Homeopathy Papers

Solving Confusing Cases

Last modified on May 24th, 2018

What happens when all the symptoms in the case don’t add up to one remedy? How do you choose?

hi elaine,

[I’m] not finding the same remedy in all the rubrics. seems like this must happen alot when assembling a case? or does this happen in only the “difficult” cases?

Kelly

Dear Kelly,

You’ve asked a profound question. This is why homeopathy is so difficult!  First of all, people think they have to assemble all the symptoms from their whole life and before you know it, they’ve compiled 40 or 50 symptoms!  And I can guarantee you that you will not find that one single remedy covers all of them!  So, as Dr. Kent advised us, “Don’t mix up acute and chronic symptoms,” that’s the first thing!  Think about what it is you want cured!  If you’ve got a million things wrong with you, pick one!  Pick the worst thing!  It might be that you’re never well since a virus which is lingering on subacutely.  Then forget everything else and work on that!  If you’re working on an acute case, know that some of the symptoms are going to be more valuable than others.

We always say to take the totality of symptoms, but as you’ve pointed out, if you go to the Repertory (our index of symptoms)

and look for the symptoms in the case, you sometimes find that a single remedy doesn’t cover all of them.

For example, if you have a runny nose and sore throat with amelioration (improvement) in a storm, you may see that you can’t find a single remedy that covers the whole case. So, how, under the circumstances, does one pick a remedy? It seems to suggest that you have to disregard some of the symptoms as being irrelevant or less important, and that’s exactly what you have to do!

The symptom with the most value in this particular case is “Stormy weather ameliorates”! Why? It’s because it’s the only individualizing symptom in the case!  What’s individualizing about sore throat and runny nose?  Nothing!  They’re COMMON!

It doesn’t occur to the average person that we all have colds differently! And it’s how we’re different, in homeopathy, that leads to the correct remedy.   Everything else in this case is like everyone else’s cold–except for this one thing; therefore, that’s what’s going to unlock the case for us, that’s where the remedy is going to be found!

This is how homeopathy works–it’s the peculiar symptom, it’s the striking symptom which might seem unrelated to the complaint and not very important at that, that points the way to the remedy. So, in this case, you’d check the Repertory for “Generals: storms amel.” (Murphy’s Repertory) and there are only 3 remedies!  So, from three thousand remedies, we’re down to 3!  That’s pretty darn good, don’t you think? 

Here’s the problem with the Homeopathy Repertory:

1. Some remedies were very extensively tested on volunteers and have hundreds of years of clinical use, and are, consequently, over-represented in the Repertory. Remedies like Sulphur may show up in almost every section from Asthma to Vertigo and so, in a strict “repertorization”, will “win” every time!

2. Other remedies are under-utilized, under-represented in the Repertory and will never “win” in a strict repertorization!

3. There are numerous symptoms in the Materia Medica (our other “Big Book”)

that were never entered into the Repertory! For instance, the remedy Chocolate isn’t in the rubric “Abandons/Forsakes His Own Children”, even though Chocolate is known to do that; that’s just one example. (Simillimum, summer 2003, p. 48)

So we can see that we have to have some other strategies going for us other than strict repertorization to solve a case!

What might those strategies be?  Here they are:

1. The most recent symptom or complaint takes precedence. The most recent issue in a case can’t be ignored, especially when all homeopaths know that “healing takes place in reverse order”!  (Hering’s Law).  A newly-acquired tendency to cry and want sympathy might suggest that this person needs Pulsatilla now!

2. SUFFERING in the case takes precedence. If someone has pain, you have to hone in on that, you have to take the case of the pain, even though you may suspect that your patient is constitutionally a Sulphur or a Calc-carb. When you see a person with, for example, a Bryonia pain–sharp, stitching pain, worse for the slightest motion–you have to give Bryonia right away, it doesn’t matter that he sticks his feet out of the covers, is messy, doesn’t like to bathe, and other symptoms that would surely lead us to Sulphur!

3. Find the worst thing when you don’t know what to do, or there’s more than one thing going on at once! When there seems to be a million symptoms in the case, and there usually are, ask your patient, “What’s the worst thing that’s the matter with you right now?” Then take the case of whatever that is. He may say, “If I didn’t have insomnia, a lot of my other problems would go away, I wouldn’t be so dizzy and nauseous and weak.” So, the case then becomes one of insomnia–you’d ask him to describe it, what does he think about while lying awake, does he wake at a certain time each night, what may have caused it, and so on.

4. Look for what’s excessive in the case: Too much talking, too much sweating, too much dryness, too much…whatever.

5. Find the over-sensitivity: Look to see what the person is over-reacting to: Criticism? Rainy weather? Music? Sunlight?

