The homeopath forms a conceptual image of the disease by collecting data from the patient, patient’s relatives and from his own observations. The totality of a case is the basis for repertorization and serves the purpose to find out the most similar medicine of the Materia Medica. The success of repertorization depends on the ability to deal with symptoms and on the balance of the information collected and translated into rubrics.
Based on a different conception of the Totality of Symptoms there are different repertorization method. The four major influences in the art of repertorization are Hahnemann, Kent, Boenninghausen and Boger. Each of them emphasizes different aspects to form the totality of a case, yet they all have their origin in the Organon. “It is possible to obtain the needed correspondence in a great variety of ways and degrees, and one practitioner will find it in one way and another in another”. It is important for a homeopath to be familiar with these subtle differences so that he may apply them depending upon the prescribing data elicited from the patient. Each case is to evaluate as a whole in order to see which of these repertorization methods is best suited to the case in hand.
A thorough understanding of the plan and construction of the different repertories is indispensable for the application of the appropriate repertorization method.
The Totality of Symptoms
The foundation for ALL these methods is the TOTALITY of symptoms, which in homeopathic practice is the true diagnosis of the disease, and at the same time the diagnosis of the remedy. Totality is the qualitative sum total of all the symptoms presented by the patient.
Hahnemann defined the Totality of Symptoms as the outwardly reflected picture of the inner essence of the disease and the sole means whereby the disease can make known what remedy it requires. Symptoms are the outward and visible signs of the inward disturbance of the vital force and when these symptoms are removed the disease ceases to exist.
Among those medicines whose human condition-alternating power has been investigated, the medicine whose observed symptoms are most similar to the totality of symptoms of a given natural disease will and must be the most fitting, the most certain homeopathic remedy. In this medicine is found the specificum for this case of disease.
§ 147 Organon [emphasis added]
Strange, Rare, Peculiar and Characteristic Symptoms
There is much carbon, but few diamonds. To distill the essence out of all symptoms Hahnemann’s criterion were the more striking, exceptional, uncommon, unusual, and characteristic signs and symptoms. He states:
In the search for a homeopathically specific remedy, that is, in the comparison of the complex of the natural disease’s signs with the symptom sets of the available medicines, in order to find among them an artificial disease potence that corresponds in similarity to the malady to be cured, the more striking, exceptional, unusual, and odd (characteristic) signs and symptoms of the disease case are to be especially and almost solely kept in view. These, above all, must correspond to very similar ones in the symptom set of the medicine sought if it is to be the most fitting one for cure.
§ 153 Organon
This has been found to be applicable to any component of the totality, irrespective of whether it is location, sensation, modality, or concomitant, or the symptoms of mind and disposition or even the symptoms of the parts of the body (particulars). The peculiar, unusual and striking symptoms represent that which is curable in each case of sickness and are the foundation of the homeopathic prescription.
Hence it is for the totality of the characteristic and peculiar symptoms that the similar remedy must be found, rather than for those symptoms which appear commonly in almost every case and remedy. They are peculiar to a few drugs and to a few patients suffering from similar diseases, reveal the individuality and are guides in the differentiation of remedies.
Hahnemann categorized the symptoms broadly into common and uncommon symptoms. Common symptoms are pathognomonic and found in many disease manifestations and remedies. They have some diagnostic but least prescribing value as they do not show how the patient reacts to the particular “morbific agent”. They are useless as they do not serve to distinguish, and you need to distinguish, to pick out the remedy. So with all common symptoms, whether general or particular, they will not help you. Never start on these, they are absolutely useless unless you can get something that qualifies and distinguishes, that is peculiar to this patient.
Uncommon symptoms however are peculiar or particular to a patient or a remedy. They cannot be explained by physiology, pathology and anatomy. The stranger the symptom is the more valuable it becomes because it makes the patient unique. They are graded by their uniqueness and rarity accordingly. “The truly characteristic symptoms of the patient exist exclusively outside of the pathological groups of symptoms of the discerned disease; nay more, they are symptoms which never necessarily belong to the disease or any form of it, but which appear as absolutely accidental”.
The key to the enigma is the GRADING OF SYMPTOMS, hence the first step is to understand that which is common to all diseases, and that which truly individualizes the patient.
The Importance of the MIND
Hahnemann clearly stated that:
The psychic condition of the patient is often the decisive factor in choosing a homeopathic remedy, because it is a particularly characteristic symptom and one that can least of all remain hidden from the carefully observant physician.
§ 211 Organon
He advises us in § 213 Organon that “one will never be able to cure according to nature – that is, homeopathically – if we do not, in every case of disease, even in such as are acute, observe, along with the other symptoms, those relating to the changes in the state of the mind and disposition, and if we do not select, for the patient’s relief, from among the medicines a disease-force which, in addition to the similarity of its other symptoms to those of the disease, is also capable of producing a similar state of the disposition and mind”. Moreover, Hahnemann points out that the emotional and mental state is always altered, both in emotional and mental diseases as well as so-called physical diseases. The altered mental and emotional state is closely related to our active miasmatic state.
Hence the psychic condition of the patient should be written down among the totality of symptoms as one of the most important, if one desires to have a faithful picture of the disease from which to make a successful homeopathic cure. But, the mental symptoms do not exist in isolation but are part of the totality of symptoms. Mental symptoms can be more common to all human beings or truly characteristic, strange, rare and peculiar.
Hahnemann’s followers, namely Kent, Boenninghausen and Boger, all placed emphasis on the totality of symptoms, the prime importance of peculiar, uncommon and striking symptoms as well as the symptoms of the Mind. A case may be workable by any of the methods, but the arrangement of the repertorial syndrome will be different due to their different approach in the evaluation of symptoms. Kent emphasizes Mentals, Boenninghausen points out the Modalities and Concomitants. Generals (physical, pathological, mental) Boger tells us.
“The art of repertorization lies in reconciling and getting the benefit of one or more of these viewpoints, depending upon the nature of the case before us, and the characteristic symptomatology we have been able to observe and elicit…. It is the unanimous opinion of leaders, however, that the symptoms of the disease that may be of diagnostic and prognostic value, which are common to the disease as such, have to be scrupulously kept out of consideration in our search for the curative remedy. Their positive value lies only in the fact that, when separated, the remaining symptoms are those which are characteristic of the individual sufferer“.
Process of Repertorization
1) Proper case taking including clinical, homeopathic and miasmatic analysis: taking the case fully and correctly is of crucial importance, as the choice of the remedy will entirely depend on how effectively the case has been taken.
2) Recording of the case.
3) Defining the problem: What has to be cured (see § 3 Organon).
4) Classification and evaluation of symptoms according to Boenninghausen’s, Kent’s or Boger’s type, i.e. grading or ranking of different symptoms in order of their value in order to completely frame the totality and match them with the drug symptoms to find the simillimum.
5) Selection of the repertory: the final choice of the repertory depends upon the gained symptom picture.
6) Conversion of symptoms into rubrics and sub-rubrics.
7) Repertorization (permutation and combination of rubrics) and preparation of the repertorization form.
8) Analysis of repertorial results and final selection of the remedy: higher matched and graded medicines are analyzed. Repertorization is a means to an end, never an end itself. The mechanical use of repertories and accumulation of remedies which run through all or most of the rubrics only approximates the choice and is greatly overshadowed by the relative standing of the individual symptoms. Emerging remedies have to be studied in the materia medica for differentiation and the final selection of the remedy.
The simillimum is not necessarily the remedy securing the numerically highest number of marks. The number of rubrics covered is more important than the number of marks. If one finds an unusual remedy coming through for even one or two important symptoms, the physician should check it up in the materia medica if that could be the indicated remedy. Not having fully proved or represented in the repertory, it may not come through as the indicated remedy in repertorization. Kent also teaches us that we do not shall expect a remedy that has the generals must have all the little symptoms.
Different approaches – same remedy ?
It is always the whole patient who is sick, and as there is only one remedy most similar to the case all three methods should come to the same indicated remedy in a given case. However, the symptom picture of the patient is seldom complete and forces us to chose the best approach depending upon the presenting symptom picture.
Pocket Book (BTPB)
|Boenninghausen’s Characteristics and Repertory (BBCR)||Kent’s Repertory of Homeopathic Materia Medica|
|The philosophical background is based on the following concepts
All methods have their origin in the Organon and prescription is based on the Totality of Symptoms.
|Doctrine of Complete Symptoms,
Doctrine of Analogy,
Modalities, Evaluation of
Principle of Grand
modality) present in
one part is
predicated to be a symptom of the whole.
|Doctrine of Complete Symptoms,
Causation and Time,
present in more than three parts).
|From Generals to Particulars, with highest emphasis on the Mental Generals and strange, rare and peculiar
Particular symptoms are used for further differentiation and the final selection of the remedy. They must be qualified.
The place of Generalization and
Concomitants is very limited in Kent’s view of the totality.
|Arrangement of symptoms
The evaluation of symptoms is a must in all methods, and depends upon their value.
All methods emphasize the prime importance of characteristic, unusual, uncommon, strange, rare and peculiar symptoms as
Mentals are used for differentiation and the final selection of the remedy.
|The arrangement depends on the availability of data and their peculiarity:
(agg. and amel.),
Mentals are used for differentiation and the final selection of the remedy.
chill, heat, sweat as to Type/partial, Time, Aggravation, Amelioration, Concomitant.
|Strange, rare and
Symptoms have to be graded according to their value.
Complete symptoms, prominent
marked sensations and modalities,
when generals are lacking or strongly marked mentals are not available,
suffering in few parts but no modalities for all the suffering parts
with paucity of
symptoms (if the totality of the state can be filled out),
useful to get related remedies by working on the chapter on Concordances
|Cases rich in
particulars with marked modalities and concomitants,
one-sided diseases (if the totality of the state can be filled out),
objective symptoms and pathological
cases without many mental symptoms,
useful to get related remedies by working on the chapter on Concordances
|Cases having generals and characteristic
when mental symptoms or physical general
symptoms are marked,
useful in treating mental or emotional disorders,
In cases with lacking Mentals, the Physical Generals and
Characteristic Particulars will make the totality. If Generals are lacking, Characteristic Particulars should be used for repertorization, or,
Boger’s repertorization methods.
James Tyler Kent
Kent’s concept of totality
Kent also emphasized the detailed study of the expressions of the whole person which must be given primary importance to understand the nature of the disease. He studied all symptoms to understand the disease, which proceeds from center to circumference, from inward to outward. The totality of a case is formed by Mental Generals, Physical Generals and Characteristic Particulars.
Kent’s Totality of Symptoms is erected by the following hierarchy:
STRANGE, RARE AND PECULIAR SYMPTOMS
These may occur among mentals, generals, or particulars and must therefore be of varying importance and rank !
2. PHYSICAL GENERALS
Things affecting the whole body.
Ailments from, agg. and amel.
Symptoms related to sex, appetite, desire and aversion to food, weather, positions, food aggravations and amelioration’s, reactions to heat and cold, etc.
Symptoms related to the parts. (These must be qualified.)
From Generals to Particulars
Kent argues that â€žthe whole problem, like any other scientific problem, must be gone into and followed from generals to particulars”, what is in correspondence with his rule of government from center to circumference. There is one center that rules, controls and is supreme. All true diseases flow from center to circumference and the order of repair in the economy is also from center to circumference.
Man is prior to organs and the home in which he lives is his body. What is expressed in parts is always preceded by a deviation in the state of health of the person. Such a deviation can be known only through expressions at the general level.
J.T.Kent in Lectures on homeopathic philosophy
The homeopathic physician must use discrimination, must individualize things dissimilar in one thing and yet similar in other ways. This is done by the Generals, for without Generals of a case, no man can practice homeopathy; without these he will not be able to individualize and see distinctions. Kent points out that â€žin ninety-nine cases of a hundred you can leave out the particulars, for the particulars are usually contained within the generals”.
