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ENDORSEMENTS

At last, the first comprehensive modern homeo- This is not another study of materia medica. It is
pathy textbook in English since Herbert Roberts primarily a study into the concepts that lie behind,
in 1936 and George Vithoulkas in 1978, and it and the process of case analysis, developed in a way
surpasses them both. Despite being a textbook and to a degree that I have not met before. It will
it is exciting and innovative with time and space be a very useful textbook for students, and offer
for reflection and personal growth. The inspired experienced practitioners a source for reflection
choice of authors for some of the chapters (Sherr, and further development of their understanding of
Norland and Curtin, for example) crosses bound- and competency with their work.
aries and enlivens the discussions. Read this and Starting from a study of different models of
your practical understanding of the theories of health, the book takes us through the themes
homeopathy will grow. It is equally suitable for involved in simpler case presentations on to those
experienced medical and professional homeopaths, in difficult cases. Whilst being primarily a theo-
and for students on all qualification courses. retical discussion, case examples are frequently
used for illustration and avenues provided to
Francis Treuherz MA RSHom FSHom
assist with the many obstacles in the way of the
Registered Homeopath, Homeopathic Private
homeopath.
Practitioner, London and Letchworth, UK
Dr Nick Goodman MbBS MFHom FACNEM
A tour de force, from basic homeopathy, through General Practitioner and registered homeopath,
practical application to the more esoteric Sydney, Australia
boundaries of holistic thought. Something for
everyone. David Owen’s style of interactive This is the most comprehensive book there is on
teaching is reflected in this comprehensive the principles and practice of homeopathy. The
work – if you want to be both educated and beauty of this book is that its breadth is matched
challenged to broaden you horizons, then read in equal measure by its depth. No aspect of
this book. homeopathy is neglected, from local prescrib-
ing to Sankaran’s sensations and miasms.
John Saxton BVet Med VetFFHom Cert. IAVH
The style is at once practical and profound, and
MRCVS President, Faculty of Homeopathy
honours the many different ways that homeopa-
Homeopathic teacher, author and veterinary
thy is practised. I am particularly impressed by Dr
homeopathic referral practitioner, UK
Owen’s numerous insights into the psychodymam-
ics of the homeopathic history, and his emphasis
One of the confusing aspects of homeopathic
on the homeopath’s own personal evolution. In
practice has been the apparently random focus
his own words, by reading this book the student’s
of different prescribers on varying aspects of a
work is transformed ‘from being a necessary task
particular case. David Owen presents a theoreti-
to being an opportunity for growth’.
cal background from within which to understand
and work with this phenomenon. From the out- Dr Philip Bailey MBBS MFHom
set he makes it clear that this book should bring Private Practitioner and author of Homeopathic
the reader to ask and meditate on questions, as Psychology (North Atlantic Books, Berkeley,
much as it may provide some answers. California), Fremantle, West Australia

v
Endorsements

This book drips holism and there is wisdom here and challenged to review issues of health, self,
aplenty. Speaking as someone who has wrestled illness, caring and treatment. This weave is practi-
with homeopathy for 30 years, David’s book cal and accessible, rooted in clinical practice and
touches on concerns and connections that any examples, yet tackles at the same time the pro-
serious practitioner will share. I predict it will found issues and questions which homeopathic
become a classic. practice and training raises. This is an important
Professor David Peters, step forward in homeopathic textbooks that I
School of Integrated Health, University of West- would recommend whatever your current level of
minster, London, UK practice.

This exceptional book gathers, reflects on, and David Reilly


deeply enquires into, the evolving principles of Consultant, Glasgow Homeopathic Hospital;
homeopathy in a way that encourages any practi- Researcher and Teacher, Glasgow Homeopathic
tioner to develop themselves, their understanding Academic Centre
and their art.
Written with an approach that invites reflec-
tive pause, the reader is supported, encouraged

vi
THE ‘FIVE THEMES’

There are five themes which run across the sec- therapeutic process. It is more than a record of the
tions and chapters of the book. These are repre- consultation as case skills facilitate what can happen
sented by small, stylised icons within the text to in a consultation, it determines what the patient
help highlight and connect the themes. chooses to reveal, the level at which the consultation
takes place and the depth to which the homeopath
perceives.
Philosophy
The principles and key concepts that provide the
conceptual framework on which the clinical prac- Case Analysis
tice of homeopathy is based. Allowing the student
and practitioner to address the practical and theo- Case analysis allows what is perceived of the
retical challenges of contemporary homeopathic patient to be matched with what is known of
practice. the remedies; according to homeopathic princi-
ples. It governs the order, pattern and interpre-
tation that emerge in the healing process. The
Materia Medica variety of case analysis strategies and method-
ologies available to the homeopath is a major
The materia medica of remedies is central to factor that determines the breadth of their clini-
understanding how homeopathy is practised. cal competence.
How the remedy pictures are developed and the
different ways the pictures are expressed provide
the foundation and building blocks that allow the
homeopath to both understand the patient and to Case Management
prescribe rationally. The many different ways the The prescription of a homeopathic remedy is only
remedy pictures can be expressed informs the very one part of the therapeutic and healing process.
way a homeopath thinks and is able to perceive a In each case the illness, the patient, the homeo-
patient. path and the effect each has on the other needs to
be considered. Case management brings together
the science of the homeopathic therapeutic system
The Case with the artistry of the caring and healing clini-
The homeopathic case puts the relationship between cian. Focussed on the process of cure and care of
the homeopath and patient at the heart of the the patient.

vii
CONTRIBUTORS

Helen Beaumont MB ChB DRCOG MRCGP MFHom Peter Gregory BVSc VetFFHom Cert. IAVH MRCVS
Homeopathic Physician and General Practitioner, UK Veterinary Surgeon, UK
Iris Bell MD PhD David Lilley MBChB(Pret) FFHom(London)
Professor, Department of Family and Community Homeopathic Physician, South Africa
Medicine, USA
Misha Norland RSHom FSHom
Maggie Curley MB ChB DRCOG MFHom Homeopathic Physician, UK
Homeopathic Physician and General Practitioner, UK
Tony Pinkus BPharm MRPharms LFHom
David Curtin MBBS MFHom PCH MCH(hon) Homeopathic Pharmacist, Director (Ainsworths), UK
Homeopathic Physician and General Practitioner, UK
Jeremy Sherr FSHom MCH Bac
Philip Edmonds HND DSH RSHom Homeopath, UK
Homeopath, UK

x
FOREWORD

It is not easy to write a different book about kind of approach. The third model is the holistic
homeopathy. This book manages to be different. model and this has already become a mainstream
Health care needs something to change. Chronic view in undergraduate medicine, and especially in
diseases are increasing throughout the world and postgraduate general practice training. It is some-
health services in every country are straining times referred to as a ‘biopsychosocial model’ and
under the burgeoning demands of people who are as such represents a significant advance on the
suffering. No government seems to be able to put ‘biomedical’ one. It refuses to be reductionist and
sufficient resources into health care to stem the places the patient as a person at the centre of the
tide. The Faculty of Homeopathy, under David care process. The holistic model focuses on the
Owen’s Presidency, developed a 25-year plan in whole of the patient’s suffering rather than solely
the year 2000. The plan was firmly based on the on their pathology. Eric Cassell in The Healer’s
foundation of our recognition of two important Art reflects this as a move away from a focus on
points. Firstly, that there is a desperate need for disease to a focus on illness. These three models
a new kind of medicine for the 21st Century. The bring us up to the current state of the art in the
existing model is just not good enough. Secondly, practice of medicine. Inspiringly, David Owen
that homeopathic medicine is ideally placed to goes on to outline two further models which chart
contribute to the creation of exactly the kind of a path to a future, better, more effective medicine.
medicine that the 21st Century world needs. The holographic model is really unknown in the
The structure of this book is founded on that the biomedical and even biopsychosocial models.
first recognition. What might a new kind of medi- Indeed, it is only rarely mentioned by those who
cine look like, and how will it relate to the cur- claim to practise holistically. I know of only one
rent model? The five models of health laid out in therapy which really understands it and which
the introductory chapter and which are then used uses this model in daily practice – homeopathic
as the entire framework of this text are, firstly, practice. The idea that when a patient presents
the pathogenic model – this is the predominant their suffering; everything is connected and every
model of health underpinning the dominant bio- symptom, every area of disturbance reveals the
medical model. It is highly reductionist and fun- same underlying problems and issues is fundamental
damentally based on a machine-like metaphor to the homeopathic approach. For a doctor, such
where parts become damaged or broken and an approach is very, very exciting. It means that
need to be replaced or fixed. Arthur Frank, in all the patient’s symptoms can be understood to
his excellent The Wounded Storyteller, describes reveal the fundamental, underpinning disorder.
this as the ‘Restitution Narrative’ – ‘I’m broken/ But more than that, it also reveals the exact, best,
my xxx is broken . . . please fix me’. The second unique therapeutic intervention for that patient.
model is the biological model. This model has It is the antithesis of the one-size-fits-all approach
developed from the pathogenic model as under- of modern pharmacology. This would be enough.
standings from complexity science have illumi- The vision of the holographic model would give
nated the processes of systems rather than only us plenty to explore, research and develop to
of components. As a model, it is more complex create a new 21st Century medicine. However,
and more accurate than the pathogenic model there is yet another model here too – the rela-
but it is still really the same reductionist, ‘fix me’ tional model. This, again, builds on strands and

xi
Foreword

developments of recent years. Balint groups from homeopathy. Homeopathic medicine does already
the 1950s introduced general practitioners to ways use all these five models of health and any health
of understanding the significance of the doctor– care professional would find that their work
patient relationship and showed them how to be would be enhanced and their rewards increased
aware of their own responses to patients and even if they learned how to integrate homeopathy into
how to use this awareness therapeutically. Sadly, what they already do. This book is not just about
the Balint movement has been washed away by theory and models, it lays out the ‘how to’ of
an approach based on targets and box-ticking. homeopathy.
Medicine NEEDS these new models of health to I hope you enjoy this book. I am very sure that
be developed and widely disseminated. reading it has the potential to change your profes-
You would think that all this would be quite sional life.
enough. It is exciting and it is visionary and it
should provoke any doctor to think more deeply Bob Leckridge BSc MB ChB MFHom
about their practice. However, this particular Specialist in Homeopathic Medicine
book does even more than this because it lays 2006
out extremely clearly the way to practise

xii
FOREWORD

By his choice of title, David Owen has set himself medica, but the text is interspersed with numer-
in a proud tradition, for his Principles and Practice ous clinical vignettes, giving the flavour of clinical
of Homeopathy is far from being the first book practice. It also reflects the burgeoning diversity
of this, or similar, title. Illustrious antecedents of the contemporary homeopathic scene.
include Richard Hughes’ slim volume of the same The great and unique strength of Principles
title, now over a century old. Herbert Roberts’ and Practice of Homeopathy is its multi-faceted nature:
Principles and Art of Cure by Homoeopathy, between no other pair of book covers will you find
published in 1936. ML Dhawale’s three-volume the breadth of approach, by authors who know their
Principles and Practice of Homeopathy published topic in depth, distilled with such brevity and clarity.
in 1967 and Ernest Roberts’ recent Homoeopathy: No one author can claim the depth of expertise in all
principles and practice. But best known to contem- areas required for a modern comprehensive textbook,
porary British homeopaths is Charles Wheeler’s and in a welcome development, in line with modern
classic Introduction to the Principles and Practice of practice, a number of chapters are written by experts
Homoeopathy which went through three editions in the areas, each with an introduction by Owen him-
between 1919 and 1948. Many British homeo- self. There are chapters on veterinary homeopathy,
paths of recent generations were brought up on homeopathic software, Miasms (by David Lilley) and
‘Wheeler and Kenyon’ (Douglas Kenyon became the Sankaran method (Helen Beaumont and Maggie
co-author for the third edition). Curley), among others. David Owen himself contrib-
The comparison between David Owen’s book utes a series of thoughtful concluding chapters which
and Wheeler and Kenyon is a gauge of how home- cover the management of difficult problems and the
opathy has evolved over the last 60 or so years. ‘self-maintenance’ for homeopaths. All are interspersed
The older book has a bare 50 pages of principles, with case histories, illustrations and points for reflec-
followed by 300 of materia medica and a mini- tion.
repertory. Each medicine monograph starts with
an account of the nature of the substance, fol- Dr Peter Fisher
lowed by its toxicology and pharmacology before Clinical Director
describing its homeopathic uses. By contrast, Royal London Homoeopathic Hospital
Owen’s book contains no systematic materia 2006

xiii
ACKNOWLEDGEMENTS

‘Every blade of grass has its Angel that bends over thinking and approach was Dr Lee Holland with
it and whispers, “Grow, grow”.’ The Talmud whom I discovered more could be learnt from the
difficult cases than the easy ones. It is to him, and
The knowledge in this book is tiny compared to through my memory of him to those patients which
the truths of homeopathy held by the homeo- challenge me (and you), that I dedicate this book.
pathic profession as a whole. Any wisdom it I would particularly like to thank Dr Jeremy
offers does not solely belong to me or any other Swayne who has studiously corrected earlier drafts
single teacher – it belongs to the total sum of the and critically reviewed the text. Also to Patricia
homeopathic profession and its patients, who are Ridsdale, who as an ex-student and now a col-
the reason for its existence. Those who have writ- league has encouraged and given feedback. Other
ten different chapters and those who have both inspiration came from Robin Shohet who has
taught me and learnt with me represent the many invited me to explore models of reflective practice
homeopaths that have contributed to this knowl- and supervision and has supported me in ‘finding
edge. The bibliography at the end of each chapter my voice’ and writing this book. I am grateful for
introduces, cumulatively, other key texts that have the support of many friends, like Alan Heeks, who
been important in my learning and lay the founda- have reminded me of the opportunities and les-
tion for further reading. sons to be learnt while writing the book, stood by
I am especially grateful to my colleagues and the me as I faced my fears and have encouraged me to
students of the Homeopathic Professionals Teaching share my dreams.
Group (HPTG) especially Alice, Brian, Charles, The challenge of writing this book would not have
John, Peter, Andy, Lee and David who make study- been possible without the patience, encouragement
ing and teaching such a transformative experience. and love of my family. Thank you to my wife Sue, and
One colleague who had a huge influence on my children William, Oliver, Henry and Miranda.

xiv
PREFACE

‘You must give birth to your images. practising homeopathy comes from limiting the
They are the future waiting to be born. universal principles of homeopathy.
Fear not strangerness that you feel. I hope that you accept this book as an invitation
The future must enter into you to explore and journey towards your own clarity
Long before it happens. and certainty; to celebrate the diversity homeopathy
Just wait for the birth offers and find a way of practising that is not only
The hour of clarity.’ Rainer Maria Rilke practical, inclusive and effective, but also suits the
unique contribution you can bring to this healing art.
This is a practice that will help those patients who
Every homeopath I know describes, at some
wish to understand and work through their illnesses
time, entering unfamiliar terrain. This book will,
to a deeper and subtler level, leading to better health
I hope, be helpful to the student when navigat-
for themselves, our environment and our future. It is
ing through such ‘terrain’. To make your journey
a way of working that is stimulating, rewarding and
through the book easier it is designed on a spi-
enjoyable for you – the future of homeopathy.
ral pattern – weaving together the philosophy, an
The nature of writing is that it lends itself to
understanding of the materia medica, the patient’s
the expression of certain concepts and ideas better
case, the analytic strategies and the management
than others. I realise that, at times, it may seem
issues raised. There are six sections, each with five
as if I am making sweeping statements or being
chapters. Very approximately each year of a three-
defensive about concepts that are important to
year training course on homeopathy will link with
me. While I am passionate about sharing these
two sections. Each section will deepen and prog-
ideas with you I welcome any doubts about my
ress the ideas previously discussed.
interpretation of things. Learning is not easy and
My passion for homeopathy and the belief that
at times questioning different ideas and challeng-
it is the health care system for the future of human-
ing assumptions and concepts will serve you bet-
ity is the overwhelming reason why I decided to
ter than anything you read. My belief is that if I
write this book. At times it reflects the consensus
can, in some way, share my enthusiasm, then it
of homeopathic thinking; at others it may seem
will help you to engage with your own inquiry
potentially outrageous to you. The principles cov-
and sustain you when it becomes challenging or
ered here are, however, validated by my clinical
just plain, laborious hard work.
experience and those of colleagues with whom
I’ve practised and taught. These have led to a clar-
ity and certainty of mind about the different ways Why you should read this book
that health can be viewed, described here as five ‘What lies before us and
different but complementary ‘models of health’. What lies behind us
This book looks at what information about our Are small matters compared
remedies and patients is needed to practice in To what lies within us.
each model. I am eager to share these with you And when we bring
as I have observed, over many years of teaching What is within us
students and supporting and supervising practitio- Out into the world
ners, that the greatest confusion and difficulty in Miracles happen.’ David Thoreau

xv
Preface

Learning homeopathy is a journey, there are How you might get the most from
no time machines, no reaching the end before
leaving the beginning, no ways someone else can
this book
‘What doesn’t kill me makes me stronger’
do the journey for you or carry you. Some of the
Albert Camus
journey is well trodden and easy to follow, some
in the outer world and some in your inner world. Clarifying the questions and searching for answers
Some of the journey is difficult, where you must is essential for our development and I would not
make your own pathway and upon which it is easy want to take this struggle away from you. If this
to get lost. book makes your journey more conscious (even
The principles provide fixed and consistent if at times you find it more difficult) then this
markers in this sometimes unfamiliar terrain. is, I believe, the price we pay for the privilege
The practice, as recorded by different practi- of studying and working as a homeopath. My
tioners, provides signposts pointing the way. At belief is that we will not run out of questions to
times different signposts point in different direc- go through. In the same way as the last patient
tions and you will at times feel lost and confused. won’t ever be treated, so when one set of ques-
This is as much a preparation for working with tions is answered another will arise. Offering you
patients as anything else. We each have to wrestle, the questions and answers is not just a gift but also
struggle and eventually find our own way around a responsibility. For you to gain the insights that
the world of illness that parallels and shadows I hope you will, your perception will need to be
the world of health. You, like me, will need to attuned and your presence focused. One of the
reflect, meditate and try out the different, at best ways to do this is to read this book actively,
times contradictory or paradoxical, teachings to not passively. This means not assuming each sub-
find your own way! ject will unfold gradually and sequentially but,
Every homeopath will also, at some point, at each heading, to think positively about what
reach a place where they feel alone and stuck. you already know, what you want to learn about
At such a moment I hope this book will remind this topic or idea, and what questions you would
you that you are not alone and help you to like to have answered about that topic. If you are
courageously move from your ‘stuckness’. When attuned and focused when reading this book it
you have experienced this many times you will (as with the patients you see) bring insights. If
will know that these difficulties are where you you are questioning and reflective then for every
find the true connection with your colleagues insight you gain, you will discover yet another
and from where you have the opportunity to question. To help in this questioning and reflective
fly above the problems and ‘stuckness’ to gain process I cannot state too strongly the importance
new perspective. My experience is that I move of being in a supportive learning environment;
between uncertainty and certainty. As a homeo- somewhere where you can share your successes
pathic student I sought certainty but the reality but more importantly your failures – where you
of being a practitioner has made me realise that can own your fears and dream your own dreams!
it is how I embrace and work with the uncertain In order to both broaden and deepen your
that determines my personal insights and ability training I hope you find a learning environment
to see and work with patients. There will be many where your education, support and development
times in the book when I invite you to reflect on are all addressed. It may require different col-
your own uncertainty. If you enter fully into this leges, courses, teachers, mentors, peer groups
it will help you make your own map – which you and supervisors at different times and for dif-
will find infinitely better than anyone else’s, and ferent students, to facilitate your learning. This
which will make you safer and more comfortable book, indeed any book, by its nature, cannot
with the uncertain. provide all this.

xvi
Preface

There are, for example, real challenges regarding son will find some aspects of the book more or less
integrating homeopathy with other healthcare sys- useful than another. This is as it should be, and
tems. It is influenced by the conventions of different where a point is important I have made it several
communities that patients belong to and the beliefs times – each time in a way that I hope will appeal to
and priorities that individual patients hold. Each of different readers. It does mean that some points are
these cannot be covered in specific detail although the repeated, frequently revisited and deepened in dif-
general principles are covered in the chapters which ferent chapters and sections. Typically, learning con-
address case management. It is beyond the scope of sists of different stages and is approached differently
the book to look in detail at organisational, pub- by those with different learning styles (see Chapter
lic health or social issues related to providing a 12). Learning a subject deeply (like treating a patient
homeopathic healthcare system to a community. at the deepest levels) will often involve cycling
For this vital work to be done, the commitment through a number of stages as your knowledge of
of practitioners to the health of communities and the subject (or patient) deepens. Your own preferred
populations as well as individuals is required. To way of learning and consulting will be influenced by
work meaningfully with this requires the realisa- the stages and styles you feel most comfortable with,
tion by individual homeopaths of the importance as well as how the information is presented. When
of their own professional organisation, providing paced and managed this learning cycle will naturally
far more than examination/assessment processes lead to the understanding of a subject deepening.
and regulation. For you as a student it means that Different readers will start in a different place and
as well as an environment where you feel safe and find some parts easier than others.
supported it is vital for you to find a peer group If you find you are distracted by something in the
and professional community. text then check to see if you can accurately describe
The focus of this book is on your personal under- the point for yourself as it may need more reflection
standing of homeopathy. It does not set out to provide before you can deepen your understanding. Realising
materia medica or to offer specific case management your own learning style and preferences will help you
advice for treating patients with specific condi- assimilate and personalise the huge amount of infor-
tions. Although brief illustrative materia medica and mation that studying homeopathy requires. It will
case vignettes are used to connect the theory to the also offer insight into how you relate to others – so
practice. It will offer you most when studied along- important to understand when treating patients.
side other texts, when you have the opportunity for As the book progresses so the ideas may appear
the observation of a variety of homeopathic cases more challenging; they also move from historical
and can begin to practise with careful but challenging teachings to perceptions from current practice. I
clinical supervision. am completely confident in these perceptions and
their value but, being newer, they do not carry the
same endorsement by other homeopathic teach-
REFLECTION POINT ers. In many cases teachers of other therapeutic
● What is your learning environment like? Can you be modalities verify them. The homeopathic truth
yourself, could you have your case taken, if necessary does not change but our interpretation and expla-
receive treatment, share your concerns and discuss your nation does. So, for example, this book aims to
failures, etc? What else do you need to best facilitate your extend an understanding of the principles and
learning and how will you get it? practice of homeopathy to include psychological
concepts, e.g. observations about the therapeutic
relationship including projection both onto and by
Style practitioners, which are confirmed by the experi-
This book is written in a way that attempts to address ence and observations of those using psychothera-
readers’ different preferences in learning. Each per- peutic approaches to treatment.

xvii
Preface

Writing this book has provided an invalu- celebrating the difference and uniqueness that
able process for me to reflect on, and record, each of us has to offer. If this book helps you to
how I work and the principles I follow. Daily I clarify the principles and values you choose to
see homeopathy revealing staggering qualities in work with, to find what works best for you, helps
people as they journey between illness and health you understand those who work differently, and
and in homeopaths as they struggle to glimpse the encourages you to extend and explore your own
mysteries of life. I am grateful for the opportu- therapeutic ‘territory’ then it will achieve all that
nity to have reflected on these observations and I could hope for.
thoughts and the privilege of being able to share Readers are invited to contact me with com-
them. I hope this book helps you examine both ments or feedback on the text; by e-mail to
your attitudes and behaviours to yourself and davidowen@doctorsnet.uk
others and encourages you to enquire deeply
about your role as a healer and seek out those
who can personally supervise your training and
support your education.
I have spoken only of those models of health,
approaches to treatment and methodologies to
prescribing with which I am familiar. None is right,
none is wrong. Other practitioners with different
experiences may describe what they do, and how
they work – it is for you to decide if they sit within
the framework I have described. I wish you luck in
developing your own style of practice to suit the
situation in which you work and the patients you
are likely to see. I own up to a slight sense of envy
of all the excitement and opportunities that your
study of homeopathy will bring to you. But I am
equally enthused by the questions and opportuni-
ties that patients and students daily present.
My heartfelt desire is to engender tolerance,
open-mindedness and insight amongst practitio- David Owen
ners using homeopathy, while at the same time Winchester, 2007

xviii
CHAPTER ONE

What is Health? Philosophy

David Owen

Introduction ment whether we think of it in terms of objects


or energy. By knowing these, it is possible to
The laws that govern health are the cornerstones
work with the great healing potential of nature
of a homeopath’s knowledge. How we understand
and individuals.
the relationship between the substance and energy
The first law is that every action is matched by
of life determines the model we use to describe
an equal and opposite reaction. When a force is
health. Homeopathy is the matching of a remedy
directed in one direction an opposite force operates
to a patient based on their similarities (like treating
in the other direction. This law explains why every
like). Homeopaths use several different models to
cause has an effect, why certain lifestyles produce
explain health and define illness. The model used
certain symptoms and why the homeopath seeks to
determines the approach to treatment. For each
understand all aspects of a symptom, including those
approach to treatment there are several methods
which at first may appear hidden or unconscious.
of prescribing. This chapter invites you to reflect
The second law is that nothing (in a closed
on what you think health is before outlining five
system) is ever ultimately created or destroyed but
models of health.
that it just changes its form or nature. So energy
The different relationship between homeopath
will change from kinetic to potential, compounds
and patient – where symptoms describe the inter-
may break into component elements, health and
face between patients and their environment, and
illness are aspects of the same thing and birth and
illness may be seen as a necessary aspect of being
death are considered a change in ‘state’.
well – invites further reflection about homeopathic
The third law is that change is a constant, that it
patients and the meaning of illness. How symp-
is inevitable. Complex systems in time decay; simple
toms arise and communicate the patient’s needs is
systems in time become more complex. Organisms
mediated by what is termed the vitality. The natural
try to move towards or maintain a steady state, but
forces that govern the vitality and the general laws
when a steady state is approached or obtained for
of health start to describe the homeopathic laws.
any length of time it inevitably becomes unstable
again. The only constant is change.
The fourth law is that all observation is affected
Laws of Health by the medium through which the perception is
The science of homeopathic medicine is based on taking place. For example, things look different
a framework of laws described by philosophers when seen through air or water, and because it
and validated over generations by observers and takes time for us to see things, we only see them as
practitioners. The laws apply to all organisms they were and never as they are. Two people will
and they follow laws that govern our environ- have different views of the same things.

3
CHAPTER ONE What is Health?
Foundation

Lastly, the fifth law says that the same laws govern of a population, and on what benefits an illness
objects as govern energy. All matter has the potential can bring. Health is therefore not a single point of
to change and all change is an expression of energy, balance but a dynamic state with changing points

I so matter has a ‘potential energy within it’. Our


bodies are influenced by energy, including thoughts,
of balance; temporary removal of some symptoms
is not the same as a cure. Joan, with depression,
that we are exposed to and that we express. seeks treatment and takes antidepressants. This
helps her feel less different but it alters her art and
also leaves her susceptible to other illnesses.
REFLECTION POINT
● What do these laws tell you about health? How do these
laws affect different therapeutic systems, for example REFLECTION POINT
the body’s reaction to medicines or the remembering of ● You might like to reflect on some other situations seen
thoughts from the past? in practice that inform us about what health is, and isn’t.
Think about the situations described below and what
they tell you about health and illness.
What is Health?
To stimulate your thinking about health consider
the ‘health’ of the individual in these different As John gets older, his mobility reduces to a
situations: point where he finds it hard to walk to the shops
Peter comes into the practice feeling completely unaided. He has no pain but just can’t walk as far
fit and well but needing a medical for his insurance as he used to. Perception of health is related to
company; he has raised blood pressure and inves- what you expect of your body.
tigations lead to a diagnosis of a serious disease. Julie feels ‘absolutely fine’ but wants to ‘make sure
Peter was obviously not healthy before he walked I keep healthy’. She asks her homeopath if she would
into the practice but he did not know this. benefit from homeopathic treatment – might it make
Lucy and James are born with identical birth- her healthier? Julie takes a remedy and feels that she
marks that will, if untreated, stay all their lives; has significantly more energy and an increased sense
James feels disfigured by his while Lucy feels hers of well-being. Was she not healthy before?
is a distinguishing mark. Symptoms in different David always feels at his best after a cold or
people cause different responses. cough. When is he healthy?
It is also important to remember health and ill- Jan brings her child to see you: the child is
ness have important functions in communities as content and happy but Jan describes the child as
well as in individuals. An individual’s illness will a ‘slow developer’ or ‘poor sleeper’. Who has the
affect their community and their community will health problem?
affect them. We have a primary role to care for Mike and Mary take their pet dog to their vet-
an individual and often a secondary role in caring erinary homeopath, as they want it to bark less, be
for a family group or community. At times, these friendlier to children and less protective of them.
roles conflict: The breed is strongly territorial. Does the pet or
Joan has depression and feels different from the owners have the problem?
her family and community. She is an artist, and
her work makes her family and community feel What is Natural Health?
uncomfortable but leads to some members of her People, animals, plants and micro-organisms
community reflecting on how they see things and can all be healthy without following a system
brings for them greater insight. There are impor- of care and health. The ability to be healthy
tant questions to ponder both on the conflict that existed before any healing system was devised
can exist between treating an individual and that and natural laws alone are sufficient for healing

4
The Models of Health

Foundation
most organisms most of the time. Symptoms are food poisoning) or of repairing or minimising the
in many ways necessary for health. When you damage after the cause is removed (scarring after
‘catch a cold’, a normal and healthy response is an injury) or adjusting to the damage by modify-
to develop symptoms. Tiredness might lead one
to have an early night; thirst, to taking extra fluids.
ing the environment or situation the organism is
in (arthritic pain limiting mobility). In this model
I
These things will help you throw off the cold. the absence of symptoms is an indicator of health.
So having symptoms is an integral part of being Throughout Sections I and II, the book focuses
healthy, not an opposite. on what is required to use homeopathy in these
As individuals are drawn to explore lifestyles first two models of health, and on how to treat on
and environments that are more varied or chal- causation and presenting symptom.
lenging to them, so the challenge to maintain a The holistic model looks at health in a broader
healthy state increases. As this happens so the context than just that of the presenting illness. It
individual attempts to act in a way that can help sees that in more complex cases the factors that
maintain or return to a healthy state. The more affect the health of the patient are many, and that
any treatment system takes into account each one simple cause is unlikely to explain the illness
of the laws of health the more it will work with and the illness is unlikely to be expressed through
individuals’ natural ability to heal themselves. one group of symptoms. The cause and effect can
simultaneously exist in many aspects of the patient
and the environment – indeed at the extreme view
The Models of Health
This book considers five main ways of looking Pathogenic
at illness and health. They are not exclusive and
frequently are combined together to try to under- Causation
stand a patient’s illness from several perspectives.
However, each leads to particular approaches to
treatment, each has strengths and weaknesses, Biological
expectations and limitations. They are represented
diagrammatically in Figure 1.1. Symptom

The pathogenic model sees illness in terms of


an external cause that can lead to a chain of causa-
tion. When the cause happens it causes the patient Holistic M in d
to ‘get ill’. When the cause is treated or reversed it
Totality and
ral

can enable the patient to ‘get better’. The biologi- Constitution


Bo

ne

cal model recognises that a single cause in every y


Ge
d

living system does not always have the same effect.


Holographic
In non-living systems the effect of any cause is in
theory predictable, for example a chemical reac- Theme or
tion. In the biological model of health the symp- Essence
toms always express the illness and represent how
the healthy organism has been affected by a cause. Relational
It may therefore reflect indirectly information
about causation. The symptoms represent the way Observer reflects
an organism is attempting to re-balance itself in the observed

response to the cause. The symptoms may both


be a way of overcoming the cause (diarrhoea in Figure 1.1 The five models of health

5
CHAPTER ONE What is Health?
Foundation

of this model, cause and effect are co-dependant underlies most ‘intuitive’ prescribing. In this model
and no one change or symptom happens in isola- health is only partially about what the patient con-
tion. The trends and patterns in the patient both sciously expresses and much more about what is

I when well (constitutional state) and when ill


(totality of symptoms) indicate the remedy state
hidden and the influence of this on the observer.
The holographic and relational models in my expe-
(see section III). In this model health is not just the rience offer a great deal in the management of the
absence of symptoms but also describes something difficult cases. They build on and are an extension
of your resistance to common causations or what of the holistic model, and the concepts behind them
we call susceptibility; it also recognises that illness are introduced gradually through this book.
in some situations is necessary and even a require-
ment of long-term health as a way of rebalancing Models, Approaches and Methodologies;
when the environments we are in change. Impression Plan and Prescription
While the pathological, biological and holis- Each model of health invites different interpreta-
tic models are easily recognised in much homeo- tions and realisations about homeopathic remedies,
pathic teaching they, like any model, have their cases, analyses and treatment. Although in practice
limitations. Two other models are outlined briefly these are often blended together, a thorough under-
below but discussed in more detail in section VI. standing of each in turn is a prerequisite to a ratio-
The holographic model recognises that symp- nal system of care. Each of the five models of health
toms do not just happen in many areas of the body leads to particular approaches to treatment, and
at the same time but that each individual symptom each approach is served by different methodologies.
describes the underlying pattern of change in the Different but complementary information about the
whole person. The whole is glimpsed by seeing, in homeopathic remedies is needed to use each meth-
enough detail, any of the component parts. Like odology and different aspects of the patient’s case
a hologram every piece of the whole, however will provide the information necessary to apply each
small, reflects the whole picture. Ultimately in approach. These are developed and built up through-
this model any one symptom, if known fully, will out the book but an outline of the different mod-
express the essence of the patient. els, approaches and main methodologies is given in
In this model, the observer uses one or more dif- Table 1.1 with a reference to the section of this book
ferent concepts or methodologies to interpret what in which they are developed in more detail.
they see, such as yin and yang, the three miasms, three It helps to think of the model of health as deter-
kingdoms, four humors, five elements, seven rays, mining the overall impression of the patient, the
twelve astrological signs or any other division the context in which the patient’s story or narrative
observer finds helpful to use. In this model health is is told (see Chapter 3). Different models often
both about what is visible and expressed and also about suit different types of case and this is explored in
the deeper, compensatory or underlying aspects. Chapter 10. Each model of health can have several
In the relational model the context of any symp- different approaches to treatment and a number of
tom and the relationships of the patient, including prescribing methodologies. The methodology of
the relationship with the homeopath, is central. prescribing gives the method of selecting a specific
The homeopath might be directed to the impor- homeopathic prescription that matches the patient
tance of a symptom or sensation by a sensation or in a particular context. Different methodologies
feeling of their own, for example, a tingling in their indicate remedies prescribed in slightly differ-
spine or hairs standing on end. In this model the ent ways and are therefore likely to have slightly
homeopath is using his reflections or awareness of different outcomes. (The idea of separating out the
this to explore what is happening in a patient. It is impression, plan and prescription in each case is
through this that the homeopath goes on ‘gut feel- developed in Chapter 8.) The different models,
ing’, on ‘I feel this in my water’ and I suspect this approaches and methodologies are often combined

6
The Models of Health

Foundation
Table 1.1 MODEL APPROACHES AND METHODOLOGIES
Model Book Approach Methodology
of Health Section to Treatment of Prescribing

Pathogenic I Causation Aetiological


Isopathic
I
Biological II Presenting Local
symptoms Clinical
Keynotes

Holistic III Totality Three-legged stool


Constitution Mind, body, general
Morphological constitution

Holographic IV, V, VI Essence Miasms


Thematic Families
Kingdoms
Related remedies

Relational V, VI Reflective Psychodynamic


Emotional
‘Intuitive’

in practice or emphasised in different situations but just removing or treating the cause will not always
it is important to first understand each in detail. lead to a cure as damage may have occurred over a
period of time. We see that the duration and sever-
The Pathogenic Model ity of the cause is central to the extent to which this
In this model health is the ability to withstand model alone will heal patients.
causes of illness. It concerns itself with the causa- Strictly speaking, treating on causation means
tion of the patient’s problems and is the basis of treatment based on ‘aetiology’. However it includes
much simple and effective treatment, using many predisposing and precipitating or provoking causes.
different treatment modalities including simple In many cases the causative association between
lifestyle changes such as avoiding acidic foods events is less clear, such as a patient getting headaches
in indigestion. It also lends itself to sensible self- when constipated, or very unclear, such as a patient
treatment in the home on the basis that once the feeling happier when constipated. In these cases the
cause is removed or treated recovery will follow. It closeness in time between symptoms is important,
is often most effective when there are single caus- including which symptom pre-existed the other. If the
ative factors, sometimes referred to as a trigger patient had never been happy before or unless they
factor. It is the level of much conventional disease are constipated, it increases in importance. In more
treatment today, such as treating an infection by chronic illnesses there may be several causative factors
killing the infective organism. which may or may not be connected. If a clear order
When a patient presents with an illness, the ques- of causes exists it can help to understand which was
tion the enquiring physician using this model asks is the first and which are acting more deeply.
‘what is the cause?’. If, despite treatment, the cause is A homeopathic treatment using causation may
maintained then, although treatment may give relief be chosen on the trigger event, on the factors that
the illness either remains or resurfaces later as a recur- preceded the patient’s illness, and events from
rence. Not all illnesses caused by a single causative which they had ‘never been well since’ or in com-
agent are superficial. Radiation exposure, asbestosis, bination with other approaches and methods of
smoking damage and nutritional deficiency can all prescribing. The case of Alice in Case Study 1.1
be accommodated within the causative model, but illustrates this.

7
CHAPTER ONE What is Health?
Foundation

The Holistic Model


CASE STUDY 1.1
The holistic model recognises that any single
Alice, age 11, presented with recurrent upper
cause may, in different people, have a different
respiratory tract infections. Each of these was
I helped to some extent by acute prescriptions
effect, and any one individual can produce simi-
lar symptoms from diverse causes. Susceptibility
but she continued to get relapses. She was
determines what causative factors the patient is
brought for a consultation to see if a more
sensitive to, the degree to which they respond,
deep-acting remedy might help prevent the
and what symptoms they are likely to develop, i.e.
recurrences. Taking a history the colds had
their vulnerability to particular illnesses. In the
started shortly after a grandparent had died.
holistic model the enquiring physician investigates
Alice had been protected from the loss of the
the ‘individual susceptibility’ and asks why does
grandparent and had not attended the funeral
the patient have this particular illness with these
but neither had she had a chance to talk about
particular symptoms and what will help them now
her feelings. Alice was prescribed a remedy
and in the future?
based largely on the suppressed grief but also
In this model, whatever the pattern of cau-
taking into account the local symptoms. After
sation, symptoms include both the physical and
being sad and tearful for a few days she felt
psychological symptoms of an individual. These
much better and had a significant reduction in
will affect the environmental preferences of the
upper respiratory tract infections.
individual, what we may call ‘situational’ factors,
as they may extend to any situation the patient
chooses or ‘finds’ themselves in including work,
relationship, cultural, etc. Taking all aspects of the
The Biological Model situation as well as local causes and effects leads to
The biological model sees health in terms of the a totality approach to treatment that incorporates
effects of a cause. In this model health is the local, psychological and general symptoms.
organism’s ability to rebalance itself after a threat Our situations are always changing and our
or cause. It is also called ‘homeostasis’ or ‘auto- health in one situation does not assure us of
regulation’. When a patient presents with an ill- being healthy in another. There is a quality to
ness, the question the enquiring physician asks in being healthy in the holistic model that not only
this model is ‘what response has the patient had addresses our ability to be in balance with the
to the cause; what is the disease process that has environment we are in now, but also the ability to
ensued?’. It may follow (but not necessarily) that be in balance with the situations we are likely to
the cause is known. In the biological and patho- come across, or the changes we are likely to face.
logical model the relationship between cause and The pathological and biological models are about
effect is usually considered as a linear relation- the individual’s ability to function optimally in a
ship, i.e. cause first and effect second and, at its set or given environment, while the holistic model
simplest, especially in acute illness, focuses on provides a model to explore health as something
one cause giving one effect – e.g. a fever caused that is sustainable.
by an infection. A more sophisticated biological
model is one with multifactorial causes, where a The Holographic Model
number of different causative factors can predis- As cases advance, particularly if they are only par-
pose or lead to a number of effects, including a tially treated, then they get more and more com-
variety of symptoms. For example, poverty may plicated. Fewer symptoms are clearly expressed
be a contributing factor to poor nutrition, which in the totality of symptoms and a holistic model
may contribute to susceptibility to a particular becomes harder to work with. In these cases, where
illness. many symptoms become overshadowed by others

8
The Models of Health

Foundation
and where much of the case can appear to be in to other more abstract qualities such as a theme
shadow, an essence and thematic approach, based of rigidity (Kali salts) or performance (metals).
on the holographic model, opens the possibility of They all, however, share an element of ‘subjectiv-
working with what would otherwise be difficult
cases. The holographic model recognises that cause
ity’ – that is why understanding the relationship
between patient and homeopath is so important
I
and effect are mutually dependent and the pattern (see Chapter 23). Historically homeopaths have
behind the causation and expression of the illness is shied away from such interpretations but increas-
what points to and requires treatment. ingly they offer opportunities to perceive cases
Using this model the homeopath asks what is that are difficult to treat with other approaches
the order or pattern being expressed or revealed and that can be rigorously explored using insights
by the patient. Treatment is based on these pat- on perception from modern science and the thera-
terns, referred to as essences and themes that are peutic relationship from psychotherapy.
matched to the essence and themes in the homeo-
pathic remedies (see Chapters 22 and 27) – both Well-Being
seeing the case and the remedies thematically go The pursuit of well-being often preoccupies many
hand in hand. At times these themes relate to patients. Many wish to feel a positive sense of well-
traits that run through groups of patients and that being and to ‘feel healthy’. Health, however, is not
correlate to susceptibility, including inherited and something you can be separate from or ‘feel’. It is
acquired disposition. When related to the influ- easy to find patients where health, like beauty, has
ence of a particular disease process that causes a become an idealised state, becoming influenced,
distinctive pattern of illness, not necessarily the determined and promoted by prevailing fashion,
same as the disease itself, it is referred to as a miasm markets, culture and political norms. It is per-
(see Chapter 17). Originally in homeopathy three haps why much complementary medicine is found
miasms were described, relating to the traits set up within the beauty sector, as an attempt to counter
by the illnesses of scabies, gonorrhoea and syphi- the dominance of the narrow objective measures of
lis, corresponding in turn to a general pattern of health that have more to do with fitness. Health is,
deficient, excessive and disordered reactivity. Some however, neither fitness nor beauty.
homeopaths do not accept the theory of miasms;
some do not accept the concept of essence and The Relational Model
themes – those that do, find them a useful model ‘What is crucial . . . is that, according to the theory of
for understanding more deep-seated illness and relativity, a sharp distinction between space and time
what would otherwise be confusing cases. cannot be maintained . . . thus, since the quantum the-
As a patient with deep-seated illness begins ory implies that elements that are separated in space
to respond to treatment, so other models and are generally non-causally and non-locally related pro-
approaches may become indicated. The homeo- jections of a higher-dimensional reality, it follows that
path starts to see that returning to and maintain- moments separated in time are also such projections of
ing health is a process that may go through several this reality.’
stages, often using different models of health as David Bohm, Wholeness and the implicit order
treatment unfolds over time.
While the pathological, biological and holistic The relational model uses the principle that the
models are relatively objective the holographic health of a patient cannot be considered as sepa-
model relies on the recognition of patterns that rate from those things around the patient. The
are not a random collection of events but that have patient is at all times projecting onto the sur-
a perceived order or ‘intelligence’ in the observer. rounding people and environment and the people
These patterns may be connected to the typical and environment will constantly be projecting
symptoms of a disease in the case of miasms or due on to the patient. This leads to an approach that

9
CHAPTER ONE What is Health?
Foundation

recognises and reflects on these projections, that Health Compared with Fitness
are not just psychological but are often most Fitness is the ability to perform optimally in a set
accessible in the conscious and unconscious reac- or limited situation. For example, a sports person

I tions of the homeopath, leading to what are here


referred to as a ‘reflective’ approach to treatment
may perform very well in one particular sport
but not in another. Fitness helps you ‘fit into’ a
and psychodynamic methodologies of prescrib- particular environment or situation. You can be
ing. Here the dynamic nature of the relationship fit intellectually or emotionally when you are in
between patient and homeopath reveals important a particular intellectual or emotional situation,
aspects of the case (that might otherwise be hid- but this doesn’t necessarily mean you will cope
den) and informs the treatment and prescription. if the physical, intellectual or emotional situa-
It is particularly useful for understanding and tion changes significantly. Homeopaths see many
working with cases that may present with a single, people who work hard at their fitness, including
often overwhelming, symptom such as a tumour athletes, but they often have problems dealing
or where a disease is diagnosed in the absence of with things like changes in their career, ageing, or
symptoms such as hypertension. These most hid- bereavements. They may be fit but they are not
den of homeopathic cases are sometimes called necessarily healthy. Many patients pursue fitness
‘one-sided cases’ and are often treatable when rather than health, and much of the conventional
using this model at a deeper level than they might health care system is focused on being fit, getting
otherwise be. the body to work well or in balance in a given
The relational model requires homeopaths to environment.
reflect carefully about their physical and emotional In John’s case the treatments he needs may be
reaction to patients and to know themselves well. many, depending on his choices and the models of
health that are used to understand this case. How
Health in the Different Models do you understand this case through the different
Health as Balance models of health?
Balance can be considered in a number of ways,
from returning to a previous state after being ‘off
CASE STUDY 1.2
balance’, to returning to the same state but with the
John enjoyed running. It helped him cope
ability to resist being ‘knocked off balance’ again.
with stress. However, he started to get pain in
Balance may also be a state that reflects harmony,
his right knee, which he treated with an anti-
either internal, for example, balanced emotions,
inflammatory. His knee deteriorated until he
or external, for example, balanced diet. It may, for
required surgery. At that time he was unable
some, reflect a point of development, ‘I’m getting
to exercise, and found he was unable to cope
more balanced’, or a positive state to attain, ‘I’m
with the stress of his job. He was diagnosed as
looking for a better work–life balance’. For oth-
depressed and started on antidepressants.
ers it is something only recognised when lost. In
practice a homeopath works with several different
notions of balance and health within different mod- Health in the holistic model is the ability and
els. In the Biological model the relevant symptoms potential to maintain the integrity of the organ-
are tightly focussed around ‘the illness’. At other ism in a changing environment. Unfortunately,
times a broad range of symptoms including those much research into health care looks at the ability
not immediately and directly related to the present- of an individual to perform or operate only in a
ing illness may be considered to describe balance particular fixed set of circumstances over a brief
in the holistic model of health. While each model time. It looks at a single outcome, or at imme-
provides a discrete view you may already be able to diate changes that give a pointer towards fitness
see where the models can ‘run into’ one another. but very little information about health. This is

10
The Models of Health

Foundation
possibly the single biggest reason why much con-
CASE STUDY 1.3
ventional research methodology is flawed when
Karen has recurrent chest infections as a child.
applied to treatments used in the holistic, hologra-
Each is treated with antibiotics. The infections
phic or relational models of health.
Fitness is something that you can train and
get more frequent and her resistance seems I
to get lower. It is suggested she goes on con-
practise for in a given environment, whereas
tinuous antibiotics which she is reluctant to
health is more difficult to prepare for – although
take. She seeks a homeopathic opinion and
you can anticipate some of the likely changes that
is supported through her next few acute infec-
will affect you, for example as you age.
tions using homeopathy. Her attacks get less
frequent and, over six months, her resistance
Tensions Between Different
to infections improves.
Models of Health
While no one model of health will be appropriate to
interpret a patient’s health needs in every setting, has to happen, that symptoms are the body’s reaction
and while several models can be used together, to the disease. This whole process is a healthy one
they do also raise various conflicts. For example, and leads to an enhanced and developed resistance
in the holistic model a homeopath sees minor as Karen’s case illustrates.
challenges to a patient’s health as preparation for
other more serious challenges; childhood minor Balancing the Subjective
acute illnesses might help a patient cope with and Objective Views of Health
more serious illnesses in later life. Holistically it When we combine a subjective and objective view
is important for some acute illness to happen and of health we notice that the observer and what
for the patient to throw it off naturally. In the is observed are connected. To distinguish between
pathological and biological models, if the acute what is inside and outside the body, the patient
illness is treated by an approach that undermines and their environment, is artificial. In the same
the individual’s susceptibility they may, from way one part of the individual cannot ultimately
the holistic model, end up less healthy. In some be seen as separate from another. A holistic view
models of health it is easier to think of health as a recognises that the different parts of an individual
dynamic process rather than an absolute state. In are intimately connected. The holographic view
order for the body to remain healthy it has some- recognises that when one thing changes, every-
times to move out of balance. When it is out of thing else changes – nothing changes in isolation.
balance it can react and come back into balance. The relational view recognises that when there is
In this way being healthy includes the ability to change in what is being observed there are also
generate symptoms and get ill. changes in the observer. Monitoring and work-
ing with yourself as the observer, including your
The Importance of Illness personal development, is an important part of
The moving out of balance when a situation working in these models of health.
changes is a disturbance of the organism, a disease.
The organism, if it responds in a healthy way, gen- Summary of the Five Models
erates a reaction to the disease in order to attempt No one model can accurately describe what is
to rebalance itself. While health may be noticeable happening in every patient but separately or
and observed by the absence of symptoms, the in combination, they provide insight into most
symptoms are vital to maintaining health. Health situations, from the most straightforward to the
and illness are not so much like black and white as most complex case presentation. In applying the
like shadow and light. They are like two sides of different models of health, the homeopath has to
the same coin. The homeopath accepts that illness hold different boundaries and to use different skills.

11
CHAPTER ONE What is Health?
Foundation

I frequently observe homeopaths moving over time Different patients choose to work explicitly with
and with experience into more individual ways of different approaches to treatment. Some choose
working. Blending the models and choosing the simply to counter a cause, others to remove a par-

I most applicable approaches and methodologies


in a given situation is central to developing your
ticular effect. Some patients recognise that their
health is related to things that are happening in
optimum way of working for any given patient and their lives that may provide opportunities for
clinical setting. growth and development. Still others recognise
The five models described do not exclude their illness in terms of their susceptibility to what
others that readers will find important or even has gone before, including hereditary factors.
vital to how they work; other authors may name Patients with these different views will seek out
or refer to them differently. Being clear about different ways to be healthy and choose different
the model used helps in determining not only the treatments in different situations. Part of the chal-
optimal treatment approach but also deciding lenge to a homeopath is to recognise this diversity
on the strengths and weaknesses of the available and choose which models are optimum for each
methodologies and interpreting rationally the condition, situation and patient. The more open
outcome of any prescription. a patient is to understanding and expressing their
The student of homeopathy may find ideas illness and health through a particular model the
in the holistic, holographic and relational mod- easier it is to use the corresponding approach to
els raise important questions about the ‘nature treatment.
of man’ and the relationship of the patient to
their ‘global’ environment and the nature of ill-
ness. The focus of this book is on the health of Reframing illness
the patient and their physical and psychological ‘There is a vitality, a life force, an energy, a quickening,
well-being. We will touch on questions related to that is translated through you into action, and because
the health of a population but I encourage you to there is only one of you in all time, this expression is
reflect and question each other and your teachers unique. And if you block it, it will never exist through
in relation to the spiritual nature of patients and any other medium and will be lost.’
yourself. I do not seek to answer these questions Martha Graham
but am pleased if they are asked, as I believe they
can bring you to the heart of what it is to be a When we think of illness as having a purpose
homeopath. for individuals and communities, we start to ‘re-
Before moving from the models of health to frame’ our thoughts about it. Rather than some-
the homeopathic approaches to treatment, it is thing to be avoided at all costs illness starts to offer
helpful to focus on the homeopathic patient and opportunities, and sheds light on the relationship
how illness expresses itself – particularly what between our inner and outer worlds. A change
is offered by an understanding of vitality in the to a patient’s outer world, such as a change in
cause and treatment of illness. family dynamics or diet, affects the inner world,
from how they think and feel to the functioning
of different organs. Many patients gain, through
illness, insight into how the outer world affects
Homeopathic Patients the inner world. Less common is the insight into
‘The role of the homeopath is to help patients in their how a patient’s illness and health can affect indi-
pursuit of health and it requires “insight, discernment, vidual circumstances. If illness is an opportunity
knowledge and awareness”.’ to learn, then before removing an illness it is
Paragraph 3 Organon, Medical Art appropriate to reflect on whether what is to be
by Dr Samuel Hahnemann learnt has been.

