Repertorisieren

Vergleich: Erste Mitteln + Klein - groß. Siehe: Repertorization + Repertorien

http://www.naturmed.de/files/pdfs/Frei%20-%20Homoeopathische%20Behandlung.pdf

Kritik:

[William H. Burt]

Often noticed that when a remedy has a certain very striking symptom or modality, it will often cure the exact opposite of that symptom or modality. For example, Lycopodium has very strongly “desires for sweets,” will often cure when there is a strong aversion to or aggravation from sweets.

[Filip Degroote]

10 Simple Rules to Find the Appropriate Homeopathic Remedy

Dr. Filip Degroote shares his ten rules to find the simillimum. He also shares his groups of remedies from different kingdoms that can be used in prescribing.

The reason for writing these ‘rules’ is the crisis in the homeopathic world due to the lack of new homeopathic physicians. Homeopathy is chosen for study by fewer students than some decades ago. I believe the following reasons account for this:

1^st there is the threat from outside, namely the pharmaceutical and the so-called scientific world which wants to eradicate homeopathy worldwide. Secondly, there is the threat from inside our homeopathic community, where there is still a silent competition going on between the different approaches and schools in classical homeopathy which creates a split, sometimes between homeopaths living in the same region. This disunity in classical homeopathy also created confusion in the minds of patients and therapists who showed some interest in homeopathy, not to mention the still always existing supplementary confusion created by the ‘false’ complex homeopathy. Consequently, especially for beginning therapists, this disunity without cohesion comes over as chaotic, which makes the matter too complex and inaccessible.

But, like any complex matter it can be mostly described in simple terms. During my 40-years practice I distilled the following ten simple rules.

Ten simple rules to make a good homeopathic prescription:

1^th. Throw aside all theories of belief and opinion, and dwell in simple fact! (James Tyler Kent, Lesser Writings)

Nowadays we are confronted with different homeopathic schools. Those schools are competing with each other and have a dividing effect on the homeopathic community. Although their theories are interesting to get acquainted with, some of them radiate a dogmatic approach which is in contrast with their real lack of efficiency in practice.

It has to be noticed that the different points of view are often very contradictory at first sight. Moreover, some of those approaches are quite difficult and nearly inaccessible

to understand, so that if you look for similarities between them, you will not find them. This creates confusion and is, in my opinion, the main reason for the current crisis in homeopathy.

An example:

Different schools have competed for decades to be the exclusive one possessing the ‘true homeopathy’. There can only be ‘one’ simillimum. At a unifying homeopathy congress in September 2017 in Bruges, a case was proposed to be solved by the different schools and it led to finding a different remedy by each school. This proves that these various approaches fail and that a general starting point has to be sought again.

So theories may not become dogmatic!

2. In homeopathy we need to use an ‘as complete as possible’ repertory!

Homeopathy has become strong through the repertory. That’s why all valuable data, whether coming from the provings or from the clinic, have to be included in the existing repertories. The time is passed that symptoms originating from daily practice were labelled as unreliable. Nowadays this clinical information is widely accepted and used by leading homeopaths and gives us the opportunity to understand our remedies better.

3^th When the second and following prescriptions have to be prescribed, look for new symptoms! NOTE: It is a misconception that a remedy can only be considered as the simillimum if that remedy has shown its curative action during one or two years.

4^th Use only strange, peculiar and unusual symptoms § 153 – Organon Hahnemann. What is a peculiar symptom?

The leading symptoms of the case to be prescribed upon are those that are “strange, rare, or peculiar,” but what exactly is meant by that? In Barthel’s Characteristics of Homeopathic Materia Medica we find a brief summary of the twelve ways in which the “strange, rare, and peculiar” symptom may be understood. All these examples are

from the remedy Phosphorus.

The symptom is peculiar in itself: “long narrow stool.”

The symptom is peculiar through the modality: “mania for work before menses.”

The symptom is peculiar through its localization: “cold knees at night.”

The symptom is peculiar through sensations: “anus feels open.”

The symptom is peculiar through extension: “pain coccyx extending through spine to vertex, drawing head backward during stool.” (dgt)

The symptom is peculiar through beginning, progression, and end: “pain increases and decreases with the sun.”

The symptom is peculiar through contrary symptoms: “lack of vital heat, but heat aggravates.”

The symptom is peculiar through its periodicity: “headaches every 7^th day.”

The symptom is peculiar through alternating symptoms: “delirium alternating with consciousness.” (dgt)

The symptom is peculiar through sequences: “bloody vomiting following suppressed menses.”

The symptom is peculiar through vicarious symptoms: “vicarious epistaxis.”

The symptom is peculiar through the absence of expected symptom: “increased sexual desire without erections.”

5^th Mental and general1 symptoms are the most indicative symptoms to be taken into account to find the most appropriate remedy for the patient (Organon- § 211;

Kent Lecture XXXIII) This includes also mind-symptoms originating from the unconscious, as dreams2 and delusions.

6^th Avoid as much as possible ‘objective clinical symptoms’ which represent the false ‘clinical homeopathy’! Keeping in mind that Hahnemann was the first to evaluate subjective symptoms as the most important ones! The combination of ‘new, peculiar and subjective’ symptoms can easily be found in dreams. That’s why my Dream Repertory is of such a great value. This repertory contains nearly two times more supplementary MIND information than the existing Synthesis ‘Mind + Dreams’ chapters together. Dreams, which are not specifically related to the daily reality and consequently have their origin in the creative unconscious of the patient, are normally very useful, even when dreamed only once! See: Radar Opus: Dream Repertory – Degroote; Dreams from homeopathic perspective – Degroote.

7^th Which mental features can be selected as valuable symptom?

All the so-called personal mental features, related to education, culture and habits, have to be avoided (even during the first intake consultation). Only when some features are so exaggerated from the common point of view that they are clearly noticed, can they be retained! A mistake homeopaths frequently make is that they re-use some of those so-called personal treats again and again when searching for a new prescription. This happens especially when the first remedy appears of having failed to act but also when the previous remedy was successful. Homeopathic patients in our complex Western civilization need a more deep-acting mentally fitting homeopathic remedy than for example in India where clinical homeopathy in many cases gives splendid results.

8^th The adagio, that the totality of the symptoms has to predominate when prescribing, must often be put aside, when we have the disposition of striking, singular, uncommon and peculiar symptoms. Prescribing on those symptoms cannot be always considered as key-note prescribing.

Argument:

– We know much too little about our small remedies to make a complete image of them, frequently because the provings were done on a very small number of participants or were not done in such a complete way as in the old days.

– Sometimes we see a confirmation in the presence of an allied remedy in an important retained symptom which doesn’t contain the simillimum. (see below)

9^th Knowledge of the remedies which are similar to each other through the different kingdoms can give you a hint to find the ‘simillimum’.

See: Allied and Satellite remedies, Notes on Miasms and Remedy interactions, first edition – 1994 (dgt) – below a more enlarged version by the author (2019):

ALLIED and SATELITTE REMEDIES:

Some remedies have a very close relationship, because:

– they have some components which are identical.

– they are a sort of combination of two existing remedies; this is especially found in some mineral-complex remedies.

– they are known in the clinic as being very similar.

So, we can identify some groups of remedies: e.g. :

Ammonium group (NH4+): (all ammoniums), (chitin (C8H13O5N) which is present in the exoskeleton of crustaceae, spiders and insects, and in the mollusca), Caust Ichth. Merc-sol.

Antimonium group: Aethi-a. Ant-ac. Ant-ar. Ant-c. Ant-f, Ant-i. Ant-m. Ant-met. Ant-n. Ant-n-l. Ant-o. Ant-s-aur. Ant-s-r. Ant-t. Calc-st-s.

Argentum-like remedies: Cit-v.

Arsenicum group: Achy.(warm-blooded), Ail. (Ant-ar.), Ars. Ars-h. Ars-i. Ars-met. Aster-xyz. (Calc-ar.), (Lob.), Luid-ci. (Nat-a.), …

Calcarea carbonica group: (all calcareas), (Alum.), Bell. Blatta-o.vml3, (Cist.) (resembles calc. only physically), (Con.), Cor-r. (Graph.), Hep. Hyos. Lap-a. (Rhus-t.), (Rumx.), (Sep.), Stront-c. Tarax. Urt-u.

Calcarea phosphorica group: Calc-hp. Calc-p. Carb-an. Chin. Puls. Rumx.