Kent argues that the method of working out a case from Generals to Particulars is the most satisfactory. However, if a case is worked out merely from the particulars it is more than probable that the remedy will not be seen due to the fact that the particulars may not have been observed yet. Thus to depend upon a small group of remedies relating to some particular symptom is to shut out other remedies which may have that symptom, although not yet observed.
Particulars (local symptoms) are common to many remedies and patients and cannot help us at all to differentiate remedies. Being “scanty”, i.e. incomplete, they cannot be given the highest rank. Yet Kent did not ignore them provided they were qualified by modalities of aggravation or amelioration or by concomitants.
By working in the other direction, however, i.e., from general to particular, the general rubric will include all remedies that are related to the symptoms, and, if after having done this, the particulars are then gone into and the remedy which runs through the general rubrics is found to have the particular symptoms, this will aid in its choice as the one to be prescribed.
Kent, Repertory of the homoeopathic Materia Medica, p.vii
The importance of the MIND
Among the Generals the symptoms of the Mind are of prime importance based on the assumption that disease has its origin in the mind, and on Swedenborg’s philosophy, in which Mind was seen to occupy a higher position than the physical body, and in the hierarchy extending from the dynamic plane to its ultimation in physical disease.
On the Value of Symptoms
Kent classified disease symptoms into three main categories whose value is classified into three grades:
Symptoms are classified into generals and particulars to evaluate their importance and â€župon correct generalizing depends all successful work as a homeopathic prescriber”. Both kind of symptoms can be either common or uncommon. All symptoms must be judged as to their value as characteristics, in relation to the patient, and “the student and physician must work to settle the generals, common symptoms and particulars to the fullest extent, if he wants to save work”.
Kent has developed a more sophisticated hierarchy of symptom-values which takes more time and greater application in understanding the various shades of differentiation of symptom-values and then to utilize the same for the repertorial analysis. It is to emphasize that each individual case and its symptoms requires evaluation according to its own requirement. “When you have taken a case on paper you must settle upon the symptoms that CANNOT be omitted in each individual“.
He gave very definite guidelines regarding the value of symptoms. In his evaluation of symptoms, Mentals occupy the highest place, followed by Physical Generals, and lastly the Particulars (particulars must be qualified by modalities).
Strange, rare and peculiar symptoms belong to the highest generals “because strange, rare and peculiar must apply to the patient himself”. Hence, these must take a high place in the search for the remedy. But Kent also says, “Get the strong strange, peculiar symptoms, and then SEE TO IT THAT THERE ARE NO GENERALS IN THE CASE THAT OPPOSE OR CONTRADICT”, as to prescribe on them exclusively is easy, but often fatal. “They may put you straight on to your drug (if the rest of the case fits!) – they may put you straight off it “, if they have never been recorded as having evoked. “When looking over a list of symptoms, first discover three, four, or five or six (or as many as may exist) symptoms that are strange, rare and peculiar: work these out first. These are the highest generals, because strange, rare and peculiar must apply to the patient himself. When you have settled upon three, four or six remedies that have these first generals, then find out which of this list is most like the rest of the symptoms, common and particular.”
General symptoms relate to the patient as a whole. They characterize the patient and are therefore of higher value than the particulars which affect only a given organ. With generals the patient refers certain symptoms or conditions of symptoms to himself, inner consciousness and ego, by saying â€žI am…”, â€žMe..” or â€žI feel…” or â€žI do” thus and so etc. The highest rank of all belongs to those symptoms, that are not only peculiar, but also general. They are broadly classified in mental and physical generals.
All mental symptoms are classified as Generals as they reflect the inner self and individuality of the patient, the subconsciousness or involuntary action of the mind. Kent regarded Mentals as belonging to the highest grade as they express the inner-most of the patient most absolutely and the symptoms around which other symptoms revolve – hence, they are most characteristic of the individual. They, if they are marked, dominate the case. If a mental trait is marked, and especially if it denotes change from patient’s normal, it is of the utmost importance to the case, and must be in the same type of rubrics as in the patient, i.e. if the symptom is very marked, the remedy you are in search of must be among the remedies in that rubric. They are of highest value in case taking and are frequently the key to the whole case.
But even the Mental Symptoms are graded. Of the highest importance are those that relate to the will. Of second grade, those that affect the understanding, and of the third grade, those that relate to the memory. Will and emotions deal with excitements, determinations, weaknesses, loves and hates, moods and temperaments, traits, suspicion, fear, jealousy etc. These are of the highest importance among the mentals. Understanding deals with perversions of understanding, intelligence, perceptions, illusions, delusions, dreams, loss of sense of proportions etc.
Physical generals are an expression of the reaction of the patient to the environment. They stand next to mentals and deal with the body as a whole under various physical conditions or circumstances, like disorders of sexual function, cravings and aversions of food and drink, menstrual state, sleep, symptoms caused by external influences like heat, cold, weather, climate, motion, time, position, posture etc. Kent also writes, that â€žmodalities, or conditions of aggravation and amelioration applying to the case as a whole or the patient himself, are generals of high rank”.
Particulars express the disturbance and suffering of some part, organ or function of the body, indicating the concentration of the disease in a certain part of the body. They can be qualified by location, sensation, modalities and concomitants. In these symptoms the patient speaks of â€žMy”. They assume importance in cases where generals point to more than one remedy or are not well marked or when particulars are characterized by outstanding peculiar locals, sensation, modalities or concomitants.
Common particulars may in certain circumstances assume a comparatively high rank when two common symptoms appear associated, i.e. when two symptoms, insignificant otherwise, combine. Then they can be the differentiating factor, even when the components were observed by quite different provers.
Generals are sometimes made up of particulars. If there are certain symptoms running through several particulars then these symptoms have become generals as well as particulars.
Kent writes, that â€žnothing in particulars can contradict or contra-indicate strongly marked generals, though they may appear to do so…” because the whole is greater than it’s parts. General symptoms rank higher simply because they relate to the man as a whole that, and if it is a strong and well marked one, it can overrule any number of even strong particulars. On the other hand, a number of strong particulars must not be neglected or under-estimated on account of one or even more weak generals. It is this question of the rank of symptoms that is the chief objection to the numerical method of selecting the remedy and all the mechanical methods are to end in failure for quality will ever be of more importance than mere quantity.
How to work out a case
First, differentiate the symptoms between generals and particulars, common and uncommon symptoms. As Kent gives more importance to Generals these should be found out in the first instance.
In the introduction to his repertory Kent offers the following suggestion:
After taking the case according to the lines laid down in the “Organon” (§§83-140), write out all the mental symptoms and all symptoms and conditions predicated of the patient himself and search the Repertory for symptoms that correspond to these.
J.T.Kent, Repertory of the homoeopathic Materia Medica, p.vii
All cases should be worked out according to Kent’s above hierarchy, using the uncommon, characteristic, rare and peculiar symptoms. Thus, first work out the Mental Generals, then Physical Generals and finally the Particulars.
Write out all the Mental Symptoms and all the symptoms and conditions pertaining to the patient himself, and search the repertory for the symptoms that correspond to these. Then we are advised to search for such Physical Symptoms that include the whole being, i.e. Physical Generals, as are predicated of the blood, color of discharges, bodily aggravation and amelioration, as well as desire for open air, desire for heat, cold air, for rest, motion which may be only a desire or a general feeling of amelioration. Circumstances that make the whole person feel better or worse is of much greater importance than when only a part is affected, and these are often quite opposite. The case is further individualized by using the Particular Symptoms predicated of the organs, functions and sensations, always giving importance to their modalities, especially the time of occurrence of every symptom, until every detail has been examined.
Then the symptom picture has to be examined collectively and individually, and lastly the closest fit remedy or remedies have to be studied in the Materia Medica until there is no doubt about the most similar remedy. In each case one must necessarily refer to the Materia Medica to confirm the choice of the remedy. You will generally find, that one drug stands out more and more pre-eminently, it may not be in all the rubrics, “but is has got to be in all the important ones, i.e. those best marked in the patient and of highest grade”.
Using eliminative rubrics
This standard method can be bypassed by the use of Eliminative symptoms, which are expected to contain positively the indicated remedy. Only the remedies covering this symptom are taken into account for further elimination. It is usually a short rubric and belongs to the highest ranks in Kent’s evaluation. A marked mental symptom that cannot be omitted can be used as an eliminating symptom, to compare with all the subsequent rubrics you consult. With this strong eliminating symptom you can go through the rubrics of the patient’s symptoms in their order, i.e. mentals, first, then generals, then particulars with modalities – taking from each list only the remedies that appear in this first rubric. In this way you can work down, till you are satisfied that the remedy is found that fits the patient as a whole. But to eliminate with safety you must be sure that the symptom is real and marked and actually expresses the patient.
Dr.Gibson Miller used “Hot and Cold Remedies” as eliminative rubrics to work out the case (see appendix).
These principles also apply for “Kent’s Final General Repertory of the Homoeopathic Materia Medica”, written by Dr.Pierre Schmidt, as well as “Kent’s Repertorium Generale”, written by Jost Künzli von Fimmelsberg. Both are revised editions, taking the effort to complete and correct Kent’s repertory.
Some notes on Kent and Constitutional prescribing
Kent also mentioned a time component which is to be considered in the evaluation of symptoms. He writes that symptoms persisting from childhood are of high importance and can point to possible causation’s for the developing pathology and to the indicated remedy. However, the pathological result itself is not of much help in selecting the simillimum.
When treating a patient constitutionally (this refers to the innate constitution) he laid emphasis on the “character” of the patient and viewed disease on the background of the constitution. Here, also those symptoms have to be included which were present before the chief complaint. But it is an often misunderstood conception that Kent treated patients exclusively based on their “constitution”. He also applied the procedure more similar to Hahnemann, and where the symptoms are used which appear since the occurrence of the chief ailment and refer to the actual layer. Nor did he always apply the “constitutional” remedy in acute diseases but the indicated remedy according to the symptoms, which may differ from the “constitutional” remedy.
Clemens Maria Franz von Boenninghausen
Boenninghausen’s concept of totality
Boenninghausen based his grouping of symptoms on Hahnemann’s teachings that it is imperative to prescribe on the TOTALITY of the case, and that all the changes in the sensations and functions should be noted down as fully as possible. He states that the physician needs to be completely informed of all aspects of the patient in order to find the remedy which corresponds with the greatest similitude to all its perceptible symptoms and to cure rapid, gentle and permanently. He advised us to neglect the name of a disease, and to consider the characteristic and marked symptoms and to disregard common symptoms which belong to the disease.
Boenninghausen’s concept of totality is based on the following concepts:
- Doctrine of Analogy
- Grand Generalization
- Doctrine of Complete symptoms
- Prime importance to Modalities
- Doctrine of Concomitants
- Importance of Physical Generals
- Placing the mental symptoms at the end
- Evaluation of remedies
Doctrine of Generalization
Boenninghausen discovered that the sensation as well as conditions of aggravation and amelioration are not confined to a particular symptom, but are applicable to all symptoms of the case. He emphasized the generalization of the sensations and modalities as in his opinion they naturally predicated the whole patient. Hence, a particular sensation or modality is generalized on a large scale.
Doctrine of Analogy
Boenninghausen had observed that symptoms appear in constantly varying combinations in provings as well as diseases, and are governed by the peculiarities of the individual. He learned that “symptoms which existed in an incomplete state in some part of a given case could be reliable completed by analogy, by observing the condition of other parts of the case”. He proceeded upon the Hahnemannian theory that it is the whole patient who is sick, that the parts together make the whole and the whole consists of parts. Therefore, every symptom or part of a symptom belongs to the case as a whole and enables us to complete partial symptoms by combining separated fragments as a whole.
