Producing a Picture of the Natural Disease Using the Method of C. M. Boger
Translated by Katja Schütt and Alan Schmukler
Cyrus Maxwell Boger’s ideas have experienced an unexpected renaissance in recent years. Boger’s approach is based on the concept of the genius-characteristic of the remedy. His views are contrary to the contemporary tendency of “completing” Kent-based repertories, by new and often doubtful additions. The following article describes, by means of an illustrative case, the approach of perceiving and evaluating the symptoms of the case, and finding the remedy, using Boger’s concise tools of the Synoptic Key and General Analysis.
Samuel Hahnemann wrote that “the most difficult part of the task” of the homeopath is accomplished when “the totality of the symptoms that specially mark and distinguish the case of disease or, in other words, when the picture of the disease, whatever be its kind, is once accurately sketched” . Then we only have to choose the remedy that bears the largest similarity to the disease picture.
This process of finding the homeopathic remedy is often rightfully called case analysis, because analysis means separating and dissolving the whole into its parts, and this is what the homeopath does when choosing certain symptoms and repertorizing them. In most cases such an analysis of the picture of the natural disease is necessary, as our knowledge of remedies is insufficient to suggest the indicated remedy, after just getting an overview of the patients symptoms. However, exaggerating this analysis bears the danger of splitting the picture into dissociated symptoms and rubrics, and losing the view for the innate hierarchy of the framework of the patient’s symptoms. This problem will be demonstrated by means of a case. For this purpose, a case was consciously chosen which is neither spectacular with respect to the described remedy, nor to the disease the patient was treated for.
Patient, 50 years – January 2007
Chief Complaint: Exhaustion since the last few weeks.
Falls asleep when sitting down. Regularly falls asleep in the evening in front of the television, sitting with her head inclined backwards and snoring.
Forgets things which were spoken about, and daily agreements.
She has difficulties naming things and therefore frequently calls them “the thing” or something similar.
She is currently on vacation and wanted to undertake much and relax, but is sitting all day in the kitchen and reading.
Only wears convenient casual clothing at the moment.
She is easily overstrained and mentally and physically exhausted, even if only slightly challenged.
The condition ameliorated only once, when she was rambling about the city (“this distracts me”).
Usually she is very dutiful, but at the moment, feels rather indifferent towards her work.
Her husband has observed that recently, she is better able to accept another’s opinion. Ordinarily she often loses her temper, when being confronted with a different opinion.
She often has loud eructations, and frequently passes loud flatus involuntarily. Then she excuses herself, even if nobody is there.
Appearance: Varicose veins on the legs, ptosis, a pronounced nasolabial fold, and dark circles under the eyes.
She has already consulted several physicians. Besides a low iron level, the findings did not reveal further pathologies.
She cannot give a reason or trigger for her complaints. She suffered from a period of nightly anxiety two months prior to the beginning of her actual ailments (waking with anxiety, severe palpitation and great restlessness).
This is the spontaneous report of the patient completed by further inquiries. If a homeopath wanted to consider the chief complaints and repertorize them for the indicated remedy, this patient’s report undoubtedly offers a great many symptoms which could be translated into repertory language, based on of one of the large Kentian type repertories. When approaching the case analysis in this way, the picture of the natural disease is fragmented into many little parts, to which the respective, detailed rubrics are assigned. The hope is that the indicated remedy will cover as many of these rubrics as possible, and therefore emerge from repertorization. It would then be confirmed by subsequent study of materia medica. In the following, possible rubrics from Synthesis 9.1 are given. They are not weighted according to their relevance, but the chronology of the patient’s report :
Generals – Weakness (809)
Mind – Prostration of mind (362)
Sleep – Position – sitting (25)
Respiration – Snoring (89)
Mind – Memory – Weakness – expressing oneself, for (48)
Mind – Memory – Weakness – say; for what he is about to (54)
Mind – Memory – Weakness – words; for (84)
Mind – Reading – desires (18)
Generals – Sedentary habits (28)
Mind – Mental Exertion – agg. (224)
Mind – Ailments from – anticipation (94)
Mind – Occupation – amel. (76)
Mind – Laziness (380)
Mind – Mildness (120)
Stomach – Eructations – loud (64)
Rectum – Flatus – loud (46)
- Generals – Varicose veins (137)
Face – Linea nasalis (13)
Face – Discoloration – bluish – eyes – around, circles (130)
Of course no homeopath would repertorize the disease picture of the patient in this way, but rather chose certain rubrics for repertorization. The criteria for the choice of rubrics are the importance of the respective signs, or combination of signs, in a given case and their qualitative and quantitative representation in the homeopathic materia medica.
