An Introductory/Advanced introductory lesson in homeopathic practice Molly Punzo, MD NCH Annual Conference 2011 Alexandria, VA
Goals and Objective Learn the fundamentals of effective case-taking Make sure you get the characteristic symptoms you will need to solve the case Learn common from characteristic symptoms Become familiar with the TCS: Totality of Characteristic Symptoms Repertorization of the TCS Key NotesGuiding SxLeaders Learn Key Notes, Guiding Sx or Leaders of remedies And finally: Match the TCS to the Key Notes or Leaders of a remedy!
Let’s start with a scenario Your 10 yo wakes you up and comes into your room and says she doesn’t feel well. She is wrapped up in her blanket. She says her throat and stomach hurt and she feels like throwing up.
What are you thinking? Are you thinking of a remedy? What do you need to do next?
Karen Allen, CCH “Individualization of the case characteristic through recognition of the characteristic expression of the vital force is the single most important skill in case analysis, and has the greatest potential to immediately improve your results!”
Homeopathic Case-Taking 101 Get as many specific, unique and precise symptoms as possible Observe the person if possible You need a minimum of 3-5 really good characteristic symptoms to be able to solve an acute case You will have LOTS of symptoms by the time you’ve finished. A combo of common and characteristic But you need at least 3-5 solid precise symptoms you can hang your hat on before you can begin to repertorize.
The Organon: § 7, 153, 154 and 258 Collectively describe how to solve a case by identifying the “Totality of the Characteristic Symptoms”
The Organon says… § 7 …we can perceive nothing but the morbid symptoms, it must… be the symptoms alone by which the disease demands and points to the remedy suited to relieve it - and, moreover, the totality of these, its symptoms, of this outwardly reflected picture of the internal essence of the disease, that is, of the affection of the vital force, must be the principal, or the sole means, whereby the disease can make known what remedy it requires - the only thing that can determine the choice of the most appropriate remedy - and thus, in a word, the totality of the symptoms must be the principal, indeed the only thing the practitioner has to take note of in every case of disease and to remove by means of his art, in order that it shall be cured and transformed into health.
§ 153: Characteristic vs. Common symptoms In this search for a homeopathic specific remedy…, the more striking, singular, uncommon and peculiar (characteristic) signs and symptoms of the case of the disease are chiefly and most solely to be kept in view; for it is more particularly these that very similar ones in the list of symptoms of the selected medicine must correspond to, in order to constitute it the most suitable for effecting the cure. The more general and undefined symptoms; loss of appetite, headache, debility, restless sleep, discomfort, and so forth, demand by little attention when of that vague and indefinite character, if they cannot be more accurately described, as symptoms of such a general nature are observed in almost every disease and from almost every drug.
§ 154 If the disease picture constructed from the list of symptoms of the most suitable medicine contain those peculiar, uncommon, singular and distinguishing (characteristic) symptoms, which are to be met with in the disease to be cured in the greatest number and in the greatest similarity, this medicine is the most appropriate homeopathic specific remedy for this morbid state…
§ 258 The true practitioner…..must bear in mind the truth that of medicinal agents, that one alone invariably deserves the preference in every case of disease which correspond most accurately by similarity to the totality of the characteristic symptoms, and that no paltry prejudices should interfere with this serious choice.
Characteristic symptom Characteristic symptom THIS IS THE BARE MINIMUM 1 2 3
What makes a symptom “C H A R A C T E R I S T I C ? ”
Characteristic Symptoms: §153 CHARACTERISTIC SYMPTOMS are those symptoms which are precise, strange, rare, peculiar, very strong, specific, uncommon for that person (very important!), and UNCOMMON for that illness and for that person (if acute) You must then match these CHARACTERISTIC SYMPTOMS with the CHARACTERISTIC SYMPTOMS OF A REMEDY. You find the characteristic symptoms (Key Notes or Leaders) of a remedy by reading your materia medica(s) and picking them out, or by reading books which have distinguished these for you already: Nash Leaders; Allen’s Keynotes; Hering’s Guiding Symptoms, Phatak, Boericke, etc… This is the very essence; the MOST FUNDAMENTAL TENET of Homeopathy
Describe “FLOWER” What are the COMMON qualities of a flower? What helps you to distinguish one kind of flower from another? CHARACTERISTIC e.g. makes that flower CHARACTERISTIC?
