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ENDORSEMENTS

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

v
Endorsements

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

This exceptional book gathers, reflects on, and David Reilly

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

vi
THE ‘FIVE THEMES’

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

vii
CONTRIBUTORS

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

x
FOREWORD

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

xi
Foreword

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

xii
FOREWORD

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

xiii
ACKNOWLEDGEMENTS

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

xiv
PREFACE

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

xv
Preface

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

xvi
 Preface

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

xvii
Preface

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

xviii
CHAPTER ONE

What is Health? Philosophy

David Owen

Introduction ment whether we think of it in terms of objects

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

3
 CHAPTER ONE What is Health?
Foundation

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

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

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

4
 The Models of Health

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

The pathogenic model sees illness in terms of

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

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

Bo

ne

cal model recognises that a single cause in every y

Ge
d

living system does not always have the same effect.

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

response to the cause. The symptoms may both

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

5
 CHAPTER ONE What is Health?
Foundation

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

I when well (constitutional state) and when ill

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

6
 The Models of Health

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

Pathogenic I Causation Aetiological

Isopathic
I
Biological II Presenting Local
symptoms Clinical
Keynotes

Holistic III Totality Three-legged stool

Constitution Mind, body, general
Morphological constitution

Holographic IV, V, VI Essence Miasms

Thematic Families
Kingdoms
Related remedies

Relational V, VI Reflective Psychodynamic

Emotional
‘Intuitive’

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

7
 CHAPTER ONE What is Health?
Foundation

The Holistic Model

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

8
 The Models of Health

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

9
 CHAPTER ONE What is Health?
Foundation

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

I tions of the homeopath, leading to what are here

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

10
 The Models of Health

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

11
 CHAPTER ONE What is Health?
Foundation

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

I most applicable approaches and methodologies

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

12
 Homeopathic Patients

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

13
 CHAPTER ONE What is Health?
Foundation

through the vitality that individuals are able to

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

I in vitality precede illness and recovery, and indi-

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

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

14
 Homeopathic Patients

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

15
 CHAPTER ONE What is Health?
Foundation

non-allopathic therapies (paragraphs 288–291)

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

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

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

The Minimum Dose

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

16
 Bibliography

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

17
CHAPTER TWO

Provings Materia Medica

Jeremy Sherr

Introduction by David Owen What are Homeopathic Provings?

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

19
 CHAPTER TWO Provings
Foundation

I have travelled to many countries, but my most

BOX 2.1
memorable voyages and greatest insights have
‘And further, while we were preparing the
been through remedy provings. In the last 20 years
so-called old medicines we never forgot our
I I have organised 27 provings and have participated
in 18. My health has been enhanced and not dam-
position as explorers of the unknown world
of results, of effects; never forgetting the
aged in any way. The personal and collective jour-
ground-work of our healing art, we prepared
neys into these provings have enriched, on many
from time to time new medicines also; we
levels, my life and the lives of those with whom I
made a regular proving at least once a year,
have conducted the provings. Through them, my
often twice and even three times a year. These
fellow provers and I have experienced the sting of
provings were the high feasts in our church,
a scorpion, the cold riches of sapphire, the opu-
and you cannot consider yourselves true
lence of jade, the cycle of salmon, the monotony of
members of it without joining in these feasts.
rape seed, the flight of an eagle, the enlightenment
Proving is a most wonderful thing; the
of hydrogen, the gentleness of deer, the hardness
world has never known its like. We suffer,
of diamond, the nurturing of olive and the rigidity
and we enjoy it; we sacrifice a little of our
of germanium. We have explored these and many
comfort, and gain abilities and power by it;
other secrets from nature’s treasure chest by enter-
we lose a part of a few days, and gain years
ing into nature herself, by diving into her substances
of strength by it; we go to school to learn,
and shape shifting our beings into her mould.
and we increase the certainty of the healing
In the process we have learnt, in time-honoured
art. At the same time, to prove drugs is of all
tradition (see Box 2.1), many things including:
other ways the very best, the nearest and the
●
The power of the collective, experiencing the
easiest to learn to master our materia medica.
unity of a single substance influencing a large
It is the way to learn; to observe the art of
group of people providing a window into
arts, the principal one on which all others are
the collective consciousness of humanity (see
based.’
Chapter 26).
Constantine Hering
●
The need for exactness and attention to detail
while organising and editing provings for
publication.
●
What to retain and what to discard, what is
fiction at worst. The use of signatures, toxicology,
useful and what is superfluous, and how to
clinical experience, family pictures or intellec-
present material in the most effective way.
tual concepts may contribute to our understand-
●
Proof of the relevance and accuracy of our
ing but they cannot approximate to the precise
experiments, as case after case has responded
knowledge gained by a thorough proving.
positively to the new remedies, based on the
indications we have gathered.
Why More Provings?
The Necessity for New Provings There are billions of sick individuals, each with
‘Therefore, we have only to rely on the morbid phenomena their own unique configuration of illness. The
which the medicines produce in the healthy body as the sole more precise the match between remedy and
possible revelation of their in-dwelling curative power.’ patient, the more profound the cure will be. To
S Hahnemann, Organon, Para 21 increase the certainty of our healing science, we
need many more remedies.
Provings are the pillars upon which homeopathic A new remedy will cure a class of cases that
practice stands. Without accurate provings all pre- existing remedies may only palliate. For example,
scribing indications are vague guesses at best and many cases needing Chocolate were previously

20
 Taking Part in a Proving

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

21
 CHAPTER TWO Provings
Foundation

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

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

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

Types of Provings Methodology of the ‘Full Proving’

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

22
 Methodology of the ‘Full Proving’

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

23
 CHAPTER TWO Provings
Foundation

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

I of extraction, collation and editing of symptoms

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

24
 Methodology of the ‘Full Proving’

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

25
 CHAPTER TWO Provings
Foundation

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

I the proving. After 6 months the provers should be

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

26
 Bibliography

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

27
CHAPTER THREE

The Homeopathic Consultation The Case

David Owen

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

29
 CHAPTER THREE The Homeopathic Consultation
Foundation

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

I might identify a homeopathic treatment. Even

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

30
 The Homeopathic Case

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

31
 CHAPTER THREE The Homeopathic Consultation
Foundation

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

I aspects of the case can be considered as a hierarchy

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

32
 The Homeopathic Case

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

33
 CHAPTER THREE The Homeopathic Consultation
Foundation

tion. For example, a parent treating Ben at home

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

Tonsils athy and finally the recurrent sore throats. To the

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

34
 The Homeopathic Consultation

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

35
 CHAPTER THREE The Homeopathic Consultation
Foundation

times when they see some remedies particularly

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

36
 The Homeopathic Consultation

Foundation
BOX 3.2 BOX 3.3
Exercises to Help the Health Practitioner to Some Practical Hints on Recording the Case
be Alert and Attentive ●
Leave sufficient margins on both sides
●
Focus on the first two minutes of a recent ●
In the left margin make notations on the I
meeting with someone, either a patient or history and add additional objective infor-
socially. Think about how they arrived, what mation as it surfaces or later on in subse-
was the atmosphere like when they arrived? quent consultations. This can include the
●
What might have been influencing how patient’s expression or movements.
they felt before you met them? ●
In the right margin identify different
●
How did you look when you first saw themes running through the history and
them? any speculative thoughts, including reme-
●
How did they carry themselves, where did dies, that surface and cannot be dismissed
they sit, how were they dressed? ●
Place one symptom on alternate lines so
●
Describe their complexion, their breath- that you can return later to add informa-
ing, and the colours they were wearing tion about that symptom
●
What other senses can you use to describe ●
Make references to texts, whether reper-
them? Did you touch them when you tories or materia medica, in one or other
shook hands? What was the texture of the margin or in different coloured ink so they
skin like? Was there any odour? can be noted at follow-up
●
If you think about them hard can you imag- ●
Use quotes for actual phrases used by the
ine, in any way, what it is like to be them? patient that describe central features of the
What would help you do this – can you sit case or more peculiar or unusual symp-
like them, hold yourself like them, and are toms
there any ways your life is like theirs? ●
Ask the patient to bring a small photo-
●
Can you imagine what their life is like? graph of themselves with them at their first
●
Think about this exercise and why you appointment. Having this in their file pro-
chose the person you did vides an instant reminder of them if you
●
What people or types of people might you have to analyse the case away from them
find this a difficult exercise to do with? or when speaking on the phone to them.
●
Why are these people difficult to do this
exercise with, and what does this tell you
about yourself?
●
If you saw them as patients how might you
in the consultation, e.g. a patient talking about her
adjust your work to help you stay alert?
father while making fists of her hands, or some-
one talking about a bereavement, and saying that
it didn’t affect them, while holding their throat.
There is a tension between recording what the The best record is one that most accurately
patient says verbatim and summarising the key sums up what was observed in the consultation;
points, themes and observations that run through including what the homeopath was able to per-
the case and also being seen to give the patient ceive even if the patient was not conscious of it.
your full attention. Both are necessary and both Too much writing can be at the expense of eye
have their place. While a straight transcript of a contact and observation, and may adversely affect
case may hold a full record of what was said, it the consultation. Box 3.3 suggests some practical
won’t necessarily indicate where the emphasis was hints on recording the case.

37
 CHAPTER THREE The Homeopathic Consultation
Foundation

story and how the way we understand a case is

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

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

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

38
CHAPTER FOUR

Assessing the Homeopathic Case Case Analysis

David Owen

Introduction The Core Principles

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

39
 CHAPTER FOUR Assessing the Homeopathic Case
Foundation

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

causes present? General Patient’s

management vitality
●
What does the case tell us about the
patient’s vitality?
●
How ‘stuck’ is the case in terms of dura- Possible Duration
outcomes and depth
tion and depth?
of symptoms
●
What is the conventional diagnosis or dif-
ferential diagnosis of the patient? Diagnosis
Confirmatory
●
What is the model or models of health that and exclusion
give the best impression of how and why Methodology Model of health
the illness has developed? for prescribing Approach to
treatment
●
What approaches to treatment are avail-
Figure 4.1 The cycle of case analysis
able in a particular case?
●
According to what methodology or mix of
methodologies is a remedy most reliably very helpful to know what was happening to the
prescribed? patient when the illness started. The stronger the
●
How ‘well indicated’ is a remedy – includ- link between causation and illness, the more likely
ing confirmatory and exclusion factors? looking at the pathological model of health and
●
What are the likely and possible out- relying on the causation approach to treatment will
comes? lead to a successful prescription. The more likely
●
What general management factors must that a specific causation is to cause an illness in all
the patient and the homeopath take into patients then the more successful a treatment based
account? on that causation is likely to be – if, of course, a
●
Is there a clear understanding of the illness treatment for that causation is known.
and is there an agreement with the patient There is a range of causative factors, from the
about the treatment being offered and its transient, through those that are easily changeable
duration? to others that appear fixed. They include environ-
●
When is the treatment best reviewed mental factors such as pollution and life style fac-
and how will response to treatment be tors like diet. When there are fixed or maintaining
assessed? causes, then the approach to treatment needs to
take this into account, as in the case of James.
communicated to the patient. Failing to do these
steps or communicate them is, I suspect, one of
CASE STUDY 4.1
the main reasons why some homeopaths find it
James presents with headaches, he drinks
difficult to move from a theoretical understanding
very little but when he drinks more water his
of homeopathy to practising successfully.
headaches are better. He has ample oppor-
tunity to drink but just does not want to. In
What is the Causation and are this case it may be appropriate to understand
Maintaining Causes Present? and possibly prescribe on the patient’s lack of
Identifying causal, contributing and associated
thirst rather than prescribe on just the head
factors, even when there are several different fac-
pain.
tors, is an important part of any case analysis. It is