Let us consider the last point the first: When reviewing the list of symptoms it is obvious that certain rubrics represent the details of the case quite well, whereas others are less suitable to represent the important aspects of the case. In Synthesis 9.1 the rubric “Mind – diversion – amel.” only indicates a cross reference to the rubric “Mind – occupation – amel”, which does not properly reflect the meaning of the symptom. Moreover, the number of listed remedies given in brackets is between 13 and 809, giving the single rubrics usually a highly different significance and function within the repertorization results. It is assumed that a remedy listed in the first grade in the possibly characteristic rubric “Sleep – position – sitting”, which contains 25 remedies, gets a significantly higher rank than one of the almost seventy remedies of the third grade listed in the general rubric of “Weakness”. The more rubrics that are included into such a repertorization, the more confusing the result becomes, with the need for interpretation. The result might even be meaningless in certain cases. 
Let us now consider the other criteria for the choice of symptoms – their respective significance within the symptomatology of the case. It has always been debated about what constitutes the greatest possible similarity in homeopathy, and whether this is best reflected by the numerical totality of symptoms, i.e. that the remedy covers as many symptoms of the case as possible, or, by the genius – totality, i.e. that the characteristic symptoms of the remedy agree with those of the case. Whereas Hahnemann mentions both of them in the Organon , later homeopaths clearly favored the primacy of the totality of characteristic symptoms. Let me quote Constantine Hering, who represents the view of many important homeopaths. In his article “On forming the disease picture”: he wrote :
“It is always the whole man who is ill, and all that deviates in all his parts and functions belongs together. But in disease there is always a part which is primarily affected, or a function that is primarily disturbed. Starting from this centre we have to get an overview about the signs which form a picture, and to orient our further procedure accordingly. It is always dilettante to focus on single signs, and also to look for single signs. We only have to order the signs according to their value. […] For now the signs have to be emphasized which belong to the centre of the disease; first of all all peculiar and strongly marked signs, and around them the general, vague, indeterminate and unimportant ones. When choosing the remedy not only all these signs, or most of them, have to be covered by the remedy, it also has to cover them in the same degree. The peculiar signs of the patient have to be the peculiar signs of the remedy, and a single sign of the disease picture has to have the same importance as it has within the signs of the remedy. […] Therefore the arrangement of the picture is of uttermost importance, as the signs of the remedy have to agree in their grade with the signs of the disease. To do this is almost always possible although the number of diseases is much higher, whereas the number of remedies is limited. But in diseases always only a few peculiar symptoms stand out, whereas the number of peculiar signs of a remedy is much higher.”
According to Hering, the following principles should be considered when analyzing a case:
The symptoms of the case do not have the same value.
There is a centre of the disease which reveals itself in a certain localization or dysfunction.
The characteristic of the case is represented by the centre of the disease as well as the numerically usually less characteristic signs.
The characteristic of the disease has to be represented in the symptoms of the indicated remedy in the same degree.
Let us try to consider the above mentioned case from Hering’s point of view. The first point would be to determine the primarily disturbed function, to determine the centre of the disease. When reflecting on the patient’s report of symptoms, a general aspect becomes obvious, which seems to underlie every single symptom: The aspect of decrease, relaxation. This aspect is reflected in the mind symptoms (decreased interest in work, weakness of memory, difficulty finding words, problems in judging), on the energetic level (falling asleep when sitting, rapid mental and physical exhaustion when being challenged, no spirit of enterprise although diversions like walking in the city ameliorate), as well as on the physical level (functional: involuntary flatus; tissue-level: ptosis, varicose veins).
The aspect of relaxation would constitute the “primarily disturbed function” and therefore the “centre” of the disease according to Hering, due to its general representation. Contrary to the initially described fragmented case analysis, the picture of the natural disease is not separated into single parts in this method of perceiving the case, but it is consolidated by simple rules derived by analogy. This process of perceiving patterns or repetitions within the symptom picture I want to call case synthesis. Of course, inherent in this process is an analytical function. However, it does not stop here but achieves a synthetical quality, before the conversion into a repertory rubric by means of a generalizing summary.
