Independent Research Project
Students of homeopathy are introduced to the repertory very early in their formal training. This introduction begins with an overview of the chapter layout, inevitably Kentian, and the organizational hierarchy of rubrics in those chapters. Over the next three years of study we go on to further detailed explorations of specific chapters and individual rubrics. Becoming an accomplished repertory user is a life-long undertaking. Even with the assistance of computer software repertory and materia medica programs. These programs provide rubric cross references for us, give us master synonyms and concepts, and allow us to search the entire repertory in an instance or quickly generate multiple analysis charts. Most of us struggle with rubric selection during our school years all the while making marginal notes to ourselves on where to find rubrics for specific symptoms and about which authors and rubrics are reliable. As new students we are quick to pick up the repertory. Creating analysis charts gives us a certain satisfaction and provides our first taste of “doing” homeopathy. In our haste to begin producing homeopathy the relationship between the repertory and the materia medica can go entirely unexplored. Once we’ve begun submitting repertory charts for our in-school cases we seldom return to this basic issue.
Our introduction to the repertory can include a general overview of its role in case analysis with specific attention to its application and limitations. On this solid foundation we can then construct a more particular knowledge of the repertory’s chapters, the rubrics we can count on, the authors on whom we can always rely and those valuable cross references that associate remote parts of the repertory for us. As an offshoot to discussing Boenninghausen’s Therapeutic Pocketbook I hope to provide an opportunity to explore the place the repertory holds within the process of case analysis and how we can make the best use of it.
Background to the Pocketbook
Even in Hahnemann’s day there was a need for an index to the expanding Materia Medica. Hahnemann himself began to compile such a work around 1817. His Symptomenlexikon reached four volumes of alphabetically-listed symptoms from his Materia Medica Pura and Chronic Diseases but was never completed. Early ongoing attempts at creating an index during the 1820s and 1830s employed a range of techniques from simple alphabetic listing of symptoms to more complex arrangements based on the characterizations of symptoms expounded in the Organon. These ordered arrangements, undertaken by such notable homeopaths as Boenninghausen, Jahr and Hering, made it easier to find specific symptoms.
It was Boenninghausen who introduced the first repertory of the homeopathic materia medica. This repertory was published in 1832 and was called the Systemic Alphabetic Repertory of Antipsoric Remedies (SRA). With this work Boenninghausen introduced the use of rubrics to summarize lengthy proving symptoms and also introduced a four-tiered remedy grading scheme to indicate clinical reliability. Its organization was no longer merely alphabetic, being arranged now according to the various body regions and systems found in Hahnemann’s Materia Medica Pura and Chronic Diseases. In 1835 the second volume of this repertory, the Systemic Alphabetic Repertory of Non-Antipsoric Remedies (SRN) was published. These two works comprise the first repertory of Boenninghausen and form the model on which our modern repertories are based.
In 1834 Jahr published a repertory based on Boenninghausen’s SRA. Its second edition was translated into English under the editorship of Hering. This version later found its way, via Lippe and later on Lee, into Kent’s repertory. The content and structure of Kent’s repertory is based on Hull’s translation of Jahr’s third edition, the work of E.J. Lee and C.M. Boger’s publications. I won’t attempt to outline the lineage of our modern day repertory as this has been done thoroughly by Dimitriadis.1
Boenninghausen did not cease his efforts to construct a repertory with the publication of his SRA and SRN. At the urging of Hahnemann, he set out to combine these two earlier works into a single volume but gave up the endeavour when he realized that it could not be achieved in a manageable form. It was while attempting the amalgamation of his two repertories that Boenninghausen realized the approach that would result in his 1846 repertory called The Therapeutic Pocketbook for Homeopathic Physicians for use at the Bedside and the Study of Materia Medica Pura – most often referred to as the Therapeutic Pocketbook.
In its original form Boenninghausen’s Therapeutic Pocketbook indexed the 126 remedies from Hahnemann’s Materia Medica Pura and The Chronic Diseases. T.F. Allen’s 1897 edition of the Pocketbook contained 220 additional remedies and omitted 4 from the original publication – Angustura and the three magnetic remedies (Magnetis poli ambo, Magnetis polus arcticus and Magnetis polus australis) – bringing the total to 342 remedies. Allen’s additions are considered incomplete.
