There’s been a lot of discussion on the Hpathy Discussion Board lately about how you know when you’re done taking a case. How do you know when to stop asking questions? One person asked, “Is it just ‘sensation, location, modalities’ and then you’re done?” Well, good question! In the March issue, I wrote an article called “A Flurry of Questions” which turned into my famous “Acute Case Questionnaire”:
It might be good to print that out and always have it with you. Building on that article, let’s talk about the reason for these questions.
1. Onset. Why do we ask about onset? Some remedies are famous for their sudden onset, like Aconite and Belladonna. If a patient says to you, “I suddenly came down with a fever…” from 3,000 remedies, you might be down to just two!
2. Etiology. This is the big one, and the one that’s so often over-looked. First of all, to back-track a minute, in case-taking, we need what are called “complete symptoms” and a complete symptom has the following components: etiology, sensation, location, modalities (things that make the symptom better or worse) and concomitants. The etiology means the cause or precipitating factor. You’d be surprised how often it’s the weather! You have to ask your patient, “What’s the weather like where you are?” Cold windy weather can be sufficient reason for an Aconite prescription, especially if it came on suddenly.
Besides weather, other common etiologies include: Never well since the flu or other virus (and the remedy is often Gelsemium, see “Generals: convalescence” in the Repertory and you’ll see there are various subrubrics to choose from which basically mean: Never Well Since this ailment or that ailment.) More common etiologies are: humiliation, mortification, bad news, grief, loss, disappointment, injury, surgery, sleep loss, over-work, drugs, etc. These are all common etiologies to look for when taking a case.
Some of you are going to say, “Why should we base a remedy on the precipitating factor or cause and not on the totality of symptoms the way we were taught?” That’s a very good question! When you have a shock to the system, the vibration will hit and do damage to your weakest organ or system. If I receive bad news, my sciatica might act up. If you receive bad news, your allergies might act up. What should we treat, the allergies? The sciatica? Or the SUSCEPTIBILITY to the shock we received, the weakness that made us susceptible, the “leak”, if you will, the “weak link” that let this vibration in and do damage? If we prescribe on just the totality of symptoms, we’ll find a sciatica remedy, or an allergy remedy. If we prescribe on the etiology (the cause), we prescribe on the weakness that let the shock in.
I’ll give you an example: my very first case was a man, a successful financier from London, with prostatitis, which was causing him quite a bit of trouble including pain, anxiety and frequent urination. He had been prescribed antibiotics to no avail. He was anxiety-ridden because of this problem, and it was ruining his life. I used a logical approach in the beginning and suggested he take Sabal 6C three times a day (that’s homeopathic Saw Palmetto, famous for being a prostate remedy) and it didn’t work. “So much for the easy way!” I said. “Now, tell me when this all started and what was going on in your life at that time.” These are golden questions in the homeopathic interview: when did it start and what was going on at that time? He said he had gotten a promotion at work, but he didn’t feel prepared for it, he didn’t feel adequately trained for it, plus, he was still having to do his old job because he hadn’t been replaced. So, he was being taken advantage of by his employer, plus embarrassing himself (his words) dealing with clients, as he didn’t feel competent in his new position. So, I used the following rubrics from Murphy’s Repertory:
Male: Prostate remedies
Mind: Embarrassment, feelings of
Mind: Indignation, ailments from
Mind: Fear, undertaking anything new
The remedy that covered all the rubrics was Lycopodium. So, the Rx was Lycopodium 6C three times a day in water with 10 succussions (pounding the bottle into your palm 10 times) before each dose. At the end of the first week he reported feeling less anxiety-ridden even though the symptoms were still there. At the end of two weeks, the symptoms were starting to abate. Eventually, we went up to 9C, then 12C and finally 30C and by then he was just taking the remedy as needed AND…he quit his job and got a less stressful one! And now, here’s the interesting thing I learned later: His grandfather died of Prostate cancer! So, here’s our analysis: this man had inherited a weak prostate; so, when a stress came in (the new position he felt unprepared for) it bounced off all his healthier organs, and landed on his weak prostate. So what is the problem here, what has to be cured? His his disposition to become embarrassed and humiliated? Yes! Luckily, the remedy for that is also a prostate remedy! So, this is the significance of etiology. Keep in mind that you’re not always going to find a compelling etiology in every case, but, at least look for it.
