Need of Pathology – A knowledge of pathology of the disease is necessary to interpret the symptomatology obtained and prescribe the true Homoeopathic remedy not merely the seemingly Homoeopathic one. In other words, our Homoeopathic relationship implies similarity in the mechanism as well as expression or description of a symptom. Isolated symptoms from drug provings and Materia Medica do not do this for us and, therefore, we must be on our guard.
Thus, “Jaundice” is a symptom but can be produced in several ways. In selecting a Homoeopathic drug, we want one which will produce jaundice in the way that the particular disease produced it.
The obstructive jaundice might call for a drug like Myrica or Hydrastis but a jaundice of blood origin would more probably correspond to China or Arsenic. Many drugs have dizziness but this symptom is produced in different ways. It may be aural, gastro-intestinal, metabolic, and each type should have a drug the produces vertigo in a similar manner. Here our choice might be Conium, Cyclamen, or Plumbum.
Constipation is produced in many ways. Whether due to spasm or atony, make a difference in the drug selected. We must match in mechanism as well as in name. Again, the fever, restlessness and so on, of typhoid fever, might call to mind Aconite-but a little thought will show this to be but a partial and apparent Homoeopathic relationship.
Pathology would interpret the fever, the restlessness of the typhoid patient and associate them with the coming prostration, the septic condition, the asthenia-conditions wholly foreign to Aconite which can deal only with Sthenic inflammation and healthy blood. In other words, the sequence of symptoms should correspond to the known pathogenic process of the drug selected.
Pathology which is present is not so helpful after an organic disease has become established. This is beyond the point when Homoeopathy or any other method is very successful. In such diseases, the beginning complaints-prodromal symptoms-are a better guide. Cases Without Characteristic Symptoms
There are cases where it is almost impossible to obtain any very characteristic symptoms and because of the fact all therapeutic results, by any method, are mediocre. Such cases come into our office and say succinctly, “I have high blood pressure, ” I suffer from gas,” ” I have a severe cough,” etc. In such cases, the only plan is to take this basic complaint and give a clinical remedy which has his symptom well marked and to proceed under one of the methods mentioned in a later paragraph.
This is another factor which is of practical importance in the application of our Materia Medica. The usual classification based on the main action of the drug in question is not satisfactory for Homoeopathic purposes though adequate enough to express the crude general effect.
If we accept the U.S.P. classification of such of our Homoeopathic drugs as appear there, we arrive at misleading conclusions regarding the drug’s real value and scope which are distorted and curtailed in the effort to harmonize with certain standards.
Thus, for Homoeopathic use, the face that Lycopodium is a protective, Nux vomica a bitter, Ipecac an expectorant, Aconite a depressant, and Arsenic an alternative-such generalizations convey nothing to help us in our method of drug therapeutics. Indeed, as we consider each drug and individual entity, it becomes increasingly difficult to classify and only broad generalizations can be indulged in without error. A few relationships, however, are academically important for purposes of study and they are also of some practical value.
Similarity of origin or family relation means that a group of drugs belongs to the same botanical family or chemical group. It is not difficult to note certain great features common to these drugs. Usually such features are caused by a common alkaloid or active principle.
Thus the Solanaceae family has certain alkaloids in common (Atropin, Hyoscine, and Hyoscyamine) and their toxic effects are much alike due to this fact. There are about twenty alkaloids in Opium and this family (Papaveraceae) also contains our drugs Sanguinaria and Chelidonium. Aconite, Pulsatilla, and Cimicifuga all belong to the Ranunculaceae family.
One would make a great error, however, to pick out the most important drug of one of these families and consider this knowledge sufficient for Homoeopathic application of the others. There is no short-cut to a drug’s individuality. For example, Sanguinaria, Chelidonium, and Opium though of the same family have vitally different symptomatic indications such as can only be obtained by proving. This is because though containing similar alkaloids they are different in amount and relationship.
Antidotal Relationship – We do not refer here to the well- known physiologic and chemical antidotes.
Homoeopathic antidotes destroy the existing action of a remedy in the body. Similarity of action is the basis of this antidotal phenomena. Thus, Anacardium antidotes Rhus, especially on the skin. Hepar to Mercury, Coffee to Nux vomica, Camphor is the most important general antidote nullifying most vegetable drugs, The proper antidote for each drug is listed in the Materia Medica.
