Taking the Case and Repertorizing

homeopathy doctor

G.D. Pettitt shares some basic axioms for case taking and repertorizing.

Common Symptoms

In inflammation, for instance, worse from pressure is what one would expect, and of little value—so many drugs and most inflammations have it. But, better from pressure, in these circumstances is priceless, and leads you to a small group of drugs such as Bryonia.  Remember the priceless symptoms for success are the strange, the rare, the unaccountable ones, those that flatly contradict preconceived ideas, and lead off straight for a limited number of drugs. “ Eliminating Symptoms.” . . . It expresses what we all desire in repertorizing, and what we have got to be very chary of using too rigidly, lest we lose the remedy we are looking for.

Say your patient complains of dyspepsia, with burning pain in the stomach and the frequent vomiting of sour fluid. He pours you out particulars which he has at his finger tips, since they are just the symptoms to impress a man’s memory by intruding themselves on his consciousness in a very realistic way. You jot them down till you have got his case as fully as most people go, with all its modalities, i.e. the conditions as to heat and cold, movement and rest, position, hours of day and night, relation to food and drink, etc., of the stomach condition complained of. You have assured yourself, by careful examination, as to whether the trouble is likely to be organic or functional, or whether some of the symptoms have to be discounted as secondary to some gross lesion. And now it is your turn .You have to elicit the general symptoms of your patient. You have got to switch him off the siding “My” and on to the main line “I“.

Now you find that he cannot stand heat—whatever his stomach may do and that he is ill if long out in the sun and  that he wants a cool room, prefers cold weather and a cool climate; he never goes near the fire ; and you noticed when he came in that, though the weather was cold, he was not buttoned up, or thickly clothed. It is not closeness or stuffiness so much that effects him, but heat. He is one of the predominently hot-remedy people. There is an eliminating symptom for you. You know, at once, whatever his stomach condition may be—its particular symptoms might be equally well met by Arsenicum, Phosphorus, Nnx vomica, Lycopodium, Natrum mur., or a host of others—but with that temperament, that warm personality, it would be useless for deep and curative work to think of giving him Arsenicum, Phosphorus, Nux vomica, Lycopodium or Sepia. He is a hot patient, and those are predominantly cold remedies.  You can strike them out at once. For even if one of them exactly fitted the precise stomach symptoms only, gave temporary relief to the immediate condition, the patient would relapse again and again. It would act as a palliative, not as a curative drug.  It might provide a temporary organ stimulus. It could never be the stimulus of the organism. And here you see well the difference between deep and superficial work—between curative and palliative. When you get the real simillimum the odds are that, instead of palliating the stomach condition, you will aggravate it for the moment, aggravate it once for all to cure. If you do not know your work, you will think you have got the wrong remedy, and antidote or change it and your patient will be, as far as you are concerned, incurable. But it may be your ignorance that makes him so.

So now, down all the rubrics, mental, general, and particular, you will carry that great eliminating symptom, worse for heat and ruthlessly cut out all remedies that are chilly, and therefore deeply help chilly people ; none of these you need write down at all. You can go on to any other general, and especially to any marked mental symptom, and often get a pretty correct idea of the exact remedy before you ever start to tackle the particular and immediate suffering for which the patient comes to you.  Now, supposing you discover that he is liable to fits of depression, and yet cannot endure any attempt at consolation, that he becomes a fiend if anyone attempts to cheer him up, even to enquire what is amiss, that people have learnt to leave him severely alone when his moods are upon him . Why, with these two important symptoms alone—worse from heat, worse from consolation—which have got to be in equal type—by equal type we mean Capitals—Ordinary or Italics—Capitals are the highest and prominent, and so on, remember in the patient and the drug, you have reduced your area of search to Lit. tig., Nat. mur., and Platina  for Lycopodium and Merc, come through the “ consolation test “ in the lowest type only, which is hardly good enough for such a marked loathing of consolation as this.

