A Homeopathic Student's Introduction To Boenninghausen's Therapeutic Pocketbook

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Homeopathy = Hpathy A Homeopathic Students Introduction to Boenninghausens Therapeutic Pocketbook : Homeopathy Papers : Hpathy.com
AHomeopathicStudentsIntroductionto BoenninghausensTherapeuticPocketbook
PostedByKeithWilsonOnMarch14,2012@1:45pmInHomeopathyPapers|11 Comments
IndependentResearchProject Introduction Studentsofhomeopathyareintroducedtothe repertoryveryearlyintheirformaltraining.This introductionbeginswithanoverviewofthe chapterlayout,inevitablyKentian,andthe organizationalhierarchyofrubricsinthose chapters.Overthenextthreeyearsofstudywe goontofurtherdetailedexplorationsofspecific chaptersandindividualrubrics.Becomingan accomplishedrepertoryuserisalifelong undertaking.Evenwiththeassistanceof computersoftwarerepertoryandmateriamedica programs.Theseprogramsproviderubriccross referencesforus,giveusmastersynonymsand concepts,andallowustosearchtheentire repertoryinaninstanceorquicklygenerate multipleanalysischarts.Mostofusstrugglewithrubricselectionduringourschool yearsallthewhilemakingmarginalnotestoourselvesonwheretofindrubricsfor specificsymptomsandaboutwhichauthorsandrubricsarereliable.Asnew studentswearequicktopickuptherepertory.Creatinganalysischartsgivesusa certainsatisfactionandprovidesourfirsttasteofdoinghomeopathy.Inourhaste
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tobeginproducinghomeopathytherelationshipbetweentherepertoryandthe materiamedicacangoentirelyunexplored.Oncewevebegunsubmittingrepertory chartsforourinschoolcasesweseldomreturntothisbasicissue. Ourintroductiontotherepertorycanincludeageneraloverviewofitsroleincase analysiswithspecificattentiontoitsapplicationandlimitations.Onthissolid foundationwecanthenconstructamoreparticularknowledgeoftherepertorys chapters,therubricswecancounton,theauthorsonwhomwecanalwaysrelyand thosevaluablecrossreferencesthatassociateremotepartsoftherepertoryforus. AsanoffshoottodiscussingBoenninghausensTherapeuticPocketbookIhopeto provideanopportunitytoexploretheplacetherepertoryholdswithintheprocessof caseanalysisandhowwecanmakethebestuseofit. BackgroundtothePocketbook EveninHahnemannsdaytherewasaneedforanindextotheexpandingMateria Medica.Hahnemannhimselfbegantocompilesuchaworkaround1817.His Symptomenlexikonreachedfourvolumesofalphabeticallylistedsymptomsfromhis MateriaMedicaPuraandChronicDiseasesbutwasnevercompleted.Early ongoingattemptsatcreatinganindexduringthe1820sand1830semployeda rangeoftechniquesfromsimplealphabeticlistingofsymptomstomorecomplex arrangementsbasedonthecharacterizationsofsymptomsexpoundedinthe Organon.Theseorderedarrangements,undertakenbysuchnotablehomeopaths asBoenninghausen,JahrandHering,madeiteasiertofindspecificsymptoms. ItwasBoenninghausenwhointroducedthefirstrepertoryofthehomeopathic materiamedica.Thisrepertorywaspublishedin1832andwascalledtheSystemic AlphabeticRepertoryofAntipsoricRemedies(SRA).Withthiswork Boenninghausenintroducedtheuseofrubricstosummarizelengthyproving symptomsandalsointroducedafourtieredremedygradingschemetoindicate clinicalreliability.Itsorganizationwasnolongermerelyalphabetic,beingarranged nowaccordingtothevariousbodyregionsandsystemsfoundinHahnemanns MateriaMedicaPuraandChronicDiseases.In1835thesecondvolumeofthis repertory,theSystemicAlphabeticRepertoryofNonAntipsoricRemedies(SRN) waspublished.ThesetwoworkscomprisethefirstrepertoryofBoenninghausen andformthemodelonwhichourmodernrepertoriesarebased. In1834JahrpublishedarepertorybasedonBoenninghausensSRA.Itssecond
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editionwastranslatedintoEnglishundertheeditorshipofHering.Thisversionlater founditsway,viaLippeandlateronLee,intoKentsrepertory.Thecontentand structureofKentsrepertoryisbasedonHullstranslationofJahrsthirdedition,the workofE.J.LeeandC.M.Bogerspublications.Iwontattempttooutlinethelineage ofourmoderndayrepertoryasthishasbeendonethoroughlybyDimitriadis.1 Boenninghausendidnotceasehiseffortstoconstructarepertorywiththe publicationofhisSRAandSRN.AttheurgingofHahnemann,hesetoutto combinethesetwoearlierworksintoasinglevolumebutgaveuptheendeavour whenherealizedthatitcouldnotbeachievedinamanageableform.Itwaswhile attemptingtheamalgamationofhistworepertoriesthatBoenninghausenrealized theapproachthatwouldresultinhis1846repertorycalledTheTherapeutic PocketbookforHomeopathicPhysiciansforuseattheBedsideandtheStudyof MateriaMedicaPuramostoftenreferredtoastheTherapeuticPocketbook. InitsoriginalformBoenninghausensTherapeuticPocketbookindexedthe126 remediesfromHahnemannsMateriaMedicaPuraandTheChronicDiseases.T.F. Allens1897editionofthePocketbookcontained220additionalremediesand omitted4fromtheoriginalpublicationAngusturaandthethreemagneticremedies (Magnetispoliambo,MagnetispolusarcticusandMagnetispolusaustralis) bringingthetotalto342remedies.Allensadditionsareconsideredincomplete. PartI:AfirstlookatthePocketbook1 Chapterlayoutandrubrics Conceptually,BoenninghausensTherapeuticPocketbookisquiteunlikeKents repertoryandthosemodernrepertoriesdescendedfromit(SynthesisandThe CompleteRepertory).ThePocketbookslayoutisdramaticallydifferenthavingonly sevenchapterscomparedtofortyrepertorychaptersfoundinSynthesis.Thefirst thingthatstrikesyouaboutthisrepertory,asidefromthescantnumberofchaptersit contains,isthatitlackschapterheadingsbasedonbodyregions,somethingthat wehavecometoexpectfromKentsrepertory.WhilethechaptersonSleep& Dreams,Mind&Sensorium,FeverandChangeofGeneralStateseemfamiliar enoughtherearechapterscalledSensationsandComplaintsandespecially ConcordanceofHomeopathicRemediesthatappearcompletelyunfathomable.The remainingchapteriscalledPartsoftheBodyandOrgansandittoohasan unfamiliarlayoutatfirstglance.
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RegionsofthebodycanbefoundlistedinthePocketbookbuttheyappearwithina singlechaptercalledPartsoftheBodyandOrgans.Inthischapteryouwillfind rubricslike:PartsoftheBodyandorgansBackScapulae,PartsoftheBody andorgansEarsExternalear,PartsoftheBodyandorgansLowerlimbs Leglower.TheserubricsarenotunlikethosefoundinSynthesisandcontain subrubricsreferringtomorespecificlocations.Howeverwhatimmediatelystrikes youisthatnoneoftheserubricsreferstoanykindofpainorothersensations:they arerubricsoflocationonly. LookingnextatthePocketbookchaptercalledSensationsandcomplaintswefind rubricslike:SensationsandcomplaintsBonesbandaroundlikea, SensationsandcomplaintsExternalpartsofthebodyandinternalorgansin generaladhesionofinnerparts(sensationas),Sensationsandcomplaints GlandspressingoutwardfromwithinorSensationsandcomplaintsSkin nailsulcerated.Eachrubricdescribesasymptomsensation(subjective experience)oracomplaint(objectiveexperience)butcontainsnoindicationin whichbodilyregionthesensation/complaintoccurred.Theserubricsarerubricsof sensation/complaintonlyandtheyareallgatheredtogetherinthissinglechapter justasalltherubricsoflocationweretogetherintheirownchapter.Thetablebelow comparesthechapterlayoutofthePocketbookwiththatoftheSynthesisrepertory.
TherapeuticPocketBook
Synthesis
Mind&Sensorium
Mind
PartsoftheBody&Organs
Vertigo
Sensations&Complaints
Head
Sleep&Dreams
Eye
Fever
Vision
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ChangeofGeneralState
Ear
ConcordanceofHomeopathic remedies
Hearing
Nose
Face
Mouth
Teeth
Throat
ExternalThroat
Neck
Stomach
Abdomen
Rectum
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Stool
Bladder
Kidneys
Prostate
Urethra
Urine
UrinaryOrgans
MaleGenitalia
FemaleGenitalia
Larynx&Trachea
Respiration
Cough
Expectoration
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Chest
Back
Extremities
Sleep
Dreams
Chill
Fever
Perspiration
Skin
Generals
LookingnextatthechaptercalledChangeofgeneralstateweseeitisdividedinto twosectionscalledAggravationandAmelioration.Underaggravationyouwill findrubricslike:ChangeofgeneralstateAggravationascendinghigh ascendingaheight,climbingup,ChangeofgeneralstateAggravationcold airfromdry,ChangeofgeneralstateAggravationfoodanddrinksfrom partakingcertainmeatsmoked,ChangeofgeneralstateAggravation weatherdryweatherduring.Listedunderameliorationyouwillfindrubricssuch
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as:ChangeofGeneralstateAmeliorationairinopen,Changeofgeneral stateAmeliorationheadbendingfrombackward,Changeofgeneral stateAmeliorationmotionfromcontinuedmotionfrom.Theserubricsare rubricsofmodalityonlyandonceagaintheyappearintheirownexclusivechapter. TheremainingchaptersinthePocketbookfunctionprettymuchinthesameway. ThechapterMindandSensoriumisdevotedtomentalstatesandSleepand Dreamstothosestates.ThechaptercalledFeverisextensiveandcovers conditionsofchill,circulation,coldness,heat,perspiration,shiveringandstagesof fever.ThefinalchapterConcordanceofhomeopathicremediesissetasidetoallow broadcomparisonsbetweenremediesandisespeciallyusefulatthetimeofthe followupconsultation. AfewexamplesshouldhelpdemonstratetheworkingsofthePocketbookschapter arrangement.InthefirstexamplewelltakerubricsfromSynthesisforthesymptom pulsatingpainintheheadandcomparethemtorubricsfromthePocketbookforthis samesymptom(Table1onthenextpage).InSynthesisasinglerubricfromthe Headchapter,Headpainpulsating,capturesthedescriptionofthiscomplaint. Therubriccontainsadescriptionofwhereinthebodythesymptomisfound(its location)andalsothetypeandqualityofthesymptom(itssensation).The configurationofthisrubricfollowstheKentianconventionlocation[Head] sensation[pain],sensation[pulsating]thathasbecomefamiliartomoststudents. TurningtotheTherapeuticPocketbookweseethathereittakestworubrics,each fromadifferentchapter,tocoverthissamesymptom.Thefirstrubricaddressesthe siteofthecomplaint,whichisthehead(itslocation)whilethesecondrubric capturesthepulsatingqualityofthesymptom(itssensation).InthePocketbook eachrubricisfoundinadifferentchapterandcoversonlyaportionoftheentire symptom.Table1illustratessuitablerubricsforthisexamplefromtheTherapeutic PocketbookandalsofromSynthesis. Table1:Headpain,pulsating TherapeuticPocketBook Synthesis
Mind&Sensorium
Mind
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PartsoftheBody&Organs InternalHead Generalin
Vertigo
Sensations&Complaints Externalpartsofbodyand internalorgansingeneral Pulsation Internalpartsin
Head Pain pulsating
Sleep&Dreams
Eye
Fever
Vision
ChangeofGeneralState
Ear
Hearing
Nose
Face
Mouth
Thebreakingapartofsymptomsandthedispersalofthosepartsindifferent repertorychaptersisuniquetotheTherapeuticPocketbookandisperhapsthemost difficultfeaturetoadjusttowhenfirststartingtouseit.However,aswillbe
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discussedlateron,thissamearrangementenablesflexibilityinrubricselection unequalledbyanyotherrepertory. Nextwelltakeupthesymptomoppressionintheupperchest,worseascending. Thisisamorefullydescribedsymptomincludingoppression(asensation)inthe upperchest(alocation)thatisworseascending(amodality).Thissymptom(Table 2)requirestworubricsinSynthesis,asthereisntasinglerubricwithoppressionin theupperchestthatalsocoversworseascending.Bothrubrics,though,arefound withinthesamechapter,Chest,onecoveringthedescriptionofoppression (sensation)andalsoitsbeingworseascending(modality)whiletheotherrubric addressesthespecificsiteofthecomplaintintheupperchest(location).Youwould needtocombinethesetwoSynthesisrubrics.TurningtotheTherapeutic Pocketbookweseethatitrequiresthreerubricstocoverthissamesymptom.We havearubricthatcontainsoppression(sensation)whileanotherrubriccoversthe siteofthecomplaint(location).Thethirdrubricaddressestheaggravationfrom ascending(modality).OnceagaineachPocketbookrubriccoversasinglefacetof theentiresymptom.Asaresultthismorefullydescribedsymptomwithitslocation, sensationandmodalityrequiresthreePocketbookrubricsinordertorepresentthe completesymptom,oneforeachcomponentofthesymptom. Table2:upperchestoppressionworse ascending TherapeuticPocketBook Synthesis
Mind&Sensorium
Mind
PartsoftheBody&Organs
Vertigo
Respiration
Head
Oppressionofbreath
Eye
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Chest
Vision
Internalchest
Ear
Upperpart
Hearing
Sensations&complaints
Nose
Sleep&dreams
Face
Fever
Mouth
Changeofgeneralstate
Teeth
Aggravation
Throat
Ascendingfrom
ExternalThroat
Neck
Stomach
Abdomen
Rectum
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Stool
Bladder
Kidneys
Prostate
Urethra
Urine
UrinaryOrgans
MaleGenitalia
FemaleGenitalia
Larynx&Trachea
Respiration
Cough
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Expectoration
Chest Oppression Ascending aggravates Upperpart
Back
Inathirdexamplewehavethesymptom:headpain,boringinnature,locatedinthe occiputandworseascending(Table3).Inthissymptomweagainhavea descriptionofalocation,asensationandamodality.InSynthesiswefindarubric, intheHeadchapter,forpainintheocciputmadeworsebyascendingbuttherubric doesnotcontainthequalityofboringpain.AsecondSynthesisrubric,alsofoundin theHeadchapter,haspainintheocciputthatisofaboringnature.Sowerequire tworubricsbothlocatedinthesameSynthesischapter.TurningtothePocketBook wefindweagainrequirethreerubrics.Thefirstrubricdescribingthesiteofthe symptom(theocciput)isalocationrubric.Thesecondrubricdescribesthequalityof thepain(aboringpain)andisasensationrubric.Thethirdrubricisamodality rubric(worsefromascending).Youmayrecallthatintheprecedingexample(Table 2:oppressedbreathingworseascending)wefoundarubricintheTherapeutic PocketbookchapterChangeofgeneralstatetocovertheaggravationfrom ascending.Inthecurrentexampleofboringpainintheocciputwehaveanother symptomwiththesamemodalityworsefromascending.UsingthePocketbookwe gobacktothechapterChangeofgeneralstateandselecttheidenticalrubricused inthepreviousexample,Aggravationascendingfrom.IntheTherapeutic Pocketbookthesamemodalityrubriccanbecombinedwithmorethanonelocation orsensationrubricinordertocreateanewcombinationofrubricsexpressinganew symptom. Table3:boringpaininthe occiputworseascending
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TherapeuticPocketBook
Synthesis
Mind&Sensorium
Mind
Partsofthebody&organs
Vertigo
Internalhead
Head
Occiput
Pain
Sensations&complaints
Occiput
Externalpartsofthe bodyandinternal organsingeneral
Ascendingstairsagg
Boringpain
Occiput
Sleep&dreams
Boringpain
Fever
Face
Changeofgeneralstate
Mouth
Aggravation
Teeth
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Ascendingfrom
Throat
NowifintheTherapeuticPocketbookthesamemodalityrubriccanbecombined withmorethanonelocationrubricormorethanonesensationrubricthenthe obviousquestionatthispointwouldseemtobeHowcanyouknowwhichofthe twolocationsorsensationsthismodalityreallygoeswith?Orwhatifthemodality goeswiththelocationbutnotthesensation?Orwhatifitstheotherwayaround? Okay,sothisismorethanonequestionbuttheshortansweristhatthereisntany wayforyoutoknow.Amorecompleteanswertothisquestionwouldhaveto includeaqualifier:atthestageofcaseanalysiswhenyouresearchingtherepertory forrubricsyoureallydontneedtoknowthis(atleastnotyet). TheTherapeuticPocketbookallowsyoutoselectanynumberofrubricsfromoneof itschaptersandcombinethemwithotherrubricstakenfromtheotherchapters.You canchoosearubricfromthechapteronlocationsandcombineitwithoneormore rubricsfromthechapteronsensationsandthenaddthattoanyoneormorerubrics fromitschapteronmodalities,whateverittakesinordertosculptoutthedescription ofthesymptom.Thisisoneofthehardestconceptstoembraceaboutthe Pocketbookwhileatthesametimeitreflectsamostremarkableinsightfromthe mindofBoenninghausen.Wellbeginthenextsectionwithacloserlookatseveral oftheseinsightsallofwhichareembodiedinthedesignoftheTherapeutic Pocketbook. PartII:TheGeniusofBoenninghausen TheTherapeuticPocketbookisthefruitofBoenninghausensdiscerningmind(he wasalawyerbyprofession)andhispropensityforcategorization(hewastrainedas abotanist).WeregoingtospendsometimelookingintoseveralBoenninghausen insightswhichrelatetohismethodofcaseanalysisandwhicharecompletely groundedintheteachingsofHahnemann.Wellbeexaminingtheseinsightswith emphasisontheirincorporationintothedesignofthePocketbookandhowthey influenceitsuse.Wellbediscussingthemintheorderinwhichtheyappearlisted here. 1. Symptomscanbeconsideredasconsistingofthreecomponents:sensation, locationandmodality. 2. Provingandclinicalpatientsymptomsareoftenincompletelyreported.