An interesting and little-understood phase of antidotal relationship is the power of a higher potency to modify the action of the same drug in a lower potency. We make practical use of this with a few drugs, notably Rhus. Poison Ivy is best treated with a high potency of Rhus toxicodendron.
Concordant or Compatible Relationship – Hahnemann first made the practical observation that certain remedies act better if given in series. They are not of the same family but of the same family but of wholly dissimilar origin and if given following one another they accomplish more than either alone. The best example is the Lycopodium – Sulphur – Calcarea triad for many chronic cases. In acute patients it has been found that such drugs as Belladonna and Mercurius, Pulsatilla and Sepia, Kali phos. and Ignatia, follow each other well.
Complementary Relationship – Complementary relationship is somewhat similar inasmuch as they must be compatible, but here work done by one remedy is completed by another – complementary action.
This relationship is especially useful in organic diseases where the person is under medication a long time. For example, work begun by Apis is finished by Natrum muriaticum. Aconite is often best followed by Sulphur; Chamomilla by Magnesia phos; Belladonna by Calcarea, etc.
Though by no means a rule such practice is often suggestive and time-saving.
Inimical Relation – This is the very opposite of the above. There seems to be a lack of harmony between certain drugs. This may be so marked that, when following each other in the treatment of a case, disturbances that are hard to analyze make their appearance.
Such a relation seems to exist between Apis and Rhus, between Causticum and Phosphorus, Sepia and Lachesis, and others. Experience teaches that we should not use these remedies in series. It will be observed that all of the above drugs have a somewhat similar disease – producing power and hence this relationship, like antidotal relationship, depends on similarity.
We have no explanation for these phenomena but understanding that drugs are distinct entities with individual powers, we can readily see that certain forces can work advantageously side by side and others by mere contact upset the orderly progress of the case. Beside Practice
In the application of Homoeopathy, cases can usually be considered as either besides cases or repertory cases. If the former, our prescription is based on the symptoms present, but other factors attain importance. A man with a large general practice is apt to prescribe somewhat routinely for certain symptom groups-his results from such a method have been satisfactory and he sees no necessity for the detailed analysis of each case. Emphasis here is called to the use of symptom groups rather than disease.
For instance, there are certain symptom groups (symptoms which are found together) in Pneumonia which practically always call for either Phosphorus, Bryonia, or Veratrum viride. Experience rapidly teaches a physician to recognize such a group and, hence, his work is much simplified. He does not give every pneumonia case Phosphorus, but varies his prescription according to the particular symptom group present. At the same time, this same experience teaches him to consider only a few suitable drugs.
This general truth holds good for all methods of therapeutics. The more remedies there are for a disease, the less reliable those remedies are. The very fact that there are so many drugs recommended brings with it the thought that none of them can be effective. Theoretically any drug may be indicated (in Homoeopathy). But the fact remains that our choice is confined to a minimum, which experience has shown to be suitable to the symptom group under consideration.
Our rules for prescribing at the bedside then might be summed up as follows :
1. Is there anything in the etiology of the disease which would help us to select a drug?
2. Does inspection of the patient and his actions call to a mind remedy?
3. Do the complaints of the patient correspond to the characteristic sensations and modalities of any drug which we can think of offhand?
4. In a case which has “gone the rounds,” are the symptoms present due by any chance to “drugging”? This is frequently overlooked.
Probably, several drugs qualify as possible remedies at this point. We next must reinforce our choice (or eliminate it) by the following questions :
1. Does the elective affinity of the drug correspond?
2. Is this drug seemingly Homoeopathic or actually Homoeopathic? i.e., does it produce symptoms in the same manner that the disease produces symptoms in our patient?
3. Is it capable of similar functional change, similar irritation, similar pathology?
4. Does it correspond to the stage that the disease is then in?
At times, drugs are loosely spoken of as “beginning,” “mid- point,” and “end-point” drugs by which is meant that they, as a rule, are at the peak of their influence at these stages of disease. Thus, Aconite is most certainly a beginning drug-Bryonia one which comes in when disease is well-established-and Lachesis and Arsenic might be classified as essentially end – point drugs- the last stages of disease.
Having selected our drug, the next step is to decide how and when to give it. Only general suggestions are in order and the following are believed to be the crystallized experience of the majority of the school. This does not mean that it is the best, and indeed it has little resemblance to the original rules laid down by Hahnemann.
