This article examines the rational context within which a practitioner would properly and lawfully use the technique known as “repertorization.”
Repertorisation is the specific technique of taking the “totality of symptoms” of a given disease and then using a compilation of these indications, cross-referenced to medicinal agents, to find the curative remedy for the given disease.
Thus, we must first determine when such a technique is needed and justified, and secondly, if so justified, what exactly does the “totality of symptoms” entail?
The first step would seem to be meaningless for most, as it is assumes that the very essence of homeopathy is precisely the process of using the “totality of symptoms” to determine the curative remedy.
However, any half-serious study of Dr. Hahnemann’s writings reveals that there is a broader context, and that the use of symptoms to determine the remedy is only one approach.
In Aphorism 7 of the Organon, we find the first reference to “totality of symptoms.” Here we read:
“…so must be the totality of these its symptoms, this outwardly reflecting image of the inner Genius [Wesen] of the disease, that is of the suffering of the Living Power, the most important or only thing, whereby the disease can make the remedy that it may require discernible — the only thing that can determine the most suitable auxiliary means — so in a word, must the totality of the symptoms be the most important thing, indeed the only thing for the Remedial-Artist [Heilkünstler], that he has to discern and clear away in each disease case by his art.”
It would appear clear here that the use of “the totality of these its symptoms” is “the most important, indeed the only thing” to be used by the Remedial-Artist [Heilkünstler], and to the extent that a case is complex and requires the use of a repertory, the process of repertorization is also “the most important thing, indeed the only thing for the Remedial Artist [Heilkünstler].”
However, we must also read the lead-in to this statement:
Now, since one can perceive nothing else in a disease, from which there is no obvious occasioning or maintaining cause (Occasional Cause) to be removed other than the disease-signs…
Thus, Hahnemann sets a condition on his statement regarding the “totality of symptoms,” namely that it is the only thing besides another thing, that is, an “obvious occasioning or maintaining cause.” Where such exists, it is “to be removed.” It is only when this cannot be done that the disease-signs or symptoms must be relied upon, and in such cases, also the totality.
Equally, Hahnemann further points out that even then, the practitioner of his complete system (Heilkünstler) must also take into account “any contingent miasm” and “attendant circumstances” as set out in Aphorism 5.
§. 5.1. As remedial aids, the data of the most probable occasion of the acute disease as well as the most significant factors in the entire history of the protracted sickness serve the physician in finding out its fundamental cause…
These instructions are only fully understandable if one grasps that all of this relates to the critical and fundamental concept of “disease.” Everything that Hahnemann states from beginning to end depends on a proper understanding of Hahnemann’s nosology, or disease classification. This was explained in earlier articles in this magazine.
The most fundamental distinction that Hahnemann made was between primary, constant nature (Wesen) diseases and those that are secondary and of a variable nature (Wesen). In the so-called “Lesser Writings,” Hahnemann made clear (see earlier articles on these writings in previous articles of this magazine) that the practitioner must first treat the primary diseases, usually on the basis of the known or discernible cause (such as in a measles or cholera epidemic). This is repeated in Aphorism 5, where Hahnemann starts with treatment (“remedial aids”) based on knowledge of the “fundamental cause.”
When this is not possible, the practitioner must then rely on the use of the symptoms, the outward image or Gestalt of the disease. Generally, however, this disease image will only reveal the secondary diseases, and seldom the primary disease that lies underneath.
Another important aspect of Hahnemnann’s directions here involve the clear understanding that “disease” and “patient” are not the same thing. Hahnemann makes clear in Aphorism 40 that a patient can have more than one disease. Also, the totality relates to disease, not to the patient, so that there is a “totality of symptoms” for each disease a patient might have. Thus, there is a duty placed on the practitioner, the Remedial-Artist (Heilkünstler), when using the totality of symptoms approach, to determine which symptom totality goes with which disease. It cannot be presumed that there is only one totality and only one disease.
Next, we need to consider what Hahnemann meant by “totality of symptoms.”
While in most cases, Hahnemann uses the term, “totality of symptoms,” he does speak often of what is characteristic about symptoms as being most important, and in Aphorism 257 he uses the more complete phrase “totality of characteristic symptoms.” Thus, we can reasonably take it to mean that where Hahnemann uses the term “totality of symptoms” he means in effect “totality of characteristic symptoms.”