Boenninghausen’s avowed object was to open a way into the wide field of combinations and to help the physician to obtain complete symptoms, because, in reality many patients only express parts of a complete symptom.
He found that the process of breaking up the symptoms in the Materia Medica, could be reversed to meet every varying form of disease, through analogy, by which the location in one part, a sensation in another part and a modality of a third part could be taken together to form a grand totality of the individual – even though this combination of symptoms had never been seen in provers. Though symptoms are broken up and scattered, they can be brought together in a consistent and logical form, which enables the prescriber to meet any group of syndromes that may confront him in practice. The principle of generalization is helpful especially in those cases where the modality of a particular symptom is not available in the repertory.
Importance of modalities
Boenninghausen attached special importance to symptoms with modalities in the construction of the totality and generalized these modalities. Causative modalities are of most importance, followed by aggravations, and lastly ameliorations.
From one point of view the Conditions of Aggravation or Amelioration have far more significant relation to the totality of the case and to its single symptoms that is usually supposed. The correct choice of the suitable remedy depends very often chiefly upon them.
Preface to the Therapeutic Pocket book
Modalities often elucidate the situation quite plainly whereas the local and general symptoms may have certain sensations that are difficult to differentiate according to Boenninghausen.
Doctrine of Complete Symptoms
Boenninghausen was convinced of the necessity of four elements for constituting a complete symptom, and when having these it gets the status of a Grand Symptom. Without these four elements he did not consider a symptom to be reliable. He proceeded on the hypothesis that the totality was not only the sum total of the symptoms of the case, but was in itself one grand symptom, the symptom of the patient. Boenninghausen was convinced that the solid basis of the four-square foundation was the only method of securing the totality of the case, placing emphasis on concomitant symptoms and modalities. However, he also advised us, that:
One single symptom may it be ever so complete and plainly pronounced can never be the complex of all the signs of a disease, which are externally perceptible (i.e., the whole complex of symptoms), nor enable us to guess the rest.
Boenninghausen’s Lesser Writings, p. 285
According to the doctrine of complete symptoms each particular symptom consists of the following components:
3. Modalities (Conditions of aggravations and amelioration’s)
The location includes site, area, part, side of the body, organ, function or tissue affected, any extension or change in place or side of the body. It is directly related to the diagnosis of the disease, but if it bears uncommon peculiarity it may be directly related to the remedy. Though there are no local diseases because the various parts and functions are dependent and bound together and the patient is always ill and affected as a whole, there is one part or there are some parts that are affected more than others. Every drug affects a particular organ, tissue or region where it expends its power – known as elective affinity. Therefore, to know the locality is essential to recognize the complete nature of disease.
Sensation means the kind of feeling, impression or consciousness of an impression upon the central nervous system through the medium of the sensory or afferent nerves or through one of the organs of senses. The kind of sensation makes a symptom qualified. Frequently the character/sensation also indicates the seat of the action (helpful for diagnosis of the disease) and may point thereby to the elective affinity of the drug (burning pains – mucous membranes; dull, boring, gnawing pains – bones; sticking, cutting pains – serous membranes). If peculiar then it will help in the selection of the remedy.
Modalities should always be noted as they are conditions or circumstances influencing or modifying the symptom during the drug action (proving) or in a disease.
Every drug acts best under certain conditions and has its own mode of action, distinguishing it from every other. Therefore modalities are of uppermost importance and mainly related to the selection of the curative remedy. Aggravations denote the increase or intensification in the degree of suffering (the existing symptom) by some appreciable circumstance or condition, whereas amelioration indicates relief of suffering.
It is on this principle that Boenninghausen constructed the therapeutic Pocket Book. He broke up (or classified) the symptoms and separated the locations, sensations and modalities in rubrics that were all generalized.
Doctrine of Concomitants
The doctrine of the totality of symptoms includes the concomitants, i.e. those symptoms that seemingly have no relation to the leading symptoms from the standpoint of theoretical pathology. They have an actual relationship in that they co-exist or appear at the same time, in the same patient. They have no diagnostic value but are very important for the individualization of the patient as they constitute what Hahnemann called the strange, rare and peculiar symptoms. The concomitant symptom must be added to complete the symptom picture, i.e. that peculiar or accidental feature which always exists in every totality, in both the patient and the remedy, and by which it is differentiated from every other case or remedy. Non-logical concomitants are very important characteristics because they often predicate the peculiarities of the individual as a whole. But they do not replace the totality of symptoms. They complete the image by providing information uncommon and peculiar to the patient.
The concomitant symptom is to the Totality what the condition of aggravation or amelioration is to the single symptom. It is the differentiating factor.
Boenninghausen’s Therapeutic Pocket Book, p.1
The concomitant symptoms may also have a location, sensation, modalities and concomitants. Every patient reacts to the same complaint in a different manner and will have different concomitant symptoms because of the variations in constitution, temperament and predispositions as well as environmental factors.
Boenninghausen has given precedence to modalities and concomitants as these are not so difficult to elicit. They characterize each case differently and have proved to be of great help in the differentiation of the remedies.
Boenninghausen’s emphasis on the importance of the Concomitant symptoms has led to the statement that his repertory is founded on the Doctrine of Concomitants.
Many homeopath use concomitant symptoms in a general sense (knowingly or unknowingly) but we no longer have a special section in the newer repertories where unique concomitant pairs of symptoms are recorded for reference.
Boenninghausen observed a relationship between remedies which he included in his repertory. He searched the materia medica for points of contact between remedies based on similar locations, sensations, modalities and concomitants. In this way he was able to note which remedies where most likely to follow each other in individual cases through repertorization. He opined that it is the similarity of remedies that provide them with their antidotal action as well as complementary powers.
These Concordances help to understand the essential nature of a remedy and its place in the materia medica, and also to understand the second prescription if and when needed. In cases where the partial simillimum causes an improvement but then starts to produce accessory symptoms, a closely related to the first remedy will often correct or finish the case. It may also be useful in cases, when a remedy causes an increase in symptoms like an aggravation that is not followed by improvement. The Concordance can also be used to aid the selection of the most similar remedy.
The importance of the MIND
Boenninghausen did not underestimate the mentals. He wrote:
The greatest and most important variations are here found mostly in the states of the mind and spirit, which must by scanned all the more carefully, if they are not only sharply distinct, but also of rare occurrence and, therefore, correspond to only few remedies.
Boenninghausen’s Lesser Writings, p.107
In his essay on Directions for forming a complete image he prescribed the detailed procedure and also points out the necessary consideration of the peculiarities of the mental disposition.
For a sure selection of the right remedy, the most plain and definite information is necessary and it should always be particularly mentioned what was the patient’s disposition when well, and how changed through his disease.
Boenninghausen’s Lesser Writings, p.298
However he gave a very small place to mentals in repertorization with the justification that in actual practice, it is difficult to extract reliable mentals, and that it was not practical politics. Mind, being a complex entity, is the most difficult to understand and the reference to the Materia Medica the best way to understand the fineness and subtlety of the mental state according to Boenninghausen. He placed the symptoms of the mind at the end and used them as confirmatory symptoms and for final differentiation.
To the fourfold category of symptoms the mental rubrics may be part of the concomitants.
Forming a complete image
Although Hahnemann points out the importance of characteristic symptoms it is left to the physician to judge what is understood by them. Boenninghausen tried to find an answer by himself as he didn’t receive any reply on the subject of characteristic symptoms – a prize question he proposed to the worldwide homeopathic community for two years. Boenninghausen emphasized the need for forming a complete image and specified seven points to understand the full picture of the disease. Finally he found these seven words designed in this maxim to contain all the essential momenta to form the complete image of a disease in the form of verses from writings of theologic scholastics of the 12th century. The following seven factors mirror all the essential aspects required to get a complete image of the disease:
1. Quis – Who
2. Quid – What
3. Ubi – Where
4. Quibus auxiliis – Accompanying symptoms
5. Cur – Why
6. Quomodo – Modification, agg. and amel.
7. Quando – When
Quis (extracted from Boenninghausen’s Lesser Writings)
As a matter of course the personality, the individuality of the patient, must stand at the head of the image of the disease, for the natural disposition rests on it. To this belongs first of all the sex and the age; then the bodily constitution and the temperament; both, if possible, separated, according to his sick and his well days i.e., in so far as an appreciable difference has appeared in them. The greatest and most important variations are here found mostly in the states of the mind and spirit, which must by scanned all the more carefully, if they are not only sharply distinct, but also of rare occurrence and, therefore, correspond to only few remedies. A great number of medicines are thrust aside, just because they do not correspond to the personality of the patient. The spiritual and dispositional individuality of the patient here gives the most important, often almost the only deciding points for the selection of the remedy, where the disease involved is one of the mind or spirit, and generally the two disturbances present themselves so conjoined into one that the signs of the one only receive their full and definite character from the other. Many other things belonging to this rubric, but concerning the bodily individuality and presenting, as it were, the chief features in the portrait of the patient, are contained in those books under the heading of “general.”
This question refers to the disease, i.e., to its nature and peculiarity. It may be unquestionably received as an axiom that we must first know an evil accurately before we are able to give any effectual aid against it. But this axiom must be associated with another, which is no less true and no less important, namely this: That we must also know and possess the means which are able to relieve the evil when it is recognized. Where these are lacking, the former are of course of no avail.
The most penetrating and most indubitable diagnostic as offered by the best allopathic manuals is rarely of ever sufficient for the homeopath, so as to enable him to make a sure selection of the remedy, and such a diagnostic at most, and even then not always, may serve to exclude all those remedies from the competition which do not correspond with the common genius of the disease, but seem to act chiefly on other parts of the organism.
The seat of the disease really makes a part of the former question, but it nevertheless deserves to be more particularly emphasized, as it frequently furnishes a characteristic symptom, since almost every medicine acts more and also more decidedly on certain particular parts of the living organism. These differences not only enter into consideration in certain so-called local diseases, but also in those diseases which are called by more general names, as affecting the whole body, e.g., gout and rheumatism. For it is probably never or very rarely the case that all parts of the body are affected in the same degree; even if it should be merely the case that the right side is more affected than the left or the reverse. But the examination of the parts affected is most necessary and most required when the whole to which they belong is larger, and is described merely in that general way which allopaths seem to delight in. Of course, the exact individualization of the seat is most necessary in local ailments. Finally, we must yet consider in this question that neither the internal changes, which can be determined by these instruments, nor the material external changes, which manifest themselves openly to our notice, never present the dynamic disease itself, but are only its products, and are only developed in the course of the disease. When, therefore, these first beginnings are checked by the suitable remedy before those disorganizations take place, then these latter would not come to be developed, and it would be an inexcusable procedure to allow these sufferings to advance to a point where these material changes can be recognized in an artificial manner.
This refers to the accompanying symptoms. Now since in homeopathy the chief aim consists in ascertaining the remedy which most completely corresponds to the totality of the symptoms, it is evident that this point is of the greatest importance and deserves the most careful consideration. For every disease presents in its recognizable phenomena a more or less numerous group of symptoms, and it is only their totality which presents its complete image. It is from this point of view that the concomitant ailments are to be regarded when we select a remedy according to the motto: Similia similibus. Thence it is evident that the rare, striking and peculiar symptoms which present themselves demand a more prominent place than the common ones, because on them chiefly though not exclusively the similitude depends. Boenninghausen echoes § 153 of the Organon when he points out that the striking, strange, unusual and peculiar symptoms lead to the correct simillimum.