Chapter layout and rubrics
Conceptually, Boenninghausen’s Therapeutic Pocketbook is quite unlike Kent’s repertory and those modern repertories descended from it (Synthesis and The Complete Repertory). The Pocketbook’s layout is dramatically different having only seven chapters compared to forty repertory chapters found in Synthesis. The first thing that strikes you about this repertory, aside from the scant number of chapters it contains, is that it lacks chapter headings based on body regions, something that we have come to expect from Kent’s repertory. While the chapters on Sleep & Dreams, Mind & Sensorium, Fever and Change of General State seem familiar enough there are chapters called Sensations and Complaints and especially Concordance ofHomeopathic Remedies that appear completely unfathomable. The remaining chapter is called Parts of the Body and Organs and it too has an unfamiliar layout at first glance.
Regions of the body can be found listed in the Pocketbook but they appear within a single chapter called Parts of the Body and Organs. In this chapter you will find rubrics like: Parts of the Body and organs – Back – Scapulae, Parts of the Body and organs – Ears – External ear, Parts of the Body and organs – Lower limbs – Leg; lower. These rubrics are not unlike those found in Synthesis and contain sub-rubrics referring to more specific locations. However what immediately strikes you is that none of these rubrics refers to any kind of pain or other sensations: they are rubrics of location only.
Looking next at the Pocketbook chapter called Sensations and complaints we find rubrics like: Sensations and complaints – Bones – band around; like a, Sensations and complaints – External parts of the body and internal organs in general – adhesion of inner parts (sensation as), Sensations and complaints – Glands – pressing – outward; from within or Sensations and complaints – Skin – nails – ulcerated. Each rubric describes a symptom sensation (subjective experience) or a complaint (objective experience) but contains no indication in which bodily region the sensation/complaint occurred. These rubrics are rubrics of sensation/complaint only and they are all gathered together in this single chapter just as all the rubrics of location were together in their own chapter. The table below compares the chapter layout of the Pocketbook with that of the Synthesis repertory.
Therapeutic Pocket Book
Looking next at the chapter called Change of general state we see it is divided into two sections called “Aggravation” and “Amelioration”. Under aggravation you will find rubrics like: Change of general state – Aggravation – ascending – high; ascending a height, climbing up, Change of general state – Aggravation – cold air; from – dry, Change of general state – Aggravation – food and drinks; from partaking certain – meat – smoked, Change of general state – Aggravation – weather – dry weather; during. Listed under amelioration you will find rubrics such as: Change of General state – Amelioration – air; in open, Change of general state – Amelioration – head – bending; from – backward, Change of general state – Amelioration – motion; from – continued motion; from. These rubrics are rubrics of modality only and once again they appear in their own exclusive chapter.
The remaining chapters in the Pocketbook function pretty much in the same way. The chapter Mind and Sensorium is devoted to mental states and Sleep and Dreams to those states. The chapter called Fever is extensive and covers conditions of chill, circulation, coldness, heat, perspiration, shivering and stages of fever. The final chapter Concordance of homeopathic remedies is set aside to allow broad comparisons between remedies and is especially useful at the time of the follow up consultation.
A few examples should help demonstrate the workings of the Pocketbook’s chapter arrangement. In the first example we’ll take rubrics from Synthesis for the symptom pulsating pain in the head and compare them to rubrics from the Pocketbook for this same symptom (Table 1 on the next page). In Synthesis a single rubric from the Head chapter, Head – pain – pulsating, captures the description of this complaint. The rubric contains a description of where in the body the symptom is found (its location) and also the type and quality of the symptom (its sensation). The configuration of this rubric follows the Kentian convention – location [Head]; sensation [pain], sensation [pulsating] – that has become familiar to most students.
Turning to the Therapeutic Pocketbook we see that here it takes two rubrics, each from a different chapter, to cover this same symptom. The first rubric addresses the site of the complaint, which is the head (its location) while the second rubric captures the pulsating quality of the symptom (its sensation). In the Pocketbook each rubric is found in a different chapter and covers only a portion of the entire symptom. Table 1 illustrates suitable rubrics for this example from the Therapeutic Pocketbook and also from Synthesis.
|Table 1:Head pain, pulsating|
Therapeutic Pocket Book
The breaking apart of symptoms and the dispersal of those parts in different repertory chapters is unique to the Therapeutic Pocketbook and is perhaps the most difficult feature to adjust to when first starting to use it. However, as will be discussed later on, this same arrangement enables flexibility in rubric selection unequalled by any other repertory.
