Chapter 4: Clinical Homoeopathy
Chapter 4
Clinical Homoeopathy
Abstract: Patient’s care is the main focus of health care of community. Since 200 years ago,
homeopathy system started to treat patients in individualized manner by adapting a holistic
concept of matching patient symptoms with corresponding symptoms pictures caused by a
remedy when given to a normal person in large doses. For a good homeopathic prescription a
great deal of information is essential which is not needed in ordinary medicine. The homeopath
must know his patient, spiritually, emotionally, mentally, physically and sociologically. He must
give as much time as he needs to acquire this knowledge. In homeopathy, Case taking is half of
the cure. In this chapter; guideline for the processes the homeopaths should follow during case
taking, type of questions that should be asked to the patients, screening the diagnostic symptoms
and studying the modalities that influences the context of homoeopathic treatment and assist in
the individualization of the treatment of different patients. In addition, the guideline for selection
of the remedy, potency and follow up scheme is outlined.
4.1. Introduction
The direct patient care needs therapeutic relationship, clinical skill, clinical strategy and
service provision. Clinical strategy is the way we deploy the present clinical skills on behalf of
individuals or communities. This includes the use of time, the way the skill is directed towards
certain people according to their type of need, the skill we choose to develop etc. Service
provision in turn involves the way practitioners make themselves available and accessible to
patients.
The science of medicine applies to clinical and diagnostic method, including
symptomatology, pathology, epidemiology, molecular biology, genetics and all the other
sciences that complete the whole matrix of disciplines concerned to elucidate the nature, etiology
and evolution of illness .It applies to therapeutic method, including prevention, rehabilitation and
palliative care. And of course involves the research methodology by which investigation takes
place and develops the other activities; and all of these involve the practitioner in the study of
natural history and complex dynamics of illness and of the healing process.
The philosophy, sociology and anthropology of medicine involve practitioners in the
distinction and relationship between sickness, illness and disease. From here and on the same
bases the relationship between treatment & therapy, healing and holism appears. The reason for
mapping out these various dimensions and elements of medicine is to emphasize that
homeopathy is implicated in all of them.
As mentioned before, homeopathy is one of the “alternative” methods in treating many
diseases and ailments. It’s also believed that If homeopathy has no remedy for some disease, no
one has it. On the contrary, anything that can be cured by the classical allopathic treatment can
be also cured homeopathically, if the rules of classical homeopathy are properly followed, and
the substantial advantages of homeopathy are then maintained, those of non use of chemical
drugs, almost imperceptible amount of remedy, spontaneous cure within the laws of nature, and
the consequential preventative effect. In addition to this, homeopathy cures even the diseases,
which the classical medicine declares as incurable and which it names “chronic diseases”.
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Guideline for the processes the homeopaths should follow during the individualized patient
examination, screening the diagnostic symptoms, studying the modalities and selection of
remedy and potency will be outlined.
4.1. Case histories and case taking
In order to achieve the best results while dealing with the patient a homeopath is advised
to follow certain characteristics as an approach to closer understanding and to increase the link
between him and the patient.
The following quotes are suggested for the homoeopath:
1. Attitude
1.Start with a clear mind and be polite.
2.Let the patient know you are concerned for their health and that homeopathy will
bring fundamental constitutional improvement (immune system strength) to them.
3.It is of utmost importance that the interviewer be interested and concerned with the
welfare of the patient.
4.There should be no implication of judgment by the homeopath. Advice should not
be offered and moral injunctions should be avoided.
5.Restrain your conversation. Let them tell their case their way without interruption.
6.In allopathic studies doctors r told not to believe the patient, ask as few questions as
possible and believe only what they see. The homeopath must do his best to create an
atmosphere of confidence and benevolence and try to comprehend the human being who
comes to be helped.
2. Interrogation
1. Extensive description of the precise kind of information needed in homeopathy and
particularly the use of homeopathic questionnaires should be avoided. This makes the
patient focus on insignificant details.
2. Ask what brings you to see a homoeopath, or Tell me what is that troubles you, and
then be silent.
3. When they have finished, ask “What else?” Keep the talkative patient on track with
small comments and the quiet patient talking with questions like “Anything else
about…?”
4. Elicit the more delicate symptoms by commenting about the beneficial way that
remedies affect the entire person and the importance of knowing the whole patient
5. After the patient’s story go back to each item and get the details that didn’t tell you
such as the modalities. Question them about any they have left out.
6. Refer to Schmidt’s wonderful questionnaire after the patient’s story.
7. Don’t ask yes-or-no questions. (“Are you thirsty?”)
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8. Don’t suggest an answer (“You don’t stand the cold very well, do you?”)
9. Don’t confirm a remedy that has come to mind with questions. Schmidt calls this the torpedo
method or torpillage. (“Are you generally worse between 4 and 8 p.m.?)
10. Don’t ask the patient to choose between two alternatives. Let them find their own choice.
(Do you prefer dry or wet weather?)
11. When questioning about one symptom, finish it before moving to another one. Skipping
around confuses the patient and scatters your ideas.
12. If a question brings no answer let it alone, for he does not know or has not noticed. Questions
giving a choice of answers are defective.
13. When asking what illnesses the patient has had and how he recovered, pay attention to
whether they fully recovered or they say “hasn’t been well since.”
14. Keep an outline of questions handy until you know it.
15. Go after the more delicate symptoms of mental and emotional states at the end after you have
been with the patient for awhile to gain confidence and better details.
16. If you have the ability to get a close family member’s or friend’s information about the
patient without making the patient nervous then you may learn more.
17. Verify symptoms with cross-questions when you don’t think the patient well understood or
well answered the question. (He feels worse after meals... Ask “If you have an important matter
to decide, or a delicate letter to write, or some important call to make, would you do it at 2
p.m.?)
18. Accept no diagnostic suggestions or pathological theories or former opinion of other
physicians as these are deceptive guides for the selection of a drug.
3. Observation
1. Observe closely:
 The personality of the patient.
 His apparent state of mind both in himself and in relation to the doctor (whether depressed,
shy, suspicious, secretive, afraid, ashamed etc.).
 His apparent physical status (signs of disease in gait, complexion, difficulty in breathing, etc.).
 Traits of character as shown in dress, cleanliness, neatness, pride, etc.
2. The chief signs are those symptoms that are most constant, most striking, and most annoying
to the patient. The physician marks them down as the strongest, the principal features of the
picture. The most singular, most uncommon signs furnish the characteristic, the distinctive, the
peculiar features.
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3. Gathering concomitants that all point to the simillimum will create a true characteristic,
otherwise just ignore them. An affected organ may only be able to show concomitants which
then becomes the only guide for selection of a remedy.
4. Most subjective symptoms are so indefinite or so common that they have little importance. If
it occurs in an unusual place, that’s important.
5. A reply without a change in expression regarding likes and dislikes doesn’t really indicate a
symptom.
6. Notice any alternation of symptom groups, such as bronchial symptoms, skin manifestations,
gastric, and rheumatic complaints. Also seasonal and periodical variations.
7. Listening actively means using your imagination and sensitivity to live the experience of the
patient. This pondering of what makes the symptom in the patient will allow you to ask
questions that further reveal the symptom.
4. Recording
1. We cannot depend upon our memory in taking the case, and getting the case properly before
us for analysis. The picture must be preserved in indelible form so that you can review it without
leaving out any important symptom.
2. Always get the patient’s age, occupation, marital status, hair color, eye color, complexion, any
peculiarity of the patient as to form, appearance, size, etc.
3. Get relatives death causes, consumption, asthma, cancer, tumors, scrofula, hives, erysipelas,
skin diseases of any kind, or any other chronic complaint, or any peculiarity of either side of the
family.
4. Record all the important points in the words of the patient, both in what the patient says and in
what he himself observes.
5. Put the symptoms in a column at the left of his paper, leaving at least an inch blank between
the items to be subsequently filled in as the patient reverts to that subject or later, when the
physician questions about it. He may prefer to put facts pertaining to history on one sheet or in
one column, those pertaining to actual physical symptoms in another, and mentals in a third, but
this requires experience and adeptness. It is safer for the beginner to list them all as they come
and sort them later in the working out of the case.
6. Arrange your record of symptoms into three columns. The first one contains the dates and
prescriptions. The second contains the distinct symptoms as headings and the third are the
modalities. Otherwise, it’s defective.
7. Put a mark by or underline the symptom that you need to go back and ask about later to get
more details or verify.
8. Use underlining to prioritize the symptom’s clarity, intensity and spontaneity in the following
manner:
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No underlining: Symptoms are hazy, not given spontaneously, and not perceived as very intense
by the patient.
One underline: Symptoms of greater clarity and greater intensity, yet still elicited only upon
questioning.
Two underlines: Symptoms of great clarity, moderate intensity, and volunteered spontaneously.
Three underlines: symptoms with the highest clarity, great intensity, and given entirely
spontaneously by the patient.
9. You should have a bound book. Use the left hand page for recording symptoms and the righthand page for the modalities.
10. Discount symptoms to be expected from the pathology present. Thus anxiety in heart
disease, paræsthesia in anemia, œdema in nephritis, hunger in thyroid and gastric ulcer, and
depression in constipation.
11. If you are dealing with an acute condition, don’t dip into the chronic symptoms that have
been present at other times. The chronic will retreat in an acute explosion and at the end of the
acute attack, the chronic will return instead of what people think the aftermath of the acute
symptoms.
12. Note results of previous diet, local and physical treatment, for often the true symptomatology
is obscured by previous treatment and a period of observation is desirable before homeopathic
treatment is instigated.
5. Time management
1. End the appointment after the patient’s story and continue in another session if necessary
unless they are in acute pain or distress.
2. A medical history, physical, and lab tests should be done at the end of the questioning.
3.The maximum number of chronic cases that you can do in a single day is hardly two or three.
4.4.a.Taking the case
A case well taken is half cured, (Garth Boericke). For a good homeopathic prescription a
great deal of information is essential which is not needed in ordinary medicine. The homeopath
must know his patient, spiritually, emotionally, mentally, physically and sociologically. He must
give as much time as he needs to acquire this knowledge. He must not prescribe anything but
placebo, in a chronic case, until he has it. In an acute case he must know these same factors in so
far as they affect the acute condition. The following points show an ideal example of the
interviewing procedure;
1. The physician must be receptive, like a photographic plate ready to receive the image of the
patient. He must clear his mind of other preoccupations and of previous opinions about the
patient. He must be tranquil, cordial, and after the first greeting and question what brings you to
see me? or Tell me what is that troubles you, he must be silent.
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2. The physician must allow the patient to tell his own story in his own way. Questions or
interruptions of any sort detail the patient at this stage, and may cause the doctor to lose essential
information.
3. The physician must observe from the moment the patient enters. The office should be so
arranged that the light falls on the patient. The main points to be noted are:
4. The personality of the patient.
5. His apparent state of mind both in himself and in relation to the doctor (whether depressed,
shy, suspicious, secretive, afraid, ashamed etc.).
6. His apparent physical status (signs of disease in gait, complexion, difficulty in breathing,
etc.).
7. Traits of character as shown in dress, cleanliness, neatness, pride, etc.
8. The physician must record every item which seems to him important, in the words of the
patient, both in what the patient says and in what he himself observes, in a column at the left of
his paper, leaving at least an inch blank between the items to be subsequently filled in as the
patient reverts to that subject or later, when the physician questions about it. He may prefer to
put facts pertaining to history on one sheet or in one column, those pertaining to actual physical
symptoms in another, and mentals in a third, but this requires experience and adeptness. It is
safer for the beginner to list them all as they come and sort them later in the working out of the
case.
9. When the patient has come to a full stop the physician may say, What else? and by waiting
elicit much more and often much more valuable information. If the patient is reticent or gives
only brief and objective data, and the physician is unable to persuade him to give more, this
passive method may have to be abandoned in favor of active questioning. The object is to drain
the patient dry of what he knows of himself. If the patient is loquacious, time may necessitate the
prevention of irrelevancies and the utmost tact is needed to keep him on the main track and yet
not loose important side lights.
10. When the patient is through with his story a few remarks by the physician may be in order as
to the aid that can be given though our remedies and the necessity for special knowledge of the
patient as a whole and many details ordinarily overlooked. This pleases the patient and insures
cooperation in answering the often rather intimate questions which must follow.