The causes of the disease play a prominent part in pathological books, and justly. But a large part of this amounts only to guesses and attempts at explanation, which mostly have only a very subordinate value or none at all in the proper therapy of the disease, and which are too remote for our doctrine which is directed merely to the practical. The causes of diseases are most generally and, indeed, very properly divided into external and internal. The internal causes properly refer only to the general natural disposition, which in some cases amounts to a peculiar supersensitiveness (idiosyncrasy). The external causes or occasional causes embrace everything which, where there is such an internal disposition to disease, may produce disease. The general natural disposition which is also called the proximate cause, really belongs to the first question (Quis?) which respects the individuality of the patient. It only belongs here in so far as the consequences of a former disease may have modified the original natural disposition, and thus it deserves mention. The occasional cause, however, is the matter with which the present question occupies itself and which deserves to be more closely considered. As to the natural disposition notified through previous diseases, this either depends on the miasmatic-chronic nature of those diseases as yet unexterminated, among which in agreement with the teachings of Hahnemann many homeopaths even at this day count psora, syphilis and sycosis, or it is derived from the remains and after-effects of acute diseases, which when they do not belong to the former, as is frequently the case, constitute the numerous class of medicinal diseases or poisonings. Not infrequently, however, we meet with cases where both these momenta have cooperated to undermine the natural health, thus producing a monster of a disease which is even more deeply in-rooted and more difficult to combat. As to the recognition and treatment of the first mentioned miasmatic diseases and their complications, Hahnemann himself in his masterly work on the Chronic Diseases left us the most complete directions, founded on many years’ experience.
Poisonings and medicinal diseases are in one line and it makes no difference by whose hand any one has been deprived of his health by means of a substance injurious to his organism; among these substances medicines as well as poisons find their place. Of course, it is always of the greatest importance to know in every case the medicines or poisons, in order that they may be met by the proper well-known antidotes. The simple poisons may be pretty easily and surely recognized by their effects!
In the medicinal diseases this is much more difficult, because seldom or never is one medicine given by itself, but always mixed with others; it can not, therefore, yield a clear and definite image. With these, therefore, it is necessary, as in the other case it is desirable, and it facilitates the treatment, if we can have a reliable account of what has preceded, and to be able to look over the prescriptions.
We must consider these symptoms, called anamnestic, as being of special importance in this question. Although the ordinary consequences of such morbiferous circumstances and events are mostly already contained in the lists of symptoms of the medicines proved on healthy people, yet homeopathic practice has long ago shortened and made sure the tedious and troublesome path of such investigations, and indicated for most of these cases the remedies which are foremost in their usefulness in such cases. This is e.g., very much simplified in cases of contusions, sprains, burns and the like. In other cases, e.g., in colds, the matter is already somewhat more complicated, since the kind of a cold and the part of the body affected offer differences which again point to different remedies.
Finally we must yet add a word under this question about infectious diseases. To meet these diseases, which often spread until they become a real calamity, Homeopathy has the most sure and approved prophylactics, and these, indeed, are the very same which have the power of healing those diseases when they have developed.
Boenninghausen was very concerned that Hahnemann’s doctrine of chronic miasms was being overlooked. No case taking method is complete if it does not include the fundamental cause of chronic diseases, the miasms. The interdependence of the constitution, temperament, and miasms must not be overlooked by the homeopath.
The knowledge of the cause of a disease helps in choosing the indicated remedy, managing the case, and removing obstacles to the cure. Often, we don’t know the underlying cause of a disease but we can observe its effects on the vital force through the totality of symptoms which are present.
In homeopathy this refers to the modalities that make something better or worse. Quite a prominent part in this rubric is occupied by the partaking of food and drink, and this not only in diseases of the digestive organs, but also in fevers and other internal and external affections. Even negative signs, so far as they belong to this rubric, should not be neglected.
This last question concerns the time of the appearance, of the aggravation or the improvement of the ailments. There are two major areas that highlight the time factor, (a), the periodical return of morbid symptoms after a longer or shorter cessation, and (b), the aggravations and alleviation’s depending on the time of the day. Of the greater importance are the aggravations and alleviation’s at particular times of the day, and this with respect to those which refer to single symptoms as well as those that refer to the general health. There is hardly any disease, in which during the different times of the day there does not manifest itself a more or less decided and distinct aggravation or alleviation. Now since homeopaths have learned these peculiarities also in the various medicines during their provings on healthy persons, they are enabled to make extensive and blessed use of this peculiarity in their therapeutics, and they are obliged to do this in order that they may satisfy the rule Similia similibus also in this respect.
The more complete and faithful the image of the disease is, the more safely can the selection of the most suitable medicine for the present group of symptoms be made, and the more surely we may expect help for the same.
How to work out a case
To work out the case and utilize the Therapeutic Pocket Book symptoms are to be classified, broken up, and arranged in the following order:
3. Modalities (Conditions of aggravation and amelioration)
By listing characteristic symptoms in this order the essential elements of the disease state are clearly mapped, and what appears as fragmentary symptoms can be recombined in such a manner that they represent a more complete totality. The corresponding rubrics in the repertory are located. Mental symptoms are used for final differentiation and selection of the remedy. This methodology can be applied to all repertories once it is understood.
Boenninghausen also differentiated between primary and secondary symptoms as the elements of symptomatology. Primary symptoms belong to the chief complaint and should be taken completely. The remaining symptoms belong to secondary symptoms. The patient may have suffered already from secondary symptoms before the chief complaint manifested itself, and may appear intensified now. They may have risen only after the occurrence of the chief complaint. But in case they appeared after the primary symptoms of the chief complaint, they are of importance for the selection of the remedy, that is, the newest symptoms of the patient are of most importance for the choice of the indicated remedy.
Likewise as there are common and characteristic symptoms in the patient, there are symptoms which individualize the remedies. Boenninghausen called them “Golden Grains” and “Genius Symptoms”. “Golden Grains” only pertain to one remedy and are highly specific. If such a “Golden Grain” is found in the patient the remedy can almost be prescribed with security. However, “Genius Symptoms” are symptoms that go like a tread through the whole remedy (like anxiety in Acon). These can only be extracted from the comparative analysis of the totality of symptoms of a remedy and constitute, together with the Golden Grains, the characteristic profile of the remedy. Boenninghausen also searched for these types of symptoms to find the simillimum.
Concept of Polarities to check consistency
The agreement between characteristic symptoms of the disease and remedy should be consistent as far as possible. Therefore, remedies for which contrary modalities are characteristic, are to be eliminated.
Several homeopath like Kent and Hering have criticized the principles of analogy and voted against the use of associated complaints as concomitant symptoms. They were concerned that excess analogy could introduce imaginary combinations of symptoms. Kent criticizes that Boenninghausen over-did the Generals by ignoring modalities of particulars which he said should remain with particulars only and should not be made generals. But Boenninghausen favored the grand generalization although he was aware that they may be contradictory in many remedies. He opined that these apparent contradictions do not interfere with the final results of a well-constructed case.
Cyrus Maxwell Boger
Boger’s edition of Boenninghausen’s Characteristics and Repertory is the amplified version of Boenninghausen’s Therapeutic Pocket Book edited by Allen.
At Boger’s time, both the Boenninghausen and Kentian schools were popular. Boger studied both but accepted Boenninghausen’s way of working out of a case, convinced that the basic principles, plan and construction of Boenninghausen’s repertory were sound, comprehensible and practicable. He accepted Boenninghausen’s approach to the totality of the patient with emphasis on Physical Generals, Modalities and Concomitants.
But he was also aware of the difficulties faced by homeopath while using the Therapeutic Pocket Book as well as the criticism leveled against its principles and methodology. Boger was of the opinion that it was better to include main rubrics with subrubrics that carry further particularization. Thus his repertory includes all the generalizations and particularization’s. Unlike the BTPB where General and particular modalities are not differentiated, the BBCR has the modalities for each part assembled at the end of each section and at the end of the book devoted to general modalities. Concomitants are also mentioned at the end of each chapter and there are some new chapters not found in other repertories. That is, each chapter has a separate section for aggravations and amelioration’s as well as concomitant symptoms and a cross reference. There are also separate chapters on sensations and complaints and conditions of aggravation and amelioration in general. Also, there are mental rubrics in the BBCR not found in Kent’ Repertory and in Boenninghausen’s Characteristics.
Boger rewrote Boenninghausen’s Therapeutic Pocket Book in order to minimize the error of Grand Generalization and his work is seen as an attempt to bridge Boenninghausen and Kent. His appreciation of time-dimension, causative modalities, tissue affinities and pathological generals give a new vista in understanding the case.
Boger’s concept of Totality
Boger has favored the understanding of the whole case on the levels of constitution, diagnosis and ongoing pathology. He emphasized on the complete study of the case and also advised against giving more importance to a single symptom, even if it might be a key-note one. Stressing too much upon some particular factor at the expense of the disease picture often makes a cure hard. He expressed the importance and hierarchy of the various types and parts of the symptoms and that every symptom should be valued as per the condition. Boger too subscribed to the principle of totality of symptoms and was fully in agreement with the idea of what constitutes a complete symptom, which is studied in relation to four factors, viz., location, sensation, modalities and concomitants.
He also stressed the importance of uncommon symptoms for the choice of the indicated remedy and Boger advised against the great error of regarding a numerically large mass of symptoms that are general (common) in their character, but do not individualize the case, as a sufficient guide in choosing the remedy.
The keen perception and appreciation of those symptoms, which at the same time, correspond to the nature of the disease and also designate the remedy which is exclusively or at least most decidedly indicated – this alone betokens the master mind.
C.M.Boger, Boenninghausen’s Characteristics, Materia Medica & Repertory, p.viii
Boger’s concept of totality is based on the following concepts:
- Doctrine of Complete Symptoms
- Prime importance of Modalities
- Doctrine of Concomitants
- Doctrine of Generalization
- Doctrine of Pathological Generals
- Doctrine of Causation and Time
- Clinical Rubrics
- Placing the Mental symptoms at the end
- Fever totality
- Evaluation of Remedies
Doctrine of Complete symptoms
Boger borrowed the idea of complete symptoms from Boenninghausen’s method of erecting a totality. But he improved over it by relating sensation and modalities to specific parts, and it is seldom necessary to do grand generalization.
Affected parts, i.e. locations, are to be considered as to their local sensations. It is to check whether there is a pattern that can be generalized. Sensations however are expressed according to the mentality of the subject, it therefore follows that the attributes of the symptoms (modalities) are of greater importance than the sensations themselves.
Importance of Modalities
Boger accepted Boenninghausen’s approach to the totality of the patient with emphasis on Modalities, Concomitants and Physical Generals. He considered the modalities to be of paramount importance, among them the causative modalities are of the highest rank.
Sensations and modalities are first referred to the parts concerned, and in case the are absent they can be referred to in the general chapter. If general modalities are represented well, they should be used for repertorization. Boger also viewed contradictory modalities between the patient and remedy as a criterion for exclusion of the remedy.
Doctrine of Concomitants
Regarding concomitants Boger writes: “As a group the concomitants contain many anomalous and peculiar symptoms. They are often so distinctive of a remedy as to render the name of the disease under which a peculiar symptom may occur of little moment. Nevertheless the modalities, mental accompaniments and duration of an unusual symptom govern its position. When these go to make up an harmonious picture it becomes a true characteristic, otherwise it has only a negative value.”
Doctrine of Generalization
Boger emphasized General Symptoms as the middle path between the mental symptoms and the particulars. He wrote:
In ordinary practice generalization is least understood and very often neglected to the detriment of good work. A curative prescription can only be based on “generals” which include and are derived from the “particulars”.
C.M.Boger in Gunavante, Perceiving Crucial Symptoms, p.22
He generalized many conditions when they were found in more than three parts or organs. That is, when three regions manifest the same sensations or modalities this symptom can be generalized, and Generalization is one of the most important functions to be performed in the process of the evaluation of symptoms. But Boger was aware of the danger of over generalization and carried out the process of generalization in his works very carefully.
