Category Archives: Boenninghausen

The grading system of Boenninghausen.

The more I read the writings of modern day homoeopathic ‘experts’, the more I realise that we cannot trust in their utterances. A simple thing like translating Boenninghausens Therapeutic Pocket Book from German to English by Allen was mangled. First by the grading system, then incorrect English translation of the German rubrics, and finally by the addition of extra remedies in a manner in which did not reflect the accuracy of the carefulness of grading the symptoms.

It is always best to go to source in order to establish the accuracy of the situation. Here is Boenninghausens own words in the preface to the 1846 edition.

“On account of the large number of remedies, under nearly every rubric, it has been thought indispensable, on account of both the above-mentioned objects, to distinguish their relative values by means of various types, as I have done in my former repertories, and which Hahnemann has repeatedly shown to be necessary. So, throughout the whole work, there will be found five classes distinguished by the type, of which the four most essential ones are in the first division,

Mind and Disposition, under the rubric ” Covetousness,” which may serve as an example. The word Puls, in spaced Italics, occupies the highest, most prominent place. After this follow, in descending order, in simple Italics, Ars. and Lyc, as less important, but still especially distinguished by the characteristics of the remedies as well as by practice. Of a still lower order are the spaced Roman letters in N a t r. and S e p., and in the last rank will be found Calc, printed in Roman letters not spaced. The fifth place, the last of all, contains the doubtful remedies, which require critical study, and which occur most seldom; these are enclosed in parentheses”.

Logic: Why would Boenninghausen include a grade for doubtful remedies? Doubtful remedies can not be graded for usefulness. Why did he state that The four most essential remedies are in the first division?

Further investigation from the handwritten copy of the 1846 printers edition, shows clearly what is meant. The underlining system was like this. Grade 1, no underline. Grade 2, one underline, Grade 3, 2 underlines. Grade 4, 3 underlines.

There was no grade attribution for remedies in parenthesis. There is only this system used throughout.

Further, 20 year later in the reprint, Boenninghausen removed the remedies in paranthesis and left the main work intact. One can only assume that the original parenthesis remedies were included for further study and research. NONE were added to the repertory.

Other homoeopaths of the time acknowledged the grading system. Hering for one.

Herings foreword to  His Guiding Symptoms.

Is the same as that in the “Analytical Therapeutics” and in the “Condensed Materia Medica.” A more complete and concise review of the arrangement will precede the Repertory, which is to follow close upon the last volume of this work.

     To facilitate the study of the relative value of symptoms, four marks of distinction have been adopted, “TextTextTextText”, which correspond to the four degrees in Bœnninghausen’s Repertory….”

There is no more to say.

 

Case taking errors.

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:

§ 85
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.
§ 86
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?

In our case, which is still ongoing, had we not followed the instructions Hahnemann gave for taking precise symptoms and modalities, we would have GIVEN THE WRONG REMEDY and failed to elicit a cure.

Why?

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.”

A Contribution to the Judgement Concerning the Characteristic Value of Symptoms

A Contribution to the Judgement Concerning the Characteristic Value of Symptoms
By Clemens Franz Maria von Boenninghausen

          It is now over three years since the great Homoeopathic Congress was held in Brussels, Germany being, I am sorry to say, but little represented. In the last session of this meeting after several propositions had been read, my resolution was adopted and a prize-question was proposed, to answer which a period of two years was granted. This prize essay, as the Homoeopathic journals have also made known, was intended to call out a “Treatise concerning the greater or lesser (characteristic) value of the symptoms occurring in a disease, to aid as a norm or basis in the therapeutical selection of the remedy.” The answer to this question was not limited to Belgium or to France, but it was handed over to the competition of the whole medical world, and it was thus unanimously acknowledged to be a subject of the greatest importance. Nevertheless, this question, in spite of the daily increase of the homoeopathic literature, has thus far remained unsolved. This silence extending far over the time set, which was computed liberally enough, seems to justify the assumption that the solution of the question has met with considerable difficulties, though every homoeopath must every moment find himself in the position to ask himself this question, and to have to answer it. It might not appear altogether proper for me, the author of the question, to also now enter among the competition for this prize. But the old practitioner will be pardoned for furnishing at least some contribution to the solution, and thereby again calling attention to the question.

          The teaching of the Organon in this matter really contains the proper, true kernel of the answer, and this, of course, deserves to be first premised. It is found in the great Paragraph No. 153 (5th Ed.) and is as follows:

          In seeking for the specific homoeopathic remedy, i.e., in this juxtaposition of the phenomena of the natural disease and the list of symptoms of the medicines, in order to discover a morbid potency corresponding in similitude to the evil to be cured, the more striking, particular, unusual and peculiar (characteristic) signs and symptoms of the case should especially and almost solely be kept in view; for there must especially be some symptoms in the list of the medicine sought for corresponding to this, if the remedy should be the one most suitable to effect the cure. The more general and indefinite symptoms, such as lack of appetite, headache, weariness, disturbed sleep, uncomfortableness, etc., in their generalness and undefinedness deserve but little attention, unless they are more especially pronounced, as something of such a general nature is seen in almost every disease and in almost every medicine.

          It is seen, however, that it is here left to the physician to judge what is understood by the “more striking, particular, unusual and peculiar” symptoms, and it might, indeed, be difficult to furnish a commentary to this definition, which would not be too diffuse and, therefore, easily understood, and on the other hand would be complete enough to be properly applied to all these cases. Whence is it that we are unable to show any such definition in our literature? Even what Hahnemann adduces in §86, and those that follow, only contains some examples which are given without any systematic order, and are therefore but little suited to impress themselves on the memory, a requirement which in all such matters must appear to be of very great importance.

          After looking about in the whole of the medical writings, allopathic as well as homoeopathic, for an aid, I remembered that in the middle ages they were accustomed to bring all such matters into the form of verses, in order that the memory might thus be assisted. The modern learned world knows, e.g., the diet of the Schola salernitana, dating from the beginning of the twelfth century, drawn up in leonine verses, as is supposed, by a certain John of Milan, from which some parts are quoted even to this day. But though I did not find here anything for the present purpose, I yet found something which, as it seemed, might prove useful with writers of quite a different doctrine. There is, namely, a hexameter dating from this same period but from the theologic scholastics; this is, indeed, of a somewhat jolting construction, nevertheless it contains briefly and completely the various momenta according to which a moral disease is to be judged as to its peculiarity and grievousness. The verse is the following: “Quis? quid? ubi? quibus auxiliis? cur? quomodo? quando?

          The seven rubrics designated in this maxim seem to contain all the essential momenta which are required in the list of the complete image of a disease. May I be allowed, therefore, to attach my remarks to this scheme, with the desire that this hexameter, which was formerly used only by theologians, may now be also impressed on the memory of homeopaths and be put to use by them.

 1. Quis?

          As a matter of course the personality, the individuality of the patient, must stand at the head of the image of the disease, for the natural disposition rests on it.

          To this belongs first of all the sex and the age; then the bodily constitution and the temperament; both, if possible, separated, according to his sick and his well days i.e., in so far as an appreciable difference has appeared in them. In all these peculiarities whatever differs little or not at all from the usual natural state needs little attention; but everything that differs in a striking or rare way therefrom deserves a proportionate notice. The greatest and most important variations are here found mostly in the states of the mind and spirit, which must by scanned all the more carefully, if they are not only sharply distinct, but also of rare occurrence and, therefore, correspond to only few remedies. In all such cases we have all the more cause to fathom these states with all possible exactness, as in them frequently the bodily ailments recede to the background, and for this very reason offer but few points for our grasp, so that we may be able to make a sure selection among the remedies which compete.

          Paragraph 104 of the Organon makes it a duty of the homoeopath to make a written scheme of the image of the disease, and whoever has once acquired a certain facility in this will easily know how to satisfy this requirement and gradually acquire a certain specializing penetration, which will prove to him of ever increasing usefulness. For as every man presents an individual nature different from every other one, and as every medicine must be exactly adapted to this individuality, in agreement with the symptoms, which it is able to produce in the total man, so, an once, at this first investigation as to the Quis? A great number of medicines are thrust aside, just because they do not correspond to the personality of the patient.