11. The data needed for an ordinary medical history may hardly have been touched on up to this
point and should not be inquired into even yet. If by this time the consultation period is over, if
the patient is not in acute pain or distress, or has not come from a long distance, a subsequent
appointment should be made for the next day if possible, and the patient should be definitely told
that the physician must do a complete physical examination and the necessary routine laboratory
tests at the next visit. Instructions for bringing a 24 hour urine specimen should then be given.
This makes the patient realize that in addition to the interest to all details of the case the
physician is going to be thoroughly scientific.
12. The physician should now take up each item that he has noted on paper and get the patient to
tell him more about it. When the patient has exhausted all that he can tell about each item the
physician should bring out the modalities, if, for instance, the item is pain in the stomach and the
patient volunteers that it is burning and has no relation to meals and no radiation, the physician
must find what aggravates or ameliorates it, what time it occurs, its concomitants, its relation to
mental states, if any, etc. When each item has been so modified and filled in, the physician must
run through the list and see which of the possible mentals, generals, particulars, and modalities
have not been mentioned and question the patient about each of these.
13. All questions that the physician asks must be so put that the patient cannot reply with a
simple Yes or No but must think before answering. The physician must be careful never to
suggest an answer by the form of his question and must guard against questioning for the
symptoms of a particular remedy which may have come to his mind. If he has seen a fairly
definite remedy picture in the patient's story and wished to clinch it he must take special care not
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to lead the patient into the answer he desires, and may even suggest the opposite, and watch the
reaction.
14. When the physician has covered the fields outlined above in detail, according to a systematic
out line, which the novice should have before him during the interview and which the master
knows by heart (we append a suggested one), he must make sure that he has questioned the
patient on every system and function, otherwise some important detail will be missed which
might prove a keynote suggesting the study of one or more remedies.
15. The mental symptoms and characteristics of the patient (which, as will be brought out in a
later lecture, are the most important if strongly marked) should usually be elicited last when the
patient's confidence has been more fully gained. Especial tact and insight on the part of the
physician are needed to evaluate the emotional causes of disease, for instance, few patients
would know that ailments from mortification might be the most important symptom in their
cases, or that suppression of sex needs or anger might rank as a leading cause in their illness.
16. At the close of the interview the patient must be made to feel that the physician is deeply
interested in his case, that he will take the hours needed to thoroughly study up) (to repertorize)
the case, and that the special method of homeopathy can bring not only relief but also a
fundamental improvement in the whole constitution which will tend to ward off subsequent
illness and increase the powers and well being of the patient. A thorough physical examination
and the routine laboratory work, or any extra tests suggested by the history, must be done on
every new patient and at least yearly on old patients, and the patients instructed as to why they
should not use other drugs during homoeopathic treatment what the dangers of suppression are,
when they should report back, and what they may expect as the immediate results of the
treatment. One other point may be valuable in knowing the patient and that is to get the version
of the immediate family or close friends. This is sometimes dangerous, as nervous patients hate
to know that they are being talked over, but the wise physician can take much contradictory
evidence and arrive at a more just and sympathetic evaluation of the case. By this time the
physician should have a remarkably accurate picture of the patient in all his phases subjective,
objective, and pathological. From this totality of symptoms he can, by correctly evaluating the
symptoms as we will show in a subsequent lecture, derive a true image of the patient and the
remedy.
Generally a homoeopath should ask things concerning these categories:
 location
 sensation
 modalities
 mentals and other physical generals
 causation
 concomitants and other strange, rare, and peculiar symptoms
 personal history of illnesses
 family history of serious or chronic illness
4.4.b. Case taking outline
It is necessary to track down and analyses the patients’ information carefully as
previously suggested. The following points show the stress points on which the homeopath
depends on finding the key symptoms and analyzing the case.
1. The patient's story; where the patient talks until he/she runs out of things to say.
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2. Modalities; Apply the following to each of the symptoms gathered so far in the following
order:




Causes
Prodrome, onset, pace, sequence, duration
Character, location, laterality, extension and radiation of pain or sensations
Concomitants and alternations
3. Aggravation or amelioration
 Time (hour, day, night, before or after midnight); periodicity; season; moon phases
 Temperature and weather: Chilly or warm blooded usually, chilly or warm blooded in
present illness; wet dry cold, or hot weather; weather changes; storm or thunderstorm
(before, during or after); hot sun, wind, fog, snow, open air, warm room, changes from one
to other, stuffy or crowded places; drafts, warmth of bed, heat of stove, uncovering
 Bathing (hot, cold or sea), local applications (hot, cold, wet or dry)
 Rest or motion (slow or rapid, ascending or descending, turning in bed, exertion,
walking, on first motion, after moving a while, while moving, after moving), car and seasickness
 Position: Standing, sitting, (knees crossed, rising from sitting), stooping (rising from
stooping), lying (on painful side, back, right or left side, abdomen, head high or low, rising
from lying), leaning head backward, forward, sidewise, closing or opening eyes, any unusual
position such as knee-chest
 External stimuli: Touch, hard or light, pressure, rubbing, constriction (clothing, etc.), jar,
riding, stepping, light, noise, music, conversation, odors
 Eating: In general (before, during, after, hot or cold food or drink), swallowing (solids,
liquids, empty), acids, fats, salt, salty food, starches, sugar and sweets, green vegetables,
milk, eggs, meat, fish, oysters, onions, beer, liquor, wine, coffee, tea, tobacco, drugs
 Thirst, quantity, frequency, hot, cool or iced, sours, bitters, etc.
 Sleep: In general (before, during, on falling asleep , in first sleep, after, on
 Menses (before, during, after, or suppressed)
 Sweat: Hot or cold, foot-sweat, partial or suppressed.
 Other discharges: Bleeding, coryza, diarrhea, vomits, urine, emissions, leucorrhoea, etc.;
suppression of same
 Coition, continence, masturbation, etc.
 Emotions: Anger, grief, mortification, fear, shock, consolation, apprehension of crowds,
anticipation, suppression of same.
4. Strange, rare and peculiar symptoms; these symptoms should be pulled out when possible.
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4.4.c. Screening for the Patients symptoms
Many considerations must be taken in order to maintain the full patient’s symptom
picture. This stage could be counted as the most important stage in the whole case taking process
, since through this stage the symptoms will be analyzed and categorized according to its
importance and according to the previously described symptoms picture.
For an overall symptom picture the doctor will not only ask about the patient chief
complaint , instead , the homeopath will ask for a full picture on all of the patients’ physical ,
mental , psychological , and life style states.
In this section, a Questionnaire is added as an example to the questions that might be
of help to the practitioner, and according to the patients’ case the homeopath may chose to add
or neglect any of those questions .However and as a general guide line ,for the patient
questioning to cover the most important seeked aspects the following points must be taken into
consideration.
 The constitutional type of the patient (endrinologico-homeopathic correspondences, lack
or excess of vital heat, lack of reaction, sensitiveness, etc.)
 Ailments from emotions (see also mental generals); suppressions (emotions; discharges
such as menses, sweat, leucorrhoea, catarrh, diarrhea, etc.; eruptions; diseases such as malaria,
rheumatic fever, exanthemas, syphilis, gonorrhea, etc.; of pathology such as hemorrhoids,
fistulae, ulcers, tonsils, tumors, other surgical conditions, etc.); form exposure to cold, wet, hot
sun, etc.; from mechanical conditions such as overeating, injury, etc.
 Menses, date of establishment, regularity (early or late), duration, color, consistency,
odor, amount, clots, membrane, pain (modalities of), concomitants, aggravation or
amelioration before, during, or after, both physically and mentally, menopause (symptoms of)
 Other discharges (see above) cause, color, consistency, odor, acrid or bland, symptoms
from suppression of, symptoms alternating with, hot or cold, partial discharges as of sweat,
laterality, better or worse from discharges (before, during, or after)
 Sleep, better or worse from, position in, aggravation after, difficulty in getting to sleep,
waking frequently or early, at what hour, somnambulism, talking in sleep, dreams (see
Mentals), restless during
 Restlessness, prostration, weakness, trembling, chill, fever, etc.
 Aggravations and ameliorations applying to patient as a whole as above.
 Objective symptoms such as redness of orifices, superfluous hair, applying to patient as a
whole
 Pathology which applies to patient as a whole, such as tendency to tumors, wens, cysts,
polyps, warts, moles, individual and family tendency to certain diseases or weaknesses of
specific organs or tissues (also related to a. above and to physical examination), frequency of
catching cold
 Will: Loves, hates, and emotions (suicidal, loathing of life; lasciviousness, revulsion to
sex, sexual perversions; fears; greed, eating, money, emotionality, smoking, drinking, drugs;
dreams; homicidal tendencies, desire or aversion to company, family, friends; jealousy,
suspicion, obstinacy, contrariness, depression, loquacity, weeping, laughing, impatience,
conscientiousness)
 Understanding: Delusions, delirium, hallucinations, mental confusion, loss of time sense
 Intellect: Memory concentration, mistakes in writing and speaking
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4.4.d. Case Taking Questionnaire
General Symptoms
1. At what time in the 24 hours do you feel worst?
2. In which season do you feel less well?
3. How do you stand the cold, hot, dry, and wet weather?
4. How does fog affect you?
5. What do you feel when exposed to the sun?
6. How does change of weather affect you?
7. What about snow?
8. What kind of climate is objectionable to you, and where would you choose to spend your
vacation?
9. How do you feel before, during and after a storm?
10. What are you reactions to north wind, south wind, to the wind in general?
11. What about draughts of air and changes of temperature?
12. What about warmth in general, warmth of the bed, of the room, of the stove?
13. How do you react to extremes of temperature?
14. What difference do you make in your clothing in winter?
15. What about taking colds in winter and in other seasons?
16. How do you keep your window at night?
17. What position do you like best — sitting, standing, lying?
18. How do you feel standing a while, or kneeling in church?
You remark that this question of the standing position comes again. You will find this way of
repeating it is intentional here and there in the questionnaire. It is a very useful and necessary
procedure for verification.
19. What sports do you engage in?
20. What about riding in cars or sailing?
21. How do you feel before, during, and after meals?
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22. What about your appetite, how do you feel if you go without a meal?
It will be often answered to you: “I can easily go without a meal but I never can stand a big
dinner or banquet.” A question that you did not ask, but which demonstrates that the question
was well formulate as it made the patient talk and left him his own choice.
23. What quantity and what do you drink? What about thirst?
24. What are the foods that make you sick, and why?
If the patient does not answer after a while, just ask looking closely at him: sweets, salty things,
sour, greasy food, eggs, meat, pork, bread, butter, vegetables, cabbages, onions, fruits?
25. What about wine, beer, coffee, tea, milk, vinegar?
26. How much do you smoke in a day, and how do you feel after smoking?
27. What are the drugs to which you are very sensitive or which make you sick?
28. What are the vaccinations you have had, and the results from them?
29. What about cold or warm baths, sea baths?
30. How do you feel at the seaside, or on high mountains?
31. How do collars, belts, and tight clothing affect you?
32. How long are your wounds in healing, how long in bleeding?
33. In what circumstances have you felt like fainting?
Mental symptoms
During all these questions, the physician must by kind words, put his patient at ease, but
must watch him very closely, without the patient’s noticing it.
1. What are the greatest griefs that you have gone through in your life?
Quite often the patient will lower the head and look quite moved, and a kind word of the doctor
will be needed. It is why, as soon as the extra-version of self-expression has been made, this
following question will make the patient look at you again in an astonished way, and sometimes
with a happy smile.
2. What are the greatest joys you have had in life?
These two questions are very important and, when asked at the right moment, will pave the way
for the coming questions.
3. At what time in the 24 hours do you feel blue, depressed, sad, and pessimistic?
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4. How do you stand worries?
5. On what occasions do you weep?
If the patient cannot answer, we will just ask — not losing for one second his expression —
music, at reproaches, at which time of the day? Certain people can refrain from weeping, some
others cannot.
6. What effect does consolation have on you?
If the answer is “It depends by whom,” you may say: “Just by people you like,” because very
often people say they do not like to be comforted because they think of members of their family
they hate.
