Editor: This is Part II of this article. If you have not read Part I, Please read it first here.
Towards Individualization: Case History
Interrelation of Remedy and Case History
In homeopathy, as taught by Hahnemann, there is a similarity between remedy and case history. This relationship is purely one-sided: an already known (proven) remedy is prescribed to an unknown patient who is similar in one way or another. The contrary relationship, that the patient’s experience helps define the theme(s) of the remedy, is never analyzed or critically examined. It is common in seminars, that homeopathic “gurus” will present a remedy on the basis of a “typical” case, without a comprehensible rationale for the remedy selection, and with insufficient observation of the case to justify their postulate. In our daily practice, such an intuitive approach may be quite justified. However, we don’t permit poorly examined or analyzed cases to infiltrate the Materia medica. Neither should uniquely appearing symptoms from such case histories make their way into the repertories.
If we now submit both the collection of symptoms and the case history to a strict, always identical analysis according to the Masi model, it becomes possible, with all appropriate caution, to draw conclusions from patients to a remedy-hypothesis. This was already done in 1996, when the Materia Medica Homoeopathica had been published , in which hypotheses of Citrus vulgaris, Calcium arsenicosum, Toxicophis and Vipera berus could be worked out thanks to long-standing cases from different homeopathic offices. Even today we work absolutely in the same manner, especially if too few detailed proving symptoms are available. This way, we succeeded recently to revise Sambucus nigra and Bufo, because in both cases many years of case histories where available.
A third kind of interrelation, which is of special importance to the work by Masi, is the correction of the remedy’s hypothesis, which can be carried out with the help of a patient’s case. This way, in the case of Cenchris, quite different hypotheses had been published by the French group AFADH  and in Materie Medica Homoeopathica . A Cenchris case of many years ultimately supported the hypothesis of the AFADH .
Another example happened recently during the run of a lecture, when the remedy picture of Sabina could be reviewed with use of a long-standing case history. When we made the preparations it appeared, that the old hypothesis of 1996, which was fully based on Thomistic philosophy, today seemed to be too “cracked”, too little held in concrete terms, too close to the real symptoms. It was obvious that we first had to rework the old revision one more time, and we succeeded in building a new “more true-to-life” hypothesis, which then in the re-inspection fitted better to the available case history.
A different anamnestic technique
In the search for the primary Psora of the individual patient, we need an anamnestic technique which asks more about the motivation, the inner motives and the background of the person. A common head-to-foot-examination with the help of papers derived from questionnaires or of a technique focusing on repertory-rubrics doesn’t suffice. Rather, it is necessary to perceive the patient in a deeper, more meticulous way.
Prerequisites of a successful Anamnesis
Here, a detached fundamental attitude and an open formulation of the question are of crucial importance. Participation in training courses in interaction focused on themes, in guiding conversation and in active listening, e. g. by Thomas Gordon or Carl R. Rogers are highly recommended. The time frame for a deepened anamnesis has been postulated by Masi as unlimited. He thought about an anamneses of eight hours, visits to the patients’ houses or even joint visits at pubs. There’s no need to explain that this can’t be done in a homeopathic practice. Therefore, it must be possible to record the two-hour interview with the patient as much as possible verbatim, in order to gain sufficient materials this way.
Spontaneous Report by the Patient
Primarily, there are the spontaneous reports by the patient, as well as the exact grasp of all complaints. One of the most central misunderstandings regarding the “Masi-method” is the assumption that it would be interested only in mental symptoms. In truth, especially conspicuous physical symptoms, modalities or individual sensitivities can be important guidelines when writing the patient’s hypothesis.
Asking for the cause often leads to the mental level. In this area, we focus mainly on the motivation behind human reaction to joy, grief, anger or fear. E. g., if a patient reports that his complaints had begun with a divorce, to many homeopaths the rubric “mind – love disappointment, unhappy, ailments from” might light up. But if we inquire in an open manner, about what along with the divorce has hit him, he might tell us that it has been a huge disgrace, because all of his friends have known that his marriage was going downhill. Or, since the divorce he had no chance to express his sexuality which is difficult at his age (and dangerous in a time of AIDS). So we can see that different psychological backgrounds can lead to very different remedy-hypotheses.
What is the Focus of the Patient’s Inner Attention?
Even banal statements can indicate the individual focus of the patient. During anamnesis it is important not to fall into the trap of considering reactions as “normal” too early. The risk exists especially when the patient’s history has a strong similarity to our own lives. That’s exactly when we regard reactions as ordinary, which therapists of a different nature might find outstanding. For example, if a patient begins to talk about the current stress of having to get up every night because of her little children, then, at the first we may consider it ordinary, missing the chance to inquire further. To such a question she may answer that she awakes several time a night in panic, one of her kids might have suddenly died. Or we learn that the youngest never sleeps more than half an hour straight, and so we know, that this symptom requires the treatment of the child, not of the mother.
Evaluation of the Course of Treatment
As had been explained earlier in the theoretical part, a person is healthy to us, when he succeeds in moving between the different miasmatic phases, that is, when he can react appropriately to the ups and downs of circumstances.
Recognizing the Miasmatic Dynamics
In tertiary Psora, flexibility between these reaction-mechanisms is disturbed. Blockades are built up and the person remains in a compensatory state. He claims not to have any problems aside from those tiresome physical complaints (Egotrophy). Or he only looks on the dark side and sinks into a deep depression (Egolysis). Or he blames other people for his suffering (Alterolysis).
Process of Recovery – Evaluation of the Psoric Crises
Opposite to these dynamics runs the healing process when a person gets a remedy which is very close to him. While physically Hering’s Law of Cure is still valid, cure on the mental level develops in the opposite direction than postulated by Classical Homeopathy:
The coping by the patient breaks apart and he may pass through a period of fears, despondency and insecurity. In the same time, he has to experience an improvement of his physical complaints. The contents of this psoric crisis absolutely have to be in context with the basic ideas of the remedy given and with the biography of the patient. If we perceived a “senseless” crisis at this moment, it would point to an involuntary remedy proving. During the psoric crisis different reactions can arise: a person becomes angry because of his fate; he can get in touch with his existential fears, or he suddenly feels insecure in areas where previously functioned properly. Frequently, a violent exhaustion may appear, following the compensatory attitude of “letting go.” . It is also possible to remember traumas and fears from childhood. But he also experiences euphoric phases of confidence – until finally everything settles down in a healthy balance. In other words, healing occurs from tertiary to secondary Psora. In an ideal case, the person even partially recognizes his blind spots and finds a creative way of handling them.
