Dr. Cyrus Maxwell Boger, a renowned homeopath, has significantly contributed to the field of homeopathy through numerous writings and publications, enriching homeopathic literature. He revitalized the study of Dr. Boenninghausen’s works and revised the Boenninghausen therapeutic pocket book as the Boger Boenninghausen Characteristics & Repertory.
He has also shared his insights and experiences in the Boger Synoptic Key, establishing himself as a distinguished author in the field. His profound understanding of homeopathic principles, coupled with his extensive knowledge of materia medica and prescribing skills, has earned him a well-deserved reputation as a prominent figure in homeopathy.
Let us, through this case, understand the utility of Boger’s Synoptic Key in Repertory Analysis.
Case presentation:
A 38-year-old female, a homemaker, came with a chief complaint of severe abdominal pain. She reported a dull, aching pain in the upper abdomen, which started approximately three months ago, but which she dismissed as related to gas or acidity. After this, she did a USG and was diagnosed as having gallstones.
The pain initially was mild and intermittent but gradually worsened over the past 20 days, becoming severe and colicky. The pain was like a cramp and sharp causing the patient to bend. The pain radiated to the right side as well.
Pain is aggravated by eating and she even noticed an increase in intensity when there was some mental stress. She felt somewhat better when she would press at a particular part of the abdomen.
She was also scared because her father had a history of cholecystectomy due to gallstones. Other symptoms included nausea during the episodes of severe pain.
She feels anxious and restless during the painful episodes. The pain exacerbates her worry and agitation.
Past Medical History: No significant past medical history.
Family History:
Father- DM, cholecystectomy. Mother- Hypertension
Physical History:
- Appetite: Normal
- Thirst: Decreased
- Craving: She has a liking for fatty, cheesy, fast foods, but lately controls because of her gallstones
- Aversion: –
- Urine: Normal
- Stool: Normal
- Perspiration:
- Thermals: Chilly
Personal History:
The patient is a housewife and lives in a nuclear family with her husband and daughter. She has no major stresses or concerns unless her in-laws come to stay with them. When probed further about any other concerns, she mentioned that she was worried about her weight. She had been mocked, or insulted for being overweight and she had been trying to lose ever since and trying all methods of diet and exercises, etc.
Once someone insulted her publicly and she was greatly affected after that episode.
Physical Examination:
Abdomen: Tender on palpation, especially in the right upper quadrant. Murphy’s sign is positive. There is no jaundice or signs of peritonitis.
Investigations:
USG Abdomen: Reveals multiple gallstones with mild distention of the gallbladder. No evidence of gallbladder inflammation or obstruction of the bile ducts.
Diagnosis:
Acute Gallstone Colic
Totality of Symptoms:
- Dull, aching pain in upper abdomen
- Pain worsens with eating
- Pain relieved by bending forward or applying pressure
- Cramp-like, squeezing pain
- Tenderness in right upper quadrant of abdomen
- Nausea
- Anxiety and restlessness during pain
- A/f: humiliation
- Multiple gallstones
Analysis:
| Symptoms | Classification |
| Dull pain in abdomen | Location with sensation/characteristic |
| Cramp, cutting pain, in the right upper quadrant | Location with sensation |
| Pain aggravated after eating | Particular modality |
| Pain relieved by bending forward | Particular modality |
| A/f: humiliation | Mental characteristic concomitant |
| Mental stress aggravation | Characteristic mental concomitant |
| Anxiety and restlessness during pain | Common mental concomitant |
Repertorial Analysis:
- [Boger ] [condition of agg & amel]bending or doubling up, amel.
- [boger ] [condition of agg & amel]eating, agg.
- [boger ] [condition of agg & amel]emotions, mental excitement, etc.:agg.:
- [boger ] [condition of agg & amel]emotions, mental excitement, etc.:mortification, chagrin, vexation, etc., agg.:
- [boger ] [generalities]compression, squeezing, pinching, as of a vise, cap, etc.
- [boger ] [generalities]calculi, atheroma, etc
- [boger ] [generalities]cramp, colic, etc:
- [boger ] [stomach and abdomen]pain, dull, aching, indefinite, etc.
Rubrics from Boger’s synoptic key and its philosophical implication:
| Rubric | Philosophical implication |
| Stomach and abdomen: Pain, dull, aching, indefinite, etc. | Affection of abdomen |
| Generalities: Calculi, atheroma, etc. | The tendency to calculi formation- gallstones. When the concept of what is true to part is true to whole – the concept of grand generalization is applied, and this is further extended to the generalization of the pathology of gallstones when it comes to the creation of a pathological general. |
| Generalities: Cramp, colic, etc. | Grand generalization considered again |
| Generalities: Compression, squeezing, pinching, as of a vise, cap, etc. | Grand generalization of physical pain |
| Emotions, mental excitement, etc.: agg. | Mental concomitant |
| A/f: humiliation | Mental concomitant |
| Mental stress aggravation | Mental concomitant |
| Anxiety and restlessness during pain | Common mental concomitant |
Repertorization:
Remedy Selection:
Colocynth 30C once daily was prescribed based on the reportorial analysis
Follow-up 1 (1 Month Later):
Improvement was noted in pain intensity and frequency. Nausea was resolved. Continue current treatment.
Follow-up 2 (2 Months Later):
Further improvement was observed, with rare and mild pain episodes. No complications were detected. Continue current treatment.
Follow-up 3 (3 Months Later):
Significant improvement in symptoms.
This case shows the utility of Boger’s Synoptic Key in sub-acute presentation of pathological cases and a suitable similimum was selected. Boger’s genius in understanding concepts such as tissue affinity, pathological generals, and modalities, pathology, and pathogenesis can be seen in his well-structured repertory.
The totality of symptoms was formed based on characteristic pathological, physical and mental symptoms aligning with Hahnemann’s emphasis on individualization.
Boger’s utilization of Boenninghausen’s concept of grand generalization, “what is true to the part is true to the whole,” guided our selection of rubrics accordingly. While Boger’s repertory may have limitations in terms of the number of remedies represented, its integration of philosophy with practical utility at the bedside makes it an indispensable tool for the discerning homeopath.