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| Hpathy Ezine, Nov. 04 | ||||
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Solving Confusing Cases -- Elaine Lewis |
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| hi elaine, [I'm] not finding the same remedy in all the rubrics. seems like this must happen alot when assembling a case? or does this happen in only the "difficult" cases? Kelly
Dear Kelly, You've asked a profound question. This is why homeopathy is so difficult! We say we take the totality of symptoms, but as you've pointed out, if you go to the Repertory (our main reference book) and look for the symptoms in the case, you rarely find that there is one remedy shared by all. For example, if you have a runny nose and sore throat that extends to the ear, with amelioration (improvement) from thunder and lightning storms, you may see that you can't find a single remedy that covers the whole case. So, how, under the circumstances, does one pick a remedy? It seems to suggest that you have to disregard some of the symptoms as being "irrelevant" and that's exactly what you have to do! The symptom with the most value in this particular case is "Thunder and Lightning ameliorate"! Why? It's because it's so unusual! It's so peculiar! Here's a person who's sick with a cold and feels better in a storm! It's weird! It doesn't occur to the average person that we all have colds differently! And it's how we're different, in homeopathy, that leads to the correct remedy. Think of it as looking into a microscope to identify the kind of bacteria present, the only ones you can see are out on the fringe--they're waving a big red flag, "Look at me! Look at me!" The others are all huddled in a ball, so, you're looking out on the fringe where you can see! The only thing I "see" in this case is someone whose symptoms go away in a storm! Everything else is like everyone else's cold! Indistinguishable! This is how homeopathy works--it's the peculiar symptom, it's the striking symptom that you can't ignore, which seems to have nothing to do with the complaint, that makes it so you can find a remedy. So, in this case, you'd check the Repertory for "Envrironment: thunderstorms amel." (Murphy's Repertory) and there's only about 4 remedies, and then you'd check to see which of the 4 most closely fits your case. Here's the problem with the Repertory: 1. Some remedies were very extensively "proven"--tested on volunteers-- and have hundreds of years of clinical use, and are, consequently, over-represented. Remedies like Sulphur may show up in almost every rubric from Bloating to Vertigo, and so a strict repertorization will almost always show Sulphur as the "winner" every time! 2. Other remedies are "under-proven", under-used, and are poorly represented in the Repertory and will never "win" in a strict repertorization. 3. There are numerous symptoms in the Materia Medica (our other "Big Book") that were never entered into the Repertory! For instance, the remedy Chocolate isn't in the rubric "Abandons/Forsakes His Own Children", and clearly it should be there. (Simillimum, summer 2003, p. 48) So we can see that we have to have some other strategies going for us other than strict repertorization when solving a case. What might those strategies be? Well, different homeopaths have lots of tricks up their sleeves, but here's a few I think we would all agree upon: 1. The most recent symptom takes precedence. The most recent symptom in a case can't be ignored in favor of the ones we find more interesting. It might be that before you can get to the heart of the case, a recent "boring" symptom may block your way if you don't knock it off first! For instance, a patient who's had arthritis for years and has just fallen and bumped his head, needs Arnica--our injury remedy--even though the arthritis has been around longer and represents a deeper problem. 2. SUFFERING in the case takes precedence. If someone has pain, you have to take the case of the pain, even though you may suspect that your patient is constitutionally a Sulphur or a Calc-carb. When you see a person with, for example, a Bryonia pain--sharp, stitching pain, worse for the slightest motion--you have to give Bryonia right away, it doesn't matter that he sticks his feet out of the covers, is messy, doesn't like to bathe, and other symptoms we associate with Sulphur. 3. Find the worst thing! When there seems to be a million symptoms in the case, and there usually are, ask your patient, "What's the worst thing that's the matter with you? What symptom do you want to go away first?" Then take the case of whatever that is. He may say, "If I didn't have insomnia, a lot of my other problems would go away." So, the case then becomes one of insomnia--you'd ask him to describe it, what does he think about while lying awake, does he wake at a certain time each night, what may have caused it, and so on. 4. Look for what's excessive in the case: Too much talking, too much sweating, too much dryness, too much...whatever. 5. Find the over-sensitivity: Look to see what the person is overly sensitive to: Criticism? Rainy weather? Music? Sunlight? 6. The patient's response to stress--is there a pattern? You may find that this is a person who cries about everything, or over-reacts violently to everything, or feels that he can't ask for help, despite having these stresses in his life. The RESPONSE to stress is more significant than having a stress, per se. 7. The cause. Very often if we know the cause, we can pack up our bags and go home! The cause determines many or possibly even most of our prescriptions! "You've had this since the accident? Oh, why didn't you say so? The remedy's Arnica!" "You had this since your boyfriend broke up with you? Why didn't you say so! The remedy's Nat-mur." "You've had this since the flu? Why didn't you say so? The remedy's Gelsemium!" (I'm over-simplifying to make a point.) In general, when confronted with symptoms which don't fall neatly under the umbrella of one remedy, THROW OUT THE COMMON SYMPTOMS right away--symptoms like "Depression", "Headache", "Runny Nose"--symptoms which could be any one of 500 remedies, forget about them! THROW OUT EVERYTHING THAT'S NOT INTENSE. Look for what's PECULIAR. Look at what's RECENT. Look for SUFFERING. Look at what's STRIKING. Look for a THEME (always crying, always talking about birds, etc.) Ask what's the WORST THING in the case (generally, pathology on the MENTAL/EMOTIONAL plane, if intense, tends to be the worst thing--fears and delusions, for example, can cripple a person worse than a broken leg). Look at how the person RESPONDS to his complaint. Find out what he's HYPERSENSITIVE to. Look to see what he's doing OVER AND OVER again; look to see what he's SAYING over and over again. See if you can separate the symptoms into acute and chronic and treat acutes first. Look for the CAUSE. In the final analysis, instead of 20 symptoms in the case, you may find that you're down to 4 or 5! So, for example, in a Chocolate case, regardless of the diagnosis--arthritis, or menstrual cramps, etc.--the rubrics or symptoms you might finally decide upon may look like this: Desires chocolate (theme, over and over again, excessive) Ameliorated in the countryside (unusual in that most people don't need to be in the country to feel better) Ameliorated by curling up in a ball (response to the complaint, odd, striking) Aggravated by the presence of her children (overly sensitive to her children, odd, striking) Desires to travel/escape (response to the complaint) (These really are Chocolate symptoms, I'm not making this up!) So, it's what's unusual in the case, it's what's excessive, it's the response, it's what's repetitive, it's what's striking, and remember to treat the suffering first and look for etiologies (causes). If there are "layers" in a case, each layer will begin with a CAUSE, an event, which will shift a person over to a new remedy picture--or, it might take him deeper into his own constitutional state; for example, there's the Healthy Sulphur who's ambitious, pursuing a career, getting good grades, warm, loves the outdoors, extroverted, active, etc.; and there's the very sick Sulphur, who's become a recluse, stays indoors, is chilly, and has become lazy and has stopped trying. A healthy Sulphur, after failing repeatedly in business, for example, will take on this new state, but it's still Sulphur. Try to see what the critical "events" in the person's life were. There are a set of remedies that correspond to each event--remedies for the flu, remedies for loss of a loved one, remedies for injury, remedies for business failure, etc. If you see that a person has never been the same since a significant event, the symptoms themselves become less significant and the CAUSE becomes paramount, and you would want to try to match a remedy in the CAUSAL rubric to your case. Kelly, does this make any sense? When did Kelly leave? Now, see, that's very peculiar! "Unable-to-sit-through-a-rambling-explanation". I'm thinking Sulphur! |
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