7. On what occasions do you feel despair?
8. In what circumstances have you ever felt jealous?
9. When and on what occasions do you feel frightened or anxious?
If the patient does not answer, ask: “Some people are afraid of the night, of darkness, to be
alone, of robbers, of certain animals, of death, of certain diseases, of ghosts, to lose their reason,
of noises at night, of poverty, of storm, of water.” According to the way of answering, you will
at once see the real fears, and be able to discriminate those which are not to be taken into
consideration.
10. How do you feel in a room full of people, at church, at a lecture?
11. Do you go red or white when you are angry, and how do you feel afterwards?
12. How do you stand waiting?
If he does not answer, just question him about impatience.
13. How rapidly do you walk, eat, talk, write?
14. What have been the complaints or effects following chagrin, grief, disappointed love,
vexation, mortification, indignation, bad news, fright?
15. In time of depression, how do you look at death?
Certain patients have presentiments of death, thoughts of death, ever desire to die; other have
tendencies or desires of suicide, some would be courageous enough to do it, others are afraid, in
spite of desiring it.
16. Tell me about over-consciousness and over-scrupulousness, about trifles; some people do not
care about too many details and too much order.
17. What about your character before, during and after your period?
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Food cravings and aversions
Of course, all these questions have been already asked in the beginning of the
questionnaire, but by asking them again, you are able, by doing some cross-questioning, to
determine if they have been answered well the first time or not.
1. What is the kind of food for which you have a marked craving or aversion, or what are those
that make you sick or you cannot eat?
Here, also, it is very important to watch very carefully the expression of the atient,
because it is very easy to read on the face by observing the corners of the mouth coming down if
the patient is disgusted, or on the contrary coming up with big shining eyes if the craving or a
strong alimentary attraction is felt. Then, one can add, for example:—
2. What about pastry and sweets?
3. What about sour or spiced food?
4. What about rich or greasy food?
5. How much salt to you need for your taste?
6. What about thirst and what do you drink? Coffee wine, soft drinks, etc.
Sleep:
1. In which position do you sleep, and since when that position? Where do you put your arms,
and how do you like to have your head?
2. What are you doing during sleep?
If the patient doesn’t answer, you add: “Some people speak, laugh, shriek, weep, are restless, are
afraid, grind their teeth, have their mouth or their eyes open.”
3. At what time do you wake up, or when are you sleepy? What makes you restless or sleepy?
4. What about dreams?
(For Ladies), Menses:
1. At what age did they begin?
2. How frequently do they come?
3. What about their duration, abundance, color, odor, what about clots, etc.
4. At what time in the 24 hours do they flow most?
5. How do you feel before, during, and after menses?
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Analysis
To analyze the given case after receiving all the required answers, the homeopath
must first note or categorize the given data. After the patient interview the homeopath must then
be able to pinpoint the symptoms and differentiate between them in the following manner :
The chief complaint
The chief complaint has a psychological value out of all proportion to its value in
homeopathic prescribing: it brings the patient to the physician…
The young physician places much dependence upon this part of the case; it is close to his
training along diagnostic lines. The older prescriber, while giving due weight to the chief
symptoms, feels that in prescribing he must consider the totality of the symptoms…
That group of which the patient complains most, almost without exception cannot
be relied upon for the definite selection of the remedy; it is the concomitant group of symptoms
which, taken in conjunction with the major group of symptoms, makes possible the definite
selection of the remedy by greatly reducing the number of remedies indicated in such conditions,
and upon a closer analysis we can pick the simillimum unerringly from this small group.
We might site numerous complaints where the chief complaint would lead us into
a morass of remedies, any one of which might give relief to the patient, but only one of which
would cure.
At times, the chief complaint seems contradictory to the auxiliary group of
symptoms brought out by the physician's questioning… The physician will find many such
alternating symptoms groups, any one of which may be the chief complaint. Only the
thoughtless physician will tell the patient that the present symptom group is the one to be
considered at the present time, and when the other symptom group appears it will be plenty of
time to consider that group.
Generals
The generals are sometimes made up of particulars. After you have gathered the
particulars of every region of the body and you see there are certain symptoms running through
the particulars, those symptoms that run through the particulars have become generals, as well as
particulars.
While we cannot hope to cure a patient without strong general symptoms, yet conditions
of aggravation or amelioration may in themselves become generals, if they appertain in the same
way to several parts of the body; they then become conditions of the man as a whole or general
symptoms, even though they seemingly express themselves in local parts. For instance, if a
headache is < by motion; if the pain in the knee is < by walking or stepping; if there is pain in
the shoulder from raising the arm; then the < from motion becomes a general as of the whole
man, although it seemingly appears in dissociated parts.
The things of which [the patient] says, I feel, are apt to be generals…. When the
patient tells things of his affections, he gives us things that are most general.
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In analysis of the case, the value of symptoms must be taken into consideration
on several points. First, the personality of the patient, the individuality of the patient, must stand
out pre-eminently in the picture.
The menstrual period gives us a state which we may call general….Her state is, as
a rule, different when she is menstruating.
In ninety-nine cases out of a hundred you can leave out the particulars, for the
particulars are usually contained within the generals. If there be but one remedy that has the
numerous generals, and covers those generals absolutely and clearly and strongly, that will be
the remedy that will cure the case.
The Totality is an ideal not always to be realized. As a matter of fact, in practical
experience it often impossible to complete every symptom, or even a large part of the symptoms.
Not all of the modalities of a case are general in their relation, and are not
necessarily confined to the particular symptoms with which they had first been observed.
Particulars
The patients generally call attention to the commonest things, while it is strange and
peculiar things that guide to a remedy.
When the physician comes to look over the record after an examination to get the image
to classify and arrange it, he will find what is peculiar, and those symptoms that are most
general, and those that are but common. These three grades appear in every complete case, and
in every complete proving of a remedy.
Every case has common symptoms, but peculiar symptoms may be absent and you must
not expect to cure when peculiar symptoms are absent.
It is almost impossible to name all the peculiarities in all the cases that we might find, but
there are certain ones that stand out. First of all, those symptoms that are common and found in
almost all diseases may be left out of our count unless they manifest themselves in a striking
manner. The same may be true of those ailments and symptoms that usually appear in the
disease under consideration, unless they should be distinguished by some rare peculiarity, and in
this way offer something particularly characteristic, like thirstless fever, or chill with desire to
uncover. On the other hand, all the attendant symptoms should be carefully noted:
(a) Those symptoms which rarely appear in connection with the leading disease, and therefore
are found rarely among the provings.
(b) Those which belong to another sphere of disease than the principal ailment.
(c) Those which have more or less characteristic signs of the medicine even though they have
not before been noticed in the present relationship or diagnostic group.
It is necessary to have individualizing characteristics to enable you to classify that which
you have, to perceive the value of symptoms, and, if you must settle down to a few remedies, to
ascertain which of these is more important than another, or most important of all.
The things that characterize are things to make you hesitate, to make you meditate.
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E.g. the common symptoms are those that appear in all cases of measles, that you would
expect to find in measles. It would be strange to have measles without any rash; that would be
peculiar.
The things that are general are the first in importance. After these have been gathered,
you may go on taking up each organ, and ascertaining what is true of each organ. Many times
you will find that the modalities of each organ conform to the generals. Sometimes, however,
there may be modalities of the organs, which are particular that are opposed to the general.
Hence we find in remedies that appear to have in one subject one thing, and in another subject
the very opposite of that thing. In one it will be a general, and in another it will be a particular.
Having chosen a remedy according to generals, there may be a lot of little particulars that
may appear to contra-indicate, but they cannot; for nothing in particulars can contra-indicate
generals. One strong general can over-rule all the particulars you can gather up. Aggravation
from heat will throw out Arsenicum from consideration in any case.
Dr. Herring in his quaint fashion years before the keynote system was ever heard of, said:
Every stool must have at least three legs, if it is to stand alone. He advised selecting at least three
characteristic symptoms as the basis of prescribing.
Example:
A woman complains of a common symptom such as a dragging down feeling in her
bowels in prolapsus. There is nothing about this that will let you find the remedy. A rubric that
has more than a dozen remedies will be a common symptom.
The whole problem must be followed from generals to particulars.
How should we decide to give Sepia when Lil tig., Murex., Bell., Puls., Nux-v. and Natm will fit.
What is in the Sepia patient that no other patient has, The dragging down is just the same,
but with it an awful all-gone sinking feeling in the stomach, and she gets relief only when sitting
with the legs crossed. She has a constant feeling of a lump in the rectum that makes her want to
pass a stool, but she goes for days without any urging at all. She is sallow and sickly, talks of
bilious symptoms and has a yellow saddle over the nose. She has an aversion to children, feels
very sad that she does not love her husband as she ought to, and is unable to exercise the love
she has to her children.
What would a Nux-v patient say about this? She would be chilly, full of coryza, with
stuffing up of the nose in a warm room, she would be very irritable, snappish, want to kill
somebody, want to throw her child in the fire, want to kill her husband, have constipation
probably which with every pain would make her want to go again, little stool is passed and
urging to go frequently.
Diagnostic
In fact, the simillimum is practically never found among the diagnostic symptoms. In
considering the diagnostic symptoms in the selection of the remedy, its only practical value is in
excluding those remedies from consideration, which do not correspond to the genius of the
disease, but act chiefly on other parts of the organism.
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In considering the value of symptoms there are certain symptoms that are apparently
caused by conditions, and that almost precede the symptomatology, and seem to give a basis for
the patient’s condition. These may be exposure to cold; exposure to wet; all those conditions of
which people say that thus and so was the cause of their illness and the cause of their symptoms.
These play a large part in pathological prescribing. In pathological prescribing these causes of
disease loom large; in homeopathic prescribing they do not loom as large, save as showing the
tendencies of the patient.
The purport and the aspect of every motion of the human being must be thoroughly
studied in order to place less and less reliance on diagnostic symptoms as diagnostic symptoms,
and learn more the value of symptoms as symptoms.
A true homeopathic prescription cannot be made on pathology, on morbid anatomy;
because provings have never been pushed in that direction.
Keynotes
The term keynote is merely suggestive as used in this connection, the reference being to
the analogy between materia medica and music. This analogy is shown in the use of other
musical terms in medicine, as when the patient speaks of being out of tune, or the physician
speaks of the tone of the organism. Disease is correctly defined as a loss of harmony in function
and sensation.
The keynote in music is defined as the fundamental note or tone of which the whole
piece is accommodated. In pathology the term pathognomonic symptom expresses what might
be called the keynote of the disease, or that which differentiates it from other diseases of a
similar character
Much has been said of keynote prescribing; many at the present time use a repertory
simply as a means of seeking a key to unlock the case through the peculiar and unusual
symptom. This has certain value, if we are so fortunate as to find the simillimum by some
outstandingly peculiar symptom; but most often this is not enough, and it has little more value
than selecting at random any one remedy from a group known to have a certain symptom in the
provings. We must not fail to recognize the value of the totality of the symptoms; and this must
take into consideration the chief complaints, those of which the patient most often complains,
plus the peculiar characteristics of the patient. If both these elements are present, we may be sure
we are on the right track.
The real keynote system as taught and practiced by the late Dr. Henry N. Guernsey (but
perverted by many) does not conflict with the doctrine of the totality of symptoms, nor does it
fall short of complying with Hahnemann's injunction to pay most attention to the peculiar and
characteristic symptoms of the case. It is, in fact, strictly Hahnemannian. The truth is that Dr.
Guernsey simply invented a new name for the old Hahnemannian idea.
Other
Get the original form of the malady. To do this, at times we have to trace through a mass
of difficulties and conditions to get back to the original form of the trouble…. Very often we can
take up the thread and get back to the remedy that was clearly indicated, even twenty years
before. The patient's disease has not been cured, it has only been changed and modified; but it is
the same patient, and the same sickness and requires the same medicine.
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In analyzing the case, very valuable symptoms are those pertaining to the aggravations
and ameliorations, because the aggravations and ameliorations are the natural modifiers of
diseased states and are the definite reaction of the man himself.
4.5. Case management
Treatment cannot be by medicine alone. Patients receiving homoeopathic treatment
cannot be passive recipients of the remedies. They need to be encouraged to be involved by selfhelp and preventative measures. They must accept that changes in their lifestyle, diet and habits
may need to be made, coupled with sheer will power to regain their health.