If you can get such marked eliminating symptoms to begin with, see what a comparatively small number of drugs you have to carry down through all the rubrics, and how much easier and quicker it is to get your remedy, and how much greater confidence you have in the result of your search. You will generally find as you work down, that one drug stands out more and more pre-eminently—it may not be in all the rubrics, but it has got to be in all the important ones, i.e. those best marked in the patient, and of the highest grade, you are convinced and it is a mere waste of time to go further.

Of course there are heaps of cases where you cannot get any mental or other general symptoms so definitely marked as in the foregoing, and where you have to be more careful not to take symptoms too easily for “ eliminating “ purposes, or to knock out drugs on any inefficient cause. If you do you will find yourself landed with Sepia, probably, most times, though you might very often do worse, because Sepia will often restore a case which has been messed up.  Times of day, if very definite, help. Some people are perfectly well all day, but their nights are purgatorial; some are in pain all day long, but perfectly well at night. Some rise feeling miserably ill and tired after a good night’s rest, and with nothing to account for it—it is important to ascertain this! … a case of insomnia? or the no cause principle was proved to be imaginary in one case—and only feel pretty well as the day wears on, and bright and happy, and ready for mental and physical work in the evening, when you would expect them to be tired.

I have B patient with the symptoms just mentioned. He is ultra-tidy, spends much time folding his clothes after midnight but during the day he is too tired to speak, which amounts to “out of proportion”, so Arsenicum is his remedy. Others have all their sufferings in the evening—after days neither strenuous nor fatiguing. These are important generals, and very useful in helping to determine the drug. Some drugs have their very hour of the clock, and others a very marked periodicity.

Worse from damp, and worse from dry weather are deep-seated and very important. If strongly marked in the patient they may be used as eliminating symptoms. “ I feel ten years younger today because it is raining. All my joints are quite loose, and I can move freely”, while others stiffen and ache for a mere passing shower. Then there are other patients who dare not get into a bath, who are obliged to “ wash in sections “, as one of them expressed it, since they feel faint, or actually do faint, as soon as water flows over their skins, while in a lesser degree, others feel miserably weak and ill after a bath. Such symptoms must be very marked and definite to carry great weight or to rule out drugs, but they help immensely.

Last, and least important of all, comes the name of the patient’s malady. Look it up, if you like, at the very end, and it may joyfully confirm your choice of remedy, which it must not unduly bias. If your patient is an asthmatic patient, it is comforting to know that the drug his symptoms demand has again and again cured bad cases of asthma but remedies that have never been recorded as having cured asthma will do the same if the symptoms of the patient cry out for them, as their simillimum.

Drugs have not all been pushed far enough to produce lesions and their voices do not carry, as a rule, deeper than function—except in the case of accidental poisoning. But get the right drug, the stimulus needed, and you will find the reaction of the organism deep enough in all conscience, and long sustained.  Then, keep your hands off! Wait long for a second definite cry before you dare to interfere. You may wait months—then wait.  Remember, it is the patient who has to cure himself, the drug cannot cure him. The drug is only the stimulus that starts the vital reaction. So long as curative reaction is in progress, it is senseless—criminal—to interfere. This is the way to crush your work, to vitiate your experience, to break your heart. So long as the patient is improving, let him be, and never meddle until he begins to slip back. That is the first possible moment to repeat or to reconsider the case. It is safer to be a little late than a little too soon. You must “go last slowly”, there is no other way.

When aggravation occurs under the use of a single highly potentized remedy given in a single dose, it is the best possible proof that the remedy has been correctly chosen, but it has been given at the wrong time, or that the dose was too powerful.  The homoeopathic aim should be to give such a dose and at such a time that the homoeopathic aggravation is just evident and no more, and when the patient is distinctly better or distinctly worse, stop the medicine.

The result in both cases should be steady and permanent improvement, and when this ceases, the same medicine may be repeated, or another chosen according to circumstances after the case has been retaken. This more especially applies to chronic diseases, but even in acute cases the same rule applies. In all cases the safest rule is not to repeat as long as improvement continues, and then a different potency to that previously administered.