Cuprum group:(asteraceae), Choc. (ferrums), Lev. (loganiaceae), (mollusca: e.g. limx.), (solanaceae), (snake remedies especially those made of the snake poison), (zincums)

Ferrum group: (all ferrums), (fabaceae), Alf. All-c. All-s. (Alum.), Anth. Arn. Bit-ga. Cham. (Chin.), (Chinin-s.), (Choc.), Chr-met.stj, Crot-c. Cupr.stj, Cyna. Graph. (Ham.), Hecla, Kali-bi.stj, Lact. Lev. Lycpr. Mang.stj, Mill. Nicc.stj, Orig-v. Puls. Rat. Ratt-norv-s.hrn, Rumx. Slag, Tarax. Thlas. Urt-u. , Vanad.stj, Viol-t. Zinc.stj

Ferrum phosphoricum group: Bar-c. Carb-an. Chin. Ferr-gp. Ferr-p-h. Ferr-py. Mag-m. Phos. Plb-met. Puls. Rumx. Sec. Zinc-met.

Fluor group: Am-f. Apat. Bar-f. Blatt-o. Bothri-sg. Calc-f. Ceras-ce. Crot-d-t. Dendr-ang. Ensis-d. Fl-ac. Hecla, Kali-f. Lap-a. Lamp-sl. Lycps-v. Mag-f. Mag-sil-f. Micru-ln. (Mosch.), Nat-f. Nat-sil-f. (Sabad.), Sep. Slag, Topa-au. …

Iodum group: (all iodides), (brown algae, a.o. Lamin-d.), Adel. Aq-mar. Fuc. Hed. Iodof. (Meny.), Spong. Spong-n-t. Teucr. Thyr.

Kalium group: (all kali’s and their components), (fungi: contain kali-p.), (all snake remedies: especially Crot-c.), (trees), Alum. Anthraco. (Aran-xyz.), (Buteo-j.), Carb-v. Caust. Elat. (which contains potassium), Haliae-lc. Lam. Lyc. Puls. (which flowers contain potassium sulphate), Sabin.(remedy is made from the young shoots which contain much potassium), Spig. (responsible people who look like Nat-m.vml), Stram. (which contains potassium), Tarax. Tul.

Lycopodium group: (Abrot.), Chel. Lyc. (Senn.)

Magnesium group: (all magnesias and their components), Choc. (Gink-b.), Hecla, Phase-vg. Slag°, Urt-d. Urt-u. (Viol-o.), (Viol-t.)

Magnesium phosphoricum group: Bell. Coloc. Gels.

Manganese group: (ericaceae), (fabaceae), Slag

Mercury group: Aethi-a. Aethi-m. Cinnb. (all mercuries), Merl. Phyt. Podo.

Natrum muriaticum group: (all lac remedies), Am-m. (Apis), Aq-mar. Borx. (Bry.), Cisplat. Crot-ax. Crot-d-t. (extravert and social), Hall, Kiss. Lac-d.c1 (and all lac remedies), MAG-M. (Medus.), Methyl.vjp (= love of money, breaks off with family), (all natriums), (Sarr.), Sil-mar. Spig.vml

Nitricum (NO3-) / Nitrogen group: (all nitrogen remedies, including: ammoniums), Aml-s. Beta-co. Calc-pic. Cisplat. (Crot-ad.), Esin. Glon. Gunp. Merc-sol. Nicot. Pic-ac. Prot. Pulm-hist. Scat. Trinit. …), (asteraceae), (chenopodiaceae: Beta, Beta-co.), (cruciferae), (fabaceae), (insecta)

Nux vomica group: (Carb-v.), Cupr. Grat. Nux-v. (Sep.), Stry.

Oxalic acid group: (araceae), (caryophyllales with especially chenopodiae and polygonaceae: a.o. Beta, Chen-al. Chen-g. Fago. Portu-o. Rheum. Rumx. Spin-o.), Narc-ps. (oxalidaceae), Petros. Pip-n. Thea

Phosphor group: (fungi), (labiatae), Abies-n. (Acro-xyz.), Adeps-s. All-c. All-s. Blatta-o. Bol-e. (Calc-p.), Caras-au. Crot-d-t. Crot-h. (Cycl.), (Dendr-vir.), (Echinodermata), (Gels.), Lac-del. Lec. (Medus.), (Nat-p.), Ph-ac. Phos. Phos-ti. (Rumx.), Sabad. Scir. (Sphen-m.), Ther-n. Trach. Urt-d. Urt-u. (Viol-t.)

Platina group: Cisplat. Pall. Plat.

Pulsatilla group: Arist-cl. (aristocratic puls.dorcsi), Calc-m. Calc-p. Cycl. Ferr. (Graph.), Kali-i. Kali-s. (= an intense puls.) , (Naja), Puls. Sil. (Sulph.)

Rhus toxicodendron group: Form.bg (looks like apis but the modalities are of rhus-t.), (Calc.), Com. Med. Euph. (cancer with rhus-t. symptoms), Ran-b. Ran-s. Rhod. Rhus-r. Rhus-t. Rhus-v.

Sepia group: (some carbons), Asper. Fl-ac. (Medus.), (Nat-m.), Nux-v. Sep. Sep-cal-bil. Sep-os. Sulph.

Silica group: Alf. Alum-sil. Amethyst, Bamb-a. Bamb-vg. Calc-sil. Castor-eq. Equis-h. Flint, Get. Hecla, Lysim. Nat-sil-f. Puls. (Rumx.), Sanic. Sil. Sil-mar. Sphing. Urt-d.

Urt-u.

Snake remedies, remedies allied to the: Abel. Cimic. (= cold lachesis), Cupr-met. Lac-c. Rauw. Zinc-met.

Sulphur group: (iridaceae), (liliaceae), Acon. Aethi-a. Aethi-m. All-c. Ant-c. Arn. Atro-s. Bov. Teste (recognition), Cadm-s. Calc-s. Carbn-s. Chinin-s. Cinnb. Choc. Hep. Iris, Iris-foe. Mag-s. Merc-s. Mytil. Nat-s. Psor. Rumx. Sel.pd, Sep. (sep. contains 40% sulph.), Sul-ac. Sul-i. Sulph. Tegen-do. Tell. Tet. Vanil. Vip. (materialism), Vip-l-f.

Zincum group: (all zincums), (snake-remedies made of the Snake poison), (Cuprum), (ferrums), Pin-pi. Tus-fa. (Viol-o.), (Viol-t.)

10. Aggravations after a ‘real’ simillimum are extremely rare and usually due to past events in the life of the patient (referring to bacteria and viruses) or in the life of the ancestors (referring to the miasmatic state of the patient).

These aggravations can be resolved almost immediately by administrating the unblocking homeopathic isopathic (bacterial or viral) agent or the appropriate classical or bowel nosode, followed in general again by the administration of the already known simillimum.

REMARKS:

OPTIONAL:

– A simillimum generally acts deeper and faster if followed by the ancestral adjudgement. When the simillimum can be complemented by a classical remedy (usually Psorinum) or a bowel nosode, the effect of the given simillimum deepens.

– Precise confirmation of the appropriate remedy can be obtained by applying the Energetic Examination (dgt)

See: Energetic Examination – Radar Opus: Physical Examination and Observation in Homeopathy (update-2014); Muscles, Nerves and Vertebrae Repertory; Degroote energetic remedy picture; and: Energetic examination: a course about the method.

[Farok Master]

INFORMATION given in REPERTORY is NOT ALWAYS GOSPEL TRUTH!!!

The purpose of a repertory is to facilitate the search for the most similar remedy or remedies corresponding to a given set of symptoms. The repertory should guide us

to the proven and reliable symptoms associated with a medicine with certainty and at the same time show us the relative importance of the symptoms.

Unfortunately, these requirements are not met by even the best and most famous repertories. There are a large number of errors of omission as well as commission in Kent's great Repertory of the Homoeopathic Materia Medica. Kent knew that his repertory was in a state of infancy, but he may not have been specifically aware that it contained numerous unreliable symptoms. These arose from a somewhat indiscriminate use of the works of earlier writers of repertories.

Naturally, all repertories which are founded of Kent's Repertory carry over all these mistakes. The nature of the errors and reasons for them become clear when we study the history of Homoeopathic repertories. Therefore, we start with the following outline of the history.

All said and done I honestly use repertory in my practice daily but at the same time I keep it as my slave and not as my master.

The most important use in my practice of repertory is to learn materia medica and prepare my notes, this is such a useful tool.

The next best use is to understand which group of remedies come forward in a given case, once you know the group of remedies is known it then becomes a simple task

to extract materia medica and see the actual symptoms.

Remember! symptoms in repertory are not always reliable until and unless you do not confirm it with provings and reliable materia medica like Guiding Symptoms of Hering.