Signs of “wrong” Prescriptions
After inexact prescriptions, we can often see that persons feel mentally stronger but the physical complaints stubbornly persist, or shift to a different organ. In this case a so-called egotrophization is in progress. Also a shift of the course of disease to another phase of tertiary Psora is possible. So, a patient e. g. may fall into a depression or he may react with inappropriate aggression. The latter especially is viewed as a development from inside to outside (Hering’s Law?) by homeopaths or as “liberation” – mistakenly from our point of view. Thanks to the “miasmatic dynamics” we therefore can judge the process of recovery much more reliably.
Palladium -Revised by the Masi-Method
In the following we want to use Palladium to demonstrate how the study of a remedy can be done by using the so-called “Masi-method”. In a first step the proving symptoms are collected, if possible, in the original language and unedited by a subsequent author: in the case of Palladium we used the symptom collections by Allen, Hering and Clarke [1, 4, 6]. A first analysis of Palladium is the construction of the list of themes. In this article, for the sake of brevity, we use only in extracts. The original list of themes consisted of six pages Din-A-4.
Step 1: Drawing up a list of themes
Pl. ???? let untouched the original list of themes! An abolition of the enumeration and a regrouping are confusing, because we will refer to the numbers of teams again and again in following chapters! Also, the putting together of small teams to a larger one is extremely problematical, because the work by Masi is centrally about the contents of the symptoms, not about traditional groupings.
Feels best in company and wants to be flattered. He 1.18
Forgets every pain in society, but is agg. next day; attaches great weight to other people’s opinions; likes to be flattered. Cl 1.10
Feeling of Neglect
Imagines herself neglected; wounded pride. He 1.8
Suggestibility, the Opinion of other People
They set great store on other people’s opinion, and attach great importance to what others think. Hence they are very excitable in company and their complaints are worse next day. He 1.5
The symptoms are induced or aggravated by wounded pride and fancied neglect; irritability which often finds vent in violent expressions. Cl 24.4
He 1.11, Cl 1.10
Amiable , yet Obstinate
She tries to appear as amiable as possible, but is obstinate. He 1.14
They set great store on other people’s opinion, and attach great importance to what others think, hence they are very excitable in company and their complaints are worse next day. He 1.5
Mental excitement, particularly in company, also walking, aggravates her troubles in right ovary and groin; she is particularly agg. the day after a musical evening or party. He 1.16
Feels best in company and wants to be flattered. He 1.18, Cl 1.10, 12, 16.13
The Day After
Mental excitement, particularly company, also walking, aggravate her troubles in right ovary and groin; she is particularly agg. the day after a musical evening or party. He 1.16
Forgets every pain in society, but is agg. next day; attaches great weight to other people’s opinions; likes to be flattered. Cl 1.10, He 1.5
While walking it seems to him as if he had grown much taller; the feeling recurs repeatedly. The symptom did not return later either when lying down or walking. A 123
When walking in street in evening, it seems to him as if he had grown taller He 1.3
Time seems longer
Time seems to pass more slowly. He often looked at the clock and less time seemed to have passed than he expected. A 2
Dreams of Houses
Dreams every night, particularly towards morning, of houses or buildings, beside which he stands, or in which he stands before a window, or walks over wide stairs through many rooms. A 152, He 37.5, Cl 26.5
Sat three hours in church, in the evening, listening to a tedious sermon and dull exercises, which gave her a pain in the back, but no headache. Another time, this would not have failed to come. A 91
In the evening she went to church, and walked home rapidly, when the menses reappeared. (…) A 75
Extremely fatigued in evening; feels mentally gone; is averse to speaking a foreign language which at other times he speaks fluently; it is too much of an exertion, he is tired of it. He 1.1
Though usually tired in the evening, feels mentally “gone”; is very awkward in speaking English, it is too much trouble, he is tired of it. A 6
Aversion to any effort to exercise; must lie down. Cl 24.2
Unusually sleepy in evening; very much exhausted and indisposed to work, he takes first chance to lie down. A 148, A 75, 122
Is so tired that he reels on coming into a room. Cl 2.1
He 1.1, A 6, 121, 148, 150
Unusually sleepy in the evening, while riding in the carriage and seeing patients, not after coming home. A 149
Feels heavy, tired in the limbs, inert, and undecided, in the morning. A 121
Depressing news makes all her symptoms worse. He 1.15
Feels sore in abdomen after menses, with fear and apprehension that something horrible will happen. Cl 16.3
Irritable: in evening; and impatient, from headache, could “knock people’s heads off”He 1.9
Very impertinent; makes a face like a savage. He 1.10
Can’t bear anything
She’s in a disagreeable mood; feels as if she could not bear or put up with anything, without anything having occurred. The child is the only one with whom she is not impatient. A 5
She is in a disagreeable mood; feels as if she could not bear or put up with anything, without anything having occurred. The child is the only one with whom she is not impatient. A 5
Soon after rising, between 6 and 7 A.M. most violent, sharp, knifelike pains in the lower portion of the abdomen; she seldom had anything similar. It was so severe that she could not hold the child, but passed off after a passage. Two slight attacks after breakfast, with inclination to stool; nothing passed, however, but wind. A 52
During the night pain in the back across the hips, perhaps because the child was restless. She was anxious about it, but not impatient. A 92
She had a dreamy headache, more in the upper and back part of the head, different from the headache she had had in the last few days. A 24
Tottering, Swaying, Back and Forth
A dinner, pain in vertex, a violent pressure, causing a numbness, as from great heat or cold. Between 2 and 3 P.M. the headache became severe; she had to lie down. She felt as if her head were being swung to and from, from behind forward, not from side to side. Slept one hour, then the headache was better. A 23
Slight fullness in forehead and a sensation as if the brain were being shaken; lasted for thirty-six hours, but was not unpleasant. A 15, Cl 2.2, 2.4
Sensation as if a weight lying on centre of brain; each expiration = sensation as if the weight were pushed from occiput to forehead. (…) 2.3
Heaviness, like a weight in pelvis. Cl 16.8, Cl 16.13, 14, A 16
Growth of Beard
Growth of whiskers more slow. Cl 6.6
He thinks he notices a marked diminuation of growth in his beard. A 37
Special Sensations in the Teeth, Foreign-Body Sensation
Sensation as if incisors were elongated and projecting, interfering unpleasantly with lower lip. Cl 7.1
Peculiar pain in throat when swallowing, as if something were hanging in the region of the hyoid bone, as if breadcrumbs had lodged there; the pain disappears for several minutes, then returns suddenly, while the muscles of the throat are in a passive state, a disagreeable, tickling sensation, as if an awn had lodged in the throat. A 41
Since several days, and particularly noticeable today, there’s a sensitiveness of the second left upper incisor, and a feeling as if it were a dead foreign body. A 38, Cl 7.2, 9.2, 3, 5
Is troubled at times with symptoms of tapeworm. Palladium seemed to have a special effect upon it. Sensation as if the abdomen were enlarging very quickly. Several stitches in the left side, in the region of the hip-bone, but more inward; in the intervals a peculiar pain, as if air-bubbles pressed forcibly upward through the intestines. The stitches and the peculiar feeling in the intestines returned, and extended to the right side.