Finnally the patient must be able to count in the empathy of the homoeopathic
practitioner. He or she must be caring, sympathetic, patient, tolerant and understanding.Thus, the
natural healing processes within the patients’ body are optimized. Therein lies the key to a
successful and rewarding homoeopathic practice.
This homoeopathic approach is far removed from “instant medicine” –prescribing a few
tablets hastily, in an impersonal, mechanistic manner to suppress the severity of the most
obvious symptom, and sending the patient away to continue the habits or lifestyle which may
have caused the condition in the first place.
‘If during treatment ,especially of chronic disease, the first doses produce a so-called
homoeopathic aggravation, i.e. a noticeable heightening of the disease symptoms originally
observed , then it is a sure sign the doses were too large.’ (Organon, 282).
It follows, therefore, that a higher potency (smaller dose) should then be substituted.
From the Law of similars, whereby similar symptoms of the disease from which the
patient is suffering are induced by the homoeopathic medicine, it follows that a slight worsening
of the symptoms may be a precursor to cure.
Indeed, it is often said that an aggravation is a sign that the homoeopathic remedy is
doing its job .In any case, if an aggravation occurs, it may only be a slight worsening of the
symptoms or transitory, and may not even be noticed by the patient; “A slight homoeopathic
remedy aggravation in the first hours is a good portent that the acute disease will probably be
cured”. (Organon, 158).
If homoeopathic aggravations are marked, or if they persist, it is said that the patient is
proving the remedy’. In this case, as Hahnemann pointed out, it may be that a remedy poorly
matched according to the simillimum, may actually induce new symptoms in the patient, and
dosing should be stopped .
‘An appropriately chosen homoeopathic remedy gently removes the disease without
arousing any new symptoms. It is, nevertheless, usual in the first few hours if the dose is too
large (to low a potency) for it to affect some small aggravation’ (Organon, 161, 247).
Note: this homoeopathic aggravation is quite different from ‘modality aggravation’
(factors which make the symptoms feel worse).
Nevada and Hahnemann
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4.5.a. Studying symptoms
Symptoms can be classified in four different ways:
1. Presenting, prescribing, concomitant.
2. Subjective, objective,
3. Characteristic.
4. Strange, rare and peculiar. Mental and emotional, general, particular, common.
5. A complete symptom.
1. Presenting symptoms
Are those of which the patient complains, and so we are aware of these first.
Sometimes the homoeopath does not give much emphasis to the presenting symptom because it
is only and external manifestation of the inner economy. So the homoeopath must account for
each presenting symptom and must find its position in the total symptom picture. A well-chosen
remedy will deal with the presenting symptoms when it improves health and raises the vitality of
the vital force.
Example:
When you go to the dentist with toothache (presenting symptom), but it may be that the
cause is an abscess.
Pain in the ear (presenting symptom) may arise from inflammation of the mastoid area.
Prescribing symptoms
Characterize the individuality and susceptibility of the patient. These are the most
important symptoms because they enable us to identify the remedy. Remember that each remedy
is unique in the way it affects patients, and we choose the remedy that matches the symptom
picture produced by the patient. Kent describes prescribing symptoms as something that stops us
in our tracks, making us hesitate because it is unusual, or out of the ordinary. it will not amaze us
that a patient has a red face with a high fever, but our curiosity is stimulated if she has a red face
only when she tries to lie down. Such a symptom is valuable to the homoeopath because it is
individual. few remedies have this unusual variation, so it is easier to single out a remedy. all
prescribing symptoms are out of the ordinary and unexpected.
Examples:
Sweating occurs only on the head, or only on uncovered parts.
The cold feet are blue and sweaty.
The pain of the piles continues for at least 2 hours after the stool is passed.
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Concomitant symptoms
Accompany and are associated with other symptoms. Sweating is commonly
associated with fever, but when it occurs with diarrhea or pain it is a concomitant symptom. In a
remedy such as Antimonium Crudem, gastric problems are associated with skin eruptions.
Examples:
Headache accompanied by nausea.
Swelling accompanied by stinging pains.
Numbness of the fingers and toes, accompanied by copious urination.
2. Objective symptoms
Are observable by someone other than the patient. The whole range of tests, diagnostic
procedures, and instrumentation in modern medicine, has been created to discover objective
symptoms. The doctor uses these symptoms to build up a pattern to which disease labels are
applied - these then become common symptoms, of course. In the absence of objective signs, the
doctor is unwilling to apply a label, and so cannot easily tell the patient what is wrong.
Subjective symptoms:
Are felt only by the patient. Subjective symptoms are therefore not verifiable
scientifically. If you feel hot, tiered or thirsty, you will be the only one who can describe this
heat tiredness or thirst. There are no instruments to measure these factors. Of course, the reliance
is on the patient telling the truth about subjective symptoms, and we rely on his or her ability to
describe such symptoms accurately.
One valuable aspect of the subjective symptom to preventive medicine lies in the ability
of the patient to feel ill long before overt pathology develops. On the subjective level the
patient’s vital force may be less disturbed, and thus more easily cured.
The homoeopath is equally at home with both sets of symptoms, and indeed usually puts
greater emphasis on the subjective symptoms because many of these represent the mind of the
patient, which is the most evolved and individual part.
3. Characteristic symptoms
May apply to the patient or the remedy; usually we think of them as forming a remedy’s
distinctive symptom picture.
When ill, each patient produces symptoms which repetitions of previous illnesses. So
illness is not self-contained and omnipotent but is manifest by the individual according to his or
her own pattern of weakness (predisposition). For example, Mrs. X may have nausea and/or
dizziness precede any illness, whether it is a cold, food poisoning, typhoid, etc., and this
characteristic weakness may make her prone to motion sickness and may be prevalent when she
has less sleep than normal. Another example any involve 20 patients who all need the remedy
Nux Vomica. even though they have different illnesses: one may beartritic, another have croup
,another heartburn, one have high blood pressure, yet all are characterized as impulsive, easily
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angered people who all suffer from pressing pain on the vertex of the head after eating rich
foods. The last group of symptoms is characteristic of the remedy Nux Vomica, and there is no
physiology connecting them in the illnesses mentioned. Occurring as a pattern they form the
Materia medica, the symptom picture characteristics of a remedy.
Hierarchy of symptoms:
The hierarchy of symptoms is most fully developed by Kent. The basic premise is that
some symptoms are more important than others. Some symptoms are more expressive symptom
picture of a remedy. Some symptoms indicate a deeper disturbance of the vital force.
4. Strange, rare and peculiar (s, r & p)
These are just what the name suggests, they are rare and uncommon. During the provings
few provers produced s, r & p symptoms: these are only produced when the remedy being
proved is strongly resonant to the prover’s vital force. Thus when s, r, & p symptoms are present
they point to so few remedies, that, when matched with the patient’s total symptom picture, one
of these remedies will have a profound effect. An s, r, & p symptom is therefore of treat value.
S, r & p symptoms may come from any of the other groups except that containing the
common symptoms.
Examples on the mental and emotional level may be:
Laughs at serious things;
Dreams that are prophetic;
Hysteria better after eating;
On the general level, examples might be:
Sleepy in the daytime, sleepless at night;
Faints after a bowel movement;
Sweats only on the left side;
There are many s, r & p symptoms at the particular level.
In the head we might have:
Feels head is made of wood;
Teeth feel too long.
Purple halo around the urine;
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Sensation of a ball rising from the stomach to the throat.
Mental and emotional
These refer to all emotions, to temperaments, to disturbances of the will and
understanding. dreams are included, as are delusions, sleep-walking or talking, fears,
preference for company or solitude, embarrassment, forgetfulness, laziness.
The mental and emotional symptom is put so high in the hierarchy because it represents
the character of the individual, i.e. It labels that which makes us stand out most clearly as
humans and as individuals. it is the most highly evolved part of human society,
distinguishing us from animals, plants and minerals. it represents the most the most complex
part of our organism and, therefore, if deranged shows the deepest disturbance of the vital
force, since such a derangement strikes deeply at our very nature.
All m/e symptoms are subjective but not all subjective symptoms are m/e some
subjective symptoms are on the level of sensation, and it is these that appear first in any
disorder, i.e. The feelings of disease
General symptoms
These refer to the body as a whole, and to metabolic processes such as
digestion, excretion, sweating, sleeping, menstruation. in Kent’s repertory some of these
have their own sections, e.g. Sleep, perspiration. others, such as menstruation, urination
and appetite, are found under the relevant part. Most general symptoms are found in the
section called generalities. (Further below)
A general symptom is indicated when a patient speaks of ‘I….’ (I am tired, I am cold, I
am feeling faint, I am nauseous) rather than the parts (my stomach is nauseous, my arm
is tired of writing, my feet are cold.)
General symptoms include most exciting and maintaining causes, which are the trigger
factors that disturb the vital force and weaken it so that illness may follow. Colds, sore ears and
sore throats are often caused by exposure to cold weather, so the general symptom is worse in
cold weather.
Particular symptoms
These refer to separate parts of body, such as the hands, feet heart, eyes.
If the symptom of a part is well defined, with qualities of time, location, sensation and
modality, it gains in importance within the hierarchy or, if it is s, r, & p, it may even go
right to the top of the list. usually, however, the particular symptoms are of less importance
because they do not reflect the whole of the organism, and by their physiological nature they
are restricted in the degree to which they can represent individuality.
Some particular symptoms are more important than others because they may show
greater disturbance of the organization of the whole organism.When the vital force throws, any
disturbance as far from the center as possible, this may result in a wart on the finger, which is
relatively unimportant although an indication of disorder.
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Many presenting symptoms are particular symptoms, because we are not taught in our
culture to see the body as a whole but as physical and divided into separate units.
Examples:
A callus on the left index finger;
Excess sugar in the urine;
Dry brittle hair that splits easily;
Vomit of glary grey mucus;
Varicose veins since last pregnancy,
Common symptoms
These are associated with disease patterns and are used by the allopath to diagnose
‘diseases’ such as the common cold, diabetes, acne, duodenal ulcer, measles and schizophrenia.
If you have a runny nose with a cold there is nothing for the homoeopath to prescribe
on if there is green mucus coming out of your left nostril only in the morning, there are three
bits of individuality; greenness, left sidedness and worsening e morning. Now the homoeopath
has a case, and information to match to the symptom picture of a remedy.
Examples:
Pain down the left arm in a heart attack;
Burning pain in the epigastric area with a gastric ulcer;
Opisthotonos with an increase of cerebrospinal fluid, as
In meningitis;
5. A complete symptom:
When the patient tells of a symptom usually only a fraction of the information is
conveyed. Mr. X may complain of a sore elbow, but this is a particular symptom and its does
not have enough individuality to be of value as prescribing symptom, although there may be
more information that would increase its value. Through further questioning each symptom can
be explored further to complete the symptom. Questioning may find out more about the
following;
(a)
(b)
(c)
(d)
(e)
time
location
sensation
modality
intensity
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(a) Time:
The time when the symptom first arose may tell us more about the weak spots or
predispositions of the vital force, and may be most valuable as an indicator of that to which it is
resonant. The time is the point at which the symptom started or was caused. Usually this is the
exciting cause, the trigger to which this particular vital force reacts or is resonant. it may be that
there is a maintaining cause, an ongoing exposure to detrimental environmental factors. Usually
there is a build-up, so the maintaining causes are less obviously related to time.
(b)Location
The location of each symptom gives an idea of the accuracy and precision necessary in
homoeopathic prescribing. if the patient has a headache ,for example, identify where is the pain,
above the right eye, or the left …etc.
(c) Sensation
The sensation of a symptom is subjective. it may cover such strange, rare and peculiar
symptoms as that of a worm crawling up the throat, of blood boiling in the veins, or a pain
that feels like red hot needles.
The most common sensation experienced with a symptom is pain.
(d) Modality
The modality of a symptom is what makes it better (>) or what makes it worse (<)
sadly, many people today simply banish pain with an aspirin, without looking to see what is
indicated by the pain or without trying some of the simple old remedies, such as hot or cold
compresses. Sometimes the best remedy is to remove themselves from a stuffy atmosphere, or
to refrain from coffee, chocolate or whatever. What makes the symptom better or worse can
help differentiate a remedy, or may give rise to s, r & p symptoms.
