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| Hpathy Ezine - September, 2006 | ||||
Acute
vs. Chronic Remedies,
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A quiz respondant this month votes for Sulphur over Lycopodium, which she prefers, because Lycopodium is a "chronic" remedy and the case is an acute. I have been pondering this premise: that there are two types of remedies: deep acting/ "constitutional"--remedies, and superficial "acute" remedies, like Arnica. You might say that in a given case, because a person may be incurable, you don't want to give a deep acting constitutional remedy; there might be too much suffering on the surface to be concerned about what's going on "deep" in the case. Since I think we are agreed so far, here's where I am in need of an explanation: Are we looking for an acute remedy or a remedy for an "acute"? This is where the confusion lies. If you're lucky, in an acute illness, you will have the good fortune of seeing a complete "remedy picture" in the patient, an example of which might be someone who has been in a car accident: He injures his head. There is blunt trauma, shock, bruising, soreness and swelling and yet the person says, "I'm fine really, no, I don't want to go to the hospital, there's nothing wrong with me, really!" The person then nods off, and only responds again if he hears the word "hospital". This is a constitutional Arnica case! Why would I say that? Because we've got the whole kit and kaboodle here! The mentals, the physical particulars, the physical generals... And yet, this is an acute, to be sure; nonetheless, this person is now "Arnica"! He may have been "Sulphur" yesterday, but he is "Arnica" today. He is in an "Arnica state". Arnica is his "constitutional remedy". If he doesn't get Arnica now, he may be "Arnica" for the rest of his life and therefore have a fear of being injured, a fear of being approached, aversion to being touched, forgetfulness, a tendency to have accidents, to be accident-prone, to dream of accidents, etc. No one would say, "We can't give Arnica in this acute case because Arnica is a constitutional remedy--it covers the whole case! It goes too deep!" We all know that would be preposterous! I think we all know that Arnica IS an acute remedy, but more to the point, Arnica is the indicated remedy! The "too deep" remedy here is Sulphur--his former constitution, but not his current constitution! Sulphur is the layer underneath Arnica and it has nothing to do with this case; it might even aggravate if it were given. Let's look at another example: A person has a heart attack. He is scared to death that he is going to die! The remedy? Aconite. Why? Because your average heart attack victim is scared to death that he's going to die and that is the essence of Aconite: scared to death! It covers the deepest part of the case! The remedy must always cover the deepest part of the case, regardless of whether the case is acute or chronic. This heart attack victim may have been Sulphur yesterday, but he is Aconite today. Today, for the time being, he is an "Aconite Person". Is Aconite an acute remedy or a constitutional remedy? It is only the indicated remedy because it covers the deepest level of this case. By the time this person has had his fifth heart attack, he will no longer be Aconite; he will say, "Oh, this again, another heart attack!" By now, he's already wearing one of those emergency necklaces where he just presses a button and the paramedics come running! Aconite will no longer work now. There will no longer be any mental symptoms in the case to prescribe on, the fright will be gone, leaving a physical presentation and this is what you will try to match with a remedy. Here's a typical heart attack presentation: constricting pain as if a band around the chest squeezing tighter and tighter, and the remedy is...? Come on, you must know it. OK, I'll put it at the end of the article. Is this, then an "acute" remedy because there are no mental symptoms in the case? My way of looking at it is this: When a person presents with an acute, the question always is, "What has changed since this illness or event occurred?" If a change has occurred on the mental plane, then that is the deepest part of the case and the chosen remedy will have to cover that, assuming that it is clear and intense. "I'm sort of irritable, I guess, " would not qualify. If the patient is irritable--but he's ALWAYS irritable--this is not a part of the case! If the patient desires to be alone, but he has ALWAYS desired to be alone, this is not a part of the case. Similarily, if a person is thirsty, but is ALWAYS thirsty, this is not a part of the case either! If the remedy is chosen based on it's similarity to the physical symptoms alone, it will not work if there's a mental presentation that is a part of the case! My favorite