But how do we find the indicated remedy now? When consulting one of the large, Kent-based repertories, one soon recognizes that they don’t contain generalized rubrics which cover the desired quality of the mental and physical symptoms, as the possible general rubrics given in the Synthesis, “Generals – Relaxation – physical ” or “Generals – Relaxation – Muscles, of” are limited to the physical level. The above mentioned rubric “Generals – Weakness” is useless for the remedy choice, considering the number of 800 remedies listed. Using the mind rubric “Exhaustion – mental” seems to be speculative, as the reason for the patient’s condition cannot be determined with certainty, and would be useless as well as it contains 362 remedies.
Hering’s requirement that the characteristic aspects of the case have to agree with those of the remedy, does not seem to be practicable in the described case, when using current repertories written after Kent’s fashion. This is not surprising, as these repertories conceptually focus on listing differentiated symptoms as much as possible, wherein also lies their strength.
The writings of American homeopath C.M.Boger (1851-1935) offer another view. In agreement with Hering, his main concern was not to lose the overall picture of the patient as well as the remedy, by means of too much fragmenting into single aspects. His attitude is expressed succinctly in the following quote:
“What often makes a cure difficult, is the laying of too much stress upon some particular factor at the expense of the disease picture as a whole, thus destroying its symmetry and forming a distorted conception of the natural image of the sickness. This does not however mean that all symptoms stand on the same level, for certain effects must be more prominent than others, yet be part and parcel of them.”
Boger endeavored to resolve this problem by means of generalization. He analyzed the symptoms of homeopathic remedies and summarized symptoms, and in this way arrived at increasingly more general characteristics. This schema is not found in any other homeopathic literature, in quite this way.
Two examples from Boger’s former lectures on the materia medica given in 1903 -1904 will illustrate his approach. Boger made the first quote in his lecture on Rhus toxicodendron, focusing on the general representation of the aspect of redness in the series of symptoms of the remedy:
“A strand of red runs through its symptomatology. It is not a rare thing to see the urine leaving a red stain or stools that are brick red or red from blood, when it is indicated. In pneumonia when the expectoration is rusty red it is one of the most useful remedies. Then we have dysentery with its red, mucous stools and puerperal fever with muddy, red lochia. A tongue which is dry and red or has a triangular red tip is frequently found in any or all of the above mentioned diseases. Sometimes a bloody, red saliva runs from the mouth during sleep.”
The redness of Rhus tox is characteristic, according to Boger’s understanding, as the discoloration is found in various tissues and many different discharges. The second quote is from Boger’s lecture on Bryonia:
“The provers speak of bursting, splitting, out pressing or tightening pains; simply different ways of saying that the parts seem distended or over-full. The pulse also is full, quick and tense. The affected parts are evidently engorged. There is all-pervading tension and lack of flexibility which even involves the mental sphere.”
With this comment Boger expresses several subsequent generalization steps: First, he summarizes several propositions of the proving report with respect to the symptoms of the pain sensations, which he views as synonyms. The aspect of tension only becomes generally characteristic, as it is found on the physical level with the respective quality of the pulse, in the prevalent emotional state, and also as objective signs. The tendency to affirmatively extend the general impact of the physical level on the area of the mind, is explicitly intended by Boger.
Boger analyzed the homeopathic materia medica in this way and described the results in the repertory General Analysis (GA) and the repertory part of the Synoptic Key (SK), so that they are suitable to be used in practice. [9,10] Usually the number of rubrics clearly decreases when progressively generalizing more and more general aspects. It is also obvious, that only a few remedies represent a certain general aspect in the required manner. Therefore it is not surprising that Boger’s written works contain comparatively few rubrics with a quite manageable list of remedies. Boger’s late work General Analysis, summarizes the characteristics of the homeopathic materia medica in a little more than 350 rubrics which contain about 15 remedy entries on the average. To illustrate this, two rubrics of the General Analysis are shown below which describe the quality of the above example:
GA 232 REDNESS
ACO. Ap. Arg-n. Arnica BELL. Bryonia Chamomilla China Ferrum Lachesis Mell. Mercurius Nux-v.
