling, of MIND - FEAR - falling, of - afternoon MIND - FEAR - falling, of - evening MIND - FEAR - falling, of - letting things fall, of MIND - FEAR - falling, of – room, in, agg. MIND - FEAR - falling, of - sleep, on going to MIND - FEAR - falling, of - turning head, on

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MIND - FEAR - falling, of - walking, when MIND - FEAR - fasting, of MIND - FEAR - fever, while chilly MIND - FEAR - fever, on going to bed MIND - FEAR - fever, typhus, of MIND - FEAR - fire, things will catch MIND - FEAR - fit, of having a MIND - FEAR - food, after MIND - FEAR - friends has met with accident, that a MIND - FEAR - friends, of MIND - FEAR - gallows, of the MIND - FEAR - ghosts, of MIND - FEAR - ghosts, of - evening MIND - FEAR - ghosts, of - night MIND - FEAR - grieving, as if MIND - FEAR - happen, something will MIND - FEAR - happen, something will - when alone relieved by conversation MIND - FEAR - happen, something will - warmth of bed amel. MIND - FEAR - health, that she has ruined MIND - FEAR - heart, disease of MIND - FEAR - heart, arising from MIND - FEAR - heart, will cease to beat unless constantly on the move MIND - FEAR - heat - during MIND - FEAR - high places MIND - FEAR - hurry, following MIND - FEAR - husband, he will never return, something would happen to him* MIND - FEAR - imaginary things MIND - FEAR - imaginary animals

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MIND - FEAR – imbecile, that he would become MIND - FEAR - infection, of MIND - FEAR - injured, of being MIND - FEAR - insanity, of MIND - FEAR - insanity, of - night MIND - FEAR - joints are weak, that MIND - FEAR - jumps out of bed from MIND - FEAR - jumps, on touch MIND - FEAR - jumps, out of the window MIND - FEAR - killing, of MIND - FEAR - killing, of - with a knife MIND - FEAR - labor, during MIND - FEAR - labor, after MIND - FEAR - looking before her, when MIND - FEAR - losing senses MIND - FEAR - lying in bed, while MIND - FEAR - manual labor, after MIND - FEAR - medicine, of taking too much medicine MIND - FEAR - men, of MIND - FEAR - menses, before MIND - FEAR - menses, during MIND - FEAR - menses, during, menstrual colic MIND - FEAR - mirrors in room, of MIND - FEAR - mischief, he might do, night on waking MIND - FEAR - misfortune, of MIND - FEAR - misfortune, of - daytime MIND - FEAR - misfortune, of - morning MIND - FEAR - misfortune, of - forenoon

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MIND - FEAR - misfortune, of - afternoon MIND - FEAR - misfortune, of - afternoon - 2 p.m. MIND - FEAR - misfortune, of - evening MIND - FEAR - misfortune, of - evening - bed, in, amel. MIND - FEAR - misfortune, of - chilliness, during MIND - FEAR - misfortune, of - heat, during MIND - FEAR - moral obliquity alternating with sexual excitement MIND - FEAR - murdered, of being MIND - FEAR - music, from MIND - FEAR - narrow place, in MIND - FEAR - nausea, after MIND - FEAR - near, of those standing MIND - FEAR - noise, from MIND - FEAR - noise, from - night MIND - FEAR - noise, from - at door MIND - FEAR - noise, from - rushing water MIND - FEAR - noise, from - street, in MIND - FEAR - noise, from - sudden of MIND - FEAR - observed, of her condition being MIND - FEAR - occupation, of MIND - FEAR - out of doors, to go MIND - FEAR - paralysis, of MIND - FEAR - people, of MIND - FEAR - people, of - children MIND - FEAR - physician, will not see him he seems to terrify her MIND - FEAR - piano, when at MIND - FEAR - pins, of MIND - FEAR - pneumonia, of

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MIND - FEAR - poisoned, of being MIND - FEAR - poisoned, of being - night MIND - FEAR - poisoned, of being - has been MIND - FEAR - poverty MIND - FEAR - pregnancy, during MIND - FEAR - putrefy, body will MIND - FEAR - rain of MIND - FEAR - riding, when in a carriage MIND - FEAR - robbers, of MIND - FEAR - robbers, of - midnight on waking MIND - FEAR - room, on entering MIND - FEAR - run over of being, on going out MIND - FEAR - say something wrong, lest he should MIND - FEAR - self-control, losing MIND - FEAR - serious thoughts MIND - FEAR - sitting amel. MIND - FEAR - sleep, before MIND - FEAR - sleep, he will never sleep again MIND - FEAR - sleep - to close the eyes lest he should never wake MIND - FEAR - sleep - to go to sleep MIND - FEAR - society, of his position in MIND - FEAR - sold, of being MIND - FEAR – speak, to MIND - FEAR - spoken to MIND - FEAR - starving, of MIND - FEAR - stomach, arising from MIND - FEAR - stomach, of ulcer in MIND - FEAR - strangers, of

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MIND - FEAR - suffering, of MIND - FEAR - suffocation, of MIND - FEAR - suffocation, of - night MIND - FEAR - suffocation, of - closing eyes MIND - FEAR - suffocation, of - lying, while MIND - FEAR - suicide MIND - FEAR - superstitious MIND - FEAR - supper, after MIND - FEAR - surprises, from pleasant MIND - FEAR - syphilis, of MIND - FEAR - talking loud, as if would kill her MIND - FEAR - thinking of disagreeable things, when MIND - FEAR - thinking - sad things, of MIND - FEAR - thoughts, of his own MIND - FEAR - throat, from sensation of swelling of MIND - FEAR - thunderstorm, of MIND - FEAR - touch, of MIND - FEAR - tread lightly, must, or will injure himself MIND - FEAR - trifles MIND - FEAR - troubles, of imaginary MIND - FEAR - unaccountable MIND - FEAR - undertaking anything MIND - FEAR - upward, of being drawn MIND - FEAR - vertigo, of MIND - FEAR - vexation, after MIND - FEAR - voice, of using MIND - FEAR - waking, on MIND - FEAR - waking, on - from a dream

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MIND - FEAR - waking, on - of something under the bed MIND - FEAR - walking, of MIND - FEAR - walking - across busy street MIND - FEAR - walking - in the dark MIND - FEAR - walking, while MIND - FEAR - walking, open air, while MIND - FEAR - warm room MIND - FEAR - water, of MIND - FEAR - weeping amel MIND - FEAR - wet his bed, fears he will MIND - FEAR - wind, of MIND - FEAR - women; of MIND - FEAR - work, dread of MIND - FEAR - work, dread of - headache, during MIND - FEAR - work, dread of - literary, of MIND - FORGOTTEN something, feels constantly as if he had MIND - FRIGHT, complaints from MIND - FRIGHTENED easily MIND - FRIGHTENED easily - night MIND - FRIGHTENED easily - night - wakens at 3 a.m. MIND - FRIGHTENED easily - chill, during MIND - FRIGHTENED easily - falling asleep, on MIND - FRIGHTENED easily - menses, before MIND - FRIGHTENED easily - nocturnal emissions, after MIND - FRIGHTENED easily - roused, when MIND - FRIGHTENED easily - sneezing, at MIND - FRIGHTENED easily - touch, from MIND - FRIGHTENED easily - trifles, at

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MIND - FRIGHTENED easily - trifles, at - day before menses MIND - FRIGHTENED easily - waking, on MIND - FRIGHTENED easily - wakens in a fright from least noise MIND - FRIGHTENED easily - wakens terrified, knows no one, screams, clings* MIND - FRIGHTENED easily - weeping amel. MIND - FROWN, disposed to MIND - GESTURES - plays with his fingers MIND - GOING out, aversion to MIND - GRIEF MIND - GRIEF, ailments from MIND - GRIEF - trifles, over MIND – HELPLESSNESS, feeling of MIND - HIGH places, agg. MIND – HOME, desires to go MIND - HORRIBLE things, sad stories affect her profoundly MIND - IMPATIENCE - trifles, about MIND - IMPULSIVE MIND - IMPULSE, morbid - stab his flesh with the knife he holds, to MIND - INCONSOLABLE MIND - INCONSOLABLE - over fancied misfortune MIND – INJURE, fears to be left alone, lest he should himself MIND - INSANITY - fright or anger, caused by MIND - IRRESOLUTION MIND - IRRESOLUTION - acts, in MIND - IRRESOLUTION - ideas, in MIND - IRRESOLUTION - trifles, about MIND - IRRITABILITY MIND - KILL, desire to

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MIND - KILL, desire to - barber wants to kill his customer MIND - KILL, desire to - desire to kill the person that contradicts her MIND - KILL, desire to - sight of a knife MIND - KILL, desire to - sudden impulse to MIND - KILL, desire to - sudden impulse to - herself MIND - KILL, desire to - sudden impulse to - throw child into fire MIND - LAMENTING - future, about MIND - LAUGHING - anxiety, during MIND - LIGHT - desire for MIND - MENTAL SYMPTOMS - alternating with - physical symptoms MIND - MONOMANIA MIND - MORTIFICATION - ailments, from MIND - NARRATING her symptoms agg. MIND - PLAYFUL - indisposition to play, in children MIND - RELIGIOUS affections MIND - REMORSE MIND - REPROACHING himself MIND - REST, cannot, when things are not in proper place MIND - RESTLESSNESS MIND - RESTLESSNESS - anxious MIND - RESTLESSNESS - anxious - compelling rapid walking MIND - RESTLESSNESS - anxious - epilepsy, during intervals of MIND - RESTLESSNESS - bed, driving out of MIND - RESTLESSNESS - bed, tossing about, in MIND - RESTLESSNESS - internal MIND - RESTLESSNESS - menses, before MIND - RESTLESSNESS - menses, during MIND - RESTLESSNESS - storm, before

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MIND - RESTLESSNESS - storm, during MIND - SADNESS MIND - SADNESS - misfortune, as if from MIND - SENSITIVE MIND - SENSITIVE - ailments to most trifling MIND - SENSITIVE - cruelties, when hearing of MIND - SENSITIVE - external impressions, to all MIND - SENSITIVE - moral impressions, to MIND - SENSITIVE - music, to MIND - SENSITIVE - noise, to MIND - SENSITIVE - noise, to - slightest MIND - SHRIEKING - children, in MIND - STARTING, startled MIND - STARTING - anxious MIND - STARTING - anxious, downward motion, from MIND - STARTING - called by name, when MIND - STARTING - easily MIND - STARTING - falling, as if MIND - STARTING - fright, from MIND - STARTING - hawking, at MIND - STARTING - noise, from MIND - STARTING - prick of a needle, at the MIND - STARTING - sleep, on falling MIND - STARTING - sleep, during MIND - STARTING - sleep, from MIND - STARTING - sneezing, at MIND - STARTING - spoken to, when MIND - STARTING - touched, when

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MIND - STARTING - tremulous MIND - STARTING - trifles, at MIND - STARTING - twitching MIND - STRANGER, presence of, agg. MIND - SUCCEEDS, never MIND - SUICIDAL disposition MIND - SUICIDAL disposition - thoughts MIND - SUPERSTITIOUS MIND - TALKING - sleep, in MIND - TALKING - sleep, in - anxious MIND - THOUGHTS - frightful MIND - THOUGHTS - frightful - night on waking MIND - THOUGHTS - frightful - seeing blood or a knife, on MIND - THOUGHTS - future, of the MIND - THOUGHTS - intrude and crowd around each other MIND - THOUGHTS - intrude and crowd around each other - sexual MIND - THOUGHTS - intrude and crowd around each other - work, while at MIND - THOUGHTS - persistent MIND - THOUGHTS - persistent - alone, when MIND - THOUGHTS - persistent - evil, of MIND - THOUGHTS - persistent - expression and words heard recur to his mind MIND - THOUGHTS - persistent - homicide MIND - THOUGHTS - persistent - thinks mind and body are separated MIND - THOUGHTS - persistent - thinks of nothing but murder, fire and rats MIND - THOUGHTS - persistent - unpleasant subjects, haunted by MIND - THOUGHTS - profound MIND - THOUGHTS - profound - future, about his MIND - THOUGHTS - tormenting

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MIND - THOUGHTS - tormenting - evening MIND - THOUGHTS - tormenting - night MIND - THOUGHTS - tormenting - sexual MIND - THOUGHTS - vanishing, of MIND - THOUGHTS - wandering MIND – THUNDER storm, before MIND – THUNDER storm, during MIND - TIMIDITY - about appearing in public MIND - TOUCHED, aversion to being MIND - TRIFLES, seem important MIND - UNREAL, everything seems MIND - WALKING rapidly from anxiety MIND - WANDER, desires to MIND - WASHING always, her hands MIND - WEARY of life MIND - WEEPING - emotion, after slight MIND - WEEPING - future, about the MIND - WEEPING - nightmare, after MIND - WEEPING - sad thoughts, at MIND - WEEPING - trifles, at MIND - WEEPING - trifles, at - at least worry, children MIND - WILL, contradiction of MIND - WORK, aversion to mental VERTIGO - VERTIGO VERTIGO - ANXIETY, during VERTIGO - FRIGHT, after HEAD - CONGESTION - anxiety, with HEAD - HEAT - anxiety, with

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HEAD - NUMBNESS, sensation of HEAD - PAIN - looking down, out of window cause vertigo, anxiety, sweat* HEAD - PAIN - Stunning, Forehead - sweats from anxiety - walking in open air* HEAD - PERSPIRATION of scalp - Forehead - anxiety, as from HEAD - UNSTEADY feeling EYE - PUPILS - dilated EYE - STRABISMUS - mental emotions or fear agg. VISION - DIM - anxiety, during EAR - NOISES in - anxiety agg. EAR - NOISES in - humming - mental anxiety agg. FACE - EXPRESSION, anxious FACE - EXPRESSION - bewildered FACE - EXPRESSION - distressed FACE - EXPRESSION - frightened FACE - EXPRESSION - suffering FACE - EXPRESSION - vacant FACE - HEAT - anxiety, during FACE - PERSPIRATION FACE - PERSPIRATION - cold FACE - STIFFNESS, muscles FACE - TENSION of skin FACE - WRINKLED FACE - WRINKLED - forehead MOUTH - DRYNESS TEETH - PAIN - anxiety, with THROAT - CHOKING THROAT - LUMP, plug, etc., sensation of THROAT - SWALLOWING - difficult

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STOMACH - ANXIETY STOMACH - APPREHENSION in STOMACH - EMPTINESS - morning - anxiety with STOMACH - NAUSEA STOMACH - NAUSEA - anxiety, after STOMACH - PAIN - fright, from STOMACH - PAIN - burning - fright, after ABDOMEN - ANXIETY in ABDOMEN - APPREHENSION in, sensation of ABDOMEN - RESTLESSNESS, uneasiness RECTUM - CONSTIPATION - stool remains long in rectum, anxiety; awful* RECTUM - DIARRHEA – anticipation, after RECTUM - DIARRHEA - anxiety, after RECTUM - DIARRHEA - excitement RECTUM - DIARRHEA - fright, after RECTUM - URGING - anxious RECTUM - URGING - fright, from RECTUM - URGING - startled, when BLADDER - APPREHENSION in region of BLADDER - RETENTION - fright, after BLADDER - URGING to urinate - anxious KIDNEYS - PAIN - Region of - extending to - groin - nausea; with anxious GENITALIA - MALE - MASTURBATION, disposition to GENITALIA - FEMALE - ABORTION - fright, after GENITALIA - FEMALE - INFLAMMATION - uterus - emotional excitement * GENITALIA - FEMALE - MENSES - copious - excitement, after RESPIRATION - ACCELERATED RESPIRATION - ACCELERATED - anxiety, during

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RESPIRATION - ANXIOUS RESPIRATION - ASTHMATIC - emotions, after RESPIRATION - DIFFICULT - morning - chest, from anxiety in RESPIRATION - DIFFICULT - excitement agg. RESPIRATION - DIFFICULT - fright, after RESPIRATION - DIFFICULT - perspiration - anxious face and sleeplessness COUGH - NERVOUS COUGH - STRANGERS, child coughs at sight of CHEST - ANXIETY in CHEST - ANXIETY in - excitement agg. CHEST - ANXIETY in - heart, region of CHEST - APPREHENSION CHEST - APPREHENSION - heart, region of CHEST - CEASES to beat; as if heart - had ceased CHEST - CONSTRICTION, tension, tightness CHEST - INFLAMMATION - Heart - Endocardium - pain and great anxiety CHEST - OPPRESSION CHEST - PAIN CHEST - PALPITATION OF HEART CHEST - PALPITATION OF HEART - anxiety CHEST - PALPITATION OF HEART - audible CHEST - PALPITATION OF HEART - excitement, after CHEST - PALPITATION OF HEART - fright, after CHEST - PALPITATION OF HEART - noise, from every strange CHEST - PALPITATION OF HEART - tumultuous, violent, vehement CHEST - PALPITATION OF HEART - unrequited affections, from CHEST - PALPITATION OF HEART - waking, on - startled from a dream EXTREMITIES - COLDNESS - Foot - anxiety, during

