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
Sankaran:
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)
Die Worte, die dem Patienten als Spiegel wiederholt werden, sind wortwörtlich seine eigenen.
Erzählen Sie mir von Ihrem Problem (Hauptbeschwerde).
Das (exakte Wiederholung der Patientenworte) macht Ihnen Sorgen, sind Ihre Beschwerden, ist das so richtig?
Wie macht es Ihnen Beschwerden?
Beschreiben Sie das bitte (Wiederholung der letzten Worte des Patienten).
Beschreiben Sie es genauer, das Empfinden.
Wie fühlt sich das an?
Beschreiben Sie dieses Gefühl (Wiederholung der Patientenworte) etwas mehr.
Einblicke ins Pflanzenreich
Was ist das für ein Empfinden, dies (Wiederholung der Patientenworte)?
Wenn Sie sagen, dass (die letzten Worte), was meinen Sie damit?
Beschreiben Sie bitte das Empfinden des (exakte Wiederholung der Patientenworte).
Wie fühlt sich das (Patientenworte) an?
Was ist das (exakte Wiederholung der Patientenworte)?
Erzählen Sie mir davon.
Und wenn es etwas gibt, das Sie "unbedingt tun müssen", wie fühlt sich das an?
Beschreiben Sie mir das Gegenteil von (exakte Wiederholung der Patientenworte).
Wie fühlt sich das an, wenn Sie das (was der Patient gesagt hat) unbedingt
tun müssen?
Und dann?
Wann fühlen Sie sich nicht so (Wiederholung der Patientenworte)?
Erzählen Sie mir davon.
Was für eine Wirkung hatte diese Situation auf Sie?
Was haben Sie dabei (immer) gefühlt?
Sie sagten, es war wie (exakte Wiederholung der Patientenworte) - wie hat
sich das für Sie angefühlt?
Was ist das (exakte Wiederholung der Patientenworte) für ein Empfinden?
Was für ein Gefühl hatten Sie in dieser Situation?
Was bewirkte, dass Sie sich in diesen Situationen besser fühlten?
Was verschaffte Ihnen dann am besten Erleichterung?
Was empfinden Sie, wenn Sie das tun (das, was Erleichterung verschafft)?
Welche Sorte Bücher lasen oder lesen Sie?
Ein beispielhafte Fragenliste zum Empfinden
Was für eine Wirkung hatte das auf Sie?
Was für ein Gefühl hatten Sie dabei?
Was für Träume haben Sie?
Gab es in der Vergangenheit irgendetwas besonders Unangenehmes?
Oder etwas besonders Angenehmes?
Irgendwelche Tagträume?
Was sind das für Gefühle? Welche Gefühle kommen dabei auf?
Beschreiben Sie mir dies (exakte Wiederholung der Patientenworte),
Was für Schmerzen hatten Sie dann? Wie hat sich das angefühlt, was haben Sie dabei erlebt?
Was ist das für ein Empfinden?
Beschreiben Sie (das Empfinden).
Beschreiben Sie mir das Empfinden genauer.
Beschreiben Sie mir das (das bisher Beschriebene).
Was ist das Gegenteil?
Wenn Sie davon reden, "sich alles um einen herum positiver anzuschauen", an was für ein Beispiel denken Sie dabei?
In welcher Situation haben Sie das Gefühl gehabt (genaue Wiederholung der Patientenworte)?
Erzählen Sie mir davon (von der bestimmen Situation). - (Man muss jedes Wort als ein Schritt zum nächsten Wort nehmen.)
Welches sind die anderen "schönen Orte" - wenn Sie unter Stress sind?
Beschreiben Sie das näher.
Beschreiben Sie mir den Ort genauer.
Was für ein Empfinden löst das bei Ihnen aus, körperlich, gefühlsmäßig?
Was für ein Gefühl ist das?
Wie fühlt sich das an?
Was ist "gut" für Sie?
Von all den Dingen, die Sie "in Stress bringen", was setzt Ihnen am meisten zu?
[Dr.
Margaret Lucy 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
GRADING of
SYMPTOMS... 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 (
b) those particular, not to the patient as a
whole, but to some part of him (
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? < 21 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
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.