When more than one symptom has the same modality, that modality, becomes a general
symptom. It may still remain a modality, but we must ask if this is not a cause rather than
merely a worse form i.e. whether it’s a weakness of the vital force, a trigger factor or
exciting cause ; if the modality is really causative it goes under the time section.
(e) Intensity
Often there is a group of symptoms - sore throat, sore head, distended abdomen,
swollen cervical glands and weepiness. There may be six, 12, or even 20 remedies that fit all
these symptoms. But it may be that only one of these has cervical glands most pronounced.
Another three remedies may have the headache most pronounced, and yet another may, have the
abdominal distension most pronounced.
The intensity of a symptom, especially when it is pain, may cause us to give that
symptom prior consideration in another way. some particular symptoms may indicate a
medical emergency, such as appendicitis or meningitis, and these should be dealt with
promptly to maintain life.
(f) Grades of symptom in the repertory
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In most repertories there are three grades of symptom, represented by three different
typefaces. These grades are devised from the provings, of the remedies.
When a remedy is written in bold black type it means that the symptom was present
in almost all the provers after they had taken the remedy. This same symptom is therefore
highly marked and most characteristic in the symptom picture of a patient who needs that
remedy.
Italic type is used when a large group of provers produced that symptom and it is known
from clinical experience that the remedy has cured that symptom.
Ordinary type refers to a low occurrence of that symptom when the remedy was proved.
Further provings or clinical experience may upgrade the symptom otherwise it may not be
significant at all in the symptom picture of the remedy.
4.5.b. Studying Modalities
A modality is defined as a mode or influence that involves affirmation of possibility.
Modalities are influences that qualify or modify the significant symptoms experienced by the
patient. These modifying influences in the context of homoeopathic treatment assist in the
individualization of the treatment of different patients. In other words, a modality is a factor,
which worsens or improves the symptoms of a disease, as perceived by the patient. Note that a
modality is not a symptom in itself, but an individual qualification, describing the modification
of a symptom or the patient as a whole towards a worse or better condition.
A modality can influence the choice between two or more remedies, which are strongly
indicated on the grounds of the symptom picture and constitutional factors. They are therefore,
of great practical importance to the homoeopathic practitioner. A firm modality specific to one
of a short list of remedies will point to that remedy to be prescribed.
Modalities may be experienced by the patient as an improvement or worsening of his or
her symptom or the patient as a whole towards a worse or better condition. Worsening of his or
her symptoms is known as an aggravation, it’s denoted by the sign >. Improvement, that is
symptoms are better or less serve, is known as an amelioration. It is denoted by the sign <.
Hahnemann wrote: ‘a physician should look for the more striking, singular, uncommon
and peculiar characteristics, signs and symptoms of the case of disease’. Modalities are among
these singular and characteristic signs and are often a valuable guide to the choice of a remedy as
general symptoms may be too universal. It should be noted that a modality aggravation is
different from the homeopathic aggravation. In the latter case, this slight worsening of the
symptoms is brought about by the administration of the homoeopathic remedy prescribed
according to the Law of Similar which induces similar, but stronger symptoms in the patient
(artificial disease). As such, the homoeopathic aggravation is more fundamental than modality
aggravation.
4.5.b.i. Classification of modalities
These may be classified in terms of the causative nature of aggravations or ameliorations.
Thus, some modalities are a general worsening or improvement of symptoms, whilst others only
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affect a single part or function. In the former case the patient feels better in himself or a greater
of well being.
A. Physical modalities
E.g. Touch, exertion, rest, exercise, movement, position of body, pressure. Many
remedies are indicated by physical modalities. These are mainly noted according to the
following;
a)
b)
c)
d)
e)
f)
affected
g)
h)
i)
Touch (of Pressure)
Rest
Movement
Sitting
Physical Exertion
Lying Down (lying on the left & right sides, lying on stomach, lying on an
side or part, lying on back )
Ascending Stairs
Breathing
Bending forward
B. Temperature (climatical) modalities
Modalities of temperature, climate and weather are probably most important in
considering the correct remedy. The patient is usually quite firm in response. These are mainly
noted according to the following;
a) Heat & Warmth
b) Cold
c) Climate (Cold Weather, Cold Weather with Cold Wind, Warm Weather, Dry Weather,
Stormy Weather,)
C. Time Modalities
Day or night, morning or afternoon or evening when symptoms are at the peak or through
of their activity. Times are approximately for hourly modalities, but they serve as a useful guide.
Most time modalities are aggravations. These are mainly noted according to the following;
a) Hourly Modalities
b) Morning
c) Afternoon
D. Dietary Modalities
E. Localized Modalities
Localized Modalities predominantly affect a particular part of the body and may be leftsided or tight-sided. Also of importance is movement of symptoms from one part of the body to
another, thus, symptoms may start on the right side and spread to the left side or vice versa,
whilst others may move in all directions. Movement can be very pronounced. The identification
of a left-sided remedy or a right-sided remedy can be very significant in prescribing and must
always be borne in mind.
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F. Miscellaneous Modalities
Some modalities are quite unique and defy classification. Obviously, they are therefore,
important. Some are listed below:
1.Worse for music
a. Acidum Phos.
b. Nat. Carb.
c. Phosphorus
d. Nux Vom.
e. Sepia
f. Thuja
2.Worse for sexual intercouse
a. Acidum Phos.
b. Lycopodium
c. Nux Vom.
d. Silicea
e. Staphisagria
3.Worse for noise
a. Nat. Mur.
b. Coffee
(pain in limbs)
c. Mag. Carb.
(deafness)
d. Phoshorus
(headache)
e. Ignatia
(headache)
f. Silicea
(headache)
g. Acidum Nit.
(headache)
h. Tabacam
(headache)
i. Kali Carb.
j. Aconite
k. Ipecac.
l. Zincum Met.
m. Belladonna
4.Worse in darkness
a. Causticum
b. Phosphorus
c. Rhus Tox.
d. Stramonium (mental problems)
5.Better in darkness
a. Cicuta
b. Hepar Sulph.
c. Nux Vom.
d. Nat. Carb.
e. Sepia
f. China
g. Euphrasia (eyes)
h. Merc. Sol.
i. Chelidonium (headache)
j. Sulphur (headache)
6.Worse in fasting
a. Calc. Carb
b. Crocus
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c. Iodium
d. Kali. Carb
e. Cocculus (stomach pain)
f. Ignatia (stomach pain)
g. Bromium
7.Better for fasting
a. Nux Vom.
b. Nat. Mur.
8.Better for passing wind
a. Nux Vom.
b. Colocynthis
c. Carbo Veg.
9.Worse for hiccough
Bryonia (headache)
10. Worse for laughting
a. Phosphorus
b. Plumbum Met.
c. Carbo Veg. (cough)
d. Psorinum (pain in liver)
11. Worse for rubbing
Psorinum
12. Better for rubbing
a. Hypericum (arms)
b. Phytolacca (hip pain)
c. Rhus Tox. (sciatica)
13. Worse for sneezing
a. Arnica (backache)
b. Sulphur (backache)
14. Better for sneezing
Naja (asthma)
15. Worse for urination
a. Cantharis
b. Nux Vom.
c. Gelsemium (headache)
4.6. Repertorising ;
A repertory is an index of symptoms, where symptoms are listed alphabetically and for
each symptom that indicated remedies are listed. New reference to the Do tend to advise that of
each section gives general groups of remedies, or rubrics. Those symptoms most prominent or
remedies most strongly indicated are given in bold type. The next most strongly indicated
remedies are given in Italics, and the lease syndicated is given and playing type of text.
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The Kent repertory which is a truly exclusive work, and the most used repertory, is
divided into 30 sections in the following order:
1. Vertigo
2. Head
3.eye
4. Vision
6. Nose
7. Face
8. Mouth
9. teeth
11. Stomach
12. Abdomen
13.rectum
14. Stool
16. Male genital
17. Female genital
18. Larynx
19. Trachea 20. Respiration
21. Cough
22. Expectoration
23. Chest
26. Sleep
27. Chill
30. Skin
31. Generalist
28. Fever
24. Back
5. Ear
10. Throat
15. Urinary organs
25. Extremities
29. Perspiration
Kent advised that, in every case, one should proceed from generals to particulars.
Generals, in this classification include things which modify all parts of the organism, the more
these states relate internally to the whole person, the more general they are.
For example, thirst, chilliness, menstruation. Particulars, relate to a specific organ, gland
or tissues. Unexplained symptoms are termed peculiar.
4.6.a. Repertorizing styles
1.
2.
3.
4.
5.
6.
7.
8.
Armchair
Lily pad
Keynote
Artistic method (Kent)
Doctrine of Signatures
Scientific
Eliminative
Constitutional 1. Armchair prescribers
Based on wanting to satisfy the urge to solve a problem that you know you have the
answer to. Remedy prescribed on the first thing that reminds you of any remedy you've ever
heard of or currently are studying.
Best defense: Remind yourself that you are fallible and are dealing with another person's
valuable life.
Kent’s comment on armchair prescribers
It is a fatal error for the physician to go to the bedside of a patient with the feeling in his
mind that he has had cases similar to this one, and thinking thus: In the last case I had I gave so
and so, therefore I will give it to this one. The physician must get such things entirely out of his
mind.
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2. Lily pad
It’s based on ability to remember Materia Medica and the belief that this will guide to the
correct remedy. Usually starts out listening to patient until a remedy comes to mind and then the
line of questioning shifts from listening dispassionately to comparative Materia Medica.
When enough symptoms have confirmed the remedy in the prescriber's mind, they stop.
If symptoms don't confirm then they head to the repertory for more possibilities or bounce
around in the Materia Medica for more choices. When that doesn't work or books aren't available
they ask more questions usually in the generals’ category. A response there usually leads to
hopping around to more new remedies to check for a possible match.
3. Keynote
Commonly based on having the patient reveal one unusual symptom that has been
recorded in the repertory. It’s more properly seen as a way to reduce the number of symptoms to
a few generals that will match few remedies. Selecting one very peculiar symptom to base a
prescription on is still best left to a very experienced repertorizer.
4. Artistic method
Always write out the entire list of remedies from the general rubric and the modality such
as a special period of aggravation. Many brilliant cures are made from the general rubric.
Kent is a stickler for knowing the Materia Medica to the point of having a feeling about a
patient for a remedy since the patient does not always give you a clear picture.
Clarify the anamnesis by selecting a group of three or four essentials in one case and
discarding all other remedies which do not turn up here. – Kent
A better method that demands that judgment be passed on all the symptoms after the case
is carefully taken. The value of these symptoms is in proportion as they relate to the patient
rather than to his parts. The orders of symptoms to take are those most peculiar to the patient and
then those less and less peculiar until those that are common. Generalities first: aggravations and
ameliorations of the general state or many of their symptoms. Mental symptoms are then to be
taken in this order:
1. Loves and hates, or desires and aversions
2. Rational or intellectual mind
3. Memory
Omit all symptoms that relate to a pathological cause and all that are common to disease
and to people. Then a group of about five to ten remedies will appear which can then be
compared and related to the remaining symptoms of the case. Physical symptoms next to be
taken:
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1. Generalities related to the entire man and his entire body, or his blood and fluids. Includes
both symptoms and modalities. All the remedies that are found here are to be retained with the
mental group.
2. Particulars of the regions of the body, organs, parts and extremities. Preferences are given to
discharges from ulcers, menstruation, ears, etc., as these are closely related to health.
3. Modalities of the parts affected which often are the opposite of the patient.
Strange and rare symptoms are to be ranked much higher.
4. Keynote symptoms can guide to cure or help a case provided that the mental and the physical
generals do not contradict the modalities.
Note the three spheres of influence – mental, emotional, and physical.
5. Doctrine of Signatures
The Doctrine of Signatures is a very old notion which predates homeopathy and was
already mentioned in the writings of the Swiss physician Paracelsus von Hohenheim (14931541). It proposes the idea that God gave everything in nature its unique healing powers and left
a clue for us to discover in the appearance of each plant or substance. For example, the dark lines
on the petals of Digitalis purpurea are reminiscent of blood vessels. Indeed, Digitalis is a wellknown allopathic drug for heart problems and also has an affinity for this organ in its
homeopathic preparation. Similarly, the yellow juice of Chelidonium majus reminds one of the
yellowish complexions typical of patients with liver problems. Chelidonium is known for its
affinity to the liver.
