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
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)
ccvv
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? < 219 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, Colocynth is 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. (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
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
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 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.
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 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.
6th Then, besides
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
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
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
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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