For example, Coloc. effective for internal spasms
caused by anger.
Dehydration: Chin. Carb-v.
Grief or loss: Ign. Nat-m., Caus.;
Vaccination: Thuj. Sil.;
Head injuries: Arn. Nat-s. Hyper.
Humiliation: Staph. Ign. Lyc.
Sexual abstinence: Con.
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. (Robin Murphy: Nat-m. has a relationship with
Con.)
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
1st 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!
2nd 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
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.
3rd 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.
4th 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.
5th 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 – 3 h., 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.
Ars. <
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.
5th
PECULIARS. So, to hark back... Phos.: a very cold
person, but his stomach is > 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
< heat
and cold; only the Generals and Particulars are exactly reversed! For Lyc. 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.
6th Then, besides
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 -
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.
6th "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 thousandfold - 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
FROM HEAT, and ruthlessly cut out all the remedies that are chilly, and 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 Lach.
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.
Eifersucht/Jealousy An example/ein Beispiel
[Chandran Nambiar]
”Jealousy
a Hyos. feels at emotional level all together
different from Lach., a jealousy snake remedy like
evokes, which a repertory will not be able to differentiate and there
understanding of the
kingdom
helps.” Says a follower of Sankaran.
Sankaran:
‘jealousy’ of hyos is only a ‘superficial emotion’,
where as in ‘snake poisons’, ‘jealousy’ is a ‘level 5′ vital sensation!
Actually Hyos. or Lach. are never
prescribed on the basis of ‘jealousy’ only. He can differentiate between these
two drugs comparing other mental, general and particular symptoms expressed by
the particular patient.
It is very
simple for a homeopath who knows how to use repertory and materia
medica. Differentiating between Hyos.
and Lach. becomes an issue only for Sankaran’s followers, who try to find similimum
on the basis
of singular
‘vital sensations’.
My approach
of individualization and deciding the similimum is as
follows:
I would use the rubric ‘jealousy’ for this
symptom, if it is very prominent/
[Kent]Mind:
JEALOUSY: Anan. Apis. Calc-p. Calc-s. Camph. Cench. Coff. Gall-ac. Hyos. Ign. Lach. Nux-v. Op. Ph-ac. Puls. Raph. Staph. Stram.
Then I can ‘eliminate’ drugs from this group,
using two or more prominent mentals, generals and
particulars expressed by the patient. For example, patient < after sleep, I
would use the following rubric:
[Kent]Generalities
: SLEEP : After : Agg.:- Acon.
Aesc. Ambr. Am-m. Anac. Apis. Arn. Ars. Asaf.
Bell. Bor. Bov. Bry. Cadm. Calc. Camph. Carb-s. Carb-v. Caust. Cham. Chel. Chin. Cina. Cocc. Coff.
Con. Crot-c.
Dig. Euphr. Ferr. Ferr-ar.
Graph. Hep. Hyos. Ign. Kali-ar. Kali-c.
Kali-p. Kreos. Lac-c. Lach. Lyc. Mag-c. Mur-ac. Naja.
Nat-a. Nux-m. Nux-v. Olnd. Op. Paeon. Ph-ac. Phos. Phyt. Puls. Rheum. Rhus-t. Sabad. Samb.
Sel. Sep. Spig. Spong. Stann.
Staph. Stram. Sulph. Thuj. Verat.
If the patient is prominently hot
generally, I would use this rubric:
[Kent]Generalities: HOT REMEDIES (Gibson Miller’s): Aesc. All-c. Aloe. Ambr. Apis. Arg-n. Asaf. Aur-i. Aur-m. Bar-i. Bry. Calad. Calc-i. Calc-s. Coc-c. Com. Croc. Dros. Ferr-i. Fl-ac. Grat. Ham. Iod. Kali-i.
Kali-s. Lach. Led. Lil-t. Lyc. Nat-m.
Nat-s. Nicc.
Op. Pic-ac. Plat. Ptel. Puls. Sabin. Sec. Spong. Sul-i. Sulph. Thuj. Tub. Ust.
Vesp. Vib.
After eliminating these three
rubrics
only Lach. Apis. Puls.
Op. remain.
