Dr. Rajan Sankaran

MB: 16 years and more than 10 books- all focusing on understanding the case, case taking, analysis and materia medica. Why there is still no book from you that deals with case management, potency selection, repetition and everything that needs to be done to take a case to the curative stage – after the remedy has been administered?

RS: As you can understand, there is no management if there is no right remedy. So all my efforts so far have been focused on how to get more consistently to the right remedy. This has taken up all my time and energy. Only recently, I have come to a comprehensive system and could focus on writing on the aspects you mention. My latest book, Sensation Refined, focuses, besides other things, on Potency, Repetition, Acute conditions in chronic cases, etc.

MB: Now that prompts me to ask you some more practical question.

First. Although potency selection is not a straightforward issue we all have some basic algorithms/wire-frames in our mind that help us decide the potency for a given case quickly enough. How do you select the potency for a given case? What thought process goes on in your mind when the time comes to decide the potency?


RS:  I decide the potency by the level of the patient.

It is important to know if the person is feeling the sensation locally or generally. Often the sensation is the same, but the level at which they experience it in their everyday lives determines the potency. When the sensation is general, it is common to mind and body, and it comes up in all circumstances.

Normally, in the process of case-taking, we are able to reach sensation level with the patient. However, he or she may not be living at this level in everyday life. The potency is selected according to the level that is experienced daily by the patient.


LEVEL 1: NAME: STRUCTURAL PATHOLOGY: 6C

Prominently seen: Here the symptoms of the pathology are the only ones available, and completely dominate the picture. For example, oedema in heart failure, breathlessness in lung fibrosis, severe joint pains in osteo-arthritis, paralysis in multiple sclerosis.
Stage of Pathology: There is structural pathology.
Modalities: There are no characteristic symptoms or modalities locally and generally. The modalities that exist are primarily related to the pathology. For example, a case of cancer of the oesophagus will have aggravation on swallowing.
Degree of characteristics: Emotions: Emotions, if any, are related to the pathology, are common, and not individual.
Delusions: In the present moment, they will not be there, but on enquiry you may find that there may have been delusions and dreams in the very distant past.
Hand gestures: will not be prominent or readily available. One will have to use bypasses to get to the sensation level where hand gestures are seen.
Perception: It’s not me, but the part that has the problem. The whole is not involved. The word “I” isn’t there. “The disease is something else sitting on me.”

“THERE IS …” a tumour in my stomach.
For example, if somebody’s house developed a big crack in the roof, he would
say, “There is a crack in the roof.” He sees the problem as local, structural, and not really belonging to him.

LEVEL 2: FACT: 30C

Prominently seen: Here, the local symptoms and local modalities are more
prominent.
Stage of Pathology: Structural pathology is often found locally.
Modalities: The modalities affect the locals and not the generals.
Degree of Characteristics: The modalities could be characteristic. The nature of the problem itself could be characteristic, but generals are not prominent.
The patient gives most importance to local complaints and it is difficult for him to talk about emotions and delusions.
These levels seem to be well compensated and one has to dig deep into his past to elicit the state that preceded that localization.
Emotions and Delusions: Dreams, emotional modalities, general modalities, cravings, etc are often very minimal.
Hand gestures: Few or absent.
Perception: “There is a problem with something that belongs to me.” Or “I have a problem in this particular area of my life.” The patient will define the nature of the problem, which will be characteristic.

“I HAVE …joint pain, or burning in the stomach.”
For example, I have a joint pain. < First motion, climbing, > Continued motion.
Q: What effect does this problem have on you?
A: No effect.
Given Calc fluor 30.

When you are planning to build a house, and can’t see eye to eye with the architect about it, you could say, “I have a problem with my architect. He is very fixed in his ideas.” The problem is seen locally in a part that belongs to you. For other examples, “I have a rude boss.” Or “I have inefficient staff.”