Let me give you an example I once saw an acute relapse of chronic migraine the following rubrics were considered

 HEAD - PAIN from exposure to sun; from

 HEAD - PAIN > hard pressure

 HEAD - PAIN at night

 HEAD - PAIN increasing gradually

 HEAD - PAIN < fasting

 HEAD - PAIN in evening

 HEAD - PAIN > cold washing

 HEAD - > cold applications

 HEAD - > cold air

 HEAD - CONSTRICTION (> pressure)

 MIND - ANXIETY about one’s own health

When I analysed the symptoms using the repertory I found that Sulphur, Belladonna and Nitric acid, Lobelia came in forefront getting equal marks and covering the same amount of rubric, how do we come to a conclusion?? the answer is simple reading materia medica and going through the provings helped me to select Lobelia inflata which reduced pain in few hours, do you really think I would have prescribed Lobelia inflata without using repertory? the answer is not sure. The next best use is using the concordance section of Boger Boeninghausen repertory. You can’t imagine how useful is this in my practice, let me give you an example of a simple remedy like China.

When I have used china as a constitutional remedy in a chronic case, the same person after some time if he undergoes stress or any mental trauma he will mostly require Ignatia or Pulsatilla, but the same person if he develops any joint or bone problem he will mostly develop symptoms of Merc-sol. or the same person if he develops skin disease then he may require Rhus-tox or Sulphur.

This is so true the never once I was let down by using the remedies mentioned under concordance section of Boeninghausen repertory.

The biggest disadvantage of repertory is to use pathological rubrics esp. cancer and related rubrics.

Most of the repertories give a wrong interpretation of pathology let take an example of Leukaemia.

Leukaemia as a disease has been known for a long time, but its pathology was not clearly defined until lately. Homoeopaths suggested a number of remedies for the treatment of leukaemia which they based on their vague understanding of its pathology. This was accepted without any critical assessment on the part of the homoeopaths and found its way into the repertory. Even today this rubric exists in the repertories with the full array of the proposed remedies. This disease was ascribed to the hydrogenoid constitution of Grauvogl.

That is why Natrum sulphuricum was put forward as one of the most important remedies, but also Thuja is there. Other than Thuja und Natrum sulph a whole series of remedies was put together which have a deeper relationship to sycosis or the hydrogenoid constitution. We note parenthetically that not all these remedies are to be found in Kent. In the whole of the homoeopathic literature Leukaemia is hardly dealt with. That is to say that there are no almost no reports of cures for this disease. And I would say for good reasons – because most of the drugs mentioned in the repertory have no relationship to the pathology of leukaemia. They cannot cure this disease and therefore the homoeopaths have no cases to present. Documented cases of true cures I have as yet to find in the journals.

My experiences have shown the importance of just a few more remedies like Benzenum, Bothrops atox and Ferrum picricum etc. but which have to be still properly proved in practice. Certainly Natrum sulph and Thuja are not among them.

Any repertory built on the basis of Kent’s Repertory and not considering the above points will carry over all the mistakes. I have checked other older repertories, which have their own unreliability's. To make additions from these repertories we need to do good screening and reverification. A good repertory should have a structure which clearly delineates the suppositions and the unproven from the proven. Well founded suppositions are valuable. They give a direction for further research which will decide the extent to which this symptom is significant. Each drug has certain basic symptoms, symptom complexes, which can be general or specific, and then each drug has specific pathological conditions, which belong only to this remedy. All these pathological relationships and symptom complexes have to be added to the repertory. They are missing in the repertories.

Let me illustrate this with the following example involving Calcarea sulphuricum and the symptom of being thirsty.

Spongia and other medicines have been written about in the materia medica as thirsty, but in my experience Spongia is only thirsty in the very beginning. And then after sometime there appears without doubt a strong thirstlessness, even for a drop of water. These are very important points, especially regarding stages or phases of an illness,

as we treat disease conditions and not a conglomeration of symptoms in homoeopathy. Coming back to Calcarea sulph we find quite the reverse than with Spongia and other remedies, it is thirsty throughout all the stages. This symptom I discovered very early in my practice and verified it repeatedly.

I have often cure with Calcium sulphuricum cases in which Pulsatilla was first tried unsuccessfully. This symptom of thirsty has sometimes been enough, if no other medicine was clearly indicated. This has now been incorporated in my synthesis repertory as a „reliable and distinguishing“ symptom. The treasure trove of homoeopathy develops from the practice, and consists of the proven and reliable symptoms and symptom complexes which we mostly find in the journals. The problem with the repertories came up because the authors of the repertories indiscriminately put in any symptom they felt like from the unstructured diversity of the homoeopathic literature. This led to ever more unreliable and false symptoms being integrated in a repertory. Once it was in the repertory it was considered to be God’s Word. We have talked about suppositions. These as we have said are legitimate, but have to be proved in practice. Let us take the example of Cocculus, one of H.’s remedies. One had great hopes in its curative powers in neurological diseases. Unfortunately Cocculus did not live up to its promise. Newer ones have lived up even less to their supposed curative powers.

T.F. Allen in his Preface to The New American Edition of Boenninghausen’s Pocket Book wrote: “it must be confessed that most of our new symptomatologies have not borne the searching light of clinical experience so well as those left us by Hahnemann.” Therefore we have to rethink the pathological action of a medicine if it does not fulfil its original promise, or, as Burnett called it, its range of action. But if these suppositions are allowed into the repertory, and they have been, then they have to be proved to be allowed to stay in there. If nobody makes these corrections because everybody thinks it is true, then the inaccuracies remain in the repertory. There are innumerable examples of this. For the purpose of illustration we again take the example of Indigo.

Indigo and other medicines were being given for supposed cases of epilepsy. It is found in the repertory under Epilepsy, But the truth is that Indigo has to my knowledge not once cured epilepsy. This is true for a great number of medicines. Many of the cases cited as cures of epilepsy just did not fulfil the criteria of epilepsy. They were just epileptiform type of cases. Even though there were voices against it all these medicines were included in Kent’s repertory. Therefore sometimes even experienced homoeopaths using these rubrics were unable to cure many of the cases of epilepsy.

The remedies which are capable of curing this disease have to have the basic nature of the pathology of epilepsy. The number of such remedies is not very large.

Many more examples can be given.

When we stop to think that many tens of thousands of symptoms of H. and his co-workers were missing in Kent’s Repertory then we can have a certain idea of the vastness

of what needs to be done. Because it is not just sufficient to merely add these symptoms to a repertory. Each of these symptoms has to be evaluated exactly according to its worth. The correctness of the repertory of Boericke has also been taken for granted. Even if Oscar Boericke states that the symptoms have been verified, we will find similar kind of mistakes as with Kent’s repertory and also other kinds. Just the example of abscess will make this clear. In those days the homoeopaths put everything into one pot - pustules, boils, carbuncles, abscesses, suppuration. It is certainly legitimate to think that a deep acting remedy, which produces suppuration, should also be able to have some kind of curative action on abscesses. But this has to be confirmed in practice. Most of the drugs for abscess found in

the repertory have cured only for pustules or boils!!!!

[T.K. Moore, M.D.]

A single symptom causing suffering is completely recorded only when its history, origin, progress and conditions attached, circumstances of aggravation, of amelioration,

time of occurrence and of greatest intensity, how affected by position, rest, motion, eating, drinking, or the performance of any body function, by mental emotions or by

any other cause – all this is included in the totality.

Cure takes Time

A constitution cannot be radically changed for the better in a week or a month. Hahnemann demanded at least two years for the cure of a chronic case. When such a case comes for treatment, refuse to take it unless the patient will promise all the time required. A patient may be told that his immediate condition may be ameliorated, but he

must not consider himself cured and may experience a return of symptoms. The Prescriber - J.H. Clarke MD

Hering’s laws:

From above downwards.

From within outwards.

From a more important organ to a less important one.

In the reverse order of their coming.

Fallaufnahme nach Sankaran.x

Sankaran has outlined 6 basic levels that should be traced during a homoeopathic case taking:

Level 1: Pathological (The main complaint or diagnosis)

Level 2: Symptomatic (Description of actual symptoms, such as local symptoms, modalities and location)

Level 3: Emotional (What does it feel like? What is the emotional state of the patient whilst experiencing the symptoms?)

Level 4: Delusion (What does the patient feel like? Symptoms of the neuro-endocine-immune axis)

Level 5: Sensation (The sensation felt in the body when exploring the symptoms)

Level 6: Energy (Background pattern, movements and patterns observed or evoked by the interview experience)

The task of finding out the totality of characteristic symptoms and their peculiar nature was taken up by Dr Von Boenninghausen.