If the patient is very talkative, I
will use this rubric:
[Kent]Mind:
LOQUACITY: Abrot. Acon. Aeth. Agar. Agn. Aloe. Ambr. Anac. Ant-t. Apis. Arg-m. Arn.
Ars. Ars-h. Ars-i. Aur. Bapt. Bar-c. Bell.
Bor. Bov. Calad. Calc. Camph. Cann-i. Canth. Carb-s. Carl. Caust.
Chel. Cimic. Coc-c. Cocc.
Coff. Croc. Crot-c. Crot-h. Cupr. Dulc.
Eug. Eup-pur. Ferr-m. Ferr-p. Gamb. Gels. Glon. Grat. Guare. Hydrc.
Hyos. Iod. Ip. Kali-i. Lach.
Lachn. Lil-t. Lyss. Mag-c. Meph. Merc-i-f.
Mur-ac. Nat-a.
Nat-c. Nat-m. Nicc. Nux-m. Nux-v.
Oena. Onos. Op. Par. Petr. Phos. Plb. Podo. Psor. Pyrog. Rhus-t. Sec. Sel. Stann.
Staph. Stict. Stram. Sulph. Tab. Tarax. Tarent. Teucr. Thea. Ther. Thuj.
Trom.
Verat.
Viol-o. Zinc.
The choice is between Apis. Op. Lach.
If there is underlying grief as
causative factor, I can use this rubric:
[Kent]Mind:
GRIEF: Ailments, from: Am-m. Anac. Ant-c. Apis. Ars. Aur. Calc-p. Caust. Clem. Cocc.
Colch. Coloc. Con. Cycl. Gels. Graph. Hyos. Ign.
Kali-p. Lach. Lob-c. Lyc. Naja. Nat-m.
Nit-ac. Nux-v. Ph-ac.
Plat. Puls. Staph. Tarent.
Verat.
Now, only Lach.
Apis. remain.
If the patient dislikes company, I can use this
rubric:
[Kent]Mind:
COMPANY: Aversion to:- Acon. Aloe. Alum. Ambr. Anac. Anan. Ant-c. Ant-t. Atro. Aur. Aur-s.
Bar-c. Bar-m. Bell. Bry. Bufo.
Bufo-s. Cact. Calc. Calc-p.
Calc-s. Cann-i. Carb-an. Carb-s. Carb-v.
Cedr.
Cham. Chin. Cic. Cimic. Cinnb. Clem.
Coca. Coloc. Con. Cop. Cupr. Cur. Cycl. Dig.
Dios. Elaps. Eug. Ferr. Ferr-i. Ferr-p.
Fl-ac. Gels. Graph. Grat. Ham. Hell. Helon. Hep. Hipp. Hydr. Hyos. Ign. Iod. Jug-c.
Kali-bi.
Kali-br. Kali-c. Kali-p. Kali-s. Lac-d. Lach. Led. Lyc. Mag-m. Mang. Meny. Nat-c. Nat-m.
Nat-p. Nicc. Nux-v. Oxyt. Petr. Phos. Pic-ac. Plat.
Psor. Ptel. Puls. Rhus-t.
Sec. Sel. Sep. Stann. Sul-ac.
Sulph.
Tarent. Tep. Thuj. Til.
Ust. Verat.
NowLach.
remains.
Now I will
go through the materia medica
of LACHESIS and verify whether it agrees with all other important symptoms
given by the patient.
Problems confronting one when
first attempting to prescribe homœopathically. [Dr
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
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
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.
[Sankaran]
Die sieben Ebenen
Ebene 1: Name
Auf dieser Ebene identifiziert sich der Patient mit der pathologischen Diagnose der Situation. Er stellt seine Probleme beispielsweise als vergrößerte Prostata, Migräne, Arthritis, Depression, Schizophrenie etc. dar.
Ebene 2: Fakten
Die Patientin beschreibt die reinen Fakten der Situation, das könnten pathologische Symptome wie Kniegelenksschmerzen sein. Sie erklärt die Situation, indem sie ihre Empfindungen, Lokalsymptome und Modalitäten beschreibt. Zum Beispiel, dass ihre Kopfschmerzen über den Augen liegen, nur abends auftreten und sich durch festen Druck bessern; oder dass sich ihre Arthritis wie ein brennender Schmerz anfühlt < Bewegung.