In administering medicines to women, it is better to give a medicine just after the menstrual period, unless there are acute symptoms demanding immediate relief. Allow a full week to elapse from the time the period began before prescribing a new medicine or repeating the old one. In female patients the case should always be reviewed after the period is well over.  Again in the treatment of chronic diseases, the too hasty repetition of the dose cannot be too carefully avoided. The whole cure may fail if the anti-psoric remedy which has been prescribed is not allowed to act uninterruptedly to the end.  But we may assume that the remedy which includes three of the characteristic symptoms, discovered after the examination of a patient, in its pathogenesis, will be sufficient to make a cure almost certain. The physicist says that objects such as his instruments of precision rest most securely on three points of support; so look for these three characteristic symptoms.

(1) In the locality or tissue affected.

(2) In the sensations of the patient and character of the pain.

(3) Among the conditions of aggravations or ameliorations—especially Time, etc.

(4) Among the accompanying symptoms.

The three rules for the treatment of chronic diseases are :

(1) The characteristic drug must be similar to the characteristics of the case. In making this comparison, the more prominent uncommon, and peculiar features of the case exclusively and especially considered and noted, for these in particular should bear the closest similitude to the symptoms of the remedy, if it  is to accomplish the case.

(2) The symptoms of the case and the symptoms of the remedy must not only be alike one by one, but they must be also of the same rank.

(3) In the arrangement of symptoms after examination of a case, the value, the importance, the rank of the symptoms, must be considered, in careful comparison of several remedies, having the same similarity.

THE CASE

Example : Mrs. P., 45.

Indigestion and constipation, 20 years.

Stomach. Hot pain and heavy feeling, mostly two hours after food , better for cold drinks. (gets this every day, but sometimes not so bad as others.)

Very nervy, fears, and worse after company.

Loves sympathy and rubbing, is comforted by both.

Fears thunderstorms, dark, etc.

Stool, thin and almost white, like dogs.

Can’t stand the cold in general.

Stomach worse for warm food.

The case worked out:

Loves sympathy and rubbing—Calc, Nat. c, Phosphorus

Fears thunderstorms, dark, ghosts, etc.—Nat. c, Phosphorus

Stomach pain ameliorated by cold drinks—Nat. c, Phosphorus

Stomach pain aggravated by warm food—Phosphorus  Aggravated by cold in general—Phosphorus

Stool, narrow and white, like dogs—Causticum, Phosphorus 

Phosphorus was closely indicated and Phosphorus has cured the whole person. Mr. P. says : “ You have made my wife a new person, our nights and days used to be awful, but she, with her pain and mental suffering, and I with my anxiety and distress about her, I was nearly out of my mind.”

DRUG PICTURES

We have emphasized the importance of visualizing different drugs. Homoeopaths do visualize drugs—some one—some another. Natrum muriaticum is not always a clear picture, but all the same he speedily betrays himself, as we get to grips.  In this way, probably, one is inclined to think “this patient is surely Sepia !” <sea-air and all the rest (< =worse ; > = better) of it ; and lo ! the patient craves salt, he loathes sympathy and fuss, which put Phosphorus out of court, and the case turns out to be a typical Nat. mur. case.

Or “ backache “ may be the illuminating symptom, backache relieved by pressure. One of those priceless little rubrics ! If it is pain low down in the back, relieved by pressure, Sepia and Nat. mur. might compete. Sepia and Nat. mur. in the lumbar region—Sepia when it is sacral. There are several drugs like Nat. mur. in symptoms – Sepia is one  Others are Phosphorus, Ambra, Murex. It is imperative to get a true realization of drugs.  Nat. mur. and Phosphorus enter into cuttlefish juice—Sepia

Ambergris which is found in, and expelled from the intestinal canal of the sperm whale—Ambra—and the juice of the “ purple fish “—Murex purpurea. All these have similar symptoms in their pathogenesis, all have their origin in the sea. Furthermore these are all chronic conditions, and they have acute stages.These are well represented by Apis mel. (Honey bee), Bryonia, Ignatia, and Nux vomica.