In his lesser writings Boenninghausen gives the following seven types of symptoms which make up the totality of characteristic symptoms

1. Quis - meaning makeup of the patient.

2. Quid - meaning peculiar sensations of the patient.

3. Ubi - meaning peculiar locations of the disease.

4. Cur - meaning cause of the disease.

5. Quamodo - meaning modality of time.

6. Quanto - meaning modality of circumstances.

7. Quibus Auxilus - meaning concomitant symptoms.

[Dr. M.L. Tyler and Sir John Weir] presented by Sylvain Cazalet

Success in Repertorising depends on ability to deal with symptoms; and this has to be taught; it is not innate (= immanent). People all the world over are wasting their lives, working out cases at enormous expenditure of time and minutest care, for comparatively poor results: and all for want of a little initial help. The key to the enigma, which

they lack, is the grading of symptoms in such-wise as to economise labour without compromising results; and, in the cases where all the more-or-less-indicated remedies lack some symptom or other of the totality, to know which symptoms are of vital importance to the correct prescription; and which are of less importance, and may therefore probably be neglected; and also which may be safely used as eliminating symptoms, to throw out remedies by the dozen from the very start; and which cannot be safely used to throw out any remedies at all, on pain of perhaps losing the very drug one is in search of - the curative simillimum.

To begin with, symptoms are of two orders:

a) those general to the patient as a whole (Kent's GENERALS),

b) those particular, not to the patient as a whole, but to some part of him (Kent's PARTICULARS).

[T. K. Moore, M. D.]

In chronics, the latest symptoms, even though they may appear insignificant, are always the most important in the selection of remedy. The oldest are the least important.

All symptoms in between must be arranged in order of their appearance. Only such patients remain well and are really cured who have been rid of their symptoms in the

reverse order of their development.

Repertorisieren in Akute:

Elaine, my daughter had swine flu! I wish I could write it up for you but I wasn’t able to help her much. I tried maybe 8 different remedies during the course of the illness

but nothing really helped.

My sister had the same symptoms when she stayed with me the month before. Poor thing was sooo sick- she’s still talking about it! I tried many remedies to no avail.

After she left, I bought 2 remedies that I thought would have helped her (that I didn’t have) just in case one of us came down with it. But, none of them helped my daughter.

I wondered what others have found helpful for this flu because:

* gels.

* bry.

* ars.

* acon.

* eup-per.

and a bunch of others did nothing.

The symptoms were (in order) sore throat, high (104° F) fever, severe body aches, severe chilliness, pounding headache.

Now Kelly, as you know, none of the symptoms you just mentioned mean anything to the homeopath!

What? And why do I say that? Because the Repertory rubrics for these designations (fever, sore throat, etc.) are so large, so huge, so generic that virtually every homeopathic remedy in the Materia Medica covers them!!! Homeopathy is a system of “peculiars”. What’s peculiar about your fever? What’s strange about your sore throat? That’s what

we have to know! This is the only way we can find a remedy. Towards that end always remember: The Big 4! The Big 4? Yes, the Big 4: Sensation, Location, Modalities, Concomitants

Oh my God! You’re right! It’s a little tricky, I gotta admit; but, I think you’ve got something going there! So, I think you better tell everyone what the Modalities are.

Kelly, modalities are REALLY important to us; if we don’t get the modalities in a case, we may not be able to solve it! Modalities are all the factors that exert an influence on the complaint! For example, you have the flu, let’s say; and believe it or not, there will be factors that will make it better or worse and we need to know what these things are; you may be better for cold drinks, or, worse from fresh air, or better for hot bathing or hot drinks like tea, or better from hand-holding and sympathy, or worse from all company and conversation. These little details could not possibly be more important to the homeopath! Try and think of EVERYTHING that makes your complaint better or worse!

And what about concomitants, what are they?

Concomitants are the adjunctive symptoms in the case. “Additional symptoms”. They are highly valued because they are often the striking, strange, rare or peculiar ones which Hahnemann says we need to know or the likelihood of cure is rather slim. Take for example, menstrual cramps with burping. What does burping have to do with menstrual cramps? Nothing, that’s what makes it the concomitant! I need a remedy that burps and hopefully also has cramps! When Shana had menstrual cramps one time and started burping, I went right for the Carb-v. (our major burping remedy) I didn’t even stop to think about it! It worked too!

Observing the patient is very important and can often give you the concomitant. Observe what the patient is doing and saying. This is so important, it’s part of my questionnaire: What are you doing? What are you saying?

Sometimes body language tells us what we need to know. Bryonia patients are lying perfectly still and won’t answer your questions (because the slightest movement aggravates – even talking).

Colocynth and Mag-p. patients are bent over double. Gels. patients answer every question with “Huh…?” because they’re in a semi-stupor. Nux-v. is rudely making demands (“I’m still waiting for the glass of water I asked for two seconds ago!”). Ars. beggs you not to leave! (“Can’t you just stay one minute more?”)

Do you need to know anything else besides the Big 4?

Which, again, are?

OK, singing now: Sensation-Location, Modalities-Concomitants/Sensation-location, modalities-concomitants!

Very good Kelly! Yes, yes it would help to know more; three more things:

1. Is there a time issue? Is the patient < in the evening? < 2 - 19 h.? < at midnight, etc.? Think of this as the Time Modality.

2. Did the complaint come on suddenly or gradually? Complaints that come on suddenly are often covered by just two remedies! Acon. and Bell.!

Really?

Sometimes Bapt. if the case is septic.

And what does that mean?

Sepsis is characterized by bad odors, stuporousness, confusion, etc. If a septic condition comes on suddenly, think of Bapt. Bapt. is thought of as a “worse” Gelsemium with the addition of thirst; plus, stuporous presentation, apathy and inclination to sleep.

3. I’m leaving the best for last.

What’s that?

3. Etiology!

That means the cause! Am I right?

Yes. You have to know this! The remedy must cover it! Unless the etiology is something vague, like, “germs” or something really common, it alone could be so valuable as to solve the case for you! How often has this happened? You’ve taken the case, it looks really good for a certain remedy, like Bell.: the patient is red, full of heat, burning; you’re just about to give Bell. when you ask, “When did it start, after what?” And the patient says, “Oh! Allergy to peanuts!” Allergic???? That’s not Bell. that’s Apis! See, when you know the cause, it changes everything!

Ladies and Gentlemen, take note: Etiology Over-rules Symptomatology!

We seldom need to know any details, such is the importance of etiology.

So, getting back to your daughter’s flu, when you say “sore throat”, I would say:

What was the sensation?

What makes it better or worse?

Where in the throat is it, right side? left side? the whole thing?

We need to do this for every symptom. A properly delivered symptom would sound something like this:

I have constipation with no urging which is chronic and causes much abdominal pain which causes me to bend over double and rub as hard

And why do I say that? Because the Repertory rubrics for these designations (fever, sore throat, etc.) are so large, so huge, so generic that virtually every homeopathic remedy in the Materia Medica

covers them!!! Homeopathy is a system of “peculiars”. What’s peculiar about your fever? What’s strange about your sore throat? That’s what we have to know! This is the only way we can find a remedy. Towards that end always remember: The Big 4!

Anything else you need to know in taking an acute case?

WHAT’S WRONG!

WHEN DID IT START, AND, DID IT COME ON SUDDENLY or GRADUALLY?

DO YOU KNOW WHAT CAUSED IT?

(Don’t forget to observe the patient; what’s he doing, what’s he saying, what does he look like?)

WHAT MAKES YOU BETTER OR WORSE IN GENERAL?

(this includes time of day when person is better or worse) Plus, all the “I” symptoms.

THE LOCAL SYMPTOMS with THE BIG 4: sensation, location, modalities, concomitants

(You need to know this for each local symptom that’s part of the case! Don’t tell your homeopath, “My leg hurts! My scalp itches!” Say, “My leg hurts in the calf area, I got it from over-stretching, it’s better from rubbing.” “My scalp itches. Scratching makes it worse! Very hot water makes it stop.”)

Remember that Concomitants are any symptoms that are unexpected or just curious. They may be “normal” but out of place, or in excess, or less than what you’d expect like lack of thirst during fever.

IF THE CASE HAS A MENTAL/EMOTIONAL CONCOMITANT, THE REMEDY MUST MATCH THAT (unless it’s vague or common)!

Is there a hierarchy of symptoms?

It happens there is! We’ve already said that etiology overrules symptomatology, and that Generals are more valuable than Particulars in terms of remedy matching. So, here it goes:

Diagnosis/name of the condition–aka, “The Chief Complaint” (ask patient to describe in his own words)

Onset–sudden or gradual

Etiology (what caused the complaint, and when)

The Appearance–what does the patient look like? What does he ”say” and “do”? (He may say things like, “I’m doomed!” or “Bring me some ice!” all clues to the remedy; he may be tossing and turning; or, conversely, lying perfectly still; all important information.)