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3. Intherecordedprovingsthemostconsistentsymptomfeaturesarethe modalities,thesecondmostreliablefeaturesarethesensationsandtheleast reliable(mostvariable)featuresarethelocations. 4. Thesamesensations,andespeciallymodalities,arefrequentlyfoundin differentlocationsand/orbodysystems.Theyarenotboundtoasingle locationorsystemandinfacttheyarethegeneralcharacteristics. 5. Themoreconsistent(characteristic)featuresofsymptomsaretransferable acrosslocationsandmaybeusedtocompletethemissingdetailsoflesswell describedsymptoms. 6. Theuniquenessofacaseisoftenfoundinitsparticularcombinationof otherwisecommonfeatures. (1)Symptomscanbeconsideredasconsistingofthreecomponents: sensation,locationandmodality. In18602Bnninghausenprovidedalonganswertoaquestionconcerningthe (characteristic)valueofsymptomsinthehomoeopathicdiagnosis(selectionofthe mostsimilarremedy),whereinheidentifiessevenparameterswhichtogether providetheelementsrequiredinformingthecompleteimageofadisease.These sevenwerereducedtofouressentialcomponents:complaint(sensation),location, modality,concomitant.WiththistetralogyBnninghausendescribedthecomplete case(completeimageofanillness).Unfortunately,eventothepresentday,thisis erroneouslytaughtasreferringtothecompletesymptom,whichhowever, Bnninghausenclearlydefinesas: anenumerationofallthesensationsandphenomenaeverysymptomshould begivenclearlyandcompletelyWithrespecttocompletenessineverycasethe exactlocationsoalsotheaggravationoramelioration[aretobeascertained] IvealreadymentionedthatBoenninghausenintroducedtheuseofrubricsto summarizelengthyprovingsymptoms.Thiswasasignificantdevelopmentin homeopathicliteratureasitallowedfortheconstructionofmanageablereportorial indexes.InBoenninghausensrepertorythisallowedforthereconstructionof complexsymptomsthroughretrievingtheirseparatelyindexed(intheformof rubrics)representativecomponentfeatures:thefeaturesoflocation,sensationand modality. SynthesisandtheTherapeuticPocketbooktakedivergentapproachesin
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representingsymptomfeaturesasrubrics.Synthesistendstoplaceeachrubric withinachapterbearingthenameofaspecificlocationorbodilysystem.Rubrics withinsuchchapterswillcontaindescriptionsofsymptomsensationsand,where suchinformationisavailable,alsothedetailsofconditionsunderwhichthat symptomismadeworseorbetter.AsymptomrepresentedasarubricinSynthesis willincludeasmuchsupportingdescriptivedetailaspossible,attemptingtofitall thisintoasinglerubrictobesituatedwithinaspecificrepertorychapterbearingthe nameofabodylocationorsystem.Forexample Headpainocciputbendingheadbackwardmustbendheadbackward drawingpain RubricsintheTherapeuticPocketbookareformedinanentirelydifferentmanner. Thedescriptivedetailcontainedineachcomplexmateriamedicasymptomis abstractedandsummarizedintermsofitssensation,itslocationanditsmodality. Thisabridgeddescriptionisthenintentionallybrokenapart,toberecordedas multiplediscreterubricseachofwhichrepresentsonlyasingleportioneither sensation,orlocationormodalityofthecompletesymptom.Theseindependent singlepurposerubricsarethendispersedthroughoutthePocketbookandare recordedinrepertorychapterswhichhavebeensetupforeachcorresponding rubrictypetherubricforsensationgoingintoonechapter,therubricforlocation intoanotherchapterandtherubricformodalityinyetanotherchapter LetstakeanexampleofaBelladonnasymptomfromHahnemannsMateriaMedica PurawhichisconvertedintorubricsforBoenninghausensSystemicAlphabetic RepertoryofAntipsoricRemedies.Thesymptomasitappearsintheprovingreads asfollows: Sometimescompletelossof,sometimesmerelydiminished,vision,withenormously dilatedandquiteimmovablepupils. Firstthecomplexcontextrichprovingsymptomhastobesimplifiedandreducedto itsessentialdescriptivecomponentfeaturesoflocation,sensationandmodality. Thesecomponentsarethenrepresentedasseparaterubricsintherepertorywith eachbeingplacedinthechapterthatcorrespondstothattypeofsymptom component.Eachrubricisnecessarilyquitebriefasitincludesonlyasinglefacetof theoriginalprovingsymptom.Toretrievethisentireprovingsymptomcompletewith allofitsoriginalmeaningyouwouldneedtoselectallthreeofthe(component)
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rubricsusedtorecorditintherepertory.Boenninghausenusedthisapproachinhis earlierSRAandSRNrepertoriesaswellasintheTherapeuticPocketbook.The diagramonthefollowingpageillustrateshowtheessentialfeaturesofthis Belladonnasymptomwouldberepresentedintherepertory.
FromthisexampleyoucanseethatusingthePocketbookisgoingtorequirethat wealterourexpectationabouthowmuchdescriptivedetailweregoingtofindina rubric.EachPocketbookrubricsummarizesasinglesymptomfeatureinasfew wordsaspossible.However,thelackofspecificdetailinitsrubricsdoesntmake theTherapeuticPocketbookabluntorinaccurateinstrument.Wecanstillobtain exactsymptomdescriptionsbyselectingrubricsfromeachofthechaptersandre combiningthem.Boenninghausentellsusthetechniquewearerequiredtousewith hisrepertory: Althougheachsectionmaybeconsideredbyitselfacompletewhole,yeteachone givesbutoneportionofasymptom,whichcanbecompletedonlyinoneorseveral otherparts.Intoothache,forexample,theseatofthepainisfoundinthesecond section,thekindofpaininthethird,theaggravationorameliorationaccordingto timeorcircumstancesinthesixth,andwhateverconcomitantsymptomsare
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necessarytocompletethepictureandselecttheremedy,arealsotobefoundinthe varioussections. Anexamplemayhelptoillustratethistechnique.TheLycopodiumsymptombelow istakenfromHahnemannsChronicDiseases. Crampinthecalf,causinghimtocryoutatnight,alsobyday,whensittingwithbent knees. Inthissymptomwehavealocationforthepain(calf),itssensation(cramping)anda modifyingmodality(sittingwithkneesbent)makingitacompletesymptom.In Synthesisallthreeessentialfeaturesofthesymptomarecontainedwithinasingle rubricfoundintheExtremitieschapter. ExtremitiesCrampsLegsCalvessittingagg. RepertorizingthesamesymptomusingthePocketbookrequiresthreerubrics.Each comesfromadifferentchapterintherepertory. 1. PartsofthebodyandorgansLowerlimbsLeglowerCalf 2. SensationsandcomplaintsExternalpartsofbodyandinternalorgans ingeneralcramps,cramplikesensationMuscles,inthe (3)ChangeofgeneralstateAggravationsittingwhile Itsquiteapparentfromthisexamplethatthetworepertoriesuseverydifferent approachesinrepresentingsymptoms.InSynthesisrubricsarefoundinchapters correspondingtobodylocations/systems,withtheexceptionbeingtheGenerals chapter.Thatistosay,inSynthesisrubricsarealwaysassociatedwithalocation. Organizingrubricsthiswaybindsthemtotheirspecificchapterlocationinthe repertory.ButintheTherapeuticPocketbookacompletesymptomwitha sensation,alocationandamodalityhastoberepresentedbyatleastthree rubrics,eachofwhichcomesfromadifferentchapter.Consequentlyacomplete symptomcannotbesaidtobefoundwithinanysinglePocketbookchapteratall. Letsconsiderasecondsymptom.Inthisexampleyouhaveasymptomalmost identicaltothefirstLycopodiumsymptom.Howeverinsteadofthepainbeinginthe calf,thistimeitisapainintheabdomenthoughitisstillacrampingpainandisstill worsewhensitting.Sothesensationandmodalityherearethesameasinthefirst Lycopodiumsymptomwithonlythelocationbeingdifferent.AgainSynthesis
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recordsthesecondsymptomwithalltheessentialdetailsasasinglerubric.The secondrubricisfoundintheAbdomenchapter. AbdomenPainSittingagg.cramping. InSynthesisthesamepainsensationwiththesamemodalitybutadifferentlocation necessitatescreatingacompletelynewrubricwhichisrecordedinadifferent chapter.Thetwonearlyidenticalrubricsarefoundindifferentchaptersbecause Synthesisplaceseachrubricwithintherepertorychapterthatcorrespondstothe symptomslocationinthebodyortoitsspecificbodysystem(againtheexceptionis theGeneralschapter). UsingthePocketbooktodescribethissecondsymptomwemustselectanewrubric forthenewlocation,butseeingasthesensationandmodalityareidenticaltothose inthefirstsymptomwecanrepresentthemusingthesamePocketbookrubricswe usedearlier.Thesecondsymptomcanberepresentedthisway. (1)PartsofthebodyandorgansAbdomeninternalAbdomeningeneral (2)SensationsandcomplaintsExternalpartsofbodyandinternalorgansin generalcramps,cramplikesensationMuscles,inthe (3)ChangeofgeneralstateAggravationsittingwhile InthesetwoexamplesweseehowthePocketbooksdiscreterubricsforsensations, locations,andmodalitiescanbeusedoverandoveragaintorepresentdifferent individualsymptomsbymeansoftheiruniqueconfigurations. Thereareacoupleofimmediateadvantagesdesigningarepertorythisway.First, therepertoryremainsmuchsmallerduetoitsbeingabletorepresentindividual uniquesymptomsthroughdifferentcombinationsofthesamestockofcomponent rubrics(thisiswhythePocketbookhas7chapterswhilethereare40inSynthesis). Second,itiseasiertoknowwheretofindrubricsinthePocketbook.Allsymptom locationsareinonechapter,symptomsensationsinanotherandsymptom modalitiesinyetanother. Torepertorizeasymptomthatincludesadescriptionofasensation,locationand modalityyourequireatleastthreerubrics.Asymptomwithonlylocationand sensationrequiresatleasttworubrics.Thisarrangementissimple,directand predictable.Itdoesntthecontainthoseinconsistentarrangementsinrubric
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organization,thatoftenoccurinSynthesis,suchasExtremitiesCrampsLegs Calvessittingagg(wheretheorderislocationsensationlocationmodality), andAbdomenPainSittingagg.cramping(wherenowtheorderislocation sensationmodalitysensation).InSynthesistheorderofwordsinarubric determinesitsplacementwithinthechapter.Consequently,ifyoumakeachangeto theorderofdescriptorsinarubricyoualsochangethelocationoftherubricwithin thechapter.Thiscanturnrepertorizationintoagameofhideandseek.Withthe systematicarrangementusedinthePocketbookthisproblemdoesnotoccur symptomsareveryquicklyandeasilyrepertorized. Thethird,andgreatest,advantagetothedesignofthePocketbookisthatitcan repertorizesymptomsthatfallshortofbeingcompleteduetotheirlacking descriptionofeithertheirlocation,ortheirsensationortheirmodality. (2)Provingandclinicalpatientsymptomsareoftenincompletelyreported. InthecourseofdoingmyresearchIlearnedthattheoriginalprovingsof Boenninghausensday3containednumerousomissions.Thiswasadisheartening revelationthatonlyaddedtomysenseoffrustrationregardingtherepertory. However,afterexaminingtheoriginsoftheTherapeuticPocketbookIunderstood thereasonsfortheseomissionsandthechallengeitposedfortheearly homeopathswhosoughttobringordertotheirnewscience. BoenninghausenhadthoroughlystudiedHahnemannsprovingsandinadditionto thishehadkeptmeticulouscaserecordsfromhisownpractice.Inboththerecorded provingsandhisowncaserecordsheencounteredthesameproblem:thatof incompletesymptomreporting.InhisoriginalprefacetothePocketbookhe commentsonhowtheincompletenatureofsymptomsrecordedintheprovings posedahindrancetosuccessfulprescribing. Ifmanysymptomsareincomplete,eitherbecausethepartofthebodyorthekindof sensationisnotclearlyindicated,or,whatismostfrequent,becausethe aggravationsorameliorations,accordingtotimeorcircumstances,areomitted,the difficultiesofcorrectapprehensionandthejudgmentofthevalueofsuchsymptoms forthenecessitiesofcuringaregreatlyincreased,forthecharacteristicnevershows itselfinasinglesymptom,howevercompleteitmaybe,sincetheindividualityofthe proverexercisesaninfluenceovertheprovingwhicheasilymisleads Wecanseethenatureofincompleteprovingsymptomreportingifwedoasearchin
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HahnemannsMateriaMedicaPuraandTheChronicDiseasesforawellproven remedysuchasArsenicumalbum.AsearchusingEncylopaediaHomeopathica turnsup55instancesofthewordheadacheintheprovingofArsenicum.A samplingoftherecordedprovingsymptomsappearsbelow: Melancholy,sadmood,afterameal,withheadache Headacheintheocciput. Headache,forseveraldays,immediatelyrelievedbyapplyingcoldwater,buton removingitismuchworsethanbefore. Tensionintheheadheadache,asifstretched. Periodicheadache. Headacheofexcessiveseverity. Semilateralheadache. Headacheabovethelefteye,verysevereintheeveningandatnight. Pinchingheadacheabovetheeyes,soonpassingaway. Throbbingheadacheintheforehead,justabovetherootofthenose. Youcanseethereisalotofvariationinthedetailincludeintheseproving symptoms.Thefirstrecordincludesmental/emotionalaccompanyingsymptomsas wellasacontext(afterthemeal).Thesecondrecordcontainsnodescriptionofthe painbutdoesincludethelocation(occiput).Thethirdrecordcontainsalotofdetail aboutamodality(applyingcoldwater).Thefourthrecordemphasizesasensation (asifstretched),whilethefifthrecorddescribesarathervagueperiodicheadache. NoticethatnotoneoftheseoriginalrecordedsymptomsfromtheArsenicumproving iscompleteintermsofincludingadescriptionofsensation,locationandalso modalityinsteadeachentryseemstoreportonlypartofacompletesymptom. ThattheprovingsrecordswereincompletewasahugeobstacleBoenninghausen hadtoovercomeincreatinghisrepertory.Theproblemthisposedforsuccessful prescribingwasonlymadethatmuchworsebyasimilarlackofdescriptivedetailin thesymptomsreportedbypatients,aswereadinthefollowingtwoquotations:
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TheTotalityisanidealnotalwaystoberealized.Asamatteroffact,inpractical experience,itisoftenimpossibletocompleteeverysymptom,orevenalargepartof thesymptoms.Patientshavenotobserved,orcannotstateallthesepoints.They willgivefragmentsthelocationofasensationwhichtheycannotdescribe,ora sensationwhichtheycannotlocateortheywillgiveasensation,properlylocated, butwithoutbeingable,throughignorance,stupidity,failuretoobserveor forgetfulness,tostatetheconditionsoftimeandcircumstancesunderwhichit appeared.Sometimesnoamountofquestioningwillsucceedinbringingoutthe missingelementsofsomeofthesymptoms. Inexaminingacase,hegetswhatappearstothenovicetobeaheterogeneouslot ofsymptoms,orfragmentsofsymptoms.Possiblytheremaynotappeartobeone completesymptomintherecord.Hewillfindaclearlyexpressedsensationinsome part,butnoconditionofaggravationoramelioration.Inanotherpart,aclearly expressedconditionofaggravationoramelioration,butanindefinitesensationor perhapsthepatientwillsimplygiveaconditionofaggravationorameliorationwhich hereferssimplytohimselfingeneral.Hesays,Ifeelworseundersuchandsuch conditions.Inrealitythepatientisnotexpressingmanysymptoms,butonlypartsof averyfewcompletesymptoms,whichthehomeopathmustbringtogetherand complete.Theperceptiblesymptomsofdiseaseareoftenbrokenupandscattered throughthedifferentpartsofapatientsorganism.Thescatteredpartsmustbefound andbroughttogetherinharmoniousrelationaccordingtothetypicalform.[Italics added]. Boenninghausenscloseexaminationoftheprovingshadresultedinaremarkable insightandRoberts(inthesecondquotationtheitalicizedportion)referstothis whenhechargesustoreestablishthetypicalformofthecaseoncemore. Boenninghausenknewthattheprovershadbeenundertheinfluenceofasingle pathogenicdiseasedisturbance,thatofthehomeopathicremedy.Hereasonedthat theirincompletelydescribedsymptomswerefragmentedglimpsesofasingle symptomcomplexbelongingtotheremedytheyhadtaken.Bysimilarlogic,he inferredthattheincompletelydescribedsymptomsreportedbyhispatientswere alsoduetoasingledisturbance,thenaturaldiseasedisturbanceinthisinstance andthattheytoowerebeingreportedasfragmentsofasinglesymptomcomplex. Perhapsananalogousexamplefromthephysicsoflightwillhelpwiththisidea. Whenshiningwhitelightthroughaprismthelightemergesontheothersideas rainbowbandsofseparatecolours.Theprismseemstohavebrokenthelightapart
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somehow.Evenmoreremarkableisthatprismsmadeofdifferentmaterialswill breakapartthelightindifferentwaysproducingvariationsinthepatternofpresence orabsenceofcolourwhichisdependentonthematerialusedintheprism.The situationinhomeopathyissimilar.Thepatientactslikeaprismtothewholelight oftheremedyalteringitssymptomdisplayfromthatwhichhasbeenrecordedinthe provings.Eachpatientaltersthedisplayoftheremedyinadifferentmanner,shifting somesymptomsofthedisplaytootherlocations,allowingsomesensationsand modalitiesthroughwhileblockingothersoutaltogether.Therealartofhomeopathy istobeabletoidentifythefullyexpressedsymptompatternofaremedy,as recordedintheprovings,fromtheincompleteandoftenfragmenteddisplayof emergentsymptomsthatistheresultofeachuniqueinteractionbetweennatural diseasedisturbanceandpatient. TheTherapeuticPocketbooksdesignfacilitatestheidentificationofremedy symptompatternsthroughrubricsthateachfocusonasinglesymptomcomponent. Bymeansoftheserubricswecanhighlightthemostconsistentsymptomsinacase eventhoughtheymaybeonlypartiallydescribed.Whenplacedinjuxtapositionon ourrepertorychartsthePocketbookrubricsallowustoseethroughthejumbled disarrayofsymptomfragmentstothetypicalformofaremedysrepresentative symptomsonceagain. (3)Intherecordedprovingsthemostconsistentsymptomfeaturesarethe modalities,thesecondmostreliablefeaturesarethesensationsandtheleast reliable(mostvariable)featuresarethelocations. Boenninghausensindepthstudyoftheprovingsresultedinhisemphasizingthe modalitiesofaremedyaboveitssensationsandlocations. Onlywithreferencetoaggravationsandalleviationsofsymptomsaccordingto time,positionandcircumstancesthehigherandthelowerpotencieseverremain thesame,andthisconstantuniformityoughttourgeHomoeopathstostudythese momentawithparticularindustry,andtopayespecialattentiontothesamewhen selectingaremedy. InhiscompanionbooktoTheBoenninghausenRepertory4,GeorgeDimitriadistells usthatwhensymptommodalitiesareconsistentandclearlydefinedinacasethey revealthecoreoftheremedyhomeopathictothepatientssufferings: AccordingtoBoenninghausensaboveobservation,therangeofsymptomsa
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medicineisabletocurativelyremoveinpractice,whilstgraduallyexpandingin proportiontotheirincreasedpotentisation,neverthelessretainedasemblanceof continuityintheirbasiccharacter,whichcouldbeimpliedfromtheirdefining qualitiesoflocationandsensation(complaint/sensationsigns&symptoms).Inthis waythecompletenessofasymptomcouldevenbeinferredandextendedby analogyandthisprovedamostfundamentaladvanceinunderstandingtheoften incompletefragmentsofourmateriamedicaprovings.Butevenmoreimportantly, themodalitiesremainedentirelyunaltered,regardlessofthepotencyused.Inother words,themodalities,whenclearlyandcompletelydefined,faithfullyrepresented theconstantcharacterofamedicinalprovingandofitstherapeuticapplication theyrevealeditsunchangingcore,anditisforthisreasonthatmodalitiesoften providethemostdecisivedistinctiontothehomeopathicdiagnosis.Fromthiswe canreadilyseethatthelocationis(usually)subordinatetothecomplaint(natureof thesigns&symptoms),whichisinturnissubordinatetothemodalities.Thisholds goodtosuchanextendthat(guidedbyexperience)thehigherordermomentacan beusedexclusiveofthelowerorderinthedeterminationofthehomeopathic diagnosisforexample,inacasewithmodalitiessufficientlydistinguishingto enablethecorrectmedicineselection,thereisnoneedtoconsiderthelowerorder location/complaintintheprescriptionwhenusingTBR.[TherapeuticPocketbook] Whenourcaseincludessymptomsthatarewelldefinedandconsistentintheir presentationweshouldmakeapointofincludingthemintheanalysis. RepresentingsuchsymptomsintheTherapeuticPocketbookwilllikelyrequire usingmultiplerubricsoneforsensation,anotherforlocationandathirdfor modality.Ifwewanttoplaceadditionalemphasisonanimportantsymptomwe applyadditionalweightingtoitinourrepertorizing.Thisadditionalweightingmust beappliedequallytoalltherubricswehaveusedrepresentingthesymptominthe Pocketbook. Wedonotalwaysneedtothinkofrepertorizingwholesymptomswhenusingthe Pocketbook.Ifourpatientdescribesthesensationofaconsistentsymptombut cannottellusifithasamodalityoraparticularlocation,wecanrepertorizethe sensationalone.Similarlywhenourpatientgivesusadescriptionofamodalitybut cannotprovidemuchelsewecan,andshould,repertorizethemodalitydespitenot havingacleardescriptionofwherethesymptomisorevenwhatitfeelslike becausemodalitiesaremorereliableasguidestofindingtheremedy. Shouldourcasehavearecurringmodalityorsensation,onepresentinseveralof