As a scientific system, there is no basis for confirming these associations that folk
medicine has given us. What they do provide us with is a very good basis for a mnemonic
system. In studying Materia Medica, you can take advantage of Euphrasia's pupil-like markings
as a way to remember that Eyebright is a major remedy for the eyes.
6. Scientific
A mechanical method that takes all the symptoms with all the associated remedies and
gradings, making a summary of the ones that show the strongest. It is quite possible that a
remedy not having the highest ranking can be most similar in personality to the disease when
seen in light of the Materia Medica.
7. Eliminative
A method of scientific repertorizing that saves time. When choosing symptoms for
repertorizing you choose the most significant rubrics and then if a remedy is not included in
those, it is eliminated from any further consideration.
8. Constitutional
Based on the belief that a person has one or more remedies that they have an affinity
with. Dr. Kent was of the opinion that it is the sick individual as a whole to be cured rather than
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the totality of characteristic symptoms or the pathological condition of the diseased organs of the
patient. Therefore he have highest or first rank to the general characteristic symptoms of the
patient as a whole. These symptoms are also called the constitutional symptoms of the patient.
He said that there are no fixed types of constitutions.
The extreme version of this is used to ask the question "What remedy are you?" which is
a similar system to astrological signs in determining a personality type.
Hahnemann on constitution
Useful to the physician in assisting him to cure are the particulars of the most probable
exciting cause of the acute disease, as also the most significant points in the whole history of the
chronic disease, to enable him to discover its fundamental cause, which is generally due to a
chronic miasm.
In these investigations, the ascertainable physical constitution of the patient (and
intellectual character, his occupation, mode of living and habits, his social and domestic
relations, his age, sexual function, ..etc., are to be taken into consideration. All the sufferings,
accidents and changes of the health of the experimenter during the action of a medicine essential
to a good and pure experiment are complied with) are solely derived from this medicine, and
must be regarded and registered as belonging peculiarly to this medicine, as symptoms of this
medicine, even though the experimenter had observed, a considerable time previously, the
spontaneous occurrence of similar phenomena in himself. The reappearance of these during the
trial of the medicine only shows that this individual is, by virtue of his peculiar constitution,
particularly disposed to have such symptoms excited in him. In this case they are the effect of
the medicine; the symptoms do not arise spontaneously while the medicine that has been taken is
exercising an influence over the health of the whole system, but are produced by the medicine.
Kent on constitution
There are constitutional states in patients by virtue of which they are always affected in a
certain way, and these states are often left after proving, or are found in those who have been
poisoned by a drug. All these patients will have alternating symptoms which will confuse the
physician before he knows their constitutional state. It is an important thing to know the
constitutional state of a patient before prescribing. You will always be able to do better for your
patients when you know all of their tendencies.
Of course, in acute diseases symptoms sometimes stand out so sharply that an acute
remedy can be administered without reference to any constitutional state. Acute cognates can be
established in almost any patient. For instance, the Calcarea patient will need an acute cognate of
Calcarea when he is sick with acute symptoms. The acute symptoms fit into and are established
and formed by the constitutional state of the patient.
You will have patients that will come to you at every change of the wind, at every attack
of snuffles the baby has, at every little headache or every little pain. If you then proceed to
change your remedy or prescribe for each one these little spells of indisposition, you will, in the
course of a little while, have such a state of disorder in the individual that you will wonder what
is the matter with this patient. You had better give her no medicine at all, and if she is wise and
strong and can feel confidence you can say to her that she does not need medicine for this attack;
but occasionally give her a dose of constitutional medicine when these little attacks are not on.
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Other more fixed systems are as follows:
Unani, the name given to the system that Hippocrates started and the system of medicine
that Hahnemann used his Arabic to study, recognizes constitutional disorders in the form of
Sanguine, Bilious, Phlegmatic and Melancholic temperaments. These later became the Five
Temperaments: Melancholic (dark eyes, tendency to laziness and sadness), Sanguine (high color,
fine, delicate skin, impressible natures), Choleric (red hair and freckles), Lymphatic, and
Phlegmatic.
Ayurveda, the dominant system of medicine in India since Unani, recognizes the
symptoms of Vat, Pit and Kaph as the constitutional symptoms of the patient suffering from
chronic diseases to be cured.
Dr. Grauvogl's constitutional types are grouped into Hyrogenoid, Oxygenoid, and
Carbo-nitrogenoid.
Dr. Allandy describes the four types of constitutions as antoni-plastic, toni-plastic, toniaplastic, and atoni-aplastic.
Dr. Nebel describes his three types of osseous constitutions as carbo-calsis, phosphocalsis, and fluoro-calsis.
Dr. Vannier describes eight basic prototypes, named for Greek and Roman divinities
with definite individualizing traits. These are Mars, Saturn, Apollo, Venus, Jupiter, Mercury,
Luna, and Terra. Each type is described in terms of dominant characteristics, morphology, mind,
character, diseases to which they are prone, and changes that commonly occur with age and in
specific circumstances.
4.7. Prescribing
The classical method of practicing Homoeopathy demands the administration of a single
remedy at one time, Chosen in accordance with the application of the law of similars.
Hahnemann would never countenance two or more remedies given at the same time, although
the prescription of the follow up remedies or remedies in rotation is acceptable in classical
homoeopathy.
If the remedy is chosen according to Hahnemann’s well defined principles, then this
remedy alone will affect a speedy and permanent cure. The symptom picture of this remedy most
closely matches the totality of the disease symptoms of the patient. Hahnemann recognized that
an exact match of the symptoms between the artificial disease induced by the remedy and the
natural disease of the patient was virtually impossible. And he called only for the greatest
possible similarity.
When a number of remedies have more or less equal claims to be prescribed, a single
Bowel Nosode could be effective.
4.7.a. Repetition of doses
In his Organon, Hahnemann advised that a single dose of a well selected homoeopathic
medicine is to be given or the same medicine to be repeated .his reason to this advice was, since
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no more efficacious mode of proceeding was discovered the homoeopath has to stick to the
principle of a single dose at a time and that the very smallest of the carefully selected remedy act
upon the patient and, moreover, to exhaust its action. Hahnemann also stated that neither by a
large dose of the well selected remedy nor by several small doses of it given in quick succession,
can the largest possible good be affected in the treatment of disease and more especially of
chronic diseases.
Hahnemann described the reason for the statement, that by such a procedure the vital
force does not quietly adapt itself to the transition from the natural disease to the similar
medicinal disease, but it usually so violently excited and disturbed by a large dose, or by a
smaller dose, even of a homoeopathically chosen remedy given rapidly one after the other, that
in most cases its reaction will be anything but salutary and will do more harm than good.
Dr. J.T. Kent has described the cases where a second prescription should be a change of
remedy:
1) To antidote the first prescription, if possible;
2) When after the administration of the medicine- “a new group of symptoms appears
somewhere in the body relative to the patient, such as the patient has never had”.
3) To complete a remedy.
It might be pointed out here that Kent’s second condition for the change of remedy
corresponds to Hahnemann’s teaching.
4.7.b. Pathological constitutional prescribing
Pathological Prescribing
Pathological prescribing places the emphasis on the pathology present in the patient and
the homoeopathic remedy which directly affects the tissues involved in the pathological changes.
This method of prescribing does not act at as deep a level as constitutional prescribing and is
most effective when serious pathological process and the homoeopathic remedy are clear.
Constitutional Prescribing
Constitutional prescribing is considered to be the deepest level of homoeopathic
treatment. It suffers from the disadvantage that specific pathological processes may not be
directly affected quickly enough to all the cure of the whole person. Dr. Kent also favored high
potencies- 1M, 10M and CM (100,000) given at a low frequency.
Viewed in the extreme, the constitutional remedy for a particular patient may be
beneficial for virtually any ailment that the patient may be suffering from, which makes the
remedy most valuable to the patient (if their constitutional remedy can be identified).
Many homoeopaths take the view that constitutional symptoms have no foundation in the
principle of the simillimum , but the concept that people respond because of a certain affinity to
particular drug is , nevertheless, quite acceptable. Indeed, Hahnemann himself was the first to
observe this phenomenon.e.g. He mentioned that Nux Vomica seemed particularly well suited to
fiery, violent and malicious people, whilst on the other hand, Pulsatila was well suited to timid,
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anxious, tearful people of a gentle mild disposition. However, Hahnemann placed no special
emphasis on these remarks possibly due to lack of clinical data.
4.7.c. Combined remedies
Complexists are those practitioners who favor the prescribing of combination of two or
more remedies at the same time. This is sometimes described as Polypharmacy.
Combinations of up to twenty remedies are usually employed, although the usual
numbers is around five to ten remedies. Many of these combination remedies emanate from
Germany.
The choice of the remedies is on a pathological basis, designed to embrace the totality of
symptoms, which is certainly a point in their favor. The remedies are usually combined in low
potency (3x, 6x, 12x, 6x). A variation of the “combination” remedy is a mixture of the same
remedy at different potencies. For examples, Arnica 6X, Arnica 12X and Arnica 30X combined
as liquid potencies in equal proportions. The remedies are chosen as far as possible to achieve a
synergistic effect, avoiding remedies which antidote on another and including groups of two or
more complementary remedies.
The concept of the of the combination remedy would, have been firmly rejected by
Samuel Hahnemann as this is the antithesis of the single remedy, selected according to the
principle of the Law of Similars. Classical homoeopathic have referred to the combination
remedy as the shotgun or blunderbuss approach to homoeopathic treatment, but it is fair to state
that such remedies have been proven effective for certain well defined, acute conditions. Here is
an examples of a combination remedy of formulated to provide symptomatic relief for Fatigue:
REMEDY
INDICATIONS
Arnica Montana 6x
Physical and mental fatigue and trauma.
Bellis Perennis 6x
Fag and stasis, weariness and melanchonly.
Gelsemium Sempervirens 6x
Mental dullness, intense weariness, aversion to effort weakness,
irritability.
Nux Vomica
Weakness, irritability.
Veratrum Album 6x
Weakness of whole muscular system, muscular fatigue,
weak memory.
Calcarea Phosphoricum 12x
Weariness after exertion.
Kalium Phosphoricum 12x
Weariness, particularly during menstruation,exhaustion,
weakness during convalescence.
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4.7.d. Specific remedies
There are certain remedies which are highly effective with the most people in the
treatment of clear, strongly indicated acute conditions, or they have an affinity for a particular
organ or tissue. In these cases, the symptom picture is predominant and the constitutional aspects
of the remedy and its modalities are minimal- they very opposite of a “constitutional remedy”.
The remedy is said to have a weak constitutional picture. These remedies are known as
“specific”, or at least “near specifics” for certain conditions. Thus, they represent the closet
approach of homoeopathy to allopathy with specific indications for specific drugs, or the
allopathic end of the ‘homoeopathic spectrum’.
These remedies, therefore, find particular application in first-aid treatment.
Examples of “near specific” are:
REMEDY INDICATION
Arnica Montana
Bruises
Cuprum Metallicum
Cramp (calves)
Colchicum Autumnale
Gout
Hammamelis Virginana
Hemorrhoids, varicose veins.
Thuja Occidentalis
Warts
Chamomilla
Teething infants
Cineraria Maritima
Cataracts
4.7.e. Dosage
The conventional single dosages for homoeopathic remedies are:
Adults
Two tablets
Or three pills (pilules)
Or ten drops liquid
Children
One tablet
Or two pills
Or a few granules on the tip of a spoon
Or five drops liquid

Tablets or pills are best dissolved (do not chew them) under the tongue.
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 They are best taken between meals, when the mouth is clean and free from tobacco or
highly
flavored foods or toothpaste.
 There is no need to “wash the medicines down” with a drink.
 Tablets may be ground to a powder on a clean spoon for administration to children and
babies.
 Tablets or pills should not be handled as the remedies are very sensitive to contaminants.
Tip the tablets into the lid of the container.
4.7.f. Importance Of Remedial Potency
After studying the case, comparing it with the Repertory and eventually with the Materia
Medica, and then selecting the correct homeopathic remedy, the simillimum, comes the decision
about the use of a particular potency. The choice of potency is very important. The elementary
division of potencies to low, medium, high and very high, varies with the different schools. It is
always orientational, without exact contours. Personally I subscribe to the division outlined by
Kent. The low potencies are: C 1 to C 15. The medium: C 30 to C 200. The high: C 1000 to C 10
000. The very high: above C 10 000, i.e. CM, MM, MMM (one hundred thousand, million,
billion).