Test: Rate the following symptoms on a scale of 0-10 0: symptom is not at all helpful 10: is a VERY useful, e.g. characteristic, symptom
Here we go! I don’t feel very well My throat hurts The inside of my ear itches I am cold I am thirsty I have a fever I am tired My throat burns like fire on the left side My head hurts Every time I cough, my head feels like it’s going to explode My head feels better when I squeeze it with my hands like this… I’m very thirsty and perfer ice cold water A little while after I drink anything, I have to run and throw up
Qualities that Make a Sx. Characteristic Time of day/night when sxs are better or worse Very helpful! Causation: Did anything bring the sx on? Grief; trauma; diarrhea or some other illness; stress; bad news, etc.. Concomitants: Are there other symptoms which are present with the primary symptom? Headache AND cough Diarrhea AND headache Irritability AND pain Teething AND earache Rash and diarrhea? Etc… Thirst? Especially if a change from usual
Temperature: Does the person prefer open air, closed, fanning? Warm? Cold? Does the patient FEEL hot, cold, warm, chilled, etc… Pain? Pain? Make them DESCRIBE THEIR PAIN (sensation) AND have them USE ADJECTIVES! Burning? Throbbing? Dull? Stabbing? Stitching? Needles? Tingling? Pulling? Hot poker?, etc… Desires: food and drink (warm, cold, spicy, bland) Perspiration? What part of the body? Odor? What if anything makes the person feel BETTER? Worse? Time of day, position, warm or cool applications, binding or wrapping, moving, resting, air temp, inside, outside, drinking, weather, etc…
Mental/Emotional Symptoms Are VERY important to include Especially if different than “usual” Are they: Anxious? Angry? Irritable? Depressed? Dejected? Quiet? Want company? Want to be left alone?
Always try and include at least one or more good mental/emotional sx in repertorization of a case
Repertorization: Repertorize mainly the Characteristic Sx. (§ 153) “Common” symptoms are NOT very helpful and actually can confuse this process Fatigue during illness; loss of appetite while ill; sore throat without other qualifying symptoms; body aches during a flu; pain with motion if there is a fracture, etc … You CAN use these symptoms, but you must obtain specific information relative to them …. If you can’t solicit enough characteristic symptoms, WAIT until a clearer picture emerges
TRUE OR FALSE You have repertorized your case. You can now choose the remedy that comes up highest (#1) in the repertorization?
You are NOT done yet! Now you must study the top several remedies that came up during repetorization You never ever select a remedy just because it shows up first when you repertorize! You must narrow the case down to a handful of remedies and STUDY them well in the materia medicas until one “clicks.” Look for the “keynotes” or “leaders” of the remedies and match these to the sx you are trying to cure
Back to that first case… Your 10 daughter yo wakes up and isn’t feeling well. It’s close to midnight. She looks ill and is clearly not her usual self. She comes in wrapped up in a blanket; she says her throat and stomach hurt; she feels like she is going to throw up. She begs you to let her come into your bed because she doesn’t want to be by herself. You ask her why and she says because she feels so bad. She wants to be with you in your bed.
Observations and events: She is pale She is quite upset and anxious (not usual for her) She cannot get comfortable in the bed and keeps stirring, tossing and turning. At one point she wants to go back to her room. She comes back to your room a few minutes later She is wrapped up in blankets and says she still feels cold, yet she feels warm to touch and has a temperature (101.5) She wants to wear her pajamas, robe and still be covered in multiple blankets She asks for something to drink. You get her some water and she drink some. A few minutes later, she drinks more. She does that on and off all night. She says her throat is burning. She stirs most of the night and finally falls asleep around 4 am In the morning, you fix her give her some warm cereal and toast. She eats a little, not much…a few minutes later, she runs and throws up; is tearful and very distressed. She said she had diarrhea, too…was vomiting and had diarrhea at the same time….poor kid!
Remember to think about: Timing of sx Thirst Concomitant sx Mentals (mood and other mentals) What makes sx better or worse Observations Temperature preferences of the person
Anxious Restlessness after midnight… Vomiting after eating (how soon after eating or drinking?) Throat BURNING Thirsty for small sips, often Vomiting AND diarrhea Cold, feeling internally: Strong sx. Desires warmth, feels cold despite having multiple blankets Aggravation around and after midnight (till 4am it says)
Arsenicum: From Nash Leaders Very great anguish and restlessness; cannot rest anywhere, moves from place to place; wants to go from one bed to another; fear of death, of being left alone, great restlessness and utter prostration. Burning in mouth, pharynx and esophagus; drinks often but little at a time. Unquenchable thirst; drinks often, but little at a time; the water disagrees. Vomiting and stool simultaneous. Vomiting immediately after eating or drinking.
Nash’s Testimony: Arsenicum 1. Great anguish and restlessness, driving from place to place. Fear of death, of being left alone, great restlessness and utter prostration. Very great anguish and restlessness; cannot rest anywhere, moves from place to place; wants to go from one bed to another. (Nash:Leaders) 2. Great prostration (sometimes sudden), sinking of vital forces. 3. Intense burning sensations. 4. Intense thirst, drinks often but little at a time; cold water disagrees. 5. Vomiting and stool simultaneously, worse after eating or drinking. 6. Modalities, worse in cold air, from cold things, cold applications and 1 to three AM. Better in warm air or room and hot applications to affected parts.