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thesymptoms,thenthismodalityorsensationacquiresadditionalimportance becomingelevatedtothestatusofageniussymptominthecase.Genius symptomsareplacedattheheadoftheanalysisasourprescriptionmustinclude them.WiththePocketbookwecanselectasinglerubricforsucharecurrent modalityorsensationandaddthattoouranalysis.ThePocketbooksdiscrete rubricsforsensation,locationandmodalitypermitustoassignspecialimportance toageniusmodalityorsensationbygivingitsrubricadditionalweighting.Allthose remedieshavingthismodalityorsensationwillbebroughtforwardintheanalysis asaresult.Onstudyingtherelevantmateriamedicaoftheforemostremedies appearinginouranalysis,ifwefindaremedywiththesameconsistentmodalityor sensation(orevenlocation)runningthroughmultiplesymptomsofitsproving,we mayfeelconfidentinconsideringthatremedyfurtherasthepresenceofthis recurrentthemeinbothremedyandpatientsuggestsasolidmatch. (4)Thesamesensations,andespeciallymodalities,arefrequentlyfound associatedwithdifferentlocationsand/orbodysystems.Theyarenotbound toasinglelocationorsystemandinfacttheyarethegeneralcharacteristics. Boenninghausenrecognizedfromhisstudyoftheprovingsandhisownpatient recordsthatsymptommodalitiesandsymptomsensationswerenotconfinedtothe particularlocation(s)inwhichtheywerereportedandthat,infact,theywere symptomsbelongingtothewholepatientandwereespeciallyimportantinselecting theremedy. Fromonepointofviewtheindicatedconditionsofaggravationorameliorationhave afarmoresignificantrelationtothetotalityofthecaseandtoitssinglesymptoms thanisusuallysupposedtheyareneverconfinedexclusivelytooneoranother symptom,butonthecontrary,acorrectchoiceofthesuitableremedydependsvery oftenchieflyuponthem.Inreality,then,theyarethegeneralcharacteristics. Theprocessofgeneralizingsensationsandmodalitiesbearssomeexplainingand thismightbestbeservedthroughanexampletakenfromtheprovingofCausticum. Themodalityinthisexampleisworsesitting.DrawingfromHahnemannsMateria MedicaPuraandChronicDiseaseswecanperformasearchundertheremedy Causticumforthewordsittingtoseehowoftenthismodalityshowsup.Thesearch inEHreveals37occurrencesofsittingsomeofwhichIvelistedbelow: Frequentfitsofchokingoninspiring,asifsomeonewasconstrictingthewindpipe,
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sothatitobstructedthebreath,whensitting. Pressive,cramplikepaininthesacrumandtherenalregion,whensitting. Sensationasfromabruiseinthesacrum,whenwalkinggoingoffwhensitting. Stitchesintheback,asfromneedles,whensittingdown. Thenatespaininsittingonthem,asiffrombeingbeaten,orasifturgid. Adrawingpressivepaininthehip,whensittingandwhenwalking. Tearinginthehipjointanddownthewholelimb,bothsittingandwalking. Feelsasifparalyzedinthethighs,insittingandinwalking. Turgidityinthehoughsinsitting,andwhencommencingtowalkbetterwhen continuingthewalk. TearinginthelefttendoAchillis,whensitting. Painasfrombruising,alloverthebody,especiallyinthearms,whensittinggoing offwhenatworkandintheopenair. Sleepiness,especiallywhilesitting,butalsowhilewalking. Frequenturgingtourinatewithoutdischargethen,whensitting,aninvoluntary discharge. Loudrumblingintheabdomen,whensitting,asiffromemptiness. Momentaryvertigo,whilesitting,asifthewasabouttostagger Inthisshortlistyoucanseethatanaggravationassociatedwithsittingisarecurring featureintheremedyCausticumandthatitisnotspecifictoanyonelocationor associatedwithaparticularsensationonly.ThisisexactlywhyBoenninghausen generalizedit.Heknewfromhisstudyoftheprovingsthatthiswasrepeatedlytrue ofremedymodalitiesandthatitwasalsotrueofsensations,thoughtoalesser extent. ThusthestatementthatthePulsatillacaseisworseinacloseorwarmroomisa generalizationdrawnfromtheobservationofparticularsymptomsinnumerous
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cases,bothinprovingsandclinically.Thesameistrueofnearlyeveryconditionof aggravationandameliorationcontainedinBoenninghausensRepertory,the greatestmasterpieceofanalysiscomparisonandgeneralizationinourliterature. Experiencehasshownthatmostoftheseconditionsormodalitiesof Boenninghausenaregeneralintheirrelations.Theattempttolimittheapplicationof themodalitytotheparticularsymptomswithwhichtheywerefirstobservedhasnot ledtosuccessinprescribing.Boenninghausendidhisworkwell,andhefollowed strictlytheinductivemethod.Ofthesemodalitieshewrote:Alloftheseindications aresotrustworthy,andhavebeenverifiedbysuchmanifoldexperiences,thathardly anyotherscanequaltheminranktosaynothingofsurpassingthem.Butthemost valuablefactrespectingthemisthis:Thatthischaracteristicisnotconfinedtooneor anothersymptom,butlikearedthreaditrunsthroughallthemorbidsymptomsofa givenremedy,whichareassociatedwithanykindofpainwhatever,orevenwitha sensationofdiscomfort,andhenceitisavailableforbothinternalandexternal symptomsofthemostvariedcharacter.Inotherwords,theyaregeneral characteristicsdeducedbyacriticalstudyofparticularsandverifiedinpractice. Boenninghausenrecordedthesecharacteristicmodalitiesandsensationsasrubrics inhisTherapeuticPocketbookinawaythatallowedthemtobecomegenerals abletobeappliedtoanylocationwhatsoever.Aswevealreadyseen,heachieved thisthroughextricatingthesymptomelementsofsensationandmodalityfromtheir originalcontext(thelocationsinwhichtheywerereported)andrecordingthemin thePocketbookasstandalonerubricsthatwereplacedindesignatedchaptersfor eachtypeofcomponent. Toseehowtheserubricscanbeusedtorepresentactualprovingsymptomslets takealookatafewsymptomsfromtheprovingofBryonia.5WeseethatBryonia hasarecurringmodalityofbeingworsefrombecomingheatedorwarmed: Toothacheontakingsomethingwarmintothemouth. Whileeatingthereoccursatearingshootingtoothache(thatextendsdownintothe cervicalmuscles),whichisespeciallyaggravatedbywarmth. Sorethroat:dryandrawinthethroatduringemptyswallowingondrinkingthis sensationgoesoffforashorttime,butsoonrecursitisworstinthewarmroom. Whenhecomesfromtheopenairintothewarmroomhehasafeelingasifvapour wereinthewindpipe,whichcompelshimtocoughhefeelsasifhecouldnot
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breatheinairenough(aft.2h.). Fineshootinginthewrist,whenthehandbecomeswarmandwhenatrestbutit doesnotgooffbymovement. Onaslightmentalemotion(onlaughing)theresuddenlyoccursashooting(itching) burningalloverthebodyasifhehadbeenwhippedwithnettlesorhadnettlerash, thoughnothingistobeseenontheskinthisburningcameonafterwardsbymerely thinkingofit,orwhenhegotheated. IntheTherapeuticPocketbookthisrecurringthemeisrepresentedbyasinglerubric Changeofgeneralstateaggravationheated,overheatingfrombecoming andBryoniaislistedthereasa4.ByrecordingthismodalityofBryoniaasa separaterubric,freetobeappliedincombinationwithanylocationand/orsensation rubric,thePocketbookmirrorsthepervasivenessofthemodalityasitisfoundinthe Bryoniaproving.ItisthisuniquefeatureofthePocketbookthatallowsustoapply Boenninghausensinsightregardingsymptomgeneralizationatthepointintime wherewearerepertorizingthecase. WecanusethisrubricincombinationwithotherrubricsinthePocketbookto accuratelyrepresentanyofthesymptomsfromthelistabovewithoutlossof meaning.Forexample,torepertorizethefirstsymptomwewouldusetworubrics: PartsofthebodyandorgansteethtoothacheingeneralplusChangeof generalstateaggravationheated,overheatingfrombecoming.To repertorizethesecondsymptomwewouldneedfourrubrics:Partsofthebodyand organsteethtoothacheingeneral,addthemodalityofbeingworsefrom eatingChangeofgeneralstateaggravationeating,thenSensationsand complaintsexternalpartsofthebodyandorganstearing(drawing)forthe natureofthepain,andonceagainforthemodalityworsewarmthweuseChange ofgeneralstateaggravationheated,overheatingfrombecoming. ConstantineHeringandErnestFarringtonweretwonotablecriticsof Boenninghausensrepertorydesignonthegroundsthatinformationwaseither beingdistortedorlostwhenalocallyspecificmodalityorsensationwasremoved fromitsparticularlocationandtreatedlikeageneralsymptom.However, Boenninghausendidnotsuggestthatthemateriamedicashouldbetreatedthis way,onlytherepertory.HisCharacteristics6doesnotcontainsymptomscreatedby analogyandremainsafaithfulaccountofremedysymptomsrecordedfromthe
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provingsandfromclinicalexperience.Repertoryandmateriamedicabothrepresent theaccumulatedknowledgeofourremedies,albeitindifferentways,andeachhas theirrightfulplaceinanalyzingthecase.However,thefinalauthoritymustalways belongtothemateriamedica. (5)Themoreconsistent(characteristic)featuresofsymptomsaretransferable acrosslocationsandmaybeusedtocompletethemissingdetailsoflesswell describedsymptoms. Bnninghausenobservedthatindividualsymptomsrecordedinourpuremateria medicaareoftenonlyfragmentary,andthattheircompletioncouldbeinferred(by analogy)fromrelatedorassociatedsymptomsintheprovings.Bnninghausenwas abletoidentifyeachandeverycharacteristicfeatureoftheremedieshe studied,confirmedthroughhisextensivepractice,andincreasinglyfocusedon gatheringonlysuchcharacteristicsduringtheprocessofcasetaking. ThesymptomsinthefollowinglistaretakenfromtheprovingofConiumappearing inHahnemannsChronicDiseasesandhisMateriaMedicaPura.Theyrefertothe sensationofvertigoandwerereportedbyseveralprovers: Dizzinessandwhirlingintheheadfortwodays. Verydizzywhilewalking. Intoxication. Theleastspirituousliquorintoxicateshim. Evenamixtureofwaterandwineaffectshishead. Constantstupefactionofthehead,withcontinuousdesiretosleep. Reeling. Vertigo,whirlingaroundwhenherisesfromhisseat. Vertigo,afterstooping,whenraisingupagain,asiftheheadwouldburst. Vertigo,worselyingdown,asifthebedwerewhirlingaroundinacircle. Vertigo,earlyonrisingfromthebed.
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Vertigoongoingdownstairsshehadtoholdontosomething,andforamoment shedidnotknowwhereshewas. Vertigowhichfatiguesthehead. Vertigo,sothateverythingseemstowhirlaround. Aquicklookoverthelistrevealsthatwhilesomeoftheentriescontainverylittle detail,othersdescribeasymptomwithgreatspecificity.Boenninghausenwould havereadasimilarlistofvertigosymptomsashestudiedthemateriamedicaofhis day.Hewasabletoretaininviewthatdespitethevariationintheamountofdetail reportedbytheprovers,alloftheirsymptomshadtobeduetothesamecausethe remedytheyhadtakentothepointofprovingit.Boenninghausenknewthatthis variationinrecordedsymptomscouldbeattributedtotheindividualityoftheprovers andreasonedthattheincompletenessoftheirprovingsymptomscouldberectified throughtheuseofanalogy.WithreferencetothelistofConiumvertigosymptoms above,Dimitriadisexplainstheprocessofcompletingsymptomsbyanalogy: Itcanbeseenthatthesesymptomsallrefertoasingletypeof(vertiginous) complaintandthatsomeoffernoqualification,whilstothersprovidequitea strikingdescription,ordecidedmodalityYet,torepeatthepoint,thereisno doubtthatallthesesymptomsaretheeffectsofasingleremedy,asingle pathogeny,eachsymptomrevealingthesamecomplaintwithagreaterorlesser degreeofdefinition(completeness)asobservedinanumberofsubjectsduring proving.Withthisinmindletusnowconsidertheabovegroupofsymptomsas relatedpiecesofasinglesymptom,whichwouldthenlooksomethinglikethis: Intoxicatedfeelinginthehead,withvertigo,tothepointofreelingasifeverythingis reelingaroundaggravatedby:theleastalcohol,whilstlyinginbed,whilstwalking, onrising(frombed,fromsitting,afterstooping)withmomentarydisorientationwhilst descendingthestairs,shehastoholdontosomething. ThiscompositepictureofvertigoproducedbyConiumisthusmoredefined, completedbyanalogy(i.e.,bytransferringandcombiningthequalifying characteristicsofrelatedsymptomfragments),witharesultantgooddescriptionof thecomplaint,anditsclearmodalities. Symptomscompletedbyanalogymuststillbebrokendownintotheirabridgedand representativecomponentstobeenteredintothePocketbook.Boenninghausens
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brilliancewastocataloguethesesymptomfeaturesusingmultiplerubrics,eachof whichcapturedanessentialsymptomcomponent(location,sensation,modality), suchthattheycouldberecombinedtorestorethefullmeaningoftheproving symptomonceagain.KeepinmindthatthiscompletedConiumsymptomisa compositesymptom,constructedfromthecombinedpartialdescriptionsgivenby severalprovers.WemightberepresentthissymptominthePocketbookusingeight rubrics: 1. MindandSensoriumConfusion[cloudiness,etc.]confusionofmind, fogginess 2. MindandSensoriumConfusion[cloudiness,etc.]stupefaction 3. MindandSensoriumConfusion[cloudiness,etc.]vertigo 4. ChangeofgeneralstateAggravationrisingfromstooping 5. ChangeofgeneralstateAggravationrisingfrombedwhen 6. ChangeofgeneralstateAggravationrisingfromsittingwhen 7. ChangeofgeneralstateAggravationfoodanddrinksfrompartaking certainspirituousliquorsingeneral[alcoholicdrinks] 8. ChangeofgeneralstateAggravationlyingwhilebedin Aseachindividualrubriccapturesonlyasinglecomponentofthecompleted symptom,recreatingtheentirecompositevertigosymptomwouldrequireselecting alleightrubrics.
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Fortunately,whenusingthePocketbook,wedontneedallthedetailsofthefully completevertigosymptomtobepresentinordertoonceagainfindConium(listed 6thplaceabove).Givenanypartofitsfullsymptomdescription,wecouldmatchthat partialdescriptiontoone,ormore,oftheeightrubricsweveusedtorepresentthe completedvertigosymptomandstillbringConiumintoouranalysis.Considera situationwithapatientwhotoldusthathehadvertigoaccompaniedbyconfusion. Wecouldcapturethatsymptom,andConium,usingrubrics1and3fromthechart above.Withapatientwhotoldusthatshehadvertigowithafeelinglikebeing intoxicated,wecouldrepresentthisusingrubric2and3onthechart,andonce againfindConium.Shouldapatienttellusthathisvertigowasworserisingfrom bed,wewoulduserubrics3and5,andonceagainfindConium. TheTherapeuticPocketbooksdesignissuperblypractical.Boenninghausen enablesustofindaremedyagaingivenapartialdescriptioncorrespondingtoany oneormoreofthecomponentsofits(fullycompleted)symptom.Thoughwemay haveasymptomthatisonlyincompletelydescribedwecanstillrepertorizethe symptomfragmentandbringtheremedyfromwhichitoriginatedintoouranalysis. BymeansofthisingeniousdesignthePocketbookovercomestwoimmense
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obstaclestohomeopathicprescribing.First,byrecordingsensationsandmodalities asindependentrubricsinseparatechapters,itpermitsustotransfertheconsistent andclinicallyverifiedcharacteristiccomponentsofremediesinordertocomplete themissingdetailsoftheprovings.Secondly,itenablesustorepertorize incompletelydescribedsymptomsobtainedwhiletakingthecase.Inthiswayit overcomesthegapsinsymptomsreportedbypatients. Awordofcautionisneededatthispoint.WiththePocketbookourfreedomto associaterubricsinanycombinationwhatsoeverisnotwithoutitslimits.Thatlimitis reachedatthepointofcontradictionwiththemateriamedica.Aclassicexampleof suchacontradictionistheheadacheofArsenicum.Arsenicumisknowntobebetter fromheatgenerally,yetithasaheadachethatisamelioratedbycoldwater7and alsobycoldair8.NowintheTherapeuticPocketbookwecantaketherubric Changeofgeneralstateameliorationwarmthingeneralfromtorepresent Arsenicumswellestablishedameliorationfromwarmth.AddtherubricPartsofthe bodyandorgansinternalheadgeneralintorepresentthelocationofahead painthenaddarubrictorepresentaburningsensationSensationsand complaintsexternalpartsofbodyandinternalorgansingeneralburning internalorgansofthenincludeanotherrubricforaburstingsensationSensations andcomplaintsexternalpartsofbodyandinternalorgansingeneral bursting(dragging,pressingasunder)painasifandfinallyarubricforflushing ofthefacePartsofthebodyandorgansfacecolorred.Withthiscombinationof fiverubricswevecreatedaheadachefromtherepertorythatisburningandbursting innature,accompaniedbyaflushedfaceandbetterfromwarmth.Ifweplacethese rubricsonananalysischartweseethatArsenicumappearsineachrubricweve usedforthisheadache.Giventhisremedyswellknownameliorationfromwarmth thisshouldntcomeasmuchofasurprise.
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However,whenwegotothemateriamedicawefindthefollowingrecordedbyKent forArsenicum: Whentheheadacheisofacongestivecharacter,withthesensationofheatand burninginsidethehead,andthereisafeelingasiftheheadwouldburst,andthe faceisflushedandhot,thatheadacheisbetterfromcoldapplicationsandinthe coolopenair. UsingthePocketbooksunrestrictedpotentialforrubriccombiningwevemanaged tocreateasymptomforArsenicumthatisnotconfirmedinitsmateriamedica. Moreover,inKentsLecturesonHomeopathicMateriaMedicawereadofan Arsenicumheadachewithamodalityoppositetothemodalitywehaveassociated withthisheadache.Wheneverourreadingturnsupsomethingcontradictorylikethis weshouldstronglyquestionwhatisbeingsuggestedbytherepertory.While modalitiesandsensationsarefeaturesofthepatientasawholeandmaybe transferredfromonelocationtoanother,theymustalwaysgivegroundtolocally specificmodalitieswhenevertheyarepresent. (6)Theuniquenessofacaseisoftenfoundinitsparticularcombinationof otherwisecommonfeatures.
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InAphorism153Hahnemanntellsuswhichsymptomswearetofocusourattention oninordertoobtainthemostusefulelementsofthecaseforourprescription.9 Historicallytherehasbeenmuchdebateoverthemeaningandimplementationof thisaphorism.Oneword,thewordcharacteristic,hascomeunderaspecialscrutiny havingbeensubjecttoconsiderableinterpretation. Inparagraph153ofTheOrganon,Hahnemannsaysthatincomparingthecollective symptomsofthenaturaldiseasewithdrugsymptomsforthepurposeoffindingthe specificcurativeremedy,themorestriking,singular,uncommonandpeculiar (characteristic)signsandsymptomsofthecasearechieflyandalmostsolelytobe keptinviewThisseemsasufficientlycleardescriptionofwhatHahnemannmeant bycharacteristicsymptomsandyetthetermhasbeenthesubjectofmuch discussionandmanyhavedifferedastowhatconstitutesacharacteristic. Confusionaroseandstillexiststhroughtheinabilityonthepartofmanytoreconcile theteachingofthisparagraphwiththeapparentlyconflictingdoctrineofTheTotality oftheSymptomsastheonlybasisofatruehomoeopathicprescription. Thequotationaboveraisesanimportantquestion:Istherereallyaconflictbetween prescribingonthetotalityofsymptomsandprescribingonthecharacteristic symptoms?Toanswerthisquestionweneedtotakeacloserlookatthisword characteristic. AccordingtoDimitriadischaracteristic,asitappearsparenthesizedinthis aphorism,hasbeentakentoapplytothewordimmediatelyprecedingit.Thatword isthewordpeculiar.Dimitriadisdisagreeswiththisinterpretation.Inhisopinion thetermcharacteristic,asitwasusedinthetimeofHahnemann,meant consistent.Thefollowingquoteistakenfromanextensivefootnoteinwhich Dimitriadisdiscussestheinterpretationofaphorism153: Theparagraph[aphorism153],hasunfortunately,beenpoorlyworded,sinceit impliesthattheparenthesized(characteristic)referstothewordimmediately precedingit[peculiar],butthisisnotpossible,since,aswehaveshownearlier, thetermcharacteristicdoesnotmeansingularbutconsistent.Therefore,andit hastakenalongtimeforustorealisethemisleadingcompositionofthisparagraph (whenrenderedintoEnglish),Hahnemannsadditionof(characteristic)refersto thewholeseriesofprecedingdescriptorswhich,heremindsus,mustalsobe characteristic(consistent)[Italicsadded].
