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Homeopathic Repertory |
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| Hpathy Ezine - March, 2009 | ||||
Repertorisation-- Ian Watson |
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| “The best repertory anyone can have is in his own memory.” John H. Clarke | The Prescriber DefinitionRepertory = index, list, catalogue. This method embraces a variety of techniques whereby a repertory is employed to determine a small group of remedies, from which the most similar one to the case may be chosen. IntroductionRepertories were introduced into homœopathy because the expanding materia medica became, even in Hahnemann’s lifetime, too voluminous to allow quick and easy reference. A repertory provides an efficient means of accessing the materia medica, without having to read and compare endless lists of symptoms. The purpose of repertorisation, however, is not to replace materia medica study. Rather it is designed to provide a bridge between the case being worked on and the remedy pictures in the materia medica. A successful repertorisation takes the prescriber to those few remedies bearing close similarity to the case, which may then be studied and compared in the materia medica to determine the final choice. Some practitioners are highly skilled in the use of a repertory and are able, by selecting the rubrics very carefully, to narrow the choice down to one remedy using the repertory alone. The most important thing to keep in mind is that a repertory should be considered as a complement to, not a replacement for the materia medica. Those practitioners I have met who are repertory technicians of the highest order are first and foremost, without exception, masters of the materia medica.
Repertories in UseKent’s Repertory has dominated the scene for the best part of this century. Kent is said to have laboured for over sixteen years to produce it, and many homœopaths still rank it as one of the standard works of reference. It is, however, seriously outdated now in its original form, so thankfully there have been numerous attempts to update, revise and replace it. The Synthetic Repertory of Barthel and Klunker is basically an updated version of Kent’s Repertory, with additional material from a wide variety of sources. This repertory is produced in three volumes, but unfortunately contains no particular symptoms whatsoever. Other modern repertories following the same format as Kent but with much additional material have been produced by Eizayaga and Kunzli. Yet another modern repertory based on Kent’s which has gained a strong following amongst classical homœopaths, is the Synthesis Repertory of Ed. F. Schroyens. Containing around 200,000 additions to Kent’s original version and based on the RADAR computer repertory programme, this is probably the best Kentian-style repertory currently available in book form. Another Kentian repertory, which is not for the faint-hearted, is the Complete Repertory of R. Van-Zandvoort, based upon the MacRepertory computer programme. Robin Murphy’s Homeopathic Medical Repertory is, for me, the most user-friendly and versatile repertory currently available. It was first published in 1993 and was quickly sold out and replaced by a considerably revised second edition. The format has been a source of some controversy, as Murphy took the radical step of replacing the Kentian schema with a completely alphabetical layout. Whilst it takes a bit of getting used to for those raised on Kent, it is, in my experience, much quicker and easier to access once you are familiar with it. Those who have never been exposed to a Kentian-style repertory should, in my opinion, save themselves a huge amount of unnecessary labour and simply start off with this one. Another criticism levelled at Murphy is that his repertory lacks the references scattered throughout repertories such as Kunzli’s, which enable the user to trace the source of remedy and rubric additions. Personally I find these references superfluous, and Kent himself never saw the need to include them. To me, a repertory will always be a dynamic, imperfect and incomplete reference work, and I feel that any homœopath’s clinical experience is as valid as anybody else’s. There is a kind of elitism within homœopathy these days which suggests that certain ‘masters’ are to be trusted, and clinical experiences coming from any other source must be treated with suspicion - a delusion of superiority if ever there was one! Although there are more comprehensive repertories available now, Murphy’s has several key features that make it a favourite amongst thousands of users worldwide. Apart from the alphabetical format, it also contains a large number of clinical rubrics and modern-day terms such as Raynaud’s Disease, Allergic Reactions, Multiple Sclerosis, Endometriosis, Chemotherapy agg., etc. Murphy’s repertory also has some wonderful new chapters which gather together a mountain of information scattered throughout the homœopathic literature. These include Environment, Food, Blood, Children, Diseases, Toxicity and Emergencies. Phatak’s Concise Repertory is still one of my favourite homœopathic books, and is especially useful when using the physical generals approach. I find Phatak’s Repertory to be a wonderful time-saver in practice provided it is used appropriately. If there are mental or particular symptoms to be repertorised, Murphy is usually a better choice. To save time, I will often select a single general rubric from Phatak to start an elimination repertorisation (see below), and then use rubrics from Murphy for the remainder. Boenninghausen’s Characteristics and Repertory is one of the earliest repertories, but was completely revised and updated by Boger in the early part of this century. It is a major work, but is probably doomed to stay on the back shelves of most homœopathic libraries these days. Clarke’s Clinical Repertory was produced as a companion volume to his Dictionary of Materia Medica and