Please find a PDF from the IHM to you regarding the grading system of the TPB.
Category Archives: Boenninghausen
In Seville, Spain, a long time patient of my colleague Manuel went into hospital for several weeks after developing a strange leg infection. The skin was peeling and deep cracks appeared in the heel and ankle of the right foot. These photos were taken after being released from hospital.
Manuel asked Antonio and myself to come to the clinic and observe and offer suggestions. As you can imagine, walking was difficult and the lady was in a lot of pain.
We put her in the reception room as it was easier for her to sit there, and raised her leg onto another chair to view the issue.
We took an hour looking at it. I examined thoroughly, came to no conlcusion as to the cause, noted that the hospital treatment of antibiotics had reduced the infection a little but the problem persisted.
She cried when we touched the areas of skin that has peeled and the inflamed leg. Very painful. I asked what made it better and she said that nothing did.
Going into the bathroom, I moistened a paper towel and came back and placed it on her ankle and top of her foot. She said how much it felt better. I touched the area and she didnt notice or complain as previously.
Aphorism 153 indicates that we solely keep the view on the characteristic, the strange and the rare in the expression of the disease.
§ 153 Fifth Edition
In this search for a homoeopathic specific remedy, that is to say, in this comparison of the collective symptoms of the natural disease with the list of symptoms of known medicines, in order to find among these an artificial morbific agent corresponding by similarity to the disease to be cured, the more striking, singular, uncommon and peculiar (characteristic) signs and symptoms1 of the case of disease are chiefly and most solely to be kept in view; for it is more particularly these that very similar ones in the list of symptoms of the selected medicine must correspond to, in order to constitute it the most suitable for effecting the cure.
We also note, Hahnemann indicated the more ‘ striking’ symptom must be taken into consideration. On this basis, I took the following rubrics:
I didnt add the locations, simply because MOST remedies are in leg and foot and ankle. I took the effect of the disorder on the person, ie the cracking of the skin in the ankle and heels, and the nature of the disorder in terms of the flaking of the skin. For me, the outstanding modality was the immediate relief from moistening of the skin.
Manuel saw the patient one week later and the patient was walking. The skin was healing, still red but healing. No more peeling and the cracks had gone. I saw her about 6 weeks later and apart from slight redness, everything was better.
Why 3 rubrics only.?
The choice covered the disorder in its entirety. The modality was a clear indication of the bodys response to the disease. The essential symptom of both in the disease AND the remedy. The TPB showed that only 23 remedies had that modality. Combined with the other two rubrics, Pulsatilla was the only remedy to produce both the amelioration and the characteristics of the problem.
153: for it is more particularly these that very similar ones in the list of symptoms of the selected medicine must correspond to, in order to constitute it the most suitable for effecting the cure. The more general and undefined symptoms: loss of appetite, headache, debility, restless sleep, discomfort, and so forth, demand but little attention when of that vague and indefinite character, if they cannot be more accurately described, as symptoms of such a general nature are observed in almost every disease and from almost every drug.
We are providing an online course in Spanish through the Mexican I.H.M. facility.
In the UK, we are concentrating on practitioner training in-house, to ensure total absorption of the material presented and to be sure the individual has a firm grasp on the process of case taking and what to concentrate on for rubric and remedy selection.
We aim to provide a centre for practitioners who wish to learn Hahnemannian homoeopathy via one and two-day seminars, mentoring programs, live patient assessments, study nights and guest speakers. To facilitate this, we are in the process of purchasing a commercial guest house in Eastbourne for in-stay patients and clinic. We concentrate in the main on using the Therapeutic Pocketbook as an accurate repertory that emulates the methodology of Hahnemann.
We will solely be focused on homoeopathy and the appropriate remedies and not include flower remedies or the use of.
We will of course consider mechanical adjustment if required via osteopathy or chiropractic as an adjunct to the curative treatment if a joint needs realigning.
For those wishing to take the four-day course to become a member of the IHM Register, the intensive teaching will also as a bonus include 3 free nights and breakfast at the hotel. Subject to availability, extra nights can be booked for a reduced fee.
We hope to be taking possession and working on the courses from June.
Main concerns :
1.- “ Many pathologies are not mentioned in the repertoire”
2.- “ Some parts of the body, such as the prostate, are not in the repertoire”
3.- “ Only 125 remedies come in the repertoire”
From the first two concerns, one can find that they are due to a lack of attention in the reading referring to the case taking and analysis within the Organon. While it is true that we can make a clinical diagnosis within our office, for example, hypertension or diabetes, it is also true that the selection of the remedy should not be based on the name of a disease. Homoeopathic diagnosis has nothing to do with the name of the patient’s nosological diagnosis, but rather with its signs and symptoms.
Detailed reading will lead us to understand that the most important thing is to observe how the disease affects the patient. If we talk about a specific pain, then, the most important thing will be to know where (in what region), what kind of pain, since when, what (causality factors) aggravates it, which improves it, that accompanies it, etc. Individualizing the case according to how the symptoms are observed in the patient is the basis.
The same is true for the prostate when, for example, hypertrophy (enlarges), then causes problems. Here the point will be to know how this affects the patient; What symptoms it produces. It is important to find which symptom the differential can make; and understand that this can come from any collective symptom of the patient, which is even alien to the location of the current condition, but that is similar to the symptomatic totality.
However, something we must remember is that the intention of using the repertoire during our consultation is to GUIDE us towards a remedy very close to the image of the patient’s disease, whose homoeopathic diagnosis will be determined by our final consultation towards pure materia medica. In other words, it is necessary to have in-depth knowledge of MMP in order to properly exercise our profession.
If one achieves reasoning like this and realizes that the repertoire achieves the assembly of a complete picture of a disease from the combination of scattered symptoms, but fully organized in it, then one has already begun to understand the true meaning of the TPB.
With respect to the number of remedies contained in the TPB; 125 remedies appear in the original and for example, some others appear in another Boenninghausen work. I must say that I personally work with about twenty (or more) additional remedies to those listed in the repertoire. I mostly use the remedies available for Bönninghausen in 1864 and a few more proven from 1860 to 1900, with which fast and lasting cures are achieved.
The fact that remedies such as Gelsemium, Phytolacca, Argentum nitricum, and Kali bichromicum do not appear on the TPB is not a failure as such. I am sure that when I have found a peritonsillar abscess with acute pain in the throat radiated to the ears when swallowing saliva pointing towards the symptomatic totality, I have prescribed Phytolacca decandra. Thus, one must understand the “image” of any of these remedies well enough to recognize it when one sees it, as well as other remedies that are not in the book. Knowing our tools is indispensable.
Or as Julian Winston would ask otherwise in his review of The Therapeutic Pocket Book :
“Do we stop using Kent’s repertoire because it doesn’t contain Chocolate, Hydrogen, Germanium, Neon, Bamboo, or Ozone?”
The same question would apply to the Boenninghausen repertoire.
In any case, I would like to comment that in my daily homeopathic medical practice, I find that only about 20-30 standard-use remedies are prescribed frequently, while the remaining others are given sporadically.
There is no reason to become anxious because the repertoire does not contain 1,500 or 2,000 remedies. Once we have investigated the high rates of effectiveness in the cases of Hahnemann and Boenninghausen; We realize that most diseases can be treated with fewer medications, but have been properly tested.
In conclusion; If you have a remedy that has been PROPERLY EXPERIENCED and has been used and verified, and therefore always useful; then it is valid that it is in its additional ones; although in personal opinion, new remedies should not be added arbitrarily to a repertoire, until there is a worldwide consensus of expert scientific homeopaths to establish guidelines for the collection and organization of the characteristic symptoms of provings, verification and the graduation of remedies in an orderly and systematic manner according to the Hahnemann / Boenninghausen criteria.
Translated from the Spanish. Original Post here: https://institutodemedicinahomoeopaticaamericalatina.wordpress.com/por-que-boenninghausen/
By Dr. Guillermo Zamora, Surgeon UAG, Dhom. Lic. For the Institute for Homoeopathic Medicine.
The story begins about 14 years ago, when I was a little dissatisfied with the results of the method I was taught in the postgraduate school (the Kentian), I began to investigate other possibilities of obtaining a more exact remedy in my prescriptions.
