I’m guessing no one saw my “Repertory Round-Up, part-1”? So, you might want to have a look at it. I, for one, thought it was very educational!
So, this time we are going to talk about picking rubrics for a case. Actually, you can thank Maria for this because she begged me to write an article about the pit-falls of repertorizing! As you know, I’m in charge of the Hpathy Quiz. Every month I submit a real case and ask my readers to guess the remedy, and every month people give me the wrong answer, more often than not; showing they don’t know what’s important in a case and what should be ignored.
We can’t begin a discussion about picking rubrics without reminding ourselves of Hahnemann’s famous paragraph 153 of The Organon which states:
“…the more striking, strange, rare, peculiar (characteristic) signs and symptoms in the case are especially, almost exclusively, the ones to which close attention should be given because it is these above all which must correspond to the very similar symptoms in the symptom list of the medicine being sought….”
What Hahnemann is saying here is, the common symptoms of a disease will not help you. And yet, invariably, people repertorize the common symptoms of the disease all the time. People are writing down everything the patient says, finding a rubric for it, repertorizing, and invariably coming up with the wrong remedy. And why does this happen? Because as I have explained many times, the Repertory is not complete by any means! Remedies that should be in rubrics are not there. Many symptoms that are in the Materia Medica have not been entered into the Repertory, believe it or not. Therefore, if there are too many rubrics in your case, there’s an increasing likelihood that the remedy you need will get lost. Let’s look at examples from some of our quizzes. Here’s a case from 2 or 3 months ago; I will shorten it for you:
It came on suddenly, my nose is runny with clear fluid
My throat is itchy and feels scraped. My nose is runny with clear fluid 24-7. I sneeze constantly also at times, it has no time
My nose, throat, chest feels a little congested. Body aches a little, I feel kinda numb, lite headed.
What makes me feel better is warmer weather or areas. The cold air makes it worse, makes my nose more runny and sneeze more
Burning sensation inside nose, numb light-headed feeling.
Runny nose that’s clear and watery, burns my nose and upper lip.
I feel numb, I kinda wanna just lay down.
I just feel numb, that I don’t wanna do anything.
I wanna be alone, I feel discomfort.
I am blowing my nose in excess, just trying to rest
I am more thirsty and more hungry for food in general
Slight fever at all times.
I feel dull, like I just wanna rest.
I have coughed because my throat was itchy
Now, here’s what people did. They repertorized everything from “body aches” to “fatigue”! All of this “information” is what I call “clutter”! Remember, you’re supposed to be looking for symptoms that Hahnemann called “characteristic”. And what is “characteristic” according to Hahnemann? “Striking, strange, rare and peculiar”! So, what is peculiar about this case? There is only one thing! Yes, just one thing out of all these symptoms, all these words and phrases posted above! And do you know what that one symptom was? Increased appetite during fever! Yes, the only thing that really mattered, homeopathically speaking, in this case, was “increased hunger during a fever!”
Why? Because it’s so rare! It’s so peculiar! The average person LOSES his appetite during a fever, right? So this is very STRIKING. So if you go to the repertory, and I have Murphy’s Repertory, go to “Food: appetite, increased, fever, during”, and there are only 8 remedies, and only one is in BOLD, and that remedy is Phosphorus!
Now, all we want to know is: does the rest of the case fit Phosphorus? Well, the patient also had increased thirst! Another big point for Phosphorus! The case had a lot of “burning”, does Phosphorus have burning sensations? Yes! Is Phosphorus listed under “sudden manifestation of complaints”? Yes! In fact, does anything in this case contradict Phosphorus? No! So there you have it!
Let’s find another case. I’m just going back and looking at quizzes at random. Again, I’ll shorten it for you:
Very sore throat that’s been creeping up on me since last weekend. Sharp pain when I
swallow. Hurts worse when it’s dry. Green solid mucus in nose. As of this morning, I’m also
dealing with strong stomach cramps and diarrhea with trembling/fever/chills – that was
Could have been caused by traveling in damp weather? My room mate is enjoying the exact same health experience right
now (although she is dry-coughing and expectorating a lot, I’m not). We went to Block
Island last weekend, which was cold and damp (though gorgeous). I spent a lot of the
time being motion sick from the ferry in bad weather followed by some car rides on not
Throat: Sharp pain in back of throat, lump in throat when I swallow. Slight constant ache
in left ear with left ear tinnitus.