40
 The Core Principles of Case Analysis

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

41
 CHAPTER FOUR Assessing the Homeopathic Case
Foundation

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

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

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

42
 The Core Principles of Case Analysis

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

43
 CHAPTER FOUR Assessing the Homeopathic Case
Foundation

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

I the homeopath is helped in making an informed

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

44
 Assessing Cases Using Causation

Foundation
when ethically indicated or when legally required.
BOX 4.2
These and other broader management issues to be
Reflection on the Core Principles of Case
discussed later become increasingly important as the
Analysis
homeopath starts treating more serious illnesses.
●
Case analysis is a way of seeking ‘mean- I
ing’ to a case, whether in terms of external
Is There a Clear Understanding of the
causation, an illness, susceptibility, a per-
Illness and is There an Agreement
sonal story or in relation to others. It is
with the Patient About Treatment and
informed by knowledge of philosophy, the
Duration of Treatment Being Offered?
materia medica, and the case.
Summarising the model of health, plan of any
●
The ‘meaning’ describes something of the
treatment and the methodologies used to pre-
journey the patient has taken with the ill-
scribe, and getting agreement from the patient on
ness and points to the journey to wellness.
this basis, as part of the analyses, is good practice.
In anything other than the most straight-
If there is no agreement or if the patient offers
forward of illnesses this is likely to be a
information that means the analysis needs to be
process that ‘unfolds’ over time.
modified then this can be taken into account and
●
Patients and their symptoms can be under-
the relevant steps repeated.
stood using different models of health,
This agreement includes informing the patient
several of which can be used concur-
about the need for reviewing the treatment and that
rently. They will determine the optimum
a course of treatment, in more complex cases, is
approaches to treatment and this will indi-
likely to involve several consultations and prescrip-
cate the most suitable methodologies to
tions. While this agreement may be quite informal
select an indicated remedy.
it should be recognised that it forms the basis of
●
Remedies are homeopathic when pre-
the ‘contract’ between patient and homeopath. If
scribed according to homeopathic prin-
this agreement is not reached then the expecta-
ciples applied through a homeopathic
tions of the patient and homeopath are likely to
process of matching like with like.
be different. So, for example, the patient may just
wish to be rid of a troublesome symptom while the
homeopath is seeing the symptom only as an alarm tored in order to inform the homeopath. Even if
bell of more deep-seated illness. In later chapters the patient does not attend for follow-up some
the contract and its importance, in particular to feedback on the treatment should be part of the
the therapeutic relationship, are revisited. agreement so that the homeopath may monitor
and develop the way that it works. Before mov-
When is Treatment Best Reviewed ing on you might like to reflect on how the case
and How will Response to Treatment analysis seeks and allows communication of the
be Assessed? meaning behind a case and treatment given.
The end of any case analysis process is clarifying Having looked at the broad issues involved in
what follow-up is required and setting the frame- assessing a homeopathic case that apply to all case
work for this. It may include being explicit about analyses, it is appropriate in this chapter to focus
expectations, so the treatment can be meaningfully on the more specific issues that apply particularly
reviewed. Although a full analysis does not need to cases viewed within the pathological model
to take place at every consultation, steps in the of health and that are suitable for treatment based
process will need revisiting. The review of treat- on causation. Before moving on you might like to
ment is not only important for the patient but also reflect on how the case analysis seeks and allows
for the homeopath. How a case progresses and communication of the meaning behind a case and
remedies act or fail to act in a case must be moni- treatment given.

45
 CHAPTER FOUR Assessing the Homeopathic Case
Foundation

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

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

46
 Assessing Cases Using Causation

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

47
 CHAPTER FOUR Assessing the Homeopathic Case
Foundation

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

I from infective agents – they do not always match

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

48
 Bibliography

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

49
CHAPTER FIVE

Introduction to Prescribing Case Management

David Owen

and experience) that may be used in many ways

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

51
 CHAPTER FIVE Introduction to Prescribing
Foundation

and undertake to care for and treat patients. These

BOX 5.1
are not separate entities but are in practice a seamless
Criteria That Make Easy Prescribing More
process, one flowing naturally into the other.
Successful
I ●
A patient with clear symptoms
●
A patient with clear causation but no ongo-
Straightforward Prescriptions –
ing causes
Minor Ailments and First Aid ●
Likely remedies known well
Situations ●
A patient with high vitality
●
A patient with only minor ailments
A straightforward prescription is one where the
●
An illness of short duration
case is clear, the analysis is not complicated and
●
No other treatment having been taken
the prescription is well indicated. Usually these
●
Immediate access to the remedies so treat-
are cases that do not have too many levels to them
ment can be started early
and where the layers of illness are few. In practice
this often means acute illness in an otherwise well
individual, with good vitality and who has not had
or is not having too much other medication that home and they are hugely preferable to treatment
might distort the presenting picture. Frequently in with the analgesics, anti-inflammatories, antipyret-
straightforward cases if anyone were exposed to ics, etc. that make up so much of conventional home
that particular cause they would get the same symp- treatments. By helping the patient to throw off
toms. It makes sense to start one’s clinical practice minor ailments, many cases of more serious illness
with such cases even though these are also often the can be avoided and it prevents the harm caused by
cases that will heal spontaneously in time. straightforward cases treated inappropriately with
Many minor ailments and first aid situations strong drugs leading to the development of more
present straightforward cases where the indi- deep-seated problems. Treatment is often success-
cated remedy is clear and it is only necessary to ful in these cases and the proportion of conditions
prescribe superficially. The potential benefit to that you will be able to treat in this way depends on
patients being able to treat themselves in this way the number of remedies you know.
is huge, for example a patient able to take a rem- Patients will find a number of books that can
edy quickly after trauma or at the earliest stage in help them treat minor ailments for example in
a cold. The criteria that make this approach more Dr Lockie’s The family guide to homeopathy or
likely to help are listed in Box 5.1. his Encyclopedia of Homeopathy.
This approach can also lend itself to a busy
practice of other health care professions whether
it is the use of Arnica by midwives or osteopaths or Methodologies of Prescribing
the use of one or two remedies with a clear cystitis
picture in family practice. There are a small range
Within Each Approach to Treatment
of homeopathic remedies that can help in many The homeopathic student will realise that many
different first aid and minor ailments. One of the minor ailments can be helped with homeopathy,
easiest ways of working in this way is to be familiar and this will avoid a patient’s symptoms being sup-
with the causes and presenting symptoms of each pressed and leading to more serious illness. Limiting
and to give them when a patient presents a recogni- the treatment you offer to a certain range of cases is
sable match. There are many homeopathic first aid an important way of working within your compe-
kits that contain some of these remedies so they are tence; it is obvious that by knowing more homeo-
immediately available for use. Often homeopathic pathic remedies and understanding those you know
patients use these to help treat problems in the better, you can treat more patients and gradually

52
 Methodologies of Prescribing Within Each Approach to Treatment

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

onto their world or, in the context of homeopathic

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

53
 CHAPTER FIVE Introduction to Prescribing
Foundation

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

I A Systematic Management Strategy

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

BOX 5.2
Key Methodologies to Prescribing Within Five Main Approaches to Treatment
Causation Totality/Constitution
●
Trigger event or aetiology ●
All physical, mental and general symptoms
●
Isopathy and tautopathy ●
Three-legged stool
●
Nosodes and family history ●
A mix of physical, mental and general key-
●
Anticipating causes, prophylaxis or preventa- notes
tive treatment ●
Physical and psychological type
●
Maintaining cause ●
Central disturbance
●
Detox, organ and drainage treatmentl
Essence
●
Never well since ●
Miasmatic
Presenting Symptoms ●
Categories of remedies
●
Local or clinical prescribing ●
Remedy families and kingdoms
●
Single main symptom ●
Types of essence
●
Single keynotes ●
Related remedies (see Chapter 27)
●
Several keynotes in one or more areas of the case ●
Herd prescribing (see Chapter 18)
●
The complete symptom ●
Using fundamental sensation or feelings in
●
Epidemic remedies the patient
●
Doublet or triplet symptoms, linked symptoms
Reflective
●
Previous well indicated remedy ●
Psychodynamic using feelings generated in the
●
Combination remedies
homeopath by the patient (see Chapter 29)
●
Strange, rare and peculiar ●
Intuitive
●
Confirmatory and contradictory symptoms
●
Symptoms ‘As if. . .’

54
 Methodologies of Prescribing Within Each Approach to Treatment

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

55
 CHAPTER FIVE Introduction to Prescribing
Foundation

CASE STUDY 5.1 CASE STUDY 5.2

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

56
 Methodologies of Prescribing Within Each Approach to Treatment

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

57
 CHAPTER FIVE Introduction to Prescribing
Foundation

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

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

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

58
 Methodologies of Prescribing Within Each Approach to Treatment

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

59
 CHAPTER FIVE Introduction to Prescribing
Foundation

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

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

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

60
 Different Approaches in Practice

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

61
 CHAPTER FIVE Introduction to Prescribing
Foundation

The homeopath should always remember that

BOX 5.3
most patients with most illnesses get better on
Treatment of Sore Throats
their own. If the self-healing process is unfolding
●
Aconite for a sore throat started after being
I without hindrance then at best we may make just
a slight improvement in the speed of recovery and
in a cold wind or after a shock. Especially
if burning, redness, smarting, dryness, tin-
at worst we may slow, prevent, or manifest a new
gling in the throat and if it hurts to swal-
deeper illness. Giving no prescription is always
low water.
an option. It is not the same as giving no treat-
●
Baryta carbonica for recurrent cases of
ment, as reaching this decision will have already
sore throat following exposure to cold and
included elements of a therapeutic consultation
chill, and better for drinking. The tonsils
and identifying obstacles to cure. Not prescribing
are frequently large, especially the right
is important if a disturbance is resolving rapidly
tonsil. Suited to timid children. Offensive
as there may be no clear case to prescribe on or a
foot sweat. Better swallowing fluids.
previous remedy may be acting.
●
Belladonna often has a viral type fever with
a dry and burning sore throat. The tonsils
are often inflamed and bright red with a
Straightforward Cases red, hot face and skin. Worse talking and
any touch but with little or no thirst.
Having looked at the range of different methodol-
●
Gelsemium has a sore throat that develops
ogies and approaches available to the homeopath,
several days after exposure to warm moist
it is appropriate to concentrate first on what are
relaxing weather, they are very shivery but
generally the easiest conditions to prescribe for.
with little thirst.
These are generally the conditions where there is
●
Lachesis for a similar burning pain in the
a clear and single causation – what we will call a
throat worse from swallowing liquids but
straightforward case – and those conditions where
due to over use of the voice with pain
there is a clear symptom picture of recent and
worse on the left side. The throat appears
relatively quick onset, typically an acute illness,
more blue or purple colour than red and is
what we often call a simple case. These will, if the
characteristically much worse for any con-
vitality of the patient is good and the trigger not
striction around throat.
overwhelming or persistent, respond well to treat-
ment. In many cases the methodologies will be on
causation and/or main symptoms but a totality
or other methodology may be used if the remedy
suits the patient. I advise you start by prescribing for straightfor-
The example of some of the local remedies used in ward and simple cases the 12c or 30c strengths of
treating acute sore throats is given in Box 5.3; there remedies. In the most acute situations these may
are many others but it gives the sort of informa- be needed every half hour (or more) and as symp-
tion that can distinguish them. While sore throats toms improve the interval between repetitions can
are often amenable to local treatment some may be increased. As a general rule, repeat a remedy
indicate a more deep-seated condition, particu- as often as is needed but stop when no further
larly if they are recurrent or persistent. Certain improvement is obtained. Be warned that it is
remedy pictures are more tuned for these chronic very easy to get diverted into hunting for a perfect
presentations. The selection of potency and fre- potency, with each text and school suggesting dif-
quency of administration of remedies is covered ferent potencies, rather than concentrate on the
in Chapter 20. For those new to homeopathy most important task of finding the closest remedy
and while developing your knowledge and skills match possible.

62
 Bibliography

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

63
CHAPTER SIX

The Symptom, Susceptibility Philosophy

and Hierarchy
David Owen

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

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

67
 CHAPTER SIX The Symptom, Susceptibility and Hierarchy

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

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

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

II toms, the mental symptoms and the general

symptoms give the case.
uation, including their effect on the homeopath.
Table 6.1 suggests some of the trends that run
●
In the holographic model the qualities that across the different models of health, although these
run through several symptoms or the pattern are not hard and fast and many cases can be helpfully
expressed through the symptom are most perceived through several models or views of health.
important. Identifying these provides part of the information
●
In the relational model it is the deepest most for assessing the type of case that best describes a
fundamental sensation and feeling that under- patient (see Chapter 10) and on which management
lies the symptoms and how this affects others decisions are made. For example many prescribers
that is used to select a prescription. will use a different remedy potency depending on
their view of the case (see Chapter 20).
Illnesses in the Different Models In the pathological model the illness is caused
of Health by something that disturbs the equilibrium of the
Different models of health provide the homeo- patient and is to be overcome. In the biologi-
path with a spectrum of views of patients that cal model the illness is a change in the patient

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

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

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

Sensation behind
the Symptoms

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

and Susceptibility

Biological The Illness and Simple e.g. 30c

Presenting Symptom

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

68
 Using Different Models and Approaches

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

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

Causation and the

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

Table 6.2 gives a suggested comparison of the REFLECTION POINT

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

69
 CHAPTER SIX The Symptom, Susceptibility and Hierarchy

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

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

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

II relationship to the observer and illness can be seen

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

70
 Using Different Models and Approaches

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

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

Causation and the

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

Table 6.4 THE SORTS OF PERCEPTION POSSIBLE IN EACH MODEL

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

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

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

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

71
 CHAPTER SIX The Symptom, Susceptibility and Hierarchy

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

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

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

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

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

Combining Different Models

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

72
 Laws of Cure

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

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

Causation and the

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

73
 CHAPTER SIX The Symptom, Susceptibility and Hierarchy

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

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

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

The Boat Metaphor–Illustrating the Interplay

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

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

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

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

74
 The Patient, the Environment and the Symptom

The Environment Another way of describing vitality is in terms of

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

Presenting Symptoms
physical but also emotional and intellectual state.