Doctrine of Pathological Generals
Boger went further to seek general changes in the tissues and parts of the body as he was not satisfied by merely following the principle of complete symptoms. He regarded Pathological Generals as representing the tendency of the whole constitution and stressed their value as opposed to the diagnostic pathology. He argued that these are the pathological conditions which become characteristic of the patient and affect him in many parts. Pathological Generals tell the state of the whole body and its changes in relation to the constitution. Certain types of constitutions are prone to certain pathological changes in different levels of systems and organs, showing the behavior of the whole constitution, which is important to understand the individual.
In the chapter on Sensation and Complaints in General numerous Pathological Generals are listed. For example: convulsions, spasms, hemorrhagic tendency, indurations, muscles in general, offensiveness, swelling, suppuration, sycosis, ulcers, diathesis, warts, nevi, keloids, polyps, fibroid tumors, corns, constitutional types, miasmatic expressions, discharges if common to two or more parts, if more than two parts show a similar kind of pathology, structural alterations. Please note that not all rubrics mentioned in this section are pathological generals, rubrics become pathological generals only if the case expresses likewise. This requires knowledge of pathology and the clear interpretation of symptoms from the standpoint of pathology and expression. It is also to bear in mind that pathological rubrics are largely based on clinical observations and confirmation, thus they contain imperfect lists of remedies.
Doctrine of Causation and Time
Boger has given an adequate place and importance to Causation and Time of the expressions as these factors are definite and reliable in his point of view. Each chapter in the book is followed by time aggravation, the section on aggravation also contains many causative factors. In the chapter Choosing the Remedy he gives importance to the miasmatic cause, as well as the exciting cause.
Boger appreciated the use of Clinical Conditions in grouping medicines and their use in selecting a remedy in absence of characteristic symptoms, and mentioned several clinical conditions. Though they should be put to a limited use, they help the physician in cases of advanced pathology (gross tissue changes) where the physician is left without a clear symptom picture. They help mainly in finding out a palliative drug, or a drug which is suitable in helping to overcome the present crisis, and especially to start the treatment of one-sided diseases, following the instructions as given by Hahnemann in § 173 ff. Organon. However the remedy should agree with the whole picture and should not be used just because it covers two pathologies at two or more parts. These rubrics are helpful to arrive at a group of remedies, which can be further narrowed down with the help of modalities and concomitants to select the most similar remedy. They cannot be neglected as they have a group of common symptoms, which medicines also have produced in provings. However, the results are of lesser quality since the similarity is only at the level of common symptoms.
The Fever Totality is a unique contribution of Boger. The arrangement of the chapter is self-explanatory and helps to repertorize any simple as well as complicated cases of fever. All three stages of fever, i.e. chill, heat and sweat, have to be analyzed with regard to Type/Partial, Time, Aggravation, Amelioration, Concomitant.
Concordances or relationships of remedies should be worked on the same principle as followed in the Therapeutic Pocket Book.
The importance of the MIND
Mind symptoms are of the highest rank for the final generalization and completion of the totality, provided they are clearly marked. Hence, out of the remedies that would emerge the mental outlook will do the final selection.
Boger did not start a case with mentals, but with modalities (general and particular) and concomitants. He kept broad general mental symptoms for the same reasons already given in the description of Boenninghausen’s method: Mind symptoms are accepted in their hierarchy but both expressed the difficulty in eliciting them without any alteration.
Although mental symptoms are highly significant and attractive to the choice, correct or incorrect, they are not as dependable as guides against a wrong choice of the remedy as the great physical generals.
C.M.Boger in Gunavante, Perceiving Crucial symptoms, p. 23
But the Mind is given adequate importance as it is imperative that the remedy selected is in agreement with the mind. Boger argues:
Mind mirrors itself with great accuracy in the different modes and manners of physical expression. The interdependence of mental and physical states is so great that we can never afford to overlook it entirely. They, moreover, always clarify every other symptom; often in a decisive way.
C.M.Boger in Tiwari, Essentials of Repertorization, p.213
Forming a complete image
Boger writes that the “interpretation of what constitutes a striking or singular symptom, except as pointed out in §86 and the following, is left to the judgement of the physician, but is elucidated in the following seven considerations”:
1. Changes of personality and temperament
2. Peculiarities of disease
3. The seat of disease
5. The cause
These factors are elucidated similar to Boenninghausen’s seven factors which mirror all the essential aspects required to get a complete image of the disease.
Changes of personality and temperament are particularly to be noted, especially when striking alterations, even if rare, occur; the latter often supplant or by their prominence may obscure the physical manifestations and consequently correspond to but a few medicines. The expressions of the intellectual and moral dispositions are interdependent and their combined character affords the best and almost sole indication in the selection of medicines for mental affections.
The nature and peculiarities of disease, as well as of medicines, must be known thoroughly. Allopathic diagnosis can seldom or never suffice for the sure selection of the indicated homeopathic remedy.
The seat of the disease often points to the decisive indications, for almost every medicine acts more definitely upon certain parts of the body. It is important to ascertain the seat of the local disease accuracy. The amount of attention to be given to the affected part is necessarily proportioned to the magnitude of the general disease of which it is a portion.
In finding the simillimum for the whole case the concomitants, above all, demand the most thorough examination. These are a sound doctrine of procedure for the more strange, rare and peculiar the symptom grouping is, the better guide we have for the choice of the indicated remedy. While carefully elucidated characteristics strikingly portray the leading features of a case they are always modified by the peculiarities of the relief before the picture can be said to be accurate. Well known or common-place concomitants are unimportant unless they are present in an extraordinary degree or appear in a singular manner. Therefore, those accessory symptoms are to be examined carefully which are rarely found combined with the main affection, those belonging to another sphere of disease than that of the main one and those which bear the distinctive marks of some drug. A concomitant may so distinctly and decidedly depict the nature of a remedy, and consequently indicate it. Such symptoms evidently belong to those which Hahnemann called striking, extraordinary, and peculiar (characteristic) and are to receive our almost exclusive attention because they lend their individuality to the totality.
So much depends upon the knowledge of the cause of disease, that without it the choice of the simillimum cannot be made with safety. The modified natural tendency to disease depends upon the uneradicated miasms of psora, sycosis and syphilis. The best selected remedy is often ineffectual unless preceded by the proper antipsoric, antisycotic or antisyphilitic, as the case may be.
The modalities are the proper and most decisive modifiers of the characteristics, not one of which is utterly worthless, not even the negative ones. A closer inspection of the symptoms will reveal their sensations and relations to the different parts of the body and establishes undoubted difference in the manner of their appearance, the modality. Modalities must be specialized in order to apply the most suitable remedy. When the symptoms seem to point out a particular remedy with which the modalities however do not agree, it is only negatively indicated and the physician should seek for another remedy having the same symptoms. Cravings and aversions to different foods furnish some of the most important points in deciding upon the remedy.
The time is hardly less important than the aggravation and amelioration itself, and could be of great use were the different stages of disease left undisfigured by drug influences, for they constantly produce the most devious effects upon the natural course of disease. This homeopathic objective concerns the hour of the day when symptoms are better or worse, as well as the periodical return of the symptoms, both having a direct bearing upon the choice of the remedy. The latter coincides with epochs having special accidental causes. The general or special modalities referable to the time of day are of much greater importance, for hardly any disease lacks this feature and the provings supply the same peculiarity, qualifying them for the best and most comprehensive uses.
Regarding case taking Boger advised us to first elicit the evident cause and course of sickness down to the latest symptom, and that especially the natural modifiers of sickness, the modalities, should be very definitely ascertained. A consideration of the mental state comes next in order of importance, to be followed by the patient’s own prescription of his sensations, then the entire objective aspect or expression of the sickness (facial expression, demeanor, nervous excitability, sensibility, restlessness etc.), and lastly the affected parts. These will clearly outline the disease picture and point toward the simillimum. The actual differentiating factor may belong to any rubric.
How to work out a case
The arrangement of symptoms is based on the availability of data and peculiarity of symptoms. Each outstanding symptom is followed by the next strongest. Depending upon the availability of data and value of symptoms cases are to be repertorized using the following scheme:
Causative Modalities (ailments from)
Other Modalities: aggravations and amelioration’s
Location and Sensations
If the case has definite Causative modalities these should be used in first place. If the case does not represent with causative modalities, but has other general as well as particular modalities these should be used in the first place. If the case does represent with clear concomitants these can be used first. If the case shows changes in the tissues at different locations in a person, which follow a pattern and therefore express the deviation in the constitution, then Pathological Generals should be included.
Diagnostic rubrics can be used for repertorization when the case does not have any other choice and lacks in characteristic expressions. Mental symptoms are used for final differentiation.
Following Boenninghausen’s method (Boenninghausen’s Therapeutic Pocket Book) cases can be repertorized by using the following order:
Locations and Sensations
In fever cases with distinct stages (chill, heat, sweat) the case should be repertorized by using the following order: Chill, Heat, Sweat. Each of these components has to be investigated with respect to: Type/Partial, Time, Aggravation, Amelioration, Concomitant.
Boger viewed the objective symptoms as more reliable, concrete and least deceptive, hence they should receive our first attention. These are symptoms which others can determine by any of the five senses, and which are quantifiable and generally observable by the physician. Subjective symptoms however are liable to be altered by the provers, by the patient as well as by the physician while interpreting.” Most subjective symptoms have an indefinite character or are common to many disorders, therefore deserving of little attention. It is only when an ordinary symptom appears in an extraordinary place or way that it becomes of much value.” Subjective symptoms are prescribed by the patient as his feelings or sensations, and are those symptoms which the patient alone can feel and express, but which the doctor can neither see, hear, etc.
Boger describes the last appearing symptoms as one of the most important in the selection of the remedy. Even in a confusing presentation one should be guided by the recent symptom.
Boger also used other repertories to work out a case, namely the “Synoptic Key” and “General Analysis”.
Some notes on the approach of other homeopath
Hering emphasized the use of the three legged stool as the “Minimum Syndrome of the Maximum Value”, which means using a very small group of the most peculiar and characteristic symptoms to identify the indicated remedy, and to verify its correctness by reference to the Materia Medica. If one has at least three of the grand characteristic symptoms it is possible to locate a fairly small group of remedies that contain the simillimum.
Hering adopted the idea of the complete symptom but criticized the idea of over-generalization. He wanted to remain with the combinations of symptoms found in the provings and clinical confirmations. For this reason, there is no special general section in Hering’s Guiding Symptoms. Hering specialized in the study of mental concomitants to bodily ailments and collected a good amount of material on the subject. He wrote a special repertory on mental concomitants called “An Analytical Repertory of the Symptoms of the Mind”. This book opens the door to unique combinations of physical and mental symptoms taking place in the same patient. His “mental concomitants” include groups of physical and psychological symptoms that form joined redline characteristics.
His separation of the pathognomonic symptoms common to the disease from the constitutional concomitants of the patient helps in judging the characteristic value of the symptoms.
Dr. Stearns endorsed Boger’s view and was convinced that Objective Symptoms are most reliable. He chose not more than five or six symptoms for analysis, of which one was a mental, one pathological, one objective and two physical generals.
Phatak carried on the work of C.M. Boger and his work is considered by many to be the best small work on the subject (A Concise Repertory of Homeopathic Medicines). He included all of the rubrics in the repertory and index of the Synoptic Key and the General Analysis, as well as new rubrics he developed by the use of analogy and generalization. He expanded the rubrics with remedies collected from his vast experience, and also added remedies from other reliable sources like J.T. Kent and J.H. Clarke. He became an expert in coining general symptoms in the same way as Boenninghausen and Boger before him.