LEVEL 3: EMOTION: 200C

Prominently seen: Here there is equal prominence of generals and locals.
There is a good flow, or interrelation, between generals and particulars; i.e. one leads to the other. For example, headache from anxiety. The local affects the general, and general affects the local.
The chief complaint is excited by a circumstance, which is usually present.
The present position aggravates. He will say, “Each time there is a situation I am sensitive to, I am affected. If it is not there, I am not affected.”
Stage of Pathology: The main complaints are usually functional.
Modalities: The local symptoms have general modalities. For example, headache worse from anger.
Degree of characteristics:
Emotions: The patient is sensitive at the emotional level, and takes things emotionally. “I am affected by it.” For example, “Each time the patient comes late, I get really irritated.”
Delusions:
Hand gestures:
Perception: “I have a problem that affects me.” He sees the problem not affecting the part but affecting him. Even if the problem is local, the affect on him is general.

“I FEEL…”
For examples: “I feel depressed by the situation.” Or “I am irritated by the headache.”


LEVEL 4: DELUSION: 1M

Prominently seen: The symptoms of the whole being are prominent; the whole person is affected. The disturbance is significant along the PNEI (Psycho-neuro-endocrino-immunological) axis. The complaints are usually general, either intensely mental, or hormonal. For examples, intense fears, or obesity.
Dreams, interests and hobbies are prominent.
For example, a Calcarea carb child with strong craving for eggs, with strong sweating on the scalp. He has strong fears and nightmares, seeing ghosts at night. His complaints are obesity and a tendency to catch cold. There is disturbance along the PNEI axis and he lives out his sense of insecurity. He says, “I sweat,” “I crave…,” and if he could express it that way, he would say, “I am a very insecure child. I need a lot of protection.” It is the whole being in a particular situation.
The state is more or less continuous, and doesn’t depend on external circumstance. The person does not live in the present. He lives in one fixed situation in the past, which is his nightmare or delusion. Or he lives in the future, in an imaginary situation, which is fixed. He lives his life in a kind of fantasy of that delusion, the whole life is modified by the delusion. For example, if a person who has Argentum metallicum as a remedy becomes a public performer and can’t imagine his life without that, he needs 1M because he lives his
delusion.
Stage of Pathology: There are not very great pathological and structural changes.
Modalities: They are general and characteristic.
Degree of Characteristics: High. Cravings and aversions are well marked.
Emotions:
Delusions: They are well marked and expressed in the human realm. For example, he will say that, “My wife is harassing me.” Or “My boss is after me, or suppressing or insulting me.”
There will be human stories. This is the stuff of movies, novels, biographies. It is also the stuff of the dreams, the nightmares and the fantasies, interests and hobbies.
Hand gestures: They are more prominent than 200C, and it is much easier to take to sensation level.
Perception: Here, the problem is with the situation, the dream, the fantasy, which is his life. He sees his circumstance, which is a continuous on-going, nearly permanent phenomenon.
It is not only when it is present that he is affected. It is always present, and so there is no relief. “I am persecuted.” “I am a great person.” It is his constantly perceived reality.
Consider this example of a Drosera case. She had done well (on the 1M potency). Then a situation occurred. Her son married and wanted to live away from her. This really affected her and she felt very sad.

R: What is the feeling in the sadness?
P: I had a dream as if something is being torn away, like a cloth is being torn.
R: What was the experience of the dream?
P: It is as if a part of me is separating; has been taken away from me.
R: Describe the sensation of tearing, separating, and taken away from me.
P: (couldn’t go further easily, but after much persistence, spoke her experience) I felt cheated, deceived.

Later on, when describing her headache, she said, “It is like clamped, caught or entangled.”
Her everyday experience was at the human level; about the separation from her son; the loss. The dream did not have the vital sensation, which was “deceived, cheated, and clamped or entangled.” These belong to the non-human language of Drosera. She was living in grief.
Grief is an emotion, but in this case, it is not only constant, but it is also seen as an image of something being torn.
Hence, she was still at the 1M level.

I AM …living in constant delusion.