          The spiritual and dispositional individuality of the patient here gives the most important, often almost the only deciding points for the selection of the remedy, where the disease involved is one of the mind or spirit, and generally the two disturbances present themselves so conjoined into one that the signs of the one only receive their full and definite character from the other. Hahnemann, indeed, recognized the importance of this two momenta from the beginning, but the necessity of weighting the two in their connection with one another he only recognized later on it its full measure; and he then placed the symptoms proper to the two, which in the first provings had been separated, one making the beginning and the other the end, in the “Chronic Diseases” immediately one after the other, an improved arrangement, which we also find in the best works on Materia Medica Pura of later times.

          Many other things belonging to this rubric, but concerning the bodily individuality and presenting, as it were, the chief features in the portrait of the patient, are contained in those books under the heading of “general.” It would be desirable and would greatly facilitate the use if everything not pertaining thereto should be excluded, and the former be brought under a particular rubric denominated either “Individual” or “Personal,” in such a way that the corporeal would present a separate picture, as has been done with respect to the spiritual and mental.

2. Quid?

          Of course this question refers to the disease, i.e., to its nature and peculiarity.

          It may be unquestionably received as an axiom that we must first know an evil accurately before we are able to give any effectual aid against it. That occasionally relief may be given, without having first recognized the nature of the evil, as little refutes this axiom as the fact that an unexpected event occurs frequently which lies outside of our computation, and which either leads to good or evil, while neither the good will, nor the knowledge of the physician have the least to do with it.

          But this axiom must be associated with another, which is no less true and no less important, namely this: That we must also know and possess the means which are able to relieve the evil when it is recognized. Where these are lacking, the former are of course of no avail.

          Since the times of Hippocrates, thus since more than two thousand years, very much has been done with respect to the first point, and we have especially enjoyed a great progress and enlightenment within the last century and up to modern times. The path of pure observation and experience, which for a time had been pretty much forsaken, and on which that ancient Father of the healing art had gathered his valuable material, has again been entered upon. At the same time our contemporaries possess and use the great advantage enuring to them from the fact that they stand on the shoulders of their predecessors, and can thus view a greater circle of vision and, more especially, that astonishing progress has been made in all the subsidiary sciences, especially in chemistry and anatomy; so also they have had the advantage offered them by many physical instruments, which it must be confessed they have used with industry and care. By these means the modern physiological school, and, at the same time, the diagnostics of diseases, have reached an excellence not attained in earlier times.

          The only thing of which every Homoeopath has to complain in this matter, is that things are conducted in too general a manner for his doctrine, and that almost universally diseases are described and treated of under the same name, which differ essentially in their nature, and require for their cure very different medicines.

          An immediate result of this failing is, that Homoeopaths can make only a very limited use of the great advance made by the dominant school in diagnostics, since their generality excludes every special direction as to the suitable remedy.

          Now since the modern Materia Medica of allopathy, as well as the older one, moves in the same generality, the conclusion follows almost inevitably that even the most cultivated allopath often stands undecided when he is to make a choice of remedies, so that almost every one of them will order something different, and that he is usually compelled to mix many thins together in order to cover the various indications.

          More about this will be found in the course of this short treatise in a more suitable place, where the other questions are also discussed. Here I can only say so much about it.

          a. That the most penetrating and most indubitable diagnostic as offered by the best allopathic manuals is rarely of ever sufficient for the Homoeopath, so as to enable him to make a sure selection of the remedy, and that

          b. Such a diagnostic at most, and even then not always, may serve to exclude all those remedies from the competition which do not correspond with the common genius of the disease, but seem to act chiefly on other parts of the organism.

 3. Ubi?

          The seat of the disease really makes a part of the former question, but it nevertheless deserves to be more particularly emphasized, as it frequently furnishes a characteristic symptom, since almost every medicine acts more and also more decidedly on certain particular parts of the living organism.

          These differences not only enter into consideration in certain so-called local diseases, but also in those diseases which are called by more general names, as affecting the whole body, e.g., gout and rheumatism. For it is probably never or very rarely the case that all parts of the body are affected in the same degree; even if it should be merely the case that the right side is more affected than the left or the reverse. But the examination of the parts affected is most necessary and most required when the whole to which they belong is larger, and is described merely in that general way which allopaths seem to delight in. Such names as headache, eyeache, toothache, colic and the like can in no way contribute to a rational choice of a remedy, not even when also the kind of pain is indicated.

          Of course, the exact individualization of the ubi is most necessary in local ailments. Every Homoeopath knows from experience how necessary it is, e.g., in treating toothache, to select a remedy which in accordance with its provings on healthy persons has shown its action on the especial tooth to be treated. Among the most striking and decisive phenomena in this respect we should especially number the sores on the upper side of the joints of fingers and toes, which under allopathic treatment frequently prove very obstinate, and not infrequently become malignant, and necessitate an amputation, and, as I had an opportunity of witnessing here in two cases, may even have a fatal result. Every Homoeopath knows the efficacy of Sepia in these ulcers of the joints, which have no otherwise distinguishable features when this remedy is taken internally; without any external medication it will have a sure effect. Medicines which correspond to similar ulcers on other parts of the body in such cases are utterly useless.

          If the practice of auscultation and percussion, as well as the use of the stethoscope, the plessimeter, etc., had been as well known to Hahnemann and his pupils as to our young physicians, they would no doubt have made the most extended use of the same for gaining a more exact knowledge and delimitation of interior ailments. They would have found out in lung troubles, e.g., definite local signs pointing to the use of certain remedies, and would have indicated them more accurately, and would not have limited themselves to defining them as being on the left or on the right side or at the top or below. To bring up to date and to specify more closely might be one of the chief duties for those who make additional provings at the present time, and might serve to an important and essential enrichment and completion of our Materia Medica more than a whole mass of confirmations of older symptoms or the finding out of new ones, which mostly have a lack of individuality.

          At the same time it will be conceded from the allopathic side that the closer delimitation of the part affected, even though it may be of moment in the completion of the diagnosis, will be of no use to allopathic therapy, because this school is unacquainted with the peculiarities of the various medicines. No allopathic Materia Medica gives any information that the one remedy, e.g., corresponds more to the anterior or the posterior lobe of the liver, more to the upper or the lower part of the lungs, on the right or the left side, according to which the choice of the remedy may be made. Even if we Homoeopaths do not as yet know this as to all remedies, we do know it with respect to many of them, and for what is lacking we find a substitute in other signs, since, as is well known, all of these correspond to the remedy to be selected, at least they must not be opposed to it. Thence it may be seen that these new inventions, the value of which I am not in any way inclined to undervalue, have far less value in a therapeutic direction than in prognosis, where they show the extent and the dangerous nature of the malady.

          Finally, we must yet consider in this question that neither the internal changes, which can be determined by these instruments, nor the material external changes, which manifest themselves openly to our notice, never present the dynamic disease itself, but are only its products, and are only developed in the course of the disease. When, therefore, these first beginnings are checked by the suitable remedy before those disorganizations take place, then these latter would not come to be developed, and it would be an inexcusable procedure to allow these sufferings to advance to a point where these material changes can be recognized in an artificial manner. It was necessary to mention this, in passing, in order that it may be shown how Homoeopathy proceeds, and to deny most decidedly the objection sometimes made that Homoeopathy is merely an expectative method, which allows the disease to develop without hindrance until it is too late to help. On the contrary, Homoeopathy knows and uses in infections diseases sure prophylactic remedies, which are always and exclusively such as have the power to heal the disease itself, and they never omit their use for the protection of those around the patient.

 4. Quibus Auxiliis?

          If the hexameter which we are following had been originally written for our doctrine, probably a more suitable expression would have been used in this instance, e.g., quibus sociis or quibus comitibus? Still the name does not matter, and it is manifest that it must refer to the accompanying symptoms.

          Now since in Homoeopathy the chief aim consists in ascertaining the remedy which most completely corresponds to the totality of the symptoms, it is evident that this point is of the greatest importance and deserves the most careful consideration.