3. Sensation. Go to your repertory to the Generals chapter and look under Pains; or in Murphy’s it might also be in “Clinical: diseases, symptoms” or in his 2nd ed., “Diseases: symptoms”. You’ll see there are remedies listed for the following rubrics:
Pains appear suddenly/gradually,
the direction of pains–upward, downward, inward, etc.;
the extension of pains; radiating of pains; pains along the nerves, and other information regarding pains.
Look now under “Symptoms” in the same chapter, or look under “Diseases” in the Clinical chapter if you have Murphy’s Repertory 3rd ed. as I said above, and you’ll see the following rubrics:
Symptoms change constantly/rapidly;
symptoms alternate, and so on.
Here are some examples of sensations you can find in the Generals chapter:
air sensation (that it is blowing on him),
water (as if water were dashed on him),
worms–as if crawling under the skin.
If there is a sensation on a single part, go to that chapter of the repertory and you’ll probably find it. For instance,
Head: bubbling sensation;
Head: crackling sensation;
Head: empty sensation;
Head: expanded sensation, feels inflated; and so on.
This is what we mean by the “sensation”. Be sure and try to find that out. Don’t let somebody get away with just saying that they have a “pain”. That’s not going to help us!
4. Appearance. This can be very important. I recently solved a case based on a patient’s report that he had two identical red spots, one on each cheek, mirror images. That’s Arnica!
5. Location. That is rather self-explanatory. If a person has a sore throat, where in the throat is it? The left side? The right side? Both sides? We have remedies that cover complaints that are only on one side, or that extend from point A to point B, or that wander from joint to joint or go back and forth, so, this question is important to us.
6. Modalities. This is another big one. Very often, this is the deciding factor. I’ve had many cases where “rainy weather aggravates” was the deciding symptom. Modalities are things that make the patient better or worse. If you ask him what makes him feel better, he will often say “nothing” or he will say, “Motrin.” They don’t get it! So, you have to help them out. You can try asking, “What are you doing now because of this illness, what’s it making you do?” The answer might be, “I’m lying here in the dark with an ice pack on my head.” So, this person is worse light, and better cold applications. You’re not going to give this patient Mag-phos, which is definitely worse for anything cold! Do you know what the modalities are? I could never remember them, so I made up a poem:
Temperature, weather, motion and time
Position, reaction to stimuli
Like light, noise, talk, touch
Eating and Drinking
(It’s not so much!)
Please hold your applause ’til the end. What do I mean by these things? Temperature not only refers to the temperature outside but the room-temperature as well. There’s the famous Pulsatilla aggravation from warm, closed rooms, but Nux Vomica is better for this! You will find Nux Vomica wrapped up in blankets, and even the slight draft caused by turning over in bed will aggravate his cold or flu.
By motion, I am referring to remedies like like Bryonia, famous for the inability to tolerate even the slightest motion–even moving the eyes or taking a deep breath can make the complaint worse. On the other hand, a remedy like Sepia can be much improved if he or she can get out and do vigorous exercise, like swimming, dancing or playing tennis.
Reaction to stimuli: Some people can’t tolerate stimulation when they’re sick; odors, for example, will make them nauseous. Look in the Repertory–”Stomach: nausea, odors”. Colchicum is the main remedy here. Others can’t tolerate noise or conversation (“Mind: noise, aversion to”). Others, like Phosphorus, are so much improved by encouraging words that often just the doctor saying, “This is not serious at all, you’re going to be well in no time,” is sufficient to cause a vast improvement in Phosphorus, but not so for Arsenicum, who will simply not believe you! Arsenicum will make you say it over and over again! “Are you sure I’m going to be alright? How do you know? When will I get better?”