Another way in which Nat. mur. is apt to betray his identity is a deep crack in the centre of the lower lip Sepia has this also.  The craving for salt in Nat. mur. cases is a. very real hunger. Yet with all he gets in crude form, he is not assimilating enough for his tissue needs, till he gets the stimulus of the potentized drug.  Burnett’s picture of Nat. mur. is as follows:

“ Very chilly, worse at sea, crack in centre of lower lip, unconquerable sleepiness after dinner in the evening, muddy urine, lachrymation with headache, malaria, quinine poisoning , then the ‘ chill ‘ hour, about 10 a.m.”

Fiery zigzag before headache, emaciation, especially about the clavicles and upper parts of the body, face shines. Nat. mur. has very marked periodicity. In malaria the chill starts at 10 a.m. or 9-10 or 10-11 a.m., and the drug has other very definite hours for chill, headache, neuralgia.  Mentally Nat. mur. is irritable—hates fuss and consolation—weeps—and weeps more or flies into a passion if consoled. Nat.  mur. tries to remember old disagreeables—old insults—for the purpose of brooding over them and being miserable.

Nat. mur. gives way on the emotional and sentimental side.“ Falls in love with the wrong person, and breaks her heart.” Is absurdly obsessed by a foolish passion for a married man—falls in love with the coachman. In these states Nat. mur. brings sanity and order.  Ignatia is the acute of Nat. mur., and when Ignatia is too superficial and ceases its action in an indicated case, Nat. mur. will take on and complete the cure.  When you get < heat and cold, > open air, then ask early “ How does wind affect you ?  Eyes water! You say you weep—from what ? Nat. mur. will answer – “from admonition and pity.” Is worse from consolation. If asked how are you?  Nat. Mur. will answer “ better, thank you ! “ when he is not.  Lachrymation with laughter is pure gold. As for “ fond of salt, aversion to fats, greasy skin, crack in lower lip, you will find the remedy in Nat. mur. Nat. mur. loathes fat and craves salt.

Arsenicum . . . Arsenicum has been called the gentleman with the gold-headed cane. He is one of the fastidious drugs—these are Arsenicum and Nux vomica—he wants everything in order, restless, must be moving or doing, never mind the trouble of putting the picture straight, it must be straight , or of folding the coat with absolute precision.  The first thing you will notice about your Arsenicum patient is his restless—his incessant movement. The Sepia face is without strong lines; the Arsenicum face is deeply lined, lines that denote the anxious temperament. He strikes you at once as anxious—suspicious. He is not too sure about you, though he has come to consult you. What do you mean by your questions? He is restless under them, you feel his distrust, he hesitates whether he shall answer them. He is not an easy patient for a homoeopath to tackle unless you spot him through his distrust and surprise him by the fact that you know him through and through, and can dictate to him his symptoms.  That has sometimes an extraordinary effect on a patient.  In disease the Arsenic face is anxious—distressed—haggard—sickly—suffering—the Hippocratic face, and all these of the highest type.  Arsenicum is full of fears, fears alone—fear of robbers—fear of knives—for the evil he may do with them—for the terrifying thoughts they suggest—fear of killing—fear of suicide.

One of Arsenic’s peculiar symptoms is burning—relieved by heat. No other drug has that peculiar symptom. It may be anywhere, even to haemorrhoids, and put you on to Arsenic.  Burning in stomach and abdomen, relieved by heat – the twin brother of ArsenicPhosphorus—has burnings in stomach, but in this case relieved by cold drinks.

Ptomaine poisoning exhibits the exact picture of Arsenic at its intensest—restlessness—anxiety, agony of pain, vomiting and purging ,intense prostration and fear of death. Therefore Arsenic is the great remedy of ptomaine poisoning. Again, great prostration, out of all proportion to the malady, is not found in any but an Arsenicum patient.

Excerpted from From: Healthyself Sept 1945

About the author

G.D. Pettitt

2 Comments

  • No doubt a good article. The author must be an accomplished homeopath. And very busy, rightfully too. I find after advising single dose, there’s no point in telling stop the remedy when there is clear aggravation or improvement. this could not be a result of mere haste like his misspelling “Go fast slowly” as “Go last slowly” which only indicates a busy schedule taking into account his perfect technique of case taking and repertorization.
    Nonetheless a worthy article by an expert is much valuable in the present day situation where there is dearth of expertise or skill for want of clarity in the conceptuals.

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