Causation and the

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

75
 CHAPTER SIX The Symptom, Susceptibility and Hierarchy

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

assistance the homeopath provides treatment to

Causation and the

CASE STUDY 6.3 facilitate these changes.

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

II irritability and restlessness. He noticed that

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

76
 Treating Symptoms

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

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

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

Causation and the

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

77
 CHAPTER SIX The Symptom, Susceptibility and Hierarchy

Working with Other Treatment Modalities Summary

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

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

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

78
 Bibliography

Clover A 1989 Homeopathy reconsidered, a new look

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

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

Causation and the

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

79
CHAPTER SEVEN

The Materia Medica Materia Medica

David Owen

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

81
 CHAPTER SEVEN The Materia Medica

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

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

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

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

82
 Levels of Detail in the Materia Medica

Table 7.1 FEATURES OF MATERIA MEDICAS LINKED TO EACH APPROACH

Model
of Health Main Information Linked to Example of Remedy

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

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

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

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

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

Totality that those describing the totality include causation

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

83
 CHAPTER SEVEN The Materia Medica

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

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

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

II The remedies are the tools of the homeopath’s

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

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

84
 Levels of Detail in the Materia Medica

BOX 7.2
Sources of Information About Remedies
Main Sources ●
Symbolic including shape and colour of
●
Provings e.g. China Officianalis source (Doctrine of Signatures)
●
Toxicology e.g. Lachesis, venom of the bush- ●
Case history pointing to an affinity with a

Presenting Symptoms
master snake substance e.g. nickel allergy

Causation and the

●
Recorded clinical use e.g. Euphrasia (eyebright) ●
Personal or cultural use of a remedy e.g.
Coffea or Cannabis indica use etc
Subsidiary Sources ●
Emotional and intuitive insights such as in
●
Appearance or behaviour of the source e.g.
the Bach flower remedies
Silica in sand and glass
●
Environment of the source e.g. Arnica grow- Other Systems
ing on mountains, also called fall-herb Other systems use other criteria to determine II
●
Disease patterns e.g. nosodes how a remedy acts e.g. the Biochemical tissue
●
Historical, including herbal usage of the rem- salts and Bach flower remedies. As these are
edy e.g. Caulophyllum known as squaw root not prescribed on provings they are not always
from its use in childbirth. considered homeopathic, although they act as
●
Traditional/cultural usage e.g. Anhalonium ‘energetic’ remedies. Biochemical tissue salts use
●
Pharmacological including adverse effects a range of 12 inorganic salts prepared similarly
e.g. Lithium Carbonicum to homeopathic remedies. Bach flower remedies
●
Connections with biological families are a range of energetic remedies prescribed on
●
Mythological e.g. Aurum from the use of gold the dominant emotional state of the patient.

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

85
 CHAPTER SEVEN The Materia Medica

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

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

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

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

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

86
 Symptoms in the Materia Medica

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

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

Causation and the

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

87
 CHAPTER SEVEN The Materia Medica

mation; some repeat content but use different

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

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

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

II in Box 7.3 and to put these and the development

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

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

88
 Different Materia Medicas

Kent’s Lectures on Materia Medica Vithoulkas’s Essences

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

Presenting Symptoms
Clarke’s Dictionary

Causation and the

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

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

89
 CHAPTER SEVEN The Materia Medica

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

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

The first edition of the Organon is published

181 1
Causation and the

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

1828 Chronic Diseases. S. Hahnemann

Queen Victoria begins her reign 1837

Potato famine in Ireland begins 1842

II
Pasteur completed first test 1862
leading to pasteurization

1874 Allen’s Encyclopaedia of Pure Materia Medica

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

Freud defines anxiety neurosis 1895

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

1927 9th ed. Boericke’s Materia Medica

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

1942 Tyler’s drug pictures

Crick and Watson proposal of the 1953

double helical structure for DNA

1977 Phatak’s Materia Medica

1980 1980 1885 Vithoulka’s Essences

1986 Coulter’s Portraits

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

Figure 7.2 Time line of the development of significant materia medicas

90
 Different Materia Medicas

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

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

Causation and the

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

91
 CHAPTER SEVEN The Materia Medica

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

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

medicas and one repertory. A repertory is a system-

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

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

92
 Different Materia Medicas

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

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

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

Causation and the

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

93
 CHAPTER SEVEN The Materia Medica

Computer Materia Medicas The Life Cycle of Remedies

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

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

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

94
 Bibliography

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

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

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

Causation and the

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

95
CHAPTER EIGHT

Taking the Case The Case

David Owen

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

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

97
 CHAPTER EIGHT Taking the Case

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

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

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

II several different illnesses each with presenting

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

Past medical Figure 8.1 Mind map of

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

Menopausal Weight
Gynaecological symptoms gain
problems

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

Family history
of menopausal
difficulties

98
 Making a Start

on the biological model, starting with the present-

BOX 8.1
ing symptoms but extending to other connected
Outline of the Homeopathic Case
symptoms.
●
Presenting symptom: the complete symp-
tom including the causation, time, loca-
Overview of the Case
tion, sensation, intensity, modalities and
‘A human being is part of the whole, called by us the
treatment history

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

Causation and the

●
ences himself, his thoughts and feelings as something
one, include treatments given
separated from the rest – a kind of optical delusion of
●
Past history: illness, treatments, accidents,
his consciousness. This delusion is a kind of prison for
operations
us, restricting us to our personal desires and to affection
●
Review of systems: bowels, urinary, stom-
for a few persons nearest us. Our task must be to free
ach, respiratory, skin, allergies, headache,
ourselves from this prison by widening our circle of com-
passion to embrace all living creatures and the whole of
fits or faints, genitourinary, gastrointesti- II
nal, respiratory, neurological, cardiovascu-
nature in its beauty.’
lar, ear, nose, and throat (ENT), the senses
Albert Einstein
musculoskeletal, skin etc
●
Significant life events
Initially while you are gaining experience, it is
●
Mental: psychological*
helpful to have a basic structure in mind for a
●
General: environmental and dietary history*
consultation. In practice having explored the
●
Treatment history
main presenting symptom the case will often flow
●
Family history: illnesses in both sides of
onto another related area of the case and all the
the family; add parents and grandparents*
areas mentioned in Box 8.1 can be covered in the
●
Social history: deepening the case, marital,
style of a semi-structured interview. Box 8.1 gives
economic status, career etc., social habits,
a checklist of the main areas of the case that the
smoking alcohol, drugs, exercise*
homeopath may need to enquire about. Each area
●
Examining the patient
may reveal vital information about the present-
●
Making a diagnosis: including the homeo-
ing symptom, may provide vital confirmatory or
pathic diagnosis
exclusion symptoms and contribute to the total-
ity. The psychological, general, family and social *Covered in Chapter 13.
areas of the case are covered in Chapter 13.
A central essence or theme or relational aspect The abbreviated case of Sharon shows how a
of the case may emerge in any of these areas and case might unfold; in another patient with simi-
because the presenting symptom is frequently lar symptoms or to another homeopath it might
discussed or handled in a certain way, it is often unfold differently. Remember that all cases given
first most noticeable or hinted at in areas of the in this text are abbreviated to show only the most
case away from the presenting symptoms or by relevant information for the point being illus-
unconscious movements of the patient’s hands or trated and a great deal more information is taken
body or by a change in the observer, such as the and recorded in the full case.
prickle in the hairs of the neck of the homeopath, Figure 8.1 shows one way of understanding
the curiosity about one phrase or word, an emo- how the different areas of Sharon’s case connect
tional reaction from a nervous giggle to the eyes and how a remedy that acts deeper than just symp-
watering etc. The practitioner must never allow tomatically might fit this pattern. In Sharon’s case
the structure of case-taking to pre-empt the spon- Calcarea carbonicum fitted not just her presenting
taneous flow of the patient’s story, sometimes in symptoms but it was confirmed by her appear-
quite unexpected directions. ance, food and general symptoms. She felt better

99
 CHAPTER EIGHT Taking the Case

the whole case and set the tone of the consulta-

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

want to change, how the symptoms affect them.

Causation and the

mone replacement therapy (HRT) for meno-

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

had had, including thyroid function, were dis-

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

100
 Hearing the Symptoms

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

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

Causation and the

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

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

101
 CHAPTER EIGHT Taking the Case

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

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

a historic context and make links to other events.

Causation and the

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

II As cases get more complex so they may appear

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

102
 Hearing the Symptoms

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

Presenting Symptoms
Review of Systems psychological interventions like counselling, and

Causation and the

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

103
 CHAPTER EIGHT Taking the Case

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

the individual and the case – either without the Investigations

Causation and the

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

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

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

104
 The Case and Seeking Agreement to Work a Certain Way

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

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

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

Causation and the

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

105
 CHAPTER EIGHT Taking the Case

symptoms – it is important to be able to create a

BOX 8.2
safe space for taking the case. Psychological space
Reflections on the Homeopath as a Hunter
is created through the pause or measured silence,
●
How does being familiar with the location
that to be safe needs the patient (and homeopath)
that you are working in help you detect
to be comfortable. In this space the deeper aspects
subtle changes of atmosphere or symp-
of a case often unfold and small observations
toms?
Presenting Symptoms

about words, movements and behaviour reveal a

Be prepared to wait with patience to allow
Causation and the

●
great deal.
the symptom to present itself.
Using open-ended questions helps patients
●
How might you create opportunities for
to feel invited to reveal symptoms. For example
the symptom to reveal itself, particularly
asking ‘can you share with me some of the things
the deeper, more hidden symptoms which
that have made you happiest and saddest?’, then
are frequently more characteristic?
II ●
Might the right sort of bait, or provoca-
sensitively asking for clarification or more detail
is very different from closed questions that have
tion, entice the symptoms to the surface?
their place but reveal much less, e.g. ‘that must
The bait might include pauses, invitation,
have made you happy?’
explanations, mimics, challenge or provo-
cation.
Classify the Symptoms
●
How might modelling back to the patient
‘Each individual symptom must be considered. Every
the behaviour of a parent, a partner or
symptom must be examined to see what relation it sus-
even themselves allow patients to get in
tains to and what position it fills in the totality in order
touch with or recreate a symptom, e.g.
that we may know its value, whether it is a common
unresolved feelings? (If this isn’t done con-
symptom, a particular symptom, or whether peculiarly
sciously the homeopath may unconsciously
a characteristic symptom.’
be subject to these projects anyway.)
James Tyler Kent
●
When is the time to gently challenge a symp-
tom that is partly revealed? Challenging it
Once symptoms are revealed and explored com-
might simply be naming it or an attempt to
pletely then it is possible to order them not only
understand it.
by weighting but also by their relationship to other
●
The one that got away – there will always
symptoms. This can be in terms of chronological
be symptoms that are just out of reach;
appearance, hierarchy, sphere of action (mental,
sometimes there will just be a sense that
general or local), how strange or rare or peculiar.
there is something more to the case and it
Sometimes it is only while trying to classify or
may not be until follow-up or sometime
weigh a symptom that it becomes clear that the
later that the symptom will surface and be
symptom is far from complete, at other times the
seen clearly.
importance of other symptoms surfaces, as Mary’s
case illustrates (Case Study 8.6).

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

106
 The Case and Seeking Agreement to Work a Certain Way

the patient improves and the case becomes more

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

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

Causation and the

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

107
 CHAPTER EIGHT Taking the Case

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

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

their health before the appointment and also to

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

we can use this information to give meaning to the

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

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

108
CHAPTER NINE

Local Prescribing and Case Analysis

Repertorisation
David Owen

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

109
 CHAPTER NINE Local Prescribing and Repertorisation

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

is often incorporated with causation approaches Different Methodologies

Causation and the

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

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

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

110
 Local Prescribing

the weighting of symptoms and knowledge of the

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

Presenting Symptoms
I always get...’

