UNDERSTANDING BOENNINGHAUSEN’S CONCORDANCE THROUGH EVOLUTION AND ITS APPLICATION

Navnit V. Vachhani, MD (Hom)^1*

Anoop M. Nigwekar, MD (Hom), MBA ²

Nikunj J. Jani, MD (Hom)³

¹ Consulting Homoeopathic Physician, Dr Vachhani’s Homoeopathy Clinic, Junagadh, Gujarat

 ² Professor & Head, Department of Repertory, Dr M. L. Dhawale Memorial Homoeopathic Institute (MLDMHI)

 ³ Associate Professor, Department of Repertory, Dr M. L. Dhawale Memorial Homoeopathic Institute (MLDMHI)

*Address for correspondence: Dr Navnit Vachhani

Email: navnit123heal@gmail.com

How to cite this article:

Vachhani NV, Nigwekar AM, Jani NJ. Understanding Boenninghausen’s Concordance through evolution and its application. Journal of Integrated Standardized Homoeopathy (JISH) 2019; 02(02)

Received on: June 08, 2019

Accepted for Publication: July 06, 2019

Abstract:

The relationships of the remedies in Homoeopathic practice has always been significant for case management. Many authors have contributed to the subject, but Boenninghausen’s contribution stands as a milestone. Though not adequately appreciated by Homoeopaths, it is very important in case management. This paper highlights the evolution and utility of the application of Boenninghausen’s Concordance (Remedy Relationships).

Keywords: Concordance, Boenninghausen, Remedy Relationship, Second Prescription, Therapeutic Pocket Book.

Introduction:

Remedy relationship is commonly understood as relations between remedies in the form of complementary, antidote, inimical, follows well by, etc. This account is available in the works of Drs Hering, Knerr, Clarke and Boericke. The remedy relationships tables in their works have been used as references, mostly for second prescription, to antidote. and to avoid inimical reactions. However, Boenninghausen’s work on Remedy Relationships is elaborate and has a wide range of application. His work on Remedy Relationships appeared as Concordance in his Therapeutic Pocket Book.

Boenninghausen’s Concordance is his unique contribution to the profession but its practical utility seemed to fade away with time. Many Modern Homoeopaths are not aware of its usefulness and application. As Dr H A Robert says, “To the majority of Homoeopathic physicians the last chapter in the Pocket book, Relationships, has been a complete mystery.”[1]

Dr H. A. Robert and Dr M. L. Dhawale, who revived Boenninghausen’s work, especially popularized the Therapeutic Pocket Book and its application at the bedside after Kent’s storm. They also recommended use of Concordance as follows:

Dr Roberts says about the Concordance chapter in Therapeutic Pocket Book, “ …with this background we cannot believe that any part of the book would be for merely casual use; it was the accumulation of practical knowledge of many years’ experience. [1]

Dr Dhawale writes, “A systematic use of this section(Concordance) not only steers the prescriber to the second prescription but also guides him to a more happy prescription when the previous choice has proved a close miss.”[2]

The Historical Evolution of Concordance:

Before understanding its application, it is necessary and beneficial to appreciate the evolution of the Concordance chapter as a concept and tool in the Therapeutic Pocket Book (1846).

Dr Hahnemann too used remedy relationships as we find, “Hahnemann’s Paris casebooks show that the founder was already using well-known acute and chronic relationships like Aconite and Sulphur or Belladonna and Calcarea.” [3]

At the time of Boenninghausen, observation from Hahnemann were available as,

Sulph>>  Calc ( Calc works well if given after Sulph).

Sep >>Caust.

Sep >>Lyc.

Calc>> Nit Ac.

Kali –c >> Nit Ac.

Kali-C  >>Phos.

Ars>>Sulph.

Merc>>Sulph.

Sil>> Sep.

Nit-Ac >> Sep.

Sulph>> Sep

The observation shared was that the subsequent named remedy works better if it follows the previous one.

Dr Jahr listed this experience also some other experiences in his handbook. Boenninghausen feared it may lead to routinism and direct application without considering similia.[4]

Relative Kinship of Homoeopathic Medicines -1836 :

However, it was Boenninghausen who wanted the remedy Relationships to be more elaborate and flexible for its wider use. He wrote…“I feel that something had to be done in a more serious way, than done before.”[4] Therefore, after the publication of Systemic Alphabetic Repertory, well- known as Anti-Psoric Repertory in 1832, The Relative kinship of Homoeopathic Medicines was published in 1836, the first serious attempt of its kind on the subject. This work developed during the compilation the anti-psoric repertory.