After 11 A.M. transient pain in the lower portion of the intestines, on the right side, as if the testicles were squeezed. About an hour later, after a meal, the above-mentioned stitches returned, but were of short duration. They returned several times, first on the left side, then less severe on the right; often single stitches, or more accurately, bites, as if an animal were snapping and tearing off little bits from the inside. Flatulency and distension of the abdomen. Sensation as if the intestines were strangulated and twisted in different directions, more in the upper than lower portion. Frequent passage of flatus. Painful stitches in the left side, followed by cutting, more right than left side, almost unbearable, lasting some minutes; returns after a short interval and lasts longer (first day). Stitches in the abdomen (second day). Unpleasant sensation in the groins, painful to pressure, feeling as if emptied of viscera (third day). The prover had no more symptoms of tapeworm for more than a year afterwards. A 53
Cl 12.5-7, 13, 15
Erections every morning, but none in the evening and at night, even none from excitation. A 73
Crawling as of fleas, and itching on various parts of the body, on the back, arms, abdomen, thighs, and ankles. A 143, A 117, 139, 144
Sensation as if he were getting a stiff neck, especially on both sides, above the first dorsal vertebrae; immediately after in the lower portion of the scapula, and at the same elevation in the spinal column, a pressing pain as if a dull object were being slowly pressed against the spine. This is followed by a repetition of stiffness in neck. 86
In the afternoon, dull pressing backache, as from sitting up stiffly too long. A 90
While sitting still, constant painless twitching, which crooks the fingers, particularly the index finger, until twelve o’clock. A 108
On the following days she has a sensation as if the articulating ends of the thigh-bones expanded or were pressed out of their sockets, especially on the left side; she did not notice it while walking, but when pressing down as if for a stool. A 114
Itching over the whole body, while undressing, in the evening. A 145
Step 2: Dividing up into the miasmatic dynamics
In the second step we examine the list of themes according to the symptoms of the suffering (secondary Psora), the compensation (Egotrophy), the withdrawal (Egolysis) or the attack (Alterolysis) and we draw up a new listing on the basis of these rubrics which then, in a third step, should lead to a central theme.
When Palladium suffers from his condition, he will complain about being impressionable Th 3. For every daily affair he takes advice and help and can’t make his own decisions. He believes he is not able to get on with the difficulties of daily life on its own; feels excessively exhausted from his problems Th 12, 13, 21. In an effort to effect others, he describes his pains and problems in a very flowery, dramatic or drastic way Th 28-32.
Another point of suffering is when he has the feeling of not getting enough recognition. He longs for dramatic appearances, for applause and for being loved. This is why he likes to stay with a group of people Th 5. However, the day after, he sinks into an extremely gloomy mood, feels exhausted and emptied Th 6. He very easily feels being rejected and his pride is hurt Th 2. Since he wants to be worshipped and admired by the other people, he is often bored, most especially in church. Th 10.
Behind this, there is a hidden inner emptiness, a lack of personality. In anamnesis, we may notice his superficial answers or the fact that he digresses repeatedly from his problems to reports of the many compliments he had been paid here and there. He also can behave impertinently, because he is sure of his effect – he looks like a savage Th 20.
In compensating his experience of loss he makes an effort to be charming Th 4. This way he gains the wanted acceptance and can even fill in the missing connection with other people. He adapts himself to the mainstream and knows how to present himself properly in the moment. Clothes may be an equally important topic of conversation, including jewelry, make-up, cosmetic surgery etc.
He may also enjoy spending time with children Th 23, because he can get their admiration and recognition by his charming nature.
A further way of compensation for Palladium is by espousing the development of inner values. He would wrap himself in sackcloth and ashes, he would so obviously pay every attention to supporters, so that the masked egotrophy can be recognized.
Everything is too demanding for him, he grows tired of things, does not like to entertain, doesn’t want to go out, does not want to take care of himself or seek to help anybody.
An irritable, violent character of Palladium shows up when he has the feeling that others don’t give him the recognition he believes he has earned. His wounded pride rises defiantly, he feels so angry that he could chop off the people’s heads. Th 18.
Step 3: Primary Psora – What is the Individuality of the Person?
On the basis of the reorganization of the symptoms according to miasmatic dynamics, we finally search for a “central theme”, a leitmotif or basic concept of the corresponding remedy. With that, we proceed accordingly to a constant formulation of the question.
Which “Conditio humana” does he neglect? Where does he seek perfection?
In order to gain acknowledgement and prestige from other persons, we have to possess values on which there is a social consensus. It can have to do with inner qualities like intelligence, personal integrity, social competence, etc. Or it may relate to external values like youth, beauty or wealth.
Palladium does not like to make an effort developing an inner personality. He does not like to work for intellectual-mental values. Rather he is interested in image and dazzling appearance. He wants to be flattered Th 1. The term flatter is derived from French â€šflatter’, in Latin flaccus, and it means to make limply, to soothe, to caress. Consequently, Palladium wants to gain happiness and well-being from his obliging, charming manner. Th 4. He considers the outwardly presented persona as crucial. Appearance is more important to him than reality.
