Dr. Ajit Kulkarni delivered a very practical seminar at Moscow from 18-22 April, 2008.  This was Dr. Kulkarni’s third visit to Moscow and we had already attended to his earlier seminars.

In view of need of practical subjects, we decided to ask Dr. Ajit Kulkarni to deliberate on three subjects, each subject to be delivered throughout the day - Diabetes mellitus, a growing problem of the world, Management of Fevers in homoeopathy as it is a challenging job in clinical practice and Intercurrent Prescribing, a debatable subject in homoeopathy. The fourth day was reserved exclusively for live cases and their analysis and guidance. Even on the first three days we asked Dr. Ajit Kulkarni to take a live case before the group, relevant to the subject.

Without deliberating much on the clinical side of DM, as our association is of medical doctors, Dr. Ajit Kulkarni spoke at length on management of DM. He emphasized that homoeopathy has a definite scope in this multi-faceted disease and DM represents, in a true sense, the very holistic nature of homoeopathy. Modern man’s life style, diet habits and lack of exercise are always regarded as contributory factors in DM. But apart from these factors, Dr. Kulkarni put up the basic theme of Love as a major cause. He correlated love with sugar and held that just as sugar running out occurs in DM, love remains being unutilized in the patients. His contention is that love is a basic emotion of human beings and everyone has a basic need of it. Everyone wants it, wants to share it, but the circumstances as well as patient’s own ego problems build up a wall that doesn’t allow the free flowing of this emotion, and thus a state develops of accumulation of love i. e. sugar. Behind the desire of diabetics to enjoy sweet things, and their inability to assimilate and absorb them, stands an unsatisfied desire for love, along with an inability to accept love and absorb it unreservedly. The patient adds the redundant things of his own and makes the whole stuff sour and acidic.  He noted that love as an emotion, if not received or even not shared, begets many emotions out of which aggression and jealousy play a vital role. Diabetes leads to over-acidification of the whole body and acid is a symbol of aggression. Thus a diabetic person represents polarity between love and aggression, between sugar and acid. The people who accept love are only able to give love. Diabetics give out love only in the form of unassimilated sugar. The lesson the disease diabetes gives is ‘without love a person is likely to become sour, acidic and diabetic and that bad results follow after consuming sweet things if the problem is at the level of poor assimilation.’

Dr. Ajit Kulkarni presented many cases of DM from his practice.

A female, aged 59 years. Obese. Diabetes since 7 years. Was operated for breast Ca (had metastasis to axillary glands) before 4 years. 3 cycles of chemotherapy given.

Chief complaints- Chronic hyperacidity. Severe burning from stomach to throat. Water brash. < fasting, > eating. Tendency to hawk up tenacious mucus, which >. Stuck sensation in stomach, as if all food has lodged = oppression of chest. Osteoarthritis of knees and right frozen shoulder; < motion. Polyuria. Pain in hypogastrium if urine is withheld. Chronic hoarse and dry cough without any modalities.

Life space- Family consists of a husband, 2 sons- married with 2 grandsons from each son. Husband retired from bank. Patient housewife. Cross with everyone. Doesn’t listen to anybody. Will not observe dietetic restrictions or any exercise. Very lazy. What is the use of your medicines if you tell me to observe all this?  She has a sharp tongue. If angry she will go on talking for a long time. She may abuse others and speak very sarcastically. Doesn’t respect any one. Due to constant quarrels, D-I-Ls opted for separate homes. Now the family is separate and they have close apartments. Patient doesn’t visit any home. ‘All relatives should come to meet me’. Behaves with contempt. High self-image.

Interview was a bit difficult. Her BL was of superiority gesture. She spoke with sarcasm over today’s doctors’ behavior with the patients.

Investigations - Blood sugar -  Fasting 232 gm%   PP- 278 mgm% Hb - 9.2 gms%

Selection of remedy Lactic acid

Reasons

•         The combination of DM, arthritis & hyperacidity

•         Sarcastic and contemptuous behavior

•         The acridity of Acid group of remedies

•         Locality: Breast

•         Frequent urination

Follow-up For over 3 years, beginning from low potency in 30 c, then in ascending scale. Improvement at all levels including investigations occurred in this case.

The second day began with Management of fever cases.

In order to highlight the benefits of fever, Dr. Kulkarni informed that from an evolutionary perspective, the phenomenon of fever has been operative for hundreds of millions of years. Fish, amphibians, and reptiles develop fever. When fish are injected with bacterial endotoxin or gram-negative bacteria, they raise their body temperature by swimming to warmer water. The notion of fever as beneficial persisted for more than 2,000 years and countless patients were treated with ''fever therapy'' to aid recovery from syphilis, tuberculosis, mania and even cancers. In the mid-1800's, aspirin & other antipyretic drugs became commercially available and the medical view of fever changed abruptly. For the next hundred years, physicians and patients focused on bringing down fevers, with drastic measures. The new findings raise serious questions about the wisdom of taking antipyretics for fevers below 40⁰c  i.e. 104 F.

Pediatricians now suggest that moderate fevers be allowed to run their course, for they may shorten the illness, potentiate the action of antibiotics and reduce the chances of spreading the infection to others. Fever increases the phagocytic and bactericidal activity of neutrophils and the cytotoxic effects of lymphocytes.