example is a story told by our friend Barb about a family reunion of sorts in which one of her guests was stung by a bee! Barb gave Apis and it didn't work. What? She was shocked--and embarrassed because everybody was looking! Finally she had the presence of mind to notice that the guest was anxiety-ridden. Barb gave Aconite and it worked! Is Aconite a bee sting remedy? Not that I know of! For most people a bee sting is an issue of stinging pain, swelling and a desire for cold applications, all of which goes for the remedy Apis; but for this lady, the deepest part of her case was fear, and the chosen remedy had to match that; hence, the remedy was Aconite, our main fear remedy, eventhough Aconite has precious little to do with any other part of the case! Now, looking at this the other way--the opposite way-- in cases with no mentals, can we reject a remedy that matches well except that it's well-known mental concomitant isn't there? Can we withhold Belladonna because the patient doesn't see insects climbing on the wall? Can we withhold Arnica because the patient doesn't say, "I'm fine, really, I'm fine!"? Sometimes a case has no mental or emotional concomitants! So just ignore the mental picture of the remedy you're giving if everything else matches! I'm reminded of Kent's famous story about his dog. Do you know this story? Kent's dog got into the trash one night and ate up all the fat from the left over meat. The next morning the dog was nearly dead! Kent gave the dog...what. Do you know? Think....Ailments from Fat. Yes, Pulsatilla! Pulsatilla? Isn't that the clingy, cry-baby remedy? Well, it's also our "Ailments from Fat" remedy! The dog's life was saved--somehow without being clingy or a cry-baby! Every remedy has a healthy presentation, an acute presentation, a chronic presentation, an "end stage" presentation, an early-stage presentation, an etiology it's known for...in other words, a person can need Pulsatilla just because he's eaten too much fat and for no other reason and that is just as much a Pulsatilla case as a clingy child with an earache; or a case of fever with thirstlessness, or even a prostatitis case with a thick yellow bland discharge. Can we give Pulsatilla if the patient is not crying, nor jealous, nor feeling abandoned? If there is no mental concomitant in the case stating otherwise, yes, we certainly can! A final word on the subject by James Tyler Kent, MD: The Examination of the Patient from Kent's Lectures on Homeopathic Philosophy When an individual is suffering from a dangerous crisis, a serious accident or emotional trauma, or a virulent acute miasm [an infection like the flu], the treatment of choice is the acute remedy or acute intercurrent. After the acute state has subsided the underlying fundamental cause must be removed by complementary constitutional treatment to prevent reoccurrence and complete the cure. No remedy is exclusively an "acute remedy" by nature. A remedy becomes acute or chronic depending on the strategy of the homoeopath and how he applies the remedy. Deep acting remedies like Arsenicum, Mercury or Sulphur are often used in acute diseases if the symptoms of the acute layer call for them. [emphasis: EL] The key in such situations is not to mix the acute and chronic symptoms together in one grand totality as this confuses the case. Always remember this, folks: Acutes get treated first, the constitutional case will have to wait. I read an article by Miranda Castro in the 1995 "American Homeopath" where she tells the story of her brother in the hospital with pneumonia. She was distraut with not being able to figure out his constitutional remedy until she suddenly had a "light-bulb moment" after her brother said that the worst thing about being sick was people noticing that you can't cope! "Do you like eggs!" Miranda blurted out. Yes, it turns out he did! But Calc-carb., though helping him sleep that night, did nothing for the pneumonia! Miranda realized she'd have to give the acute remedy which was Crotalus h. Upon checking the MM, she saw that even the mentals of Crot-h.-- dwelling on thoughts of death and aversion to family members (he wouldn't speak to his father)--were part of the acute case. With repeated doses of Crot-h. 30C, vast improvement occurred within 24 hours. Any remedy that matches the acute case is suitable--we don't have "acute" and "chronic" remedies, although I hasten to add that some of our remedies are under-researched and under-used and are therefore known for just one or two things which they have become famous for, like the way Wyethia is known for tremendous itching of the roof of the mouth, nose and throat. Don't mix up constitutional symptoms with the acute complaint; the acute complaint is everything that has changed since the person became ill. It's all the ways that the patient is different from