Opium Pho. Rhus-t. Sanguinaria Sepia SUL.
GA 277 TENSION, tightness
Bry. Caus. Lyc. Nat-m. Nux-v. PHO. PUL. RHUS-T. Sul. Vio-od.
When you understand Boger’s way of reasoning and procedural method, it is clear that the GA and SK rubrics are not just summarized, re-graded or newly interpreted entries of former works written by Jahr, or Boenninghausen’s Therapeutic Pocket Book, but that they are new conceptual creations, to which the assignation of an extended scope is explicitly intended.
The rubrics also demonstrate that Boger used three different grades, despite the few remedy entries. However, the criteria for the grades differs completely from the grading system used by Boenninghausen or Kent. Boger’s remedy entries are all based on the axiom of the general characteristic, which are usually clinically verified to a high degree. The different grades within the rubric only serve to accentuate the differentiation of remedies within the rubric and are not considered in the punch card repertory of the General Analysis.
Boger formulated a total characteristic for each remedy in the form of a materia medica synopsis, in the Synoptic Key, so as not to get lost with all the single symptoms of the remedy. The synopsis facilitates a further pre-selection of the repertorized remedies, and allows one to quickly assess whether the characteristic aspects of the remedy, are similar to the case. 
When considering this reduction of the whole pathogeneses of the homeopathic materia medica to a few, small remedy rubrics, it is clear that similar criteria necessarily apply for the conversion of the patient’s symptoms into the rubrics of the GA or SK.
To find similarity between the remedy and the patient, Boger assigns the concept of “characteristic” from the remedy to the patient and extracts the “genius symptoms” from the symptoms gained by the patient’s anamnesis. Such a “genius of the patient” can be represented in one or several of the following three features:
Bird’s eye view: repeatedly occurring signs in the current symptom picture (= regional generalization)
Anchoring: repeatedly occurring signs in the personal history and possibly family history (= temporal generalization)
Dominance: a sign or combination of signs that sticks out of the whole symptom picture due to their importance
When considering the patient’s symptoms through anchoring or the bird’s eye of view, often certain localizations, organs or tissues, or pathological general symptoms, turn out to be characteristic of the whole case. Therefore Boger’s concept of the so-called “anatomical sphere” is of extraordinary importance. Here we can again see the conceptual closeness to Hering’s “centre” of the disease, that is, the primarily affected “part” with regard to localization, organ etc., or the “primarily disturbed function”.
We now come back to the initially described case. The central aspect of relaxation clearly meets Boger’s criteria of penetration, seen from a bird’s eyes view, as it manifests in several ways in the current symptom picture. It also meets the criteria of dominance, as it is so pronounced, that it overshadows almost all other features. Therefore it seems legitimate to look for a respective rubric in Boger’s tools. The following rubric is listed in the General Analysis :
GA 065 RELAXATION
Aethusa Alo. Ant-t. Arsenicum Calc-c. Caps. CAUS. China Cocc. Colchicum GEL. Helleborus
Hyo. LYC. Merc-cy. MUR-AC. Nat-c. Natrum mur. Opium PHO-AC. Ver-a.
Independent from the grading within the rubric, all 21 remedies listed in the GA rubric represent the aspect of Relaxation as the characteristic of the remedy to a high degree. Therefore, it seems desirable to further narrow down the choice of remedies. The paradoxical fact that the patient did not feel the desire to lie down, despite her weakness, is seen as a peculiar sign that matches the prevailing dysfunction of the disease case. The patient prefers to sit during the whole day, while reading in the kitchen, or sleeping in front of the television in the evening.
This detailed description only becomes understandable through the aspect of dominance and clearly constitutes a qualitatively less valuable aspect than the central sign of Relaxation. Therefore, the second rubric should not be used for mechanical elimination, but only for hierarchization. That is, the repertorization of both rubrics only serves to narrow down the choice of remedies, and to check first those remedies which cover both rubrics. When it turns out that no remedy that covers both rubrics, also truly covers the symptomatology of the case, the other remedies listed in the GA rubric “Relaxation” also have to be checked.
The case clearly demonstrates a situation often met in practice: Subjectivity plays a larger role when determining Boger’s characteristics according to the principle of dominance, than when using the criteria of anchoring and the bird’s eye view. Whereas anchoring and the bird’s eye view can be easily taught and proved by arguments, the evaluation of dominance essentially depends on the individual perception and assessment of the homeopath.