At that time, one of our teachers, who taught the aforementioned method, alluded to a small book of medical matter that she held in her hand, and affirmed that her father (the founder of the school) was very successful in his prescriptions thanks to that work. At that time I paid close attention to that book and wrote down all the details of the reference on a small piece of blank sheet. Time later, I began to read it and I realized that it was a medical matter that contained symptoms that were called “Keynotes” (Key symptoms) … something completely removed from the logic of Kent.
Once I graduated, I decided to create a flowchart, which I organized based on the information contained in this work and some others that contained Keynotes symptoms. I arranged in different divisions corresponding for example to the locations, circumstances, Mentals, Sensations, Modalities, and many others. It took more than a year to finish ordering ALL the symptoms in this work.
While I was doing the work I was impregnated with the keynote symptoms of this little book which I read and reread no less than 6 or 7 times, while my effectiveness rate improved day after day. It drew my attention that at some point the author quoted a certain Boenninghausen, at that time someone unknown to me, but as I divided my flow chart I began to realize that Keynotes were nothing other than COMBINATIONS of one location + one modality, or of a sensation with a modality, or even in some occasions, of a location with a sensation. For this reason, a little later I decided to get a copy of the Therapeutic Pocket Book (TPB), version 1846 of Boenninghausen.
During the time I tried to use this copy, an English version, the truth is that I was very confused to use it; I did not have a clear idea of how to use it, and I was not familiar with it either. Most of the time, I used my flow chart, and to a lesser extent Kent’s repertoire to consult some rubric. However, although the effectiveness rate had increased markedly (say 20 to 50-60%), I still felt dissatisfied with the result.
One day, there comes one of those moments that you think you are not going to touch, and one of my children begins to get sick of the skin (Dermatitis), coming to present on one occasion Ritter syndrome (a disease caused by golden Staphylococcus) . Despite all my efforts, both in my diagram and through the use of Kent ‘s repertoire, only Rhus – T was thrown at me , which was in accordance with the recommendation of several international homeopaths whom I had asked for an interconsultation. If anything, the recommendation was made to use Sulfur as an alternative. Anyway, frustratingly these remedies did not give the desired result.
It is then, that after having read some of his dissertations, and astonished by the content of them, appears on the scene Dr. Gary Weaver, President of the Institute for Homoeopathic Medicine, who selflessly and making use of his knowledge and expertise in The TPB, helped me with my son’s case. He told me that my conclusion of Rhus-T through my tools was logical and even close to the diagnosis, but that in reality the remedy was Sepia . Little convinced of his diagnosis, I followed every step in his prescription. The result that would come shortly after would be surprising; and a couple of remedy changes along the way would be enough to solve the case completely.
Thus through this excellent homeopath I acquired knowledge really Hahnemannian method and I realized the great favors a good tool offers ( e s for this reason that translated the TPB of Polony & Weaver Spanish ). Today, Dr. Gary Weaver is still the person to whom I consult when I have problems in the family. Recently, another of my loved ones almost died (literally) from a kidney problem, and once I learned that when emotions are mixed, it is better to consult a colleague, he gave me an example of the success obtained when using a good tool in the correct way.
During this learning process, I understood that in those combinations that I observed during the construction of my flow chart, the Keynote symptom was always made up of a part that was very consistent in the proving, and of another that was shared by few remedies ( as I now know that Guernsey claimed), and that most came from the Therapeutic Pocket Book of Boenninghausen. But I also realized that the TPB is built by the abstraction of symptoms from the provings and that it has the quality of being able to be used in order to recombine by analogysymptoms to obtain an infinity of combinations that have never even been seen before in a proving. That’s why we can deduce, that many combinations were out of those Keynotes. Therefore, it is also important to mention that this process of abstraction and recombination during the taking of a case has a specific methodology, which makes this repertoire a unique and indispensable work.
Nowadays I use the Boenninghausen repertoire most of the time in my daily practice (95%), sometimes I consult my flow chart (4%) and very rarely (Kent’s repertoire) (1%). My effectiveness rate has been increasing, from 85-95%.
You may ask: Is it possible to succeed using Kent’s repertoire? The answer is YES, but with a certain margin of error, and as long as we have an acceptable knowledge of Pure Materia Medica (and EC), we know what rubrics to use and what is the true method to take a case according to the Hahnemann guidelines. , who until now has only been misinterpreted and little investigated by most of the schools, even those that advertise themselves as very “Hahnemannian”. On the contrary, it is rare school that comes to support a seminar like ours, unique in its kind. What has happened is similar to the game of the “decomposed telephone” where a message that is given at the origin arrives completely distorted to the last receiver. By then, when we arrive with an apparently “new” message, but that simply was NOT taken into account (or was not known about it), interests are affected (school programs, homeopathic software, books, seminars, “dubiously experienced remedies that are for sale”, ie laboratories, etc. ) and then it seems that Hahnemann becomes repulsive to the “affected”, or in the more measured of the comments it is said that “Hahnemann and Boenninghausen are outdated”, as if science was a matter of fashion, and even more serious, as if they had been studied and researched. In short, that same conflict of interest in the BIG PHARMA (pharmaceutical industry) by which the homeopathic community tears so much of its clothes, is the same problem that you have at home. homeopathic software, books, seminars, “dubiously experienced remedies that are for sale”, ie laboratories, etc.) and then it seems that Hahnemann becomes repulsive to the “affected”, or in the more measured of the comments it is said that “Hahnemann and Boenninghausen are outdated”, as if science were a matter of fashion, and even more serious, as if they had been studied and researched. In short, that same conflict of interest in the BIG PHARMA (pharmaceutical industry) by which the homeopathic community tears so much of its clothes, is the same problem that you have at home. homeopathic software, books, seminars, “dubiously experienced remedies that are for sale”, ie laboratories, etc.) and then it seems that Hahnemann becomes repulsive to the “affected”, or in the more measured of the comments it is said that “Hahnemann and Boenninghausen are outdated”, as if science were a matter of fashion, and even more serious, as if they had been studied and researched. In short, that same conflict of interest in the BIG PHARMA (pharmaceutical industry) by which the homeopathic community tears so much of its clothes, is the same problem that you have at home. or in the more measured of the comments it is said that “Hahnemann and Boenninghausen are outdated”, as if science were a matter of fashion, and even more serious, as if they had been studied and really researched. In short, that same conflict of interest in the BIG PHARMA (pharmaceutical industry) by which the homeopathic community tears so much of its clothes, is the same problem that you have at home. or in the most measured of commentaries it is said that “Hahnemann and Boenninghausen are outdated”, as if science were a matter of fashion, and even more serious, as if they had been studied and really investigated. In short, that same conflict of interest in the BIG PHARMA (pharmaceutical industry) by which the homeopathic community tears so much of its clothes, is the same problem that you have at home.
In the case of the teachers of the IMH none will teach a personal opinion, nor will teach philosophy, much less dare to tell you that they discovered the black thread or that they are the black thread as many modern gurus who are out there wanting self-proclaimed and that really AFFECT what is most important for a conscious homeopath; to his patients. The IMH teachers will only teach you genuine Homeopathy, as Hahnemann taught it and with which he cured tuberculosis, syphilis, pneumonia, psychosis, diarrhea, etc. etc. etc.
Now; returning to the best homeopath in history (after Hahnemann), Dr. Boenninghausen; I know that what I can say, being a little known person, may not have much value, but it is the same Hahnemann who bears witness to the sagacity of Boenninghausen. Hahnemann considered the work of Boenninghausen as one of the best works as we can see in the footnote number 109 of paragraph 153 in the Organon 6th. Edition:
“Dr. Von Boenninghausen, for the publication of the characteristic symptoms of homeopathic medicines and for his Repertory, has rendered a great service to Homeopathy …”
This repertoire fell into disuse given the popularity of Kent’s repertoire. However, thanks to the research of the Institute for Homoeopathic Medicine team on the original works and materials, it has been possible to elucidate that the Boenninghausen repertoire, specifically the Therapeutic Pocket Book version 1846, leads to the methodology established by Hahnemann himself; this repertoire is in itself, a SYNOPSIS of everything that constitutes case-taking and follow-up. This is reflected in the following testimony of Hahnemann:
“… .Bon von Bönninghausen of Münster has studied and captured my homeopathic treatment system so completely that as a homeopath it deserves to be given full confidence, and if I fell ill and could not help myself, I would not be entrusted to any other doctor . “
… Haehl, R .: Samuel Hahnemann, His Life and Work, 1922, 2 volumes, Indian edition, BJain, New Delhi, 1985, vol.2, p.483.