6. The patient’s response to stress–is there a pattern? You may find that this is a person who cries about everything, or over-reacts violently to everything, or feels that he can’t ask for help, despite having these stresses in his life. The RESPONSE to stress is more important to us than the fact of having a stress in the first place.

7. The cause. Very often if we know the cause, we can pack up our bags and go home! The cause determines many or possibly even most of our prescriptions! “You’ve had this since the accident? Oh, why didn’t you say so? The remedy’s Arnica!” “You had this since your boyfriend broke up with you? Why didn’t you say so! The remedy’s Nat-mur.” “You’ve had this since the flu? Why didn’t you say so? The remedy’s Gelsemium!”  “You’ve had this since a head injury?  Well! In that case, the remedy’s Nat-sulph!”  (I’m over-simplifying, I know, I know.  BUT, sometimes it IS that easy!)

In general, when confronted with symptoms which don’t fall neatly under the umbrella of one remedy, THROW OUT THE COMMON SYMPTOMS right away–symptoms like “Sore Throat”, “Headache”, “Runny Nose”–symptoms which could be any one of 500 remedies, it’s not going to help you unless you can get the patient to elaborate!  For instance, “Sore throat, better from talking!”  That is so peculiar, there might be only one remedy that covers that–actually, there are two: Calc-carb and Hepar sulph!  

THROW OUT EVERYTHING THAT’S NOT INTENSE.  If you’re feeling only “sort of” this way or that, it’s not going to help you find a remedy.

Look for what’s PECULIAR.  Now, I know, you’re going to say, “Elaine, I always ask my clients if there’s anything peculiar about them and they always say No!”  It’s because you can’t ask it that way!  The whole point of my Questionnaire, which is on my website, is to uncover anything that’s peculiar in the case; but, in general, you would have to ask your client or patient, “When people have said to you, ‘Why can’t you do this or that?  Why is that so difficult for you?’ what were they referring to?”  Or,  “What have your well-meaning friends tried to change about you, or help you with, or help you do differently?”  This is the way to find out what is peculiar about your patient.

Look at what’s RECENT.

Look for SUFFERING in the case and hone in on that.

Look at what’s STRIKING about the person, what makes you turn around and look twice?

Look for a THEME (always crying, always talking about birds, always complaining, etc.)

Ask what’s the WORST THING in the case (generally, pathology on the MENTAL/EMOTIONAL plane, if intense, tends to be the worst thing–fears, anxiety, delusions, for example, can cripple a person worse than a broken leg).

Look at how the person RESPONDS to his complaint.  Think about it:  Denial?  Panic?  Paralysis?  Fear?  Yelling?  Blaming?  Throwing things?

Find out what he’s HYPERSENSITIVE to.  In fact, you might say, “What evokes strong emotions or strong reactions in you?”

What is he doing and saying?  He might have some odd trait like constantly moving his feet, slouching, looking away or blinking; he might keep saying, “I’m really worried about this, I’m really worried about that…..” or every other word might be a curse word.

See if you can separate the symptoms into acute and chronic and treat acutes first.

Look for the CAUSE.

Finally, if you see keynotes of a remedy?  That is very characteristic, very individualizing!  Nothing in the case might make any sense to you as far as a remedy is concerned, and then all of a sudden you hear a keynote!  “I have a burning thirst for ice cold drinks!”  Ahhh!!!!  Phosphorus!

In the final analysis, instead of 30 symptoms in the case, you may find that you’re down to 5 or 10!

So, for example, in a Chocolate case, regardless of the diagnosis–arthritis, or menstrual cramps, etc.–the rubrics or symptoms you might find may look like this:

Desires chocolate

Ameliorated (better) in the countryside

Ameliorated by curling up in a ball

Aggravated by the presence of her children

Desire to travel/escape

(These really are Chocolate symptoms!)

So, it’s what’s unusual, excessive, repetitive, peculiar and striking that matters, and remember to treat the suffering first and look for causes and keynotes of remedies.

If there are “layers” in a case, each layer will begin with a CAUSE, which will shift a person over to a new remedy picture–or, it might take him deeper into his own constitutional state; for example, there’s the “healthy” Sulphur who’s ambitious, pursuing a career, getting good grades, warm body temperature, loves the outdoors, extroverted, active, and so on; and then there’s the “unhealthy” Sulphur, who’s reclusive, stays indoors, is chilly, and has become lazy and stopped trying. A healthy Sulphur, after failing repeatedly in business, for example, might take on this new state, but it’s still Sulphur!

Try to see what the critical “events” in the person’s life were. There is a set of remedies that corresponds to each event–remedies for the flu, remedies for loss of a loved one, remedies for blunt trauma, remedies for business failure, etc.  This is called the primary rubric.  Go there, look at the remedies listed, and if the rubric isn’t too large, you can say, “Which remedy does he most closely resemble?”  If it is too large, scroll down and look at the subrubrics.