One thing is certainly true : Unless a man follows absolutely the directions for repetition, dosage, and preparation of drugs and is conversant with Homoeopathic philosophy, he has no right to say, “Such and such a remedy failed me.” It is the author’s belief that very successful Homoeopathic medicine may be practiced as outlined in this book, but he is fully aware that it falls far short of what many consider the proper teaching of Homoeopathy. No method is above challenge, and for the majority of medical cases, the following suggestion seem best :
1. Give a sub-physiological dose.
2. Improvement calls for less frequent dosage and possibly a higher potency.
3. The more clear cut the determinative symptoms, the more justified we are in using a higher potency.
There are other considerations that come up, but these are the three main principles of Homoeopathic dosage.
In general, when a drug has been carefully worked out, the tendency is to give a few doses several hours apart and await results. This is applicable to chronic ailments. It is based on the fact that we want to determine the reaction of that patient, and see whether his symptoms disappear from ” above downwards, from within outwards, and in the reverse order of sequence.”
In regard to the potency used, it will be found that the more carefully a drug is prescribed, the more often one will use a high potency. Sometimes quite definite aggravations follow a good Homoeopathic prescription when too low a potency is employed, and it goes unrecognized, the physician simply thinking that the case has become worse. All this emphasizes the fact that Homoeopathic drugs dare not to be lightly used, and their reaction is to be watched for in precisely the same manner that one would look for manifestations after giving a dose of vaccine.
During the interim, the patient’s natural anxiety in regard to medicine is to be taken care of by judicious resort to a placebo. In acute cases, much more frequent dosage is used and required. In the first place, our prescription is not so exact, being a beside one, and, therefore, aggravation is not so apt to follow. It is probably a “similar” one, but not the “simillimum.” Then, it is certainly a debatable question as to how much and how frequently the body needs this drug help or stimulus.
When the body resources are constantly being called upon to expend vital energy, it seems but logical to aid these forces as frequently as possible. The fact that it is an acute disease also accounts for more frequent changes in the remedy to meet the changing totality as the disease progresses in that patient. Constitutional treatment is particular too, and may only be accomplished by Homoeopathy.
It has a wide field in pediatric practice and is suitable to many chronic diseases. Such a course of Homoeopathic treatment is not accomplished in a week or a month, but truly astounding results accrue after a sufficient length of time has been allowed. It is preventive medicine in the best sense by which pathological discrasures are aborted or cured. All treatment of difficult cases is constitutional, and it has been found that a certain class of remedies are best for this purpose. Such drugs profoundly effect metabolism and physiologic processes, in contra-distinction to the more superficial remedies whose sphere is functional change and whose action is comparatively short.
Constitutional prescribing is never undertaken at the bedside but only after a most exhaustive examination, with due regard to history, physical examination, and laboratory findings. The method differs in nowise from that already outlined in the selection of the drug, but usually requires repertory study and its further consideration will be taken up under the chapter dealing with Chronic Disease and the Repertory.
Tissue remedies are of constitutional nature, but are often prescribed without this careful analysis, mostly on the grounds originally outlined by Schuessler who introduced them. They are especially valuable, if exhibited during the convalescent period of the disease. They also have well-marked pathological pictures which make them a favorite with men who incline to let this be the criterion of their prescriptions.
There are twelve tissue remedies. Tissue remedies are given on a “deficiency” basis. This theory teaches that an unbalanced or deficient inorganic salt content in the cells manifests itself by profound structural and functional changes to which the name of numerous diseases have been given. Dr. Schuessler, the originator of this method, when challenged as to whether this deficiency was cause or effect made answer that ” It is an effect (the nature of the disease), the cause being a foreign irritation….which can cause a deficiency of a cell salt.”
What interests Homoeopaths particularly is the fact known to us that an abundance of a certain cell salt in the blood or food does not mean that this substance is capable of assimilation-if the body is diseased. Thus, in chlorosis, iron may be given in material doses. It is not the amount but the catalytic effect. The body is perfectly capable of taking up iron from the food, if given the proper stimulus.
Incidentally, Schuessler does not recommend iron in chlorosis but Calcarea phos. This furnishes a better stimulus to take up iron than iron does itself. We know that the same conditions hold in regard to the absorption of Natrum muriaticum. Thus, a person can be taking all sorts of salt yet it requires an attenuated preparation to re-adjust the body metabolism. The same is true of Calcarea, Sulphur, and other organic medicinal agents.