Generals

Particulars (the big 4, which are, again?)

Are you askin’ me? Are you talkin’ to me?

So now you’re Robert DeNiro all of a sudden? Let’s move on to discharges. If there are discharges, you’ll want to know their color, odor and consistency. You’ll also want to know if they create a sensation – like burning, irritation or itching, etc.

Plus, for heaven’s sake, don’t mix up acute and chronic symptoms! Don’t tell the homeopath you’re thirsty if you’re ALWAYS thirsty! Don’t tell him you’re irritable if you’re ALWAYS irritable!!

By knowing how to solve acute cases, you can stop a complaint from going chronic! You can save a life! You can stop a person’s suffering! Even people with chronic disease develop acutes of one kind or another; this is why we have to treat chronic disease in a manner that allows us to stop the chronic remedy during an acute, give the acute remedy, and resume chronic treatment when the acute resolves. Obviously high-potency, one-dose chronic prescribing does not lend itself to this! We can’t let people suffer, they’ll leave homeopathy and go right to their doctor!

Patients must not be expected to describe their sensations in the bald language of the repertory. A patient will more likely say, “The pain is worse when my hat is on”, than he will say, means “The pain is aggravated by pressure”.

Do not go against the modalities: [Elaine Lewis]

Modalities are the things that make the complaint better or worse. (itchy rash isn’t better for hot applications, don’t give Rhus-t! Rash isn’t aggravated by hot bathing, don’t give Sulph.! If a person is better for a good night’s sleep, don’t give Lach.! If a person says, “I love warm, stuffy rooms”, don’t give Puls. your first choice! It’s hard to imagine what could be more important in a case than the modalities (except finding the cause)! Be sure and ask for them. When someone tells you their complaints first try to find out the cause, what caused it, because you may be able to use an “ailments from” rubric to solve the case, which might make the symptoms, themselves, irrelevant; then, if discovering the cause does not open up the case for you, ask them, “What makes it better or worse?” I don’t care what they say is wrong with them. Sometimes we can be overwhelmed when we hear a case! So much is wrong! It sounds so serious! Just remember to say, “What caused it?” Then, “What makes it better? What makes it worse?” Give examples: heat, cold, motion, cold drinks, hot drinks, lying down, hot or cold applications, sympathy/company, massage, pressure, sleep, etc. There’s almost nothing you can do if all you have is the name of the illness! But for example, if someone says, “I have a headache that’s better for hard pressure,” that could be Bry.! Now, try to think of a remedy that’s WORSE for hard pressure–that’s the remedy NOT to give!

Acute Case Taking in a Nutshell:

Here are the basics questions to be answered:

What changed since you got sick?

When did it start?

Do you know what caused the problem?

What are the symptoms? (physical and mental)

Do they extend from one place?

What are the sensations? (burning, aching, stinging, itching etc.)

What are the locations of the symptoms?

What are the modalities? (What makes it better or worse?)

What are the concomittments? (What symptoms occur together?)

Prescribing on Causation

Some remedies associated with specific causes.x

[T.K. Moore, M.D.]

A single symptom causing suffering is completely recorded only when its history, origin, progress and conditions attached, circumstances of aggravation, of amelioration, time of occurrence and of greatest intensity,

how affected by position, rest, motion, eating, drinking, or the performance of any body function, by mental emotions or by any other cause – all this is included in the totality.

Repertorisieren for Chronic Ailments:

Look for:

Excesses, Deficiencies, Blockages, Loss of vital fluid. Also, sensitivities to noise, weather, etc. What do they over-react to?

Motivation: What’s their motivation for doing whatever it is they say they’re doing? For example, Nux-v. is ambitious. Ars. feels vulnerable and insecure so he is motivated to accumulate more money than he actually needs and to cultivate a support network of people who are dependent on him so they can never leave. Phos. is motivated to make friends in order to counter the delusion that he is alone, isolated on some distant island.

What is the focus of their time/energy/attention? What is dissipating their energy? Is there suffering? Treat any suffering first. Look for keynotes of remedies.

See if there is a compelling etiology. For example if everything happened after a head injury, that fact is more important than the totality of symptoms. The rubric would be ”Head: injuries, ailments from”.

The top layer is a chronic disease with X or Y acutes. You’ll need a remedy for the disease and an intercurrent remedy for the acute/s.

Determine the “essence” remedy underneath the disease. Finally, determine the constitutional remedy–the healthy state the person was born with. It could be calc-carb, sulphur, etc. For example: Disease: cancer- remedy–conium. Essence remedy underneath: Nat-m. Constitutional remedy under Nat-m.: Phosphorus. How would you know? The cancerous tumor is hard/indurated with a concomitant of vertigo on turning the head - Con. The Patient began her life as an out-going, sociable person, extroverted, tall and thin; then was put into foster care after losing her parents and became Nat-m. (Nat-m. has a relationship with Con. according to Robin Murphy.)

Regarding Aggravations: If a remedy aggravates with no amelioration, it could mean: right remedy, but out of order. You may be overlooking a recent layer; may have prescribed “too deep”. Look for suffering in the case which needs to be cleared first; such as, pain or infection or disease/pathology. Try the remedy again after you have cleared the top layer and it might work then.

THE GRADING OF SYMPTOMS

1^st grade: MENTAL SYMPTOMS if well marked. These take the highest rank; and a strongly marked mental symptom will always rule out any number of poorly-marked symptoms of lesser grade. (For these may never have appeared in the drug-pathogenesis - perhaps for lack of a sufficiently drastic proving; and yet, time and again, the drug will clear them up). The mental symptoms, always provided that they are very definite and well-marked, are the most important symptoms of the case.

But for the mental symptoms particularly, it is well to go constantly through the Repertory (Mind-section), and to master all that is presents; and to make cross references; and to be sure that you get the correct rubric; and often combine two rubrics that practically amount to the same thing, and yet do not give quite the same list of drugs. As, for instance, aversion to company and better alone may not be quite the same thing; and yet it is often difficult to sort them. Again, worse in the dark, and fear of darkness are difficult to fix correctly in many cases, while the elements fear of robbers, fear of ghosts - of apparitions, etc. may come in: so here you have at least 4 rubrics which you may have to combine on pain of missing something. Many of the rubrics must be considered in company, and all with intelligence and some elasticity, or there is great danger of eliminating the very drug you are in search of. And - the better you know your Repertory, the more rapid your work will be, and the better your results. Never grudge turning its pages!

2^nd grade, after the mental symptoms, and his reactions to mental environment, come, if well marked, such general symtoms of the patient as his reactions, as a whole, to bodily environment: - to times and seasons, to heat and cold, to damp and dry, to storm and tempest, to position, pressure, motion, jar, touch, etc. But they have got to be in capitals or in italics in the patient as well as in the Repertory, to take this rank; or to be safely used, some of them, as eliminating symptoms. ("Some of them", because there are perhaps only half-a-dozen symptoms which it is at all safe to use in this way; and then only, of course, if strongly marked).

And, once again, be sure that you have your very rubric; and if necessary combine two rubrics that work out practically as synonyms, and yet do not present quite the same list of drugs. A doctor was driven to despair over a case of melancholia by using better for open air instead of desire for open air. The symptom was so intensely marked that it was used without hesitation as an eliminating symptom, ruling out Sulphur (which has desire for open air), but which had every other big symptom of the case in capitals and which promptly cured. You have got to know your Repertory from cover to cover, if you are to have the best results: and you have got to use it with brains and imagination.

3^rd grade general symptoms are CRAVINGS and AVERSIONS. But to be elevated to such rank, they must not be mere likes and dislikes, but longings and loathings: in big types in the Repertory, and in the patient - in corresponding types, anyhow !

In corresponding types everywhere and all through: and this is most important. As, for instance, if your patient is only a little restless, Ars. and Rhus-t. superlatively restless remedies, will, of course, be rather contra-indicated. Big types in the Repertory will never help you, unless the symptoms are big type in the patient too. In first taking the case, it is well to vary the type as you set down the symptoms; to put those poorly marked in brackets, and to underline the intensely marked symptoms: for that will help you to match them correctly.

4^th in women, the MENSTRUAL STATE, i.e. general aggravation of symptoms before, during and after the menses. Of lower rank comes the question of menses early, late, and excessive - and this last of course only where there is nothing such a polypus, fibroid, menopause, to account for it.