Nose: Dry chunks
Belly: Continual cramps in mid-gut, just…ow. Stool feels like it’s poking me in the anus
sharply from the inside out.
I don’t look happy, that’s for sure! And my back is very slumpy.
Throat, better: hot liquids, swallowing food.
Throat, worse: cold liquids feel better in the moment but then increase mucus; dry air
Nose, better: warmth (showering)
Nose, worse: lying on left side (right sinus is slightly congested)
Belly, better: slumping over while sitting, pressure in and toward navel on left side of
Everything: better for open air, worse for being in the direct line of the fan
I’m sad and whiny and I want/don’t want comfort.
I woke myself up making whiny noises this morning.
Moaning and groaning, whining.
I’m thirsty but afraid to drink anything for fear of setting off the angry intestine monsters.
Hot mint tea sounds good. Maybe hot rice in a bit. I’m hungry but afraid to eat anything.
Hot feeling, trembly all over, light sweat, especially on my forehead.
I just feel so whiny.
It seems like some sort of flu/cold thing.
Quiet, reluctant to move, sleepy, collapsed, whiny, so whiny…sooooo very whiny and
So, again, I don’t think I have to go into why you would be wrong to pick “sore throat”, “diarrhea”, “stomach cramps”, etc. The question is, what is peculiar about this case? What is striking?
Well, frankly, it must mean something that she used the word “Whiny” over 50 times! Now, to me, when I hear “Whiny”, I think of Ignatia! And if you go to “Mind: whining”, sure enough, Ignatia is there in bold. Is there anything else in this case that makes us think of Ignatia? You know that Ignatia is a remedy of “conflict, contradictions and paradoxes”, right? Their headaches are better for stooping, their upset stomach is better for eating, and not surprisingly, their sore throat pain is better for swallowing food! And that’s the very symptom we have here in this case–throat pain, better swallowing food! Also, she’s in conflict about what she wants! “I want to drink but I’m afraid.” “I want / don’t want comfort.” So I went with Ignatia, and it cured the case! If you wanted to repertorize, here are your rubrics:
Shall we look at another case?
Hi Elaine. This is the acute questionnaire I filled out about PMS. Actually, the symptoms I described are most intense days 1-7 of my cycle (I actually bleed on days 1-4, then my period part stops on day 5). I started my period today, and this cycle was the shortest in almost three years, only lasting 17 days. On average, my cycle is 22 days. Also, I’ve had terrible cramps the past two cycles. I usually take 2-3 Ibuprofen the day of my period. These past two cycles, I’ve had to take 3 pills twice in 24 hours. Today, I had to take 4 pills to get the cramps to subside. Before I started natural medicine, I had to take 4 Inuprofen 2 X the first day.
My former homeopath had me try Mag Phos 6C and 30C and Colocynthis for cramps, but neither helped. My cramps are a burning pain across my whatever it is that is cramping, better with heat and pressure. It is accompanied by fatigue, nausea, upset stomach, and stiffness/tightness in my body, and I also do quite a bit of moaning and whining.
OK, what are we going to repertorize? “PMS”? “Terrible cramps”? “Fatigue”? “Upset Stomach”? What’s peculiar about this case? How about “menses with body stiffness and tightness”? Have you ever heard of that? I haven’t! Never! What homeopathic remedy is famous for “stiffness”? Rhus tox! So now we ask ourselves: does Rhus tox have burning pain? Yes! Is Rhus tox better for heat? Yes! Is there any reason that this case can’t be Rhus tox? No!
Here’s another case. The patient’s mother is doing the talking, and we’re going to go through it line by line!
Age: 12 years old
Male or Female: Male
Describe the complaint or complaints in your own words:
He began last Friday with a small dry cough. By the next day he had a fever. By day 4 we were at the doctor with diagnosed Viral Pneumonia.
