Homeopathy Papers Organon & Philosophy

The Hahnemannian Art of Taking a Case

Last modified on November 4th, 2014

Hahnemann
Written by Uta Mittelstadt

A review of Hahnemann’s dictums for homeopathic case taking.

Supposedly there are as many approaches to taking a case as there are homeopaths. For the homeopath, at the very core of the patient-practitioner encounter, lies the deeper purpose of extrapolating from the expressions of the patient, sufficiently detailed information concerning the presented ailment or disequilibrium. This information retrieved during the consultation, is explored for the patient’s peculiar and idiosyncratic symptoms. Only from those unique and specific expressions can a best matching remedy be selected that most precisely meets the picture of the current presenting state of that particular patient. The art of finding the most appropriate, curative remedy is the fundamental purpose of homeopathic practice, and the greatest quest of the homeopath for his patients.

HahnemannHahnemann, in the Organon, gives specific descriptions of how disease is viewed in a homeopathic context, how remedies are made, how healing is expected to proceed, how a case is to be taken and much, much more. The following is a descriptive compilation of the directions Hahnemann gives to the practicing homeopath, in his Organon [1], on how to take a patient case.

Hahnemann begins to elaborate on the investigation into a case history as early as in Aphorism 6, where he pronounces characteristic traits that a practitioner requires when taking a patient’s case. He states that the homeopath has to be “…sharp-witted, but unprejudiced”. He continues in this Aphorism to describe, in a generalised form, what it is that the practitioner has to note in order to treat an ill patient. He stresses that a practitioner has to recognise “divergence of the human conditions from the healthy prior state…that which he [the patient] has perceived himself, his surroundings have found and the practitioner may note” (Aphorism 6). Hahnemann gets more specific in Aphorism 7, where he insists that attention must be paid to retrieving the totality of symptom expressions of the patient. He indicates that “It is the only means to convert illness to health”, and it is “… the primary, the only thing that a practitioner has to note and remove with his art…” (Aphorism 7).

Hahnemann further describes how a homeopath should go about retrieving, from the patient, the disease specific information. The practitioner is reminded in Aphorism 82 of the Organon of Medicine that he should be “meticulous in the appraisal of the plumbable symptoms and idiosyncrasies” of the presented disease, and is further cautioned that it is indispensable to strictly individualize each case of illness (Aphorism 82).

In Aphorism 83 then, Hahnemann  pronounces and emphasises, further characteristics that a practitioner should express when appraising an individualised patient case. Individualized case taking, so Hahnemann states, requires of the homeopath to express “ …nothing but unbiasedness, healthy senses, and attentiveness in his observation …”.  Hahnemann also urges in this aphorism that the homeopath should be “accurate in the note-taking of the disease picture”.

Hahnemann gives precise directions on how to proceed when taking a patient’s case. He proposes in Aphorism 84 that the following procedure should be followed:

         “The sick brings forth his discomfort.

         The family members tell of his complaint, his comportment and whatever else they have perceived on him.

         The practitioner sees, hears and notices by all other senses what is altered and unusual in the     patient.

         The practitioner takes notes in writing of all, and in the same expressions that the patient and his relatives used”.

In the succession of this aphorism Hahnemann stresses that the homeopath should not interrupt the descriptions that are given, unless the speaker were to drift to other topics. For the purpose of enabling correct note-taking Hahnemann suggests that the patient and his family should be reminded at the beginning of the consultation to speak slowly (Aphorism 84). Hahnemann even recommends clearly structured note-taking in order to facilitate amendment during the progression of the case-taking (Aphorism 85).

Once all persons have completed their narrations, so it is indicated in Aphorism 86, the practitioner should complement the descriptions of the case by adding specific characteristics to the symptoms. For this purpose the homeopath should have the patient ascertain each single symptom by further interrogating him for confirmation of the nature of the expressions of the complaint. As such the practitioner should seek further specification by asking about the time when a situation occurred, about occurrences before, during or after medication, about the nature, sensation, duration and location of pain. He should inquire the time of day or night and the bodily positions in which the symptoms are better or worse and should verify the exact occurrences of the causative circumstances (Aphorism 86).

In Aphorism 87 then, Hahnemann reminds us of an important aspect to keep in mind when taking a case. He emphasizes that the practitioner should not ask leading or suggestive questions as this could lead to imprecise responses. In fact the practitioner should pay special attention to utilize a general terminology that prompts the patient or other persons concerned to give particular comments (Aphorism 88).  Information that may not yet have been mentioned in the patients or relatives account of the diseased state, such as the bodily functions and dispositions should be explored at this stage. These include: “bowel movement, micturation, sleep pattern, temper, mood, reflective ability, appetite, taste, thirst, food preferences and aversions, comportment following food or drink intake, particularities of head, abdomen or limbs” (Aphorism 88).