Only a few schools have made the decision to make a change in teaching, and only a handful of homeopaths have taken the decision in a personal and independent way to align themselves with the instructions proposed by Hahnemann by virtue of compliance with the principle of similar.
Is it too late to restore what has been destroyed?
The IHM is posting a wonderful and informative article by Dr. Guillermo Zamora, MD , Homeopath written in 2010.
As Homoeopathic physicians, we are often asked if usage is made of antibiotics in cases of infection, and I have long held that at times, judicious application of them may be necessary. This article will give food for thought. (Editor G.W.)
It is clear that at Dr. Hahnemann´s times, was unknown the existence of microbial life, however, it seems to be that Dr. Hahemann in some way alluded to the possibility that something else could cause illness. We can see this in the following paragraphs of the Organon:
Paragraph 31, Organon, 6th ed:
“The inimical forces, partly psychical, partly physical, to which our terrestrial existence is exposed, which are termed morbific noxious agents, do not possess the power of morbidly deranging the health of man unconditionally1; but we are made ill by them only when our organism is sufficiently disposed and susceptible to attack of the morbific cause that may be present, and to be altered in its health, deranged and made to undergo abnormal sensations and functions – hence they do not produce disease in every one nor at all times.”
In the next paragraph, Dr Hahnemann refers to the infectious miasmas:
- 78 Sixth Edition
“The true natural chronic diseases are those that arise from a chronic miasm, which when left to themselves, and unchecked by the employment of those remedies that are specific for them, always go on increasing and growing worse, notwithstanding the best mental and corporeal regimen, and torment the patient to the end of his life with ever aggravated sufferings. These, excepting those produced by medical malpractice (§ 74), are the most numerous and greatest scourges of the human race; for the most robust constitution, the best regulated mode of living and the most vigorous energy of the vital force are insufficient for their eradication.1”
Please read the footnote.
“1 During the flourishing years of youth and with the commencement of regular menstruation joined to a mode of life beneficial to soul, heart and body, they remain unrecognized for years. Those afflicted appeal in perfect health to their relatives and acquaintances and the disease that was received by infection or inheritance seems to have wholly disappeared. But in later years, after adverse events and conditions of life, they are sure to appear anew and develop the more rapidly and assume a more serious character in proportion as the vital principle has become disturbed by debilitating passions, worry and care, but especially when disordered by inappropriate medicinal treatment”.
Often come to mind the famous quotes of the famous Dr. Kent:
“I wonder if scientists reflect when they make statements about bacteria. Naturally they would say that the more bacteria the more danger, but this is not so.”
“Save the life of the patient first and don’t worry about the bacteria. They are useless things.”
“The Bacterium is an innocent feller, and if he carries disease he carries the Simple Substance which causes disease, just as an elephant would.”
In this last sentence, I wonder if the bacteria would transport only the simple substance or they are able to carry more than that, for example: Exotoxins.
*Exoenzyme (Taken from wikipedia):
“An exoenzyme, or extracellular enzyme, is an enzyme that is secreted by a cellL and that works outside of that cellL. It is usually used for breaking up large molecules that would not be able to enter the cell otherwise.”
“An exotoxin is a toxin excreted by a microorganism , including bacteria, fungi, algae, and protozoa. An exotoxin can cause damage to the host by destroying cells or disrupting normal cellular metabolism. They are highly potent and can cause major damage to the host. Exotoxins may be secreted, or, similar to endotoxins, may be released during lysis of the cell.
Most exotoxins can be destroyed by heating. They may exert their effect locally or produce systemic effects. Well known exotoxins include the botulinum toxin produced by Clostridium botulinum and the Corynebacterium diphtheriae exotoxin which is produced during life threatening symptoms of diphtheria.
Exotoxins are susceptible to antibodies produced by the immune system, but many exotoxins are so toxic that they may be fatal to the host before the immune system has a chance to mount defenses against it.”
It is according to the last paragraph where I would focus more, overall, to mention some of the most dangerous bacteria or bacterial gender in medicine.
Taken from: “ Microbiología Médica de Volk, 3rd edition.”
- Staphylococcus Aureus:
Gram + bacteria, which produces a light golden pigment, called Polysaccharide A. The ability of these to cause disease depends on its resistance to be phagocytosed and its production of extracellular toxins and enzymes, for example:
Coagulase: This is an extracellular enzyme coagulase-reacting normally present in plasma (perhaps prothrombin) and plasma coagulation by converting fibrinogen into fibrin. The only pathogenic effect has been suggested for this enzyme is covering with fibrin microorganisms to inhibit phagocytosis.
Staphylococcal hemolysins: There are four: Alpha, beta, gamma and delta: It has been shown that alpha toxin, damages the smooth muscle cells and also destroys the skin (it dermonecrotic). It is also toxic to macrophages, platelets, and causes degranulation of PMNs.
Beta toxin is an enzyme that reacts with phosphorylcholine sphingomyelin to separate and further cooling causes cell rupture.
Gamma toxin, produces red blood cell destruction.
The toxin delta: injured a large number of blood cells and the injury apparently is a consequence of the reaction of hydrophobic amino acids in the phospholipids of the cell membrane.
Leukocidin: This toxin is composed of two separable components that act synergistically to cause damage to polymorphonuclear cells and macrophages.
Exfoliatina: This exotoxin, encoded by a plasmid, cause “severe exfoliative dermatitis” (Please see the case at the end); or also called “scalded skin syndrome of Staphylococcal origin”. It is characterized by the formation of wrinkles and exfoliation of the epidermis, resulting in significant loss of fluid through the skin bare. The epidermal sloughing is caused by an exotoxin diffusible, and thus infecting staphyloccocus may be present or absent in the affected skin area.
Staphylococcal enterotoxins: This exotoxin, causes food poisoning characterized by severe diarrhea and committees. Have been described 6 antigenically distinct enterotoxins A, B, C1, C2, D and E. These toxins are not destroyed and can be termoestabiles even if the food is heated sufficiently to destroy viable staphylococci.
Pyrogenic toxins: These toxins intensify the susceptibility to toxic shock (such as that occurs in women using tampons during menstruation) and cause a similar rash of scarlet fever.
Penicillinase: Enzyme capable of destroying penicillin.
- Excherinchia Coli:
- Coli: This produces one or two different toxins, the so-called thermolabile LT and is destroyed by heating at 85 degrees C for 30 minutes, and the thermostable, designated with the letters ST and is not destroyed by heating at 100 degrees C for 30 minutes.
E. Coli causes gastrointestinal infections in a severe way and sometimes fatal in infants. In adults, the infection is known by many names, for example, “Traveler’s diarrhea.” It can cause cystitis, pyelonephritis, abscesses, even sepsis.
So, as these two microorganisms producing lethal exotoxines, there are some more such as the following:
- The Clostridium Genre, for exemple, Clostridium Perfringens , C. Boulinum
- The Bacillus Genre : Bacillus Cereus (Rare and are required high concentrations of microrganisms). Bacillus Anthracis.
- Pseudomona Aeruginosa.
It seems that the quantity in number of bacteria is also important because for this it will depend the amount of toxins circulating in the body
Furthermore, and as I wrote in my article “How could coexist conventional medicine and homeopathy?”:
“III.-Poisons (i.e. bites of venenous animals, intoxications by known chemical substances), : These cases should not be viewed as dynamic diseases, therefore must be treated with the antidote from conventional medicine and / or supportive measures such as dialysis, antibodies filtration and some immunoglobulin used in immunology for blocking of certain toxins”
Now, I would add “And diseases produced by microorganisms producing lethal exotoxines should not be taken as dynamic diseases; therefore antibiotics should be used on circumstances where lethal toxins are endangering the patient´s life”
Of course, I would like to know about cured cases regarding this matter. Kindly, I invite you to share them with me.
This is a staphylococcus skin case of mine which was treated homeopathically for 5 days. A Lycopodium patient, male, 6 years old (Lycopodium the first two days was improving burning pain, itching, drying vesicles).
4 days of evolution (behind left knee)
Behind right knee
After 5 days the patient still was developing new vesicle eruptions and the vesicles that had dried, they were wet again. Furthermore, the patient started to get sloughing and fall of large areas of skin (exfoliation or desquamation) on more than 10% of body surface (As if he were burned). I made several changes: Belladonna (on the third day) and Arsenicum (5th day) … No results. Neither worsening nor improvement.