5^th PARTICULARS - the symptoms that bulk so largely for the patient, and for which he is as a matter of fact, actually consulting you. You will have taken them down first, with the utmost care and detail, listening to his story, and interrupting as little as possible; but you will consider them last: for these symptoms are really of minor importance from your point of view (certainly in chronic cases) because they are general to the patient as a living whole, but only particulars to some part of him. In a great railway system, for instance, a strike that raises the price of fuel for a few weeks, an accident on the line that means compensation to the repair of few yards of permanent way, are less vital to the Company than the brain quality of its General Manager, of the force, competence and activity of the Chairman and Board of Directors. Make the executive of the Company efficient, and it will deal in the best way with details. In like manner, put your patient, as a whole, in order, and he will straighten out the disorder of his parts. You have got to get at him; and you can only get at him through his general and mental symptoms. Start for the Particulars, and see where they land you! In the body politic, where the executive is not sound, you deal with lax discipline here, with peculation there, with incompetence, and disorder, and slackness, and inefficiency. There is rottenness at the core; and you will find that as fast as you clear up one mess; the system breaks down at a new part. Go for the Management; put that right; and let it act. So with your work: - start treating an eczema, per se, and "cure" it, to find yourself confronted with - say asthma; prescribe for that, and the wretched patient comes back presently with a brand-new disease - Rheuma: tinker with that - and the heart gives out. Go for the executive - for the patient himself; - the patient who was all along capable of eczema - asthma - rheumatism: go for the patient as a live entity, revealed by his general and mental symptoms in chief; deal with him according to the Law of Similars, and he will do the rest. Always provided that the thing has not gone too far, that the tissue changes are not too gross, he will even undo the rest, step by step backwards, to the reproduction of the initial lesion on the skin. The whole is greater than its part. Never juggle with "Particulars" at the expense of the life of the whole.

But, in their right position of secondary importance, you must go into the particulars all the same, and with great care (if only to confirm your choice of the drug); and it will amaze you to find how they fall into line, when the choice is correct. More than that, when the drug has been chosen on general grounds, the patient will return and tell you, not only "I'm better", and that the trouble for which he consulted you is better, but he will volunteer, "My knees are better too, all the swelling has gone"; and referring to your notes you discover that you had never heard of his knees before ! and he will go on and tell you that his back (of which you hear now for the first time) is much less painful: and the constipation, which he had not previously mentioned, is a thing of the pasts. (This was a Nit-ac. case!).

Among the PARTICULARS, your first-grade symptoms will always be anything peculiar, or unusual, or unexpected, or unaccountable. You now want to know not only how your patient, as a whole, reacts to environment, but how his head, his stomach, his lungs, his muscles and joints stand heat and cold, damp weather and dry, react to stuffy atmosphere or draughts, desire or resent movement and jar. You will find one headache being banged against the wall; while another has to be nursed with such extreme care that the sufferer dare not move a finger, and would swear, if the movement of his lips were not agony, when you clumsily lurch against his bed. Or another headache will demand a bolt-upright position; while for a fourth the only thing is to kneel up, while it is pressed low into the pillow, or against the floor.

Now, to get the terms clearly

A GENERAL SYMPTOM, OR A GENERAL, IS ONE THAT REFERS TO THE PATIENT HIMSELF, AS A WHOLE, AND OF WHICH HE CAN SAY "I", instead of "My". "I feel the cold frightfully: " "I dare not move hand or foot in a thunderstorm; and I simply couldn't be alone." "This heat is knocking me all to pieces - I just can't stand it!" - these are Generals. In these the patient expresses himself. Remember, he is the sum of many lives, building up many tissues, and organs of diverse function. Through the Generals the Dweller-in-the-House speaks –

through the Mentals and Generals: - the Life which is the sum of the lives, and something beyond that: - the Life "in which they live and move and have their being"; and with whom, whatever their individual life and vigour, they perish. Truly the whole is greater than its part. Surely it is scientific to deal with the whole first, as a Whole?

But where your patient says "My" instead of "I", there you have a Particular. "My headache is awful in the house: the only thing for it is to go out and walk about. It often drives me out of bed at 2 or 3 a.m. to walk the Common for hours." (These are not exaggerated statements: we are giving you, all through, actual words of actual patients; and the magic drug for the last was Puls.).

But the Generals and the Particulars may not only be quite different, but they may be flatly contradictory in the same patient: so you see how imperative it is to get them clearly, and to know what value to give to each. Arsenicum is worse from cold: Ars. stands in the list of "predominantly cold remedies" in capitals. And yet the headache of Arsenicum is better from cold. Ars. has been described as only comfortable when "rolled in blankets up to his chin, with his head out of the window." Lycopodium is a warm remedy in the main, and often cannot stand heat: yet his stomach symptoms, which are a great feature of the drug, are ameliorated by hot food and drinks. Of these the patient says not "I", but "My", therefore they are particulars. He may say, "I cannot stand heat", (a General of the highest importance, and one of the most safe and useful of eliminating symptoms - if strongly marked !) - "I cannot stand heat, but my indigestion" (a particular of the greatest importance to the patient, and on which he lays the greatest stress) "is better for hot food and drinks. Cold things always disagree with me", (meaning his stomach). Again, Phosphorus stands in capitals as a very cold person -

If you are to be a good prescriber, by the way, your drugs have got to be people for you, with whims, fancies and terrrors; with tempers and idiosyncrasies and characteristics: you have got to see them stalking about the world, speaking and moving and halting, with the bodies-minds-souls of men. You have got to travel with them in tram or train, and they will betray themselves, buttoned up and shrinking together, or loose and jolly and open; fidgety, restless, fearful; dull and inert; quarrelling for an open window, growing at the draught with windows closed. You have got to dine with them, and they will reveal themselves in their relation to food and drink, and in the mental revelations such convivial moments of relaxation call forth. You may spot them, standing for preference, or sinking always into the nearest seat; stoop shouldered and drooping, or erect and full of "go"; depressed and querulous; restless and anxious, as their deeply lined faces testify; smooth and smug; dirty complexioned and careless of appearance; chalky faced and flabby of superlative tissue: compact and hard as nails; fault-finding - affectionate and mild - responsive to every wave of sentiment and emotion - dull and indifferent. Look for them everywhere, and learn them, and they will betray themselves at every turn; and you will often save yourselves hours of solid work, by spotting them as they enter your consulting room.

5^th PECULIARS. So, to hark back. Phos.: a very cold person, but his stomach > cold drinks. When that is sick he craves for cold water, which is vomited, however, so soon as it gets warm in the stomach.

This is a particular, true, but a priceless one, because it is peculiar to Phos. And here we have a new term - a "PECULIAR" symptom, strongly diagnostic of one drug. These peculiar symptoms are especially useful in acute diseases where you are more likely to meet them, and where they often provide a brilliant short-cut to the drug, saving time and toil. And see how these peculiar unaccountable, contradictory symptoms help you - how unexpected they are, and how diagnostic ! here you have the superlatively chilly Phosphorus: and yet his pains are often of the most intensely-burning description: and though, as a whole, he cannot tolerate cold, yet his sick stomach craves for icy drinks, which it cannot even retain when they get warm ! Take your Generals and Particulars mixed-up and awry and just-anyhow, and you might land in giving such a patient Lycopodium; for both are worse for heat, and worse for cold; only the Generals and Particulars are exactly reversed ! For Lycopodium is in the main, intolerant of heat, which his stomach craves; while Phosphorus detests the cold which his sick stomach demands with vehemence. See how all-important it is to get your Generals and Particulars right! This is where we fail, and blame Homœpathy.

6^th Then, besides Kent's Generals and Particulars, you have COMMON SYMPTOMS. A symptom may be common to all cases of a certain disease, and therefore of no great use in picking out the individual remedy for a particular case of that disease; or it may be common to a very great number of drugs, and therefore indicate one of a large group of remedies only; and so of very little use in repertorising. Take thirst, a general symptom of the patient, though in the Repertory relegated to the section "Stomach": - "I'm terribly thirsty." If there is nothing to account for the thirst, it may be an important symptom; though common to a great number of drugs! But if the patient is running a high temperature, or suffering from diabetes, or if his work keeps him in the heat of a bakehouse or an engine-room, or if the weather is suddenly and unusually hot, the symptom becomes a Common symptom, and almost valueless. Don't waste life in writing down that awful list of remedies "Thirsty". Absence of thirst under conditions where you would expect it, on the contrary, becomes a very important symptom, as absence of thirst with a very high temperature - Kent has a rubric for that.

Remember - THE MORE UNCOMMON A SYMPTOM IS, THE MORE VALUABLE: THE LESS YOU CAN ACCOUNT FOR A SYMPTOM AND THE MORE INTENSELY PERSONAL IT IS, THE MORE IMPORTANT. In inflammation, for instance, worse from pressure is what one would expect, and of little value - so many drugs and most inflammations have it ! But better from pressure, under these circumstances, is priceless, and leads you to a small group of drugs, such a Bry. Frequent micturition with a fibroid impacted in the pelvis is not a symptom that will help you in working out your case; it is a Common symptom and amply accounted for... and this leads one to insist on the absolute necessity for correct diagnosis before you even open your Repertory. Remember, the priceless symptoms for success are the strange, the rare, the unaccountable ones; those that flatly contradict preconceived ideas, and head off straight for a limited number of drugs.