Where does he experience insufficiency.. a loss because of that?
Because Palladium puts his full attention on external things, he looses the quality of the inner personality. He becomes very easily influenced. Th 3. The only thing what is interesting for him is the opinion of other persons about him.
He can’t get in close touch with anybody. This he experiences especially “the day after” – for example after a social event – as morning-after feeling. Nobody is here anymore who is flattering him or who applauds to him, which is what he is striving for. Th 5, 6. On the sexual level, being without any relationship leads him to impotence. Th 33.
He is directed to external things so much, that he loses the inner synchronicity with things. The correct sense of time gets lost, time seems to take too long and it is empty Th 8. Especially in the morning, he is indecisive Th 17 – and because he has no inner goal, he also cannot find anything externally, which may be the focus of his interest.
Following rejection, what does he experience as threat or as punishment?
Palladium has no inner personality structure to oppose the events which come up to him. Therefore, he is afraid, he might not be able to endure anything Th 21.
He is afraid that something terrible might happen Th 16 and depressing news aggravates all of his symptoms Th 15. A woman gets anxious when her child is restless. Th 23.
What is the focus of the inner attention?
Palladium exclusively is interested in the effect he has on the external. He wants to make himself liked, show a spruced facade, wants to appear charming, wants to gain approval and applause from others. He wants to be praised and honoured like a God.
How could conscious dealing with the fundamental problematic nature appear?
If Palladium succeeds in evaluating his inner values, he will begin to examine his reigning concepts of values. He becomes aware that superficial applause alone does not lead to long term happiness, and therefore he can endeavour to seek true relationships. He accepts the needed effort to develop an inner personality.
His practiced eye for external effects would still stand in good stead, for example in professional window dressing or in image-consulting.
In a last, often used step, we go through the list of themes once more and think about which peculiar single signs we now can understand anew in the light of our hypothesis, and how we can interpret them on the basis of their symbolic, mythological and linguistic contents:
Interpretation of single themes or signs
Palladium dreams of houses, buildings, in which he had been or beside which he was frequently standing; dreams he were standing at a window, going up- or downstairs, walking through different apartments. Th 9. This kind of description makes us suppose that it has to do with empty rooms in which he walks around or through the windows he watches. These dreams describe the inner emptiness of Palladium. One can even discover a parallel to the substance, which is porous and permeable like a house with empty rooms.
Maintenance of the external posture
The sensation, as if he will get a stiff neck, and as if a blunt object slowly would be pressed against the spinal column Th 36, or backache as from prolonged stiff upright sitting Th 37, suggest the idea of a person who sits with a corset or with a stiff white collar. A picture of external correctness and “countenance”. The appearance should be kept up at all costs.
Also the feeling as if the heads of the femurs would expand or would be pressed out from the sockets Th 40, point to his problems which are caused by the upright position – probably, because he lacks the inner strength for it.
Palladium in its social relationships
Backache appears in different situations: e. g. in the church, where he listens to a boring sermon and follows tedious ceremonies Th 10. The attention of the other people is focused on the priest and God respectively, which equals for Palladium the loss of his own reputation.
A woman gets a backache, because her child has been restless Th 23: Another person demands her attention and care. Also the outstanding sleepiness on the route to visit patients. Th 14 can be explained by the lack of interest in other persons.
Palladium does not like to speak a foreign language, which suits him well otherwise Th 11 – Here, his rejection reflects doing something for appreciation by others. He wants to be admired for his own sake without having to make an effort.
When sitting still, continuous painless jerking which bends the fingers, especially the index finger Th 39. Bending the index finger asks other persons to look at him and – in the case of Palladium – to give recognition.
When without any clothes on, itching all over his body Th 41. Without any clothes on which lends his persona recognition, image and appreciation, he feels like being affected by fleas Th 34, that is, ashamed and humiliated.
Lack of inner substance and quality
In the bowels Th 32 of Palladium there is a sensation of a painful muddle: a feeling as if the intestines get tangled and if they would be twisted into different directions. A pain, as if air-bubbles were pressed through the intestinal walls, which is experienced as if an animal is snatching and biting off little pieces from the inside. The twisted intestines illustrate his rejection, his inner development – for example by transformation of substance – for carrying out. Instead, he again feels threatened by a parasitic animal and being eaten up. As a result, he has the feeling of being emptied by the internal organs.
The side whiskers grow considerably slower Th 29. This physical symptom underlines the missing inner qualities of Palladium. The beard is a symbol of virility, courage and wisdom. The considerable significance which a beard can have regarding reputation and honour is shown, for example, when beards of enemies are cut as a deep insult. Those who fell victim to this practice were hiding until the beard had grown again so as not to make a laughing stock of themselves .
Special sensations present in the head of Palladium: he has a “dreamy” headache Th 24. Synonyms to dreamy are: drowsy, lost in thought, inattentive, absent-minded. The missing inner substance can appear like a certain “blockheadedness”. It is, like his head is being shaken, but it was not unpleasant to him. Or a feeling as if the head is being swung from back to front. Th 27. It is interesting that he doesn’t experience the swinging as unpleasant. One can imagine, that Palladium is watching his inner pictures as through a kaleidoscope – by shaking, ever new, delightful patterns develop which make no sense or don’t have a deeper meaning.
If the shaking is accompanied by pressure and pain, then he suffers from his being rejected, from thinking through his impressions, from using his brain after all.
He also has the feeling of a weight which is pushed from the back of his head to the forehead Th 28. It seems as if his intellectual energy is concentrated and condensed in the forehead.
Dichotomy: large and small
Palladium is irritable and impatient due to the headache and he could chop off people’s heads Th 18. This is a nice picture which illustrates, that he wants to shorten the people around him a little bit in order to be head and shoulders above them Th 7. By the beheading, he also takes away intellectual capacity from them.
The desire for recognition and applause of Palladium frequently is compared with Platinum. Platinum also feels entitled to be worshipped like God, but here it is about divine knowledge, omnipotence and higher transcendence. The vanity, which is solely focused to the outward appearance in Palladium is hardly comparable to Platinum. .