In this article, I could talk about my successful cases, however, it could be that I had failed (homeopathy never fails), or it could be that there is the need to establish new criteria in order to increase the patient´s safety. I must say that after 5 days, I took the patient to the hospital, and I administered antibiotics against Staphylococcus aureus. Locally, I washed his skin lesions (Three times a day) with soap and water and later I used Cantharis MT (5 drops into a glass water). The patient improved almost 100% in two days, therefore he was taken out of hospital. Doctors were surprised for the quick response and nobody believed that during six years the child had never taken antibiotics, but only homeopathy.
I was recently asked about Phosphorous in eruptions. Specifically I was asked why Phosphorous doesn’t appear in the TPB symptom Eruption, pustules (symptom no. 1426 in P&W Synopsis), when the word “pustule” appears twice in Hahnemann’s proving.
In the proving “Pustules” appears in the following contexts:
431 – Eruption of pimples in the face
432 – Eruption of pimples on both of the cheeks.
433 – Frequent pustules and scurf from suppuration in the face, after the least lesion of its skin.
434 – Rough, red, mottled eruption of the face, slightly elevated. [Ng.].
459 – Burning pain on the red of the lower lip, with white blisters on the inner side of it, with burning pain (aft. 11 d.).
460 – The lower lip is cracked wide open, in the middle.
461 – An itching spot on the left lower jaw, he had to scratch it raw.
462 – Itching of the upper lip, with pain after rubbing.
463 – Swollen upper lip, every morning.
464 – Eruption on the red of both the lips, at times with stitches.
465 – Pustules on the commissures of the lips.
Trawling through Merriam Webster revealed that although pustules usually refer only to blister-like eruptions, and not always to pus filled ones, it is often used interchangeably with pimples, used to imply a more impressive presence of the eruption.
So bearing in mind that when looking through provings we are dealing with several levels of translation – from sensation to words in German, from words of the prover to Hahnemann’s collated and edited proving in German, and from Hahnemann’s German to modern (fairly) English – we probably have to include pimples in this. This is P&W’s footnote on the TPB rubric:
 Pustules, any type of skin eruptions, which elevate over the skin and can be filled either with pus or pus-like fluid and form crusts that may or may not erode the skin.
Why have I put you through so many pimples and pustules? Because this kind of question is why so many people miss the point when starting to work with the TPB.
The TPB is essentially a practical manual, a guide to materia medica. It reflects how Boenninghausen used the provings in his clinic, how he searched for information and how he deduced the symptoms to use and the remedies to investigate.
So you may be dealing with pimples. Or pustules. Or pimples which are turning into pustules. In the case I was asked about, the practitioner seemed fairly sure of the Phosphorous for the other symptoms, but found the absence of the remedy in pimples gave him reason to hesitate.
In such cases the issue is not whether the eruption is a pimple or a pustule. The issue is far more about the nature of the pimple/pustule.
– Is it crusted?
– Is there fluid in the pimple/pustule?
– Is there a colour, a texture, a smell?
– Is there pain on touching?
– Is there constant pain, and what is its nature? Burning, aching, stitching?
– Is the patient crippled with embarrassment about the pimple/pustule, much more than usually?
– Is it before/during/after menses?
– Is it after binge eating?
Do you see where I’m going with this? The remedy will become clear not from the question “what is it, pimple or pustule?” but from all the other questions. To remind you of Boenninghausen’s questions:
Quis – Who is the patient, what does he do, what’s his usual state of health
Quid – What is the complaint – sensation
Ubi – Where is the problem – location
Quibus Auxilibus – with what/concomitants
Cur – Why, trigger, maintaining causes
Quomodo – Modalities, aggravations and ameliorations
Quando – Time modalities, occurrence, aggravation and amelioration.
My main point here is that learning to work with Boenninghausen means learning to think very differently about symptoms and case-taking. If you’re starting out with Boenninghausen from a Kentian background – as I did – looking for rubrics can feel like hunting for a tooth which has been pulled out. You will not find the rubric you’re looking for if you’re searching for Face, eruptions, cheeks, pustule, yellow, excoriating. If you’re lucky – as you will be here, you will find Face eruptions cheeks. And you’ll have to look for the rest step by step – Eruptions yellow, eruptions excoriating, pustules (and pimples). My preference is to look more for the smell, the color, the modalities – and then once I’ve narrowed things down to several remedies, to search for the other qualities through the reversed materia medica and through the proving itself.
The more I read the writings of modern day homoeopathic ‘experts’, the more I realise that we cannot trust in their utterances. A simple thing like translating Boenninghausens Therapeutic Pocket Book from German to English by Allen was mangled. First by the grading system, then incorrect English translation of the German rubrics, and finally by the addition of extra remedies in a manner in which did not reflect the accuracy of the carefulness of grading the symptoms.
It is always best to go to source in order to establish the accuracy of the situation. Here is Boenninghausens own words in the preface to the 1846 edition.
“On account of the large number of remedies, under nearly every rubric, it has been thought indispensable, on account of both the above-mentioned objects, to distinguish their relative values by means of various types, as I have done in my former repertories, and which Hahnemann has repeatedly shown to be necessary. So, throughout the whole work, there will be found five classes distinguished by the type, of which the four most essential ones are in the first division,
Mind and Disposition, under the rubric ” Covetousness,” which may serve as an example. The word Puls, in spaced Italics, occupies the highest, most prominent place. After this follow, in descending order, in simple Italics, Ars. and Lyc, as less important, but still especially distinguished by the characteristics of the remedies as well as by practice. Of a still lower order are the spaced Roman letters in N a t r. and S e p., and in the last rank will be found Calc, printed in Roman letters not spaced. The fifth place, the last of all, contains the doubtful remedies, which require critical study, and which occur most seldom; these are enclosed in parentheses”.
Logic: Why would Boenninghausen include a grade for doubtful remedies? Doubtful remedies can not be graded for usefulness. Why did he state that The four most essential remedies are in the first division?
Further investigation from the handwritten copy of the 1846 printers edition, shows clearly what is meant. The underlining system was like this. Grade 1, no underline. Grade 2, one underline, Grade 3, 2 underlines. Grade 4, 3 underlines.
Further, 20 year later in the reprint, Boenninghausen removed the remedies in paranthesis and left the main work intact. One can only assume that the original parenthesis remedies were included for further study and research. NONE were added to the repertory.
Other homoeopaths of the time acknowledged the grading system. Hering for one.
Herings foreword to His Guiding Symptoms.
Is the same as that in the “Analytical Therapeutics” and in the “Condensed Materia Medica.” A more complete and concise review of the arrangement will precede the Repertory, which is to follow close upon the last volume of this work.
To facilitate the study of the relative value of symptoms, four marks of distinction have been adopted, “Text, Text, Text, Text”, which correspond to the four degrees in Bœnninghausen’s Repertory….”
There is no more to say.
A few words written here to offer direction from Hahnemanns instructions to us. In the previous article written by Boenninghausen, https://instituteforhomoeopathicmedicine.wordpress.com/2017/06/25/the-choice-of-remedy/
it was pointed out one of the commonest mistakes made in case analysis, is the incompleteness of taking the symptoms.
In our clinic recently, a similar set of circumstances arose in a particular case, and we agreed on a remedy that presented in every way to a similimum. However….. Even though the remedy chosen fitted well, Manuel said to me, ” you have that unconvinced look again” and so we reviewed the case over, asking more questions. We found a modality that we had missed and one which WAS the key to the case.
There is an issue that faces all homoeopaths. That is one of taking an accurate and complete notation of all the ALTERED symptoms of the disease state present. A brief look at what is required:
He begins a fresh line with every new circumstance mentioned by the patient or his friends, so that the symptoms shall be all ranged separately one below the other. He can thus add to any one, that may at first have been related in too vague a manner, but subsequently more explicitly explained.
When the narrators have finished what they would say of their own accord, the physician then reverts to each particular symptom and elicits more precise information respecting it in the following manner; he reads over the symptoms as they were related to him one by one, and about each of them he inquires for further particulars, e.g., at what period did this symptom occur? Was it previous to taking the medicine he had hitherto been using? While taking the medicine? Or only some days after leaving off the medicine? What kind of pain, what sensation exactly, was it that occurred on this spot? Where was the precise spot? Did the pain occur in fits and by itself, at various times? Or was it continued, without intermission? How long did it last? At what time of the day or night, and in what position of the body was it worst, or ceased entirely? What was the exact nature of this or that event or circumstance mentioned – described in plain words?
