There’s been a lot of discussion on the hpathy.com discussion board lately about how to know when the case has been taken completely. One questioner asked, “Is it just ‘sensation, location, modality’ and then you’re done?” We’ll, you’re getting close! In the March issue, I wrote an
There’s been a lot of discussion on the hpathy.com discussion board lately about how to know when the case has been taken completely. One questioner asked, “Is it just ‘sensation, location, modality’ and then you’re done?” We’ll, you’re getting close! In the March issue, I wrote an article called “
A Flurry of Questions” in which I enumerated what you need to ask someone in the throes of an acute illness. It might be good to print that out and always have it near by. Building on that article, let’s talk about what some of these questions mean.
1. Onset. If an illness came on suddenly, you may be down to just two remedies–Aconite and Belladonna (and Baptisia if the patient seems toxic); that’s the importance of this question–from 3,000 remedies, you’re down to three!
2. Etiology. This is the big one, and the one that’s often over-looked. In case-taking, we need what are called “complete symptoms” and a complete symptom has the following: onset, etiology, if known; sensation, location, modalities (things that make the symptom better or worse) and if there’s a discharge–the color, odor and consistency.
The etiology means the cause or precipitating factor. Very often it’s the weather or temperature. You have to ask your patient, “What’s the weather like where you are?” You’d be surprised how often this is the key to the case. I can think of two of my cases where I knew the remedy as soon as I asked about the weather. One was an arthritis sufferer who said that he got so much worse just before a storm and all during the storm and finally recovered only after the storm. He needed Rhus tox. and Calc-carb. Then there was a psoriasis patient who told me that the rain made her so much worse, it was a disaster for her. She dreaded the rain. She needed Rhus tox too. Other times, the weather is more than just an aggravating factor, it actually causes the ailment, the way cold windy weather can be sufficient cause for an Aconite prescription regardless of the symptoms.
Besides weather, other common etiologies include: Never Well Since the flu or other infectious ailment (and the remedy is usually Gelsemium. Go to Generals: convalescence; or in Murphy’s
Repertory, Clinical: convalescence and you’ll see there are various subrubrics to choose from which basically mean, Never Well Since this ailment or that ailment.) More common etiologies: Humiliation, bad news, grief, loss, disappointment, injury, surgery, sleep loss, over-work–these are all common etiologies to look for when taking a case.
Some of you are going to say, “Why should we base a remedy on the precipitating factor or cause and not on the totality of symptoms the way we were taught?” That’s a very good question. When you have a shock, the vibration will hit and do damage to your weakest organ or system. If I receive bad news, my sciatica will most likely act up. If you receive bad news, your allergies might act up. So, what should we treat, the allergies? The sciatica? or the SUSCEPTIBILITY to the shock we received, the weakness that made us susceptible, the “leak”, if you will, the “weak link” that let this vibration in and do damage? If we prescribe on just the totality of symptoms, we’ll find a sciatica remedy, or an allergy remedy. If we prescribe on the etiology (the cause), we prescribe on the weak link and repair it and futher shocks don’t get in. I think the goal must be to seal the leak, so the weak organ or system isn’t constantly irritated, and that’s what prescribing on the etiology is all about.
I’ll give you an example: my very first case was a man, a successful financier from London, with an enlarged prostate, it may also have been infected, and was causing quite a bit of trouble including pain and frequent urination. He had been prescribed antibiotics to no avail. He was anxiety-ridden because of this problem, and it was ruining his life. I tried the totality of symptoms approach first and suggested he take Sabal 6C three times a day (that’s homeopathic Saw Palmetto) and it didn’t work. “So much for the easy way!” I said. “Now, tell me when this all started and what was going on at that time.” These are key questions in the homeopathic interview: when did it start and what was going on. He said he had gotten a promotion at work, but he didn’t feel prepared for it, he didn’t feel adequately trained, plus, he was still having to do his old job because he hadn’t been replaced. So, he was being taken advantage of, he felt, by his employer, plus embarrassing himself (his words) dealing with clients, as he didn’t feel competent in his new position. So, I used the following rubrics from Murphy’s Repertory:
Male: Prostate remedies
Mind: Embarrassment, feelings of
Mind: Indignation, ailments from
Mind: Fear, undertaking anything new
The remedy that covered all the rubrics was Lycopodium. So, Lyc. 6C three times a day in water with succussions (shaking the bottle) before each dose. At the end of the first week he reported feeling less anxious eventhough the symptoms were still there. At the end of two weeks, the symptoms were starting to abate. Eventually, we went up to 9C, then 12C and finally 30C and by then he was just taking the remedy as needed AND…he quit his job and got a better one! And now, here’s the interesting thing I learned later: His grandfather died of Prostate cancer! So, here’s our analysis: this man had inherited a weak prostate, so when a stress came (the new position he felt unprepared for) it bounced off all his other organs, and landed on the prostate; so what’s the problem here, what has to be cured? Is it a weak prostate, or the Lycopodium Cowardice? What is the real illness? It’s the Lycopodium cowardice–that’s how the vibration got in! Ailments from embarrassment, ailments from indignation! So, this is the significance of the etiology. Keep in mind that you’re not always going to find it, but, at least remember to ask.
