Clinical Cases Homeopathy Papers

Cycles and Segments Analysis – A Case Presentation

Paul Herscu’s Cycles and Segments
Amy Rothenberg
Written by Amy Rothenberg

Homeopath Amy Rothenberg illustrates Paul Herscu’s Cycles and Segments process with a case of vertigo.

The goal of this article is to give a broad overview on Cycles and Segments philosophy as well as to shed light on some of the more day-to-day aspects of using Cycles and Segments in practice. Paul Herscu ND originally described this way of thinking in the early 1990’s and continues to distill and refined Cycles and Segments with the help of many of those we have been fortunate to teach. I have been using the Cycles and Segments approach to case taking and case analysis for the past fifteen years and have been teaching the material just about as long. I find the internal consistency and focus it affords, helps me organize so much of homeopathic knowledge and streamlines my practice, ultimately helping my ability to help my patients.

 

I did not start out using Cycles and Segments after my naturopathic school homeopathy training.  Like many loving new wives, I was at first resistant to any ideas that Paul had! Trained in the 1980’s, I was, as many a classical homeopath, prescribing most often on pattern recognition; I was always hoping for that “feeling” with patients when I was most certain I had found a remedy that would help. The problem with pattern recognition was that sometimes there was a pattern I did not recognize or worse, I thought I did, yet the remedy did not work. And when it came to teaching, the arbitrariness of that approach did not suit me. I was teaching rudiments of materia medica and the repertory and passing down philosophy as I had been taught, but I grew increasingly dissatisfied. The further I went into practice and into teaching, the more I craved an approach that would unify homeopathic knowledge, that would be logical and eminently teachable. The philosophy of holism was so wonderfully spelled out and eloquently described by our forebears and I, like many before me, could do an adequate job in passing that philosophical part on, yet the practical tools of our trade seemed far from that elegance, at worst reductionistic; the implementation did not echo the beauty of our philosophy.  Add to that, the learning curve was just too steep; I knew the profession was loosing many bright potential practitioners because it was unscientific, there was too little structure and predictability and not much assurance that remedies would work. Some grabbed onto particular philosophies or other natural medicine approaches, the truly disillusioned, left.

 

As Paul formulated his ideas about Cycles and Segments and taught other teachers, colleagues, students and peers, myself included, and received feedback on what worked and what did not, we could both see that the benefits of this unified, organized and always-applicable-to-every-patient approach were going to run deep. Finally we could tell when we were done taking a case. Finally we could see how all the unusual or characteristic symptoms fit into the patients’ stories. Finally we could tell which were the important symptoms in the case, i.e. which minutiae we should pay attention to. And finally, we could understand what the remedy given should do for the patient. The randomness was lessened, the accuracy was improved and ultimately, the patient outcomes were better. When Paul, with help, put the philosophy and practical application into a computer program (the Herscu Module on RADAR) the ability to use Cycles and Segments in the office, with the patient present, became a reality for many. We knew by then we had something that was at once teachable, transparent and relatively easy to master. We could take a frank beginner and in a solid couple of years of dedicated study, have them able to take a cogent, organized case, correctly analyze the information gathered from the patient’s story, from their own observations and perceptions, repertorize with skill and direction, and come up with 6-10 possible remedies or so. This is the right direction for our profession. From there, even most beginners can cross off 2-3-4 remedies and then move to comparative materia medica to help inform their decision on how to choose the best possible remedy for the patient. Also there would now be a short list of other possible remedies to consider at the time of the first follow up visit and the homeopath would not be starting from square one. We have now taken hundreds of students through the process of learning Cycles and Segments. Some were seasoned prescribers, others brand new to the profession. We continue to take and integrate feedback on this approach.

 

Nothing in homeopathy is easy, but it should not be so daunting that it turns away dedicated and well-intentioned providers. By training small groups at first and by creating a supportive network of alumni, we aim to give those who use Cycles and Segments a community in which to practice. The Internet has been helpful in this regard, our alumni Listservs are used often for help with cases, getting feedback, asking about rubric selection and philosophical questions as well as sharing some of the small wonders of homeopathic practice. Our highest goal is that ultimately, our patients will benefit from accurate prescribing and that the potential of homeopathy will be realized. We also keep as an ongoing objective that those who offer care will relish a challenging but not overwhelming job; we love when any homeopath works hard, feels engaged, inspired and also satisfied in work well done.