We did not examine each symptom and COMPLETE the location, the sensations and the modalities. In my clinical experience, it is the modifying factors of a symptom that give the leading clues to the correct remedy. I make it a practice to NOT IGNORE ANY SYMPTOM IN ITS ENTIRETY as it may prove the key to remedy selection.
You may find that a single modality present in each symptom MIGHT becomes a general symptom of the case. Without having each symptom itemised into its components, There is no accurate case to prescribe for. You may find that a modality is singular to a particular symptom, and on that basis alone is key to the case. I often hear inexperienced prescribers say that they dont like to use rubrics that narrow down the list of remedies too early in case “they miss something”. I personally look for symptoms that CANNOT be ignored and have but few remedies in them.
We will look at this logically.
A known infecting agent will produce a known set of pathological symptoms. By virtue of this knowledge, a name can be given to the disease state, and expressions of that disease will be exhibited in the patient so that, for example, measles can be diagnosed as the “Disease”.
A patient before us has a known disease. This disease has symptoms of
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z.
Not all symptoms will be exhibited in the patient. Our patient for example, will present E J K P V W X Y and Z. However, the collection of these symptoms is the descriptor for the named disease.
So we look at the exhibited symptoms that the patient presents, and note (for example) the Fever, the skin eruptions and the feeling of Nausea.
We start with examination of HOW the fever affects the patient. Is it hot? cold? is it followed or accompanied by perspiration? Is there a time modality? Is it worse for covering or uncovering? What affects it? Is it better or worse from heat? etc etc.
We look at the skin symptoms and examine each and every eruption, location, modality etc.
We look at the Nausea and do the same.
From this we can conclude that Hahnemann fully accepted that the illness was due to infection, but that the reaction to it IS INDIVIDUAL TO THE ORGANISM INFECTED. On this basis, we must keep in mind what is common to the infection and NAMED disease symptoms, and YET peculiar to the individual…….in their individual expression, from which we can elicit the prescribing symptoms for a remedy match.
The choice of the remedy in any concrete case of disease can not be made too carefully or too cautiously. No less in the healing art than in morals, the motto holds good: “Bonum ex omni parte, malum ex quorumque defectu.” Many failures occur, especially with unpracticed beginners, because in examining the symptoms the one or the other was overlooked. Even with the older and more experienced homeopathic physicians, especially such as are very busy, such an occurrence occasionally takes place. (Boenninghausen)
Never be afraid to re look at a case that is not resolving. Of such a case Boenninghausen wrote:
“………But I was cruelly and painfully disappointed when the patient after this period appeared before me, for he was not improved in any respect; on the contrary, his sickly appearance and the threatening redness of the cheeks had increased and the feverish symptoms had been suspiciously augmented. In the meantime the remedy had been used exactly according to my directions, and nothing had been overlooked either in diet or in his mode of life. What then had been the reason for my total failure? Under such circumstances the only reason could be the defective or incorrect examination of the symptoms, so I went over them again carefully, one by one.”
A Contribution to the Judgement Concerning the Characteristic Value of Symptoms
By Clemens Franz Maria von Boenninghausen
It is now over three years since the great Homoeopathic Congress was held in Brussels, Germany being, I am sorry to say, but little represented. In the last session of this meeting after several propositions had been read, my resolution was adopted and a prize-question was proposed, to answer which a period of two years was granted. This prize essay, as the Homoeopathic journals have also made known, was intended to call out a “Treatise concerning the greater or lesser (characteristic) value of the symptoms occurring in a disease, to aid as a norm or basis in the therapeutical selection of the remedy.” The answer to this question was not limited to Belgium or to France, but it was handed over to the competition of the whole medical world, and it was thus unanimously acknowledged to be a subject of the greatest importance. Nevertheless, this question, in spite of the daily increase of the homoeopathic literature, has thus far remained unsolved. This silence extending far over the time set, which was computed liberally enough, seems to justify the assumption that the solution of the question has met with considerable difficulties, though every homoeopath must every moment find himself in the position to ask himself this question, and to have to answer it. It might not appear altogether proper for me, the author of the question, to also now enter among the competition for this prize. But the old practitioner will be pardoned for furnishing at least some contribution to the solution, and thereby again calling attention to the question.
The teaching of the Organon in this matter really contains the proper, true kernel of the answer, and this, of course, deserves to be first premised. It is found in the great Paragraph No. 153 (5th Ed.) and is as follows:
In seeking for the specific homoeopathic remedy, i.e., in this juxtaposition of the phenomena of the natural disease and the list of symptoms of the medicines, in order to discover a morbid potency corresponding in similitude to the evil to be cured, the more striking, particular, unusual and peculiar (characteristic) signs and symptoms of the case should especially and almost solely be kept in view; for there must especially be some symptoms in the list of the medicine sought for corresponding to this, if the remedy should be the one most suitable to effect the cure. The more general and indefinite symptoms, such as lack of appetite, headache, weariness, disturbed sleep, uncomfortableness, etc., in their generalness and undefinedness deserve but little attention, unless they are more especially pronounced, as something of such a general nature is seen in almost every disease and in almost every medicine.
It is seen, however, that it is here left to the physician to judge what is understood by the “more striking, particular, unusual and peculiar” symptoms, and it might, indeed, be difficult to furnish a commentary to this definition, which would not be too diffuse and, therefore, easily understood, and on the other hand would be complete enough to be properly applied to all these cases. Whence is it that we are unable to show any such definition in our literature? Even what Hahnemann adduces in §86, and those that follow, only contains some examples which are given without any systematic order, and are therefore but little suited to impress themselves on the memory, a requirement which in all such matters must appear to be of very great importance.
After looking about in the whole of the medical writings, allopathic as well as homoeopathic, for an aid, I remembered that in the middle ages they were accustomed to bring all such matters into the form of verses, in order that the memory might thus be assisted. The modern learned world knows, e.g., the diet of the Schola salernitana, dating from the beginning of the twelfth century, drawn up in leonine verses, as is supposed, by a certain John of Milan, from which some parts are quoted even to this day. But though I did not find here anything for the present purpose, I yet found something which, as it seemed, might prove useful with writers of quite a different doctrine. There is, namely, a hexameter dating from this same period but from the theologic scholastics; this is, indeed, of a somewhat jolting construction, nevertheless it contains briefly and completely the various momenta according to which a moral disease is to be judged as to its peculiarity and grievousness. The verse is the following: “Quis? quid? ubi? quibus auxiliis? cur? quomodo? quando?“
The seven rubrics designated in this maxim seem to contain all the essential momenta which are required in the list of the complete image of a disease. May I be allowed, therefore, to attach my remarks to this scheme, with the desire that this hexameter, which was formerly used only by theologians, may now be also impressed on the memory of homeopaths and be put to use by them.
As a matter of course the personality, the individuality of the patient, must stand at the head of the image of the disease, for the natural disposition rests on it.
To this belongs first of all the sex and the age; then the bodily constitution and the temperament; both, if possible, separated, according to his sick and his well days i.e., in so far as an appreciable difference has appeared in them. In all these peculiarities whatever differs little or not at all from the usual natural state needs little attention; but everything that differs in a striking or rare way therefrom deserves a proportionate notice. The greatest and most important variations are here found mostly in the states of the mind and spirit, which must by scanned all the more carefully, if they are not only sharply distinct, but also of rare occurrence and, therefore, correspond to only few remedies. In all such cases we have all the more cause to fathom these states with all possible exactness, as in them frequently the bodily ailments recede to the background, and for this very reason offer but few points for our grasp, so that we may be able to make a sure selection among the remedies which compete.
Paragraph 104 of the Organon makes it a duty of the homoeopath to make a written scheme of the image of the disease, and whoever has once acquired a certain facility in this will easily know how to satisfy this requirement and gradually acquire a certain specializing penetration, which will prove to him of ever increasing usefulness. For as every man presents an individual nature different from every other one, and as every medicine must be exactly adapted to this individuality, in agreement with the symptoms, which it is able to produce in the total man, so, an once, at this first investigation as to the Quis? A great number of medicines are thrust aside, just because they do not correspond to the personality of the patient.