Next we’ll take up the symptom oppression in the upper chest, worse ascending. This is a more fully described symptom including oppression (a sensation) in the upper chest (a location) that is worse ascending (a modality). This symptom (Table 2) requires two rubrics in Synthesis, as there isn’t a single rubric with oppression in the upper chest that also covers worse ascending. Both rubrics, though, are found within the same chapter, Chest, one covering the description of oppression (sensation) and also its being worse ascending (modality); while the other rubric addresses the specific site of the complaint in the upper chest (location). You would need to combine these two Synthesis rubrics. Turning to the Therapeutic Pocketbook we see that it requires three rubrics to cover this same symptom. We have a rubric that contains “oppression” (sensation) while another rubric covers the site of the complaint (location). The third rubric addresses the aggravation from ascending (modality). Once again each Pocketbook rubric covers a single facet of the entire symptom. As a result this more fully described symptom – with its location, sensation and modality – requires three Pocketbook rubrics in order to represent the complete symptom, one for each component of the symptom.
|Table 2: upper chest oppression worse ascending|
Therapeutic Pocket Book
In a third example we have the symptom: head pain, boring in nature, located in the occiput and worse ascending (Table 3). In this symptom we again have a description of a location, a sensation and a modality. In Synthesis we find a rubric, in the Head chapter, for pain in the occiput made worse by ascending but the rubric does not contain the quality of boring pain. A second Synthesis rubric, also found in the Head chapter, has pain in the occiput that is of a boring nature. So we require two rubrics both located in the same Synthesis chapter. Turning to the Pocket Book we find we again require three rubrics. The first rubric describing the site of the symptom (the occiput) is a location rubric. The second rubric describes the quality of the pain (a boring pain) and is a sensation rubric. The third rubric is a modality rubric (worse from ascending). You may recall that in the preceding example (Table 2: oppressed breathing worse ascending) we found a rubric in the Therapeutic Pocketbook chapter Change of general state to cover the aggravation from ascending. In the current example of boring pain in the occiput we have another symptom with the same modality “worse from ascending”. Using the Pocketbook we go back to the chapter Change of general state and select the identical rubric used in the previous example, Aggravation – ascending from. In the Therapeutic Pocketbook the same modality rubric can be combined with more than one location or sensation rubric in order to create a new combination of rubrics expressing a new symptom.
|Table3: boring pain in the occiput worse ascending|
Therapeutic Pocket Book
Now if in the Therapeutic Pocketbook the same modality rubric can be combined with more than one location rubric or more than one sensation rubric then the obvious question at this point would seem to be – How can you know which of the two locations or sensations this modality really goes with? Or what if the modality goes with the location but not the sensation? Or what if it’s the other way around? Okay, so this is more than one question but the short answer is that there isn’t any way for you to know. A more complete answer to this question would have to include a qualifier: at the stage of case analysis when you’re searching the repertory for rubrics you really don’t need to know this (at least not yet).
The Therapeutic Pocketbook allows you to select any number of rubrics from one of its chapters and combine them with other rubrics taken from the other chapters. You can choose a rubric from the chapter on locations and combine it with one or more rubrics from the chapter on sensations and then add that to any one or more rubrics from its chapter on modalities, whatever it takes in order to sculpt out the description of the symptom. This is one of the hardest concepts to embrace about the Pocketbook while at the same time it reflects a most remarkable insight from the mind of Boenninghausen. We’ll begin the next section with a closer look at several of these insights all of which are embodied in the design of the Therapeutic Pocketbook.
The Therapeutic Pocketbook is the fruit of Boenninghausen’s discerning mind (he was a lawyer by profession) and his propensity for categorization (he was trained as a botanist). We’re going to spend some time looking into several Boenninghausen insights which relate to his method of case analysis and which are completely grounded in the teachings of Hahnemann. We’ll be examining these insights with emphasis on their incorporation into the design of the Pocketbook and how they influence its use. We’ll be discussing them in the order in which they appear listed here.
- Symptoms can be considered as consisting of three components: sensation, location and modality.