Bovista also rejects the development of inner structures, but is directed to the extent of being, which it wants to absorb as an unselected, amorphic mass. It wants to enjoy the stimulation by the group of people, but it suffers, when its inner personality is challenged by this contact. It is interesting, that the two substances can be compared by their sponge-like structure . Esther Ostermünchner
A Case of Niccolum in the Light of the Work by Masi
In the following case report the pattern of the preceding presentation of Palladium is maintained to demonstrate the comparability between patient-analysis and the study of the remedy. Also, in this course of the disease, we can observe the suppression, that is the alteration of the pathological process into tertiary Psora by a falsely chosen first remedy.
7 Year Old Girl – Neurodermatitis
Because of her neurodermatitis, in December 1998, LAURA comes together with her mother for a first anamnesis.
Report by the mother: Laura was born with a vivid red skin on her face. During her infant years eruptions on her arms and at the popliteal region appeared. Now it only exists at the popliteal region; it comes and it goes. It itches and she scratches and which makes it bleed. Treatment with a greasy ointment ameliorates a little bit. When it had been even worse, she was also given Cortisone.
Report by the child: I like mathematics in school. In language, I’m fed up mainly when we have to write in block letters. Cursive writing is fine, but I can’t write such nice letters in block capitals. I like doing fine things with my hands, knotting little bracelets, threading pearl necklaces or doing embroidery. Drawing girls and designs I like most. Almost never do I draw boys, I can do better with girls. Almost always they are princesses or Cinderellas, or the princess from Frog Prince and also fairies. I like to read as well. Just now “the Wawuschels”, who have such green hair which glows; then they don’t need any light. (She was dying to learn reading already at 5 years of age.)
I am annoyed when the lining of the chain of my bicycle falls off. Then I have to fix it again and again. Or I am annoyed when my father and mother talk to each other and suddenly stop knowing of what to tell. I sometimes listen to delicate music, then I dream about the sea or about a tropical forest, and once I had a very long dream – that I was a woman who could make all sorts of pearls to produce necklaces on her own.
Symptoms as a small child: Laura was drawing while I asked the mother about the time when she was a small child. The mother reported: Laura was always behaving well, she was kind, conforming and very decent. No specific diseases. She went through chickenpox quite well and in general gets over diseases easily. As a baby one always had to hold her hand when she was going to sleep. When she woke up because I had let go of her hand, she called or shouted for me to come back. She gets on well with other children and cares for her friendships, too. She has the same girlfriend for years. She is very ambitious, she is among the best students in school. She gets angry at herself if something doesn’t work. Always when she is about to learn something new, she gets angry when being given tips and guidance from her parents. She wants to do it on her own and the way she likes it. We proposed to her to play flute. She didn’t like it at all. We persuaded her to try taking a test lesson, and now she is full of enthusiasm for it. She also didn’t want to go to Kindergarten. One year later she had no problem with it. It is important for her to have a regular daily routine. For example, she always walks to school by the same path. She doesn’t like changes.
Fears and more peculiarities: Quite some time ago, she was afraid of war. Laura states : I saw that soldiers come across the field. I was afraid, because they were carrying weapons. Today I can sometimes see that people on the street are vampires, mum and dad as well, only I am not. I’m afraid, because I don’t know what to do. Once before I was afraid that my mother is not my real mother, that she had a mask on which exactly looked like mum. I also thought the same about my dad. The mother adds: sometimes she is a little bit clumsy, awkwardly walking. She stumbles over a landing between flights of stairs or she falls from a little wall.
List of Themes
In the first step we group the statements of the patient into themes.
1. Connection, Chains, Disruptions
â€¢ As a baby and when going to sleep, one had to hold her hand.
â€¢ Likes doing fine work: knitting, doing embroidery, making chains.
â€¢ Fantasy, she could create all kind of pearls to make her chains on her own.
â€¢ Prefers cursive writing (not block letters).
â€¢ She cares for her friendships for years.
â€¢ She gets angry when father and mother stop telling her something.
â€¢ She gets angry when the lining of her bicycle chain falls off. Then I have to fix it again and again. (Her drawing consists of sheer scattered organ-parts @ picture 1)
â€¢ Problem with the skin, organ of contact.
2. Afraid of War, soldiers came across the field, they all where carrying weapons.
3. Vampires, Masks
â€¢ People are vampires, mum and dad too, only me, I’m not.
â€¢ Afraid that the parents are not the true ones, bit wearing masks which look like them.
4. News, Changes
â€¢ Does not want tips and guidance with new things.
â€¢ Always wants to walk the same path to school.
â€¢ Didn’t want to go to Kindergarten at first.
â€¢ Didn’t at all want to play flute.
5. Prefers drawing girls, princesses, fairies, almost never she draws boys.
6. The “Wawuschels” have glowing hair, so they don’t need any light.
7. Reading, Language
â€¢ She was dying to learn reading.
â€¢ She gets angry when her father and mother stop telling stories.
â€¢ She wants thick books to be read to her.
8. Does not like tips and advice on new things.
9. Ambition, Mistakes
â€¢ Does not like writing block letters, does not write such nice letters.
â€¢ She is very ambitious. In school she is among the best students.
â€¢ She gets annoyed about her own mistakes.
â€¢ She’s always been well-behaved, conformistic.
10. Sometimes she is a little bit clumsy, awkwardly walking.
Classification according to Miasmatic Dynamics
In the second step we examine the list of themes according to the following symptoms:
â€¢ Symptoms of the disease (secondary Psora)
â€¢ Symptoms of compensation (Egotrophy).
â€¢ Symptoms of retreat (Egolysis).
â€¢ Symptoms of the attack (Alterolysis).
Also, we search for primary-psoric hints, for symptoms with metaphorical content, which cannot be readily classified according to the other miasmatic phases. For example “as-if-symptoms” or dreams without emotional reaction. They must be explained at the end of the remedy or case-analysis based on the “blindness” [distorted perception] of the patient.
The drawing with the single, scattered organs has to be evaluated as the most immediate expression of her individuality (@ pict. 1).
In which symptoms can we find the disease of this child?
â€¢ People are vampires, mum and dad, too, only me, I’m not.
â€¢ Afraid, that her parents are not the real parents, that they wear masks which only look like them.
â€¢ Does not like to play flute, does not want to go to the Kindergarten, does not like changes.
â€¢ Afraid of war. Soldiers came across the field, they all were carrying weapons.
â€¢ Has to hold the hands of her parents when going to sleep.