12
Homeopathic Patients

Foundation
re-establish balance through the production of
REFLECTION POINT symptoms. At the time homeopathy was formu-
● What would the world be like without illness – if no-one lated in the 18th century, the idea of vitalism was
got hangovers after drinking too much, if no-one got
joint problems from using or misusing their bodies, if
common, so it was not unusual to think of all
living organisms as having a vital principle that
I
no-one starved from not eating enough, or was obese energised, co-ordinated and brought together the
from eating too much? functions of an organism. Using this terminology
allowed homeopaths historically to conceptualise
on a subtler level the physical, chemical and bio-
A definition of health and illness I invite you logical changes that take place in an individual
to consider is that ‘health is the freedom to move when ill.
through the different circumstances in which you The potential energy needed to throw off an ill-
find yourself and illness is the loss of that freedom’. ness is similar to the way electrical energy is needed
A healthy response to illness is to make changes to to operate an electrical appliance. The life force can
yourself and, where possible, your environment to be thought of as a battery that needs charging now
bring them back into balance. Illness is important and then and is subject to being drained; the vitality
for keeping our environment and our bodies in can be thought of as the current generated when
balance; symptoms are what exist at the interface the battery charge flows. In health, life force inte-
of the patient’s inner and outer worlds. The symp- grates and allows the different parts to co-ordinate,
toms remain necessary until the inner and outer including normal physiological functions.
worlds are brought into balance. Understanding Many patients, as Paul’s case illustrates, are pre-
that a patient’s inner world and outer environ- pared to talk about their general feelings or general
ment are connected allows us to tell things about energy and this is similar to what historically might
a patient’s inner world from the environment that have been described as vitality. It allows the body
they desire or fear and those they actually live in. to regulate, balance and evolve and, as such, is an
intrinsic quality of life connecting the separate parts
The Life Force and Vitality of the mind and body. Much debate that reflects on
The life force is non-material and therefore some- the purpose of life rather than maintenance of health
times described as a ‘spirit-like’ force or ‘dynamis’ takes place as to whether the vitality is intrinsically
that is expressed in living organisms as vitality. intelligent with perception and creativity (free and
In today’s language we might instead talk about spirit-like) or ‘blind’, following patterns established
general well-being, resistance and immunity. If in the individual that it animates (instinctive).
you think of a living organism like an electrical
machine the life force would be the battery or gen- CASE STUDY 1.4
erator and the vitality the electric current. If you Paul consults with a history of recurrent minor
imagine it as a spinning top, the life force might infections; he is exhausted from overwork
be thought of as what keeps it spinning, and the and a ‘stressful’ home life. He complains of
vitality as the force that throws things out to the generally feeling unwell, and when asked how
periphery, both keep it balanced and upright. he would score his ‘general energy’ between
The concept of life energy is found in many zero and ten, says it rarely gets above four.
other therapeutic systems, e.g. as ‘chi or Qi’ in tra-
ditional Chinese medicine, as ‘prana’ in Hinduism
and ‘vis medicatrix naturae’ by Aristotle. When Vitality
the organism is out of balance the life force that Most patients have a sense of their level of vitality
animates the body expresses itself through the and it is important for the homeopath to reflect
vitality. The vitality stimulates the organism to on what it does and how it is sustained, as it is

13
CHAPTER ONE What is Health?
Foundation

through the vitality that individuals are able to


heal themselves. It is what allows subtle homeo- A Vitality fluctuates with normal life events
B Period ofgradually reducing vitality
pathic medicines to have major effects. Changes C Vitality starts to gradually drop and fails to spontaneously

I in vitality precede illness and recovery, and indi-


cate when there is a need for the patient to be
recover
D Recognising the start of an illness, often a threshold
event, although vitality might heve been dropping

Vitality
supported or to make changes to environment or for some time before
lifestyle, before remedies can act fully.
A 4
Different models of health reveal different
views on whether it is the vitality or the envi- B
3
ronment that is the cause of all illness. At one
2
extreme, in the pathological model, all cause and
cure could be considered to be due to external fac- 1
Time
tors, e.g. it is the bacteria that cause infection. This C D
leads to a deterministic approach to care where
Figure 1.2 The vitogram
patients are made ill and cured by others. At the
other extreme it is the susceptibility of the patient
that in the holistic model invites illness, e.g. it is self-correcting and some early nights or a change
the host’s low resistance that lets the bacteria get in diet can improve the vitality and precede a
established. This leads to a fatalistic approach to recovery from the illness. Figure 1.2 illustrates the
care where nothing can be done for or to a patient idea of vitality changing over time, demonstrat-
unless they do it themselves. ing its gradual drop (which often is a precursor
Integrating these different models, whether as to chronic illness) and showing several common
a homeopath or any therapist, is part of the art of ways the vitality then changes (described below).
medicine – being able to hold a balance of seeing As the vitality drops, the individual is more
the inside affecting the outside and the outside susceptible to acute and recurrent acute illnesses,
affecting the inside. One way to do this is to see the which is why these are often precursors of chronic
vitality and the patient’s circumstances and envi- illness. The four common changes to the vitality
ronment as directly related. On the one hand the illustrated in Figure 1.2 are:
vitality enables the body to react and change its sit- 1. patients deteriorate rapidly and the vitality
uation when out of balance; on the other hand, the may drain quickly
vitality is nurtured and supported (if not produced) 2. the vitality may carry on draining away only
by life experiences. When an individual gets stuck slowly where they use supportive treatments
in their environment, the vitality starts to stagnate 3. they temporarily stimulate their vitality but
and, when the individual stops completely, it is with no underlying cure they relapse
dead. This fluctuation of the vitality can be illus- 4. they may correct the imbalances of their life
trated graphically through the ‘vitagram’. that have led to the low vitality or receive
treatment that allows the vitality to return to
The Vitagram its normal levels.
The vitagram schematically represents the individ-
ual’s vitality over time and you will see in Chapter In order to better understand patient vitality see
3 how this links to life events as a ‘time line’. It is the reflection point below.
helpful for you and your patients to appreciate
that the vitality or ‘general well-being’ fluctuates
depending on what you have been doing, e.g. a REFLECTION POINT
poor diet or several late nights might reduce it ● If you are sitting in a room with someone who has a
and alter susceptibility to illness. Normally it is cold, what factors in you are likely to influence whether

14
Homeopathic Patients

Foundation
you catch it and how does this connect to your general the effect the patient has on the homeopath. The
well-being and vitality? same remedies may be used in each model but are
● How would you score your vitality from 0 to 10, If 10 out understood in different ways.
of 10 was the highest and 0 out of 10 the lowest? What
do you think improves your vitality?
The Law of Similars is based on reliable obser-
vations that if a substance produces symptoms
I
● What would your ‘vitagram’ look like over the last 5 when taken by a healthy person, the same sub-
years? When would you think your vitality has been stance can help an ill person with a similar set of
highest and when was it at its lowest? symptoms. The recording of symptoms produced
when a substance is given to a healthy subject is
called a proving and is explored in detail in the
The Law of Similars and Approaches next chapter. Dr Samuel Hahnemann was the first
to Treatment to record this systematically and his life and exper-
In each model of health, the corresponding iments first with Cinchona bark and his thinking,
approach to treatment follows a central tenet of as reflected in the Organon of the Medical Art, are
homeopathy, ‘like treating like’. In the causation essential study for the student of homeopathy. He
approach then using something that acts in the observed that taking Cinchona, used at the time to
same direction as the cause can stimulate a healing treat malaria, created in a healthy person a fever
reaction, similar to desensitising treatments for similar to malaria. He successfully used Cinchona
allergic illness and the stimulation of a patient’s to treat fevers homeopathically and developed his
immunity by vaccination. In the symptomatic thinking over six editions of the Organon.
approach an acute symptom can often be appreci-
ated as a person’s way of trying to get well. For Samuel Hahnemann (1755–1843)
example, when a patient develops food poison- Hahnemann was 35 when he conducted the
ing they get diarrhoea and vomiting. This is the experiment using Cinchona bark. At the age of 50
body’s way of clearing out the food poisoning as he published his reflections on this for the first
rapidly as possible. The symptoms are the body’s time – ‘The Medicines of Experience’ – observing
way of trying to return to a balanced state and the that medicines should be prescribed on the basis
most helpful treatment works in the same direc- that they are similar to the disease symptoms a
tion as the symptoms. The information the body patient has. Medicines were chosen on the basis
needs to rebalance itself is contained in remedies of the symptoms and the homeopathic remedy
that can also cause diarrhoea and vomiting. was known by the effect it has on healthy people
In the holistic model the totality approach is (provings). In 1810 he published ‘The Rational
based on selecting a remedy that closely matches Art of Healing’ – this and the second edition
the symptom picture. It is as if the vitality pro- focus predominantly on the scientific concerns
duces symptoms in an effort to return the organ- regarding the new approach to treatment. In the
ism to a healthy state. It requires a stimulus as it third, fourth and fifth editions he incorporated a
has failed to resolve spontaneously. The illness more metaphysical inclination with an increasing
is like a pendulum that has stuck. Tapping it is emphasis on the doctrine of vitalism. The fourth
enough to free the gravitational pull on the pen- edition introduced the theory of chronic diseases
dulum to return to equilibrium. In the holographic into the basic text, while in the fifth edition the
model the pattern of symptoms expresses what dynamics of remedy preparation are discussed.
the patient needs from the illness. In treatment The sixth edition of The Organon, written by
this is met by the information available through Hahnemann in his eighties and completed the year
homeopathic remedies. In the relational model before he died, was not published until nearly 80
the treatment approach has many similarities to years after his death and is still essential reading
‘psychodynamic’ treatments that are informed by for all homeopathic students.

15
CHAPTER ONE What is Health?
Foundation

non-allopathic therapies (paragraphs 288–291)


(Singer & Overbook 2004).
The idea that low doses of a similar substance

I could have as strong, if not stronger, effect than


higher doses, and with significantly less adverse
effects, he referred to as the ‘minimum dose’.

The Minimum Dose


Homeopathic remedies stimulate the vital force and
provide the information for the body to throw off ill-
nesses. As the remedy is acting on a subtle level, the
aim is to give the dose in an equivalent subtle form
that is also the minimum effective concentration. To
do this, a process of preparation known as ‘potenti-
sation’ incorporating dilution and vigorous shaking
(succussion) has been developed (see Chapter 20).
For some people the minimum dose has
become the most characteristic feature of home-
opathy, although this is incorrect. It is the pro-
cess of prescribing remedies on the basis of ‘like
treating like’ that is the most characteristic feature
of homeopathy. However, Hahnemann did also
The Structure of the Sixth Edition observe that remedies have different effects when
of the Organon used in different strengths or potencies. This is
There are seven main sections in the Organon and reflected in the theory of hormesis, which suggests
over different editions the themes of each evolved that different doses of toxins have different and
gradually. The first section is an overview of the at times opposite, sometimes stimulatory and
objectives for the physician (paragraphs 1–2). The sometimes inhibitory, effects (Calabrese 2001
second defines homeopathy in terms of what is to and 2004). Different potencies often match the
be cured, what is curative in medicines and how methodology and model of health that is being
to adapt medicines to particular patients (para- used to understand and treat a case. For exam-
graphs 3–5). Section 3 looks at the central role ple, a prescription based on causation or a single
that symptoms play, what the illness is and how a presenting symptom is more likely to require a
cure is obtained (paragraphs 6–8). In Section 4 the low potency while a remedy prescribed themati-
Law of Similars is explored – looking at how dis- cally is likely to benefit from a higher potency. Of
ease and medicine act dynamically and how symp- course, in many cases, more than one model and
toms indicate not only what treatment is needed methodology may point to the same remedy.
but also, from the effects that they can produce in
healthy individuals, where the curative power of
the medicine lies (paragraphs 9–27).
Section 5 explores a possible mechanism of
Summary
how homeopathy works in comparison with other This chapter has covered some of the core con-
disease treatments of the time (paragraphs 28–70). cepts of homeopathy. You may like to return to
Section 6 looks at how to practise homeopathy the laws of health and five models of health, both
(paragraphs 71–285) and Section 7 briefly consid- to clarify your ideas about health and illness and
ers the context of homeopathy in relation to other to help you understand the role of the homeopath

16
Bibliography

Foundation
in helping patients. Understanding the different Bibliography
views of health that patients have is an important
part being a homeopath. While some methodolo- Carlyon J 2003 Understanding homeopathy. Helios,
New York
gies will appeal to you more than others, it should
be noted that some patients will only be prepared Danciger E 1987 The emergence of homeopathy. I
to work at certain levels and, if you are unfamiliar Century Hutchinson, London
with the different approaches to prescribing, you Dhawle M L 1967 Principles and practice of homeopa-
will limit your effectiveness as a homeopath. thy. Institute of Clinical Research, Mumbai
An understanding of the different models of Dudgeon R 1853 Lectures on the theory and practice of
health is also central to understanding the ener- homeopathy (Indian edition). B Jain, New Delhi
getic action of the remedies and the different ways
Gibson D M Elements of homeopathy. The British
the remedy picture can be expressed and collated.
Homeopathic Association, London
Before building on this further, we look in Chapter 2
at how the information related to different remedies Haehl R trans Wheeler M L, Grundy W H R 1922
Samuel Hahnemann: his life and work. Homeopathic
is expressed through provings.
Publishing Company, London, Indian edition 1995, B
Jain, Delhi
Hahnemann S 1842 Organon of the medical art, 6th
References edn. Based on a translation by Steven Decker, edited
Calabrese E J 2004 Hormesis – basic, generalizable, cen- and annotated by Wendy Brewster O’Reilly. 1995,
tral to toxicology and a method to improve the risk-assess- Birdcage Books, Washington
ment process. Int J Occup Environ Health 10:466–467
Handley R 1990 A homeopathic love story – the story
Calabrese E J, Baldwin L A 2001 Scientific foundations. of Samuel and Melanie Hahnemann. North Atlantic
Hormesis Crit Rev Toxicol 2001 31:351–695 Books, Berkeley
Singer S R, Overbook M 2004 The structure of the Kent J T 1900 Lectures on homeopathic philosophy.
Organon. Homeopathy 93:151–153 New edition 1981. North Atlantic Books, Berkeley

17
CHAPTER TWO

Provings Materia Medica

Jeremy Sherr

Introduction by David Owen What are Homeopathic Provings?


To the homeopath the remedies we use are more The basic principle of homeopathy is ‘like cures
than just medicines. Understanding them pro- like’; what a medicinal substance can cause it can
vides a medium, through which we perceive also cure. To ascertain what a medicine can cause,
and order the world. They provide the ideas we administer it to healthy people. This experiment
and concepts that bring sense to a patient’s is called a homeopathic proving (from the German
story. They are not random or unnaturally ‘preufing’, meaning experiment). During the prov-
‘manufactured’ but represent the very world the ing all effects of the remedy (physical, mental and
patient lives in and are drawn from the min- emotional) are recorded in detail. Once the experi-
erals, plants and animals around us. Provings ment is over all the symptoms experienced by each
are how the information held within the rem- volunteer are gathered into a collective record. The
edies is revealed. The information is not secret more comprehensive the proving, the more it rep-
and indeed it is expressed in many ways by the resents the totality of remedy effects, which forms
source of each remedy. However, it is the prov- the basis of the materia medica. This collective
ings that rationally and minutely reveal the full totality of symptoms is used as a guide for homeo-
picture of a remedy and as such lay the founda- pathic prescriptions. At later stages the picture is
tion to the art of case-taking and the science of consolidated through clinical experience, and syn-
case analysis. Jeremy Sherr is a leading light in thesised into a more concise record that may be
the field of provings and his enthusiasm and eye collated with others into a materia medica.
for detail gives him a contemporary and relevant Homeopathic remedy indications have remained
authority that makes his observations reliable effective and unchanged for the last 200 years. Beyond
and frequently useful in practice. To the student the scientific evaluation of medicinal effects they pro-
of homeopathy it may appear unduly technical vide a method for homeopaths to explore and con-
and daunting to be talking about provings and firm their healing systems, a tool for physicians to
taking part in provings at such an early stage in experience their remedies and a means by which the
your study. However, before you start learning healthy may cure the sick. They provide the most fas-
in great detail the materia medica, it is invalu- cinating journey into nature’s inner world, into our
able for you to understand where the infor- own deepest nature and our personal development.
mation comes from. I encourage you to study
Jeremy’s other writings and look at some of My Experience with Provings
the detailed contemporary provings that he and ‘The best journeys are made without ever leaving home’
others have produced. Lao Tzu

19
CHAPTER TWO Provings
Foundation

I have travelled to many countries, but my most


BOX 2.1
memorable voyages and greatest insights have
‘And further, while we were preparing the
been through remedy provings. In the last 20 years
so-called old medicines we never forgot our
I I have organised 27 provings and have participated
in 18. My health has been enhanced and not dam-
position as explorers of the unknown world
of results, of effects; never forgetting the
aged in any way. The personal and collective jour-
ground-work of our healing art, we prepared
neys into these provings have enriched, on many
from time to time new medicines also; we
levels, my life and the lives of those with whom I
made a regular proving at least once a year,
have conducted the provings. Through them, my
often twice and even three times a year. These
fellow provers and I have experienced the sting of
provings were the high feasts in our church,
a scorpion, the cold riches of sapphire, the opu-
and you cannot consider yourselves true
lence of jade, the cycle of salmon, the monotony of
members of it without joining in these feasts.
rape seed, the flight of an eagle, the enlightenment
Proving is a most wonderful thing; the
of hydrogen, the gentleness of deer, the hardness
world has never known its like. We suffer,
of diamond, the nurturing of olive and the rigidity
and we enjoy it; we sacrifice a little of our
of germanium. We have explored these and many
comfort, and gain abilities and power by it;
other secrets from nature’s treasure chest by enter-
we lose a part of a few days, and gain years
ing into nature herself, by diving into her substances
of strength by it; we go to school to learn,
and shape shifting our beings into her mould.
and we increase the certainty of the healing
In the process we have learnt, in time-honoured
art. At the same time, to prove drugs is of all
tradition (see Box 2.1), many things including:
other ways the very best, the nearest and the

The power of the collective, experiencing the
easiest to learn to master our materia medica.
unity of a single substance influencing a large
It is the way to learn; to observe the art of
group of people providing a window into
arts, the principal one on which all others are
the collective consciousness of humanity (see
based.’
Chapter 26).
Constantine Hering

The need for exactness and attention to detail
while organising and editing provings for
publication.

What to retain and what to discard, what is
fiction at worst. The use of signatures, toxicology,
useful and what is superfluous, and how to
clinical experience, family pictures or intellec-
present material in the most effective way.
tual concepts may contribute to our understand-

Proof of the relevance and accuracy of our
ing but they cannot approximate to the precise
experiments, as case after case has responded
knowledge gained by a thorough proving.
positively to the new remedies, based on the
indications we have gathered.
Why More Provings?
The Necessity for New Provings There are billions of sick individuals, each with
‘Therefore, we have only to rely on the morbid phenomena their own unique configuration of illness. The
which the medicines produce in the healthy body as the sole more precise the match between remedy and
possible revelation of their in-dwelling curative power.’ patient, the more profound the cure will be. To
S Hahnemann, Organon, Para 21 increase the certainty of our healing science, we
need many more remedies.
Provings are the pillars upon which homeopathic A new remedy will cure a class of cases that
practice stands. Without accurate provings all pre- existing remedies may only palliate. For example,
scribing indications are vague guesses at best and many cases needing Chocolate were previously

20
Taking Part in a Proving

Foundation
prescribed the very similar Sepia with limited The difference between a proving and a crude
success. It is likewise for Cygnus and Ignatia or life experience lies in the potency and force.
Androctonus and Anacardium. To compensate for A stimulus resulting from a crude mother tinc-
the lack of new provings, existing remedy pictures
have been inaccurately expanded beyond their
ture experience (such as vexation, vaccination, a
snake bite, a movie, food poisoning or a drug)
I
natural sphere of action. may be violent and can invoke strong or damag-
Of the thousands of remedies in our materia ing symptoms. On the other hand, provings of
medica, only a few hundred are well proved. Many homeopathic potencies use a dynamic force which
remedy pictures are based on small and incomplete is at once gentle and profound, and unlikely to
provings, toxicology, traditional herbal use or spec- cause any lasting damage.
ulation. As a result they consist of common symp-
toms, which are of little use in prescribing, as they
have too little detail to allow accurate matching Safety and Provings
to symptoms or are incomplete in areas of the body ‘the organism of the prover becomes, by these frequent
or mind, so not allowing a totality prescription. attacks on his health, all the more expert in repelling all
external influences inimical to his frame and all artificial
Learning Through Provings and natural morbific noxious agents, and becomes more
Taking part in provings provides great insight into hardened to resist everything of an injurious character,
the power of remedies and the various responses . . . by means of these moderate experiments on his own
of our defence mechanism. It is also a practical les- person with medicines. His health becomes more unalter-
son in the structure and construction of the materia able; he becomes more robust, as all experience shows.’
medica and repertory. During the proving one gains S Hahnemann, Organon, Footnote to Para 141
intimate knowledge of the remedy. The remedy
enters into our spirit and permeates every part of In all the provings I have conducted, the vast
our being, just as a virus takes over a cell nucleus and majority of provers benefited or learnt from the
directs the entire cell to its own purpose. We become experience and were willing and eager to do
the remedy and the remedy becomes us. This is the another proving. However, it is only natural to
deepest level of materia medica knowledge. experience apprehension before a proving. After
all, one is going to experience bothersome symp-
toms and a change of attitude that may well be
unpleasant. Provings can cause painful symptoms
Taking Part in a Proving and may affect relationships and work.
It is important to understand that provings can Life is full of risks. If we take none, we will never
only induce symptoms which are pre-existent or experience new things and learn. The key is to maxi-
latent in us. These symptoms may be from a long mise the benefits and minimise the risks. Gentle and
past or a distant future, but we are inherently capa- well organised provings do precisely that. By choos-
ble of producing them. Thus a proving illuminates ing relatively healthy provers, using a minimal dose
an intrinsic part of us that is yet unexplored – and applying close supervision while the proving
symptom seeds that have lain dormant within now lasts, the damage from provings is very small.
germinate and flower. It is true that a small number of provers
On the simplest level, provings provide a partic- (5– 10%) get stronger symptoms. Usually these
ular stimulus to which our vital force reacts by pro- symptoms do not last long, but on rare occasions
ducing symptoms. Similarly, any new experience I have known symptoms to continue for months.
which stimulates us to react is essentially a prov- This serves to remind us that conducting a prov-
ing. But only the intentional uses of potencies in an ing is no light task and should be undertaken with
experimental setting are homeopathic provings. full care and responsibility. The safety of provers

21
CHAPTER TWO Provings
Foundation

must be our main concern at all times. The proving prescription will produce proving symptoms in the
should be discontinued if it is harmful to the subject. sensitive patient (see Chapter 16). This is a com-
While there are small risks, the advantages far out- mon occurrence and a valuable source of symp-

I weigh them. Not only does the proving create a new


remedy and offer a unique learning opportunity, the
toms. Unfortunately, these unintentional provings
often go unnoticed or are mistaken for aggrava-
stimulation of a proving actually invigorates us and tions, random events or return of old symptoms.
increases our health and wisdom.

Types of Provings Methodology of the ‘Full Proving’


There are many levels of proving methodology. On
Creating a full proving which aims to give a com-
one hand, there is the highly organised, accurate
prehensive new remedy picture requires time,
and thorough ‘full’ proving. On the other, there
enthusiasm, commitment and leadership. Box 2.2
are the casual or ‘fast track’ provings. Well organ-
lists some of the most important factors.
ised and reliable provings are undertaken by a large
number of people over a considerable period of
time, with the purpose to fully unfold the totality BOX 2.2
of a new remedy, including physical, mental and The Most Important Factors in Producing a
emotional symptoms. The results are incorporated Full Proving
into the materia medica and repertories, making 1. Good organisation.
the information available for homeopathic poster- 2. Use provers who have studied together
ity. A project such as this must naturally be under- for a while or a group of provers who
taken with extreme care and thoroughness. know each other. This lends a cohesion
which amplifies the epidemic ‘as if one
‘Fast Track’ Provings person’ effect.
The ‘informal’ or partial proving includes provings 3. Homeopaths usually make the best prov-
on oneself, a patient, or with a small study group. ers. They know what they are looking for.
This is often a proving of an existing remedy. Such 4. Random provers from scattered locations
experiments are undertaken in order to gain direct produce poor provings, as do paid ‘vol-
inner experience of a remedy and are not usually unteers’.
intended or suitable for publication. Some prov- 5. Ensure careful and close supervision.
ings concentrate on dreams and mental symptoms, 6. Believe what the prover tells you, how-
in an endeavour to uncover the deeper meaning of ever strange – it may be significant.
the remedy. Some homeopaths conduct meditation Clinical experience will confirm or deny
provings, often not actually taking the remedy but the symptom.
just holding it. Another method is for the group 7. Hold a provers’ meeting after 6–10
to prepare a remedy by extensive trituration while weeks.
paying attention to the symptoms that arise. While 8. Careful and extensive editing of the find-
the advantage of fast track provings is a short cut ings.
to an inner essence, they miss many of the physical, 9. Attention to detail and perseverance.
general and long-term symptoms. Poorly prepared 10. Allow two to three months for editing
and conducted provings can be dangerous (and and collating a proving.
inaccurate), because they lack prover screening and 11. Prepare for provers’ fatigue and possible
long-term supervision. drop-out.
By far the most frequent provings are those 12. The best group size for a proving is 5–20
done by patients who inadvertently receive an inac- provers.
curate prescription, i.e. a dissimilar remedy. Such a

22
Methodology of the ‘Full Proving’

Foundation
Relationship to Conventional Drug Trials proving being a collective infection similar to an
Some of the more conventionally minded homeo- epidemic.
paths would like provings to emulate allopathic This makes firm guidelines on how many
(Phase 2) drug trials, in a search for acceptance or
total accuracy. While there are many similarities,
provers should use placebo and how to handle
symptoms from a placebo difficult to give. I tend
I
there are also large differences. to use placebo in 10% of provers, which serves
A proving will never be 100% accurate (not that to keep provers reflective about accuracy in the
phase 2 trials are, but they strive for this impos- reporting of symptoms.
sibility). This inherent inaccuracy is a result of the
many variable susceptibilities of the provers, and Choosing and Preparing the Remedy
the huge variables of daily life. If we consider that Any substance, natural or artificial, may be used,
adding an extra prover to any proving may pro- as long as the same source is used in conjunction
duce a whole range of additional symptoms, while with this proving forever after. A substance may
leaving out a particular prover will lose these symp- be selected for any reason. Often it is because of
toms, it becomes clear that it is impossible to have a suspected medical potential, personal interest,
perfect proving. The only way to resolve this would toxicological or chemical properties. It is essential
be to prove on every different type of person, but to record and verify the exact details of the origi-
this would produce an impossible amount of infor- nal substance, such as species, gender, time when
mation. Therefore a proving should be considered gathered, location, quantity by volume or weight,
a suggestion for clinical application, rather then a percentage and volume of alcohol, age and part of
final or ‘complete’ product. specimen, etc. In the case of a remedy made from
a disease agent or tissue, precise details regarding
Double Blind the donor should be recorded.
While most modern provings are double blind In plants, one should investigate the herbal and
(neither the patient nor immediate supervisor botanical literature to discover the most potent
know the substance being proved), classical prov- part of the plant and the best time of gathering.
ings were not blinded at all, and yet they have It is preferable that the plant is collected from its
produced very reliable results over a long period natural environment. All substances should be as
of time. Double-blind tests are supposed to natural and free from pollution as possible. The
compensate for bias in the observer and patient. exact mode of pharmaceutical preparation should
In previous writings I suggested provings should be recorded.
be double-blind, but recent experience has led
me to believe that it is not an essential factor in The Roles in a Proving
producing high quality provings. Co-Ordinator
The co-ordinator (also called the master prover
Placebo and principal investigator) is responsible for the
I and others have also suggested the use of placebo. proving – including choosing the remedy to be
Theoretically the placebo serves to distinguish proved, the safety of provers, the accuracy of
the effects of the remedy from the effects of the supervisors, and the diligence of editing and
proving process. According to this idea we should final publication. The co-ordinator oversees all
eliminate symptoms similar to the placebo symp- the supervisors and provers, ensuring that every-
toms from the proving. However it has been the thing is functioning properly and safely. The role
repeated experience of many modern provers includes keeping track of the dates each individ-
that the placebo produces symptoms typical of ual proving begins (which preferably should be
the proving. This may sound strange in conven- around the same time so as to keep management
tional terms, but it is consistent with the idea of a simple) and also recording which provers are

23
CHAPTER TWO Provings
Foundation

experiencing symptoms, how many doses each serious obstacles to cure, difficult mental and emo-
took, etc. tional states and low vitality, because they lack the
The most demanding role is the third stage dynamic force to recover.

I of extraction, collation and editing of symptoms


into the materia medica format. As the proving Remedy Reactions
progresses, the co-ordinator will get to know Reactions to a proving depend mainly on the rela-
the symptoms and develop a feel for the remedy, tionship between the susceptibility of the prover
which will aid in the difficult process of choosing and the nature of the remedy proved. Other fac-
reliable symptoms. tors are potency, sensitivity, dose, repetition and
timing. As the proved remedy has a random rela-
Supervisors tionship to the prover, there are many possible
‘Every real medicine … acts at all times, under all cir- reactions. These can be broadly divided into three
cumstances, on every living human being, and produces main categories; the homeopathic, the antipathic
in him its peculiar symptoms.’ (opposite) and the allopathic (dissimilar). It is the
S Hahnemann, Organon, Para 32 variety of the different effects on a large number
of provers that creates a full and meaningful total-
Good supervision is the key to a high quality ity. In any proving there is a possibility that some
proving. Often symptoms are produced, but due provers will find symptoms are cured – these can
to poor supervision they go unnoticed. It is the be added to the proving as such. It is essential that
supervisor’s role to identify and clarify symptoms, the exact nature of the symptom prior to the cure
to separate real from random, and to encourage be recorded.
the prover to be diligent. The supervisor must also In the case of antipathic action a symptom
be alert to the prover’s well-being. Consequently will be ameliorated first, followed by aggrava-
supervisors should have some homeopathic expe- tion. This means that the primary action in the
rience. This is a good learning opportunity for proving will be a sense of well-being or improve-
students nearing graduation. The prover’s case ment of symptoms, followed by a worsening or
should be taken by the supervisor prior to the aggravation of the prover’s situation. In a clinical
proving. This is essential in order to create a base- setting this would be an unfortunate result, often
line to compare symptoms from before and after indicating organic pathology. However, as the
the proving. prover is relatively healthy, each should be able
During the proving the supervisor takes the to return to their former state once the remedy
prover’s case every day, until symptoms begin to effect is over.
subside and communication can be less frequent. The third possible reaction, and the most
Daily interrogation is important as provers often common, is the allopathic or dissimilar reaction,
do not notice their symptoms or realise that they which occurs when the remedy sustains no logical
are experiencing a proving. It is often difficult to relationship to the prover’s susceptibility. The
distinguish the delicate proving symptoms from characteristics of a dissimilar reaction are symp-
daily events and life fluctuations. The prover often toms that the prover never experienced before, i.e.
cannot perceive that they are changing, even when new symptoms. These are the most significant and
their behaviour is radically different from usual. reliable symptoms of a proving. Every individual
will bring out a different aspect of the remedy.
Provers
The prover should be in a reasonable state of Sensitivity
dynamic health, meaning they should be able to Some individuals are more sensitive provers than
‘bounce back’ from negative situations. One should others, some are sensitive to the particular remedy
not do a proving on persons who have pathology, and others are sensitive in general. The latter can

24
Methodology of the ‘Full Proving’

Foundation
be divided into pathologically sensitive provers, in the history of provings reveals total inconsis-
who are extremely useful provers but often dif- tency. Provings have been done with any potency
ficult to cure, and healthy provers, who are very from the lowest to the highest and with any dose
aware.
This awareness consists of a capacity to ‘lis-
ranging from a single dose to daily repetition over
a long period of time.
I
ten’ to the gentlest changes in body and mind. As some people show symptoms easily, while
Rather then pushing a proving to the extremes others need to be pushed, I recommend a maxi-
of suffering and pathology, provers and super- mum of six doses over two days. If any symptom
visors should become proficient at listening to occurs, no further doses should be taken. This will
these ‘whispers’. Often the most important prov- generally produce a clearer proving and safeguard
ing symptoms are brought about by one or two the prover. While symptoms are often very mild,
of the most sensitive provers, the others serving like a delicate cobweb over one’s normal con-
to fill out the bulk of common symptoms. Many sciousness, I find that at least 80% of the people
well-known remedy keynotes and ‘pictures’ arise developed distinct symptoms before taking all six
from only one or two sensitive provers. Though doses, many after the first dose.
conventional research methodology may dis- In each of my provings I have used a wide
count these as statistically insignificant, home- range of potencies. Occasionally after completing
opathy considers these to be highly characteristic a proving in the lower potencies a sensitive indi-
and extremely valuable. vidual can repeat the proving with a single dose of
Sensitive provers are also sensitive to other higher potency. This will produce finer and more
events taking place around them. It may be dif- characteristic symptoms.
ficult to know if a prover had bad milk in their
tea, or if they developed a stomach ache due to Recording Proving Symptoms
the remedy. The prover keeps careful notes regarding all
symptoms, modalities and times using their natu-
Seemingly Unconnected Events ral language. All symptoms are identified as new,
During the proving particular attention should be old, altered or cured. Comments and observations
paid to random external factors that may affect from friends and family are helpful; accidents and
the prover, giving rise to false symptoms. These coincidences should be noted.
include infections, epidemics, colds, exposure to
noxious influences and poisons including various First Group Meeting
forms of pollution. In addition, external physi- The group meeting is an essential part of the prov-
cal injuries or external emotional factors such ing. It is also a grueling but wonderful experience.
as grief, shock, fright, etc. may affect the prover, Each prover tells of their experience in detail, and
giving rise to symptoms that are unrelated to the supervisors comment on this. During this meeting
proving. In all cases of strong external forces, or the totality of all provers’ experiences are woven
stronger dissimilar disease, it is prudent to elimi- together into a cohesive whole. The remedy pic-
nate the resulting symptoms, or even to terminate ture is ‘midwifed’ into the world, and we see its
the particular proving. However one should keep face and features for the first time.
an eye open for external events which re-occur in The provers’ stories may well trigger awareness
many provers, and are actually a response to the of many symptoms that have gone unnoticed or
proving. are attributed to ‘life’. These symptoms can be
extremely important, but supervisors and co-
Dose ordinators must exercise great care and discrimina-
There are many diverse opinions concerning dose tion when adding them. The proving meeting also
in provings. A study of the dose and potencies used serves as an important opportunity for the prover

25
CHAPTER TWO Provings
Foundation

to ‘discharge’ the proving in a safe and supporting to imagine homeopaths studying the proving in
environment, which often feels very good to prov- 100 years’ time. They would not want too much
ers and allows them to come to a completion of superfluous detail, but they would want to under-

I the proving. After 6 months the provers should be


contacted to check if anything else of significance
stand the exact sensations, functions and symp-
toms of the prover. Cumbersome sentences and
has occurred. unnecessary detail should be edited for the sake
of clarity. Cross references are inserted where
Extraction appropriate.
The prover’s and supervisor’s accounts are amal- Toxicological and clinical data for the substance
gamated into a single cohesive document includ- can then be collected and added to the proving
ing valid symptoms and omitting all superfluous, information. A pharmaceutical report and a sub-
doubtful or irrelevant information. stance report should be added. I tend to present
symptoms from those who received placebo and
Choosing Symptoms anecdotal events in a separate section, so that the
During this stage it is essential to be precise, cen- reader can decide their relevance.
sorious, forgiving and sensitive simultaneously. It Many co-ordinators strive to arrive at an
may be helpful to remember that many symptoms essence of a remedy during this stage. To my mind
from Hahnemann’s provings that seemed dubi- it is premature to constrict the proving total-
ous at the time were later clinically confirmed. ity into a simple idea before having some years
Extracting symptoms for a proving is a delicate of experience with it. It is preferable to present
and difficult task, which should be undertaken the proving as a full and simple document for the
with the utmost care. With clinical experience, an unprejudiced study of the profession.
annotation as to the nature of the doubt can be Proving symptoms also need to be added to
added. the symptom registers, called repertories, which
It is also interesting to note that many of our homeopaths use (see Chapter 9). If particular
famous keynotes, now considered leading symp- provings ‘flood’ the repertory with minute or repeti-
toms, originated from a single occurrence in one tive symptoms it becomes imbalanced. A repertory
prover. For example, the isolation of Camphor is an index to materia medica, thus not every minor
and the enlarged sensation of Platina. It is at this aspect of a symptom needs to be repertorised.
stage that the co-ordinators discover that good A few years of clinical experience of the remedy
supervision constitutes 80% of the work. can help identify the strongest and confirmed
symptoms before adding them to the repertory.
Collation and Editing
The aim of this stage is to convert written diaries
into materia medica format. Symptoms are scruti-
nised, validated or rejected, and then edited into a
Summary
proving that is coherent, logical, useful and non- Provings are a vast subject which every serious
repetitive. The end result is more useful if it con- homeopath must study in detail. Some homeopaths
nects to how other materia medica are compiled may feel that understanding provings is irrelevant
(see Chapter 7). to them, but my experience is that participating
During the editing careful attention should in a proving is an important part of homeopathic
be given to retaining the original language of education. Provings are the basis of homeopathy.
the prover. A delicate balance must be found We are fortunate to have inherited wonderful
between leaving in the essential and removing provings from our homeopathic forefathers. It is,
the superfluous. My practice during this stage is I believe, our duty to continue this process.

26
Bibliography

Foundation
Kent J T 1900 Lectures on homeopathic philosophy.
Bibliography Ehrhart & Karl, Chicago MI. New edition 1981. North
Hahnemann S 1842 Organon of the medical art, 6th Atlantic Books, Berkeley: Lecture 28.
edn. Paragraphs 105 to 145. Based on a translation by
Steven Decker, edited and annotated by Wendy Brewster
O’Reilly. Birdcage Books, Redmond WA. An earlier
Sherr J 1997 The dynamics and methodology of homeo-
pathic provings. Dynamis Books, Malvern. I
translation by Dudgeon and Boericke is also available For a list of modern provings and publications see www.
online: www.homeopathyhome.com/reference/organon/ dynamis.edu
organon.html

27
CHAPTER THREE

The Homeopathic Consultation The Case

David Owen

‘Fiction can be truer than history because it goes beyond causation is obvious, in others it is less so. In every
the evidence and each of us knows from his own experi- case, an attempt to understand the cause will help
ence that there is something beyond the evidence.’ towards knowing the ‘full story’ and planning the
E M Forster, Aspects of the Novel treatment, which of course may include remov-
ing a persistent causative factor, as the case of Jan
illustrates.
Introduction
CASE STUDY 3.1
We can observe the same ‘truth’ of the above quote
Jan, aged 38, had a small patch of eczema
in the consultation process. The written record of
in the midline below her umbilicus. This was
the consultation between doctor and patient is
really irritating her, having been present on and
called the ‘homeopathic case’, often shortened to
off for 12 years. She had used low strength
‘the case’. A clear case that identifies accurately
hydrocortisone cream to treat it, and although
‘what is wrong with the patient’ leads smoothly
this had helped, its effect didn’t last, so she
to the case analysis where the patient and homeo-
wanted to find an alternative. Around the
path can reflect upon and explore what lies behind
time the eczema started, she had taken up
the patient’s story, to find ‘what is needed for a
riding horses. The eczema was occasionally
patient to heal’. The consultation not only records
better in the winter, and also when she had
objectively symptoms and signs of the case when
been away on holiday for more than a couple
viewed in the pathological and biological models
of weeks when she hadn’t been riding. In the
of health but also opens up the subjective world
past, she had noticed that she reacted with
of the patient and explores the meaning, pattern
a skin irritation to some jewellery. At consul-
and effect of symptoms so important in using the
tation, we wondered whether her problem
holistic, holographic and relational models of
was due to nickel allergy, rather than a true
health.
eczema. She was advised to make sure that
she wore some clothing between the nickel
buckles and clasps on her jodhpurs and her
The Homeopathic Case skin. Since then she has had no further prob-
This chapter focuses on the kind of case neces- lem with her eczema.
sary for working with the pathological model of
illness and identifying causation, but also identi- At the simplest level consciously reflecting
fies many core aspects to the case whatever the on causation often allows a patient to remove or
model or approach used. Although in some cases reduce a cause of a simple problem. At the next

29
CHAPTER THREE The Homeopathic Consultation
Foundation

level many patients find it an easy way to treat Causation and the Models of Health
themselves for minor ailments. In more established Although causation may be an indicator for treat-
illness causation combined with local symptoms ment in its own right, it may also be part of any

I might identify a homeopathic treatment. Even


in more complex cases identifying causation can
approach to treatment. Cause and effect are fre-
quently described together and can be understood
point towards, or away from, different remedies. in relation to their interactions (like a story).
Jan in the case above remained clear of derma- Several different causes can contribute to more
titis but three years later presented with a profuse complex cases that can sometimes be best under-
sinusitis and a non-infective irritating vaginal dis- stood within the context of the whole patient in
charge. At this time she discussed a previous geni- their historical and biographical context. A pattern
tal infection with gonorrhoea when she was aged of causes often reveals themes that run through a
25 that had been treated with antibiotics. This was case that might be expressed in a way that brings
a deeper cause that informed a prescription based out the fundamental pattern in the narrative. In
on essence. The deeper cause was connected and the homeopathic relationship understanding what
consistent with a pattern or what might appear as is projected and what this causes is key to appreci-
a spiral of causes that included the gonorrhoea, the ating the fundamental sensations and feelings that
skin sensitivity, sinusitis and vaginal discharge. arise in the patient and homeopath as part of the
Understanding the patient’s ‘case’ is intimately relationship between them.
connected to our understanding of homeopathic
philosophy and the homeopathic remedies. As we The Patient’s Story
study the various remedy pictures, so we gain A core skill of the homeopath is to assist the
insights into the variety of possible causes and patient in telling their story. At the simplest level
symptoms that can affect each of us. For example, the patient’s story is ‘I get these symptoms when
understanding the different remedies that have this happens to me’. This level of association by
anger in their picture allows us to understand how the patient may explain the causes of many minor
anger can be a cause and how different patients ailments. Some of the best known and easiest to
contain or express their anger. In practice there use homeopathic remedies are used to treat simple
is invariably a connection between the cause and causation in this way, as Carol’s case illustrates.
the effect. For example, Nux Vomica is a remedy
that gets competitive, it will be susceptible to being
CASE STUDY 3.2
irritated by the slightest sense of failure and will be
Carol, a 48-year-old mother of three, fell four
hypersensitive to criticism. By studying the variety
weeks ago while ice-skating with her children.
of symptom pictures described in the remedy
She had rib pain that settled over 24 hours
provings it expands the homeopath’s ‘vocabulary’
with painkillers. After a week, she started
and improves the ability to hear and describe what
to get severe pain over the right side of her
is happening to a patient.
chest, where she had knocked herself. This
We can know a lot about philosophy and be
was enough to suggest the remedy Arnica,
aware of many remedies but if we lack the proper
but further confidence in the prescription was
skills to take the patient’s case, we will fail to pre-
possible because she described the pain as
scribe the most appropriate remedy. Knowledge of
‘an inner bruise’ much worse from any pres-
homeopathic philosophy, awareness of the differ-
sure or touch, and she couldn’t bear her chil-
ent remedy pictures and skill in taking the patient’s
dren or husband coming near her in case they
case are all part of understanding a patient. When
touched her right side. Arnica is a remedy pre-
the homeopath’s knowledge, awareness and skill
scribed for blunt injury where there are associ-
are developed and in balance, a patient’s treat-
ated features of tenderness and aggravation
ment will often be clear.

30
The Homeopathic Case

Foundation
It can be helpful to think of an individual
from touch. Interestingly, after Arnica a bruise
organism as having features that are expressed at
came up, suggesting the starting of a natural
different depths, or within a successive number
healing process.
of shells like Russian dolls one inside the other
(see Chapter 6). The homeopath, like a good
I
The remedy Arnica is often referred to as a
biographer, wants to reveal what is happening
‘trauma remedy’, meaning that the symptom picture
at different layers in a person’s life. Different
that people develop after a trauma often requires
layers often require different interviewing styles
the remedy Arnica. This is called the Arnica state.
(see Chapter 13). The homeopath is looking
Matching the ‘remedy state’ to the ‘patient’s case’
for the appropriate depth of cause for the layer
on the basis of similar is homeopathy.
the patient has suffered on, as in the case of
James.
Levels of Causation
In most straightforward cases the causes most con-
nected to the presenting symptoms will usually
point to the remedy. As cases get more complicated
frequently the causes run deeper, often involving
a hierarchy of causes that in confused cases can
be difficult to see and might only gradually be CASE STUDY 3.4
revealed as a patient moves through a course of James, 13, had always been susceptible to
treatment. The most obvious association between accidents. At these times, his parents had
apparent cause and effect doesn’t always describe often given him much Arnica, with good
fully what is happening; contrast the previous case effect. One day he presented with pain
of Carol with Jane’s apparently similar case. over the ribs, diagnosed as costochondri-
tis, following a fall while skiing some time
ago. Although Arnica had helped him, he
CASE STUDY 3.3 still had some pain. On taking the case at
Jane, age 75, presented with chest pain fol- a follow-up appointment, James explained
lowing a road accident. She had been driv- that he thought he deserved the pain. At this
ing slowly with her husband as a passenger point in the consultation his mother com-
when she hit the car ahead. The steering forted him by putting her arm around him,
wheel hit her chest, and it was exactly here covering with her hand the point where he
that she first experienced pain. Her husband’s felt most pain. His mother commented that
face was badly cut, which required him to stay James had been especially cuddly, need-
in hospital overnight. Jane was very anxious ing physical affection since the birth of his
and was prescribed tranquillisers to help her younger sister. Encouraging James to talk
sleep. When I saw her, Arnica had not helped. about his feelings enabled him to talk about
Although the pain was a problem for her, his jealousy towards his sister and feelings
much worse was her fear. Since the accident, of insecurity at school that came across as
she had not driven as she was frightened of shyness. The remedy Pulsatilla was chosen
something else happening to her husband. on the basis of his jealousy and his shyness
For her, it was the shock that required treat- with need and desire for affection. After this
ing, and after taking the remedy Aconite, she not only did his pain get better, but he also
made a speedy recovery. (Aconite is a remedy reported feeling happier and more confident
prescribed for fear, which includes the features in himself. Interestingly he also became less
of rapid onset after shock.) accident prone.

31
CHAPTER THREE The Homeopathic Consultation
Foundation

There may be several different but concurrent into the Arnica remedy state. This is important to
causes such as a physical injury and an emotional remember, as a strong causation can, even with
shock; ordering these according to the different deep-seated symptoms, be the main indicator to the

I aspects of the case can be considered as a hierarchy


of causation. In some patients the deeper causes may
remedy. Significant illnesses can be caused by this
sort of causation, for example after radiation poi-
be painful to recall, and the symptoms themselves soning, of course not all of them are easily revers-
may be how the patient has avoided, denied or con- ible with homeopathic remedies. In Chapter 6 we
tained the causation. For example, a patient with a explore how the susceptibility of the individual
gastric ulcer might develop an aversion to foods that determines the causes that the patient is susceptible
upset them, or a patient who has been bullied and is to and in Chapter 10 we explore how a population
upset by conflict might seek to avoid confrontation, can be susceptible to, for example, an epidemic.
blame themselves for their problems and develop
low self-esteem. This might attract bullies and so the
hierarchy becomes a repeated pattern of causation REFLECTION POINT
so often observed in deep-seated cases. ● Think of a significant life event you have experienced.
In acute cases, the trigger event is often a major How did it affect you and what did those symptoms
factor in the remedy state the individual has devel- mean to you? Has it left you more sensitive to other life-
oped and therefore helps in choosing the prescrip- events like this? How might it have affected a different
tion the patient is likely to need. person in a different way?
Causative factors are just as important in the psy-
chological realm. Sometimes an initial causation can
trigger a reaction that goes through several different Sometimes the causation of certain symptoms
stages. For example, after a grief, the patient may only becomes apparent through reflection on the
go through stages of shock, denial, sadness, anger, case. At other times, the case becomes clear in the
exhaustion, etc. A healthy group reaction would context of more general life events, the ‘biopatho-
involve the patient moving through each of these graphy’, which is orientated particularly towards a
over a period of time, but if the patient becomes biographical or autobiographic view of the evolu-
stuck in any of them, they are likely to develop prob- tion of the patient’s health history. When we seek to
lems. By understanding the homeopathic materia understand the case at deeper levels, and to under-
medica for different grief remedies, we are able to stand recurrent or chronic disease, the evolution
hear the patient’s story of their grief in more detail. and change of symptoms over time is important,
In which state the patient gets stuck will determine especially where one symptom is clearly the cause of
which remedy they are likely to need and will be another. In some cases, the cause can best be under-
influenced not only by the nature of the causation stood as a physical event in the patient’s life; in oth-
but by their experience of previous loss, their sus- ers, it can better be seen in terms of the environment
ceptibility and the support that they have. We begin of the patient, or in psychological terms. Causation
to see that it can be quite appropriate to move into a is frequently mirrored in the patient’s physical and
remedy state for a period of time as a way of react- psychological state as well as the environment.
ing to a particular environment or situation, but it
is when the patient gets stuck in this state that it The Narrative
becomes a problem and that a remedy is required. ‘Somewhere between the first year and final year of
Different patients have different susceptibilities medical education, undergraduate students exchange a
to different causes. Some, if they are strong enough, narrative facility for eliciting and appreciating patients’
will put many patients into a particular remedy narratives for the learned experience of constructing a
state. For example, for many people, if they expe- medical history.’
rience severe enough blunt injury, they will enter Interview skills of first-year medical students.

32
The Homeopathic Case

Foundation
The story, when we record it meaningfully, is The Language of the Case
more memorable than a simple sequential record In recording the narrative the patient’s own words
of events. Told from the patient’s perspective, it are important. There is a balance between using
becomes a ‘narrative’, carrying with it something
of the patient’s place in the world and what it
the patient’s exact words to anchor the case in the
patient’s reality, and recording a superficial but
I
means to the patient. quick summary of the case that may fail to reveal
When relating to the patient through hearing an underlying pattern or order. A good balance is
the narrative, the homeopath begins to ‘enter into’ to include some of the patient’s phrases and dia-
the patient’s life. In the relational model of health logue verbatim, so that if you were reading a case
the dynamic between the patient and homeopath to a colleague they would get a sense of who the
is an important part of the ‘living narrative’ of the patient was. Some words a patient uses can be eas-
patient and connects with the living narrative of ily summarised whereas important ‘feeling’ words
the homeopath. How this shapes the quality of can describe more complicated aspects of the case.
the therapeutic relationship and the importance For example words with emotional intensity behind
of monitoring our own processes when hearing a them like ‘sad’, ‘guilty’, etc. can immediately con-
case is explored in Chapters 23 and 25. For exam- nect to deeper experiences in the patient’s life.
ple, when James (Case Study 3.4) talked about his It is helpful to record any significant actions,
pain and his mother comforted him I noticed that including repetitive movements, as they can rein-
I felt sad. This prompted me to ask about his feel- force what is said and provide non-verbal clues to
ings and it alerted me to notice how his mother the case. Some young children and pets can’t use
touched him. words and so a fuller description of their behav-
Understanding and recording the patient’s case iour, especially their interaction with parents or
as a narrative gives far more information than owners, can communicate aspects of their story.
just documenting the symptoms. It allows us to Some patients will respond quite differently in
glimpse an order and pattern behind the case that different company, and the observations and
can itself lead to a prescription, or it can provide comments of a parent, spouse, sibling or work col-
essential information to start exploring the case league can shed light on aspects of the patient that
at deeper levels. While we want to record the might not otherwise be revealed. Box 3.1 sum-
events as they happen to the patient, we also want marises some of these key points of the dynamic
to understand the themes behind the events in process of homeopathic case taking.
the same way as we seek to understand the plot
behind a story. If we record that James fell and
hurt himself, it is an accurate description of what BOX 3.1
happened. It tells us the event but not much about Key Points on the Homeopathic Case
what lies behind it. If we say that James kept fal- ●
An important aspect of the homeopath’s
ling and hurting himself, and the pain was his way job is to enable the patient to tell their
of getting sympathy, then this reveals a theme and story fully
starts to reveal the narrative. ●
Only when we have taken an accurate case
While a patient’s story can be understood as can we know what is to be cured
a sequence of different causes and effects, and ●
It is more than a simple record of events,
each cause might point to a different remedy, in it is more than a story with memorable
the patient’s case as a narrative a fuller description themes, and it is more than a narrative
comes about when we can see the events connected grounded in the patient’s experience – it is
to each other. The case may be better described in all of these together, including the patient’s
terms of the pattern running through it, sometimes and homeopath’s reflections
expressed as the essence or a theme of the case.

