How To Take A Case
Questioner: Elaine, I have been interested in homeopathy for over 35 years, before almost anyone in the US had heard of it. It was hard to even find a book of any kind about it at that time. However, I persisted and through the years have participated in study groups, attended school in it for 3 years, and have taken advanced courses of study since then. I have a library of books, homeopathic software, yet I find homeopathy very unreliable. I can’t seem to make it work!
Elaine: What are you trying to do? Are you trying to find the constitutional remedy for people with sore throats, viruses, ear infections, insect bites, PMS, headaches from being out in the sun, upset stomachs from bad water, abscesses from periodontal disease, pains from over-lifting, seizures from vaccinations and other things like that? Because if that’s what you’ve been trying to do all these years, no wonder you can’t make it work!
People think they have to take a two hour constitutional case for every complaint that walks in the door. We hear so much about constitutional prescribing and how to find the constitutional remedy that we sometimes forget that a patient may come to you because of something totally unrelated to his or her core personality!
What people really need to learn is acute and emergency prescribing! Here’s the information you need to get from a patient:
1. What’s wrong, what is the matter? (the diagnosis, the name of the complaint, how it presents, etc.) Describe in detail.
2. When did it happen?
3. What caused or precipitated it? (They might deny knowing, so you have to prod them, “What happened the day the headache started or just before, retrace your steps,” etc.)
4. Did it come on suddenly or gradually? (Some remedies are known for their sudden onset of symptoms. You most likely wouldn’t give Belladonna for a complaint that took days to come on.)
5. What’s different about you in general since this complaint started? How have you changed; for example, your thirst, your sensitivity to temperature, company, noise, need for sleep, appetite…what’s different about you? (You see, what you DON’T want to hear about is their chronic state! Kent warned us to keep these two separate.)
6. What’s the local sensation: the pain, the itch, etc., describe it; what is it like, does it radiate, move around, extend anywhere, etc.?
7. Where is the complaint located?
8. Think of everything that makes your complaint both better and worse. This is the question pertaining to what we call “modalities”–factors that influence the case. If we don’t get any information on modalities, God help us!
9. What else is wrong, unusual or different? This is the question pertaining to concomitants. Concomitants are “fellow travelers”. Anyone can have a “cold” or “headache”, but, how many people have a headache with: Crying? Thirstlessness? A burning watery discharge from the eyes? Burping? This information narrows down the field of remedies considerably. You add the modalities and concomitants into the case and you could be down to just three remedies before you know it!
So, look at this: You’ve got a cold that’s miraculously better in a hot shower, worse at night, inexplicably attended by forgetfulness and confusion… What’s the remedy? Rhus tox! How did we know? We asked for the modalities and concomitants!
10. What is peculiar, is there anything unusual or striking about this complaint? Here we’re looking for keynotes of remedies. What if your patient says, “I’m fine as long as I’m fanned! As soon as the fan is turned off, I become distressed, restless, and I need for the fan to come back on!” Well, you’ve got to be thinking about Carbo veg. here! And perhaps Pulsatilla too. You can’t ignore this symptom, the remedy has to cover it! This is much more valuable information than a patient saying, “I have a cold”.
11. What is your energy like? Are you nervous, moving about pointlessly or are you inclined to just lie or sit disinterestedly or anything in between? For example, Gelsemium and Baptisia will just lie there. They may want something but it’s too much trouble for them to ask for it or even to reach for it–even if it’s right next to them! On the other hand, you have Arsenicum who is so anxious and restless, she can’t lie still, has to jump up out of bed even though Arsenicums are usually weak and prostrated. So ask, “Describe your energy.”
12. Ask, “What are you doing/what are you saying?” Just imagine if a person keeps saying, “Don’t go! You can’t leave me!!!!” What remedy is that? It’s Arsenicum, of course!
13. If there are discharges, what is the color, odor and consistency of them?
14. Are odors an issue in this case?
15. What do you look like, anything telling about your appearance? Droopy eyelids, bright red lips, purplish discoloration of eruptions, etc.?
Now, if you can get this kind of information out of your patient, and you have your repertory software, which makes things easier for you, you should have no trouble solving the case!
Remember, if your client has a specific diagnosis, like measles, teething pain, kidney stones, etc., this makes your job easier! At least 80% of the time, your remedy is right there in that rubric! You don’t have to say to yourself, “My client has kidney stone colic, it could be any one of 3,000 remedies!” No, it’s in the rubric for kidney stones; then, you need the information listed above:
The location: which side is the pain on? The sensation: what’s the sensation, what does the pain feel like? The modalities: what makes it better or worse? The concomitants: what else is wrong at the same time? What are you doing (for instance, walking bent over or pulling the knee up to the chest when lying down?