3. Sensations. Go to your repertory to the Generals or Generalities chapter and then scroll down to Pains. You’ll see there are remedies listed for the following rubrics:
Pains appear suddenly/gradually,
disappear suddenly/gradually;
the direction of pains–upward, downward, inward, etc.;
the extension of pains; radiating of pains; pains along the nerves, and other information regarding pains.
Look now under “Symptoms” in the same chapter, or look under “Diseases” in the Clinical chapter if you have Murphy’s Repertory 3rd ed., and you’ll see the following rubrics:
Symptoms change constantly/rapidly;
many symptoms,
symptoms alternate, and so on.
Here are some examples of sensations you can find in the Generals chapter: constriction,
dryness,
air sensation (that it is blowing on him),
cobweb sensation,
emptiness,
faintness,
heat,
knots,
lightness,
plug,
water (as if water were dashed on him),
worms–as if crawling under the skin.
If there is a sensation on a single part, go to that chapter of the repertory and you’ll probably find it. For instance,
Head: bubbling sensation;
Head: crackling sensation;
Head: empty sensation;
Head: expanded sensation, feels inflated; and so on.
4. The appearance. This can be very important. You wouldn’t give Chamomilla to someone who is lying quietly; and you wouldn’t give Gelsemium to someone who was thrashing about and screeching. Check for the color and the expression in the face, and the pupils–check to see if they’re dilated or contracted.
5. Location is rather self-explanatory.
6. Modalities. This is another big one. Very often, this is the deciding factor in the case. I gave the example above where in two cases, “rainy weather aggravates” was the critical symptom. Modalities are things that make the patient better or worse. If you ask him what makes him feel better, he will often say “nothing” or he’ll say, “Motrin.” They really don’t get it, so, you have to help them out. Ask, “What are you doing now because of this illness?” The answer might be, “I’m lying here in the dark with an ice pack on my head.” So, this person is worse light, and better cold applications. You’re not going to give this patient Mag-phos, which is definitely worse for anything cold! Do you know what the modalities are? I could never remember them, so I made up a little poem (actually, it’s more of a cheer!):
Temperature, weather, motion and time
Position, reaction to stimuli
Like light, noise, talk, touch
Eating and Drinking
It’s not so much!
Please hold your applause til the end. What do I mean by these things? Temperature not only refers to the temperature outside but the room-temperature as well. There’s the famous Pulsatilla aggravation from warm, closed rooms, but Nux Vomica is better for this. You will find Nux Vomica wrapped up in blankets, and even the slight draft caused by turning over in bed will aggravate his cold or flu.
By motion, I am referring to remedies like like Bryonia, famous for the inability to tolerate even the slightest motion–even moving the eyes or taking a deep breath can make the complaint much worse. On the other hand, a remedy like Sepia can be much improved if he or she can get out and do vigorous exercise, like swimming, dancing or playing tennis.
Reaction to stimuli: some people can’t tolerate stimulation when they’re sick; odors, for example, will make them nauseous. Look in the Repertory–Stomach: nausea, odors. Colchicum is the main remedy here. Others can’t tolerate noise or conversation (Mind: noise, aversion to). Others, like Phosphorus, are so much improved by encouraging words that often just the doctor saying, “This is not serious at all, you’re going to be well in no time,” is sufficient to cause a vast improvement in Phosphorus, but not so for Arsenicum, who will simply not believe you! Arsenicum will make you say it over and over again! “Are you sure I’m going to be alright?”
A big clue to the remedy can lie in the patient’s food and drink desires. You might be confused between Pulsatilla and Phosphorus, as they both are better for company, worse alone, better for sympathy and both love ice cream, but Pulsatilla is thirstless and Phosphorus is very thirsty for ice cold drinks.
What do I mean by “Time”?