33
CHAPTER THREE The Homeopathic Consultation
Foundation

tion. For example, a parent treating Ben at home



The case allows us to see not only what
might suggest a ‘right sided, sore throat’ remedy
is there, but also to start to see below the
for the acute picture. A homeopath, in a short
surface, to see the cause
I ●
Several causes may exist as several layers
consultation or over the phone, may prescribe a
remedy based on the flushed and startled appear-

It is helpful to have your own homeopathic
ance of the patient, and the experienced homeo-
case taken
path, with more time, may explore the ‘never well

Reflect on your perception, openness,
since’ theme. In each scenario, the prescription is
accuracy and precision in listening to and
likely to be the remedy Belladonna, but the match
recording patients
of remedy to symptoms over the ‘time line’ gives
the homeopath much greater confidence of a
When we talk about a patient being a certain deep acting result, and the concurrence of rem-
remedy type, like a ‘Pulsatilla type’, we are using edy at each level informs our choice of strength
our knowledge of the materia medica and the (potency) of prescription.
language of the materia medica to sum up whole
areas of a patient’s case. We need to be aware of
the risks involved in ‘pigeon holing’ a patient, CASE STUDY 3.5
or trying to extrapolate a certain behaviour into Ben, age 9, presented with an acute fever
how they might act in all situations. and sore throat, worse on the right side. He
flushed easily on exertion and had a startled
look. He had enlarged cervical lymph glands
The Time Line since his tonsils were removed at age 5, and
had been getting recurrent sore throats ever
Using causation, we can usefully describe a
since a bout of scarlet fever aged 2.
patient’s health in terms of life events and symp-
toms, and record the case as a ‘time line’ by not-
ing when symptoms develop. Consider the time
line in Ben’s case (Case Study 3.5) illustrated in It is surprising how often key events in the patho-
Figure 3.1. genesis of illness are frequently not volunteered
In order to treat this case we can focus on the by the patient, and the information only surfaces
acute episode, the recurrent pattern, the trigger when asking about other events. Ben’s parents were
event, or any combination of these. Where the surprised when they recognised that in fact he had
case is focused will depend on the patient, the never completely recovered from scarlet fever. The
homeopath and the circumstances of the consulta- ‘time line’ also has a relationship with the changes
in his vitality (see Chapter 1) and sheds light on
how a patient might improve after the correct rem-
edy, curing firstly the fever, then the lymphadenop-
Symptom severity

Tonsils athy and finally the recurrent sore throats. To the


Scarlet removed homeopath the direction of cure follows what is
fever
Recurrent
referred to as laws of cure (see Chapter 6).
sinusitis Early causes are not always the most deep-seated
Lymph gland
enlarged and sometimes the patterns or cycle of causes are
0 1 2 3 4 5 6 7 8 9 more important than just the order in which they
Age
happen. The type of causes an individual is suscep-
Now
tible to and the pattern or hierarchy of causes is
Figure 3.1 Time line used to understand Ben’s symptoms often an important aspect of difficult cases.

34
The Homeopathic Consultation

Foundation
shy and relatively difficult to get to talk in a stuffy
REFLECTION POINT room with little natural light.
● What are the implications of choosing between the Some patients and homeopaths will enjoy sit-
different approaches to treatment if the causative
factors are present, if they are no longer present, or if
ting face-to-face, others prefer a more oblique sit-
ting angle. Some are more comfortable with a desk
I
there is no clear causation? between them, others without a desk or with the
desk to one side. Some patients feel more com-
fortable in the middle of the room, others near
The Homeopathic Consultation a wall or in a corner. With two or three different
chairs in different places in the consulting room it
When the patient and homeopath are alert and
is surprising how much can be told about a patient
attentive, the consultation changes in subtle ways as
and how the consultation can be helped by which
the therapeutic process begins.
they choose. One helpful exercise is to think about
In an ideal world every case would express
how the patient experiences the consultation; try
all the available information. The reality is that
sitting in the patient’s chair and when studying
not every patient is able, or wants, to show every
different remedies imagine how each might feel in
aspect of themselves or their problem, no environ-
different environments.
ment is equally conducive to hearing every case and
not every homeopath is perceptive to all of every
case. In each homeopathic consultation, especially
Time
The time necessary to take a homeopathic case
as deeper aspects of the case are sought, the fac-
will vary depending on the homeopath and treat-
tors affecting the patient, the doctor and the con-
ment approach, the patient and their complaint.
sulting environment need to be considered. These
Too short a consultation time is often given as
three aspects of the consultation interact and as the
the limiting factor to understanding a patient in
homeopath becomes more experienced each devel-
a consultation. Whilst this is true in some cases it
ops a range of styles to suit different consultations.
is possible in just a very brief amount of time to
understand a great deal about patients.
The Consulting Room It is a matter of planning the consultation so
The consulting room needs to be a place where the that the case can be covered in the time available;
patient and homeopath feel at ease but focused, expectations need to be set appropriately for each
in ‘relaxed attention’, where both can feel present consultation. It is important when treating com-
and receptive to each other. For the patient to relax plex cases to see the case building over a series of
and trust in the consultation, he must be allowed consultations and using a semi-structured record
adequate time to say what needs to be said and not for the case can facilitate adding information to
be worried about being overheard or interrupted. the case over several consultations.
Practically, there need to be comfortable seats and
provision to record the history, as well as access to The Patient
repertories and materia medica. On occasions family Some patients are much more likely to reveal their
members will attend and although it can add some- case to you than others; this in itself reflects their
thing to the recall of the history it can also inhibit remedy state. Some patients are closed to all types of
the patient and homeopath. In more in-depth cases, homeopath, such as patients needing Natrum muri-
having some time alone with the patient (unless a aticum; others, like Phosphorous, are open to most
parent is required by a child) is recommended. homeopaths (see Kim and Sarah’s Case Study, 3.6).
Different environments will help or hinder Many patients can be open or closed depending on
different patients and this must be taken into you, the environment, the type of symptoms being
account. For example Kim, a Pulsatilla child, is described and how they feel when you see them.

35
CHAPTER THREE The Homeopathic Consultation
Foundation

times when they see some remedies particularly


CASE STUDY 3.6
frequently. These remedies often reveal much
Kim, age 15, presents with menstrual prob-
about the homeopath’s condition. Ultimately the
lems. Initially she is very shy. At her second
I visit she is more open and talks about feelings.
better you know yourself, the clearer your refer-
ence point and the easier it will be to gain insight
She responds to Pulsatilla. Sarah, age 16, has
into diverse and different people.
similar problems; she also is shy and remains
reluctant to reveal much about her personal
Listening Skills
life. She steers the consultation away from
One of the important skills or competences of any
anything personal or to do with feelings. She
health practitioner is being alert, to be attentive
responds to Sepia.
to the patient and to themselves. It is surprising
how often homeopaths having difficulties with
the consultation find it difficult to pay attention
When the consultation involves a third party, to what the patient is saying. Frequently in these
a parent or partner, or, in veterinary practice, an consultations the patient’s details are hard to
owner, it is always coloured by them. Sometimes recall in detail. When this starts to happen it is
the colour can add to the picture, e.g. the sharing important to re-engage with the patient. As with
of something the patient might not have noticed most skills, it is possible to develop your ability to
or been able to express; sometimes it distorts, concentrate and be attentive; the exercises in Box
like the behaviour of a child with a dominant and 3.2 will help.
controlling parent. Many patients hide aspects of At your first encounter with a patient you
themselves if they feel ashamed or judged by oth- receive far more information than you can reg-
ers. For example, patients may deny recreational ister consciously or record (and they also receive
drug use or excess alcohol consumption. Certain much information about you). By developing your
remedy types feel a pressure to act, behave and attentiveness you will find it easier to invite the
look ‘normal’; a strong need to belong and be patient to be fully present. One of the commonest
liked might colour how they dress or what they barriers to being alert to the patient is the health
reveal, for example about food preferences or practitioner having strong feelings themselves and
their sexual orientation. this can include being overwhelmed by feelings
of vulnerability, shock, threat and even, we have
Factors in the Homeopath to say, repulsion and attraction. When these feel-
How homeopaths interpret what is heard in a ings surface it is important to analyse why they
consultation will be coloured by their own state are there – commonly it is because the practitio-
and affect what they consider relevant. For some ner has unmet needs or makes judgements about
cases and in some methodologies this is more the patient, or professional boundaries are not in
often a problem than in others. The more insight place.
the homeopath has into his or her own state and
the more experience of working with these they Note-Taking and Record-Keeping
have, the less problematic are the inevitable pro- ‘He writes everything down with the very same expres-
jections between homeopath and patient that sions used by the patient and his relations. The physician
accompany all relationships. It may explain why keeps silent, allowing them to say all they have to say
certain patients needing particular remedies are without interruption, unless they stray off to side issues.
difficult to perceive accurately for some homeo- Only let the physician admonish them to speak slowly
paths. When supervising homeopaths, it is com- right at the outset so that, in writing down what is neces-
mon for each homeopath at times to find some sary, he can follow the speaker.’
remedies hard to recognise and to go through S Hahnemann, Organon, 6th edition

36
The Homeopathic Consultation

Foundation
BOX 3.2 BOX 3.3
Exercises to Help the Health Practitioner to Some Practical Hints on Recording the Case
be Alert and Attentive ●
Leave sufficient margins on both sides

Focus on the first two minutes of a recent ●
In the left margin make notations on the I
meeting with someone, either a patient or history and add additional objective infor-
socially. Think about how they arrived, what mation as it surfaces or later on in subse-
was the atmosphere like when they arrived? quent consultations. This can include the

What might have been influencing how patient’s expression or movements.
they felt before you met them? ●
In the right margin identify different

How did you look when you first saw themes running through the history and
them? any speculative thoughts, including reme-

How did they carry themselves, where did dies, that surface and cannot be dismissed
they sit, how were they dressed? ●
Place one symptom on alternate lines so

Describe their complexion, their breath- that you can return later to add informa-
ing, and the colours they were wearing tion about that symptom

What other senses can you use to describe ●
Make references to texts, whether reper-
them? Did you touch them when you tories or materia medica, in one or other
shook hands? What was the texture of the margin or in different coloured ink so they
skin like? Was there any odour? can be noted at follow-up

If you think about them hard can you imag- ●
Use quotes for actual phrases used by the
ine, in any way, what it is like to be them? patient that describe central features of the
What would help you do this – can you sit case or more peculiar or unusual symp-
like them, hold yourself like them, and are toms
there any ways your life is like theirs? ●
Ask the patient to bring a small photo-

Can you imagine what their life is like? graph of themselves with them at their first

Think about this exercise and why you appointment. Having this in their file pro-
chose the person you did vides an instant reminder of them if you

What people or types of people might you have to analyse the case away from them
find this a difficult exercise to do with? or when speaking on the phone to them.

Why are these people difficult to do this
exercise with, and what does this tell you
about yourself?

If you saw them as patients how might you
in the consultation, e.g. a patient talking about her
adjust your work to help you stay alert?
father while making fists of her hands, or some-
one talking about a bereavement, and saying that
it didn’t affect them, while holding their throat.
There is a tension between recording what the The best record is one that most accurately
patient says verbatim and summarising the key sums up what was observed in the consultation;
points, themes and observations that run through including what the homeopath was able to per-
the case and also being seen to give the patient ceive even if the patient was not conscious of it.
your full attention. Both are necessary and both Too much writing can be at the expense of eye
have their place. While a straight transcript of a contact and observation, and may adversely affect
case may hold a full record of what was said, it the consultation. Box 3.3 suggests some practical
won’t necessarily indicate where the emphasis was hints on recording the case.

37
CHAPTER THREE The Homeopathic Consultation
Foundation

story and how the way we understand a case is


REFLECTION POINT
helped and hindered by our understanding of the
● What are you most confident about in your case taking
homeopathic remedies and the language we use.
and how have you developed that confidence? What
I opportunities do you have to take cases and to monitor
Although we separate out the philosophy, rem-
edies, case and analysis in order to make them
and receive feedback on your technique? Have you
more manageable the practice of homeopathy
considered observing yourself on video, asking a friend to
intertwines each of these. Depending on the
give you feedback or had your case taken by a colleague?
treatment approach we use we will focus on the
● Do you find certain patients easier to work with than
history in different ways. When the patient has
others? If so how can you modify your technique and
told the story, we naturally turn to ordering and
consulting room to help these patients tell their story?
prioritising the information through the process
● What is important to you for creating a space where you
of case analysis.
feel comfortable and where you would feel comfortable
if you were coming in as a patient?

Bibliography
Greenhalgh T, Hurwitz B 1998 Narrative-based medi-
Summary cine. BMJ Books, London

As we explore the homeopathic consulta- Mitchell A, Cormack M 1998 The therapeutic rela-
tion throughout the book we will see how the tionship in complementary health care. Churchill
Livingstone, Edinburgh
patient’s story interfaces with the doctor’s

38
CHAPTER FOUR

Assessing the Homeopathic Case Case Analysis

David Owen

Introduction The Core Principles


When a close enough match of remedy to patient is
of Case Analysis
made the alchemy of healing takes place. In many ‘straightforward cases’ it is possible to
Case analysis brings together the philoso- go straight to making a prescription and much of
phy, the knowledge of homeopathic remedies what is discussed below is part of an unconscious
and the case. It aims to address important ques- process. If when you start prescribing you take
tions that need to be asked before treating any an overview of the patient’s treatment and case
patient. It includes, but is far from just, select- analysis, then when you start to treat more com-
ing an approach to treatment and applying a plex cases there is a structure to return to. The
methodology to match a patient to a remedy structure I am inviting you to consider is a series
on the basis of similars. Case analysis encom- of questions, as outlined in Box 4.1. Each repre-
passes aspects of understanding why something sents a stage in the process of case analysis. It is
has happened, attaching meaning, defining the helpful to answer these in every case but the more
patient and how they relate to their environ- difficult the case the more important it becomes
ment and to others. The ability to carry this out not only to finding the homeopathic remedy but
is a major factor in determining the competence also to the patient’s overall management.
of a homeopath. In practice as the case and analysis unfolds
This chapter looks at these broader issues these questions represent stages of the case and
of case analysis before exploring treatment analyses. The answers to each overlap and form
based on causation, sometimes referred to as part of the overall analyses of the case. At times,
aetiological prescribing. Aetiological prescrib- especially in straightforward cases, some of the
ing, such as Arnica for blunt injury, is a use- answers are self evident, at others the clarification
ful methodology to start prescribing for many of one stage informs and leads onto subsequent
minor ailments and is often where a homeopath stages. Figure 4.1 illustrates these stages as part
starts to gain experience. However it is just of a cycle that in turn informs the optimum man-
one of many different methodologies covered agement of cases (see Chapter 15). Although you
in this book; which of these the homeopath is might choose to do some of the analysis at a time
able to work with will determine the patients when the patient is not with you the consultation
and conditions the homeopath can prescribe is not truly over until each of these stages has been
accurately for. completed and, where appropriate, the answers

39
CHAPTER FOUR Assessing the Homeopathic Case
Foundation

When to
BOX 4.1 review and
when to
Core Questions to Answer as Part of Case assess
Analysis Understanding
I ●
What is the causation and are maintaining
and agreement Causation

causes present? General Patient’s


management vitality

What does the case tell us about the
patient’s vitality?

How ‘stuck’ is the case in terms of dura- Possible Duration
outcomes and depth
tion and depth?
of symptoms

What is the conventional diagnosis or dif-
ferential diagnosis of the patient? Diagnosis
Confirmatory

What is the model or models of health that and exclusion
give the best impression of how and why Methodology Model of health
the illness has developed? for prescribing Approach to
treatment

What approaches to treatment are avail-
Figure 4.1 The cycle of case analysis
able in a particular case?

According to what methodology or mix of
methodologies is a remedy most reliably very helpful to know what was happening to the
prescribed? patient when the illness started. The stronger the

How ‘well indicated’ is a remedy – includ- link between causation and illness, the more likely
ing confirmatory and exclusion factors? looking at the pathological model of health and

What are the likely and possible out- relying on the causation approach to treatment will
comes? lead to a successful prescription. The more likely

What general management factors must that a specific causation is to cause an illness in all
the patient and the homeopath take into patients then the more successful a treatment based
account? on that causation is likely to be – if, of course, a

Is there a clear understanding of the illness treatment for that causation is known.
and is there an agreement with the patient There is a range of causative factors, from the
about the treatment being offered and its transient, through those that are easily changeable
duration? to others that appear fixed. They include environ-

When is the treatment best reviewed mental factors such as pollution and life style fac-
and how will response to treatment be tors like diet. When there are fixed or maintaining
assessed? causes, then the approach to treatment needs to
take this into account, as in the case of James.
communicated to the patient. Failing to do these
steps or communicate them is, I suspect, one of
CASE STUDY 4.1
the main reasons why some homeopaths find it
James presents with headaches, he drinks
difficult to move from a theoretical understanding
very little but when he drinks more water his
of homeopathy to practising successfully.
headaches are better. He has ample oppor-
tunity to drink but just does not want to. In
What is the Causation and are this case it may be appropriate to understand
Maintaining Causes Present? and possibly prescribe on the patient’s lack of
Identifying causal, contributing and associated
thirst rather than prescribe on just the head
factors, even when there are several different fac-
pain.
tors, is an important part of any case analysis. It is

40
The Core Principles of Case Analysis

Foundation
At times the illness a patient gets is a way of basic dietary advice and emotional support. In this
identifying, for the patient, what the causes are. way the role of the homeopath, as with any health
Removing the symptoms without addressing the practitioner, is more than just the application
cause is the commonest sort of suppression and
invariably leads to the illness being expressed
of a technique and includes helping the patient
become aware of possible causative factors and to
I
through other symptoms. Before attempting to find different ways to deal with or approach the
remove symptoms it is always appropriate to causations.
reflect on what the cause is and if it needs treat-
ing – even if this is only one factor in the even- What does the Case Tell us About the
tual treatment given. For example, if we choose to Patient’s Vitality?
give a remedy that reduces the irritating cough of An important step in analysing any case is to
a smoker without supporting the patient to stop gather an idea of how high or low a patient’s
smoking, then this may lead to a deeper illness. If vitality is. It will influence at what depth the case
instead he is given treatment that helps him deal is treated and where the treatment is directed. If
with why he smokes, perhaps a stressful emotional the vitality is low treatment might first focus on
environment or issue related to self-image, then reducing the maintaining causes and building the
the cure is likely to be at a deeper layer. For this patient up.
reason reflecting on the cause is one of the foun- A basic level of fitness with good sleep pat-
dations of effective case analysis. tern and a harmonious emotional environment
are good indicators of reasonable vitality, as is
Maintaining Causes the patient’s own subjective assessment of ‘gen-
In many acute, first aid and home treatment situ- eral energy’. Without adequate vitality the cause
ations the causative factors are only temporary. In may be uncertain, the symptom picture unclear,
more chronic illness it is not uncommon for cau- much of the holistic picture obscured and other
sation to be ongoing, a ‘maintaining cause’. This approaches unreliable. In treating cases with
often needs to be dealt with as part of the curative low vitality it often takes a longer time to get a
process, as in Peter’s case. complete picture, as the vitality needs to increase
One of the tasks of case analysis is to identify before the case can be seen more clearly. It is usual
specific causative factors from the past and to to find that as the treatment progresses so the
vitality increases. Therefore assessing change in
vitality is an important part of any follow-up, as it
CASE STUDY 4.2 may inform the next stage of treatment.
Peter presented with headaches that were
linked to stress at work. Natrum muriaticum How ‘Stuck’ is the Case in Terms
fitted the cause and symptoms of the head- of Duration and Depth?
ache but the remedy and treatment also The development of a case, including its duration
helped him talk about a problem that he had and how numerous and how clear its symptoms
been ‘bottling up’. are, will help to reveal how ‘stuck’ it is. When a
case is stuck symptoms have less clarity and change
identify maintaining causes. For example, if we slowly, with fewer individualising symptoms. The
see a patient with a blister on their foot, there is more stuck symptoms are the more likely they are
little point treating the blister unless we check the to relate to structural changes in the body and less
patient’s shoes and advise a change of footwear likely they are to be symptoms of sensation (see
if that is the cause. In chronic illness poor nutri- Chapter 6 for Perspectives of depth).
tional intake and psychological stress are common When a case is stuck it is often linked to
maintaining causes and many patients require a low vitality in the patient that may be due to

41
CHAPTER FOUR Assessing the Homeopathic Case
Foundation

factors in the patient’s personal circumstances, past a patient has been a significant cause of the dumb-
medical history, lifestyle, environment or relation- ing down of medicine. Fourth, it eases communi-
ships – so-called obstacles to cure. In such cases cation with other health carers.

I the patient’s resistance to the illness is low and


recovery is slow or hindered. There are parallels What is the Model or Models of Health
between how stuck a case is and how open each that Give the Best Impression of How
patient is to making life style changes, perhaps as a and Why the Illness has Developed?
consequence of how little they believe they can get Describing the ‘who, what and where’ of an illness
better. To engage these patients and get them to is the main aim of the homeopathic case. Finding
see illness as more than the presenting complaint the ‘how and why’ is intimately connected to this
and to comply with treatments that are more than and the main aim of the case analysis.
‘a pill for every ill’, is part of the challenge that Different therapeutic systems work within
needs to be considered by the homeopath in the different belief systems using different assump-
case analyses. tions about health that describe different mod-
els of health. While no one model is likely to fit
What is the Conventional Diagnosis or every patient in every situation, a collection of
Differential Diagnosis of the Patient? models of health that fundamentally share the
Homeopathic texts make full use of standard same basic laws can, as experience has shown,
medical terminology, unlike some other comple- work in many patients in many cultural belief
mentary therapeutic systems such as traditional systems over many generations. While some
Chinese medicine. Homeopaths that are not also schools of homeopathic thinking often favour a
medical doctors sometimes find their training does particular model of health and approach to treat-
not prepare them for the sound anatomical, physi- ment, for the homeopath able to move between
ological, biochemical and psychological under- models of health, the opportunities exist to select
standing of health that the biological, pathological a model that makes sense of a patient’s illness
and holistic models of health require. A case anal- when others do not. The varieties of models that
ysis usefully includes, where possible, a medical are described in this book create the possibility
diagnosis, but with additional information. This of an eclectic homeopathic profession that could
sometimes, misleadingly, leads to homeopaths become a mainstream provider and maintainer of
that are doctors separating out the case into health. Which model of health to use depends
medical and homeopathic aspects that can limit on the patient and the illness, the homeopath
the perception of the case in the relational and and their preferences, and the social and cultural
holographic models of health. norms they work in.
A diagnosis gives several benefits to the patient The attraction of homeopathy as an eclectic
and homeopath. First, it gives the patient informa- system is that each model of health relies in part
tion about the different treatment options avail- on the same philosophy, the same remedies and a
able and the ability to make informed choices. connected understanding of the case. It is possible
Second, it points to what the likely natural his- to move between and combine, cautiously, the
tory or prognosis of the disease is going to be. It different approaches to treatment based on what
is only by having an idea of what is likely to hap- the patient and homeopath find acceptable and
pen with no intervention that the homeopath can relevant. Sometimes it is very clear which model
accurately assess what has happened following a is most appropriate, for example, often in acute
prescription. Third, it does, with inherent limita- straightforward cases the biological model may
tions, allow comparison of different treatments in suit best. In cases where there may be multiple
different patients – although the limiting of treat- different organs involved, a holistic model might
ment regimes to suit a diagnostic label rather than be indicated. In others where the illness may be

42
The Core Principles of Case Analysis

Foundation
hidden behind one main presenting feature, the taking place in the case. For example treatment might
relational or thematic approach may suit. Sue’s include advice on avoiding a maintaining cause, and
case illustrates how the agreement on what model a prescription based on a holistic view that incorpo-
of health to use can change. rates the presenting symptoms. However in some
cases it is not so straightforward. There may be clear
I
causation but no known remedy for that causation,
CASE STUDY 4.3 or there may be a sense of a clear theme or essence
Sue presented with twins just under 2 years but no remedy the homeopath knows for this.
old and was finding it ‘hard to cope’ with her Planning the treatment does not require a fixed
hectic life. She had been used to ‘being in course of action as the plan may be revisited fre-
control of my life’ and to having ‘protected quently, but in the same way an illness is understood
time’ for herself and her relationship with her in the context of how it has evolved over time, a
husband. She wanted help for cramps in the treatment is planned in the context of how a cure
calves that came on at night. She was reluctant is achieved through what might be thought of as a
to take conventional medicines and wondered ‘journey back to wellness’. In many cases the health
if homeopathy might help but found it hard to of the patient and the disease can be perceived in a
talk about her feelings. Sue wanted a specific number of different ways. A plan of treatment might
remedy for night cramps and Cuprum metal- involve several stages of homeopathic prescribing and
licum prescribed on the presenting symptom other treatment modalities, as well as including how
gave relief when taken nightly but the improve- to deal with obstacles to cure using lifestyle advice.
ment relapsed once she stopped taking it.
At a follow-up appointment Sue discussed According to What Methodology
her feelings of heightened anxiety and panic or Mix of Methodologies is a
attacks that started after the twins were born Remedy Most Reliably Prescribed?
and about which she felt ashamed. It was The underlying principal behind all methodolo-
agreed to treat her holistically and a constitu- gies is to find as close a match as possible between
tional match to Sepia was made. This helped what is being treated in the patient’s state and the
her feel better in herself and the cramps known materia medica. The experienced homeo-
gradually ceased. path is able to move between different methods
of prescribing fluidly and easily, maintaining an
awareness of where the different methodologies
What Approaches to Treatment are overlap and how they may be combined to lead
Available in a Particular Case? to the best prescription. If we aim to treat patients
In many cases the model of health, approach to treat- from the most straightforward home ailment to
ment and methodology for prescribing each comple- the most complicated deep-seated pathology, there
ment one another. The benefit of separating out is no doubt that we are going to need a range of
the treatment approach is that it may include many methodologies. Add to this the patient’s prefer-
treatment suggestions, of which a homeopathic pre- ence to work in different ways with different peo-
scription is just one. There are different homeopathic ple and we can see that no one methodology will
treatment approaches possible within each model of provide the optimum prescription in every case.
health. Deciding which treatment approach you are In more deep-seated conditions often the best
going to use will influence not only the methodology remedy is one that is indicated by several methodol-
you follow to choose the remedy (simillimum) but ogies. This has led to several established ‘formulas’
will also determine other aspects of the case analy- for prescribing, such as using key symptoms and
sis and the treatment plan i.e. it allows treatments to essence. Each methodology will have its own benefits
be explicitly matched to a particular view of what is and limitations – understanding these will inform

43
CHAPTER FOUR Assessing the Homeopathic Case
Foundation

the homeopath about the likely outcome of taking a outcome is achieved. For example, different remedies
remedy. If the likely outcome of each methodology in different strengths and taken in different regimes
is known then when several remedies are indicated have different durations of action and have different

I the homeopath is helped in making an informed


choice between them.
likelihood of causing an aggravation (see Chapter
16). There are many patients who have given up on
treatment or changed homeopath after a perfectly
How ‘Well Indicated’ is a Remedy, good prescription because the outcomes were not
Including Confirmatory or Exclusion considered or explained – including patients who
Factors? have relapsed and failed to take a repeat prescription,
In any homeopathic case there can be several possi- patients who have given up because a remedy is only
ble homeopathic medicines indicated. Some homeo- acting slowly and patients who have not tolerated an
paths talk about a single simillimum to a case, others aggravation. In these cases careful consideration of
that there are a range of similars – some closer than the remedy, the potency and the prescribing regimes,
others (Kent 1926). Using different views of the rem- along with considering the correct information and
edy and case preferred remedies may appear more explanation to give to the patient, are a vital part of
strongly or weakly indicated. While ideally the same the analysis and management.
remedy will be indicated by several different models Many patients view the effect of a homeopathic
of health, frequently this is not the case. Similarly prescription as similar to conventional medicines as
a single methodology often points to several close both frequently involve ‘taking a medicine’. If you
remedies and how well indicated, or not, a remedy document and assess the outcomes you expect (there
is by other methodologies may confirm or exclude are several ways of ‘scoring’ outcomes - see pages
a remedy. A remedy confirmed in this way is more 321 and 322) it gives you and the patient impor-
likely to give a positive outcome. Knowing the mate- tant feedback. Remember outcomes do not just
ria medica of likely remedies is essential in recognis- have to be about frequency and severity of present-
ing what features confirm a possible prescription and ing symptoms but can also be about ‘general well
what features relatively contraindicate it. The most being’, ‘energy’ and ‘vitality’. These outcomes can
useful information about remedies that confirm or often more realistically indicate progress in more
contradict a prescription is often the most unique deep-seated illnesses and give valuable information
or strongest features of a remedy, referred to as the about choice of potency, frequency of administra-
keynotes of a remedy (see Chapter 7). tion and indications to change a remedy.
From several indicated remedies a ‘best indi-
cated remedy’ that is the strongest match between What General Management
the case and the remedies can be chosen. Factors Must the Patient and the
Homeopath Take into Account?
What are the Likely There are several general management points that
and Possible Outcomes? need to be considered along with the case analy-
After identifying the best indicated remedy the likely sis. These are the broader questions relating to a
outcomes need to be considered. It is at this point patient’s treatment and include the possibilities of a
that the strength of any prescription – referred to in remedy being antidoted, the general advice appro-
homeopathy as the ‘potency’ – and the regime for priate to a patient receiving homeopathic treatment
taking the remedy need to be decided. Although ulti- and consideration of any other medicine that has
mately the patient can only get better, worse or stay been or may be required for the patient – including
the same, there are several ways these things happen. conventional medication or other treatments. Other
Reflecting on these before prescribing can often ease general management issues include the need to doc-
the patient’s overall care and may in some cases lead ument the diagnosis, advice and treatment, and to
to reviewing the prescription so that a better-tolerated correspond with other carers to improve care, or

44
Assessing Cases Using Causation

Foundation
when ethically indicated or when legally required.
BOX 4.2
These and other broader management issues to be
Reflection on the Core Principles of Case
discussed later become increasingly important as the
Analysis
homeopath starts treating more serious illnesses.

Case analysis is a way of seeking ‘mean- I
ing’ to a case, whether in terms of external
Is There a Clear Understanding of the
causation, an illness, susceptibility, a per-
Illness and is There an Agreement
sonal story or in relation to others. It is
with the Patient About Treatment and
informed by knowledge of philosophy, the
Duration of Treatment Being Offered?
materia medica, and the case.
Summarising the model of health, plan of any

The ‘meaning’ describes something of the
treatment and the methodologies used to pre-
journey the patient has taken with the ill-
scribe, and getting agreement from the patient on
ness and points to the journey to wellness.
this basis, as part of the analyses, is good practice.
In anything other than the most straight-
If there is no agreement or if the patient offers
forward of illnesses this is likely to be a
information that means the analysis needs to be
process that ‘unfolds’ over time.
modified then this can be taken into account and

Patients and their symptoms can be under-
the relevant steps repeated.
stood using different models of health,
This agreement includes informing the patient
several of which can be used concur-
about the need for reviewing the treatment and that
rently. They will determine the optimum
a course of treatment, in more complex cases, is
approaches to treatment and this will indi-
likely to involve several consultations and prescrip-
cate the most suitable methodologies to
tions. While this agreement may be quite informal
select an indicated remedy.
it should be recognised that it forms the basis of

Remedies are homeopathic when pre-
the ‘contract’ between patient and homeopath. If
scribed according to homeopathic prin-
this agreement is not reached then the expecta-
ciples applied through a homeopathic
tions of the patient and homeopath are likely to
process of matching like with like.
be different. So, for example, the patient may just
wish to be rid of a troublesome symptom while the
homeopath is seeing the symptom only as an alarm tored in order to inform the homeopath. Even if
bell of more deep-seated illness. In later chapters the patient does not attend for follow-up some
the contract and its importance, in particular to feedback on the treatment should be part of the
the therapeutic relationship, are revisited. agreement so that the homeopath may monitor
and develop the way that it works. Before mov-
When is Treatment Best Reviewed ing on you might like to reflect on how the case
and How will Response to Treatment analysis seeks and allows communication of the
be Assessed? meaning behind a case and treatment given.
The end of any case analysis process is clarifying Having looked at the broad issues involved in
what follow-up is required and setting the frame- assessing a homeopathic case that apply to all case
work for this. It may include being explicit about analyses, it is appropriate in this chapter to focus
expectations, so the treatment can be meaningfully on the more specific issues that apply particularly
reviewed. Although a full analysis does not need to cases viewed within the pathological model
to take place at every consultation, steps in the of health and that are suitable for treatment based
process will need revisiting. The review of treat- on causation. Before moving on you might like to
ment is not only important for the patient but also reflect on how the case analysis seeks and allows
for the homeopath. How a case progresses and communication of the meaning behind a case and
remedies act or fail to act in a case must be moni- treatment given.

45
CHAPTER FOUR Assessing the Homeopathic Case
Foundation

Assessing Cases Using Causation role of magnesium in muscle contraction it is not


surprising. So, although causation can point to
A cause is an event that gives an outcome. In a specific remedy it can also point to a group of
homeopathy we observe many causative events
I but it is the degree of association between cause
remedies and while several may help, a more indi-
vidual prescription is possible if the symptoms, like
and outcome that determines how useful treat- ‘better from pressure’, are taken into account.
ing on causation is. When there is a high degree Those factors, such as ‘better from pressure’,
of association, we talk about causation. When which modify symptoms are collectively known
there is less, we talk about causal or contributory as modalities – some modalities hint at causation
factors and when slight, we might just notice it and the degree of association between cause and
as an association. For example, dermatitis may symptom. When a patient is unable to describe the
have a contact sensitivity, e.g. to nickel (causa- detail of a symptom then causation can be particu-
tion), a contributory factor like stress, or an asso- larly useful, e.g. in veterinary practice or in babies,
ciation, worse in colder weather. In identifying as Victoria’s case illustrates.
the degree of causation, the symptom and cause
need to be considered together – this is illustrated
by Sam’s case.
CASE STUDY 4.5
Victoria, Sam’s twin sister, has not been both-
ered by colic unduly and tends to eat and
CASE STUDY 4.4 breast feed in a more relaxed and less speedy
Sam, age 5 months, presented with discom- fashion than Sam. However, Victoria does suf-
fort during and after feeding that had been fer from a worsening of her behaviour and a
going on since starting to wean at 4 months. break out of dermatitis when teething. She
After eating he becomes distressed, curls up becomes irritable and unpleasant towards her
and is relieved by passing wind or from firm brother, pushes away her mother and father
pressure over the abdomen (better ‘from who try to comfort her and develops an itchy
being carried over the shoulder’). On taking rash. Victoria had a dramatic improvement
the history it transpired that he would occa- after being prescribed Chamomilla on the
sionally have these colicky type symptoms, basis of causation from teething and it is com-
even when breastfed, if the mother had eaten monly prepared as ‘teething granules’.
strong tasting food such as onions or curries.
Colocynthis, made from bitter cucumber, was
prescribed mainly on the causation ‘after eat-
ing’ but also on the feature ‘better from pres- While the symptoms are common features of
sure’. Sam’s colic settled down and his mother teething, it would, on the basis of causation, be
started introducing a range of foods that were possible to consider Chamomilla for any onset
well tolerated. after teething or indeed where pain and discomfort
is caused in a patient and the patient is unable to
rationalise the cause or see it coming to an end.
In most cases where the pathological model of
Knowing the Causation in Remedies health is the best to understand the case, either the
In Sam’s case you can imagine why bitter cucum- illness is acute and the vitality is high (and the case
ber produces proving symptoms that include unlikely to be stuck) or, in chronic illness, the link
colic. Interestingly there are also high levels of between causation and the patient’s illness has been
magnesium in this plant and remedies made from demonstrated in other patients and other models
magnesium salts also work well in colic. Given the of health do not give a contradictory picture.

46
Assessing Cases Using Causation

Foundation
Treating Cases on Causation BOX 4.3
Causation is most likely to be a useful strategy when Some Causes and the Corresponding
the strength of the causative relationship is strong, Remedies
e.g. if most people exposed to that causative fac-
tor would get that symptom. In later chapters we

Bruising from blunt injury Arnica I

Cough from getting cold Aconite
explore how to match the appropriate prescribing and wet
methodology to the depth of the case. ●
Itch from insect bite Ledum or
Apis
Dosage and Potency ●
Diarrhoea from food Arsenicum
Choosing the best indicated remedy is the aim of all poisoning Album
case analyses. At the same time a choice also needs ●
Hangover from alcohol Nux Vomica
to be made on the treatment regime and dosage. excess
Some remedies may be prescribed frequently, oth- ●
Sunburn from sun Sol
ers as a single dose. Generally as the homeopath ●
Hay fever from pollen Mixed Pollen
moves from a less confident to a more confident ●
Insomnia from caffeine Coffea
prescription, and as the criteria used to select the
remedy match at a deeper and in a more fundamen-
tal way to the case, so a higher potency is given. As CASE STUDY 4.6
a higher potency is given it is usually repeated less Philip, aged 28, presented with fatigue for 12
frequently – this is explored in detail in Chapter years. At times it improved only to relapse after
20. As a rough guide most simple and straightfor- exertion or upper respiratory tract infections,
ward cases prescribed on causation and presenting which he was very slow to throw off. At 16 he
symptoms will be treated with ‘lower potencies’ had glandular fever and although no-one has
such as the 6 or 12 or 30 potencies. In more com- suggested that this was linked to his chronic
plex cases, prescribed for on holistic, thematic or fatigue, he felt that his energy had never been
relational grounds, a higher potency of 200, 1M or the same since. The glandular fever coincided
higher is often recommended. See Chapter 10 for with his school exams, which he was unwell
discussion of simple and complex cases. for, and he struggled to progress academically
afterwards. There were options to treat Philip
Acute Illness based on the presenting symptoms of his
Many first aid and trauma remedies are pre- acute flare-ups following upper respiratory tract
scribed on a basis of causation or a combination infections or more generally on the fatigue. The
of causation and presenting symptoms. However, decision was made, based on previous expe-
it is important to note that when not all patients rience, to prescribe Carcinosin, a remedy that
respond to the cause in the same way they are has a specific causation of glandular fever and
likely to need a remedy based more on the symp- has a reputation for helping cases that pres-
toms. Box 4.3 illustrates some causes and the ent having ‘never been well since’ glandular
corresponding remedies. fever. One month after two doses of Carcinosin
his energy was starting to improve. Gradually
Chronic Illness his well-being improved and his susceptibility
In more chronic illness the causation is less likely to recurrent infections decreased. Three years
to cause the same symptoms in every case and so after the initial presentation he returned with
other approaches are more likely to be required signs of fatigue that had come on following
– although treating on causation may provide a exertion during preparation for a marathon run.
suitable starting place until the case becomes A further dose of Carcinosin helped him.
clearer. While understanding the aetiology will

47
CHAPTER FOUR Assessing the Homeopathic Case
Foundation

automatically suggest a cause – for example the should be considered along with causation. Each
use of remedies made from allergens for allergic patient has their own susceptibility – some will be
conditions (pollen in hay fever) or remedies made shared with many others, such as the susceptibil-

I from infective agents – they do not always match


the case at the deepest or most appropriate layer,
ity to blunt injury or high-dose radiation, some
will be more personal, such as sensitivity to a par-
as Philip’s case illustrates. ticular pollen. However, every patient will have
The link between chronic fatigue and the certain situations where they get ill – by studying
increased prevalence of glandular fever raises many these situations we gain insight into our patients
questions. What environmental factors might affect and by proving the homeopathic remedies on sus-
a patient’s susceptibility? Is the glandular fever the ceptible patients we build up our materia medica.
primary cause or are there other causes precipi-
tating the glandular fever and making the patient
susceptible? Why does it happen so frequently in REFLECTION POINT
teenage years? Why do some patients ‘throw off ’ ● What do you think the connection is between cause and
the glandular fever better than others? So there are susceptibility and provings and illness?
many questions raised when doing a case analy-
sis of more deep-seated conditions. In all but the
most basic prescription on causation these broader
management issues need to be considered.
Summary
At the end of the case analysis the homeopath will
Levels of Causation have worked through a thought process and series
It is possible to see cause at a number of levels. of decisions about the case and its treatment. The
In an infection there might be factors that lead process will, in part, depend on your level of
to exposure and increase the susceptibility to knowledge of homeopathic principles and mate-
the infection. For example, in malaria is it the ria medica. Depending on the decisions you and
swamp, the mosquito or the malarial parasite the patient make about the treatment you will be
that is causative? In many conditions a number of clear on the ‘context’ of the treatment, including
causes might be contributing and only those that the role of other carers. As you understand more
point to remedies that can be confirmed might be about homeopathy you will have greater choice of
considered. methodologies available to you, as well as a wider
In these cases the best indicated remedy is likely range of materia medica that will ‘come alive’ for
to match several of the causes and/or the suscep- you. In many cases the patient’s priorities and
tibility of the patient. For example, in post-natal understanding of the illness will inform the even-
depression there may be a cause from the birth, tual methodology and prescription.
the mother’s loss of independence, the surfacing Much benefit can be obtained using homeopathy
of the mother’s previously unresolved ‘mother’ following a causative or symptomatic approach –
issues, tiredness, hormonal imbalance, or strong especially in home prescribing, treatment of minor
emotions of fear, anger or failure about the birth. remedies, or indeed more serious and complex
Any one of these might point to the remedy Sepia cases where the full picture may only become
but the prescription is only likely to act deeply if it clear after preliminary treatment informed by
fits several of these and it will act at a deeper level causation. In parallel with exploring the different
if it fits the underlying susceptibility. approaches to prescribing it is important to think
The concept of susceptibility is explored in about the practical considerations of prescribing
more detail in Chapter 6 and throughout Section including remedy strength, potency, administra-
II. However, it raises an important point that tion, storage, availability and pharmacy. These

48
Bibliography

Foundation
are addressed in Chapter 20. Reflecting on these Bibliography
issues brings up questions relating to competence
and broad issues about clinical management that Foubister D 1988 Tutorials on homeopathy. Beaconsfield
Publishers, Beaconsfield
are developed in the next chapter.
Jack R A F 2001 Homeopathy in general practice. I
Beaconsfield Publishers, Beaconsfield
References Watson I 1991 A guide to the methodologies of
Kent J T 1926 Lesser writings. Ehrart & Karl, Chicago homeopathy. Cutting Edge Publications, Kendal

49
CHAPTER FIVE

Introduction to Prescribing Case Management

David Owen

and experience) that may be used in many ways


Introduction and in many settings. It can be practiced in homes,
Every treatment has its time. pharmacies, as part of family or general practice,
in dedicated homeopathic practice, as part of
This chapter explores putting the foundations and a integrated practice along with other therapies
basic principles described in previous chapters into and in veterinary surgeries. Consultations may
practice. Although these principles allow the most be momentary or last several hours, but in every
deep-seated illness to be treated homeopathically we setting the practitioner develops by learning from
started initially looking at more straightforward and every patient and every treatment. The more
easy prescriptions, which is where most homeopaths unexpected the outcome the more important the
start their prescribing. Homeopathy means ‘like lesson, so cases that do not respond can teach as
cures like’ (similia similibus curentur); essentially a much, if not more, than those that do.
patient’s case is matched to a remedy picture leading The acceptance of, and comfort and compe-
to a prescription of a remedy. There are, however, tence in using different models of health to under-
different views of both patients and remedies that stand and treat patients will depend not only on the
lead to different approaches and methodologies to homeopath’s personal view but on how members of
find a prescription. This chapter explores the main a community view their own lives and connections to
approaches to treatment and methodologies of pre- others. The practice of homeopathy is more than just
scribing connected to the five models of health previ- the prescription of a remedy. Its contribution does
ously described, and goes on to look in more detail at not just depend on how much it is used or the lat-
the methodologies based on the causative approach est research but it expresses core beliefs and values
and pathogenic view of health. In other management that are important in understanding that the health
chapters the relevant approaches and methodologies of any individual is not static but always shifting – in
are covered in more detail, although a brief summary the same way that the health of a population, com-
to orientate the student to these different approaches munity, society or culture is always changing. While
is given here. It leads on to important questions about throughout this book the focus is on treatment of the
how different approaches and methodologies can be individual, this cannot be separated from the broader
combined in practice and questions what informa- public health considerations (see Chapter 30).
tion and competencies are needed to work at differ- When you have thoroughly assessed the homeo-
ent levels of illness. pathic patient you have already given them much
The management advice in this book is at all information feedback and advice that will be helpful
times intended as advisory rather than proscrip- in understanding and treating their condition. The
tive. Homeopathy is a tool (a body of knowledge next step is to make the homeopathic prescription

51
CHAPTER FIVE Introduction to Prescribing
Foundation

and undertake to care for and treat patients. These


BOX 5.1
are not separate entities but are in practice a seamless
Criteria That Make Easy Prescribing More
process, one flowing naturally into the other.
Successful
I ●
A patient with clear symptoms

A patient with clear causation but no ongo-
Straightforward Prescriptions –
ing causes
Minor Ailments and First Aid ●
Likely remedies known well
Situations ●
A patient with high vitality

A patient with only minor ailments
A straightforward prescription is one where the

An illness of short duration
case is clear, the analysis is not complicated and

No other treatment having been taken
the prescription is well indicated. Usually these

Immediate access to the remedies so treat-
are cases that do not have too many levels to them
ment can be started early
and where the layers of illness are few. In practice
this often means acute illness in an otherwise well
individual, with good vitality and who has not had
or is not having too much other medication that home and they are hugely preferable to treatment
might distort the presenting picture. Frequently in with the analgesics, anti-inflammatories, antipyret-
straightforward cases if anyone were exposed to ics, etc. that make up so much of conventional home
that particular cause they would get the same symp- treatments. By helping the patient to throw off
toms. It makes sense to start one’s clinical practice minor ailments, many cases of more serious illness
with such cases even though these are also often the can be avoided and it prevents the harm caused by
cases that will heal spontaneously in time. straightforward cases treated inappropriately with
Many minor ailments and first aid situations strong drugs leading to the development of more
present straightforward cases where the indi- deep-seated problems. Treatment is often success-
cated remedy is clear and it is only necessary to ful in these cases and the proportion of conditions
prescribe superficially. The potential benefit to that you will be able to treat in this way depends on
patients being able to treat themselves in this way the number of remedies you know.
is huge, for example a patient able to take a rem- Patients will find a number of books that can
edy quickly after trauma or at the earliest stage in help them treat minor ailments for example in
a cold. The criteria that make this approach more Dr Lockie’s The family guide to homeopathy or
likely to help are listed in Box 5.1. his Encyclopedia of Homeopathy.
This approach can also lend itself to a busy
practice of other health care professions whether
it is the use of Arnica by midwives or osteopaths or Methodologies of Prescribing
the use of one or two remedies with a clear cystitis
picture in family practice. There are a small range
Within Each Approach to Treatment
of homeopathic remedies that can help in many The homeopathic student will realise that many
different first aid and minor ailments. One of the minor ailments can be helped with homeopathy,
easiest ways of working in this way is to be familiar and this will avoid a patient’s symptoms being sup-
with the causes and presenting symptoms of each pressed and leading to more serious illness. Limiting
and to give them when a patient presents a recogni- the treatment you offer to a certain range of cases is
sable match. There are many homeopathic first aid an important way of working within your compe-
kits that contain some of these remedies so they are tence; it is obvious that by knowing more homeo-
immediately available for use. Often homeopathic pathic remedies and understanding those you know
patients use these to help treat problems in the better, you can treat more patients and gradually

52
Methodologies of Prescribing Within Each Approach to Treatment

Foundation
those with more serious illnesses. However, expand-
ing the knowledge of remedies is, as we are already
seeing, only part of a homeopath’s training. Another
key factor in managing patients is in understanding
and being able to utilise the rich matrix of method- 3
I
ologies for selecting a remedy. The homeopath aims 5
from these different methodologies to have an indi- 1 4
2
vidualised management strategy for treating every
patient. While this comes in part from experience,
it is important to have a theoretical overview of the
different methodologies.
Figure 5.1 gives a diagrammatic illustration of
the five main approaches to treatment from the dif-
ferent perspectives of the ‘disease’, the patient and 1 The disease entity as set up by the cause sometimes
externalised as an environmental trigger, the infective
the homeopath. Where the causative approach uses organism, or the nutritional deficiency
the external cause of the disease, the symptomatic 2 The interface between ‘the disease’ and the patient,
uses the expression of the disease directly on the reflected by the presenting symptoms
patient. The totality is the overall expression of 3 The overall effect of the disease on the patient as
a whole and can be understood as the person’s
the illness through the whole patient and the con- susceptibility to the disease
stitution expresses the susceptibility. The essence 4 The interface of the patient and the homeopath
understood through the patterns observed. How
approach uses the expression of the case through the the homeopath perceives the patient in their world
interface between the patient and homeopath. The reflected by all changes of sensation, function and
structure including symptoms related to the disease
pattern of changes in the whole affects every symp- (often more conscious) and those projected on to
their world and on to the homeopath (more often
tom, and so the essence and themes in every part unconscious). (see Chapter 23)
reflect the essence or themes in the whole. The rela- 5 The homeopath’s internal experience of the patient
tional approach uses the expression of the patient suffereing from their disease

onto their world or, in the context of homeopathic


= the disease
treatment, onto you – the homeopath.
The causative, the symptomatic and the total- = the patient
ity approaches are well described historically. The
= the homeopath
essence and thematic approach, based on the holo-
graphic model, and the reflective approach, based
on the relational model, have more recently become Figure 5.1 Five main approaches to treatment from the
major methodologies. While they can significantly perspectives of the ‘disease’ the patient and the homeopath
improve the treatment of difficult cases, they are
offered without the same historic validation that
the first three approaches carry or even the same Subjectivity Verses Objectivity
standard acceptance of the terminology. Figure 5.1 When the homeopath moves from the pathogenic
illustrates how within the paradigm of ‘homeopath to the relational models of health, and therefore
treating a patient suffering from a disease’, the from the causative to reflective approaches, so
homeopath’s view incorporates and is informed by the perspective will shift from the more objective
the patient’s state. The patient’s state incorporates to the more subjective (see Chapter 23). Each view
and is informed by the realm of the disease as an has its own balance of subjectivity and objectivity
entity. As you move from the causative outwards, and which view the homeopath finds it easiest to
each approach is naturally informed by and incor- work with will be influenced by their own comfort
porates aspects of the previous approaches. and training. In practice being able to move between

53
CHAPTER FIVE Introduction to Prescribing
Foundation

different perspectives and different paradigms of and presenting symptoms of a case or not use it if it
health will enable you to perceive, understand and fails to match the totality or constitution.
prescribe accurately in many more cases. The analogy of trying to find someone in a crowd

I A Systematic Management Strategy


might help understand these different approaches.
Imagine you were looking for someone in a crowd.
The many different methodologies to selecting a Causation might use where they joined the crowd.
remedy cluster around these five approaches. These Symptomatic might use where in the crowd they
methodologies are outlined in Box 5.2 but they were last seen or where they were heading. Totality
are not a comprehensive list, only an indication of might describe what you remember of what they are
some of the different methodologies available. Each wearing. Constitution might describe their general
is presented in more detail either in this chapter or and facial appearance. Essence might describe why
subsequent ‘management’ chapters. Although the they are likely to be there and who they are likely
methodologies are represented as discrete ways of to be next to. A reflective approach might use what
matching a remedy to a patient there is a degree of you know of them and if you were them where you
overlap between them and in practice several may be would go to in the crowd.
used to point towards a remedy (or group of rem- Given these approaches you might like to
edies) or indeed to direct you away from a remedy imagine you were actually looking for someone in
partially indicated by another methodology. So you a crowd and to think what method you might use
might choose a remedy as it has both the aetiology to look for them. For example you might try to

BOX 5.2
Key Methodologies to Prescribing Within Five Main Approaches to Treatment
Causation Totality/Constitution

Trigger event or aetiology ●
All physical, mental and general symptoms

Isopathy and tautopathy ●
Three-legged stool

Nosodes and family history ●
A mix of physical, mental and general key-

Anticipating causes, prophylaxis or preventa- notes
tive treatment ●
Physical and psychological type

Maintaining cause ●
Central disturbance

Detox, organ and drainage treatmentl
Essence

Never well since ●
Miasmatic
Presenting Symptoms ●
Categories of remedies

Local or clinical prescribing ●
Remedy families and kingdoms

Single main symptom ●
Types of essence

Single keynotes ●
Related remedies (see Chapter 27)

Several keynotes in one or more areas of the case ●
Herd prescribing (see Chapter 18)

The complete symptom ●
Using fundamental sensation or feelings in

Epidemic remedies the patient

Doublet or triplet symptoms, linked symptoms
Reflective

Previous well indicated remedy ●
Psychodynamic using feelings generated in the

Combination remedies
homeopath by the patient (see Chapter 29)

Strange, rare and peculiar ●
Intuitive

Confirmatory and contradictory symptoms

Symptoms ‘As if. . .’

