Drs. Paul Herscu and Amy Rothenberg, a husband and wife team, are homeopaths and naturopathic physicians. Together, they founded the New England School of Homeopathy in 1987 and he and Amy are the directors. Dr. Herscu’s is author of The Homeopathic Treatment of Children: Pediatric Constitutional Types and Stramonium: With an Introduction to Analysis using Cycles and Segments. That book was the foundation for a unique and creative new approach which Paul and Amy teach at NESH and all over the world. Paul is also author of Provings, with a Proving of Alcoholus, which is a comprehensive guide to the philosophy and methodology of conducting a proving. Dr. Rothenberg, also a writer and teacher, was the long time editor of the New England Journal of Homeopathy and is the author of The A Cappella Singer Who Lost Her Voice and Other Stories from Natural Medicine.
AS: We recently published a case quiz and forty nine people responded with around fifteen different remedies, none of which were correct. Is this difference of opinion something we just have to accept in homeopathy?
AR : Thank you for this terrific question Alan. The answer is a resounding NO!! Paul has written extensively on this topic in the Herscu Letter, Letter #134 where he has done some of the statistical analysis on this topic and underscoring how, as a profession, we MUST do better and that in fact, with those we have trained, we are! The questions comes right after two recent weekends where we had the pleasure of bringing together students and practitioners who have studied with us for at least a two year course which we teach with an emphasis on using Cycles & Segments (C&S). C&S allows us to group symptoms that are similar and helps us to streamline both case taking and case analysis. The aim of these clinical weekends is to see patient after patient for several days. Paul or I take the case and then, with the participants, work to analyze the case & come up with the remedy prescription. We take the case to model all the different aspects of case taking: understanding the narrative, seeing how the main symptoms are contextualized in the person’s life, doing a thorough review of symptoms including physical generals and how to get to the most important aspect of the patient’s story. We know the most important aspect because we see examples of it throughout the case. In the articles associated with this interview, you can find more complete and detailed descriptions of C&S as well case examples.
We have repeatedly been impressed by our students/colleagues in this regard, in their ability to zero in on what needs to be helped, to figure out what aspect of the patient’s story is the part(s) to pay attention to! With Cycles and Segments, we are grouping similar symptoms together, we are building an understanding of what drives the imbalance or pathology. We train people to be better at focusing on the right thing! That is a huge issue in homeopathy and always has been. Any patient at any given time can have a myriad of symptoms and it can be overwhelming for the homeopath and challenging to know what to pay attention to. But if you know you are supposed to pay attention to those things that are most limiting to the patient and occur over & again in a case, it becomes more manageable.
We use other tools to help as well. Paul’s development of the Map of Hierarchy is invaluable. Not all remedies are created equal. If we understand that a patient is further to the right on the Map of Hierarchy, ie further disturbed with deeper pathology, then we know not to consider more basic polychrests. To get a fuller understanding of Cycles and Segments and the Map of Hierarchy and how we use them in practice, see the first 40 pages of Paul’s Stramonium with an Introduction to Analysis Using Cycles and Segments. To read more about a case where the Map of Hierarchy was relevant and essential to understanding a patient over time, see the case of Autism attached.
When we have a group doing cases together it is common for the group, whether 20 people or 100 people or more, to come down to 4-5 remedy choices. This is closer to an acceptable rate. And with that number, often several of the remedies are close, say Belladonna & Veratrum album or in another case, Carsinosin and Silica, as opposed to what might seem like a random list of unrelated remedies.
Regarding the experiment you described, this seems to be a common experience in our profession, as at conferences one can often see what you describe . We think we know at least some of the reasons it occurs. Those reading or watching the case are not focused on the correct things, and/or they are only focusing on one particular aspect of the case, not the whole person. Seeing our students time and again get right into the ballpark is heartening for us. That they may have 4-5 remedies to think about, gives the practitioner a good back up remedy, should the first one chosen, fall short. I am edified as a teacher, knowing my students come down to the same small handful of relevant remedies, one of which most often does help, when we see patients together.
I have one example of this. Some years ago, Paul was teaching an international group of students, in Greece. He showed a video case that a prominent homeopath had taken, and the 130 participants came to 3 remedies, by analyzing it in the Cycle and Segment fashion, one of which was given and cured the complaint. A similar sized group who had watched the same original case came up with 49 remedies, though none came up with the prescriber’s choice, which was one of the 3 that we came up with in our analysis. To highlight the point even more, the knowledge level of prescribing was very high in both groups, the same exact symptoms were captured in both groups, and finally the correct remedy was a commonly prescribed remedy. The main difference was that in one group, we had a clear method of analysis which allowed the practitioners a pathway to analyze the case appropriately.
AS: That’s encouraging, because if homeopaths are arriving at wildly different remedies for the same case, it means there are more wrong answers. In Cycles and Segments, where do deficient cases fit in, where there might be few symptoms to go on?
PH: Without digressing into a long discussion on both Hahnemann and Boeninghausen’s concepts of full cases and what was considered a “complete” symptom, there are numerous writers through the generations who have tackled this issue. For us it seems that the application of Cycles & Segments helps to eliminate many of these so-called deficient cases.
First, those cases that might be considered deficient but actually are not, include:
1. Patients who are incurable with homeopathy in their current situation. This is not to say they are incurable with say, surgery, but with homeopathy alone, their disease may well be incurable;
2. The second grouping would be those who for one reason or another, want to decline homeopathic treatment, who then “present” as a deficient case, i.e. they have a bad attitude and will purposely not give correct and full responses etc.
3. The third group could be considered deficient because they are medicated enough so they are no longer able to present with a complete case.
If you look at each of these instances, it is not that they are truly deficient, as much as, for one reason or another, either the patient is unwilling or unable to present symptoms. There are ways around these kinds of cases, but these are not what we are really talking about when we discuss deficient cases.
That said, the majority of deficient cases, or the focused writing on this subject historically, has been corrected for through the philosophy & application of Cycles & Segments. For example, Boenninghausen’s complete symptom included seven qualities, and an incomplete or deficient case will have one or more of these pieces missing. The concept of a Segment inherently takes care of this problem. We may see a modality represented in a different symptom altogether, or we may find that we arrive at a more complete symptom by something that comes out in the observation part of case taking, where we see or feel or observe certain aspects of a patient. We can funnel that information through the lens of looking for a particular Segment and when we train for those observation skills, we find much of the case reinforced by just such an ability to group like symptoms. (See case examples.) For us, this continues to be one of the most compelling reasons to use Cycles and Segments; it solves many of the problems we as homeopaths have had to wade through in the past.