          For every disease presents in its recognizable phenomena a more or less numerous group of symptoms, and it is only their totality which presents its complete image. This image may be compared to a portrait, which can only then claim to be a striking likeness when all the features of the original are faithfully presented in it. It is not sufficient that mouth, nose, eyes, ears, etc., should be presented in such a manner as characterizes man, and distinguishes him from the monkey and other animals but as every human physiognomy possesses its peculiarities and is distinguished from every other, so also here the more or less strongly pronounced abnormalities must most carefully and with the greatest faithfulness and truthfulness be presented and given their prominence. If therefore, retaining our former comparison, the nose should have a most peculiar form, color or size, it would not be sufficient to present this alone, though it should be most lifelike, and to add all the rest according to fancy, but also the secondary parts, which, as it were, form the background, must present a whole, such as it exists in reality, in order to give a perfect likeness.

          It is from this point of view that the concomitant ailments are to be regarded when we select a remedy according to the motto: Similia similibus. Thence it is evident that the rare, striking and peculiar symptoms which present themselves demand a more prominent place than the common ones, because on them chiefly though not exclusively the similitude depends.

          From this it naturally follows that the value of such concomitant symptoms for the purpose intended varies widely. But it would too far transcend the purpose of this contribution if I should adduce and explain all the many categories of value. I shall therefore limit myself to the presentation of a few of the most important points here involved:

          First of all, those symptoms which are found in almost all diseases may be left out of our count, unless they manifest themselves in a striking manner.

          The same obtains as to those ailments which are wont to appear as constant concomitants or at least as usual in the disease under consideration, unless they should be distinguished by some rare peculiarity and in this respect offer something characteristic.

          On the other hand, all those attendant symptoms should be carefully noted which (a) rarely appear in connection with the leading disease, and are, therefore, also found rarely among the provings; (b) those which belong to another sphere of disease than the chief ailment, and (c) lastly, those which have more or less of the characteristic signs of one of the medicines, even in case they have not before been noticed in the present juxtaposition.

          Now if besides this among the last mentioned concomitant symptoms there should be one or another in which the genius of one of the remedies should be plainly and definitely portrayed, so that it would be plainly pointed out, this one symptom thereby would acquire such an importance that it would even outweigh those of the chief ailment, and many then be at once considered as the most suitable. Such a symptom would be included among those which Hahnemann calls “striking, strange, unusual and peculiar (characteristic) signs,” and which are then “almost alone to be considered” because they preeminently give to the whole disease its individual character.

          One circumstance deserves to be particularly mentioned here which particularly shows the importance and value of concomitant symptoms, namely, that several very efficient and in part specific remedies in certain diseases were discovered almost exclusively through them, the other symptoms indicating the main disease not having pointed in that direction, nor indeed could they have given such an indication, because the noticeable proximate signs could not sufficiently indicate the real peculiarity of the disease. This same system of concomitant symptoms also gives to Homoeopathy a much greater sureness in the treatment of diseases as compared with Allopathy, which first constructs for itself a frequently deceptive diagnosis of the disease, which at most only points out the genus of this disease, and where there are important attendant symptoms it endeavors to help itself by adding to the leading remedy given for the genus of the disease one or another remedy to cover the concomitant ailments.

 5. Cur?

          Why? The causes of the disease play a prominent part in pathological books, and justly. But a large part of this amounts only to guesses and attempts at explanation, which mostly have only a very subordinate value or none at all in the proper therapy of the disease, and which are too remote for our doctrine which is directed merely to the practical.

          The causes of diseases are most generally and, indeed, very properly divided into external and internal.

          The internal causes properly refer only to the general natural disposition, which in some cases amounts to a peculiar supersensitiveness (idiosyncrasy). The external causes or occasional causes embrace everything which, where there is such an internal disposition to disease, may produce disease.

          The general natural disposition which is also called the proximate cause, really belongs to the first question (Quis?) which respects the individuality of the patient. It only belongs here in so far as the consequences of a former disease may have modified the original natural disposition, and thus it deserves mention.

          The occasional cause, however, is the matter with which the present question occupies itself and which deserves to be more closely considered. As to the natural disposition notified through previous diseases, this either depends on the miasmatic-chronic nature of those diseases as yet unexterminated, among which in agreement with the teachings of Hahnemann many homoeopaths even at this day count psora, syphilis and sycosis, or it is derived from the remains and after-effects of acute diseases, which when they do not belong to the former, as is frequently the case, constitute the numerous class of medicinal diseases or poisonings. Not infrequently, however, we meet with cases where both these momenta have cooperated to undermine the natural health, thus producing a monster of a disease which is even more deeply in-rooted and more difficult to combat.

          As to the recognition and treatment of the first mentioned miasmatic diseases and their complications, Hahnemann himself in his masterly work on the Chronic Diseases left us the most complete directions, founded on many years’ experience. The much disputed division of medicines into antipsorics and non-antipsorics need not be considered here. It is enough to know that the former far excel the latter in their effectiveness in chronic diseases, and that their originator has nowhere excluded them from use in acute diseases. Later experience has also taught us that additional medicines from our medical treasury should be numbered in this category which have not been thus treated of in that excellent work. I am only sorry that Hahnemann has not been able to fulfill the promise which he gave me in writing, that he would treat as thoroughly and completely the images of syphilis and sycosis with his accustomed mastership as he had done in the above mentioned work (Vol. 1, p. 58 f. of the Second Ed.) with respect to latent and re-awakened psora. Whether we may believe in what many somewhat derisively call Hahnemann’s Psora-theory, or reject the same, the attentive practitioner must frequently have found cases where even the remedy chosen with perfect correctness, in some acute disease, did not unfold its proper and decided effect before one of the so much criticized antipsorics – frequently Sulphur – had first been used, when psora had been involved, or an antisyphilitic or antisycotic when syphilis or sycosis had been present before and had remained uncured. It must, however, be confessed to be one of the most difficult tasks of the physician to always make the most suitable choice among the antipsoric remedies, as most of them have almost the same symptoms and very few truly characteristic symptoms are found with the different remedies. The more necessary is it for the homoeopath to study with continuous industry these lists of symptoms and to compare them with each other in order that he may pick up the scattered grains of gold for his use.

          Poisonings and medicinal diseases are in one line and it makes no difference by whose hand any one has been deprived of his health by means of a substance injurious to his organism; among these substances medicines as well as poisons find their place. Of course, it is always of the greatest importance to know in every case the medicines or poisons, in order that they may be met by the proper well-known antidotes. The simple poisons may be pretty easily and surely recognized by their effects! It would have required but one case of poisoning occurring before the eyes of a Homoeopath for him bo have recognized the effects of Arsenic, which yet remained unknown to all the allopathic physicians, in the case of the thirty murders of Gessina Timme in Bremen, until the facts were obtained. In the medicinal diseases this is much more difficult, because seldom or never is one medicine given by itself, but always mixed with others; it can not, therefore, yield a clear and definite image. With these, therefore, it is necessary, as in the other case it is desirable, and it facilitates the treatment, if we can have a reliable account of what has preceded, and to be able to look over the prescriptions. Since this may be of use even later on, as the treatment proceeds, the journals of many Homoeopaths have a special rubric reserved for this subject. We must consider these symptoms, called anamnestic, as being of special importance in this question. Although the ordinary consequences of such morbiferous circumstances and events are mostly already contained in the lists of symptoms of the medicines proved on healthy people, yet homoeopathic practice has long ago shortened and made sure the tedious and troublesome path of such investigations, and indicated for most of these cases the remedies which are foremost in their usefulness in such cases. This is e.g., very much simplified in cases of contusions, sprains, burns and the like. In other cases, e.g., in colds, the matter is already somewhat more complicated, since the kind of a cold and the part of the body affected offer differences which again point to different remedies. Thus there is a great difference in this respect as to whether the person has been simply exposed to the cold, or whether this took place while the body was in a perspiration, or if he at the same time got wet through. So also it is well known that different remedies are indicated when internal parts (stomach, abdomen, chest) have been exposed, or merely external parts (head, feet, back), and this must be carefully weighed in every case. All this, as before said, is found among the symptoms in the Materia Medica; but when once it is known that a cold in the head from exposure to cold air, after previously being in a heated room, or after having the hair cut, points to Belladonna or Sepia; after taking cold in the feet, to Baryta or Silicea, and when at the same time there has been a wetting, to certain other remedies, then the attention will first of all be directed to these, and only comparison be made with others which are also occasionally indicated when the first are not sufficiently suitable.