54
Methodologies of Prescribing Within Each Approach to Treatment

Foundation
retrace their likely steps, to wait in a certain place Each methodology invites you to look at your
to see if they come past you, to find one feature of patient’s and your own world in a slightly differ-
clothing that stands out etc. In practice you may ent way. There is therefore a process of personal
use several, which ones determined by the size and
the intensity of the crowd, the time you have, how
development for the homeopath who wishes to
become competent in a wide range of approaches. I
well you know them (representative of both the A preference by groups of homeopaths for some
case and remedies) and your perspective (if you of these different approaches and methodolo-
are taller you might find some methods easier). gies rather than others accounts for the different
Some homeopathic teachers describe and clas- schools of thought within homeopathy.
sify the methodologies differently, and while for the An important practical consideration is that
student homeopath this is confusing it illustrates each of the different methodologies differs in the
the variety of views and methodologies available. information used to select the homeopathic rem-
However, to compare them and develop them for edy. They each have a slightly different emphasis
yourself, a model in which to think of them, such as on what is the most relevant part of the case his-
the one in Box 5.2, is important. It is hoped that the tory, and they look at slightly different information
homeopath inquiring scientifically into these meth- in the materia medica. They lend themselves to
odologies will remain aware that one methodology different practice settings, and prescriptions often
is not isolated from any other, they are not an exclu- used in different potency and with different inter-
sive list and that the art of homeopathy requires a vals of repetition of dose. They each bring slightly
palette of methodologies that different homeopaths different expectations and are likely to give differ-
will mix in different ways to suit different patients. ent outcomes. While not wanting to restrict the
homeopath’s choice of approach or methodology
some student homeopaths might find it easier to
REFLECTION POINT develop and build their approaches to treatment
● Reflect on what the different words used to name each and methodologies for prescribing by stages.
methodology mean to you in the light of what has been
covered in this section so far. How might each tell you Treating Causation
something different about a patient and their health? Understanding causation can point to many interven-
tions in addition to the other homeopathic method-
ologies. An overwhelming infection will point to the
Which is Most Homeopathic? need to control the infective organism. Onset after a
In every case there are different assumptions that physical trauma such as a whiplash injury might point
are made to allow us to observe patients, identify to a manipulative treatment of the spine, or ortho-
their illness and suggest treatments. paedic intervention. In addition, life style changes
It is valid to use homeopathy in any of these might be indicated to remove maintaining causes.
ways but each has its own strengths and limita- Remembering to consider other treatments reminds
tions. Throughout this book I try to refer con- the homeopath of the importance of the context of
sistently to these approaches and methodologies general health care and maintenance in which you
with the aim of helping you develop a familiar- work, not just as a prescribing technician. You might
ity with a range of approaches and methodolo- like to reflect on the broader management that is
gies while appreciating that what homeopathy can indicated in Anne’s case (Case Study 5.1).
offer is bigger than any one. In some patients, the
best remedy may be indicated by more than one Trigger Events
approach or methodology. In other patients sev- Many remedies are renowned for their trigger
eral different remedies may be indicated by one events or causative factors, and working with this
methodology and a choice made between them. model it is always worth asking when studying the

55
CHAPTER FIVE Introduction to Prescribing
Foundation

CASE STUDY 5.1 CASE STUDY 5.2


Anne, age 27, has a cough that keeps recur- Jill (28), a hairdresser, presented with dermati-
ring. She uses regular cough linctus that helps tis of the hands aggravated by her work. After
I her sleep. She has an underlying asthmatic several unsuccessful prescriptions using dif-
element that is aggravated by dust mite and ferent methodologies, the skin improved tem-
animal dander. Anne is helped by isopathic porarily using the remedy Castor Equi, made
treatment of her dust mite sensitivity by using from the rudimentary thumbnail of the horse.
a homeopathic preparation of her known aller- Following this Jill obtained more significant
gens. She fails to make a further improvement benefit with a remedy prepared from a mix
from homeopathic treatment based on other of different human hairs. If she repeated this
approaches. She eventually finds another monthly she was able to carry on cutting hair.
home for her pets, takes steps to minimise
inhalant allergens and her cough stops.
a simple prescription that helped in a case that
did not initially improve with more complicated
homeopathic remedies, ‘what factors are likely methodologies.
to cause illness in patients needing this remedy?’. Tautopathy is a type of isopathy where the
Often in more complex cases a mix of causes might causative agent is a conventional drug, where the
be present. In others the causation is summed up as adverse effects point to their range of action and
the patient being ‘never well since’ something hap- they can be helpful when prepared homeopathi-
pened. How confidently this methodology points cally in treating iatrogenic disease or in reducing
to the best remedy, like any other, depends on the adverse effects. For example, a potency of a vac-
depth of the case and the extent other methodolo- cine can help ‘unlock’ a case of vaccine damage.
gies confirm the remedy. In more complex cases a previous or concurrent
prescription of a conventional drug can prevent
Isopathy and Tautopathy a case responding to a deeper-acting remedy.
One method of treatment on the basis of causa- In these cases a tautopathic prescription of the
tion is to focus on the use of medicines derived drug in potency can make a significant difference
from pathogenic agents of the disease or from to the case and allow another methodology to be
a product of the disease process, e.g. allergens, used, allowing a deeper remedy to be seen clearly
infective organisms, infected tissue or discharges. or to act more fully. We will return to how drugs
This is collectively known as isopathy and is one can act as an ‘obstacle to cure’ in Chapter 15.
of the easiest ways of prescribing. Homeopaths Another situation where this methodology can
differ in whether the selection of medicines on help is in patients seeking assistance in reducing
the principle of identical (as isopathy is sometimes conventional medication, for example in the with-
referred to), rather than similar criteria make it drawal of benzodiazepines, where careful tauto-
less ‘homeopathic’. There are many cases where it pathic doses can reduce the severity and duration
can ease symptoms or help a clearer picture emerge of withdrawal effects. Isopathic medicines can also
even if it does not cure. But in more deep-seated be used for the reduction of recreational drugs, e.g.
cases the benefits will often be limited in scope nicotine, amphetamines and hallucinogenic drugs –
and duration. although these conditions should only be treated
Examples of isopathic treatment include the when a more general appreciation of homeopathy
treatment of shoe leather, chlorine or nickel sen- has been gained so that reactions to prescriptions
sitivity with remedies made from leather, chlo- can be fully understood. If the conventional or
rine or nickel respectively. Jill’s case illustrates recreational drug is still being taken the benefits

56
Methodologies of Prescribing Within Each Approach to Treatment

Foundation
are unlikely to be significant or long lasting. Some tissue or diseased plants are called nosodes. They
remedies used isopathically have been proved and may be used isopathically and are particularly use-
a fuller picture of their materia medica is known, ful when there is a history of the particular illness
which allows them to be selected according to
other methodologies in addition to causation, as
in the individual, or in the family or society, as
these may all indicate a particular susceptibility to
I
the case of Lydia illustrates. an illness. For example, a patient who has been
unwell since influenza may benefit from a remedy
prepared from the influenza virus. The susceptibil-
CASE STUDY 5.3
ity of an individual due to an illness from the past
Lydia, who is 35, presented with palpitations
is considered as a trait or taint. Groups of patients
that had been present for 3 years. She had
often share certain taints, e.g. many patients
been fully investigated and had no organic
appear to have a susceptibility related to a past
heart disease, although she was getting occa-
history or family history of tuberculosis. These
sional runs of atrial fibrillation and at times
taints are referred to as ‘miasms’ – an important
her pulse would be quite high. She had been
concept in understanding more chronic illness and
treated conventionally with digitalis but it was
helpful in managing otherwise confused cases (see
increasingly failing to control this adequately
Chapters 15, 17, 22).
and she wanted to explore homeopathic treat-
In many remedies made from disease agents
ment before going down further conventional
and drugs there are provings that frequently cor-
treatment routes. One of the aggravating fac-
respond in some ways with the disease picture
tors for the palpitations was coffee and she
and side effects but with the sort of enhanced
had avoided this in her diet. She gave a his-
detail only possible from a detailed proving. Some
tory that prior to the palpitations she had sleep
homeopaths use the disease picture and adverse
problems, which also had been aggravated by
effects of certain drugs as a way into the materia
coffee. Coffea might have been prescribed on
medica of these substances.
an isopathic basis but in this case it also fitted
because in the materia medica of coffee there
Anticipating Causes, Prophylaxis
is an unusual extreme sensitiveness and sus-
or Preventative Treatment
ceptibility to nervous agitation. As a confirma-
In some cases it is possible to anticipate likely caus-
tory she disliked tight clothing.
ative factors, e.g. childbirth, surgery, exposure to
Interestingly, after getting a substantial
infection (such as a sibling’s chicken pox), or sus-
improvement in her palpitations after Coffea
ceptibility to travel sickness. It is possible to use
she was able to reduce her digitalis, although
homeopathic treatments prior to the (causative)
she did relapse on two occasions after taking
event in the hope of stimulating the vitality, so that
strong coffee.
it is already ‘keyed up’ or ‘keyed in’ to respond to
the causative factor. Many patients find using rem-
edies this way helpful to reduce the likelihood of
Other examples of isopathy include prescribing illness and to reduce the severity of any symptoms
allergens like pollen in hay fever, infective agents that develop. Preventative treatment raises impor-
or disease discharges in infections, and healthy tant questions about how accurately the effect of
and diseased tissues in disease of specific organs any event can be predicted and to what extent and
and tissue. at what level remedies can act to prevent illness.
This is explored in Chapter 6 when health and ill-
Nosodes and Family History ness are considered in terms of the presence and
Homeopathic medicines derived from diseased absence of information. It is important to remem-
tissue including micro-organisms, diseased animal ber that effects are also capable of being causes in

57
CHAPTER FIVE Introduction to Prescribing
Foundation

their own right and that cause and effect are not that are involved in a disease process or involved in
always best understood as a linear or one-way reac- detoxification uses remedies based on the affinity
tion. For example, the Bach flower remedies recog- that some homeopathic remedies have for particular

I nise the feelings the patient has as both an effect of


something that has happened to them and also a
organs (organotrophic remedies), e.g. Chelidonium
and Nux Vomica have an affinity for the liver.
cause of other things that are happening. Sometimes there may be a disordered organ
due to a previous illness, family susceptibility, par-
Bach Flower Remedies ticular illness or environmental poison, to men-
Bach flower remedies are prescribed on the basis tion just a few causes. It is unlikely that a remedy
of key emotions, and it is interesting to look at selected this way will match at a very individual
how they were developed using the feeling fac- or deep level but it may be a methodology to
ulties of the homeopath. Dr Edward Bach, when help see a clearer case, relieve a patient’s suffer-
feeling particular, strong emotions, was drawn to ing or to support other treatment approaches.
certain plants and substances. He found that by Sometimes these may be isopathically prescribed,
using medicines made from those plants, those e.g. a homeopathic preparation of thyroid gland
emotions were alleviated. This led to the develop- may help normalise symptoms in patients with
ment of his range of flower essences. These are thyroid problems when used alongside other
very useful when you are starting to enquire about treatments. Many herbal remedies are known by
the patient’s emotional state and wanting to sup- their action on different organs and some of the
port the patient emotionally, but not yet able to homeopathic remedies made from these herbs
match a remedy at a deeper level. have affinities with these organs. This organ-based
methodology is useful not only in patients with an
Maintaining Causes unclear deeper picture but also those with a low
The presence of maintaining causes is, as you would vitality when organ support and drainage can be
expect, a common cause of relapse or of limited an important initial stage of treatment while the
response to a prescription based on those causes. vitality builds or a deeper picture emerges. Some-
A cause may still be present or ongoing such as an times this is refered to as clearing the case.
allergy where the allergen is still present or an infec- Toxins may include metabolic products some-
tive organism is present. In practice there is often a times referred to as homotoxins and some remedies,
hierarchy of causes and this may only become clear or combinations of remedies (antihomotoxins) are
over a course of treatment. Identifying maintain- prescribed on the basis of reversing this or as an
ing causes that the patient cannot throw off is one antidote (A O’Byrne 2003).
indication that a deeper causation exists.
Treating Symptoms
Detox, Organ and Drainage Treatment This approach (see also Chapter 9) identifies
Detoxification treatment is based either on seeing homeopathic remedies in terms of the presenting
toxicity as causation, or on recognising that certain symptoms, e.g. prescribing Ipecac for nausea.
organs are actively engaged in detoxification and A combination of the location and presenting
need support and/or stimulation during treatment. symptom gives many conventional diagnoses e.g.
For example, lead and other heavy metals or envi- tonsillitis – ‘itis’ meaning an inflammation of the
ronmental pollutants, at levels much lower than are tonsils. Prescribing based on a single main symp-
thought to be toxic in the normal population, may tom or diagnosis is sometimes referred to as local
be toxic in susceptible patients. Homeopathic medi- prescribing. It becomes more unique and individ-
cines made from toxins such as these appear to help ual the more the symptom ‘sums up’ the patient
by assisting elimination of the toxins or by reduc- in a unique and individual way. The stranger and
ing susceptibility. Supportive treatment for organs more peculiar the symptom to the disease or to

58
Methodologies of Prescribing Within Each Approach to Treatment

Foundation
the patient, or both, the more likely the remedy make up the ‘two sides’ of the whole and they are
will match the patient’s needs. explored in much greater detail in Section III. The
At the next level several symptoms may be taken complete totality would encompass every symptom,
into account, to see which remedies fit each of the
symptoms. When two or more symptoms are linked
however minute, and the exact constitutional would
cover everything to which the patient is susceptible.
I
together in the same illness or at the same time In practice these methodologies can only approxi-
they are referred to as concomitant. Depending on mate to an individual and may point to different
the association of the symptoms, how fully they remedies.
describe the case and how unique they are, they The constitutional methodology is described
can indicate a very individual remedy. Throughout by Watson (1991) as taking the whole person into
Section II the symptomatic approach is revisited. account as far as is possible, and treating the person
In cases with many different symptoms and lay- simultaneously on all levels – physical, mental and
ers of illness it can be helpful to identify the cen- emotional. The expression ‘treat the person not the
tral or most unique aspect of the case, sometimes disease’ is central to this methodology. The correla-
referred to as the ‘central disturbance’. Prescribing tion between the constitution and a person’s resil-
on the central disturbance is more likely to give a ience to illness leads some homeopaths to promote
remedy that matches the most central and deepest the prescription of a constitutional remedy as a way
aspects of the patient’s case. of preventing illness. The constitutional approach
embraces several different methodologies that are
connected in that they see aspects of the ‘non-
REFLECTION POINT
pathological features’ of the patient reliably indi-
● Before considering other approaches to treatment
cating remedies that either reflect the susceptibility
and their methodologies reflect on the strengths and
to certain situations or the totality an ill patient
weaknesses of using causation and symptomatic
is likely to develop. It includes the constitution
approaches. What sort of cases would they work well on
described on physical features like body shape, hair
and when might they not be indicated?
colour and morphological type, such as phosphoric,
carbonic and fluoric types. It also encompasses the
Treating Using the Totality constitution described in terms of the psychological
and Constitution character, including emotional type, which became
Each individual is influenced by many different the dominant methodology for many homeopaths
experiences, both physical and psychological, and in the latter part of the 20th century and is some-
the complete clinical picture encompassing all times referred to as the Kentian method after James
symptoms, signs and investigations is the total- Tyler Kent. The materia medica studied or used to
ity. The totality approach (see also Chapter 14) is match to the constitution is sometimes referred to
sometimes described as like a ‘three-legged stool’ as the constitutional picture of a remedy, and the
combining local, mental and general symptoms – patient as fitting a constitutional type.
and like a stool all three legs are needed to make a
‘Ten years of practice will be a revelation to you, so that
stable and reliable base from which to prescribe.
you will understand people and their minds. You will
As homeopaths, working holistically, we see all
almost know what they are thinking, and will often take
our patients having psychological changes due to
in a patient’s constitution at first glance.’
their somatic condition and somatic changes due to
James Tyler Kent, Lesser Writings
their psychological state. In a ‘world without gaps’,
when one thing changes all aspects change. While
the totality is the complete clinical symptom picture Treating Using Essence and Theme
when a patient is ill, the constitution is an expression Running through constitutional and totality
of the sum susceptibility of the patient. Together they ‘pictures’ and ‘types’ are different themes used

59
CHAPTER FIVE Introduction to Prescribing
Foundation

both to compare remedies and to prescribe on be aware of this in the early stages of studying
more thematic and essence criteria. The essence homeopathy so that themes, when they exist, can
and thematic approach (see also Chapters 22, be noted when studying ‘related remedies’ or dif-

I 29) selects a treatment on the patterns of symp-


toms, signs, and behaviour of the individual and
ferential diagnosis.
There are also themes that run through groups
matches them to the essence and thematic pat- of patients connected by, for example, appear-
tern of the remedy. This description often allows ance, family, race, etc. This can be an important
a more ‘joined-up’ description of the patient pointer when prescribing for young children on
where each symptom is connected to other symp- themes that run through the parents or in vet-
toms and forms an overall pattern to the case. erinary prescribing, where there may be themes
While some patterns are clear ‘for all to see’, for running through species, herds of animals or even
others the patterns are not so clear and like some between owner and pet.
Impressionist paintings different observers may see Some themes can be very specific and indi-
and interpret the case and picture differently. cate a single or small group of remedies or
The essence methodology focuses on match- patients. Others can be more general and rep-
ing a single central pattern that expresses itself resent large groups of remedies or patients. For
throughout the patient’s case and remedy picture. example, the many Natrum muriaticum (com-
It was described and used in many cases that would mon salt) qualities such as reserved sensitivity
have been difficult to treat using other method- that runs through many, but by no means all,
ologies by George Vitoulkas. The emergence of English patients.
this methodology has coincided with, and some There are many different ways of seeing and
would say enabled, an understanding of illness expressing the patterns within groups of patients
with increased awareness of how a single pattern and remedies. One of the best-known looks at
or gestalt can run through a patient’s psychologi- links related to the historically common illness
cal and physical state. Frequently in chronic illness of scabies (psora) and the deep-seated illnesses
this pattern can be expressed or noticed as linked of syphilis (syphilitic) and gonorrhoea (sycosis).
to a core emotional state. These patterns of illnesses set up themes that are
The thematic methodology, which has devel- inherited and are referred to homeopathically as
oped from using essence, observes that in many miasms, the ‘traits’ referred to earlier, and lead
patients and remedies a single theme fails to to a miasmatic approach to prescribing. While
adequately express or explain all the symptoms. these three miasms have a long history in guiding
By observing several patterns or themes running homeopathic prescribing, the recognition of other
through patients and remedies, we can more miasms or themes, due to previous, inherited or
often accurately match patients and remedies. cultural illness can shed light on otherwise diffi-
There are some themes that run through a num- cult cases (see Chapter 22).
ber of remedies and this has led to a significant The understanding of remedies in groups also
development in the studying of homeopathic allows the homeopath to begin to look at the
remedies based on grouping remedies together. relationship between remedies above and beyond
Often the same or similar themes run through those that have been historically noted and to
groups of remedies that are connected in other think of what remedies might complement, follow
ways, including by biological families, chemical well or be closely linked to remedies in the same
composition, location of remedy source, etc. For group or family.
example, remedies with high levels of carbon in
their source material share qualities of trepida- The Reflective Approach to Prescribing
tion, anxiety and fear; they are often pessimis- Changes in ourselves, including our emotional
tic and have negative attitudes. It is helpful to state, reflect what is happening around us.

60
Different Approaches in Practice

Foundation
Likewise, what you become aware of in yourself ‘right brain’, reflecting different brain wave activ-
in a relationship is a guide to what is happening ity and different areas of the brain associated with
in the other person and to the treatment required. each intelligence (Springer & Deutsch 1981). The
For example, noticing the desire to comfort a
typical ‘Pulsatilla’ child and using this to influence
relational model, reflective approach and psycho-
dynamic methodology are explored in more detail
I
a prescription is an example of this ‘reflective’ in Section VI, where the techniques that seek to
approach. In fact this is a factor in all ‘relation- use small and subtle changes including emotional
ships’. This can be an important guide to the treat- changes in the observer to help give insight into
ment required and by making it conscious it can what is happening in a patient are explored fur-
inform the homeopathic process. ther.
While the reflective approach to prescrib-
ing (see also Chapters 23, 29) is not historically
described as a core homeopathic methodology
it does, in experienced homeopaths, contribute
Different Approaches in Practice
to the choice of remedy. Perhaps more impor- Different homeopaths will use different
tantly, when not understood, it can lead to dif- approaches to prescribing in different cases. All
ficulties recognising certain remedy types or bias the approaches can help the homeopath to pre-
in prescribing certain remedies. The relationship scribe a similar remedy based on ‘like treating
between patient and homeopath influences (in the like’. Some approaches will be better suited than
author’s experience of supervising other homeo- others to finding the closest match (the simil-
paths) much prescribing, whether consciously or limum). Each homeopath is likely to develop
unconsciously, constructively or destructively. personal preferences of these different method-
Using a reflective approach underlies the descrip- ologies and over time and in different situations
tion of different remedy pictures as if they are these preferences will change.
people, where a collection of symptoms and signs Different methodology might well point to dif-
reflects a pattern that is described as if it has a per- ferent remedies. By matching the methodology
sonality, a history, a future, a life – so-called ‘living used to prescribe to the depth of the case, some
materia medica’. guidance is possible as to which method might be
The psychodynamic methodology is greatly most useful in what sort of case. An informed deci-
informed by the psychotherapeutic concepts of sion can be made between remedies indicated by
projection (transference and counter-transference) each methodology and the likely prognosis for each
explained more fully in Chapter 23. The poten- can be predicted. Distinguishing between remedies
tial to understand this has been facilitated greatly selected on a particular methodology or combina-
by the description of emotional intelligence. tion of methodologies helps in predicting the out-
Emotional intelligence refers to the capacity for come and progress of any treatment. Recording
recognising and working with our own feelings the approach and methodology used in making a
and those of others. In a medical context emo- prescription will also help at follow-up in assessing
tional intelligence gives insight into patients from a treatment.
observing their emotional state and the effect of
their emotional state on us and informs the advice Self-Healing
and treatment given. It is distinct from but com- Each individual has huge capacity to adjust to
plementary to academic intelligence focusing on threats and changes to their environment and
analytical and cognitive capacity and measured by situation with imperceptible or minor symp-
IQ (Gardener 1983, Salovey & Mayer 1990). The toms. Many are recognisable as the body ‘tell-
emotional and academic intelligences are some- ing us something’, e.g. tiredness, particular food
times colloquially described as ‘left brain’ and desires, a twinge in the leg, a mild sore throat.

61
CHAPTER FIVE Introduction to Prescribing
Foundation

The homeopath should always remember that


BOX 5.3
most patients with most illnesses get better on
Treatment of Sore Throats
their own. If the self-healing process is unfolding

Aconite for a sore throat started after being
I without hindrance then at best we may make just
a slight improvement in the speed of recovery and
in a cold wind or after a shock. Especially
if burning, redness, smarting, dryness, tin-
at worst we may slow, prevent, or manifest a new
gling in the throat and if it hurts to swal-
deeper illness. Giving no prescription is always
low water.
an option. It is not the same as giving no treat-

Baryta carbonica for recurrent cases of
ment, as reaching this decision will have already
sore throat following exposure to cold and
included elements of a therapeutic consultation
chill, and better for drinking. The tonsils
and identifying obstacles to cure. Not prescribing
are frequently large, especially the right
is important if a disturbance is resolving rapidly
tonsil. Suited to timid children. Offensive
as there may be no clear case to prescribe on or a
foot sweat. Better swallowing fluids.
previous remedy may be acting.

Belladonna often has a viral type fever with
a dry and burning sore throat. The tonsils
are often inflamed and bright red with a
Straightforward Cases red, hot face and skin. Worse talking and
any touch but with little or no thirst.
Having looked at the range of different methodol-

Gelsemium has a sore throat that develops
ogies and approaches available to the homeopath,
several days after exposure to warm moist
it is appropriate to concentrate first on what are
relaxing weather, they are very shivery but
generally the easiest conditions to prescribe for.
with little thirst.
These are generally the conditions where there is

Lachesis for a similar burning pain in the
a clear and single causation – what we will call a
throat worse from swallowing liquids but
straightforward case – and those conditions where
due to over use of the voice with pain
there is a clear symptom picture of recent and
worse on the left side. The throat appears
relatively quick onset, typically an acute illness,
more blue or purple colour than red and is
what we often call a simple case. These will, if the
characteristically much worse for any con-
vitality of the patient is good and the trigger not
striction around throat.
overwhelming or persistent, respond well to treat-
ment. In many cases the methodologies will be on
causation and/or main symptoms but a totality
or other methodology may be used if the remedy
suits the patient. I advise you start by prescribing for straightfor-
The example of some of the local remedies used in ward and simple cases the 12c or 30c strengths of
treating acute sore throats is given in Box 5.3; there remedies. In the most acute situations these may
are many others but it gives the sort of informa- be needed every half hour (or more) and as symp-
tion that can distinguish them. While sore throats toms improve the interval between repetitions can
are often amenable to local treatment some may be increased. As a general rule, repeat a remedy
indicate a more deep-seated condition, particu- as often as is needed but stop when no further
larly if they are recurrent or persistent. Certain improvement is obtained. Be warned that it is
remedy pictures are more tuned for these chronic very easy to get diverted into hunting for a perfect
presentations. The selection of potency and fre- potency, with each text and school suggesting dif-
quency of administration of remedies is covered ferent potencies, rather than concentrate on the
in Chapter 20. For those new to homeopathy most important task of finding the closest remedy
and while developing your knowledge and skills match possible.

62
Bibliography

Foundation
In many straightforward cases the symptoms a pathic approaches and this lays the foundation for
patient gets are acute because the causative factors managing homeopathic patients. Prescribing on
happen suddenly, or certainly reach a threshold causation and presenting symptoms can offer a great
suddenly. The causative factors may be physical
(trauma) or emotional (shock) but tend to be quite
deal in the treatment of acute illnesses but a solid
foundation of the principles will also prepare you
I
large and the situational and environmental change for exploring the methodologies and approaches
that precipitates the illness is often the most appar- necessary to tackle more deep-seated cases and
ent factor leading to the remedy. The importance more chronic illness. In the next section we look
of understanding the cause is that if a number of at factors which affect prescribing in simple cases
different individuals experience the same cause and introduce the idea of complex cases and their
then many of them are likely to get the same illness management.
and need the same remedy. If the strongest stimuli
present an individual with a situation they are just
not prepared for and do not have the information References
to cope with they will get ‘ill’. Untreated it is likely
Gardener H 1983 Frames of mind. Basic Books,
to take some time for an individual to re-balance New York
and take on board the information they need to
cope with that situation – homeopathic treatment Salovey P, Mayer J 1990 Emotional intelligence.
Imagination, Cognition and Personality 9:185–211
can greatly speed up this process.
The strength of the cause and individual sus- Springer S, Deutsch G 1981 Left brain, right brain.
ceptibility will determine the extent and degree W H Freeman, San Francisco
to which this is true. In some individuals there Watson I 1991 A guide to the methodologies of home-
might be a predisposition to particular causes so opathy. Cutting Edge Publications, Kendal
one patient might find a specific food upsets them
but not others. In others there may be a cause
that affects most individuals, e.g. a strongly toxic Bibliography
substance in the environment. In others a patient Bellavite P, Signorini A 1995 Homeopathy: a frontier
might only be sensitive in certain situations such in medical science. North Atlantic Books, Berkeley
as being sensitive to an allergen only when they
Blackie M G 1976 The patient not the cure. MacDonald
are stressed or at a certain threshold of exposure.
and Jane’s, London
Cameron D M 1951 Low potency prescribing.
Br Homeopath J 41(2):77–92
Summary
Lockie A H 1989 The family guide to homeopathy.
At the end of Section I you have examined the Elm Tree Books, London
basic principles and laws of homeopathy, how
Lockie A H 2000 Encyclopedia of homeopathy. Dorling
the information of materia medica is derived
Kindersley, London
from provings, and looked at the homeopathic
case as a way of understanding the patient and O’Bryne A 2003 The symphonic architecture of antiho-
the illness. In Chapter 4 we explored the broadest motoxic medicine. Explore 12:3
principles behind analysing cases homeopathically Roberts H A 1936 The principles and art of cure by
and the important questions upon which we need homeopathy, a modern textbook. Homeopathic
to reflect. In this chapter the different approaches to Publishing Company, London
treatment and methodologies for prescribing have Vithoulkas G 1980 The science of homeopathy. Grove
been covered to create an overview of the homeo- Press, New York

63
CHAPTER SIX

The Symptom, Susceptibility Philosophy

and Hierarchy
David Owen

Introduction the homeopathic ‘laws of cure’. These laws of cure,


like many other aspects of homeopathy, have devel-
Symptoms occur when a patient is not in harmoni- oped over many years of careful observation.
ous balance with their environment. The environ- While the approach and response to treat-
ment includes any relationships, their life situation ment is influenced by the disease a patient has,
or circumstances and their life style, as well as the the homeopath is more interested in the patient
‘ecological environment’. All these together con- who has the disease. For this reason it is helpful
tribute to the patient’s ‘environment’. This chap- to speak less about how acute or chronic an ill-
ter explores the way the patient and environment ness is but rather how simple or complex a case is.
relate. The interface between the patient and envi- While acute illness is often present in straightfor-
ronment reflects in its broadest sense the symp- ward and simple cases and chronic illness in more
toms a patient has. complex cases, this is not always so. A complex
Section I looked at symptoms arising from a case may present with an apparent acute illness or
cause in the environment. In this section symp- symptom that is in fact simply the ‘tip of the ice-
toms are explored through the susceptibility of berg’ as far as the case is concerned. A simple case
the patient as this determines what causes they may present with a longstanding chronic symptom
are susceptible to. The relative significance, value but when the cause is removed or a local remedy
and importance of each symptom is important to given the symptom goes completely.
understanding the susceptibility of cases with sev-
eral symptoms. Homeopathically symptoms are
compared and ordered by looking at the breadth of Symptoms in the Different
systems affected, the depth and severity of symp-
toms, and how one symptom relates to another.
Models of Health
Being clear about the order or hierarchy of symp- ●
The pathological model sees the illness hap-
toms is important to understanding more complex pening to the patient, the symptoms being
cases and interpreting the reaction to treatment. predominately useful as pointers to causation
It helps the homeopath plan an appropriate treat- (although in practice this is often combined
ment and predict the response to treatment. with the biological model).
Understanding the range of possible responses ●
The biological model sees the illness as the
to treatment enables the homeopath to assess how effect or reaction within the patient in terms
curative any treatment may be. Particular patterns of of symptoms that the patient describes and
response are found to be so reliable as an indicator signs that can be observed. (Hereafter, both
of a good outcome that they have become known as signs and symptoms will be referred to as

67
CHAPTER SIX The Symptom, Susceptibility and Hierarchy

‘symptoms’, unless the distinction needs to can ‘make sense of ’ a wide range of illnesses. The
be made explicit.) Symptoms can either be pathogenic model perceives the world of disease
directly related to the illness in which case through aetiological agents (infections, toxicity),
they are called ‘local symptoms’, or inciden- the biological model perceives the world of disease
tal to it, i.e. non-local. In physical illnesses through effects (organ, disease process/inflamma-
non-local symptoms are often the mental and tion). In the totality model the disease is seen in
Presenting Symptoms

emotional symptoms, or those relating to the the context of the world of the patient (mind,
Causation and the

physical environment called general symp- body, general). In the holographic model the dis-
toms. In the symptomatic approach to treat- ease is seen in the context of a pattern or theme
ment it is usually the local symptoms that are running through the disease and patient (overac-
identified and on which treatment is based. tive, underactive etc) and in the relational model

In the holistic model the local physical symp- in terms of the effect of the individual on their sit-

II toms, the mental symptoms and the general


symptoms give the case.
uation, including their effect on the homeopath.
Table 6.1 suggests some of the trends that run

In the holographic model the qualities that across the different models of health, although these
run through several symptoms or the pattern are not hard and fast and many cases can be helpfully
expressed through the symptom are most perceived through several models or views of health.
important. Identifying these provides part of the information

In the relational model it is the deepest most for assessing the type of case that best describes a
fundamental sensation and feeling that under- patient (see Chapter 10) and on which management
lies the symptoms and how this affects others decisions are made. For example many prescribers
that is used to select a prescription. will use a different remedy potency depending on
their view of the case (see Chapter 20).
Illnesses in the Different Models In the pathological model the illness is caused
of Health by something that disturbs the equilibrium of the
Different models of health provide the homeo- patient and is to be overcome. In the biologi-
path with a spectrum of views of patients that cal model the illness is a change in the patient

Table 6.1 THE FIVE MODELS OF HEALTH AND SOME TRENDS RUNNING ACROSS THEM
Perspective Localisation Suitable for Potency
Models of of the of the cases that are: (see Chapters
Health Focus On Homeopath seat of illness (see Chapter 10) 15 & 20)

Relational The Therapeutic More Subjective More internal to the More hidden Higher
Relationship patient e.g. 10M

Holographic The Pattern or More confused e.g. 1M


Sensation behind
the Symptoms

Holistic The Patient’s Totality Complex e.g. 200c


and Susceptibility

Biological The Illness and Simple e.g. 30c


Presenting Symptom

Pathogenic The Illness and More Objective More external in the Straightforward Lower, e.g. 12c
Its Cause patient’s environment or 6c
or situation

68
Using Different Models and Approaches

expressed as symptoms that are the reaction of the e.g. aspects of Sankaran’s levels, and how they may
individual to the cause (influenced by the patient’s connect to the models of health (Sankaran 2004).
susceptibility). The homeopath seeks to find a
remedy through an approach that takes account The Cause Behind the Cause
of several significant symptoms. In practice the When we assess a patient in the biological model,
pathological and biological models are under- we endeavour to understand the symptoms.

Presenting Symptoms
stood through the dynamic between patient and Causation will not suffice if it does not explain

Causation and the


the situation they are in. Both often see illness as a such questions as:
threshold event where patients often believe that ●
why has this happened now?
the onset of an illness is sudden. In many cases ●
why has it caused these particular symptoms?
however, when a careful and comprehensive his- ●
why, even when the cause is removed, have
tory has been taken it may become clear that the things not improved?
illness has been developing for some time.
For example, in many ‘infections’ it is not a II
complete or accurate account of the disorder to
REFLECTION POINT blame only the infective organism, we need also
● Any ‘model’ will only be accurate to a certain extent and to understand the terrain that allows the infection
different ways of understanding illnesses and patients to thrive. When trying to understand the way the
will each provide different strengths and weaknesses. illness has developed we must ask how or why a
What do you think the strengths and weaknesses of the patient’s health was originally disturbed to become
five models of health presented are? susceptible to infection now.

Table 6.2 gives a suggested comparison of the REFLECTION POINT


models presented so far and two other comple- ● Remembering that healing is something that happens
mentary ways that you might like to study further, within patients rather than something the practitioner
e.g. five-element theory provides one way of seeing does to or for them, you might like to reflect on the
patterns that run through cases and remedies (see purpose of illness and the qualities of healing. What
Chapter 21 page 279) and is used extensively in tra- are the implications of the different views each model
ditional acupuncture (Maciocia 1989). There is no of health offers on the homeopath’s role in the healing
reason why you should use any particular number process and understanding of what a cure is?
of different models or stages and you may seek to
connect and merge a number of different systems,
Using Different Models
Table 6.2 COMPARISON OF MODELS OF HEALTH
WITH FIVE ELEMENT THEORY AND SANKARAN’S and Approaches
LEVELS
When it is difficult to see one remedy that links
Five Element Sankaran’s
Models of Health Theory Levels the causes and the different symptoms together
some homeopaths respond by treating each group
Relational Ether Energy of symptoms separately. This can lead to a rather
Holographic Fire Sensation piecemeal approach to treatment. Another option is
to look at the patient from another perspective such
Holistic Air Delusion/emotion
as the holistic model of health, where one remedy
Biological Water Fact may cover a greater proportion of the case. Each
model sees illness and health in a different way
Pathogenic Earth Name
and if one model of health leads to only a partial

69
CHAPTER SIX The Symptom, Susceptibility and Hierarchy

understanding of the case another model may pro- Symptoms are produced by the individual in
vide a better understanding – and several together response to the situation they are in. Those symp-
an even better understanding. In the holistic model, toms bear a relationship to the patient’s situation,
every aspect of the patient is important and the sus- including the causative factors. In response to
ceptibility of the patient and the hierarchy of the certain strong causative factors most individuals
different symptoms become central to understand- will get symptoms. In response to other causes,
Presenting Symptoms

ing the case. The holistic model invites a view where whether an individual gets any symptoms or what
Causation and the

illness and health are not opposites but aspects of those symptoms will be is determined by suscep-
the same whole (see Chapter 11). In later sections tibility. In this way both the cause of any symp-
of the book the holographic and relational models tom and the symptoms themselves reflect the
of health invite you to reframe your concept of ill- patient’s susceptibility. If a student in a class of
ness, where health and illness are informed by the 20 has an infection then if very virulent all the

II relationship to the observer and illness can be seen


as a necessary part of being healthy, both for an
other students might catch it, if less virulent only
those with susceptibility will get it. Each student
individual and a population (see Chapter 26). who catches it might get slightly different symp-
These evolving principles and perspectives pro- toms – how these symptoms differ point to each
vide both a rich and wide interpretation of illness individual’s susceptibility. While several of the
and reflect the uncertainty and art of clinical prac- students might respond to the same remedy the
tice. The model of health used to best understand more unusual the symptoms the more it points
the case will most often determine the approach to a unique susceptibility and the more likely a
to treatment and point to the methodology to remedy will be needed to suit that individual’s
select the remedy. Any homeopathic remedy can susceptibility.
be prescribed according to any approach as long As the causes and symptoms become more com-
as the relevant homeopathic picture of the remedy plicated the more the homeopath aims to build a
is available. In practice some remedies are better deeper picture of the patient. This is achieved by
known in some approaches and methodologies understanding both the cause and effect from the
than others. To help unravel this it is necessary to perspective of the patient’s susceptibility. The sus-
examine the symptom and its depth or hierarchy ceptibility of each of us shapes our tolerance to
in relation to the patient’s susceptibility. different environments, our resistance to different
illnesses and our sensitivity to particular remedies.
Susceptibility By determining our response to different stimuli
‘If a man were in perfect health, he would not be sus- and challenges in our environment, our suscep-
ceptible. Whatever man is susceptible to, such he is, and tibility colours every aspect of our nature and
such is his quality.’ behaviour.
John Tyler Kent In more complex cases different symptoms
each reflect the patient’s susceptibility; this is
‘By susceptibility we mean the general quality or capa- taken into account in the holistic model of health
bility of the living organism of receiving impressions, the and is why susceptibility plays such a central role
power to react to stimuli. Susceptibility is one of the fun- in understanding cases holistically (see Section
damental attributes of life, upon it depends all function- III). Deciding which symptoms are more central
ing, all vital processes, physiological and pathological. to the case helps us to know how strongly they
Digestion, assimilation, nutrition, repair, secretion, excre- should be considered and is done by deciding on
tion, metabolism and catabolism as well as all disease their place in the ‘hierarchy of symptoms’. The
processes arising from infection or contagion depending most central symptom often points to the ‘centre
on the power of the organism to react to specific stimuli.’ of the case’ and is sometimes referred to as the
Stewart Close, The genius of homeopathy ‘deepest disturbance’.

70
Using Different Models and Approaches

Hierarchy of Symptoms and Perspectives other symptoms are linked together – if there
of Depth: Penetration, Levels, Breadth, were several themes each could be thought of as
Layers and Intensity a layer that might each cover part of the whole
If susceptibility and symptomatology express a or that might be understood as one intertwined
patient’s unique individuality, then hierarchy provides with another. We might talk about a Phosphorous
the structure through which it is expressed and the ‘layer’ or the Tubercular ‘layer’; both these rem-

Presenting Symptoms
perspective through which it is seen. Each model of edies might be partially indicated in the same case

Causation and the


health has a slightly different way of perceiving the (see Chapters 26, 27). In the relational model
depth of symptoms (Table 6.3). I suggest when talk- it is the ‘intensity’ of the feeling, sensation and
ing about causation or aetiology it is helpful to think relationship that indicates its importance. So the
about how deep a cause ‘penetrates’. Thinking about strength of feeling and how unusual the feeling is
localised symptoms it helps to identify the ‘level’ of both influence how important it is.
the symptom, sometimes on an axis of peripheral
to most central. In the totality or the constitution
Each model of health allows perception of
the patient and the illness at different depths and
II
each feature or symptom is viewed in the context the information from one may give more useful
of ‘breadth and continuity’ with other features and and deeper information than information from
symptoms through the whole picture. another. It is not the case that causation always
Thematically, symptoms can be understood as gives more superficial information than a theme
connected to a series of layers, overlapping and or relational insight. Table 6.4 illustrates the sorts
overlaying each other. In an essence approach then of perception possible in each model.
those symptoms with themes that run through In taking and analysing the case the homeo-
path often combines several different approaches
Table 6.3 WAYS OF EXPRESSING DEPTH IN and therefore systems of ordering the symptoms.
RELATION TO THE FIVE MODELS OF HEALTH The same feature or symptom might be inter-
Modes of Health Perception preted differently in each model and according to
the approach used. It may help to think of these
Relational Intensity of relationship
perspectives as different axes or different ways of
Holographic Layer of theme viewing or ‘focusing’ on the case (Swayne 1998) –
these are considered in more detail in each relevant
Holistic Breadth of constitution/totality
section. Approaches based on ‘cause and effect’ mir-
Biological Level of symptom ror much of the conventional practice of weight-
ing the importance of aetiology and presentation
Pathogenic Penetration of cause
of clinical symptoms. Many homeopathic students,

Table 6.4 THE SORTS OF PERCEPTION POSSIBLE IN EACH MODEL


Breadth of Intensity of
Penetration of Cause Level of Symptom Constitution/Totality Layer of Theme Relationship

A coffee kept me awake I’m restless I like to be on the go I digest things quickly Friends say I’m ‘wired’

I’m tired as I didn’t I’m weak and I always want to be My digestion and I make others ‘buzz’
sleep well lethargic busy bowels are rushed’

I’ve not slept well since I fall asleep at work My body and mind are Everything in my body The patient’s homeopath
we moved always sluggish works too fast and is exhausted by the
my mind speeds all consultation
over the place

71
CHAPTER SIX The Symptom, Susceptibility and Hierarchy

who are aware of the conventional model of disease As a local approach to treatment had failed to cure
classification, find biological and pathogenic models Sam a totality approach was taken. In this approach
of health an easier place to identify the hierarchy of the symptoms related to Sam’s behaviour and per-
symptoms, so initially find it easier to either prescribe sonality were important, as were those relating to
homeopathically in these models or prefer remedies temperature and food, especially the more unusual
indicated more strongly by these approaches. ones. He had themes of the remedies Pulsatilla and
Presenting Symptoms

Each of these different perspectives of symptoms Phosphorous. The feeling in the homeopath also
Causation and the

can be considered in terms of their clarity, dura- revealed aspects of the case. Sam was prescribed the
tion, uniqueness and influence on the patient (and remedy Phosphorous on a balance of information
homeopath). A causation may be more important from different approaches. After three doses of the
the longer it has been going on. A local symptom 200c Sam’s recurrent acute problems stopped and
will often be most important the stronger it is and his mother reported that he generally seemed to

II the more it restricts a person’s life. In a totality or


constitutional approach the more unique or unex-
have ‘more energy’ and was less ‘clingy’.
Given the importance of the distinction
pected the symptom the more it might reflect the between the different models I recommend you
patient’s individual state and so point to a remedy clarify for yourself – if necessary revisiting the
with the best indications. This is why symptoms tables above – what you understand when we talk
that are strange, rare and peculiar (SRP) are so about depth, level, hierarchy, breadth, layers and
important at giving person-specific ‘keynotes’. intensity of symptoms.

Combining Different Models


REFLECTION POINT and Approaches
● Sam’s case illustrates some of these different As the case of Sam illustrates, in practice as you
perspectives. You might try to decide which fits which learn about and become experienced in different
approach to treatment and how the perspectives models and approaches they will often point to the
compare. same remedy and reinforce the confidence of any
prescription. In more difficult cases you may have
to choose between remedies partially indicated;
the clearer you can be on the different approaches
CASE STUDY 6.1
and the perspective each gives, the easier it will be
Sam, 12 years old, was prone to recurrent
to manage these cases. While attempting to clar-
upper respiratory tract infections which he
ify these different approaches it is possible that
had had since pneumonia when 3 years old.
you will be tempted to over simplify or unreal-
Sometimes he got ear infections, helped with
istically separate out the information available in
Belladonna, sometimes sore throats, which
each model. In practice each model influences the
improved with Ferrum Phos. Despite local
others and how symptoms are perceived.
treatment, symptoms kept recurring. He was
Aetiology has to be interpreted in terms of its
worse in the cold air and craved cold drinks,
symptoms, its influence on the totality and con-
especially cold milk and iced water. He liked
stitution. It will bring forward some themes and
a lot of attention and sympathy when ill and
be interpreted in light of the relationship between
wanted to be held or stroked by his mother.
you and the patient. Each local symptom is in bal-
He always had a fear of the dark and a dislike
ance with its cause, is related to the totality, will
of loud noises and this theme of ‘sensitivity’
be part of a theme and create a certain response
seemed to underlie his need for sympathy. He
in you. Each theme has a cause, an effect and has
made the homeopath feel that they wanted to
its own complete picture and effect on you. Each
reassure him.
reflection is caused by something, produces and

72
Laws of Cure

notices particular symptoms, colours the totality sal of duration and depth. When treating a single
and relates to a theme. severe symptom there may well be other aspects
of the case to treat once the most severe symptom
is controlled. In these cases we see a cure proceed-
Laws of Cure ing with an overall improvement in how a patient
feels as they move from more severe (life threaten-

Presenting Symptoms
‘In all diseases, especially acute cases, the patient’s emo- ing) to less severe symptoms.

Causation and the


tional state and entire behaviour are the surest and most Understanding the laws of cure will tell you
likely of the signs showing a small beginning of ameliora- when a remedy has acted, when it is continuing
tion or aggravation. Where there is the slightest beginning to act and the direction of the action. It also indi-
of improvement the patient will demonstrate a greater cates whether and when a change of prescription
degree of comfort, increasing composure, freedom of spirit, (potency or remedy) is needed.
increased courage, a kind of returning naturalness . . . This
can be easily seen if one observes with exact attentiveness
By understanding the journey an individual has
to go through to get well, we can start to understand
II
but it cannot be easily described in words.’ and note where an individual is on that journey from
S Hahnemann, Organon, Paragraph 253 the symptoms they are experiencing in response to
the treatment. Fundamentally the journey into illness
Whichever model of health is used, the first indica- is cured by a journey out of illness, i.e. retracing your
tion of change in the direction of cure, i.e. the first steps, when the symptoms disappear in the reverse
indication that a true healing process has begun, order to which they appeared. It can be thought
will be an improvement in vitality and general well- of as a centrifugal force ‘throwing’ the illness out.
being. Changes in symptoms may accompany this, This clearing of symptoms may involve several heal-
or follow on from it as the vitality of the patient ing reactions; the main two to be distinguished are
improves. aggravations and healing crises (see Chapter 10).
When we recognise that illness comes about in
relation to natural laws that incorporate the hier-
archical relationships of symptoms that have been
REFLECTION POINT
described, then it should be apparent that rever-
Before moving on, take a few minutes to answer the
sal of illness or ‘cure’ will also follow a similar
following questions:
order. Understanding this allows us to judge if a ● What is the scope for an individual to self-heal and do
treatment has effectively stimulated the healing pro-
they always have the information needed to adjust to
cess before having to wait until the cure is complete.
the circumstances they find themselves in?
Hering first referred to this in 1867 in his book ‘An ● If, in response to an illness, an individual becomes
analytic therapeutic of the mind, volume 2’ but it
healthier, can we expect as life goes on that individuals
was not until 1910 that Kent first talked about
will become more and more healthy?
direction of cure (in the reverse order to which ● If suffering acute illnesses in childhood helps develop
symptoms appeared) and in 1911 that Kent wrote
resistance to difficult situations in later life, is it healthy
about Hering’s Law (Saine 2000).
to have an absence of illnesses as a child?
● Are there only three possibilities when you suffer an illness?
Hering’s Law 1. You gather the information to cope with the situation
Constantine Hering noted that cure proceeds in
you are in
reverse order of appearance of the symptoms,
2. You modify the situation you are in (or your
from the most important organs to the least impor-
circumstances)
tant organs, from within outwards (i.e. most cen-
3. You succumb
tral organs first), and from above down. In other ● Can you have more than one illness at a time?
words, essentially improvement follows a rever-

73
CHAPTER SIX The Symptom, Susceptibility and Hierarchy

The Patient, the Environment will not be apparent, rather they are noticed by
changes in the behaviour of the boat equivalent
and the Symptom to symptoms.
By considering an illness in terms of the relation-
ship between the patient and their situation, the REFLECTION POINT
homeopath understands the importance of each ● Boats, like human beings, all have much in common
Presenting Symptoms

in developing a subtler understanding of illness. with each other, although their ability to respond to
Causation and the

The interplay between an individual’s susceptibil- changing conditions varies. There is no single or
ity, their environment and the symptoms gener- optimum environment for all boats. Much depends
ated by their vitality can be illustrated by thinking on the configuration of the hull, the specific design of
of the analogy of a boat, what it is designed for, the vessel, where it is taken or the tasks it is used for.
the different conditions affecting it and the way it Different designs (patients) give different performance
II is crewed (Fig 6.1).
An individual’s journey through life might
(susceptibility). There is no one perfect design, rather an
optimum design for different situations and conditions.
be compared to a voyage in a small boat where How a boat performs in certain conditions might
the boat represents the individual. The sea and represent its health, which varies from ‘plain sailing’,
weather conditions represent the environment or going where you want to without a problem, to ‘making
situation the boat is in. The crew that can alter heavy weather’, to being ‘submerged’, ‘awash’ or even
course or ‘man the pumps’ represent the vitality. ‘swamped and sinking’.
The vitality, like the crew seen from a distance,

The Boat Metaphor–Illustrating the Interplay


between the Individual’s Susceptibility,
Environment and Vitality
Depending on the conditions the boat travels into,
or finds itself in. The environment and situation the
boat is exposed to will alter not only how it
performs but will also potentially fill the
boat up, whether from waves or rain.

The vitality/crew
The vitality is reflected in the fitness and the skill
of the crew: how able they are to navigate the
boat into the most suitable conditions and also
to pump the boat out when necessary

An individual’s susceptibility
Illness as recounted by patients, is often thought of as a threshold event. When the history The boat’s structure and design will itself dictate
is carefully taken, the boat can often be seen to be leaking, taking on water or not performing the situations and conditions in which it sails most
optimally for some time before suddenly sinking. In the same way, although patients may favourably, and the situations and conditions in
think an illness starts at a certain point in time, often the history will reveal there has been which it struggles. This is equivalent to the
a gradual onset, sometimes going on for many years before the patient first reports they individual’s constitutional susceptibility. To some
have become ill. By understanding the environment, susceptibility and the vitality, one can extent it will determine where the boat can safely
paint a dynamic picture of the health of the individual. As the situation gets more hostile, go, although modifications to it and careful crewing
so the integrity of the boat and the skill of the crew become increasingly important to can extend the range of the environments it can
maintaining health. Different boats, like different people, perform at their best in different move into.
environments.

Figure 6.1 The boat metaphor of the interplay between an individual’s susceptibility, their environment and the symptoms generated by
their vitality

74
The Patient, the Environment and the Symptom

The Environment Another way of describing vitality is in terms of


Different individuals find different environments a patient’s resistance to getting ill. In this respect
challenging to them. The environments that the it is similar to the conventional idea of immunity.
patient is exposed to will be determined in part by If the vitality is low then we are less able to cope
choices they make; when considering a patient’s with a change to our environment, as the case of
environment it is important to assess not only the Samantha illustrates.

Presenting Symptoms
physical but also emotional and intellectual state.