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Dimitriadisinterpretationoftheparenthesizedcharacteristictomeanconsistent makesasignificantdifferencetotheinterpretationofaphorism153.Twoother wordsneedtobeclarifiedinordertofullyappreciatethechangeinmeaning. Dimitriadistakesissuewithinterpretingthewordpeculiartomeanstrange,oddor unusual.Hemaintainsthatthisisadecidedlymoderninterpretationandonenot applicabletothewordsusageinthetimeofHahnemann.InHahnemannstime peculiarwouldhavehadthemeaningofsomethingbelongingtooneorsingular.An exampleofthisearlierusageofthewordisthesentenceAhot,dryclimateis peculiartoArizona.whereherepeculiarcarriesthemeaningofdistinctiveof,or specificto,someplaceorsomething.Thewordsingularisevenmoreemphaticin thatitcarriestheadditionalmeaningofsomethingbeingnotableorextraordinary.If wegobacktoAphorism153now,replacingsingularwithnotable,andpeculiar withdistinctive,wearriveatareadingwithasubstantiallydifferentslant: Inthesearchforahomeopathicallyspecificremedy,thatis,inthecomparisonofthe complexofthenaturaldiseasessignswiththesymptomsetsoftheavailable medicines(inordertofindamongthemanartificialdiseasepotencethat correspondsinsimilaritytothemaladytobecured)themorestriking,notable, uncommon,anddistinctive,(consistent)signsandsymptomsofthediseasecase aretobeespeciallyandalmostsolelykeptinview.These,aboveall,must correspondtoverysimilaronesinthesymptomsetofthemedicinesoughtifitisto bethemostfittingoneforcure.Themorecommonandindeterminatesymptoms (lackofappetite,headache,lassitude,restlesssleep,discomfort,etc.)aretobe seenwithalmosteverydiseaseandmedicineandthusdeservelittleattention unlesstheyaremorecloselycharacterized. Thisinterpretationofaphorism153laysemphasisonthedistinctiveandconsistent symptomsineachcaseofillness,adifferentinterpretationfromthatofKentwho emphasizedthestrange,rareandpeculiarfeaturesofdiseaseplacingtheSRPat theheadofhisfamoushierarchyofsymptoms.IwouldsuggestthatDimitriadis interpretationofAphorism153isclosertoHahnemannsoriginalintentaswefindit expressedinhisearlierwritings: Thechiefsignsarethosesymptomsthataremostconstant,moststriking,andmost annoyingtothepatient.Thephysicianmarksthemdownasthestrongest,the principalfeaturesofthepicture. OnRemedyKeynotes
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Homeopathshavelongsoughttomakethetaskoffindingthesimillimumless arduous.Somesetaboutthisbyorganizingourmateriamedicainwaysthat facilitateditslearning.OnesuchapproachwasGuernseysKeynote: It[thekeynote]isonlymeanttostatesomestrongcharacteristicsymptom,which willoftenbefoundthegoverningsymptom,andonreferringtotheSymptomen Codex,alltheotherswillsurelybethereifthisoneis.Theremustbeaheadto everythingsoinsymptomatology,ifthemostinteriororpeculiar,orkeynoteis discernible,itwillbefoundthatalltheothersymptomsofthecasewillbealsofound underthatremedythatgivesexistencetothispeculiarone,ifthatremedyiswell proven. Guernseyintendedthatthetermkeynoterefertothosesymptomswithina remedystotalitythatmoststronglydeclareditsindividuality.Forthisthesymptom hadtopossesstwoqualities.First,ithadtobeaprominentsymptom,consistently presentintheprovingsandclinicalpictureoftheremedyandsecondly,ithadtobe asomewhatuncommonsymptom,onenotsharedbymanyremedies.Nowinour examinationofAphorism153wefoundbothconsistencyanddistinctivenessare requiredforasymptomtobemostusefulinhomeopathicprescribing.Thesearethe veryqualitiesfoundinGuernseyskeynotes.Thisrealizationdidnotescapethe attentionofStuartClosewhoappliedhimselftoreconcilingtheseseemingly divergentviewpointsintheongoingcontroversygeneratedbyAphorism153: Thereiscertainlythatineverycaseofillnesswhichpreeminentlycharacterizes thatcase,orcausesittodifferfromeveryother.Sointheremedytobeselected, thereisandmustbeapeculiarcombinationofsymptoms,acharacteristicor keynote Ifitisunderstoodthatthekeynotetoacasemayandoftendoesexistin,orconsist of,apeculiarcombination,asDr.Guernseyputsit,andthatitisnotmerelysome peculiar,single,possiblyincompletesymptomwhichthetyroisalwaysmistakenly lookingfor,thesubjectisclearedofpartofitsobscurity Theremedykeynoteexpressesanessentialandprominentaspectofitsremedy andmayserveasaquickguidetoasmallgroupofremediessharingacentrally importantandhighlycharacterizingfeature.Whenpresentinacaseofdisease,the keynotecanpotentiallyindicatethecurativeremedyprovidedtheothersymptomsof thediseasetotalityalsoexistinthesymptomatologyoftheremedy.Themere
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presenceofakeynotesymptom,thoughitmaybestronglysuggestiveofaremedy, doesnotguaranteesimilitude. Forexample,considerapatientwhosechiefcomplaintisarheumatoidarthriticjoint painintheshoulder,stitchingandpressinginnatureandbetterinwetweather.The location,thesensationandthemodalityofthejointpainsuggestseveralpossible remedies.Ifwewereconsideringremedieswithkeynotesmatchingtheshoulder painwewouldbethinkingofremedieslikeBryonia(stitchingrheumaticpains), Causticum(ameliorationinwetweather),Rhododendron(rheumatic,goutypains) andNuxvomica(ameliorationinwetweather).Ifthepatientalsowasdistinctlychilly whenthejointpainwasatitsworst(concomitantsymptom#1)wemightlookat remedieswiththiskeynote,suchasPulsatilla,ArsenicumandCausticumagain.If alongwiththisthepatientwasextremelythirstyandforlargequantities (concomitantsymptom#2)thenwewouldthinkofBryonia,Arsenicum,Sulphur,and Phosphorusastheseremedieshavethiskeynotesymptom.
Letslookattheremediesweveconsideredonthebasisoftheirkeynotes: SulphurfailstocoverchillinesswiththepainCausticumdoesnotmatchthethirst forlargequantitiesevenRhododendron,whichmatchesthenatureoftheshoulder painsowell,completelyfailstocoverthetwoconcomitantsymptomsthattogether

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definethecasewhilePulsatilla,withitskeynoteofchillinesswiththepains, appearsinthirteenthplaceintheanalysis.Eachofthesefourremedieshasoneor morekeynotesmatchingpartofthecaseyetnotoneofthefourcoversthetotality ofsymptoms.OnlyBryoniacoversthestitchingpains,rheumaticpainsandthirstfor largequantitieswhilealsobeingintherubricforchillinessduringthepains.Though thislastsymptomisnotakeynoteofBryoniaitisadefiningfeatureofthecaseand soitmustbeincludedinthesymptomexpressionoftheprescription.Reviewingthe symptomsofthiscaseweseethatnotoneofthem,onitsown,isatallstrange,or rare,orpeculiar.Noteventhekeynotesymptoms.Itistheiroccurrenceasatotality displayedinasinglepatientwhichismostdefining,distinctiveandremarkable,and whichismetbyoneremedyalone. InthisdiscussionofAphorism153weveseenthatillnessandremedyare individualizedbytheirconsistentanddistinctivesymptoms.Forourprescriptionto bewellchosensimilitudemustexistherebetweentheseuniquesetsofsymptoms. Dr.P.P.Wellssays:Characteristicsymptomsarethosewhichindividualizeboth thediseaseandthedrug.Thatwhichdistinguishestheindividualcaseofdiseaseto betreatedfromothermembersofitsclassistofinditsresemblanceamongthose effectsofthedrugwhichdistinguishitfromotherdrugs.Thisiswhatwemeanwhen wesaythatwiththesethelawofcurehaschieflytodo.Whenwesaylikecures likethisisthelikewemean.(Italicsadded). Contemporaryhomeopathicscholarsaredevelopingamodernlanguagetoexpress themeaninganddirectivesofAphorism153.Dr.JoeKellerstein10refersto homeopathicdiagnosisasaprocessofpatternmatching.(Kellerstein)Inour analysisofthecasewearetobringthecharacteristicsymptomstotheforeground whilerelegatingtheindistinctandcommonfeaturesofthepatientspathologytothe background. Wearelookingforsymptomsthataresowelldescribedorsouniqueorsopeculiar thatonlyasmallgroup,orperhapsevenoneremedy,haseverbeenrecordedas curingthatsymptom.Whenwehaveinourcaseagoodnumberofthesevery characteristicsymptomswehaveasmallnucleusofsymptomscalledagenius,or themostcharacteristicsymptomsinthecase.Thegeniusofthecasearethesmall groupofmostcharacterizingsymptoms,mostusefulsymptomsinpointingtoone andonlyoneremedy.Andthegeniusiswhatmustmostcloselycorrespondtothe geniusofthecorrespondingremedy.
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Inthisforegroundsymptomdisplayitistheconcomitanceorforminwhich symptomsaregrouped(Close)thatrevealsthecharacteristicfeaturesoftheillness anditsdefiningindividuality.Whenwerepertorizethesecentralsymptomswe delineatethefundamentalpatterninformingthegeniusofthecase.ThePocketbook displaysthisforusthroughtherubricsweselect,andbymeansofmatchingpatient symptompatterntoremedysymptompattern,itrevealsthoseremediesmost homeopathictothatgenius. PartIII:TheroleoftheRepertory WeshouldexpectourMateriaMedicatobeacarefulcompilationofthepureand clinicalsymptomatologyofourremedies.Varioustextsofferarangeofemphasis fromprincipallyclinicalofferings,topurelypathogenetic(proving)symptomatology, tomixesoftheseandrangefromcomprehensivetreatisestoconcise keynote/confirmatorysymptomlistings.TheRepertory,ontheotherhand,does notcontainadefinitivedescriptionofindividualremedies,butisexpectedtoserve asaguidetorecognizingthesimillimumforacase.Assuch,itsgreatestpotential forerrorisinexclusionmissingthesimillimumforthecaseathandinouranalysis. WithreferencetotheMateriaMedicaandseasonedwisdomremainingthefinal goldstandardsinremedyselection,wecantoleratetheRepertorysuggestingafew extraremediesinouranalysesparticularlywhentheseerrorsofinclusionserveto avoidmissingagoodremedysuggestionduetoanerrorofexclusion. RubricsintheTherapeuticPocketbook Arubricisakindofencapsulationorsummaryofthemateriamedica.Insome respectsitslikeadatabasesearchinthatitretrieveslistsofremedynamesbased onbriefkeyworddescriptionsofsymptoms.TherubricsinSynthesisandthe Pocketbookaredesigneddifferentlywhenitcomestoperformingthisfunctionof retrieving.IllbeusingEncyclopaediaHomeopathica(EH)toperformseveral searchesusingsymptomdescriptionsinordertodemonstratethedifference betweentherubricdesignsofthesetworepertories.FirstIllbeusingsymptom descriptionsarrangedtoperformlikeaSynthesisrubrictoshowhowthatrepertorys rubricsencapsulatethemateriamedica.ThenIllusethesamewordsarrangedlike thestandalonerubricsfoundintheTherapeuticPocketbooktoshowhowthat repertoryrepresentsthemateriamedica.Idliketotakeasimplesymptom,suchas atearing/drawingpainintheknees,toillustratethis.
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LetsbeginwithanEHsearchsetupinthemannerofaSynthesisrubric.Icanuse EHtosearchforthewordkneesandalsofortearinganddrawing.Illenter thesewordsinthesamelineinthesearchparameterssothatEHwillonlyshowme remedieswhereallthesewordsappearinthesamesentence.Theresultsfromthis firstEHsearcharelistedbelow.11
Foraremedytoappearinthissearchwemustbeabletofindoccurrencesofthe wordkneesandalsooccurrencesoftearinganddrawingpainswithinthesame symptom.ThissearchisequivalenttousingtheSynthesisrubricExtremitiespain kneestearingpaindrawingpain,whereinorderforaremedytoappearinthis rubricitmusthavesymptomslocatedinthekneesthatarealsotearingand drawinginsensation.SixremediesappearinthisSynthesisrubric. ThenextEHsearchdemonstratestheTherapeuticPocketbookapproachtothis samesymptom.Wewillagainusethewordskneesandtearinganddrawing butthistimewellenterkneesononelineandtearingwiththesynonym drawingonanotherline.Splittingupthelocationofthesymptomandthesensation ofthesymptomthiswaywillactuallyresultintwocompletelyseparatesearches. Theresultsfromthesearchsetupthiswayappearonthefollowingpage.
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TheEHsearchsetupthiswaylooksforsymptomsinvolvingtheknee(indicated withbluebars)andthenlooksforsymptomsinvolvingtearing/drawing sensations(indicatedwithtealbars).Inthesearchresultsdisplay,therewillbe remedieslistedwithonlyresultsforkneesymptoms(thebluebars)whileother remedieswillhaveonlyresultsfortearing/drawingsymptoms(thetealbars).The remedieswereinterestedinaretheoneshavingblueandtealcolouredresultsas thismeanstheyhavesymptomsassociatedwiththekneeandalsosymptomswith tearing/drawingsensations.Thesearchsetupthiswayfinds103remedies. TheTherapeuticPocketbookstworubricsPartsofthebodyandorganslower limbsjointskneesandSensationsandcomplaintsexternalpartsofbodyand internalorgansingeneraltearing(drawing)pressingJointsintheapproach thistearing/drawingkneesymptominthesamemannerasthetwoseparatesearch listsinthechartabove.Thefirstrubricwillgiveusalistingofremedieswith symptomslocatedintheknees,regardlessoftheirsensationwhilethesecond rubricprovidesacompletelyindependentandunrelatedlistingofremedieswith jointsymptomswhicharetearing/drawinginnatureregardlessoftheirlocation(the Pocketbookcombinestearinganddrawinginonerubric).Thenumberof remedieslistedineachofthetwoPocketbookrubricsisquitelargebecauseeach rubricdealswithonlypartofthewholesymptomdescription. Lessdetailcanbebetter
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Youmightquestionwhyyouwoulddesignarepertorytoperforminthemannerof thesecondEHsearch.Whatadvantageistheretohavingonerubrictolistremedies withkneesymptomsandanotherrubrictolistremedieswithtearing/drawing jointsymptoms?Neitherrubricliststearinganddrawing,andkneestogetheras asinglesymptomanditwouldseemthatcombiningthemintoasinglerubricwould bemorepracticalandatthesametimemoreaccurate. Butifyouthinkbackonthe4thoftheBoenninghauseninsightsyoubegintoseethe methodinthismadness.Havingonerubricforthesensationandanotherforthe locationbreakstheconnectionbetweentearing/drawingandknees.The connectionisbrokenbecauseBoenninghausenregardssymptomsensationsasa generalcharacteristic.ThePocketbooksindependentrubricfortearing/drawing willshowustheoccurrenceofthisparticularsensationregardlessofitslocationor accompanyingmodalities.Itshowsusalistofallremedieshaving tearing/drawingjointpainsymptomsoccurringinanylocation.ThePocketbooks secondrubricdealsonlywiththelocation.Itwillshowusallremedieswithknee symptomsregardlessofthetypeofsensationoraccompanyingmodalitypresent. Betweenthetworubricswegeteveryremedywithsymptomsofeithertypeandwith thiswehavemorepossibleremedymatchestoourcaseconsequentlyfewer remediesexcludedatthepointofrepertorization. Certainlynocaserestsonasinglesymptom.Totrulyseethedifferencebetween thesetworepertoryrubricstylesweregoingtoneedsomeadditionalsymptomsto makeupanillustrativecase.Toourchiefcomplaintoftearing/drawingpainsin theknee,letsaddsymptomssuchaseruptionsatthemarginstheanus,sensitivity tonoise,anaggravationfromjarringandinflamedcornsonthefeet.Well repertorizeallthesesymptomsfirstwithSynthesisandthenwiththePocketbookso thatwecancomparetheresultsobtainedwiththetworepertories.TheSynthesis analysischartfollowshere:
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Thereare246remediesontheSynthesischartwithonly1ofthoseremedies, Sulphur,appearinginalltherubricsused.Thesmallestrubricinthisanalysisisthe firstonefortearing/drawingpainintheknees.Itcontainsonly6remedies.(Orto putitanotherway,iteliminates240remedies.) Lookatthe2ndremedylistedonthechart,NitricAcid.Ithasagradeleveloftwoor threeineveryrubricexceptthefirst,whereitdoesnotappearatall.Thisisaremedy knownforitssensitivitytoslightcauses,suchasnoise,andalsoitsaggravation fromjarring.Itisalsoknownforeruptionsatthemarginsofthebodysopenings. NitricAcidcoverstheconcomitantsymptomsverywellbutitisexcludedfromthe firstrubricforthechiefcomplaintoftearing/drawingkneepain.Wemightnot considerNitricAcidinthisanalysisbecauseitisnotincludedinourchiefcomplaint. ThenextchartshowstheanalysisofthesesamesymptomsusingtheTherapeutic Pocketbook.ThePocketbookschartcontains7rubricsandlists125remedies.Of these125,thereare6remediesappearinginalltherubricsweveused.The Pocketbookissuggestingthatfiveadditionalremediesmeetallthesymptom requirementsfoundinoursimulatedcaseoftearing/drawingkneepain.
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ThesmallestrubricinthePocketbooksanalysisistheoneforthecornsandit contains12remedies.Thatsonlyoneremedylessthanisfoundinthe correspondingrubricusedintheSynthesisanalysis.Sothewaythetworepertories representthesymptomofinflamedcornsisnotmakingmuchofadifference.The differencebetweenthetwoanalysescomesentirelyfromthemannerinwhicheach repertoryrepresentsthetearing/drawingkneepain.Earlierwelookedathowthe Pocketbookrepresentsthissymptombyusingtworubricsthefirstincludesthe symptomsensationandlists104remediesandthesecondrubricincludesthe symptomlocationandlists117remedies.WhiletheSynthesisrepertoryrepresents thissymptomusingasinglerubricthatincludesboththesensationofthepainand alsoitslocationandcontainsjust6remedies.Letslookmorecloselyatthis Synthesisrubricinordertoseehowwellitcorrespondstothemateriamedica. SynthesislistedSepiain3rdplaceeventhoughitisnotintherubricusedfor tearinganddrawingkneepain.WhileSepiaisthefirstremedyonthe Pocketbooksanalysischart.IfIsearchinEHundertheremedySepiafortheword tearing(andalistofsynonymsincludingdrawing)andalsoforthewordkneesI canfind441symptomswiththewordstearing/drawing,153symptomswiththe wordkneesand40symptomscontainingbothtearing/drawingandkneesinthe samesentence.TheremedySepiaappearstohaveanabundanceoftearing pains,anddrawingpains,andalsoastrongaffinityforsymptomsintheknees.A smallsamplingofdrawingortearingkneepainsfromthemateriamedicaof
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Sepiaappearsbelow: Arthriticdrawinginthekneeandfingerjoints, Tearinginthekneeandelbowjoints(aftersixteendays), Tearinginthewholethigh,particularlyintheknees,afterdinnerandsupper, Drawingpaininthekneejoints,evenings, Drawingandtearingshootingsinknees,hams,andheels.12 LetslooknextatNitricAcid.IcanuseEHtofind316instancesoftearing/drawing painsinvariouslocationsand65instancesofkneesymptoms.Mostimportant though,Icanfind18instancesoftearing/drawingpainsassociatedwiththeknees someofwhicharelistedbelow: Pressivedrawingpainabouttheknees,ankles,andotherjoints, Drawingandtearinginthethigh,extendingfromthekneeupward,onsittingdown, relievedbysitting, Tearinginthethigh,extendingupfromtheknee,whilewalking, Violentdrawingintheknees,endingwithajerking, Rheumaticpainsanddrawingfromkneetogroin,withsorenessoftestes.13 WiththeresultswereabletofindusingEH,weshouldwonderwhySynthesisdoes notincludeeitherSepiaorNitricAcidinitsrubricExtremitiespainkneestearing paindrawingpain.ThereasonforthisisthatneitherSepianorNitricAcidhas painswhicharetearingandalsodrawingandwhicharealsolocatedinthe knees.Still,theEHsearcheswevedoneusingthewordstearing,drawingand kneesturnedupnumerousinstancesofsymptomswiththesefeaturesforboth remedies.Withoutdoubtatearinganddrawingkneepainiswellwithintherealm ofthepossibleforbothremedies(Sepiahad40kneesymptomswithtearingor drawingpains.NitricAcidhad18similarsymptoms).ThePocketbooksanalysison page40whichlooksatthelocationkneesandthesensationtearing/drawing separately,andwhichincludesbothSepiaandNitricAcidinitstopsixremedies,is definitelyindicatingthispossibility.