Boericke divides the symptoms as basic and determinative. Basic symptoms appear in every proving and are of a general nature. Usually they are diagnostically important but of little value in the choice of the remedy. Determinative symptoms are individual or personal symptoms found in the patient, and are characteristic or guiding symptoms if found in a drug pathogenesis. These symptoms are necessary for the selection of the simillimum.
Determinative symptoms comprise the following features:
Strange, rare, peculiar symptoms
Boericke and Margaret Tyler favored the use of some larger general rubrics as eliminative rubrics, such as lack of vital heat, what is being criticized by some Kentians.
Also Dr. Gibson Miller has advised the use of “hot and cold” remedies as the first step in the eliminative process.
Guernsey, Lippe, Nash
The school led by Guernsey, Lippe and Nash has found “Key-Notes” to be valuable in suggesting the most likely remedy, the accuracy of which in relation to the remaining symptoms should be got confirmed by reference to the Materia Medica.
The opinion regarding his approach differ greatly. Some argue that he has shown through precept and example that the properly understanding of the State of Mind and Disposition is capable of yielding immense advantage in our efforts to find the true simillimum. Others point out that the mental symptoms do not exist in isolation but are part of the symptom totality. They criticize in Sankaran’s approach that the supremacy of mental symptoms has overshadowed the idea of strange, rare and peculiar symptoms, and that renouncing general and particular symptoms means to fall in the same mind-body split observed in allopathic medicine.
Working out a case on Boenninghausen’s method the list may become quite long and the physician has to refer to a large number of large rubrics. Dr.M.L. Dhawale has modified this method without compromising with the principle and result, by rearranging the order of symptoms:
1. Causative modalities
2. General aggravations
3. General amelioration
4. Physical Generals
6. Mentals – for reference and differentiation
CASES ILLUSTRATING REPERTORY WORK
Perceive the MOST uncommon, unusual, peculiar symptom
Extracted from Gunavante’s Perceiving Crucial symptoms 
A lady suffering from severe congestive headache. The attack was attributed to some mental excitement to which she had been subjected in the afternoon. The pain began in the evening and thinking to obtain relief, she retired early. The violence of the attack soon compelled her to leave the bed and walk the floor to obtain relief. The pain was pressing, throbbing, bursting, as if the head was too full. The head, face and neck were red and hot; the carotids throbbed violently. Felt “Would become insane if it continued another hour”. The only relief she could obtain was by pressing the sides of her head with both hands and walking as rapidly as possible from end to end of the suite of three rooms. The congestion, etc. certainly pointed to Bell but the manner of obtaining relief from rapid motion – the most uncommon symptom – promptly excluded Belladonna Any remedy that would cure her must contain among its totality, this peculiar symptom which is a characteristic of Sepia. A few pellets of Sep 200 in spoonfuls of water every ten minutes relieved her before the third dose arrived. She fell asleep and next day she way as well as usual.
A case worked out on Kent’s Repertory, using eliminating rubrics
Extracted from Kent’s “Use of the repertory”
Miss C. age. 35 – June 13th, 1910 – Sleepless since 20 years age ; brought on by excessive musical study ; never taken any sleeping drugs. She lies quite wide awake at night, brain active all the time, especially after lights are out. Often kept awake by persistent tunes ; hardly ever falls asleep for three hours after going to bed ; readily wakened by the least gleam of light : even if drowsy becomes sleepless immediately on getting into bed. Dreams always ; nightmare.
General health has been good. Throat : painless hoarseness : all colds fly here.
Stomach : Appetite good. Averse fats, milk. Craves ices, cold food. Emptiness without hunger soon after getting into bed which might prevent sleep. > Eating. Emptiness at 11 a.m.
M. P. normal.
Mental : Very excitable to music : irritable ; impatient ; discontented. Fears : in a crowd ; being hemmed in; fire; suffocation. Indifferent to people, especially relatives. Depressed easily.
Chilly : Hates the cold ; < thunderstorms.
CHILLY, used as an “eliminating symptom” to cut all the warm remedies, in all the following lists.
Indifference relations (Kent, p. 55) – Helleborus, Hepar, Nat-c., PHOS., SEP.
Fears crowd (p. 43) – Arsenicum, Aurum, Baryta carb., Calcarea, Carb-an., Causticum, Conium, Ferrum, Ferr-ars., Graphites, Hepar, Kali-ar., Kali-bi., Kali-c., Kali-p., Nat-a., Nat-c., Nux-v., Phosphorus, Plb., Rhus-t., Stann.
Fears suffocation (p. 47) – Carb-an., Phosphorus, Stramonium
Fears fire (p. 45) – Cuprum
< Thunder (p. 1403) – Agaricus, Aurum, Causticum, Hypericum, Kali-bi., Nat-c., nitricum acidum, Petroleum, Phosphorus, PSOR., RHOD., Rhus-t., Sepia, Silicea
Averse fats (p. 480) – Arsenicum, Belladonna, Calcarea, Carb-an., Carb-v., CHIN., Chin-a., Colchicum, Cyclamen, Helleborus, Hepar, Nat-c., PETR., Phosphorus, Rheum, Rhus-t., Sepia
Averse milk (p. 481) – Am-c., Belladonna, Calcarea, Carb-v., Guaj., Ignatia, LAC-D., Mag-c., NAT-C., Nux-v., Phosphorus, Rheum, Sepia, Silicea
Desires cold food (p. 484) – Am-c., PHOS., Silicea, Zincum met.
Desires ices (p. 485) – Calcarea, PHOS.
Emptiness 11 a.m. (p. 488) – Alumen, Nat-c., Phosphorus, Sepia, Zincum met.
Emptiness without hunger (p. 489) – Agaricus, Alumina, Arsenicum, Baryta carb., China, Cocc., Dulcamara, Helleborus, Mur-ac., Phosphorus, Rhus-t., Silicea, Sul-ac.
Sleepless after going to bed (p. 1252) – Borax, Carb-v., Mag-c., Phosphorus, Ph-ac.
Same idea (tune) always repeated (p. 1254) – Baryta carb., Calcarea, Coffea, Graphites, Petroleum
Hoarseness, painless (p. 760) – CALC., CARB-V., Causticum, Phosphorus
= Calcarea 611 ; Nat-c. 610 ; Phosphorus 1224 ; Sepia 510.
Remarks. The larger rubrics such as sensitive to noise, impatience, etc., are left out as all the competing remedies are in them.
Phosphorus not only best indicated, but it has the important peculiar symptoms, – indifference to relations ; all the fears (except fire) ; and the marked craving for ices.
June 16th, 1910 – Phosphorus 10M. 3 doses, 6 hours apart.
July 4th, 1910 – She writes “been sleeping better and have been much quieter mentally at night.” No medicine.
July 27th, 1910 – “Very much better generally ; sleeping better, even with worrying times. Not half so tired as usual ; no emptiness even at 11 a.m. ; not restless mentally at night ; no persistent tunes or thoughts ; not dreaming so much ; extraordinary better.” No medicine.
Oct. 10th, 1910 – Abroad, tiring journey, so took Phosphorus 10M, 3 doses, 6-hourly.
January 27th, 1911 – Been sleeping perfectly well and much better in every way ; no persistent tunes at night ; hardly ever dreams. No medicine.
Jan. 14th, 1912 – “Still sleeping quite well ; have absolutely nothing to complain about.” No medicine.
A case worked out on Kent’s Repertory, using eliminating rubrics
Extracted from Kent’s “Use of the repertory”
Mrs. W., Ã¦. 58 – Dec. 6th, 1910 – Complaining of headaches ever since a girl in her teens ; usually requires to go to bed for at least two days every month (not at period). She has a heaviness all over head as if in iron case ; and head extremely tender to touch, also much throbbing in left temple.
< Warm room ; exposure to sun ; if heated ; east wind ; touch.
> Rest ; alone ; quiet ; lying down ; pressure.
Menopause, two years ago. Has some bearing down sensation if she strains, with burning internally and a feeling of distension.
Stomach – Appetite fair ; averse fish ; desires fats.
Mental – Fears : dark, robbers. Always in a hurry. Very sensitive to all impressions. Moody : < consolation (gets angry).
Climatic. – < Warmth (faintish ; summer – exposure to sun. Flushes, heat with sweats. < Thunder (hair stands on end, and gets bad headaches).
WARM PATIENT – Therefore following lists only include those drugs affected by heat.
< Consolation (Kent, p. 16) – Lil-t., Lycopodium, NAT-M., Platina, Thuja
Fear dark (p. 43) – Calc-s., Lycopodium, Pulsatilla
Robbers (p. 47) – Arg-n., Lachesis, Natrum mur., Sulphur
Hurry (p. 52) – Aloe, Ambr., Apis, Arg-n., Bryonia, Caladium, Calc-s., Gratiola, Iodium, Kali-s., Lachesis, LIL-T., Lycopodium, NAT-M., Opium, Ptelea trifoliata, Pulsatilla, SULPH., Thuja
< Thunder (p. 1403) – Bryonia, Lachesis, Lycopodium, Natrum mur., Pulsatilla, Sulph., Thuja, Tuberculinum
< Summer (p. 1404) – Arg-n., Bryonia, FL-AC., Iodium, Lachesis, Lycopodium, Natrum mur., Pulsatilla, Thuja
Faintish warm room (p. 1361) – Lachesis, Lil-t., Lycopodium, PULS.
Faintish crowded room (p. 1359) – Natrum mur., Sulphur
Averse fish (p. 480) – Natrum mur., Sulphur
Desire fats (p. 485) – Sulph.
Particulars of Headache
< Sun (p. 149) – Aloe, BRY., LACH., Natrum mur., PULS., Sulphur
< Warm room (p. 151) – Aloe, APIS, Bryonia, Coc-c., Croc., Ferr-i., Iodium, Kali-s., Ledum, Lil-t. Lycopodium, Natrum mur., PLAT., PULS., Spongia, Sulphur
< Touch (p. 149) – Bryonia, Gratiola, Ledum, Lycopodium, Natrum mur., Sabin.
> Lying (p. 142) – Bryonia, Calc-s., Coc-c., Fer-i., Fl-ac., Lachesis, Lycopodium, Natrum mur., Spongia, Sulphur
> Pressure (p. 145) – Apis, Arg-n., BRY., LACH., Lil-t., Lycopodium, NAT-M., Nicc., PULS., Sabin., Sulphur, Thuja
Bryonia 814 ; Lachesis 817 ; Lycopodium 1015 ; Natrum mur. 1222 ; Pulsatilla 819 ; Sulph. 1016 .
Remarks. Nat-mur. seems to suit the case, not because it is numerically highest alone, but because it corresponds to the type of the patient. Nat-mur. has marked aversion to fats, which this patient desires : but that would not rule out the drug for this reason ; that, though the desires and aversions are general symptoms, they rank much lower in the scale than the mental symptoms. A strong mental symptom like the markedly < consolation would rule out many of lesser importance. Pulsatilla again could never suit this case, no matter how great its numerical value, because of the marked < from consolation. Repertory work is never mechanical, and is only a guide to the study of Materia Medica.
Dec. 9th, 1910 – Natrum-mur. 200, 3 doses.
Dec. 15th, 1910 – A marked aggravation of the headache three days after taking the powders.
February 14th, 1911 – Not had a bad headache since ; no heaviness or caged-in feeling. Bowels began to act naturally soon after the medicine. Hardly any flushes of heat. Much better generally ; got up after influenza and not felt shaky, used to take her weeks to recover. No medicine.
February 20th, 1911 – Got bad colic due to chill which caused return of headache for one day only. Natrum-mur. 200, 3 doses.