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EXTREMITIES - FORMICATION - fingers - anxiety, as from EXTREMITIES - GOOSE FLESH EXTREMITIES - HEAT - Hand - anxiety, with EXTREMITIES - NUMBNESS EXTREMITIES - TREMBLING EXTREMITIES - TREMBLING - anxious EXTREMITIES - TREMBLING - Hand - anxiety; with EXTREMITIES - TREMBLING - Lower limbs - anxiety SLEEP - DISTURBED SLEEP - DREAMS - accidents SLEEP - DREAMS - animals SLEEP - DREAMS - anxious SLEEP - DREAMS - danger SLEEP - DREAMS - difficulties, of SLEEP - DREAMS - falling, of SLEEP - DREAMS - fire SLEEP - DREAMS - frightful SLEEP - DREAMS - misfortunes, of SLEEP - DREAMS - nightmares SLEEP - DREAMS - pursued, of being SLEEP - DREAMS - robbers SLEEP - DREAMS - snakes SLEEP - DREAMS - unsuccessful efforts to do various things SLEEP - RESTLESS SLEEP - SLEEPINESS - excitement, after SLEEP - SLEEPLESSNESS - anxiety, from SLEEP - SLEEPLESSNESS - excitement, from SLEEP - SLEEPLESSNESS - thoughts activity of mind, from

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SLEEP - SLEEPLESS - thoughts activity of mind, from - same idea repeated * SLEEP - SLEEPLESS - uneasiness & anxiety, uncovers which cause chilliness * SLEEP - WAKING - frequent SLEEP - WAKING - fright, as from CHILL - COLDNESS in general CHILL - ANXIETY, caused by CHILL - EXCITEMENT, after CHILL - FRIGHT, from CHILL - SHAKING - fright, from FEVER - NIGHT - anxiety and sweat, with FEVER - NIGHT - dry burning heat - anxiety; with FEVER - ALTERNATING WITH - fright PERSPIRATION - ANXIETY, during PERSPIRATION - ANXIETY, during - evening PERSPIRATION - ANXIETY, during - night PERSPIRATION - ANXIETY, during - dinner, after PERSPIRATION - CLAMMY PERSPIRATION - EATING, while - anxiety and cold sweat PERSPIRATION - EXCITEMENT, after PERSPIRATION - FRIGHT, from PERSPIRATION - STRANGERS, in the presence of SKIN - GOOSE FLESH GENERALS - ANXIETY general physical GENERALS - BATHING, dread of GENERALS - CATALEPSY - fright, after GENERALS - CHOREA - emotional GENERALS - CHOREA - fright, from GENERALS - CONVULSIONS - excitement, from

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GENERALS - CONVULSIONS - fright, from GENERALS - FAINTNESS - blood, at sight of in GENERALS - FAINTNESS - close room, in GENERALS - FAINTNESS - crowded room, in GENERALS - FAINTNESS - dark places, in GENERALS - FAINTNESS - excitement, on GENERALS - FAINTNESS - fright, after GENERALS - FAINTNESS - pain, from GENERALS - HEAT - flushes of GENERALS - HEAT - flushes of - alternating with chills GENERALS - HEAT - flushes of - emotions, from GENERALS - HEAT - flushes of - perspiration - and anxiety GENERALS - HEAT - sensation of GENERALS - NUMBNESS GENERALS - ORGASM of blood GENERALS - ORGASM of blood - emotions, after GENERALS - ROOM full of people agg. GENERALS - STORM, approach of a GENERALS - STRETCHING - anxiety, from GENERALS - TREMBLING GENERALS - TREMBLING - Externally - anxiety, from GENERALS - TREMBLING - Externally - emotions, after GENERALS - TREMBLING - Externally - fright, after GENERALS - TWITCHING GENERALS - TWITCHING - fright, after GENERALS - WEAKNESS - fright, after * - Symptom language slightly altered to fit in the format

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Boger - Boenninghausen`s Characteristics and Repertory

(BBCR)

Introduction Boenninghausen was a close student and disciple of Hahnemann. The credit for publishing the first repertory goes to Boenninghausen. He published ‘Repertory of the Antipsorics’ in 1832, with a preface by Hahnemann. In 1835, Boenninghausen`s ‘Repertory of medicines which are not Antipsoric’ and in 1836, ‘An attempt at showing the relative kinship of homoeopathic medicines’ was published. He brought out the Therapeutic Pocket Book incorporating the results of his vast experience in 1846. This became a standard reference book till the close of 19 th century. Boenninghausen was the first to evaluate the remedies in relation to the individual symptoms. He also evolved the doctrine of concomitants, which he believed to be of peculiar and characteristic value. Roberts, H.A says that “The works of Boenninghausen are among the most comprehensive in logic, philosophy and applicability of early writers – perhaps with the single exception of the works of Hahnemann. The most comprehensive and far reaching in influence.”

Boger, C.M was a student of Boenninghausen. He studied many of the original works of Boenninghausen in German and corrected many

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faulty translations of his work in English. He was impressed by the practical utility of the Therapeutic Pocket Book. Boger was also aware of the difficulties faced by practitioners in using the Therapeutic Pocket Book as well as the criticism leveled against its principles. He enlarged this by adding many other works of Boenninghausen to form BBCR.

He also added 17 new remedies which were proved after Boenninghausen. In his preface to the book, Boger says, it embraces the following major books: 1. Boenninghausen`s Therapeutic pocket book 2. Boenninghausen`s repertory of Apsoric medicines. 3. Repertory of Antipsoric medicines by Boenninghausen 4. Sides of body by G. miller and Boenninghausen. 5. Intermittent fever by T.F. Allen. 6. Whooping cough by Boenninghausen and Clarke. 7. Aphorisms of Hippocrates. 8. Boenninghausen`s characteristics of materia medica. 9. Domestic physician by Hering. So, the Boger-Boenninghausen`s repertory in its current form represents the combined wisdom and experience of two masters, Boenninghausen and Boger.

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Philosophical background Boger gave new life to Boenninghausen`s work by refining and enriching the basics and recasting the structure and methodology. This gave a new lease of life to it after it had receded to back stage. Boger attempted to bridge Boenninghausen and Kent. He avoided the extreme

generalisation

of

Boenninghausen

and

extreme

particularisation of Kent. He took the best part of both. Boger subscribed to the principle of totality of symptoms as given by Hahnemann. His concept of complete symptom was comprised of the Location, Sensation, Modalities and Concomitant.

Boger`s work BBCR is based on the following concepts: 1. Complete symptoms and concomitant. 2. Doctrine of pathological generals. 3. Doctrine of causation and time. 4. Evaluation of remedies. 5. Fever totality. 6. Concordances. Concomitant Symptoms Concomitant symptoms are the attendant circumstances \ existing symptoms which accompany or co-exist along with the chief complaint.

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It was defined as the fourth element for a symptom, the other being Location, Sensation & Modalities of the symptom. These symptoms which occurred together or in definite association with a presenting complaint were considered to be more valuable for prescribing and more characteristic of the individual’s reaction as they do not have any connection with the pathology of the case. These are of the same class as the rare, strange and peculiar symptoms. These symptoms can be of immense help in difficult cases. Mostly the concomitant of the symptoms are related to the modalities. So, the concomitant is to totality what the condition of aggravation or amelioration is to a single symptom. This is the differentiating factor for a concomitant. Evaluation of Remedies In Boger Boenninghausen Characteristics and Repertory, the grading of the remedies as done by Boenninghausen has been followed. The remedies are graded into five ranks as follows: CAPITAL

5 marks.

Bold

4 marks.

Italic

3 marks.

Roman

2 marks.

(Roman) in parenthesis 1 mark. The gradation is based on the frequency of appearance of the symptoms in provers.

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Structure of Boger Boenninghausen`s Characteristics and Repertory The main divisions could be divided into seven chapters, as follows – 1. Mind, Intellect, Sensorium and Vertigo. 2. Locations of complaints etc.in different anatomical parts. 3. Sensations in general; Glands, Bones, Skin. 4. Sleep and Dreams. 5. Fever, Blood, Circulation, Chill, Heat, Perspiration. 6. Conditions of Aggravation and Amelioration in general. 7. Relationships of remedies. (Concordances).

In Boenninghausen`s Repertory, Anxiety as a rubric is given on page 192. The main rubric of anxiety is followed by 7 sub-rubrics. It has 101 drugs of which 9 are in Capitals, 21 in Bold, 18 in italics and 53 in roman. In addition to this, there are 12 more remedies found in sub-rubrics that are not found in the main rubric of anxiety. In addition to the main rubric, anxiety is found in 73 various rubrics in various repertories. Anxiety as a concomitant symptom under different chapter of the repertory is edge of this repertory. “Emotions” is substituted for anxiety in some of the chapters under concomitants. A total of 173 remedies run through the rubrics of this book.

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REPERTORIAL REFERENCES OF ANXIETY IN BOGER BOENNINGHAUSEN REPRTORY SYMPTOMS MIND - Absence of mind, lost in thoughts, absent minded MIND - Agitated MIND - Alternating with physical symptoms MIND - Anger, crossness, etc. MIND - Anthropophobia, aversion to others MIND - Anticipations, from MIND - Anxiety, agony MIND - Anxiety, agony - business, about. MIND - Anxiety, agony - head, in MIND - Anxiety, agony - epigastric MIND - Anxiety, agony - abdominal MIND - Anxiety, agony - chest, in MIND - Anxiety, agony - heart, precordial MIND - Anxiety, agony - waking, on. MIND - Aversion to - business MIND - Beclouded, dim MIND - Benumbed MIND - Beside oneself, frantic, madness etc. MIND - Care - full of MIND - Careful, critical, scrupulous, conscientious MIND - Cares, affected by daily MIND - Cautious MIND - Changeable, inconstant, irresolute etc. MIND - Collar, pulls at

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MIND - Company, averse to MIND - Compassion, sympathy (immoderate) MIND - Concentration, difficult MIND - Confusion, befuddled, muddled etc. MIND - Corner, mopes or broods in a MIND - Counting - continued MIND - Cowardly, fainthearted etc. MIND - Death - fear, of MIND - Death - fear, of - sleep, on going to MIND - Death - sensation of MIND - Delirium, frenzy - anxious, fearful, etc MIND - Depression MIND - Despairing, discouraged, hopeless etc MIND - Despairing, discouraged, hopeless etc - recovery, of MIND - Disconsolate, unhappy MIND - Distracted, preoccupied, difficult concentration can’t think* MIND - Dizziness and instability of MIND - Dullness, mental obtuseness MIND - Emotional excitement, effects of MIND - Escape, desire to MIND - Excitable MIND - Excitement MIND - Fastidious MIND - Fearsome, anxiety, dread, frightened easily, etc MIND - Fearsome, etc - air, open, in MIND - Fearsome, etc - alone, of being MIND - Fearsome, etc - anxious, restless fear MIND - Fearsome, etc - apoplexy, of

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MIND - Fearsome, etc - approached, being, strangers, etc MIND - Fearsome, etc - awaking, on MIND - Fearsome, etc - cats MIND - Fearsome, etc - crowds, of MIND - Fearsome, etc - dark, of the MIND - Fearsome, etc - disease, of MIND - Fearsome, etc - dogs, of MIND - Fearsome, etc - door, opening the MIND - Fearsome, etc - driving, when MIND - Fearsome, etc - eaten, being MIND - Fearsome, etc - eating, after MIND - Fearsome, etc - evening, in MIND - Fearsome, etc - evil, bad news, misfortune etc MIND - Fearsome, etc - failure MIND - Fearsome, etc - falling, of MIND - Fearsome, etc - future, of MIND - Fearsome, etc - ghosts, of MIND - Fearsome, etc - hypochondriacal MIND - Fearsome, etc - imaginary MIND - Fearsome, etc - incurable, being MIND - Fearsome, etc - insanity MIND - Fearsome, etc - insensible, becoming MIND - Fearsome, etc - killed, being MIND - Fearsome, etc - knaves MIND - Fearsome, etc - lightening MIND - Fearsome, etc - lying, when MIND - Fearsome, etc - man, of MIND - Fearsome, etc - melancholic

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MIND - Fearsome, etc - morning, in early MIND - Fearsome, etc - nightly MIND - Fearsome, etc - ordeals MIND - Fearsome, anxiety, dread, frightened easily, etc - overpowering MIND - Fearsome, etc - palpitation, with MIND - Fearsome, etc - pins MIND - Fearsome, etc - places, of MIND - Fearsome, etc - poison, of MIND - Fearsome, etc - pregnancy, during MIND - Fearsome, etc - rattling, noises from MIND - Fearsome, etc - recurrent MIND - Fearsome, etc - restless MIND - Fearsome, etc - robbers, of MIND - Fearsome, etc - sadness, alternating with MIND - Fearsome, etc - shadows, of MIND - Fearsome, etc - stomach, from MIND - Fearsome, etc - storms, thunder, of MIND - Fearsome, etc - suffocation, of MIND - Fearsome, etc - tearful MIND - Fearsome, etc - tremulous MIND - Fearsome, etc - twilight, in MIND - Fearsome, etc - undertaking, anything MIND - Fearsome, etc - vexation, after MIND - Fearsome, etc - work, while at MIND - Fretful MIND - Gloomy MIND - Grief, sorrow and care MIND - Held wants to be

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MIND - Helpless MIND - Hiding MIND - Howling MIND - Hurry MIND - Hypochondriasis MIND - Ideas - fixed MIND - Ill Humor, crossness MIND - Illness, sense of and sick feeling MIND - Illness, sense of and sick feeling - imaginary MIND - Illusions, delusions, visions, etc. - frightful MIND - Imaginations, fancies, fixed ideas etc. MIND - Impatience MIND - Impulses, morbid MIND - Inconsolable MIND - Indecision, hesitation MIND - Indolence, averse to work etc. MIND - Insanity, irrational - fear of MIND - Insanity, irrational - obsession, with MIND - Insecurity, mental MIND - Introspective, introverted, absorbed etc. MIND - Irritable, cross MIND - Knife, impulse to injure with MIND - Learning to speak, late in MIND - Low-spirited MIND - Meditation, reflection, brooding, etc. MIND - Meditation, reflection, brooding, etc. - deep, profound MIND - Memories, disagreeable. MIND - Memory - involuntary recollection

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MIND - Memory - poor, weak, forgetful, etc. - emotions, from MIND - Mistrust, suspicious, doubt MIND - Monomania MIND - Mortification MIND - Pain, intolerant of MIND - Peevish, fretful MIND - Pensive, deep in thought MIND - Perplexity MIND - Phantasies - frightful MIND - Play, indisposition to MIND - Plays with fingers MIND - Presentiments, premonitions, forebodings, etc. MIND - Religious ideas MIND - Remorse, condemned feeling etc. MIND - Repeats same thing MIND - Restlessness MIND - Sadness, melancholy MIND - Senses losing, sense of, faintness etc MIND - Sensitive MIND - Shrieking, screams, cries out MIND - Solicitude MIND - Solicitude - of one’s health MIND - Solicitude - for others MIND - Speech - repeats, same thing MIND - Startled easily, terror etc MIND - Strangers, embarrass MIND - Stupefied, dazed MIND - Superstitious

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MIND - Talk - subject, dwells, on one only MIND - Thought, absorbed in MIND - Timidity MIND - Tossing about MIND -Touched, averse to being MIND -Touches, everything. MIND - Trifles, occupied, with MIND - Trifles, vexed over MIND - Uneasiness MIND - Unsociable, shy, averse to society MIND - Vexation, effects of MIND - Wailing MIND - Wanders about, restlessly MIND - Weeping, tearful MIND - Will, weak MIND - Aggravation - Approach of persons MIND - Aggravation - Blood, rushes of, with MIND - Aggravation - Company MIND - Aggravation - Emotions, after MIND - Aggravation - Excitement MIND - Aggravation - Face, heat of, with MIND - Aggravation - Fright MIND - Aggravation - Hurry, from MIND - Aggravation - Palpitation MIND - Aggravation - Restless, when MIND - Aggravation - Strangers, among SENSORIUM - Confusion (in head), muddled etc. SENSORIUM - Faintness, fainting etc.