Causation and the

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

The Complete Symptom Confirmatory and Eliminatory Symptoms

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

111
 CHAPTER NINE Local prescribing and repertorisation

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

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

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

II remedies combined together that may each cover

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

112
 Case Analysis Using Causation and Local Symptoms

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

Presenting Symptoms
perspiration
before bladder spasms

Causation and the

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

No Equisetum copious urine

bladder feels weak
continuous flow

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

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

113
 CHAPTER NINE Local prescribing and repertorisation

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

Rubrics
Causation and the

Rubric is a name given to symptoms that groups

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

II edies that have – in their proving and through

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

114
 Repertorisation

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

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

Causation and the

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

115
 CHAPTER NINE Local prescribing and repertorisation

BOX 9.2 BOX 9.3

The Framework of Kent’s Repertory Sub-headings of Kent’s Repertory Using as
●
Mind, i.e. mental symptoms An Example The Headings Under Which
●
Vertigo, head, eye, vision, ear, hearing, i.e. a ‘Pain in the Head’ Might Be Looked Up
special senses Sides
Nose (including smell), face Time
Presenting Symptoms

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

Causation and the

all alimentary system Extending

●
External throat, stomach including desires Parts of the head
and aversions to different foods and thirst Sides
●
Abdomen, rectum, stool Time
●
Bladder, kidneys, prostate, i.e. urogenital Modification
II system Extending
●
Urethra, urine, genitalia (male) Kind of pain
●
Female genitalia including menses, leucor- Sides
rhoea Time
●
Larynx and trachea including voice Modification
●
Respiration, cough, expectoration Extending
●
Chest including heart symptoms and Parts of the head
breast Sides
●
Back, extremities, i.e. locomotor system Time
●
Sleep including dreams Modification
●
Chill, fever, perspiration Extending
●
Skin
●
Generalities including food aggravations.
at the time the repertory was published been
confirmed by reproving ‘but stand out pretty
The Grading of Remedies strong’ or have been verified clinically. In this
Most repertories include a useful introductory grade are also included those remedies that did
chapter on layout and how remedies have been not cause the symptom in provers but have
weighted, including the number of gradations cured the symptom in patients.
and how they are indicated. The grade a remedy
is given in a rubric is not, as it is in a case, an The Evolution of the Repertory
indication of the intensity of the symptom it pro- There have been hundreds of repertories pub-
duces, but represents how frequently and easily lished, often sharing some common source material.
the symptom is produced. Relatively few of these are still in common use today.
In Kent’s repertory bold remedies brought Box 9.4 gives details concerning some of the most
out the symptom in ‘all or a majority’ of the well-known and used paper repertories; computer
provers, each confirmed by reproving and hav- repertories are covered in Chapter 19.
ing been extensively verified clinically. Second
grade (italics) remedies brought out the symp- Card Repertories
tom in ‘a few’ provers, confirmed by reproving Repertorisation by hand is a slow process. In an
and occasionally verified clinically. Third grade effort to reduce the time and effort of writing
(ordinary type) remedies brought out the symp- down rubrics and remedies for repertorisation,
tom ‘now and then’ in provers. These had not, punched card repertories started to be developed

116
 Repertorisation

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

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

Causation and the

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

117
 CHAPTER NINE Local prescribing and repertorisation

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

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

Stressing modalities for local symptoms as four levels of gradation.

Causation and the

applicable to the whole person followed by

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

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

118
 How to Repertorise

each remedy in all the rubrics with the grades

BOX 9.5
scored as ordinary type = 1, italics = 2, bold = 3,
Some Advantages of Computerised
(and those repertories with bold italics = 4). By
Repertories
taking a selection of rubrics and sub-rubrics that
●
It is usually far quicker to refer to a com-
represent the case and scoring the remedies in these
puter repertory than the book
it is possible to generate a numerical score for each
Repertorisation is dramatically quicker –

Presenting Symptoms
●
remedy.
almost instantaneous – and as a result can

Causation and the

In theory the simillimum should be the rem-
be done during the consultation
edy that covers the greatest number of the selected
●
Additions and modifications to the reper-
rubrics to the highest degree. However, if the
tory can be made very easily
numerical result is to be correct there are several
●
Production and distribution of reper-
presuppositions that need to be fulfilled. These are
tory upgrades on disk are far cheaper and
quicker
discussed in more detail in Chapter 14, page 181.
The result is that repertorisation is only a guide to
II
●
It may allow the user to add personal
the possible correct remedies even if the repertory
rubrics and remedies
contains the rubrics required to find the simillimum
●
Every remedy in every rubric can be tagged
and the remedy that is the simillimum.
giving its source/author
●
It enables rapid searches for information:
Analysis Strategies
(a) key words, (b) synonyms of key words
There are a number of different analysis strategies
and (c) remedies
possible with repertorisation. In local prescrib-
●
Rubrics from the same repertory or differ-
ing the grades of the remedy in each rubric are
ent repertories can be combined to give a
added together to give a total or ‘rubric score’ that
more complete rubric
is used to indicate the most likely remedy match.
●
A range of different analysis strategies or
These use the principle of inclusion and exclusion
combination of strategies can be used with
presented earlier, where the remedy with symp-
the ability to change from one to the other
toms found in the case will increase the likely
instantly; with different strategies the anal-
inclusion of that remedy while remedies without a
ysis can compensate for different features
symptom can be relatively excluded. How strong
of either a) the case or b) the strengths/
or central the symptom is and how clearly the
weaknesses of the repertory.
remedy does or does not have that symptom will
●
Graphical display of the analysis makes
give the strength of the inclusion or exclusion.
interpretation a great deal easier
This is similar to using a strong or key symptom
as an ‘eliminatory’ rubric, where to aid analysis
ing and weighting. Homeopaths using different only those remedies in one or two key rubrics are
models of health see the hierarchy of symptoms dif- considered as possibilities, while others are effec-
ferently and to some extent the layout of repertory tively eliminated.
reflects the priority of the compiler. The remedies Other strategies are covered in Chapter 14 but
in the rubrics and the strength or grade required they include looking at small remedies, emphasis-
are identified. Then, most simply, repertorisation ing rare remedies that have few symptoms in the
adds up how many times each remedy occurs in the repertory. In small rubrics, the smaller the num-
selected rubrics, taking into account the grading of bers of remedies in a rubric, the more the remedies
the remedy in the rubric, and the weighting of the in that rubric are emphasised – equivalent to
symptom to achieve a numerical score. ‘strange, rare and peculiar’ symptoms. Prominence
There are different ways of scoring each rem- emphasises remedies that are unusually strong in
edy; the most common is to add the grading for a rubric, – basically keynotes. Finally, it is possible

119
 CHAPTER NINE Local prescribing and repertorisation

to bring out family groupings of remedies that are ●

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

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

repertory throughout the interview. Others, espe- up features of the remedy being studied to see how
cially when focusing on the case, repertorise at the prominent the remedy is in the rubric and what other
end. Some hear the patient mention an unusual remedies are present, especially those that are of the
symptom and seek it in the repertory, others same or higher grade.
hear it and want to know what’s behind it; both
are relevant. In the repertory the remedies shown
II guide which confirmatory and eliminatory ques- When analysing by hand many homeopaths start
tions to ask. Of course sensitivity is needed when by choosing rubrics of a ‘middle’ size. For example,
browsing in the repertory with the patient pres- in a tonsillitis case – Throat, pain, swallowing, on:
ent but sometimes the pause allows the patient to contains about 120 remedies that are too many to
share something useful they might not otherwise. work with easily and it is a very common symptom.
As cases get more complex, so deciding the priority Alternatively if you take Throat, pain, warm room
of what to repertorise increases. Flicking through amel., then the only remedy listed is Magnesia car-
the repertory searching for rubrics can help to both bonicum. Even if this is a strong peculiar symptom
focus on and free-associate around the case, lead- it is not useful on initial repertorisation because
ing sometimes to the sudden exciting discovery. the right remedy, unless it is Magnesia carboni-
cum, might be excluded at the start in such a small
rubric. Rubrics like Throat, pain, extending to the
REFLECTION POINT ear, which has about 30 remedies, and Throat,
●
Try using several repertories to analyse a simple case pain, warm drinks, amel., which has 12, are much
using local symptoms. What makes one repertory easier more manageable. At the end of the analysis the
to use than another, and what are the limitations of large rubric can be brought in to support or oppose
each? the choice of likely remedies.
●
When looking up symptoms why is it important to
distinguish between a local modality and a general
symptom, e.g. ‘worse during menses’ may be found
under ‘menses’ in ‘generalities’ or under many other
Summary
symptoms that are worse at the time of menses? Do In Chapters 1 to 9 the homeopath will, along with
not look in ‘female genitalia, menses’ as it deals with teaching from other sources, have developed skills
the particular types of menses and lists other modalities and knowledge to enable the treatment of many
affecting the periods. self-limiting diseases and some more serious dis-
●
What are the strengths and weaknesses of the eases. The same principles are used and extended
imaginative use of the repertory when the patient’s state in dealing with more deep-seated cases but a thor-
is seen indirectly or symbolically through the rubric? ough grasp of the idea of the importance of iden-
●
What influences the order in which you set about tifying the symptoms in detail and matching the
searching the repertory? Do you naturally find yourself symptoms to the materia medica through reperto-
thinking of some rubrics as more important than others? risation is the centre of totality prescribing, where
How does this relate to any grading of symptoms? How much homeopathic prescribing takes place. In
might you use confirmatory and eliminatory rubrics? parallel with looking at different methodologies

120
 Bibliography

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

Presenting Symptoms
repertory. The Homeopath 10:3.

Causation and the

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

121
CHAPTER TEN

Managing Different Case Management

Types of Cases
David Owen

Introduction more difficult. While not all simple cases are

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

123
 CHAPTER TEN Managing Different Types of Cases

Type of case
Straightforward Simple Complex Confused Hidden

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

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

changes simillimum is hard to for full picture to emerge

observe

Symptoms and wave form

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

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

REFLECTION POINT As cases become more complex so more symp-

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

124
 The Homeopathic Continuum

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

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

Causation and the

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

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 CHAPTER TEN Managing Different Types of Cases

Table 10.1 COMPARING SIMPLE AND COMPLEX CASES

Aspect of the Case
and Treatment Simple Complex

Causation Single Multiple

Onset Rapid Slow

Presenting Symptoms
Causation and the

Illness Acute Chronic

Focus of the case On the illness On the person

Symptoms Often one main one Several

Symptom focus More external/superficial More internal/deeper

II Time to take the case Shorter Longer

Treatment Easy Difficult

Response to treatment Fast More gradual

Style of case Taken Received

Use of potency Low to mid Mid to high

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

126
 The Homeopathic Continuum

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

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

Causation and the

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

A Simple case

From outside From above In cross section

Patient’s
inner state

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

From outside From above In cross section

Patient’s inner state

(less visible)

Three levels
of symptoms

Three levels
of symptoms
Patient’s inner state

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

127
 CHAPTER TEN Managing different types of cases

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

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

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

II Confused and Hidden Cases

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

128
 Types of Simple Cases and Acute Illnesses

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

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

Causation and the

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

129
 CHAPTER TEN Managing different types of cases

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

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

Causation and the

specific cause can be blamed for hysteria or shared

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

II an infective agent and to collective susceptibility.

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

130
 Types of Simple Cases and Acute Illnesses

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

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

Causation and the

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

131
 CHAPTER TEN Managing different types of cases

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

Management of Simple Cases

Causation and the

CASE STUDY 10.1

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

II chest infections she seems to go downhill in

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

132
 Management of Simple Cases

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

Presenting Symptoms
treatment based only on the presenting problem.

Causation and the

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

133
 CHAPTER TEN Managing different types of cases

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

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

Favourable
Causation and the

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

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

II equally the patient may need a different remedy in

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

134
 Management of Simple Cases

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

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

Causation and the

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

135
 CHAPTER TEN Managing different types of cases

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

homeopathically? and sensitivity of the patient including the symp-

Causation and the

toms. Further, it raises the question of how the

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

II the first two sections of this textbook will prepare

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

136
CHAPTER ELEVEN

Holism and Understanding Philosophy

Complex Cases
David Owen

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

139
 CHAPTER ELEVEN Holism and Understanding Complex Cases

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

Symptoms, Susceptibility The Totality and the Constitution

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

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

140
 Symptoms, Susceptibility and Suppression

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

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

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

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

141
 CHAPTER ELEVEN Holism and Understanding Complex Cases

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

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

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

142
 Symptoms, Susceptibility and Suppression

REFLECTION POINT Atom

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

possible causes and how might these causes relate to

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

priest have seen the case differently?

Symptoms

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

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

143
 CHAPTER ELEVEN Holism and Understanding Complex Cases

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

if the individual could develop an acute illness the

Totality and

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

Chronic disease and complex cases can be the

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

144
 Symptoms, Susceptibility and Suppression

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

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

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

Circumstances including hereditary predispo-

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

145
 CHAPTER ELEVEN Holism and Understanding Complex Cases

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

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

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

146
 Suppression

Suppression different places at different times, to flooding or

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

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

147
 CHAPTER ELEVEN Holism and Understanding Complex Cases

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

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

148
 Suppression

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

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

149
 CHAPTER ELEVEN Holism and Understanding Complex Cases

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

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

pression and local or partial symptom treatment.

Totality and

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

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

150
 Summary

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

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

151
 CHAPTER ELEVEN Holism and Understanding Complex Cases

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

Dossey L 1982 Space time and medicine. Shambala,

Boulder

References Sankaran R 1991 The spirit of homeopathy.

