Report on Three day Residential workshop with Dr. Dhiraj Nanda

By Dr. G. Mohan and Dr. Ramesh

Society of Advanced Homoeopathic Sciences in collaboration with New Life Educational Society organized ‘Three Day Residential Workshop on Clinical Homoeopathy with Dr. Dhiraj Nanda’ from 15th March to 17th March, 2010 at Hotel Arihant, Pachmari, Madhya Pradesh. The theme of workshop was to learn in relaxed and enjoyable manner. A limited of 40 seats were available for the workshop. In spite of two festivals that were during these days all seats were booked well in advance. 

Day 1 – Case-taking; Observations; Session continued till 10.30pm

The first scientific session on day one started after a very short inaugural session. The inaugural session consisted of garlanding of portrait of Dr. Hahnemann and lighting of ceremonial lamp. Dr. Chanchal Jain, Dhiraj Nanda, Dr. Nishanth Nambison and Dr. Smita Nambison were on the dias. The aim of first day was on case-taking. Dr. Dhiraj Nanda explained case-taking in detail, with 3 stages of case-taking and 4 methodologies.
Here he divided case-taking into 3 stages: Pre-Interview, Interview and Post-Interview.
Explaining the pre-Interview, Dr. Nanda said case-taking starts even before the patient enters our consultation room or even before we have asked our first question to the patient. He explained these with certain examples and pointers and even explained the rubrics that depict each of these behaviors.

Talking about interview he said when a patient comes to you for the first time you should be like a blank paper as you have to start from the beginning and understand the man in the disease who has come to you. One has to play at least three roles: listener, observer and recorder. What the patient says may not be as important as how he says. Never interfere when the patient is talking. He explained the importance of observations and pauses that occur during the interview part of case-taking with certain cases of his experience.

While explaining the importance of post-Interview he explained that post-interview comes after you have closed the interview session and is a part or extension of the main interview. It has two main objectives, first to probe in details of information that remained incomplete during interview; and second to confirm the important findings to the interview session. Here, we need to ask open-ended questions, inductive-deductive questions or confirmatory questions depending on the case. 
Dr. Dhiraj Nanda talked about four different methodologies of case taking. They were- silent listening; observation; deduction; and induction.
Silent listening: It is a state of attentively hearing what the patient is communicating to us.

Observation: It is study of patient by surveillance, viewing, watching and monitoring him. He quoted the aphorisms where Dr. Hahnemann had mentioned the importance of observation in case-taking. If observations are contradictory to what patient is telling, observations should be given more importance, as what we observe is definitely more reliable.
Deductions: It is interpretation or assumption or presumption based logical or reasonable inference. One can deduce from observations, past history, and by method of inductive deduction.

Induction: It is the method in which we initiate or stimulate the patient to generate the history. Here the doctor stimulates the patient to come out with some more details of some aspect of his personality or history.  
By the time the session on case-taking ended, it was evening. As most of the delegates wanted to talk and discuss about observations, a post tea session was arranged.
In this session Dr. Nanda pointed out that the incidence that is regarded as precursor to birth of homoeopathy roots from observation. It was an observation that made Dr. Hahnemann think about law of similars. So right from its birth homoeopathy has been associated with the phenomena of observation. He stressed that observations when interpreted logically provide absolutely dependable information. Time and again experience has proved that what one observes is certainly more dependable than what the patient says. Observations are useful in various aspects of homoeopathic practice. These are:

• Case-taking;
• Case-analysis
• Understanding the ‘Direction of Cure’. 

He explained that observations are definite pointers towards:
- Miasms;
- Rubrics;
- Constitutions;
- ESD 

He stressed on the point that what the patient says should match to what one observes. For this one should have the knowledge of what is be observed and how is to be interpreted. Skills of observations can god-gifted or acquired. Hahnemann was blessed great skills of observations.  Fortunately, one can develop good skills of observations. With a little effort and regular practice one can develop fairly good skills of observations.  After this he proceeded ahead with ‘Observations and Physical Appearance’. One of the aspects that are of interest to homoeopaths is to know the hidden mind through physical appearance. Is it possible? Experiences ratify this relation between certain behaviour patterns with certain appearances of the physical body. Dr. Hahnemann had recognized this fact more than 200 years ago. This is clear from aphorism 5 of ‘Organon of medicine’. Dr. Nanda quoted from literature on physical appearance by pioneers in the field of homoeopathy. Speaking on the ascertainable physical constitution of the patient being a pointer towards the miasms he quoted extensively from ‘The Principles and Art of Cure by Homoeopathy by H. A. Roberts – Reprint Edition 2000, published by B. Jain Publishers, New Delhi. 

 

Dr. Nanda explained the direct utility of physical appearance in reportorial analysis. Dr. Nanda stressed upon the importance of physical appearance in acute prescribing. He explained one can use the Thermal, Thirst, Laterality & Physical Appearance Axis which can be used when there is paucity of data / information to lead us to constitutional similimum. Applying the axis greatly reduces the number of remedies left for use to work with. By the time session for Day 1 concluded with the study of observations it was almost 10.30pm.  

Day 2 – Live cases and Case-analysis; Enjoyments; Causa occasionalis; Session continued till 12.00 mid-night

The second day started early. The first session on second day was live case taking. The delegates were divided into groups of 3-4 doctors.  Each group was assigned a case out 12 cases that were called by the organizers. One after another all the 12 cases were presented to Dr. Nanda who analyzed and prescribed the remedy. The remedy prescribed was explained to participating doctors. This was followed by lunch. After lunch, the second day was of enjoyment. The delegates visited places like Jatta-Shankar, Bee-fall and Sunrise-Sunset points. Many delegates enjoyed a refreshing bath at Bee-fall.

Delegates returned to the venue by 7pm. The night session started from 7.30 pm. Dr. Nanda explained how to deal with the cases when there is a maintaining cause. He explained ‘Causa occasionalis’ in practice in details. He explained maintaining causes with respect to different environments of the patients and related rubrics from different repertories. The session continued till almost mid-night with a break of half hour for dinner. 

Day 3 – Miasms, video clips; prescription vs. nutrition; understanding rubrics; treated cases; Questions and answers; Session ended at 4.00pm

Third day morning session was on observing miasms through video clips. Dr. Nanda presented eighteen video clips in this session. Dr. Nanda ended the session with illustration of different rubrics associated with observations and physical appearance from repertory. Most of these rubrics were explained along with photographs. The next session of the day was based on a question whether is it essential to prescribe a remedy to each patient who comes to the clinic for consultation. This session was entitled as prescription vs. nutrition. Dr. Nishanth Nambison from Bhopal presented a case of hepato-celluar carcinoma treated by homoeopathic medication along with indicated nutrition supplement.

Pre-lunch session was on understanding rubrics. Dr. Nanda explained the greed in different remedies mentioned under the rubric ‘Avarice’. Next he explained how different remedies will react after disappointment in love. He also explained the rubric ‘hatred, persons of, who had offended him’.

Post-lunch session was of question answer session where Dr. Nanda answered the questions of the participants.
During different sessions of seminar Dr. Nanda presented many cases treat by him. Some important cases were two cases of Hepatitis B; two cases of Hepatitis C; a case of Idiopathic Thrombocytic Purpura; a case of Interstitial infection of Lung; a case of carcinoma prostate; a case of testicular tuberculosis; a vascular necrosis of bilateral femoral heads; a case of diabetic nephropathy; and a case of uretro-vesicular reflux.

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