The spiritual and dispositional individuality of the patient here gives the most important, often almost the only deciding points for the selection of the remedy, where the disease involved is one of the mind or spirit, and generally the two disturbances present themselves so conjoined into one that the signs of the one only receive their full and definite character from the other. Hahnemann, indeed, recognized the importance of this two momenta from the beginning, but the necessity of weighting the two in their connection with one another he only recognized later on it its full measure; and he then placed the symptoms proper to the two, which in the first provings had been separated, one making the beginning and the other the end, in the “Chronic Diseases” immediately one after the other, an improved arrangement, which we also find in the best works on Materia Medica Pura of later times.
Many other things belonging to this rubric, but concerning the bodily individuality and presenting, as it were, the chief features in the portrait of the patient, are contained in those books under the heading of “general.” It would be desirable and would greatly facilitate the use if everything not pertaining thereto should be excluded, and the former be brought under a particular rubric denominated either “Individual” or “Personal,” in such a way that the corporeal would present a separate picture, as has been done with respect to the spiritual and mental.
Of course this question refers to the disease, i.e., to its nature and peculiarity.
It may be unquestionably received as an axiom that we must first know an evil accurately before we are able to give any effectual aid against it. That occasionally relief may be given, without having first recognized the nature of the evil, as little refutes this axiom as the fact that an unexpected event occurs frequently which lies outside of our computation, and which either leads to good or evil, while neither the good will, nor the knowledge of the physician have the least to do with it.
But this axiom must be associated with another, which is no less true and no less important, namely this: That we must also know and possess the means which are able to relieve the evil when it is recognized. Where these are lacking, the former are of course of no avail.
Since the times of Hippocrates, thus since more than two thousand years, very much has been done with respect to the first point, and we have especially enjoyed a great progress and enlightenment within the last century and up to modern times. The path of pure observation and experience, which for a time had been pretty much forsaken, and on which that ancient Father of the healing art had gathered his valuable material, has again been entered upon. At the same time our contemporaries possess and use the great advantage enuring to them from the fact that they stand on the shoulders of their predecessors, and can thus view a greater circle of vision and, more especially, that astonishing progress has been made in all the subsidiary sciences, especially in chemistry and anatomy; so also they have had the advantage offered them by many physical instruments, which it must be confessed they have used with industry and care. By these means the modern physiological school, and, at the same time, the diagnostics of diseases, have reached an excellence not attained in earlier times.
The only thing of which every Homoeopath has to complain in this matter, is that things are conducted in too general a manner for his doctrine, and that almost universally diseases are described and treated of under the same name, which differ essentially in their nature, and require for their cure very different medicines.
An immediate result of this failing is, that Homoeopaths can make only a very limited use of the great advance made by the dominant school in diagnostics, since their generality excludes every special direction as to the suitable remedy.
Now since the modern Materia Medica of allopathy, as well as the older one, moves in the same generality, the conclusion follows almost inevitably that even the most cultivated allopath often stands undecided when he is to make a choice of remedies, so that almost every one of them will order something different, and that he is usually compelled to mix many thins together in order to cover the various indications.
More about this will be found in the course of this short treatise in a more suitable place, where the other questions are also discussed. Here I can only say so much about it.
a. That the most penetrating and most indubitable diagnostic as offered by the best allopathic manuals is rarely of ever sufficient for the Homoeopath, so as to enable him to make a sure selection of the remedy, and that
b. Such a diagnostic at most, and even then not always, may serve to exclude all those remedies from the competition which do not correspond with the common genius of the disease, but seem to act chiefly on other parts of the organism.
The seat of the disease really makes a part of the former question, but it nevertheless deserves to be more particularly emphasized, as it frequently furnishes a characteristic symptom, since almost every medicine acts more and also more decidedly on certain particular parts of the living organism.
These differences not only enter into consideration in certain so-called local diseases, but also in those diseases which are called by more general names, as affecting the whole body, e.g., gout and rheumatism. For it is probably never or very rarely the case that all parts of the body are affected in the same degree; even if it should be merely the case that the right side is more affected than the left or the reverse. But the examination of the parts affected is most necessary and most required when the whole to which they belong is larger, and is described merely in that general way which allopaths seem to delight in. Such names as headache, eyeache, toothache, colic and the like can in no way contribute to a rational choice of a remedy, not even when also the kind of pain is indicated.
Of course, the exact individualization of the ubi is most necessary in local ailments. Every Homoeopath knows from experience how necessary it is, e.g., in treating toothache, to select a remedy which in accordance with its provings on healthy persons has shown its action on the especial tooth to be treated. Among the most striking and decisive phenomena in this respect we should especially number the sores on the upper side of the joints of fingers and toes, which under allopathic treatment frequently prove very obstinate, and not infrequently become malignant, and necessitate an amputation, and, as I had an opportunity of witnessing here in two cases, may even have a fatal result. Every Homoeopath knows the efficacy of Sepia in these ulcers of the joints, which have no otherwise distinguishable features when this remedy is taken internally; without any external medication it will have a sure effect. Medicines which correspond to similar ulcers on other parts of the body in such cases are utterly useless.
If the practice of auscultation and percussion, as well as the use of the stethoscope, the plessimeter, etc., had been as well known to Hahnemann and his pupils as to our young physicians, they would no doubt have made the most extended use of the same for gaining a more exact knowledge and delimitation of interior ailments. They would have found out in lung troubles, e.g., definite local signs pointing to the use of certain remedies, and would have indicated them more accurately, and would not have limited themselves to defining them as being on the left or on the right side or at the top or below. To bring up to date and to specify more closely might be one of the chief duties for those who make additional provings at the present time, and might serve to an important and essential enrichment and completion of our Materia Medica more than a whole mass of confirmations of older symptoms or the finding out of new ones, which mostly have a lack of individuality.
At the same time it will be conceded from the allopathic side that the closer delimitation of the part affected, even though it may be of moment in the completion of the diagnosis, will be of no use to allopathic therapy, because this school is unacquainted with the peculiarities of the various medicines. No allopathic Materia Medica gives any information that the one remedy, e.g., corresponds more to the anterior or the posterior lobe of the liver, more to the upper or the lower part of the lungs, on the right or the left side, according to which the choice of the remedy may be made. Even if we Homoeopaths do not as yet know this as to all remedies, we do know it with respect to many of them, and for what is lacking we find a substitute in other signs, since, as is well known, all of these correspond to the remedy to be selected, at least they must not be opposed to it. Thence it may be seen that these new inventions, the value of which I am not in any way inclined to undervalue, have far less value in a therapeutic direction than in prognosis, where they show the extent and the dangerous nature of the malady.
Finally, we must yet consider in this question that neither the internal changes, which can be determined by these instruments, nor the material external changes, which manifest themselves openly to our notice, never present the dynamic disease itself, but are only its products, and are only developed in the course of the disease. When, therefore, these first beginnings are checked by the suitable remedy before those disorganizations take place, then these latter would not come to be developed, and it would be an inexcusable procedure to allow these sufferings to advance to a point where these material changes can be recognized in an artificial manner. It was necessary to mention this, in passing, in order that it may be shown how Homoeopathy proceeds, and to deny most decidedly the objection sometimes made that Homoeopathy is merely an expectative method, which allows the disease to develop without hindrance until it is too late to help. On the contrary, Homoeopathy knows and uses in infections diseases sure prophylactic remedies, which are always and exclusively such as have the power to heal the disease itself, and they never omit their use for the protection of those around the patient.
4. Quibus Auxiliis?
If the hexameter which we are following had been originally written for our doctrine, probably a more suitable expression would have been used in this instance, e.g., quibus sociis or quibus comitibus? Still the name does not matter, and it is manifest that it must refer to the accompanying symptoms.
Now since in Homoeopathy the chief aim consists in ascertaining the remedy which most completely corresponds to the totality of the symptoms, it is evident that this point is of the greatest importance and deserves the most careful consideration.