Causation and the


Factors such as stress, anxiety and fear often have
a significant impact on well-being. CASE STUDY 6.2
Samantha, age 23, suffered from eczema as an
The Individual infant and sporadically through childhood and
The characteristics we share in common deter- adolescence, which responded to a reduction
mine both the families and species we belong to
and our core susceptibilities. All individuals are
of dairy products. She consulted in her early
twenties with a recurrence of the eczema and
II
susceptible to certain environments. Some are spe- premenstrual syndrome that aggravated her
cific and peculiar to the individual, while others skin. When her vitality was challenged by pre-
may be common to the species, family or culture menstrual symptoms she become less able
we belong to. In nature when groups of organisms to cope with dairy products and her symp-
share basic characteristics, those characteristics toms deteriorated. The homeopathic remedy
categorise that group’s preferences for and opti- Aethusa was prescribed on her local symp-
mal situations where they flourish. toms and dairy sensitivity. It produced an initial
Different individuals’ susceptibility may vary aggravation of the skin, but this settled when
from the trivial to the seriously life threatening; she avoided dairy products. Once the aggra-
the effect will also depend on the degree of envi- vation settled, her premenstrual symptoms
ronmental exposure. For example, some patients had improved, the eczema improved and she
might be very sensitive to slight increases in expo- was better able to tolerate dairy products.
sure to sunlight, while all patients will be sensi-
tive to excessive exposure to sunlight. The more
unusual the susceptibility or greater the sensitivity
the more it tells us about the individual. REFLECTION POINT
● Reflect on the triad of the environment, the individual
The Vitality and the vitality and how these three factors affect how
A patient’s vitality is revealed by the way the individ- an illness is experienced. How does the classification of
ual adapts to the environment, and how particular illnesses as immune, acquired or inherited depend on
organs and systems function in particular environ- which of the three the attention is focused on?
ments. These adaptations are taking place all the ● In Samantha’s case which aspects correlate to the
time, and include slight changes in the healthy environment, the susceptibility and the vitality?
functioning of organs, such as a shift in preferences
for food or temperature, or a mental or emotional
reaction that might, for example, lead to particular The Symptom
dreams. Often these changes are only noticed when The symptom is how the organism’s self-regulating
something ‘goes wrong’; when symptoms develop, mechanisms respond to environmental challenges.
they become the way that we interpret the energetic In provings, susceptible individuals produce
state or vitality of the individual, although to the symptoms when they are ‘challenged’ by the rem-
trained clinician these changes can often be detected edy. The symptoms that develop, including any
even before a patient notices them. changes they seek to make to their situation and

75
CHAPTER SIX The Symptom, Susceptibility and Hierarchy

the environments they seek out or avoid, describe feature of living organisms and depends on the
the remedy state. The case of Peter illustrates the dynamic relationship between the susceptibility,
importance, in unravelling more complex cases, the environment and the vitality. When patients
of understanding the relationship between symp- become ill, they frequently recover their health
toms, environment and susceptibility. and discover a new way of being healthy without
‘treatment’. When this natural process requires
Presenting Symptoms

assistance the homeopath provides treatment to


Causation and the

CASE STUDY 6.3 facilitate these changes.


Peter presented with constipation and haem- However, there exists a tension in treating
orrhoids. He liked drinking coffee and eat- symptoms. On the one hand symptoms are how
ing spicy food that gave him an initial ‘buzz,’ illness expresses itself and therefore the aim of
but later aggravated him, causing increased cure is their removal. On the other hand symp-

II irritability and restlessness. He noticed that


when he became irritable and restless he
toms occur due to causes and susceptibility and if
these are not modified by treatment then symp-
craved more spicy food and coffee. Peter also toms recur or new symptoms come about. In
reported a contrary reaction to alcohol; hav- simple cases with minor or temporary causation
ing initially avoided it, he discovered it was a prescribing solely on the presenting symptoms
useful means of ‘slowing down.’ Nux Vomica may be adequate to throw off the symptoms and
relieved the constipation and haemorrhoids give a cure. In more complex cases an approach
and he discovered, after the remedy, it was that takes into account the many aspects of a
easier to avoid the foods and drink that aggra- patient’s life style and susceptibility needs to be
vate his symptoms. considered; in such cases thinking of illness and
treatment in terms of pieces of information can be
helpful (Wheeler 1948).
REFLECTION POINT
● The question posed is which comes first – the Remedies as Information
susceptibility of the individual to the diet or the diet When ill, patients often make spontaneous
causing the susceptibility? changes to their life style or situation. Animals are
drawn to helpful herbs, children ask for a cud-
dle or patients make simple diet changes or sleep
As a general rule, to operate effectively as a more. Illness often leads the patient to make the
homeopath it is important to be aware of the envi- changes necessary for healing. These qualitative
ronmental factors affecting the patient and, where changes can be thought of as providing something
appropriate, to support a patient in removing these required for healing and this can be thought of as
causative factors. When an appropriate remedy is a type of information. For example, in simple iron
prescribed an individual is better able to tolerate deficiency anaemia treatment might consist of
the situation and is often enabled in making envi- material doses of iron or, as is often the situation
ronmental modifications that may appear to hap- in mild cases, something that helps the digestion,
pen spontaneously, such as preferring healthier absorption or utilisation of iron may be adequate.
foods, sleeping better or dreaming more. Some herbs increase absorption of certain nutri-
ents, as might the prescription of homeopathic
iron; see the case of Sandy in Case Study 6.4.
Treating Symptoms In this way the remedies might be thought of as
The body is far more than just a collection of providing information for a natural process to
its parts. A damaged car would not repair itself function better and for the patient to move to a
but the body often can. This is a distinguishing healthier state than before – although this infor-

76
Treating Symptoms

mation, or some would say ‘energetic’ view, does


CASE STUDY 6.5
not preclude there being other models for how
Maxine, age 5, suffered from recurrent ear
homeopathic remedies act.
infections that responded temporarily to
homeopathic Belladonna but then recurred.
CASE STUDY 6.4 A more comprehensive case history was
taken indicating treatment with Calcium car-

Presenting Symptoms
Sandy, a woman of 35, presented with exhaus-
bonicum. Her mother reported that Maxine

Causation and the


tion. She had always suffered from heavy
periods but during the past 7 years they had was more energetic following treatment, was
become heavier and there was no evidence of more ‘alert’ and was sleeping better and less
uterine pathology. Her haemoglobin count was anxious. Maxine had ‘given up’ milk after tak-
10.6. She was diagnosed with iron deficiency ing the remedy and had started to stand up
anaemia and prescribed iron supplementa- to her brother more. After two subsequent
tion. The iron made her constipated, so she minor ear infections she remained clear of ear II
stopped it. Despite high levels of dietary iron infections.
and supplementation her iron stores still reg-
istered as low. When she presented homeo-
pathically she said, ‘I bruise easily’ and she Equally, perhaps they represented important shifts
also had a peculiar symptom of being sensitive in her situation. The more deep-seated the illness
to noises. She felt an immediate improvement the more the treatment is likely to alter the state
in her energy on Ferrum Phos 12c once a day of the patient and to lead to a change in situation
and after a month of treatment her haemoglo- and the environment they choose to live in. They
bin had marginally improved. After 3 months may change their temperature or food preference
the haemoglobin was 11.8 and after 6 months or change how they relate to other people; in
it was 12.4. Her heavy periods decreased and some cases it is prudent to warn patients of these
after a year she stopped taking the remedies possibilities.
regularly and needed only a short course after
a heavy bleed or when she felt tired. Working with Life Style Treatments
When a lifestyle cause is obvious and remov-
able, one approach to treatment is to encour-
Discovery Versus Recovery age the patient to make simple life style changes,
Each individual develops certain symptoms in e.g. change of diet or reduction of stress. Indeed
response to their particular environment, depend- if causes are not removed and symptoms treated
ing on susceptibility. Getting better, so that they no alone the illness is likely to express itself in some
longer ‘need’ these symptoms, requires a change other way or treatment may be unsuccessful due to
in the environment or their susceptibility, or both. a ‘maintaining cause’. Homeopaths recognise the
In practice the three elements of the triad of the need to work with life style factors alongside the
patient, the symptoms and the situation each correct prescription in order to obtain and maintain
change dynamically and a healthy state is one that health. The homeopathic case informs the homeo-
is evolving as each aspect of the triad changes. It path about diets, rest, exercise, relationships, etc.
is a process of discovery, not just recovery. While and a homeopathic prescription can facilitate what
the homeopath may provide support in this pro- might otherwise be difficult life style changes. For
cess it ultimately requires a change by the patient. this reason a homeopath is more than someone who
Maxine’s case shows this even in an acute illness. prescribes homeopathically – they are also aware of
Perhaps the giving up milk and standing up to and supportive of other treatments and advice that
her brother was just because she was feeling better. facilitate this healing process.

77
CHAPTER SIX The Symptom, Susceptibility and Hierarchy

Working with Other Treatment Modalities Summary


In some cases a symptom can be in its own right
a cause for another symptom. Treatment, in prac- In many minor ailments and acute cases prescrib-
tice, often requires working with a variety of dif- ing on the presenting symptoms with or without
ferent interventions and may involve bringing causation gives a well-indicated remedy. Treating
together several different strands of treatment to more complex conditions requires identifying
Presenting Symptoms

plan a programme that takes several aspects of a the deeper symptoms and understanding the
Causation and the

patient’s situation and susceptibility into account. hierarchy. In later sections we will revisit the
John’s case is an example. foundations set in this chapter including main-
taining factors, obstacles to cure, low vitality and
aggravations.
CASE STUDY 6.6
We have introduced two important con-
John, aged 28, had a history of eczema since
II childhood and asthma starting in his early
cepts, one of health as an interplay between the
patient’s susceptibility, vitality and situation (or
teens. The asthma responded only partially
environment), and a second of understanding
to a well-indicated homeopathic remedy. He
health in terms of information as well as gross
had a mildly kyphotic spine and poor posture.
material factors. These concepts will inform
John had a course of osteopathic treatment
the subtle examination of the materia medica
that ‘made him feel taller’ and after this the
and the homeopathic case in this section and
same homeopathic remedy became more
allow you to develop a structure for approach-
effective and the asthma started to improve.
ing more complex cases in subsequent sections.
They are not always easy concepts and they may
Many types of treatment can be utilised to clar- require further reflection in order to put them
ify a case and help in its overall treatment. This into practice.
book concentrates on the homeopathic interven- This chapter invites you to start to ‘re-frame’
tions but other approaches and their effect on the health in energetic terms, with illness a way of
case and response to treatment need to be consid- adapting to changing circumstances and envi-
ered as increasingly complex cases are treated. If ronment. Disease process provides an opportu-
remedies are thought of as information then they nity for the organism to respond to a stimulus
might be likened to a blueprint or an architect’s and acquire knowledge and resistance to illness
plan of a building. In order to construct or repair that allows the individual to explore many dif-
a ‘building’, in addition to the plan, physical build- ferent evolving and changing life situations.
ing materials are required. The absence of the right While patients with simple illness can often
material and support such as adequate diet, rest, do this themselves over time, it can be greatly
and relaxation (including emotional) accompany- speeded up using a homeopathic approach.
ing the correct remedy is a common cause for a Simple cases when the natural healing process is
well-indicated remedy failing to act. not facilitated or is blocked by drug treatments
(even mild analgesics, anti-inflammatories, anti-
REFLECTION POINT biotics and antihistamines, for example) are a
● If information is required for health how might this major cause of more complex cases. For this
relate to psychological, energetic, chemical or genetic reason being able to treat acute conditions and
information? How is treating a patient by modifying their simple cases homeopathically and isopathically –
situation or environment different from treating their whether in the home or by the homeopath, the
susceptibility? How does this affect their ‘resistance’ to family doctor, the nurse or the pharmacist –
other illnesses? is important in preventing more serious and
increasingly complex disease.

78
Bibliography

Clover A 1989 Homeopathy reconsidered, a new look


References at Hahnemann’s Organon. Victor Gollancz, London
Maciocia G 1989 The foundations of Chinese medi-
Gaier H 1991 Encyclopaedic dictionary of homeopa-
cine. Churchill Livingstone, Edinburgh
thy. Thorsons, London
Saine A 2000 The method, lectures on pure classical
Hahnemann S 1896 trans Tafel L 1896 The chronic
homeopathy II. Lutra Services, Eindhoven
diseases, their specific nature and their homoeopathic

Presenting Symptoms
Sankaran R 2004 The sensation in homeopathy. treatment, 2 vols. Boericke & Tafel, Philadelphia.

Causation and the


Homeopathic Medical Publishers, Mumbai Reprinted 1998 Homeopathic Book Service, Sitting-
bourne
Swayne J 1998 Homeopathic method, implications
for clinical practice and medical science. Churchill Hahnemann S trans Dudgeon RE 1852 The lesser writ-
Livingstone, Edinburgh ings of Samuel Hahnemann. W Headland, London.
Indian edition 1995 B Jain, New Delhi
Wheeler C 1948 An introduction to the principles and
practice of homeopathy, 3rd edn. William Heinemann,
London
Johnston L 1991 Everyday miracles: homeopathy in
action. Christine Kent Agency, Van Nuys, CA
II
Shine M 2004 What about the potency? Food for
Thought Publishing, London
Vithoulkas G 1979 Homoeopathy: medicine of the new
Bibliography man. Thorsons, Wellingborough
Close S 1924 The genius of homeopathy. Lectures and
Vithoulkas G 1980 The science of homeopathy. Grove
essays on homeopathic philosophy. Boericke and Tafel,
Press, New York
Philadelphia. Indian edition 1959; Haren & Brother,
Calcutta. Also available online: www.homeoint.org/ Vithoulkas G 1991 A new model of health and disease.
books4/close/index.htm North Atlantic Books, Berkeley

79
CHAPTER SEVEN

The Materia Medica Materia Medica

David Owen

‘What we had repeatedly found confirmed by cures, different materia medicas is like different maps
day after day, week after week, and year after year, is that might describe or portray the same place but
what we took as our basis, as true gain in the new sci- in different ways. In the same way as a map iden-
ence; these were what we called the characteristics of tifies key features we explore key symptoms or
the drug.’ ‘keynotes’ of the remedies.
C. Hering The remedies represent a huge amount of dif-
ferent information and it is helpful when embark-
ing on learning it and deciding how to reference
Introduction it to explore your own preferred style of learning.
It is worthwhile spending a little time thinking
The materia medica is how we know the unique
about and comparing different materia medicas
qualities and characteristics of each remedy, what
so that you can, over time, build your own per-
it can cure. Homeopaths must know this informa-
sonal materia medica in a way that suits you and
tion or how to find it so that they can match the
that can be expanded as you broaden the range of
appropriate remedy to the case. The homeopath
approaches and methodologies you wish to use.
gathers this information especially, but not only,
from provings (see Chapter 2). Many homeopaths
see that the information about each remedy is also Levels of Detail in the Materia
expressed in other ways, including toxicological
and clinical effects but also through such things
Medica
as the appearance of the source material, where Ultimately, all materia medicas are a collection of
the source material is found, cultural relevance of symptoms. The detail and the way they are col-
the source material, etc. The information about lated determine both their size and how applicable
a remedy is recorded in the materia medica, but they are to finding remedies according to different
these vary greatly in what sources of information methodologies. Each has different priorities and
are included, the level of detail and how they are includes remedy details to suit some situations
laid out. more than others. Choosing the most appropriate
Different materia medicas suit different approaches level at which to study each remedy is influenced
to treatment and methodologies. For example, those by many factors. These include the patients and
that best suit first aid and acute prescribing are often diseases likely to be treated, the homeopath’s pre-
brief and focus on causation and presenting symp- ferred approach to treatment and learning style,
toms and are not the same as those that fit essence and the practice environment in which the rem-
or thematic prescribing. One way to think of the edies are likely to be used. Likewise the materia

81
CHAPTER SEVEN The Materia Medica

BOX 7.1
Reflective Exercise: ‘The Maze’
Imagine you are stuck in a maze. In what different overview of the maze, a map of it, and to use
ways might you be given the directions you need to this overview to navigate out. It may be possi-
get out? In a straightforward maze you might start ble to recognise a pattern behind the map that
Presenting Symptoms

with trial and error and in many cases this might would equate to an essence or theme, e.g. to
Causation and the

‘get you out’ – equivalent we could say to self-heal- always turn left, or mostly to turn in the direc-
ing. As the maze gets more complicated then you tion that makes you go furthest. It might be valid
might need to think about it in different ways and to try to understand the design or designer of
use different approaches to find your way out. the mazes and how they are ‘relating’ to you.
At the causative level you might just retrace If it is to tease you it may always take the least
II your steps and, if not too far in, follow the
daylight or draught. At the presenting symp-
likely direct direction, if it is to relax you it may
take you the easiest route when offered a choice.
tom level there may be one key junction at Each of these methods can, of course, be
which to choose the right direction, or a series combined in practice– as can the homeopathic
of junctions – followed one junction at a time models and approaches, but the information
with separate ‘local’ directions for each junc- and interpretation of the information that each
tion. The totality model would seek to form an uses is different.

medica you know and the texts you have avail- may point to the cause directly, e.g. the remedy
able will influence how you are able to analyse Radium Bromide, made from radioactive radium,
the case. This is one reason why those who carry can in potency help patients with radiation dam-
out provings and compile the materia medicas are age and is sometimes given to patients receiving
at the centre of homeopathic development. The radiotherapy.
exercise in Box 7.1 provides an opportunity to
reflect on the different levels of information that Presenting Symptoms
might be found about remedies and how they cor- In many simple cases the presenting symptoms
relate with the five models of health using the point to a likely remedy. The stronger the symp-
metaphor of a maze. tom in the patient and the more notable the
symptom in the remedy the more likely a remedy
Selecting the Materia Medica matched on this basis is to work. In addition it can
According to Approach help greatly to understand related aspects of the
The information needed to use each of the five symptom such as things that make them better or
main approaches to treatment covered in this worse, other symptoms, the nature of any pain,
book is slightly different. etc. – what we refer to as the complete symptom.
Communicating both the strength and the connec-
Causation tions between different symptoms is an important
When there is clear causation it is helpful to see aspect of the materia medicas and is done through
this in the case and in the materia medica. The different methods of ‘weighting’ different symp-
modalities often hint at causation even if it is not toms and building what is referred to as a ‘symp-
clearly stated as such, e.g. a condition reliably tom picture’. Table 7.1 looks at the information
and frequently aggravated by wet weather may be about the remedies most useful for each approach,
caused by it. In some remedies the source material both in the case and in the materia medica.

82
Levels of Detail in the Materia Medica

Table 7.1 FEATURES OF MATERIA MEDICAS LINKED TO EACH APPROACH


Model
of Health Main Information Linked to Example of Remedy

Causation Causative factors Features that make symptoms better Aconite after exposure to cold
or worse, called amelioration (>) wind
and aggravation (<)

Presenting Symptoms
Causation and the
Presenting Main symptoms and keynote The complete symptom including the Night cramps helped by Cuprum
symptom symptoms including some typical clinical presentation, metallicum (copper)
‘strange, rare and peculiar’ location and modality
symptoms

Totality Symptoms related to the patient’s Stronger more unusual and unique Remedies that we know and
mind (mentals), body (physical) symptoms. The intensity of use widely in chronic and
and environment (generals). symptoms is illustrated by scoring acute cases and for disease
It may be laid out in the words
of the provers or systematised
them, using italics, bold type or
underlining.
of many types are
sometimes referred to as
II
into mentals, parts of the body ‘polychrests’, e.g. sulphur
and generals

Essence The pattern behind symptoms, Groups of symptoms that share Graphite showing qualities of
describing the themes or trends similar qualities or shared carbon remedies, also of
in remedies. Often describing patterns of symptoms. Several mineral remedies
a group or family of remedies different themes can run
and what they have in common through the symptoms of a case
particularly in relation to the
sensation or feeling behind
the symptoms.

Relational Not frequently described in the How these remedies make the Feeling like the Pulsatilla patient
materia medica but the feelings homeopath or those around the needs a hug
that emerge in a remedy state patient feel. Different homeopaths
and sometimes those might feel differently but if they
generated when thinking are in a ‘steady state’ their
about or working with feelings can reliably point to the
patients needing a remedy remedy

Totality that those describing the totality include causation


As cases become more complex they are likely to and the presenting symptoms.
need a remedy prescribed on a diverse symptom
picture, which in turn needs a much more detailed Essence and Theme
materia medica to describe them. When using the Essences and themes in different remedies frequently
totality approach symptoms from the mind, body relate to patterns that run through several remedies,
and general symptoms are included. Remedies particularly those whose source materials share some
known to have a clear totality picture and that features, such as a group of remedies that come from
are frequently indicated using this approach are the sea or a group of remedies belonging to a par-
sometimes known as ‘polycrests’. Sometimes rem- ticular botanical family (family materia medica) –
edies less well known or used are called ‘small each showing some common and some slightly dif-
remedies’, although when studied more fully or ferent symptoms.
in different situations they may indeed have a
broad range of action. In different cultures and Relational
over time the frequently used remedies change. In In the relational model the dynamic between the
practice many materia medicas are cumulative in patient and homeopath is often something devel-

83
CHAPTER SEVEN The Materia Medica

oped by experience in the profession as a whole; In compiling the materia medicas there are
the individual homeopath can draw upon this many different sources of information about the
common insight to point to the remedy, e.g. the remedies. Not all remedies and certainly not all
feeling of wanting to comfort or ‘hug’ a child materia medicas make use of information from
needing the remedy Pulsatilla. This is sometimes each of these but a variety of sources help to build
described as ‘situational’ materia medica. It also a complete and memorable remedy picture. The
Presenting Symptoms

includes any personal but reliable experience the provings are central to this but other sources also
Causation and the

homeopath has and how different remedies can provide important information (Box 7.2). It is
make them react and feel. possible to think of information about each rem-
edy corresponding to the different approaches
Depth Versus Breadth on Learning to treatment and models of health, giving a pic-
Materia Medica ture built up with several different, but often

II The remedies are the tools of the homeopath’s


trade – the more that are known the greater the
complementary pieces of information – as Figure
7.1 illustrates for the remedy Belladonna. The
range of tasks that can be undertaken. But the tools name comes from bella = beautiful and donna
are only useful when combined with the craft of = woman, and it was used as eye drops to dilate
the operator. For most homeopaths it is a practi- the pupils, itself a type of proving. It contains
cal matter of learning a range of remedies in suf- atropine, which has well known pharmacological
ficient depth to suit the methodologies favoured, effects and is a rapidly acting poison (also called
supported by knowing how to access more infor- deadly nightshade). Sometimes characteristics are
mation about the remedies when needed. This is linked to the botanical solanacea family to which
followed by gradually extending both the range of it belongs. Sometimes it is related to the remedy
remedies and the details about each, often learn- calcium carbonate, to which it is described as the
ing through new provings, the experience of other ‘acute’ – meaning that in many acute illnesses and
homeopaths, and through their own cases. simple cases responding well to Belladonna the
In simple cases, a few well-known remedies (and underlying picture can be Calcarea carbonica.
importantly having them available when you see
the patient) may be all that is needed. In complex
cases where a greater sense of individualisation in 5
matching the remedy is needed a greater breadth of 4
remedies is likely to be required. Ultimately a good 3
homeopath will have both a breadth and depth of 2
remedy knowledge. They build their knowledge of 1
the remedies from a variety of descriptions of the
remedies as well as from clinical experience.

Sources of Information
There are thousands of proved remedies available 5 Relational Intense, presence, can appear threatening
4 Holographic Overactivity, hypersensitivity, plant characteristics
to the homeopath and this number is growing shared with other members of the solanaceae
steadily. In addition there are any number of rem- family
3 Holistic Restless, staring (dilated pupils), fearful (fear,
edies that may be used on other indications. About black dogs)
70% of the remedies that have been ‘proved’ are 2 Biological Throbbing pain, redness, fever
plants. Most other remedies are from animal 1 Pathogenic Scarlet fever
products or minerals. A few are known as ‘impon-
derables’ and made from such things as electricity, Figure 7.1 Different levels of materia medica information
radiation, sunlight and magnetism. correlated by model of health to the remedy Belladonna

84
Levels of Detail in the Materia Medica

BOX 7.2
Sources of Information About Remedies
Main Sources ●
Symbolic including shape and colour of

Provings e.g. China Officianalis source (Doctrine of Signatures)

Toxicology e.g. Lachesis, venom of the bush- ●
Case history pointing to an affinity with a

Presenting Symptoms
master snake substance e.g. nickel allergy

Causation and the



Recorded clinical use e.g. Euphrasia (eyebright) ●
Personal or cultural use of a remedy e.g.
Coffea or Cannabis indica use etc
Subsidiary Sources ●
Emotional and intuitive insights such as in

Appearance or behaviour of the source e.g.
the Bach flower remedies
Silica in sand and glass

Environment of the source e.g. Arnica grow- Other Systems
ing on mountains, also called fall-herb Other systems use other criteria to determine II

Disease patterns e.g. nosodes how a remedy acts e.g. the Biochemical tissue

Historical, including herbal usage of the rem- salts and Bach flower remedies. As these are
edy e.g. Caulophyllum known as squaw root not prescribed on provings they are not always
from its use in childbirth. considered homeopathic, although they act as

Traditional/cultural usage e.g. Anhalonium ‘energetic’ remedies. Biochemical tissue salts use

Pharmacological including adverse effects a range of 12 inorganic salts prepared similarly
e.g. Lithium Carbonicum to homeopathic remedies. Bach flower remedies

Connections with biological families are a range of energetic remedies prescribed on

Mythological e.g. Aurum from the use of gold the dominant emotional state of the patient.

Sometimes other sources of information, in ent provers, and the rigour and protocol of the
addition to the provings, are particularly signifi- proving. How the symptoms are collated and
cant in the adoption of a remedy. Any substance arranged determines how easy it is to find this
can, when prescribed on the basis of like treating information. Some original records of provings
like, be considered a homeopathic remedy, but the give complete detail about the reaction of each
accurate matching possible when a comprehensive prover in a descriptive style. Others combine
remedy picture is used allows both deeper-acting similar symptoms from different provers, while
and more confident prescriptions to be made. This some systematise the proving under mind, part
chapter considers provings, toxicology and clini- of the body and general headings. As a way of
cal use, although the other sources are referred to systematising the materia medica this structure
elsewhere and not only provide useful detail but has gradually evolved, often requiring a trade-off
can serve as an aide-memoire to key points of the between ease of use and completeness.
materia medica.
Toxicology
Provings There are many accounts in literature and in folk-
Provings present a wealth of information about lore of the effects of poisoning on the human
the reactions that take place when individuals are organism. From the early days of homeopathy
exposed to remedies; how these are conducted accounts of poisonings have helped in developing
has been covered in Chapter 2. Reliability of the materia medica and are the source of many
proving symptom is influenced by the objec- symptoms in the early materia medicas. One of
tivity of the symptom, repeatability in differ- the earliest recorded poisonings was of Socrates

85
CHAPTER SEVEN The Materia Medica

with Conium maculata; it gives a description of photography was not common but a feature of
the ascending paralysis that can respond to this patients responding to Arsenicum Album is that
remedy. Knowledge of toxicology has also influ- they frequently become less anxious about their
enced what substances are selected for proving photograph being taken. Extrapolating from this,
as it points to substances that have a significant a fear of having a photograph taken may point
effect. The toxicology of Belladonna from a medi- towards the remedy Arsenicum Album. We can be
Presenting Symptoms

cal herbal of 1834 gives an account of the poison- more confident about this because it is consistent
Causation and the

ing of a group of soldiers: with the concern about appearance and control
‘. . . dryness and burning heat of the throat and mouth, ver- that we observe in Arsenicum Album.
tigo, dimness and confusion of sight; dilation and immo-
bility of the pupil; delirium, coma, an eruption resembling
that in Scarletina, and occasionally strangury . . . The REFLECTION POINT

II greater number were delirious, but the delirium was gay;


a great number also lost their voice, and others spoke con-
● If remedies provide information that helps a patient move
to a new balanced state, why should this information
fusedly; there was also much motion of the hands and fin- produce these symptoms in provings? And to what
gers; several were blind for some time; and in all, the pupils extent might this same information be expressed in the
were dilated.’ appearance of the remedy, where it is found and any
effects, myths, beliefs that are associated with it?
Clinical Experience
Some homeopathic remedies are chosen in spe-
cific conditions as much on their clinical reputa-
tion as on their provings e.g. Chamomilla, Ferrum
Symptoms In The Materia Medica
Phosphoricum and Euphrasia (Eyebright). This Symptoms, including signs, are the language of
can sometimes be adequate for treatment of acute the case (see Chapter 8), disease (see Chapter 6)
conditions at a symptomatic level although prov- and the remedy. As every substance has in theory
ings reveal a more complete picture, allowing a the potential to challenge someone who has the
more accurate and confident match. Mostly this susceptibility to that substance, every substance
clinical information limits the use of the remedy could be a remedy. A remedy may provoke as a
to local or clinical methodologies. It is some- proving anything from a single subtle symptom
times possible to see remedies favoured by certain to a comprehensive symptom picture. Weighting,
groups of homeopaths. For example, in an inter- or evaluating the strength of each symptom indi-
national study on treating upper respiratory tract cates the relative importance and reliability of that
infections in the UK, Ferrum Phosphoricum was symptom. Different materia medicas indicate this
well used as it has a ‘clinical reputation’, but in the by using different typefaces (capitals, bold, italic,
USA it was much less used. underlined, etc), or using numbers (+2, + 3 or
When new symptoms emerge as a patient is in ‘aversions’ −2, −3, etc.), or by labelling symp-
being treated with a particular remedy it is possible toms in some way e.g. as keynotes. (Similar ways
they are related to that remedy. In a way this is like to indicate the importance of symptoms in talking
making a proving on a sick person and although about or recording a case are also used.)
frowned on in principle, because the patient’s sick-
ness will alter the remedy reaction, in practice many Keynotes
early provings were done on patients. Certain symptoms and causations are observed as
Clinical experience offers a way of updating reliable indicators for certain remedies; these often
information about remedies when provings were relate to key features of the remedy called the key-
completed some time ago or in different cultures. notes. These are reliable symptoms observed in
For example when Arsenicum Album was proved provings and may also be observed in toxicology

86
Symptoms in the Materia Medica

or clinical practice. They are sometimes claimed better from heat, the headache better from heat is
to describe symptoms of a remedy uniquely and more distinctive. These things make the keynote
in local prescribing may be matched to the charac- more individual to the patient and remedy – and
teristic symptoms of the individual’s expression of therefore more important. They may be more
the disease process. Examples of keynotes are the individualising because they are strange, rare or
irritability and sensitivity to pain in Chamomilla peculiar. Strange in that they are paradoxical

Presenting Symptoms
and the fearfulness in Aconite. in a particular situation, rare in that they occur

Causation and the


infrequently. Or they may be peculiar in that they
Importance of Keynotes would not be expected in a particular situation. A
Keynotes may be used as relative inclusion (confir- symptom may stand out due to its own uniqueness
matory) and exclusion (eliminatory) checks before or because of the things that modify (modalities)
prescribing. For example, a keynote of Sulphur is the symptom’s expression.
that it is untidy and it would be unusual (but not
impossible) to prescribe Sulphur in a very precise, Modalities II
tidy and fastidious case; a keynote of Argentum Modalities are factors that modify the behaviour
Nitricum is a desire for sweets and it would be or degree of intensity of a symptom or sign. They
unlikely to be prescribed in a case that did not may be a normal physiological function, an emo-
have a desire for sweets. An exclusion symptom tional state, an activity or environmental factor.
relatively eliminates from consideration those They include palliative measures the patient may
remedies that do not have that symptom (see use to minimise the symptoms, such as rubbing or
Chapter 9). scratching a rash, or holding a painful part of the
Keynotes are often summaries of something body.
observed in many provers and represent an abbre- Modalities (see also Chapter 8, p. 101) can be
viation of often more complex symptoms. In clini- strong or weak and are scored in the same way as
cally-based materia medicas using keynotes allows symptoms. If a modality is especially strong, strange,
them to be shorter, making it easier to find your rare, peculiar, or fits several symptoms it can be
way around them, to make comparisons and to considered a keynote. For example, a patient whose
memorise. Keynotes of presenting symptoms are joint symptoms are aggravated from movement but
sometimes called ‘guiding symptoms’. Personal who also generally hates moving about when feeling
keynotes may also be symptoms that you reliably ill, describe the modalities of the remedy Bryonia,
observe in patients. For example, I am confident where ‘worse (<) from movement’ is a keynote.
that many Staphisagria patients talk with a fixed
lower jaw as if they are talking through their teeth. Appearance
Arsenicum Album patients often have not only an Some physical features of patients indicate certain
aversion to being photographed but also an aver- remedies, e.g. a ‘saddle nose’ may be a feature of
sion (or desire) for red foods like tomatoes and patients fitting Syphilinum, and red hair may be
beetroot. a feature of Phosphorous patients. Information
about the appearance of patients is most likely
Strange, Rare and Peculiar to be based on the appearance of individuals that
Keynotes, like other symptoms, become more clinical experience shows responds well to that
important the stronger they are, in the remedy substance, or types of patient susceptible to poi-
or the patient, e.g. ‘I must eat something sweet soning by it, or to those most likely to exhibit
every half hour’. However they also become more strong proving symptoms to it. Sometimes the
important the more striking they are in a particu- appearance of the patient can change during a
lar case or remedy picture. So in a remedy that proving, e.g. during a proving of Sepia a sallow
is generally worse from heat but has a headache complexion may develop.

87
CHAPTER SEVEN The Materia Medica

mation; some repeat content but use different


Different Materia Medicas layouts. It is interesting to compare this historical
Materia medicas vary in layout, number of rem- record and the wealth of relevant information col-
edies, amount and sources of information, and lected over this time with the relative transience
from brief outline descriptions to verbatim reports of much of currently conventional medicine that
of provers. Some, such as Hughes, concentrate on has its origin in the apothecaries and barbershops
Presenting Symptoms

local cause and symptoms. Others, like Hering, of the 19th century. At the time Hahnemann
Causation and the

used much clinical information and verification. was developing his ideas on homeopathy, most
Some, such as Kent, draw out a picture of mental illnesses were thought to be due to an excess of
and general symptoms that directly lead to think- blood or impurities in the blood. Healing required
ing of remedies as a totality. Some of the most blood-taking and blood purification using emet-
significant materia medicas historically are listed ics, purgatives, agents causing salivation, perspira-

II in Box 7.3 and to put these and the development


of homeopathy in context some world events are
tion, urination, drawing plasters, etc.
Only after 1980 do the remedy descriptions
included (Figure 7.2). Many of these early materia really begin to draw out the essence and themes
medicas share some of the same sources of infor- in the remedy pictures. Vithoulkas was one of the

BOX 7.3
The Most Significant Materia Medicas
Materia Medica Pura, S Hahnemann type in Allen as a result of a single proving of
In the materia medica pura are some original prov- the 200th potency which emphasised it. Both
ings before potentised remedies were used. Hughes and Hering were major contributors to
Allen’s work.
Chronic Diseases, S Hahnemann
Includes theory of chronic disease and a list of Hering’s Guiding Symptoms of our Materia
provings of 23 new medicines as well as sev- Medica
eral already published. Hahnemann no longer Less interested in the provings and ‘old school’
offers the name of provers as they were prob- symptoms than in those symptoms which had
ably drawn (contrary to his own rules) from his been shown in the light of clinical experience to
patients with chronic diseases, and it includes be useful. Free of annotations with one symptom
apparently inert substances like Silicea, Natrum per line making it easy to read, and with mark-
muriaticum and Lycopodium. Provings used ings indicating the most well verified symptoms.
the 30c potency and the distrust of these prov- Used by Kent in grading of symptoms for his
ings together with hostility to his new theories repertory (see Chapter 9).
resulted in a split in the homeopathic camp. All
Hughes’ Cyclopaedia of Drug Pathogenesy
the remedies were later proved in Vienna and
Hughes had co-operated with Allen’s Ency-
generally substantiated.
clopaedia but did not agree with high potency
Allen’s Encyclopaedia of Pure Materia Medica provings and provings made on patients.
A large collection of provings, all with refer- It contains toxic and material drug prov-
ences – some dangerously toxic and using high ing symptoms from healthy provers and gives
dilutions. High potency provings tie up with detailed information on causation and present-
clinically useful symptoms e.g. the uterine pro- ing symptoms. It gave rise to a number of the
lapse sensation in Sepia which was a minor clinically orientated guides based on ‘local pres-
symptom in ‘Chronic diseases’ got into bold cribing’.

88
Different Materia Medicas

Kent’s Lectures on Materia Medica Vithoulkas’s Essences


Descriptions of individual remedies assumed A thematic interpretation of the materia med-
an easy narrative style. Talk about ‘the Sepia ica using imagination, feeling and a consider-
patient’ or ‘Pulsatilla patient’ was the beginning able knowledge to bring to life and reinterpret
of the idea of constitutional prescribing. the remedies through a modern and memorable
psychological picture.

Presenting Symptoms
Clarke’s Dictionary

Causation and the


Eclectic and practical, and each remedy starts Sankaran’s Situational Materia Medica
off with an interesting account of cured cases Reflects the adaptive way an organism responds
and includes a list of common conditions. to a real or imagined situation. Explores the
fears and delusions behind each remedy state.
Boericke’s Materia Medica
Symptoms centre around a particular type of
A succinct summary of the materia medica with
useful preamble and well chosen italics for
reality distortion, e.g. the remedy Tarantula has
dancing and desire for music in its provings.
II
emphasis, a good desktop guide.
Perhaps explained by the organism trying to
Boger’s Synoptic Key of the Materia Medica attract attention due to a basic delusion of unre-
A combined repertory and materia medica organ- quited love i.e. trying to attract the attention of
ised along lines promoted by Boenninghausen the loved one.
emphasising modalities, localities and sensations.
Scholten’s Homeopathy and Minerals
Tyler’s Drug Pictures Certain characteristics being associated with
A chatty and readable materia medica using different anions and cations e.g. calcium and
frequent quotations from other materia medicas. Muriaticum elements, combining to form a
composite picture. He relates characteristics to
the element’s place in the periodic table.

first to describe comprehensive patterns that run sensation (that runs through a theme) or feelings
through a remedy that he named ‘essences’. These that runs through a case or remedy is represented
patterns have developed alongside materia medi- in emotional or thematic materia medica.
cas looking at groups of remedies based on similar Relationally it is important to know not only
clinical pictures, such as Borland’s children’s types, how a patient needing a particular remedy makes
and sometimes on the source material of the rem- you feel but also what it is like to be that remedy
edy, such as Scholten’s use of the periodic table. yourself and how do you relate to those aspects
Materia medicas with constitutional, thematic and of the remedy that are in you? This is sometimes
relational information are less common than those called living materia medica.
with causation, presenting or totality symptoms. Different tools are needed for different jobs. The
Constitution is reflected by situational preferences ideal materia medica needed for each separate pre-
including the environment sought out (reflected scribing methodology varies, and the homeopath
in generals) and relationships moved into and developing a range of prescribing methodologies will
away from (reflecting psychological preferences). benefit from using several different materia medi-
Sometimes referred to as ‘situational materia cas. Box 7.3 shows how the structure of the mate-
medica’. ria medicas has evolved and also offers insight on
Themes are reflected in the feeling world both how the different approaches to treatment (and, less
of physical sensations and emotional feeling. The explicitly, the models of health) have developed.

89
CHAPTER SEVEN The Materia Medica

Treaty of Versailles and first hot air balloons 1783 Hahnemann publishes a paper: ‘On Poisoning by Arsenic: Its Treatment
1786 and Forensic detection.’
French Revolution begins. George Washington 1789 1790
becomes President of USA The Cinchona Experiment.
At the time Hahnemann was translating Cullen’s Materia Medica

Napoleon becomes Emperor 1804 Hahnemann publishes ‘The Medicine of Experience’. No mention
1806 yet of the word ‘homeopathy’.
1810
Presenting Symptoms

The first edition of the Organon is published


181 1
Causation and the

1811 1821,1st ed., 1825 33 2nd and part 3rd ed. Materia
Medica Pura. S. Hahnemann

1828 Chronic Diseases. S. Hahnemann

Queen Victoria begins her reign 1837


Potato famine in Ireland begins 1842

II
Pasteur completed first test 1862
leading to pasteurization

1874 Allen’s Encyclopaedia of Pure Materia Medica


1879 1879 1891 Hering’s Guiding Symptoms of our Materia Medica
1884 1884 1891 Hughes’ Cyclopaedia of drug pathogenesy

Freud defines anxiety neurosis 1895


1900 Clarke’s Dictionary
1904 Kent’s Lectures on Materia Medica
Picasso the beginnings of Cubism 1906
Jung publication of Symbols of Transformation 1912

1927 9th ed. Boericke’s Materia Medica


1931 4th ed. Boger’s Synoptic Key of the Materia Medica

1942 Tyler’s drug pictures

Crick and Watson proposal of the 1953


double helical structure for DNA

1977 Phatak’s Materia Medica


1980 1980 1885 Vithoulka’s Essences

1986 Coulter’s Portraits


1991 Sankaran’s situational Materia Medica
1992 Vermulen’s Concordant Materia Medica
1993 Scholten’s group analysis of mineral remedies
in ‘Homeopathy in Minerals’

Figure 7.2 Time line of the development of significant materia medicas

90
Different Materia Medicas

Layout of the Materia Medica Given the diversity of texts easily available there
The aim of a materia medica is to communicate as is no reason why a homeopath should not have a
effectively as possible, in an orderly and systematic range of texts available in books or electronically
way, the use of remedies in different situations. to enable a variety of approaches to suit differ-
Since the time of Kent, in most detailed materia ent patients. Many homeopaths will start with a
medicas the symptoms from different sources are keynote text for ease of use, supported by a more

Presenting Symptoms
often collated according to anatomical location, ‘totality orientated’ text with access to the individ-

Causation and the


as in the Boericke materia medica (Box 7.4). ual provings when the remedy picture is unclear.
The bullet points below cover some of the things
Choosing a Materia Medica to think about in selecting a text and some of the
Different homeopaths favour different texts and limitations of some materia medicas. Does it:
while initially you are likely to be influenced by

detail likely causation and common primary
those that teach you, over time homeopaths often
select different texts that suit their way of working.

symptoms?
give a totality picture? (in practice some mate-
II
ria medicas are more ‘diseases centred’; others
are more ‘person centred’)
BOX 7.4 ●
collate information from a range of provers?
Example of Layout of a Materia Medica ●
integrate clinical observations and toxicologi-
Based on Boericke cal information?
Name and source ●
detail aspects of the constitutional type?
Introduction, including pointers on usage and ●
give information on essence and theme?
generals ●
point to how these remedy types behave and
Mind interact with others and in a consultation?
Head ●
suit your way of working and is it easy to use?
Eyes (there is often a trade-off between ease of use
Ears and comprehensiveness)
Nose
Mouth Limitations
Throat ●
Many were compiled from information from
Stomach provers of previous generations where the
Abdomen language of expression of symptoms is very
Rectum different from that used currently.
Urine ●
Given the amount of information and the
Kidney numbers of individuals collecting and collating
Genitalia it, errors naturally occur. Proving symptoms
Respiratory may be recorded incorrectly, inaccuracies may
Back be copied, unreliable sources used. For exam-
Extremities ple, in their proving of Aethusa (Fool’s Parsley)
Sleep Hartlaub and Trinks got the symptoms mixed
Fever up with those of Conium (Hemlock). From
Skin there the error was copied and handed down
Modalities: what makes symptoms better (>) to numerous materia medicas and eventually
and worse (<) corrected in Allen’s Encyclopaedia.
Relationship to other remedies, follows ●
The possibility for error increases when symp-
well, etc. toms are abbreviated, or symptoms from one
Information on dosage, frequency and duration prover are combined with another. If footnotes

91
CHAPTER SEVEN The Materia Medica

or references of each prover for every symp- abbreviated and weighted in different texts. The
tom are used the text becomes unwieldy. weighting in the first uses plain type, italics and
capitals to represent increasing degrees of strength
Comparing the Different or association. The second and third use plain
Materia Medicas type and bold for the same purpose. In the third,
The descriptions below are edited extractions from keynotes are put in double brackets << >>. The
Presenting Symptoms

the mind section of the remedy Silica in four materia fourth is not weighted.
Causation and the

medicas and one repertory. A repertory is a system-


atic list of symptoms of a homeopathic medicine,
usually from several sources, indicating the degree of
association or strength of the symptom (see Chapter REFLECTION POINT
9). Using extractions from a repertory, the relevant ● Different practitioners prefer different materia medicas
rubrics that contain the remedy at a particular level
II of association, strength or uniqueness, or a combi-
– what qualities are most important to you and why?
From the example below, what features of materia
nation of these things can be constructed. medicas and repertories might you find helpful to your
These five sources illustrate something of the study of the remedies and what make it harder?
variety of layouts, including how symptoms are

BOX 7.5
Extracts of Mental Symptoms for the Remedy Picture of Silica (Sil) from 5 different sources
Vermulens 1992 Boericke 1927
Faint-hearted, anxious. Nervous and excit- Yielding, FAINT-HEARTED, ANXIOUS.
able. Sensitive to all impressions. Brain fag of Nervous and excitable. SENSITIVE to all
businessmen, lawyers, preachers and students. impressions. Brain-fag. Obstinate, headstrong
Obstinate, headstrong children. Fixed ideas; children. Abstracted. Fixed ideas; thinks only
thinks only of pins, fears them, searches for of PINS, fears them, searches and counts
and counts them. Yielding. Sensitive weeping them.
mood. Cries when kindly spoken to. Sullen.
Morrison 1993
Loss of self-confidence; dreads failure, but
<<Yielding, refined, delicate patients.>>
unfounded. Starts from slight noise. Confusion
Quiet and self-contained. THE PATIENT
worse < conversation. Forgetfulness better >
WILL ADMIT TO HAVING CONVICTIONS
after eating. Prostration of mind after writ-
WHICH HE DOES NOT ARGUE, even seem-
ing. Remorse about trifles. Indisposed to talk
ing to acquiesce to another’s viewpoint though
loud. Unconsciousness after taking cold water.
internally keeping his own view. <<Anxious
ANXIETY DURING MENSES. Clairvoyance.
conscientiousness over small details.>>
CONSCIENTIOUS ABOUT TRIFLES.
<<Anxiety from noise.>> Anxious and
CONSOLATION aggravates. Intolerant of
depressed.
contradiction; Dullness in children. Dullness
<<Stage-fright.>> Performance anxiety.
from damp air; after dreams. Fear of literary
Test phobia.
work. Homesickness. Inconstancy. Irresolution.
Mental dullness. Dreads or is aggravated
INTERNAL RESTLESSNESS. Restlessness
by mental exertion.
while sitting; on waking. Sensitive to voices.
Weak memory. Mental deterioration.
Starting when touched. TIMIDITY ABOUT
Dementia.
APPEARING IN PUBLIC. Undertakes noth-
Fear of pointed objects or pins.
ing lest he fail.

92
Different Materia Medicas

<<Obstinate>> children who ‘weep Repertory Extraction from Kent 1877


when reprimanded’. Below is the result of a search of the mind section
Shy children who will not answer the pre- of Kent’s repertory for Silica where it occurs in
scriber directly but instead whisper to the second (italic) or third level (bold) with no other
mother who must relay the information. remedy sharing the symptom with the same or
Psychic capacity; clairvoyant. higher grade. No entries for silica at the first

Presenting Symptoms
Fixed ideas. (lowest) level are shown. It therefore only shows

Causation and the


the stronger symptoms that Silica may have but
Tyler 1942
it also shows some of the remedies that share the
Silica, they say, lacks grit – needs sand. And
symptoms of Silica. It gives an interesting view
doses of Silica stimulate mightily these weak-
of the strongest and/or most particular symp-
lings who are going under, to put up a fight,
toms, as well as an idea of other closely related
mental and physical
You look up, as poor little Silica is dragged
remedies, for example Phosphorous (phos) is II
in three of these rubrics and it is known to be
reluctantly in. He is listless; not interested;
closely homeopathically related to Silica.
not frightened.
Mind; ANXIETY; fright, after (read as
You see a pale, sickly, suffering face; and
anxiety coming on after a fright): acon., gels.,
you realise at once that there is something
lyc., merc., nat-m., op., rob., sil.
deeply wrong there;
Mind; ANXIETY; menses; during: acon.,
He doesn’t get on, he doesn’t thrive. He
bell., calc., canth., cimic., cina, coff., con.,
doesn’t learn; he doesn’t even play. He is irri-
ign., inul., kali-i., merc., nat-m., nit-ac., nux-
table and grumpy. He is always at the bottom of
v., phos., plat., sec., Sil., stann., sulph., zinc.
everything, and his teacher can’t make no think
Mind; ANXIETY; noise, from: agar., alum., aur.,
of him; she writes, see! – ‘he shrinks from effort,
bar-c., caps., caust., chel., nat-c., petr., puls., Sil.
from the least responsibility, and is utterly lack-
Mind; CONFUSION; conversation agg.: sil.
ing in self-confidence and self-assertion.’ Doesn’t
Mind; DELUSIONS; images, phantoms,
seem to have no ‘go’ in him. He doesn’t seem to
sees; sees, all over: merc., sil.
be able to think! He can’t fix his mind. He can’t
Mind; DELUSIONS; needles, sees: merc., sil.
read or write. And yet he’s always worried to
Mind; DULLNESS; writing, while: acon.,
death over little things he’s done wrong. That’s
arg-n., cann-s., chin-s., glon., mag-c., nux-m.,
it: he’s so odd, and so unlike the others.
rhus-t., sil.
He gets violent attacks of headache, she
Mind; FEAR; work, dread of; literary, of:
says, and complains that the back of his head
nux-v., sil., sulph.
is cold. That’s where the pain is, but it goes
Mind; PROSTRATION of mind; reading,
all over his head. He says his head will burst.
from: aur., sil.
He wants it tied up tight. He wants it warm.
Mind; PROSTRATION of mind; writing,
Warm and tight, that’s what his head has got
after: sil.
to be – when he gets one of his attacks.
Mind; REMORSE; trifles, about: sil.
And a funny thing she has noticed, he’s
Mind; RESTLESSNESS; waking, on: am-c.,
always ill with the new moon!
ambr., bell., canth., cedr., chin., cina, dulc., hyper.,
Look at his nails – rough and yellow; and
ph-ac., phos., sep., sil., squil., stann., tarax.
feeling as if he had got a splinter in his finger.
Mind; UNCONSCIOUSNESS; cold; after
Or gets red, swollen finger that throbs and feels
taking: sil.
like a felon. Or look at that finger, how it is
Mind; WEEPING; afternoon: carb-v.,
swollen, and the bone feels big. He wakes cry-
cast., cop., dig., phos., sil., tarent.
ing, and says his hands have gone to sleep…’

93
CHAPTER SEVEN The Materia Medica

Computer Materia Medicas The Life Cycle of Remedies


Several computer programmes hold details of a Nux Vomica as a remedy state has a clear rela-
number of different material medicas. It is pos- tionship with stimulants, e.g. caffeine and spicy
sible to both scroll through computer screens to foods. At one stage it craves these stimulants and
look at different pages of material medica and will invariably use them excessively. Over time
to search for key words, phrases or combina- patients needing this remedy frequently become
Presenting Symptoms

tions of words. They are frequently combined upset and averse to these foods, simply because
Causation and the

with a computerised repertory (see Chapters 9, they aggravate their symptoms. The symptoms on
19). Some patients and homeopaths feel there is show will depend to some extent where that rem-
a subtle change of the relationship between the edy is in its life cycle.
homeopath and patient when a computer is used Causticum provides another example of ‘a life
rather than books. Others recognise the poten- cycle’ of a remedy. It starts out with a high level
II tial of having all the literature in one source and
not needing to swap between different books.
of emotional sensitivity to those who are suffer-
ing and will be drawn to helping those who are
in pain or suffering. However, later on in the life
Dynamic Materia Medica history of the Causticum patient, when they may
In most materia medicas each remedy is por- have given a great deal to others, they will start to
trayed essentially through a list of symptoms. ‘break down,’ and their symptoms and the under-
As a result it is easy when studying the remedies lining pattern may become more brittle and rigid.
to construct a fairly fixed picture of the reme- They may then enter a state when they actually
dies. In practice a more fluid picture is helpful withdraw from and avoid those in need as a way
in grasping the full expression of the remedy – a of protecting themselves from their own sensitiv-
remedy picture developing over time and accord- ity. A single, one-dimensional description of any
ing to the changing life situation of the patient. one remedy may express contrary symptoms that
If we don’t understand how a case develops different patients express at different times in the
over time (see Chapter 3) we can find it hard to remedy life cycle. Understanding the pattern that
make sense of seemingly contrary information. unfolds, through the different stages of a remedy’s
For example, Phosphorous starts off with huge manifestation, is often a start to recognising the
levels of sensitivity and is emotionally open, but themes and essence in the remedy. For example
then becomes emotionally exhausted, when the in Aurum metallicum, made from gold, there are
sensitivity focuses internally through worry and frequently issues related to golden objects, self
anxiety. esteem (the golden child), money, etc. (Gutman
Once we understand these contrary, sometimes 1937).
opposite and paradoxical symptoms, they add a In this way the remedy is more than just a
new dimension to the understanding of a rem- collection of symptoms; rather it has a character
edy picture and how it can unfold. A comprehen- that may be compared to characters in a film or
sive remedy description will indicate something book. In the same way that every patient has a
of how a remedy picture is in its various stages; story that unfolds over time, so too does every
a comparison with other remedies might point remedy. As you develop a comprehensive pic-
to how one remedy state can move to another. ture of the remedy through the materia medi-
For example, the exhausted and ‘burnt out’ cas, and from seeing it in patients, so you start
Phosphorous case may move to the remedy pic- to become aware of how the remedy picture
ture of Phosphoric acid, which can have fatigue unfolds over time in different environments.
and marked mental then physical debility. In this Matching how the remedy unfolds to how the
way it can be helpful to think of the remedies as case unfolds over time is one example of the-
having a life cycle. matic prescribing.

