What is a Symptom? What are we Treating?

A symptom (from Greek σύμπτωμα, “accident, misfortune, that which befalls”,from συμπίπτω, “I befall”, from συν- “together, with” and πίπτω, “I fall”) is a departure from normal function or feeling which is noticed by a patient, reflecting the presence of an unusual state, or of a disease.

A symptom is subjective, observed by the patient, and cannot be measured directly,  whereas a sign is objectively observable by others. For example, paresthesia is a symptom (only the person experiencing it can directly observe their own tingling feeling), whereas erythema is a sign (anyone can confirm that the skin is redder than usual). Symptoms and signs are often nonspecific, but often combinations of them are at least suggestive of certain diagnoses, helping to narrow down what may be wrong. In other cases they are specific even to the point of being pathognomonic.

 § 6 Fifth Edition
The unprejudiced observer – well aware of the futility of transcendental speculations which can receive no confirmation from experience – be his powers of penetration ever so great, takes note of nothing in every individual disease, except the changes in the health of the body and of the mind (morbid phenomena, accidents, symptoms) which can be perceived externally by means of the senses; that is to say, he notices only the deviations from the former healthy state of the now diseased individual, which are felt by the patient himself, remarked by those around him and observed by the physician. All these perceptible signs represent the disease in its whole extent, that is, together they form the true and only conceivable portrait of the disease.

For those that like to quote Kent and assert that the homeopath treats the person, not the disease, we would like to correct this false assumption by quoting aphorism 2:

§ 2
The highest ideal of cure is rapid, gentle and permanent restoration of the health, or removal and annihilation of the disease in its whole extent, in the shortest, most reliable, and most harmless way, on easily comprehensible principles.

It is always a source of disappointment to watch a homeopath take a case and spent hours and hours extracting symptoms that are a waste of the patients time and the practitioner’s time and of no value in treating the patient. Hahnemann very clearly detailed what information is required for changed and altered symptoms that are perceptible both to the patient and to the observing practitioner. In his instructions on how to take a case he emphasised that the important symptoms must be fleshed out so as to know exactly how the expressed symptom affects the patient.

Hahnemann also stated: “to only take symptoms pertinent to the case”.

§ 83
This individualizing examination of a case of disease, for which I shall only give in this place general directions, of which the practitioner will bear in mind only what is applicable for each individual case, demands of the physician nothing but freedom from prejudice and sound senses, attention in observing and fidelity in tracing the picture of the disease.

§ 84
The patient details the history of his sufferings; those about him tell what they heard him complain of, how he has behaved and what they have noticed in him; the physician sees, hears, and remarks by his other senses what there is of an altered or unusual character about him. He writes down accurately all that the patient and his friends have told him in the very expressions used by them. Keeping silence himself he allows them to say all they have to say, and refrains from interrupting them1 unless they wander off to other matters. The physician advises them at the beginning of the examination to speak slowly, in order that he may take down in writing the important parts of what the speakers say.

In discussing these matters with homoeopaths, many of them point out that aphorism 85 on shows Hahnemann detailing points outside of the disease process currently exhibited. If you actually read carefully Hahnemann focuses on the salient points of change in the patient, and generally asks if anything else has changed during the onset or prior to the onset of the current malady experienced, or if any other symptoms exist that the patient has noted which are not connected to the disease presented. He does not detail anything except that what has changed.

The IHM have reviewed many of the case books of Hahnemann and can see clearly from his case taking that he solely keeps in view just the altered symptoms and does not cover every part of the pathology except as outlined above.

The problem that exists among Kentian prescribers is a multifaceted one. Firstly Kent classified symptoms as one being above another in hierarchy. For example he classifies the mental and emotional state as being the key and the primary indicator for a prescription. This holds true to such an extent that most practitioners will not prescribe a medicine without a mental collection of symptoms. This is patently wrong.

Hahnemann’s instructions were to observe only the symptoms that have altered or changed. If a patients personality has not changed or his or her reaction to a situation is unaltered, then clearly a mental or emotional observation of a changed state is not present. A medicine is given for an altered state, not a personality.

Another problem that Kentian practitioners face, is that some of the modern materia Medicas present remedies as a personality or a type. This is also patently wrong. The materia Medica should be a collection of accurately observed symptoms that are produced by a substance.

For this reason for example, Pulsatilla can be given to a normally aggressive and non-compliant male for symptoms presented which are typical and produced by the substance Pulsatilla as a direct result of the effects of that medicine. If the symptoms are such that no other medicine can produce the symptom state, and the patient’s mental or emotional state has not changed, then Pulsatilla can be given with an assurance that it is the correct medicine for the ‘changed and altered state’.

Pulsatilla will work more readily if the patient’s mental and emotional state, during the disease, has changed to a mild disposition. However, it is not necessary, as stated previously if the only symptoms presented match Pulsatilla.

Hahnemann pointed out, in his experience, that Pulsatilla worked only rarely in the cases where the mental symptoms did not alter as well. Yet in his case work records we see a lot of Pulsatilla prescribed for different conditions in men where the mental symptoms where not yielding or placid but remained unaltered.

So for the Kentian practitioner wishing to have more success in his case taking, we would humbly suggest that the return to the Hahnemannian method and stop looking for personalities, for types, for in core delusions or a central state based on mental emotional pathology, and just stick to observing deviations from health in the symptoms presented, without speculating on the reasons for a deep inner conflict.

More on this later.

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