- Proving and clinical patient symptoms are often incompletely reported.
- In the recorded provings the most consistent symptom features are the modalities, the second most reliable features are the sensations and the least reliable (most variable) features are the locations.
- The same sensations, and especially modalities, are frequently found in different locations and/or body systems. They are not bound to a single location or system and in fact they are the general characteristics.
- The more consistent (characteristic) features of symptoms are transferable across locations and may be used to complete the missing details of less well described symptoms.
- The uniqueness of a case is often found in its particular combination of otherwise common features.
In 18602 Bönninghausen provided a long answer to a question concerning the (characteristic) value of symptoms in the homoeopathic diagnosis (selection of the most similar remedy), wherein he identifies seven parameterswhich together provide the elements required in forming the ‘complete image of a disease’. These seven were reduced to fouressential components: complaint (sensation),location, modality, concomitant. With this tetralogy Bönninghausen described the complete case (complete image of an illness).Unfortunately, even to the present day, this is erroneously taught as referring to the complete symptom,which however, Bönninghausen clearly defines as:
“…an enumeration of all the sensations and phenomena …every symptom should be given clearly and completely…With respect to completeness in every case the exact location…so also…the aggravation or amelioration … [are to be ascertained]”
I’ve already mentioned that Boenninghausen introduced the use of rubrics to summarize lengthy proving symptoms. This was a significant development in homeopathic literature as it allowed for the construction of manageable reportorial indexes. In Boenninghausen’s repertory this allowed for the reconstruction of complex symptoms through retrieving their separately indexed (in the form of rubrics) representative component features: the features of location, sensation and modality.
Synthesis and the Therapeutic Pocketbook take divergent approaches in representing symptom features as rubrics. Synthesis tends to place each rubric within a chapter bearing the name of a specific location or bodily system. Rubrics within such chapters will contain descriptions of symptom sensations and, where such information is available, also the details of conditions under which that symptom is made worse or better. A symptom represented as a rubric in Synthesis will include as much supporting descriptive detail as possible, attempting to fit all this into a single rubric to be situated within a specific repertory chapter bearing the name of a body location or system. For example
Head-pain-occiput-bending-head-backward-must bend head backward-drawing pain
Rubrics in the Therapeutic Pocketbook are formed in an entirely different manner. The descriptive detail contained in each complex materia medica symptom is abstracted and summarized in terms of its sensation, its location and its modality. This abridged description is then intentionally broken apart, to be recorded as multiple discrete rubrics each of which represents only a single portion – either sensation, or location or modality – of the complete symptom. These independent single-purpose rubrics are then dispersed throughout the Pocketbook and are recorded in repertory chapters which have been set up for each corresponding rubric type – the rubric for sensation going into one chapter, the rubric for location into another chapter and the rubric for modality in yet another chapter
Let’s take an example of a Belladonna symptom from Hahnemann’s Materia Medica Pura which is converted into rubrics for Boenninghausen’s Systemic Alphabetic Repertory of Antipsoric Remedies. The symptom as it appears in the proving reads as follows:
Sometimes complete loss of, sometimes merely diminished, vision, with enormously dilated and quite immovable pupils.
First the complex context-rich proving symptom has to be simplified and reduced to its essential descriptive component features of location, sensation and modality. These components are then represented as separate rubrics in the repertory with each being placed in the chapter that corresponds to that type of symptom component. Each rubric is necessarily quite brief as it includes only a single facet of the original proving symptom. To retrieve this entire proving symptom complete with all of its original meaning you would need to select all three of the (component) rubrics used to record it in the repertory. Boenninghausen used this approach in his earlier SRA and SRN repertories as well as in the Therapeutic Pocketbook. The diagram on the following page illustrates how the essential features of this Belladonna symptom would be represented in the repertory.
From this example you can see that using the Pocketbook is going to require that we alter our expectation about how much descriptive detail we’re going to find in a rubric. Each Pocketbook rubric summarizes a single symptom feature in as few words as possible. However, the lack of specific detail in its rubrics doesn’t make the Therapeutic Pocketbook a blunt or inaccurate instrument. We can still obtain exact symptom descriptions by selecting rubrics from each of the chapters and re-combining them. Boenninghausen tells us the technique we are required to use with his repertory:
“Although each section may be considered by itself a complete whole, yet each one gives but one portion of a symptom, which can be completed only in one or several other parts. In toothache, for example, the seat of the pain is found in the second section, the kind of pain in the third, the aggravation or amelioration according to time or circumstances in the sixth, and whatever concomitant symptoms are necessary to complete the picture and select the remedy, are also to be found in the various sections.”