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VERTIGO - Anxious VERTIGO - Nervous VERTIGO - Aggravation - Emotions VERTIGO - Aggravation - Excitement, mental VERTIGO - Aggravation - Fear VERTIGO - Aggravation - Fright, after VERTIGO - Aggravation - Narrow streets, places, etc. VERTIGO - Aggravation - Walking - path or bridge, on a narrow VERTIGO - Concomitants - Anxiety VERTIGO - Concomitants - Blood, rushes of VERTIGO - Concomitants - Confusion, bewildered etc. VERTIGO - Concomitants - Fear of death VERTIGO - Concomitants - Hypochondriacal mood VERTIGO - Concomitants - Respiration, difficult VERTIGO - Concomitants - Restlessness HEAD - Internal - Anxiety felt in HEAD - Internal - Anxious headache HEAD - Internal - Nervous origin HEAD - Internal - Tension in general HEAD - Internal - Aggravation - Anxiety, with HEAD - Internal - Aggravation - Death, fear of, with HEAD - Internal - Aggravation - Face, hot, with HEAD - Internal - Aggravation - Fright, after HEAD - Internal - Aggravation - Grief HEAD - Internal - Aggravation - Hypochondriacs, in HEAD - Internal - Aggravation - Irritable, cross, with HEAD - Internal - Aggravation - Mental disturbances or emotions HEAD - Internal - Aggravation - Restlessness, with

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HEAD - Internal - Aggravation - Vexation, irritation HEAD - External - Hair - bristling, standing on end, etc. HEAD - External - Hair - pulls her hair, or of others HEAD - External - Aggravation - Emotions, anxiety, etc. EYES - Look - anxious EYES - Nervous, sympathetic reflex to symptoms EYE - Pupils - dilated CORYZA - Concomitants - heart, anxiety at CORYZA - Concomitants - Nervous excitement FACE - Anxious look FACE - Blood, rush of, to FACE - Deathly countenance FACE - Expression - anxious FACE - Expression - confused FACE - Expression - despair, of FACE - Expression - fear, of FACE - Expression - frowning FACE - Expression - miserable FACE - Expression - suffering FACE - Heat FACE - Muscles - drawn FACE - Tension (of skin) FACE - Wrinkled FACE - Wrinkled - forehead, forming etc. FACE - Aggravation - Emotions TEETH - Uneasiness TEETH - Gums - Uneasiness TEETH - Concomitants - Anxiety

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TEETH - Concomitants - Face - heat of TEETH - Concomitants - Restlessness TEETH - Concomitants - Sweat, anxious MOUTH - Dry feeling in MOUTH - Dryness MOUTH - Throat (and gullet) - Anxiety in MOUTH - Throat (and gullet) - Choking, strangling MOUTH - Throat (and gullet) - Foreign body, as of a crump, ball, etc MOUTH - Throat (and gullet) - Globus, as of a ball, lump, knot, hystericus* MOUTH - Throat (and gullet) - Plug, lump etc MOUTH - Throat (and gullet) - Swallowing - difficult MOUTH - Throat (& gullet) - Swallowing - urging to - suffocation, with fear* MOUTH - Throat (and gullet) - uneasiness in WATERBRASH AND HEARTBURN - Risings in throat (gulping up) WATERBRASH AND HEARTBURN - Risings in throat - anxious * NAUSEA AND VOMITING - Nausea NAUSEA AND VOMITING - Nausea - anxiety, with NAUSEA AND VOMITING - Nausea - anxious, deathly, etc. NAUSEA AND VOMITING - Retching and gagging NAUSEA AND VOMITING - Retching and gagging - anxious NAUSEA AND VOMITING - Aggravation - Emotions NAUSEA AND VOMITING - Aggravation - Fright, after NAUSEA AND VOMITING - Concomitants - Fear, anxiety NAUSEA AND VOMITING - Concomitants - Fear, anxiety - death, of NAUSEA AND VOMITING - Concomitants - Irritability NAUSEA AND VOMITING - Concomitants - Restlessness STOMACH - Anxiety at STOMACH - Anxiety at - rising, from

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STOMACH - Digestion, weak STOMACH - Digestion, weak - emotions, from STOMACH - Digestion, weak - hypochondriacs, in STOMACH - Emotions are felt in STOMACH - Epigastrium - Anxiety in, emotions felt there, etc. STOMACH - Epigastrium - Sinking at STOMACH - Aggravation - Anger, vexation - fright, with STOMACH - Aggravation - Emotions STOMACH - Aggravation - Fright, after STOMACH - Concomitants - Anxiousness STOMACH - Concomitants - Hypochondriasis, with HYPOCHONDRIA - Anxiety in liver HYPOCHONDRIA - Aggravation - Emotions ABDOMEN - Anxiety, anguish, etc. in ABDOMEN - Anxiety, anguish, etc. in - rising, from ABDOMEN - Fright, pain as after a ABDOMEN - Uneasiness ABDOMEN - Aggravation - Emotions ABDOMEN - Aggravation - Hypochondriasis, with ABDOMEN - Amelioration - Fright FLATULENCE - Aggravation - Anxiety, with FLATULENCE - Aggravation - Emotions STOOL - Concomitants before stool - Anxiety, fear STOOL - Concomitants before stool - epigastrium - Anxiety in STOOL - Concomitants before stool - Fear, anxiety STOOL - Concomitants before stool - Fear, anxiety - of persons STOOL - Concomitants before stool - Uneasiness, discomfort STOOL - Concomitants during stool - Anxiety

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STOOL - Concomitants after stool - Anxiety, fear, etc. STOOL - Concomitants after stool - Fear, anxiety STOOL - Aggravation and amelioration - Emotions, anger, fright etc STOOL - Aggravation and amelioration - Fear, anxiety; with STOOL - Aggravation and amelioration - Fear - others, of URINE - Micturition - Urging - anxiety, with URINE - Micturition - Urination - strangury - fear, fright, etc., agg. URINE - Before urination - Anxiety URINE - Before urination - Fright URINE - During urination - Anxiety URINARY ORGANS - Bladder - Anxiety SEXUAL IMPULSE - Semen - emission of - anxiety, then SEXUAL IMPULSE - Concomitants after coition - Anxiety SEXUAL IMPULSE - Concomitants after pollutions - Heat, anxious RESPIRATION - Anxious RESPIRATION - Short RESPIRATION - Impeded by - Anxiety RESPIRATION - Impeded by - Dreams, anxious RESPIRATION - Impeded by - Epigastrium - anxiety in COUGH - Anxious COUGH - Sympathetic reflex COUGH - Concomitants - anxiety, fear VOICE AND SPEECH - Anxious CHEST - Inner - anxiety in CHEST - Inner - constriction CHEST - Inner - oppression CHEST - Heart and region of - agitated CHEST - Heart and region of - anguish

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CHEST - Heart and region of - anxiety at CHEST - Heart and region of - distress CHEST - Heart and region of - uneasiness CHEST - Aggravation - anxiety BACK - Back proper, dorsal region - anxious sensation BACK - Lumbar region, small of back - uneasiness, in LOWER EXTREMITIES - Gait - anxious SENSATIONS & COMPLAINTS IN GEN - Anxious feeling - internal anxiety* SENSATIONS & COMPLAINTS IN GEN - Anxious feeling - In limbs SENSATIONS & COMPLAINTS IN GEN - Fainting, faintness etc SENSATIONS & COMPLAINTS IN GEN - Fainting - emotions* SENSATIONS & COMPLAINTS IN GEN - Hypochondriasis & hysteria SENSATIONS & COMPLAINTS IN GEN - Irritability SENSATIONS & COMPLAINTS IN GEN - Muscles - tense SENSATIONS & COMPLAINTS IN GEN - Restlessness SENSATIONS & COMPLAINTS IN GEN – Starting, as if in affright SENSATIONS & COMPLAINTS IN GEN - Trembling, shaking etc SLEEP - Falling to sleep, late - prevented by - agitation SLEEP - Falling to sleep, late - prevented by - anxiety, fear SLEEP - Falling to sleep, late - prevented by - blood, orgasm of SLEEP - Falling to sleep, late - prevented by - chest, oppression of SLEEP - Falling to sleep, late - prevented by - emotions, from SLEEP - Falling to sleep, late - prevented by - falling, fear of SLEEP - Falling to sleep, late - prevented by - frightened, easily SLEEP - Falling to sleep, late - prevented by - restlessness SLEEP - Falling to sleep, late - prevented by - starting SLEEP - Falling to sleep, late - prevented by - startled, as if SLEEP - Sleep - anxious

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SLEEP - Sleep – restless SLEEP - During sleep - anxiety SLEEP - During sleep - nightmare SLEEP - During sleep - nightmare - in first sleep SLEEP - During sleep – starting up (as in an affright) SLEEP - Waking - waking - anxious SLEEP - Waking - waking – fright, as from SLEEP - Waking - waking - restlessness, with SLEEP - Waking - sleeplessness - fear or anxiety SLEEP - Waking - sleeplessness - palpitation SLEEP - Waking - sleeplessness - tossing about - anxious SLEEP - Waking - sleeplessness - worry DREAMS - Anxious, frightful, etc. DREAMS - Anxious, frightful, etc - of animals. DREAMS - Anxious, frightful, etc - day’s events of DREAMS - Anxious, frightful, etc - the dead DREAMS - Anxious, frightful, etc - difficulties, perplexity* DREAMS - Anxious, frightful, etc - disease DREAMS - Anxious, frightful, etc - dying of DREAMS - Anxious, frightful, etc - exertion, laborious, etc DREAMS - Anxious, frightful, etc - falling DREAMS - Anxious, frightful, etc - fire DREAMS - Anxious, frightful, etc - forms of DREAMS - Anxious, frightful, etc - ghosts DREAMS - Anxious, frightful, etc - heavy DREAMS - Anxious, frightful, etc - lewd DREAMS - Anxious, frightful, etc - loathsome DREAMS - Anxious, frightful, etc - misfortune, fatal accidents

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DREAMS - Anxious, frightful, etc - pursued being DREAMS - Anxious, frightful, etc - quarrels and strife DREAMS - Anxious, frightful, etc - shooting DREAMS - Anxious, frightful, etc - thieves DREAMS - Anxious, frightful, etc - thunderstorms DREAMS - Anxious, frightful, etc - vivid DREAMS - Anxious, frightful, etc - voyages DREAMS - Anxious, frightful, etc - war DREAMS - Anxious, frightful, etc – water DREAMS - Restless, disturbed CIRCULATION - Congestions - ebullition, rush of blood, flashing, orgasms* CIRCULATION - Palpitation - anxious CIRCULATION - Palpitation - audible CIRCULATION - Palpitation - blood rushes of, with CIRCULATION - Palpitation - breathing, with short CIRCULATION - Palpitation - chest, oppression in, with CIRCULATION - Palpitation - chest, pain in, with CIRCULATION - Palpitation - emotion from CIRCULATION - Palpitation - faintness, with CIRCULATION - Palpitation - nausea, with CIRCULATION - Palpitation - shaking whole body CIRCULATION - Palpitation - sweat, with cold CIRCULATION - Palpitation - violent CIRCULATION - Heartbeat - heartbeat - audible CIRCULATION - Heartbeat - heartbeat - shaking the whole body CIRCULATION - Heartbeat - heartbeat - tumultuous and stormy CIRCULATION - Pulse - pulse - quick (accelerated) CIRCULATION - Pulse - pulse - shaking the whole body

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CIRCULATION - Aggravation - Emotions CHILL - Chill, etc - Aggravation - Emotions CHILL - Chill, etc. - concomitants - mind - anxiety CHILL - Chill, etc. - concomitants - chest - palpitation CHILL - Chill, etc. - concomitants - skin - goose skin HEAT & FEVER IN GENERAL - Heat and burning - anxious HEAT & FEVER IN GENERAL - Aggravation - Emotions HEAT & FEVER IN GENERAL - Concomitants - mind - anthropophobia HEAT & FEVER IN GENERAL - Concomitants - mind - anxiety HEAT & FEVER IN GENERAL - Concomitants - mind - delirium - anxious HEAT & FEVER IN GENERAL - Concomitants - mind - fear HEAT & FEVER IN GENERAL - Concomitants - mind - frightened easily HEAT & FEVER IN GENERAL - Concomitants - mind - restlessness HEAT & FEVER IN GEN. - Concomitants - respiration - breathing - anxious HEAT & FEVER IN GEN. - Concomitants - chest - heart - anxious SWEAT - Sweat, sweatiness - anxious SWEAT - Concomitants - mind - anthropophobia SWEAT - Concomitants - mind - anxiety SWEAT - Concomitants - mind - death, fear of SWEAT - Concomitants - mind – frightened easily SWEAT - Concomitants - mind - restlessness SWEAT - Concomitants - mouth - mouth - dryness, of SWEAT - Concomitants - respiration - breathing - anxious, quick* SWEAT - Concomitants - respiration - breathing – oppression, of SWEAT - Concomitants - chest - heart, palpitation of SWEAT - Concomitants - sensations & generalities - restlessness* CONDITIONS OF AGG.\ AMEL. IN GEN - Emotions, agg. CONDITION OF AGG\ AMEL IN GEN - Emotions - anger - anxiety, agg.*

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CONDITION OF AGG\ AMEL IN GEN - Emotions - fright (anxiety) - agg* CONDITION OF AGG\ AMEL IN GEN - Emotions - fright - of an ordeal CONDITION OF AGG\ AMEL IN GEN - Society, company, agg*. CONDITION OF AGG\ AMEL IN GEN - Strangers, when among agg CONDITION OF AGG\ AMEL IN GEN - Walking - narrow bridge, agg* * - symptom slightly altered to fit the format

REPERTORIAL REFERENCES FROM OTHER REPERTORIES. The Rubrics relating to anxiety are also found in other repertories such a Synthesis, Synthetic, Knerr`s repertory and Phatak`s repertory. Only those rubrics which are present in these repertories and not in Kent and Boenninghausen are highlighted here. SYNTHESIS REPR 5.2 MIND - AILMENTS FROM - anxiety - prolonged, from MIND - ANGUISH - eating, after MIND - ANTICIPATION - examination, before MIND - ANTICIPATION - stage fright MIND - ANXIETY - night - children, in MIND - ANXIETY - beside oneself from anxiety, being MIND - ANXIETY - breakfast - amel. MIND - ANXIETY - burning of stomach and coldness of body; with MIND - ANXIETY - cough - whooping, during MIND - ANXIETY - face - heat of face; with MIND - ANXIETY - face - pale face; with

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MIND - ANXIETY - face - perspiration of face; with MIND - ANXIETY - face - perspiration of face; with - cold MIND - ANXIETY - face - red face; with MIND - ANXIETY - flatus - obstructed flatus; with MIND - ANXIETY - sexual desire; from suppressed MIND - ANXIETY - swoon, after MIND - ANXIETY - torturing MIND - ANXIETY - wine, after MIND - BITE, desire to - nails MIND - CLINGING - take the hand of mother, will always MIND - CONCENTRATION - difficult - attention, cannot fix MIND - DELIRIUM - terror, expressive of MIND - FEAR - cancer, of MIND - FEAR - control, losing MIND - FEAR - crossing Street MIND - FEAR - elevators, of MIND - FEAR - everything, constant of MIND - FEAR - failure of - examinations; in MIND - FEAR - fright - previous fright; because of a MIND - FEAR - full of fear MIND - FEAR - open space; fear of MIND - FEAR - shadows MIND - FEAR - shadows - candlelight; thrown by MIND - FEAR - wolves, of MIND - IMPULSE, morbid - absurd things; to do MIND - IRRITABILITY - imagined occurrences, about MIND - RESTLESSNESS - driving about MIND - STARING - thoughtless

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MIND - STUPEFACTION - anxiety, with MIND - SUICIDAL disposition - anxiety, from MIND - WEEPING - anxious HEAD - CONGESTION - anxiety, with HEAD - HEAT - anxiety, with HEAD - PERSPIRATION of scalp - forehead - cold - trembling anxiety, with VISION - DIM - anxiety, during FACE - HEAT - anxiety, during FACE - PERSPIRATION - anxiety, with FACE - TENSION of skin - masseter muscles ABDOMEN - RESTLESSNESS, uneasiness - anxious RECTUM - DIARRHOEA - anxiety, after CHEST - CONSTRICTION - anguish, with CHEST - PAIN - aching - anxiety, with SLEEP - DISTURBED - perspiration by - anxiety, from SLEEP - SLEEPINESS - anxiety, with GENERALS - CONULSIONS - anxiety, from

SYNTHETIC REPERTORY (VOL 1, 2 & 3).

