Solving the homeopathic case: What symptoms do we pick? When do we repertorize and when do we not?
Ladies and gentlemen, your attention please; we have reached an important landmark of sorts! This is our 50th episode of “Tidbits”!
It means that for over 4 years now, every month without fail, a truly exciting issue of “Tidbits” has rolled off the presses! OK, enough self-congratulations for now, let’s get back to work!
Who remembers “Repertory Round-Up part 3”? We picked rubrics in a great case of Vertigo, and you might want to read it again because it leads right into our discussion of today. (click below)
As you know, I do the Hpathy Quiz every month and invariably, there are many wrong answers, and I’m starting to get the impression that no one knows what a “characteristic” symptom is! You remember Hahnemann’s famous paragraph 153 from the Organon, right? “The most striking, strange, rare, peculiar (characteristic) symptoms in the case are the ones we need to pay almost exclusive attention to as they must match the same symptoms in the chosen medicine.”
Notice he doesn’t say, “Add up all the symptoms in the case and find a remedy that matches them.” No, just the “characteristic” symptoms! So guess what? We have to find out what a characteristic symptom is! So here we go:
1. The symptom is BIZARRE. It’s WEIRD. It makes you turn around and say, “Huh? What did you just say? Could you repeat that please?” Also, a symptom that’s RECENT is characteristic. Why? Because according to “Hering’s Law”, “Healing takes place in REVERSE ORDER!” meaning it starts with the most recent symptom! So, matching that symptom is most likely very important.
2. The symptom is PECULIAR or strange for the disease. For example, it’s normal to have thirst during a fever, we wouldn’t pay any attention to that. Any symptom that’s expected, we don’t care about! But if a person had no thirst with a fever…that would be very characteristic and we would surely want to look up “thirstlessness during fever”.
3. The symptom is normal but EXCESSIVE. What if a person had thirst during fever but he was pouring glass after glass of water and never feeling satisfied; we would surely have to look up “thirst with fever”.
4. Symptoms that you’d expect to be there but aren’t there; or they’re there only in the smallest way. Let’s say a person has a very bad sore throat by all appearances but says he has no or little pain! That would really be strange! And what remedy has that? “Painless sore throat”: Baptisia.
5. The symptom is a keynote of a remedy! Robin Murphy always says, “If you see a keynote of a remedy, give the remedy!” That means the example in #3 should be given Phosphorus right away without a moment’s hesitation.
6. The symptom is characteristic because it’s the concomitant. What does that mean? You might have a common symptom, such as vomiting with a stomach flu, there wouldn’t be much we could do with a symptom like that, right? It’s very common; it’s expected, and that’s not going to help us very much, is it; but, if the patient had a “concomitant” diarrhea at the same time? That would be very peculiar; we would surely repertorize that! The rubric is “Stomach: vomiting, diarrhea, during” and the two main remedies are Arsenicum and Veratrum alb.
7. Two symptoms alternate: as one goes away, the other one comes back.
8. Sensation, location and modalities! A symptom means nothing to us without its sensation, location and modalities! You might think you have a symptom, such as headache on vertex; but you won’t even be able to find it in the Repertory unless you know the “Sensation” because the “sensation” is listed first: first comes the sensation, then comes the location. So to find “headache on vertex” in the Headache chapter, you will only find it as “Headache: aching pain, vertex” or “Headache: shooting pain, vertex”, or “Headache: pulsating pain, vertex”. There’s no “Headache: vertex”! (Vertex means top of the head.) So you have to ask the patient, “What’s the sensation?” In my questionnaire, I always give lots of examples (“Is it throbbing? Lancinating? Dull? Achy? Bruised? Sore? Stinging?”) otherwise, you get “I don’t know” in answer to every question!
And as for modalities–the factors that make the complaint better or worse, including the time of day or night that the person is better or worse–nothing could be more important! You might have a very common symptom in your case; a useless symptom, by all rights; but, attach a modality to it, and wham! you’re down to just a few remedies! For example, “Coughing: eating amel.” (cough, better eating). There are only 13 remedies in that rubric and only one in bold–Spongia! So, you add a modality to a symptom, and all of a sudden, a common symptom becomes characteristic!
