A few words written here to offer direction from Hahnemanns instructions to us. In the previous article written by Boenninghausen, https://instituteforhomoeopathicmedicine.wordpress.com/2017/06/25/the-choice-of-remedy/
it was pointed out one of the commonest mistakes made in case analysis, is the incompleteness of taking the symptoms.
In our clinic recently, a similar set of circumstances arose in a particular case, and we agreed on a remedy that presented in every way to a similimum. However….. Even though the remedy chosen fitted well, Manuel said to me, ” you have that unconvinced look again” and so we reviewed the case over, asking more questions. We found a modality that we had missed and one which WAS the key to the case.
There is an issue that faces all homoeopaths. That is one of taking an accurate and complete notation of all the ALTERED symptoms of the disease state present. A brief look at what is required:
He begins a fresh line with every new circumstance mentioned by the patient or his friends, so that the symptoms shall be all ranged separately one below the other. He can thus add to any one, that may at first have been related in too vague a manner, but subsequently more explicitly explained.
When the narrators have finished what they would say of their own accord, the physician then reverts to each particular symptom and elicits more precise information respecting it in the following manner; he reads over the symptoms as they were related to him one by one, and about each of them he inquires for further particulars, e.g., at what period did this symptom occur? Was it previous to taking the medicine he had hitherto been using? While taking the medicine? Or only some days after leaving off the medicine? What kind of pain, what sensation exactly, was it that occurred on this spot? Where was the precise spot? Did the pain occur in fits and by itself, at various times? Or was it continued, without intermission? How long did it last? At what time of the day or night, and in what position of the body was it worst, or ceased entirely? What was the exact nature of this or that event or circumstance mentioned – described in plain words?
We did not examine each symptom and COMPLETE the location, the sensations and the modalities. In my clinical experience, it is the modifying factors of a symptom that give the leading clues to the correct remedy. I make it a practice to NOT IGNORE ANY SYMPTOM IN ITS ENTIRETY as it may prove the key to remedy selection.
You may find that a single modality present in each symptom MIGHT becomes a general symptom of the case. Without having each symptom itemised into its components, There is no accurate case to prescribe for. You may find that a modality is singular to a particular symptom, and on that basis alone is key to the case. I often hear inexperienced prescribers say that they dont like to use rubrics that narrow down the list of remedies too early in case “they miss something”. I personally look for symptoms that CANNOT be ignored and have but few remedies in them.
We will look at this logically.
A known infecting agent will produce a known set of pathological symptoms. By virtue of this knowledge, a name can be given to the disease state, and expressions of that disease will be exhibited in the patient so that, for example, measles can be diagnosed as the “Disease”.
A patient before us has a known disease. This disease has symptoms of
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z.
Not all symptoms will be exhibited in the patient. Our patient for example, will present E J K P V W X Y and Z. However, the collection of these symptoms is the descriptor for the named disease.
So we look at the exhibited symptoms that the patient presents, and note (for example) the Fever, the skin eruptions and the feeling of Nausea.
We start with examination of HOW the fever affects the patient. Is it hot? cold? is it followed or accompanied by perspiration? Is there a time modality? Is it worse for covering or uncovering? What affects it? Is it better or worse from heat? etc etc.
We look at the skin symptoms and examine each and every eruption, location, modality etc.
We look at the Nausea and do the same.
From this we can conclude that Hahnemann fully accepted that the illness was due to infection, but that the reaction to it IS INDIVIDUAL TO THE ORGANISM INFECTED. On this basis, we must keep in mind what is common to the infection and NAMED disease symptoms, and YET peculiar to the individual…….in their individual expression, from which we can elicit the prescribing symptoms for a remedy match.
The choice of the remedy in any concrete case of disease can not be made too carefully or too cautiously. No less in the healing art than in morals, the motto holds good: “Bonum ex omni parte, malum ex quorumque defectu.” Many failures occur, especially with unpracticed beginners, because in examining the symptoms the one or the other was overlooked. Even with the older and more experienced homeopathic physicians, especially such as are very busy, such an occurrence occasionally takes place. (Boenninghausen)
Never be afraid to re look at a case that is not resolving. Of such a case Boenninghausen wrote:
“………But I was cruelly and painfully disappointed when the patient after this period appeared before me, for he was not improved in any respect; on the contrary, his sickly appearance and the threatening redness of the cheeks had increased and the feverish symptoms had been suspiciously augmented. In the meantime the remedy had been used exactly according to my directions, and nothing had been overlooked either in diet or in his mode of life. What then had been the reason for my total failure? Under such circumstances the only reason could be the defective or incorrect examination of the symptoms, so I went over them again carefully, one by one.”