â€¢ Does not like to write block letters (prefers cursive writing).
With which attitudes does Laura compensate her disease? How does she try to become superior to the problem?
â€¢ She likes to make fine things: knotting, doing embroidery, making chains.
â€¢ Illusion, she could create all kinds of pearls to make her chains on her own.
â€¢ Prefers cursive writing (not block letters).
â€¢ She cares for her friendships for years.
â€¢ Prefers drawing girls, princesses and fairies, hardly she draws any boys.
â€¢ Does not like to get any tips and advices.
â€¢ The “Wawuschels” don’t need any light, because their hair is glowing.
â€¢ Ambitious, she doesn’t want to make mistakes.
â€¢ Reads with very young age and much.
â€¢ She always walks the same path to school.
Egolytic symptoms are not present in this case history.
How does Laura make her environment responsible for her disease?
â€¢ She is annoyed when mum and dad stop telling stories.
â€¢ She is annoyed when the lining of her bicycle falls off. Then I’ve got to fix it again and again.
Central Theme – Primary Psora or what is the Individuality of a Person?
Which “conditio humana” does Laura reject? In what does she seek perfection?
Laura suffers, when she has to let go of her parents’ hands, when she writes block letters, when she is confronted with new things. And in her illusion she feels being cut off from the parents and from the other people around her. It seems there exists a rejection in the areas of letting go and changes.
However, the egotrophic compensation may point to what a person wishes more than can ever be achieved in his real being. For Laura, there seems to be a demand for “closeness” and autonomy.
The illusion, in which she creates pearls on her own in order to make chains expresses this: I want to make bondings on my own, that is I want to experience myself in closest connection with my environment and I want to decide about it by myself.
The theme bondings and interruptions passes through all miasmatic phases:
â€¢ She suffers, when her parents stop the flow of words and she compensates it alterolytically: If you would not stop talking, then I won’t need to get angry.
â€¢ She suffers from changes, from the interruption of what is accustomed. She compensates it egotrophically: I always want to walk the same path to school, this way I can escape from unexpected influences and from interruptions.
Laura also rejects starting anew again and again, to meet new influences and to experience herself as an individual person who is all alone. Admittedly, she can have new associations, she can feel closeness, but this is never a lasting condition.
Because of that, how does Laura experience insufficiency, a loss?
The experience of loss can happen in all areas where she experiences interruption. The insufficiency – which the patient rarely is aware of, but which is presented on the analytical meta-level – would mean: I cannot be in association sufficiently. Therefore she feels being cut off or being alone in situations which would not cause any reaction in other people.
Following rejection, what does the patient experience as threat or as punishment?
The greatest threat is the interruption of the bonds between parents and child. The parents are wearing masks, and they pretend as if they were her parents, or they transform to vampires. She is left behind without any ties to them.
She has daydreams of war and soldiers, which can be seen as a picture of destruction and interruption of a whole, connected structure.
What is the Focus of her Inner Attention?
Therefore, the focus of Laura’s inner attention lies in themes like closeness, distance and continuity, that is, the breaking up and interruptions. An expression is presented with her drawing (@ picture 1).
Picture 1: The drawing (original size A1) shows a heart which is upside down and which contains single organs. In the text at the left side, they are listed once more. Eye & mouth & foot & nose & ear & bottom & head & hand. Heart of Laura.
The Search for the most suitable Remedy
Also with the “work by Masi”, in most cases we make use of a repertorization. Often, individual mental symptoms cannot be repertorized, because the mind-rubrics are too general, or because small rubrics have not been added. Therefore we try to refer to the most accurate clinical rubrics. In the history of Laura this is limited to the symptoms of the skin and with the exception of polychrests, we would hardly achieve any interesting results.
When choosing the remedy I was mainly led by the impressive drawing of the child. For me, it was a high-quality aphorism 153-symptom. I knew about Baptisia, that such chopping up-feelings can happen.
Baptisia believes that the bond, which ties together the different parts to an integrated and coherent thing would be too inconsistent. For Baptisia, the whole thing is nothing else than the sum of its parts. He is afraid of disintegration of the unity which holds together an existing thing . The following symptoms we find from Hering: He thinks that his legs would make conversation. He thinks that his gouty toe would have a nice chat with his gouty thumb. He feels his being scattered all over the place and he turns around quickly to get together the different parts.
Like any other remedy, Baptisia also has main symptoms. However, the correspondence with Laura’s eczema was poor. Nevertheless, I prescribed this remedy because I didn’t know any other remedy which would cover the mental part any better.
Prescription (Mid-January 1999): Baptisia Q 1, once a day.
Follow-up two months after Baptisia Q 1
March 1999: No amelioration. The only change was some aggravation of the skin, sometimes more – sometimes less.
Prescription: I see some resonance with the remedy because of the aggravation of the skin. Therefore I raise the potency to Q 3.
Follow-up three months after Baptisia Q 3
June 1999: It works fine with these drops. The skin has healed. But Laura expresses that she doesn’t want at all to be healthy, then she wouldn’t be the same Laura anymore. Recently she has also been quite aggressive, and she literally devours books. I advise to wait and see, and to proceed with the remedy if necessary.
Already here I should have been sitting up and taking notice, because this statement does not fit to a real cure. The aggression and the intensive reading speaks in favour of a shift to tertiary Psora. With this, she compensates her disease, which means that the skin eruption is being suppressed.
Prescription: Baptisia Q 3, as required.
Follow-up four months after Baptisia Q 3
End of July 1999: The new intake of the drops didn’t help at all. The eczema is more visible again, she also has spots on her face, she also had a fever and since then the skin has got quite in a muddle. With this report it was clear that the process of recovery went into the wrong direction. Aside from the psychological refusal of a recovery, against Hering’s rule, we observe on her body a migration of the eczema in an upward direction.
Differential Diagnosis: Niccolum
I’ve been searching for a differential-diagnostic remedy to Baptisia, and I found in the repertory by Guy Loutan  under the term “composition”: Ferr-p., Nicc., Kali-s., Baptisia, Sabad, Anacardium, Thuja, Hamamelis, Viol-o., Pulsatilla Aside from the theme “interruption”, I also established priority to her demand of autonomy. This theme is common in different nuances in most metals, therefore I had a closer look at Niccolum.