We cannot enter into a discussion of the truth and falsity of Schuessler’s theory here-but simply state that the theory has caused a great deal of investigation into this class of drugs and some at least have been carefully proved. Whatever their mode o action, there is no doubt as to their therapeutic value when given on indications outlined in the Homoeopathic Materia Medica.
Clinical Remedies – This is the name given to those drugs which have had a partial or incomplete proving, but whose efficiency has been demonstrated at the bedside. Usually, their entrance into the Materia Medica has come about in this wise : A physician would start to prove an unknown drug and notice, for instance, particular symptoms in the urinary tract.
Having found out the elective affinity of the drug, he would give this to a series of renal cases and note its effect. Besides its beneficial effect in the urinary field (if present), he would observe clinical and curative symptoms which disappeared under this same drug in other parts of the body. From such data a clinical pathogenesis was constructed and, if the drug action was confirmed by other observers, it was incorporated into the Homoeopathic Materia Medica.
There are many reliable clinical remedies in the Materia Medica such as the tissue remedies and many of the drugs spoken about in Hahnemann’s “Chronic Diseases.” Clinical remedies like clinical symptoms depend on the integrity of the observer for their valve. In spite of this drawback, we personally have the greatest respect for verified clinical remedies and many of the most brilliant results from Homoeopathic treatment can be traced to the use of one of these drugs.
As a rule, clinical remedies are given in dosage corresponding to that recommended by the original investigator. In most cases, it consists of drop doses of the tincture or lower potencies.
When a case only presents one or two complaints, often a clinical remedy serves better than an incomplete totality. Illustrations are : Granatum for dizziness Uva ursi for pyelitis, Kali mur. for follicular tonsillitis, Magnesia phos. for crampy pain, Naphthaline for whooping cough, etc.
Use of the Repertory
In complicated cases, where the symptoms do not point clearly to any one drug, it is necessary to make use of the repertory. A repertory is a compilation of symptoms arranged for ready reference where all drugs having a particular symptom are grouped under such a heading. This heading or caption is know as a rubric. A rubric then is followed by a list of drugs which have this particular symptom.
As all drugs have symptoms in greater or less degree, the quality of type denoting the drug also shows how characteristic this symptom is. The secret of successful use of a repertory is to acquire thorough familiarity with any one of the numerous ones by constant reference to it.
This is necessary because the language of the repertory may be different from the language of your patient who describes his symptom, yet both mean the same thing. The use of the repertory is certainly an art in the highest sense, calling for nice judgment and sound evaluation of symptoms. Time consumed is great, but no more so than in many diagnostic procedures which do not pay such valuable dividends.
There are a number of repertories on the market. Boenninghausen, Boger, Kent, and Knerr are general in type and there are a number of special repertories dealing with certain disease only such as Bell on Diarrhoea, Pulford on Pneumonia, and several Materia Medicas also have abbreviated repertories as part of their text, such as Royal, Neatby and Stoneham, Pierce, and Boericke.
The ideal repertory deals only with symptoms yet there are also so-called clinical repertories which, instead of using a symptom as a heading or rubric, employ the name of a disease, thus grippe or influenza would be followed by such drugs as Gelsemium, Rhus, Eupatorium.
Certain general characteristics are common to all. In the first place, the case must have been taken in detail, preferably on a chart of the “B” type (page 155). Having obtained an adequate list of both classes of symptoms, we can now proceed to select one which will serve as an eliminative symptom.
Elimination is the object of all repertory work. We cannot consider all drugs. An eliminative symptom is usually (not always) a determinative symptom, one which is a feature of that person’s individuality of his reaction to environment. Given such a symptom, we argue that inasmuch as the drug to be selected must have this particular symptom, being such an integral part of the picture, it follows that we need only those drugs which do have this eliminative symptom and use this as a major list.
It will be seen that we assume that in this list there is one drug which has the totality of symptoms. This is a tremendous shortcut and very convenient if the eliminative symptom fulfills the requirements, but it is easily seen that a mistake here invalidates all subsequent work, hence, it is usually wise to add to the eliminative or major list such drugs as are seen to recur consistently in the various rubrics consulted. A satisfactory eliminative symptom then should have two characteristics:
1. It should be an individual or vital attribute of the disease in question.
2. It should be followed by a moderate number of drugs. Usually they are to be found among the general modalities, the mentals, or qualified common symptoms of the case.