          Finally we must yet add a word under this question about infectious diseases, about which in pathological manuals we read so much that is contradictory and unreliable; the influence of which teachings is, however, much more far reaching than is generally supposed. To meet these diseases, which often spread until they become a real calamity, Homoeopathy has the most sure and approved prophylactics, and these, indeed, are the very same which have the power of healing those diseases when they have developed. Therefore, when we find in a family a case of infectious typhoid fever, there the same remedy, which has been given the patient in accordance with his symptoms, will also be sure to protect those in the house from infection, as it destroys the natural disposition thereto, and it will even in the shortest time restore those with whom there may have already been apparent the beginning of the disease. This last fact is the more important, as these first beginnings are usually so poor in symptoms that no certain choice can be founded on them; but the known occasional cause fully makes up for what is lacking. Of course, such a cure is not so brilliant as when the patient has been at the verge of the grave, but the gain for him and the consciousness of the physician is his sufficient reward.

 6. Quomodo?

          From his etymology, this preposition excellently describes the essence and the scope of the question before us. For the word Modus in the old classics not only refers to the manner and mode in general, but also to all the modifications which can take place in anything, thus the measure, the rule, the aim, the relations, changes, etc.; thus whatever, with the exception of time, which is included in our last question (Quando), possesses the ability to produce a modification, aggravation or improvement with the patient, naturally belongs, according to the usage of the language, to this rubric. This question has a double importance to Homoeopathy, first, because it was first discovered and developed by Homoeopaths, and is, therefore, their indisputable and exclusive property, and secondly, because all the results of provings and experience, without exception, belong to the more or less characteristic signs, of which no one is a matter of indifference, not even those of a negative kind.

          Allopathy has never given any general attention, which might have been of use to therapy, to this momenta. At least its manuals on Pathology, Therapy and Materia Medica contain nothing of importance on this subject. Homoeopathy, on the other hand, soon after its discovery, recognized its great therapeutic value, and we find the first but already clear traces of it in Hahnemann’s “Fragmenta de viribus medicamentorum positivis,” which appeared in the year 1805. But during the progressive development of our science its importance appeared more manifest, and it was soon declared to be indispensable, so that in the later provings the attention was more and more directed upon it. On this account the latter provings are the more complete, with the exception of those made by Hahnemann in the Materia Medica Pura, which were elaborated with especial industry and on account of their constant use accompanied with copious notes.

          If we compare the lists of symptoms of the medicines which have been proved somewhat fully, even a superficial survey will show that we find in almost every one of them the general indications of almost every disease; headache, colic, pain in the chest, diarrhoea, constipation, as well as dyspnoea, pains in the limbs, fever and cutaneous ailments, etc., are in no case quite absent. But if we study these indications somewhat more closely, with respect to the special parts of the body and the different sensations, then, indeed, differences will appear, and we frequently discover symptoms which appear more or less frequently in one remedy and are totally lacking in another. But the number continues too large to bring the decision to a sure and indubitable point, and we soon feel the need of securing additional points in order that we may find the true and suitable simile among the competing medicines. But the Quomodo with the Quando generally solves the riddle in the most satisfactory manner, and not only removes every doubt, but also furnishes the proof for the solution which we may have before supposed to be the right one. That in such investigations and comparisons we must also, as in what precedes, occupy the especial standpoint, is a matter of course. It is not sufficient, e.g., to merely consider motion in general in contrast with rest in the body, or in the part affected, we must also consider incipient and continuous motion, as well as the different kinds and degrees of motion. The same applies to lying down, we must not only consider the kind of position (on the back, on the side, doubled up, horizontal, etc.), but also aggravation or improvement in the parts affected by lying on the painful part, or the part not painful; all this is to be found out accurately and adapted to the remedy.

          Quite a prominent part in this rubric is occupied by the partaking of food and drink, and this not only in diseases of the digestive organs, but also in fevers and other internal and external affections. Here it is not so much the amount of appetite, or thirst, to which also allopathy in some cases gives a proper importance, but especially the dislike or the desire for particular kinds of food and drink, and more especially also the change of condition after partaking of one or another article of food that often gives the most important hints as to the medicine to be selected. All experienced Homoeopaths have therefore always given the greatest attention to this subject, and it is very much to be desired that whatever different persons have discovered in this direction should be collected and published.

          It was mentioned above, in passing, that even negative signs, so far as they belong to this rubric, should not be neglected. An example will show best what is meant by this: when a patient, for whose condition Pulsatilla seems suitable according to the five preceding questions, feels best while at rest in a warm room, while he feels uncomfortable in the open cool air, and also is fond of fat foods and bears them well, or offers other peculiarities which are in conflict with the characteristics of Pulsatilla, this would give an urgent cause to doubt the applicability of it to his case and to look for another remedy which also in these points corresponds with the symptoms.

          I am sorry that the space for these contributions, which anyways may seem to have been already greatly exceeded, does not permit me to enter more in detail on one and another matter belonging to this division, as I may openly confess that I consider the indications obtained from this and the following question as the most important, indubitable, and therefore the decisive ones for therapeutical purposes. Even the numerous class of reflex actions, almost all of which fall into these two rubrics, do not by their internal contradictions diminish this importance, as soon as we know their mutual value, and are, therefore, enabled to estimate properly the worth of each.

 7. Quando?

          This last question concerns the time of the appearance, of the aggravation or the improvement of the ailments, and follows in natural order after the preceding, and is hardly of less importance in therapy than the last one.

          From the time of Hippocrates and his commentators up to our times great attention has been bestowed on the periods of time in the various phases and stadia of the disease. The endeavor has been made to fix the period and continuance of the beginning, of the increase, the acme, the decrease and of the end of the disease. This would, indeed, make a useful contribution to the recognition and the characterization of the disease. But only in case it should be left altogether to itself and not be modified by medical interference. But on the other hand it can not be denied that this cannot give the least aid in the selection of the remedy, if only owing to the fact that the medicines cause disturbances in the natural course of the disease, which frequently lie altogether outside of all computation. Least of all can they be of any advantage to allopathic therapy, because it lacks all criteria from which to indicate the one or the other. I hope that I may not here hear the objection that, e.g., the periodical return of a fever points to an actual or a disguised intermittent fever and therefore indicates Quinine in its various preparations; for we are not likely to find a homoeopath who has not in his practice had to treat numerous victims of this error.

          Homoeopathy intends something quite different in this question, having nothing in common with what precedes. But it is concerned with two momenta which have an immediate effect on the choice of the remedies, namely (a), the periodical return of morbid symptoms after a longer or shorter cessation, and (b), the aggravations and alleviations depending on the time of the day. These two will require but a few words.

          The periodical return of morbid phenomena often coincides with periods of time which carry with them particular occasional causes. Among these are to be numbered the menstrual ailments, as well as those which are conditioned by the seasons, the weather, etc. Where such definite secondary causes cannot be discovered, and where as is mostly the case, the attacks are not closely bound to any sharply defined periods, they have no therapeutic value for homoeopaths as they lack the quality of a useful indication.

          But of the greater importance are the aggravations and alleviations at particular times of the day, and this with respect to those which refer to single symptoms as well as those that refer to the general health. In this respect Homoeopathy possesses a great and valuable treasury of well proven experiences which are being more and more enlarged by careful observations. For there is hardly any disease, from the malignant internal fevers down to local ailments, in which during the different times of the day there does not manifest itself a more or less decided and distinct aggravation or alleviation. Now since homoeopaths have learned these peculiarities also in the various medicines during their provings on healthy persons, they are enabled to make extensive and blessed use of this peculiarity in their therapeutics, and they are obliged to do this in order that they may satisfy the rule Similia similibus also in this respect.

          To demonstrate the preceding with some special facts, I will only adduce here the importance which the time of the day has on coughs with respect to the expectoration, as well with respect to the greater ease with which it is discharged, as also the consistence and the taste. Something similar we know about the stools, and although most of the remedies have diarrhoea among their indications, we so far know only of two (Conium and Kali carb.) where this takes place only by day and not by night.