LEVEL 5: SENSATION: 10M

Prominently seen: There are only the nerve sensations generally and in all parts. The patient is not only living his sensation, but acting it out; his behaviour and mannerisms display it. The whole pace, the whole energy pattern changes. The mental symptoms are a direct expression of the sensation (source). The source is more prominent than the human. Hence, the non-human-specific words and gestures are very prominent, even in everyday life.
There is something obviously peculiar about these patients, the way they speak and act, the energy pattern will be seen almost jumping out of them. You straightaway see that here, something is different. You don’t have to dig deep.
The state will be very obvious and the person may even sound insane, as he talks the language of total nonsense.
For example, in the case of the child who needed Tarentula, you will find the intense restlessness, and the behaviour of striking, being cunning, and trapping. He jumps on someone and brings them down.
It is difficult for the patient to support this state in his every day life unless he is a child. Therefore we don’t have many adult 10M cases. These cases are very rare.
Stage of Pathology: Often there is no structural pathology. The affection is functional.
Modalities: Strongly related to the source.
Emotions and Delusions: They are direct expressions of the vital sensation.
Hand gestures: Very prominent and characteristic of the source.
Perception: (the source).
There will be direct symptoms from the source.
Tarentula, at the 1M, will feel less attractive, or revengeful. At the 10M,
he would display the actions of Tarentula, like jumping, hitting, impulsive action, rage, extreme fear of being killed, etc.
At 1M a Baryta carb person experiences in his everyday life, I am dependent, I need the other person. At 10M he feels that “part of my brain is missing, I am an idiot; I am deficient.”

I EXPERIENCE…. And he acts it out…


LEVEL 6: ENERGY: 50M

I have not yet seen a case at this level. I surmise that the patient will express pure energy here, and action will be the most prominent thing. There will be movement, sound, speed and colour. This is beyond experience, because experience is at sensation level. The patient does not speak about the experience. He IS the experience.
You will see only the energy of the source, without its kingdom features. In that sense, it is undifferentiated.


LEVEL 7: BLANKNESS: CM

I have not seen this yet. I can only theorize that this is the stage of coma, which is beyond the level of energy. This is the most important level; it is from here that the patient gives his history. It is a level beyond the energy pattern, where there is blankness, and a silence. It is the screen on which the pattern plays itself out.
The being witnesses the phenomena as an observer.
If the person in everyday life experiences himself to be the witness, the blank screen on which the pattern of his life is played out, then he is at Level 7.

MB: You select a remedy after a detailed case taking. You take into consideration the kingdom, genus, species, miasm. You are very sure of your remedy and potency selection. You give the remedy - and suppose it does nothing! What do you do in such a scenario?

RS:  I take the case again to see where I went wrong. If after doing that I can’t see anything else, and if I have given the remedy sufficient time, and nothing happens, I refer the case for a second opinion to a colleague.

MB: You analyze a case according to the kingdom, genus, species – and a remedy comes up that is unproved and has no materia medica available to confirm the remedy choice. What do you do in such a scenario – use the unproved, unconfirmed remedy or do a repertorization and look for alternatives?

RS:  If I am convinced from very strong correlation to the kingdom subkingdom and
source that it is the right remedy, I will get it potentised and give it to the patient , rather than giving one which is in the material medica, but which does not match the energy of the case.

MB: Can a person whose chronic simillimum belongs to the Animal Kingdom, come up with seasonal acutes that demand plant or mineral remedies?

RS:  Sure. But it is not very common. Normally one remedy takes care of the acutes as well. But in some cases a different remedy, maybe from a different kingdom is called for in acutes.

MB: What do you do when a chronic patient comes up with a seasonal acute, an accident (food-poisoning) or a trauma?

RS:  I go into the depth and see if he needs his regular remedy or there is a new totality for the moment that calls for a different remedy. Very often it is the former.