6^th "ELIMINATING" SYMPTOMS

This is a new word, but expresses what we all desire in repertorising, and what we have got be very cautious of using too rigidly, lest we lose the remedy we are looking for.

Instances best reveal meanings. Take one. Say your patient complains of dyspepsia, with burning pain in the stomach, and the frequent vomiting of sour fluid. He pours you out particulars, which he has at his finger-tips; since they are just the symptoms that impress a man's memory, by intruding themselves on his consciousness in a very realistic way. You jot them down till you have got the case as fully as most people go, with all its modalities (i.e. the conditions as to heat and cold, movement and rest, position, hours of day and night, relation to food and drink, etc. of the stomach condition complained of). You have assured yourself, by careful examination, as to whether the trouble is likely to be organic or functional; or whether some of the symptoms have got to be discounted, as secondary to some gross lesion. And now it is your turn. You have to elicit the general symptoms of your patient; you have got to switch him off the siding "my", and on to the main line "I". And you now find that he cannot stand heat - whatever his stomach may do; that he is ill if long out in the sun: that he wants a cool room, prefers cold weather and a cold climate: that he never goes near the fire: and you noticed when he came in that, though the weather was cold, he was not buttoned up, or thickly clothed. It is not closeness or stuffiness so much that affects him (you have got to be careful between these!) but heat. He is one of Dr. G. Miller's "predominantly hot-remedy people". There is an eliminating symptom for you! You know at once, whatever his stomach condition may be (its particular symptoms might perhaps be equally well-met by Ars. Phos. Nux-v. Lyc. Nat-m. or a host of others); but with that temperament, that warm personality, it would be useless for deep and curative work to think of giving him Ars. Phos. Nux or Sep. He is a hot patient, and these are predominantly cold remedies. You can strike them out at once. For even if one of them, aptly fitting the exact stomach symptoms only, gave temporary relief to the immediate condition, the patient would relapse again and again. It could not hold. It would act as a palliative, not a curative drug. It might provide a temporary organ-stimulus: it could never be the stimulus of the organism. And here you see well the difference between deep and superficial work - between curative and palliative. The people who get their honest triumphs in similars, and see at least brilliant temporary results in superficial and acute conditions, and believe honestly that these are the very best attainable by medicine, scout the idea of the lasting triumphs of the simillimum. They know well, from years of experience, their own limitations; and it seems to them outrageous that other people should make larger claims.

As a matter of fact, when you get the real simillimum, the odds are that, instead of palliating the stomach condition, you will aggravate it a thousand fold - for the moment; aggravate it, once and for all, to cure. And if you do not know your work, you will think that you have got the wrong medicine and antidote or change it; and your patient

will be, so far as you are concerned, incurable. But it may be your ignorance only that makes him so!

So now, down all the rubrics, mental, general, and particular, you will carry that great eliminating symptom, WORSE HEAT, and ruthlessly cut out all the remedies that are chilly, and therefore deeply help chilly people. None of these you need write down at all. Using Dr. G. Miller's list, which we will give in a moment, you can go on to any other General, and especially to any marked mental symptom, and often get a pretty correct idea of the exact remedy before you ever start to tackle the particular and immediate suffering for which the patient comes to you. Now supposing you discover that he is liable to fits of depression, and yet cannot endure any attempt at consolation; that he becomes a very fiend if anyone attempts to cheer him up - even to enquire what is amiss: the people have learnt to let him severely alone, when his moods are upon him; why, with these two important symptoms alone, worse from heat, and worse from consolation, which have got to be in equal type, remember, in the patient and in the drug, you have reduced your area of search to Lil-t. Nat-m. and Plat. (for Lyc. and Merc. come through the "< consolation test" in the lowest type only, which is hardly good enough for such a marked loathing of consolation as this !) Or, if your patient had been as predominantly chilly and worse for cold as this one was for heat, and the aggravation from consolation test came out as strongly, you would have found yourself at the start of your work with Ars. Bell. Calc-p. Ign. Nit-ac. Sep. and Sil. with two or three others to play with in brackets - lowest type. If you can get such marked eliminating symptoms to begin with, see what a comparatively small number of drugs you have to carry down through all the rubrics, and how much easier and quicker it is to get your remedy, and how much greater confidence you have in the result of your search. You will generally find, as you work down, that one drug stands out more and more pre-eminently: - it may not be in all the rubrics, but it has got to be in all the important ones, i.e. those best marked in the patient, and of highest grade. And presently you throw down your pen: you are convinced; and it is a mere waste of time to go further.

Now take the same case and start, instead, on the marked symptoms complained of by the patient - the Particulars, and just see what work you have cut out for you! Begin with the rubric Vomiting, and write it out for the last time, and see what it entails. And write all the drugs, in all the types, lest you should miss any. Take his particular symptoms, one by one, and write, and write, and write.

Vomiting, 162 drugs.

Vomiting water, 108 drugs.

Vomiting sour, 89 drugs.

Burning pain in the stomach, 186 drugs.

Pain in the stomach p.c. 110 drugs, etc.

It may be easily such a list, of which this is but the merest beginning: - no wonder that people get "Repertory funk!" - for remember that people are actually doing this, at this moment, in all quarters of the world: for they are sending us their beautifully-neat, conscientious and exhaustive work to show, as they ask for a better way: and it is their cry for help that has caused this article to be compiled. Sheets and sheets of paper you will cover. One that lies before us now has all the drugs in forty-nine different rubrics, some if immense length, as Stools offensive, Burning urine, Stools pasty, Yellow stools. Why, before you ever come down to such symptoms, you should have three of four drugs only in hand: - and they are symptoms of the lowest grade, and Common symptoms; hardly worth glancing through for confirmation of the drug. Moreover, there is the possibility that you may accidentally omit the very drug you want from some of the long lists you are so slavishly copying: and the odds are, that when they are all complete, without the aid of eliminating symptoms some half-a-dozen drugs will come out pretty near one another when you count up at the end, and that your travaux d'Hercule will leave you unconvinced and still in doubt.

A pathognomic symptom is the distinguishing symptom of a disease or condition, e.g. the peculiar rash and odor of measles, the primary and secondary fever of smallpox, etc.

A characteristic symptom is the distinguishing symptom of a drug. It is to the drug what the pathognomic symptom is to the disease, e, g,, agg. of all the symptoms by means of sleep under Lachesis.

Which Symptoms are Important?

Functional symptoms in an organ are of much less value than symptoms which occur in other parts during the function of that organ. Burning pain in the urethra, during or after micturition, is of little value in gonorrhoea, for it is usually present; but pain in the testicles, thighs, or abdomen during or after micturition, or symptoms of some other part not immediately concerned in that function, would be more important. So, also, pain in the stomach after eating, in indigestion, is not of as much value as vertigo or headache after eating would be in the same attack.

Problems confronting one when first attempting to prescribe homœopathically. [Dr Elizabeth Wright Hubbard] Presented by Sylvain Cazalet

Dr. Underhill has told you most graphically and humorously how he was led into homœopathy so I will omit my initiation except to say that after working at the Allgemeine Krankenhaus in Vienna in the usual way, I was apprenticed for nine months to a homœopathic physician in Geneva where I studied, literally, from 12 to 16 hours a day.

Before he was willing to take me as a pupil, he gave me a stiff examination in ordinary medicine, including Anatomy, fractures, surgical diagnosis, pathology, bacteriology, and chemistry, and gave me slides to diagnose under the microscope, etc. He then asked me certain questions as to what I thought life was about, why I went into the practice of medicine, what were the chief duties of a physician and so on. These questions perplexed me, as I did not then understand their bearing on the philosophy of homœopathy. It was, "What do homœopaths give for rheumatism?" Having read somewhat in homœopathic literature. I answered that homœopaths do not give a remedy for rheumatism or for any disease name or diagnosis (although, of course, certain remedies are more frequently indicated in rheumatic conditions). They give a remedy on the symptoms of the patient who has the disease, in other words on the reaction of the individual in question to any given disease entity. This defines one of the fundamental differences between the homœopathic approach and regular medicine.