9. MENTALS / EMOTIONALS We all know how important they are, I don’t have to tell you. BUT! They have to be peculiar! If they make sense, they’re not symptoms–meaning, not characteristic! If I say, “I hurt my knee and now I’m depressed,” is that a symptom? We’d all be depressed if that happened! And another thing you have to do is use your powers of discernment when a patient is talking to you. He might say, “I don’t want any company, I want to be alone.” That sounds like a really good symptom (“company agg.”)! But is that really true? Find out! In the vertigo case we linked to above, the patient was aggravated by the company that was THERE–namely, her kids!!!! That’s why she wanted to be alone! So what seemed like a great symptom was actually not a symptom at all! Kids aren’t going to take care of you, they expect YOU to take care of them, even when you’re sick!
10. ETIOLOGY! The famous etiology I’m always talking about! It’s expressed as “ailments from” in our Repertory. Etiology is at the top of the hierarchy of symptoms. And since I brought that up, this would be a good time to segue into Part-B of our discussion, namely…
The Hierarchy Of Symptoms
Ailments from/Never Well Since a certain occurrence or illness. When the etiology is clear (“I’ve been dizzy since a concussion I had in a car accident”) then look no further! In this case, the remedy is Arnica, and a second choice might be Nat-sulph.
What’s wrong with you?
We have to know what disease or condition you have so we can go to that rubric and see which of the remedies there match the characteristic symptoms of your case. Measles? Heart disease? PMS? Arthritis? Gallstones? Kidney stones? Ovarian cyst? Stomach virus?
Some of you are going to say, “But isn’t this allopathy?”
If I don’t know what you have, I could be giving you a measles remedy for poison ivy because both diseases have a rash! You know, that’s the thing about symptoms, they cover a lot of diseases, and you can’t seriously think that you get the same remedy regardless of what the diagnosis is! Really? Think about that! Take a symptom like diarrhea, so many illnesses have it: Food poisoning, Crohns Disease, Stage fright…do they all need Arsenicum? The food poisoning patient might need Arsenicum, but the stage fright person might need Gelsemium; so, knowing the symptom isn’t enough, we have to know what’s wrong with you, what the issue is.
3. Sudden Onset
A sudden onset might trump everything in the case and lead to an immediate consideration of Aconite or Belladonna. Here’s a typical sudden-onset case. You go out in the cold/dry winds of a day in March and you forget your hat. Half an hour later you have an earache. That would be Aconite.
4. Delusions; Striking/Strange/Rare/ Peculiar/ and Most recent symptom
7. Physical Generals–symptoms that start with the word “I”
8. Local symptoms–symptoms that start with the word “My”
Now, to help us out, let’s look to this month’s Quiz Answer as an example: “Revisiting: A Mrs. Rosie O’Donnell From Fort Lee, NJ Writes…”. As you may remember, Rosie had a very complicated case; she seemed to have a million things wrong with her! My quiz respondents dutifully repertorized all of Rosie’s symptoms, giving equal weight to the local symptoms and the strange/rare/peculiars, etc. The “cold feet” Rosie complained of, and her hang-nails got the same value as her most recent symptom– aversion to cheese–and her day-long crying spell, which was just “weird” (very peculiar) in my opinion.
Checking with our hierarchy of symptoms, was there an etiology in this case? No. Was there a diagnosis? No. Was there Sudden Onset? No. Strange/Rare/Peculiar and Recent? Yes!!!! Two things: A newly acquired aversion to cheese and a desire to cry for no reason.
So now, I want you to picture the Hierarchy of Symptoms as a chest of drawers and imagine that each drawer is labeled.
The top drawer says “Etiology”, the 2nd drawer says Diagnosis, the 3rd drawer says Sudden Onset, the 4th drawer says Delusions and Strange/Rare/Peculiar and Most Recent Occurrence, and so on. Now, pay close attention. What happens when you pull open the top drawer and look inside? ALL THE OTHER DRAWERS DISAPPEAR!
In effect, they’re gone!
You can’t see them anymore if you’re looking into the top drawer!
In effect, “Etiology” is “over-ruling” or “over-powering” or “over-riding” all the other drawers (symptoms), just like Robin Murphy always said!
Now close the top drawer and open drawer # 2 and what happens? All the drawers (symptoms) below it disappear! If you open the 4th drawer (delusions/strange/rare/peculiar), all the drawers underneath that disappear! What does all this mean? It means that the highest symptom in the hierarchy over-rules all the ones below it! Practically speaking, if your case had a clear mental/emotional, all the symptoms below it would become irrelevant! They’re gone!
