There’s been a lot of discussion on the hpathy.com discussion board lately about how to know when you’re finished taking a case. One person asked, “Is it just ‘sensation, location, modalities’ and then you’re done?” Well, it’s a good start! In the March issue, I wrote an article called “A Flurry of Questions” which became my Acute Case Questionnaire:
It might be good to print that out and always have it near by. Building on that article, let’s talk about the reason for some of these questions.
1. Onset. Why do we ask about onset? If an illness came on suddenly, you may be down to just two remedies out of 3,000–Aconite and Belladonna (and Baptisia if it’s a septic case; and by that I mean a case characterized by bad odors, muscle aches and stuporousness); that’s the importance of this question–from 3,000 remedies, you’re down to three just by asking if it came on suddenly or gradually–and here we are generally talking about a virus, not an injury.
2. Etiology. This is the big one, and the one that’s so often over-looked. First of all, to back-track a minute, in case-taking, we need what are called “complete symptoms” and a complete symptom has the following components: etiology, sensation, location, modalities (things that make the symptom better or worse), concomitants and if there’s a discharge–the color, odor and consistency. The etiology means the cause or precipitating factor. It could easily be 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. Cold windy weather can be sufficient reason 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 often Gelsemium, see “Generals: convalescence” in the Repertory 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 are: humiliation, mortification, bad news, grief, loss, disappointment, injury, surgery, sleep loss, over-work, drugs, etc. 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 to the system, 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 weakness that let the shock in.
I’ll give you an example: my very first case was a man, a successful financier from London, with prostatitis, which was causing him quite a bit of trouble including pain, anxiety 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 used a logical approach in the beginning and suggested he take Sabal 6C three times a day (that’s homeopathic Saw Palmetto, famous for being a prostate remedy) 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 in your life at that time.” These are golden questions in the homeopathic interview: when did it start and what was going on at that time? 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, the Rx was Lycopodium 6C three times a day in water with 10 succussions (pounding the bottle into your palm) before each dose. At the end of the first week he reported feeling less anxiety-ridden even though 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 less stressful 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 in (the new position he felt unprepared for) it bounced off all his healthier organs, and landed on his prostate; so what is the problem here, what has to be cured? His his disposition to become embarrassed and humiliated? Yes! Luckily, the remedy for that covers the prostate too. So, this is the significance of etiology. Keep in mind that you’re not always going to find a compelling etiology in a case, but, at least look for it.
3. Sensations. Go to your repertory to the Generals chapter and look under Pains; or in Murphy’s it might also be in “Clinical: diseases, symptoms” or in his 2nd ed., “Diseases: symptoms”. You’ll see there are remedies listed for the following rubrics:
Pains appear 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. as I said above, and you’ll see the following rubrics:
Symptoms change constantly/rapidly;
symptoms alternate, and so on.
Here are some examples of sensations you can find in the Generals chapter:
air sensation (that it is blowing on him),
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.
This is what we mean by the “sensation”. Be sure and try to find that out. Don’t let somebody get away with just saying that they have a “pain”. That’s not going to help us!
4. The appearance. This can be very important. I recently solved a case based on a patient’s report that he had two identical red spots, one on each cheek.
5. Location is rather self-explanatory. If a person has a sore throat, where in the throat is it? The left side? The right side? Both sides? We have remedies that cover complaints that are only on one side, or that extend from point A to point B, or that wander from joint to joint or go back and forth from side to side.
6. Modalities. This is another big one. Very often, this is the deciding factor. I’ve had many cases where “rainy weather aggravates” was the deciding 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 will say, “Motrin.” They don’t get it; so, you have to help them out. You can try asking, “What are you doing now because of this illness, what’s it making you do?” 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 poem– Ahem!
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.