A big clue to the remedy can lie in the patient’s food and drink desires. You might be confused between Pulsatilla and Phosphorus, as they both are better for company, worse alone, better for sympathy and both love ice cream, but Pulsatilla is thirstless and Phosphorus is very thirsty for ice cold drinks.
What do I mean by “Time”?
I mean the “aggravation time”, the time your patient gets worse. Look in the Generals section of your repertory and go to “Time”, or, in Murphy’s, go to the Time chapter and scroll to either afternoon, evening, night, or morning, and check out the sub-rubrics for the exact time. You may be surprised to see how time plays a role in your patient’s ailment that even he may not realize! I remember a cold I had once where the cough came on at 11:30 every night without fail! It’s in the Repertory. “Cough: night, 11:30 PM” and the remedy is Coccus Cacti. Unfortunately, I didn’t have any Coccus cacti at the time….
“Position”, what do I mean by this? Position can be an important clue. What if your patient is all bent over double? Go to Generals: doubling up of the body–Mag-phos. and Colocynth are the main remedies. Is there anything note-worthy about your patient’s position?
7. Concomitants. What’s so important about these? These are the symptoms that are associated with the complaint, along for the ride, so to speak–they are often PECULIAR! The concomitants can be the deciding factor in your remedy choice. Consider this:
Headache with nausea and vomiting–Ipecac
Headache with sudden outbursts of temper–Staphysagria
Headache with excessive salivation–Mercury
Headache with despair–Aurum
Headache with restlessness and anguish–Arsenicum
Same complaint, different concomitants, different remedies!
8. Discharges. Remember the color, odor and consistency of discharges. My mother used to say, “Why do you have to know all these things?!” (Sorry, Ma.) Look at “Generals: mucus”, and all the sub-rubrics.
9. Generals. What are the generals? They’re the “I” symptoms. “I’m hot! I’m cold! I’m thirsty! I’m sleepy, don’t bother me.” I could never remember the Generals either, so, I’m afraid I wrote another poem!
Warm or cold?
Restless, dull, or weak?
How’s your thirst or hunger: for salty, spicy or sweets?
Are you sweating? An odor? What, where and when?
A repeating modality…
And now we’re at an end.
Oy vey! Yes, I know, I was running out of steam when I wrote that one! So, what do I mean by Sweating…what, where or when? It means what exactly are you sweating? Go to the Perspiration chapter in your repertory. You’ll see that sweat can be acrid, bloody, burning, clammy, cold, hot, oily, warm….You’ll see that there are aggravation times for sweat, there’s a variety of odors to choose from, a variety of stains and colors; let me just say that Thuja is known for its oily perspiration, and Sulphur is known for sweat on waking, and of course, some remedies are famous for sweat on certain parts, like Silica for it’s sweaty feet where the perspiration is said to actually eat through the socks and shoes! I’m just reporting what I read, folks!
10. Mentals. Just make sure the mentals have something to do with the case and aren’t normal mentals like “I love animals!” Plus, your usual mental state is not a part of the case! If you’re a big cry-baby all the time, don’t add it to your acute case; and, if I haven’t been clear, don’t repertorize anything that you ALWAYS have, just what has changed since you got sick.
11. What Are You Saying? This is a big one; for example, the Lachesis patient may say, “I need air, I’m suffocating, I’m choking, I need the window open.” (Lachesis is a snake, and the throat is the most vulnerable part of their body, the place where they can be grabbed and controlled.) Someone else might say, “There’s too much air in here, close the window!” Nux vomica says that. “Please don’t leave! Do you have to go? Can’t you just stay another minute?” Arsenicum says that! Pulsatilla might say that too; but the difference is, you actually feel sorry for Pulsatilla but Arsenicum makes you feel trapped, like he has no compunction about keeping you there forever against your will! So be sure to ask your client, “What have you been saying?”