94
Bibliography

Evolving Materia Medica different levels of detail and in different formats,


Given the dynamic relationship between the remedy and lend themselves to different ways of work-
states produced in patients and the environments we ing. It is important to explore different materia
live in, it is not surprising that as our environment medicas in order both to discover remedies that
changes and as the illnesses people get change so are new to you and to deepen your knowledge
we see new materia medica becoming more promi- of the remedies you already know. Taking part

Presenting Symptoms
nent. For example, in a society that starts to abuse in provings, and recording your own experience

Causation and the


more recreational drugs including cannabis and hal- of remedies and clinical practice will consolidate
lucinogenic substances it is not surprising that we your own knowledge of remedies and extend
see the remedies of Cannabis Indica and Agaricus the knowledge of the remedies available to the
(from a toadstool that contains muscarin) becom- homeopathic profession. Although not the easiest
ing more often indicated. As we see more patients to use, access to original records of provings of
suffering from allergies, then those substances to
which patients have increased sensitivity are likely
remedies is helpful in making judgements about
the reliability of information, and to reveal detail
II
to become more important remedies. Interestingly, of information about the context in which any
these changes do not seem to manifest just on those one prover generated proving symptoms.
who have used cannabis and hallucinogenic sub-
stances or who have allergies but, albeit to a lesser
extent, in a whole population. References
As homeopaths, when we look for homeopathic
Boericke W, Boericke O 1927 Pocket manual of
remedies we need to stay alert to the environment homeopathic materia medica. Boericke and Runyon,
our patients are in. The range or ‘palette’ of remedies Philadelphia
we might need is informed by the environment in
Gutman W 1937 Homeopathy: fundamentals of its
which we live. Historically, herbalists have always
philosophy, the essence of its remedies. Homeopathic
used plants that grow in similar environments or Medical Publishers, Bombay
climatic conditions to the environment a patient
Kent J T 1899 Repertory of the homeopathic materia
has lived in. Of course, with increased globalisa-
medica. Examiner Printing House, Lancaster PA. Last
tion the ability of patients to travel both geographi- edition 1957. Ehrhart and Karl, Chicago. Reprinted
cally and emotionally from culture to culture has 1986 Homeopathic Book Services, Sittingbourne
changed. So individuals are faced with increasing
Morrison R 1993 The desktop guide to keynote and
diversity of environments. As each environment
confirmatory symptoms. Hahnemann Clinic Publishing,
can present a different challenge to a differently Grass Valley, CA
susceptible patient, it is consistent that as the vari-
ety of environments we meet increases so the num- Tyler M L 1942 Homeopathic drug pictures.
Homoeopathic Publishing Company, London
ber of remedies to provide the best information to
cope with that challenge also increases. Therefore Vermulens F 1994 Concordant materia medica. Merjlin,
the homeopath in cultures that are cosmopolitan Haarlem
and changing fast is likely to need to be aware of a
wide range of remedies and alert to new challenges
and remedies to treat these. Bibliography
Gibson D 1987 Studies of homeopathic remedies.
Edited for publication by Harling M and Kaplan B.
Summary Beaconsfield Publishers, Beaconsfield
The materia medicas are an essential tool that Tyler M, Weir J Repertorising. British Homoeopathic
include information about medicines expressed at Association, London

95
CHAPTER EIGHT

Taking the Case The Case

David Owen

Introduction most case-taking, will share the same start, the


presenting symptoms and first impressions.
As homeopaths we look for hints, gestures, half-
remembered characteristics, as if we are trying to
recognise friends at a masquerade.
This chapter looks at the homeopathic case
Making a Start
from the starting point of the presenting symptom The first few minutes of the consultation establish
but goes on to see that every symptom and modal- much about how the rest of the consultation and
ity is important in shaping the overall case and that even subsequent consultations will go. It is interest-
there is a continuum from prescribing on a local or ing how often even the most complicated cases will
presenting symptom to evolving a case to prescribe start by saying something like, ‘I just wonder if you
on many (often seemingly) unrelated symptoms have anything for my arthritis’. It is only later you
as a totality. The aim, in practice, is for the case- find out that it is one of many problems that have
taking to be a seamless process, often appearing perhaps gone on for decades. In any case-taking ini-
as a relaxed and informal conversation but need- tial impressions are important. The first perception
ing to be a comprehensive, fluid and reflective you have of the patient is unique and often things can
exchange between the homeopath and the patient. be glimpsed in the first few moments of a consulta-
To achieve this, the homeopath needs an appre- tion that are otherwise difficult to see. For example
ciation of all areas of a case that might be relevant how a child is playing in the waiting room, where
and experience of taking and recording a case. someone is sitting, how eager or happy they are to
The presenting symptom is a good place to begin. meet you, who they are with, their expression, how
Although to an observer and patient the process they hold themselves, how are they dressed etc. It is
may appear passive, in every case the homeopath worth remembering that the patient is also assessing
is actively seeking to recognise information so that you from the outset. What you and your practice do
when interpreted through one or more models of and how you come across will influence the tone of
health, the meaning of a patient’s situation and ill- the consultation, e.g. if before the first meeting you
ness is clear. There are a number of different styles can provide information explaining how you work
and skills involved in case-taking that a homeopath it may help to relax the patient.
will need to develop in order to meet the needs of
the patients that they are likely to see. This chapter Type of the Case Related
starts to explore those styles and skills. to Model of Health
In practice the symptom picture will have The type of history you choose to take will be
evolved over time but most cases, and therefore influenced strongly by the models of health you

97
CHAPTER EIGHT Taking the Case

choose to work with. In situations where you work of learning and to reveal connections and themes
on causation, local or clinical prescribing you may running through a case. Figure 8.1 illustrates this
only need a brief history that may not, in the first based on a case presented later in this chapter.
aid setting, even need recording in any detail. If In cases when there is a very complicated or
you are integrating homeopathy into a busy family confused picture or where the history cannot be
or general medical practice you may have serious obtained clearly in this manner, another approach
Presenting Symptoms

time limitations. Generally as you move through that can be helpful is to suggest the patient talks
Causation and the

the models of health the focus of the case widens through their life from birth through childhood,
from the local illness to the broadest consider- up to today. It describes a ‘time line’ but with
ations and the detail required increases, as does several strands that may each represent differ-
the time to take the case. ent problems, leading to the question: ‘And what
As cases get more complex, patients present brings you to consult with me now?’.

II several different illnesses each with presenting


symptoms. Starting by establishing each differ-
As we move through the different models, so a
broader, less structured or standardised consulta-
ent complaint, possibly numbering the different tion may take place. The homeopath may invite
symptoms, can help keep track of them and make the patient to ‘tell me everything about yourself ’
sure that modalities are identified and recorded or may find and explore how the patient’s state
for each. Different symptoms may naturally link is expressing itself in the consultation, including
together, and some order or pattern may emerge. how the patient and homeopath relate.
Sometimes this may only become clear over sev- In practice of course these are not discrete and
eral consultations. An indication as to which is different styles, but just as one model of health
the most deep-seated disorder can sometimes be will rarely be used alone, elements of each are
established by asking the patient what order the often combined, leading to a range of case-taking
symptoms appeared in, or which symptom trou- techniques. Different groups of patients may each
bles them the most, or which one they would most require special experience for example in the
like to be without (see Hierarchy in Chapter 6). case of children (Shepherd 1938, Herscu 1991,
Another way to record this is as a mind map, par- Wynne-Simmons 1993) or in veterinary practice
ticularly useful for those who use a very visual style (see Chapter 18). In this chapter the focus will be

Past medical Figure 8.1 Mind map of


and surgical Sharon’s case.
history
Hormonal
Loss of libido Replacement Anxiety
Therapy

Menopausal Weight
Gynaecological symptoms gain
problems

Difficulty exercising
Sharon aged 56
Social difficulty Osteoarthritis of the hip
with husband (presenting complaint)

Family history
of menopausal
difficulties

98
Making a Start

on the biological model, starting with the present-


BOX 8.1
ing symptoms but extending to other connected
Outline of the Homeopathic Case
symptoms.

Presenting symptom: the complete symp-
tom including the causation, time, loca-
Overview of the Case
tion, sensation, intensity, modalities and
‘A human being is part of the whole, called by us the
treatment history

Presenting Symptoms
Universe, a part limited in time and space. He experi-
Other main symptoms: may be more than

Causation and the



ences himself, his thoughts and feelings as something
one, include treatments given
separated from the rest – a kind of optical delusion of

Past history: illness, treatments, accidents,
his consciousness. This delusion is a kind of prison for
operations
us, restricting us to our personal desires and to affection

Review of systems: bowels, urinary, stom-
for a few persons nearest us. Our task must be to free
ach, respiratory, skin, allergies, headache,
ourselves from this prison by widening our circle of com-
passion to embrace all living creatures and the whole of
fits or faints, genitourinary, gastrointesti- II
nal, respiratory, neurological, cardiovascu-
nature in its beauty.’
lar, ear, nose, and throat (ENT), the senses
Albert Einstein
musculoskeletal, skin etc

Significant life events
Initially while you are gaining experience, it is

Mental: psychological*
helpful to have a basic structure in mind for a

General: environmental and dietary history*
consultation. In practice having explored the

Treatment history
main presenting symptom the case will often flow

Family history: illnesses in both sides of
onto another related area of the case and all the
the family; add parents and grandparents*
areas mentioned in Box 8.1 can be covered in the

Social history: deepening the case, marital,
style of a semi-structured interview. Box 8.1 gives
economic status, career etc., social habits,
a checklist of the main areas of the case that the
smoking alcohol, drugs, exercise*
homeopath may need to enquire about. Each area

Examining the patient
may reveal vital information about the present-

Making a diagnosis: including the homeo-
ing symptom, may provide vital confirmatory or
pathic diagnosis
exclusion symptoms and contribute to the total-
ity. The psychological, general, family and social *Covered in Chapter 13.
areas of the case are covered in Chapter 13.
A central essence or theme or relational aspect The abbreviated case of Sharon shows how a
of the case may emerge in any of these areas and case might unfold; in another patient with simi-
because the presenting symptom is frequently lar symptoms or to another homeopath it might
discussed or handled in a certain way, it is often unfold differently. Remember that all cases given
first most noticeable or hinted at in areas of the in this text are abbreviated to show only the most
case away from the presenting symptoms or by relevant information for the point being illus-
unconscious movements of the patient’s hands or trated and a great deal more information is taken
body or by a change in the observer, such as the and recorded in the full case.
prickle in the hairs of the neck of the homeopath, Figure 8.1 shows one way of understanding
the curiosity about one phrase or word, an emo- how the different areas of Sharon’s case connect
tional reaction from a nervous giggle to the eyes and how a remedy that acts deeper than just symp-
watering etc. The practitioner must never allow tomatically might fit this pattern. In Sharon’s case
the structure of case-taking to pre-empt the spon- Calcarea carbonicum fitted not just her presenting
taneous flow of the patient’s story, sometimes in symptoms but it was confirmed by her appear-
quite unexpected directions. ance, food and general symptoms. She felt better

99
CHAPTER EIGHT Taking the Case

the whole case and set the tone of the consulta-


CASE STUDY 8.1
tion. While the centre of the case may be unclear
Sharon, aged 56, attended for help with
or unconscious at this stage, much of its impor-
osteoarthritis of the hip. She had over 5 years
tance is revealed by discussing those areas of the
put on 5 stone in weight and wanted help los-
patient’s life which are most greatly restricted
ing weight; she found exercise difficult. The
by their illness – what they can’t do, what they
weight gain came on after starting on hor-
Presenting Symptoms

want to change, how the symptoms affect them.


Causation and the

mone replacement therapy (HRT) for meno-


Helping the patient to be at ease and to talk about
pausal hot flushes but Sharon is unhappy with
symptoms will set the tone and pace of the con-
her relationship with her husband and comfort
sultation and will be of help later in completing
eats. Sharon described the weight gain, then
the symptom picture. How the first consultation
the hot flushes and the alternatives to HRT she
begins will influence the rest of that consultation
had tried and that she had recently stopped.
II Other treatments and investigations Sharon
and also all subsequent consultations.

had had, including thyroid function, were dis-


Rapport
cussed. She went on to talk about her past
It is surprisingly easy in the attempt to gather
gynaecological history and other past history,
information about the symptoms to forget the
including a review of other systems. After
importance and priority of establishing rapport
prompting she shared details of her mother’s
and developing an understanding of the patient –
menopause and other family history. She was
‘in chasing a prescription the patient can be lost’.
anxious about having the same problems as
Always reflect on why the patient has the illness
her mother and this lead to her discussing
and what needs to happen for them to be well.
her fears and anxiety. Steering the consulta-
tion back to her hot flushes the consultation
explored her general temperature preferences
and other environmental factors – this led to Hearing the Symptoms
a review of the effect of her symptoms on her
While a symptom may at its most straightfor-
daily life. Sharon spoke about the effect on
ward be expressed as a single observation, the
her libido and her disrupted sleep pattern and
homeopath is often concerned with the detail
how this affected her marriage. At this point
that makes this symptom unique. Its character,
she spoke about her deep worries about the
the type of pain, the colour of discharges, loca-
future and her children.
tion – e.g. which side, which particular finger
and the pattern of symptoms – i.e. how often it
comes, what makes it better and worse and what
following treatment and her symptoms improved it alternates with. All this information helps com-
gradually. plete the symptom. The description of a symp-
tom may also include its causative factor, and so
The Importance of the Beginning we see the symptomatic approach incorporating
of the Case the causative.
You only get to begin once.
It is a well recognised feature of medical con- The Complete Symptom
sultations that patients will sometimes reveal A complete symptom can, because it is particularly
crucial information, even their real reason for individualising, point to a clear and well indicated
attending, as they are about to leave the room. prescription. The complete symptom gives infor-
Equally, the first things the patient observes and mation about causation, location, sensation (such
communicates are often things of significance to as the type and radiation of pain in a painful con-

100
Hearing the Symptoms

dition), and modalities including timings of the remedies that are generally < movement might
symptom, and also intensity. The intensity of symp- be considered. These characteristic modalities
toms or those features that modify symptoms can become increasingly important as the homeopath
be indicated by using capitals, underlining or scor- moves from analysing cases based on causation,
ing the symptom in the same way as in the materia through local prescribing on presenting symptoms
medica (see Chapter 7). So a strong burning pain to cases analysed on totality, essence or thematic

Presenting Symptoms
may be BURNING PAIN, burning pain or burn- prescribing.

Causation and the


ing pain (2). By convention most symptoms are Sometimes language fails to describe the
scored between 1 and 3. The complete symptom exact symptom or quality of symptom. There
also includes extensions and concomitants and is are many different types of pain or grief and our
described in more detail in Chapter 9 (p. 111) ability to hear, communicate and cross reference
the exact symptom is limited by this. In other
Modalities
Modalities are things that change the symptom.
cases there is the language but exactly what each
means may not be clear, e.g. fever may be con-
II
They are influenced not only by changes in the sidered hectic (consuming and high) or insidi-
environment but also by co-existing clinical condi- ous, relapsing, remitting; pain may be sticking,
tions, the patient’s emotional state, activities and gnawing, biting, etc.
behaviour. They also point to aggravating factors There may be modalities that run counter
that may be an extension of the causative factors. to the general symptoms – the more unusual a
Remember they are indicated by < for aggrava- modality the more it tells us about the individual’s
tion and > for amelioration, and the intensity can unique susceptibility. For example, contradictory
be indicated as << strong aggravation (equivalent modalities like burning better by warm applica-
to ‘2’ or single underlining or italic) or <<< very tions, exhaustion with obsessive tidiness, breath-
strong aggravation (equivalent to ‘3’ or double lessness better lying flat, or unusual sensation as if
underlining or bold), as in Jonathan’s case. head will fly off.

Presenting Symptoms
CASE STUDY 8.2 Most straightforward and simple cases have one
Jonathan, aged 42, presented with a reactive main presenting symptom. There are three aspects
arthritis following a throat infection. The joint of any presenting symptom that need to be taken
pains were <<wet, < cold and >> from warmth into account – the situation in which the patient
> rubbing the painful joint and < at first then became ill, the symptom itself and how the pre-
>> from gentle movement. He responded to senting symptom relates to any other symptoms
Rhus tox with gradual improvement of his joint that emerge as a more complete history is taken.
pain. The more all three aspects are covered by a pre-
scription the better the chance of recovery. If we
return to the principle that no one symptom alters
In some cases a modality can be shared by sev- in isolation then associated symptoms will inform
eral different symptoms, e.g. joint pain better for us about each other, although they may not be
stretching and sore throat better for yawning (a directly causative or predisposing, e.g. ‘my head
type of stretch). If this is the case the importance of aches when I am constipated’, where the consti-
the modality is increased. If the modality appears pation may or may not be a predisposing or pro-
in symptoms of different body systems, e.g. cough voking factor. The closer the association the more
worse for talking or moving and diarrhoea better important this link, e.g. ‘I always get constipated
for lying still, then it is again increased and some when I’ve a headache’. Although at first it appears
would then consider it a general symptom and all there is a clear distinction between causation and

101
CHAPTER EIGHT Taking the Case

a modality, in practice there is a gradation from a Past Medical History


clear ‘A causes B’ through different degrees to ‘A The presenting symptoms are in many cases only
is associated to B’, on to the opposite extreme that the ‘tip of the iceberg’. While the tip is what you see
‘A and B are not associated and have no connec- there are frequently significant factors in other areas
tion’. Establishing where A and B lie in relation to of the case. Asking when the patient was last com-
each other is part of case-taking. pletely well often allows them to see their illness in
Presenting Symptoms

a historic context and make links to other events.


Causation and the

Other Main Symptoms One reason for some cases to be more difficult to
Some patients particularly used to working with treat is because large parts of the case are apparently
causation or local approaches may not always invisible (see Hidden cases in Section VI). Many
notice or volunteer symptoms in areas other patients present their past history of illnesses in a
than their main presenting complaint. way that is unrelated to their main complaint. To

II As cases get more complex so they may appear


to have more seemingly unconnected presenting
the homeopath the past history frequently points to
the susceptibility and what lies behind and below
symptoms. In taking the case there may be modal- the current problems. An unresolved illness or one
ities that are common to several. For example, where symptoms have simply been suppressed
several symptoms may be worse in the morning, through allopathic treatment is not uncommonly a
or be relieved by the application of heat. These cause for present illnesses. This is why understand-
common modalities are likely to be linked to the ing symptoms and causation in terms of levels is so
patient’s susceptibility. They may include symp- important, as Joy’s case illustrates.
toms that describe the individual’s mental, general
or physical state.
CASE STUDY 8.4
Joy, aged 36, had a 20-year history of irritable
CASE STUDY 8.3 bowel syndrome (IBS) – especially diarrhoea
Joan, aged 52, presented with a sore throat and urgency when needing the toilet. In the
made worse from swallowing liquids. When the consultation she was anxious and fidgety and
importance of other symptoms is explained she she said this had been bad since her IBS. She
reveals that she suffers from extreme jealousy gives in her history that at age 16 she suffered
and is suspicious of her husband. When Joan from food poisoning that was treated with
is especially jealous her sore throat is often drugs to stop her diarrhoea. The symptoms
worse. After taking the remedy Lachesis, she of IBS started soon after the food poisoning
feels her jealousy recede and feels better in and the remedy picture of Arsenicum Album
herself. Joan comments that the sore throats was indicated on the symptoms of the original
she has been getting were only a ‘small part of food poisoning, as well as modalities of the
my general problems’. IBS and keynote symptoms of anxiety, cold-
ness of the extremities and craving for lemon
juice. Arsenicum Album helped her symptoms
While patients often want to talk mainly and at follow-up Joy commented she felt more
about the presenting symptom, because they are relaxed and was sleeping better.
most worried by them, when the importance of
other symptoms is explained the case can often
proceed into these other areas, as happened It is interesting that Joy had become more anx-
with Joan. Often if the presenting complaint is ious since having the IBS and it is common that
physical then psychological symptoms can be changes to a person’s physical well-being influ-
under-reported. ence their psychological well-being and vice-versa.

102
Hearing the Symptoms

That is why we seek to understand our patients understand this aspect of the case as not only does
and remedies as both physical and psychological it frequently alter the characteristics and modali-
entities and why cases other than the most simple ties of the patient’s presenting symptoms, but also
often benefit most from an approach that is closer it is a major factor in causing new symptoms (see
to the totality than local approach. Suppression in Chapter 11). Treatments include
not only conventional drugs and surgery, but also

Presenting Symptoms
Review of Systems psychological interventions like counselling, and

Causation and the


When a patient is keen to talk about a particular any complementary medical treatments. It is help-
complaint or group of complaints they may neglect ful to ask patients to bring with them any medica-
to mention other aspects of their health that may tion that they are taking or to list any treatment
provide valuable information to the homeopath. they have had in the past. The longer the symp-
One of the best ways of quickly reviewing those toms have gone on, the more important it is to go
other aspects is to ask about the different organ
systems – digestive, respiratory, circulatory, mus-
further back in the treatment history. For chronic
illness, information about vaccinations, birth his-
II
culoskeletal, etc. Another way of reviewing the tory, early infant traumas, etc. are all relevant, as
systems is to ask if the patient has had any prob- Paul’s case illustrates.
lems with any other part of the body, running
from top to bottom, e.g. any headache, neck ache,
CASE STUDY 8.5
arm problems, chest problems, stomach problems,
Paul, aged 38, presented with many allergic
pelvic problems etc. Even quite minor problems in
symptoms for which he had over the years
the past might be significant to the homeopath.
been prescribed much medication. It was diffi-
cult for Paul to see any link between symptoms
Significant Life Events and trigger factors after all this time, especially
Given what we now know of the holistic nature of
since his symptoms had been modified by
health, the significance of a particular life event as a
so much treatment. Through exploring Paul’s
possible causative factor or influence on susceptibil-
treatment history and symptom time-line it
ity would appear obvious. I frequently explain the
suggested his allergies started shortly after a
relevance of significant life events in terms of how
smallpox vaccination aged 8 and being taken
we know moving house or experiencing bereave-
abroad. This pointed to a remedy Thuja, that
ment can affect health, even causing measurable
was confirmed by keynotes and which helped
changes in the immune system, and that even
his allergy.
apparently minor events can be relevant homeo-
pathically. I ask them to list significant events, the
effects they have had on them and the ages when If a patient has had previous treatment by a
they happened. Patients are usually good at recall- different homeopath it is worth noting, particu-
ing significant life events although it helps some larly detailing any reactions to former treatments
patients to think about this before they attend, as given. This leads on to making contact with previ-
they may ask family members to remind them of ous and inter-current carers to request treatment
events that they might otherwise not remember or, details. It may also be the place to discuss with
if they happened as a child, they are unaware of. the patient issues relating to their shared care with
other health carers.
Treatment History
Treatment history will often come up during dis- Mental Symptoms, General Symptoms,
cussions of past or present problems. It is sur- Family History, Social History
prising how many patients take medication for These are covered in Chapter 13 as they are often
conditions they forget to mention. It is vital to considered more important in the totality of a

103
CHAPTER EIGHT Taking the Case

case; however, a patient may present for help due examination engenders trust and a deepening of
to symptoms in any of these areas. the therapeutic relationship, which is important
both for the patient and the doctor. Frequently
Examining the Patient new and sometimes important information sur-
Taking a homeopathic case history and examining faces during or after an examination.
the patient are complementary to understanding
Presenting Symptoms

the individual and the case – either without the Investigations


Causation and the

other is flawed. The relevant examination of the If there are indications then the examination may
patient in relation to the presenting pathology be extended to include necessary investigations.
can be vital in reaching a diagnosis, as well as They tell us not just about the conventional diag-
revealing important information about present- nosis and severity of illness and response to treat-
ing symptoms. For example, if a patient has a ment but can also point to homeopathic remedies.

II rash, how and where exactly does it appear? Any


signs observed are enquired about in the same
With more sensitive interpretation of test results it
is possible to get pointers to many remedies, e.g.
way as symptoms in order to give a complete pic- the low normal thyroid function of Sepia, the slow
ture – what are the modalities, causation, local- clotting time of Phosphorous, and the low normal
ity, etc. iron and haemoglobin of Ferrum salts.
Observing the patient also reveals much about
their physical constitution (body shape, hair tex- Making a Diagnosis
ture and colour), their generals (how many clothes The diagnostic label we give to a patient’s illness is
do they wear, where do they sit) and mentals (how an attempt to simplify and codify the reaction of
expressive they are, their appearance and their the ‘vital force’; to label how the patient’s vitality
style of dress). It is surprising how much informa- and environment reach a point of balance.
tion can be gained simply from shaking hands with Making a diagnosis is important but the
a patient, whether it is the moist ‘soggy’ hand- homeopath wants more than just a disease label.
shake of a ‘Calcarea carbonicum patient’, or the ‘Jimmy has a sore throat’ tells us something of his
light, tentative ‘cold’ handshake of the ‘Arsenicum presenting symptom and ‘Jimmy has a virus’ may
Album patient’. tell us about causation, but neither gives much
An accurate and complete record of the con- information about his susceptibility or how to
sultation should also include a contemporary note distinguish between the many local remedies that
of the patient’s movements and mannerisms dur- might help patients with sore throat. More infor-
ing the consultation. Even subtle movements and mation is needed to make an accurate and use-
mannerisms give clues to important aspects of the ful assessment and homeopathic diagnosis. Has
case and indicate where the case might need to Jimmy got enlarged tonsils? Has he over-used
be expanded. A patient may appear to be holding his voice? Was he exposed to a very cold wind
back something by covering their mouth, or touch before he felt ill? Where exactly is he feeling
their body when emotionally moved by something the pain? What is the pain like? Has he stopped
or be trying to communicate something when they eating or drinking? Does he have recurring sore
make certain movements – pointing or making a throats? These are all important qualifications of
fist might be obvious but small movements are just the diagnosis.
as important. As we move into the holistic per- Often homeopathically a diagnosis is a
spective every movement, sign and physical char- description to include conventional disease ter-
acteristic may encapsulate and transmit key points minology. Rather than a label, it becomes an
of the consultation. abbreviation of the patient’s story, a summary
Above and beyond this information, physi- or an overall impression of the patient and their
cal contact with the patient as part of a relevant symptoms.

104
The Case and Seeking Agreement to Work a Certain Way

Impression – Plan – Prescription ● In a consultation, how much detail should be recorded


It is helpful at the end of the consultation to and how can this be done without interfering in taking
clearly document what your impression of the the case?
consultation has been, the plan of how you have ● It is not uncommon during a case for some remedies
agreed to manage the case, and any methodology to suggest themselves, how can the potential to bias
used and prescription advised. The impression the case towards or away from these remedies be

Presenting Symptoms
leads on to a plan of treatment and management managed?

Causation and the


issues such as liaison with other health carers, ● There are many benefits to disclosing treatment plans
advice on concurrent medication, how treatment and prescription details to patients. Are there times
might progress and possible reactions to treat- when this may not be the beat course of action? If so,
ment. This leads on to recording specific pre- when and why?
scription advice given and the need, or not, for
feedback and follow-up. As more complex cases
are managed the usefulness of separating out
II
each of these steps increases.
The Case and Seeking Agreement
Discussing the impression with the patient to Work a Certain Way
shares the meaning we have constructed from There are certain styles and skills to case-taking
the case and helps patients gain insight from their and the successful homeopath will develop a num-
experience of the illness. It also allows any inac- ber of these to suit different patients at different
curacies made by the homeopath to be checked times. No one set of skills or particular style will
and is likely to improve compliance of any advice suit every situation – what is strength in one situ-
given. Explaining the plan to the patient promotes ation can be a weakness in others. The trainee
understanding of what the patient can expect from homeopath is well advised to explore different
homeopathic treatment and importantly, as often styles and different skills to develop a range of
is the case in more deep-seated illness, when treat- approaches to case-taking. Two of the best ways to
ment needs to be seen as just a step in the pro- develop this are by observing others at work and
cess of cure. This is an important step in clarifying to experience having your own case taken. Once
and reviewing the agreement between the patient there is an awareness of the variety of styles and
and homeopath about the treatment process. This skills available and what they each reveal, then
in turn affects the rapport and empathy between experience and practice will allow the homeopath
homeopath and patient and will in difficult cases to personalise the case-taking for each case. It is
prepare the ground for seeing a deeper case at the always worth reflecting on what makes a homeo-
next appointment. path successful at identifying symptoms, particu-
larly ones that the patient might be reluctant to
show, or even be unconscious of. Some of the dif-
REFLECTION POINT ferent styles are covered in this book and the con-
Consider some of the tensions that exist in taking a case trast between ‘taking the case’ in this chapter and
and reflect on how you will respond to these in your own ‘receiving the case’ in Chapter 13 is intentional.
practice: Identifying the most appropriate model of
● The patient prioritises what they feel are the worst health, approach to treatment and method of pre-
symptoms but what makes a symptom more or less scribing in each case at a particular time develops
important to the homeopath? alongside taking the case. The homeopath may adopt
● So much happens spontaneously and unconsciously – many, sometimes very different, styles of case-taking
how can this be made more conscious without interrupting to suit different patients. Case-taking can seem like
the spontaneity? a hunter ‘hunting down’ the symptoms and the

105
CHAPTER EIGHT Taking the Case

symptoms – it is important to be able to create a


BOX 8.2
safe space for taking the case. Psychological space
Reflections on the Homeopath as a Hunter
is created through the pause or measured silence,

How does being familiar with the location
that to be safe needs the patient (and homeopath)
that you are working in help you detect
to be comfortable. In this space the deeper aspects
subtle changes of atmosphere or symp-
of a case often unfold and small observations
toms?
Presenting Symptoms

about words, movements and behaviour reveal a


Be prepared to wait with patience to allow
Causation and the


great deal.
the symptom to present itself.
Using open-ended questions helps patients

How might you create opportunities for
to feel invited to reveal symptoms. For example
the symptom to reveal itself, particularly
asking ‘can you share with me some of the things
the deeper, more hidden symptoms which
that have made you happiest and saddest?’, then
are frequently more characteristic?
II ●
Might the right sort of bait, or provoca-
sensitively asking for clarification or more detail
is very different from closed questions that have
tion, entice the symptoms to the surface?
their place but reveal much less, e.g. ‘that must
The bait might include pauses, invitation,
have made you happy?’
explanations, mimics, challenge or provo-
cation.
Classify the Symptoms

How might modelling back to the patient
‘Each individual symptom must be considered. Every
the behaviour of a parent, a partner or
symptom must be examined to see what relation it sus-
even themselves allow patients to get in
tains to and what position it fills in the totality in order
touch with or recreate a symptom, e.g.
that we may know its value, whether it is a common
unresolved feelings? (If this isn’t done con-
symptom, a particular symptom, or whether peculiarly
sciously the homeopath may unconsciously
a characteristic symptom.’
be subject to these projects anyway.)
James Tyler Kent

When is the time to gently challenge a symp-
tom that is partly revealed? Challenging it
Once symptoms are revealed and explored com-
might simply be naming it or an attempt to
pletely then it is possible to order them not only
understand it.
by weighting but also by their relationship to other

The one that got away – there will always
symptoms. This can be in terms of chronological
be symptoms that are just out of reach;
appearance, hierarchy, sphere of action (mental,
sometimes there will just be a sense that
general or local), how strange or rare or peculiar.
there is something more to the case and it
Sometimes it is only while trying to classify or
may not be until follow-up or sometime
weigh a symptom that it becomes clear that the
later that the symptom will surface and be
symptom is far from complete, at other times the
seen clearly.
importance of other symptoms surfaces, as Mary’s
case illustrates (Case Study 8.6).

exercise in Box 8.2 compares some of the skills of a The Case as a Journey
hunter to a homeopath working this way. By seeing how an individual operates in different
environments a homeopath observes the individ-
The Invitation and the Pause ual’s susceptibility. The fears and anticipations
The homeopath creates a space for the remedy to that an individual has will reflect the fear and
reveal itself. anticipation of the circumstances they might find
For the case to emerge – especially the themselves in. Their delusions, dreams, imagina-
more embarrassing, unconscious or psychological tions and hopes will reflect the environments they

106
The Case and Seeking Agreement to Work a Certain Way

the patient improves and the case becomes more


CASE STUDY 8.6
straightforward so the approach to treatment can
Mary describes herself as full of fears. Taking
become more straightforward.
the case, it becomes clear that she is most
fearful of illness but only after describing all
The Use of Questionnaires
her symptoms does the one she is most fear-
Questionnaires can facilitate consultations but
ful of, heart attack, surface. When we explore

Presenting Symptoms
they can also make them less spontaneous. They
what symptoms are related to this fear she

Causation and the


facilitate by allowing a large amount of data to be
describes small points of pain over the chest
prepared by the patient beforehand and by ori-
that she thinks her father, who died from heart
entating the patient to the areas of importance to
disease, had. On examination, pressing the
the homeopath. For example, a question about
costal cartilage, which she describes as being
significant life events can make patients begin to
‘stabbed in the heart,’ reproduces her chest
pain. She is reluctant to talk about her relation-
see the relevance of life events.
Jane presented with anxiety symptoms that she
II
ship with her parents. She responds to Kali
thought were menopausal. After listing life events
carbonicum, a remedy that includes fear of
a correlation between the anxiety and her children
heart disease and well-circumscribed pains.
leaving home was clear.
After the treatment Mary had less pain and fear
On the down side, when patients talk about
and was able to talk about unresolved issues
things that they have already recorded in their
regarding her relationship with her father.
questionnaire, they can be more difficult to weight
and their connection to other aspects of the case
are drawn to or away from. During the homeo- may be less clear. For example, symptoms may be
pathic consultation, by exploring these things we ‘glossed over’ or patients may come emotionally
ask a patient to journey into those different cir- prepared, so the normal pointers that something is
cumstances. We explore how the symptoms are particularly significant may be filtered out. Some of
linked with those different environments. the strengths and weaknesses are listed in Box 8.3.
In addition to being given in advance, ques-
Deepening the Case tionnaires can also be used as a ‘work-book’ or
Often the illnesses a patient gets reflect, and are checklist during a consultation – useful when
influenced by, their journey through different envi- starting in practice or developing new approaches
ronments and life situations made over some time. to treatment that each offer a slightly new
During a course of homeopathic treatment, and approach to case-taking. Questionnaires may be
particularly in patients who use homeopathy over useful at different times in your career, initially
a long period of time, patients often move from when you need a checklist to ensure you have
thinking about their health in terms of what has covered all possible areas of case-taking. Later on
been done to them by external causes, to thinking they may enable you to focus on the areas of the
of their health in terms of optimum well-being and case that you consider most relevant while just
as an internal process which provides an opportu- quickly checking over areas not dealt with in the
nity to learn, change and grow. Helping patients to consultation. They can, when designed by you,
navigate through this transformative process is for help complement your style of working and as
some people more important than getting rid of such will evolve as you evolve. I would caution
the symptoms. The homeopath requires a mental against using someone else’s standard question-
agility to not only apply the right approach at the naire other than as a checklist at the very begin-
right time but also the skill to clarify the optimum ning of your practice, rather you should design
approach at each stage. As difficult cases open up and modify your own – for this reason a model
so the approach to prescribing deepens, then as questionnaire is not offered.

107
CHAPTER EIGHT Taking the Case

BOX 8.3
Strengths and Weaknesses of Questionnaires
Strengths covered in the consultation if other things take
Saves time at the appointment, especially in greater priority. It may reveal the patient’s style
detailing basic information such as address and of writing and handwriting and can be com-
Presenting Symptoms

date of birth. Enables the patient to reflect on bined with the ‘consent to treat’ form.
Causation and the

their health before the appointment and also to


Weaknesses
find out and write down chronological events,
It may interfere with spontaneity and may be
current medication and past medication, signifi-
considered intrusive by the patient. It may take
cant events in the past, details of family history.
time for the patient to complete, which they
It may also allow them time to complete a life
might be reluctant to give. It may make patients
II style questionnaire over a period of time, when
they can observe their life style, e.g. a dietary
feel that things other than on the questionnaire
are not relevant, so they might be less prepared
history over one week. It may allow patients to
to explore them. It may make patients feel the
ask family members and friends for feedback
consultation is more recipe-like than necessary.
on how they come across, aspects of their tem-
It allows patients to list their different symptoms
perament or details about the family history.
with no clear priority hierarchy.
It also allows broad questions to be asked about
past medical history; which may not always be

we can use this information to give meaning to the


REFLECTION POINT
treatment we are able to offer.
● Do you agree or disagree that the consultation is far
more than just ‘finding the remedy’? What do you
consider your own strengths and weakness in case-
taking to be? To what extent are cause and effect References
inter-related, so that the disease is observed as not Herscu P 1991 The homeopathic treatment of children.
just having a simple cause followed by an effect, but North Atlantic Books, Berkeley
rather that cause and effect can be related to and help
Shepherd D 1938 The magic of the minimum dose.
understand each other? Having thought about taking the Homoeopathic Publishing Company, London
homeopathic case and studying Box 8.3, do you think
a questionnaire for patients will be helpful; if so what Wynne-Simmons A 1993 The children’s toy box. British
Homeopathic Association, Luton
would you include in it?

Summary Bibliography
Enthusiasm for case-taking and exploring cases in Foubister D 1963 The significance of past history
their entirety is central to the homeopath’s quali- in homeopathic prescribing. Br Homeopath J April
ties. Mastering the ability of case-taking is essen- 52(2):81–91
tial to becoming a good homeopath and leads Leckridge B 1997 Homeopathy in primary care.
quickly on to how to order the information that Churchill Livingstone, New York
is revealed from the case. The next chapter looks Roberts H A 1937 Sensations as if, a repertory of sub-
at how, in case analysis, we start to sift though jective symptoms. Boericke & Tafel, Philadelphia PA.
the information generated by the case and how Indian edition. 2002. B Jain, New Delhi

108
CHAPTER NINE

Local Prescribing and Case Analysis

Repertorisation
David Owen

‘To be a genuine practitioner of the medical art, a physi- influence the final selection of the remedy. While a
cian must: broad understanding of the local symptoms within
Clearly realise what is to be cured in diseases, that is, the totality will emerge as this chapter proceeds it
in each single case of disease (discernment of the disease, is helpful to start by focusing on the analysis of
indicator), cases on the presenting symptom. The skills and
Clearly realise what is curative in medicines, that knowledge learnt in using each model, approach
is, in each particular medicine (knowledge of medicinal and methodology overlap with and inform the
powers), study of the others. There is no absolute reason
Be aware of how to adapt what is curative in medi- why the homeopath should develop prescribing in
cine to what he has discerned to be undoubtedly dis- the order suggested through this book, although it
eased in the patient, according to clear principles. In this may be wise to gain experience in managing cases
way, recovery must result. from the simplest to most complex. An apprecia-
Adapting what is curative in medicine to what is dis- tion of each approach will help the homeopath
eased in patients requires that the physician be able to: maximise their treatment strategies for differ-
Adapt the most appropriate medicine according to its ent cases. This chapter also starts to develop the
mode of action to the case before him…’ importance of matching of the model, approach
S Hahnemann, Organon, Para 3 and methodology to the level of complexity of
the case and the idea that in any one case several
methodologies may each point to a remedy. When
it is the same remedy, our confidence in the pre-
Introduction scription increases; when it is not the same rem-
Having identified what is wrong, where possible edy strategies that require an understanding of the
what is causing what is wrong, or at least what strengths and weaknesses of each methodology
was going on when things went wrong, it natu- help select an optimum prescription.
rally follows to ask what needs to happen to help While the analysis of any case has to address
the patient back to a new state of balance, to plan the key questions identified in Chapter 4, many of
a course of treatment. these take place as the case is taken – the analysis
The realities of practice are that there is often a chapters of this book will now look predominantly
spectrum of information between the purely local at the question of finding the indicated homeo-
symptoms, aspects of the totality, the patterns run- pathic remedies. Focus in this chapter is particu-
ning through the case and the interaction with the larly on the approach to treatment based on the
patient, on which to base a prescription. A broad local symptoms and the methodologies for match-
range of factors can consciously and unconsciously ing the local but complete symptom to the remedy,

109
CHAPTER NINE Local Prescribing and Repertorisation

a method frequently suited to treatment of In these cases local treatment may be just the start
localised and acute conditions. of a process of gradually deepening understand-
ing and treatment. Indeed, this process of gradu-
ally treating at deep levels is what much chronic
Local Prescribing disease treatment is all about.
Treating on presenting symptoms (local prescribing)
Presenting Symptoms

is often incorporated with causation approaches Different Methodologies


Causation and the

and is often a starting point for homeopaths treat- of Local Prescribing


ing simple or straightforward cases with acute Box 9.1 lists the main local methodologies. Each
illness. The aim is to identify a remedy that circum- has different advantages and disadvantages. Each
scribes the case, that covers all the main features may be, and often is, combined with another
and, if possible, to cover both causation and pre- (and with other approaches) to improve reliabil-

II senting symptoms.
There are several reasons why treating on cau-
ity. Establishing for a particular patient in a par-
ticular context the most important symptoms and
sation alone may not be indicated or successful. how they are related is the beginning of any case
In some acute illness there is no strong, clearly analysis.
indicated precipitating or causative factor. In oth-
ers there may be lots of different causes – when Single Main Symptom
there is no clearly indicated remedy from the Choosing a remedy on the single presenting symp-
cause or where a prescription based on causation tom or sign is sometimes referred to as ‘clinical’
fails to act fully. In these cases the homeopath prescribing. It is quick but often many remedies
wanting to look more widely for a remedy may share the same symptoms.
first consider the presenting symptoms.
Some homeopaths are critical of local prescrib- Single Keynotes
ing, believing it fails to act deeply enough, perpetu- The main presenting symptom is not always the
ating a lengthy and (I believe) wasteful schism in most useful. A hierarchically significant symptom –
homeopathy. When a local prescription has acted, including ‘strange, rare, peculiar’ – in the case
an individual is not only freed of their acute symp- matching a significant symptom in a remedy may be
tom but they frequently feel generally better and a strong pointer to a remedy match. This is where
happier as well. They are less likely to get a recur-
rence and from the evidence of families who have
used homeopathy in the home over many years it BOX 9.1
appears their general resistance to chronic disease Methodologies of Local Prescribing
is improved. As such local prescribing seems a com- ●
Single main symptom
pletely valid and appropriate use of homeopathy ●
Single keynotes
for simple or straightforward cases (in Chapter 10 ●
Several keynotes in one or more areas of
the different types of case are described). Not only the case
can the use of local remedies and first-aid remedies ●
The complete symptom
in the home and by health carers greatly help to ●
Confirmatory and eliminatory symptoms
reduce acute suffering, but they can also do a great ●
Epidemic remedies
deal for the health of the population by reducing ●
Doublet or triplet symptoms and linked
the amount of symptoms being masked by conven- symptoms
tional drugs and reducing iatrogenic disease. ●
Previous well indicated remedy
In some more deep-seated cases only an acute ●
Combination remedies
or local picture may be manifest, or the homeopath ●
Strange, rare and peculiar
may choose just to focus on the local symptoms.

110
Local Prescribing

the weighting of symptoms and knowledge of the


keynotes in the materia medica is very useful. So Sensation
for example the patient with cold extremities who ‘Stabbing pain
like a needle’
finds relief when they are in cold environments
would be peculiar and link with keynotes in just a Location Causation
‘Its hurts in ‘When I don’t
few remedies. one spot on the drink enough,
left hand side

Presenting Symptoms
I always get...’

Causation and the


Several Keynotes in One
Concomitants
or More Areas of the Case ‘When my throat
The more unique, stronger and representative of hurts I always
Modalities get diarrhoea’
the case keynotes are, the more likely they lead to ‘The pain is better
for hot drinks’
a good prescription. Identifying the weighting and
hierarchy of keynotes again makes case analysis
much easier.
Extension
‘It starts in my throat,
II
Remember, if you are finding it difficult to but spreads to my
whole neck’’
weight a symptom in order to compare its value
to other symptoms, then it is worth considering its
Figure 9.1 The complete symptom
intensity, its uniqueness, its depth and duration.
Consider how strongly the symptom is affecting
the patient, how much it is limiting normal func-
tion, how ‘strange, rare or peculiar’ a symptom is, similar sensation. Sensation may connect to other
whether it is a quality that affects several symp- aspects of the case, including thoughts and feel-
toms or been present for a long time, and how ings. Concomitants or extensions (where anatom-
deep or central it is, i.e. does it affect a vital organ ically a symptom moves or extends to) are how
like the heart or kidneys? one symptom relates to symptoms in other parts
The greater the number of symptoms, the more of the body, and so also starts to point towards a
important it is to have a hierarchy. Not seeing an wider totality. Two or three related or concomi-
order to the symptoms can blind the homeopath tant symptoms are sometimes referred to as dou-
to the most relevant symptom. blet or triplet symptoms.

The Complete Symptom Confirmatory and Eliminatory Symptoms


The complete symptom looks at all aspects of Inclusion symptoms are often other presenting
the symptom that the patient presents, to include symptoms, but can also be other aspects of the
causation, location, sensation, modalities and patient such as mental and general symptoms, that
concomitants and extensions. This is illustrated in confirm or reinforce the indication of a particular
Figure 9.1 as symptoms being like a cube, hav- remedy. The more aspects of the case the remedy
ing six faces. The location is the part of the body fits, the more confident the homeopath can be
or personality most affected and may include with the prescription.
an idea of how narrowly focused a symptom is, For example, in a case of food poisoning
e.g. whether a pain is felt at a specific point or when the remedy Arsenicum Album is indicated
more generally. The modalities are those things on the basis of the causation, it may also be indi-
that modify the symptom and often provide the cated by the presenting symptoms of diarrhoea
characteristic that makes the symptom more indi- and/or vomiting. Restlessness, anxiety and chilli-
vidual. The sensation is what best describes how ness are the confirmatory symptoms that sig-
the symptom feels to the patient and it is possible nificantly increase the confidence with which a
in several apparently diverse symptoms to find a prescription could be made. Likewise eliminatory

111
CHAPTER NINE Local prescribing and repertorisation

symptoms are symptoms that are highly unlikely allows them to be compared with the symptoms
to be present in an otherwise possibly indicated that emerge in the homeopathic case and with
remedy and will lead ‘relatively’ to exclude a other remedies. When prescribing on causation
remedy from consideration. there may be just one or two remedies to distin-
guish between. When prescribing on presenting
Other Methodologies symptoms there may be several. Books with lists of
Presenting Symptoms

Other methodologies that may be used for pre- remedies for different conditions can be useful in
Causation and the

scribing are developed elsewhere. They include the prescribing for common or well recognised causes
prescription of the same remedy in several cases of and presenting symptoms, and the modalities can
an epidemic (see Chapter 10), using a remedy that indicate the relative closeness of different remedies
has previously acted well, whatever the methodol- to the picture the patient is presenting. Here, too,
ogy on which it was based, and the use of several confirmatory symptoms can be helpful. In more

II remedies combined together that may each cover


aspects of the case (see Chapter 26).
obscure symptoms remembering where to find
them in the materia medica can be difficult, and
an index of symptoms with the remedies that have
each symptom is helpful – this is a repertory.
It makes sense always to use the easiest but also
Case Analysis Using Causation the most efficient and accurate method to match
and Local Symptoms the remedy to the case. In more simple cases a
The aim of each methodology is to match the case step-by-step method like a flow diagram may
to a remedy or ‘shortlist’ of likely remedies, the work best. In more complicated cases, matching
shortlist being sometimes referred to as the ‘dif- several different symptoms in the case and remedy
ferential diagnosis’. Once several remedies close to by a process of comparison (like comparing two
the case emerge they may be compared from their pictures – one the patient, one the remedy – to
materia medica pictures. As the symptoms become see if they are similar enough), may need to take
more numerous and complicated it becomes more place. When using comparison, different skills are
difficult to identify and remember which particu- required and different interpretations are possible.
lar symptoms relate to which particular remedy. It is possible for different homeopaths to come up
While for simplicity’s sake prescribing on cau- with different remedies because they have seen
sation as opposed to local symptoms has been the priorities of the case or information about the
separated out, in practice both are very much remedies differently.
connected. A remedy that is covered by both is
much more likely to act than one covered by only Step-by-Step (Flow Diagram)
one of them. Local treatment based on symptoms Case Analysis
alone is most useful when it is only possible to At its simplest, a remedy and case can be matched
see the case at the level of symptoms expressed through a process of comparing a shortlist of
locally and there is no obvious maintaining cause. possible medicines to the case – as in first-aid
The patient’s life style and circumstances and their type prescribing. For acute illness there may be
susceptibility will still, of course, have an effect several steps in making the match and these can
but these are not always visible or amenable to be thought of as ‘flow diagrams’ that allow sev-
treatment. eral possible remedies to be compared (Figure
9.2). From the questions asked about the symp-
Matching the Case to the Remedy toms, remedies can be confirmed or eliminated.
Given the desire to match the patient’s case with a It relies heavily on keynote information in the
homeopathic remedy, it makes sense to develop a case and in the materia medica of the possible
way of presenting and learning the remedies that remedies. This flow diagram or decision-tree

112
Case Analysis Using Causation and Local Symptoms

Other features of
the remedy
Pain during urination
relief afterwards Cantharis pain before, during,
after urination
Yes rapid onset of symptoms
Pain and
urgency Pain during urination Mercurius dark offensive urine
marked with no relief afterwards

Presenting Symptoms
perspiration
before bladder spasms

Causation and the


urination
No Yes Sarsaparilla unbearable pain at end
of urination
Pain worse at flow easier if standing
end of urination (may also have pain
after urination)
No Yes Staphisagria honeymoon cystitis
burning in urethra
Pain relieved
by urination
between urination
II
No Yes Causticum frequency/urgency
leaking of urine after
Difficulty urination
starting

No Equisetum copious urine


bladder feels weak
continuous flow

Figure 9.2 Flow diagram of common symptoms in cystitis (with thanks to Dr A Gove)

approach lends itself to cases where there is a two pictures (patient and remedy) that are most
fairly clear diagnosis or symptom picture, with alike.
not too many symptoms or modalities. When One way to systematise this approach is by
we approach materia medica in this clinical way trying to match each of the important or charac-
we are able to make comparisons between dif- teristic symptoms of the case to the important or
ferent remedies, for example in urinary infec- characteristic symptoms of the remedy. This can
tion between Cantharis and Sarsaparilla, to see be helped by using a repertory that consists of
which is best suited to any simple case. For many symptoms, each of which has attached to it a list of
health practitioners this flow diagram approach remedies that have that symptom in their materia
to selecting a prescription is one of the easiest medica. Each symptom and its collection of rem-
ways to start prescribing, and is a good way to edies is called a ‘rubric’. Within each rubric there
start integrating local homeopathic prescribing may be sub-rubrics of that symptom but with dif-
with other treatment approaches. ferent modalities and therefore more detailed elab-
orations of the main rubric. There may be several
levels of rubric, sub-rubric, sub-sub-rubric, etc. –
Comparison or Picture studying them will give an idea of the different
Matching Method symptoms and modalities a remedy picture has.
When patients present a variety of symptoms Remedies can be compared in cases with sev-
the overall collection of the symptoms may be eral symptoms on the frequency with which the
thought of as resembling a picture. This picture remedy occurs in the different rubrics. As the
can then be matched to the symptom picture of approach to treatment broadens from the local
the remedy, and the analytic process is similar towards the totality so more information is
to the puzzle of comparing different sketches or included in the analysis, the greater the individ-
cartoons to spot the differences and to find the ual’s susceptibility is represented, and the more

113
CHAPTER NINE Local prescribing and repertorisation

ways there are of interpreting the repertorisa- related to other symptoms. For example, a sensa-
tion. As this happens, so the number of partially tion of being brushed by a feather might be inter-
indicated remedies increases and the importance changeable whatever symptom it belongs to. This
of differential diagnosis to distinguish them also is sometimes referred to as ‘sensations as if ’ and is
increases. an approach that runs through Boenninghausen’s
repertory.
Presenting Symptoms

Rubrics
Causation and the

Rubric is a name given to symptoms that groups


of homeopathic remedies share, e.g. a rubric REFLECTION POINT
might be ‘a fear of heights’ with a list of rem- ● Compare the diagrams of snowflakes in Figure 9.3,
edies that include that symptom in their materia which ones are similar and which are different? What
medica. This rubric would include all the rem- helps and what hinders the comparison? What features

II edies that have – in their proving and through


clinical experience – been shown to work in cases
might equate important, strong, peculiar and keynote
features? It is interesting to reflect that while each
that have a fear of heights. However, each of snowflake is made up of the same material each has
those remedies might represent a very different a unique pattern, the ‘information’ that determines the
reason for fearing heights. Rubrics are collected shape might perhaps be similar to the information in the
in repertories; an essential part of the training of remedies.
homeopaths who wish to work with cases other ● How is designing a systematic index for all possible
than the most straightforward is an understand- symptoms (a repertory) like trying to write a key to
ing of how repertories are designed and how to classify every snowflake?
use them. They are an invaluable tool for search- ● What might the fact that every snowflake appears
ing for the information about different remedies different but is made from identical material say
and discovering those remedies that fit particular about the ‘information’ that determines the shape of a
symptoms. snowflake?
As one expects, in the compiling of reperto-
ries, at each removal from the actual language
that the prover uses to describe their experience
of a remedy proving, there is potential for error. A
While rubrics and repertory are an essential aid to
matching cases there is no replacement for com- B
paring the actual language of the original prov-
ers with the language that patients use to describe
their symptoms. Although many repertories are
large, they do not include every symptom – espe- C
cially not the complete symptom. As such, finding
a rubric for a particular symptom is difficult and
learning to use a repertory is an important part of
the homeopath’s training. The homeopath needs D
to be not only a detective but also a translator,
matching the symptom expressed by the patient
to a symptom or rubric that has been translated
from a proving. Some homeopaths feel that the
quality of the complete symptom, e.g. as reflected Comparing different pictures, illustrated by diagrams
of different snowflakes
by the modality and sensation, can be analysed
using the same modalities and sensations, even if Figure 9.3 Comparing different pictures

114
Repertorisation

Differential Diagnosis dies and rubrics (symptoms) from past and present
An exercise that helps us in differential diagnosis provings and clinical experience, and making
is to examine the different character of remedies corrections, alterations and modifications. No
sharing particular symptoms. For example, when repertory is ever complete and some repertories
we consider remedies that have an element of fas- contain information that is not in another.
tidiousness we want to understand why they might Great care has to be taken in compiling reperto-

Presenting Symptoms
be fastidious and how they show this trait, so that ries to make sure the information is accurate. Even

Causation and the


they can be distinguished from other fastidious rem- so, there can be considerable difficulties in turning a
edies. Difficulties arise in any analysis strategy when symptom from the materia medica into a form that
patients fall between different remedies. In these is appropriate to the repertory. This is a limitation
cases we must often take another look at the case to that has to be borne in mind when using the reper-
see if there are other symptoms we have overlooked, tory. Some repertories have tried to preserve the lan-
to consider remedy pictures other than those so far
considered and to look at other analysis strategies.
guage of the patient and prover (Knerr, Allen) and as
a result have many more rubrics than others.
II
Related Remedies The Structure of the Repertory
We also find that some remedies are related to Most of the repertories are divided into chapters,
one another – sometimes because they often each covering a bodily system. The divisions vary
appear together in the same differential diagno- quite a bit from repertory to repertory and you have
sis, sometimes because they may be an acute or to get used to the structure of each one; an example
chronic complement to one another, and some- of the structure of Kent’s repertory is given in Box
times because one may frequently be observed to 9.2. Some, like Clarke’s and Phatak’s, have no chap-
follow another well in a treatment strategy. These ters and are strictly alphabetical. Kent’s repertory and
relationships may point to groups of remedies that those based on it include information about the lat-
might need to be considered in a case favouring erality of symptoms (e.g. right or left) and the time
one remedy over another. They may appear in the of incidence of symptoms (e.g. morning, afternoon),
materia medica or in a separate ‘relationship’ rep- before the alphabetical list of modalities, which is fol-
ertory and are discussed further in Chapter 27. lowed by the extension of symptom to other parts.
The order of rubrics throughout deals with
the general before the particular. For example
in ‘extremities’, pain is taken in general first (i.e.
Repertorisation those things that affect all the extremities), then it
‘A tool for finding the best indicated remedy’ moves to joints and bones, then to particular parts
of the arms and legs. Then it repeats the whole
The word repertory comes from the Latin reperire process with each different type of pain going
(to find). The repertory lists the remedies relating alphabetically from aching to tearing.
to each symptom, like an index, and is the reverse In extremities the parts are listed from above
of the materia medica (which lists the symptoms downwards, so shoulder is listed first, going
of each remedy). Through the repertory homeo- down to fingers, then from nates (buttocks) and
pathic remedies can be selected, compared and hip down to toes. Other sections, such as the
contrasted using different methodologies. abdomen or head, list the parts alphabetically,
As the materia medica grows in both the num- e.g. hypogastrium before umbilicus. Generalities
ber of drugs and the symptoms and features of are also in alphabetical order except for time,
those drugs, so the repertory grows. Most of the which starts the chapter (laterality is under ‘side’).
repertories we use today have drawn their infor- Box 9.3 illustrates some sub-headings found in
mation from preceding repertories, adding reme- Kent’s repertory.