The Prescriber, with which it is cross-referenced to some extent. It actually contains four repertories in one, as it includes sections on causations, temperaments and relationships of remedies as well as the clinical index. Its main advantage is that it tends to emphasise the minor remedies, whereas virtually every other repertory tends to emphasise the polychrests. However, this is offset by the fact that Clarke chose to use different remedy abbreviations to every other author, which renders it somewhat confusing to use. There are literally dozens of ‘lesser’ repertories available, most of which focus on a particular disease state or bring together data from many sources on a similar theme, such as causation, dreams, time aggravations etc. One such repertory I have found helpful is the Homœopathic Aide-Memoire written by Peter Coats. This is essentially a pocket-sized repertory for acute prescribing, but contains other gems of clinical information as well. When to RepertoriseRepertorisation can be used to support almost any prescribing technique, but it is probably most effectively used when symptom-similarity is the primary basis for the prescription, the reason being that the repertories we have available are chiefly composed of symptom-lists. It is generally less appropriate when using a miasmatic or organopathic approach. Some repertories, such as Clarke’s and Murphy’s are more clinically orientated and are therefore useful in supporting a therapeutics approach. Repertorisation TechniquesThere are three main ways in which a repertory may be used in practice: 1) Spot Checking This means simply flicking through the repertory to find a key rubric in the case and noting which remedies feature. Many practitioners do this during the case-taking as a means of checking out a particular line of enquiry, eliminating or confirming a remedy or group of remedies in mind. Case Example A twelve year-old boy was brought into our clinic displaying behavioural problems and various digestive disturbances. Lycopodium seemed well-indicated for him but had failed to make much impression, so we questioned him further. Asked about fears, he reflected a little, then responded without any shadow of doubt that he had a fear of being paralyzed! Not knowing if such a symptom even existed in the materia medica, I went straight to Kent’s Repertory where the symptom was found in the Mind section with just five remedies listed. The only remedy in italics was Anacardium, which was found to cover the rest of the case well and was given with marked improvement. This case demonstrates the value of a spot-check and illustrates how rapid a repertorisation can be, provided the characteristic symptoms are chosen at the outset. 2) Elimination Repertorisation This is a more thorough technique but is designed to prevent the prescriber having to write out lengthy lists of remedies, most of which need not be considered. The method involves choosing a key symptom from the case about which it can be said that the remedy the patient needs has to be in the corresponding rubric. That primary rubric is then taken as a starting point, and only the remedies listed in it are repertorised any further. There are several instances in which this is an appropriate strategy: i) When there is a clear cut, direct aetiology in the case (see Aetiologies). For example, if someone dates all of their presenting complaints back to a severe fright, ‘ailments from fright’ may be taken as the primary rubric. It is very unlikely that a remedy outside of that group will be needed. It is worth noting that in the Synthetic Repertory, all of the ætiological rubrics which are scattered throughout the mind section of Kent’s Repertory have been brought together under the single heading ‘Ailments from’. ii) When there exists a single, outstanding symptom in the case, in any category (mental, emotional or physical; general or particular), provided it has an unusual intensity, peculiarity or uniqueness in the type of case being treated (see Symptoms). As an example, I treated a woman with a degenerative nervous system disease whose sufferings were always aggravated at the full moon. I took the rubric ‘Moon Phases, Full Moon etc. Agg.’ (Phatak’s Repertory, page 237) as an eliminator, which, although it contains only a small number of remedies, was a safe choice because of the peculiarity of the modality. The rest of the case repertorised out to Alumina, which was given with great benefit. iii) When there exists a clearly-defined pathological process, provided no other outstanding feature of the case exists to over-ride this. For example, if the patient clearly has cancer or measles or hepatitis, the corresponding rubric may be safely chosen for elimination purposes unless there is a symptom in the case which is so strong or peculiar as to take precedence. It should be remembered that if the disease is to be treated first, only those symptoms that pertain to the disease should be included in the repertorisation. Supposing a child is brought in with measles, the rubric ‘Fevers, measles’ from Murphy can be used as a safe starting point in the vast majority of cases. The other symptoms of the case may then be used to narrow down that group, but any symptoms which existed before the measles and which are unchanged should not be included. If, for example, the child has had a great thirst since the onset of the measles, then it is a symptom of the disease and should be repertorised. If, however, the child has always been that thirsty, then it is a symptom of the person and should only be repertorised when treating constitutionally, after the measles has been cured. 