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

Roy M 1999 The principles of homeopathic philoso-

phy. Churchill Livingstone, Edinburgh

152
CHAPTER TWELVE

Dynamic Materia Medica Materia Medica

David Owen

‘Myth, legend, poetic imagery all represent a proving in Studying in increasing detail a growing number
one way.’ of homeopathic remedies can appear a daunt-
Ralph Twentyman ing task. The homeopath will find it helpful to
develop a range of approaches to studying to help
understand and remember the many aspects of
these remedies. Remedy pictures are not random
Introduction but have clear coherent patterns and wherever
In the previous chapter we saw that the totality of possible it can help to observe order in them
symptoms and the constitutional picture of each expressed as trends and themes. Observing these
remedy provide two important aspects of each rem- patterns prepares the homeopath for connecting
edy picture. By considering both of these the homeo- and extending the materia medica through the
path is helped to understand both the case and the consideration of ‘related remedies’.
remedies themselves in a much more detailed and Seeing how remedies have trends of symptoms
subtle way than on the presenting symptoms and in common or share constitutional features allows
keynote symptoms alone. A more complete under- comparison between them, so that they are seen
standing of remedy pictures involves seeing the rem- not in isolation but in a context and in relation-
edies as dynamic pictures representing a spectrum of ship with and to each other. This is a prerequisite
states, with aspects to it that evolve over time or in for deepening the use of related remedies within a
response to different situations. A remedy may have treatment strategy.
quite a different presentation early on in cases, when Remedy pictures represent a range of different
in different relationships or depending on life style. possible reactions, some of which are opposite and
Different homeopaths will perceive remedies paradoxical, in response to different situations.
and learn about them in different ways. Not only Knowing something of these paradoxes reveals not
does developing a detailed picture allow match- only what symptoms and themes the remedy might
ing at the level of the totality and constitution but show in different situations but also some of the
also it brings broader understanding of the variety most important and central points to be explored
of different ways a patient might react to differ- in the case. In this chapter we explore the idea of
ent circumstances. This richness of materia medica patterns of symptoms and constitutional features
gives language to the different expressions of the that run through the remedies. At a meta level the
case in different patients, and allows the homeo- pattern (and therefore remedy) can be thought
path to conceptualise and compare one case to of as an expression of ‘information’ and we can
another and develop a rational approach to the consider these patterns in terms of them running
holistic treatment of each patient. along different axes, between different poles.

153
 CHAPTER TWELVE Dynamic Materia Medica

Learning the detail of each remedy’s materia features that are reflected through weight-
medica challenges most homeopathic students and ing of symptoms in the materia medica and
provides an opportunity to explore the limitations in the rubrics of the repertory. A remedy (and
of our perception. For example, it is often easier its information quality) also expresses itself
when reading through a remedy picture to see and through features of the source material itself –
recall certain aspects of its materia medica. This how it occurs in nature, the sorts of people that
same, unconsciously selective, view and recall of are drawn to or are sensitive to it, its social, cul-
patients is a major handicap to seeing the true tural and mythological connections. These two
totality or constitutional picture. It is through the sources of knowledge, like the totality and con-
personal development that goes with developing stitution, frequently complement each other and
a more dynamic way of studying that our clini- work holistically to inform a complete under-
cal work, as well as our knowledge of the materia standing of the remedy.
medica, can become broader and deeper, more The better known the remedy the more this
rounded and comprehensive. richness of materia medica applies. In some rem-
edies the known totality is incomplete, perhaps
because only a few provings have been done or
REFLECTION POINT there is a lack of up-to-date information. In oth-
● What remedies do you find it difficult to study or ers, especially little used remedies or those whose
Constitution
Totality and

remember and why do you think this is? What aspects source material has little apparent significance to
of your own psychology might make learning particular the treatment population, the constitution may be
remedies easy or hard? If there are remedies you find it poorly defined.
III easy or hard to study in depth, how might this influence
your prescribing? Can the Complete Picture Ever
Be Fully Expressed?
In the same way as every patient has aspects of
Totality and Constitutional themselves that are manifest at a certain time and
aspects that are hidden or unconscious, it is help-
Materia Medica ful to think of remedies as having aspects that
‘To treat a patient you have to find out what is wrong are revealed or hidden at different times and in
with them, to the homeopath the materia medica is part different situations. When studying a complete
of the language needed to hear the case as much as it is remedy picture the homeopath seeks to know all
part of any cure.’ aspects and to understand how the hidden side
may become manifest over time. Thus different
The pattern or information running through a aspects of the remedy may be seen in different
remedy will express itself in the slightest detail patients or over a period of time and features in
of the materia medica, whether elicited through the patient can seem to alter between being symp-
proving, clinical observation or toxicology. The toms or constitution – as Gill’s case illustrates in
remedy also has a material and physical effect Case Study 12.1.
but by including the quality of the remedy as The more we understand the remedies as a story,
information it reflects the sense that the remedy and realise that the stories have parts which are
enables and facilitates a healing process rather shown and parts which are hidden, the more we
than itself being the healing process. Every rem- are able to perceive the completeness of the materia
edy expresses itself in mental, emotional and medica. This is one reason why remedies can have
physical features, and through changes of sen- opposite symptoms, e.g. the usually gentle Pulsatilla
sation, function and structure. It has intense can show intense sibling jealousy. Indeed, reme-
features, peculiar features and reliable keynote dies frequently have opposing symptoms within

154
 Totality and Constitutional Materia Medica

practice ‘the constitution’ reflects a susceptibil-

CASE STUDY 12.1
ity to certain causes and symptoms, and both the
Gill presented in her teens with hay fever. She
constituent characteristics and particular suscepti-
was highly sensitive, energetic, focused and
bilities are described together. So, for example, a
intuitive. She was tall and thin, bruised eas-
Phosphorous constitution includes a susceptibility
ily and had a reddish tinge to her hair; she
to bruise easily as well as a ‘phosphorescent’ per-
responded well to Phosphorous.
sonality that is sensitive to atmospheres. They may
In her late 20s she had several episodes of
be features that are within the normal range or
drug-induced psychosis and presented aged
become symptoms. Subjects who most often prove
28 as ‘burnt out’ and ‘scatter brained’, get-
a remedy, and patients who respond to the same
ting bruised from the slightest contact and
remedy, often share similar features – the most dis-
having become anorexic. She worked as a
tinctive of these features, if not symptoms, make
clairvoyant but complained of nightmares. Gill
up the constitutional picture. Identifying common
was helped greatly by Phosphorous but com-
characteristics of patients in this leads onto the
plained that she had become less clairvoyant.
‘typing’ of patients into different ‘constitutional’
Over time she ate better and put on weight,
categories. It introduces the idea that different
her hair colour changed and she became less
patients and remedies share certain features and
of a typical ‘phosphorous constitution’.
belong to constitutional groups that may share

Constitution
Totality and
common themes (see Chapters 21, 22).

Constitution Types
their picture at different times in the same patient
or in different patients. These markedly contra-
The four humours described by Galen are a
historic example of this. He described the
III
dictory characteristics of the same remedy are
nervous, bilious, sanguine and phlegmatic
sometimes described as the remedy’s ‘polarity’.
types – and each has some shared susceptibil-
As you develop a rounded picture of a remedy
ity. Unfortunately the potential richness for
state not only can the remedy appear to have its
medicine in developing these has been neglected
own ‘life cycle’ with different symptoms manifest
in many developed cultures in favour of the
at different times but also it can consist of axes
understanding of disease in terms of external
of symptoms, where the axes might run between
causation – particularly infection.
opposite symptoms.
Many of the remedies have a side that is best
Morphological Constitutions
known but sometimes the presence of symptoms
Some constitutions are described predominately
that would normally be hidden, which might
on body shape and are sometimes referred to as
include ‘strange, rare and peculiar’ symptoms, are
the ‘bio-typology’ or ‘morphological’ constitution.
a strong confirmation of a remedy.
These types in turn connect to the susceptibility of
patients or proneness to certain illness. The mor-
The Constitution phological constitution is most often described
‘The Constitutional Remedy is a picture of the sum total as the physical appearance (Box 12.1) but is also
of the strengths and weaknesses of the person mentally reflected in many structural components of the
emotionally and physically.’ organism. An important lesson for the homeopath
Margery Blackie is that it is valid to gather information on a physi-
cal constitution from the appearance of muscles,
The constitution is the sum of the constituent nails and hair or even at the organ, tissue and cel-
parts – while it is not the presenting symptoms lular level. Using morphological types is helpful to
or ‘clinical picture’ it does connect to this. In complement the totality – and is especially useful in

155
 CHAPTER TWELVE Dynamic Materia Medica

children and veterinary practice (see Chapter 18).

BOX 12.1
One of the implications of seeing morphology
Main Morphological Features of Physical
linked to the constitutional type is that it makes
Constitution (According to Vannier)
the constitutional type appear fixed. In my experi-
ence, constitutions do change but not in an unpre- Fluoric
dicted or disconnected way; rather they evolve Slack skin and ligaments with a gangly
and unfold. demeanour. They have joints at wide angles,
Historically, Eduard von Grauvogl described prominent dilated veins, poor dentition,
the three constitutions of endomorphic, mesomor- irregular dental lines and an asymmetric face.
phic and ectomorphic appearance (referred to as Their movements are jerky and they may
oxygenoid, hydronoid and carbo-nitrogenoid type have a lumpy muscular or skeletal structure.
functions), linked to ‘morbid constitutional type’ The hands and feet may look overdeveloped
(Clarke 1999), and later developed in relation to to their limbs and bodies and they may appear
the fluoric, carbonic and phosphoric groups of slightly asymmetric.
remedies (Vannier 1998).
Phosphoric
There is a correlation between different ele-
Often tall and thin, sometimes to the point
ments and their relationship to the different typol-
of waif-like type. They seem at times ethereal
ogy, e.g. the different effects of carbon, fluoride
Constitution
Totality and

and poorly grounded, moving in a ‘floaty’

and phosphorus on tissues correlate with the dif-
or drifting type of way. They typically bruise
ferent types and, in turn, to remedies containing
easily and are hypersensitive to their environ-
these elements (Vijnovsky 2000).
ment. Their limbs may look over-developed
III to their body.
REFLECTION POINT Carbonic
● Which of these best describe you? Can you think of Short, rounded and sometimes move as if
friends that fit the others? having to overcome a great deal of inertia.
● What illnesses do you suspect each type might be They may have narrow angle joints and be
particularly susceptible to? short and round. The skin can be engorged
with sclerotic veins and arteries. Their limbs
may look underdeveloped in relation to their
Matching an Individual’s Constitution body and head.
to a Remedy’s Constitutional Picture
An individual’s constitution includes morphological
appearance, colouring, complexion, and personal- A typical constitutional picture of the rem-
ity, as well as susceptibility to certain symptoms. edy Pulsatilla is described in the case of Jeni, in
Any classification of remedies on constitution aims practice it is combined and complemented with
to blend features and characteristics and to build a some symptoms – together revealing more than
picture that can be of practical use. If the picture is either alone. Although brief, it reflects susceptibility
complete, the homeopath may feel confident using of structure, function and sensation. The totality
it when the totality is unclear; if it is unclear, you and constitution often ‘fit together’ like hand and
may require confirmation from causation or aspects glove.
of the totality, including ‘strange, rare and peculiar’
(SRP) symptoms and keynotes. Learning a constitu- The Psychology of the Materia Medica
tional picture to the many homeopathic remedies is Working holistically we need to know and match
something that often comes with experience as few the psychological picture of the remedies as well
texts clearly describe these pictures. as their physical and general characteristics. The

156
 Totality and Constitutional Materia Medica

homeopaths sometimes identify slightly differ-

CASE STUDY 12.2
ent remedies as polychrests – the value of this
Jeni, age 6 years, has blonde hair and blue
label is chiefly to teach the student those rem-
eyes. She is jealous of her younger sister. Her
edies that are used frequently and about which
parents describe her as gentle, yielding, and
more should be known in the early stages of
wanting many hugs; she cries easily. Jeni feels
practice. They are well proven and well used,
better in open air and sleeps with the window
and because the features of those who respond
open. She ‘must have’ natural daylight and is
most strongly can be confidently observed they
prone to feeling flat on ‘grey days’. Her favou-
often have the clearest constitutional pictures
rite colour is purple, she is self-conscious
and will be the first remedies you are likely to
about what she wears and timid when she
get experience of. However, the practical useful-
goes out.
ness of polychrests does not absolve the devel-
Her digestion problems are aggravated by
oping homeopath from the need to build a wide
heat and fatty food and she is thirst-less when
repertoire of remedies that can be used holisti-
ill. Her indigestion symptoms move around the
cally on totality and constitution. Frequently a
body. She gets catarrh easily and after anti-
case can appear difficult just because it does not
biotics for an ear infection had thrush with a
fit a major polychrest!
thick bland discharge.
For polychrests in particular the remedy name

Constitution
Totality and
has become synonymous with a ‘constitutional
typology’ and a clear set of symptom keynotes. So
psychological profiles of different remedies reveal we speak about the Phosphorous type, Pulsatilla
subtle but important distinctions between other-
wise closely related remedies. The ability to dis-
type, Sulphur type etc. Homeopaths often learn
remedies by gradually building up the picture in
III
criminate between them in this way is likely to layers that frequently correspond to the different
develop in parallel with our psychological under- models of health and approaches to treatment. So,
standing of patients and ourselves. While this is for example, the causation and common present-
also true for our ability to discriminate between ing symptoms might be learnt first, followed by
other aspects of different remedies and patients, it keynotes, SRPs, totality and constitution. Only
is in the psychological sphere that the most sensi- after this are the patterns, themes and relational
tive and discerning comparisons are to be made – aspects of the remedy drawn out.
often with the greatest value in differential While this suits those who wish to build their
diagnosis. materia medica knowledge one piece at a time,
for others, immersing themselves in learning a
Polychrests remedy in all its aspects includes thinking of a
‘There are a few medicines the majority of whose symp- patient needing a remedy and how they might
toms are of the commonest and most frequent occurrence view themselves and others (including the homeo-
of human diseases, hence very often found in efficacious path) and how people (including the homeopath)
homeopathic employment, they are called polychrests’ might relate and feel towards them (see Chapters
S Hahnemann, Materia medica pura, 2nd edn 21, 22, 27). Developing an understanding of how
different remedies relate to others in a group or
Remedies where there are symptoms in many family has been a major step forward in broaden-
areas of the body and that have recognisable con- ing the range of remedies available to the homeo-
stitutional features are, not surprisingly, those path. When a remedy is learnt well it is possible
that are used in a wide spectrum of acute and to understand other remedies in part by how
chronic disease. They are frequently prescribed they relate and compare to them (see ‘Related
and are collectively called polychrests. Different Remedies’, Chapter 27, p. 374).

