Study of Materia Medica and Repertory

In Homoeopathy information on drugs is given in the books on Homeopathic Materia Medica. Materia Medica is an old term originally applied to study botanical and chemical properties of drug along with their use in diseases. Currently the drug study has number of connotations.

1. Pharmacognosy:  The study of natural history, physical and chemical properties of drug.
2. Pharmacy: The art of preparation of drug.
3. Pharmacology:  The study of action of drug on body, both in health and disease.
4. Therapeutics:  The art of applying drug in disease.

Before elaborating on drug study historical development of homeopathic materia medica will be useful.

Historical note

It all began with Samuel Hahnemann (1755-1843).  He was a qualified German physician, a brilliant person by all standards.  Dismayed by the then prevalent practice of medicine, consisting of applying leeches to let out diseased material in the body, giving purgative or emetic with similar fanciful theories, he left practice and involved himself in studying chemistry and translating medical books. While translating Cullen’s materia medica he came across a statement – cinchona cures malaria because of its bitter properties. Cinchona was known to cure cases of malaria but is it because of its bitter taste?  He wondered. There are many other bitter substances then why cinchona only cures malaria? He decided to find out the effects of cinchona on human body by taking cinchona extract in measured quantity every day. To his surprise, he found the development of symptoms of malaria that is chill, heat and perspiration. The conclusion was, the symptoms produced by the drug on healthy human being, match with the symptoms of a disease which the drug is able to cure. He carried out similar experiments with other drugs like Belladonna.

In 1996, Hahnemann published his new principle of drug therapy, “Similia similibus curenture” it means let likes be treated by likes. He named the process of finding out the drug effects by administering the drug to a person in health as drug proving. In his life time he proved 99 drugs, the details of these drugs are given in two voluminous books-

1. Materia Medica Pura
2. Chronic diseases

In addition to symptoms produced through proving, few symptoms of poisoning, either accidental or otherwise are also noted. The symptoms are arranged from anatomical view point starting with head and ending in feet.

From 1855 to the beginning of twentieth century, practice of homoeopathy spread in Europe, America, Russia, India and few other countries. Number of drugs were added after proving.

Allen’s Encyclopaedia of materia medica was published in 1879. Allen also added symptoms observed in patients after administration of drug and few symptoms which are cured under the drug.

More or less at the same time Hering published 10 volumes of Hering’s guiding symptoms. This work is of great practical value as the author has given clinically verified symptoms, tissue affections, short of description of cases wherein the drug was found to be useful. General modalities and relationship with other drugs are also given.          

A note on the relationship of drug is given at the end.

The books mentioned so far provide the details and can be used as reference books. Commentaries on materia medica are the books giving selected symptoms from practical angle along with clinical experience of the author. Number of practitioners have written commentaries notable amongst them are –

1. “Leaders in Homoeopathic therapeutics” by E. B. Nash.
2. “Lectures on Materia Medica” by J. T. Kent.
3. “Homoeopathic Drug Pictures” by M. L. Tyler.

Mention must be made of “A dictionary of practical materia medica” by J. H. Clarke. One can place this work somewhere in between reference books and commentaries. Commentaries are useful to develop a sort of framework of drug pathogenesis or an image of a drug. At bedside one needs concise and precise data on drug. A synoptic key of materia medica by C. M. Boger is extremely useful at bedside along with Hering guiding symptoms as a reference book.

Study of Materia Medica: A lifelong journey

The purpose of studying materia medica is to find out whether the symptoms of a drug match with the symptoms of a patient. It is useful, therefore, to arrange the salient features of a drug in similar fashion as we perceive totality.

As we have noted earlier totality has following important aspects.

1. Locations and pathophysiological processes
2. General symptoms
3. Mental symptoms
4. Characteristic particulars

Let us take an example of a drug to find out how one can perceive totality or drug image of a drug by sifting data in various books.

Study of Phytolacca

Clarke’s dictionary of practical material medica-

i. Source of the drug is given – Phytolacca decandra

           Natural order – Phytollacacae

The drug is prepared from tincture of fresh roots dug in winter, tincture of ripe berries, tincture of leaves.

ii. Under clinical conditions, the author mentions disease entities where the drug has been used by the practitioners. It is better to note it down system wise to have a broad view of the drug pathogenesis.

For example – under Phytolacca

GI tract – Anal fissure, cholera, diarrhoea, dysentery, constipation, glossitis, haemorrhages, intestinal catarrh, liver affections, mouth ulcers, Ca rectum.