Dies ist meistens die Ebene der Keynote-Verschreibungen. (Zum Beispiel leidet ein Arsenicum-Patient unter brennenden Schmerzen, die sich durch Wärme bessern.) Es handelt sich bei den Emotionen oder auch den Empfindungen auf dieser Ebene ausschließlich um Lokalsymptome. Wenn ich zum Beispiel meine Migräne bekomme, fühle ich mich sehr reizbar (eine Emotion auf der Ebene der Fakten). Die Modalitäten
wären auf dieser Ebene ebenso lokal. Als weiteres Beispiel: Wenn ich meine pfeifenden Asthmaanfälle bekomme, fühle ich ein Jucken am Kinn.
Ebene 3: Emotion
Die Patientin beschreibt Gefühle, die mit den Fakten verbunden sind. Dies können Emotionen wie Ärger, Gereiztheit, Traurigkeit, tiefer Kummer, Vergnügen etc. sein. Auf dieser Ebene werden die Emotionen zwar
gefühlt, müssen aber nicht spezifisch für die Beschwerde sein. Die Patienten bringen ihre Gefühle hinsichtlich ihrer Situation zum Ausdruck. Zum Beispiel: „Ich habe Streit in meiner Ehe und fühle mich verlassen.“
Bei den Modalitäten auf der Emotionsebene kann der Homöopath Gefühle beobachten, die auch einen Bezug zur Hauptbeschwerde besitzen. Wenn die Patientin mit ihrem Ehemann streitet und wütend wird, bekommt sie Migräne.
Ebene 4: Wahnidee (delusion)
Die Ebene der Wahnideen ist gekennzeichnet durch sehr ausdrucksstarke Bilder. Emotionen werden intensiv wahrgenommen und mit einer bestimmten Situation oder Szene in Verbindung gebracht. Eine Wahnidee ist Ausdruck einer Empfindung, dargestellt in menschlicher Form. Der Patient projiziert etwas auf Bilder und Szenen. Jemand fühlt sich zum Beispiel verpflichtet, sich um seine Gemeinde zu kümmern, und sieht sich
selbst als Atlas, die Last der ganzen Welt auf den Schultern tragend.
Auf dieser Ebene kann der Homöopath von Träumen, unterbewussten Bildern, persönlichen Interessen, Hobbys und ähnlichen Ausdrucksformen des Patienten Gebrauch machen. Besonders Träume sind oft sehr deutliche Ausdrucksformen von Wahnideen (delusions). Auf dieser Ebene der Fallaufnahme ist es sehr wichtig, Gesten, häufig benutzte Metaphern, genaue Bilder und imaginäre Situationen zu beobachten. Ein Beispiel:
„Meine Schwiegermutter streitet immer mit mir. Sie bereitet mir Kummer und quält mich. Sie ist wie ein Tiger, der mich angreift.“
Ebene 5: Empfindung
Jenseits unserer Vorstellungskraft und ihrem Ausdruck auf der Ebene der Wahnideen (delusion) befindet sich ein anderer Bereich, der vollkommen nicht-Menschen-spezifisch ist. Er gehört zum allgemeinen Bewusstsein, das wir mit Pflanzen, Mineralien und Tieren teilen. Themen des Überlebens (Tierreich), der Struktur (Mineralreich) und Empfindsamkeit (Pflanzenreich) werden auf dieser Ebene ersichtlich. Hier drückt der Patient
seine bloße, unbearbeitete Erfahrung der Situation aus. Auf dieser tiefen Ebene der Empfindung vergrößert sich die Chance des Homöopathen, einen Zugang zu der nicht-Menschen-spezifischen Sprache zu erhalten,
die die Vital-Empfindung ausdrückt, die sich wiederum auf allen Ebenen des Falles manifestiert.
Die Empfindungen werden mit Bezeichnungen zum Ausdruck gebracht wie heiß, kalt, scharf, taub, gefangen, gezogen, zusammengezogen, ausgedehnt, zerbrechlich, verfolgt, klingend etc. Eine Frau hat beispielsweise Schmerzen in den Nasennebenhöhlen, die sehr schlimm sind, als ob etwas brechen würde. Es wäre weniger schmerzhaft zu sterben. Sie beschreibt: „Es fühlt sich an wie eine Platte, wie das Einlegen einer Platte.