12. Thirst. The amount of thirst, the desire for warm or cold or ice are all very important in differentiating among remedies. Food: do they want cold or warm? Sweets, salty, spicy? More importantly, if they’ve changed their food or drink desires since they became sick, this is really important. There was one case of sore throat I solved with the information that the throat felt better with spicy food—so peculiar! This person needed homeopathic red pepper! (Capsicum)
13. Fever. When taking a fever case, first ask if they’re dry or sweating. Next ask about their thirst. Then ask for the concomitant:
Fever with nausea, fever with irritability, fever with anxiety, fever with diarrhea, restlessness, chills…. What organ or system is malfunctioning? What time of day or night does the fever come on? Any discharges? Example:
Fever with yellow nasal discharge and thirstlessness–Pulsatilla. Fever with nausea, diarrhea, chills, anxiety, burning pains, thirst for frequent sips of water, worse around midnight–Arsenicum.
14. Sweating. We’ve already gone into that. Where on your body? What time? After doing what? Does it have an odor? A color? Is it oily? Profuse? etc.
15. Odors. Sometimes odors can be indicative of the remedy. Foul odors will lead you away from remedies like Aconite and Belladonna and more toward the toxic remedies like Mercury, Baptisia and Pyrogen.
16. Striking, strange, rare and peculiar. We’ve touched on this already. Suffice it to say that the common symptoms of a complaint will rarely help us find a remedy, a symptom like “sore throat” is useless to us, so is “headache”, that’s the reason for all these questions. We need “complete symptoms”, remember? We need the etiology, sensation, location, modalities and concomitants.
Now, P.S., I’ve added a few more questions to my questionnaire since I first wrote this article. One of them is, describe your tongue. Mercury, for example, has a “scalloped” (indented) tongue–the teeth make an impression on the perimeter; Ipecac has a smooth red tongue with no coating, Rhus tox often has a red tip in the shape of a triangle.
If the patient has a cough, you have to ask him if it’s dry or loose and you have to ask him what it sounds like. Does it sound like a rattle? A seal barking? A saw “sawing” through wood? Is it a painful cough? Does it hurt your chest? Your throat? Your head? What sets it off? It could be a tickle in the chest or throat, it could be deep inhalation, it could be that the previous cough sets off the next cough and it just escalates from there. Do you cough anything up? Describe it. Then you have to know what stops the cough: cold drinks? Hot drinks? Sitting up? Eating? Lying down? And so on.
I also ask, “What is your energy like?” Some remedies have a very characteristic “look” about them. Rhus tox is very restless. The longer they sit or lie still, the worse they get. They have to keep moving, turning, walking, etc. Gelsemium, on the other hand, just wants to lie down and sleep! Arsenicum is very weak and yet is very restless and agitated; so, sometimes this question can tell you all you need to know.
I ask what is most peculiar or striking about the case? A person might say, “It’s that I’m so whiny!” Or, “I can’t stop drinking! As soon as I finish one glass of water, I pour another.” Or, “All I want to do is drink!” Now surely you know that your remedy has to cover that.
I ask people to tell me what they eat and what they “take”. Why? You may come to see that their food choices or drugs are causing the whole case! If you know they’re taking a Rx drug, look up the side effects, you may find the complaint there!
I ask if they’ve been given a diagnosis. At the very least, this tells you what chapter you should be in. For example, let’s say you have a patient with dullness of the mind. Why? Is this dullness because of an accident? Then the remedy would be Arnica. Is it dullness because of a fever? Then the remedy could be Gelsemium. If you can put the symptom in a larger context, you’re much better off.
If you don’t ask these questions, all you’ll get from your patient is, “I’m sick!” or “I don’t feel well” or “I have sinusitis.” Or, “I have a headache!” and so on. Too many remedies come up for these general statements, you have to have a way of narrowing them down to 2 or 3 choices, that’s the reason for the questionnaire!
Elaine Lewis, D.Hom., C.Hom.