Respiratory tract – Asthma, cough

C.V.S – Angina, hypertrophy heart, fatty heart

Renal – Albuminuria 

Musculoskeletal – Bone diseases, gout, lupus, backache, stiff neck, rheumatism, sciatica

Male genitals – gonorrhoea, impotence, orchitis 

Female genitals – threatened abortion, breast affection, breast Ca, lactation abnormalities, leucorrhoea, sore nipples.

Endocrine – obesity, dentition difficult

CNS – ciliary neuralgia, headache, spinal irritation

Lymphatic (immunity) – gland enlargement, influenza, mumps

Skin – Barber’s itch, boils, cicatrices, erythema nodosum, lichen planus, ringworm, ulcers, warts

ENT – diphtheria, ear affections, laryngitis, tonsillitis, pharyngitis

Eye – diplopia, granular conjunctivitis, ophthalmitis

iii. characteristics – The author then proceeds with information on drug from various sources. Try to note down the locations, pathophysiology, general symptoms and characteristic symptoms.

Taking example of phytolacca –

Poisoning has produced spasmodic action even tetanic type of rigidity and convulsions followed by relaxation.

Generals –

Characteristic particular –

Dentition with irresistible desire to bite the gums or teeth together.

Leaders in homoeopathic therapeutics – (E. B. Nash)

The author put before us the clinical picture in various disorders, sometimes indicating differentiation with other drugs. He has described Phytolacca in tonsillitis, mastitis, sciatica etc. it is not possible to remember details of such description nor it is necessary to do so. But after reading the book it is most likely that Phytolacca will come to our mind in cases of tonsillitis, sciatica etc.

Some of the experiences provide clinical tips. For ex. The author writes that he has removed breast tumour with a single dose of Phytolacca CM during the wane of the moon.

Kent’s lecture on Homoeopathic materia medica

By and large the lectures are based on Hering’s guiding symptoms. Kent was a highly successful physician and naturally added his experience while writing on the drug.

The author starts with the general symptoms and pathogenesis of the drug. It is followed by mental symptoms which one finds difficult to comprehend and apply. Subsequently important symptoms are described from head to foot. At places he describes clinical conditions in which the drug was used along with differentiation from other drugs. While studying Kent’s materia medica, it is useful to concentrate on generals given in the beginning. Similarly, the clinical description along with differentiation from other remedies is useful. Note the style of presentation is different.

Notes from Kent on Phytolacca –

Locations	Pathophysiology and clinical conditions
Glands 2 (parotids)	inflammations, mumps
Mammae 3	Metabolism, scanty breast milk, tumours
Skin2	immunological, psoriasis, pityriasis, ringworm, old cicatrices Inflammation (Graphites)
Nose	coryza with nasal obstruction, bloody sanguineous discharge
Musculoskeletal esp. Periosteum, glands, bone, skin	inflammatory non-articular rheumatism (comp. kali iod.)

Generals-

< cold damp weather, resembles mercury, can be called as vegetable mercury.

Homoeopathic drug picture (M. L. Tyler)

The author quotes from various sources as well as adds her own experience.

Relationship of drug:

All authors mention “related drugs”.  What do we mean by it?

i. The related drug or drug relationship starts with the source of the drug. The drug may be from mineral, vegetable or animal kingdom. For ex. Calcium, Natrum (sodium), Kali (potassium), Argentum (Silver) etc. are from mineral kingdom. Amongst these Calcium, magnesium, strontium, barium, radium are from group II A (alkaline earth) of the periodic table. They exhibit quite a few similar drug effects. Similarly, heavy metals like Alumina, Plumbum, Gold etc. show effects which we observe at old age.

From vegetable sources, some of the plants are from same family and may show similarities in effects.

From animal kingdom, take the example of snake venoms. Almost all of them have action on blood and blood vessels.

ii. Next area of relationship is at the clinical level.

When one considers the drug based on totality of symptoms, two or three drugs may come so close that differentiation is difficult. For ex. Phosphorous and Silicea, Calcarea and Magnesia, Phytolacca and Mercury etc. these are called related or similar drugs.

The drug may be complementary in the sense that it can cure some of the disturbances not taken care of by earlier drug. For ex. Silicea after Hep. sulph 

In suppurative conditions, sulphur is indicated after many remedies like Nux vomica, Bryonia, etc.

The drug may be antidotal. It means it alleviates effects produced by unnecessary repetition or wrong potency selection. For ex. Nux vomica antidotes effects of many drugs.

The drug may have inimical relationship. It means it will spoil the case if given after the drug. For ex. Calcarea is not given before Sulphur.