I mean the “aggravation time”, the time your patient gets worse. Look in the Generals section of your repertory and go to “Time”, or, in Murphy’s, go to the Time chapter and scroll to either afternoon, evening, night, or morning, and check out the subrubrics for the exact time. You may be surprised to see how time plays a role in your patient’s ailment that even he may not realize! I remember a cold I had once, where the cough came on at 11:30 every night without fail! It’s in the Repertory. Cough: night, 11:30 PM and the remedy is Cocus Cacti.
“Position”, what do I mean by this? Position can be an important clue. What if your patient is all bent over double? Go to Generals: doubling up of the body–Mag-phos. and Colocynth are the main remedies. Is there anything note-worthy about your patient’s position?
7. Concomitants. What’s so important about these? These are the symptoms that are along for the ride that make no sense, in that they have nothing to do with the complaint; and in the homeopathic understanding, that’s what makes them so important–they are PECULIAR! The concomitants can be the deciding factor in your remedy choice. Consider this:
Headache with nausea and vomiting–Ipecac
Headache with violent outbursts–Staphysagria
Headache with excessive salivation–Mercury
Headache with despair–Aurum
Headache with restlessness and anguish–Arsenicum
8. Discharges. Remember the color, odor and consistency of discharges. My mother used to say, “Why do you have to know these things?!” Sorry, Ma.
Look at Generals: mucus, and all the subrubrics.
9. Generals. What are the generals? They’re the “I” symptoms. “I’m hot! I’m thirsty! I’m sleepy, don’t bother me.” I could never remember the generals either, so, I’m afraid I wrote another poem. Here it is:
Warm or cold?
Restless, dull, or weak?
How’s your thirst or hunger: for salt, spicy or sweets?
Are you sweating? An odor? What, where or when?
A repeating modality
And now we’re at an end.
Yeah, I was running out of gas when I made that one up! So, what do I mean by Sweating…what, where or when? It means what exactly are you sweating? Go to the Perspiration chapter in your repertory. You’ll see that sweat can be acrid, bloody, burning, clammy, cold, hot, oily, warm….You’ll see that there are aggravation times for sweat, there’s a variety of odors to choose from, a variety of stains and colors; let me just say that Thuja is known for its oily perspiration, and Sulphur is known for sweat on waking, and of course, some remedies are famous for sweat on certain parts, like Silica for it’s sweaty feet where the perspiration is said to actually eat the socks and shoes!
10. The mentals. Just make sure the mentals have something to do with the case and aren’t normal mentals like “Loves animals”! Plus, your usual mental state is not part of the case! If you’re a big cry-baby all the time, don’t add it to your acute case; and, if I haven’t already said it, don’t repertorize anything that you ALWAYS have, just what has changed since you got sick.
11. What does the person say? This is a big one; for example, Lachesis may say, “I’m having trouble swallowing.” (Lachesis is a snake, and the throat is the most vulnerable part of their body, the place where they can be grabbed and controlled.) Someone might say, “I wish I could just fly away from here.” There’s a reason for choosing the word “fly” when one could have as easily said, “I wish I could get outta here.” Try to tune into themes and repetitions of words and phrases. The “fly away” person may need one of our bird remedies.
12. Thirst. The amount of thirst, the desire for warm or cold or ice are all very important in differentiating among remedies. Food: do they want cold or warm? Sweets, salty, spicy? More importantly, if they’ve changed their food or drink desires since they became sick, this is really important.
13. Fever. When taking a fever case, first ask if they’re dry or sweating. Next ask about their thirst. Then ask for the concomitant:
Fever with nausea, fever with irritability, fever with anxiety, fever with diarrhea, restlessness, chills, no chills…. What organ or system is malfunctioning? What time of day or night does the fever come on? Any discharges? Example:
Fever with yellow nasal discharge and thirstlessness–Pulsatilla. Fever with nausea, diarrhea, chills, anxiety, burning pains, thirst for frequent sips of water, worse around midnight–Arsenicum.
14. Sweating. We’ve already gone into that.
15. Odors. Sometimes odors can be indicative of the remedy. Foul odors will lead you away from remedies like Aconite and Belladonna and more toward the toxic remedies like Mercury, Baptisia and Pyrogen.
16. The striking, strange, rare and peculiar symptoms. We’ve touched on this already. Suffice it to say that the common symptoms of the complaint will rarely help us, that’s the reason for all these questions. We need complete symptoms, we need the etiology and onset, we need colors and odors, we need concomitants and modalities; and after all this, we stand a good chance of coming up with the right remedy.
Elaine Lewis