Sie könnte auseinander brechen. Ich wünschte, sie würde meinen Kopf zerbersten lassen. Die ganze Fläche ist ein Schmerz, zerbricht in zwei Teile, vielleicht wird das noch mehr Schaden in mir verursachen.“
Sogar Wahnideen basieren auf Empfindungen. Der Patient drückt auf der Empfindungsebene viel durch die Sprache der Wahnidee aus, trotzdem ist die Sprache der Empfindung unbestimmter, unlogischer und verrückter
als die der Wahnidee. Wahnideen stellen sich als Fantasien oder Bilder in Form einer Geschichte oder eines Films dar. Bei Empfindungen ist das nicht möglich, sie werden in der abstrakten Form der rohen,
unbearbeiteten Gefühle ausgedrückt. Auf der Empfindungsebene wird die Dualität von Körper und Geist aufgehoben und die Vital-Empfindung kommt meistens direkt zum Vorschein. Ein Patient, der sich in einem
Konflikt befindet, erzählt: „Es ist, als ob sie mich, mein Leben und meinen Frieden stören.“ Diese Abneigung, gestört zu werden (Pflanzenfamilie der Violales), ist die Hauptempfindung. Sie ist weder psychisch
noch physisch, sondern eine Gemeinsamkeit der beiden Ebenen.
Emotionen werden auf dieser Ebene sehr intensiv und mit bestimmten Empfindungen wahrgenommen. Ein Beispiel wäre ein Mensch mit schrecklichen Angstzuständen, der sich phasenweise als sehr benommen
empfindet (Opium). Empfindungen bringen sich auch in Träumen sehr gut zum Ausdruck. Wenn beispielsweise in einem Fall die Vital-Empfindung „schneiden“ und „stechen“ ist, könnte der Patient davon träumen,
von Soldaten zerstückelt und zerhackt zu werden (Bryonia). Auf dieser Ebene kann der Homöopath das Naturreich und das Miasma des Falles bestätigen.
Ebene 6: Energie
Das Energiemuster, das der Energieebene entspringt, manifestiert sich aus dem Innersten des Menschen. Es handelt sich um eine tiefe Schicht und darunter ist Stille. Die Art, in der Patienten diese Energiemuster in
sich tragen, bestimmt die Empfindung und beinhaltet die Basisenergie, die Farben, Formen und Bewegungen bestimmter Naturreiche und Arzneien. Die Energieebene ist ein Raum, der alle Formen und Gestalten
enthält, die im physischen Bereich existieren. Materie wird auf dieser Ebene strukturiert.
Die tiefste mögliche Heilung passiert auf dieser Ebene. Auf dieser Ebene ist es schwierig, die Energie direkt zu beobachten. Verfolgt der Homöopath den Fall jedoch weiter in die Tiefe, beginnen sich die abstrakten
Gesten seines Patienten zu offenbaren und die Energiemuster werden sichtbar. Der Patient drückt sich auf dieser Ebene auch in der Quellensprache aus. Diese Quellensprache stammt aus dem kollektiven Bewusstsein
und der Patient beschreibt die Eigenschaften der homöopathischen Substanz, die er braucht. Zum Beispiel sprach eine Patientin, die eine Pflanzenarznei aus der Familie der Coniferen benötigte, von einer klebrigen,
honigähnlichen Substanz, die Raumtemperatur hat, die nicht heiß wie Lava ist und aus einem Riss, einer Röhre fließt. Die Substanz, die sie beschrieb, ist der Saft eines Baumes.
Terebinthina, eine terpentinartige, harzige Absonderung, die von Nadel-Bäumen stammt, wurde erfolgreich verschrieben. Hier auf der Energieebene erfährt der Mensch die Empfindung nicht, sondern er lebt sie.