An example may help to illustrate this technique. The Lycopodium symptom below is taken from Hahnemann’s Chronic Diseases.
Cramp in the calf, causing him to cry out at night, also by day, when sitting with bent knees.
In this symptom we have a location for the pain (calf), its sensation (cramping) and a modifying modality (sitting with knees bent) making it a complete symptom. In Synthesis all three essential features of the symptom are contained within a single rubric found in the Extremities chapter.
Extremities – Cramps – Legs – Calves – sitting – agg.
Repertorizing the same symptom using the Pocketbook requires three rubrics. Each comes from a different chapter in the repertory.
- Parts of the body and organs – Lower limbs – Leg; lower – Calf
- Sensations and complaints – External parts of body and internal organs in general – cramps, cramp-like sensation – Muscles, in the
(3) Change of general state – Aggravation – sitting; while
It’s quite apparent from this example that the two repertories use very different approaches in representing symptoms. In Synthesis rubrics are found in chapters corresponding to body locations/systems, with the exception being the Generals chapter. That is to say, in Synthesis rubrics are always associated with a location. Organizing rubrics this way binds them to their specific chapter location in the repertory. But in the Therapeutic Pocketbook a complete symptom – with a sensation, a location and a modality – has to be represented by at least three rubrics, each of which comes from a different chapter. Consequently a complete symptom cannot be said to be found within any single Pocketbook chapter at all.
Let’s consider a second symptom. In this example you have a symptom almost identical to the first Lycopodium symptom. However instead of the pain being in the calf, this time it is a pain in the abdomen; though it is still a cramping pain and is still worse when sitting. So the sensation and modality here are the same as in the first Lycopodium symptom with only the location being different. Again Synthesis records the second symptom with all the essential details as a single rubric. The second rubric is found in the Abdomen chapter.
Abdomen – Pain – Sitting agg. – cramping.
In Synthesis the same pain sensation with the same modality but a different location necessitates creating a completely new rubric which is recorded in a different chapter. The two nearly identical rubrics are found in different chapters because Synthesis places each rubric within the repertory chapter that corresponds to the symptom’s location in the body or to its specific body system (again the exception is the Generals chapter).
Using the Pocketbook to describe this second symptom we must select a new rubric for the new location, but seeing as the sensation and modality are identical to those in the first symptom we can represent them using the same Pocketbook rubrics we used earlier. The second symptom can be represented this way.
(1) Parts of the body and organs – Abdomen; internal – Abdomen in general
(2) Sensations and complaints – External parts of body and internal organs in general – cramps, cramp-like sensation – Muscles, in the
(3) Change of general state – Aggravation – sitting; while
In these two examples we see how the Pocketbook’s discrete rubrics for sensations, locations, and modalities can be used over and over again to represent different individual symptoms by means of their unique configurations.
There are a couple of immediate advantages designing a repertory this way. First, the repertory remains much smaller due to its being able to represent individual unique symptoms through different combinations of the same stock of component rubrics (this is why the Pocketbook has 7 chapters while there are 40 in Synthesis). Second, it is easier to know where to find rubrics in the Pocketbook. All symptom locations are in one chapter, symptom sensations in another and symptom modalities in yet another.
To repertorize a symptom that includes a description of a sensation, location and modality you require at least three rubrics. A symptom with only location and sensation requires at least two rubrics. This arrangement is simple, direct and predictable. It doesn’t the contain those inconsistent arrangements in rubric organization, that often occur in Synthesis, such as Extremities – Cramps – Legs – Calves – sitting – agg (where the order is location-sensation-location-modality), and Abdomen – Pain – Sitting agg. – cramping (where now the order is location-sensation-modality-sensation). In Synthesis the order of words in a rubric determines its placement within the chapter. Consequently, if you make a change to the order of descriptors in a rubric you also change the location of the rubric within the chapter. This can turn repertorization into a game of hide and seek. With the systematic arrangement used in the Pocketbook this problem does not occur; symptoms are very quickly and easily repertorized.