          With respect to the ailments which have a typical return, independent of other causes, we have a considerable series of remedies corresponding to this, without on that account excluding others, when they are indubitably indicated by their symptoms. Only in cases where this return is sharply and definitely pronounced, as for example in the evening from 4 to 8 o’clock (Helleborus and Lycopodium), or exactly at the same hour (Antimon. crud., Ignatia and Sabadilla), we should give it a special importance and only be careful that there may be no contraindications.

          I conclude these contributions, which I have only hastily sketched down, with the hope that I may have succeeded in putting into the true light the difference between Allopathy and Homoeopathy and to incite my colleagues on their part to treat these important themes more at length, even if this be done only with respect to some one of the questions indicated at a time.

Brief Directions for Forming a Complete Image of a Disease for the Sake of Homoeopathic Treatment.


By Clemens Franz Maria von Boenninghausen

dental_doctor-thinkingsmall    “The invisible, morbid mutation in man’s internal and the change in condition perceptible to our senses in the external (the complex of symptoms), form before the eyes of creative Omnipotence what we call disease; but only the totality of the symptoms is the side of the disease, which is turned to the disciple of healingonly this is perceptible and is the main thing which he can know about the disease, and what he needs to know for the purpose of cure:” –Sam. Hahnemann, Organon of Healing. §6, Fourth Ed.

“The invisible morbid change within and the complex of the symptoms perceptible from without and belonging to the disease are as necessarily conditioned the one by the other and constitute the disease in such a unity, that the latter stand and fall with the former, that they must exist together and disappear together, etc...-Ibid. §11.

“The physician who would investigate the hidden relations in the internal of the organs, may daily make his mistakes; but the homeopath, if he with proper care seizes upon the true image of the complete group of symptoms, has a sure director, and if he succeeds in removing the entire group of symptoms, then he will have surely removed the hidden cause of the disease.-Royal Councilor Rau, “The homeopathic Method of Healing,” Heidelberg. 1824, p.103.

From the words quoted, which contain an important part of the principles of Homoeopathic Practice, we not only see what the physician must know about the patient, in order that he may be able to make a sure selection among the known remedies, but also why he must know it. One single symptom may it be ever so complete and plainly pronounced can never be the complex of all the signs of a disease, which are externally perceptible (i.e., the whole complex of symptoms), nor enable us to guess the rest. Still less is possible if our aid is asked against quite a general name of a disease, which is not otherwise defined (e.g., headache, eyeache, toothache or bellyache), or against an ailment which includes quite a variety of diseases (as, e.g., convulsions, fever, gout, eruptions or against some troubles like lack of appetite weakness, aptness to take cold, insomnia, etc.), which belong to the common symptoms of disease, which are therefore seldom characteristic.

Homoeopathy can only promise a gentle, sure and permanent cure where it is enabled to oppose to disease that remedy which corresponds with the greatest similitude to all its perceptible symptoms, thus where the physician is completely informed of everything with the patient, which is other than should occur with a patient who is in complete health and is of his age and sex. Of course there are cases where the physician is able after a few questions and answers to determine with certainty the selection of the remedy. But in such a case these must refer to the characteristic points of the remedy, which to the experienced Homoeopath not infrequently are so plainly pronounced that he cannot be in doubt. But only the physician who is familiar with the pure virtues of the remedies and the peculiar sphere of action of each one can judge of this, as in one case a symptom else hardly considered may be characteristic, while in another case it may not have any particular value, and will deserve less consideration.

If, therefore, a patient wishes to report his illness to a physician living at a distance, and enable him to select the suitable remedy, he has to act in the following manner:

  1. He should give a general image of the patient by stating the age, the sex, the constitution, modeof living, occupation and especially the dispositiowhen the person was well. In many cases it is also of importance to know other peculiarities, such as, e.g., the complexion, the colour of the hair, leanness or corpulence, whether slender or thickset, enc…., and this should be added.
  2. Then a brief mention should be made of former sicknesses passed through, together with their course and cure, with a remark as to any sequelai they may have left. Then it is very desirable to know the kind of treatment used and the medicines that were prescribed, and if this can be shown by enclosing the prescriptions used thisshould be given briefly but plainly and clearly.
  3. Then the present disease should be described, first in its general outlines, emphasizingthe most prominent or the most troublesome symptoms; then should be given exactly and circumstantially according to the whole extent all the symptoms, describing in every case just how the patient himself feels, or how those around him observe the matter, abstaining from the use of technical terms and learned names as far as possible, as these are general in their nature, while homeopathy must individualize most strenuously.
  4. Then let him give a complete register of all the morbid symptoms, i.e., an enumeration of all the sensations and phenomena with the patient which are not seen in a healthy person. To avoid all unnecessary prolixity and countless repetitions, every symptoms should be given clearly and completely. Withrespect to clearness the usual conversational language in which the internal sensations of the patient may be expressed is at all times the best, and we need only take care that all indefinite and therefore inexpressive words, such as pain and ache, be omitted, and instead of them the kind of pain be described in the best known and most unequivocal expression.

With respect to completeness in every case the exact location of the pain in the body (e.g., on the head: the forehead, the temples, the sides of the head, the vertex, the occupied; then also whether on the right or the left side, in the half of the whole of the head); so also the time and circumstances should be enumerated, which have an influence on the aggravation of amelioration of the pains. As to the time the exact times of the day (whether morning, forenoon, afternoon, evening, night, before midnight, after midnight) should be enumerated. So also the periodical aggravation or amelioration as to hours, days, or seasons should be exactly reported. Among the circumstances it should always be stated what influence is exerted by rest or by motion, and by particular, modes of the same (e.g., lying, sitting, standing, walking, running, riding on horseback or in a vehicle, etc.), so also the influence exerted by warmth or cold, the open air and the room, by various enjoyments, by touch, by baring the body, by overheating, by eating and drinking in general, by emotions, by dry or wet weather, by thunderstorms, by daylight or candlelight, etc., as to the aggravation or amelioration of the symptoms.

In order that there may be a natural sequence in the symptoms and that nothing may be omitted, the subjoined rubric of the condition of the patient should be followed, and in every case it should be noted what there is of morbid; in those cases, where there is nothing morbid, we pass it over, but that which is especially marked, should be underscored. Every new symptom begins a new line. The reporter must consider that every special symptom belongs always to one and the same disease, and that the homeopathic physician must view and weigh every group of symptoms even in epidemic diseases, as if it never before existed in the world, and now appeared for the first time.

The subjects to be considered and the order in which they are to be given are the following:

VERTIGO.

  • According to its nature(whirling around, falling forward, to the side, backward, in a circle, etc.).
  • According to the time of the day(morning, forenoon, afternoon, evening, night, before midnight after midnight).
  • According to position and circumstances.
  • Aggravated.
  • Improved (e.g., on rising from bed or from a seat, on raising oneself up, while moving, while at rest, when stooping, on awaking, before, during or after eating, while riding, during the chill, during the heat, in the open air, in the room,. while walking, riding, ascending, while lying on the back, on the side, while looking upward, during warmth, during cold, during or after stool, after drinking alcoholic beverages, etc.).
  • Attendant troubles (e.g., it becomes black before the eyes, nausea and vomiting, yawning, flushes of heat, various pains in the head or the body, bleeding in the nose, weariness and swooning, trembling, etc.).

OBSCURATION.

  • According to the sensations(e.g., numbness, unconsciousness, stupidity and dizziness, dullness of the head, staggering, drunkenness, chaos in the head, etc.).
  • According to the time of day.
  • According to the position and circumstances.
  • Aggravated.
  • Relieved.

III. IMPAIRMENT OF THE UNDERSTANDING.

  • According to its nature(e.g., exhausted by mental work, nervousness, difficulty in comprehending, inability to think, stupidity, delirium, fixed ideas, lack of thoughts, weakness of thoughts, excited fantasy, fanciful illusions, delusions of the senses, inability to remember distraction, insanity, etc.).
  • As to the time of the day.
  • According to the position and circumstances, aggravated or relieved.

LOSS OF MEMORY.

  • As to its nature: diminutionin the memory, weakness, loss, forgetfulness.