Also–and here’s a big mistake people are making–they are repertorizing a case that has a clear etiology! If you’ve got a clear etiology, stop repertorizing (unless the etiology rubric contains many remedies) but by and large, we know that ailments from from fright is Aconite, we know that ailments from acute grief is Ignatia, we know that ailments from blunt trauma is Arnica–we don’t need to take the case when we know the etiology!
If you have Ailments From injury, the remedy is most likely Arnica, never mind what the symptoms are! If Arnica doesn’t work, THEN you can go repertorize!
Here’s something for you to remember: Ailments after head injury? It’s almost always Nat-sulph., never mind what the symptoms are!
Ailments from acute grief? It’s almost always Ignatia, just give it!
Ailments after anesthesia? Just give Phosphorus!
A lot of our cases are “Ailments From” or “A/F” cases. After you’ve given the remedy, then you can repertorize if you want, in case the “Ailments From” remedy doesn’t work but, give the obvious remedy first. Another way we have of saying etiology is NWS (Never Well Since). Start learning to look for your “ailments from” rubrics.
No matter how careful I am to find the similimum I usually get no results.
See, again, I would have to ask, the simillimum of what? Of the sprained ankle? Almost every patient has something like this; be it asthma, arthritis…something that’s hindering them. If not, then by all means, take a constitutional case.
I have had the occasional success, but strangely they were the ones where I would just prescribe something off the cuff without much study at all just knowing the keynotes.
Keynotes are not to be pooh-poohed! They are often the “strange, rare and peculiar” symptoms which Hahnemann says the remedy simply must cover! It doesn’t surprise me that you were able to solve cases using keynotes! Maybe you should have done more of that! What are keynotes of a remedy? They’re what a remedy is known for, what enables you to recognize it. What are the keynotes of New York City? The Empire State Building, Broadway, rude cab drivers–none of whom will stop for you let me tell you! Grand Central Station, Madison Square Garden, intolerable traffic, reckless drivers, buildings without elevators, lack of parking…It’s the same thing for a remedy! There are things we call “keynotes” that a remedy is known for. My teacher, Robin Murphy, always used to say, “If you see a keynote of a remedy, give the remedy!”
What are the keynotes of Arsenicum? Chilliness, anxiety, restlessness, fear of death, unable to lie still, weakness, begging for help, desire for company, desperately seeking help as if their life depended on it, critical, judgmental, fastidiousness.
What are the keynotes of Gelsemium? Weakness, shakiness, feeling sick, not up to the task–whatever the task is, dizzy, dull, dopey, stuporousness, chills up and down the back, droopy eyelids, thirstless and apathetic.
What are the keynotes of Bryonia? Bryonia cases almost always consist of some kind of very sharp or severe pain which is worse for least movement, even inhaling! The nausea is also worse least motion, even worse lifting the head off the pillow. Bryonia is usually dry with great thirst. He does not want company because company always asks questions and Bryonia is worse for answering. With any complaint, Bryonia is worse for least motion. However, Bryonia may be better for hard, firm pressure. They may want you to press hard on their headache, for example. You will see Bryonia lying perfectly still.
So, you see, the keynotes are the traits that allow you to pick a remedy.
I see homeopathy apparently flourishing all over the world now, new systems have popped up, people report miraculous results, and yet it has never worked for me.
I am suspecting you have never learned to crawl before you tried walking and running. You’re supposed to take a course, go to a homeopathy school. It’s like you see a drummer playing and you say, “Hey! Give me the sticks, I wanna try!” It looks so easy, like anyone should be able to do it. And it never occurs to you that the drummer took lessons.
I would love to be a homeopath but I could never practice something that is so difficult and prone to failure in my own experience. Does anyone else find homeopathy as frustrating as I do??
I have the feeling that most people do, especially if they don’t know what it is that has to be cured! I’m sure many people think you get a repertory or software, you add up all the symptoms in the case, even the ones from childhood, and the remedy that comes out on top, the “winner”, so to speak, cures everything in the case. This “method” is bound to disappoint most of the time. You’ll wind up with a 15-way tie for first place! No clear winner. Why? You’ve lumped everything together! Migraines, PMS, fear of flying, sciatica, gum disease, adult-onset diabetes….No single remedy is going to run through all of this! Start with what is bothering the patient right now. It may be as simple as an ear infection. Treat that. The patient may never come back because there was that one thing that kept him from school or work, but, sometimes, that’s all a person wants, just to get his life back!
Acute vs. Chronic Prescribing
Elaine, that’s good! Acute prescribing brings back the confidence which one has lost due to following frustrating software and new concepts propagating all the new season. But one thing……what if some chronic patients enter in the clinic? Chronic in the sense that they are suffering from chronic asthma, chronic dysentery, lasting cough, constipation, spermatorrhea, leukorrhea etc. Many of our medicines work for acutes like allopathy (speedily) and patients feel better and ready to go for work next day but for chronic again there should be some working short cuts. Are there?