 

In this article I will share a case and illustrate how to apply Cycles and Segments to a typical patient in practice. While I am taking the case of a patient, I create a Cycle of the patient’s complaints. A Cycle is made up of group of Segments. A Segment is a group of symptoms that represent the same idea.  Below, I will describe the computer program I use to assist me, but the underlying philosophy and approach can be utilized without any computer software as well. With each symptom a patient shares, I think to myself, what is that symptom an example of? And are there other examples in their story? I not only think that question, I pose it to the patient or parent of the patient. My orientation is to hear complaints with this understanding. As I am observing patients, their dress, posture, body language, all the kinesthetic elements I also use in casetaking, I am perceiving those things in context, too. For instance, if I have a patient with abdominal bloating, I would ask what is that an example of? Perhaps it is an example of fullness and swelling. Perhaps they also have swelling around the eyes or swollen ankles. I would put all these symptoms in one Segment as they represent the same idea and then I look for the best rubrics to represent these specific ideas. I would call the Segment : “Swelling.” Sometimes we see Segments that include physical body and mental or emotional concerns, too. In a section called swelling, if it applied, I might also use a rubric like Mind, Haughty. On the other hand, if there was abdominal swelling that was quite firm, I might see that as an example of “hardness,” and would wonder if there were other examples of “hardness” in their story, such as hard nodules in the glands, or tendency for forming hard stools. Perhaps the person was also very shut down emotionally- all examples of hardness. So conclusions about understanding any particular symptom, i.e. to make a generalization about a Segment, are always context dependent and as such, rely strongly on what else is going on in the patient’s story. You cannot predict the way any symptom will fall within the context of the person’s life, but you can make observations and you can have those observations inform your questions.

 

In another case, if I had a patient with tremendous discharge, say chronic loose stool or excessive nasal mucous and they also had issues with anger outbursts, I could put these seemingly disparate symptoms and their related rubrics in one Segment and I might call that Segment “Discharges.” In this way, no symptom takes on disproportionate measure and I am sure that I am looking at the overall tendencies of the patient. I no longer worry that I will not perceive or remember the exact correct rubric, because I am understanding the whole concept of the patient’s pathology. I can also trust that the remedy that will prove helpful to the patient will come through the repertorization. In this way Cycles and Segments liberates the homeopath. We can move away from the striving for perfection and in so doing, do a better job for our patients.

 

The Herscu Module on the RADAR computer program that reflects this approach is straight forward to use and with most all my patients, I repertorize on my laptop as I am taking the case. After an initial period where I work hard to connect with the patient, which includes explaining my approach a bit if they are interested, (I send most new patients a copy of my CD What Every Homeopath Wants Her Patients to Know*, before our first visit) I can be found clicking away as we speak. I am not saying it is easy to do this; i.e. take the case, stay connected to the patient and grounded myself, group symptoms accordingly as they are coming at you, think about rubrics and how to organize them, take adequate written notes AND use the homeopathic software. But as a long-time and competent “multi-tasker,” I love it! Like many others who have come along on this strange ride of becoming computer literate, it is reminiscent of playing a musical instrument. The computer becomes a kind of outgrowth of my thinking. When I had my very first computer in 1986, it was large and took up half my desk and I was awkward with it. Sitting beside or behind one of those behemoths and having to look as I typed interfered with my case taking and I felt some patients feel alienated. But now, as many of us and our patients have computers on or nearby through much of the day and have developed some facility with the tool, patients do not seem to mind. But if that does not work for you, not a problem! Take the case and repertorize afterwards. The most important thing, before you let the patient go, is that you understand the patient, understand all their symptoms, the modalities, the physical generals and most importantly, be sure by the end of your time together you understand what makes that patient tick, what drives their behavior, what most limits them. Grasping their nature, personality wise and their interests, likes and dislikes will all be helpful, too. If you understand all that, as opposed to just an elongated laundry list of problems and modalities, you will be well on your way to finding a remedy that can help.

About the author

Amy Rothenberg

Amy Rothenberg

Dr. Amy Rothenberg is a homeopath and naturopathic physician, writer, teacher and co-director of the New England School of Homeopathy. She was the long time editor of the New England Journal of Homeopathy and is the author of The A Cappella Singer Who Lost Her Voice and Other Stories from Natural Medicine. She teaches Cycles and Segments with her husband Dr. Paul Herscu and lectures all over the world.

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