 

Boenninghausen’s observation:

In the Relative Kinship of Homeopathic Medicines, he explains his views and observations. He opined that this type of limited and direct reference (which was available then) often ignores the homoeopathic principles, in application of next remedy. Example: Calc.>>Lyc. It was interpreted as Calc. should not be given after Lyc and it became a common notion. But he had given Calc. even after Lyc. With good effects, when indications agreed.

Hence, he was convinced that “relationship” is far more than just a few equations observed clinically. Therefore, he decided to work on this observation, in a way where it can be used effectively and without ignoring Homeopathic principles. As he wrote...“I feel that something had to be done in a more serious way, than done before.”[4]

Evolution of the Concept and Representation of Remedy Relationship.

Therefore, he worked seriously on the subject, “……importance of the knowledge of the remedy relationships (which I realized in an early stage) urged me during the last two years to make comparisons in that direction, and to have a steady eye on the subject while prescribing.”[4] (1836)

This is how Remedy relationships of Boenninghausen shaped up and enlarged to become a useful work, with his careful study and clinical observations. He goes on, “…great opportunity arose, when I started to arrange the repertories and furthermore the arrangement of the main areas of actions of the remedies, being combined and simultaneously worked at. By this cumbersome process, I gained certain insi

ghts, which then had to be tested in practice” [4]

Thus, Repertory compilation and a serious study of Materia Medica were responsible for development of Remedy Relationships along with clinical experiences. During the compilation of the Anti-Psoric Repertory he started to work on the Relative Kinship of Homeopathic Medicines.

This work is more compact than the Therapeutic Pocket Book. As can be seen in the image, a group of remedies is listed under the heading of a particular remedy, but this is not as elaborative and detailed as in the Therapeutic Pocket Book’s Concordance. However, in comparison with then other available works, this is a very systematic and elaborate work on remedy relationships.

[image-2: Affinities of Homeopathic Medicines in Relative Kinship of Homeopathic Medicines. Sources: https://play.google.com/store/books/details?id=Xhs4AAAAMAAJ]

 

Incompleteness of the work:

As Boenninghausen wrote “…as I believe, the not unimportant results of my findings will inspire ready homoeopaths to publish their findings, then, the aim is not missed, and I don’t need to be afraid of having presented a premature work to the knowledgeable world.”[4]

Though based on larger observation and study, the work still remained less utilised; its usefulness not being certified by users. Boenninghausen himself accepted many errors and omissions in this work, but the idea of its use was strong, which led to a more accurate and larger work in the Therapeutic Pocket Book as Concordance.

 

Concordance in Therapeutic Pocket Book:

Boenninghausen applied the concept he developed during Relative Kinship of Homoeopathic Medicines, and expanded it with more accuracy and utility. He improved and enlarged it with more titles under the remedy (rubrics), more remedies added for the remedy under consideration Usefulness broadened with flexibility. Corrections were done.  The scope got wider and multi-faceted, as he wished in his earlier paper on Relative Kinship in guidelines.

Development and formation:

Prepared during all those 10 years of development of Therapeutic Pocket Book, he carried out Comparisons of the effects of all medicines in use, in relation to the sections-chapters-Rubrics (found in TPB e.g. localities) Thus, formation and construction of TPB also shaped the ‘Concordance’, the way it is.

Basic overview of the Concordance chapter:

In the Concordance chapter, under each remedy, the following rubrics are provided with remedies that are related according to his study.

In the original German Therapeutic Pocket Book and Hempel’s translation, these rubrics were denoted with Roman numbers (e.g. I, II, III, IV etc. as seen in the image above).

Allen’s edition presents them as 1. Mind 2. Localities 3. Sensations 4. Glands 5. Bones 6. Skin 7. Sleep and Dreams 8. Blood, Circulation and Fever 9. Aggravation 10. Other Relationships 11. Antidote 12. Injurious (inimical)

[Image-3: Concordance of Aconite in Boenninghausen’s Therapeutic Pocket Book. Source: https://play.google.com/store/books/details?id=8Rs4AAAAMAAJ]

 

 

 

 

Boenninghausen used following system to denote relative value in the concordance chapter. Allen adopted different print styles to denote relative value for comparison.