â€¢ The comparison between the focus of the inner attention of the patient and of Niccolum shows interesting correspondences: In Niccolum, it is directed towards the being as a part of a compound. Everything that reminds of it, provokes the psoric sensitivity: Mingling or purity, continuity or interruption, distance or closeness. The other people continuously remember Niccolum about their being as a part. Niccolum feels threatened by them, it experiences them as obstacles. It wants the total autonomy of its activities .
â€¢ On the level of the symptoms we find the following dreams with Niccolum:
â€¢ Dream; that she saw a man coming whom she knew, whom initially she thought to be the devil, whom she recognized again shortly after, what made her happy in the same way as it had been threatening her before.
– A transformation resembling Laura’s masks and vampires.
– A terrible dream: she saw the head of a relative being cut off (…) or a dream about squabbles when they were out for murder and manslaughter; she wanted to chop off the fingers of a relative, but she couldn’t achieve it in spite of all the efforts she was taking.
– Illusions in a dream which reflect the theme of a physical chopping up.
â€¢ The main symptoms of Niccolum show a clear agreement with the skin of the patient. There are skin eruptions on the face and on the extremities as well as many symptoms of itching. It is not a specific remedy for the skin, but all the allergic redness is well known which nickel based metal parts like ear studs or jeans buttons can provoke on the skin.
Prescription (beginning of September 1999): Niccolum Q 3, once a day.
Follow-up one month after Niccolum Q 3
Mid-October 1999: The eruption on the eyes ameliorated within 10 days, after this there was improvement at the inner elbow, and at her feet it is still flickering a little bit. At the same time her mind calmed down together with the facial eruptions. Laura takes the drops independently by herself, she says that they are good for her.
Prescription: Continuation with Q 3, report when the bottle is empty.
Follow-up four months after Niccolum Q 3
Early January 2000: Never has it been grave again, but also never completely well. She keeps on scratching somewhere on her body, but one can’t see anything. In the hollow of the knees, it is slightly cicatrized. The face looks pretty nice. She has become a glowing child, doesn’t have such an elderly skin anymore.
Prescription: Niccolum Q 6
Follow-up three and a half and eight months after Niccolum Q 6
Mid-April 2000: She is fine now. Since February her skin is fine. We are very happy. Before, the winter had always been a hard time. Sometimes, for 1-2 days, she has some redness which then vanishes on its own.
Early August 2000: Again an eruption at the inner elbows, at her wrists and she has very sensitive eyelids. Many spots where the eczema had been violent before, now, in the summer sun, they remain white. Since the beginning of July she took the drops again, but they didn’t help her. What has happened? We went on holiday, Laura never wants to go on holiday.
Prescription: She’s been confronted with many new things. Changes irritate her Psora. Niccolum C 200.
Follow-up six weeks after Niccolum C 200
Mid-October 2000: The eczema sometimes is at the wrist and forearm, sometimes at the eye, it can flare up for one day and vanish again. In the hollow of her knees she always has a dry skin, but it is not irritated at the moment. The spots which have healed up now are brown again. The irritability of her skin has started in summer when she was confronted with her unloved holidays and I realize that she has moved to upper school according to her age.
Prescription: Thus, she is continuously confronted with the theme of changes. Niccolum XM
Follow-ups after Niccolum XM
End of November 2000: Very satisfied with the skin. No irritable spots anymore.
Mid-April 2002: She’s doing fine with her skin. Now she complains about pain at the finger tips of both hands. It is as if writing on the blackboard with a chalk. Otherwise she feels good. She is “in bloom”.
Prescription: Niccolum XM
Early June 2002: The annoying feeling at the finger tips has gone. Ten days ago it has started with the skin again at the thighs and at the buttocks, then it has vanished again and now it has started at the lower legs. At the thighs, the skin is pretty okay again. Wait and see. The eczema at the lower legs vanished a few days later.
Early September 2002: Since summer holiday a red border around her eyes, as if the skin were salty, it itches violently. The same sensation at the angle corners of the mouth. She never wants to go to holiday. Before the holidays began, we told the children that we are going to move to another place next spring. Laura doesn’t want that.
Prescription: Niccolum XM
Inquiry in August 2004: She never had any problems with her skin. It is somewhat dry, she always has to put cream on it. Isolated flaring up every now and then and under her protectors of her shinbones when playing soccer.
Since I have moved my private clinic to another place resulting in a longer distance to the place of residence of the patient, direct contact with her was made more difficult. Unfortunately I had no opportunity to follow-up her mental development according to the hypothesis of Niccolum.
Evaluation of the Method by Masi Elizalde
By Thomas Ade –
Most of the “Post-Masians” today don’t use Thomism as a pattern of reference, but they try to grasp the central idea of a remedy without this restriction within a single philosophical system. The following thoughts and experiences were implemented in the Revised Materia Medica which was published by us: the reduction to one philosophy and one set pattern of terms works for so long, as we stick to a limited number of remedies! Thirty, fourty remedies can be dealt with easily following strict guidelines. But if the number of remedies increases, suddenly unwanted overlapping of terms occur, greater differentiation becomes difficult and it partly appears to be far-fetched.
Also the transfer of case histories to a philosophical fundamental concept presents many severe difficulties. We always run the risk of presuming an interpretation of other people’s life histories which goes far beyond what is therapeutically meaningful. Many case histories also do not offer the appropriate material. For example, when someone has no dreams or hardly any mind-symptoms or thoughts about their own life, we cannot practically “put the philosophical superstructure on them”. In our daily practice, it has also been quite difficult to put “typical” feminine topics into the Thomistic pattern. For obvious reasons, feminine topics practically are not present for Thomas von Aquin.
For all those reasons, in the first years of our examination of the revision by Masi, we were facing difficult problems in translating modern questions of being human according to this philosophy. A further difficulty was with the Christian-patriarchal language with all those moral codes of sin and punishment, which, according to our opinion, only clouds the question about disease and cure of the human being, instead of shedding light on it.
