Homeopathy Papers

Tidbits 43: Repertory Round-up, part-3

Elaine Lewis
Written by Elaine Lewis

How to pick rubrics in a homeopathic case

Maria, once again, has asked me to walk her (and my readers in general) through a homeopathic case and explain what I’m thinking as I go.  I’ll give it a try.  Here we have the case of a long-time friend of the hpathy ezine, Gabi from Canada, who recently sent me the following email (and also gave me permission to use her case in “Tidbits”).  Gabi’s answers to the Questionnaire are in red, my comments are in blue):

 

Hi Elaine,

Here is my questionnaire. I had to ask for help after the third time this has happened!

Let me know your fees at the moment.  Sending you a hug along with the questionnaire and I hope you can help me…

Gabi xx

Acute Case Questionnaire

  1. Describe the complaint or complaints in your own words.

This is the second or third time it happened. I have severe vertigo (the room moves all over)

So the first thing I’m thinking here is that I have to read the entire Vertigo Chapter!  Do you know why?  Because I know that “room moves all over” is NOT in the Repertory!  I need to ask Gabi what she means by it, but I need it in the form of a rubric or it’s not going to help me!  So my goal is to find all the rubrics in Vertigo that can possibly mean “room moves all over” and then tell her to pick one, which I did, and guess what it turned out to be?  It was under “Objects”!  Yes, OBJECTS!  (See why I had to read the whole chapter?)  “Vertigo: Objects, general, seem to turn in a circle, room whirls”.  That’s the rubric!  I mean, the room is spinning and we’re supposed to know to look under “objects”!  I’m shaking my head.

…and nausea so bad that I am about to throw up.

OK, so, we’ve now got our second rubric:  “Vertigo, nausea, with”.

This time it happened after I was lying down on the floor trying to stretch my left shoulder that has been giving me pain.

I took this to mean that lying down aggravates.  Later in the questionnaire she says she must sit up, so, that would tend to confirm it.  So I took the rubric, “Vertigo: lying, while, agg.”

I’ve been sick with this and that, especially EAR ACHE, the loud ringing persists and the pain is on the left side, inside sometimes it gets worse than outside.

“Generals: air, open air, outside, amel.”  I decided to find out if the ear symptoms are true concomitants or if they’re chronic complaints.  If they’re chronic complaints, we have to dismiss them as not being part of the case.  Well, as it turns out, they are chronic; so, we will ignore them for now.  Kent says don’t mix up chronic symptoms with the ones in your acute case.

I have tried a number of remedies. ACONITE right after it happened and lately BRYONIA but with limited success. I want to get rid of this it’s debilitating…

Do we have to make an issue out of the last sentence?  No.  Anyone with this problem would want to get rid of it and anyone would find it debilitating.

  1. Etiology–

I don’t know how it started the first time, I simply woke up and the room was moving all around me it was awful, I stumbled to the bathroom as I can’t walk straight when it happens.  It also makes me incredibly sad to be like this.  Right now it might have to do with what happened when ______ was here (she just left) there was a lot fighting with my kids, old issues came up, awful stuff.

Am I going to take “ailments from emotions”?  I could but, Gabi’s not really sure about this, so, I’m moving on.

  1. Sensation–

Like I’m falling.

“Vertigo: falling sensation”.

  1. Appearance–

Deep black rings around my eyes (I have tried PHOSPHORUS too but it doesn’t work)

5. Location–

The head and the ear but also the left kidney it is painful, better by warmth I have a hot water bottle, the shoulder, it’s all on the left side.  Stomach–bloating after eating.

I took “Stomach: distention, eating, after”.  I asked again and the ear, kidney pain and shoulder all pre-date the vertigo; so, they’re not part of our case.

6. Modalities– This is a fancy word that means, “What makes your complaint better or worse”?

I have to sit up or it all moves around me, knees are up, warmth, lemon water, not eating, silence, sleep, worse closing my eyes, worse motion, turning my head, better fresh air

I already have “worse lying” so I passed on taking “better sitting”.  I took “Vertigo: eyes, closing, on, agg.”, “Vertigo: turning, on, moving the head”, “Vertigo: motion agg.”