For every disease presents in its recognizable phenomena a more or less numerous group of symptoms, and it is only their totality which presents its complete image. This image may be compared to a portrait, which can only then claim to be a striking likeness when all the features of the original are faithfully presented in it. It is not sufficient that mouth, nose, eyes, ears, etc., should be presented in such a manner as characterizes man, and distinguishes him from the monkey and other animals but as every human physiognomy possesses its peculiarities and is distinguished from every other, so also here the more or less strongly pronounced abnormalities must most carefully and with the greatest faithfulness and truthfulness be presented and given their prominence. If therefore, retaining our former comparison, the nose should have a most peculiar form, color or size, it would not be sufficient to present this alone, though it should be most lifelike, and to add all the rest according to fancy, but also the secondary parts, which, as it were, form the background, must present a whole, such as it exists in reality, in order to give a perfect likeness.
It is from this point of view that the concomitant ailments are to be regarded when we select a remedy according to the motto: Similia similibus. Thence it is evident that the rare, striking and peculiar symptoms which present themselves demand a more prominent place than the common ones, because on them chiefly though not exclusively the similitude depends.
From this it naturally follows that the value of such concomitant symptoms for the purpose intended varies widely. But it would too far transcend the purpose of this contribution if I should adduce and explain all the many categories of value. I shall therefore limit myself to the presentation of a few of the most important points here involved:
First of all, those symptoms which are found in almost all diseases may be left out of our count, unless they manifest themselves in a striking manner.
The same obtains as to those ailments which are wont to appear as constant concomitants or at least as usual in the disease under consideration, unless they should be distinguished by some rare peculiarity and in this respect offer something characteristic.
On the other hand, all those attendant symptoms should be carefully noted which (a) rarely appear in connection with the leading disease, and are, therefore, also found rarely among the provings; (b) those which belong to another sphere of disease than the chief ailment, and (c) lastly, those which have more or less of the characteristic signs of one of the medicines, even in case they have not before been noticed in the present juxtaposition.
Now if besides this among the last mentioned concomitant symptoms there should be one or another in which the genius of one of the remedies should be plainly and definitely portrayed, so that it would be plainly pointed out, this one symptom thereby would acquire such an importance that it would even outweigh those of the chief ailment, and many then be at once considered as the most suitable. Such a symptom would be included among those which Hahnemann calls “striking, strange, unusual and peculiar (characteristic) signs,” and which are then “almost alone to be considered” because they preeminently give to the whole disease its individual character.
One circumstance deserves to be particularly mentioned here which particularly shows the importance and value of concomitant symptoms, namely, that several very efficient and in part specific remedies in certain diseases were discovered almost exclusively through them, the other symptoms indicating the main disease not having pointed in that direction, nor indeed could they have given such an indication, because the noticeable proximate signs could not sufficiently indicate the real peculiarity of the disease. This same system of concomitant symptoms also gives to Homoeopathy a much greater sureness in the treatment of diseases as compared with Allopathy, which first constructs for itself a frequently deceptive diagnosis of the disease, which at most only points out the genus of this disease, and where there are important attendant symptoms it endeavors to help itself by adding to the leading remedy given for the genus of the disease one or another remedy to cover the concomitant ailments.
Why? The causes of the disease play a prominent part in pathological books, and justly. But a large part of this amounts only to guesses and attempts at explanation, which mostly have only a very subordinate value or none at all in the proper therapy of the disease, and which are too remote for our doctrine which is directed merely to the practical.
The causes of diseases are most generally and, indeed, very properly divided into external and internal.
The internal causes properly refer only to the general natural disposition, which in some cases amounts to a peculiar supersensitiveness (idiosyncrasy). The external causes or occasional causes embrace everything which, where there is such an internal disposition to disease, may produce disease.
The general natural disposition which is also called the proximate cause, really belongs to the first question (Quis?) which respects the individuality of the patient. It only belongs here in so far as the consequences of a former disease may have modified the original natural disposition, and thus it deserves mention.
The occasional cause, however, is the matter with which the present question occupies itself and which deserves to be more closely considered. As to the natural disposition notified through previous diseases, this either depends on the miasmatic-chronic nature of those diseases as yet unexterminated, among which in agreement with the teachings of Hahnemann many homoeopaths even at this day count psora, syphilis and sycosis, or it is derived from the remains and after-effects of acute diseases, which when they do not belong to the former, as is frequently the case, constitute the numerous class of medicinal diseases or poisonings. Not infrequently, however, we meet with cases where both these momenta have cooperated to undermine the natural health, thus producing a monster of a disease which is even more deeply in-rooted and more difficult to combat.
As to the recognition and treatment of the first mentioned miasmatic diseases and their complications, Hahnemann himself in his masterly work on the Chronic Diseases left us the most complete directions, founded on many years’ experience. The much disputed division of medicines into antipsorics and non-antipsorics need not be considered here. It is enough to know that the former far excel the latter in their effectiveness in chronic diseases, and that their originator has nowhere excluded them from use in acute diseases. Later experience has also taught us that additional medicines from our medical treasury should be numbered in this category which have not been thus treated of in that excellent work. I am only sorry that Hahnemann has not been able to fulfill the promise which he gave me in writing, that he would treat as thoroughly and completely the images of syphilis and sycosis with his accustomed mastership as he had done in the above mentioned work (Vol. 1, p. 58 f. of the Second Ed.) with respect to latent and re-awakened psora. Whether we may believe in what many somewhat derisively call Hahnemann’s Psora-theory, or reject the same, the attentive practitioner must frequently have found cases where even the remedy chosen with perfect correctness, in some acute disease, did not unfold its proper and decided effect before one of the so much criticized antipsorics – frequently Sulphur – had first been used, when psora had been involved, or an antisyphilitic or antisycotic when syphilis or sycosis had been present before and had remained uncured. It must, however, be confessed to be one of the most difficult tasks of the physician to always make the most suitable choice among the antipsoric remedies, as most of them have almost the same symptoms and very few truly characteristic symptoms are found with the different remedies. The more necessary is it for the homoeopath to study with continuous industry these lists of symptoms and to compare them with each other in order that he may pick up the scattered grains of gold for his use.
Poisonings and medicinal diseases are in one line and it makes no difference by whose hand any one has been deprived of his health by means of a substance injurious to his organism; among these substances medicines as well as poisons find their place. Of course, it is always of the greatest importance to know in every case the medicines or poisons, in order that they may be met by the proper well-known antidotes. The simple poisons may be pretty easily and surely recognized by their effects! It would have required but one case of poisoning occurring before the eyes of a Homoeopath for him bo have recognized the effects of Arsenic, which yet remained unknown to all the allopathic physicians, in the case of the thirty murders of Gessina Timme in Bremen, until the facts were obtained. In the medicinal diseases this is much more difficult, because seldom or never is one medicine given by itself, but always mixed with others; it can not, therefore, yield a clear and definite image. With these, therefore, it is necessary, as in the other case it is desirable, and it facilitates the treatment, if we can have a reliable account of what has preceded, and to be able to look over the prescriptions. Since this may be of use even later on, as the treatment proceeds, the journals of many Homoeopaths have a special rubric reserved for this subject. We must consider these symptoms, called anamnestic, as being of special importance in this question. Although the ordinary consequences of such morbiferous circumstances and events are mostly already contained in the lists of symptoms of the medicines proved on healthy people, yet homoeopathic practice has long ago shortened and made sure the tedious and troublesome path of such investigations, and indicated for most of these cases the remedies which are foremost in their usefulness in such cases. This is e.g., very much simplified in cases of contusions, sprains, burns and the like. In other cases, e.g., in colds, the matter is already somewhat more complicated, since the kind of a cold and the part of the body affected offer differences which again point to different remedies. Thus there is a great difference in this respect as to whether the person has been simply exposed to the cold, or whether this took place while the body was in a perspiration, or if he at the same time got wet through. So also it is well known that different remedies are indicated when internal parts (stomach, abdomen, chest) have been exposed, or merely external parts (head, feet, back), and this must be carefully weighed in every case. All this, as before said, is found among the symptoms in the Materia Medica; but when once it is known that a cold in the head from exposure to cold air, after previously being in a heated room, or after having the hair cut, points to Belladonna or Sepia; after taking cold in the feet, to Baryta or Silicea, and when at the same time there has been a wetting, to certain other remedies, then the attention will first of all be directed to these, and only comparison be made with others which are also occasionally indicated when the first are not sufficiently suitable.