115
CHAPTER NINE Local prescribing and repertorisation

BOX 9.2 BOX 9.3


The Framework of Kent’s Repertory Sub-headings of Kent’s Repertory Using as

Mind, i.e. mental symptoms An Example The Headings Under Which

Vertigo, head, eye, vision, ear, hearing, i.e. a ‘Pain in the Head’ Might Be Looked Up
special senses Sides
Nose (including smell), face Time
Presenting Symptoms

Mouth (including taste), teeth, throat, i.e. Modifications


Causation and the

all alimentary system Extending



External throat, stomach including desires Parts of the head
and aversions to different foods and thirst Sides

Abdomen, rectum, stool Time

Bladder, kidneys, prostate, i.e. urogenital Modification
II system Extending

Urethra, urine, genitalia (male) Kind of pain

Female genitalia including menses, leucor- Sides
rhoea Time

Larynx and trachea including voice Modification

Respiration, cough, expectoration Extending

Chest including heart symptoms and Parts of the head
breast Sides

Back, extremities, i.e. locomotor system Time

Sleep including dreams Modification

Chill, fever, perspiration Extending

Skin

Generalities including food aggravations.
at the time the repertory was published been
confirmed by reproving ‘but stand out pretty
The Grading of Remedies strong’ or have been verified clinically. In this
Most repertories include a useful introductory grade are also included those remedies that did
chapter on layout and how remedies have been not cause the symptom in provers but have
weighted, including the number of gradations cured the symptom in patients.
and how they are indicated. The grade a remedy
is given in a rubric is not, as it is in a case, an The Evolution of the Repertory
indication of the intensity of the symptom it pro- There have been hundreds of repertories pub-
duces, but represents how frequently and easily lished, often sharing some common source material.
the symptom is produced. Relatively few of these are still in common use today.
In Kent’s repertory bold remedies brought Box 9.4 gives details concerning some of the most
out the symptom in ‘all or a majority’ of the well-known and used paper repertories; computer
provers, each confirmed by reproving and hav- repertories are covered in Chapter 19.
ing been extensively verified clinically. Second
grade (italics) remedies brought out the symp- Card Repertories
tom in ‘a few’ provers, confirmed by reproving Repertorisation by hand is a slow process. In an
and occasionally verified clinically. Third grade effort to reduce the time and effort of writing
(ordinary type) remedies brought out the symp- down rubrics and remedies for repertorisation,
tom ‘now and then’ in provers. These had not, punched card repertories started to be developed

116
Repertorisation

BOX 9.4
Different Repertories
Manual of homoeopathic medicine – G H G exactly a patient’s symptom. It has nearly three
Jahr times as many rubrics as Kent’s repertory but a
Translated in 1836 by Constantine Hering and third of the number of remedies. Uses five levels

Presenting Symptoms
the other members of the faculty of the North of gradation.

Causation and the


American Academy of the Homoeopathic
Repertory of the characteristic symptoms,
Healing Art in Allentown, Pennsylvania. Used
clinical and pathogenic, of the homoeopathic
two levels of gradation (roman and italic). Jahr
materia medica – Edmund Lee
started work on this for Hahnemann while he
First published 1889. An enlargement of Lippe’s
was still a medical student in the 1810s.
repertory.
Boenninghausen’s therapeutic pocketbook
Repertory of the homoeopathic materia medica
II
– T F Allen
– J T Kent
First published in 1846. This was Boenning-
First published in sections starting with the
hausen’s small concise pocket book of his major
‘Mind’ in 1897. First complete edition pub-
work, the ‘Repertory of the antipsoric rem-
lished in 1899. Subsequent editions: 2nd 1908,
edies’ published in 1833. It has many very large
3rd 1924, 4th 1935, 6th 1957. It was based
rubrics because symptoms were divided into
on the repertories of Lippe and Lee. Used by
characteristics that are not limited to a single
many homeopaths for much of the 20th century.
symptom, but run through the remedy picture,
Uses three levels of gradation (roman, italic and
e.g. ‘burning’ is a characteristic sensation run-
bold).
ning through many symptoms in the remedy
Arsenicum Album. It sees five levels of gradation Clinical repertory – J H Clark
and gave rise to the so-called ‘Boenninghausen First published 1904. This repertory is actually
method’, the precursor of essence and thematic five repertories in one book. Only the clinical
prescribing. repertory is relatively complete but it illustrates
how different methodologies suit information
Encyclopedia of pure materia medica – T F Allen
presented in different ways.
First published in 1879. It has only 75 remedies,
1. Clinical repertory – has an extensive range of
compared to Kent’s 654, but almost twice as
pathological rubrics
many rubrics.
2. Repertory of causation
Repertory to the more characteristic symptoms 3. Repertory of temperaments, dispositions,
of the materia medica – Constantine Lippe constitutions and states – this is where you
First published 1880. Based on the reper- find ‘scrawny women, foxy persons and
tory found at the end of Jahr’s ‘Manual of worn out business and professional men’
Homoeopathic Medicine’. 4. Repertory of clinical relationships
5. Repertory of natural relationships
Repertory of Hering’s guiding symptoms –
Calvin Knerr Materia medica with repertory – Boericke
First published 1896; derived from Hering’s Ninth edition published 1927. Compared to
10-volume materia medica – contains guiding Kent it has 394 more remedies, only about an
symptoms by his student Knerr. The rubrics are eighth of the number of rubrics, but very many
more exact and longer than most other reperto- clinical and pathological rubrics not in Kent. It
ries, making it ideal for seeing if a remedy covers is a useful ‘pocket guide’.

117
CHAPTER NINE Local prescribing and repertorisation

Boenninghausen’s characteristics and repertory – Synthetic repertory – H Barthel & W Klunker


C M Boger First published in 1974. The three volumes are
First published in its present form in 1936. drawn from sixteen sources and it is one of very
It was based on Boenninghausen’s repertory few repertories to give the source of every entry.
and enlarged with additions and new rubrics. It has 40% more remedies than Kent and uses
Presenting Symptoms

Stressing modalities for local symptoms as four levels of gradation.


Causation and the

applicable to the whole person followed by


The final general repertory – Pierre Schmidt
concomitant symptoms (i.e. attendant symp-
Published 1980 to correct and extend Kent’s
toms), then sensations and then the location of
repertory
the symptoms.
Synthesis – editor Frederik Schroyens and the
Sensations as if – H A Roberts
II First published 1937. A repertory of sensations.
complete repertory – Van Zandvoort
Both Synthesis and the Complete are comprehen-
Dictionary of sensations as if – Ward sive repertories that are based on Kent’s structure
A repertory of sensations. Two volumes. but with many additional rubrics and remedies.
Because they are so large they can be difficult to
A concise repertory of homoeopathic medicines use in the early stages of studying the repertory,
– S R Phatak but they are recommended for the repertorisation
First published 1963. Designed by Dr Phatak of the totality. They include information about
to be a very compact and handy repertory; where additions to the repertory come from and
based on Boger’s ‘Synoptic key’. Arranged form the basis of the main repertory programmes
like a dictionary in one complete alphabetical used in the computer repertories, although many
list without division into chapters of body sys- repertories are available in the computer repertory
tems so a useful first repertory for simple cases. programmes (see Chapter 19).

from 1888 but were very limited by the number of How to Repertorise
cards needed; one for each rubric. But they did ease
the conceptual transition to computer repertories. When looking for the best remedy homeopaths are
An example is W J Guernsey’s Boenninghausen trying to find a remedy that covers the most impor-
Slips, produced in 1888 with 2500 cards. tant features of the patient. The repertory has two
ways of helping this, as a simple and straightfor-
Computer Repertories ward index to the materia medica and as a method
The computer has revolutionised the homeo- for systematically processing the symptoms and
pathic repertory and access to the materia med- rubrics in what is called ‘repertorisation’. This
ica. Some of the advantages are given in Box 9.5 technique indicates how well a particular remedy is
but this is covered in more detail in Chapter 19. represented in the rubrics selected, allowing com-
Some programs are also able to search the mate- parisons between remedies and levels of confidence
ria medicas and journals to create rubrics that can in a prescription to be formulated.
be used as part of any analyses. The flexibility of
analysis strategies and options to extract informa- The Use of the Repertory
tion about symptoms using for example phrases, In repertorisation the symptoms can be weighted
expressions or words that the patient uses is able and are matched to rubrics in the repertory. In all
to generate quite individualised rubrics. cases the hierarchy of symptoms points to the grad-

118
How to Repertorise

each remedy in all the rubrics with the grades


BOX 9.5
scored as ordinary type = 1, italics = 2, bold = 3,
Some Advantages of Computerised
(and those repertories with bold italics = 4). By
Repertories
taking a selection of rubrics and sub-rubrics that

It is usually far quicker to refer to a com-
represent the case and scoring the remedies in these
puter repertory than the book
it is possible to generate a numerical score for each
Repertorisation is dramatically quicker –

Presenting Symptoms

remedy.
almost instantaneous – and as a result can

Causation and the


In theory the simillimum should be the rem-
be done during the consultation
edy that covers the greatest number of the selected

Additions and modifications to the reper-
rubrics to the highest degree. However, if the
tory can be made very easily
numerical result is to be correct there are several

Production and distribution of reper-
presuppositions that need to be fulfilled. These are
tory upgrades on disk are far cheaper and
quicker
discussed in more detail in Chapter 14, page 181.
The result is that repertorisation is only a guide to
II

It may allow the user to add personal
the possible correct remedies even if the repertory
rubrics and remedies
contains the rubrics required to find the simillimum

Every remedy in every rubric can be tagged
and the remedy that is the simillimum.
giving its source/author

It enables rapid searches for information:
Analysis Strategies
(a) key words, (b) synonyms of key words
There are a number of different analysis strategies
and (c) remedies
possible with repertorisation. In local prescrib-

Rubrics from the same repertory or differ-
ing the grades of the remedy in each rubric are
ent repertories can be combined to give a
added together to give a total or ‘rubric score’ that
more complete rubric
is used to indicate the most likely remedy match.

A range of different analysis strategies or
These use the principle of inclusion and exclusion
combination of strategies can be used with
presented earlier, where the remedy with symp-
the ability to change from one to the other
toms found in the case will increase the likely
instantly; with different strategies the anal-
inclusion of that remedy while remedies without a
ysis can compensate for different features
symptom can be relatively excluded. How strong
of either a) the case or b) the strengths/
or central the symptom is and how clearly the
weaknesses of the repertory.
remedy does or does not have that symptom will

Graphical display of the analysis makes
give the strength of the inclusion or exclusion.
interpretation a great deal easier
This is similar to using a strong or key symptom
as an ‘eliminatory’ rubric, where to aid analysis
ing and weighting. Homeopaths using different only those remedies in one or two key rubrics are
models of health see the hierarchy of symptoms dif- considered as possibilities, while others are effec-
ferently and to some extent the layout of repertory tively eliminated.
reflects the priority of the compiler. The remedies Other strategies are covered in Chapter 14 but
in the rubrics and the strength or grade required they include looking at small remedies, emphasis-
are identified. Then, most simply, repertorisation ing rare remedies that have few symptoms in the
adds up how many times each remedy occurs in the repertory. In small rubrics, the smaller the num-
selected rubrics, taking into account the grading of bers of remedies in a rubric, the more the remedies
the remedy in the rubric, and the weighting of the in that rubric are emphasised – equivalent to
symptom to achieve a numerical score. ‘strange, rare and peculiar’ symptoms. Prominence
There are different ways of scoring each rem- emphasises remedies that are unusually strong in
edy; the most common is to add the grading for a rubric, – basically keynotes. Finally, it is possible

119
CHAPTER NINE Local prescribing and repertorisation

to bring out family groupings of remedies that are ●


Consider how one symptom might be looked up in a
indicated. repertory in different ways. For example, how might
hypochondriasis be expressed differently by different
patients or looked up differently in the repertory (anxiety
Using the Repertory pains, fear death, thoughts of disease)?
in the Consulting Room ●
Finally, reflect on how the repertory might help you
Presenting Symptoms

Some homeopaths are always dipping into the learn the picture of a particular remedy. You might look
Causation and the

repertory throughout the interview. Others, espe- up features of the remedy being studied to see how
cially when focusing on the case, repertorise at the prominent the remedy is in the rubric and what other
end. Some hear the patient mention an unusual remedies are present, especially those that are of the
symptom and seek it in the repertory, others same or higher grade.
hear it and want to know what’s behind it; both
are relevant. In the repertory the remedies shown
II guide which confirmatory and eliminatory ques- When analysing by hand many homeopaths start
tions to ask. Of course sensitivity is needed when by choosing rubrics of a ‘middle’ size. For example,
browsing in the repertory with the patient pres- in a tonsillitis case – Throat, pain, swallowing, on:
ent but sometimes the pause allows the patient to contains about 120 remedies that are too many to
share something useful they might not otherwise. work with easily and it is a very common symptom.
As cases get more complex, so deciding the priority Alternatively if you take Throat, pain, warm room
of what to repertorise increases. Flicking through amel., then the only remedy listed is Magnesia car-
the repertory searching for rubrics can help to both bonicum. Even if this is a strong peculiar symptom
focus on and free-associate around the case, lead- it is not useful on initial repertorisation because
ing sometimes to the sudden exciting discovery. the right remedy, unless it is Magnesia carboni-
cum, might be excluded at the start in such a small
rubric. Rubrics like Throat, pain, extending to the
REFLECTION POINT ear, which has about 30 remedies, and Throat,

Try using several repertories to analyse a simple case pain, warm drinks, amel., which has 12, are much
using local symptoms. What makes one repertory easier more manageable. At the end of the analysis the
to use than another, and what are the limitations of large rubric can be brought in to support or oppose
each? the choice of likely remedies.

When looking up symptoms why is it important to
distinguish between a local modality and a general
symptom, e.g. ‘worse during menses’ may be found
under ‘menses’ in ‘generalities’ or under many other
Summary
symptoms that are worse at the time of menses? Do In Chapters 1 to 9 the homeopath will, along with
not look in ‘female genitalia, menses’ as it deals with teaching from other sources, have developed skills
the particular types of menses and lists other modalities and knowledge to enable the treatment of many
affecting the periods. self-limiting diseases and some more serious dis-

What are the strengths and weaknesses of the eases. The same principles are used and extended
imaginative use of the repertory when the patient’s state in dealing with more deep-seated cases but a thor-
is seen indirectly or symbolically through the rubric? ough grasp of the idea of the importance of iden-

What influences the order in which you set about tifying the symptoms in detail and matching the
searching the repertory? Do you naturally find yourself symptoms to the materia medica through reperto-
thinking of some rubrics as more important than others? risation is the centre of totality prescribing, where
How does this relate to any grading of symptoms? How much homeopathic prescribing takes place. In
might you use confirmatory and eliminatory rubrics? parallel with looking at different methodologies

120
Bibliography

the perceptive homeopathic student will start to Henriques N 1998 Crossroads to cure, the homeopath’s
notice how cases might unfold over a period of guide to the second prescription. Totality Press, St
time. The more local methodologies may well fit Helena
illnesses in their early stages but later more deep- Kent J T 1877 Repertory of the homeopathic materia
seated approaches may be required. medica. Ehrhart and Karl, Chicago
Kent J T 1990 The development and formation of the

Presenting Symptoms
repertory. The Homeopath 10:3.

Causation and the


Acknowledgements Kent J T, Schmidt P, Chand D H 1980 Kent’s final
general repertory of the homeopathic materia medica.
Dr Lee Holland and Dr Charles Forsyth National Homeopathic Pharmacy, New Delhi
Phatak S R A 2004 Concise repertory of homeopathic
medicines. B Jain, New Delhi
Bibliography Rastogi D P 1990 Boenninghausen’s repertory. The II
Homeopath 10:3
Barthel H, Klunker W 1973 Synthetic repertory, vol 1:
Psychic symptoms. Haug, Heidelberg Roberts H A 1937 Sensations as if, a repertory of subjec-
tive symptoms. Boericke & Tafel, Philadelphia. Indian
Barthel H, Klunker W 1973 Synthetic repertory, vol 2:
edition 2002. B Jain, New Delhi
General symptoms. Haug, Heidelberg
Saine A 1990 The story of Kent’s repertory. The
Boenninghausen C 1891 Boenninghausen’s therapeu-
Homeopath 10:3
tic pocket book, 2nd edn. Translated by T F Allen.
Hahnemann Publishing House, Philadelphia Schroyens F (ed) 1993 Synthesis – repertorium homeo-
pathicum syntheticum. Homoeopathic Book Publishers,
Boericke W, Boericke O 1927 Pocket manual of homeo-
London
pathic materia medica. Boericke and Runyon, New
York Tyler M, Weir J 1912 Repertorising. Homeopathic
World 47(4): 149–170
Boyd H 1981 Introduction to homeopathic medicine.
Beaconsfield Press, Beaconsfield Tyler M, Weir J 1912 Repertorising (contd). Homeopathic
World 47(7): 296–301
Clarke J H 1904 Clinical repertory to the diction-
ary of materia medica. Homeopathic Publishing Co, Tyler M, Weir J 1983 Repertorising. Br Homeopath
London J 72(4):195–208

121
CHAPTER TEN

Managing Different Case Management

Types of Cases
David Owen

Introduction more difficult. While not all simple cases are


simple to treat, they will have a clear picture and
When treatment strategy is based primarily on the
often a clearly indicated remedy. In managing
presenting clinical features of the illness, categoris-
more complex and difficult cases it is important
ing illness as acute or chronic provides important
to understand how they have often evolved from
information about prognosis. Of more importance
simple cases and how as treatment progresses
for person-centred medicine is to put the patient
they become simple again. Behind every difficult
who has the illness at the centre of the case. This
case is a complex case, and behind every complex
allows and requires a subtle but important change
case is a simple case.
of focus that acknowledges both the disease pro-
Before looking at the management of complex
cess and the whole state of the individual who is
cases there is much still to understand about what
presenting it. This we collectively refer to as the
is to be cured, the types of cases and the manage-
homeopathic case. The case allows us to discern the
ment of the simple case.
most appropriate model of health and approach to
treatment for that individual and the methodologies
and management strategies that are most likely to
help. Homeopathic cases can be categorised using
The Homeopathic Continuum
a spectrum that extends from the straightforward Establishing where on the spectrum a particular
and simple through the complex to the difficult – case lies is an important aspect of homeopathic
this should not be confused with what some diagnosis. The type of case will often be a major
homeopaths refer to as simple prescribing (single factor in determining the predominant model of
remedy) or complex prescribing (using mixtures of health and approach to treatment. The type of
remedies; see Chapter 30). case will influence the style and focus of the con-
While acute illness is often part of a simple sultation, the treatment options and expectations,
case and chronic illness part of a complex or dif- and the knowledge and resources the homeopath
ficult case this is not always so. Difficult cases are may need to call upon. Figure 10.1 describes five
divided into those that are relatively confused categories of case; each might best be understood
and those that are relatively masked or hidden. through a different model or mix of methods of
In this chapter we explore these different catego- health as previously described. The symptom pic-
ries of cases and the implications for their man- ture of the different cases is illustrated graphically
agement. In the same way as acute illness may as a ‘wave form’ where the two axes might be
develop into chronic illness, so simple cases may thought of as intensity and location of the symp-
become complex and complex cases may become toms. In this way each case can be represented as

123
CHAPTER TEN Managing Different Types of Cases

Type of case
Straightforward Simple Complex Confused Hidden

Duration of treatment
Responds very quickly if Responds quickly if no shift Takes time for full resolution Often cases need time to May take several episodes
cause not ongoing and to reveal deeper symptoms as symptoms follow law of become clear and the of care, including phases
Presenting Symptoms

‘what you see is what and no obstacles to cure cure and may need several deepest case to emerge. of maintenance between
you’ve got’. (see Chapter 15) remedies if picture Until this happens the times of active treatment
Causation and the

changes simillimum is hard to for full picture to emerge


observe

Symptoms and wave form

II
Straightforward Simple Complex Confused Hidden
Where there is a direct and Cases whose clinical A complex mix of symptoms A confused mix of symptoms, Cases that present with one
transparent relationship presentation is simple, often often with chronic illnesses, some overshadowing others. or more main symptom that
between a cause and a commonplace with a clear, which are multifaceted and where the impact of may hide the true case (which
clearly circumscribed, often limited and easily multifactorial where cumulative life events, or the may be serious or life
single main symptom. recognisable symptom symptoms are clearly suppressive or iatrogenic threatening), for example in
Frequently these are acute picture. They may represent expressed with a clear order effects of conventional malignancy, heart disease or
illnesses suitable for ‘first aid’ the surface manifestation of and hierarchy. What you see treatment have distorted the schizophrenia. There is often
and home treatment a deeper seated problem. is a broad picture often manifestation of the illness. no clear pattern or order to
Often acute illnesses but involving a number of There may be no clear order how the illness developed.
include recurrent acute systems and symptoms. They or hierarchy to the case and There may be past or inter
manifestations of deeper require a more thorough case it may be thought of as being current illness that may have
problems history and analysis if they composed of several layers. been ‘confused’ and
are to be treated effectively. When one layer is treated suppressed. The hierarchy is
often another will emerge. not clear and understanding
What you have at any one the patient frequently requires
time does not represent all an understanding of
that is there. unconscious issues and
cultural susceptibility. Also
referred to as ‘masked’ or
‘one sided’ cases.

Figure 10.1 Types of case illustrated as a ‘wave’ and correlated to models of health and approach to treatment

REFLECTION POINT As cases become more complex so more symp-


● In what ways do each type of case lend themselves to toms are seen and overlap. In confused cases one
being understood in each of the five models of health symptom can overshadow and distort what is seen
and approaches to treatment? of another. In hidden cases a single symptom might
● Thinking of the case as a wave form or shape (as in Fig. completely mask other aspects of the case. Finding a
10. 1) how might what you see be influenced by the remedy simillimum involves finding the remedy pat-
time you have available, the case taking skills you have tern (from provings) and matching it to the symptom
and the case the patient is prepared to reveal? How picture. If you imagine each symptom as a triangle
would what you perceive influence the treatment you then in a simple case one main presenting symptom
offer? with all its modalities represents a single triangle
that can be matched to a remedy. Confused cases
an individual picture based on the symptom ‘fre- have a number of symptoms that each may partially
quency’, similar to each individual sound having disguise others, like several triangles overlying each
its unique ‘sound wave’. other. A similar remedy can be chosen on a few of

124
The Homeopathic Continuum

the key symptoms (keynote prescribing) or on the tion. If the cause is strong, persistent or recurrent
overall pattern if recognised (thematic prescribing). the case is unlikely to remain straightforward.
In confused cases, aspects of the symptoms are
missing from the picture and the theme may resem- Simple Cases
ble more the silhouette of the compound shape – In simple cases a cause triggers an understandable and
as the case is treated so more detail becomes clear. often predictable symptom picture. Often this focuses

Presenting Symptoms
In a hidden case a single (or sometimes several) around a single group of symptoms, which is why it is

Causation and the


main, often serious, symptom presents like a huge sometimes thought of and referred to as ‘local’ (not to
triangle; the symptoms behind it are effectively be confused with local treatment when used to refer
masked from normal view. Additional aspects of to applications or injections applied locally/topically
the individual and the case will be expressed and to a particular site). In simple illness the same cause
perceived in the context of the homeopathic rela- may present slightly differently depending on the
tionship (see Chapter 23). In simple cases match-
ing the symptom to what is seen now is adequate
individual patient’s susceptibility; one local picture
may be due to several different causes. Most acute
II
but as cases become more complex, the symptoms diseases can be thought of as having a single trigger
that are overshadowed also need to be considered. and are either straightforward or simple. There is a
In confused and hidden cases it may require several simple or straightforward relationship between the
treatments before the overshadowed and masked cause and a clear symptom picture. If the patient is
symptoms are revealed – finding the simillimum otherwise well ‘what you see is what the patient has
is more like matching a three-dimensional model got’. Patients show a quick response to correct treat-
than a simple two-dimensional ‘wave pattern’! ment and the remedies that are indicated are remedies
Naming these different types of case is to some that act quickly, often derived from sources that have
extent artificial in that any homeopathic case may a quick and dramatic effect on people such as poisons.
start at any point along this continuum, and then Remember there is a link between the speed of onset,
move as the case deteriorates or resolves. How the the ‘clarity’ of symptoms and the speed of response as
case is perceived is both a function of how it is they all reflect the patient’s vitality.
presented and how the homeopath chooses to see As simple cases get more complicated, and the
it. You may see the same case in several different illnesses more chronic, so the relationship between
ways, influenced by such things as the time avail- cause and effect is more complex and the case
able, your experience and the aim of the treat- picture and approach to treatment changes. For
ment. Each way of seeing the case brings its own example, headaches due to a hangover are straight-
emphasis to the case, materia medica, and analy- forward, those due to stress might be simple or
ses and different management expectations. complex, while migraine might be complex or con-
fused. A headache as the sole presenting symptom
Straightforward Cases of a brain tumour would be a hidden case. If a case
In the most straightforward cases the cause usually presents with more than one acute illness it may
has a predictable clinical effect and therefore the be a more complex case but if treated as a simple
susceptibility of many people to that cause is the case then it is what has changed the most or most
same. Self-healing will often occur once the cause recently that indicates the acute cause that is near-
is removed, e.g. many minor ailments such as a blis- est the surface and requires treatment first.
ter from tight shoes, not sleeping due to noise, a Understanding the type of case helps interpret
sore throat from over use of the voice, a soft tissue many aspects of the case and helps in clarifying
injury, sunburn, etc. Treatment here is often based the management and expectations of treatment.
on avoiding or removing the cause and assisting Table 10.1 shows some of the variables that distin-
the person’s general well-being to aid recovery guish simpler cases from more complex ones and
– homeopathic treatment is selected on the causa- the general implications for their management.

125
CHAPTER TEN Managing Different Types of Cases

Table 10.1 COMPARING SIMPLE AND COMPLEX CASES


Aspect of the Case
and Treatment Simple Complex

Causation Single Multiple

Onset Rapid Slow


Presenting Symptoms
Causation and the

Illness Acute Chronic

Focus of the case On the illness On the person

Symptoms Often one main one Several

Symptom focus More external/superficial More internal/deeper


II Time to take the case Shorter Longer

Treatment Easy Difficult

Response to treatment Fast More gradual

Style of case Taken Received

Use of potency Low to mid Mid to high

Complex Cases and the case but part of understanding the case is
The distinction between acute and chronic illnesses making this clear – the symptoms are how patients
is not black and white; nor is it between simple and protect themselves or what, at one level, they need
complex cases. Many factors affect where a case lies to have to survive their situation or environment.
on this spectrum including the cause, previous ill-
nesses and treatment, hereditary predisposition and Symptoms as an Interface Between Patient
the ability of the patient to remove causative fac- and Whole Life Experience
tors and/or move to a healthier situation. Over time We may consider the development of symptoms
simple cases inevitably either get better or become as the organism’s way of rebalancing itself, and
more complex, and it is frequently possible to see illnesses a necessary way of adjusting to change or
how a complex case has evolved from a relatively challenge in circumstances. In this way the body
simple onset. This is one reason why it is so impor- ‘gives off ’ symptoms like a centripetal force acting
tant to let simple illness heal properly, especially in the direction of the law of cure, that is to say
in children, so as to prevent cases becoming more from within outwards. The symptoms themselves,
complex. Likewise, complex cases either move to whether commonplace (such as discharge, sweat-
more simple cases as their cure proceeds or become ing, fever and heat) or more various, are ways for
more complex and eventually confused. the body to ‘clear itself out’.
In a simple case it is often quite obvious how the It is not uncommon for patients to feel better
symptoms help the patient deal with the illness – after an acute illness because they have literally
a pain may ensure a joint is rested, tiredness may cleared their system out in this way. Sometimes
indicate a need for rest, etc. In this way the symptom the body just needs an opportunity to throw
can be thought of as an interface between the patient things out, e.g. the headache that accompanies
and the environment. In complex cases it is often any moderate fast or excess alcohol consumption
harder to see a direct link between the symptoms is a sign of the body throwing off metabolic tox-

126
The Homeopathic Continuum

ins. It is therefore not surprising that this cura- of boundaries where the presenting symptoms can
tive process of developing acute symptoms often be imagined as ‘the front line’ or ‘outer defences’.
follows a prescription of homeopathic remedy In the analogy of a castle the patient’s inner nature
that stimulates self-healing. This healing reac- or final defence might be likened to a castle’s keep.
tion is an important part of the process of cure. In more complex cases there can be many symp-
Seeing symptoms as an expression of an inner toms and they can overlie each other giving sepa-

Presenting Symptoms
energy restoring equilibrium (in physiological rate levels in a similar way that walls surround a

Causation and the


terms, homeostasis), also allows us to conceive castle’s keep. The interface between patient and
symptoms as an interface. situation, like a wall, appears quite different when
Figure 10.2(a) illustrates symptoms patients seen from the outside and from above.
develop as an interface or boundary between In simpler cases the presenting symptom is
them and their situation. The three perspectives likely to stand out, to be obvious. More complex
relate to how the symptom is seen from outside,
how it can be seen from above and how it can
cases, as illustrated in Figure 10.2(b), may have
several symptoms – the more deep-seated ones
II
be understood from a cross-sectional perspec- being more central and important, representing,
tive. Different symptoms provide different sorts so to speak, the more desperate attempts of the

A Simple case

From outside From above In cross section

Patient’s
inner state

Outer defense
symptoms
Symptoms
Patient’s inner state
B Complex case

From outside From above In cross section

Patient’s inner state


(less visible)

Three levels
of symptoms

Three levels
of symptoms
Patient’s inner state

Figure 10.2 Symptoms as an interface between the patient and the situation: (a) simple case (b) complex case

127
CHAPTER TEN Managing different types of cases

organism to defend itself. So the inner might be illness. They may represent just the acute phase of
considered higher than the outer defences, like a chronic illness – after the acute phase clears, the
the increasingly high walls around a castle. What deeper picture begins to be seen. In the glandular
is perceived will be influenced by where you are fever example, for instance, an underlying chronic
looking from and how well you can see through susceptibility may be revealed when a full family
the symptoms. In complex cases the inner walls history is taken or as treatment unfolds.
Presenting Symptoms

will not be completely visible from outside and Not only is there a gradation between cases of
Causation and the

it is necessary to see through or treat the outer different degrees of complexity, but also the com-
levels or walls to see the deeper aspect of the case plexion of a case may change both as it is treated
clearly, a process sometimes described (forgive the and as more or different information is revealed.
mixed metaphors) as ‘like peeling an onion’. Initially as more of a case is revealed the picture
may deepen; then, as treatment progresses and the

II Confused and Hidden Cases


In confused or hidden cases the deeper symptoms
symptoms unfold, the case may revert to a simpler
picture. Cases may need several different approaches
may be invisible behind the outer presenting symp- to treatment over time; understanding this progres-
tom (see Fig 26.1). When several causative and sion is central to working with difficult cases.
contributory factors and levels of symptoms exist
the picture becomes progressively confused until Matching Model of Health and Approach
the true nature of the illness becomes obscured to Treatment to Types of Case
or hidden, and ‘what you see is just a fraction of Each type of case offers its own unique challenges,
what the patient has got’. In completely hidden but by classifying them in some way it is possible
or masked cases there may be no immediately to learn lessons from one case that can inform our
apparent connection between the outer symptom approach to another. No one approach to treat-
or ‘wall’ and the inner symptoms that are more ment is in itself better or worse than another, but
likely to reflect the patient and real nature of the each will be optimal in different cases. The devel-
illness. opment of the case depends not only on what
symptoms are shown, but perhaps more impor-
In Practice tantly, those perceived by the homeopath. This
While most acute illnesses are simpler cases and in turn will depend on the setting the homeopath
most chronic illnesses are complex cases, there are and patient are working in, and their implicit and
exceptions. Many cases that have ‘never been well explicit choice as to how they will work, including
since’ single strong triggers are simple cases even what models of health they are using to under-
though the illness might be thought of as a chronic stand the problem. In a busy primary care setting
disease because of its duration. For example the where only a few minutes are available for case-
chronic lymphadenopathy, sore throats or fatigue taking, attention to the outer-most symptom alone
following glandular fever can be thought of as may be all that is possible. To one homeopath a
having a single cause and hence a simple case. young child may present very few indications for
Often, if this is the case, it will respond speedily treatment, but to another their emotional reaction
to a single remedy; more akin to an acute illness might point to a remedy. In practice homeopaths
than a chronic one. The opposite can also be true. use a mixture of approaches in a variety of differ-
An acute illness can be just the visible tip of a more ent sorts of case; different remedies are learnt and
complex case, often when there are several caus- applied in different ways to suit these approaches.
ative factors. Typically these acute ailments are the Clarifying and matching the approach to the type
ones that reoccur or relapse; some of these varia- of case significantly helps prescribing to be more
tions are discussed later as different types of acute accurate and reliable.

128
Types of Simple Cases and Acute Illnesses

As cases get more difficult and there is more Types of Simple Cases
to be done for the patient to be well again, then
treatment takes longer. We must be aware of the
and Acute Illnesses
risks of both a too intrusive and a too superfi- There are several types of simple case that each
cial approach to treatment. As in psychotherapy, reveal aspects important in the management of
an approach that addresses deep issues in the acute illness, and that inform our understanding

Presenting Symptoms
circumstances or psyche that the patient is not of how simple cases may become chronic.

Causation and the


ready or adequately supported to address may
do harm. If a case is treated too superficially the Epidemics
response may be minor and/or short lived, leav- Epidemics affect a number of people in a simi-
ing the real problem unresolved. Sometimes no lar way; they are caused by a particular aetiol-
remedy fits the patient’s case in the model being ogy combined with a shared susceptibility. The
used. In these cases another model may point to
a different approach to treatment and a better
infective organism, if there is one, is only part
of this. Those who contract the epidemic disease
II
indicated prescription. Learning homeopathic share a common susceptibility that may point to
materia medica is a matter not only of knowing a deeper cultural susceptibility. When epidemics
more remedies but also of building up the detail start to ‘die out’ often it says as much about the
of each remedy picture according to each model population’s susceptibility as the eradication of or
of health. specific resistance to the ‘infective organism’.
Epidemics need not always be a serious illness.
For example, Molluscum contagiosum is a com-
REFLECTION POINT monplace epidemic condition in school children,
● Think of some cases you have seen. How would and while it will usually resolve untreated in time,
you categorise these cases (simple, complex etc) it is often disturbing and can become infected
and how might you draw both the symptom time and temporarily disfiguring. This epidemic illness
line (see Fig 3.1) and represent the symptom tells us something about the susceptibility of the
intensity/frequency (Fig 10.1)? What is the affected children and their underlying suscepti-
implication if just one symptom in a complex bility to veruccas and warts which, together with
picture is removed? Molluscum, are caused by viruses that create small
● Imagine a symptom or set of symptoms like a set of benign tumours. The epidemics in a community
clothes or a protective barrier around you. How might tell the homeopath about the susceptibility of the
the clothes you choose be determined by the situation population as well as the individual. In this case it
you are in and how might it both protect you and how, reflects a tendency to tissue overgrowth.
if you are unable to remove them even in different Knowing who else has suffered the illness, how
situations, might this hinder, inconvenience or restrict it manifested in them and what treatment helped
you? can point to the best treatment for others, known
● Reflect on how a remedy might be learnt differently as the ‘genus epidemicus’. Often a small group
according to the type of cases it will be used to treat of remedies will help many patients in the same
and the model of health or approach to treatment it is epidemic, and in so doing inform the homeopath
used for. For example, the remedy Staphisagria has about the susceptibility of a population.
causation from grief, cystitis symptoms, a full mental
and physical picture, themes of suppressed anger and Contagious Illnesses
sensitivity to criticism and strong feelings of frustration Contagious diseases are similar to epidemics and
and injustice. are due to exposure to a particularly virulent
agent spread by close proximity or contact. Their

129
CHAPTER TEN Managing different types of cases

immediate cause appears as an organism that is others in the population will suffer the same illness.
prevalent in groups of people living close together, As specific epidemic, endemic and contagious illness
transmitted, by definition, by direct or close con- become less prevalent it can appear to be only as a
tact. There is likely to be shared or community result of successful treatment (or vaccination) where
susceptibility. The disease is often thought of as as in fact there are as many factors that will determine
a spreading infection or infestation, but can also the susceptibility and resistance of a population as
Presenting Symptoms

be seen as having a different dynamic. Just as a there are for an individual.


Causation and the

specific cause can be blamed for hysteria or shared


grieving that passes quickly between members of a Acute Mental Illness
community (where it could be argued that it is the In acute mental illness the same rules and indica-
emotional susceptibility of the community that is tions apply as for acute physical symptoms, and
responsible), so we can attribute contagion both to treatment requires the same approach. In the same

II an infective agent and to collective susceptibility.


This concept of group or community susceptibil-
way as an apparently simple predominantly physi-
cal case may reveal a deeper underlying psycho-
ity is the domain of public health, addressing, for logical susceptibility, so a simple mental case may
example, communal problems of hygiene, poverty have a deeper, underlying physical susceptibility. If
or nutrition. The role of homeopathy in helping to these deeper causes are not dealt with the condi-
understand susceptibility has much to offer an under- tion will either not respond or relapse. For exam-
standing of a healthy environment, and could do ple, a patient with anxiety may be well matched to
much to inform a ‘holistic’ public health agenda (see an anxiety remedy, but if the anxiety is secondary
Chapter 30). It is vital for the homeopath wishing to to physical causes such as the use of cannabis, over-
understand susceptibility to be aware not only of the consumption of coffee, poor sleep, or occupational
illnesses that an individual patient suffers from but stress, then these causes need to be dealt with.
of the illnesses that exist in the environment and the
community within which the patient lives. A common Recurrent or Relapsing Acute Illness
example of contagion is head lice in school children – When the patient continues to get the same acute
the condition itself is not that serious, but what it illness, it is as if, despite seeming to resolve, the body
tells us about a population and its susceptibility is never completely throws it off. Treatment may have
important. failed to stimulate the individual’s resistance but
just, for example, eradicated an infection that then
Endemics returns. This is a common occurrence in the con-
These are illnesses or cases where the environment ventional treatment of recurring infections treated
the individual lives in is such that causative factors with antibiotics, e.g. in ear infections or cystitis. In
are likely to occur, e.g. malaria in areas of the tropics. a patient with recurrent ear infections, swollen ade-
Changes focusing on the environment are an impor- noids, increased mucus production or sensitivity to
tant part of its prevention and treatment. The con- dairy products may need to be taken into account. A
cept of endemic illness may also help us to understand patient with recurrent cystitis may need to increase
other illness such as joint aches and pains in low-lying fluid intake or make an alteration in life style.
areas, or respiratory problems in urban areas with From the homeopathic point of view there are
high levels of pollution. The illness can inform you several, possibly interconnected reasons for this.
about the patient’s situation and reaction to the envi- There may be a maintaining cause, even a very
ronment, and can be prevented or treated by changes simple one such as headache after eating a par-
to the environment. If environmental changes are not ticular food, or earache from continued exposure
made, but become a maintaining or reoccurring cause, to the cold. There may be blocks or obstacles to
then even if the symptoms are treated appropriately recovery (see ‘Obstacle to cure’ in Chapter 15)
the case may deepen and become more complex, and such as a patient using strong eucalyptus oil that

130
Types of Simple Cases and Acute Illnesses

antidotes the remedy. Or the case may be express- This patient was susceptible to Arnica at a deep
ing a deeper disturbance and the patient’s suscep- level and found it hard to move out of the Arnica
tibility is not being fully taken into account. state, almost appearing drawn to minor injuries
(accident prone). In this case the past history
Recurring Similar Acute revealed the patient had an earlier head injury and
In some patients there is an acquired or familial required a closely related remedy (Natrum sul-

Presenting Symptoms
susceptibility that means similar illnesses reoc- phuricum). After this they were much better and

Causation and the


cur. This deeply programmed susceptibility may less easily put into the Arnica state. The recurrent
be thought of as a taint or miasm (see Chapters acute illnesses that a patient gets tell a great deal
14, 17). For example, early birth trauma can cause about susceptibility; one of the important ques-
a deeper susceptibility to acute illness or being tions in taking a homeopathic case is ‘what sort of
accident prone, where the patient seems to keep minor ailments are you prone to?’.
returning to an ‘acute’ situation without the abil-
ity to break this pattern. There are many different Partially Expressed Acute II
triggers for this state – sometimes referred to as When the individual fails to express the acute pic-
the ‘acute miasm’. When the underlying suscepti- ture clearly in response to an acute cause, then it
bility is treated the patient’s susceptibility to acute may be indicative of a more serious disturbance,
disease is reduced. and/or a low vitality that can itself be a sign of
deeper susceptibility. In these cases a more com-
Situational Acute plex picture frequently emerges.
Another cause of difficulty that may need to be
addressed in complex cases is a tendency for the Masked Acute
same or a similar causation to be revisited by the A patient who presents saying ‘I never normally get
patient time after time, as if drawn to a situation ill’ may just be in a state of denial. Some patients
in which they get ill. This repeats itself until the do need to be encouraged to ‘listen to’ their symp-
patient has resolved whatever it is that needs to be toms and see illness not as a weakness but (the
addressed. It may mean avoiding certain foods, alco- ability to have symptoms and resolve them) as a
hol, emotionally damaging or abusive relationships sign of a dynamic healthy state. If they really are
or certain physical environments, such as cold sores not getting any acute illnesses, then they may have
activated by excessive sun. When the recurring pat- too low a vitality or be easily suppressing their
tern is recognised, the illness can be seen as a ‘shot acute illnesses – either way it is not a very healthy
across the bows’ – a stimulus to make changes to the state. In a healthy state people are likely to gener-
patient’s life situation or environment, or an oppor- ate acute symptoms quickly and easily when chal-
tunity for growth and development. lenged or their environment is changed. Looking
deeper into such cases may reveal an underlying
Acute or Chronic susceptibility; if their vitality is low patients may
A more deep-seated illness may underlie a spo- require more general life style advice to ‘build’
radic acute picture. For example, hay fever may them up before the case becomes clear.
only temporarily respond to local treatment if
there is a deeper allergic susceptibility. Even when Relationship of Acute to Chronic Illness
the remedy is correct, if the susceptibility is high Everyone encounters situations in which they are
a remedy may need to be used in high potency or susceptible to acute illness. If these are not expressed
a deep acting remedy found (see Chapter 20). For and a curative process followed then a chronic con-
example, after an injury a patient benefited from dition is more likely. As a case becomes chronic and
Arnica, but it failed to hold and the patient would deepens the patient develops more internalised
get Arnica symptoms from the slightest knock. symptoms. Correct treatment of straightforward

131
CHAPTER TEN Managing different types of cases

and simple cases is one of the best preventions of and treating the exacerbation or acute flare-up may
more deep-seated illness. Often overlooked when be enough to give a deeper response. If the acute
assessing the benefits of homeopathic treatment, flare-up is in response to homeopathic treatment,
this would only really be seen with long-term sometimes no further treatment is requried.
studies, as the case of Pamela illustrates.
Presenting Symptoms

Management of Simple Cases


Causation and the

CASE STUDY 10.1


Pamela is 48 and has been susceptible to There are four ways in which a medication may
recurrent chest infections each winter since act. You are likely to be managing patients who
childhood. She finds the damp environment are using, or have used, several medications in
difficult to cope with. When she gets acute sequence or together and it is therefore increasingly

II chest infections she seems to go downhill in


herself, her catarrh gets worse, she gets short
important, as you manage more complex cases,
to understand how the different remedy actions
of breath and requires treatment for asthma. might affect the case and picture presented:
On antibiotics she will often throw off the acute 1. The homeopathic, where the remedy creates a
illness but in recent years it has taken longer to symptom picture similar to the effects of the
respond and she has needed a repeat of anti- illness that it is treating.
biotics several times a year; she has also been 2. The isopathic, where the pathogenic or
started on inhaled steroids for her asthma. aetiological agent responsible for the illness
Pamela is starting to get breathless with itself is used to treat it; e.g. potencies of
catarrhal symptoms throughout the year. She infective organisms (see ‘Nosodes’ in
presents to her homeopath in an acute phase Chapters 5, 18).
and wants to try an alternative to the antibiot- 3. The allopathic approach, where the drug has
ics. She is wheezy with a peak flow of 310 and an action that bears no direct relationship to
is on a steroid and a salbutamol inhaler. She the symptoms of the illness – ‘Neither similar
has bronchitis and is coughing up thick, white nor opposite but quite heterogeneous to the
phlegm but does not have a fever. symptoms of the disease’ (S Hahnemann,
Antimonium tartrate (alongside her inhal- Organon, para 22).
ers) is prescribed on local symptoms and is 4. The antipathic (also called palliative) method,
carefully monitored – over 12 hours her acute in which the action of the drug is in direct
chest symptoms improve. After this she opposition to the effects of the illness; e.g.
describes feeling a bit more energetic. Pamela the use of codeine to cause constipation and
finds using the Antimonium tartrate controls ‘counter’ diarrhoea.
her chest flare-ups and they get less frequent.
She is advised to avoid damp environments The homeopath sees the presence of acute illness not
due to suspected mould sensitivity. After 18 only as part of the process of prevention and recov-
months her peak flow is consistently 420 and ery from chronic illness but also as an important part
she reports gradually reducing and then stop- of developing a strong and healthy ability to resist
ping her asthma medication. disease in later life. Although it is understandable to
want to avoid the discomfort of an acute illness it
does the organism no favour in developing its overall
resistance if all acute illness is avoided or symptoms
In chronic disease some patients experience are suppressed. This is one reason why the homeo-
acute exacerbations. The acute symptom may be path is concerned about the over-use of vaccination,
a diagnostic pointer to the deeper chronic illness, allopathic or antipathic treatments.

132
Management of Simple Cases

When an illness is not expressed or resolved the ful monitoring – even of local prescribing – is
underlying susceptibility of the patient changes. advisable.
Section III explores the way in which suppression
of simple cases leaves a pattern of increased sus- Be Aware of Any Other Treatment
ceptibility that contributes to the development of the Patient is On
complex cases. Some patients may respond quickly and deeply to

Presenting Symptoms
treatment based only on the presenting problem.