VOLUME 1 - PSYCHIC SYMPTOMS MIND - ABSORBED - future, about MIND - ABSORBED - misfortunes, imagines MIND - AILMENTS FROM - anticipation MIND - AILMENTS FROM - anxiety MIND - AILMENTS FROM - cares, worries MIND - AILMENTS FROM - fear

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MIND - AILMENTS FROM - fright MIND - AILMENTS FROM - fright - accident; from sight of an MIND - AILMENTS FROM - shock, mental MIND - ANGER - causeless MIND - ANGER - happen; anger at what he thinks may MIND - ANGER - trifles, at MIND - ANGUISH - noon MIND - ANGUISH - afternoon MIND - ANGUISH - evening, 7 p.m. MIND - ANGUISH - night - paralyzing anguish, impossible to call or move* MIND - ANGUISH - alone, when MIND - ANGUISH - bed - after going to bed amel. MIND - ANGUISH - cardiac MIND - ANGUISH - clothes too tight when walking in open air; as if MIND - ANGUISH - constricted, as if everything became MIND - ANGUISH - driving from place to place - restlessness, with MIND - ANGUISH - horrible things; after hearing MIND - ANGUISH - lamenting, moaning MIND - ANGUISH - lie down, must MIND - ANGUISH - motion amel. MIND - ANGUISH - nausea, with MIND - ANGUISH - oppression, with MIND - ANGUISH - oppression, with - desire to sit up or jump out of bed MIND - ANGUISH - palpitation, with MIND - ANGUISH - perspiration, during - night MIND - ANGUISH - respiration, preventing MIND - ANGUISH - room with light and people, agg, in a MIND - ANGUISH - tossing about, with

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MIND - ANGUISH - tremulous anguish, rest agg, motion amel. MIND - ANGUISH - uremia, in MIND - ANGUISH - waking, on MIND - ANGUISH - weeping, with MIND - ANTICIPATION - morning MIND - ANTICIPATION - dentist, physician; before going to MIND - ANTICIPATION - stage fright - singers and speakers, in MIND - ANXIETY - morning - perspiration; during MIND - ANXIETY - afternoon - 2 - 4 p.m. MIND - ANXIETY - afternoon - amel. MIND - ANXIETY - night - amel. MIND - ANXIETY - night - midnight - after - half waking; on MIND - ANXIETY - night - midnight - after - 2-4 h MIND - ANXIETY - night - midnight - after - 3-5 h MIND - ANXIETY - night - midnight - after - 5 h MIND - ANXIETY - abdomen; with distension of MIND - ANXIETY - alternating with - contentment MIND - ANXIETY - alternating with - exhilaration MIND - ANXIETY - alternating with - rage MIND - ANXIETY - anticipation, from MIND - ANXIETY – bed in, driving out of MIND - ANXIETY - bed, in - heat of, from MIND - ANXIETY - bed, in - sit up, must MIND - ANXIETY - bed, in - tossing about, with MIND - ANXIETY - bed, in - turning in, when MIND - ANXIETY - beer, after MIND - ANXIETY - breathing - must breathe deeply MIND - ANXIETY - causeless

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MIND - ANXIETY - chest, in - stitching in, from MIND - ANXIETY - children - infants, in MIND - ANXIETY - children - rocking, during MIND - ANXIETY – climacteric period, during MIND - ANXIETY - clothes and open windows, must loose MIND - ANXIETY - clothes - as if clothing too tight, walking out of doors; MIND - ANXIETY - coffee - amel. MIND - ANXIETY - coition - during MIND - ANXIETY - coldness of feet at night, during MIND - ANXIETY - congestion - to heart MIND - ANXIETY - conscience; as if guilty of a crime - afternoon MIND - ANXIETY - conscience; as if guilty of a crime - dreams, a. of c. in MIND - ANXIETY - conscience; as if guilty of a crime - no rest night / day * MIND - ANXIETY - convulsions - before MIND - ANXIETY - cramping rectum, during MIND - ANXIETY - cramping stomach, in MIND - ANXIETY - daily MIND - ANXIETY - dancing, when MIND - ANXIETY - dentition, during MIND - ANXIETY - disguises; which he vainly MIND - ANXIETY - do something; compelled to MIND - ANXIETY - drinking - cold water amel. MIND - ANXIETY - driving from place to place MIND - ANXIETY - duty, as if he had not done his MIND - ANXIETY - epilepsy, during intervals of MIND - ANXIETY - epistaxis amel. MIND - ANXIETY - eructations - ending with MIND - ANXIETY - everything; about

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MIND - ANXIETY - exercise - from MIND - ANXIETY - faintness, with MIND - ANXIETY - family; about his MIND - ANXIETY - fasting, when MIND - ANXIETY - fever - as from MIND - ANXIETY - fright - remains, if the fear of the fright MIND - ANXIETY - head, with congestion to MIND - ANXIETY - head - heat of; with MIND - ANXIETY - head - perspiration on forehead; with MIND - ANXIETY - health; about - relatives, of MIND - ANXIETY - himself, about MIND - ANXIETY - home, about MIND - ANXIETY - hurry, with MIND - ANXIETY - hysterical MIND - ANXIETY - inactivity, with MIND - ANXIETY - joyful things, by most MIND - ANXIETY - masturbation, from MIND - ANXIETY - menses - during - anger and a. MIND - ANXIETY - moaning, with MIND - ANXIETY - money matters, about MIND - ANXIETY - noise, from - in ear MIND - ANXIETY - nursing, after MIND - ANXIETY - oppression, with MIND - ANXIETY - pains, from - abdomen MIND - ANXIETY - pains, from - anus MIND - ANXIETY - pains, from - eyes MIND - ANXIETY - pains, from - stomach MIND - ANXIETY - paralyzed, as if

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MIND - ANXIETY - parturition, during MIND - ANXIETY - perspiration amel. MIND - ANXIETY - perspiration - with cold MIND - ANXIETY - pregnancy, in MIND - ANXIETY - present, about MIND - ANXIETY - pressure in the chest, from MIND - ANXIETY - pressure in the epigastrium, from MIND - ANXIETY - pulsation in the abdomen, with MIND - ANXIETY - pursued, as if MIND - ANXIETY - rest; during MIND - ANXIETY - rising, after - from lying MIND - ANXIETY - room, on entering a MIND - ANXIETY - salvation, about - night MIND - ANXIETY - salvation, about - faith, about loss of his MIND - ANXIETY - salvation, about - hell, of MIND - ANXIETY - salvation, about - scruples, excessifs religious MIND - ANXIETY - salvation, about - scrupulous their religious practices* MIND - ANXIETY - sitting - bent -must MIND - ANXIETY - stitching in spine, from MIND - ANXIETY - stools, after - bloody MIND - ANXIETY - stools, as for MIND - ANXIETY - stormy weather, during MIND - ANXIETY - success, from doubts about MIND - ANXIETY - thoughts; from - disagreeable MIND - ANXIETY - thoughts; from - sad MIND - ANXIETY - thunderstorm, before MIND - ANXIETY - touched, anxiety to being MIND - ANXIETY – tunnel in a train, in

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MIND - ANXIETY - urination, when the desire is resisted MIND - ANXIETY - urination, with urging to MIND - ANXIETY - vomiting, on MIND - ANXIETY - walking, amel. MIND - ANXIETY - walking, after MIND - ANXIETY - walking, cool air, in MIND - ANXIETY - weary of life, with MIND - ANXIETY - work, anxiety with inclination to MIND - ANXIETY - work - anxiety preventing MIND - ANXIETY - working, while MIND - AVARICE - anxiety about future, from MIND - BESIDE oneself being - anxiety, from MIND - BESIDE oneself being - trifles, from MIND - CARES, worries, full of - business, about his MIND - CARES, worries, full of - others, about MIND - CARES, worries, full of - relatives, about MIND - DELUSIONS - anxious MIND - DELUSIONS - doomed, being MIND - DELUSIONS - fright, after MIND - DELUSIONS - heart disease, having an MIND - DISCOURAGED - anxiety, with MIND - DWELLS - recalls - disagreeable memories MIND - ESCAPE, attempts to - anxiety at night, with MIND - FEAR - alternating with exhilaration MIND - FEAR - alternating with rage MIND - FEAR - alternating with sadness MIND - FEAR - appearing in public, of MIND - FEAR - ascending of

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MIND - FEAR - blind, of going MIND - FEAR - business, of MIND - FEAR - cats MIND - FEAR - children, in MIND - FEAR - company, of MIND - FEAR - crossing bridge or a place MIND - FEAR - crowd, in a - climacteric period, during MIND - FEAR - death of - impending death, of MIND - FEAR - delusions, from MIND - FEAR - diarrhea, from MIND - FEAR - disease of impending - incurable of being MIND - FEAR - dreams, of terrible MIND - FEAR - enemies, of MIND - FEAR - escape; with desire to MIND - FEAR - examination, before MIND - FEAR - failure of MIND - FEAR - falling, of - child holds on to the mother MIND - FEAR - going out, of MIND - FEAR - hanged, to be MIND - FEAR - happen, something will - night MIND - FEAR - humiliated of being MIND - FEAR - insanity, losing his reason, of – climacteric period, during MIND - FEAR - insects, of MIND - FEAR - knaves, of MIND - FEAR - knives, of MIND - FEAR - lifelong MIND - FEAR - lightning, of MIND - FEAR - menses, after

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MIND - FEAR - menses, suppressed - from fear MIND - FEAR - motion, of MIND - FEAR - narrow places - vaults, churches & cellars, of MIND - FEAR - neglected, of being MIND - FEAR - new persons, of MIND - FEAR - operation, of each MIND - FEAR - opinion of others, of MIND - FEAR - ordeals, of MIND - FEAR - overpowering MIND - FEAR - palpitation, with MIND - FEAR - perspiration, with MIND - FEAR - pitied, of being MIND - FEAR - position, to lose his lucrative MIND - FEAR - rage, to fly into a MIND - FEAR - rail, of going by MIND - FEAR - recover, he will not MIND - FEAR - recover, he will not - climacteric period, during MIND - FEAR - recurrent MIND - FEAR - reproaches, of MIND - FEAR - restlessness from fear MIND - FEAR - robbers - waking, on MIND - FEAR - sadness, with MIND - FEAR - scorpions, of MIND - FEAR - shadows - his own shadow; of MIND - FEAR - shivering from fear MIND - FEAR - sighing, with MIND - FEAR - smallpox, of MIND - FEAR - snakes, of

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MIND - FEAR - solitude, of MIND - FEAR - spiders, of MIND - FEAR - starting, with MIND - FEAR - stool, of involuntary MIND - FEAR - stoppage of circulation, with sensation of (at night) MIND - FEAR - strangled, to be MIND - FEAR - struck by those coming towards him, of being MIND - FEAR - suffocation, of - eating amel. MIND - FEAR - suffocation, of - heart disease, in MIND - FEAR - suffocation, of - sleep, during MIND - FEAR - telephone, of MIND - FEAR - things, of real and unreal MIND - FEAR - torturing, of MIND - FEAR - tremulous MIND - FEAR - tunnels; of MIND - FEAR - unconsciousness, of MIND - FEAR - urine, from - retention, of MIND - FEAR - work, dread of - afternoon MIND - FEAR - work, dread of - daily; of MIND - FEAR - work, dread of – mental, of MIND - FRIGHTENED easily - noon - nap, after MIND - FRIGHTENED easily - evening MIND - FRIGHTENED easily - blood, at sight of MIND - FRIGHTENED easily - delusions, from MIND - FRIGHTENED easily - shadow, of his own MIND - FRIGHTENED easily - waking, on - dream, from a MIND - IMPULSE, morbid MIND - INDIFFERENCE - anxiety, after

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MIND - IRRITABILITY - anxiety, with MIND - JUMPING - bed; out of - frightful dream, from a MIND - KILL; desire to - beloved ones MIND - KILL; desire to - child, the own MIND - KILL; desire to - poison, impulse to MIND - LAMENTING - anxious MIND - MOANING, groaning - anxious MIND - MOANING, groaning - restlessness, with MIND - STUPEFACTION - anxiety, with MIND - SUICIDAL disposition - anxiety, from MIND - THOUGHTS - tormenting - past disagreeable events, about MIND - WEEPING - anxiety, after MIND - WEEPING - anxious MIND - WEEPING - evil impended, as if MIND - WEEPING - future, about the MIND - WEEPING - nightmare, after MIND - WITHDRAWAL from reality

VOLUME 2 - GENERAL SYMPTOMS GENERALITIES - CHOREA - anxiety, from GENERALITIES - FAINTNESS - anguish, after GENERALITIES - ORGASME OF BLOOD - anxiety with GENERALITIES - TREMBLING - anxiety – with

VOLUME 3 – SLEEP, DREAMS & SEXUALITY MALE GENITALIA/SEX - MASTURBATION, irresistible tendency SLEEP - DISTURBED - anxiety, from SLEEP - DISTURBED - visions, by - anxious

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SLEEP - RESTLESS - anxiety, with SLEEP - SLEEPINESS - anxiety, with SLEEP - SLEEPLESSNESS - visions, from - anxious SLEEP - WAKING - frequent - anxiety, with SLEEP - YAWNING - anxiety, during DREAMS - ANXIOUS - anxiety amel. on waking DREAMS - ANXIOUS - siesta, during DREAMS - FRIGHTFUL - fear, followed by DREAMS - FRIGHTFUL - waking him DREAMS - NIGHTMARES - falling sleep. On DREAMS - NIGHTMARES - full moon, at

KNERR`S REPERTORY MIND - ANGUISH - abortion, in threatened MIND - ANGUISH - amenorrhoea, in MIND - ANGUISH - anger, after MIND - ANGUISH - choking, from MIND - ANGUISH - cholera, in MIND - ANGUISH - colic, with MIND - ANGUISH - dyspnoea, with MIND - ANGUISH - fainting, before MIND - ANGUISH - fever, with MIND - ANGUISH - headache, in MIND - ANGUISH - hysteria, in MIND - ANGUISH - loss of his friend, from MIND - ANGUISH - meningitis, in MIND - ANGUISH - metrorrhagia, in MIND - ANGUISH - peritonitis, in

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MIND - ANGUISH - perspiration, with cold - forehead, on MIND - ANGUISH - restlessness, with MIND - ANGUISH - shock from injury, in MIND - ANGUISH - stormy weather, in MIND - ANGUISH - suicide, attempts to commit MIND - ANGUISH - toothache, with MIND - ANGUISH - vomiting, with MIND - ANGUISH - whooping cough, during MIND - ANTICIPATION - feels matters sensitively before they occur * MIND - ANTICIPATION - unusual ordeal, of any MIND - ANXIETY - forenoon - better after little whiskey MIND - ANXIETY - accident; as if - would happen MIND - ANXIETY - alone; when - evening MIND - ANXIETY - alone; as if - and all about were dead and still MIND - ANXIETY - amenorrhea; during MIND - ANXIETY - apathy, followed by MIND - ANXIETY - aphonia, in MIND - ANXIETY - arms, had to stretch MIND - ANXIETY - ascites; during MIND - ANXIETY - asthma; with MIND - ANXIETY - attacks in - cannot control herself MIND - ANXIETY - back - small of - paralytic pain with MIND - ANXIETY - bladder paralysis, with MIND - ANXIETY - bronchitis, with MIND - ANXIETY - business, about - dyspepsia, from MIND - ANXIETY - chest, in - congestion, with MIND - ANXIETY - chest, in - effusion of serum, with MIND - ANXIETY - chest, in - gastralgia, with

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MIND - ANXIETY - chest, in - palpitations and bitter eructations, with MIND - ANXIETY - cheerful, careless mood, after MIND - ANXIETY - chorea, in MIND - ANXIETY - complaints, with all bodily MIND - ANXIETY - confusion before eyes, after MIND - ANXIETY - continued - anasarca, in MIND - ANXIETY - crime - committing, as if MIND - ANXIETY - domestic affairs about - pregnancy during MIND - ANXIETY - flatulent distention - from MIND - ANXIETY - fly away, as if she must, no peace anywhere MIND - ANXIETY - fright, after - seventh month of pregnancy, in MIND - ANXIETY - friend had forsaken her, as if MIND - ANXIETY - future, about - childbed, after MIND - ANXIETY - future, about - chronic orchitis, with MIND - ANXIETY - future, about - disgust of life, with MIND - ANXIETY - future, about - spermatorrhoea, with MIND - ANXIETY - gloomy forebodings, with MIND - ANXIETY - head - heat of; with - cold feet, and MIND - ANXIETY - mania, in MIND - ANXIETY - melancholy, with MIND - ANXIETY - restlessness, with MIND - ANXIETY - suffering, with MIND - ANXIETY - terrible MIND - ANXIETY - twitching, with * MIND - ANXIETY - typhus, in MIND - ANXIETY - unconquerable MIND - ANXIETY - vaccination, after MIND - APPREHENSIONS

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MIND - APPREHENSIONS - anxious MIND - APPREHENSIONS - bad news - would soon hear, as if MIND - APPREHENSIONS - chlorosis, in MIND - APPREHENSIONS - control, loss of - with feeling of MIND - APPREHENSIONS - disease, of MIND - APPREHENSIONS - disease, of – diarrhea, in MIND - APPREHENSIONS - disease, of - fatal termination, of MIND - APPREHENSIONS - emission, after MIND - APPREHENSIONS - evil, of - with sadness and weeping MIND - APPREHENSIONS - menses, after MIND - APPREHENSIONS - night - cannot remain in bed MIND - APPREHENSIONS - room seemed gloomy and unpleasant MIND - APPREHENSIONS - weep, with inclination to MIND - APPREHENSIONS - wrong, of something indescribable MIND - CONSCIENCE - over conscientious MIND - FEAR - amenorrhoea from fear MIND - FEAR - anorexia from fear MIND - FEAR - bed, jumps out of - fear from MIND - FEAR - breath away, takes MIND - FEAR - coition - during - impotence from fear, with MIND - FEAR - crazy, of becoming - fright, after MIND - FEAR - crazy, of becoming - with restlessness & heat MIND - FEAR - death of - amenorrhoea, in MIND - FEAR - death of - anger, from MIND - FEAR - death of - cholera, in MIND - FEAR - death of - hemorrhage, in uterine MIND - FEAR - death of - loquacity, with MIND - FEAR - death of - prolapse of uterus; with