Fever, mobilizes the body's immunological defenses against infectious organisms and directly inhibits their growth. Science is on the verge of verifying the belief of Thomas Sydenham, the 17th-century English physician, who said: ''Fever is Nature's engine which she brings into the field to remove her enemy.''

Dr. Kulkarni, while exploring the evolutionary understanding of disease with its ramifications,  exemplified the flow charts with many clinical experiences.

Requiring ……

• Requiring no treatment / Indisposition

• Requiring wait and watch until the full-blown picture is emerged, (however, if the moderate picture is present).

• Requiring definitely the treatment  

• Requiring immediate attention and  treatment in view of the over-  whelming state

Dr. Ajit Kulkarni first outlined the basic philosophy of construction of fever totality and underscored the importance of understanding it first through Bonninghausen, Kent, Allen and

Boger. He told that without knowing the core elements of fever totality either in acute or in chronic case, it is difficult to treat fever cases. While narrating many avenues of prescribing methods in handling fever cases, he focused on stages and patterns of fever with origin, duration and progress factually elicited in a painstaking way. There is no shortcut to totality and failures occur chiefly due to inadequate history.

Basics of Fever Totality

The consideration of phases…

• The Pre-clinical phase of Disease Response

• The clinical phase of Disease response

• The stages and the patterns right from prodromal phase through Chill, Heat, Sweat and also Apyrexia/interval phase manifested as  succession of stages with alternating phases

• Five responses – slow, rapid, slow then rapid, rapid then slow and status quo

• Miasmatic co-relation

• Post-fever state of the system

All these points were discussed by Dr. kulkarni at length.

Materia medica study as presented by Dr. Kulkarni dealt with patterns of fever with related remedies. He gave core indications, energy patterns and then comparative study of remedies.

Intercurrent Prescribing (IP) was presented to Russian homoeopaths for the first time. One full day was short to understand this basic subject.

The contents of Dr. Kulkarni’s presentation: The crux of the problem is when there are no sound indications and a physician is confused. He has been trying to fish out the most similar remedy by taking into account many layers and levels and yet no recovery occurs. He has tried amply, with many remedies and in various potencies, yet the patient is not on the road of recovery. His state is confusion worse confounded! IP, in such cases, has a definitive place in practice.

The concept of intercurrent prescribing is in line with law of similars and Hering’s law. It is necessary to first study why it developed. The answer resembles miasmatic concept of Hahnemann. Hahnemann developed the theory as even after 12 years of practice, there were failures even after appropriate application of the law of similars. And Hahnemann’s theory of miasms did receive scathing attacks from personalities like Hering and others. Hering commented, ‘If totality of symptoms is the only guide for selecting similimum why to go for this theory?’

It is necessary to understand that every concept in homeopathy has developed out of needs, given the wide dimensional spectrum of homeopathy. Homeopathy is a human medicine and to understand it requires myriads of tools. But we must remember that every concept has its own scope and limitation.

Intercurrent prescribing fills the gap caused by lacking data presented by patients, unsatisfactory coverage of miasmatic background by the remedies prescribed, due to incomplete knowledge of Materia Medica, incomplete clinical picture and so on. It’s not so simple that you get the totality in every case. Even if you have a quantitative totality, it carries less significance as what is needed is a qualitative one. Further, even if the data is qualified, it has to be processed in a right manner. There are many missing links in the data of the patient and they do not come onto the surface due to ‘n’ number of forces. The human being is a dynamic one and hence a constant activity-reactivity pattern is exhibited by the system in response to environmental stimuli. Further, there is genetic pre-disposition and unfolding of the genetic information in the form of disease. The pattern of energy is variable and erratic in many individuals and it may cause turbulence in the system. There is ‘dynamic’ similarity too. This aspect of homoeopathic clinical practice is a very individualistic perception and it can’t be put into words in an adequate manner. There is an individual perceptual filter specific to each physician in homoeopathic practice and it does play a role in intercurrent prescribing.

The concept of a single remedy and minimum dose are the bedrock of homoeopathic posology. But it doesn’t mean that ‘one dose and finish’ occurs in every case. Everyone feels that with one dose of a remedy every disease should be cured but this could be a delusionary expectation.

Dr. Kulkarni emphasized that IP has to be used when ‘well indicated remedies fail and the system is stuck’. He gave several cautions viz. not to use intercurrent remedial force as a ‘desperate weapon’ without a proper ‘indicated main-current’; if one is not sure of the acute / chronic similarity level, do not use the intercurrent force; it is premature to use them and quite often useless, too; control its use as per the assessment of the degree of the miasmatic activity, the presence of pressing indications and definitive specific features, and the response elicited by first dose of the remedy and finally one has to accurately update the plan of its use as per the response analysis.

Dr. Kulkarni gave several acute and chronic cases from his practice where indicated remedies failed to act and IP selected relevantly helped the case.

One of the creditable events of this seminar was much awaited publication of A select Homoeopathis Materia Medica by Dr. Tarkas and Dr. Kulkarni in Russian language. Dr. Kulkarni’s earlier two books- Kali Family with its Relations and Homoeopathic Posology have been translated and are popular in Russia. The audience applauded the sincere work of Dr. Kulkarni.

The four days were packed with knowledge and profoundly presented by Dr. Ajit Kulkarni. Every case was taken in detail before the group and analysed from philosophical and practical standpoints.