Italics spaced – 5 mark – A c o n

Italics– 4 mark – Acon

Spaced roman – 3 mark– A c o n

Roman– 2 mark- Acon

Roman in bracket -1 mark –  (Acon)

The repertory part of the Therapeutic Pocket Book and Concordance both displayed the same gradation system as above.

The gradation seems to be the result of the comparison of remedies under different headings / rubrics in the repertory and Materia Medica Pura. It was a much improved work over the Relative Kinship of Homeopathic Medicines (1836)

He recommended to use the Concordance to enhance the study of Materia Medica that he referred to as the ‘fountain head’ for any action by a Homoeopath. “This Concordance have been of the most decided importance to me, as they have not only led me to understand the genius of the medicine, but also select with more certainty the proper remedies, and to determine the order of their successive exhibition, particularly in chronic disease” -Boenninghausen, Preface, the Therapeutic Pocket Book, Hempel Ed. 1847[5]

If we now refer to a remedy represented in the concordance and the various rubrics and the remedies represented with their marks in each of the rubrics, then the remedies which score the maximum marks are those which are closest to the main remedy that is being referred. Those remedies which score lesser and lesser marks move out to the periphery. This creates a kind of concentric circle. This idea is suggested by Joslin and recommended by Roberts and Dhawale.

Here is an illustration of the Concordance of Agaricus in concentric circle style from Boenninghausen’s Therapeutic Pocket Book- Hempel’s Edition.

[Image-4: Concordance of Agaricus from the Therapeutic Pocket Book. Hempel Edition. Source:https://archive.org/details/therapeuticpock00hempgoog/page/n10]

 

 

How to use it:

Through an effort of almost 15 years on cases and Materia Medica Pura, Boenninghausen gathered data and finally it took the shape of the concordance section in the Therapeutic Pocket Book, but he did not highlight the exact method of how to use this effort of his at the bedside. Hence this Concordance chapter got neglected and remained unused till Roberts gave the proper method to work it out.

Our basic purpose in working with it, is to find an appropriate related group of remedies for a particular remedy. When working, we must find the important related rubric (if any) for the consideration, and make it eliminative, then repertorize all other rubrics. The result will show the related group of remedies for consideration.

When to use Concordance: Indications:

Related remedies can be used for different purposes and in different clinical situations.  Using both ‘related remedies’ and ‘law of similia’,  one can assure a better and appropriate similimum.

According to Boenninghausen Related remedies can be studied as / for :

1. Antidote
2. To find the remedy which follows well in a more curative way than a non-related one in the second prescription.
3. One-sided disease – where often the remedy is partially similar,
4. Chronic disease – to decide the sequence of remedies,
5. Alternating use of the remedies – where the disease picture is covered by 2 remedies or phases,
6. When remedy is indicated but fails to act after an initial aggravation. [4]

Dr H A Robert summarizes the use of Concordance under the following situations as:

• Acute case – when symptoms lead to a remedy but there is no satisfactorily clear-cut similarity.
• Acute case – when initial prescription, though well-indicated, has done no good.
• Chronic case – when the remedy selected as the similimum has benefitted but has not cleared everything. Then this helps to get a group of remedies for further consideration.
• Advanced pathological case – when patient is not able to handle the deep-acting medicine – to find the similar acting (superficially acting) complementary remedy. [6]

Though these indications cover most possible uses, the authors would like to add a further point from their personal understanding and experience. A remedy selected symptomatically may seem well-suited mathematically and reference-wise, but somehow the knowledge, experience and reference of Materia Medica may not approve the choice satisfactorily. Here, working out the concordance of that remedy may suggest a better choice.

The rubrics of the concordance section of the remedy helps in choosing an appropriate remedy based on the sphere of action.

The rubric of related remedies is interesting – the remedies listed here may not cover all the rubrics but still the remedy  if indicated will help significantly.

The study of Remedies done by Dr Som Dev helps us in understanding the closely coming remedies, but it may make us prejudiced and so is ineffective at the bedside. If the remedy is marked high in a particular rubric in the concordance then if the indications match the result obtained is significant.

It is always useful to check the Location, Sensation, Modalities, Related Remedies rubric of the remedy if there is no further improvement. A remedy that comes high here will always help, though it seems to be partially indicated as no symptom similarity is observed.