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MIND - FEAR - death of - suffocation, from MIND - FEAR - death of - uterus; from pain in MIND - FEAR - surgeon, of MIND - FEAR - touched; of being - gout, in MIND - FEAR - weary of life, with MIND - FEAR - work, of - persuaded to work; cannot be MIND - FEAR - wrong of something - commit something MIND - FOREBODINGS - brain fag, with MIND - FOREBODINGS - constant MIND - FOREBODINGS - dysmenorrhoea, in MIND - FOREBODINGS - evil MIND - FOREBODINGS - impending disaster, of MIND - HASTY - heart, with anxiety and fluttering MIND - HYPOCHONDRIASIS - anxiety, with MIND - INCONSOLABLE - anxiety about his family during a short journey* MIND - RELIGIOUS - mania - prays all the time MIND - RUNS about - as if in fright MIND - SADNESS - impending evil, with apprehension of MIND - TALKING - misfortune, about MIND - THOUGHTS - terrible - take possession of him MIND - UNEASY MIND - WORRY MIND - WRITING - unable to as rapidly as he wishes, anxious, makes mistakes* FACE - EXPRESSION - anxious - fear of death, with FACE - EXPRESSION - fear - and terror STOMACH - ANXIETY - apprehensive FEMALE GENITALIA/SEX - menses - too late - anxiety, with DREAMS - ANXIOUS - palpitation, with

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DREAMS - ANXIOUS - talking and crying in sleep, with DREAMS - ANXIOUS - weeping during sleep, with

PHATAK`S REEPRTORY

MIND - BORROWS trouble MIND - CARE & WORRY - causeless MIND - FEAR - hurt, of being MIND - FEAR - sharp things, of MIND - FEAR - stool, after MIND - FEAR - waking, on - slowly must, otherwise something will happen * GENERALITIES - FORMICATION, crawling - anxiety, with



Rubric altered a little to fit the format

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MATERIALS AND METHODS MATERIALS This study is on the patients attending my own clinics. It is based on clinical study on the patients from Mar 2005 to Feb 2006. Medicine sources: Medicines prepared by reliable and reputed companies like SBL, Medisynth, Willmar Schwabe, India; available at my own clinics are used. Potencies of medicines being used are 30, 200, 1M, 10M. Globule no 10 and sugar of milk are used for dispensing the medicines. Rectified Spirit and distilled water is used for dispensing of medicine as and when required. Placebo is used in 10 no. globules. Medicine Selection: Medicine is selected after proper case taking, using a standard format for recording (please refer Appendix) and repertorisation. The potency selection is made on the basis of susceptibility and individualization. A single dose of the selected medicine is given followed by placebo. Inclusion criteria:

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▪ Patients of ages 10 to 65, of both sex, of different socio-economic status and different habits, having anxiety disorder are included in this study. ▪ For the purpose of this study, 30 cases are taken. ▪ The diagnostic criteria of the DSM- IV is used for diagnosing & differentiating the different types of anxiety disorders. (As given in Materials and Methods). ▪ Patients already on other medication for anxiety disorder are also included. Exclusion criteria: The cases which either do not follow our instructions, or do not attend clinics / follow ups have been excluded.

METHODS To fulfill our aim and objectives, 30 cases of anxiety disorder are studied from my clinics (1 in urban area and 1 in rural area.). The data during case - taking is collected in accordance to the Homoeopathic principles.

Instructions before case taking: The patients are instructed to be free and frank in providing us fullest information possible. Also the importance of each question asked and its importance in selection of the correct Homoeopathic remedy is

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stressed. They are also assured about the confidentiality of the information. Confirmation and completion of data Case is further confirmed and completed from observers, attendants and family members, for the authenticity. Allopathic Medication Some of the patients are already on allopathic medication for anxiety when their Homoeopathic treatment is started. The allopathic medication is not disturbed initially and the Homoeopathic medicine is started in addition to that. During the course of treatment, as per the response of the patient the allopathic medication is tapered & stopped. Psychotherapy No Psychotherapy is used during this study, to observe the effects of homoeotherapeutics only. Precautions advised During the treatment, the patients are advised to keep away from factors that might aggravate their conditions in addition to Alcohol, Coffee, and Tobacco etc.

Medicine Repetition The minimum dose of the medicine is repeated only when there is recurrence or aggravation of symptoms.

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DSM IV Criteria for the Anxiety Disorders: Generalized Anxiety Disorder A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not, for at least 6 months, about a number of events or activities (such as work or school performance). B. The person finds it difficult to control the worry. C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not, for the past 6 months). Note: Only one item is required in children. •

Restlessness or feeling keyed up or on edge

•

Being easily fatigued

•

Difficulty concentrating or mind going blank

•

Irritability

•

Muscle tension

•

Sleep disturbance (Difficulty falling or staying asleep or restless, unsatisfying sleep)

D. The focus of the anxiety and worry is not confined to features of an Axis I disorder, eg, the anxiety or worry is not about having a panic attack (as in Panic Disorder), being embarrassed in public (as in social phobia), being contaminated (as in obsessive-compulsive disorder), being away from home or close relatives (as in separation anxiety disorder), gaining weight (as in anorexia nervosa), having multiple physical complaints (as in somatization disorder), or having a serious

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illness (as in hypochondriasis), and the anxiety and worry do not occur exclusively during post-traumatic stress disorder. E. The anxiety, worry or physical symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning. F. The disturbance is not due to the direct physiological effects of a substance (eg, a drug of abuse, a medication) or a general medical condition (eg, hyperthyroidism) and does not occur exclusively during a mood disorder, a psychotic disorder, or a Pervasive Developmental Disorder. Criteria for the Anxiety Disorders: Panic Attack A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes: •

Palpitations, pounding heart, or accelerated heart rate

•

Sweating

•

Trembling or shaking

•

Sensations of shortness of breath or smothering

•

Feeling of choking

•

Chest pain or discomfort

•

Nausea or abdominal distress

•

Feeling dizzy, unsteady, lightheaded, or faint

•

Derealization (feelings of unreality) or depersonalization (being

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Detached from oneself) •

Fear of losing control or going crazy

•

Fear of dying

•

Paresthesias (numbness or tingling sensations)

•

Chills or hot flushes

DSM IV Criteria for the Anxiety Disorders: Panic Disorder A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes: A. Both (1) and (2): 1.

Recurrent unexpected panic attacks

2.

At least one of the attacks has been followed by 1 month (or more) of one or more of the following:

a.

Persistent concern about having additional panic attacks

b.

Worry about the implications of the attack or its consequences

c.

A significant change in behavior related to the attacks

B. Presence or absence of agoraphobia C. The panic attacks are not due to the direct physiological effects of a substance (eg, a drug of abuse, a medication) or a general medical condition (eg, hyperthyroidism). D. The panic attacks are not better accounted for by another mental disorder.

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DSM IV Criteria for the Anxiety Disorders: Obsessive Compulsive Disorder A. Either obsessions or compulsions: Obsessions as defined by (1), (2), (3) and (4): 1. Recurrent and persistent thoughts, impulses, or images that are Experienced, at some time during the disturbance, as intrusive and Inappropriate and that cause marked anxiety or distress. 2. The thoughts, impulses or images are not simply excessive worries about Real-life problems. 3. The person attempts to ignore or suppress such thoughts, impulses or images, or to neutralize them with some other thought or action. 4. The person recognizes that the obsessional thoughts, impulses or images are a product of his or her own mind (not imposed from without as in thought insertion). Compulsions as defined by (1) and (2): 1. Repetitive behaviors (eg, hand washing, ordering, checking) or mental acts (eg, praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly. 2.The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

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B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children. C. The obsessions or compulsions cause marked distress, are timeconsuming (more than 1 hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships. D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it. E. The disturbance is not due to the direct physiological effects of a substance or a medical condition. Specify if: With Poor Insight: If, for most of the time during the current episode, the person does not recognize that the obsessions and compulsions are excessive or unreasonable. DSM IV Criteria for the Anxiety Disorders: Post-Traumatic Stress Disorder A. The person has been exposed to a traumatic event in which both of the following were present: 1.The person experienced, witnessed or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of others.

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2.The person's response involved intense fear, helplessness or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior. B. The traumatic event is persistently re-experienced in one (or more) of the following ways: 1.Recurrent and intrusive distressing recollections of the event, including images, thoughts or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed. 2.Recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content. 3.Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, traumaspecific reenactment may occur. 4.Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. 5.Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. C.Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

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1. Efforts to avoid thoughts, feelings or conversations associated with the trauma 2. Efforts to avoid activities, places or people that arouse recollections of the trauma 3. Inability to recall an important aspect of the trauma 4. Markedly diminished interest or participation in significant activities 5. Feeling of detachment or estrangement from others 6. Restricted range of affect (eg, does not expect to have a career marriage, children or a normal life span) D.Persistent symptoms of increased arousal (not present before the trauma) as indicated by two (or more) of the following: 1. Difficulty falling or staying asleep 2. Irritability or outbursts of anger 3. Difficulty concentrating 4. Hypervigilance 5. Exaggerated startle response E. Duration of the disturbance (symptoms in Criteria B, C and D) is more than 1 month. F. The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning. Specify if: Acute: if the duration of the symptoms is less than 3 months. Chronic: if the duration of symptoms is 3 months or more.

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With Delayed Onset: if the onset of symptoms is at least 6 months after the stressor. DSM IV Criteria for the Anxiety Disorders: Social Phobia A. A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults. B.Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed panic attack. Note: In children, the anxiety may be expressed by crying, tantrums, freezing or shrinking from social situations with unfamiliar people. C.The person recognizes that the fear is excessive or unreasonable. In children, this feature may be absent. D.The feared social or performance situations are avoided or else are endured with intense anxiety or distress. E.The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social

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activities or relationships, or there is marked distress about having the phobia. F.For individuals under the age 18 years, the duration is at least 6 months. G.The fear or avoidance is not due to the direct physiological effects of a substance (eg, a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder. H. If a general medical condition or another mental disorder is present, the fear in Criterion A is unrelated to it. Specify if: Generalized: If the fears include most social situations (eg, initiating or maintaining conversations, participating in small groups, dating, speaking to authority figures, attending parties). Note: Also consider the additional diagnosis of avoidant personality disorder. DSM IV Criteria for the Anxiety Disorders: Specific Phobia (formerly Simple Phobia) •Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation. •Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed panic attack. In children, the anxiety may be expressed by crying, tantrums, freezing or clinging.

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•The person recognizes that the fear is excessive or unreasonable. In children, this may be absent. •The phobic situation(s) is avoided or else is endured with intense anxiety or distress. •The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia. •In individuals under 18 years, the duration is at least 6 months. •The anxiety, panic attacks, or phobic avoidance associated with the specific object or situations are not better accounted for by another mental disorder.

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CASE NO.1 Serial No: -- 1

Date: 06--06--2005

A) Patient’s Biodata: Name: Aarti

Age: 26 years

Sex: Female

Martial Status: Single Residence: Urban

Occupation: Lecturer

Socioeconomic Status: Middle B) Presenting Complaints: Cracking in knee joint; Weak eyesight; Irritable; Fatigued easily; Difficulty in getting sleep; Takes cold easily; Pain in breast. C) History of the present Illness: All complaints have started since 1 year. It started after a disappointment in love affair. Had a love affair since last 3 years, but last year they broke up. She felt that he was taking her for granted and that he was not committed. Felt jealous, when he talked with other girls, so she broke up. Felt very sad after that break-off. Is on allopathic medication Anxit for her problems. Cracking in knee joint < on rising from a seat. Weakness of eyesight. Irritable over small matters. Gets fatigued easily after little exertion. Does not feel like doing any work. Mental as well as physical exertion fatigues.

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Has difficulty in getting sleep due to various thoughts that disturb her. Pain stitching in the left breast. D) History of the previous Illnesses: Malaria 5 years back. Chicken pox in childhood. Eruptions on face for which allopathic T/t was done. Recurrent sore throat in childhood. E) Family History: NAD F) Personal Details: APPEARANCE: Lean Thin Tall WEIGHT: Static at 50 kg. APPETITE/TASTE/THIRST: Normal. AVERSIONS, DESIRES & EFFECTS OF FOOD: Desires Pizza, Chocolates. STOOL AND URINE: Occasionally constipated. PERSPIRATION: Copious when she has anxiety. MENSTRUAL FUNCTION: Menarche: At the age of 13 years. Were irregular in the start but now normal. L. M. P. 20/05/2005. Menses: 3 / 28 ± 3 days. Flow normal. Backache before and during menses.

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Leucorrhoea: Thick and offensive, which is more before the menses. SLEEP & DREAMS: Type of sleep: Light Un-refreshing sleep. Disturbed due to thoughts. Position during sleep: No special position. This Unrefreshing and disturbed sleep is since 1 year and before that she had no problems. Dreams and their nature: Unremembered. REACTIONS: Weather: Change of weather aggravates. Odors: Odors aggravate. They make her uneasy. Exertion: Physical exertion aggravates. Thermal state: Hot + G) Emotional State: Disappointment in Love++. Irritability with restlessness. Fearful of exams. Anxiety feeling + < morning on waking, with heat sensation, nausea & perspiration. Jealousy +. Weeping Easily. Very Emotional. Sensitive ++. H) Intellectual State: Lack of confidence +.

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I) Life situations and circumstances: The patient is the youngest of three sisters. The elder sisters are married and she is still to be married. She has good relationship with everyone in the family especially with her middle sister, with whom she shares every secret of hers. Her both parents were working and she felt a lot of insecurity in her childhood. The environment at home is comfortable. She works as a lecturer in a polytechnic college and is satisfied with her job. The relations with colleagues are fine. Has few friends, but has good relations with them. J) Body Language: Gait: Rapid. Gestures:

Restlessness limbs.

Postures: Leaning. Facial expressions: Smiling. K) Physical Examination General: Temp. Normal

No Jaundice

B.P 120/ 76

No Cyanosis

Pulse 80 / min

No enlargement of Lymph nodes

No Oedema No Anemia Hair: Premature graying since 2 years. L) SYSTEMIC EXAMINATION:

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RESPIRATORY CVS

NAD NAD

PER ABDOMEN

NAD

CNS

NAD.

MUSCULO-SKELETAL NAD. Diagnosis: Generalised Anxiety Disorder Date: 06/06/2005 1 2 3 4 5 6 7

Aarti

Kent’s Repertory

MIND – LOVE, ailments, from disappointed MIND - JEALOUSY FEM GENITALIA,LEUKORRHEA, offensive FEM GENITALIA,LEUKORRHEA - thick FEM GENITALIA,LEUKORRHEA,menses,before GENERALS – CHANGE of weather agg. BACK - PAIN – menses, before

18 18 46 45 36 53 39

Lach. Calc. Puls. Nux-v. Sep. Calc-p. Ph-ac. 12/7 11/5 11/5 9/5 10/5 8/5 8/4 ----------------------------------------------1: 2 1 1 2 3 2: 3 2 2 1 1 3: 1 1 3 3 1 4: 1 3 2 2 5: 2 3 2 3 2 2 6: 1 2 2 1 1 2 2 7: 2 2 3 2 RX Lachesis 200 - 1 dose. Placebo t.d.s for 15 days. 21/06/05. Feeling better. Feels that she is little more energetic than before. Placebo t.d.s for 15 days.

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13/07/05. Feeling of being better continues. Her sleep is also better. General feeling of well being is there. Anxiety is less. Irritability and fatigue are also better by about 60 percent. Placebo t.d.s for 30 days. 14/ 08/ 05. Was feeling O.K. till 09/08/05. Had a small quarrel with her sister. Was much disturbed due to that and after that she feels that her main complaints have relapsed though the intensity is still less. Lachesis 200 1 dose. Placebo t.d.s for 1 month. 18/09/05. Felt better after the dose. The feeling of well being is persisting. Has tapered her original anti-anxiety medicine to half. Appetite, sleep, stools and fatigue are better. Placebo t.d.s for 1 month. 20/10/05. Feeling of well being persisting. Patient is better overall. She feels that even people around her feel that she is a changed person now. Is advised to continue with the reduced dosage of anti-anxiety medicine. Placebo t.d.s for 1 month.