The last – and probably the most important argument against Thomism as a dianoetic basis of homeopathy lies in the assumption, which can be traced back to Aristotle, that a materializing soul administers and governs the body, that is, always in the direction from soul to body, never the other way. This idea Hahnemann would have accepted as consistent, for he writes in aphorism 9 of the Organon about the spiritual vital force, which animates the material body and retains it in harmonious vital operation. Today we know that influence in the opposite way is also conceivable, namely, that a change in the body may lead to a change of the inner-mental experience. Imagine a person who has suffered from pain for years and who suddenly gets rid of it: an intensification of his zest for life, of optimism, social good nature etc. would not astonish us. Even modern encephalic research likes to define “mental”, as neurological functions of certain areas of the brain or as hormonal processes. Consequently, today we have to know how to handle the conception that there is an intimate cross-linking and interaction between the different parts of human existence (body, psyche, social environment etc.), and that we, in homeopathy, for a long time have not finished thinking over, where our remedies influence exactly what and in which direction.
Therefore it is necessary, if we want to come from one single basic concept, one central theme for the description of a remedy – to formulate them close to the present time, close to the social-cultural and linguistic reality. Otherwise, the linguistic conglomerates of remedies and patient cannot be brought together to a relationship of similarity.
What remains of Masi?
The search for a keyword which can stand synonymously for the problematic nature of the primary Psora, still makes a lot of sense to us. Looking for it means a well-disciplined handling of the complexity of a remedy proving, or a case anamnesis. In the work “according to Masi”, this means profiting greatly in structure and clarity.
The most important insight by Masi-Elizalde relates to the two homeopathies of Hahnemann: the a-psorical, pre-psorical homeopathy of the early years, and the antipsorical homeopathy following the development according to the Chronic Diseases, that is to say, after 1816. In this late phase, the Psora is the real target of treatment by Hahnemann. Today, thanks to the preliminary work by Masi-Elizalde, we can follow in these footsteps and proceed researching, where there existed nothing but a conceptional chaos before .
The discovery of the miasmatic phases by Masi-Elizalde as dynamics of a physical and mental development (see the theoretical part), surely exerts the most persistent influence on our concrete work with the remedy and with the patient. By the use of miasms in such a logical way, for the first time, we get a concrete and comprehensible connection to our work in daily practice – without following the oversimplifying pattern which divides remedies just into “psoric”, “sycotic” or “syphilitic” remedies.
Today, in the European area, we have several groups which, in their intellectual approach, follow Masi-Elizalde, without following strictly any dogma. They all take on single or several efforts and discoveries in their work. But an integrated and common opinion surely cannot be given. In 2005, for the first time, we had an international meeting, where we exchanged and compared study results.
Status of the commonly valid System of Reference
Homeopathy – like any other medical discipline – is far from being an accurate science. Our material always is the living human being in a dynamic process. Therefore, results never can be repeated or reduced to commonly valid statements.
Our theoretical thoughts today also are directed towards the question of whether a quantum leap in the development can happen at all.
For the time being we came to the conclusion, that a patient, who takes pleasure in being relatively healthy (see theoretical part), and who has a rather simple request to homeopathy, cannot undergo any sudden development! Those who independently deal with the problems of their lives and who, according to the circumstances, are first anxious, then egotrophic, then depressed – those who perceive their mental reactions and remember their dreams – cannot become still “healthier” or more independent. They already are close to their secondary Psora and cannot develop more “to the left” in the direction of the core of their nature – except in the sense of a wisdom, which is gained spiritually or by old age.
The primary Psora is a matter which is an epistemological matter of homeopathy and it cannot be “erased” with any remedy.
But in cases, when the patient is focused on reaction patterns of the tertiary Psora (Egotrophy, Egolysis, Alterolysis), there can be a very dramatic development in several areas of life by means of a well chosen remedy. In this case, we first encounter a psoric crisis, and then a clear shift in direction to secondary Psora, and finally to a more liberate attitude towards “the higher purpose of being”.
Only one Remedy for the whole Life?
Masi-Elizalde’s postulate, that a single remedy has to suffice for the whole life of the patient, we cannot judge conclusively at present. The opinions about this are divided within the community of the successors of Masi.
The demand for finding the simillimum for each and every human being fails for different reasons: There are too few sufficiently proven remedies. We only have a few of them at our disposal in the revised form. The access with the help of indexes and repertories needs improvement, even in the era of computers. But it is very crucial that in the end, cure is beyond our will and predictability.
When we find the rare cases, where we experience that a single remedy works for a patient to the satisfaction of everyone for many years, and has triggered a real development, we are exceptionally satisfied and motivated again and again in order to proceed our research in this direction.
Now it is appropriate to comment about the time needed for case taking. Critics of the method by Masi like to say that the time needed to work on a case history is excessively long. But if we succeed in prescribing a very well fitting remedy – in order to avoid saying the unfortunate term “Simillimum” – it will accompany the patient for a long period of time, in all kinds of acute diseases, stressful situations, etc. In all these therapeutical contacts with the patients we do not need to find a new remedy – which is extremely time-saving and it justifies the two to four hours of time reworking the case after the initial anamnesis.
 Allen T.F., The Encyclopedia of pure Materia Medica, New Delhi 1988
 Association FranÃ§aise de l’Approfondissement: De la recherche Homoeopathique
 Chevalier/Gheerbrandt, Dictionnaire des Symboles, Laffont, Paris 1982
 Clarke, Der Neue Clarke, Bielefeld 1990
 Forschungsinitiative zur Revision der Materia medica e.V. www.form-homoeopathie.de
 Hering Constantin, The Guiding Symptoms of our Materia Medica, New Delhi 1989
 Loutan Guy, RÃ©pertoire de ThÃ¨mes et de MatiÃ¨re MÃ©dicale Dynamique, 8. ed. Genf 1997
 Masi-Elizalde Alfonso, Ãœberarbeitung der Lehre, Materia Medica und Technik der Homoeopathie, Preis Stefan, Seminar zur Sicht der Homoeopathie nach Dr. Masi-ELizalde, Hoehr-Grenzhausen, 1993
 Preis Stefan, Mattmann Peter, Weihe Christoph, Studer Susanne, Weiss Karl:, Materia Medica Homoeopathica – revidiert nach Dr. Alfonso Masi-Elizalde, Luzern 1996/97
 Studer Susanne, Ostermünchner Esther, Revidierte Materia Medica Homoeopathica Band 1, HIZ, HÃ¤gglingen 2002
— Susanne Studer, Esther Ostermünchner
Translated by SiegFried Letzel
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