Can we take the rubric “Lungs: pneumonia”? We can, but with over 150 remedies listed, it’s not going to help us much.
It is in his lower right lobe.
It might be of interest to us that this is a right-sided complaint. So, a good rubric might be “Lungs, pneumonia, infection, right lung”.
Of course he is on Antibiotics. It is touch and go though. (This thing has been going through the house!) He should be better in theory by now, but is worse. His cough has gotten really dry.
Do we take “dry cough”? No, too big a rubric.
He is not getting much up. He is coughing so much the last hour he is almost vomiting. Fever comes and goes. Right now it is 101.7. He is chilly
You can take “Fevers: chilliness with fever”. We care a lot about sides of body and chilly vs. warm.
I believe as he has laid down in bed and covered up. Eyes are glassy. Thirstless.
OK, there ya go! Now we’re getting somewhere! Eyes glassy and thirstless! Why are we so excited about this? Because glassy eyes usually means Belladonna and Belladonna is also thirstless! We are on the trail of Belladonna here! (Remember, we are looking for keynotes of remedies.)
Getting on his knees to press his forehead into the pillow because it hurts.
Belladonna is in bold under “Headaches, pressure amel.”
Etiology–this means the CAUSE of the complaint.
Only cause I know was the virus he got from his brother.
Sensation–describe the pain or other sensation you have.
He can’t tell me, but from my experience and my other children- the head feels bursting. Especially when he coughs. It is awful, but the headache stays even when not coughing.
“Headaches, coughing, on”–Belladonna is in bold.
Appearance– anything remarkable? Red skin, droopy eyes, etc.?
Tired. Not saying or doing much. Eyes glassy and red.
Well, there’s the color red, another Belladonna keynote!
Location–where on the body is your complaint located?
Modalities– This is a fancy word that means, “What makes your complaint better or worse?”
He seems to feel better right now in the bed. For me and my other children the warmth of the bed really helps.
headache- he says in forehead.
Are we going to repertorize “headache, forehead”? No, it’s not a keynote of any remedy. Look at it this way, can you tell you’re in London by looking at cars, people and retail stores? No! That’s not going to help you at all! You need to see the Landmarks of London! Big Ben, the Thames, the guards at Buckingham Palace! We are trying to find the Landmarks of a remedy!
Discharges–color, odor, consistency and sensation.
I haven’t seen him cough up anything lately.
Generals–these are all the symptoms that begin with the word “I”: I’m hot, I’m cold, etc.
He has said “My leg hurts. My arm hurts” Different things hurt so I believe he is having aches.
Are we going to repertorize muscle aches? No. That’s common in a fever. We’re not interested in common symptoms.
The mentals: Is the complaint changing you mentally and emotionally?
He is quiet and staying to himself. Hardly answering me.
Are we going to look up something like “aversion to answer”? No! It’s easy to surmise that talking probably aggravates his headache.
What have you been saying?
Sorry, he doesn’t say enough for this.
What are you doing?
Laying down and being quiet.
Is that of interest to us? No. He’s sick. That’s what people do when they’re sick, they lie down.
Describe your thirst and appetite–
No thirst, although when the fever breaks he drinks. Eating OK when the fever is gone.
He’s still thirstless.
Fever comes and goes. The whole thing seems like a cycle. He coughs in between, but then the fever spikes and things get worse. I don’t have a time for when it is better/worse though.
Is there anything here that interests us? The fever comes and goes. That’s “Fever: remittant”. Belladonna’s in bold. Still, we don’t need this rubric.
When the fever breaks.
Do we need this? “Perspiration: fever, after”. Belladonna is a 2. Do we really need this rubric? Not really. It’s common to sweat when the fever breaks.
What is most striking, peculiar or identifying about your condition?
It seems to come on gradual, but then gets worse fast-fast. Little cough, then boom! the fever comes and it’s on!
Alright, there it is folks, the “Sudden Onset” Belladonna is so famous for! That really slams the door shut on this Belladonna case!
Him wanting to put pressure on his head for his headache is interesting too.
Is there a diagnosis?