157
 CHAPTER TWELVE Dynamic Materia Medica

Caricature BOX 12.2

In some remedies there are just a few well known Examples of Connections and Symbolism
constitutional features and symptom keynotes, in Between Remedy Source and Patient
others there may be several particularly strong ●
A patient needing a bird remedy (e.g. a
features, where the unusual or strongest features remedy made from dove feathers) may
are emphasised. The main features might be con- dream of birds or flying, or feel ‘discon-
sidered as drawing something of a cartoon or cari- nected to the earth’ or even have a fear of
cature of the remedy, At times there can be huge birds
amounts of information about the patient and ●
A patient who may respond to a particu-
remedy that can be overwhelming and obscure lar plant remedy may like that plant, or
the simillimum, at other times there may be mini- like the flowers from the plants within the
mal information. In both situations it can help same botanical family
to match the patient to a caricature of a remedy. ●
A Pulsatilla patient might be attracted to
Sometimes it is easier initially to learn a caricature light purple, the colour of the Pulsatilla
or outline of a remedy, and look up or gradually flower, or a Sepia patient may dress in
add other information from the materia medica. deep purple, similar to the colour of sepia
ink.
Remedies and Their Source
Constitution
Totality and

The caricature often links in some way to the origin,

source, mythology or practical use of a remedy. The of this is that when a constitutional remedy is not
link between the non-material qualities of remedies clearly indicated or fails to act fully, this kind of
III on the material world invites reflection on possible
mechanisms of action of subtle remedies, perhaps
shared attribute may point to a related remedy
(see Chapters 22, 27).
similar to the relationship seen between Jungian There is no doubt that getting to know one
archetypes and symbols (see Chapters 21, 27). remedy well, and then exploring its relationship
As homeopaths working holistically we recog- to other remedies, is a useful way of building a
nise a world full of connections where each materia medica picture. One of the first times this
part is informed and understood by exploring was done was by Douglas Borland (1938) who
its connections within the whole. Homeopathic established groups of remedies in children linked
remedy pictures can provide a way that allows together into five groups, using a pragmatic and
apparently diverse aspects of a case to cluster, eclectic method mixing psychological themes
essentially allowing order and meaning to radiate (depression and ‘nervy’), sphere of action (skin
through a case. It is perhaps understandable that a affinity) and related remedies (Calcaria-like).
remedy picture may include connections with the
source of the remedy. Box 12.2 lists some more
obvious examples. REFLECTION POINT
● The snake is symbolically used to express many different
Related Remedies characteristics, including in relation to healing. Having
Sometimes the concept of a particular constitu- read the materia medica of one or two remedies made
tional attribute, e.g. ‘a sensitive constitution’, is from snake venom, reflect on the positive and negative
used to describe a collection of remedy types that qualities you see in yourself that relate to ‘the snake’.
share that attribute. Or it may be used to describe How do the positive and negative qualities mirror each
remedies that share some common characteristic other? How can qualities in remedies be recognised in
of the source material, e.g. ‘a plant constitution’ people that they are not the simillimum of?
or a ‘phosphoric’ type. The practical importance

158
 Deepening the Materia Medica

ferent quadrants describe each learning style – see

Deepening the Materia Medica Box 12.3 – although we each have qualities from
‘We remember 20% of what we read, 30% of what we several quadrants, most have a preference. There
hear, 40% of what we see, 50% of what we say and is, of course, no right (or best) one but each helps
60% of what we do, and 90% of what we see, hear, say understand the remedies or aspects of remedies in
and do.’ slightly different ways.
C Rose (1985)
BOX 12.3
Knowing and understanding the homeopathic
remedies provides different challenges depending Activists
on the model of health through which a patient Activists like to be involved, are open-minded
is perceived. Different homeopaths make differ- and enthusiastic about new ideas, but get
ent remedies a priority and prefer different ways bored easily. They tend to act first and reflect
of learning about them. The homeopath learning afterwards, enjoy groups and like to be
materia medica by memorising keynotes is likely noticed. They learn best when involved and
to work using keynotes; the homeopath learning like problem-solving. They learn less well
remedies by understanding themes and essences is when listening passively or when reading,
more likely to include themes and essences in pre- writing or thinking on their own.

Constitution
Totality and
scribing strategies. Some of the theory and practice Reflectors
about developing a learning style provides devel- Reflectors like to stand back and think care-
opment opportunities, allowing you to understand fully before reaching conclusions. They
how you can see cases from different angles, and
facilitate the learning of materia medica.
observe and listen to others, learning best
when they can review what has happened
III
Figure 12.1 illustrates one model of learning and think about what they have learned in a
styles based on work by Peter Honey and Alan relaxed way. They learn less well when having
Mumford (1992) but informed by the work of to lead or role-play with no time to prepare.
David Kolb and using the ideas of four polar
states in the nature of man (see Chapter 14). Theorists
These in turn are informed by four key psycho- Theorists adapt observations into logical
logical functions described by C G Jung. The dif- theories and approach problems step-by-step.
They can be detached and perfectionist. They
learn well when in complex situations, using
their skills and knowledge in structured ways
Activist Reflector
with a clear purpose. They do not like having
to participate in emotional and feeling situ-
ations, especially if they are not sure of the
basic principles.
Pragmatists
Pragmatists like to try things out. They are
practical and ‘down to earth’. They learn
best when they see the application or see it in
Pragmatist Theorist
practice. They like to try it out and appreci-
ate feedback. They don’t like it if there is no
obvious or immediate benefit or if there are
no practical guidelines.
Figure 12.1 Learning styles (after Honey & Mumford 1992)

159
 CHAPTER TWELVE Dynamic Materia Medica

The challenge for each student is how to make

BOX 12.4
best use of their strengths while avoiding having
Examples of Learning Activities
‘blind spots’ to remedies or aspects of remedies.
●
Reading materia medica
Although learning can be separated out into
●
Putting what you have read into a mind
stages, in practice all these activities are happen-
map, a poem or a cartoon
ing simultaneously and different subjects might
●
Writing index cards for each remedy
be learnt in different ways. Given the volume of
●
Studying the repertory
new materia medica learning that most homeo-
●
Reading case studies
paths undertake, and the different qualities and
●
Lectures
information about each remedy it is helpful to
●
Observing others in practice
reflect on and see if you can develop your style
●
Brain-storming
of learning.
●
Questions and answers
Homeopaths will not only be more likely to
●
Role-play
use accurately the remedies they know but also
●
Being tested
will use the approaches to treatment that reflect
●
Supervised practice
the qualities of their learning style. For exam-
●
Discussing what you have read with some-
ple, those who prefer a more practical learning
one else
style may prefer learning causes and present-
Constitution
Totality and

●
Listening to a tape of someone’s experi-
ing symptoms that are observed or taught in a
ence
practical setting. They may then favour work-
●
Attending a lecture, small group work,
ing with the pathological and biological models
working in pairs, working alone
III of health. What works best for each individual
will be influenced by what they are learning,
●
Taking notes, making mind maps, using
mnemonics
their preferred approach to studying materia
●
Taking cases and supervised clinical expe-
medica and the likely setting they will work
rience
in. It is only by consciously developing outside
your natural strengths that you will grasp the
full breadth of the diverse materia medica and
the full range of different models of health in The Learning Cycle
which homeopathic principles may be applied. Learning in depth often follows a cycle and pro-
Sometimes the student homeopath may feel gresses through different stages. If you look again
there is a daunting amount of information to learn. at Figure 12.1 the arrows illustrate how the learn-
There are, however, many different situations and ing cycle frequently flows, with different ‘learners’
activities in which you can learn, some of which often starting with the style they are most familiar
are given in Box 12.4. Individuals with different with. If you start naturally with an enthusiastic and
learning styles will favour some and struggle with active enquiry into a subject it leads on to reflect-
other learning activities. ing about and even imagining things about what you
have learnt. This can then lead to a more structured
Learning evaluation or theoretical analysis of situations in
Different learning activities can be understood which you might use a remedy, and what you prag-
as favouring different types of ‘intelligence’ matically will need to know to prescribe it. Practice
or different aspects of the personality. They in turn will increase your enthusiasm to understand
include linguistic, logical, visual, musical, physi- what you are doing in more depth.
cal, social or emotional intelligences – each of Some remedies are perhaps easier to start learn-
which might give a different perspective to a ing with particular styles. For example, remedies
remedy picture. where structure and order are required, such as

160
 Summary

many mineral remedies, may benefit from a very spots for some aspects of remedies, and some rem-
structured approach (see ‘Use of the periodic edies you will find hard to ‘see’ at all.
table’, Chapter 22). Some homeopaths attribute A purely theoretical knowledge of the materia
the qualities of structure, relationship and sensa- medica is always going to be limited. As the rem-
tion to remedies of mineral, animal and plant ori- edies are used and understood they become like
gin respectively. A more sensitive, artistic teacher members of a family with an emotional and situ-
may best colour in the different shades that exist ational picture. The interaction of the patient with
between closely related plant remedies, and a rela- their surroundings is central to understanding
tionship-focused author might breathe life into the importance of themes that run through both
animal remedies. patients and remedies (see ‘Thematic approaches
One way of reframing the learning of the mate- to materia medica’, Chapter 27). The way cer-
ria medica is to change it from being a necessary tain remedy patterns, and their manifestation in
task to being an opportunity for growth. There certain patients, impact upon the psyche of the
are a huge number of different remedy pictures homeopath is a major influence on how a homeo-
available for the homeopath to study, each offer- path experiences their patients and perceives the
ing insight into oneself and one’s world, and remedies. It is at the heart of the relational model
each bringing with it an opportunity not only of health (see ‘The relational approach’, Chapter
to develop a remedy picture but also to develop 26 and ‘Relational approaches to living materia

Constitution
Totality and
insight into how different patients see and experi- medica’, Chapter 27).
ence their world.
Some students will have gushing and enthusi-
astic styles and need encouragement to explore
the more reflective, logical and practical areas of
REFLECTION POINT
● Looking at Figure 12.1 and Box 12.3, and Box 12.4
III
the remedies, patients and their own case. The reflect on your preferred learning style and activities.
imaginative style may suffer from seeing too many What strengths and weaknesses do these present to
possible ways of proceeding and be reluctant to your learning of materia medica and how might it also
pay attention to the practical aspects of case man- influence your case-taking? Think about how in a group
agement. The very practical student may be over of students each might prefer a subject to be taught in
influenced by their last similar case or the latest a different way. What is your preference and how do
study. The logical student may reflect on things so you respond if the teacher tends to teach in a different
much that they analyse things to paralysis, wanting style? Would one or several styles be best in developing
certainty before moving forward. Understanding an all-round and, one might say, ‘holistic’ view of a
your style and how it shapes your approach to remedy being studied?
both the materia medica and cases is an important
part of training.