In “Rosie O’Donnell’s” case? Our characteristic symptoms that we found were “crying all day” (peculiar) and “aversion to cheese” (most recent)–both are in drawer #4 (those 2 symptoms have to be repertorized to see which remedy covers both of them) but all the other symptoms in drawers 5-8 are now irrelevant, we don’t need to know anything more or do anything else! We don’t have to care about Rosie’s cold feet, her bloated stomach, her hang-nails, her stabbing pains, her sore pains in the liver region, etc.
As I saw it, I needed a remedy that had an aversion to cheese that also had a tendency to cry. And it was Ignatia, a very easy case that LOOKED hard because of all her random, local symptoms! Face it, your average person would have repertorized all those symptoms–maybe 7 symptoms–and heaven only knows what remedy might have come up! But that’s what people think they’re supposed to do!
So some of you are going to be wondering, “What if the etiology is ‘ailments from cold weather’ with dozens of remedies to choose from, what then?” Then you need to go down, in order, from drawer to drawer and stop when you’ve finally found a characteristic symptom; maybe it’s excessive thirst for large quantities. Are there any Ailments from Cold remedies that have excessive thirst for large quantities? Yes, Aconite! Can you confirm Aconite? Aconite goes pale when sitting up, is it the same for your patient? Aconite has pin-point pupils, does your patient? Aconite has fear and anxiety with restlessness, better open air, does your patient? If yes, you’ve pretty much confirmed Aconite, you’re done!
As a general rule, if all your symptoms are in the same drawer, you have to repertorize them.
Remember, etiology is at the top of the hierarchy. You should always be trying to find out what the CAUSE (etiology) was, if at all possible. We have some very famous etiologies:
Ailments from head injury–Arnica and Nat-sulph.
Ailments from fatty rich food–Pulsatilla.
Ailments from electricity/radiation–Phosphorus.
Ailments from cold dry winds–Aconite.
Ailments from blunt trauma–Arnica.
Ailments from acute grief–Ignatia.
Ailments from bad news–Gelsemium.
Ailments from humiliation–Staphysagria.
Ailments from “night-watching”–Cocculus.
Ailments from cold/wet weather–Rhus tox.
Ailments from injury to areas rich in nerves–Hypericum.
Ailments from animal bites–Ledum.
Ailments from insect bites–Ledum.
Ailments from mosquito bites–Ledum.
Ailments from puncture wounds–Ledum.
Every case does not have a reliable etiology. But when it does, your case is suddenly very easy for you because it’s almost over! If you’re between 2 or 3 “ailments from” remedies, you only have to look at the characteristic symptoms in the rest of your case and say, “Does this characteristic symptom cover that remedy?” For example, “ailments from cold/damp weather”, and you’re between Rhus tox and Nat-sulph and the patient says he’s “better for hot baths”, you would go with Rhus tox as Nat-sulph is not in that rubric. So you’d say, “Better hot baths confirms Rhus tox.” See? OK, now what’s next in the Hierarchy of Symptoms?
Diagnosis! And this confuses a lot of people because it’s starting to sound a lot like Allopathy! (Orthodox medicine) But Hahnemann famously said, “You have to perceive what has to be cured.” And that means, you have to have a concept of what is wrong. What’s wrong with this patient? Does he have a stomach virus? Pneumonia? Appendicitis? We have to know this because if there is no etiology, this is where we start from! We start with a statement like, “I need a stomach flu remedy”, or “I need a Pneumonia remedy.” Often, but not always, these diagnostic rubrics are very large. So we have to say, “I need a stomach flu remedy with….” and here come our characteristic symptoms! “I need a stomach flu remedy that’s very cold, apathetic and just sleeps all day.” That’s Gelsemium! Now, what if I change the diagnosis to “Grief”. “I need a Grief remedy that’s cold, apathetic and sleeps all day.” That’s Phosphoric acid! You see? You change the diagnosis, with the same symptoms, and you have a different remedy!
So, if there is no Etiology, we start our case off with: I need a _______ remedy, with the following characteristic symptoms. What’s below Diagnosis? “Sudden Onset”! If you say, “I need a flu remedy with sudden onset, you’re down to Belladonna and Aconite! How are you going to decide? Easy. Belladonna is thirstless, Aconite is very thirsty. Belladonna has dilated pupils, Aconite has pin-point pupils. Your case is now done! You might say, “But what about the fact the patient also has ….” No, it doesn’t matter! “I need a flu remedy with sudden onset that’s thirsty.” That’s it, you’re done! Why? Because when you open the Sudden Onset “drawer”, all the ones below it disappear, they’re gone! Remember? You only need to confirm either Aconite or Belladonna with one or two characteristic symptoms!