Describe your energy–
Right now he is just lying. When the fever goes he is more active.
Do we care about that? No.
What does your tongue look like?
Are we going to go to the “Tongue” chapter and look for “Pink”? No! It’s common!
6:50 pm: Do you have _____________?
Already I know it’s Belladonna. Why? I’ve got the Belladonna Landmarks (“keynotes”) all lined up! Sudden onset, the color red, glassy eyes, thirstless, right-sided complaints. We’re home free!
Do you have the 200C? If so, give a dose of that and let me know what happens.
7:54 pm: Elaine, he is coughing less and his head is better. He has been getting up some.
9:22 pm: His face is a normal color, no fever, drank and ate a bit, finally played a little and just now went to bed.
Next day: Roger is out mowing the lawn. I think he’ll probably wear himself out, but there was no talking him out of it.
Alright! Did that exercise help you? So what happens when there’s nothing peculiar in a case? Then we have our Hierarchy! The Hierarchy of Symptoms! It means you go with what’s at the top of the hierarchy! If you don’t know, please see my article “Acute vs. Chronic Remedies, The Hierarchy of Symptoms, and the Kitchen Sink”:
What’s at the top of the hierarchy, usually? The Etiology! That means the Cause! We don’t always know the cause. But when we do… that’s what we go with! “Ailments from Head Injury”–Natrum sulph. “Ailments from Nursing Loved Ones”–Cocculus. “Ailments from Fright”–Aconite, and so on.
Sometimes there are nothing but local symptoms in a case. You sprained your ankle. There is no etiology, no mentals, no emotionals, no thirst or appetite issues, no sides of the body, no sudden onset. What are you going to do? Memorize the following: Sensation, Location, Modalities, Concomitants! By asking these 4 questions, you may find out that the sprained ankle has very sharp pains that are worse for the least motion! What’s the remedy? Bryonia!
A word of warning: watch out for The Complete Repertory! I hate to say this because I like Roger Van Z. very much! But there are so many additions to the Complete Repertory that the distinction between remedies, like knowing that Belladonna is right-sided and Lachesis is left-sided, etc., has become completely blurred! I have seen Quiz contestants come up with the wrong answer ONLY because they picked a rubric from the Complete Repertory! Take for example, in the Complete Repertory, “Generals: sides, left”–Belladonna is in bold! BOLD for left-sidedness! Belladonna! In Murphy’s it’s in plain type–the lowest grade! Murphy lists 152 remedies under “left-sided”. The Complete lists 644! If there’s anything we ought to be able to count on, it’s that Belladonna is a right-sided remedy! There are many such examples. I recommend that you get Murphy’s Repertory, 2nd or 3rd edition. It’s completely in alphabetical order and much less confusing.
And then, in terms of mistakes in case-solving, there is the problem of poor judgement! A child is crying during illness and people pick, “Mind: crying”. Is this a symptom, really? Remember, it’s a kid! They cry all the time! They cry for nothing! You have to have more of a reason to pick this rubric! Is it angry crying such as what Chamomilla might have? Is it pathetic crying like Pulsatilla? Are they easily comforted by sympathy as with Pulsatilla and Phosphorus? Or are they hard to console like Arsenicum? What causes the crying? For Borax, it’s downward motion. What stops the crying? For Chamomilla, it’s brisk carrying. Look at the rubric “Mind; crying”. The subrubrics are extensive!
Many times when I correct a person’s answers, I have to say, “That’s not part of the case, I don’t see it. Where does it say that?” People are picking rubrics for symptoms that aren’t there! Try to be more careful; don’t assume things.
Now, I suggest you go to my website, click on “Acute Case Questionnaire”, print it out, and have it to refer to when you’re taking an acute case or a case involving pathology. Here it is:
This discussion continues in this month’s Quiz Answer where you will find more important information on how to choose rubrics for a case. So, please go to:
“Revisiting: 4 Day Migraine”.
OK, I’ve officially run out of steam! See you again next time!
Elaine Lewis, D.Hom., C.Hom.
Elaine takes online cases! Write to her at [email protected]
Visit her website: elaineLewis.hpathy.com