Having obtained our list of drugs by means of the eliminative symptoms and added to this list other likely drugs from our general knowledge of the case, our next step is to pick out the symptoms which we will use for repertory reference. These are arranged at the top of parallel columns in order of importance. (See Chart C, appendix.)
The determinative symptoms make up the bulk of this chart but enough basic symptoms should be included to clearly picture the case. For instance, such basics as, vomiting, dyspnoea, weakness, fever, cough, polyuria, should be included in repertory analysis.
If several drugs have the majority of the determinative symptoms then, of course, the one which has the basic symptoms most marked is to be selected or vice versa.
A beginner is always inclined to choose the wrong eliminative symptom for repertory work. Thus, he picks out representative basic symptoms such as the above and checks these against the modalities, etc. This is an unsatisfactory and tedious process and has been the cause of many physicians abandoning the repertory as impracticable. Always work from ” General ” to common symptoms. If we keep in mind to deal only with generals in repertory work, our task will be cut in half and we shall find that the common basic symptoms fit in a marvellous manner when our choice has been made.
We have tried to emphasize the importance of the initial or major list of drugs with which to work. Once this is obtained, as indicated above, we have but to check against this list the other symptom in the case. In practice, the list of drugs is usually written in a long column at the left margin of the page, the top is reserved for a symptom list in order of importance. (See Chart C, Appendix.)
Every symptom will have a list of drugs in alphabetical order, some in bold type and others in fine. Now, all we do is put a check mark opposite those drugs in our original major list which appear again under the caption of this new symptom. We pay no attention to the rest in that particular rubric. Thus, we find that perhaps half the drugs in our original list have also this second symptom.
We proceed with the other symptoms in exactly the same manner, and finally, we find that one or two drugs have almost all of the symptoms making up the repertory analysis. Then our choice is determined by referring to the Materia Medica in prescribing that drug whose pathogenesis suits best.
In very large rubrics, and where a particular symptom is a very marked characteristic of the patient, we only consider those drugs which are in bold faced type or italics. This is simply matching relative importance of symptoms and has already been mentioned above.
For instance, if weakness were a marked characteristic of one case, on looking up in the repertory, weakness, we find innumerable drugs but only a few are in black type. We would choose these, abandoning the rest. In cases where there are more than one eliminative symptom of seemingly equal value and further, each symptom calls for a very different set of drugs, it is best to combine them both and use the resulting list rather than run the chance of missing the proper drug. To illustrate the above method in detail, a short case is given in the appendix. (Appendix D and E.)
Dietary Treatment – Hahnemann held most enlightened views of diet and hygiene. He recognized and protested the wholesale use of coffee, tea, tobacco, and alcoholics, yet withal he was practical and his advice well balanced. He pointed out that diet can do much but not all.
He warned against the overuse of condiments and sauces and was against adulteration of food. He also pointed out certain substances which impair action of Homoeopathic drugs. In acute diseases, he pointed out that the instinct of the patient usually guides him aright and his cravings can be judiciously gratified. Adjuvant and Local Treatment
Simple measures are permitted, Hydro-therapy, massage, and physio-therapy in suitable cases. Local applications should be soothing rather than stimulating: Epsom salts, flaxseed, cornstarch, and olive oil. This is especially true of skin disease unless frankly parasitic in nature. “Suppressed eruptions” refer to the possible complications in other organs and symptoms from a skin eruption which has been healed locally.
Thus, untoward constitutional effects though not invariable and possibly delayed are none the less real and furnish at times valuable etiologic data for constitutional treatment. Such necessary application to allay itching, absorb exudate, and soothe denuded surface, should always be of simple nature. Highly medicinal lotions and ointments have no place in proper Homoeopathic treatment.
In these days of highly advertised patent medicines, it is well to bear in mind that camphor is a frequent constituent of sprays, rubs, salves, etc., and this is a general antidote for Homoeopathic drugs. Many Homoeopathic remedies are used locally and at times along with internal administration, thus Calendula is one of our most prized dressings. Hydrastis, Thuja, Hamamelis, Capsicum, and Sulphur are all used externally and internally in suitable cases.
Progress of the Case
The sequence of events from the therapeutic stand-point depends a good deal as to whether it is acute or chronic.
In acute cases, amelioration follows in direct proportion to the closeness of the Homoeopathic relationship bearing in mind of course the natural course of the disease in question. Fortunately this relationship is a relative thing and a reasonably similar drug acts favorably or palliatively leading to a satisfactory though possibly delayed recovery.