Causation and the


Partial Treatment In these cases it is important that the prescriber is
Treating only part of the presenting symptom pic- aware of other problems that may not have been
ture may, if the vitality is high and the illness not part of the local or presenting problem, and of
too deep-seated, be enough to stimulate complete how these may be affected by the response to the
self-healing. Otherwise it may lead to partial relief treatment of the more circumscribed problem, as
but not complete resolution. An illness that is only
partially cured is more likely to reoccur after vari-
Jean’s case illustrates.
II
able periods of dormancy or express itself through
CASE STUDY 10.2
other symptoms. This is why when treating even
Jean, age 37 and a mother of two, presented
simple cases it is best to persevere until symptoms
with premenstrual tension (PMT) and received
have completely resolved. When there is ongoing
a local prescription of Sepia 30 to take once
exposure to a causative factor there is a risk of
a day for 5 doses around mid-cycle. After two
recurrent symptoms. The patient who wants to
months she presented to another homeo-
stay well but is unable to remove the causation will
path with an improvement of her PMT but a
need occasional review appointments, because if
deteriorating sleep pattern and anxiety. She
the condition relapses repeatedly and is not treated
complained that although her PMT was better
effectively there will, over time, be a drop in vital-
she now felt worse. Jean had been on thy-
ity and an increase in susceptibility. It is frequently
roxine (thyroid supplementation) for 9 years,
the case that the carefully attuned homeopath will
since the birth of her second child. On testing
detect these things at an earlier stage than the
her thyroid level, she was found to be hyper-
patient, like the alert mechanic who recognises
thyroid. The Sepia had evidently stimulated
that a car needs tuning. Treatment at this level is
a far-reaching improvement in Jean’s whole
much easier and speedier than when the case has
health status. Stopping her thyroxine rapidly
been left and becomes more deep-seated.
improved her symptoms.
An inaccurate local prescription that matches
only a small part of the case may alter only select
aspects of the presenting symptomatology. This Monitoring other treatments is important as
type of partial treatment (and conventional pallia- the homeopathic remedy can change the patient’s
tive treatments) can lead to a more complex and, physiological state and alter the reaction to other
in time, distorted or confused picture. If the vital- treatments. Care should be taken when the patient
ity is low or the local symptoms are only part of a is on conventional medication as the picture
deeper picture, prolonged treatment of just some may be confused and may change suddenly; or
symptoms may make the case more confused. a change in the level of conventional treatment
For this reason some homeopaths warn against may be indicated in response to physiological
all local prescribing, saying that it is important changes induced by the remedy. For example, in
to always prescribe on the deepest aspects of the a case prescribed homeopathic Lithium carbonica
case – unfortunately this denies many patients while on allopathic doses of lithium (prescribed
treatment that can significantly boost their health. for mania) the patient’s serum lithium levels
Certainly caution about dose, repetition and care- increased and conventional dosage needed to be

133
CHAPTER TEN Managing different types of cases

reduced. Unmonitored, lithium toxicity might might indicate favourable and unfavourable reac-
have resulted. tions to local treatment. Change is important
either if the symptoms have altered for better or
Remember – Acute Pictures Change worse, or if there is a change in the patient’s gen-
Many acute diseases present different stages that eral well-being or ‘energy’. The possible changes
can shift back and forward over time. This may are summarised below.
Presenting Symptoms

require a review of the case each time the symp- ●


Favourable
Causation and the

toms shift, if the case is not improving. For exam- ●


Symptoms improve with no new symptoms
ple, in a patient with pneumonia, several stages ●
A temporary aggravation of symptoms
may be gone through, each possibly needing a ●
General increase in energy
different remedy. A patient might respond to one ●
Improvement of normal physiological func-
remedy in any stage if that remedy fits them deeply, tions, including better sleep, more regular

II equally the patient may need a different remedy in


each phase. Even where there is no change in the ●
menstrual cycle, etc.
A return of previous symptoms according
conventional diagnosis, the symptom picture may to laws of cure
change, and a change of remedy required. ●
Proving symptoms of the remedy given

An improved disposition of the patient
When to Prescribe Deeper ●
Unfavourable
If an individual produces unusual symptoms in ●
Symptoms worse but not following laws of
response to a common trigger then the symptoms cure or proving symptoms
tell us more about the patient than the cause, hence ●
A prolonged aggravation of symptoms
the importance of ‘strange, rare and peculiar’ ●
Increased discomfort
symptoms. These cases benefit from repertorisa- ●
No change after a reasonable time
tion to find which remedies have these individual ●
Lower energy
symptoms. ●
Disruption of normal physiological func-
In simple cases strong symptoms are likely to tions including poor sleep, disrupted men-
have been expressed by many provers of the rel- strual cycle, etc.
evant remedy. Hence these symptoms are often
keynotes of the remedy, and reliably found in Interpreting the Changes
the materia medica and repertories. These key- The time it takes for a remedy to act is variable
notes express specific information in the patient depending on the remedy, the dosage, the patient
and the remedy; matching them is like match- and the illness. In some cases, especially those that
ing a key to a lock – once unlocked, and with develop rapidly, a response may be felt within
the missing information provided by the remedy, moments, in others with deep-seated illness it may
healing can take place. Sometimes the keynote take weeks. A useful rule of thumb is to allow a
symptoms are characteristic for a disease lead- tenth of the time the patient has felt ill for recov-
ing to what are considered disease-specific treat- ery to take place, although early signs of change
ments. For example, the symptom picture of may be noticed well before this. As deeper, more
scarlet fever presents very close to the materia difficult, cases are treated so they take longer and
medica picture of Belladonna, and homeopaths several remedies are likely to be needed.
since Hahnemann have considered it ‘specific’ If the remedy has not acted, four possibilities
to that disease. need to be considered: the wrong remedy was
given, the remedy was antidoted, there was a block
Signs of Change to prevent cure (obstacle to cure), or the remedy
Remedy reactions are covered in detail in Chapter was not taken correctly. (Very occasionally it may
16 but it is useful here to reflect briefly on what be due to the wrong potency being given but in

134
Management of Simple Cases

most cases the right remedy in any potency will will work closely with other health professionals. It
give some effect – see Chapter 16.) is essential to be sure that your level of competence is
appropriate to the work that you choose to do, and
Levels of Competence to bear in mind what other systems of health care are
Finding at least one remedy for which there are available that might help a patient, and what other
indications is rarely a problem in homeopathy, areas of knowledge may need to be involved. Simple

Presenting Symptoms
and yet it is this aspect that new homeopaths cases like cystitis, acute ear infections and dysmenor-

Causation and the


spend most time addressing. What is much more rhoea may be part of more deep-seated illness, and
challenging is choosing the best indicated remedy clarifying the patient’s expectations, and how the
to suit what the homeopath and the patient are homeopath and patient are to work together, is the
trying to achieve. If the homeopath is clear about foundation of the therapeutic relationship.
the different models of health, and how they govern
and shape the individual’s health, then the manage-
ment of cases becomes more straightforward even
Introduction to the Therapeutic
Relationship (See Chapter 23) II
though more complex cases may need to progress The agreement between the patient and the
through several prescriptions. homeopath as to what will take place during the
The science of homeopathy is about match- treatment process is an important part of case man-
ing the remedy to specific criteria. The art of agement. It allows an understanding of where each
homeopathy is in understanding which models party is coming from and what each would like to
of health it is appropriate to work with in which see happen. A clear agreement allows the explo-
patient, about seeking agreement with the patient, ration of symptoms in more depth than would
gathering the information to work successfully at otherwise be possible, or even proper. Often this
that depth, and knowing how to progress during understanding evolves over the course of a con-
a course of treatment. The more deep-seated and sultation, and is reviewed during a course of treat-
complex the illness being treated, the more impor- ment. For example, the initial agreement in an
tant the balance of science and art becomes. acute illness might become an agreement to help
As the homeopath becomes more competent, prevent further acute illnesses. In simple and acute
through study and experience, each is able to work cases the agreement is often ‘obvious’ – get rid of
successfully with more deep-seated and complex this problem or deal with that symptom. Even in
cases. Having support with difficult cases is one these situations it can be important to clarify your
of the homeopath’s biggest opportunities – learn- role as the homeopath. It may simply be a matter
ing from such examples is central to developing of re-framing the patient’s implicit wish, e.g. ‘I will
competence. help you throw off this problem or symptom,’ or
In many of the great historical homeopathic ‘I believe it is important that you understand why
books there are discussions of using remedies you have this symptom and that we treat it and
in serious situations such as acute shortness of your susceptibility’. Difficulties with contracting
breath, fits, coma, bleeding, shock, mania. These are at the centre of many cases that are perceived
cases need to be considered and managed within as being difficult but need not be so.
the context of other therapeutic systems avail-
able. The homeopathic treatment may not be used
alone or indeed be the priority. The competent REFLECTION POINT
homeopath knows this and can advise patients ● Reflect on the difference between homeopathic and
within a framework of care that will include other conventional drug treatment. How are they different and
treatment approaches and other health carers. how are they similar in the treatment of acute illness?
Many experienced homeopaths realise the need What advice would you give to a patient choosing
for integrating different treatment approaches and between these two approaches?

135
CHAPTER TEN Managing different types of cases

● In a patient receiving homeopathic treatment for an received or is following are important to ‘factor
acute illness why is it important to review the patient in’ to patient care. The homeopath works along-
and what are the different possible reactions? side the patient’s natural ability to provide heal-
● Why is no remedy in itself homeopathic but only acts ing – when the patient fails to recover there are
homeopathically? What advice would you give a patient a number of reasons.
who wants to treat the minor ailments of their family The homeopathic case reflects the susceptibility
Presenting Symptoms

homeopathically? and sensitivity of the patient including the symp-


Causation and the

toms. Further, it raises the question of how the


health of the individual interfaces with the health
of the community. Subsequent sections look at
Summary the holistic, holographic and relational models of
The foundations of homeopathic thinking laid in health that build on the patient- and case-centred

II the first two sections of this textbook will prepare


the homeopathic student to treat minor ailments,
view of health as opposed to the illness- and
disease-centred approach that is so much a part of
first aid problems and some more serious illness current Western medical systems.
where a local symptomatic approach is indicated. By examining some of the management issues
These foundations will prepare the homeopath in treating patients with more straightforward and
for thinking about, assessing and prescribing for simple cases the student has been introduced to
more deep-seated cases. issues that will be met again when treating more
Homeopathy can help patients with a variety deep-seated illness. It is likely that the student pre-
of diseases, whether in the home, as an adjunct to paring for this challenge will be gaining experi-
other therapeutic disciplines or as an approach ence of cases within their competence – realising
to deep-seated chronic disease. Those using the importance of the case as far more than just a
homeopathy at this deeper level are advised to record of the presenting symptoms and preparing
understand the different emphasis on ‘the case’ to blend together a number of different treatment
rather than ‘the illness’ that homeopathy makes. strategies. Remember that when the management
By separating cases, as this section has done, of cases does not go as planned or as you expected,
the homeopath is preparing the way to under- a learning opportunity exists and it is how you use
stand and treat complex cases and to use strat- these opportunities that will determine the devel-
egies that can help in more difficult cases that opment of your knowledge and practice as much
are frequently confused, hidden or have aspects as any theoretical learning. Starting to sit in with
of each. At this early stage of practice you need experienced homeopaths and develop experience
to remember that you rarely work in isolation. of taking and managing cases, under close super-
What other treatments or advice the patient has vision, is an important part of your training.

136
CHAPTER ELEVEN

Holism and Understanding Philosophy

Complex Cases
David Owen

‘It is the theory which decides what we can observe’ you have practiced in this conventional model for
Albert Einstein some time the paragraphs below on ‘Symptoms,
susceptibility and suppression’ may need several
‘Theory, like mist on glass, obscures facts’ readings to be clear. A homeopath applying the
Charlie Chan holistic model no longer sees one part of a patient
as disconnected from another part or from the life
situation they are in. It provides an opportunity
Introduction to explore the intimate connections between the
psychological and physical, and the personal and
A holistic model of health, taking an overview of environmental aspects of health.
the patient including their mind, body and spirit*, A holistic model and totality approach allows
their circumstances and life situation, is central in treatment of patients with symptoms that are seri-
evolving a curative approach to chronic disease ous, deep-seated, long-standing and manifold. It
and complex cases. The holistic view uses the means essentially that regardless of how many dif-
totality and the constitution to find a remedy that ferent symptom complexes and apparent illness
suits a patient, rather than just the disease. This patterns or levels of disease a patient may have (in
is a major shift (sometimes referred to as a para- however many different systems or areas of the
digm shift) from the conventional model of how body and mind), from a holistic model, a patient
illness is viewed and treatment approached and if only ever has one fundamental disturbance to be
cured. The constitutional approach recognises
*NOTE that even those features that are not symptoms
Spirit is used to represent the non-material aspects of an of the illness are part of the individual’s case and
individual – when the material aspects include the physical, may guide treatment. For those whose predomi-
intellectual, emotional and instinctual ‘bodies’. The spirit nant training has been in the currently dominant
means so many different things to different people that Western model of cause-and-effect then grasping
no one definition or belief serves all patients. However, this model may at first be difficult.
for most patients the view or description of their spiritual My personal belief is that the material bodies
nature allows their story to include aspects of their nature ‘reflect’ and parallel the spiritual. It is the material
and ‘purpose’ that might not otherwise be articulated, and so bodies that get ‘dis-eased’ and that are in the remit
are important aspects of the whole person. It is helpful for the of the homeopath to work with. Your personal
homeopath to be aware that patients will hold many different beliefs will both inform and colour your percep-
beliefs that influence both their perception of normality, what tion of the situations patients find themselves in.
is right and wrong, and their ‘place’ in their world. As such the more conscious you are of what ‘spirit’

139
CHAPTER ELEVEN Holism and Understanding Complex Cases

means to you, the more aware you may be of what invited to explore and develop a holistic view to
patients believe spirit is. The more secure you are help you practice using totality and constitution
in your own belief and values the less they need to while at the same time recognising their limita-
be projected onto others. tions in dealing with confused and hidden cases.

Symptoms, Susceptibility The Totality and the Constitution


In acute illnesses and simple cases it is usually pos-
and Suppression sible to understand them either in terms of causa-
In acute illnesses and simple cases, a cause leads tion (A) or a linear cause and effect relationship
to an effect or symptom. The effect itself can be (A causes B). The link between cause and effect
a cause for other symptoms that can lead to a is frequently transparent. In chronic illnesses and
complex case. Unfortunately chronic illness and complex cases the homeopath wishes to under-
complex cases can rarely be understood solely in stand the interplay between the symptoms and
terms of symptoms and susceptibility. The picture the patient’s susceptibility (why B is sensitive to
is invariably changed in some way by the reaction cause A). As cases get increasingly difficult we see
of the patient or those around them. When this is that suppression actually alters the susceptibility
not in a curative direction it gives rise to suppres- of an individual (that treatment C contributes
sion and palliation. to B being sensitive to A). In practice symptoms,
Constitution
Totality and

Susceptibility and suppression are the keys to susceptibility and suppression each influence and
understanding complex cases and are expressed ‘shape’ the case.
in cases through the hierarchy of symptoms and Each of these aspects has to be taken into
III the presence of disease at different depths (see
Chapter 6, page 71). A characteristic of the hier-
account in interpreting the case and planning the
management. Within this wider perspective, the
archy of symptoms is that symptoms express totality of symptoms and the constitution of the
themselves in a certain order. When a symptom patient (which reveals the underlying pattern of
is suppressed it will express itself at a deeper susceptibility), provide probably the two most
level – the second part of this chapter explores commonly used homeopathic treatment strate-
suppression, its distortion of the totality and veil- gies in chronic illness. A constitutional picture of
ing of the constitution, and the importance of a patient does not necessarily include the clinical
grasping this to understand cases as they become symptoms and a prescription based on the totality
more complex. does not necessarily take into account the consti-
Looking at how susceptibility and suppres- tutional picture (Swayne 1998)
sion are dynamically linked starts to reveal why
some symptoms are more central and others more The Totality
peripheral. Whether symptoms are expressed The totality includes all the symptoms of the illness,
in the realm of sensation, function or structure including all features of the case that have come
can be an important indicator to the depth and about since the patient was healthy. Symptoms may
breadth of the symptom and therefore not only be considered as physical, mental or general and
to the susceptibility and suppression but also to may be a normal part of the disease, such as joint
the likely response to treatment. The effect of pain in a patient suffering from arthritis, or be more
suppression (from medication, hereditary and cul- unusual, such as a craving for a particular food or
tural factors) on the symptoms and susceptibility skin rash in the same patient. While to perceive
lays the foundations of most complex cases. When every aspect of every minute change due to an ill-
symptoms are suppressed from view they distort ness and its effects is the idealised goal, the reality is
or mask the case, giving rise to confused and hid- that those which are hierarchically most important
den cases. Throughout this section you are both will tell us most about the illness and the patient’s

140
Symptoms, Susceptibility and Suppression

response to it (see Chapter 6). In the totality it is


CASE STUDY 11.1
the breadth of the picture combined with the most
Alice, age 36, presented with pneumonia.
unique and peculiar features that describe the case.
She had been ‘sensitive to atmospheres’
It is usually because the perceived totality is incom-
since a trauma in childhood. Her sensitiv-
plete or the hierarchy unclear that in some cases the
ity to emotions in others was a constitutional
totality is unable to reveal what is required to be
feature important in selecting the remedy
treated – these are the confused and hidden cases.
Phosphorous. When she later presented for
It is often only over a period of treatment that in a
treatment of anxiety, her sensitivity and fearful-
confused case a clear totality, reflecting the hierar-
ness was a symptom.
chy of the case, becomes apparent.

The Constitution
The constitutional pattern of a patient is be part of the constitution on another level as
described by a picture painted by broad brush Alice’s case illustrates.
strokes but often including some unique or per- The constitution determines:
sonalising feaures. It may be most easily identi- ●
the likely reaction of individuals to any situ-
fied in different people by anything from just ation they find themselves in, including the
one or two key features to an intricate pattern situations that may provoke illness

Constitution
Totality and
of comprehensive and connected characteristics. ●
the symptoms by which they are likely to
This will depend on what their constitution is, express that reaction
how strongly it is expressed and how clearly it ●
the remedies that they are likely to need.
is seen. The patient’s constitution, character-
istics and reactions when well determine both The constitutional characteristics of a remedy
III
susceptibility and, conversely, resilience and are built up from those of patients who respond
resistance to illness. We therefore refer some- most sensitively and strongly to the remedy
times to strong and weak constitutions. There together with the observed characteristics of
is much confusion over how different homeo- individuals most sensitive to the experimental
paths use the term ‘constitution’. I recommend proving of a remedy. The constitutional picture
that both the constitution and the totality are of a patient or a remedy is based on the picture
always considered together and that it is remem- that the individual presents when ‘healthy’ – the
bered they are two sides of the same coin – ‘healthy state’ being that prior to the onset of
but that at any one time one may be more visible illness, or prior to the effects of a proving or in
or helpful in finding a remedy than the other. between episodes of illness. Aspects of the con-
The holistic case and our ability to articulate stitution will stay the same over several episodes
ideas and concepts about it are determined by of illness. When symptoms are very different or
our ability to describe a patient’s totality and suppression strong there are likely to be subtle
constitution. In this way both the totality and changes in the constitution. In this way constitu-
constitution describe essential aspects of the tions may ‘evolve’ and change depending on the
case, and either or both may be used as a valid circumstances and illnesses the patients experi-
approach to treatment when viewing the patient ence.
holistically. While it is important for the homeo- In some schools of homeopathy, however, the
path to try separating these two aspects out, in concept of ‘constitution’ is used to refer predomi-
practice they are closely related. When thinking nantly to the physical type and appearance of a
of a deeper case as having several layers it can be patient; to avoid confusion it may help to refer
thought of as like several coins stacked on top of to these as ‘morphological constitutions’ (see
one another. What is a symptom at one level may Chapter 12).

141
CHAPTER ELEVEN Holism and Understanding Complex Cases

ecules, cells, tissues, thoughts, etc.) and all aspects


REFLECTION POINT of the patient’s environment. It suggests a common
● Think about a complex case you have seen. Identify thread running through the mind, body and envi-
those features of the case that relate to symptoms, ronment to explain and allow for order, context
susceptibility and suppression. Consider how different and relationship (Bellavite & Signorini 1995).
cases with the same ‘disease diagnosis’ might have
different symptoms, susceptibility and suppression. How Remedies as qualities and information
may the case be understood as made up of symptoms One way of understanding this common thread is
of different ‘depth’ and how is it informed both by the as a quality or in terms of ‘information’ and that
totality and the constitution? an individual may be thought of as being healthy
when they have the qualities or information that
are necessary to function in a balanced way that
The Paradigm Shift or Shift in Models does not require or generate symptoms in the situ-
of Health ation they are in.
The totality model of health is significantly differ- When the situation patients are in changes
ent from the models of health so far described. It so the information they need to be healthy also
raises important questions about how the compo- changes. If the individual already contains the
nent parts of an individual are each less than the information required for the new situation then
Constitution
Totality and

whole, how cause and effect are connected to each each will adapt to it without the need for symp-
other and the situation in which the cause and effect toms. In this way the homeopathic remedies may
happen. It also raises important questions about the be thought of as providing the information a
III appropriate tools to investigate and experimentally
validate it (see Chapter 24). Each different model
patient needs to cope with the situation. This may
explain the well-observed phenomenon that hav-
of health is only partially explained or understood ing one illness seems to make some patients more
by natural progression from other models of health. resistant to others. For example, a study of 6000
Moving between each model (paradigm) of health children showed hay fever to be 14% less com-
requires a shift in assumptions, values and interpre- mon in those contracting measles than in those
tation of observations. not infected (Lewis & Britton 1998).
Each model provides you with the opportunity
to explore different ways of understanding and Revisiting Causation
viewing health. No one model will be optimal In the holistic model causation is broader than a
in every setting. However, the shift to a holistic single aetiology. There can be a number of different
model from the models based on a linear relation- causations and contributory factors in any case and
ship between cause and effect provides a chal- during treatment different factors become appar-
lenge and opportunity to the homeopath to see ent. Instead of cause it can be helpful to think
things differently. The cause and effect models of factors that influence susceptibility or trigger
are served by conventional medical language; the events. The case of Gupta illustrates how a complex
holistic model builds on this to include the inter- case presenting with a clear symptom picture can
face between the mind and body, the individual be considered to have causes in several different
and the situation. In the holistic model an illness areas of life. Different therapists, carers, advisors
has as much to do with the patient’s susceptibility and friends would suggest treatment depending on
and events and experiences leading up to the ill- where they saw the problem. A holistic approach
ness as trying to establish an immediate cause and attempts to understand a patient’s narrative from
identify a single disease process. as broad a perspective as possible, and Figure 11.1
The holistic model invites an appreciation of the suggests some of the different areas where causation
interconnectedness of all aspects of a person (mol- might be considered in Gupta’s case.

142
Symptoms, Susceptibility and Suppression

REFLECTION POINT Atom


● Reflect on different cases that might present with
symptoms of a gastric ulcer and consider the different Molecular
dimensions in Figure 11.1 that may play a part in these
cases. How do different treatments link to these different Cellular

possible causes and how might these causes relate to


Tissue
each other? Causation might be sought and contribute to
the case in any and many of the different aspects of the Glandular
patient listed in Figure 11.1 – where each practitioner will
see the cause and focus treatment will be influenced by Digestive system
their perspective. In Gupta’s case how might a counsellor,
a gastroenterologist, a surgeon, a dietician, a friend or a Hormonal

priest have seen the case differently?


Symptoms

Psychological
CASE STUDY 11.2
Gupta presented wanting help with a gastric
Familial

Constitution
Totality and
ulcer because she was not tolerating conven-
tional treatment well. It was based on block-
Social
ing production of histamine at the cellular level.
She had received treatment for an infection in
the stomach with triple antibiotic therapy, which
had given short-term relief. Neither of these
Cultural
III
Cosmic
approaches would have been available 20 years
ago. Common treatments then were based at a
Spiritual
tissue level, cutting the vagal nerve and reducing
the nerve supply to the stomach, or at an organ
level, by removing part of the stomach. Figure 11.1 Different ways of viewing causation
Gupta eats much spicy food and might
have been treated by dietary modification. She
also had a stressful life with a young family and In many cases the deeper symptoms are assumed
demanding job. The stress was partly social in to approximate to the cause, and the true primary
that she was in an arranged marriage that she cause may well be disguised as the case becomes
felt unhappy in but didn’t feel able to talk to her more confused and hidden. It can help to remem-
husband about. Her extended family was help- ber that the deepest causes in a case can be thought
ful with her children but she felt would be very of not only as a reaction to something in the envi-
unsupportive of her criticising her husband. She ronment but as subtle, energetic and information
spoke about cultural differences between her changes and that in potency, homeopathic remedies
work life as a shop assistant and home life, and provide subtle energetic and information qualities
the confusion about her identity this presented. that can help a case on several levels or in several
When talking with some friends they suggested areas of the body at the same time. So in the case
this was her ‘Karma’ and had to be accepted of Gupta it is possible that the right remedy can
as it was, while others suggested she should be found from viewing the case in one of several
not be expected to put up with things as they different ways but when this right remedy is given
were. She decided to see a homeopath. it may correct the disturbance in other levels. So if
something was to shift in Gupta’s relationship, it

143
CHAPTER ELEVEN Holism and Understanding Complex Cases

may affect her ulcer; similarly, if something shifted in Vitality and ‘The Constitution’
her gastric symptoms it may affect her relationship. As a disease progresses it can be seen to be moving
Understanding individuals in terms of this subtle deeper and deeper into a person, in what we can
anatomy and the relationship between different term a centripetal direction. The life force, through
aspects of the individual and their life situation the vitality, might be considered to resist this pro-
is something that all homeopaths hoping to use gression by throwing symptoms out towards the
homeopathic remedies at deeper levels should reflect extremities, centrifugally. What happens on the
on. Remember that changes in anatomy, physiology outside reveals what is being expressed from the
or functionality in one part of an individual or their inside. When the life force and vitality are low the
environment will affect different people in different centrifugal force is less, and symptoms less clearly
ways. For example, after a sudden bereavement five expressed (Roy 1999).
people might each go through a similar grieving pro- Given sufficient vitality, then any illness
cess. However, depending on the susceptibility each expressed in an unobstructed way would give
of those five patients may experience problems (or acute symptoms. These would express themselves
get stuck) in a different state. Other aspects of the on the most superficial or peripheral aspects of
totality and constitution do, in the holistic model, the individual. This is why many homeopaths
reveal many different types of susceptibility to loss. claim that in the evolution of all complex cases,
The different homeopathic remedy pictures that
Constitution

if the individual could develop an acute illness the


Totality and

have ailments from grief and loss give substantive chronic disease need not manifest. It is due to sus-
language and insight to the homeopath on the griev- ceptibility to certain causes and obstruction of the
ing process and patients going through it. expression of symptoms that complex cases with
III Susceptibility and Resistance
chronic diseases come about.

Chronic disease and complex cases can be the


natural result of unresolved, usually suppressed, REFLECTION POINT
acute illness. The homeopath comes to realise that ● What do you think keeps an individual’s vitality high?
susceptibility and causation cannot be considered A healthy person often appears more flexible and
separately. It is necessary to ‘blend together’ the adjusts well to change. One of the first signs of patients
aetiological factors and the susceptibility to see improving is often they will be more creative and more
the complex case. Which chronic illness a person active, and will make life style changes. If the vitality
develops will be influenced by individual suscepti- is fed and nurtured by moving between different life
bility – including acute illnesses in the past and the situations, then both the cause of illness and the
reaction to them. It is therefore important to note maintenance of health rely on the interaction between
the acute precursors of any chronic disease. the individual and the changing situations. What are the
All individuals have a resistance to some things implications on your role as a ‘healer’ when health and
and a susceptibility to others. It is a question of illness are so closely related?
working out a profile of susceptibility and resistance
for each patient. This is true not only of individuals
but also within all social and cultural groups. For this Depth of Disease
reason knowing the susceptibility and resistance of This book has already introduced the reader to
the patient’s family, colleagues, culture, race, etc. are the importance of understanding cases, of looking
important. When one disease becomes less common at symptoms in terms of layers, levels and hierar-
in any group, the homeopath reflects on what has chy. As we move into considering more complex
become more common. The strengths and resistance cases the homeopath must consider two further
of patients can helpfully point to the best remedy measures that reflect the depth of a disease – one
match as much as the weaknesses and susceptibility. is the difference between hereditary or acquired

144
Symptoms, Susceptibility and Suppression

influences, the other the difference in a symptom Structure, Function or Sensation


or illness depending on the whether it is expressed Symptoms can express themselves in qualitatively
through the qualities of structure, function or sen- different ways. They may manifest on a level of
sation. Often the more structural or hereditary a structure, function or sensation – it is common to
disease the deeper it runs and in these cases there see chronic illness developing first in sensation,
are often several levels of symptoms and different then in disturbance of function, before moving
layers of remedies running through the case. into structural damage at a tissue or organ level.
During curative treatment this order is reversed.
Hereditary and Acquired Sensation changes include feeling sick, numb, hot,
Homeopaths differ in the relative importance they pain, etc. Functional changes affect the working of
attribute to situational (environmental) factors a bodily system, e.g. diarrhoea, sweating, restricted
and susceptibility in complex cases. The resultant movement, etc. The body might restrict function
schism has been a recurrent tension between dif- in order to reduce an unpleasant sensation, such as
ferent schools of homeopathy; this mirrors the not walking with an inflamed knee joint. Structural
difference between those who see acquired factors changes include bone and joint degeneration, skin
and those who view hereditary factors as most lesions, tumours, infarction, etc. (see Chapter 15).
central to a case. One school focuses on suscepti- A patient will often get symptoms moving
bility. As Kent expresses it: through each of these overlapping phases. For

Constitution
Totality and
‘. . .it is not from external things that man becomes sick, example, a patient with a chronic sore throat may
not from bacteria nor environment, but from causes have thirst and burning pain (sensation), dryness
within himself … measles and smallpox are not on the and difficulty swallowing (function) and swelling
outside. Man is protected on the outside; he is attacked
from the inside when there is susceptibility.’
(structure). The relationship between these three
III
This susceptibility is expressed in the holistic
Sensation Function
model as the ‘constitution’. Comfort Diet
Other schools focus on the external or Belonging Habits
Relaxation Normal behaviour
acquired causation of disease and the immedi- Security Daylight
ate symptoms produced. These may be the local ‘Pain threshold’ Exercise
Loved Recreation
symptoms or the totality of what is changed. Beliefs Activities
Immunogical
In managing increasingly complex disease both Chemical
these ways of understanding illness, represented
by the constitution and the totality, are valid and
need not be mutually exclusive. (It is interesting Structure
Vascular
that despite the validity of both a constitutional Injury
and totality approach to prescribing holistically Infection
Congenital
that one or other is frequently claimed to be Posture
more holistic or more ‘classical’ than the other.) Weight and height

Circumstances including hereditary predispo-


sition and acquired influences are intimately
related with our holistic understanding of the Some symptoms will exist in only one of these ‘modes’; many will
evolution of the patient’s state. Unravelling this exist in two and some in all three. Part of making sense of any
symptom is deciding which mode or modes it is in and how it
narrative is important in making sense of the connects to other features and factors in that mode as well as how
more complex case and becomes central in clar- it connects to other symptoms.
ifying and unmasking the confused and hidden Figure 11.2 Three modes of symptom expression, with some of
cases discussed in later sections. the factors influencing the quality of symptom expression

145
CHAPTER ELEVEN Holism and Understanding Complex Cases

tells us about the severity of an illness, the prog-


nosis, and the likely response to treatment. Figure REFLECTION POINT
11.2 illustrates these three modes of symptom
● Sandra’s case illustrates some of the different factors
expression, with some of the processes that need that influence a complex case. Try to identify the different
to be taken into account when understanding levels of symptom – which are totality factors and which
symptoms in each one. You might reflect on how are constitutional factors? How do inherited and acquired
these three realms encompass the different causes factors influence it and can the features be distinguished
given in Figure 11.1. Usually disorders of struc- on qualities of structure, function or sensation? How
ture are reflected in a disturbance or limitation of might her symptoms be affecting her vitality?
function and disorders of function are mirrored in
the realm of sensation. It is not a coincidence that
structure relates to the body, function to the inter- CASE STUDY 11.3
action with environment (generals), and sensation Sandra, a 28-year-old single lady, had been
to the mind and nervous system. having premenstrual pelvic pain for 7 years.
Many symptoms of sensation, such as pain, may She had an operation for termination of preg-
relate to a physical part of the body but have quali- nancy when she was 20 that she still feels very
ties of ‘feeling’. General symptoms, such as feeling guilty about although she knew it would have
hot or cold, describe how a patient functions in or been ‘a mistake to carry on with the preg-
Constitution
Totality and

reacts to the environment; physical symptoms, such nancy’. Since the operation and signing the
as swelling, usually relate to a disorder of structure. consent form for it she had found it increas-
The homeopath is interested in how different symp- ingly difficult to sign her name on cheques and
forms, and this increasingly interfered with her
III toms or syndromes express a common (sometimes
referred to as fundamental) sensation, function or life. Lately she has had weakness and some
structural disturbance. The greater the disturbance wasting of the muscles in her right hand. She
the more restricted the individual is likely to be to is right-handed. The pelvic pain had started six
the diversity of situations they can tolerate. months after the termination of pregnancy and
Within all complex cases expressed through the had been a problem premenstrually since. At
totality it is possible to observe qualities of sensa- age 25 Sandra started to get a swelling in the
tion, qualities of function and qualities of structure. left lower abdomen, diagnosed as a large ovar-
The homeopath is always seeking to understand ian cyst. Endometriosis was also present. She
how different symptoms and qualities relate to was angry about the termination and did not
each other and the whole. In approaching more want further surgery. Her mother suffered from
confused cases, sensing the underlying changes in painful periods and had treatment for breast
the quality of symptoms provides a pattern that cancer when Sandra was 15 years old. Sandra
connects what may appear diverse and contrary was treated with homeopathic Staphisagria
symptoms of the patient’s physical appearance and and the pelvic pain gradually improved. After
temperament, and the environment they choose to expressing her anger about the termination
live in. Those drugs that mimic the body’s normal she described feeling stuck and a great sense
functions have big suppressive effects on functional of having to do ‘the right thing’. After homeo-
symptoms, e.g. corticosteroids. Those drugs that pathic Carcinosin she was able to accept her
distort sensation have big suppressive effects on mixed feelings about the termination. Gradually
sensation symptoms. Those treatments that distort her difficulty signing her name improved, and
structure (surgery) have a big effect on suppressing after 3 years of treatment her cysts and endo-
structural symptoms. metriosis had completely resolved.

146
Suppression

Suppression different places at different times, to flooding or


drought. If the river’s course is artificially blocked
Suppression is the ‘treatment of a symptom or or diverted (suppression) this will lead to a build
condition so that it is relieved but is not resolved. up on one side of the blockage and a deficiency on
It may remain dormant, or become manifest in the other (symptoms). Exactly where the blocks
some other, possibly more serious or deep-seated are likely to take place depends on the terrain or
disorder’ (Swayne 2000). In simple cases the exact constitution (susceptibility), as well as the nature
cause or how the patient comes into contact with of the obstacle. A block in one place often leads
the cause largely determines the symptom pic- the river ultimately to follow a new route, leading
ture. In complex cases the symptoms that mani- in turn to new excesses and deficiencies. In other
fest and the situations to which they are sensitive words, what is suppressed in one place eventually
are determined by the patient’s constitution and expresses itself in another. Ultimately if it is not
susceptibility. These in turn are largely influenced possible for the river (vitality) to flow, then the
by hereditary factors and suppression. Figure 11.3 landscape becomes barren.
illustrates how simple cases are moved towards Both disease symptoms and suppression symp-
complex cases (and on towards confused and hid- toms are due to disruption of the dynamic balance
den cases) by suppression. of the organism’s susceptibility and its situation.
If treatment is not to be suppressive it needs As such, symptoms from suppression can be con-

Constitution
Totality and
not to transitorily improve the symptoms at the sidered and treated in the same way as other symp-
price of the individual’s susceptibility by sacrific- toms. Suppression often takes place in response to
ing the flow of the vitality. The understanding the expression of symptoms – therefore suppres-
of the dynamic between vitality, susceptibility,
constitution and suppression might be helped by
sion is often the internalisation or driving inside
of a symptom.
III
reflecting on the analogy of a river and the terrain
it runs through. Common Causes of Suppression
If you think of the vitality as a river flow- Suppression may be from medication, over-the-
ing through an individual’s landscape, then cer- counter treatment and/or recreational drugs. There
tain features in the landscape (constitution) may may also be emotional and cultural causes, as well
inhibit or enhance its natural flow. The resulting as those from a secondary illness. The suppres-
course of the river will make it susceptible, in sive effect is to confuse or divert the expression
of an illness through an action that either bears no
direct relationship to the symptoms (allopathic) or
Simple case Complex case indirect opposition to the symptoms (antipathic)
Often acute illness Often chronic illness (see Chapter 10, p. 132).
Suppression as a block to a natural expression
with a simple cause with many different
and local symptoms contributing factors or flow can be compared to putting a lid on a
and diverse symptoms saucepan of boiling milk, without turning down
Suppression
the heat. When this starts to boil over again, fur-
e.g. fall, bruise, e.g. arthritis, migraine ther suppression puts more lids on until a virtual
hangover pressure cooker is present. It is a common reason
e.g. eczema Asthma why an occasional acute illness and simple case
becomes more chronic and increasingly complex,
Acute otitis media Recurrent otitis/
sinusitis e.g. analgesic-induced headaches.
As symptoms affect more central and vital
Figure 11.3 Simple cases are moved towards complex cases by organs so the amount of suppression needed to
suppression stop symptoms surfacing increases and the amount

147
CHAPTER ELEVEN Holism and Understanding Complex Cases

of force to keep suppressing symptoms increases. using homeopathic remedies or other natural rem-
If suppression is likened to holding down a bal- edies that only fit part of the case. This partial
loon or ball under water then the deeper the water treatment may or may not help reveal the deeper
the greater the force required to hold it down. underlying symptoms, but it is quantitatively and
Suppression often demands a great deal of force, qualitatively significantly different from suppres-
especially to suppress more deep-seated symptoms – sion and palliation.
this leads to, and is a major cause of, blocked and An ill patient may reasonably seek to modify
depleted vitality, which in turn leads to failure to the situation to cope with that illness – indeed
express a clear picture and an increasingly con- illness can be a major reason for seeking change.
fused or hidden picture of the case. In order of It might be a change of job, diet or life style, e.g.
magnitude, suppression of a structural symptom a hangover might encourage someone to give
(e.g. by surgery) will be greater than the suppres- up drinking alcohol. You may also seek out an
sion of functional symptoms (e.g. anti-diarrhoea environment that helps you to cope with your
agents and anti-pyrexials), which in turn is greater symptoms, e.g. moving to a house with no stairs
than the suppression of symptoms of sensation if you have mobility problems. This may give the
(e.g. by pain killers or indigestion remedies). appearance of being free of symptoms.
There are many causes of suppression but allo- In cases where palliation is strong the
pathic and antipathic treatments are a major fac- patient may not even be conscious of actively
Constitution
Totality and

tor in developing increasingly complex, confused choosing a certain environment to avoid symp-
and hidden cases. toms. What palliates a particular symptom is
Not all conventional drugs are equally suppres- essentially removal of what causes a symptom.
III sive. The degree of suppression depends on the
extent to which they disturb the body’s natural
Unfortunately palliation of more superficial
symptoms is a way of coping with a disease but
reaction to a stimulus and how long they have isn’t a curative process and frequently leads to
been given for. Any suppression may lead to the other aspects of the disease becoming mani-
emergence of new symptoms; it is these that are fest. It may be an important part of managing
often the adverse effects of the medication. This an illness both while the patient is pursuing a
should be distinguished from those factors that curative approach (avoiding allergens while the
can, despite a correct remedy, prevent a patient underlying susceptibility is being treated) or to
from improving. These are considered ‘obstacles give time for the vitality to build up sufficiently
to cure’ (discussed more fully in Chapter 15) to generate a healing response (resting in
and include a maintaining or persistent causative bed, eating carefully or being emotionally
factor. supported).
Suppression, palliation or partial treatment
Palliation, Suppression and Partial Cure can all distort a case making it harder to find the
Palliation and suppression are the lessening of simillimum. Anything that alters the case picture
symptoms without cure. A useful distinction can also have the effect of driving the case deeper
between suppression due to medication, either and this is one reason why complex cases become
antipathic or allopathic, and palliation due to increasingly confused and hidden. This is most
modification of the environment and the patient’s likely to happen with allopathic or antipathic
circumstances can be made. Historically in home- suppression. It is possible with palliation when
opathy, palliation has sometimes been used to there are significant or prolonged environmental
describe the antipathic suppression of symp- changes and it happens occasionally with par-
toms. Both suppression by medication and pal- tial homeopathic treatment of symptoms. Many
liation by modifying the environment need in homeopathic students are overly cautious of sup-
the homeopath’s mind to be distinguished from pression due to partial treatment of symptoms but

148
Suppression

in my experience this is minimal compared with behaviours and actions are designed to protect
the suppression that takes place from the use of from certain symptoms – each of these can have
antipathic and allopathic medication. Cautious a suppressive or palliative effect, e.g. the fluorida-
modification to the environment and treatment of tion of water, the use of preservatives in foods,
local symptoms can actually support an individual culturally-accepted recreational drugs and the
over a difficult period of problematic symptoms containing of emotions such as the bottling of grief
and allow them in time to present a clearer case, or control of anger. It is often cultural palliation
amenable for treatment at a deeper level. A cer- that prevents expression of minor but irritating
tain amount of palliation and local homeopathic symptoms until (‘as if by magic’) a deeper often
treatment does in practice often help reveal a confused or hidden case emerges.
deeper case that isn’t visible initially. Where I
would advise caution in the partial treatment of Suppression and Vaccination
symptoms even homeopathically, is if new deeper Vaccinations are given before symptoms are
symptoms are developing, if repeat dosages or manifest in an individual and therefore are best
high potencies are needed or if improvement is understood not as suppression of an individual
not following the laws of cure (see page 73). In but rather as a form of cultural suppression and
these cases it is possible to confuse or mask a case. palliation. One reason why they are so controver-
Exposure to culturally accepted suppressants like sial is that the aims of treatment or whom the ‘con-

Constitution
Totality and
coffee, nicotine and other recreational drugs can tract’ for treatment is with are not always made
also play their part in suppressing and confus- clear. There are, of course, different priorities
ing the remedy picture. Although palliation can when thinking of treating a population or an indi-
provide a necessary temporary environment for
healing to take place, it does, if prolonged, set
vidual (see Chapter 30).
Many patients report adverse effects and some
III
up an environment where the individual’s vitality complex cases seem to track back to vaccination.
and self-healing can be stifled. If the underlying If you wish to understand the principles at stake
health issues are not addressed, then as the disease I invite you to return to the idea that health relies
progresses, many patients increasingly palliate on having the right information to cope with a
their symptoms by successively withdrawing from particular threat and that a cause can be con-
their physical and psychological environment. So, sidered a challenge that the individual is unable
for example, a patient with food sensitivity who to accommodate without the need to generate
doesn’t deal with the underlying susceptibility symptoms (see Chapter 6). Vaccination might
but instead simply avoids or excludes a particular provide the information for some individuals to
food group will find that over time they increas- cope with a challenge they may be exposed to,
ingly need to avoid other food groups and become while at the same time in some individuals (and
‘more sensitive’. In a patient with chronic fatigue, there may be an overlap between both groups)
if the underlying susceptibility is not dealt with, the vaccination may cause symptoms. If the situ-
then they may increasingly have to palliate their ations that any one individual can accommodate
environment using bed-rest, special diets and par- are determined by susceptibility, then a question
ticular psychological attitudes and environments arises as to whether an individual can ultimately
in order to cope. have complete health and no susceptibility. If this
was the case they could operate in any situation –
Cultural Palliation and Suppression this is patently not true. It therefore seems likely
As different environments suit the expression of that every individual’s susceptibility is finite. In
different symptoms, then it follows in any culture this case gaining new resistance to a situation
that certain symptoms or illnesses are more com- could, if the limit to an individual’s susceptibility
mon and others less. In every culture different has been reached, lead to the loss of some other

149
CHAPTER ELEVEN Holism and Understanding Complex Cases

resistance as ‘the price’ of new resistance. Adding Types of Chronic Disease


resistance to one thing may leave the individual
susceptible to another that the patient was not
and Complex Cases
previously susceptible to. For many patients their first experience of homeop-
An individual or population may well make athy is when they have a chronic disease. Although
an informed choice to protect against particular in some of these cases, the symptom picture will be
illnesses but it is always important to consider the clear, in others there will be a certain amount of sup-
possibility that the choice the individual is weigh- pression. This often makes these complex cases more
ing up is an increased resistance to a serious but difficult to treat and the patient may need some expla-
rare illness against the increased susceptibility to a nation about how we approach chronic diseases. It is
less serious but more common illness. helpful to recognise different types of chronic disease
and complex cases each requiring a slightly different
Palliation and Suppression Affecting strategy to their management.
the Totality and Constitution
The totality of the individual is gathered from the Pseudo Chronic
expression of all the symptoms in the organism. When chronic illness is caused predominantly by
The totality will be influenced by palliation, sup- environmental and life style factors it is referred
to as pseudo chronic. This includes illness caused
Constitution

pression and local or partial symptom treatment.


Totality and

This in turn will change aspects of the individu- by mechanical causes such as repeated injury, or
al’s susceptibility and constitution. These changes injury that fails to have an acute resolution, and
themselves may be thought of as layers or stages more superficial illnesses due to poor diet, tox-
III in the case and need unravelling and taking into
account during a course of treatment.
icity, extreme weather, pollution, stressful lives,
stimulants, recreational drugs, etc. A cure may be
Every symptom needs to be understood in con- obtained by removal of causation.
text of the possible effects of palliation and sup-
pression. Hence the importance of understanding Confused and Hidden Cases
what treatment a patient has already received and In more complex cases, where the whole picture
possible adverse and side effects of such treatment. cannot be seen and the constitution or totality are not
As the treatment progresses stage by stage, so the clear, the case may appear confused and hidden. In
case changes to reflect the unveiling of these influ- confused cases the totality is not clear and the pattern
ences. The journey into illness follows a course or themes that run through the symptoms or the nar-
and direction which can be discerned by careful rative of the case may be more clearly perceived and
study; the journey into well-being follows a rever- reveal more about the individual and the nature of the
sal of this process. Hence the more suppression illness than the ‘distorted’ totality. Ultimately in hid-
and palliation in the evolution of an illness, the den or masked cases just one symptom or sign may be
longer treatment is likely to take. all that is obvious (see one-sided cases, Section VI).

Incurable Cases
REFLECTION POINT Incurable cases are those cases where the vitality
● Think about a patient you have seen with a chronic is too low or the disease too advanced for a cure
disease – what can you imagine about the ‘flow’ of to be obtained. Often the illness will have been
energy in this case, where is it blocked and stuck? present for some time before curative treatment
Where might there be excess and where deficiency? is sought. In others the suppression and pallia-
Both are always present, although one may be more tion is such that the journey back to health is not
apparent than the other. possible by a reversal of the disease process, e.g.
treating patients after surgical removal of glands

150
Summary

or fusion of joints. In these cases relief of symp- deeply. Working with these homeopathic patients
toms may be all that is possible. is dramatically different from working with those
who, often from an early age, have been subject
Palliative Care and Local Treatment to ‘much dosing’ with the favourite allopathic or
Troublesome symptom complexes, even though fashionable antipathic drugs of their day.
they do not reflect the deepest aspects of the case, Given the prevalence of cultural and medicinal
may be treated, e.g. nausea after chemotherapy, suppression and the nature of most patients’ life
the anxiety of the terminally ill. The patient may styles, a holistic approach must have an understand-
be made as comfortable as possible by modifying ing of suppression and palliation right at the centre
their situation – including special diets, emotional of an understanding of patients’ susceptibility and
support etc. In terminal care careful support and symptoms. It is the suppression and palliation of this
palliative management may allow a gradual draw- generation and our ancestors that causes so many
ing in of the life force or vitality. This compares complex cases and chronic diseases to present as
favourably to the sudden and, at times, brutal confused and hidden. It is only by recognising the
spiralling downwards of the vitality when using relationship between symptom, susceptibility and
increasing doses of suppressive drugs. suppression and reconciling these contradictory
and somewhat discordant themes that we can begin
to reverse this trend.

Constitution
Totality and
REFLECTION POINT The homeopath requires not only an under-
● Which is the healthier person – one who performs standing of the patient’s illness but also the con-
optimally in most environments seeking out challenge, text in which each subject presents, both in terms
or a person who seeks out the environment in which
they do best? Some patients will seem to be ‘drawn
of other previous and concurrent interventions and
the cultural and social influences each is subject to.
III
to’ situations where they become ill. It is as if the To hold this dual focus requires a level of personal
susceptibility determines the situations the patient seeks knowledge, insight and development that can make
out. Why do you think this might happen and what does the homeopath’s training arduous, all-encompassing
it say about an individual’s unconscious attempt to be and, at times, lonely. We explore in later chapters
healed? how sitting with the discomfort this can bring is as
much part of the homeopath’s training as learning
materia medica and analysing cases.
We have developed the philosophy that allows
Summary us to work with and treat complex cases; look-
In this chapter we have moved fundamentally ing at how causation, susceptibility, suppression
from illness being something that happens due to and palliation tie in with the vital force and the
events outside of us to something that through an symptomatology; explaining how suppression
understanding of totality and constitution is seen causes the case to deepen. We have revisited the
to connect us to our world, patients to their world importance of the holistic approach taking into
and therefore patients and us. While there is ini- account mind and body, including the emotional
tially a simple interplay between a patient’s symp- sphere of an individual. And we have talked about
toms and susceptibility, it is unfortunately almost symptoms in relation to sensation and function
immediately confused in many patients by sup- and structure and the inter-relation of these.
pression and palliation. ‘Homeopathic patients’ These concepts, when mastered and with some
who understand this and who minimise suppres- experience gained in putting them into practice,
sion and palliation are often surprisingly healthy, allow the homeopath to explore more confused
throwing off illness remarkably speedily and when and masked cases. They are important in choos-
they require a homeopathic remedy responding ing and working with totality and constitution and

151
CHAPTER ELEVEN Holism and Understanding Complex Cases

prepare the homeopath to work with thematic and Swayne J 1998 Constitution. Br Homoeopathic J 87:
relational approaches. Increasing our understand- 141–144
ing of the hierarchy of suffering and disorder Swayne J 2000 International dictionary of homeopathy.
within the individual allows us to work deeply at Churchill Livingstone, Edinburgh
the core of the problem.
Finally in this chapter we looked briefly at the
types of chronic disease and types of complex case Bibliography
the homeopath will need to manage. We intro-
Allen J 1910 The chronic miasms: vol 1 Psora and
duced the idea that symptoms themselves are both pseudo-psora, vol 2 Sycosis. Chicago
an expression of something about individuals,
Blackie M 1986 Classical homeopathy. Beaconsfield
their situations, their response to the challenge of
Press, Beaconsfield
illness and also an expression of what may have
been suppressed, and the important part that may Bodman F 1990 Insights into homeopathy. Beaconsfield
play in the evolution of the illness. All this allows Press, Beaconsfield
us to start to make meaningful comments and Chappell P 2005 The second simillimum. Homeolinks
observations about the different types of thera- Publishers, Netherlands
peutic intervention available to the homeopath at Cusins P J 2001 Holistics. CandleFlame Books, Orkney
different times.
Constitution
Totality and

Dossey L 1982 Space time and medicine. Shambala,


Boulder

References Sankaran R 1991 The spirit of homeopathy.


Homoeopathic Medical Publishers, Bombay
III Bellavite P, Signorini A 1995 Homeopathy: a frontier in
medical science. North Atlantic Books, Berkeley Twentyman R L 1989 Science and the art of healing.
Floris Books, Edinburgh
Lewis S A, Britton J R 1998 Measles infection, measles
vaccination and the effect of birth order in the aetiology Whitmont E 1980 Psyche and substance. North Atlantic
of hay fever. Clin Exp Allergy 28(12):1493–1500 Books, Berkeley

Roy M 1999 The principles of homeopathic philoso-


phy. Churchill Livingstone, Edinburgh

152
CHAPTER TWELVE

Dynamic Materia Medica Materia Medica

David Owen

‘Myth, legend, poetic imagery all represent a proving in Studying in increasing detail a growing number
one way.’ of homeopathic remedies can appear a daunt-
Ralph Twentyman ing task. The homeopath will find it helpful to
develop a range of approaches to studying to help
understand and remember the many aspects of
these remedies. Remedy pictures are not random
Introduction but have clear coherent patterns and wherever
In the previous chapter we saw that the totality of possible it can help to observe order in them
symptoms and the constitutional picture of each expressed as trends and themes. Observing these
remedy provide two important aspects of each rem- patterns prepares the homeopath for connecting
edy picture. By considering both of these the homeo- and extending the materia medica through the
path is helped to understand both the case and the consideration of ‘related remedi