Considering the limitations described, the following GA rubric was used in the above case:
GA 275 SIT DOWN, inclined to
Arsenicum Car-v. CHIN. Cocc. CON. GRAP. Guai. Natrum mur. NUX-V. PHO. Pul. Rhus-t. Stannum
The remedies Arsenicum, China, Cocc., and Natrum mur. cover both rubrics. The former episode of nightly anxiety with complaints of the heart directs the attention first to Arsenicum
In the materia medica synopsis of the Synoptic Key, the following entries are given in the tabular list of Arsenicum modalities:
SK-Synopsis ARSENICUM ALBUM
BETTER: Walking about. […] Sitting erect.
This demonstrates that Ars covers the specific combination of modalities of the case. Further confirmations found in the SK-Synopsis concern the state of mind which is characteristic for Ars, as well as the involvement of the heart, although these had not been present anymore at the moment of consultation:
SK-Synopsis ARSENICUM ALBUM
Fastidious. EXACTING. Fault-finding. ANGUISH […]; nightly
[…]. Heart .. Palpitates; < slight causes.
The patient received Ars Q18 (HAPCO) in repeated doses and recovered within a few days. Since then Ars is her basic remedy, which she requires every once a while at large intervals.
I want to point out that only the part of the anamnesis of the patient’s case history has been used, which was relevant for the explanation of the method. A main focus of Boger’s approach consists in anchoring the current aspects of the personal history and family anamnesis of the patient, especially in the treatment of chronic diseases. In this case, many other Ars symptoms can be found, but also a variety of important indications for other remedies. I also want to admit that the remedy Ars could also have been found using another approach of case analysis and also, that possibly another remedy could have been of use.
This case serves to demonstrate that a small group of symptoms can be intentionally and reliably narrowed down to a variety of remedies which contain the truly indicated remedy with a high probability, when using a synthetical-analogizing method of perception and the respective tools worked out by Boger. The experience demonstrates that the characteristics according to Boger can be frequently derived from the main complaint(s) of the patient. Although the case has only been described briefly, it illustrates the anamnesis technique and a way of finding the remedy by using Boger’s concise repertories.
The practical experiences of the last years of advanced Boger-users demonstrate that the establishment of the homeopathic similarity on the level of the genius of the patient and the genius-characteristic of the remedy, leads to a much higher certainty in prescribing and probability of success, than doing case analysis by means of single, detailed symptoms or the numerical totality of covered symptoms. Why is this so?
On one hand this approach clearly minimizes the initially mentioned danger of over-emphasizing particulars at the expense of the coherence of the whole picture. After using two, small genius rubrics created by Boger, sometimes only one, the choice of indicated remedies is already so small that a further differentiation can be made directly with the materia medica. At the same time, the approach of a generalizing case synthesis, ensures that maximum content can be comprehended with a minimum of rubrics – by imaging the central aspects and dynamics of the chronic case with its hereditary dimensions in a generalized form. It is astonishing to see that often a single GA or SK rubric represents the whole family anamnesis of several generations. Any who now suspect an oversimplification, may consider Boger’s quote from his article “The Genius of Our Materia Medica”, written in 1913:
“Every picture has a motive or central idea, which controls the meaning of the whole. The careful observer tries to find this governing factor first of all, for he knows that it colours the whole scheme and its detection will simplify matters. If there is a multiplicity of detail, the learner is discouraged and soon lost. Indeed, does not simplicity teach the highest form of art? This is a universal lesson, which applies with great force to the study of materia medica and therapy.”
The simplified reduction of the complex symptomatology to a few characteristics serves to recognize what Boger calls the “central idea”. A thorough study of Boger’s homeopathy concept and his concise tools of the Synoptic Key and General Analysis, promote and improve the ability to perceive and differentiate the symptoms of the patient as well as the remedy.
Bene curat qui bene distinguit.
1. S. Hahnemann: Organon der Heilkunst. 6. Auflage, § 104
2 .The generally critically judged quality of the remedy entries in the Synthesis and other large, contemporary repertories is not being discussed, as this would go beyond the scope of this article.
