DIAGNOSIS from the homoeopathic standpoint is arduous, many- angled and essentially individual. It is concerned with the person who is sick rather than with the “disease label” that can be attached to his symptoms.
Robert Platt is quoted as saying in 1947 : “It has seemed to me for a long time that good doctors differ from bad ones in two major respects. The time they devote to history-taking and their ability to interpret a history correctly is the first. The second is their ability to formulate a plan of treatment. I know that I am not alone in thinking that history-taking is the greatest art in medicine”.
A.Hughes, in the Lancet in 1951 wrote : “A history has to be taken-a more difficult, skilled, and accurate diagnostic measure than all the chemical and electrical paraphernalia in use today- and then the patient has to be examined. In these two procedures lie the knowledge, experience, judgement and art of medicine.”
Accurate and painstaking history-taking is at the very heart of the homoeopathic approach for only so can the all-important details of the particular illness and the individual characteristics of the particular patient be arrived at, matters essential for the selection of the Similar Remedy.
In the first place every effort should be made to discover as far as possible what is going on, and what is going wrong, in the body of the sick man; what organs are diseased, what functions are deranged, what tissues are damaged or disordered.
These are pertinent questions, and the answers to them, when available, may reveal a need for surgical, dietetic, supportive, or substitutionary treatment.
It has to be admitted that only too often the best that can be arrived at in this matter of a pathological diagnosis is liable to be inadequate or inaccurate, or both; part of the truth but far from being the whole. Partial truth can be very misleading and is but a poor guide to treatment of the underlying disorder responsible for the symptoms.
Such lesions as can be observed and such findings as can be detected, are often but the end results of a widespread disorder that must be corrected if there is to be any hope of “cure”.
This does not provide any justification for by passing the provisional pathological diagnosis. Nevertheless the risk of being over engrossed in the “part” to the neglect of the “whole” must always be borne in mind.
A careful physical examination must not be omitted, and any X- ray or other investigation must be carried out when relevant and in the genuine interests of the patient.
Knowledge of underlying pathology in addition to possibly pointing to the need for surgical or other ancillary measures, may be of assistance to the homoeopath because of his knowledge of “tissue affinities”. As mentioned in the preceding chapter, the relation of certain remedies to specific organs or tissues may be of significance for therapy when such organs or tissues are known to be involved in the disease process.
Attention must first be paid to the particular Symptoms of which the patient complains, both in relation to the present illness and also any other troubles. The latter may be considered of minor importance by the patient but may well be of signal significance in remedy selection.
It is necessary to listen, as far as possible without interruption, to the patient’s story, listing the more relevant items. While so doing, observation can be made in relation to the following :
Posture : A patient sitting tense and erect on the edge of the chair suggests ARSENICUM ALBUM;
One who flops into the chair and lounges at full length, omitting perhaps to remove his hat, might point to SULPHUR;
Sit there wringing her hands, probably IGNATIA or PHOSPHORUS;
Constant movements, especially of the feet, suggest the possibility of ZINCUM METALLICUM.
Manner : Excited, suggests PHOSPHORUS; apathetic, points to SEPIA; obviously holding back tears, likely to be NATRUM MURIATICUM; haughty and disdainful, indicates PLATINA.
Complexion : Blazing red visage points to BELLADONNA; quick changes of colour would suggest IGNATIA; pallor of lips, ears and fingers would indicate CALCAREA CARBONICA; and so on.
Expression : A scared panicky look points to ACONITUM; a furtive glint in the eye suggests LACHESIS; a bashful, bored appearance may indicate BARYTA CARBONICA; a deep furrow above the root of the nose typifies LYCOPODIUM.
Hair : Dry, lustreless hair would suggest several remedies, among them MEDORRHINUM and PSORINUM; sleek well-kept hair might point to ARSENICUM ALBUM; alopecia areata would suggest PHOSPHORUS; strikingly red lips would point to TUBERCULINUM.
Speech : This is especially worthy of note; a spate of words, uttered rather disjointedly, jumping from subject, to subject, points to LACHESIS; pointificating conversation in the manner of the club bore strongly suggests SULPHUR; readiness to reply with, perhaps, some hesitation for the sake of accuracy indicates PHOSPHORUS.
Clothes : May suggest ARSENICUM ALBUM if strikingly smart and neat; the reverse, a somewhat untidy, unkempt look would point to SULPHUR. Odour : An offensive body odour would suggest MERCURIUS, or PSORINUM; a sour smell of discharges or stools would point to CALCAREA CARBONICA; a pungent cadaverous odour would suggest BAPTISIA; a particularly foul odour would point to CARBO VEGETABILIS or PSORINUM.
The remedies mentioned are just a few examples from the materia medica.
But to return to the patient’s story, further questioning must be made to elicit the details of the symptoms. These are all- important.
Details as to the onset and course of the illness. A sudden onset and rapid development point to ACONITUM or BELLADONNA. Insidious onset and gradual progress suggest BRYONIA, GELSEMIUM or PULSATILLA.
Enquiry must include any possible cause of illness, either recent or remote. The aetiological factor can be of considerable importance as pointing to a definite remedy.
A history of illness coming on quickly after exposure to severe dry cold would suggest ACONITUM; illness ensuing after getting chilled when hot would probably require DULCAMARA; effects of loss of sleep might point to COCCULUS; a history of head injury, perhaps remote, would suggest NATRUM SULPHURICUM; and so on.
Again the character of the pain or other symptom must be enquired into, the sort of pain, the site, the spread, the severity and above all the sensibilities or modalities.
The modalities as mentioned in the preceding chapter are of special significance and often enable the choice to be made between two quite strongly indicated remedies, indicated on other features of the case.
A further aspect sometimes comes into consideration, namely laterality. It so happens that many remedies show a relation to symptoms which are predominantly either right-sided or left-sided or spread in a characteristic manner. For instance :
Symptoms starting on the right side and spreading to the left point to LYCOPODIUM; those starting on the left and extending to the right indicate LACHESIS; symptoms which shuttle from side to side point to LAC CANINUM; pain shooting centrally up a limb points to HYPERICUM; pain shooting down the limb indicates KALMIA; pain spreading in all directions points to DIOSCOREA.
It goes without saying that enquiry must be made as to previous illness, including any treatments given, and also into family history. Indications may arise in these connections for selection of a remedy related to remote causes of illness or possibly an inherited diathesis.
Enquiry into the patient’s background, may be of primary significance in relation to the present illness, namely experiences during childhood, schooldays and after, both social and occupational. In some cases even pre-natal experiences undergone by the mother during pregnancy may provide indications for selection of a special remedy in relation to illness developed in infancy or later.
Enquiries of this kind, whether reached in the first interview or later, are essential to the handling of the case. This is especially so in dealing with the more chronic or long-standing type of illness, for the sick person must be treated in relation to all his or her circumstances and surroundings and not merely as a case of this or that per diagnostic label.
Adjustment to circumstances or alteration in habits or attitudes may be called for in addition to the prescribing of suitable medicine.
From the angle of homoeopathic prescribing it is often helpful to assess the constitutional make-up of the patient. To this end enquiry should be made into matters referred to under physiology and modalities in the preceding chapter.
Individual traits in relation to appetite, food likes, dislikes and intolerances, thirst, sweating and sleep often afford useful information. As do also the general responses to environmental influences, thermal, meteorological and so on.
Important as it is to size up the patient from the temperamental and psychological standpoint it is best to leave enquiry along these lines till the patient’s confidence has been gained by the obvious interest and concern evidenced in the preceding lines of enquiry.