MB: It is not uncommon to come across patients with one sided diseases and local complaints – patients who come to us with a specific pathology and either do not have too many symptoms or are not willing to discuss anything except the specific problem for which they have come. Sometimes they can’t discuss in detail due to constraints imposed by language, religion and gender. How do you deal with such patients? Can the ‘levels’ be applied to such patients or do you rely on therapeutic prescriptions for such people?

RS: I apply the idea in most cases. My conviction that this is the right path, gives me the persistence to go into any kind of case. The cases you mention need more time and patience, but where there is the faith, there is the way!

MB: That takes me to a related question. In India, renal calculi are fairly common and homeopathy is fairly popular too for non-surgical removal of renal stones. The approach used by most homeopaths is fairly standard with focus on affinity, size and pain – If it is left sided renal stone, think of Berberis vulgaris. For right sided, think of Lycopodium. For right sided ureteric calculi, think of Ocimum. For vesical calculus, think of Sarsaparilla. If there is much burning or bleeding, think of Cantharis. If the stone is relatively large, think of Bryophyllum. If there is associated nausea, think of Tabaccum and so on. Often mother tinctures of Berberis, Hydrangea, Cantharis and Bryophyllum are used as supportive.

How do you deal with cases of renal calculi? Do you use such indications as are commonly used by other homeopaths or do you give a remedy based on the kingdom/family/miasm/level approach?

RS: It is the same approach. If I get a clear totality, and it indicates the patient’s regular remedy, I will give it. I had a severe pain of calculus myself and was treated by the remedy I needed regularly, since my state was the same then. But, if in the acute he gives clearly another totality, then I will use that remedy be it any from the materia medica and not only from the list of remedies you mentioned above.

MB: Dr. Sankaran, to one of my questions above, you said that there is no management till there is no right remedy. In practice, I have seen homeopaths using different groups of remedies. There are many people who get very good results with the remedies proved by Hahnemann and Hering. Your own teachers and many of our contemporaries fall into that group. I have seen difference in the set of remedies used in Europe and India. Most of the Indian homeopaths still do not use remedies like Chocolate, Hydrogen, Adamas, Lac leolinum, Magnesia silicata etc. There are people like you and Scholten who have come to use very rare and even unproved remedies using your understanding of various kingdoms. Each of this group, depending upon the quality of the practitioner, claims to get good results. No one cures 100% of cases and no one fails in 100% either. We are all somewhere in between. My question to you is – keeping these facts in sight, can there be more than one simillimum for a given case? Can there be more than one ‘right remedy’?

RS:  There is not a perfect similimum mostly, but we need to be within a certain range of the similimum to produce an effect. If the remedy is out of range with respect to miasm or sensation, then there will be no result.  More than one remedy within this range can be effective, but the closer we get to the right remedy, the more significant will be the effect.

MB: Do you think we need a 7^th edition of Organon?

RS:  I think it is already there in spirit, if not in a physical form, for Homeopathy is an evolving science and many have contributed to its evolution. The observations of Kent for example on the remedy reaction, Herings law, Boeninghausens generalization , etc and contemporary work like in kingdoms, group provings, etc, all represent a progression since Hahnemann’s last edition. Whether you call all this the 7^th edition or something else hardly makes a difference.

MB: What would you say to the young students and practitioners regarding the path they should use to evolve as a practitioner? How important it is to be grounded in our classic texts and methods of Hahnemann, Hering, Boenninghausen, Boger, Allen, Lippe, Boericke etc before they venture to explore the newer works, theories and approaches which are still not universally accepted?

RS:  Initially I too felt this dilemma. I felt that it could be risky to expose new comers to the new ideas before they learnt what has been traditionally taught. But I now feel differently.

I believe that both complement one another, and so they can be taught in parallel. The old and the new are not different from each other. The new concepts have as their fundamental base, the traditional knowledge of the philosophy, of provings, the Materia medica and rubrics.  