April 7th, 1911 – No real headache since last note, slight attempts ; no caged-in feeling. Bowels quite regular. Bearing down with burning and distension entirely gone. No flushes of heat. No medicine.
May 16th, 1911 – A little vertigo on first lying down : goes off immediately. Headache absent despite severe thunderstorm which formerly caused her to go to bed ; not once the cased-in sensation. Bowels still good.
Generally a different person in every way ; brighter ; more cheerful ; husband declares her to be a different person to live with. Natrum mur. 200, 3 doses.
December 27th, 1911 – May have had a slight attempt at headache, but never came to anything ; feels a new creature ; able to do much more work ; very energetic ; general health excellent. Had no medicine since above.
A case worked out on Boenninghausen’s “Therapeutic Pocket Book”
Extracted from Boenninghausen’s Therapeutic Pocket Book
This case offered comparatively few symptoms, but those few so clearly cut that we find them illustrative of the four necessary elements which we must have to use as foundations for our perfect case.
This man suffered terribly with tic douloureux, the intense spasms coming at about five-minute intervals. There was acute pulling pain in the left trigeminus nerve, accompanied with marked flushing of the face, with profuse sweat on head and chest. He upper jaw and cheek were very tender and painful. He conditions were greatly < by touch, excitement or talking; < wet weather; < at night; > by rubbing. With this condition there was ravenous hunger which always came on with the attacks.
His history divulged the fact that he had had for years a discharge from the ear, which had been stopped eight years ago by an ear specialist. Since then he had suffered from these attacks, which were increasing in frequency and violence.
Now let us see what a well rounded repertory analysis can make of this case.
Left side of face, p.59
Upper jaw, p.57
Pulling sensation, p.175
3. CONDITIONS OF AGGRAVATION AND AMELIORATION
< touch, p.304
< talking, p.303
< night, p.270
< excitement, p.279
< wet weather, p.309
Ravenous hunger, p.66
Sweat, upper parts, p.262
Heat in flushes, p. 258
Ear, discharge, p.41
The concomitant symptom of ravenous hunger is one which seemingly has no relationship to the case, but it actually occurs in distinct relationship to the case and is a most interesting concomitant.
The symptom of discharge from the ear might seem to have no relationship to the case, but since we find no rubric in Boenninghausen’s Pocket Book relating to the suppression of ear discharges, and since it was one of the first symptoms present in the chronic constitutional condition of this patient, we are certainly justified in using it in our analysis.
From these fourteen rubrics, then, we worked this case. Let us consider those remedies which came through these rubrics, having twelve or more symptoms. They were: Ars 12/41, Bry 14/45, Calcarea carbonica 12/47, Caust 12/36, Chin 12/42, Kali-c 13/38, Merc 13/46, Nit-ac 12/38, Nux-v 13/47, Phos 13/47, Puls 13/50, Rhus-t 13/51, Sep 13/47, Sil 12/45, Spig 13/44, Stann 13/39, Staph 12/40, Sulph 14/58.
Calcarea carbonica, Caust, Merc, Phos and Rhus-t all lacked the characteristic sweating (note the difference here between the sweat of upper parts and sweat of anterior parts for Calc-c). Caust lacked < wet weather. The trembling and twitching of the chronic Merc case was absent; neither did this patient have the general constitutional symptoms of Phos or Rhus-t.
The characteristic pulling sensation was absent from Ars, Calcarea carbonica, Chin, Kali-c, Nit-ac and Silicea Ars lacked also the < wet weather; China lacked the relationship to discharges from the ear; Nit-ac lacked the < talking; Puls, Sep and Sil lacked the > rubbing. Nux-v and Stann have no relationship noted to discharging ears. Spig lacked < excitement.
In Bry 14/45 and Sulph 14/58 we find every symptom present. The family attested to the fact that this man showed marked irritability during the attacks. Both Bry and Sulph have marked irritability, so we cannot use this as a means of differentiation. We might have used this as a rubric in analyzing the case. For further means of differentiation let us consider the depth of the disorder, and the fact that, while the ear was not discharging at this time, we must consider the significance of these symptoms coming on after the ear discharges were suppressed. Sulphur is one of those deep-acting remedies that have the power to unlock suppressions and to open up masked conditions, and it has also the power in itself to carry the case on, many times, to a complete cure.
This consideration confirmed our decision to give this patient Sulphur.
A case worked out on Boenninghausen’s “Therapeutic Pocket Book”
Extracted from Tiwari’s Essentials of Repertorization:
A lady, 48 years, suffering from allergic rhinitis presented with the following picture
|1. Respiratory system,
Agg. after bath
(if she takes bath in the morning symptoms do not increase)
Rx-On anti-allergic medication,
but this year not responding to the drugs
blister like swelling here and there,
feels like scratching
Loss of memory
|Pain and swelling,
can’t keep down.
|Agg. first few movements
Amel. hot bath.
Some more information about the patient:
Patient is moderately built. As a student she was very anxious. After two years of marriage, had a male baby. Baby was separated from her on health grounds, was sent to grandparents to be looked after. She developed anxiety, palpitations at night and sleeplessness. She joined a job to occupy herself and slowly overcame the difficulties. Now she is retired, son is grown up and has become a very good engineer. Son stays with grandparents and occasionally visits mother. Patient says, “He is more like a guest than my son.” She is approaching menopause. Feels alone though her husband cares for her a lot.
Mind – irritable, angry about vague things, anxiety regarding bad news
Thermal reaction – hot patient
Sweat no particulars marked
Cravings salt, pork, warm food and drinks
Aversion sweet, cold drinks
Menses regular, scanty
Before menses, feels irritated, weak, leg pain, giddiness
The case has got distinct location, sensations, modalities (local, general-physical and mental) concomitants and clear mental state, indicating the Therapeutic Pocket Book as a suitable repertory.
Selection of rubrics and repertorization:
|Joints, lower extremities||Location||140|
|Joints, upper extremities||Location||133|
|Sneezing||Sensation & Complaints||49|
|Coryza||Sensation & Complaints||46|
|Arthritic pain||Sensation & Complaints||161|
|Menses, before agg.||Aggravation||109|
|Motion, beginning agg.||Aggravation||292|
|Face erysipelatous, redness||Concomitant||52|
Calcarea carbonica 41/10
Analysis of results and final selection of the remedy:
There are six remedies, which run closely, but the simillimum can be only one. Therefore it is imperative to go back to the case and find out the simillimum.
From the case we know that the patient is hot. Now only three medicines are running together: Puls, Sulph, Lyc.
The patient is anxious whenever she faces a stressful situation, feels lonely, likes warm food and drinks. Thus Lycopodium is finally selected.
Modified method (Dhawale) with rearranged order of symptoms
The same case has been repertorized by Dr. Dhawale`s following method in the manner shown below:
|Agg. anxiety||Emotional causative modality||280|
|Agg. menses before||Physical general modality||109|
|Agg. evening||Marked aggravation||270|
|Agg. motion beginning of||Marked aggravation||292|
|Bitter taste in mouth||Concomitant||70|
|Face, erysipelatous, redness||Concomitant||52|
|Sneezing||Sensation and complaint||49|
|Arthritic pain||Sensation and complaint||161|
Calcarea carbonica 28/7
With the help of the thermal reaction and mind (mentioned in the previous method) the final remedy selected was Lycopodium.
This method is less time consuming and easy for bedside repertorization without any compromises with the principles and results.
A case worked out on Boger’s “Boenninghausen’s Characteristics and Repertory”
Extracted from Tiwari’s Essentials of repertorization
An 18 year old girl who was suffering from migraine presented the following picture:
Wants open air.
Comes suddenly or slowly.
|Starts afternoon or
<if tries to sleep
|Uneasiness in stomach,
She wants somebody nearby, likes a dark room, likes to close her eyes and lie down because of headache, but nothing gives her relief. This was the acute picture of the complaint.
Selection of rubrics:
|Stomach, symptoms with||Strong concomitant||290|
Analysis of repertorial result and prescription
Two medicines, Bryonia and Pulsatilla run very closely. Pulsatilla was the final prescription because she wanted somebody nearby during the attacks and there was marked amelioration in open air.
A case worked out on Boger’s “Boenninghausen’s Characteristics and Repertory”
Extracted from Tiwari’s Essentials of repertorization
A lady, 50 years, unmarried, complaining of joint pains since 20 years, came for homeopathic treatment. She had tried allopathic, ayurvedic and homeopathic therapies (for one year) that gave slight relief for a short period, but the complaint remained.
It was diagnosed to be a case of rheumatoid arthritis with the following picture (in brief):
small and big
since 20 years.
and swelling of single joint.
Pain as of a scorpion bite,
impossible to put feet down to rest.
< sour things
< cold things
> hot water bag
> gentle massage
|Lump like swelling
Here and there which disappeared by
When she is excited due to worries and tension, her complaints increase; it also caused breathing difficulty and some throat trouble. Tonsillectomy in childhood. She used to get frequent colds.
Patient as a person:
Appetite – good
Thirst (increased) – with dryness of mouth
Milk agg. – acidity and joint pains
Craving – sweet
Aversion – meant, milk
Constipated since childhood, takes hot water in morning, which helps her. Constipation does not bother her.
Perspiration, in winter also; palm, feet, head at night. Since a few years, palm and feet sweating reduced.
Thermal reaction: chilly
Menarche 16 years.
Flow 3-4 days.
Blood – dark red.
Bleeds more if there is tension.
Menopause at 41 years, flushes, bleeding increased.
Leucorrhea – thick, brownish.
Good, but full of dreams.
She has undergone many hardships in life. All complaints increase by tension, anxiety, vexation, grief and sorrow.
She is sentimental, affectionate, nervous, has fear of darkness, lizards, creeping animals.
Classification and Evaluation of Symptoms:
|Anger, vexation, tension, grief||Mental causative modalities|
|Cold wet feet, agg.||Physical causative modalities|
|Milk agg. – joints and stomach||Physical general modalities|
|Sour agg. – joints and stomach||Physical general modalities|
|Cravings – sweets||Physical general|
|Aversion – meat||Physical general|
|Aversion – milk||Physical general|
|Perspiration – head, soles, palms||Physical general|
|Arthritic pain||Complaints in general|
|stiffness||Complaints in general|
Selection of repertory:
It is found that the case has got strong causative modalities, generals and particulars along with marked physical generals. This case demands Boger’s method of repertorization, using causative modalities in the first place.
Selection of rubrics:
|Emotion <||Strong mental causative modality||1166|
|Wet feet <||Physical causative modalities||1152|
|Milk <||Physical general modalities||1121|
|Sour <||Physical general modalities||1122|
|Desire – sweet||Physical general||477|
|Aversion – meat||Physical general||474|
|Arthritic pain||Complaints in general||882|
|stiffness||Complaints in general||925|
Analysis of Repertorial Results and Prescription:
We have got a list of close running remedies; with the help of patient’s other symptoms, which are not included in the repertorial totality, the above medicines can be differentiated:
Patient is chilly.
Patient sweats on head, palms and soles.
Any tension leads to menstrual bleeding.
Patient is mostly constipated which does not bother her.
Finally with help of this technique, Calcarea carbonica was selected.