3) Totality Repertorisation Unless a computer is employed, this is the most cumbersome of all repertory techniques, and it should therefore be reserved for those cases where another technique cannot be used and/or where time is available in abundance. All of the symptoms considered to be important are located in the repertory and every complete rubric is copied out in full. The whole group of rubrics is then analysed to see which remedies feature in most or all of the rubrics. This type of repertorisation produces two things: firstly it may be seen which remedies appear in the most rubrics (a purely quantitative analysis), and secondly each remedy may be given a ‘score’ by adding together all of the grades of type in which it appears (a more qualitative analysis). Using Murphy’s or Kent’s Repertory for instance, remedies appearing in bold type will score three, those in italics will score two and those in ordinary type will score one. The end result of a totality repertorisation is a small group of remedies each of which carries two numbers, for example: Calc. 4/11 The interpretation is that Calcarea appeared in four of the rubrics under consideration, and achieved a total score of eleven, whilst Sulphur appeared in every rubric (which it usually does!) and achieved a total score of fourteen. This can be helpful in that one gets an idea of the relative intensity of each symptom under the remedies being considered. Card RepertoriesAttempts to mechanise and thereby speed up the repertorisation process were an inevitable development in homœopathy, and the first such attempt was the creation of a card repertory by William J. Guernsey in the late 1800’s. This and the other card repertories that followed consisted of a large number of cards, each representing a rubric and bearing a series of punched-out holes in a particular configuration. When the rubrics in the case had been chosen, the relevent cards would be picked out of the box and placed one behind the other. Where the light was seen to shine through any of the holes, this meant that the remedy which that hole represented was to be found in every rubric chosen. Considering the amount of labour that went into producing the various card repertories they have been pitifully neglected and now look set to become totally obsolete with the advent of computerisation. Probably the best-known and certainly the most comprehensive card repertory, based on Kent’s, was created and developed by Dr. Jugal Kishore of Delhi. This repertory, which is still available, contains about 10,000 cards and even manages to represent the different grades of type as they are found in the book version. ComputerisationThe process of repertorisation is totally mechanical, which is why there now exist computer programmes to replace the books. However, the real skill of repertory work lies in the selection of the symptoms and their interpretation into rubrics, which requires a good working knowledge of the repertory being used as well as an accurate perception of what has to be cured in the patient. The main advantage of computer repertories is still, therefore, a matter of speed - a case may be analysed at least three different ways on a computer in far less than the time it would take to do a single comprehensive repertorisation manually. This allows for totality repertorisations to be carried out far more frequently than would otherwise be possible, as it makes little difference to a computer whether the rubric being repertorised contains twenty remedies or two hundred. Further levels of sophistication have been introduced in recent years which permit homœopaths to carry out analyses using computer software that would be impossible using the book versions. For instance, it is possible to determine which groups and families of remedies feature strongly in a case (see Group Analysis and Thematic Prescribing) and to change the relative weighting given to certain categories of materia medica so that the smaller remedies are not always obscured by the mighty polychrests. Of the various software programmes now available, the MacRepertory system produced in the U.S.A. and the C.A.R.A. system produced in England are two of the most widely used. They share many features in common, including the ability to choose from a large range of different repertory authors and an increasingly vast database of materia medica information, making it possible to switch from repertory to materia medica and back again in the space of a few seconds. The RADAR programme is another popular piece of repertory software which contains an ‘expert system’ designed to mimic the case analysis strategies of George Vithoulkas. Disadvantages of RepertorisationThere are several drawbacks to repertorisation, the first one being that it can be extremely time consuming when carried out manually. The second is that in order to fit them into the format of a repertory, many symptoms have had to be broken down into their component parts. This means that the prescriber is often unaware of the context in which the symptom originally appeared in the provings. Knerr’s Repertory to Hering’s Guiding Symptoms contains a larger number of symptoms in their complete form than most other repertories, but because of this it is even more cumbersome to use. A third drawback is that in order to use a repertory successfully it is necessary to interpret symptoms into rubrics accurately, bearing in mind that the compiler has already carried out a similar process of translation when creating the repertory. The difficulty is that in many instances we cannot be certain exactly what Kent, for example, had in mind when he coined the rubrics ‘illusions of fancy’ or ‘wearisome’ or ‘repulsive mood’. Further Reading Bidwell, How to Use the Repertory, Jain Publishing Co., New Delhi, India Castro, Encyclopaedia of Repertories, Jain Publishing Co., New Delhi, India P. Coats, The Homœopathic Aide-Memoire, C.W. Daniel Co. Ltd., Saffron Walden, Essex B.D. Desai, How to Find The Similimum with Boger-Boenninghausen’s Repertory, B. Jain Publishers, New Delhi, India -------------------------------------------------------- © Ian Watson From: A Guide to the Methodologies of Homeopathy By: Ian Watson Published in the UK by Cutting Edge Publications ISBN 0951765760
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