The system of kingdoms is only a systematization of the knowledge of the remedies and is derived from a study of the Materia medica and the rubrics. Without those foundations, the system cannot be stable; it hangs loosely in the air. And, on the other side, without a map of the system, the Materia medica becomes cumbersome and fragmented. Both need each other.

In studying remedies as families, we are only carrying on the work done by earlier masters like E.A. Farrington who wrote, “It is my duty to show you the genius of each drug, and the relations which drugs bear with one another.  The first I have called the family relation, derived from their similarity in origin.  When drugs belong to the same family, they must have a similar action.  For instance, the halogens, Chlorine, Iodine, Bromine, and Fluorine have many similitudes, because they belong to one family.  So, too, with drugs derived from the vegetable kingdom.  Take for instance the family to which Arum triphyllum belongs.  There you find drugs that resemble each other from their family origin.  Take the Ophidians, and you will be perplexed to tell the differences between Lachesis, Elaps, and Crotalus.”

Dr Richard Moscowitz, in his analytical article Innovation and Fundamentalism wrote: “Sankaran never suggests or implies that these analyses are a basis for prescribing, and simply offers them as a schema around which to group and understand the particulars.  But that is a priceless gift, not only in redirecting our study when well-indicated remedies fail to work, but also in potentiating our enjoyment and appreciation of the natural world, which is a lot of what I love about this work.” In the same article he wrote, “What first attracted me to them, and what sustains my interest in them today, is primarily the added clarity and depth of understanding that they bring to large areas and important themes in our theory and practice which, in spite of practicing faithfully in the classical tradition for many years, I have found relatively obscure and inaccessible until now.”

Let us take Pulsatilla, as an example. Initially it was understood as a set of symptoms that had no apparent connection with each other. ‘Weeps easily,’ ‘bland discharges’ etc. Then Kent spoke about it, and generalized it by saying that its main theme is changeability. Did this make the old invalid? It just deepened the understanding, and helped us to perceive it more easily.

Now if I say that the essence is changeability, and the spirit of it is the flower that moves with the wind, and then if I say that the sensitivity of Pulsatilla is common to the sensitivity of the Ranunculaceae family, does it not put Pulsatilla in a context, without decreasing the value of all that is known about Pulsatilla?

You begin to see Pulsatilla in a deeper way, a broader way.

Therefore, there is no new Pulsatilla. It is the same old Pulsatilla, but perceived as part of a system. It is as if we see the same Pulsatilla, but also we see it plotted on the map. If we have a description of a city, as well as see its position on a map, we have a better understanding of it. In the same way, putting a remedy on the map of kingdoms and miasms will make us view it in the right context. If that deeper understanding is given side-by-side with the traditional understanding, the two understandings will be mutually complementary. The student will not only be able to see inter-relationships in the symptomatology of Pulsatilla itself, but will also have a broader understanding of it that he can relate to living patients.

Similarly, our understanding of the behaviour of a particular snake will deepen our understanding of the snake class. And an understanding of the snake class will deepen our understanding of a particular snake.

To study Spiders as a group and then individual spiders, gives a context and a background, and relates our study to nature, thus breathing life into our remedies. The newcomer will welcome such an introduction and will enjoy his study. It will expand his horizons, and he will not be limited by what is written in books. For example, he will be able to give a spider remedy to a patient with common spider features, even if these features are not in the known symptomatology of this (possibly not well proven) remedy.

Therefore, the new can be taught in parallel with the old, right from the beginning, at under-graduate level. It can form the framework in which the old beautifully fits in, and everything in the old finds its place.

MB: Dr. Sankaran, the new and old can surely work together, but students need to realize that the ‘new’ is ultimately based on the ‘old’ and they can not ignore the works of our old masters, if they wish to become well-versed in the science and art of homeopathy. The debate about the new and the old may not end soon but I am sure that the current ongoing exchange will help create an informed opinion about the new developments in homeopathy. Your elaborate answers will also help bridge the gap between the new and the old. Thank you for your time and this fruitful conversation. It has been a pleasure to hold this discussion with you.