If a patient has a predominant location as seen in the rubric of Skin / Bones / Glands / Mind  and you are referring to the concordance section of the most effective remedy, the highest marked remedy of that particular rubric may prove useful. Here too the physician has to  cautiously introduce the partially indicated remedial force.

Limitation:

This old work of Dr Boenninghausen contains earlier remedies and experiences. Though Dr T. F. Allen tried to improve it with additions at the end of the 19^th century,  today many new remedies have been proved and much clinical experience gathered, which needs to be incorporated in the standard manner. This is the best as far as old polycrests are concerned.

Case Example:

A Homoeopath consulted through correspondence for help for her case of persistent cough since 15-20 days that was not relieved with multiple medicines given one after the other.

A 4-year-old child, with complaints of Allergic Bronchitis, was under regular Homoeopathic treatment. Constitutional Remedy (CR) is Calc-Carb which relieves complaints. But this last episode was not getting clear.

Approximately 15-20 days prior, the child started with coryza and nose obstruction, which was treated with Ars-Alb. 200, with improvement, but soon this was followed by barking cough, Agg lying down, sticky greenish nasal discharge, so this time child received Kali bi. 200, with No effects, then after 2-3 days it was followed by Sambucus 200, with partial benefit, as frequency reduced but then it was Status Quo. Coccus Cacti 200 was also tried but without significant relief. Patient then also received Puls 200 and Ant-Tart. 200 as cough got rattling, but cough was increasing. This went on for almost 15-20 days since the onset. Now since the last 2 days, the cough increased³; the cough is barking and more frequent.

This case presented a mixed-up picture with non-related sequence of multiple remedies, tried to satisfy the form. The treating physician also tried the constitutional remedy in between, which was Calc Carb 1M.

This is a typical situation, where direct selection on partial pictures didn’t help. The constitutional remedy also did not help to resolve it. Concordance is useful in this type of a situation. We have to consider the remedy that is related with the constitutional remedy and covers cough / bronchitis-acute phase. Note that there is nothing available as characteristic features in presenting complaints except frequent barking cough; we consider it for its intensity.

Repertorization – work out with Concordance:

[image-6: repertorization sheet]

 

(Rubrics in Concordance like Glands, Mind, and Skin were not considered as we are dealing with Acute and those are non- relevant in this sector / case.)

Phos 200 3 doses were advised, each to be taken daily. Which relieved³ and cleared the episode.

Conclusion & Suggestions for future academic study:

• Most of all modern Homoeopaths are not well aware of this work and its importance. So standard studies should be promoted with case examples.
• Prescription based on Random reference of remedy relationship without considering the current totality is against the principles of Homoeopathy.
• Use of concordance with current totality is better than using direct remedy relationships as Calc followed by Lyco etc.
• This work needs to be upgraded in light of clinical experience, but with a standard process.
• Comparative study of Materia Medica can be enhanced by the incorporation of Concordance.

References:

1. Roberts H. A., Introduction to the Therapeutic Pocket Book. In Allen T. F., editor. Boenninghausen’s Therapeutic Pocket Book, New Delhi, B Jain Publishers (P) Ltd.; 2006. p. 37,

 

2. Dhawale M. L., Boenninghausen’s Method of Repertorization. In Principles & Practice of Homeopathy, Mumbai, Dr. M. L. Dhawale Memorial Trust; 2006. p. 109

 

3. Little D., Boenninghausen’s Life and Works. In Homeopathic Compendium Vol-2, Dharamshala, Himachal Pradesh, India, Omnibus Global; 2014. p. 158

 

4. Weitbrecht H. Boenninghausen’s Remedy Relationships – The Missing Link [Internet]. Hpathy Medical Publishers; 2019; [cited 2014 November 18]. Available from: https://hpathy.com/organon-philosophy/boenninghausens-remedy-relationships-missing-link/

 

5. Hempel C. Therapeutic Pocket Book. [Internet]. New York. W. Radde, 1847 [cited 2008 August 4]. Available from: https://archive.org/details/therapeuticpock00hempgoog/page/n10

 

6. Roberts H. A., Introduction to the Therapeutic Pocket Book. In Allen T. F., editor. Boenninghausen’s Therapeutic Pocket Book, New Delhi, B Jain Publishers (P) Ltd.; 2006. p. 57.