Making the Materia Medica Your Own Summary

As you get to know the remedies better they move This chapter develops the understanding of
from a simple description of a static state and homeopathic remedies in terms of totality and
become a narrative with a beginning, a middle and constitution. It allows for an approach to the treat-
end. They represent a process that unfolds over ment of an individual based on susceptibility and
time, depending on the environment and stimuli symptoms and sets us up to explore suppressed
that the remedy, as expressed in the patient, is cases in subsequent chapters.
exposed to. The remedies start to take on a life of The information expressed about major rem-
their own and become characters. If your learning edies not only enables a prescription on the
style is too restricted you are likely to have blind simillimum but also helps the homeopath in

161
 CHAPTER TWELVE Dynamic Materia Medica

conceptualising, pursuing and ordering a ‘whole Clarke J H 1927 Constitutional medicine. Homoeo-
person’ narrative. Studying remedies as living and pathic Publishing Company, London. Indian edition
dynamic expressions of human experience not 1999. Jain Publishing Co, New Delhi
only broadens the tools at the homeopath’s dis- Honey P, Mumford A 1992 The manual of learning
posal but also fundamentally extends and deepens styles. Honey Publications, Maidenhead
your perception and comprehension of patients. Rose C 1985 Accelerated learning. Accelerated Learning
Finally, we discussed how your understand- Systems, Aylesbury
ing of remedies and approach to learning them is
Vannier L trans Clement M 1998 Homeopathy human
affected by your own personal style. To broaden medicine. Homeopathic Publishing Company, London
your understanding of remedies you will need to
reflect on your personal learning style and develop Vijnovsky R 2000 Tratado de Homeopatia. Editorial
Paidotribo, Barcelona
those qualities you may currently find hardest.
If you do not do this then you are likely to find
‘blind spots’ that will continue to make some cases
more difficult than they need to be.
Bibliography
Broadening the understanding of materia med- Campbell A 1981 Concepts of constitution in home-
ica to different remedies in different situations opathy. Br Homeopath J 70(4):183–188
leads naturally on to receiving a different case
Constitution

Foubister D 1969 Constitutional types. Br Homeopath

Totality and

from the one that is required for local prescrib- J 58(2):77–81

ing. It also leads into discussions of more complex Gutman W 1978 Homeopathy: the fundamentals of its
case analyses and management. These are devel- philosophy, the essence of its remedies. Homoeopathic
III oped in subsequent chapters in this section. The
self-reflection and deepening of the understand-
Medical Publishers, Bombay
Kolb D 1983 Experience as the source of learning and
ing of materia medica to look at what might be development, experimental learning. Prentice Hall,
called ‘living’ or ‘emotional’ materia medica lays New Jersey
the foundations for working in the holographic
Leary B 1983 Constitutions again. Br Homeopath
and relational models of health.
J 72(4):214–216
Rose C, Goll L 1992 Accelerate your learning.
References Accelerated Learning Systems, Aylesbury
Borland D M 1938 Children’s types no. 1. Homoeopathy Twentyman R 1989 Science and the art of healing.
May 7(5):143–150 Floris Books, Edinburgh
Borland D M 1938 Children’s types no. 2. Homoeopathy
Jun 7(6):173–181

162
CHAPTER THIRTEEN

Receiving the Case The Case

David Owen

too ‘passive’ a description, as there is certain infor-

Introduction mation that is needed and much that builds natu-
When in consultation with a patient the universe rally on aspects of ‘case-taking’ covered previously.
shrinks and your senses extend to encompass the Combining these styles presents challenges to the
patient in a dynamic interaction, allowing you to homeopath. How do you draw on both the more
perceive the patient at a deeper level. Your world structured and directive style previously covered
becomes your consulting room and when you truly and the more facilitative and contemplative style
see the case in its entirety the past stands still and suited to allowing the totality and constitution to
the room disappears as you dance the homeopathic emerge? In practice aspects of the case lend them-
dance. selves to each and you guide the patient both by
In this chapter we look at how we perceive the explicit agenda you (and they) hold and also
the totality and the constitution to build a com- by the excitement and passivity that you (and
prehensive picture of the whole person. The they) use to direct the consultation.
holistic model recognises that what is happening The first part of this chapter reflects the pas-
inside the patient is reflected in what is happen- sive style of receiving the case while the second
ing outside and vice versa. This chapter explores part tackles some of the difficulties and compro-
how patients, including their unconscious, can be mises the homeopath will face in developing a
observed through their connection to their envi- personal style. Some of the techniques that allow
ronment and in their relationships with others, the homeopath to see aspects of a case that might
including to the homeopath (see Chapter 23). The otherwise be unseen are discussed in the knowl-
case may develop, like treatment, over a number edge that, as other models of health are explored
of consultations and can be thought of as a grad- and the homeopath’s understanding of the mate-
ual but continuous process rather than a series of ria medica deepens and broadens, each is likely to
distinct and separate stages. How the case unfolds develop a more individual approach to consulting
is intimately connected to the explicit and implicit that will shift between different styles and models
agreement between the homeopath and patient as circumstances require.
(see Chapter 25). This agreement clarifies what
information is important for the patient and helps
make the consultation a safe place for the patient’s
story to be told.
The Art of Receiving the Case
The title of this chapter, ‘Receiving the case’, Taking the case is about taking what the patient
is intentionally distinguished from the title of consciously offers or the homeopath deliberately
Chapter 8, ‘Taking the case’. It may at first appear elicits of the case history. Receiving the case is

163
 CHAPTER THIRTEEN Receiving the Case

about being receptive to all aspects of the case, of the case that is ‘stuck’. Noticing the change in
including many that the patient may disregard or pace may be enough to focus your attention on
be unconscious of. an important point. You can influence the case
Receiving the case is a natural step on from in many ways and we will look at some of these
taking the case. Both can happen synchronously later in the chapter. For example, with an anxious
but to receive the case it is necessary to be attuned patient who is rushing their history, you may well
to what you might receive – for this reason expe- invite them to slow down by asking them to slow
rience is important. To gain this experience a their breathing or doing a simple relaxation exer-
homeopath can allow distinct phases in the con- cise with them before continuing with the case.
sultation to ‘hear what is there but might not be Indeed, just by slowing your own breathing you
being said’. Sometimes this is at times of silence, may slow the patient down, or synchronising your
at others by returning to important but incom- breathing with theirs you can increase rapport.
plete areas of the case-taking and observing dif-
ferent details of the consultation, such as the exact Presence
words being used, how the patient sits and moves ‘The patient complains of the process of his ailments.
and how you respond to what is being said. The patient’s relations tell us what he has complained
It is often the deepest symptoms that are hard- of, his behaviour and what they have perceived about
est to see; they may be the ones the patient has him. The physician sees, hears and notices through the
Constitution
Totality and

become most used to, are most structural or have remaining senses what is altered or unusual about the
been suppressed or palliated. Some symptoms patient.’
will only reveal themselves in later consultations S Hahnemann, Para 84,

III after rapport has been deepened and the context

of the case and patient’s life situation understood.
Organon of the Medical Art, 6th edn

For the homeopath to be able to make as much of By being in the ‘here and now’ the homeopath
the case conscious as possible, perception of the opens up their senses to ‘hearing’ the case and
constitution and totality requires all of our senses experiencing the case, not just with the ears but
and depends upon you seeing the potential rel- with all the senses. This attitude in itself models
evance of everything that takes place during the for the patient and invites the patient to adopt a
consultation. more present and open attitude. In practice there
If the patient is not in a balanced state then are aspects of the history and times in the consul-
‘holistically’ every aspect of the patient will express tation when it is easier for patients to show more
this in one way or another; when the remedy state of themselves and for the homeopath to be more
is suppressed key features may be more difficult to fully present. Being present is not about over-
observe but they will express themselves at some whelming the patient but being attuned to and
level – although this may be unconscious to the noticing what the patient is presenting, making
patient or indeed unconscious to the physician. ‘present’ the patient physically, intellectually and
Remember – everything that happens is relevant! emotionally (Box 13.1).
As a general rule allowing the patient to nar-
rate their story with as little interruption as possi- Observation
ble allows what is important to surface. However, When symptoms are not easily expressed, e.g. in
there are ways of supporting the patient, particu- children, animals and those who have difficulty
larly inviting them to explore areas that might be expressing themselves, then it is even more impor-
painful. tant to use every faculty of observation. Physically
The pace of the consultation can ‘speed up’ a symptom may be expressed through the individ-
and seem to skip over difficulties. At other times ual’s posture and movement, and this may affect
it can slow down and seem to stop at an aspect your own. For example, when a Kali bichromicum

164
 The Art of Receiving the Case

especially ones that are otherwise ‘out of place’,

BOX 13.1 words that are used on a continuum from one pole
Reflection Exercises to another on a particular axis, (such as words on a
Reflect on the different roles the homeopath spectrum between success and failure may indicate
might be asked to play – this may include doc- issues about self-esteem) and the use of words that
tor, healer, facilitator, friend and witness, or can have more than one meaning all indicate that
even confessor. What other roles might there something important is surfacing.
be? List them and think about what appeals With this in mind we will return to consider
to you or perhaps challenges or disturbs you aspects of the case that were not covered in Chapter
about each role. Which are your strengths 8. Although the styles of taking and receiving the
and what are the potential pitfalls that you case may appear opposite or exclusive, in prac-
might face in each role? tice both are needed and run in parallel. There is
Focus on the first few minutes of a recent the need to gain focused and specific information,
consultation or social encounter. List every- through a sort of magnifying lens, and to receive
thing you can remember about it. Now close the broadest and subtlest of information, through
your eyes and imagine describing the encoun- a sort of wide-angle lens. It is as if the homeopath
ter to someone who has never met the per- needs the eyes both of the hawk (depth) and of the
son before – how exactly they were dressed, hare (breadth). I describe the two as discrete but

Constitution
Totality and
their complexion, their breathing, the colours they are just separate styles and skills that, as you
of their clothes, their hair, shoes, make-up or become more experienced, you move between
jewellery. Can you use other senses – was there and hold together to perceive most clearly each
a smell, what was touching them like, what
exactly did you hear? How did they meet you,
case. It is frequently in the realm of the patient’s
life situation, the mental and social aspects away
III
where and how did they stand or sit, how did from the minutiae of the presenting symptom that
they move and how did they speak? Try sitting the broader issues reveal how the many aspects of
or standing like them. Who do they remind the case tie in.
you of, and what do you have in common and
what is different from that person? General Symptoms
Now look again at the list from the first General symptoms relate to the patient’s reac-
part, how accurately does it describe them tion to their situation, particularly those physi-
compared with the second part? cal environments in which the patient generally
feels better or worse (temperature, rain etc.), food
preferences (indicated by a +) and aversions (indi-
patient presents with their rigid posture I naturally cated by a −), and appearance or body shape. Also
find that I am sitting up a bit straighter (indeed this sometimes included as ‘generals’ are other features
is quite frequent with many of the Kali salts). Their that indicate how the patient might interact with
mental state may be expressed through their rela- their situation or environment, including how
tionships to others; e.g. the relationship between they choose to modify or influence this. Some of
child and parents, or pet and owner. General these factors may be psychological or behavioural,
symptoms can be observed by seeing how the indi- e.g. how they dress, their mannerisms, gestures
vidual interacts with the physical environment. For and behaviour during the consultation, areas of
example, their clothing, where they sit, etc. might the body touched as they speak, where they look,
indicate symptoms related to temperature. The the tone of voice and sounds they make, their
precise words a patient uses are important not just handshake and where they live.
for what they communicate directly but also what General symptoms also include aspects of body
else is communicated. The repeated use of a word, function such as perspiration (where, when and

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 CHAPTER THIRTEEN Receiving the Case

odour), menstruation and sleep. Finally under is useful to have some questions that you can ask
‘generals’ the subjective sense of energy that the to broaden this out if the patient needs encourage-
patient has may be noted. The patient might ment to talk about themselves. Some that I find
be asked to score their general energy out of helpful are ‘how do friends (or family) describe
ten. This frequently seems to equate to how the you?’, ‘what are your goals and aims in life?’,
homeopath would ‘score’ the patient’s vitality. ‘how does your illness affect you?’, ‘what are the
It is both an indication of cases that may need best (or worst) things that have happened to you?’
support for their vitality before a clear case can be and ‘how would you like to be different and what
expressed and a change in it may indicate the first might you do if you were well?’.
signs of a remedy acting. Like other symptoms, the strength and unique-
General features are often a good indicator of ness of mind symptoms are important in decid-
the habitual constitutional state of the patient as ing how central to the case they are. Remember
well as contributing to the totality of symptoms that some symptoms can appear disguised when
when they are ill. Significant change in them, for they are understated or whispered – modesty or a
example a cold person becoming hot, can be a sense of what is permissible may shape what the
strong indication that the remedy state is changing, patient says. Paradoxically the partially expressed
either in the course of the illness or in response to symptoms or ‘what is not said’ can reflect more
treatment. Matching strong general symptoms in important aspects of the case. It can be particu-
Constitution
Totality and

the case and in the remedy picture provides reli- larly helpful to note phrases that are mentioned
able confirmatory symptoms. Like modalities it out of place or those attributed to other people,
can help to invite a patient to indicate where on such as ‘John always says…’. As you might expect
III the axis between two extremes their symptoms
lie, e.g. where do they lie in body temperature
from what you have read so far patients may well
spontaneously deny things that are in fact central
between very hot or very cold? to their case – ‘I’m not at all afraid’ or ‘I’ve no rea-
son to dislike…’ may mean the exact opposite. To
Mental Symptoms explore this you can sometimes invite the patient
Every patient has an effect on you – you might as to imagine what it would be like ‘if you were
well use the feeling you get as a clue. afraid’ or ‘if you did have a reason to dislike’.
These include a patient’s psychological symp- In cases with much suppression of physical
toms and also pre-morbid features reflecting their symptoms, the mental symptoms may be less dis-
psychological ‘constitution’ or predisposition, such guised and give a clearer pointer to a patient’s
as how they view themselves, and their fears, case, hence their importance. In psychological
hopes, delusions and dreams. How a patient walks illness, however, when psychotropic drugs, anti-
in, how at ease they are, their expression and how anxiety drugs, antidepressants, recreational drugs,
they respond to you will give you much informa- etc. suppress or distort mental symptoms, the
tion not only about their mind symptoms but about physicals and generals are more reliable.
how to take and receive the case. In babies much
information may have to come from the parents Emotions
and understanding the different expressions the Frequently, strong feelings in the patient, e.g.
baby has (perhaps asking the parent to mimic it or sadness, anger or anxiety, are important parts
describe when it happens). As mental symptoms of the case. Subtle modalities to these feelings
emerge they inform the whole case-taking and may be noticed or teased out when patients talk
receiving, they always run in parallel to the rest about the different circumstances in which they
of the case – although you might choose a time to arise. Patients can be invited and encouraged to
focus on the psychological picture and to ‘check’ re-experience and ‘sit with’ these feelings in the
you are noticing the mental state of the patient. It consultation. Often a strong feeling can be triggered