 

Should the practitioner still feel he has not fully been informed, he should request further clarification to complement what he needs to know of the case. As such, specific examples are given by Hahnemann in Aphorism 89. Here he specifies supplemental questions for specific bodily functions, perceptions and sensations. Following this appraisal then Hahnemann indicates, that the practitioner should take note of what he himself perceives in the patient and his state. By further interrogation he should compare these peculiarities to the statements the patient has made earlier, and should note discrepancies in their diseased nature to that in a state of good health, so Hahnemann continues in Aphorism 90 of the Organon. Hahnemann further highlights this in Aphorism 91 where he stresses that the practitioner must always refer to the healthy state of the patient when appraising symptoms of the diseased condition of the patient. Only by comparison to the “original” state can the homeopath identify the “Gestalt”, the guise, of the illness.

Incidences and occurrences ultimately preceding a disease should also be noted. Hahnemann mentions these in Aphorism 93, where he indicates that such events may not be out rightly spoken of by the patient or his relatives. These, he indicates, should be sought to be extrapolated from interrogations that “fortunately” may point to such events, or should be found out by “private investigations” (Aphorism 93). He describes such events to be suicide attempts, alcohol dependency, unlucky love, jealousy, grief, and abuse; amongst others.

Customary habits need also to be investigated, as these could be causative factors of a diseased state. Hahnemann indicates that the removal of such habitual practices could facilitate the recovery from illness (Aphorism 94).

Once more Hahnemann points out that the practitioner should be meticulous in his case-taking, when he stresses that the appraisal of information, in particular of chronic diseases, should be “as accurate and detailed as possible, down to the smallest of particularities” (Aphorism 95).

In Aphorism 98 Hahnemann again cautions the practitioner and emphasizes what he already stressed in Aphorism 6 and 83.  Here he insists again that it requires “discretion, precariousness, the knowledge of human nature, cautiousness and much patience to investigate the true and complete disease picture and its details “.

Hahnemann finishes his elaborations on appraising a case, by differentiating the art of case taking of acute from chronic diseases. He reminds the practitioner in Aphorism 99, that the acute case of illness requires of him less investigation, but continues to stress the necessity to determine a detailed disease picture. Hahnemann indicates that the lesser duration of the acute state facilitates the case taking, as the details of the illness are still fresh in the mind of the patient and his relations, and explains that as a consequence the account of the presented state is likely to be more detailed and precise.

Hahnemanns instructions make clear that taking a case is a complex task that if carried out appropriately conveys to the practitioner the homeopathic remedy that is the closest match to the presented state of the ill patient. A swift recovery of the patient is therefore the reward for the patient’s detailed description, and the in-depth interrogation of the practitioner.

Hahnemann insists in his writings: “Imitate me, but imitate me correctly and meticulously” [2], therefore he gives practical instructions for the practitioner to follow. His ‘Organon of healing art’ [1] is not only a book depicting the fundamental principles of homeopathy, it is also an instruction manual that precisely outlines how a practitioner should execute his art. It conveys specific and practical information on the execution of the homeopathic art of practice, and advice for handling the diverse forms of disease situations. It even contains Aphorisms where Hahnemann cautions the practitioner and instructs on his behavior in the homeopathic consultation, as the above synopsis has shown. Hahnemann gave a valuable outline and its application falls to the practitioner.

 

References:

[1] Hahnemann, S. (1974). Organon der Heilkunst (2.Auflage) 6B Heidelberg:Karl F. Haug Verlag.

[2] Dr. Schweikert (1830). “Machts nach aber machts genau und sorgfaltig nach”, Zeitung der naturgesetzlichen Heilkunst für Freunde und Feinde der Homöopathik. Dresden/ Leipzig: Arnoldischen Buchhandlung.

 

 

About the author

Uta Mittelstadt

Uta Mittelstadt studied homeopathy for many years, both in Portugal and the U.K. She holds a BSc (Hons.) in homeopathic medicine and an MSc in homeopathy from the University of Central Lancashire. She runs a blog on all things homeopathic at http://cleverhomeopathy.wordpress.com/

3 Comments

  • An interesting article, but in my opinion it misses the essence of case taking as formulated in aph. 82:
    “It is the duty of a homeopath to investigate and find all symptoms and modalities. He is as attached to this as to the miasms as original cause of disease, without there is no cure possible” (compilation).
    In my opinion this is only possible if one keeps in mind during the interview the disease classification as method of analysing the case. Without this – and this is my personal experience – every case remains a puzzle. This is emphasized by Hahnemann in aph. 71:
    “How can a homeopath search out what he needs to know to cure the disease ?”
    The answer to this is given by the master himself in aph. 72, i.e. classifing diseases in acute and chronic diseases, which is further outlined in aph. 73 to aph. 81.

  • You make an interesting point Cor van der Meij. Boenningheusen wrote separate repertories for Psoric and Non-psoric remedies but later realized that the demarcation was so fluid and not strictly correct. After prolonged conversation with Hahnemann, he merged both of them. The classification into acute and remedy was once more propagated by Burt in his Characteristic MM.

    However, in the experience of many Homeopaths, old and new, this classification doesn’t matter. You will often end up curing many a chronic case with Nux or Belladonna. What matters is finding the symptom totality and corresponding remedy.

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