25/ 11/ 05. Feeling of well being on all levels continues. Now the anxiety thoughts do not disturb her. Feels very good about the change. The

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dose of the allopathic drug is now stopped completely. Gained 1 kg weight. Placebo t.d.s for 1 month.

1/1/06. Has a relapse. The anxiety, fatigue are now back. On deeper interrogation revealed that she had a fight with her parents over the issue of her marriage. They wanted that now she should get married, while she felt that she needs some more time. So this had an intense effect on her and it brought back her chief complaints. Lachesis 1M 1 dose Placebo t.d.s for 1 month.

5/ 02/06 Better and improving. She feels that now she is the same person as she was, before her fight with the parents. The energy are levels better. Appetite, stools and sleep are also better. Placebo tds for 1 month.

20/03/ 06. Feeling better in all respects. Improvement on all levels as of sleep, Appetite, general well being. Not disturbed by the anxious feelings now. Placebo tds for 1 month.

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DISCUSSION OF CASE NO 1. The case presented us with diagnosis of Generalised Anxiety Disorder on 6th June 2005 and was already taking allopathic medicine for this. As it had a strong mental causation, “Love, disappointment from” in along with mental gen., the Kent’s repertory was preferred for the repertorisation.

On Repertorisation, the following drugs came up for consideration. Lach 12/7, Calc 11/5, Puls 11/5, Nux-v 9/5, Sep 10/5, Calc-p 8/5. Out of these drugs, as Calc & Puls did not cover the main rubric “Ailments from”, they were not considered. As our patient was thermally hot, the chilly remedies were left out i.e. Nux-v, Sep, Calc-p, Ph-ac and Hyos were also ruled out. So Lachesis was left as our similimum which covered all the rubrics of the totality too.

As the case was based on the mental causation, 200 potency was selected to start with. The remedy was given in single dose followed by placebo. The remedy was repeated in the same potency when there was a slight relapse on 14/08/05.

The potency of the remedy was raised to 1M, when she again had a slight relapse on 01/01/06. The allopathic medicine was tapered on 18/09/05 after a continued favorable response from the remedy.

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The response of the remedy was interpreted as favorable on the basis of the following: 1. General sensation of well being of the patient. 2. Improved energy levels. 3. Improvement in Appetite, Sleep and betterment of the main complaints.

With the help of Kent’s repertory only, the drug Lachesis could be selected. As Aur, Hyos, Ign, Nat-m, Ph-ac and Staph are prominently placed in the main rubric “Love, ailments from disappointment”. This also highlights that how with the help of repertory, the proper similimum can be selected.

During the course of treatment we observed that the relapses were mainly due to anxiety situations which occur in the life course of the patient. These relapses were encountered successfully with the same remedy either through repetition or through a raise in potency.

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Case No 2 Serial No: -- 2

Date: 08 --07--2005

A) Patient’s Biodata: Name: Shalini Kapoor

Age: 45 years

Sex: Female

Martial Status: Married Residence: Urban

Occupation: Housewife.

Socioeconomic Status: Middle B) Presenting Complaints: Pain in stomach with heartburn; Nausea; Flatulence with distension of abdomen; Palpitation; Restlessness; Muscle aches; Headache; Irritable. C) History of the present Illness: All these problems started around 2 years back after a separation from the joint family setup. They were not given their due share in the paternal property of her husband. So, they had to start from the scratch and it was a very stressful period. Pain in the Stomach. Burning type < after meals, < evening, < from stress. Since 2 years. Occasional nausea & vomiting of food. Distension of abdomen < eating. < Evening. > stools, after. Palpitation heart < from anxiety +. Restlessness

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Muscle aches which are more in the evening after a day’s work. Pain in the head , busting < when anxious + Irritability. Gets angry over small matters. Shouts during anger. < Evening. D) History of the previous Illnesses: Operated for Gall bladder stones – 5 years back. E) Family History: Diabetes in father. High Blood pressure in mother and brother. F) Personal Details: APPEARANCE: Average built. Tall. WEIGHT: Static. APPETITE: Appetite diminished. THIRST: Thirst less. AVERSIONS, DESIRES & EFFECTS OF FOOD: Desires Salty food; Fruits +. Aversion Sweets. STOOLS AND URINE: NAD. PERSPIRATION: There is profuse perspiration on face during anxiety. MENSTRUAL FUNCTION: Menarche: at the age of 16 years. Menses: 4 / 28 ± 4 days. Flow Clotted Irritability + < during menses.

L. M. P. 3/07/05

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Leucorrhoea: Thin and watery, this is more after the menses. PREGNANCY AND OBSTETRIC HISTORY: G 3 P 2 A1 Normal full term deliveries. Suffered from constipation & nausea during pregnancies. Used to take isabgol. No H/o Oral contraceptives. SEXUAL FUNCTION: Normal desire. SLEEP & DREAMS: Type of sleep: Has very restless sleep. It is disturbed from anxious thoughts and dreams. No special position during sleep Concomitants: Talks in sleep. Dreams and their nature: Accidents + REACTIONS: Air: Feels better in open. Seasons: Better in winters. Time: Evening agg. Noises agg. Exertion: Mental exertion aggravates. Thermal state: Hot +. G) Emotional State: Is fearful of going out in the Dark +; Crossing the road +. Sadness, takes bad part of everything. She has anxiety about small matters with trembling of body; Anxious about the future of her children as to what would happen. Worries a lot about every small matters. She wants to

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do away with this anxiety and worry of hers but is unable to do so. She is sensitive about the suffering of others. H) Intellectual State: Memory is weak as to where she has kept her things. She feels lack of confidence for doing various things.

I) Life situations and circumstances: Patient was the eldest daughter of 2 female and 3 male children of her parents. Her father was very strict with her. She was also responsible for various household chores in her teens. She was much anxious about her performance in school. Now, she is anxious about her children’s performance at school though they are doing well. Relations with husband are good but as he is busy with his shop, most of the responsibility of the kids is on her. She is very anxious about the future of her children. Her daughter is doing B.Sc in computers while her son is studying in Class 10th. She is a housewife, though she is well educated. Relations with her brothers are good and they are very helpful to her. J) Body Language: Postures: Arms and legs crossed. Facial expressions: Anxious + Avoids eye Contact

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K) Physical Examination General: Temp .N No Jaundice Mouth Dryness of B.P.124 / 80 No Cyanosis Pulse 80/min No enlarged lymph nodes No Oedema Anemic + L) SYSTEMIC EXAMINATION: RESPIRATORY NAD P ER ABDOMEN NAD CVS NAD CNS NAD MUSCULO-SKELETAL NAD Diagnosis: Generalised Anxiety Disorder.

Date: 08/07/2005 Shalini Kapoor. Kent’s Repr. 1 2 3 4

SLEEP - DREAMS - Accidents 25 GENITALIA – FEMALE - MENSES – clotted 77 STOMACH – DESIRES - fruit 9 GENERALITIES – WET weather agg. 85

Puls. Ars. Chin. Lach. Calc. Rhus-t. Bell. 8/4 7/3 5/4 6/3 6/2 6/2 5/3 ----------------------------------------------1: 1 3 1 1 2: 3 2 3 3 3 3 3: 1 1 1 1 4: 3 3 1 2 3 3 1 Rx Pulsatilla 200 1 dose. Placebo t.d.s for 15 days.

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25/07 /05. Felt slightly better for few days after medicine but now is all the same. Pulsatilla 1M 1 dose. Placebo t.d.s for 15 days. 13/08/05. Feeling slightly better. Feels her appetite has improved a bit and slight improvement in energy levels. Had her menses on 2/8/05. The irritability which aggravates during menses was also little better this time. Placebo t.d.s for 15 days.

1/9/05. The improvement which was there since the last visit is standstill. This time she had a new symptom i.e. frightful dreams. Appetite is also better. Pulsatilla 10 M 1 dose. Placebo t.d.s for 1 month

4/ 10/05. Feels much better. The irritability, muscle aches, pain stomach have improved much. Appetite is much better. Lethargy is also better. Just finished from her menses which started on 1/10/05. The clots were much better this time and the irritability during menses was also reduced. Placebo t.d.s for 6 weeks.

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26/11/ 05. Feels better on every level. Last menses were on 3/11/05. They were much better with respect to clots and irritability. The energy levels have improved. For the first time since the start of treatment, she felt that now she can leave off the allopathic medicine she is taking. Is advised to reduce the allopathic medication. Placebo t.d.s for 1 month.

2/1/06. Better. The main complaints for which she started medicine are much better. The clotted menses and irritability during menses is much better. The reduced dose of allopathic medicine is continued. Appetite better. Sleep better. Chief complaints also much better. Placebo t.d.s for 6 weeks.

30/01/06. Slight relapse of anxiety. Her parents had an accident and were admitted in hospital. This had a bad effect on her with relapse of anxiety. Pulsatilla 10 M 1 dose Placebo t.d.s for 1 week.

07/02/06. Better in all respects. Allopathic medicine further reduced. Placebo t.d.s for 2 months.

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Discussion of Case No 2. The case presented us with diagnosis of Generalised Anxiety Disorder on 8th July 2005 and was already taking allopathic medicine for this. As the case presented had dreams along with female generals as prominent symptoms, the Kent’s repertory was preferred for the repertorisation.

On Repertorisation, the following drugs came up for consideration: Puls 8/4, Ars 7/3, Chin 5/4, Lach 6/3, Calc 6/2, Rhus-t 6/2, Bell 5/3. As our patient is hot thermally, the chilly medicines i.e. Ars, Chin, Calc, Rhus-t and Bell were ruled out. Furthermore as Pulsatilla covered all the symptoms of the totality especially the “Desire, fruits for”, it was preferred over the left over drugs.

Considering that the mind has been affected and the presence of dreams led to the 200 as the potency of choice. The remedy was given in single dose followed by placebo. The remedy was raised to 1M potency on 25/07/05 as the patient felt that there was slight betterment followed by relapse. The potency of Pulsatilla was raised to 10 M on 01/09/05 when the improvement came to a standstill. This 10M potency was again repeated on 30/01/06 when her parents had an accident, thus increasing her anxiety. The attack was brought under control with the help of Pulsatilla. The allopathic medicine was

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tapered on 02/01/06 when the patient has started feeling comfortable on all levels. The response of the remedy was interpreted as favorable on the basis of the following: 1. General sensation of well being of the patient. 2. Improved energy levels. 3. Improvement in Appetite, Sleep and betterment of the main complaints.

With the help of Kent’s repertory only, the drug Puls could be selected as China also covers the case. Lachesis also comes in close comparison to Pulsatilla but as it did not cover the dreams of the patient, it was not preferred.

During the course of treatment we observed that the relapses were mainly due to anxiety situations which occur in the life course of the patient these relapses were encountered successfully with the same remedy either through repetition or through a raise in potency.

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Case No 3 Serial No: -- 3

Date: 10 --11--2005

A) Patient’s Biodata: Name: Sukhwinder Singh

Age: 12 years

Sex: M

Martial Status: Single Residence: Rural

Occupation: Student

Socioeconomic Status: Middle

B) Presenting Complaints: Fearful; Vertigo; Sleeplessness; Irritability; Startles from slightest noise.

C) History of the present Illness: All complaints started since 8th Oct 2005, when the Earthquake struck. He was in the school when the quake struck & there was stampede in the class. In this process he fell down and received some injuries also. The walls of his class cracked from this. It was his first experience with earthquake of such intensity and was it was full of horror for him. Has constant fear of earthquake happening again. Is sleepless due to frequent waking. < From slightest nose. Since the quake has struck, he prefers to remain outdoors even sleeps in the open.

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Irritable from noise from. Shouts from anger. He startles from the slightest noise and touch. Vertigo / Dizzy feeling which started after the earthquake. D) History of the previous Illnesses: NAD F) Personal Details: APPEARANCE: Lean Thin Tall APPETITE: Diminished STOOLS: Constipated. SLEEP & DREAMS: Sleeplessness from disturbed sleep from fears, slightest noise, frightful dreams. Dreams: Frightful, waking him REACTIONS: Thermal state: Hot G) Emotional State: Anxious, Fearful, Apprehensive. I) Life situations and circumstances: Only son of his parents. Both parents are working and the patient is cared by his grandparents. Is described as very sensitive child by the parents. Gets scared easily. Good in studies and extra-

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curricular activities. Like to play cricket and computer games. Has lost interest in things which he used to enjoy since that episode.

J) Body Language: Facial expressions: Anxious + K) Physical Examination General: Temp. N No Jaundice Pulse No Cyanosis No Oedema No Lymph nodes enlarged. No Anemia L) SYSTEMIC EXAMINATION: RESPIRATORY NAD CVS NAD MUSCULO-SKELETAL

PER ABDOMEN NAD CNS NAD NAD

Diagnosis: Post Traumatic Stress Disorder.

Date: 10/11/2005 Sukhwinder Singh Kent’s Repertory. 1 2 3 4 5 6

MIND – FRIGHT – complaints, from MIND - STARTING - easily MIND - STARTING - sleep - during MIND - STARTING – fright, from MIND - SENSITIVE - noise, slightest to VERTIGO - FRIGHT, after

46 39 82 53 18 3

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1: 2: 3: 4: 5: 6:

Op. Phos. Sil. Nat-m. Nux-v. Kali-c. Acon. 12/6 12/5 9/5 11/4 9/4 9/3 9/5 -------------------------------------------3 3 3 3 2 3 1 3 2 3 2 3 2 2 1 2 2 3 1 1 2 3 3 2 3 2 3 3 1 2 2

Rx Opium 1M 1 dose. Placebo t.d.s for 2 weeks. 26/ 11/05. Better. Vertigo is almost fully better. Temper is also better. Now gets comfortable sleep and the sensitivity / starting is also much better. Placebo t.d.s for 2 weeks.

15/12/05. Better by more than 70 percent. Vertigo is not there. Appetite has improved. Constipation is also better. The frightful dreams are less now and not much disturbing. Placebo t.d.s for 1 month. 22/01/ 06. The patient is now better in all respects. His appetite & constipation are better. His temper is now under control. The sensitivity to noise is now normal. The starting from sleep and frightful dreams are also not disturbing now. Placebo t.d.s for 1 month.

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26/02/06. Better in all respects. Placebo t.d.s for 1 month. 29/03/06. Better. No complaints on any levels. Placebo t.d.s for 1 month. Discussion of Case No 3 The case presented to us with Post Traumatic Stress Disorder which was there due to the earthquake in Northern India on 8/10/05. This case had a strong mental causation, which deranged a perfectly healthy child to an abnormal one. So Kent’s repertory was the best choice for repertorisation. On Repertorisation, the following drugs came up for consideration Op 12/6, Phos 12/5, Sil 9/5, Nat-m 11/4, Nux-v 9/4, Kali-c 9/3 & Acon 9/5. From the following drugs, Op and Acon were given preference as they covered the Causation and “Vertigo, fright after”. Opium was given preference over Aconite as the “Fear of death, predicts the day of death”, a grand general of Aconite was absent in this case. Also on referring to Knerr`s repertory in the section Mind following rubric was found in favor of Opium i.e. **MIND - After fright, fear of the fright still remaining. On the basis of acute condition of the mind, high potency of Opium i.e. 1M was selected and given as single dose. As continued progress in the improvement of the general state continued, Opium was not repeated.

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Hahnemann refers to this type of diseases as “Mental diseases appearing suddenly as an acute disease in patient’s ordinary calm state caused by some exciting factor” in § 221 of the Organon. He explains that in this type of disease, an insanity or frenzy suddenly breaks out as an acute disease from the patient’s usually quite state. This may be caused by fright, vexation, drinking alcohol etc., and attributes it to Psora. He recommends that during acute phase, deep acting remedies are not needed but remedy that corresponds to the acute picture is needed. Hahnemann stresses that after the acute state has subsided, these patients should be followed up with Antipsoric treatment to prevent recurrence & if this is not done, a worse attack from a much slighter cause is bound to follow which will be more difficult to cure.

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Case No 4 Serial No: -- 4

Date: 20--08--2005

A) Patient’s Biodata: Name: Rubina

Age: 27 years

Sex: F

Martial Status: Single Residence: Urban

Occupation: Student

Socioeconomic Status: High B) Presenting Complaints: Falling of Hair; Lump sensation in the throat; Rash forearm; Irritability; Difficulty in concentrating; Anxiety feelings. C) History of the present Illness: All her complaints started around 1 year back. They had a theft at their place in which they lost all their valuables, money etc in the safe. In addition to this, the jewellery and valuables of her maternal uncle which were with them for safe custody were also lost. After the theft, the maternal uncles were heard telling many of their relatives that the patient and his family had themselves done this in order to grab their valuables. Even a brother of hers, who did not live with them, also accused them of the theft. After this incident, her parents shifted to USA to live with her brother. This also according to her was the worst part of her life. Hair falling since 1year.