The Choice of Potency
It is known that the deeper the level of advancing pathology, the higher the potency that
should be applied. This is the fundamental rule. If the pathology is most prominent in the mental
sphere, the potency should be high. The cases of psychosis generally demand the highest
potencies, if there is to be a lasting cure. Somewhat lower potencies are appropriate when the
emotional area is affected. When the pathology is manifested only on the physical organs,
medium to low potencies come into consideration at the start of the treatment.
Another criterion for choosing the potency is whether or not there are any structural
changes in the organism, caused by the pathology. If only the physical organs are affected, then
it is necessary to choose lower potency, as if a higher potency was applied, a strong homeopathic
symptomatic reaction might occur soon after the application. The overall state of the organism
plays a significant role in the choice of potency. Old people or people with a long history of
many chronic illnesses, people who had been for decades subjected to the influence of allopathic
drugs, those who underwent various operations and whose life energy is low, need low
potencies. With people over sixty years of age it is very risky to apply potencies higher than C
15 early on in the treatment. For people in advanced stages of more serious chronic diseases
affecting their physical organs, mostly low potencies are appropriate, with elderly people only
the low potencies.
The next criterion for choosing the potency is the homeopath's aim. A female patient
might have dermatitis on her face, besides a lot of other things. She wants to quickly get rid of
the rash (she may be getting married next month), the other things are not that important to her.
This is a woeful approach to the treatment, and this must be stressed to the patient. Nevertheless,
she might insist that she wants to have the other complaints treated only after the marriage. In
such case, the lowest potencies would have to be considered. A low potency has a superficial
effect, it does not reach deep. It does not reach to the roots of the pathology. But this is why it
might have a faster effect on superficial symptoms.
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Children generally react well to higher potencies and also "spend" them faster. With
them the remedy should be applied a little more often. For instance, in cases of similar
pathology, the potency C 200 given to a forty years old patient might be effective for approx.
two years, a shorter period, maybe one year, with a six years old child.
In acute cases the potencies C 30 and C 200 are very appropriate.
At the beginning of treatment of a chronic disease, most useful are again the same two
potencies, C 30 and C 200. With the exceptions mentioned above. Such potencies are applied in
one dose, only one or two pills - and enough. When granules (small pellets) are used, perhaps
eight to twenty, with globules (larger pellets, often sold in stores), only one is sufficient. The
actual weight of remedy is not of a great consequence. Even if we used the content of a whole
vial, it would come to the same. We are supplying information, not energy.
If we are confident that the remedy is correct, we can go for a higher potency. If we are
less certain, we should choose a lower potency to determine its effect. Beginners should only use
low and medium potencies. Only when we have it confirmed that the remedy works correctly on
the patient, it is possible, when the first dose is no longer effective and the possible relapse
(return of the original symptoms) occurs, to move to higher potencies. The ascending scale of
potencies, according to Kent, is 30, 200, 1000, 10 000, LM (50 000), CM (100 000)...
The Duration of Effectiveness of One Dose
The higher the potency, the longer the period of its effectiveness. The duration of its
effectiveness if entirely individual. Some authors offer orientation charts with the approximate
periods of effectiveness. They vary to a large degree. My personal experience concerning the
duration of effectiveness, allows me to be more optimistic than a majority of other authors. In
treatment of chronic illnesses I have met with the cases where the C 30 potency was effective
longer than six months, C 200 longer than two years, C 10 000 longer than 3 years, and CM
longer than 5 years. Naturally, I only list the longest periods of effectiveness. And in the cases
concerned there were no obstructions to the treatment.
Permanent Effectiveness
Of course, often the case is that we prescribe C 200 to a complaint that lasted for many
years, that it disappears, and that it is definitely cured. But it would have always disappeared
before the end of the above mentioned periods. It does not come back even after fifteen years, it
does not return at all.
In such cases we could really say that the homeopathic remedy has a permanent effect.
And, of course, this is always so at the end of the treatment. That last potency should have a
permanent effect. Permanent effect is the true objective of homeopathic treatment.
Acute Treatment
While in the treatment of a chronic disease we administer C 30 or higher only once, and
wait with the next dose until the remedy had evidently ceased to be effective, with the acute
illness we may choose a different approach. With an influenza, meningitis, etc., we may repeat
the correctly chosen remedy, even in the potency of C 30 or C 200 in a short interval; say 15
minutes, until there is an improvement (a drop in temperature a significant subjective relief, etc.)
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After that we do not repeat it any more. Once there has been a reaction, the curing process
continues on.
Low Potencies
When low potencies are used in the treatment of chronic diseases, it is possible to repeat
D6 or C5 or LMI, for instance three times a day till the moment a reaction has been stirred up.
As soon as there is an improvement or a homeopathic aggravation of symptoms, it is necessary
to stop. The cure will continue on its own. When the case is reviewed, the whole period when
the remedy was being administered can be considered as one single dose given to the patient.
With this method, the so called plussing is sometimes used, meaning that a low potency
is dissolved in a glass of water and before use, only one spoon is transferred into another glass of
water, from which the patient drinks. The same process is repeated. The patient thus receives an
enhanced chain of potencies; the remedy is being further and further diluted. The adherents to
Hahnemann's dynamisation may also hit the diluted remedy against a firm resilient pad (a book).
Other homeopaths do not do this, only recommend stirring the remedy, and they get the results
too.
Further Administration
When repeating the remedy after a previous use, we usually move to the higher potency.
After C 30 comes C 200 then, if necessary, C 1000, C 10 000, CM.
It often happens that for a chronic condition, combined for instance with recurrent
inflammations of the ovaries, we use the potency C 200. The condition improves, the acute
attacks cease, the psychology is somewhat improved, but minor problems persist, irregular
menstruation, a little pain here and there, there is still no sense of comfort in that area. When C
10 000 is given it is much better, but only after the potency CM the total cure has been reached,
lasting many years. The cause of the problem, even though a physical one, was very deeply
buried, and only the high potency has brought the definite results. However, a low potency is
usually sufficient for such problems. When using very high potencies, certain rules apply:
a) They must not be used by a beginner. If prescribed incorrectly, the patient would be
subjected to a long lasting proving of the remedy, and it is very difficult to antidote such
potencies.
b) The correctness of the prescription should be previously verified by effectiveness of
the same remedy in a lower potency.
c) They cannot be used when there are serious structural changes of the vitally important
organs.
d) They cannot be given to people whose vital forces are significantly reduced (for
instance to old people).
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4.7.f.i. Selection of potency
Two factors are prominent;
1. The degree of “similarity” of the remedy indicates a higher potency.
2. The vitality of the patient to absorb a high potency without an excessive reaction lets
you prescribe high.
The Optimum dose
It should be clear from what has gone before that the potency should not be too high or
too low. There is an optimum dose which will resolve the symptom picture with least
aggravation and few proving symptoms. There is considerable skill in choosing this because we
have no means of accurately measuring the amount of energy needed to resolve the disturbance,
I.e. to measure the remedial action of the organism.
How To Select the Potency Needed
After admitting the prolonged aggravation of the lower potencies, over-reaction and nonreaction to higher potencies, the need to repeat lower potencies sometimes, the detrimental effect
of too much repetition, and after emphasizing the need to select the optimum potency for the
fastest safest resolution of the disturbance, the most important question how is, how to recognize
the potency needed? Many homeopathy masters established a harmonic series of potencies
which are still used the 6th, 30th, 200th, 1M, 10M, 50M and CM. And accordingly the following
protocol was designed:



Below 30 was for physical disturbance,
200 was for emotional disturbance,
1M and over was for disturbance on the mental plane.
However, the potency chosen depends on the reactivity of the vital force and may change
with the choice of remedy, as each has his or her own scale of action (fig.8.10).
Some remedies are better in certain potencies and less effective in others. In relation to
Paul Callinan’s work in Australia. By freezing remedies at - 200C he discovered that each
remedy produced its own distinct pattern of crystals , like a snowflake ,and whereas the pattern
became clearer as the potency increased it also fluctuated , sharper and less distinct, then sharper
again as the potency increased it also fluctuated , sharper and less distinct, then sharper again as
the potency was raised. Thus the 6X was sharp, the 9X indistinct, and the 12X sharper again and
more precise in definition than 6X. He confirmed that the series of fluctuations coincided with
the main potencies used today 6, 30,..etc .It is useful to identify the potencies at which the
different remedies work best. This may be achieved by a deeper study of the Materia Medica,
and especially of the symptoms produced by each potency in the proving.
Physical symptoms
First: 6th Potency
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The healthy vital force first produces physical symptoms; since it has the ability to reach
right to the edge of the pond .These physical symptoms usually occur on the level of sensation or
local inflammation, e.g. headache. There may be local suppuration in a cut or an increased
rhythm in the normal organs of excretion (bladder, bowels, sweat) after food poisoning or travel
sickness. A 6th potency is sufficient to just touch the vital force , causing a physiological
response . Where this reaction is stronger, as in acute remedies such as Aconite and Belladonna,
a 30th potency may be required.
The general Level and Intense Physical Level: 30th Potency
If the reaction of the vital force is stronger, producing generalized fever, then the 0th
potency may be necessary rather than repeated doses of the 6th potency; or it may be that the
vitality was weakened, or the exciting cause was stronger, so the disturbance penetrated deeper,
giving rise to influenza rather than just a local cold. Influenza involves sensation on the general
level and a change of rhythmic the general level. Sometimes the local inflammation may be so
intense as to require the 30th potency, especially if there are further developments on the general
level such as fever, diarrhea or nausea, or even if suppuration sets in. The 30th potency may also
be given to mild emotion states, such as examination nerves or childhood trauma.
Emotional Turmoil and Violent Acutes: 200th Potency
Then the vital force produces more violent acutes, such as dysentery and typhoid, or even
in severe cases of influenza, inflammation may be life-threatening on the general
Level, as in fever, or the change in the rhythm of the excretory organs may be violent,
and again possibly life-threatening. The 200th potency covers the case when the physical
symptoms manifest with such violence- even 1M potency may be considered.
The turmoil of the 200th potency is usually the province of emotional energy. Indeed,
such an acute condition may arise from strong emotions and so upset the economy of the body
that the patient cannot sleep, but turns and tosses, has a gnawing ache in the stomach yet
revulsion for food, or may have severe diarrhea. If the cause is severe enough, again one would
consider the 1M potency. Emotional remedies such as Ignatia are often better given in 1M
potency.
The Level of Temperament and Constitutional Treatment: 1M or 10M potency
The 1M and 10M potency level is usually applied to constitutional treatment, especially
where there are no pathological problems or structural change in any of the organs. At this level
of stimulation we can reach the cause on the higher octave, and so change all the octaves below.
At this potency level we are treating the symptoms at the apex of the pyramid, where the
symptoms are most individualized. Strong resonance is necessary for reaction.
The Lower Vitality, the lower the Potency
When the outwards movement of the vital force is prevented- because it has insufficient
vitality to reform the situation, or because the process of resolution would endanger the integrity
of the whole, or because allopathic treatment has suppressed the vital force-the symptoms
become more serious and the process described above is reversed, localizing in organs, first as
inflammation and change of rhythm, and eventually as structural change. The closer the
organism approaches structural change the lower the potency that is used. At this level the
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amount of action is limited and very slow, so the 6th potency is used. Before this stage is
reached there is first the inflammation, and perhaps discharge, e.g. pneumonia or bronchitis, for
which we might use a 200th or a 30th potency depending on the seriousness and the scope of the
symptoms. The more fever the higher the potency; the more physical symptoms the lower the
potency.
4.7.f.ii. The Collective Single Dose, the Ascending Collective Dose and the
Split Dose
In the literature and in some practices it is common to find remedies used in these ways,
and this is the best place to explain it.
Kent discovered that the use of the single dose could produce severe aggravation because
there was too much reaction from the vital force. He gave another dose of medicine within a
certain time period, which could then cut across the action of the remedy and slow it down. If
the remedy produces wave pattern of reaction, then a second remedy would cut across the
outward-moving wave. The second remedy would be out of phase initially, and would deflect
the vital force to bring it into phase, thus the main thrust of the remedy would be delayed.