Until the physician's mind has compassed the differences between the viewpoints of ordinary medical training and Homœopathy he cannot even begin to prescribe homœopathically. Let me enumerate, for clarity, wherein these differences lie. First, as above mentioned, he must grasp the principle of individualization. Modem medicine lays a good foundation for this through its interest in endocrinology and psychiatry, but except for obvious glandular imbalances it offers, as yet, no therapy commensurate with the refinements of differentiation. What does individualization mean to the homœopath and how does he arrive at it? It involves a subsidiary new method of case-taking. After you have your classical history, elicited largely by asking questions, you can often make a diagnosis but rarely a homœopathic prescription. For the latter you need to know the mental state of your patient, and what the homœopaths call his "generals", which mean the things which apply to the patient as a whole-his reaction to heat and cold, wet and dry weather and storms, motion, position, food, etc.

You need to know how these same factors affect the specific complaints of your patient, in other words the modalities of his particular disease symptoms-whether his headache is better from hot or cold applications, from motion or rest, from lying or walking, from pressure, or food, and at what time of day it is worse. ("Modalities", in other words, mean aggravations or ameliorations of specific symptoms, just as "generals" mean aggravations and ameliorations of the patient as a whole). There is a fourth type of thing that you must know about your patient in order to prescribe homœopathically and that is his rare, peculiar, or characteristic particular symptoms. These often appear trivial idiosyncrasies to the patient, things that he has always had, or that no doctor to whom he has told them, has ever been interested in. These often serve as Keynotes to guide to a remedy. But of what use is all this additional information about your patient? How does this picture of his personality aid you? You have individualized, but of what use is such differentiation, if you have only a standard treatment for the condition that you have diagnosed?

This brings us to the second great difference between homœopathy and regular medicine. The law on which homœopathy is based, or, if you prefer, the hypothesis, is to be found in the statement of Hippocrates, "similia similibus curantur." which Hahnemann revived and amplified. Dr. Sterns has told you how Hahnemann came to apply this law and made the first so-called "proving" of quinine. A "proving", in the homœopathic sense, is experimenting with a drug in minute doses on a relatively healthy human being. The record of symptoms so produced, on a large number of provers of different ages and sexes, constitutes the basis of our homœopathic materia medica. The object of proving a drug is to delineate the drug personality.

Each of our remedies is to us a living individual, they are like friends whom one recognizes whenever seen, not only by their grand characteristics but also by their mannerisms and tricks. We now have on the one hand, the drug personalities, and on the other the picture of our patient in his present state. It follows, if like cures like that we must match pictures and fit the personality of a drug to our patient, administer it, and watch the results. After one has grasped this ingenious theory and learned to put it into practice, it remains only to see it work. I, for one, being a natural septic, was slow to believe that evidence of my senses. Could the astonishing improvements and cures have been coincidence, or suggestion, or faulty diagnosis?

There are certain controls which one can use. Put the patient on the proper regimen including diet, etc. and see what that alone does for your condition. Then give Placebo, with your best manner.

In my experience, in nine cases out of ten, the patient will report no progress. When they are discouraged by this unsuccessful first prescription, give them the remedy you have chosen, the simillimum. If you feel reasonably certain that the drug-picture fits your patient; and you have the simillimum, in most cases you will see a swift and beautiful result. But these are not the only possible methods of control. There are laws of remedy action which are contrary to anything you could expect in an untreated case. When you see these, you know that your remedy is taking hold. They were formulated by Constantine Hering, one of the pioneers of Homœopathy in this country, and are as follows: The curative remedy acts from within outward, from above downward, and in the reverse order of the symptoms.

Take, as an illustration, a case of rheumatic fever in which, after the customary salicylate dosing, the joints appear to have cleared up but a heart condition develops.

Give such a patient the similar remedy and he will complain that his joints are worse again, but he himself feels better and you find that his heart is clearing up. You explain

to him that the remedy is working from within outward, the more vital organ, the heart, is getting well first, and the peripheral organs, the joints, are again involved.

Give him nothing but Placebo. Shortly he will tell you that his shoulders and wrists are clearing up but that the pain is now in his knees or ankles. Again you see the law of cure in action, from above downward, and you wait. You observe that his symptoms are disappearing in the reverse order of their appearance, the heart condition which came last, going first. If you trust your remedy under these conditions, your patient will make a real recovery without the annoying recurrences. (If, on the contrary, you found that the joints in the lower extremities cleared up and those of the upper extremities became involved, you would know you were on the wrong track and had not found the simillimum).

One of the knottiest problems for the beginner is the different concept of pathology and bacteriology. Homœopaths accept the facts of these branches of medicine. The difference lies in the interpretation. Pathology is an end result of some morbid process. The homœopath is not nearly as interested in the diseased tonsil, the hæmorrhoid, the ovarian cyst, the cancer, the tapeworm, or the psoriasis, as he is in the constitutional dyscrasia behind these. He is not eager to remove the ultimates of disease at once, but rather to cure the underlying cause. In the course of this cure the ultimate will often disappear, as in the case of diseased cervical glands or fibroids. If not, it can be removed when it has become merely a foreign body, and when the constitution is so changed that it will not ultimate itself in further pathology in a more deep seated organ.

Similarly one is taught to consider that bacteria cause disease.

The homœopath is more interested in the individual's susceptibility, than in the bacteria themselves. Instead of poisoning the malarial plasmodia with quinine or the syphilitic spirochætæ with salvarsan, the homœopath prefers to stimulate the body to make itself uninhabitable for these organisms, and he does this by means of the similar remedy. To give another instance, instead of killing off head lice with delphinium and leaving the patient susceptible to further invasions, the homœopath gives chronic constitutional remedy which removes the susceptibility and the lice seek better pasturage.

A fourth stumbling-block for the medical mind is the question of suppression. Discharges and eruptions are ordinarily classed with pathology as something to be gotten rid of by local measures.

We are taught to use argyrol in coryza, to paint cervices with mercurochrome in leucorrhœa, to stop a gonorrhœal discharge with protargol, to check a diarrhœa with opium or bismuth, to clear up skin eruptions with ammoniated mercury or sulphur ointment or other applications. The homœopath holds that this is suppression, and not cure, that these outward manifestations ate not primarily local but an expression of deep disease, the body trying to throw off impurities. They have watched the incidence of more deep-seated troubles following such "suppression". The chronic constitutional homœopathic remedy given to a case which has been so treated, will offer bring back the original eruption or discharge with concomitant relief of recent grave symptoms and ultimate clearing up from within of the original discharge or eruption. Let me illustrate with a case from my practice recently.

A women of 45, came to see me for suicidal depression, for which she could give no emotional cause. She dated her mental symptoms definitely from the time when she had had a foul, lumpy, green leucorrhœa "cured" by local vaginal applications, a few months before. I gave her a dose of Sepia (a remedy made from cuttlefish ink) on her mental symptoms. A week later she returned exuberant, all the depression for which she had been doctoring being gone, and said, "By the way, doctor. I have that awful discharge back again, just as it was before". I was delighted, warned her against suppressing it a second time, and gave Placebo. The discharge has since lessened and improved in character and she continues, as her husband says, a changed woman. So much for the fundamental differences.

Another problem which confronted me was whether the homœopathic remedy could influence definite chronic pathology. A girl of 19 came to me for severe intermenstrual bleeding. On examination I found a nodular fibroid bigger than my fist. A well-known New York specialist, she told me later, had diagnosed it and advised merely general health measures, as he did not want to x-ray so young a girl. Her chronic case worked out on mental and general symptoms to Phosphorus, which happens to be one of the main remedies useful in fibroids. Three months after I gave her this, I sent her to be checked up by the same specialist. He was amazed at the decrease in size of the fibroid and asked her what she had been doing. Six months later he pronounced her normal and sanctioned her marrying.

A further difficulty I experienced was in believing the current statement that homœopathic remedies can do no harm. THEY CAN!

Another problem which one frequently meets in general practice is that of prophylaxis. Strict homœopaths believe that vaccines and inoculations are harmful. It took considerable experience for me to be convinced that the chronic constitutional remedy is the best prophylactic. The whole subject of the chronic constitutional remedy is a fascinating one, but beyond the scope of this paper.

As a last problem comes the practical one which is such a stumbling-block to students, as to whether one can make a living on homœopathic general practice. Certainty more than half of my patients were not believing in Homœopathy, many of them dead against it, but I have found that by up-to-date examination and laboratory procedures, by the actual accomplishment of the remedies, and by adroitly "selling" to the patient the principles of homœopathy without the name, they are intrigued, send you their friends, and become staunch believers in the method.

To all of the puzzling problems outlined above, a satisfactory solution can be found, if one is willing to do the hard work involved in learning enough to get results.

I am completely "sold" to Homœopathy. When I fail I know that the failure is mine and not homeopathy's and when I can see a similar remedy for a case, I have, even before giving it, a perfect certainty that good results will be forthcoming.

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