INTERNAL HEADACHE.

  • According to the sensations(rush of blood, boring, burning, pressure inwards or outwards, pulsation, heat, cold, sensation of looseness, crawling, pressing together, pressing apart, tearing, lancinating, with tension, numbness, digging, as if bruised, drawing, twitching, etc.-every time stating with exactness whether the pain occupies the whole head, or is in the forehead, the temples, the sides, the vertex, the occiput, predominantly on the right side or on the left).
  • With respect to the time of the day.
  • With respect to position and circumstances.
  • Aggravated.
  • Relieved.
  • Accompanying ailments.

OUTER HEAD.

  • As to sensations(e.g., dandruff on the scalp, eruptions of various kinds, burning, painful sensitiveness of the skin, swelling, falling out of the hair, painfulness of the hair, sensation of pulling on the hairs, and on the scalp, heat, coldness, twitching, knots and bumps, pain of various kinds in the bones, shuddering, perspiration, tension, lancination, drawing, twitching, contraction, etc.).
  • With respect to the time of the day.
  • As to position and circumstances, worse or better.

VII. AILMENTS OF THE EYES.

  • As to the sensations.
  • On the pupil and on the eye in general.
  • In the eyebrows.
  • In the cavity of the eyes.
  • On the eyelids.
  • In the corners of the eyes (everywhere not only with exactness the kind of sensation, as in the preceding, but also exactly the locality, e.g., on the upper and lower eyelids, in the inner or outer corner of the eye, etc.).
  • As to the time of the day.
  • As to the position and circumstances.
  • Improved.
  • Aggravated.

VIII. SIGHT, VISION.

  • Asto the sensations (dazzling of the eyes, blindness, flickering before the eyes, delusion of the sight as to colors, or as to objects which are not at all present, spots, sparks, mist,. fog, etc., shortsightedness, farsightedness, photophobia, weakness of the eyes, amaurosis, or cataract, dimness of vision, blackness before the eyes, etc.).
  • Asto the time of the day.
  • Asto the position and circumstances.
  • Aggravated.
  • Improved.

EARS AND HEARING.

  • As to sensations.
  • in the ears, various issues from the ear, boring, burning, pressure in and on the ears, changes and sensations inthe glands of the ears, heat, cold, itching, pinching, crawling, tearing, lancinating, tension, drawing, clawing, consistence of the ear-wax, etc.
  • In the hearing (e.g., sensitiveness to noise, delusions of the hearing, buzzing, ringing, tingling, hissing, singing, detonations, etc.-diminution in the hearing, hardness of hearing, deafness, etc.).
  • Asto the time of the day.
  • Asto position and circumstances.

NOSE AND SMELLING.

  • As to sensations.
  • On the nose (e.g., bleeding of the nose, bleeding when blowing the nose, eruption in or on the nose, various issues from the nose, ulceration, burning, swelling, redness, itching, of the nose, crawling sensation, tension, warts or other excrescences, etc.).
  • With respect to smelling (e.g., dulness or total lack of the sense of smelling, sensitiveness of the smell, various delusions as to smelling, etc.).
  • As to the time of the day.
  • As to position and circumstances.

FACE.

  • As to color andexternal appearance (e.g., paleness, redness, various spots, freckles, blue rings around the eyes, yellowness of the face, etc.).
  • As to the sensations.
  • In the face in general (e.g., eruptions of various kinds, swelling, burning, heat, coldness, perspiration, itching, tearing, lancination, drawing, etc.).
  • On the lips (e.g., peeling off, cracking open, bleeding, eruptions, ulcers, burning, itching, spots, swelling, knots, tension, lancination, tearing, etc.).
  • On the lower jaw (e.g., convulsive pain, lockjaw, crackling or getting out of joint, various sensations in the glands of the lower jaw, swelling of the bones, tearing, lancination, etc.).
  • On the chin (e.g., tearing, lancinations, eruptions of various kinds, itching, burning, etc.).
  • Asto the time of the day.
  • Asto position and circumstances, worse or better.

XII. TEETH AND GUMS.

  • As to sensations.
  • On the teeth (e.g., boring, burning, pressure, painful sensitiveness, breaking off and becoming rotten, becoming hollow, yellow or black; itching, cold, heat, pulsation, becoming too long, looseness, gnawing and fretting, crawling, tearing, lancinations, twitches and blows, dullness of the teeth, soreness, drawing, jerking etc.-stating in every case what teeth are implicated).
  • On the gums (e.g., bleeding, swelling, ulceration, redness, paleness, itching, drawing, tearing, etc.).
  • As to the time of the day.
  • As to position and circumstances.
  • Aggravated.
  • Improved.
  • As to the ailments connected therewith, and into what parts, if any, the pain extends.

XIII. MOUTH.

  • As to the sensations.(After what has been given so far, further specifications will be unnecessary.)
  • In the buccal cavity.
  • On the hard or the soft palate.
  • In the fauces
  • With regard to the saliva. .
  • On the tongue.
  • With regard to language.
  • According to the time of the day.
  • According to position and circumstances, worse or better

XIV. APPETITE.

  • As to sensations(e.g., aversion to certain kinds of food or drinks, or special fondness therefore, voracity, quick satiety, some kinds of food or of beverages disagree, troubles appearing, after eating, etc.).
  • As to the times of the day.
  • THIRST.
  • As to sensations and circumstances (e.g., during chill, heat or perspiration, thirstlessness, etc.).
  • b. As to the times of the day.

XVI. TASTE.

  • As to the sensations (various tastes in the mouth, as well during eating as also at other times, and strange taste of some things).
  • As to the time of the day.
  • According to circumstances, aggravated or relieved.

XVII. BELCHING UP.

  • As to sensations (among these things, belching up of food, of water, etc.-with, or without, any special taste, gathering of water in the mouth, heart burn, rising up in the throat, etc).
  • As to the time of the day.
  • As to position and circumstances.

XVIII. HICCOUGH.

  • As to sensations.
  • As to the times of the day.
  • c. As to the position and circumstances, worse or better.

XIX. NAUSEA.

  • As to sensations (vomituria, retching, vomiting of various taste, flabbiness, nausea with a statement as to the part where this is particularly situated, etc.).
  • As to the time of the day.
  • As to position and circumstances.
  • Aggravated.
  • Relieved.
  • STOMACH AND CARDIAC REGION.
  • As to the sensations.
  • In the stomach.
  • In the pit of the stomach (also here in every case should be accurately stated the sensations, with an avoidance of all indefinite expressions).
  • As to the time of the day.
  • As to position and circumstances, worse or better.

XXI. ABDOMEN.

  • As to the sensations.
  • In the epigastrium.
  • In the umbilical region.
  • In the side of the abdomen and the hypochondria.
  • In the region of the hips and loins.
  • In the hypogastrium.
  • In the whole of the abdomen.
  • As to the time of the day.
  • As to position and circumstances, worse or better.

XXII. THE OUTER ABDOMEN (the abdominal walls).

  • As to the sensations.

XXIII. LAP AND ABDOMINAL RING.

  • a. As to the sensations (among these are also ruptures).

XXIV. FLATULENCE.

  • As to the sensations, flatulence, its accumulation, incarceration and discharge, with various smells, noise in the stomach, colic.
  • Asto the times of the day.
  • As to position and circumstances, worse or better.

XXV. STOOL.

  • As to quality(diarrhea, constipation, hard, soft, bloody, knotty, sharp, of especial color or smell, mucous, watery, etc.).
  • Asto the accompanying troubles.
  • Before the stool.
  • During the stool.
  • After the stool.

XXVI. ANUS AND RECTUM.

  • As to the sensations(nature of the piles and the sensations in them, as in general on the inner and outer parts of the anus).

XXVII. PERINIUM

  • As to the sensations.

XXVIII. URINE.

  • As to its quality.
  • As to the sediment.
  • As to the discharge (differencein the tenesmus and the micturition).
  • As to the accompanying ailments.
  • Before the micturition.
  • In the beginning of micturition.
  • During micturition.
  • When concluding micturition.
  • After micturition.

XXIX. URINARY ORGANS.

  • In the bladder.
  • In the urethra.