his normal self. Acutes don't always have a mental/emotional component. Don't reject a remedy that's a good match because its famous mental symptom, like crying, or insanity, isn't there. But, if there is a clear mental component in the case, the remedy will have to cover that, even if it's not known so much for the physical complaint that's presenting--as we saw in the example of Aconite being used for bee sting. Of course, if you can find a remedy that covers everything in the case, that would be ideal; but sometimes that isn't possible: This is the value in having a hierarchy of symptoms. We're more concerned that the remedy match what's at the top of the hierarchy--usually the mental and emotional symptoms--than what's at the very bottom, which is usually the local symptoms. In this context, the remedy that matches the General symptoms would be of more value than a remedy that matches only the local symptoms. The Generals are the symptoms that start with "I". "I want air!" "I want to go home!" and so on. The local symptoms start with "MY": "My ear hurts!" "My eyes keep blinking uncontrollably." Even higher than the mental/emotionals in this hierarchy is the Etiology (the cause) as demonstrated in Kent's dog's illness: "Ailments From" Fat--Pulsatilla, the main remedy. There was nothing else in this case to indicate Pulsatilla but because it covered the etiology, it was chosen. Now, since I brought it up, here is the standard hierarchy: Etiology ("Ailments From" or "Never Well Since" a certain trauma or illnesss) The State the person is in If a person has a fever, you need one of the remedies from the Fever chapter. If a person has the Measles, you need a remedy from the Measles rubric. I loved Steve Messer's conference tape on the Cows and the Farm: If you're trying to find a cow by traipsing all over the county, it will take you forever! If you at least know which farm she's from, then you can check all the cows in that farm for their peculiar markings. There may be only 20 cows in that farm. The analogy is that the farm is the "state" the patient is in, and the cow's markings are the "characteristic symptoms" or the strange rare and peculiars of the case. As Dr. B said to me once, "Elaine, if your cousin had a stroke, you need a remedy that can cause a stroke in a healthy person!" (You see, I had focused in on the patient's demeanor--extreme apathy--and was about to run with that! The right remedy though was Crot-h., a remedy known for right-sided strokes.) Onset (sudden or gradual?) A sudden onset might trump everything in the case and lead to an immediate consideration of Aconite or Belladonna and less often Baptisia. Now, be careful with this--sudden onset doesn't mean that you suddenly start coughing after someone blows smoke in your face! It means you were fine, you went out for a brisk walk in the cold, windy weather, and half an hour later you were down with a fever, sore throat and runny nose and in shock that such a sudden turn of events could take place in so short a time! That would be a perfect Aconite case, by the way. Delusions and Strange/Rare and Peculiar symptoms Mentals (symptoms like confusion, forgetfulness, poor comprehension.) Emotionals Physical Generals Local symptoms So, using this hierarchy as a guide...let's say you have a case of right-sided, throbbing headache with red face, that came on suddenly after being out in the heat of the sun. Can we cover the top of the hierarchy? The etiology? Yes, ailments from the sun. It's in Generals: Sun, headache from exposure to. What about the state? The state is headache from the sun. What about Onset? Got it covered: Sudden! Any delusions? No. Mentals? No. Emotionals? No. Physical Generals? Right-sided complaints (Generals: sides of the body, right). Local Symptoms? Face: red. Headaches: throbbing. Sulphur has red face and throbbing headache, and Sulphurs hate the heat! Can we give that? No, because you're starting from the bottom of the hierarchy, start from the top instead. Will Sulphur cover the etiology? "Heat of the sun agg.?" It's only a "1" and there are lots of 3's in that rubric, I would say no, it doesn't cover the etiology very well. "Sudden onset?" Not according to the repertory I'm using. What about right-sided complaints? It's only a 2 and there are many 3's. Belladonna, on the other hand, looks very good: it has the etiology of ailments from the sun, the state which is headaches from the sun, sudden onset, right-sided complaints, redness and throbbing, all in the highest degree. I have to do the dishes now; so, you're on your own! (Oh, and the heart attack remedy was Cactus.) |
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Elaine Lewis, DHom, CHom takes online cases. Visit her website at: www.hpathy.com/office/ElaineLewis.asp |
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