Obwohl die Vital-Empfindung auf der Empfindungsebene einfacher zu entdecken ist, hat sie ihren Ursprung auf der Energieebene. Viele spezifische Emotionen und Empfindungen werden im Zusammenhang mit Energiemustern beobachtet. Manchmal kann der Homöopath markante Energiemuster und die Beziehung bestimmter Substanzen zu der Quellensprache, die der Patient bei der Beschreibung seiner Träume
verwendet, feststellen. Jeder menschliche Ausdruck entspringt den Energiemustern (Gelächter, Schritt, Stimmlage etc.). Die Energie kann auf ihrem Weg durch den Patienten beobachtet werden. Diese Kraft drückt
sich aus durch Geschwindigkeit, Klang, Richtung und Farbe. Alles ist ständig ein Ausdruck dieser Muster.
Die Energieebene ist für die Naturreiche nicht spezifisch, da Arzneien aus verschiedenen Reichen ähnliche Energiemuster besitzen können. Zum Beispiel können drei Arzneien, die jeweils zum Pflanzen-, Mineral- und Tierreich gehören, beinahe gleiche Resultat ergeben.
Ebene 7: Stille, Bewusstsein
Tiefer als die Energieebene existiert noch eine weitere Ebene. Diese Ebene ist die Leinwand, auf der sich alle Energiemuster manifestieren können. Sie ist die Grundlage der Energie, genauso wie Energie die Basis der Empfindung ist; die Wahnidee entspringt der Empfindung; und die Emotion stammt von der Wahnidee. In diesem Sinn ist die Basis aller Energiemuster die Ebene, die selber keine Energiemuster hat. Es handelt
sich um die vollkommene Leere und die Leinwand, auf der sich alles ereignen kann.
Einige nennen es Gott oder Bewusstsein. Es ist die tiefste Schicht ohne Klang, Farbe, Licht oder Bewegung, die vollkommene Leere. Dies ist die Ebene des Momentes des Todes oder der Empfängnis, der Zustand des
Komas, ein Zustand des Nichts, ein undifferenzierter Zustand. Hier ist das verbindende Glied, das den Kreis der Ebenen schließt.
Die Anwendung der Ebenen bei der Fallaufnahme und Analyse
Wir beschäftigen uns mit einer Welt auf verschiedenen Ebenen. Wir erfahren Phänomene als Identität, Fakt oder Emotion, und im Allgemeinen endet das Bewusstsein o. unsere Erfahrung da. Offensichtlich ist das nur die
oberste Schicht der Erfahrung. Es ist die Spitze des Eisbergs und die übrigen sieben Achtel der Masse liegen darunter verborgen.
Das ist nicht nur das Unterbewusstsein, sondern das sind noch andere, tiefere unerforschte Ebenen. Der Verstand ist nur die Spitze des Eisbergs.
Dr. Rajan Sankaran
New York 2003
Man könnte das System der Ebenen als einen Entwicklungsweg bezeichnen und zwar im Sinne eines dynamischen Prozesses der Bewusstwerdung, von undifferenzierten zu differenzierten Zuständen. Der pathologische Prozess folgt auch gern diesem Pfad und neigt dazu, die Kontinuität der verschieden Ebenen zu unterbrechen. Allein die Tatsache, dass während der Fallaufnahme diese Ebenen im Bewusstsein des Patienten wieder verbunden werden, liefert einen gewissen Heilungsimpetus.
Die Landkarte der Ebenen ist eine der wichtigsten Leitlinien, mit deren Hilfe der Homöopath erkennen kann, wo sich der Patient während der Anamnese befindet und wie in dem Fall weiter verfahren werden soll. Wir müssen
nur die Hauptbeschwerde als Wegweiser durch die Ebenen benutzen, bis wir die Vital-Empfindung gefunden haben. Der Homöopath sollte den Patienten auf der Ebene, auf der er sich gerade befindet, halten, bis diese Ebene vollständig abgeklärt ist. Der Patient erzählt beispielsweise, dass ihn dieses Ziehen wild mache. Der Therapeut muss zuerst alles über dieses Ziehen (eine Empfindung auf der Faktenebene) in Erfahrung bringen, bevor er sich
dem „wild sein“ widmet (möglicherweise eine Wahnidee). Sobald die Ebene vollständig erforscht ist, kann sich der Patient auf die nächste begeben.