If we now understand that we are to consider the totality of characteristic symptoms of a given disease, we must then consider which symptoms or indications are to be taken as being characteristic.
Hahnemann provides clarification as to what is meant by the term “characteristic.”
§153. What kind of symptoms must especially be attended to?
§153.1. In the quest for the homeopathically specific remedy… the more conspicuous, exceptional, unusual, and odd (characteristic) signs and symptoms of the disease case are to be especially and almost solely kept in view…
Hahnemann next distinguishes between so-called acute (self-limiting) and so-called chronic (protracted) diseases. In self-limiting diseases, the characteristic symptoms are, not surprisingly, more striking (§152). In protracted diseases, however, one must pay attention to even the smallest detail in order to detect them.
§95 Therefore, in chronic diseases the investigation of the above-mentioned and all remaining signs of disease must take place as carefully and minutely as possible, going into the smallest details, partly because in these diseases the details are most exceptional, least resembling those of the rapidly passing diseases, and cannot be taken meticulously enough for cure to succeed; partly because the patients become so accustomed to the long sufferings that they pay little or no attention to the smaller, often very characteristic accompanying occurrents – so decisive in searching out the remedy – and view them as almost a part of their natural state, well-nigh mistaking them for health, whose true feeling they have fairly well forgotten during the course of their fifteen to twenty year long suffering, so that it hardly occurs to them to believe that these accompanying symptoms, these remaining smaller or greater deviations from the healthy state, could have a connection with their main malady.
Thus, we have a reasonably clear idea of what we are looking for. However, this is not yet the whole picture. Characteristic includes, but is not limited to, the “more conspicuous, exceptional, unusual and odd” symptoms. Hahnemann reinforces this elsewhere:
§67.1.a]3 Also, a homeopathic medicine is not therefore inappropriately selected for a case of disease because one or the other medicinal symptoms corresponds only antipathically to some of the intermediate and minor disease symptoms; if only the remaining, the stronger, especially distinguished (characteristic) and exceptional symptoms of the disease are covered and satisfied by the same medicament by symptom similarity (homeopathically), that is, are over-tuned, extirpated and extinguished, so also do the few opposed symptoms fade away by themselves after the active duration of the medicament has elapsed, without in the least delaying the cure.
Here, characteristic is that which distinguishes, which is not always congruent with that which is unusual or exceptional.
While the more common symptoms are generally of little use, Hahnemann introduces the possibility, however, that they can become characteristic.
§153.2. The more common and indeterminate ones: lack of appetite, headache, lassitude, restless sleep, discomfort, etc., merit in their generality, and if they are not more closely characterized, but little attention, since such generality is to be seen in almost each and every disease and medicine.
§102.1. This sketched image always becomes more complete upon recording several cases of this kind, not larger and more verbose, but more characteristic, more encompassing of the peculiarity of this collective disease; the general signs (e.g., loss of appetite, sleeplessness, etc.) obtain their own narrower determinations, and on the other hand, the more marked, particular, and at least in this connection, rarer symptoms belonging to but a few diseases emerge and form what is characteristic for this epidemic.
Hahnemann here provides us with a useful clarification that what is more characteristic is not so in quantity (more symptoms), but in its quality (“more encompassing of the peculiarity”). He also clearly includes the general and the marked, particular and rarer symptoms, both of which form part of the characteristic symptoms.
This opens the possibility that some common symptom, seemingly insignificant in nature can be characteristic. It may not be rare, strange or peculiar (e.g., a cramping pain in the calf muscle at 4 P.M.), yet it can be characteristic. But characteristic in reference to what?
Characteristic refers to a pattern of information that is distinctive. Each element may not be unusual or odd, but it is the arrangement of the elements in time and space that gives something its distinctiveness. What is characteristic is what helps to distinguish one thing from another.
The term characteristic is derived from the Middle English “carecter,” which means a distinctive mark or imprint on the soul. This is what later came to be called the genius, keynote or essence of a remedy or disease.
That Hahnemann had this in mind can be seen by reference to the Organon.