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Whichrepertoryanalysisismoreaccuratethen,SynthesisorthePocketbook?Im goingtoavoidthisquestionforjustalittlelonger.IdliketoreturntotheSynthesis analysisonpage39onceagain.IfImakeaminorrubricchangea BoenninghausenlikesubstitutionbyremovingExtremitiespainkneestearing paindrawingpainandreplaceitwiththetwomoregeneralrubricsofGenerals paindrawingpainandExtremitiespainkneestearingpainthen theSynthesisanalysischartonpage39changesfromhavingasingleremedy appearinginallofitsrubricstonowhavingsevenremedieswhichappearinallof itsrubrics.ThoseremediesareNitricAcidfirst,followedinorderbyRhustt, Lycopodium,Sepia,Sulphur,CalccarbandHepar.Notethatfouroftheseven remediesinthismodifiedSynthesisanalysis,whichappearsonthenextpage,were inthetopsixremediesintheTherapeuticPocketbooksanalysisonpage40. InthismodifiedversionoftheSynthesisanalysiswereusingtwogeneralized rubricstoreplaceonecomplexrubric.Indoingthiswehaventchangedanything abouttheactualsymptomitself,onlyhowwererepresentingitwiththerepertory. ComparingthetwoversionsoftheSynthesisanalysiswecanseenowhowthe rubricswechoosetorepresentasymptomcanhaveaprofoundeffectonthe analysisresults.ThismodifiedSynthesischartisnotnecessarilymoreaccurate thantheoriginalversiononpage39,butitisdefinitelymoreinclusive.Wealsosee thatthismodifiedchartlooksalotliketheanalysischartfromtheTherapeutic Pocketbookonpage40.
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Sonowtogetbacktotheissueofwhichrepertoryhasthegreateraccuracy. Accuracyincaseanalysisisachievedthroughthequestionsweaskduringthe interviewandbythesymptomsweselectforoursymptomhierarchy.Thesecrucial stepstakeplacebeforeweopentherepertory.Idliketosayatthispointthatthe accuracyofthesetworepertoriesisntreallytheissueatall.Therealissuewhenit comestotherepertorystageofcaseanalysisisthatofmissingourremedyby inadvertentlyfilteringitoutthroughourchoiceofrubricsthisistheerrorof exclusionreferredtoearlierbyWillTaylor. WeveseenthattheTherapeuticPocketbookisinclusivebydesignratherthan exclusive.Thisarisesfromtwosources.ThePocketbooksrubricsareforthemost partlargerbecausetheyaremoregeneralinnature.Theybringmoreremediesinto theanalysisattheoutsetonereasonforthePocketbooksanalysescontaining moreremedies.TheothersourceofthePocketbooksinclusivenessisthemanner inwhichsymptomsarebrokendownintotheircomponentfeaturesanddispersed throughouttherepertoryschapters.Eachinstanceofacomplexprovingsymptom withitsdescriptionoflocation,sensationandmodalitywillgeneraterubricsthat appearinatleastthreechapters.Suchasymptomcanberetrievedagaineither througharubricdescribingitsmodality,orarubricdescribingitssensation,orone describingitslocation.Thisincreasesitsrepresentationintherepertorythreefold andconsequentlyithasthreetimesasmanychancesofbeingincludedona repertorychart.Thebenefittothestudentofthisoverrepresentationintherepertory isimmediate.UsingthePocketbookwearemuchlesslikelytoeliminatethecorrect remedybyinadvertentlyfilteringitoutthroughourinexperiencedrubricselection. Thereis,however,oneminordrawbacktothewayinwhichthePocketbooks rubricsaredisplayedintheanalysis.Justlookingattheanalysischartonpage40 theresnowayforustotellwhichremedieshavetearinganddrawingandknee symptomfeaturesoccurringtogetherinthesamesymptomandwhichremedies dont.ThePocketbookdoesnotcombinethesefeaturesintoasinglerubricallowing ustoseethisimmediately.Forexample,Chamomillaappearsinalloftherubricson thechartandislistedin27thplaceintheanalysis.WhenwegototheMateria MedicawereadtherethatChamomillahastearinganddrawingpains,and kneepainaswell,howeveritdoesnothavetearingordrawingpainswhich occurintheknees.ThePocketbookstendencytobemoreinclusivebrings Chamomillaintotheanalysisdespitethis.Soinordertoknowifaremedy appearinginouranalysisistherebecauseithastheparticularsensation(s)were
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lookingfor,occurringintheparticularlocationwerelookingforittobeinwere goingtohavetoreaditsmateriamedicalookingforsymptomswiththesefeatures occurringtogether. RubricsoftheMindandSensorium ThePocketbookschapterMindandSensoriumcontainsonly36rubrics.Aswe havecometoexpectnow,theserubricsaresparseintheirdescriptionreferringto generalqualitiessuchasexcitement,mildnessormistrust.Theschemaused elsewhereinthePocketbookofbreakingsymptomsdownintotheirconstituent componentscouldnotbeappliedtosymptomsoftheMindandintellect.Limitingthe numberofrubricsinthisfirstpartoftherepertorywasachoicemadeby Boenninghausensothatwewouldgodirectlytothemateriamedicaforthe mental/emotionalsymptoms. Inregardtothefirstsection,itmustbeespeciallyobservedthatourMateriaMedica PuracontainsnowheremoresecondarysymptomsthanundertheMindand Disposition,and,ontheotherhand,mostbeginnersinhomeopathyareliableto overlookthispartofthepictureofthediseaseortomakemistakes.Therefore,Ihave considereditwisetogivehereonlywhatisessentialandprominent,underasfew rubricsaspossible,inordertofacilitatereference. BoenninghausenwasquiteHahnemannianinhisjudgmentoftheimportancethe patientsstateofdispositionhasinarrivingatthehomeopathicdiagnosis.Heknew thatoftenthementalandemotionalsymptomsholdswayoverthecaseandare mostcharacterizing.Hesuggestedthatafterwerepertorizethephysicalsymptoms toarriveatalistofleadingremedieswhichmatchthosefeatures,weshouldthen turntothemateriamedicatostudythementalsymptomsofthoseremediesinmore detail.Therewecanreadthemental/emotionalsymptomsintherichnessoftheir originalcontexttomoreaccuratelydiscerntheremedymostsuitabletothecase.In thiswaythemental/emotionalsymptomscomeintoplayinthefinaldeterminationof theremedychoice. Repertoryanalysisofpartialsymptomdescriptions Inaperfectworldwewouldalwaysobtainsymptomsintheirfulldetail.Inactuality thisisfarfromaregularoccurrence.Perhapsweareunabletoobtainafullsymptom descriptionbecausewelacktheskillstoquestionourpatientinsomearea,oritmay bethatthepatientcannotrecallaparticulardetailofhis/hersymptomsastheyhave
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longsincebecomehabituatedtothem. Asstudentswearetaughtthatsymptomdetailisnecessaryinordertomoreexactly determinethesimillimum.Howeverifweattempttorepertorizealessthan completelydescribedsymptom,byselectingacomplexlywordedrubriccontaining alotofdetail,wecanrunupagainstaproblem.Thesymptomsreferredtobysuch rubricsareoftenmoreprecisethanthepartiallydescribedsymptomgivenbyour patient,whomayonlybeabletovaguelydescribeasensation,orwhocannottell ustheexactlocation,orwhodescribesasymptomwithoutanymodalities whatsoever.Thefitbetweenthepartiallydescribedpatientsymptomandtheprecise symptomdescriptionofthedetailedrubricwillnotbeagoodoneinthisinstance. Wheneverweopttouseadetailedrubricwemustcarefullyconfirmtheclosenessof thematchbetweenitsdetailsandthoseofthepatientssymptomasthesymptom detailinherentintheirwordingwillbefoundinonlyalimitednumberofremedies. Includingaspecificallywordedrubricinourrepertorizationwithoutthisconfirmation willeliminatemanypotentiallygoodremedymatchesandmostlikelyleadour analysisastray. TheTherapeuticPocketbookcanmakelifeeasierforusinsuchsituations.Youmay recallthatwholesymptomsareintentionallybrokendownintotheircomponents whenenteredintothePocketbookandthatthesecomponentrubricsarerecordedin separatechapters.Thismakesitpossibletoretrievearubricforjustasingle symptomcomponentthatisonlythesensationorthelocationorthemodality independentoftheothercomponentsthatoriginallyaccompanieditintheproving. Therubriccanbematchedtothepartial,orfragmented,symptomdescription providedbyourpatient.Shouldourpatientdescribeasymptomslocationand sensationwithoutbeingabletorecallamodalitywecanaccuratelyrepertorizethis incompletesymptomusingtworubrics.Thefirstrubricreferencesallremedies knowntohavesymptomsinthesamelocationasourpatient,whilethesecond rubricreferencesallremediesknowntohavesymptomswiththesamesensationas ourpatient.Neitherrubricattemptstolinkthelocationandthesensationtogether andofcourseneitherrubricsaysanythingwhatsoeveraboutthemissingmodality. Bothrubricswillcontainalargernumberofremediesbecauseeachrubriconly looksatoneaspectofthesymptomratherthanatbothtogether.Thisservestokeep thefieldofpotentialremediesaslargeaspossible. (Ananalogousexamplewouldbeforustohaveonelistofthenamesofallanimals foundlivinginthetropicsandthenanotherlistofthenamesanimalswithwhitefur.
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Eachofthesetwolistswouldcontainagreatmanymoreanimalsthanyouwould findinalistrestrictedtoonlythoseanimalswhichbothliveinthetropicsandwhich alsohavewhitefur.). IdliketointroduceanexampletoshowhowtheTherapeuticPocketbookeasily accommodatesimperfectlydescribedsymptomswhileatthesametime demonstratinganinstanceinSynthesisofanerrorofexclusionreferredtoearlier byWillTaylor.UsingSynthesisandthenthePocketbookwewillfindrubricsforthe symptomvertigoaccompaniedbymentalconfusionworselyinginbed.This isaportion(i.e.,anincompleteorpartialdescription)ofthevertigosymptomsfrom theConiumprovingonpage24andwhichIvelistedhereagainjusttorefreshour memories.Youcanseeinthelistbelowthatlyingandbedarefeaturesinthe vertigoofConiumandareaccompaniedbysomementalconfusion: Dizzinessandwhirlingintheheadfortwodays. Verydizzywhilewalking. forgetfulnessandweaknessoftheheadvertigo,whenlookingaround,asifthe patientwouldfalltooneside Vertigo,whirlingaroundwhenherisesfromhisseat. Vertigo,afterstooping,whenraisingupagain,asiftheheadwouldburst. Vertigo,worselyingdown,asifthebedwerewhirlingaroundinacircle. Vertigo,earlyonrisingfromthebed. Headache(externally),asifcontracted,ontheupperpartofthefrontalbone,which goesoffbystoopingandapplyinghisownhandtothepart,withchilliness,vertigo, andpeevishwantofrecollection Vertigoongoingdownstairsshehadtoholdontosomething,andforamoment shedidnotknowwhereshewas. Vertigowhichfatiguesthehead. Vertigo,sothateverythingseemstowhirlaround. FirstwellrepertorizethesymptominSynthesisusingthreespecificallyworded
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rubricswhichappeartobequiteappropriateforthissymptom.Thenwelldoa secondSynthesisanalysisemployingmoregeneralrubricstoseehowusingless specificrubricschangestheanalysis.Welldiscussthereasonsforthedifferences weseeinthesetwoSynthesisanalysesbeforegoingontorepertorizethissame symptomusingtheTherapeuticPocketbook. Inthefirstchartbelow,theMindrubricseemsagoodmatchtothedescriptioninour example.ThetwoVertigorubricshavebeencombinedintoasinglerubricgroupin ordertoincludealltheremediesfoundineitheroneofthem.Theyrepresentthe associatedmodalityofworselyinginbed.Thewordingofthesethreerubricsseems tofitthissymptomverywell.
However,Coniumdoesnotappearinanyoftheserubricsandyetweknowthatthe symptomitselfcomesfromtheConiumproving.EventheMindrubricforconfusion withvertigodoesnotlistConiumamongitssixtyremedies.Thisanalysiscontainsa totalof67remedies. Nowletsmakesomemodificationstoourrubrics.Coniumdoesnotappearinthe rubricMindconfusionofmindvertigo,with.WecansubstitutetherubricMind Confusionofmindtogetaroundthisproblem.Coniumalsodoesntappearin VertigoBedinbedaggorinVertigolyingbedinaggbutifwesubstitutethe lessspecificVertigolyingaggConiumwillagainappearonthechart.Ive combinedtheinitialSynthesisanalysisonthesamechartwiththemodified Synthesisanalysissothatwecancomparethetwoapproaches.Therubricsinthe initialanalysishaveaweightingfactorofzerosothattheydonotinfluencethe outcomeofthemodifiedanalysis.YoullnoticethatthefirstSynthesisanalysislisted
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67remedieswhilethissecondmoregeneralanalysislistsawhopping573 remedies.
Clearly,thethreerubricsincludedintheinitialanalysisareresponsiblefor eliminatingmostoftheremedies.Thisisduetotheirdetailedwordingindescribing thevertigo.Somehowtheadditionalinformationaboutthevertigobeingworsein bedandthatitisaccompaniedbymentalconfusiondrasticallyreducesthenumber ofremediesintheanalysis,andalsomanagestoexcludearemedy(Conium)that weknowtohavethissymptom. InthemodifiedversionoftheSynthesisanalysisweadjustedourrubricstouse oneswithlessspecificdetailbecauseweknewaheadoftimethatConiumshould appearinthechart.Usinglessspecificrubricsisastrategythatwemightnotalways thinkofand,asyoucansee,itcanleaveuswithahugefieldofremediestowork with.Besides,yousay,dontweneedtorepertorizethesensationmental confusionandthemodalityworseinbedifthatdetailisincludedinthevertigo symptomdescription?Thatisaninterestingquestionandonewellbediscussing shortly.Butfornowletscontinuelookingattherubricsweveselectedforthetwo versionsoftheSynthesisanalysis.Perhapstheproblemisthatwerenotusingthe rightrubric(s)andweneedtofindarubricthatmatchestheConiumproving symptommoreaccuratelythantheonesweveusedsofar.Thiscouldallbea matterofnotknowingthatamoreappropriaterubricexists.
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Indeed,thereisarubricinSynthesisthatspecificallycapturesthedescriptionof vertigofromtheprovingfortheremedyConium.ThatrubricisVertigoturned aboutasifbedanditcontainssixremedieswithConiumbeinga(3)inthisrubric. CheckingtheauthorreferenceforConiumweseethatitisHahnemannandthatthe symptomcomesfromChronicDiseases.This,then,istheexactrubricforthe provingsymptomanditdoescontainareferencetolyinginbed. Butwait.Inourexamplethepatienthasnotgivenusadescriptionofvertigothat includesitbeingasifthebedturnedabout.Allwehaveinourdescriptionis vertigoaccompaniedbymentalconfusionworselyinginbed.Ourpatientis describingonlypartofthefullsymptomasitexistsintheprovingforConiumand which,inSynthesis,isrepresentedbytherubricVertigoturnedaboutasifthe bed.Withoutourpatientsupplyingthemissingdetailaboutthesensationofthebed movingwereallycantusethisrubricandhereinlaystheproblem. Theproblem,inanutshell,isthattheprecisedetailinsomerubricsiseither excludingthemaspotentiallygoodrubricswhenwedonthavesufficientdetail fromourpatienttousethem(thesituationwiththerubricVertigoturnedaboutas ifthebed)orwhenwedoincludecomplexlywordedrubricstheirprecisedetail resultsinexcludingpotentiallygoodremedies(thesituationwiththethreerubrics usedinourfirstSynthesisvertigoanalysis). Ifwerehonestwithourselvesnow,wehavetorecognizethatinselecting specificallywordedrubricswearechoosingbetweenthembasedsolelyonwhatwe readinandespeciallyreadintotheirwording.Wereallyhavenootheroptionat thisearlystageofourtraining.Weshouldexercisecautionwhenincludingrubrics withspecificanddetailedwordinginouranalysis.Weveseenthattherepertoryis pronetomakeatypeoferror,theerrorofexclusion,anditariseswhenwetakethe complexwordingofsomerubricsatfacevalueasiftheywerefaithfultranslationsof provingsymptoms.InthisConiumvertigoexamplehadweusedthethreerubrics fromthefirstSynthesisanalysis,basedsolelyontheirspecificwording,wewould haveeliminatedthecorrectremedybeforeweevenopenedupthemateriamedica. Exactitudeincaseanalysisisimportantforourinitialprescription,perhapseven moresoforourfollowups,buttostriveforitatthepointofrepertorizationthrough gravitatingtosmallerpreciselywordedrubricsisnotthemostconstructivemeansof achievingthataccuracy.IdbelyingifIsaidithasnttakenmequitesometimeto comearoundtoseethetruthofthis.TheeyeopeningmomentcamewhenIwas
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listeningtoateleconferenceontheBoenninghausenmethodpostedontheWhole HealthNowwebsite.EarlyinthisrecordedinterviewWillTaylortalksabouthow Boenninghausengeneralizedmodalitiesandsensationsinordertomakeupforthe deficienciesintheprovingsandtokindofcoveroversomeofthegapsinour knowledgeofremedies. [Boenninghausen]neverproposedthatweimposethesegeneralizationsonour materiamedicaButintherepertorythisisadifferentstory.Hesaidthegoalofthe repertoryistogofishingwith.wewanttodragitthroughthewaterandwedont wanttomissthefishthatweneedtoendupwith.Andsowemightneedtocastita littlebitbroaderthanwhatwerecordinthemateriamedicaforremediesthere mightbeanothersymptomthatjusthasnotbeenobservedinaprovingoryet confirmedinaclinicalsetting.Andwewouldloseitinouranalysisifwedidntcast ournetthisbroadlythisgeneralizationofmodalitiesandgeneralizationof sensationsissomethingintendedfortherepertoryandnottorewritethemateria medicainthismanner. IdliketorepertorizethesamepartiallydescribedConiumsymptomofvertigo accompaniedbymentalconfusionworselyinginbednowusing BoenninghausensTherapeuticPocketbook.Youcanseefromtheanalysischart onthenextpagethatthePocketbooksrubricscontainfarlessdescriptivedetail thantherubricsusedintheinitialanalysiswithSynthesis.
