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-congratulatory hoo-hah, let’s get 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.” He says it is the “characteristic” symptoms that must match a remedy! 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. A recent symptom is very reliable, it hasn’t had a chance to be corrupted by time, drugs, bad habits and so on. You know that Hering’s Law says that healing takes place in reverse order, right? So the most recent symptom in a case will be the first to go, so matching that symptom is essential.
2. The symptom is PECULIAR or strange in 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 in the disease, 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 reports no or very 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 by its concomitant. What does that mean? You might have a common symptom, such as vomiting in a stomach flu, there wouldn’t be much we could do with a symptom like that; but, if the patient had diarrhea at the same time? A concomitant diarrhea? 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 can’t even find it in the Repertory if you don’t know these things! We saw in “Repertory Round-Up part 3”, the Vertigo case, the patient said she had a headache on her vertex (top of her head) but we couldn’t do anything with that symptom because it’s not in the Headache chapter! It’s not there because the sensation is listed first in the chapter and the location second! So you would have to look it up as “aching pain, vertex” or “shooting pain, vertex”, or “pulsating pain, vertex”.
We didn’t have any sensation information. And as for modalities–the factors that make the complaint better or worse, including the time of day or night–you might have a very common symptom in your case; by all rights, a useless symptom; but, attach a modality to it, and wham! you’re down to just a few remedies! For example, “Coughing: eating amel.” There are only 13 remedies in that rubric and only one in bold–Spongia! So, you add a modality to a symptom and suddenly you’re down to just a few remedies; that’s how important modalities are!
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! If I say, “I hurt my knee and now I’m depressed,” is that a symptom? We’d all be depressed if that happened to us! 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! But is that really true? Find out! In the vertigo case we mentioned, 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
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 have the characteristic symptoms of our case. Measles? Heart disease? PMS? Arthritis? Gallstones? Kidney stones? Ovarian cyst? A stomach virus?
Some of you are going to say, “Isn’t this allopathy?”
If I don’t know what you have, I could be giving you a measles remedy for poison ivy! 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, the Crohns Disease patient might need Nitric acid and so on; so, knowing the symptom isn’t enough, we have to know what’s wrong with you!
3. Sudden Onset
A sudden onset might trump everything in the case and lead to an immediate consideration of Aconite or Belladonna and maybe even Baptisia in septic states.
4. Delusions, 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 Lynn, 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 symptoms: aversion to cheese and her day-long crying spell–which was just “weird” 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 and Peculiar? 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 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!
The top drawer is all you see! In effect, “Etiology” is “over-ruling” or “over-powering” all the other drawers, just like Robin Murphy said!
Now close the top drawer and open drawer # 2 and what happens? All the drawers underneath it disappear! If you open the 4th drawer (delusions/strange/rare/peculiar), all the drawers underneath that drawer 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, and there was nothing above that symptom, all the symptoms below it would become irrelevant!
In “Rosie O’Donnell’s” case? Our characteristic symptoms that we found were “crying all day” (peculiar) and “aversion to cheese” (recent)–both are in drawer #4 (those 2 symptoms have to be repertorized to see which remedy is covered by both) but all the other symptoms in drawers 5-8 are now irrelevant, we don’t need to know anything or do anything else! We don’t have to care about her 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 difficult because of her voluminous, random, local symptoms!
So some of you are going to be wondering, “When are we supposed to repertorize then?” It’s usually when your case consists of only local symptoms or when the rubrics in the higher drawers contain too many remedies to be useful.
Maybe you’ve got a cold with a runny nose that’s worse outside; a dry cough, worse talking; a bursting headache on the left side of your forehead and a desire for ice cold drinks. Well … it may be Phosphorus–since Phosphorus is famous for desiring ice cold drinks, and it’s higher in the hierarchy than the other symptoms in the case; but, since there are 16 remedies in “desires ice cold drinks”, you might want to see if you can confirm Phosphorus by asking yourself, does Phosphorus cover bursting headaches? Yes. Does it cover coryza (runny nose) worse outside? Yes. Does it cover dry cough, worse talking? Yes. So maybe it is Phosphorus! You can feel confident in giving it now.
As a general rule, if all your symptoms are in the same drawer, you have to repertorize.
Well, I’ve run 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 LEWRA@aol.com
Visit her website: www.ElaineLewis.hpathy.com