XXX. SEXUAL ORGANS.

  • As to the sensations.
  • On the sexual organs in general.
  • On the glans.
  • On the prepuce.
  • On the penis.
  • On the testicles.
  • On the scrotum.
  • On the spermatic cords.
  • On the female sexual organs.

XXXI. SEXUAL INSTINCT.

  • As to the sensations(excitation of the sexual instinct, lack of it, impotence and weakness of the potency, seminal emissions, emission of the prostatic fluid, abuse, etc.).
  • As to the concomitant troubles.
  • During and after coition.
  • After pollutions.

XXXII. MENSTRUATION.

  • As to its quality(returning too early, too late, too weak, too copious, too brief, too long lasting, blood is discharged outside of the period, suppressed menses, quality of the blood discharged, leucorrhea of various kinds, etc.).
  • As to the accompanying troubles.
  • Before the menses.
  • When the menses appear.
  • During the menses.
  • When the menses are concluded.
  • Troubles connected with the leucorrhea.

XXXIII. CATARRH.

  • As to the sensations (running coryza, stuffed coryza, quality of the mucus, sneezing, dryness of the nose, nose stuffed up without a cold, etc.).
  • As to the times of the day, worse or better.
  • As to the accompanying troubles.

XXXIV. RESPIRATION.

  • As to the sensations(nature of the respiration as to the smell or sound during respiration, retention of the breath, shortness of breath, with deep respiration, dyspnea, angina, etc.).
  • As to the prevention of the respiration.
  • As to the time of the day.
  • As to position and circumstances, better or worse.

XXXV. COUGH.

  • As to quality(with or without expectoration, husky, deep, hollow, convulsive, a small dry cough, whooping cough, tickling cough, etc.).
  • As to the expectoration (withrespect to consistence, color, taste, smell and abundance).
  • As to the time of the day.
  • As to the excitation(as well with respect to the part where the irritation is located as the external circumstances which call forth the cough)
  • As to the accompanying troubles.

XXXVI. LARYNX AND TRACHEA.

  • As to the sensations.
  • As to the time of the day.

XXXVII. OUTER THROAT AND NECK.

  • As to the sensation in it, with an accurate description of the parts affected (the skin, glands, muscles, bones, etc.).

XXXVIII. CHEST.

  • As to the sensations.
  • On the inner chest.
  • In the outer chest.
  • In the axillary glands.
  • In the glands and nipples of the breast.
  • In the heart and the cardiac region.
  • As to the time of the day.
  • As to position and circumstances, worse or better.

XXXIX. BACK.

  • As to the sensations.
  • On the shoulder-blades.
  • In the back proper.
  • In the small of the back and the coccyx.
  • As to the time of the day.
  • As to position and circumstances, worse or better.

UPPER LIMBS (arms).

  • As to the sensations(in this case we must not only distinguish the exact spot, the shoulder, upper arm, lower arm, hand, finger, the joints of the shoulder, the elbow, the wrist, and the joints of the fingers, but also distinguish whether the sensation is more in the skin, the muscles or in the bones.)
  • As to the time of the day.
  • As to position and circumstances, worse or better.

XLI. LOWER LIMBS.

  • As to the sensations(here should be observed what was said above as to the upper arm).
  • As to the time of the day.
  • As to position and circumstances, worse or better.

XLII. GENERAL AILMENTS.

  • As to the sensations, here may be enumerated what would not find a suitable place elsewhere, so, also, a general description of the kind of pains or other morbid phenomena (e.g., emaciation, bodily exhaustion, varices, trembling and quivering, attacks of epilepsy, or other illness, lack of sensibility, or supersensitiveness, convulsions, paralysis, swoons, restlessness in- the body, tendency to colds, twitches, ere.), state this with the necessary clearness definiteness and completeness.
  • As to the time of the day,keeping in view more the general state of health.
  • As to position and circumstances, worse or better; under which heading would fittingly be given a recapitulation of all that belongs here, having an influence on the wholeas well as on the parts.

XLIII. DISEASES OF THE BONES.

  • As to the sensations, in so far as they have not before been enumerated, in which case it is sufficient to refer to that.

XLIV. GLANDULAR DISEASES.

  • As to sensations, withremarks as given in the preceding rubric.

XLV. CUTANEOUS DISEASES.

  • As to the sensations, especially in those cases where the ailment ‘extends over several parts, with an exact description of the kind of cutaneous disease, the eruptions, itching, burning, ulcers, tumors, blisters, spots, herpes, erysipelas, excrescences ., and their progression according to the time and external circumstances. It is of especial importance to know in ulcers, herpes and itching what change occurs after touching, scratching or rubbing of the same and also the nature of the pus in the ulcers.

XLVI. DISTURBED SLEEP.

  • As to sensations, time, position and circumstances(stretching and yawning, late in falling asleep, waking up at night, insomnia with its well known causes, sleepiness at various times during the day, morbid sleep, troubles during sleep, somnolence, etc.).
  • As to the quality of the dreams with respect to their number, time and subject.

XLVII. STATES OF FEVER.

  • Circulation of the blood, as to its nature, time, and the circumstances influencing the same,
  • Chill, as to its quality, time of day, circumstances and accompanying troubles.
  • Heat in the same way.
  • Shuddering, in the same way.
  • Sweat, in the same way, but especially with respect to the quality of the sweat, as to its color, consistence and smell.
  • Composite fevers, as to their whole characteristic, not only as to the sequence of chill, heat and sweat, but also as to the time of the day, duration, accompanying troubles, and such as precede and follow the attack.

XLVIII. MENTAL DISPOSITION.

  • As to its peculiarity (cheerfulness, changeableness, imaginary state of disease, impatience and hastiness, indifference and insensibility, suspicion and misanthropy, lack of determination, irresolution, anxiety and desperation, timidity and fearfulness, dejection and melancholy, sadness and weeping mood, vexation and obstinacy, excitement and irritability, quarrelsomeness, and passionateness, insanity, fury, etc.); for a sure selection of the right remedy, the most plain and definite information is necessary and it should always be particularly mentioned what was the patient’s disposition when well, and how changed through his disease.
  • As to the time of day.
  • As to position and circumstances, worse or better.

The more complete and faithful the image of the disease is composed in this way, the more safely can the selection of the most suitable medicine for the present group of symptoms be made, and the more surely we may expect help for the same. Only in cases where diseases have been treated with large quantities of allopathic or domestic remedies, there will generally be added to the disease the effects of the medicines, disturbing the image, and in such a case it is absolutely necessary, as stated above, to also inform the homeopathic physician by communicating to him the prescriptions or telling him about them.

In conclusion, I would remark that every time after the completion of the full action of a medicine a new image, of the disease should be taken. It happens at times, though not often, that the symptoms throughout remain unchanged. In such a case at the first presentation one thing or another has been overlooked, and the image had not been presented quite correctly, and the remedy which accordingly was incorrectly selected remained without effect. In such a case it will therefore be necessary to go over the whole image of the disease, one point after the other, and to supplement the presentation by the necessary corrections or explanations.

Most frequently it will be found that in chronic cases which are inveterate, the chief ailing has only been diminished, but still continues, nevertheless when the medicine has completed its action, the concomitant symptoms have suffered such a change that the former remedy will not appear at all applicable any more. In such a case the homeopathic physician can only make a sure selection after having been informed of these changes by a new complete image of the disease. For it is not only taught by experience, but it lies in the nature of all chronic diseases which have in consequence been interwoven with the whole organism, that rarely or never one remedy will cover the whole complex of symptoms; so that it will be necessary in order to destroy the whole malady fundamentally to let several medicines, selected after each report, operate, until nothing morbid may be left.

 

“I knew that…” – the agonies of unlearning

By Vera Resnick

I knew that…

This is something I and other IHM practitioners often hear, or see on people’s faces when we talk about homoeopathy to homoeopaths. I can feel the thought echoing through the ether (so to speak…) when I write about homoeopathy to homoeopaths.

However, to warp an old idiom, knowing is as knowing does. If you really knew that – why don’t you do that?

Let’s start with the first basic tenet of homoeopathy: like cures like. Continue reading

Quick Acute onset.

Got a couple of phone calls last night from mothers with children issues. Both were resolved.