§130.1. If, right at the outset, a properly strong medicinal dose has initially been administered, there is the advantage of being able to record the exact sequence of the symptoms that the prover experienced and the times when each has appeared, which is very instructive for knowledge of the character of the medicine, because then the order of the initial-actions as well as that of the counter-actions comes to light most unambiguously.
We see this in chemistry, where the slight re-arrangement of an atom or chemical bond provides a completely different substance. We see it in genetics, where subtle differences in the arrangement of protein molecules can have dramatically different effects on an organism. We see it in living organisms, where we have many of the same elements (nose, eyes, ears, etc.), but slight changes or arrangements create a distinctiveness that makes us individual. We all can remember situations in which we visited a region with people who were ethnically different from us. At first, they all looked similar, but after some time we learned to tell each person apart. Others can do this with animals, whales for example. Few of the details are what you might call strange, rare or peculiar (height, weight, color, sex, voice, for example), but it was the subtle difference in the arrangement that created a character that was unique (this is all the more the case for identical twins). It is interesting that Boenninghausen also noted that the anti-psorics were more difficult to distinguish one from the other than the apsoric remedies:
It must be confessed that one of the most difficult tasks of the physician to always make the most suitable choice among the antipsoric remedies, as most of them have almost the same symptoms and very few truly characteristic symptoms are found with the different remedies. (Lesser Writings, p. 115)
So, we are looking for indications that are characteristic of the disease. It is the disease that we must treat and for which we must find a remedy. We want to, as Hahnemann charged us, annihilate the disease. We surely don’t want to annihilate our patients!
Thus, the peculiar arrangement of indications in time and space is what distinguishes one disease from another, not whether a symptom is strange, rare or peculiar when considered in isolation (and which may be available only in a limited number of cases).
Again, it is the particular arrangement of symptoms in time and space for a given disease that provide their “conspicuous, exceptional, unusual, and odd” characteristics. It is this arrangement of indications in time and space that we must reproduce for each disease.
This means that we need to understand what disease is. One picture of disease, mainly that of natural disease, is derived from the provings and clinical information. Another picture, mainly that of iatrogenic diseases, is derived from poisonings and drug pictures (the Physician’s Desk Reference).
Boenninghausen, a contemporary and close student of Hahnemann, was one of the first to understand that the characteristic indications were those that bore a particular relationship to one another. This was later taken up by another homeopath of the 19th Century, Guernsey.
Boenninghausen’s discovery of the concomitant symptoms came from an understanding of the pattern of disease. His repertory was organised along the line of relationships of symptoms. Indeed, in Aphorism 153 where he discusses the characteristic indications, Hahnemann added a footnote praising Boenninghausen’s Repertory for “arranging the characteristic symptoms of homeopathic medicines.”
If you examine Boenninghausen’s Repertory, we find little of the “…conspicuous, exceptional, unusual, and odd.” It is only in their particular arrangement that the indications become characteristic.
In summary, the term “totality of symptoms” covers more than the suffering of the patient (true symptoms). This broader totality must be related to each disease of a patient, not the patient as a whole who may be suffering from several diseases, or various effects of faulty regimen. And it is the characteristic data of a given disease that we are looking for, namely the indications that fit the unique pattern in time and space that distinguishes the disease from other diseases.
Rudi Verspoor is Dean and Chair Department of Philosophy, Hahnemann College for Heilkunst, Ottawa. He has written extensively on homeopathy and created the only college in the world offering a full program of study in Hahnemann’s complete medical system, Heilkunst. More details on studying Heilkunst can be obtained from www.homeopathy.com.
Rudi founded the National Association of Trained Homeopaths (NUPATH) in Canada, as well as the Canadian/International Heilkunst Association (C/IHA). He has advised the Canadian government on healthcare issues, made presentations to various federal and provincial governments on homeopathy, and has written for various journals as well as lectured around the world.
His publications include: Homeopathy Renewed, A Sequential Approach to the Treatment of Chronic Illness (with Patty Smith); A Time for Healing; Homeopathy Re-examined: Beyond the Classical Paradigm (with Steven Decker); The Dynamic Legacy: Hahnemann from Homeopathy to Heilkunst (with Steven Decker)
The website at www.heilkunst.com has more articles and resources about Heilkunst.