3. The electronic calculating routines of computer programs suggest that these types of distortions can be compensated for by the careful evaluation of rubrics. However, it is doubtful whether this really increases the authority of the repertorization results.
4. Compare for example Organon §§7, 67 footnote, 104, 153, 154
5. C. Hering: Vom Aufstellen des Krankheitsbildes. In: Herings Medizinische Schriften in drei BÃ¤nden. Herausgegeben von Dr. med. Klaus-Henning Gypser. Burgdorf-Verlag, Goettingen 1988, Bd. 1, S. 235.
6. C.M.Boger: Philosophie des Heilens. Müller & Steinicke, München 2002, S.38
7. C. M. Boger: Vorlesungen über Materia medica. Herausgegeben und übersetzt von Dr. med. Klaus-Henning Gypser und Dr. med. Andreas Wegener. Haug Verlag, Heidelberg 1989, S. 103.
7-8. Thank’s to Dr. K.-H. Gypser for providing the original English wording !!
8. C. M. Boger: Vorlesungen über Materia medica. Herausgegeben und übersetzt von Dr. med. Klaus-Henning Gypser und Dr. med. Andreas Wegener. Haug Verlag, Heidelberg 1989, S. 98.
9. C. M. Boger: Boger’s Lochkartei mit General Analysis. Verlag für Homoeopathie Bernd von der Lieth, Hamburg 2002. The GA-Card repertory also contains the titles of the English rubrics and an English numeration, which allows it to be used by English- speaking homeopaths with the appropriate sorting. The Card repertory is now available from Jens Ahlbrecht, who took over the store from Bernd von der Lieth (www.verlag-ahlbrecht.de).
10. C. M. Boger: Synoptic Key zur homoeopathischen Materia medica. Ins Deutsche übertragen von Jens Ahlbrecht. Verlag für Homoeopathie Bernd von der Lieth, Hamburg 2007.
11. The three-digit number before the title of the rubric, indicates the number of rubrics in the punch card repertory of the General Analysis, which contains a total of 341 rubrics.
12. In many cases, a prescription is already possible based on the comparison of remedies by means of the SK synopsis.
13. C. M. Boger calls this, in his method of case analysis of the central area, which constitutes about half of all GA rubrics, Anatomical Sphere, in a letter written to the Indian homeopath L.D.Dhawale, in 1935. Compare M. L. Dhawale: Card-repertorization according to C. M. Boger. Translated and commented on by Jens Ahlbrecht, Hamburg 2003, S. 11. Im Original abgedruckt in: M. L. Dhawale: Principles & Practice of Homoeopathy. Homoeopathic Philosophy & Repertorization. Edited by Institute of Clinical Research, Bombay 1994.
14. The Synoptic Key contains the same rubrics with the same remedies in the chapter “Generals”. Four further remedies are added (Grap. Lobelia Seneg. Sepia) in the Supplemental Reference Table, in the third part of the SK. No further comments are made with regard to the last years of understanding gained of the Supplemental Reference Table for the SK concept and the meaning of the listed remedies. I herewith refer to Jens Ahlbrecht’s article: Das ErgÃ¤nzungsregister des Synoptic Key. In: Boger-Bote. Zeitschrift zum Homoeopathie-Konzept C. M. Bogers. Nr. 1, 2 und 3/2008.
15. The amelioration by walking relates to the amelioration from rambling about the city. This also illustrates that the principle of analogizing must be used frequently when comparing the patient’s symptoms with the characteristics given in the SK synopsis.
16. Arsenicum is only covered by 12 of the 19 initially listed rubrics of the Synthesis 9.1 ! It does not cover all three rubrics of weakness of memory, the desire to read, loud eructations and loud flatus and the pronounced nasolabial fold. With a mere numerical repertorization of all 19 rubrics, Ars only appears in the 18th place.
17. C. M. Boger: The Genius of Our Materia Medica. In: C. M. Boger: Collected Writings. Edited by Robert Bannan. Churchill Livingstone, Edinburgh 1994, S. 126 [Ãœbersetzung: J.A.].
@The article was first published in “Homoeopathie Konkret”, and is republished with friendly permission of Jens Ahlbrecht and the editor of the journal. http://www.homoeopathie-konkret.de/
Dr. phil. Jens Ahlbrecht
Heilpraktiker und Psychotherapeut (HPG)