If you see that a person has never been the same since a significant event, the symptoms themselves become less important and the CAUSE becomes paramount, and you would want to try to match a remedy from the CAUSAL rubric or “Ailments from” rubric to your patient.

Now, finally, the MAGIC of the CONCOMITANT!  When we take an acute case, there are five essential things that we have to know: 1. Sensation  2. Location  3. Modalities  4. Concomitants  5. Etiology.  We’re going to get into the Concomitant right now.  This is the “along with” symptom, the symptom that’s accompanying the complaint which we don’t normally associate with it.  It’s not unusual that the Concomitant solves the case for us!  What’s accompanying those menstrual cramps?  Aside from just the cramps, what else is there, is anything else happening?  What about fainting?  Because if you’ve got cramps with fainting, that’s Sepia!  What about burping?  Because if you’ve got cramps with burping, that’s Carbo veg.  What about vomiting?  Because that would be Ipecac.  You see?  All of a sudden, it’s all about the Concomitant!  The concomitant solves the case!  Fever with excessive thirst for ice cold drinks; what’s the remedy?  Phosphorus!  Fever with thirst but for only a sip at a time; what’s the remedy?  Arsenicum.  Fever with thirst but aversion to drinking; what’s the remedy?  Belladonna.

And since I mentioned “modalities”, we have to go there too!  Every symptom comes with at least one modality.  In fact, you don’t really have have a symptom if there aren’t any modalities!  Modalities are the things that make the symptom better or worse.  So, though runny nose might seem like a symptom to you, to us it means nothing unless you’ve made an effort to gather the modalities!  Runny nose, better outside, worse inside–Pulsatilla and Allium cepa.  Runny nose, better in a steamy hot shower–Rhus tox.  Runny nose, better at the ocean–Medorrhinum. 

Remember that healing takes place in reverse order; so, your case has to be in order–chronological order!  You have to know when things happened.  If they say that something happened to them, ask when did it happen and ask, “What was going on in your life around that time that might have accounted for that, and how old were you then?”

Now, we’ve said a lot here, so we should probably summarize.  What were some of the things we learned?

1. Don’t mix up acute and chronic symptoms

2. Put your case in order, when did this happen, when did that happen, what was going on when this or that happened?  What happened first?  Then what happened?

3. Start with the most recent complaint and work your way backwards.  

4. Suffering has to be tended to first.

5. Always try to find the cause.  Then go to your “ailments from” rubrics.  “Ailments from grief”, “Ailments from head injury”, “Ailments from humiliation”, “Ailments from cold/dry winds”, etc.  The remedy’s gotta be there, it’s gotta cover that!  Not that you’re always going to know the cause; but, if you can find it, you’re in much better shape in terms of solving the case.  

6. Ignore symptoms that are common, not intense, not striking and not peculiar.

7. Find out what the patient is hyper-sensitive to.  

8. Find the modalities, and find the concomitants.  You don’t really have a symptom unless you have the modalities and concomitant that goes with it.  For example: “I have a runny nose that’s better outside, worse inside, with a concomitant bland discharge from the eyes.”  What’s the remedy?  Allium cepa.  What’s the remedy if the patient just says, “Runny nose”?  Nothing!  

9.  The Sensation.  Have we talked sufficiently about the sensation?  You have to know that too!  Headaches can feel bursting or hammering or pulsating … you have to find these things out.  If a patient says, “I have a headache,” that’s not enough!  “What does it feel like?” you have to say.  “When did you get it?  What do you think caused it?  Where is it located?  What makes it better or worse?  What else, what do you have along with it?  Nausea?  Photophobia?  Irritability?  Thirst?  What?”  This is what you have to say to a patient when he says, “I have this” or “I have that.”

Soooooo……….Kelly, are you taking all this down?  

I’m still trying to figure out how to spell “ameliorate”.  Who came up with that word anyway?  No one talks like that!

(Sigh)

About the author

Elaine Lewis

Elaine Lewis

Elaine Lewis, D.Hom., C.Hom.
Elaine is a passionate homeopath, helping people offline as well as online. Contact her at LEWRA@aol.com
Elaine is a graduate of Robin Murphy's Hahnemann Academy of North America and author of many articles on homeopathy including her monthly feature in the Hpathy ezine, "The Quiz". Visit her website at:
https://elainelewis.hpathy.com/ and TheSilhouettes.org

2 Comments

  • Hi Elaine,

    As always, I LOVE what you have written! This time you’ve written about finding the remedy in a difficult case. Every time I visit your site or read your fun and fabulous articles in Hpathy ezine, I always learn something new.

    Keep up the good work! I love homeopathy and wish I weren’t so bloomin’ old so I could become a pro but I’ll have to settle for just doing what I can. I’m working to get my children and granddaughter interested in homeopathy.

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