Finally we must yet add a word under this question about infectious diseases, about which in pathological manuals we read so much that is contradictory and unreliable; the influence of which teachings is, however, much more far reaching than is generally supposed. To meet these diseases, which often spread until they become a real calamity, Homoeopathy has the most sure and approved prophylactics, and these, indeed, are the very same which have the power of healing those diseases when they have developed. Therefore, when we find in a family a case of infectious typhoid fever, there the same remedy, which has been given the patient in accordance with his symptoms, will also be sure to protect those in the house from infection, as it destroys the natural disposition thereto, and it will even in the shortest time restore those with whom there may have already been apparent the beginning of the disease. This last fact is the more important, as these first beginnings are usually so poor in symptoms that no certain choice can be founded on them; but the known occasional cause fully makes up for what is lacking. Of course, such a cure is not so brilliant as when the patient has been at the verge of the grave, but the gain for him and the consciousness of the physician is his sufficient reward.
From his etymology, this preposition excellently describes the essence and the scope of the question before us. For the word Modus in the old classics not only refers to the manner and mode in general, but also to all the modifications which can take place in anything, thus the measure, the rule, the aim, the relations, changes, etc.; thus whatever, with the exception of time, which is included in our last question (Quando), possesses the ability to produce a modification, aggravation or improvement with the patient, naturally belongs, according to the usage of the language, to this rubric. This question has a double importance to Homoeopathy, first, because it was first discovered and developed by Homoeopaths, and is, therefore, their indisputable and exclusive property, and secondly, because all the results of provings and experience, without exception, belong to the more or less characteristic signs, of which no one is a matter of indifference, not even those of a negative kind.
Allopathy has never given any general attention, which might have been of use to therapy, to this momenta. At least its manuals on Pathology, Therapy and Materia Medica contain nothing of importance on this subject. Homoeopathy, on the other hand, soon after its discovery, recognized its great therapeutic value, and we find the first but already clear traces of it in Hahnemann’s “Fragmenta de viribus medicamentorum positivis,” which appeared in the year 1805. But during the progressive development of our science its importance appeared more manifest, and it was soon declared to be indispensable, so that in the later provings the attention was more and more directed upon it. On this account the latter provings are the more complete, with the exception of those made by Hahnemann in the Materia Medica Pura, which were elaborated with especial industry and on account of their constant use accompanied with copious notes.
If we compare the lists of symptoms of the medicines which have been proved somewhat fully, even a superficial survey will show that we find in almost every one of them the general indications of almost every disease; headache, colic, pain in the chest, diarrhoea, constipation, as well as dyspnoea, pains in the limbs, fever and cutaneous ailments, etc., are in no case quite absent. But if we study these indications somewhat more closely, with respect to the special parts of the body and the different sensations, then, indeed, differences will appear, and we frequently discover symptoms which appear more or less frequently in one remedy and are totally lacking in another. But the number continues too large to bring the decision to a sure and indubitable point, and we soon feel the need of securing additional points in order that we may find the true and suitable simile among the competing medicines. But the Quomodo with the Quando generally solves the riddle in the most satisfactory manner, and not only removes every doubt, but also furnishes the proof for the solution which we may have before supposed to be the right one. That in such investigations and comparisons we must also, as in what precedes, occupy the especial standpoint, is a matter of course. It is not sufficient, e.g., to merely consider motion in general in contrast with rest in the body, or in the part affected, we must also consider incipient and continuous motion, as well as the different kinds and degrees of motion. The same applies to lying down, we must not only consider the kind of position (on the back, on the side, doubled up, horizontal, etc.), but also aggravation or improvement in the parts affected by lying on the painful part, or the part not painful; all this is to be found out accurately and adapted to the remedy.
Quite a prominent part in this rubric is occupied by the partaking of food and drink, and this not only in diseases of the digestive organs, but also in fevers and other internal and external affections. Here it is not so much the amount of appetite, or thirst, to which also allopathy in some cases gives a proper importance, but especially the dislike or the desire for particular kinds of food and drink, and more especially also the change of condition after partaking of one or another article of food that often gives the most important hints as to the medicine to be selected. All experienced Homoeopaths have therefore always given the greatest attention to this subject, and it is very much to be desired that whatever different persons have discovered in this direction should be collected and published.
It was mentioned above, in passing, that even negative signs, so far as they belong to this rubric, should not be neglected. An example will show best what is meant by this: when a patient, for whose condition Pulsatilla seems suitable according to the five preceding questions, feels best while at rest in a warm room, while he feels uncomfortable in the open cool air, and also is fond of fat foods and bears them well, or offers other peculiarities which are in conflict with the characteristics of Pulsatilla, this would give an urgent cause to doubt the applicability of it to his case and to look for another remedy which also in these points corresponds with the symptoms.
I am sorry that the space for these contributions, which anyways may seem to have been already greatly exceeded, does not permit me to enter more in detail on one and another matter belonging to this division, as I may openly confess that I consider the indications obtained from this and the following question as the most important, indubitable, and therefore the decisive ones for therapeutical purposes. Even the numerous class of reflex actions, almost all of which fall into these two rubrics, do not by their internal contradictions diminish this importance, as soon as we know their mutual value, and are, therefore, enabled to estimate properly the worth of each.
This last question concerns the time of the appearance, of the aggravation or the improvement of the ailments, and follows in natural order after the preceding, and is hardly of less importance in therapy than the last one.
From the time of Hippocrates and his commentators up to our times great attention has been bestowed on the periods of time in the various phases and stadia of the disease. The endeavor has been made to fix the period and continuance of the beginning, of the increase, the acme, the decrease and of the end of the disease. This would, indeed, make a useful contribution to the recognition and the characterization of the disease. But only in case it should be left altogether to itself and not be modified by medical interference. But on the other hand it can not be denied that this cannot give the least aid in the selection of the remedy, if only owing to the fact that the medicines cause disturbances in the natural course of the disease, which frequently lie altogether outside of all computation. Least of all can they be of any advantage to allopathic therapy, because it lacks all criteria from which to indicate the one or the other. I hope that I may not here hear the objection that, e.g., the periodical return of a fever points to an actual or a disguised intermittent fever and therefore indicates Quinine in its various preparations; for we are not likely to find a homoeopath who has not in his practice had to treat numerous victims of this error.
Homoeopathy intends something quite different in this question, having nothing in common with what precedes. But it is concerned with two momenta which have an immediate effect on the choice of the remedies, namely (a), the periodical return of morbid symptoms after a longer or shorter cessation, and (b), the aggravations and alleviations depending on the time of the day. These two will require but a few words.
The periodical return of morbid phenomena often coincides with periods of time which carry with them particular occasional causes. Among these are to be numbered the menstrual ailments, as well as those which are conditioned by the seasons, the weather, etc. Where such definite secondary causes cannot be discovered, and where as is mostly the case, the attacks are not closely bound to any sharply defined periods, they have no therapeutic value for homoeopaths as they lack the quality of a useful indication.
But of the greater importance are the aggravations and alleviations at particular times of the day, and this with respect to those which refer to single symptoms as well as those that refer to the general health. In this respect Homoeopathy possesses a great and valuable treasury of well proven experiences which are being more and more enlarged by careful observations. For there is hardly any disease, from the malignant internal fevers down to local ailments, in which during the different times of the day there does not manifest itself a more or less decided and distinct aggravation or alleviation. Now since homoeopaths have learned these peculiarities also in the various medicines during their provings on healthy persons, they are enabled to make extensive and blessed use of this peculiarity in their therapeutics, and they are obliged to do this in order that they may satisfy the rule Similia similibus also in this respect.
To demonstrate the preceding with some special facts, I will only adduce here the importance which the time of the day has on coughs with respect to the expectoration, as well with respect to the greater ease with which it is discharged, as also the consistence and the taste. Something similar we know about the stools, and although most of the remedies have diarrhoea among their indications, we so far know only of two (Conium and Kali carb.) where this takes place only by day and not by night.
With respect to the ailments which have a typical return, independent of other causes, we have a considerable series of remedies corresponding to this, without on that account excluding others, when they are indubitably indicated by their symptoms. Only in cases where this return is sharply and definitely pronounced, as for example in the evening from 4 to 8 o’clock (Helleborus and Lycopodium), or exactly at the same hour (Antimon. crud., Ignatia and Sabadilla), we should give it a special importance and only be careful that there may be no contraindications.
I conclude these contributions, which I have only hastily sketched down, with the hope that I may have succeeded in putting into the true light the difference between Allopathy and Homoeopathy and to incite my colleagues on their part to treat these important themes more at length, even if this be done only with respect to some one of the questions indicated at a time.