Dear Dr. M,
If you check the April, 2011 ezine, the quiz answer called, “Revisiting: Asthma Since Childhood”, here was a life-long condition, an asthmatic cough, that resolved in half an hour after the remedy was given! Why? Because it was a perfect Spongia case, even though it had gone on for over 20 years!
I remember another asthma case; the patient had asthma for 15 years, ever since he worked in a construction site where there was always dust! I prescribed Blatta, which also matched the modalities. When I saw him again a week later, he was all smiles! He was amazed! He had endured asthma attacks every night, debilitating, frightful attacks.
Now, notice, I didn’t try to find the constitutional remedy here. God only knows what that might have been; consequently, the case was solved in minutes, not hours– it’s not always appropriate to be taking a constitutional case.
So, this is just an example of how even in a chronic case, you can still find a proper remedy to end a person’s suffering.
The confusion enters from the perceived need to find the “constitutional” remedy in every case, meaning the remedy that matches the patient’s “essence”, which often involves taking a 2 or 3 hour case and often overlooks the suffering in the case (the distress, the cough, the itch, etc.) with the expectation being that the constitutional remedy will cure everything that the person has; so, now everything gets thrown into the repertorization: the side-effects from allopathic drugs, the acute complaint, the experience from childhood, the malaise from eating sweets and junk food….you can just imagine that a repertorization of such a hodge-podge will yield nothing!
The homeopath has to begin by separating the case out:
1. What symptoms are drug side-effects?
2. What symptoms can be explained by junk food and missing meals?
3. What’s the most recent symptom in the case?
4. What is consuming all the patient’s time, energy and attention?
5. What is life-threatening/Is there a disease here?
When you finish catagorizing and putting the complaints in order, you can see what actually happened to the patient. You can make logical statements like:
“The patient is currently obsessing over the loss of his cat, dwelling over how he should have done this, and should have done that, ruminating over when he could have jumped in to save the cat’s life, reliving every detail …. Remedy: Nat-mur.”
Is Nat-mur his constitutional remedy? Who knows, but it matches where all his time, energy and attention are going at the moment. When that has resolved, the case can be retaken to see what has moved to the surface. He will, of course, need to be told that his diet, alone, can lead to numerous conditions and diseases like depression, anxiety, bowel problems, headaches, fainting spells and so on. It’s possible that with a change in diet alone, half the case may disappear!
Well thanks, Snoopy!
If now we re-take case after let’s say 7 days, but Nat Mur or the remedy which gave relief to patient has duration of action for say 30 days; what should be the protocols then?
Dr. M, are you still here???? OK, let me see what it is that you’re talking about. Right. Well, first of all, a remedy like Nat-mur–or any remedy, for that matter–doesn’t have an action for X number of days the way allopathic drugs have an expiration date. A remedy can be completely used up in seconds if the complaint is intense enough!
Here’s the situation: We’ve given Nat-mur because the patient had a grief, was dwelling on the past because of a loss and ruminating over what she might have done wrong or could have done better. We gave the remedy and now the patient comes back a week later and reports that she’s stopped dwelling on the past and has moved on. All is well. If she has no other complaints, then we do nothing. However, if she says, “The only thing bothering me now is this asthma I’ve had since childhood! I have this asthmatic cough, it’s dry, brassy, it’s worse at about 10 or 11 at night, worse in sleep, worse lying down, worse in the wind, and I get this oppression of the chest and choking feeling. Do you have a remedy for that?”
Our feeling about Nat-mur at this point is that it stimulated the vital energy to rebalance itself out of the stuck position it was in and so the question of whether Nat-mur “still exists” and for how-many days is quite irrelevant to us. First of all, we can’t possibly know! There’s no way to know! Is Nat-mur “there”? Is it rattling around? Is it gone? Does it matter? We only know that we’ve got a patient who’s cured on the mental/emotional plane but suffering on the physical plane with asthma; that’s all we know!
There is no basis for making the statement, “Let’s do nothing for 30 days.” Based on what? Why not do nothing for 40 days? Why not 10 days? What are we basing this assertion on?
You might say to your patient, “How distressing is this asthma? Can you live with it? If it’s not serious, and since you’ve had it all your life, you might want to just wait another week or so just to make sure Nat-mur holds; however, if the asthma is quite distressing, then I think we have to give a remedy for that right away.”
Does that help?
When To Make Your Own Remedy
Elaine, this is Marge of Green Gables again. Have you ever written a book ?
No, but I’ve written so many articles, I should probably just smoosh them all together and call it “Elaine Lewis’ Greatest Hits!”