We have to bear in mind that the information on relationship of drugs is based on experience. Further work is necessary on this important aspect of practice.

iii. With the advent of molecular biology, it is possible to use the data to postulate the probability of drug action in a specific disease.

a. Take example of osteoarthritis (OA) wherein metabolic alterations play a major role. Sulphur is one of the drugs indicated often in OA. Methionine and cysteine are 2 of 20 essential amino acids containing sulphur. Sulphur is also involved in number of metabolic processes through its participation in protein synthesis. Thus, the clinical finding of the use of sulphur in OA has support from its role in metabolic processes.

b. The data from molecular biology can also be explored in other way. For example – Mast cell activation is one of the important processes in inflammatory arthritis like RA.

Naturally occurring flavonoids like Quercetin inhibit mast cell activation.

Plants like Caper spinosa and morin contain quercetin.

Therefore, a drug prepared from these plants may be useful in RA.

(Ref. the encyclopaedia of molecular and cell biology and molecular medicine, vol. 14)

c. Telomere binding proteins in fission yeast – telomere is a specialized heterochromatin localized at the end of linear chromosome and is essential for multiple aspects of genome integrity. Telomere functions are mostly performed by telomere binding proteins. Recent studies of fission yeast telomere binding proteins have revealed that the components of fission yeast telomere are more similar to those of human than to those of budding yeast, indicating that fission yeast is evolutionary more closely related to humans than budding yeast in terms of telomere.

= Telomerase is an enzyme which specifically causes synthesis of telomere DNA.

= Normal cells lack telomerase while most tumour cells express it, suggesting an important function of this enzyme in controlling a key difference between mortal and immortal cells.

= therefore, a drug prepared from fission yeast is likely to be useful in some of the cancers in humans.

Repertory

From the foregoing account on the study of drugs, it is evident that the data on symptoms is voluminous. To help practitioners, to find out the symptoms belonging to a particular drug repertory is used. Repertory is an index to symptoms. There are number of repertories. we comment below on repertories which we have found most useful in day to day practice.

1. Kent’s repertory of Homoeopathic material medica. (expanded) published by B. Jain publishers Pvt. Ltd. First published in 1994. It has addition by P. Sivaraman

A note on the study of Kent’s repertory is given by Margaret Tyler. Preface and the comments on the development of repertory by the author are given in the beginning. One has read these carefully to understand the arrangement and the way in which the repertory can be used at bedside.

2. Boenninghausen’s characteristics and repertory by C. M. Boger, B. Jain Publishers.

As the name suggests it is an enlarged version of Boenninghausen’s work on repertory. One must be conversant with making generalization from the mass of symptoms as well as the concept of concomitants to make use of this repertory in a meaningful way. Preface by the author and forward by H. A. Roberts are good enough to ponder over the pages of this great work and make use of it in an appropriate way.

3. A concise repertory of Homoeopathic materia medica by S. R. Phatak.

This is an extremely useful repertory for day to day use. Earlier two repertories can be referred when certain cases demand a larger group of drugs. The repertory is based on Boger’s approach for selection of drugs.

4. A synoptic key to the materia medica by C. M. Boger.

The beauty of this work lies in that the author has provided in concise form the following.

Repertory, materia medica, and in part three he has given approximate duration of action of remedies, complementary remedies, antagonist remedies, ready reference table for reportorial portion. One should be conversant with materia medica as well as the repertories mentioned earlier to make use of the precise and concise information contained in few pages.

It is advisable to read the introductory remarks of a repertory, scan over the pages in spare time and ultimately use it at bedside. Study of frequently used drugs from materia medica is essential. The final selection is always on the image emerging in the mind after studying the drug and analysing the symptoms in a particular case.

Suggested Further reading –

Materia Medica –

1. Leaders in Homoeopathic Therapeutics – E. B. Nash
2. Lectures on Homoeopathic Materia Medica – J. T. Kent
3. Pointers to Common Remedies – Dr. M. L. Tyler
4. The Guiding Symptoms of Our Materia Medica (10 volumes)- Dr. Constantine Hering –
5. A Dictionary of Practicle Materia Medica – J. H. Clarke
6. The Encyclopedia of Pure Materia Medica (10 Volumes) – T. F. Allen
7. Homoeopathic Materia Medica – William Boericke
8. A Synoptic Key to the Materia medica – C. M. Boger

Repertory –

1. Kent’s repertory of Homoeopathic material medica. (expanded) – P. Sivaraman
2. Boenninghausen’s characteristics and repertory – C. M. Boger
3. A concise repertory of Homoeopathic materia medica – S. R. Phatak
4. A synoptic key to the materia medica – C. M. Boger.