The Collective Single Dose (CSD)
CSD is a total of three pills, given usually at 2 or 3-hourly intervals depending on how
quickly the symptoms are moving. Sometimes it is given at 12 hours, or 6 hours. The faster the
symptoms move, the closer together the doses.
The Split Dose (SD)
This is given immediately before sleep and is followed by another dose immediately on
waking. Once again the phasing is out, so that the reaction is slowed down. There is some
mystical idea that, since only sleep comes between the doses, there is only one dose. It should
be clear to you from what we have already discussed that Is not so. However, there are
advantages in the procedure in some cases and it should not be disposed of so quickly.
The Ascending Collective Dose (ACD)
This is the name given to the process of giving three pills 2 or 3 hours apart, as in the
CSD, but increasing the potency each time. Thus we might use a 6th potency, then the 30th then
the 200th; or the 30th then the 200th then the 1M potency. If we remember that the different
potencies work on different octaves, and the action is needed on different energy levels to cure
the patient, then this procedure can be likened to a starting handle, manually touching each level
rather than waiting for the reaction of the vital force to do so this in its own time. The procedure
is again crude, but can be effective and useful in stimulating the level wanted, then quickly
transferring the reaction to a higher, more free level, where less aggravation will occur.
4.7.f.iii. Where to take the remedy
There is an unsubstantiated argument around that people should follow certain
rules with the remedy once they get it to their mouth. Many advise letting it dissolve under the
tongue like a slow-release medication.
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All such recommendations are not based on anything more than personal beliefs,
suspicions, and superstitions based on using traditional medicines. If the remedy has no physical
substance in it, then what is dissolving under the tongue is just sugar. The rule of specific
handling here serves only to create a sense of awe in the practitioner for their “specific”
knowledge of the fine points of homeopathy and therefore their mastery in the overall aspects of
the art.
4.7.g. Frequency of dosing
Repeating a dose according to Kent's ladder of potencies
A homoeopath administers the different potencies, repeating the same potency until it
does not act any longer, and then going higher, until he has gone through the whole range of
potencies.
A homoeopath can repeat that remedy many times on a paucity of symptoms, when he
cannot give another remedy, simply because it has demonstrated itself to be the patient's
constitutional remedy. This remedy should not be changed so long as the curative action can be
maintained.
Even if the symptoms have been changed the remedy shouldn’t be, provided the patient
has continuously improved. It is a rule after the homoeopath has gone through a series of
potencies, never to leave that remedy until one more dose of a higher potency has been given
and tested; but when this dose of a higher potency has been given and tested, without effect, that
is the only means he has of knowing that this remedy has done all the good it can for this patient
and that a change is necessary.
4.7.h. Prognosis
A study of Hahnemann’s Organon and The Chronic Disease indicates what might be
expected from a remedy given to the patient. According to Kent, these may be:











Rapid cure with no aggravations.
Rapid cure after rapid, short and strong aggravations.
Long aggravations followed by slow improvement.
Long aggravations with decline of patient.
Full aggravations of symptoms with no special relief.
Ameliorations followed by aggravations.
Short relief of symptoms.
Old symptoms appear.
New symptoms appear.
Patient “proves” every remedy given.
Symptoms take the wrong direction.
4.7.h.i. The homeopathic aggravation
Acute disease reaction: quick and easy if given soon after onset. More reaction if many
days pass. A slight aggravation in a few minutes means you will probably not have to give
another dose.
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Chronic disease, long standing illness, or physical change reaction: sharp aggravations,
great prostration, violent sweating, exhaustion, vomiting and purging. Some reactions may not
be able to be recovered from. Sometimes no aggravation if there has been no tissue changes. The
repair of diseased tissue will cause great discomfort but must not be suppressed by another
remedy.
A disease picture may be a shadow of the disease to come and a remedy may pull it out
of the shadows and show itself as an aggravation. A remedy can not give symptoms to a person
that they don't have unless they are very sensitive people.
Begin cases without repetition. Give a single dose and wait, and watch its effects. There
are no good rules for when to repeat the dose.
A quick reaction means that you should wait as long as you see the remedy working
before giving another dose. Falling asleep, breaking out in sweat or mental calmness means wait
and be patient. A continued disease state or a vigorous constitution allows more repetition.
The strength of the remedy should be strong enough or similar enough to produce just
enough aggravation so you know that the curative effect will cover all of the disease state. If you
have no aggravation you will most likely have to repeat the dose or find a closer remedy.
Sometimes several remedies will be necessary to complete the case. Again sensitive people will
aggravate easily.
Potencies up to 13MM are active and we are still taking them higher. Generally start with
30x.
4.7.h.ii. Aggravation types
A. of the disease - the patient is growing worse
The patient is growing weaker, the symptoms are growing stronger.
B. of the symptoms - the patient is growing better
The true homoeopathic aggravation is when the symptoms are worse, but the patient
says, "I feel better."
1. Unending aggravation
Observe whether the patient is incurable. If so or in doubt, give no higher than the 30th
or 200th potency, and see if the aggravation is going too deep or will be too prolonged. Prepare
to antidote if there is too strong of aggravation.
2. Long aggravation
An aggravation can last for many weeks and then the patient can show slow
improvement. If then after three months you repeat and you get the same effect, it means that the
patient was almost incurable. This may last for several years while repairing the tissue damage
that had started.
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3. Short aggravation
An aggravation is quick, short and strong with rapid and long improvement of the
patient. This is the best result to see.
Surface changes will occur, such as abscesses, away from critical body areas such as the
liver, the kidneys, the heart or the brain. Distinguish these two areas.
Aggravations here will be within hours in acute cases and several days in chronic cases.
4. No aggravation
With no aggravation you have matched the potency perfectly, an unusual situation.
However, a slight aggravation is confirmation that you have just stepped just outside that perfect
area and is more satisfying.
5. Amelioration then aggravation
Did the patient spoil the action of the remedy; has he been on a drinking binge or hit the
office coffee pot without thinking? Has he handled chemicals or been around ammonia fumes?
Either the remedy was only a superficial remedy, and could only act as a palliative, or the
patient was incurable and the remedy was somewhat suitable. Re-examine the case to determine
which is the right one.
If the remedy wasn't correct, it is the best thing for the patient if the symptoms come
back exactly as they were, but very often they come back changed, and then you must wait
through grievous suffering for the picture. The patient will be more patient and have more
confidence if the doctor confesses on the spot that his selection was not what it ought to be, and
he hopes to do better next time.
If it is too short an amelioration in acute cases, it is because such high grade
inflammatory action is present that organs are threatened by the rapid processes going on.
If it is too short amelioration in chronic diseases, it means that there are structural
changes and organs are destroyed or being destroyed or in a very precarious condition.
6. Amelioration but no symptom improvement
Patients who have physical impairments that impede the remedy action from completing
can only be palliated and this will be the best you can do.
7. Aggravation with every remedy
Oversensitive patients are often incurable.
Such patients are most annoying.
You will often cure their acute diseases by giving them the 30th and 200th, and you will
relieve their chronic diseases by giving them the 30th, 200th and 500th potencies.
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Provers
Healthy provers are always benefited by provings, if they are properly conducted. Note
changes in current symptoms so as not to corrupt the proving data.
New symptoms
Sometimes a patient forgets they have had a symptom and that is all it is but entirely new
symptoms indicate an incorrect remedy. The more new symptoms you have the more likely it is
incorrect. They should be left to pass away with the action of the remedy.
Old symptoms reappear
It is quite a common thing for old symptoms to appear after the aggravation has come,
and hence we see the symptoms disappearing in the reverse order of their coming. The more that
appear the more curable is the condition.
While change is occurring, no new remedy should be given. If old symptoms return after
having disappeared, the remedy should then be repeated.
Symptoms in wrong direction
Antidote immediately if the direction of cure moves the wrong way e.g. rheumatism to
heart complaints.
When diseases go from center to circumferences, going out from the centers of life, out
from the heart, lungs, brain and spine, out from the interiors, upon the extremities, it is well.
E.g. Eruptions upon the skin and affections in the extremities.
447.h.iii. The second prescription
The medicine that has partly cured the case can often finish it, and that medicine should
not be changed until there are good reasons for changing it.
It’s of no good to shift between homoeopaths while in the middle of a medication course.
A homoeopath must:
 Be very patient in waiting for the action of the first remedy to complete. There should
be only common or trivial symptoms left over. The early repetition of the medicine and the
continued giving of the same medicine will not give a clear indication of a second remedy.
Symptoms that are being cured and the remedy's symptoms being proved are mingled together
producing a very muddy picture.
 Be patient until there is no more change in the symptoms. Observe and wait and ignore
the patient's pleas for more remedies.
 If the symptoms return somewhat after a few months as they were, differing slightly in
their intensity, increased or decreased, it is good. If there are no symptoms to work with after a
long wait, then the last remedy would be the best.
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 After three remedies give a placebo, but don’t give any remedy before reconsidering
your case; patiently await the development of symptoms.
After observing the action of the remedy
 Reassess the case through careful observation again. Look at what has changed after a
remedy you gave that has caused an effect. The disappearance of symptoms, the increase or
aggravation of symptoms, the amelioration of symptoms, and the order of the symptoms are all
changes to be studied.
 Since the patient doesn't always know if he is better or worse, so the homoeopath must
look at the symptoms and make sure that they match what the patient is saying.
 Deep-seated disease can be palliated; in this case a homoeopath must look at the depth
of action on the symptoms. The direction of cure is a sufficient observation to make a judgment
if cure is progressing.
4.7.h.iv. Sharing the case between Homeopathy and conventional medicine
Some people say that using conventional drugs cancels out homeopathic effects. But
realistically most people won’t get off of something that makes them feel better and if they are
under the care of a doctor you would be wise to not try to supercede a legal authority. Because it
can’t be well proved the point is moot.
But having had some experience, I have found that conventional drugs and vitamins will
mask symptoms so the homeopath can’t detect the direction of the case. I have had to ask the
patient what the symptoms were like when they weren’t taking the drug to approximate the
current case and work with them closely for subtle signs of improvement. The patient was able
to talk to the doctor about weaning them off of the drugs if possible and left that part in the
physician’s ballpark. Make sure that the physician knows that a complementary medicine is
being tried for the best working relationship even though you may never meet them.
About one in three Americans uses some sort of alternative medicine, from herbs to
acupuncture. But only 30 percent of those people tell their doctor. That’s unfortunate. While
alternative medicine may be helpful, it can also be risky. It’s best to keep your doctor informed
so you can integrate the best of both worlds.
Many doctors used to assume that patients who turned to alternative care were
dissatisfied with them and their mainstream medical approach. But a study of some 1,000
patients, published in the Journal of the American Medical Association, found that’s not the
case; rather, alternative seekers were simply more likely to hold a “holistic” view of health care.
It’s good to know that most people who turn to alternatives aren’t motivated by a negative
attitude about conventional care. After all, the two types should be viewed as complementary.
Cited References;
1. Dr. Rupal Shah & Dr. Rajesh Shah, Indiaspace creation.., © 1997,
http://www.indiaspace.com/homoeopathy/
2. Dr. Batra, Ailments
120
http://www.positivehealthclinic.com/ailment/index.htm(article)
http://www.homeopathyhome.com/reference/articles/tyler1.shtml
3. THE GENIUS OF HOMOEOPATHY (1924)By: Stuart Close, M.D. Copyrighted, John
Lunstroth, 2000
http://elm.he.net/~janaka/homeopathy/close/close,genius,index.htm
4. Douglas Hoff ,2001, Classical Homeopathy
http://doughoff.com/homeopathy/01_philosophy/01_toc.htm
5. Jiri Cehovsky, 1994,Translation by: Voyen Koreis,1997, Homoeopathy-More Than A Cure,
Chapters 2-8 ,10-17
http://www.ecn.cz/alternativa/book/hocu13.htm
6. Glen Irving Bidwell, How To Use The Repertory, © Deepak M R
http://www.onlinehomeo.com/nash/bidwell1.htm
7. Dr. C.H.Sharma edited by David Leland,The international manual of homeopathy and
natural medicine, Publisher: Thorsons publishers limited.
8. Diploma coarse of the British institute of Homoeopathy 1992.
9. Diploma coarse of the British institute of Homoeopathy 1988.
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