Ha! A Best Seller. Sign me up.
Finally, a sale!
Had a question for you.
Last night in middle of night I took a navel orange to eat.
A sailor on leave? You didn’t pick up the check, did you?
I took a small bite and felt a tingling down my throat. I threw it away.
(He was probably no good for you anyway, Marge.)
Hmm…I’m suspecting maybe food coloring or pesticides….
The after taste lasted quite a while.
Geez, you can’t even trust an orange from the Navy!
Then I opened another one. And ate that.
This morning felt a heaviness in my chest.
I didn’t know quite what this called for…
I took a bioplasma 12x a couple of times and the heaviness left.
I’m guessing that it called for Bioplasma 12X.
But, the heaviness returned much lighter with bitterness in mouth.
Just took Nat-sulph.
But, wonder what else would have been more effective… Arsenicum ..?
In a case like this where you know the etiology (the so-called “orange”) and the symptoms don’t really show a clear remedy picture, the thing to do is make a remedy out of the orange! I would let a piece of it, including the peel, soak in a little water (I’d mash it up); then use the water to make a remedy from. See my article, “How to Make Your Own Remedy”, it’s on my website: elaineLewis.hpathy.com
About 2 years ago, I had food poisoning that put me in the hospital for several days.
I am sure that was an Arsenicum moment…
No doubt; but remember, when the etiology is clear, and there’s no “remedy picture” to go on, or you’ve tried a number of likely remedies and nothing has worked, you can always make a remedy out of the food that caused the problem as explained above. Mix it all up (because you won’t know if it was the meat or potatoes or the creamed corn), and let it sit in water and then make a remedy out of the water.
Never Treated The Injury, Now the Pain Is Chronic; Do I Need My Constitutional Remedy?
Hello. About six months ago I strained my back by making a sudden exertion from a sitting position (in the car). After a few days, the acute pain passed away but ever since I have had a persistent generalized pain in the lower back. Stooping, just to tie my shoe laces for example, reminds me of this condition every day, although the pain is bearable.
I read that Lycopodium can be useful in these cases and certainly seems to fit my mental condition perfectly:
MENTAL AND EMOTIONAL ASPECTS: Can be dramatic, creating mountains out of molehills. Insecure and dislikes change. Avoids commitment. Fear of failure. Anxious over important events. Deep fear of being alone and of the dark. Forgetful. Finds trivial mistakes disproportionately irritating. Hates being contradicted.
Should I try this remedy? If so, in what doses ?
I’ll be grateful to receive any further information on this topic.
Let’s say for the sake of argument that you “are” Lycopodium, it probably wouldn’t have any effect on your back pain because it wasn’t your fearful “personality” that led you to make a sudden leap in your car which injured your back! The case of your pain needs to be taken. That means:
1. finding out the exact location of the pain
2. the exact sensation, like is it: cutting, stabbing, aching, sore, etc., extension of pain (extends down the right leg, for example, or extends upward)
3. the “modalities” (factors that make the pain worse or better); you may be better by bringing your knees up to your chest, or lying on a hard surface, or by limbering up or taking a hot shower; or, you may be worse by cold damp weather, stooping, cold bathing or applications, etc.
4. and finally, the concomitants (any secondary issues that may accompany this pain or condition).
Having the answers to these questions will most likely lead to the correct remedy for your lower back pain. You will need to see a homeopath to come up with a remedy for this; plus which, the homeopath will have to manage the case–decide on a potency and how often to repeat it and know when the potency should be raised. That’s all part of it too.
I take your point Elaine. I must decide soon whether this is a serious problem or not. I was hoping that after some time it would go away, in fact, I still believe it will.
In the meantime I have bought an inversion table…… and wow, that hurts too so I have to go easy on that.
With homeopathy, there’s no reason for anyone to be suffering! In fact, I carry Arnica 10M with me in my pocket at all times in case I’m suddenly injured, as you were. Taking Arnica right away can prevent chronic pain from settling in. In fact, I carry a very high potency of Arnica in my pocket because you never know how serious an accident you or someone else might be in. And I’ve actually had occasion to use it–with good effect! I once slid on my right heel causing my left knee to come down hard on the slippery, newly-mopped floor of a restaurant as I walked in the door! It took two waitresses to pull me up and sit me in a chair–I was actually moaning and groaning loudly from the pain and shock of it all. This would have spelled trouble for anyone else but I took my Arnica! 45 minutes later, I got up and walked out like nothing happened; in fact, I never had a moment’s concern!
Treat these things right away, people; don’t let them become chronic and spiral out of control!
Elaine Lewis, D.Hom., C.Hom.
Elaine takes online cases. Write to her at LEWRA@aol.com
Visit her website: elaineLewis.hpathy.com