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Lump sensation in the throat; Persistent; Feels like ball in throat, though no problems in eating & drinking. Rash forearm / back / legs since 1 year. More during the change of weather. Occ. Itching. Irritability ++. Difficult in concentrating. Anxiety feeling, which she feels is not able to control. With this anxiety she has

body aches, weakness, and pain stomach. Much

worried about future +.

D) History of the previous Illnesses: NAD E) Family History: Cancer throat in paternal aunt. F) Personal Details: APPEARANCE: Average built. Tall WEIGHT: Static APPETITE/TASTE/THIRST: Normal. AVERSIONS, DESIRES & EFFECTS OF FOOD: Desires Spices, Pickles. STOOLS AND URINE: Constipated hard stools. PERSPIRATION: Profuse face & back. No other abnormality.

200

MENSTRUAL FUNCTION: Menarche: at the age of 14 years. L. M. P. 10/08/05 Menses: 3 / 16 days. Flow normal. No concomitants. No Leucorrhoea. SLEEP & DREAMS: Type of sleep: Un-refreshing; Is disturbed from anxiety. Position during sleep: mostly on back. Dreams and their nature: Water; Preparing for examinations+ REACTIONS: Exertion: Mental exertion agg. Thermal state: Chilly +. G) Emotional State: Anxiety feeling as to what would happen. Worries a lot about her parents though they don’t have any problems. Can’t control thinking about them. Worries about small matters. Fearful. Anxiety about Future +. Short tempered. Can’t support injustice with anybody. H) Intellectual State: Intelligent +.

I) Life situations and circumstances: The patient is doing her doctorate in sciences. She has three elder brothers, one of whom lives in USA and one of them is separated from the family. She belongs to a well to do family and everything

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was fine until that incident occurred which changed the course of her life and from which she with her family had to suffer. The persistent anxiety feeling are hampering her studies and the normal functioning. Had many friends but now only a few. J) Body Language: Gestures: Nail biting + K) Physical Examination General: Temp. N No Jaundice B.P. 110 /70 No Cyanosis Pulse 76 No Lymph nodes enlarged. No Oedema No Anemia Skin: Fair color L) SYSTEMIC EXAMINATION: RESPIRATORY NAD PER ABDOMEN NAD CVS NAD CNS NAD MUSCULO-SKELETAL NAD.

**************** Diagnosis – Generalised Anxiety Disorder.

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Date: 20/08/2005 1 2 3 4 5 6

Rubina

Kent’s Repertory

MIND – HONOR, effects of wounded DREAMS - MENTAL EXERTION DREAMS - WATER SLEEP - POSITION - back, on FEM.GENITALIA, MENSES, frequent, too STOMACH – DESIRES – sour, acids etc.

3 34 44 52 161 77

Ign. Rhus-t. Sulph. Bry. Nux-v. Puls. Nat-m. 11/6 10/5 9/5 10/4 9/4 8/4 9/5 ----------------------------------------------1: 1 1 2: 3 2 2 2 3 2 2 3: 1 1 1 1 4: 2 3 2 3 2 3 1 5: 2 3 2 3 3 1 3 6: 2 1 2 2 2 2

Rx Ignatia 200 1 dose Placebo t.d.s for 2 weeks. 6/09/05. Was better a little for few days but now the same. Had her menses on 27/08/05. Ignatia 1m 1 dose Placebo t.d.s for 2 weeks. 24/09/05. Feels better. Hair falling has decreased. Had her menses on 20/09/05.

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Sleep better & refreshing. Anxiety also better. Lump sensation throat improved slightly. Occasional dreams still irritate. Placebo t.d.s for 3 weeks.

17/10/05. More better. Energy levels improved. Constipation has also improved. Had her menses on 13/10/05. Lump sensation throat better. Better over all. Placebo t.d.s for 1 month. 20/11/05. Has a relapse of complaints. Though the complaints are not that worse as at the start of treatment. The reason is the stress for her studies as she has to present some papers at a conference. Anxiety +. Lack of confidence +. Lump sensation throat aggravated. Recurrent dreams of preparing for exams. Ignatia 1M 1 dose Placebo t.d.s for 1 month. 23/12/05. Had a favorable effect of the last dose. Could complete the papers well in time and presented them well. Last menses on 13/12/05. Irritability; Hair falling; Constipation; Lump sensation throat much better. Occ. Dreams. Placebo t.d.s for one month. 26/01/06. Better in all respects. Last menses on 22/01/06. No Hair falling. Lump sensation almost gone. Confidence levels high. Got engaged in early January. No dreams since last dose. Placebo t.d.s for 6 weeks.

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28/02/06. Has a relapse of all the complaints. She got the news that her father was ill and was admitted in the hospital. Could not her control weeping. Had her last menses on 11/02/06 and now again on 27/02/06. Ignatia 1M 1 dose. Placebo t.d.s for 1 week. 07/03/06. Not much of change. The anxiety has increased with lack of confidence. Ignatia 10 M 1 dose Placebo t.d.s for 1 week. 14/03/06. Better now. Leaving for states to see her father. Placebo t.d.s for 2 months.

Discussion of Case No 4 The case presented us with the diagnosis of Generalised Anxiety Disorder on 20-08-2005. On detailed inquiry, an important mental causation was got as “Effects of wounded Honor”. So, in presence of mental cause along with Dreams, the Kent’s repertory was preferred for repertorisation. On repertorisation, the following drugs came up for consideration: Ign 11/6, Rhus-t 10/5, Sulph 9/5, Bry 10/4, Nux-v 9/4, Puls 8/4, Nat-m 9/5, Ferr 9/4 and Phos 9/4. As we had a mental causation in our case, so the remedies which covered this were to be considered. Ignatia and Nux-vomica were the

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only remedies that covered the cause. These could not be ruled out further on the basis of thermals as both of them are chilly and our patient is also chilly. Ignatia was selected as the drug of choice as it completely covered the dreams & the physical general of food cravings, which Nux-v could not qualify. The case had a base in the mental causation, so, 200 potency was selected to start with. The remedy was given in single dose followed by placebo. The remedy potency was raised to 1M on 06/09/2005 as 200 had a little effect. The 1M potency had a favorable effect on the patient leading to improvement in anxiety, sleep, bowel movements, lump sensation and general well being. There was a relapse due to the stress of her studies and a repetition of Ignatia 1M on 20/11/05 helped her a lot. This repetition helped her further by relieving her of stressful dreams and improving her confidence levels. Again on 28/02/06, she had a relapse on hearing the news of illness of her father & his hospitalization whom she loved too much. She being far away from her father couldn’t do much for him. So she felt a state of helplessness and that precipitated her anxiety state. This could not be helped with 1M potency, so the potency was raised to 10 M which had a favorable effect on her. The response of the remedy was interpreted as favorable on the basis of the following: 1. General sensation of well being of the patient. 2. Improved energy levels.

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3. Improvement in anxiety, sleep, appetite, constipation and hair falling. Kent repertory helped us in the selection of Ignatia as the similimum. On the basis of repertorisation only, we could eliminate Nux-vomica and Staphysgria, both of which are present in the rubric “Honoreffects of wounded” and differentiate it from Nux-v which was in contention for the similimum. From this case, we learnt that persistent worry and anxiety situations in the course of one’s life, result in the weakening of the favorable action of the similimum but the same can be countered effectively with the repetition or a raise in the potency of the similimum.

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Case No 5 Serial No: -- 5

Date: 04--09--2005

A) Patient’s Biodata: Name: Bikram Gupta

Age: 57 years

Sex: Male

Martial Status: Married Residence: Urban

Occupation: Pharmacist.

Socioeconomic Status: Middle B) Presenting Complaints: Has attacks of fear with sensation as if would die with increased blood pressure. Obstruction of flatulence, which leads to palpitation, anxiety, with heaviness chest and as if it would burst. Numbness of left arm / side, sensation as if the brain does not work and fear about the disease. These attacks are mostly in the morning. The distention of abdomen is very distressing and he feels if it could get better he would be better. In addition to this, there is confused feeling during the attack. These attacks last for about half an hour and then he gets better. Is under treatment for these attacks but without any relief. C) History of the present Illness: These attacks are since 2 years. No cause could be elicited.

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D) History of the previous Illnesses: Heart burn which on Endoscopic investigation revealed 2nd Grade Oesophagitis. E) Family History: Psychiatric problems in mother. F) Personal Details: APPEARANCE: Lean Thin. WEIGHT: Decreasing APPETITE/TASTE/THIRST: Diminished.

AVERSIONS, DESIRES & EFFECTS OF FOOD: Desires juicy refreshing things.

STOOLS AND URINE: Stools mucoid, difficult to flush.

SLEEP & DREAMS: Sleep Increased alternating with diminished. Unrefreshing. Aggravated in the morning. Startles from the slightest noise. Dreams and their nature: Water, Dead Persons.

REACTIONS: Morning Agg. Thermal state: Chilly.

209

G) Emotional State: Fear of closed / crowded places. So much that that he is fearful of taking a bath in the bathroom. Apprehensive about the anxiety attacks as they are unexpected. Is persistently occupied with this. Desires sympathy. Negative thoughts about the disease.

I) Life situations and circumstances: The patient is a govt. servant about to retire. His family life is normal. He has been a sensitive patient affected easily by small matters.

K) Physical Examination General: Temp. N

No Jaundice

B.P. 130/ 90

No Cyanosis Tongue: Apthae.

Pulse 84/ min

No Lymph nodes

No Oedema Anemia + Hair: Baldness. L) SYSTEMIC EXAMINATION: RESPIRATORY NAD PER ABDOMEN NAD CVS

NAD

CNS

MUSCULO-SKELETAL NAD

NAD

210

Diagnosis – Panic Disorder.

Date: 04/09/2005 Boenninghausen`s Repertory BIKRAM GUPTA 1 2 3 4 5 6 7

CONDITIONS IN GENERAL - Time - morning 144 SENS. & COMPL.GEN.- Bursting, splitting,* 104 MIND - Fearsome, anxiety,* - disease, of 33 MIND - Confused, befuddled, muddled, etc.140 MIND - Anxiety, agony - chest, in 43 SENS.&COMPL.IN GEN.,Starting,in affright*104 FLATULENCE - Flatus incarcerated,obstructed, displaced* 84 8 ABDOMEN - Inflation, distension – abdomen in general 120 9 STOOL - Mucus, of 73 10 MIND - Sympathy, craves 2 11 APPETITE - Desire - juicy things 8

Phos. Nux-v. Puls. Kali-c. Sep. Bell. Bry. 32/11 32/9 26/10 26/8 24/9 24/8 24/8 ----------------------------------------------1: 4 4 1 3 3 2 2 2: 2 2 2 3 4 4 4 3: 3 4 3 3 2 2 4: 3 4 3 4 4 4 4 5: 4 3 3 1 1 4 6: 2 4 2 3 2 4 4 7: 4 4 4 4 2 2 8: 4 4 3 4 3 4 3 9: 4 3 4 2 3 3 1 10: 1 1 11: 1 -

211

Rx Phosphorus 200 1 dose. Placebo t.d.s for 2 weeks.

19/ 09/05. No change in any of the major complaints. Had an attack on 10/09/05 & 18/09/05. Phosphorus 1M 1 dose. Placebo t.d.s for 2 weeks.

4/10/05. Had an attack on 27/10/05 which was less in intensity. Obstructed flatulence is slightly better. Sleep little better & stools also improved a little. Fear of having attacks still persists. Placebo t.d.s for 2 weeks. Phosphorus 1M 1 dose as an S.O.S to be taken during the attack.

20/11/05 Had an attack on 10/11/05. Took the S.O.S during the attack and felt better. Other complaints are also slightly better. Placebo t.d.s for 1 month. Phosphorus 1M 1 dose as S.O.S.

22/12/05. Had two attacks – one on 24/11/05. He took S.O.S during the attack and it relieved him. The intensity was slightly less. The second attack was on 19/12/05 and felt it was same as before. Had no S.O.S. to be

212

taken. Other complaints are also little better. No cause or any other detail could be elicited on investigation. Phosphorus 1M 1 dose Placebo t.d.s for 1 month. Phosphorus 1M 2 doses as S.O.S

25/01/06. Had one attack on 23/01/06 and it was not relieved by S.O.S dose. Very fearful about the disease. Feels would die. All other complaints also agg. Phosphorus 10M 1 dose. Placebo t.d.s for 1 month.

26/02/06. Was quite fine during the whole month but got an attack on 24/02/06. Though it was less in intensity, still he is very fearful. Palpitations & trembling of whole body is there. Phosphorus 10 M 1 dose. Placebo t.d.s for 1 month.

25/03/06. Had an attack of lesser intensity on 20/03/06 but the mental state of fear is still persisting. Stools better. Obstructed flatulence also better a little. Phosphorus 10 M 1 dose Placebo t.d.s for 1 month.

Discussion of Case No 5 The case presented us with diagnosis of Panic Disorder on 4th September 2005 and was already under allopathic treatment but

213

without any relief. In spite of much inquiry, no probable cause could be elicited from the patient or his attendants. Apart from the symptoms pathognomic of Panic disorder, the patient presented us few mental symptoms, strong modalities and complaints which were physical in nature. So Boenninghausen`s repertory was selected for repertorisation in this case. The totality of the case was erected and following drugs came up strongly: Phos 32/11, Nux-v 32/9, Puls 26/10, Kali-c 26/8, Sep 24/9, Bell 24/8, Bry 24/8, Calc 24/8 and Carb-v 24/8 As Phos comes out prominently from the analysis and it covered all the rubrics, it was selected as the drug of choice. The potency was selected as 200 the psychic symptoms are prominent As there was no change with 200 potency, the potency was raised to 1M on 19/09/2005. With 1M potency, the patient felt a little better, though he had an attack of lesser intensity. Considering that the patient is not able to contact us during the attack due to far off residence of the patient, a dose of Phos 1M was given to the patient as a S.O.S dose to be taken during the attack. The S.O.S had a beneficial effect on the patient during the attack. In the further follow ups too, a S.O.S was given to the patient to be taken during the attack. The attacks diminished in intensity during the next follow-ups. On 23/01/06, the patient had and attack which was not relieved by the S.O.S. So on 25/01/06, the potency of Phosphorus was raised to 10M

214

as it was felt that the 1M potency has exhausted its action. The intensity of attacks has reduced though the panic state still persists. The response of the remedy was interpreted as favorable on the basis of: 1. Decreased intensity of attacks. 2. Improvement in the Obstructed Flatus & distention of abdomen.

Un Un Ma Un Ma Ma Ma Un Ma Un Ma Ma Un W Ma Un W Un Un Ma Ma Ma Un Ma Un Un Un Un Un Ma

R U R U U U U U U R U U R R U U U U U U U U U U U R U R U U

K K B K K K K K K B K K K K K K B K K B K K K B K K K K K K

BELL COCC PULS ARG-N ARS PULS CALC LACH SIL NAT-M STAPH PULS NIT-AC NAT-M BOR NAT-M ARS IGN ARG-N PHOS SEP NUX-V LYC PHOS CALC PHOS ACON OP NAT-M ACON

1M 1M 200 200 200 200 200 10M 200 200 200 1M 1M 200 200 200 200 1M 200 10M 200 200 200 1M 200 1M 1M 1M 200 200

NI IM IM IM NI IM NI IM IM IM IM IM NI IM IM NI IM IM IM IM IM NI IM NI IM IM IM IM IM IM

REPR

S.E. Status

L M L H M M M M M M H M L L M M M H M M M H H H M M M M H M

STATUS

F F F F F F M F F F F F F F M M F F F M F M F F M F M M F M

RESI

M.STATUS

22 19 50 23 45 29 50 26 37 23 32 45 23 50 32 25 52 27 12 57 38 38 21 49 14 23 15 10 13 37

POTENCY

23-04-2005 30-04-2005 09-05-2005 15-05-2005 22-05-2005 30-05-2005 03-06-2005 06-06-2005 08-06-2005 23-06-2005 30-06-2005 08-07-2005 13-07-2005 26-07-2005 02-08-2005 08-08-2005 18-08-2005 20-08-2005 26-08-2005 04-09-2005 07-09-2005 14-09-2005 30-09-2005 13-10-2005 10-11-2005 12-11-2005 14-11-2005 12-12-2005 16-12-2005 21-12-2005

MEDICINE

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

SEX

AGE

JYOTI DEVI ANU SAVITRI DEVI NATASHA KANTA RINKI SOBHA RAM AARTI REENA RAJESHWARI SAKSHI SHALINI KAMLESH VISHNO PANKAJ ANIL VEENA RUBINA SUCHITRA BIKRAM NEHA VIPIN LOVI SETHI KIRAN AKSHIT NAMRATA SAHIL SUKWINDER KAINATH DEVINDER

DATE

NAME

S.NO

215

LEGEND H HIGH M MIDDLE L LOW R RURAL U URBAN

B

F

FEMALE

Ma

MARRIED

M

MALE

Un W

UNMARRIED WIDOWED

K

KENT REPR

NI

NOT IMPROVED

B.B.C.R.