What if there’s no Sudden Onset? What’s the next category? Strange/Rare/Peculiar, most recent symptom or occurrence. So how do you start your case now? “I need a flu remedy with fear of death if the patient is left alone.” That’s Arsenicum! Now let’s change the diagnosis: I need a remedy for schizophrenia with fear of death if the patient is left alone.” That’s Stramonium! You see how it all starts with, as Hahnemann said, “Perceiving what has to be cured”, or as we say, making a diagnosis?
So, you might say, in homeopathy, when looking for the right remedy, we go from BIG to SMALL. Big to Small. We start out with the Big category, and move down ONE DRAWER AT A TIME. As soon as you see a remedy picture or remedy image, stop opening drawers! You’ll only clutter up your case with minutia that will pull you off of your remedy!
For instance: Chief Complaint—bleeding between periods. The rubric is “Female: bleeding, uterus, metrorrhagia”. Is there an etiology? No. Diagnosis? Yes. Metrorrhagia. Over 200 remedies, too big. So you open the next drawer. Sudden onset? No. Next drawer: delusions, striking, strange, rare, peculiar (characteristic) symptoms: Yes! What are they? Patient is uncooperative, aggressive, talks loud, repeats herself and interrupts. What’s that? Lachesis! Is Lachesis in the Metrorrhagia rubric? Yes, it’s in bold! Case is over! It’s done! Don’t do anything else! Stop opening drawers! Maybe she’s hot or chilly, maybe she’s thirsty or thirstless, maybe the menstrual blood is bright red or dark or clotted… it doesn’t matter! Robin Murphy used to say, “When you see a remedy picture, give the remedy!” Don’t start your case off at the bottom of the Hierarchy. The whole point, the whole concept of a “hierarchy of symptoms” is that some things are more important than other things! And the important ones over-rule the unimportant ones!
Does everyone know what to do now??? Geez, I hope so; cuz I’m running out of gas! If you have any questions, let me know; otherwise, see you again next time!
Elaine Lewis, D.Hom., C.Hom.
Elaine takes online case. Write to her at [email protected]
Visit her website: www.ElaineLewis.hpathy.com
YOU HAVE GIVEN AN EXCELLENT SUMMARY OF ALL THE POINTS AN HOMEOPATH SHOULD REMEMBER WHILE SELECTING A REMEDY. BUT WHAT ABOUT METHOD OF SENSATION AND CHOOSING A CORRECT KINGDOM AND MATCHING A REMEDY OUT OF THAT KINGDOM?
Hi Dr. Gupta! Yes, that is a problem isn’t it? Because it doesn’t seem to fit anywhere except that finding out the “sensation” is paramount in most cases, we must have it! But it does seem that the “sensation method” has little to do with Hahnemann and The Organon. As Julian Winston used to say, “Call it whatever you want, just don’t call it ‘homeopathy’!” But you know, it would be a “strange/rare/peculiar” if the patient kept making references to “birds”, and saying things like, “I want to fly away”, or “I want to be as free as a bird” or “I felt like a caged bird”, you would, of course, pursue that because maybe the patient needs a bird remedy. And, of course, everything’s a clue–how the person dresses, how he speaks–logically or jumping from topic to topic; how he sits, what his face tells you–pale, red spots, cracks, lines, location of the hairline… but again, what are we doing? We’re looking for characteristic symptoms! We have to know that they don’t include hang-nails and cold feet, but they do include the list above in the article.
Elaine thank you so much for sharing with us such a deep knowlegde.You are precious to all of us. Warm regards from Skiathos Greece
Hi Vicky, I haven’t heard from you in ages! It’s good to see you again!
Cases most often fail because of mistakes in basic concepts. Thank you for your unique and down to earth way of explaining ideas and methods in homeopathy.
Hi Elaine, I am an avid reader of all your articles and quizzes. This is the first time I am writing to you. Thank you for the good articles till now. I have a question in Example 3 : the case of the vertigo: are n’t Phos and Causticum inimical to each other? Please clarify my doubt.
Hi! Yes, Caust. and Phos. would be inimical because they’re so similar, one could antidote the other; but, it can’t antidote a remedy that has stopped working! She’s no longer in a causticum state. And remember, you always have to cover the most recent symptom in a case, which in this instance was “vertigo on turning the head to the left”. That never happened before, and Phosphorus covers it. So you might say that Caust. pushed the case into phosphorus. Or, you might say that a phosphorus case had a causticum layer on top that had to be treated first before Phos. would work. I can’t say for sure.