DR. GIBSON MILLER’S HOT AND COLD REMEDIES
Extracted from Kent’s “Use of the repertory”
REMEDIES PREDOMINANTLY AGGRAVATED BY COLD
Abrotanum, Acet-ac., Aconite, Agaricus, Agn., Alumen, Alumina, Al-ph., Alum-sil., Am-c., Apocynum, Arg-m., ARS., Ars-s-fl., Asarum europaeum, Aurum, Aur-ars., Aur-sulph., Bad., BAR-C., Bar-m., Belladonna, Benz-ac., Borax., Bromium, Cadm., Calc-ars., CAL-C., Calc-fl., CALC-PH., Calc-sil., Camph., Cantharis, CAPS., Carb-an., Carb-veg., Carbn-sul., Card-m., Cauloph., CAUST., Chamomilla, Chelidonium, CHINA., Chin-a., Cimic., Cistus., Cocc., Coffea, Colchicum, Conium, Cyclamen, DULC., Euphras., FERR., Ferr-ars., Form., GRAPH., Guaj., Helleborus, Helonias, HEP., Hyosc., HYPER., Ignatia, KALI-ARS., Kali-bich., KALI-CARB., Kali-chlor., Kali-phos., Kali-sil., Kalm., Kreosotum, Lac-defl., MAGN-CARB., MAGN-PHOS., Mang., MOSCH., Mur-ac., Natr-ars., Natr-carb., NITRIC-AC., Nux-m., NUX-VOM., Oxal-ac., Petrol., PHOS., Phos-ac., Plb., Podophyllum, PSOR., PYROGEN., RAN-B., Rheum., Rhodo., RHUS., RUMEX, Ruta, SABAD., Sarsaparilla, SEPIA, SIL., SPIG., Stann., Staphysagria, Stramonium, STRONT., Sul-ac., Therid., Valer., Viol-t., Zincum met.
REMEDIES PREDOMINANTLY AGGRAVATED BY HEAT
Aesc-h., All-c., Aloe, Ambra., APIS, ARG-NIT., Asafoetida, Aur-iod., Aur-m., Bar-iod., Bryonia, Caladium, Calc-iod., Calc-sul., Cocc-cacti., Comoc., Crocus., Drosera, Fer-iod., FLUOR-AC., Gratiola, Hamamelis, IOD., KALI-IOD., KALI-SUL., Lachesis, Ledum, Lil-t., Lycopodium, NAT-MUR., NAT-SUL., Niccol., Opium, Picric-ac., PLAT., Ptelia, PULS., SABINA, SECALE, Spongia, Sul., Sul-iod., Thuja, Tuberc., (Rabe), Ustil., Vespa., Viburn.
REMEDIES SENSITIVE TO BOTH EXTREMES OF TEMPERATURE
MERC., Ip., Nat-carb., Cinnabar.
Ant-cr., agg. by both heat and cold : agg. by overheating and radiated heat, though many symptoms amel. by heat.
(MERC. in chronic troubles agg. by cold : in acute agg. by heat).
Plan and Construction of the Repertories
Kent’s repertory has been written from top to bottom, based on Kent’s strategy from generals to particulars. Every section of the book has the same arrangement and is produced to show forth all the particulars with the circumstances connected with it.
The most important sections are found at the beginning and the end: MIND and GENERALITIES, with Mental symptoms in the very beginning, showing that Kent gave the highest rank to mental symptoms.
The symptoms pertaining to different regions of the body and their medicines are given under 37 or 39 different sections, starting from head to foot according to the schema of Hahnemann. Each section (division) is arranged in the same manner and divided into rubrics and further sub-rubrics (sub-divisions).
Kent’s repertory was divided into 37 sections up to the 6th edition. P. Schmidt however gave smell and voice a separate rubric in Kent’s Final General Repertory resulting in 39 sections (smell is listed under nose and voice under larynx in earlier editions).
The repertory is divided into the following sections:
Genitalia – female
Larynx and trachea
Boenninghausen’s Therapeutic Pocket Book
The early editions of the repertory are divided into 7 parts:
1. Mind and Intellect
2. Parts of the Body and Organs
3. Sensations and Complaints
– in general
– of glands
– of bones
– of skin
4. Sleep and Dreams
– Circulation of Blood
– Cold Stage
– Compound Fevers
– Concomitant Complaints
6. Alterations of the State of Health
7. – Aggravations according to time
8. Aggravations according to situations and circumstances
9. Amelioration by positions and circumstances
10. Relationship of Remedies
Though each chapter can be as a whole by itself, it gives only one element of a symptom. The other elements may have to be obtained from other chapters.
In all sections as far as possible a systematic order has been united with an alphabetical arrangement is seen.
The chapters on Relationships is divided into sections, each section being devoted to a remedy, in alphabetical order, and each of them is subdivided into the following rubrics: Mind, localities, sensations, glands, bones, skin, sleep and dreams, blood, circulation and fever, aggravations. The rank of the remedies in these rubrics represents a general relationship of these remedies in the unclassified symptom groups, to the remedy under consideration.
Boger: Boenninghausen’s Characteristics and Repertory
Boger followed the construction of Boenninghausen’s Repertory of Antipsoric Medicines.
His repertory is the latest written of the three repertories and has some special advantages over Kent’s Repertory and Boenninghausen’s Therapeutic Pocket Book.
He made several sections for different parts of the body and added many rubrics and sub-rubrics. Each location is followed by the particular sensations, modalities and concomitants, and where particulars are dominating, this repertory can be utilized with advantage. Boger made concomitants more useful for practice by attaching them to the parts.
The rubric Infant, affections of with its many sub-rubrics, is unique and very useful in pediatric practice.
Different types of constitutions in the chapter Sensation and Complaints in Generals helps to select the simillimum by using it in the first place in totality.
The Fever chapter is unique and of immense use for practice. It has been completely changed in its arrangement and its contents.
He did not expand the Mind Symptoms very much in his Boger Boenninghausen’s repertory, beyond Boenninghausen’s list. The Mind-section does not compete with Kent’s section on mind, but contains some rubrics which are not mentioned in Kent.
The rubrics and sub-rubrics of the repertory are as follows:
Waterbrash and Heartburn
Nausea and vomiting
Inguinal and pubic region
Anus and rectum
Larynx and trachea
Voice and speech
Neck and external throat
Back and scapular region
Sensations and complaints in general
Skin and exterior body
Conditions in General
Conditions of Aggravation and Amelioration in General
S. Hahnemann, Organon of medicine, New York, 1999
J.T. Kent, Repertory of the Homoeopathic Materia Medica, New Delhi, 2005
T.F. Allen, Boenninghausne’ Therapeutic Pocket Book, New Delhi, 2000
C.M. Boger, Boenninghausen’s Characteristics, Materia Medica & Repertory with Word Index, New Delhi, 2004
E. Wright-Hubbard, Das Studium der klassischen homoeopathie, Heidelberg, 1990
C.F.M. von Boenninghausen, Lesser Writings, New Delhi, 2000
B.D. Desai, How to find the simillimum with Boger-Boenninghausen’s repertory, New Delhi, 2005
R.Arora, Solved Papers on repertory, New Delhi, 2006
A.Deshmukh, Classical homeopathic practice, a scientific approach, New Delhi, 2006
C. Hering, The Guiding Symptoms of our Materia Medica, New Delhi, 1974
E. Wright-Hubbard, Homoeopathy as art and science, Beaconsfield, 1990
N. Winter, Handbuch der homoeopathischen Fallanalyse, Karlsruhe, 1999
J.B. D’Castro, Logic of repertories, New Delhi, 2005
S.K. Banerjea, Repertorial analysis and evaluation, New Delhi, 1992
S.M. Gunavante, Perceiving crucial symptoms, New Dehli, 2003
J.Kishore, Evolution of homoeopathic repertories and repertorisation, New Delhi, 2004
K.B. Allen, A tutorial and workbook for the homeopathic repertory, Redmond, 206
T.C.Mondal, Spirit of the Organon, New Delhi, 2006
S.K.Banerjea, Repertorial analysis and evaluation, New Delhi, 2002
R.Arora, Solved papers on repertory, New Delhi, 2006
N.Mohanty, Evolution/Unfolding of homoeopathic repertories, New Delhi, 2005
K.N.Kasad, Konzept und Technik der Repertorisation, Bremen, 2004
T.L.Bradford, The Lesser Writings of C.M.F. von Boenninghausen, New Delhi, 2000
A study of Kent’s repertory, New Delhi,
J.T.Kent, How to study & use the repertory, M.Tyler & J.Weir, Repertorising – Use of the Repertory, New Delhi, 2003
C.M.Boger, Philosophie des Heilens, München, 2002
M.Teut,J.Dahler,C.Lucae,U.Koch,Kursbuch Homoeopathie, München, 2008
Yasgur’s Homoeopathic Dictionary, New Delhi, 2004
David Little, www.simillimum.com
G.I.Bidwell, How to use the repertory,
C.M.Boger, Philosophie des Heilens, München, 2002; or at: homeoint.org/books/bogphilo/phitakin.htm (Studies in the philosophy of healing)
Katja Schütt (Germany)
MBA, HP, DIHom(pract.)
 J.H. Clarke, Dictionary of practical Materia Medica, in I. Watson, A Guide to the methodologies of homeopathy, Devon, 2004, p.ix
 Lippe in S.M.Gunavante, Perceiving crucial symptoms, p.31
 B.D.Desai, How to find the simillimum with Boger-Boenninghausen’s Repertroy, p.27
 J.T.Kent Lectures on homeopathic Materia Medica, p. 210
 The interested reader may read Kent’s lessons about the value of symptoms in his book “The art and science of homomeopathic mdeicine”, or at:
and the article of Dr. Margaret Lucy Tyler and Sir John Weir on Repertorizing in “Use of the repertory”, or at: http://homeoint.org/cazalet/tyler/repert.htm
 S.Close, The genius of homeopathy, p.261
 Kent in M.Tyler, A study of Kent’s repertory, p.8
 Kent in M.Tyler, A study of Kent’s repertory, p.6
 Kent in M.Tyler, A study of Kent’s repertory, p.7
 Kent in M.Tyler, A study of Kent’s repertory, p.8
 M.Tyler, A study of Kent’s repertory, p.9
 J. T. Kent, Lectures on homeopathic Materia Medica, p.260
 J.T.Kent in S.Close The genius of homeopathy, p.261
 J.T.Kent, M.Tyler, J.Weir, Use of the repertory, New Delhi, 2003
 T.F. Allen, Boenninghausen’s Therapeutic Pocket Book, New Dehli, 2000, 9
 see C.F.M.von Boenninghausen, Lesser Writings: A Contribution to the Judgement Concerning the Characteristic Value of Symptoms, p. 105, or at: homeoint.org/cazalet/boenninghausen/valusympt.htm
 Boenninghausen laid the focus on the characetristic symptoms of the disease (vide §3 Organon)
 see C.M.Boger, Studies in the Philosophy of Healing
 C.M.Boger, Boenninghausen’s Characteristics, p.viii
 note again the difference to Boenninghausen where all symptoms are generalized and not listed separately as subrics to every detailed symptom
 C.M.Boger, Studies in the philosophy of healing, homeoint.org/books/bogphilo/phitakin.htm
 Please note the difference here to Boenninghausen who generalized in a large scale: according to Boenninghausen every symptom of the part is predicated to be a general symptom, i.e. if there is burning in one part it is a generalized sensation that can be applied to other parts as well, the same applies for modalities
 C.M.Boger, Boenninghausne’s Characteristics Materia Medica & Repertory with Word Index, p.V
 see C.M.Boger, Studies in the philosophy of healing
 C.M.Boger, Studies in the philosophy of healing, homeoint.org/books/bogphilo/index.htm
 S.M. Gunavante, Perceiving curcial symptoms, p.41
 J.T.Kent, How to study & use the repertory, M.Tyler & J.Weir, Repertorising – Use of the Repertory, p.48
 J.T.Kent, How to study & use the repertory, M.Tyler & J.Weir, Repertorising – Use of the Repertory, p.43
 T.F.Allen, Boenninghausen’s Therapeutic Pocket Book, p.59
 S.K. Tiwari, Essentials of Repertorization, p.193
 S.K. Tiwari, Essentials of repertorization, p.265
 S.K. Tiwari, Essentials of repertorization, p.262