IM

IMPROVED

PH GA GA GA PH GA GA GA GA GA GA GA GA GA PH GA PH GA PH PA GA GA GA GA PT PT PT PT PT PT

216

217

Age and Sex ratio of cases

No. of cases

Female

Male

9

10

5 3 3

5 0

3 3 1

1

1 1

10 - 20 20 - 30 30 - 40 40 - 50 50 - 60

Female

3

9

3

5

1

Male

3

1

3

1

1

Age group of cases

Anxiety in different areas

6, 20% 1, 3%

15, 50% 8, 27%

Urban Female

Urban Male

Rural Male

Rural Female

218

No. of cases

ANXIETY ALONG DIFFERENT AGE GROUPS 8 7 6 5 4 3 2 1 0 10 - 20

20 - 30

30 - 40

40 - 50

50 - 60

Age group GAD Female

GAD Male

PHOBIC Female

PHOBIC Male

PANIC Female

PANIC Male

PTSD Female

PTSD Male

Socio-economic status of cases

12

11

10

8

8

6

6

4

4 2 0

MALE FEMALE

1 HIGH

0 MIDDLE

LOW

MALE

1

8

0

FEMALE

6

11

4

219

Martial status of cases

16 14 12

11

10

8

8 FEM ALE

6

M ALE

4

5

4

2 0

2 0

SINGLE

M ARRIED

WIDOWED

FEMALE

11

8

2

MALE

4

5

0

Results with different potencies 20

19

No. Of cases

15 15 9

10

6 4

5

3

2

2 0

0 200

1m

10m

Potencies No. of cases

Improved

Not Improveed

220

Results in Anxiety Disorders

7, 23%

23, 77%

Improved

Not Improved

Results with Kent and BBCR 30 25 20

25 19

15 10 5

6

5

4

1

0 KENT Total cases

BBCR Imrovement

No Improvement

221

Medicines Used in Anxiety Disorders

5 Medicines ACON ARG-N

4

ARS

4

BELL BOR CALC

3 3

COCC

3 No. of cases

IGN LACH LYC

2 2 2

2

NAT-M

2

NIT-AC NUX-V OP

1 1

1 1 1 1

1

1 1 1

1 1 1

PHOS PULS SEP SIL STAPH

0 0

Medicines

222

223

DISCUSSION

For the purpose of this study, cases of anxiety disorders are taken up in detail and are followed by proper repertorisation. The data of the 30 cases from my clinics, gives me an insight to various facets of the anxiety disorders. The killer earthquake which rocked the northern region with much intensity on 8th October 2005 is providing me a chance to understand and treat cases of Post Traumatic Stress Disorder. Of the 30 cases under study, the females are found to be more affected by anxiety. The female to male ratio is around 2:1. These disorders are more in the age group of 20 – 30 years and cases of this age group alone account for the 1/3 rd of the total sample. Furthermore, it is observed that the age group 20 to 40 years account for more than half of the cases, as this age group is under great mental strain & stress, and has occupational problems etc. More cases of anxiety are reported from the people residing in the urban area than in the rural areas. The ratio of the urban to rural cases is found to be around 3: 1. Females of the urban area alone account for the 50 percent of the whole sample. While considering the socio-economic status of the patients, 63 percent of the cases are from the middle class. For the percentage as per the disease diagnosis, GAD accounts for the 60 % of the total cases and the Phobic disorders account for 17 % of

224

the cases. The PTSD cases because of earthquake account for 20 percent of the cases of my study. While analysing the cases as to their martial status, an equal incidence is found for both single and married cases under study. 77 percent of the total cases are showing improvement with the administration of the similimum selected with the help of repertories. For the purpose of repertorisation, 83 percent of the cases are repertorised using Kent’s repertory while for the remaining 17 percent, BBCR is used. As these are the cases of psychiatric disorder and are deficient in somatic ailments or symptoms, so Kent’s repertory is required more as compared to BBCR. This is also evident from the cases being discussed in detail, where in the presence of strong mental causation or mental generals, sleep & dreams is there. 76 percent of the cases for which Kent’s repertory is used, are showing improvement. BBCR, though a neglected repertory is also did not lag behind and 80 percent of the cases for which it is being used, also show improvement. Natrum mur, Phosphorus and Pulsatilla are the remedies which are indicated in 3 or more than 3 cases. Aconite, Arsenic album, Argentum nitricum and Calcarea carb are the remedies of choice in 2 cases each. A total of 19 remedies are indicated for a sample of 30 cases, which strengthens the individualization part of homoeopathy. The 1M and 10M potencies are required only when 200 potency did not work. Yet if we see the average, 200 potency worked in 80

225

percent of the cases in which it is given, thus concluding that it is the right potency to begin with. In case no.1 & 3, which are given in detail, Natrum Mur and Aconite respectively seem to be the remedies at the start. The repertorisation provides me with Lachesis and Opium respectively. These have a very good effect on the patients, thus authenticating the Master’s advice to be an un-prejudiced observer.

226

227

CONCLUSION

The data obtained from clinical studies; weigh heavily in favor of, the use of repertories in the management of the anxiety. The repertorisation of cases did not let any medicine to be out of sight till the final selection. In a number of cases, repertorisation led me to a medicine which in routine prescribing, would have been missed.

In cases which present with strong mental causation, mental symptoms & generals and dreams; Kent’s repertory is of vast help. While cases which present with strong modalities, physicals and concomitants; BBCR is of enormous help. Both these repertories, though having different philosophical backgrounds have given positive results in cases where they are used judiciously, thus authenticating their value respectively.

The utility of repertory can not be underestimated and it has proved beyond doubt to be of immense help in selection of similimum in the management of Anxiety disorders.

228

229

Bibliography Barthel H & Klunker W. Synthetic Repertory - Volumes 1, 2 & 3. Indian Edition. New Delhi: B. Jain publishers, 1985. Boenninghausen C.M.F. The Lesser Writings. Ed. Bradford T.F. Trans. Tafel L.H. Reprint Edition. New Delhi: B. Jain Publishers, 2003. Boger C.M. Boenninghausen`s Characteristics and Repertory. Revised and enlarged Ed. New Delhi: B. Jain Publishers, 1988. Diana Keable. The Management of Anxiety. First Indian Edition. Noida: B.I. Churchill Livingstone Pvt. Ltd, 1997. Farrington E.A. Lesser Writings with some Clinical Cases. New Delhi: Pratap Medical Publishers, n.d. Freud, Sigmund. On Psychopathology. First impression. New Delhi Shrijee`s Book International, 2003 Gallavardin J.P. Psychism and Homoeopathy. Trans. Mukerji R. Second revised Edition. New Delhi: B. Jain Publishers, 1987. Hahnemann S. The Chronic diseases - Their Peculiar Nature and Their Homoeopathic Cure. Trans. Tafel L.H. British Edition. Sittingbourne: Homoeopathic Book Service, 1998. Hahnemann S. Organon of medicine. Trans. Boericke W. Sixth Edition Reprint. New Delhi: B. Jain Publishers, 1983.

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Hahnemann S. The Lesser Writings. Ed. & Trans. Dudgeon, R.E Reprint edition. New Delhi: B. Jain Publishers. 1984. Hering C. Foreword. The Chronic diseases - Their Peculiar Nature and Their Homoeopathic Cure. By Hahnemann S Sittingbourne: Homoeopathic Book Service, 1998. Jahr G.H.G. Therapeutic Guide – Forty years practice. Trans. Hempel C.J. Reprinted Ed. New Delhi: B. Jain publishers, 1985. Kent J.T. Lectures on Homoeopathic Philosophy. Memorial Edition Reprint. New Delhi: B. Jain Publishers, 1984. Kent J.T. New Remedies, Clinical Cases, Lesser writings. Indian Edition. New Delhi: IBPS, n.d. Kent J.T. Repertory of Homoeopathic materia medica. Sixth Edition Reprint. New Delhi: B. Jain Publishers, 1981. Kneer C.B. Repertory of Hering`s Guiding Symptoms of our Materia Medica. Reprint Edition. New Delhi: B. Jain publishers, 1988. Ortega, P.S. Notes on the Miasms. Trans. Coulter H. First English Edition. New Delhi: National Homoeopathic Pharmacy, 1980. Phatak S.R. A Concise Repertory of Homoeopathic Medicines. Second Edition Reprint. Bombay: The Homoeopathic Medical Publishers, 1985. Risquez, F. Psychiatry and Homoeopathy. Ist Ed. Reprint. New Delhi: B. Jain Publishers, 1997.

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Sarason Irwin & Sarason Barbara R. Abnormal Psychology – The Problem of Maladaptive Behaviour. Tenth Edition. Delhi: Pearson Education Asia, 2002. Semple David, Et all. Oxford Handbook of Psychiatry. First Indian Edition. New Delhi: Oxford university press, 2005. Stein Dan J & Hollander Eric. Anxiety Disorders Comorbid with Depression. First Edition. London: Martin Dunitz Ltd, 2002. Talcott S.H. Mental Disease and their Modern Treatment. Indian Edition. New Delhi: B. Jain Publishers, 1989. Vithoulkas G. The Science of Homoeopathy. First Indian Edition. New Delhi: B. Jain Publishers, 1989. Whitmont E. Psyche and Substance. First Indian Edition. New Delhi: B. Jain Publishers, 2002.

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233

CASE TAKING PROFORMA Serial No: --

Date: __--__--____

A) Patient’s Biodata: Name: ………………………………… Age: ……….. Sex: M/F Martial Status: Single/Married/Divorced/Widowed Residence: Urban/Rural Occupation: …………… Socioeconomic Status: High/Middle/Low B) Presenting Complaints: C) History of the present Illness: (Detailed history of present illness with respect to cause and circumstances, duration, mode of onset, location with extension, sensations, modalities and concomitants, if any) D) History of the previous Illnesses: Past Medical H/o patient as per the check list given at the end. E) Family History: In his own, paternal and maternal families as per the check list at the end. F) Personal Details: APPEARANCE: Lean/Obese/Emaciated/Average/Thin/Short/Tall/Stooped/Underno urished WEIGHT: (Increasing/Decreasing/Stationary) APPETITE/TASTE/THIRST:

234

AVERSIONS, DESIRES & EFFECTS OF FOOD: STOOL AND URINE: PERSPIRATION: MENSTRUAL FUNCTION: Menarche: Late/Early L. M. P. Menses: Cycle and Duration with concomitants: Menopause and associated complaints: Leucorrhoea: PREGNANCY AND OBSTETRIC HISTORY: G P A: Mode of deliveries: Mental State during and after Pregnancy Illness and Medication during Pregnancy: H/o oral contraceptives used SEXUAL FUNCTION: Desire/Aversion/Performance and associated complaints. PAEDIATRIC HISTORY: Birth: Normal /Abnormal Birth Wt.: Mother's health: Neo-natal problems: Milestones: Problems: Physical Development / Mental Development Speech: Retarded/Lisping/Stammer/Slow/Rapid Feeding: Breast/Top/Bottle/Solids Observation: Activity: Hyper/Dull/Restless/Destructive/Quiet. Emotional: Anger/Fears/Attachments/Shyness/Change/Responsibility

235

Intellectual: Performance at School and in Extra-curricular activities Hobbies Obedience Socialization Behavioural Problems: Aggressive(Beats, Bites)/Breathholding/Clinging/Contrary/Cruel/Criminal/Dirty/Fastidious/Head banging/Obsessive/Homesick/Hurry/Stealing/Nailbiting/Obstinat e/Rocking/Tantrums/ Tics/ Thumb sucking/ Truant/Weepy SLEEP & DREAMS: Type of sleep: Light/Catnaps/Deep/Un-refreshing/Poor/Siesta Disturbed Due To: Anger/Anxiety/Work stress/ Dreams/Fears/Lovesick/Thoughts Position during sleep Any change in sleeping pattern Concomitants: Enuresis/Gestures/Grinding/Moaning/Nightmare/Perspiration/S alivation/ Snoring/Starting/Talking/Walking Dreams and their nature: REACTIONS: [Physical factors: (Effects, Ailments from, Agg. And Amel.)] Air: Cold/Open/Fan/Drafts/A.C./Closed room Weather: Clear/Dry/Foggy/Storm/Cloudy/Humid/Cold/Damp/warm/Seashore Seasons: Summer/Spring/Monsoon/Winter/Autumn Wet, getting: General/Local Covers: Covering/Uncovering, Bath Motion Time Position/Posture Coition Meditation Music/Noise/T.V. Light/Lightening/Moonlight Odors/Pain/Color/Dark/Touch/Pressure/Rubbing

236

Sun exposure/Temperature/Thunderstorms/Moon phases Exertion: Physical / Mental Thermal state: Hot/Chilly/Ambithermal Anything else……. G) Emotional State: LOVE/ ANGER/ SADNESS/ FEAR/ ANXIETY/HATE/ GUILT/ ENVY / JEALOUSY / SUSPICION AND OTHERS H) Intellectual State: PERCEPTION/THINKING/MEMORY/DECISION/CONFIDENCE/ CONSCIOUSNESS/WORK/PERFORMANCE AND OTHERS I) Life situations and circumstances: Self: Major areas of concern and worries: Past:/Present Major fears Habits and Hobbies Family Patient’s position in family Spouse Dependents Relationship with wife and children Relationship with parents and siblings Marital Relationship Environment at home Work Environment at work Relationship with Juniors/Seniors/colleagues Job satisfaction Society Relationship with friends and relatives

237

J) Body Language: Gait: Gestures: Postures: Facial expressions: Eye Contact Voice and speech: K) Physical Examination General: Temp. Jaundice Mouth B.P. Cyanosis Tongue Pulse Ear Lymph nodes Oedema Nose Sinuses Anemia Throat Skin: Growths

Complexion & Texture, Discoloration, Eruptions,

Nails: Brittle, Clubbing, Colour, Deformed, Ingrown, Infection Hair: Growth, Baldness, Colour, Dandruff, Dry, Loss, Tangled L) SYSTEMIC EXAMINATION: RESPIRATORY PER ABDOMEN CVS CNS MUSCULO-SKELETAL Comments if any: Questionnaire used to elicit the symptoms of the patients: Patients and the attendants were given ample time to explain about the problem, without interrupting them in haste, yet as and where needed the following type of questions were used; 1. What are the factors that make you worse?

238

2. What are the factors which make you comfortable? 3. What are the concerns in your life those are bothering you much? 4. In what type of environment you like to be? 5. How will you describe yourself i.e. your nature, behavior, temperament, likings, disliking etc? 6. What fears do you have? 7. How do you react to different situations? 8. What gives you the pleasure most? 9. What makes you angry or anxious? 10. Apart from your business/profession what other activities you like. 11. Which was the worst event of your life? 12. Which were the happiest moments of your life?

Checklist for Past and Family History: Anaemia

Heart diseases

Hypo/Hyper - tension

Asthma

Resp. diseases

Syphilis / Gonorrhoea

Diabetes

Rheumatism /O.A. R.A. / S.L.E

Cancer

Leprosy

Skin Diseases

T.B./Pleurisy

Musculo-skeletal

Paralysis / Polio/Stroke

Injuries / #

Jaundice

Poisoning / Pollution

Bleeding Tendency

Malaria / Typhoid Epilepsy / Fits

Chicken-pox/ Measles

Mumps / Rickets Stones / Renal diseases

Cholera /G.E. /Ulc. colitis

Mental retardation/Suppressions

Diarrhoea/Dysentery Neurosis / Psychosis Vaccination Exposure : x-ray / radiation Warts / Growths Whooping cough Anything else

Otorrhoea / Otitis Worms

239

Checklist of some Probable Causes Emotionally disturbing experiences in childhood. Prolonged insecurity. Feeling of unloved / unwanted during childhood. Preference of brother / sister. Death of family member / friend. Disappointment in a love affair. Career disappointment. Unfavourable work situation. Domestic quarrels between parents / spouse / siblings. Separation from parents / spouse. Loss of social position. Disappointment in close relationships Work stresses. Retirement from work. Strict upbringing during childhood. Major personal injury. Monetary losses. Unemployment. Change in Job / Residence. Any other.

240

Checklist of some Important Observations that can indicate Anxiety Disorders Hyperactivity of Hands. Fine Tremor of hands. Profuse and cold perspiration Palms and Forehead. Increased Pulse rate. Rapid and short breathing. Facial expression. Biting nails. Tenseness of facial muscles. Hands held in a fist. Crossed Arms. Shoulders Bent forward. Crossed legs. Shoulders bent forward. Head thrust forward. Sitting bent forward. Clenched Jaw. Restlessness of limbs. Avoids Eye Contact. Chafed and reddened Hands. Patchy hair loss.