7. Concomitants (symptoms that came with the complaint, “along for the ride”, so to speak)

I have a stiff neck.  I have a headache, like pressure in my forehead.  There is a headache together with this at the top of the head, last night it was at the back; the kidney pain, the shoulder (collar bone).

I took “Headaches: pressing pain, forehead”.  So, because there is no “Headache: vertex” rubric, there’s nothing I can do with that symptom.  Vertex, of course, means the top of the head.  I know you’re finding it hard to believe that there’s no “Headache: vertex” rubric, but, in the Repertory, the first word listed is the “Sensation”–not the Location!!!!  So, the headache chapter will have, for example, “Pressing pain, vertex”, not “Vertex, pressing pain”.  See what I mean?  So, to be able to use this symptom, I would have to say to Gabi, “What does the headache pain on the vertex feel like?”  This is why you should tell your patients, “If you’re going to give me symptoms without sensations and modalities, then don’t even bother, because I won’t be able to find your remedy!”

  1. Discharges–color, odor, consistency and sensation.

No discharges

  1. Generals–these are all the symptoms that begin with the word “I”.

I do get rushes of heat out of the blue (I tried Mercury), I’m never hungry, I’m embarrassed, nauseous, I’m weak

I took “Generals: heat, flushes of”.  There’s no subrubric for “sudden”.  We’ve already taken a rubric for nausea; as for embarrassment, anyone would be embarrassed if they couldn’t walk normally, and “weakness” would be common given that she is not eating due to having no appetite.

  1. The mentals:

Confusion would be the most pressing; dullness, sometimes feel like crying but mostly indifference

We could take “confusion”; but, with over 300 remedies under it, it appears that just about every remedy is confused!  We could also take “indifference”; but again, at almost 250 remedies, such a large rubric won’t be of much help to us.

  1. What have you been saying?

I want to be alone and quiet

Once again, we are met with the inscrutability of the Repertory!  There’s “Mind: noise, aversion to”, and that would seem to be our rubric, right?  But, I was struck by how few remedies were in it!  Just 14, and no spider remedies!  And the most famous one of all–Theridion–is not there!  I said to myself, this can’t be right; there’s gotta be a better rubric for this, but where?  So I looked and looked, and you know where it is?  It’s under “Sensitive”!  Mind: sensitive, mental, oversensitive, emotional, noise, to”.  Good heavens!  Should “oversensitive” really have come before “noise”?  And why is “mental” in there?  We already know we’re in the Mind chapter!  You know, you really have to wonder about who wrote this stuff and what they were thinking.  The rubric should be “Mind: noise, sensitive to, oversensitive”.  Am I right?  I almost took that rubric but in the end, I felt that under the circumstances, wanting quiet wasn’t so unusual.  I didn’t bother with the “wanting to be alone” symptom either because I know that no one’s there but Gabi’s 2 kids and they’re not very helpful, so, in fact, we don’t really know if Gabi would have appreciated helpful company; so, I’m just going to ignore that for now.

12. What are you doing?

I have been sick for quite a while now so I feel bad I am not doing anything except the daily things…

Nothing significant here.

13. Describe your thirst and appetite–

I am quite thirsty, want ice on the drinks, sips, I ate an orange yesterday and it made me very sick it was right after the onset of the nausea/vertigo etc.

So this is a very important question for us–thirst–and to a lesser extent, appetite.  If a person is thirsty, we can eliminate all of our thirstless remedies, like Pulsatilla (which is a big vertigo remedy, by the way).  When a person says they want ice, that’s a gift!  It really narrows down the selection!  Never be satisfied with your case until you’ve heard about your patient’s thirst.  But be careful to establish that this is a true concomitant and not just the way they normally are.  Needless to say, I took “desires cold drinks” and “desires ice”.  What about “ailments from citrus”?  No.  She was sick, THEN ate an orange.  For all we know, ANYTHING she might have eaten would have made her worse.  We have no way of knowing, so, we’ll pass on that.

  1. Fever?

I have been taking hot baths in the evenings. There was a fever the first time it happened now it would be low grade

It sounds like she’s saying that the first time she got this vertigo attack, there was a fever.  Now, however, there’s not much of a fever.  But you know what?  There’s no rubric “Vertigo: fever, with” anyway.  There is only the opposite, “Fever with vertigo”.  So we will ignore the fever question and move on.