Sulphur: So Many Symptoms! Lippe materia medica Mind And Disposition Peevishness; irritability; restless, quick temperament. Melancholy, with great inclination to philosophical and religious speculations; with anxiety about the salvation of one's soul, and great indifference to the welfare of others. Hypochondriac mood (through the day, in the evening he is inclined to be merry). Dullness: difficulty of thinking; misplaces, or cannot find the proper words when he speaks. Fantastic illusions. Qualmishness; nausea (in the morning). Vomiting: first of water, later or solid food, or sour; of the ingesta, sour or bitter, with cold perspirations in the face, or of blood. The region of the stomach becomes very painful when pressing upon it, - even the bed - cover causes pain. Burning in the stomach. Spasms in the stomach immediately after a meal.
Sulphur: Sleep sx. Totally disinclined to rise from bed in morning, nor refreshed by sleep. Sudden jerking of limbs when going to sleep. Child kicks clothes off at night. Yawning and sleepiness during day. Dropsy in afternoon and after sunset, wakeful at night. Irresistible drowsiness in daytime, wakefulness at night. Sleepiness in evening, but night is full of unrest, tossing, nervous excitement, orgasm of blood, pains of various kinds and but little sleep throughout night. Difficult falling asleep: on account of great flow of thoughts, with inclination to perspire, with itching on skin. Wakes as with fright from a fearful dram, and after waking was still occupied with anxious thoughts, as of ghosts, from which he could not free himself. Anxious, frightful dreams of dead and dying, speaks, weeps and shouts in her sleep, so as to wake herself, and after waking remains long in a confused state. Much sighing and groaning in sleep. Sleeping with half-open eyes. Frequent turning over in bed without waking. Wakes up at 3, 4 or five AM, and cannot fall asleep again. Screaming out in sleep, lamentation and moaning, talks loudly. Dreams of fire and death. Heavy, unrefreshing sleep. Jerks and twitches during sleep.
Sulphur: Time sx (Hering GS) 3, 4 or five AM: wakes, cannot fall asleep again. Five AM: painless diarrhea, driving out of bed. 6 or seven AM: sweat, after waking. 8 or nine AM: every second day, febrile attacks. 9 or ten AM: febrile attacks, postponing ten to fifteen minutes each day. Ten AM: pain at left eyebrow to superciliary ridge, feeling of hunger, faintish feeling. Between 10 and 11 AM: gone feeling. 11 AM: weak, empty, gone or faint feeling in stomach, hungry and faint, in pregnancy.
Sulphur: Temp: Heat usually agg Wants doors and windows open. ~ Asthma. ~ Pneumonia. Susceptibility to temperature, warm things feel hot. ~ Warm room: rush of blood to head better, dejection worse, headache worse, eyes dry.. Wishes to be fanned: during labor. Warm bed: itching in chilblains worse. Is obliged to uncover feet. Feather covering: worse pains in limbs. Warm applications, pulse becomes rapid. Burning everywhere, general and local, especially feet; has to stick them out of bed to cool them.
Phosphorus Anxious and fearful before and during a thunderstorm Fear of being left alone Anxious, universal restlessness, can't stand or sit still, worse in the dark or when left alone and before a thunder storm. Burning prominent in every part, as in mouth, stomach, small intestines, anus, between scapulae; intense running up spine, palms of hands Craving for cold things, ice cream, which agrees, or cold water, which is thrown up when it gets warm in the stomach.
Phosphorous: cont’ Aggravation. Evening, before midnight (Puls., Rhus); during a thunder - storm; weather changes, either hot or cold Cold air relieves the head and face symptoms but aggravates those of chest, throat and neck. Before midnight: restless. Twilight: anxious, sees more distinctly Evening: fear and dread, as if horrible faces were looking out of every corner, in bed, scraping in pharynx worse, stitching pain in stomach worse, pains and vomiting towards, chilliness Most symptoms appear in the morning and evening, while in bed, as well as after eating.
Can you begin to FEEL one remedy emerging from the pack??? If not, that’s ok….keep on reading the various remedies and several different authors….Lippe, Nash, Allen, Clarke Kent, Boericke, Phatak, etc.. Become very familiar with the “polycrests” Compare and Contrast them! How are they alike; how are they dissimilar… Get to know them like intimately: They are polycrests for a reason! Nash: Leaders in Homeopathic Therapeutics is excellent: It is written in prose by remedy…not alphabetically. They are written in their own order for a reason. While you are reading one remedy, he is contrasting and comparing many other remedies at the same time… This comparison and contrast is very useful in learning