Man sollte sich dessen bewusst sein, dass sich der Patient auch durch Zeichen und Sprache der Ebenen, die über und unter derjenigen liegen, auf der er sich gerade befindet, ausdrückt. Wir werden deshalb auf der 4en Ebene (Wahnidee) auch Gefühle und Empfindungen entdecken. Die Sprache der anderen Ebenen bedeutet nicht zwangsläufig, dass sich der Patient auch auf ihnen befindet.
Der Homöopath entwickelt durch die Anamnese und durch das Beobachten von Fällen, die er nach dieser Methode behandelt hat, eine Wahrnehmungsfähigkeit für Energien und ihre Muster. Es gibt Hinweise, auf die man
achten sollte. Das können Worte des Patienten sein, die nicht zum Erzählten passen oder die nach einer langen Pause ausgesprochen werden, Gesten, die wiederholt auftreten oder Intensität (Richtung, Geschwindigkeit, Energie) haben, oder Gesten, die nicht in den Zusammenhang passen. Wenn wir die Energie, die Gesten und die Worte wiederholt beobachten, werden wir schließlich ein Energiemuster erkennen, die sogenannte Vital-Empfindung.
Der Homöopath sucht nicht nach bestimmten Worten, sondern nach der Erfahrung des Patienten und nach dem Punkt, wo in diesem Fall die Energie liegt. Letztendlich werden Worte im Zusammenhang mit Gesten, die Energie tragen, als Wegweiser für diese Reise benutzt und müssen von uns identifiziert und bestätigt werden, um die Vital-Empfindung in dem Fall zu erkennen.
Der Patient kann verschiedene Wege wählen, zum Beispiel:
von der ersten Ebene, Name,
auf die zweite, Fakten,
zur dritten, Emotion,
weiter zur vierten, Wahnidee,
die fünfte, Empfindung,
bis zu der sechsten, Energie.
Manchmal geht die Reihenfolge auch von der Ebene 2, Fakten, auf die 5, Empfindung, und dann auf die Ebene 4, Wahnidee, über die Ebene 3, Emotion, zurück zur Ebene 4, Wahnidee und schließlich wird Ebene 5, Empfindung, erreicht. Solange sich der Patient leicht von einer Ebene zur anderen bewegt, sollten wir ihm folgen, auch wenn der Patient zwischen verschiedenen Ebenen hin und her springt. Nicht alle Patienten wechseln mühelos die Ebenen.
In vielen Fällen besteht eine Fixierung auf eine bestimmte Ebene, besonders auf die Ebene der Emotion oder die Wahnidee. Wenn der Patient auf einer Ebene feststeckt, ist eine neue Vorgehensweise nötig, um ihn auf eine tiefere Ebene zu führen. Diese Technik bezeichnet man als Bypass.
Die folgenden Beispiele handeln von Patienten, die auf verschiedenen Ebenen feststecken:
Der Patient kann sich nicht von der zweiten Ebene, Fakten, auf die dritte Ebene, Emotion, bewegen, da er unfähig ist, seine Gefühle zu beschreiben. Der Patient hat von verschiedenen Fakten seiner Krankheit berichtet, der Therapeut hat gefragt: „Welche Gefühle verbinden Sie damit?“, aber der Patient kann seine Gefühle nicht beschreiben.
Der Patient kann sich nicht von der dritten Ebene, Emotion, auf die vierte Ebene, Wahnidee, bewegen. Er hat seine Gefühle beschrieben, der Therapeut hat nachgefragt:
„Wie haben Sie es wahrgenommen?“, aber der Patient hat Schwierigkeiten, von geistigen Bildern oder visuellen Vorstellungen zu berichten.
Der Patient kann sich nicht von der vierten Ebene, Wahnidee, auf die fünfte Ebene, Empfindung, bewegen. Er kann keine Empfindungen beschreiben, obwohl er Bilder geliefert hat.
Der Patient kann sich nicht von der fünften Ebene, Empfindung, auf die sechste Ebene,
Energie, bewegen. Er beschreibt seine Empfindungen gut, kann aber die Energie nicht zum Ausdruck bringen oder diese spezielle Sprache sprechen, in der er Worte aus der Quelle verwendet.
Vorwort/Suchen Zeichen/Abkürzungen Impressum