  1. Sweating? Describe.

Sweating happens when I get those hot flashes but it doesn’t smell, I open the window for a while. I have taken Lachesis when this happens (It might not be related to the main complaint)

Then we should really not use it.  Maybe she’s starting menopause.  I’m going to take it out.

  1. Odors? Are odors an issue in the case, such as bad breath, foul or unusual odors of any sort? Any identifiable odors–like sulphur, onions, fish, etc.?

No.

17. What is most striking, peculiar or identifying about your condition?

That it doesn’t go away and the ringing in the ears is constant

Again, I found out the ringing in the ears is chronic, so, we can’t use it to find the vertigo remedy.

  1. Diagnosis?

No, I went to try to have my ear checked before Christmas when it happened the first time but it was -45 C that day and the emergency was full…I also tried acupuncture but it was only mildly helpful

  1. Describe your energy–

I am prostrated, dull, stuporous at times, anguished

The “Mind: exhaustion” rubric has over 200 remedies in it, not very helpful.  Anguished–who wouldn’t be?  This is an awful complaint!  If the symptom makes sense and is normal given what’s wrong, it’s not a symptom.

  1. What does your tongue look like? (color/coating/pattern, crack/s, shape, etc.)

Silvery white

There are almost 250 remedies under “white tongue”, so, it’s not going to be very helpful in finding a remedy.

  1. If you have a cough, please tell what it sounds like

No cough

******************************

I think you can see that Phosphorus is in first place followed by Causticum and Calc-carb.  Because Gabi had already tried Phosphorus, she took Causticum.  Here’s what she said:

I am on the Causticum now. Of the three remedies it is the most effective so far. That means only that the headache is less painful and the vertigo is less but the ringing is still there…one dose of 1M so far. We’ll wait and see.

I asked Gabi if the room had stopped spinning.

The room is not spining anymore and the vertigo is almost gone…although I haven’t tried to lie down…I feel better all around. I ate a bit but am still not hungry and the headache is there but not as bad at all…

The ringing is a metallic, electrical sound and it is so loud that I can hear it constantly (left side), It’s been on for so long I don’t know…I think it might have started after I spent time at the lake this summer got water in my ear.

Thanks so much Elaine.  I can walk normally now.

The next day, Gabi writes a rather surprising letter:

Things have changed a bit in the sense that I would only get vertigo if I turned my head to the left in the morning.

I feel quite weak. The Causticum stopped working…I am back on Phosphorus which is now working! I don’t understand why but I thought i would go backwards and try and see what would happen and it was the right decision.

Still not hungry. Ringing is still there but I’ll deal with that after…

This to say that your determining these remedies has helped.

Thanks Elaine!

Gabi

I asked if Phosphorus cured the “worse turning head to the left”.

Yes, Phos. cured the turning to the left. I chose it because of it’s left sided-ness and because the Causticum simply didn’t work anymore.

It was worse when I got up from bed and in the morning…it lasted a few minutes…I spent most of the day in bed.

I ate two small meals today so that’s better than before!

Right, getting the appetite back is a really good sign!  I asked Gabi, “Was this a new symptom–worse turning head to the left?  I’m trying to think of a reason going back to Phosphorus would have worked after it didn’t work before.  Did it also take away the excessive thirst?”

Yes it did take away the excessive thirst…and yes, vertigo on turning to the left was a new symptom, before it was everything that made me have vertigo. I feel WAY better right now.

***

So that’s the case, everybody.  Very unusual, don’t you think?  Remember the importance of the questionnaire.  It asks the questions homeopaths–not doctors–need answers to; so, be sure to have it with you!  I’m wondering if Gabi needs to make a remedy out of the lake water for her ringing in the ears…?  If she tries it, I’ll let you know what happens.

See you again next time!

_____________________________________

Elaine Lewis, D.Hom., C.Hom.

Elaine takes online cases! Write to her at LEWRA@aol.com

Visit her website: elaineLewis.hpathy.com

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:
http://elainelewis.hpathy.com/ and TheSilhouettes.org

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