Beingmoregenerallessspecificandthuslessexclusivetheybringmore remediesintotheanalysis(with125remedies)thanthenumberlistedinthefirst
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Synthesischart(with67remedies).ThePocketbookisdefinitelythebroader fishingnethere.MoreimportantlythePocketbooksrubricsbringinConium,listed in18thposition,withoutrequiringanyrubricsubstitutions. Aswediscussedearlier,therewillberemediessuggestedinthePocketbooks analysisthataregoingtobefalsehitsremediescontainingsome,butnotall,of thesymptomfeatureswearelookingforandwewillhavetoruletheseremedies outthroughourstudyoftheirmateriamedica14.Admittedly,thePocketbooks analysisgivesusalittleextraworkwhenitcomestothedifferentialdiagnosis becauseitprovidesabroaderrangeofremediesforustostudy.Still,itisfareasier toeliminateanextraremedyortwosuggestedbytherepertorythanitistofindone thathasbeenexcludedbyit.Wellmoveontodiscussingremedydifferential diagnosisandtheinterpretationofthePocketbooksanalysisinthenextsection. PartIV:InterpretingthePocketbooksanalysis TheTherapeuticPocketbookchartonthepreviouspagecontains125remediesin theanalysis,67oftheseappearinallthreerubricssimultaneously.Thisnumber seemshigh,especiallywhentheSynthesisanalysisonpage48listedonly12 remediesthatappearedinmorethanonerubric.Arewereallytoconcludethatthere werethismanyremediesinthemateriamedicaofBoenninghausenstimeknownto havevertigosymptomsmatchingthedescriptionvertigoaccompaniedbymental confusion,worselyinginbed?Weneedtotakesometimetolookmorecloselyat thisPocketbookchartbecausetherubricdesignofthePocketbookmakesitmost unlikeSynthesiswhenitcomestointerpretingtheanalysis. TheremedyConium,whichweknowtohavethisparticularvertigosymptom,isthe 18thremedylistedinPocketbooksanalysis.Intheorythen,thereare17remedies beforeitwhichmightjustaseasilyalsohavethissymptom.Weregoingtohaveto differentiatebetweentheseremediesonthebasisofthissymptomaloneandin ordertodothatweneedtoexaminetheirmateriamedicaforthissymptom. Pulsatillaisthefirstremedylistedonthechartandwemightassumefromthisthatit hasthevertigofeatureswerelookingforandwithmorecertaintythanthe18thplace Conium.SearchinginHahnemannsMateriaMedicPura(MMP)andChronic Diseases(CD)undervertigowecanfindseveralentriesfortheremedyPulsatilla. Illlistthemhere: Violentvertigo,likeintoxication.
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Vertigo,likethatwhichoccursonturningroundforalongtimeinacircle,combined withnausea. Vertigo(immediately),stillworsethenextday. Vertigoasfromintoxication. Vertigoasifthebloodmountedtothehead,rakingandgraspinginit. Attacksofvertigo,intoxication,heat. Vertigo,especiallywhensitting. Vertigointhemorningonrisingfrombedonaccountofithemustliedownagain. Vertigowhentakingawalkintheopenair,whichgoesoffonsittingdown. Vertigo,heimagineshecannotstand(inthe1sthours). Akindofvertigowhenheturnstheeyesupwardsasifhewouldfall,orasifhewere dancing. Vertigowhenstooping,asifhewouldfalldown,asfromintoxicationfollowedby inclinationtovomit(aft.6h.). Vertigowhenstoopingdown,sothatshecouldhardlyraiseherselfupagain. Vertigoasfromaweightinthehead,whenwalkingandstooping,withsome whirlingwhichwasalsofeltwhenlying. Staggeringwhenwalkingasifhehadvertigo,andyetheisnotgiddy,inthe evening(aft.3d.). Dullnessintheheadandvertigo,causedbymoving. Vertiginousobscurationofthesightaftersitting,onstandinguprightand commencingtowalk(aft.24h.). Tightnessofthechestandvertigotogetherwithweaknessofthehead,whenlying horizontallyontheback,which,however,goesoffonsittingupright. Pulsatillacertainlyhasnumeroussymptomsofvertigo.Thereisvertigoasfrom
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intoxication,vertigowithasensationofheat,vertigoworsewalkingintheopenair andbettersitting,vertigoassociatedwithlyingontheback,butnonespecifically worselyinginbedandnoneaccompaniedbymentalconfusion. LetslooknextatBelladonna,thesecondremedyappearingintheanalysis,andits vertigo: Vertigoobjectsseemtoswayhitherandthither. Whirlinginthehead,vertigowithnausea,asafterrapidturningroundinacircle,or asafterthemorningsleepfollowinganocturnaldebauch. Vertigoasifallwhirledroundinacircle Attacksofvertigo,whenatrestandwhenmoving. Agiddyfeelinginthewholehead,likevertigo,whensitting Vertigoandtremblingofthehands,sothatshecouldnotdoanythingwiththem. Whenwalkinghestaggers,holdsontothewalls,complainsofanxietyandvertigo, andoftentalksnonsenselikeadrunkenperson. Attacksofvertigowithobtusenessofsensesforsomeminutes Aweightintheupperpartoftheforehead,whichcausesvertigoandasitwere intoxication Rushingnoiseintheears,vertigo,anddullbellyache. Eructationandvertigo Vomiting,vertigo,andflyingheat Paralysisofthelowerextremities,shemustliedown,withnausea,trembling, anxietyandvertigo. Fever:atnightfebrilechill,whichwassoonsucceededbyheatofthebody,and frequentmicturationandwearinessofthelimbsthefollowingnightadoublefebrile attackofthesamekind,withvertigoandthirst HereagainwecanseethatBelladonnahaslotsofvertigo,especiallywithreeling
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likeadrunkenpersonandstaggering,butitdoesnothavevertigothatisworseon lyinginbednorvertigoaccompaniedbymentalconfusion. LookingnextatthevertigoofCalcareacarbonica(3rdintheanalysis)weseethatit hasvertigowithweakness,lackoffirmnesswhenwalkingandstanding,butagain noindicationofvertigoworsewhenlyinginbedandnoneassociatedwithmental confusion: Stupefactionofthehead,likevertigo,alltheafternoon Feelingofvertigo,asifthewasliftedhighupandthrustforward. Vertigo,asifabouttofalldown,withexhaustion. Vertigo,asifthebodydidnotstandfirm Vertigofromvexation. Vertigoonquicklyturningthehead,andalsowhenatrest. Quicklypassingvertigo,mostlywhensitting,lesswhenstandingandstilllesswhen walking. Violentvertigoinstooping,thennauseaandheadache. Vertigoafterwalking,whilestandingandlookingaround,asifeverythingturned withher. Vertigoonwalkingout,asifabouttostagger,especiallyinquicklyturningthehead. Vertigoandpainfulwhirlingintheheadasifinacircle,inthemorningonrising especiallyverydizzywhenwalkingandstanding,withchillandpinprickinginthe leftsideofthehead. Headache,alsoattimeswithvertigo,everymorningonawaking. Pressiveoutwardintheforehead,verysevereandlikevertigorelievedbypressure withthecoldhand,anddisappearingwhenwalkingintheopenair WevenowlookedcloselyatthetopthreeremedieslistedinthePocketbooks analysischartonpage52andfoundthatdespitetheirappearingprominentlyinthe analysis,noneofthemhasthesymptomwerelookingfor.Atthispointwemight
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concludethateitherwevechosenthewrongrubricsor,worsestill,thatthe Pocketbookitselfisatfault.Actuallytheresnothingwrongwithourrubricsandthe analysisisfine,itshowwereinterpretingtheanalysisthatstheproblem. OurintentionattheoutsetofthisexamplewastouseacombinationofPocketbook rubricstorepresentacomplexsymptomofvertigo.Todothiswechoseonerubric forthevertigo,anotherforthementalconfusionandathirdforthemodalityofworse lyinginbed.Quiteunderstandablyweselectedtheserubricswiththeassumption thatwecouldrecombinetheminordertorestoretheoriginalsymptomfromthe provingagain.Forourparticularvertigosymptomthesethreesymptomfeaturesare connected,associatedonewiththeotherbecausetheyoccuratthesametimein ourpatient.ButinthePocketbooktheyarenotassociatedatall.Remember,these aregeneralizedrubricsofsymptomcomponentsthathavebeenderivedfrommany provingrecords.ThePocketbooksthreerubricspresentuswiththreeunrelated lists:allremedieswiththesensationofvertigo(inthe1strubric),allremedieswith thesensationofmentalconfusion(inthe2ndrubric),andallremedieswiththe modalityofworselyinginbed(inthe3rdrubric). Ifwecanchangehowweviewtheserubrics,seeingthemasthreeindependentlists ofsymptomcomponentsandNOTasathreerubricmatchforvertigoworselying inbedwithmentalconfusionwewillbeabletolookatthePocketbooksanalysis inadifferentlight.NowwecanseethatPulsatilla,BelladonnaandCalcareaappear onourrepertorychartbecauseeachoftheseremediesdisplayssymptomsof vertigosomewhereintheirprovings,eachalsohassomesymptomsthatareworse lyinginbedandeachhassomesymptomsofmentalconfusion.Andreally,thisis allwecantakeatfacevaluefromtheanalysis.Toknowwhetherornotaparticular remedyappearingonthechartdoesinfacthavevertigospecificallyworsewhen lyinginbedandwhichisaccompaniedbymentalconfusiontoconfirmorreject thiswehavetogobeyondtherepertorytoreadthemateriamedicaofthatremedy indetail. WebeganPartIIIofthisintroductiontothePocketbookwithaquotefromWillTaylor inwhichhesaidthatweshouldnotrelyontherepertorytoprovideadefinitive descriptionofindividualremedies.Itisalmostunavoidablethatnewstudentsuse therepertoryasifitdidprovidesuchdescription,asifwecouldmatchits abbreviatedsymptomsonaonetoonebasistosymptomswehaveacquiredfrom thepatient.Thoughwemaybeginlikethis,ouruseoftherepertorychangesasour
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knowledgeofremediesgrowsandourexperienceinanalyzingthecasegrowsas well.Afterwevegainedsomeexperienceincaseanalysiswefindthatwedont opentherepertoryuntilwehaveformedahierarchyofthekeysymptomsfrom amongthemostconsistentanddistinctivefeaturesofthepatientsillness(Aphorism 153).Thenwiththeaidoftherepertorywedelimitthefieldofremediesmost homeopathictothosesymptoms.Whenweusetherepertorythiswayitremindsus ofthethemespresentinthecasethatmustalsobepresentinourremedy.The analysischartitgenerateswilldisplaythedistilledgeniusofthecasethat minimumnumberofsymptomsofmaximumvaluetotheprescription.(Kellerstein) IncaseanalysistheprimarystrengthoftheTherapeuticPocketbookliesinitstaking thebroadestpossibleapproachtothefirstcrucialaligningbetweenthesymptomsof ourpatientandthoseofremedies.ThePocketbooksinclusiveapproachensures thatwedonoteliminatearemedytoosoonatthisearlystageofouranalysis.Aswe lookovertheanalysischarttherewillbearemedyortwowhichresonateswithus andforwhichwemayexperiencethefeelingthatThisremedycouldverywellbe mypatient.Ingettingustothispointtherepertoryhasdoneallitcandoforus. Thoseremedieswearestillconsideringforthecasemustnowbeinvestigatedin depthusingthemateriamedica.Mostlikelywewillneedtoexamineseveral remedies,comparingonetotheotheronthebasistheirsimilaritytothesymptoms exhibitedbyourpatient.Inthecourseofthisstudywewillhavetheopportunityto deepenourknowledgeofmateriamedicarelevanttothesymptomsofourcaseand toincreaseourknowledgeofthesimilaritiesanddifferencesbetweenremediesthat servesussowellatthebedside.Inlookingbackatthestartofourstudieswhenwe mechanicallypluggedpatientsymptomsintotherepertorywiththebeliefthatit wouldfindtherightremedyforusunderstandingremediesinsuchdepthwas beyondourreach.Wevecomealongway. PartV:AcasefromYearIIIClinic ThetimehascometoseethePocketbookapproachatworkinanactualcase.To demonstratethisIwouldliketorevisitacasefrommythirdyearclinicinorderto comparemyinitialSynthesisanalysiswithananalysisusingthePocketbook.Iwill usethepatientnameassignedbytheclinicsupervisorsothatifyouwishtopursue thisfurtheryoucanviewthevideotapeoftheinterview.Thecasecomesfromthe thirdyearclinicthatranfromSeptember2006toJune2007.Thepatientsnameis Deanne.
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Deanneinitialinterview SymptomDetails Fatigue Easilyafterslightexertion Withachesinmuscles Mindawakebutbodytired Likeshesrunamarathon Joint/back/wrist/hippain Hip Likeinthebonebutitisnot puncturingme Extendsthroughtheback <sittingalongtime <lyingonit Superioriliacspine Comesandgoes/sharpanddull Back Dullache Excruciating <sittingforalongtime <anyexertion Acrosslowerback
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Frequentoccurrence Wrists Dullache <exertion <typing <changeintemperature Kneesandankles <anyexertion Rightkneeextendingdownthefronttotheankle Likeshinsplints Sharpshootingpain Flatulence Eructationsandflatulence Withdistensionofabdomen Accompaniedbyhunger Hungerreturnssoonaftereating(20minutes)<910pm Migraineheadaches <changeinweather <coldtohot <springtimeworsethanfall <sound,lightandvomiting Headacheaccompaniedbyvomiting,<vomitingwhichincreasesthenauseaand pain,>sleepanddarkchocolate
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Intherighteyeextendingtocheekboneunderneath Cantthinkduringtheheadache Stressheadaches,<emotionalthings,whenapaperisdue,whenworried. Accompaniedbypanicandanxiety,thinkingoftheworstthatcouldhappen. Flushesofheat <afternoons4to6pm Accompaniedbyflushedface(flushingonlyontheface).Withredcheeksacross thenoseandcheekbones.Withexhaustionandweaknessandpoorconcentration. Withnauseaandvertigo,<rising,suddenlightorsoundandanymotion.Witha ghostlywhitecomplexion,blurredvision,painintheeyes,>closingtheeyes.With irritability. ExcessiveHunger Willeatfrom4pmuntilbedtime Willwaketoeat Hungryagain20minutesaftereating Preferssaltythings,thensweetthings,thensaltythings,thensweets Lovestomatoes Eruptionsonhandsandinmouth Withinmouth.Likeablister,popsandbecomesanulcer.Ovalshapedwithwhite center.Insidethemouthonly,underthetongue,backofthroatandcheeks. Onhands.Thepalmersurfaceoffingersandhands.Onthedorsalsurfacenearthe joints.Smallredvesiclesthatareraisedandstinging<touch.Occuronceperweek. Synthesisanalysis:hierarchyofsymptoms(withweighting) Deanneslistofsymptomsappearedendless,withsomanysymptomswell describedandoccurringregularlythatmycasenoteswentonfornearly10pages. Inthestudentclinicdiscussionfollowingtheinterviewthetaskbeforeuswasto
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paredownthedetailsofthecasetotheessentials.Iarrangedthemoreintenseand consistentsymptomsinthefollowingorder: 1. Flushesofheatwithweakness,vertigoandnausea(4) 2. Fatigueafterslightexertion(4) 3. Joint/back/hip/wristpains(3) 4. Migraines(3) 5. Excessivehunger(2) 6. Eruptionsonhandsandinmouth(3) 7. Aggravationfromclothingaroundtheneck(3) Myinitialrepertoryanalysisforthiscasecontainednolessthan36rubrics.Withthis manyrubricsallIwasdoingwaslistinghersymptomswithoutanalyzingtheir importance.Imanagedtotrimthisnumberdownto11rubricsthatinmyjudgement capturedthefourmostprominentfeaturesofDeannescase: 1. Flushesofheatintheafternoonwithweakness,vertigoandnausea 2. Fatiguefromslightexertion 3. Worsefromachangeofweatherfromcoldtowarm 4. Aversiontoclothingaroundtheneck Theanalysischartappearsonthenextpage.
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Fromthechartaboveyoucanseethatoneremedystandsclearlyaheadofallthe others.Sepiawasinfacttheremedyselectedbyourclinicsupervisor,Dr. Kellerstein,forDeanne.Letmedrawyourattentiontorubrics7,8,and9fromthe chartabove.Despitecombiningtheserubricsintoasinglegrouptheystillhavethe effectofdrasticallyeliminatingmostoftheremediesfromtheanalysis.Theyhave thiseffectontheanalysisbecausetheyarecomplexrubricseachcontainingtwo symptomcomponentsbothasensationandamodality.Theirpreciseandexact wordingseemstobeagoodfitforthedescriptionofheatintheafternoon,with palenessoftheface,vertigo,blurredvision,nauseaandvertigogivenbyDeanne. Butaswehaveseen,earlierandagaininthiscaseexample,thisprecisioncomes attheexpenseofexcludingalargenumberofremediesfromourconsideration.The fourthrubric,ExternalThroatclothingaggwasincludedbecauseofan immediateandspontaneousresponseofNo!whenDeannewasaskedifshe couldwearturtlenecks. IremembercongratulatingmyselfonsomeprettygoodrubricswhenIfoundoutthat DeannehadreceivedSepiaandhadrespondedextraordinarilywelltoit.Looking backatthisanalysischarttodayIseeitdifferently.Frankly,Ihadmanagedto
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excludesomanyotherremediesasaresultoftherubricsincludedinmySynthesis analysisthatIreallydidnthaveanyotherremedychoiceatall.IfSepiahadnot workedforDeanne,Ihadnothingelsetogoon. NextwellbeginananalysisofDeannescaseusingtheTherapeuticPocketbook. TherapeuticPocketbookanalysis:hierarchyofsymptoms TheBoenninghausenmethodisembodiedintheTherapeuticPocketbook.You reallycantuseitwithoutalsousingthemethod.Recallthatthehierarchyof symptomsforBoenninghausenisnotthesameasforKent.Foronething,youll noticethatthereisntasectionformentalsymptoms.Thisisnotbecausesuch symptomsareexcludedfromaBoenninghausenanalysis.Rathertheyare addressedunderthecategoriesofchiefcomplaint,ifpresentedassuch,oras concomitantcomplaints.Boenninghausenshierarchyofsymptomswouldbegin somethinglikethis: 1. Causativemodalitiesinthementalandphysicalspheres(etiology) 2. Featuresofthechiefcomplaintdescribedintermsof: a. Modalities b. Sensations c. Locations 3. Strikingconcomitantshavingamodalities,sensationsorlocationsincommon withthechiefcomplaint. 4. Pathologicalphysicalgenerals:strikingcharacteristicsymptomsdescribedin termsof: a. Modalities b. Sensations c. Locations 5. Cravingsandaversions 6. Accessorysymptomsthosemental/emotional/physicalfeaturesofthe patientsnormalstatethatcanbeusedtodifferentiatebetweenremedies shoulditbecomenecessary. Anactualhierarchyofsymptomsforanygivencasemightbeginthiswaybutwould berearrangedshouldagrandcharacteristicmakeitselfapparent.Grand characteristicsarethoseprominent,consistentlypresentandwelldescribed modalitiesandsensationsthatappearinmorethanonesymptomcomplexinthe
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case,orwhicharenotlocalizedatall(suchashavingapatienttellyouthattheyjust havenothirstwhatsoeverorthattheycannottoleratetheslightestdraftofair).Grand characteristicsleaptothefrontoftheanalysisandcanevencountmoretowardsthe prescriptionthanthemodalitiesofthechiefcomplaintitself.Withinthecategoryof Grandcharacteristicsymptomswehavethenonregionalsymptoms(thosefoundin multiplelocationsorbodysystems),symptomsofthemindanddisposition,the generalsymptomsandthemodalities. HereistheanalysisImadeinDeannescaseforusewiththeTherapeutic Pocketbook: Nonregionalmodalities(consistentandpresentinmorethanonelocation) Worseafternoon.Appliestoexhaustionandhunger Worseexertion.Appliestowristandbackpain Worsechangefromcoldtohot.Appliestomigrainesandtowristpain Nonregionalsensations(consistentandpresentinmorethanonelocation) Dullache.Appliestowristandbackpain Weakness.Appliestothejointpainandoccurswiththeafternoon exhaustion,nausea,vertigoandflushesofheat Flushesofheat.Ageneralsymptom.Partofanextremelywelldescribed symptomthatoccursconsistentlycombinedwithnausea,exhaustion andvertigo Concomitantsymptoms(consistent) Skineruptions(vesicles)inthemouthandonthebacksofthehand Hungerfrom4pmuntilshegoestobed,accompaniedbyflatulencefrom 9pmonward.Sharesatimemodalitywiththeflushesofheat. Palefacewithflushesofheat,vertigoandnausea ThePocketbookanalysischartappearsonthenextpage.Therubricsarearranged accordingtoBoenninghausensclassificationschemeforacompletesymptom thatis,accordingtosensation,locationandmodality.