The one case of interest was from a mother who always had difficulty in treating her son once a fever developed. She called with the following symptoms that he expressed.

mattongue

The tongue is red on the tip and around the edges. He has a white coating on the back of the surface of the tongue.

Le duele la garganta, la tiene roja, la faringe con los foliculos rojos en la pared posterior. The pharynx is red and the throat is sore.

There is no noticable change in his disposition, His face is slightly pale and a slight warmth to the touch of his skin. I asked her to look at his eyes. She said that they looked normal.. We talked a little more, then I asked her to look again at his eyes. She said they now looked brillantes, bright and shiny, more than normal.

I prescribed Belladonna 30c in water as she had that in the house. She gave one dose and then put the boy in the shower. After the shower she gave another dose and he went straight to sleep. His temperature was 37.5.

She said he awoke at 3 am and wanted to sleep in her bed. There was no fever and he was a lot better…

These acutes that come on suddenly and for no reason can be treated quickly and successfully if all the basic signs are observed. Pulsatilla came up in the repertorising,  but I know that Puls does not have in general the redness of the tongue tip or sides. Note too that the absence of a change in the mental state does not preclude an accurate prescription to be made. Take only symptoms that have changed.

P&W book edition – reviewed

By Vera Resnick

v11I recently received my copy of P&W’s book version of the Therapeutic Pocketbook. And I must admit, it was love at first sight, and second, and third…

I must own up to being old fashioned. However much computers may have helped us in referencing many books, in finding correct rubrics, in the process of repertorization – it has reduced us to a bunch of small-screen addicts with heavy-duty tunnel vision.

One of the central flaws of science, replicated in the use of a computerized repertory, is that we determine what we’re looking for, and we look for it. Peripheral vision becomes irrelevant. Apart from synonyms, which can sometimes be useful, either what we’re looking for is there – or it isn’t. Anything interesting that may be lurking in the background becomes effectively invisible. Our gaze is honed in to what we’re looking for, what we find, and then to a search for alternative expressions of what we’re looking for.

I invite you now, if you will, to put down the mouse (or take your finger off the touch pad) and pick up the nearest book (no, no, a Kindle absolutely does not count). Flip through the pages without even looking for anything. Do you notice some ideas as you do so, some words that just jump out at you? If you’re doing this with a homoeopathic text, or something that interests you, you may even find yourselves noticing things you want to go back to, look at in more depth. It’s true – this can happen on the computer, but it’s a much easier process when you know what you’re looking for is sitting in your hand within the pages of the book you’re holding, and is not something you’re going to have to hunt through your browsing history to get at.

Tunnel vision is considered a problem because we are hard-wired to give importance to peripheral vision, although as a race we seem hell-bent on destroying any abilities we have in that area. We are programmed to notice something that is moving which should be still, something that has a different colour, a different shape, and our brains process a tremendous amount of information beyond that which lies in our direct focus.

The new P&W book allows us to do both. On the one hand, the book is quite large in terms of page size and lettering, and all sections are very clearly presented. When I’m looking for something specific, it’s very easy to find it. On the other hand – as I leaf through the Cough section looking for sweetish expectoration, I cannot help but notice all the other forms of expectoration appearing on the page. As I take a broader look at the page, I cannot help but notice how frequently Phos and Puls seem to stand out in their four point bold capitals, and notice the incidence of other remedies in these rubrics too. Looking at the page on Leucorrhea, I find myself wondering why I’m seeing much less of the Sepia I expect, and more of Mercury and other remedies to think about.

The point I’m trying to make is that while you can turn every computerized repertory search into a learning experience if you choose to do so, a hard copy book search will bring things to your attention just by looking through the book’s pages.

Another plus of the book is that it brings the Concordances section into focus and allows for clearer study and use of that section in repertorisation and case management.

The editors have kept their intervention to a minimum, and thus I know what I hold in my hands is faithful to Boenninghausen’s 1846 Therapeutic Pocketbook. To quote from the editor’s introduction:

“…We translated from the original German of the published first edition and had use of the handwritten printer’s edition in Boenninghausen’s own hand. We translated each rubric to bring it into modern English but retained the original meaning of each word and sentence…” P&W’s Synopsis program also has the original German edition, so it is possible to check back to the original rubrics as desired…”

Since I wrote most of the above, my software was knocked out by my antivirus gone rogue. Until I worked out the problem, which ultimately was easy to resolve, I was dependent on the book – and extremely relieved that I had it at hand. I think that for those of us who work constantly with computer software, having a hard copy which offers a faithful non-electricity non-computer dependent version is crucial for those days when nothing is working properly.

 

 

The book is available from ed@instituteforhomoeopathicmedicine.com

Drop an email and he will invoice you via PAYPAL for $85 plus delivery, usuallyabout $10.

 

Pathological desires in homoeopathy…

By Vera Resnick

But is it part of the disease state?

But is it part of the disease state?

A recent sample case showed a patient who said he kept wanting to move – even though he knew it would hurt him. When and how should we use such symptoms?

In this case the patient had dislocated his shoulder. He stated a constant desire to move even though movement was painful for him. Continue reading

Homoeopathy? Easy peasy…

Pulsatilla, anyone?

Pulsatilla, anyone?

“If it’s so easy, why isn’t everyone working this way?”

I was asked this question at a seminar I gave several years ago. This is a question that frequently puzzles us at the IHM. Because it is easy.

True, a lot of hard work is needed to get expertise, and then to improve expertise. To read, re-read, and analyze materia medica. To read and discuss cases. To comb the Organon and Hahnemann’s other writings for better understanding of the underpinning of homoeopathy – essential for prescription and case-management; for case-taking clues; for accurate work with remedies.
It’s not always easy to get rid of our preconceptions regarding remedies, to learn to be able to prescribe Pulsatilla on prescribing symptoms whether the patient is a sumo wrestler or a petite, sweet blonde. It’s not always easy to focus on absolute, presenting symptoms when our learned “knowledge” is giving us all kinds of useless hints regarding constitutionals, core delusions, sensations and similar.

Jewish tradition records a story of someone who came to a venerable Rabbi and asked him to explain the entire teachings of the law while standing on one leg.

Well here’s homoeopathy on one leg. Take your case. Take only what has changed and is presenting for prescribing, against the backdrop of the patient’s life and habits. Only use symptoms you could swear to in a court of law. Use symptoms which show the individual expression of illness in your patient.  Look for a remedy that can produce similar symptoms in the healthy, and thus create a similar, slightly stronger, artificial state in your patient. Find the core of that information in the proving. Prescribe.

Still standing here…

The thing is, once you drop the theories, the speculations, once you move away from trying to be clever and insightful, you start looking at what is in front of you. You work with the information the patient gives you about his state of illness (morbid state) – not with your speculations about his personality, or information about whether he’s always loved chicken, or whether he played with Barbie dolls as a child. You work with what you can know about remedies – information contained in the provings. You work with some information gleaned from poisoning and clinical work.  Some of this information was chosen by Hahnemann for inclusion in his provings.   This information should only be taken from the most reliable practitioners (in case you didn’t get it, at the IHM we focus mainly on Hahnemann and Boenninghausen’s work). You put it together and prescribe.

Aphorism 3, my friends. And as the learned Rabbi is reputed to have said, now go and learn the rest…

Agravación por Frío en el TPB

Autor: Dr. José Guillermo Zamora de la Paz, Médico Cirujano UAG, Dhom. Med. (Lic.) por el Institute for Homoeopathic Medicine.

Tal y como la segunda parte del título del Therapeutic Pocket Book nos indica “A Guide to the Materia Medica”, el repertorio es un guía de materia medica. Se trata de un trabajo, una síntesis, para memorizar los síntomas de la materia médica, representados para cada una de las rúbricas en el contexto de una patogenesia que debe haber sido estudiada y reestudiada previamente a fin de que el practicante pueda saber qué es lo que busca y en qué síntoma debe buscarlo. Aún ante la falta de un conocimiento profundo, ésta herramienta puede servir para el aprendizaje de esta MM, e incluso para hacer un análisis, aunque desde mi punto de vista con una menor eficacia.

Por favor haga clic sobre la imagen para amplificar

Agravación por frío Continue reading