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Deanne:differentialdiagnosis SepiaappearsfirstintheTherapeuticPocketbookanalysisjustasitdidusing Synthesis.ThePocketbookanalysischartthoughismuchfullerwithfarmore coherenceandsuggestsmorepotentialalternateremediesforthecase.Fromthe analysischartwecanseethattheprominentfeaturesinDeannescasearethose alsofoundinSepia,BryoniaandNuxvomica.Itwouldmakeourtaskeasierifone ofDeannesmodalitieswereuniquetoonlyoneoftheremediesweare considering,butwearenotsofortunate. WecanbeginourdifferentialdiagnosisbetweenSepia,BryoniaandNuxvomicaby examiningtheirconsistentcharacteristicsastheyapplytoDeanne.Weseethat Bryoniacoversmuchofthecase(havingvertigoandnauseaweaknessofthe limbsaggravationduringtheafternoonaggravationfromexertionandthe sensationheatintheface)butdoesnothaveanaversiontoclothingaroundthe neckfurthermoreBryoniaspainsareofatearingandshootingnatureratherthan Deannesdullachingpains. Nuxvomicaseemsaclosefitaswell(havingsensationsofheat,vertigowith obscurationofvision,wearinessandpainsfollowingexertionandaggravationsof itssymptomsduringtheafternoons)butitspainsaremoredrawingandconstrictive, anditdoesnothavethevesiculareruptionspresentwithDeanne.
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Calcareacarbonicaisalsoastrongpossibilityforthiscase(withexhaustion, nauseaandvertigosensationsofheatinthefacequickfatiguefromexertiondull painsaggravationofmanysymptomsduringtheafternoon)butdoesnothavethe aggravationfromwarmthwhichDeannehas. Pulsatillaisworthconsidering(withattacksofvertigo,nauseaandheatweakness anaggravationintheafternoonvesiculareruptions)butitspainsaredrawing, tearingandulcerativeratherthandullandachingasDeannehasreported. Atthispointinthedifferentialdiagnosiswehaventfoundaremedymatchingallthe featuresofthecaseandhaveonlySepialefttoconsider.Letslooknowathow closeamatchwehaveinSepia.BoenninghausensTherapeuticPocketbookisan indextoHahnemannsMateriaMedicaPuraandhisChronicDiseasessoour readingwillbelimitedtotheseworks. IcanuseEHtosearchtheremedySepiatoseehowcloselyitmatchesDeannes symptoms.Firstletslookatthechiefcomplaintofweaknessinthewrists,backand kneesworseslightexertionandheat.Icanfindseveralsymptomsrelatingtopain inthewrist,moreforsymptomsinthekneeandevenmoreforsymptomsinthe back.Recall,though,thatthelocationofasymptomistheleastreliablefeatureon whichtobaseourprescription.Letslooknowatsensationsandmodalitiesasthese arethefeatureswhichlargelydeterminetheremedydiagnosis. AsecondSepiasearchforweaknessyieldsseveralresults: Greatweaknessoftheknees Weaknessofthemusclesofthehand Nauseaandweakness Fitsofweariness Ateverymovementofthebody,hefeelsnausea,asifabouttovomitandsoweary, thatintheopenair,hehadatoncetoliedownonthegroundallthelimbswere devoidoftension. (Thereareatotalof53searchresultsindicatingweaknessisawidespread characteristicfeelingforSepia)
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Next,forthemodalityofworseintheafternoonwecansearchfortheword afternoon: wefinddizzinessandvertigoeveryafternoonfrom4to6pmwhilesittingand walking(thisisveryclosetoDeannesdescription) attackofheat,everydayfromonetosixintheafternoon,forseveraldays(thisis closetoDeannessymptom) ForthemodalityofbeingworseforheatwecansearchSepiaforthewordsheat andwarmwhichbringsmanymoreresults(Ihadtousesourcesotherthan Hahnemanninordertofindthesesymptoms): Inhotweather:conjunctivitisalwaysagg. Heatintheface,inthemorningintheevening,palenessofface. (aclosematchtoDeannewithheatinthefaceandpaleness) heatofthefaceandthehands,withpalenessoftheface, Follicularconjunctivitisoramixedformoffollicularandtrachomatousconjunctivitis, whichisobservedonlyduringthesummer,oralwaysagginhotweather. Alwaysaggr.inhotweather, SearchingSepiaforthemodalityofworsefromexertionwecansearchforexertion andfindtheseresults: fitsofwearinessreadilytiredwhentakingawalkwhenexertingthebody copiousperspirationduringslightbodilyexercise easilyoverstrained Afterslightexercise,aflushofheat Forthesensationofdullpainwesearchforthetwowordcombinationofdullpain: Dullpressivepainonasmallspotoftheocciput. Dullpainintheoldrootsoftheteethcoldthingscauseanacutepaintodartthrough
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them. Dullpressivepaininthemolars,withpaininthesubmaxillaryglands Heavinessinthestomach,withdullpainaboutthewholeoftheabdomen. Dull,drawing,tearing,sprainedpainintheshoulderjoint(afterdinner). Fortheaccompanyingvertigowecansearchforthewordvertigoandfind: Dizzyvertigo,everyafternoonfrom4to6oclock,whilesittingandwalking. heatintheheadwithhardnessofhearinganddimvision Vertigoeveryafternoonfrom3to5oclock,everythingturnsinacirclearoundher, whilewalking,sittingandlying. (fromthesethreeresultswehavevertigo,alteredvisionandthetimemodality together) Finallyforthesensationofnauseawehavethefollowingsymptoms: Bittereructationwithnausea. Attackofnausea,inthemorning,whilewalkingthingsturnedblackbeforehiseyes, therewasheatfromoneP.M.tillsixP.M.withtearinginallthelimbs,withlong continuednauseaintheevening,weaknesseventoswooning,withmelancholy everythingaffectedhisnerves,hewasveryeasilyfrightenedatnightaninordinate quantityofveryfetidflatuswasdischarged Ateverymovementofthebody,hefeelsnausea,asifabouttovomitandsoweary, thatintheopenair,hehadatoncetoliedownonthegroundallthelimbswere devoidoftension. ThekeysymptomcomponentsinDeannescaseweakness,theaggravationfrom exertion,flushesofheatintheface,beingworseintheafternoon,withnauseaand vertigoarerepeatedlydisplayedthroughoutagreatmanysymptomsfromthe Sepiaproving.Usingtheprocessofcompletingsymptomsbyanalogywecan transfertherecurringmodalitiesandsensationsexhibitedintheSepiaprovingto otherSepiasymptomsinordertoarriveatacompositesymptomcloselyresembling thekeyfeaturesofDeannescase.Wecandothissolongasthesensationsor
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modalitieswearetransferringfromonepartoftheSepiaprovingdonotcontradict anysensationormodalityalreadypresentintheprovingsymptomweare transferringthemto.WemaynowcompareourcompositeSepiasymptomtooneof thepivotalsymptomsinDeannescasenamely:flushesofheatinthefacefrom4to 6pmwithnausea,exhaustionandpoorconcentration,vertigo,palecomplexionand blurredvision.TheSepiaprovingsymptomslistedbelowareexcerptsfromeachof thesearchesoutlinedontheprecedingpages: dizzinessandvertigoeveryafternoonfrom4to6pmwhilesittingandwalking attacksofheat,everydayfromonetosixintheafternoon,forseveraldays heatofthefaceandthehands,withpalenessoftheface, lackoffirmnessinthebodyfitsofwearinessreadilytiredwhentakingawalk whenexertingthebody, heatintheheadwithhardnessofhearinganddimvision Nauseaandweakness. Stupefactionofthehead,withtightnessofthechestandweaknessinthe wholebody WecantakethislistofSepiaprovingsymptomsandbyarrangingthehighlighted partsintoasinglecompositeprovingsymptomarriveatadescriptionwhichisa strikinglyclosematchtoDeanneswelldefinedchiefcomplaint: Attacksofheateverydayfrom4to6pm,withvertigo,heatinthefaceaccompanied bypaleness,weaknessofthewholebodywithnausea,dimnessofvisionand stupefaction OftheremediesweareconsideringfromthePocketbooksanalysis,Sepiaalone coversallthecharacteristicfeaturesofDeannessymptoms(evenincludingthe concomitantsymptomofherstrongaversiontoclothingaroundtheneck).Sepia standsoutinthedifferentialdiagnosisnotbecauseithassomerarefeaturewhich theotherremedieslack.Ratheritisthecombinationofcharacteristics(themselves individuallynotdistinguishing)whichprovidestheuniqueidentifierforthecaseand itisthiscombinationofsymptomswhichSepiamatchessowellinDeanne. Differentialdiagnosisafterrepertorizationmarksthefinalstepinchoosingwhich remedywewillprescribe.Thisstageofcaseanalysisislikelytoinvolvealittlemore readingwhenusingthePocketbook.WiththePocketbookIvefoundthatmy materiamedicasearcheshavechanged.Imnolongerseekingcombinationsof
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wordsinanattempttofindasymptominthemateriamedicathatmatchesarubric.I knownowthatsymptomsintheprovingsareoftenincompleteandthatifIsearch usingsingleworddescriptionofasensationormodalityIamfarmorelikelytofinda groupingofsymptomswiththefeaturesthatImlookingfor.AlsoImnolonger searchingforanysingleprovingsymptomtomatchallthedetailsprovidedinthe patientsdescriptionoftheirailment.FromDimitriadisworkIknowthatIamableto transferaremedysrecurringmodalitiesandsensationsfromonereportedsymptom locationinitsprovingtoanother(stoppingshortofcontradictingapreexisting sensationormodality)andthatusingthistechniqueIcanarriveatacomposite symptommatchingtheprominentfeaturesofmycase.Lastly,IknowthatImust alwaysrefertothemateriamedicaofeachremedyunderconsiderationtosee whetherthesymptomsIhavefashionedintherepertoryappearrecordedthere.Its onlyafterIvecompletedthisthoroughexaminationthatIcandeterminethe similitudeofanyremedyImconsideringprescribing. PartVI:ClinicalverificationintheTherapeuticPocketbook Remedygradelevels Boenninghausenknewthatafterprovingsymptomshadbeenrecordedinthe repertorytheonlywaytoassesstheirreliabilitywastofollowtheirclinical performance.IntheTherapeuticPocketbookgradelevelsof1and2indicate characteristicprovingsymptomsforeachremedy.Aremedywouldbeenteredwith agradelevel2whenoneofitssymptomswasrepeatedlyreportedbyprovers. Remedygradelevelswouldbeincreasedinastepwisemanneraccordingtothe numberofverificationsthroughclinicalapplication.Agradeof3indicatedclinical verificationandagradelevelof4indicatedrepeatedclinicalverification. Boenninghausendidnotbeginhisstudyofhomeopathyuntil1828andpublished hisSRA(containingthisfourtierremedygradingnomenclature)abrieffouryears laterin1832.YetremediesintheSRAwerefrequentlyenteredwithagradelevelof 3or4.Theseinitialhigherremedygradelevelswereoftenbasedontheexperience ofothers.AsBoenninghausensownclinicalexperiencegrewheaddedfurther gradingmodificationstotheremediescontainedinhisrepertory. Weveseenthatasaruleittakesmultiplerubricstorepresentwelldefined symptomsusingthePocketbook.Whereasuccessfulprescriptionresultedinthe cureofaparticularsymptomBoenninghausenwouldsimultaneouslyupgradethe entirecombinationofcomponentrubricsintherepertoryusedtorepresentthecured
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symptom.ThuswhenwelookatourPocketbookanalysischartandfindaremedy havingthesamegradelevelthroughoutarubriccombinationweveusedto representasymptom,wecaninterpretthisasanindicationthatthisparticularrubric combinationwassuccessfullyusedbyBoenninghausenhimselfthuslendingan extrameasureofreliabilitytoourconsiderationoftheremedyforthatparticular symptom. Cumulativeclinicalexperience:remedyconcordances Boenninghausenhadrealizedthataremedyprescribedhomeopathicallyfora particulardisease,havingeffectedachangeinthetotalityofsymptoms,pavesthe wayforthenextmost(homeopathically)indicatedremedy,which,initsturn,works betterasaresultofthechangeseffectedbythefirst.Remedieswerethusseen,in variousconditionsofdisease,torelatetooneanother,followwellandcompletethe actionoftheformer,andtheserelationships,basedonthesimilarityofprovingto diseasesymptoms,andfurtherrefinedviaclinicalconfirmation,werepainstakingly recordedbyBoenninghausenfromveryearlyinhiscareer. TheConcordancechaptermapsouttheassociationsbetweenremediesandisthe fruitofBoenninghausenslongyearsofclinicalexperience.Thisfinalchapterofthe Pocketbookisdividedintoremedysections.Eachsectionisdevotedtoasingle remedyandtheyarelistedinalphabeticorder.Youllfindrubricscorrespondingto themajorchaptersinthePocketbookplussomeadditionalrubricsnotfound elsewhereintherepertory.Thefollowingrubricsandsubrubricsappearundereach remedy: MindandSensorium Partsofthebodyandorgans Sensationsandcomplaints Bones Externalpartsofthebodyandinternalorgans Glands Skin Changeofgeneralstate Aggravation Timeaggravationaccordingtothe Sleepanddreams Antidotes
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Relatedremedies Fever,circulation,perspirationetc Thischapterhasanumberofveryusefulapplications.Considerthesituationwhere weneedtochangeapatientsprescriptionbecausetheremedywhichhad previouslyworkedeffectively(beingthenthefirstcorrectprescription)isnolonger havingacurativeeffect.Ournextprescriptionwouldbebasedonthenewcurrent symptompictureandwouldincludeanyoriginalsymptomsstillpresentalongwith recentemergentsymptom(s)appearingsincetheadministrationofthefirst prescription.LetssaythatwehadprescribedLycopodiuminitiallyandfoundthat thepatientssleepandbowelsymptomshadimprovedbuttheskinsymptomshad notchangedandtherewerenewsymptomsrelatedtoconditionsofaggravationthat werenotpartoftheinitialpicture.Inrepertorizingthefollowupwefirstselecta rubricfromthePocketbookchapterConcordanceofhomeopathicremediesunder theremedyLycopodiumforremedieswithsimilarskinsymptoms.Tothiswewould addrubricsforthenewlyemergentmodalitiesnowpresentinthecase.Thiswaythe focusofthefollowuprepertoryanalysisisonthoseremediescoveringthenewly emergentsymptoms(aspertheinstructionsofHering)whileatthesametimebeing remediesknowntohaveskinsymptomssimilartoouroriginalprescription,and whichappearlistedintherubricConcordanceofhomeopathicremedies Lycopodiumclavatumsensationsandcomplaintsskin. Thischapterismostvaluableintreatingchronicillnesswherewitheach successfullyprescribedremedythepresentingsymptomtotalitymayshift.Guided byitscarefullychartedremedyrelationshipswecannavigateasuccessionof prescriptions. Mostfrequentlyitwillbefoundthatinchroniccaseswhichareinveterate,thechief ailinghasonlybeendiminished,butstillcontinues,neverthelesswhenthe medicinehascompleteditsaction,theconcomitantsymptomshavesufferedsucha changethattheformerremedywillnotappearatallapplicableanymore.Insucha casethehomeopathicphysiciancanonlymakeasureselectionafterhavingbeen informedofthesechangesbyanewcompleteimageofthedisease.Foritisnot onlytaughtbyexperience,butitliesinthenatureofallchronicdiseaseswhichhave inconsequencebeeninterwovenwiththewholeorganism,thatrarelyorneverone remedywillcoverthewholecomplexofsymptomssothatitwillbenecessaryin ordertodestroythewholemaladyfundamentallytoletseveralmedicines,selected aftereachreport,operate,untilnothingmorbidmaybeleft.
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YoucouldalsousetheConcordanceofhomeopathicremedieschaptertosuggest alternateremediesforacasewhereyouareunsureofyourprescription.Suppose youthoughtthemodalitiesofaggravationinthecasestronglysuggestedLachesis butyouwerentcertainthatLachesisfittheremainderofthecase.Youcouldselect therubricintheremedyconcordancechapterConcordanceofhomeopathic remediesLachesismutaschangeofgeneralstateaggravationandthiswould giveyoualistofthoseremedieswithsimilarconditionsofaggravationtoLachesis. Youwouldthenaddrubricsfortheotherprominentfeaturesofthecase. Approachingtherepertorizationthiswaytheinitialfieldofremediesintheanalysis wouldemphasizethoseremediessimilartoLachesisintheirconditionsof aggravation.Orperhapsyouareconsideringasecondprescriptionandseveral remediesseemtobeequallyindicated.Youwouldprefertogivearemedyknownto followwellafteryourfirstprescription,assomeremediesareknowntoactmore curativelywhenprecededbycertainotherremedies.Usingtheconcordance chapteryoucouldlookupyourfirstprescriptionandcheckwhichremediesfollow wellafterit.Ifoneoftheremediesyouareconsideringisamongthoselisted,then thiswouldlikelybeyournextprescription. ThereisanotherapplicationfortheconcordancechapterthatIdliketodiscuss,one ofparticularusefulnessinstudyingmateriamedica.Wecanusethischapterinthe Pocketbooktocomparefeaturessharedbyremediesandalsofeaturesthat distinguishoneremedyfromanother.Forexample,undertherubricConcordance ofhomeopathicremediesAntimoniumcrudumSensationsandcomplaints youcouldselectthesubrubricforskinsymptoms.Thiswouldgiveyoualistof remediesinthePocketbookwithskinsymptomssimilartoAntimoniumcrudum. Selectingaremedyfromthislistyoucoulddoarepertorysearchforitsgradelevel3 and4symptomsinordertogetanoverviewoffeaturesthatwouldhelpyouto distinguishitfromAntcandalsofromotherremedieshavingskinsymptomssimilar tothoseofAntc.Welltakeacloserlookatthisinthenextsection. PartVII:UsingthePocketbookinthestudyofMateriaMedica ThroughoutthisdiscussionIhavereferredtoBoenninghausensrepertoryaseither TheTherapeuticPocketbookorjustThePocketbook.Thiswaseasierthanusingits completetitleofTheTherapeuticPocketbookforHomeopathicPhysiciansforuseat theBedsideandtheStudyofMateriaMedicaPura.Thefulltitlesuggeststhatwe canemploythePocketbookasanaidtolearningmateriamedica.Iwouldliketo finishoffmyintroductiontothePocketbookwithlookathowwemightdothis.
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Asstudentsweoftentrytolearnremediesthroughakindofsinglesymptomsingle remedyapproach,latchingontoacharacteristicsymptomortwowhichweuseto setoneremedyapartfromthemultitudeofothersinourminds.Wecancommitto memorythatSulphurstickshisfeetoutofthebed,thatPulsatillaisworseinawarm room,thatcoldperspirationontheforeheadbelongstoVeratrumalbum,thatIgnatia isfortheeffectsofgrief,thatarrivingtooearlyforanappointmentdisplaysthe anxietyofArgentumnitricum,thattheburningpainsofArsenicumarebetterfrom heatthislistcouldgoonandon. Learningremediesbasedonadepictionofoneortwooftheirunusualqualitiescan createafalseimpressionofremedydistinctivenessinourminds.Wemaycometo thinkoftheseunusualfeaturesasquickroutestofindingthesimillimum.However, whenwestudytherepertoryfurtherwefindthatsomeoftheseidiosyncratic symptomsarenotasuniqueaswefirstthoughttheywere.Sulphurisnottheonly remedythatsticksitsfeetoutofthebedcovers.Thereare21remediesintherubric Extremitiesuncover,inclinationto,feetinwhichChamomilla,Pulsatilla, MedhorrinumandSulphurallhaveagradelevelof3.Thereareatotalof19 remediesintherubricMindanxiety,timeisset,ifa,indicatingthatArgentum nitricumsharesthisparticularmentalqualitywithmanyotherremedies.Pulsatilla appearsasoneof140remediesintherubricGeneralswarmroomaggand IgnatiasharestherubricMindailmentsfromgriefwithnolessthan92other remedies.Intruthremedieshavealotmoreincommonthantheyhavedifferences. Asingleunusualsymptom,evenifitisakeynotesymptom,isseldomenoughto baseaprescriptiononandrequiresthesupportoftherestofthesymptomtotality. InthechapterConcordanceofhomeopathicremediesBoenninghausenshowsus thatremedieshaveagreatdealmoreincommonthanaquickstudyoftheMateria Medicareveals.Thisoverlappingofsymptomsmeansthatinthehomeopathic diagnosistheuniquenessofacasemostoftenrestsonacombinationofits consistentcharacteristicfeaturesandnotonanysinglefeature.Stripping homeopathicdiagnosisofallofitshypeandmystiqueweareleftwithHahnemanns guidingwordsLetlikesbecuredbylikeandwhichJoeKellersteinsphrase homeopathyispatternmatchingencapsulatesperfectly.Ourstudyofmateria medicacanbeginthenwithafocusonthereliablesymptompatternsofremedies. TheTherapeuticPocketbookrubricsderivefromthemostcharacteristicsymptom featuresoftheprovings.Theyarealreadyorganizedforusaccordingtoremedy locations,sensationsandmodalities.Intheserubricsremediesappearingwith
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gradelevelsof3or4havebeenverifiedthroughBoenninghausensextensive clinicalexperience.TheRadarhomeopathicsoftwarehasasearchfeaturethatcan beusedtoretrieverubricsfromtherepertoryforanindividualremedyorseveral remediessimultaneously.Thiscomparativeextractionfeature(pressingF5starts it)isextremelyeffectivewhenusedwiththePocketbook.Letmeillustratewith anotherexample. Dimitriadishassaidthatsymptommodalitiesrepresentthecoreofaremedy.From thePocketbooksconcordancechapterIcanlookupPulsatillaandtherubric ConcordanceofhomeopathicremediesPulsatillapratensisrelatedremedies. InthisrubricLycopodiumislistedwithagradelevelof4.Boenninghausenis indicatingwiththishighgradingthatthesetworemedieshavebeenrepeatedly foundtosharemanysimilarfeatures.NowwecanuseRadarscomparative extractionfeature(pressF5)togiveusalistofthegradelevel4conditionsof aggravationandofameliorationforbothLycopodiumandPulsatilla.Thiswillallow ustoseetheirsimilaritiesanddifferencesataglance.Examiningtworemediesin thiswaydeepensourknowledgeofboththroughfirstrelatingthemontheir commonalities,andthendistinguishingthemontheirdifferences.Iveprintedthe extractionofgradelevel4modalitiesforLycopodiumandPulsatillaonthefollowing page. Modalities(gradelevel4)sharedbetweenLycopodiumandPulsatilla ChangeofgeneralstateAggravationtimeaccordingtotheafternoon ChangeofgeneralstateAggravationtimeaccordingtotheevening ChangeofgeneralstateAggravationtimeaccordingtothemidnightbefore ChangeofgeneralstateAggravationrisingfromsittingwhen 1.ChangeofgeneralstateAggravationmotionfrombeginningofmotionat 2.ChangeofgeneralstateAggravationwalkingbeginningtowalkwhen 3.ChangeofgeneralstateAggravationurinationduring 4.ChangeofgeneralstateAggravationlyingwhile 5.ChangeofgeneralstateAggravationlyingwhilebedin
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6.ChangeofgeneralstateAggravationmensesbefore 7.ChangeofgeneralstateAggravationmensessuppressedfrom 8.ChangeofgeneralstateAggravationlyingdownafter 9.ChangeofgeneralstateAggravationrestat 10.ChangeofgeneralstateAggravationsittingwhile 11.ChangeofgeneralstateAggravationwarmairin 12.ChangeofgeneralstateAggravationwarmwhenbecomingairinopen 13.ChangeofgeneralstateAmeliorationrisingsittingfromafter 14.ChangeofgeneralstateAmeliorationmotionfrom 15.ChangeofgeneralstateAmeliorationflatusafterdischargeof 16.ChangeofgeneralstateAmeliorationcoldwhenbecoming Modalities(gradelevel4)LycopodiumwithoutPulsatilla 1. ChangeofgeneralstateAggravationalonebeing 2. ChangeofgeneralstateAggravationeatingaftersatietyaftereatingto 3. ChangeofgeneralstateAmeliorationeructationsfrom 4. ChangeofgeneralstateAmeliorationcompanyin 5. ChangeofgeneralstateAmeliorationwarmwhenbecomingbedin Modalities(gradelevel4)PulsatillawithoutLycopodium 1. ChangeofgeneralstateAggravationbreathingexpirationduring 2. ChangeofgeneralstateAggravationmotionfromaftermotion 3. ChangeofgeneralstateAggravationquininefromabuseof 4. ChangeofgeneralstateAggravationtwilight(intheevening)inthe 5. ChangeofgeneralstateAggravationfrostbitefrom 6. ChangeofgeneralstateAggravationfoodanddrinksfrompartaking certainbread 7. ChangeofgeneralstateAggravationfoodanddrinksfrompartaking certainbutter
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8. ChangeofgeneralstateAggravationfoodanddrinksfrompartaking certainbreadandbutter 9. ChangeofgeneralstateAggravationfoodanddrinksfrompartaking certainbuckwheat 10. ChangeofgeneralstateAggravationfoodanddrinksfrompartaking certainfatfood 11. ChangeofgeneralstateAggravationfoodanddrinksfrompartaking certainfrozenfood 12. ChangeofgeneralstateAggravationfoodanddrinksfrompartaking certainpancakes 13. ChangeofgeneralstateAggravationfoodanddrinksfrompartaking certainpork(fat) 14. ChangeofgeneralstateAggravationfoodanddrinksfrompartaking certaintobacco 15. ChangeofgeneralstateAggravationfoodanddrinksfrompartaking certainwarmfood 16. ChangeofgeneralstateAggravationfoodanddrinksfrompartaking certainwinesulfurated[winetowhichsulfurwasadded] 17. ChangeofgeneralstateAggravationurinationbefore 18. ChangeofgeneralstateAggravationscratchingfrom 19. ChangeofgeneralstateAggravationlyingwhilelowwithhead 20. ChangeofgeneralstateAggravationmeaslesduring 21. ChangeofgeneralstateAggravationmeaslesafter 22. ChangeofgeneralstateAggravationrubbingfrom 23. ChangeofgeneralstateAggravationsuninthe 24. ChangeofgeneralstateAggravationwomenespeciallyin 25. ChangeofgeneralstateAmeliorationmoisteningaffectedpartfrom 26. ChangeofgeneralstateAmeliorationfoodanddrinksfrompartaking certaincoldfood 27. ChangeofgeneralstateAmeliorationlyingwhilehighwithhead 28. ChangeofgeneralstateAmeliorationwashingfrom Thereare20(gradelevel4)modalitiesheldincommonbetweenPulsatillaand Lycopodium.TheothersareeitherfoundinLycopodiumbutnotPulsatilla,orin PulsatillabutnotLycopodium.Givenacasewhichhadone,ormore,ofthe modalitiesnotcommontoLycopodiumandPulsatillawecouldusethatmodalityto reliablydifferentiatebetweenthetworemedies.UsingRadarsremedyextraction
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feature(F5)youcanalsoproducesimilarlistsoftheclinicallyverifiedsensations andlocationsforeachremedyinthesameway. Thismethodofstudybeginswhereourmateriamedicabegins,withtheprovings. Tothiswewouldthenaddthesecondbranchofexperientialknowledgeaboutour remediestheiraccumulatedclinicallyderivedexperiencebystudyingtheworks ofsuchrespectedhomeopathsasHering,Lippe,Nash,AllenandDunham.The chartsthatfollowcontainaconcisesummaryofthesePocketbookcomparative extractionsforLycopodiumandPulsatilla.
Modalitiesofaggravation(Gradelevel4)
Lycopodium
Pulsatilla
Afternoon,evening,beforemidnight
Afternoon,evening,beforemidnight
Sitting,risingfromsitting
Sitting,risingfromsitting
Onbeginningmotionbeginning walking
Onbeginningmotionbeginning walking
Duringurination
Duringurination
Whilelying,lyinginbed,afterlying down
Whilelying,lyinginbed,afterlying down
Beforemenses,suppressedmenses
Beforemenses,suppressedmenses
Whileatrest
Whileatrest
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Warmair,becomingwarm
Warmair,becomingwarm
Beingalone
Aftereatingtosatiety
Duringexpiration
Motion,aftermotion
Abuseofquinine
Twilight
Fromfrostbite
Bread,butter,buckwheat,frozenfood, pancakes,pork(fat),tobacco,warm food,
Wine(sulphurated)
Beforeurination
Fromscratching
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Lyingwiththeheadlow
Duringandaftermeasles
Fromrubbing
Whileinthesun
Aggravationsinwomen
ModalitiesofAmelioration(Gradelevel4)
Risingfromsitting
Risingfromsitting
Motion
Motion
Dischargingflatus
Dischargingflatus
Becomingcold
Becomingcold
Eructations
Becomingwarminbed
Whileincompany
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Moisteningtheaffectedpart
Coldfood
Lyingwiththeheadhigh
Fromwashing
Sensations(GradeLevel4)
Lycopodium
Pulsatilla
Chlorosis
Chlorosis
Tearing(drawing)internalpartsin
Tearing(drawing)internalpartsin
Consumption,phthisis,ingeneral
Consumption,phthisis,ingeneral
Tensionjointsinthe
Tensionjointsinthe
Tensioninternalpartsin
Tensioninternalpartsin
Skincolourontheskinpale
Skincolourontheskinpale
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Skinulcersgeneralin
Skinulcersgeneralin
Skinulcersfistulous(fistulae)
Skinulcersfistulous(fistulae)
Skinulcershard
Skinulcershard
Skinitchinggeneralin
Skinitchinggeneralin
Cramplikesensationinmuscles
Growling(roaring,humming,buzzing) inbody
Contortionoflimbs,drawingintobent position
Ulcerativepain,externalpartsin
Skineruptionsoozing
Ulcerativepain,internalpartsin
Skin,wetskinoozing(dischargeof moisture)
Goutlikejumpingpains,wandering (quicklyshifting)
Skin,tetters,oozing
Stitching,tearing(drawing),musclesin the
Skin,ulcers,indolent(withoutspecial sensationorpain)
Ulceration,festeringpainpainasfrom subcutaneous
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Skin,corns,pressingpainwith
Labourlikepains
Skin,corns,tearingpainwith
Chokingpain
Skin,itchingcreeping(runninglikean insect)
Dragging,hardpulling,tugging sensation
Skin,itchingscratchingafteroozing (dischargeofmoisture)
Bruisedpainasifjointsofthe
Skin,sticky
Glandsswollensensation
Skin,eruptionsmeasleslike
Skin,eruptionsrubella,German measles
Skin,eruptionschickenpox,varicella
Skinchilblainsblue
Skinulcersulceration,festeringpain asfromsubcutaneous
Skinulcerativepainintheskin
Skinswellingbluishblack
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Skinswellingstitchingpainwith
Skinswollensensation
Skinitchingscratching unchangedby
Skinitchingscratchingagg.
Skinnailsulcerativepainwith
InSummary BoenninghausensTherapeuticPocketbookfellintodisuselongago.Themore popularrepertoriesofSynthesisandTheCompleteofferaseeminglygreater coverageofthedetailsofourMateriaMedicaandincludeafargreaternumberof remedies.Forstudentsofhomeopathytheperceivedneedtohavemoreremedy detailintherepertoryisacompellingoneandthisisallthemoretangiblenowthat thesetworepertorieshavebecomecomputerized.Usingthissoftwarewecan quicklysearchtheentirerepertoryorcountlesspagesofMateriaMedicawithin minutes,accomplishingwhathomeopathysforefatherswouldhavetakenentire eveningstoachievealldonewithoutthediligenceandfocusthat,inanearlier time,wouldhaveallowedtheexercisetobecomepermanentlyingrainedinour minds. Theearlyemploymentoftheselaboursavingprogramscanleadstudentsintoa labyrinthofrepertoryspecificsthedetailsofwhichmayeclipsethosedistinguishing remedythemesonwhichprescribingdepends.Thiscanresultinaclassicinstance ofnotbeingabletoseetheforestforlookingatthetrees.Asacounterbalanceto thebewilderingsurplusofremedydetailfoundincomputerizedrepertories BoenninghausensTherapeuticPocketbookstandsasanunparalleled
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achievement,bothatthetimeofitspublishingandstilltothisday.Itisasystematic andthoroughanalysisof125remediesthatdrawstogethertheircommonfeatures, characteristicqualitiesandclinicallyverifiedapplication.Throughthebrillianceof itsuniquedesignitembodiestheremarkableinsightsofoneofhomeopathysgreat prescribers.Induetimeandwithpracticewecanlearntoapplythesesameinsights toourowncaseanalysisandourstudyofMateriaMedica. AppendixA:Boenninghausenlikerepertorization Homeopathicstudentsincurmanyexpenseswhenundertakingtheirstudies.An increasingnumberofstudentsusecomputersoftwareearlyonaswell.Such softwaredoesnotcomecheapandtosuggestthatstudentspurchaseanadditional Boenninghausenrepertorymodulewouldonlyincreasetheirsubstantialfinancial burden.Thoughhighlyinstructive,themoduleisnotnecessaryinorderto repertorizeintheBoenninghausenway.WecanapplythewisdomcontainedinThe PocketbooksdesigntoouruseofSynthesisinthefollowingmanner: 1. Acasewillmostoftenrestonthedistinctivenessofitscombinedfeatures. Whenitcomestoselectingwhichsymptomswearetoincludeintheanalysis consistencyofasymptomsoccurrence,theintensityandclarityofits expression,aremorevaluablecriteriathansymptomrareness.StuartClose setthematterstraightwhenheinstructedusthatapeculiarcombinationof symptomsoftenrepresentsthekeynotetoacase. 2. Modalitiesarethemostreliableaspectsoftheprovingsandconsequently whenpresentinourcasetheyformthebestguidetoselectingaremedy. Recurringsensationsandmodalitiesaregeniussymptomsandshouldform thecoreofourdiagnosis.InSynthesiswecanfindrubricsforgeneralized modalitiesintheGeneralssectionoftherepertory. 3. Youranalysisisonlyasinclusiveasyoursmallestrubric.Largerrubrics preservethefieldofpotentialremediesandshouldbeusedwhenever possible.SynthesisnowincludesanumberofBoenninghausenentriesinits moregenerallevelrubrics.Additionally,settingtherepertoryoptiontoFull Synthesis,rmdcopiedaddsallremediesfoundinsmallersubrubricstothe mainparentrubricensuringthattheywillbeincludedintheanalysiswhenthe largerrubricisselected. 4. Themental/emotionalcaseiscomprisedofsymptomssincetheonsetofthe earliestknownoccurrenceofillness.Likeallothersymptomstheymusthave consistentpresentation.Symptomsofthemindaredifficultonestorepertorize
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oftenbeingsubjecttothemostspeculativeinterpretationonthepartofthe homeopath.Inselectingrubricsforthemental/emotionalcaseweshoulderrto thesideofcaution,avoidingsmallseeminglyexactrubricsastheyoften eliminatetoomanyremedies. 5. Therepertoryisnotthetooltouseforremedydifferentialdiagnosis.Acareful studyofthemateriamedicaremainstheonlywaytogetaclearpictureofthe remedy(s)underourconsideration. AppendixB:ourrepertorylineage
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1AllreferencestoBoenninghausensTherapeuticPocketbookaretotheRadar version3.0.AllreferencestoEncyclopaediaHomeopathicaaretoversion2.1.All referencestoSynthesisaretotheRadarversion9.2 2Boenninghausen,Clemens.LesserWritings,AContributiontotheJudgment ConcerningtheCharacteristicValueofSymptoms. 3HahnemannsMateriaMedicaPuraandtheChronicDiseases.

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4HomeopathicDiagnosis:HahnemannthroughBoenninghausen.Sydney, Australia.2004 5Hahnemann,S.,MateriaMedicaPura 6Boger,C.M.,BoenninghausensCharacteristics 7Hahnemann,ChronicDiseases 8Allen,T.F.,EncyclopediaofPureMateriaMedica 9Inthissearchforahomoeopathicspecificremedy,thatistosay,inthis comparisonofthecollectivesymptomsofthenaturaldiseasewiththelistof symptomsofknownmedicines,inordertofindamongtheseanartificialmorbific agentcorrespondingbysimilaritytothediseasetobecured,themorestriking, singular,uncommonandpeculiar(characteristic)signsandsymptomsofthecaseof diseasearechieflyandmostsolelytobekeptinviewforitismoreparticularly thesethatverysimilaronesinthelistofsymptomsoftheselectedmedicinemust correspondto,inordertoconstituteitthemostsuitableforeffectingthecure.The moregeneralandundefinedsymptoms:lossofappetite,headache,debility,restless sleep,discomfort,andsoforth,demandbutlittleattentionwhenofthatvagueand indefinitecharacter,iftheycannotbemoreaccuratelydescribed,assymptomsof suchageneralnatureareobservedinalmosteverydiseaseandfromalmostevery drug.(OrganonoftheMedicalArt.Hahnemann,S.,Dudgeon/Boericketranslationof the6thedition) 10YearIIIClinicalsupervisorandlecturerattheTorontoSchoolofHomeopathic Medicine 11TheEHsearchesthatfollowarelimitedtoHahnemannsMateriaMedicaPura andChronicDiseasesinordertojustlycomparetherubricperformanceof SynthesistothatoftheTherapeuticPocketbook. 12AllensEncyclopediaofPureMateriaMedicaisthesourceforallsymptomssave thelastonewhichcomesfromClarkesDictionaryofPracticalMateriaMedica 13AllensEncyclopediaofPureMateriaMedicaisthesourceforallsymptomssave
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thelastonewhichcomestheprovingofNitricAcidfoundinHughesACyclopaedia ofDrugPathogenesy 14SixtysevenremediesappearinallthreerubricsinthePocketbooksanalysis chartabove.Wewoulddefinitelyneedtoincludeconcomitantsymptomsinorderto reducethenumberoflikelyremediestosomethingmanageablethatwecouldthen studyinthemateriamedica. 1Dimitriadis,George.TheFirstRepertory:Boenninghausensmodelforour Profession.
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A Homeopathic Student's Introduction To Boenninghausen's Therapeutic Pocketbook

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PartsoftheBody&Organs InternalHead Generalin

Sensations&Complaints Externalpartsofbodyand internalorgansingeneral Pulsation Internalpartsin

Head Pain pulsating

Thebreakingapartofsymptomsandthedispersalofthosepartsindifferent repertorychaptersisuniquetotheTherapeuticPocketbookandisperhapsthemost difficultfeaturetoadjusttowhenfirststartingtouseit.However,aswillbe

Chest Oppression Ascending aggravates Upperpart

Externalpartsofthe bodyandinternal organsingeneral

rubricsusedtorecorditintherepertory.Boenninghausenusedthisapproachinhis earlierSRAandSRNrepertoriesaswellasintheTherapeuticPocketbook.The diagramonthefollowingpageillustrateshowtheessentialfeaturesofthis Belladonnasymptomwouldberepresentedintherepertory.

Letslookattheremediesweveconsideredonthebasisoftheirkeynotes: SulphurfailstocoverchillinesswiththepainCausticumdoesnotmatchthethirst forlargequantitiesevenRhododendron,whichmatchesthenatureoftheshoulder painsowell,completelyfailstocoverthetwoconcomitantsymptomsthattogether

LetsbeginwithanEHsearchsetupinthemannerofaSynthesisrubric.Icanuse EHtosearchforthewordkneesandalsofortearinganddrawing.Illenter thesewordsinthesamelineinthesearchparameterssothatEHwillonlyshowme remedieswhereallthesewordsappearinthesamesentence.Theresultsfromthis firstEHsearcharelistedbelow.11

Bread,butter,buckwheat,frozenfood, pancakes,pork(fat),tobacco,warm food,

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