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 The Art of Receiving the Case

when talking about the past (key life events), social terms of their anxieties, fears, hopes, dreams and
situations (relationships to others) or family his- delusions; how they enact this in their behaviour,
tory (childhood, parents, etc), and if this happens beliefs and symptoms.
before a patient really feels ready to talk about Fears are often reflected in what the patient
them, or you feel ready to receive them a deci- imagines might happen, as if by trying to avoid
sion has to be made whether to explore them at something they are almost drawn to it – the deeper
this stage in the history or to return to them later. the fear the stronger the denial. It is reflected in
With experience it is possible to move backwards the consultation by what the patient fears might
and forwards between taking the case and receiv- happen but feels unsafe to name. It is often these
ing the case, between creating the structure for the issues that surface when specifically exploring the
case and allowing the case to just flow. Sufficient therapeutic agreement (see Chapter 25).
trust and rapport will need to be established to Delusions, on the other hand, often represent
allow patients to sit with these feelings in the con- what the patient secretly desires including how they
sultation, which is perhaps why some homeopaths see themselves and others and how they would like
only feel the consultation is ‘really starting’ when others to see them. In the consultation it is reflected
some emotion – whether laughter, tears or anger – in what the patient wants it to be like but is unable
has surfaced. to name in the therapeutic agreement, i.e. what
Some patients prepare themselves before the they want to happen but can not contract for (see

Constitution
Totality and
consultation to only show what emotions they Chapter 25).
think it is permissible to show. In understand- A patient’s fears and delusions mirror each other
ing the complex case it is particularly useful if the and although some patients more easily show one
patient experiences the feeling in the consultation,
rather than dispassionately describing a feeling that
or another, in a well received case aspects of both
will be seen. The more fundamental the state that
III
is experienced elsewhere. In this way the homeo- is revealed the more directly these two aspects can
path creates something of the different situations be seen as balancing or compensating each other.
the patient has been in or is avoiding and invites For example a patient may have a fear of falling
the patient, in the consultation, to journey into this (from an elevated position) balanced by a delusion
and explore how this feels. Importantly, the patient that they are unworthy (need to be kept down),
is both made to feel safe to do this and is witnessed or a fear of animals with a desire to (or delusions
in this. So you might ask a patient to imagine what they should) let out their animal desires. Allowing
a situation feels like, what they would like to say these fears and delusions to be seen clearly is vital
to someone or how they might react if something to working with the deeper aspects of patients.
happened. It is surprising how often some initially Not expressing them leads the patient to further
unspoken thought or feeling reveals itself in this re-enactment of their deepest pathology; not per-
way and how often this gives clues to the deeper ceiving them yourself leaves you vulnerable to the
aspects of a case. In many initially confused cases patient’s projections (see Chapters 23, 25).
clarity appears when this is revealed. Even when
there are strong common feelings such as anger or Sleep and Dreams
sadness there are invariably deeper feelings that Sleep plays a vital role in the maintenance of a
relate to situations the patient is seeking to avoid balanced state; the body is able to ‘catch up’ and
(fears and anxieties) or is in some way seeking out repair and the ‘batteries are re-charged’. If sleep
(delusions, fancies and sometimes dreams). is disturbed then the pattern of disturbance
gives a useful pointer to remedies; sleep position
Fears and Delusions gives helpful totality and constitutional informa-
Really hearing means understanding a patient’s tion. Often the general well-being and energy a
construct of their world, what their reality is in patient feels is closely connected to sleep quality.

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 CHAPTER THIRTEEN Receiving the Case

Frequently an improvement of the sleep pattern Some dreams are recurrent and more memo-
is an early sign of a significant healing reaction. rable, sometimes revealing not only information
Sometimes patients experience excessive but that may be repertorised and matched to a remedy
pleasant and natural sleepiness in response to a but that expresses important and central aspects
remedy that can be clearly distinguished from an of the case that, when named, can permit access
unhealthy sleep. to the case at a more psychologically perceptive
Many patients may not remember or are ini- layer, as Sandra’s case illustrates.
tially reluctant to share their dreams. Some sup-
pressive treatments, especially those, like sleeping
tablets, that are used to promote sleep, often CASE STUDY 13.1
block dreams. Getting a patient to remember and Sandra, age 33, years presented with asthma.
talk about dreams can take some encouragement She had recurrent dreams of being pursued.
and it needs to be made safe for the patient to Inviting her to talk about what she thought
reveal these ‘gems of the case’. After explaining was pursuing her enabled her to talk about
that dreams are important a rich ‘dream world’ a previous unmentioned abusive relation and
sometimes emerges. Some patients benefit from was part of the indication for Medorrhinum
being asked to note their dreams before com- that helped her allergic symptoms and also
ing and it can help to even encourage or invite made her feel ‘better than ever’.
Constitution
Totality and

patients to dream and to record them. For some

patients who are alien to the homeopathic pro-
cess it feels strange to be asked this in a question-
III naire or before they meet you and understand
the process. A sign of a practised homeopathic
Social History
Occupation, partner, car and home, like all
patient is often how they volunteer information, things, are important parts either of totality or
including dreams. In these ‘expert patients’ it is constitution.
often possible to receive a wealth of informa- The social history is often the area where
tion, including dreams, fears, delusions, generals patients will describe their significant relationships
and mentals in addition to the local symptoms. to others – including to their parents, partners,
Indeed, careful time management can be required, children, community and culture – and signifi-
especially if time is constrained, in order to cover cant life events such as redundancy, separation
all aspects of the case. and bereavement. These relationships are impor-
Through dreams the patient may ‘discharge’ tant in their own right and because they provide
or compensate for unwanted thoughts (excreting a vital awareness of the family, social, community
unresolved emotions) and explore unfulfilled ones. and cultural influences. This in turn describes the
Dreams may simply reflect transient disturbances context of a patient’s life, including what is per-
of the day’s events, or more deep-seated psycho- missible, normal, encouraged or defended against.
logical states that are important to the case. They This is essential as we seek to understand aspects
may reflect fears or delusions that the patient has. of the case that are otherwise hidden or masked.
Dreams are particularly important to the homeo- It can be difficult to move directly from fea-
path when experienced the night before the consul- tures in the social history to the materia medica,
tation as they may reflect the patient’s unconscious although the constitutional picture of many rem-
desire to reveal information they want to contract edies includes how they interact with others and
to work with but are uncertain about. Dreams after how they behave in social situations. It is often
taking a remedy often indicate a shift of symptoms; while exploring the social history that a patient
dreams on an anniversary of an important event are begins to grasp the implications of the illness
one way of revisiting unresolved issues. within the wider context of their life, and to

168
 Styles of Consultation

understand the potential for change that being Moving Deeper Towards Confused
well might bring. and Hidden Cases
The symptom picture may be confused when there
Family History is lack of clarity, order or hierarchy of symptoms.
Often a detailed family history can be prepared Many factors that can cause this, most notably
by the patient before the consultation; it should suppression, have already been discussed.
include not only parents and grandparents but also Patients with chronic disease may also be tak-
any children and grandchildren as susceptibility is ing conventional drug treatments that alter the
indicated by both. Siblings and their children also way symptoms are expressed. When starting as a
add information. In addition to knowing the major homeopath, if it is possible to treat cases that have
diseases that run through the family it is helpful not had ‘much dosing’ then these cases are often
to know whom the patient ‘takes after’ either in easier to interpret and prescribe for. As symptoms
appearance or temperament. This is particularly become less characteristic because of the suppres-
important in children and babies; the younger they sive effects of conventional treatment so the case
are the more important it is likely to be. There is is harder to see and therefore to treat. A chronic
often a stronger maternal influence in very young case with no suppression, e.g. eczema with cer-
babies and the paternal influence often increases tain time aggravations and contact aggravations,
between ages 4 and 10 years. Asking about the is much easier to cure than one that has been

Constitution
Totality and
family (or social situation) is often one of the intro- suppressed and the modalities lost.
ductions needed for patients to describe their major Two other major reasons why symptoms may
life events and psychological state. Often suscep- not transparently reflect the totality also need to
tibility is shaped by the family history; sometimes
this provides much of the information we have to
be considered – hereditary and cultural factors.
These and how they bias the clear expression of
III
prescribe on, as Frank’s case illustrates. While each the case are explored further in Chapter 26 and
family member is a separate case there are many Section VI.
occasions when improvement and deterioration of
family members seem to follow one another.
REFLECTION POINT
CASE STUDY 13.2 ● How can you know that what you see is all that can be
Frank, age 38 years, was the oldest of four seen? If the case is not static, and until the patient is
children. He went to boarding school age 8 cured new information is always surfacing, how often
and suffered from ‘no illnesses whatsoever’. should the case be retaken?
He had two children, one of whom was hav-
ing treatment for malaise following glandular
fever. Frank developed angina at age 36, for
which he gave very little symptoms of note. Styles of Consultation
Conventional medication helped at first but he ‘ . . . the heart of all healthcare is a therapeutic meeting
was gradually becoming increasingly lethargic. between bodies’
There was a strong family history of cancer Kellas 2006
and diabetes. He was prescribed Carcinosin,
which helped his lethargy, and at follow-up he
In most complex cases the complete case requires
gave a much fuller case and was able to talk
elements of both taking and receiving the case.
with feeling about his childhood and relation-
While taking the case lends itself to a fairly uni-
ship with his parents for ‘the first time’. As
form style of consulting, the style of receiving
Frank felt better, so his son’s health improved!
the case is more likely to reflect the homeopath’s

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 CHAPTER THIRTEEN Receiving the Case

individual approach. In addition to developing own agenda to follow and how you are likely to
your own preferred style of consultation, you respond to what they want to say.
are likely to want to develop a range of styles to Through experience and training you should
suit different approaches to treatment and dif- be intimately aware of what pushes your buttons,
ferent methodologies of prescribing. Your style how you respond at different times of the day, on
will change with different patients as the consul- different days of the week, and to different peo-
tations unfold. The style of consultation that will ple, including people of different social, age and
allow a Nux Vomica patient to reveal most will ethnic groups.
be very different from the style of consultation
that will allow a Pulsatilla patient to be similarly Time
revealing. Just as we have certain preferences of A totality approach to a complex case is likely to
learning style, and prefer teachers with a com- require a great deal of information. Many patients
patible style, so different consulting styles may and homeopaths are anxious about having too
suit different patients. Both knowing your own little or too much time. Once the homeopath has
‘default’ style and being able to adopt other styles decided on the practicality of appointment times
when needed will broaden the range of patients then it is possible to contract clearly around the
with complex cases from whom you can receive a time available for the consultation. If the patient
‘three-dimensional’ case. There is no one ‘right’ has particular needs for more time this can be dis-
Constitution
Totality and

style; rather, different factors will determine the cussed and perhaps accommodated either through
best approach in each case. If you are fixed to a longer appointment or returning sooner.
one style then some remedy types will be more If patients have particular needs to cover
III difficult to observe.
The most useful ways of developing consulta-
complicated or detailed aspects of the case then
asking them to do some ‘homework’ on it can
tion skills and styles are experience and reflection. help. As deeper issues emerge it can be a power-
One of the best ways of learning is by watching ful reflective exercise for patients to write down
yourself and others in practice; both by sitting in their feelings and document their experiences.
and by watching videos of others and yourself. It is also a way to sensitise patients to noticing
or remembering information they might not oth-
Starting erwise recall. For example, they may be able to
Most individuals make a rapid and often accurate note dietary preferences between visits, or to note
assessment of each other within seconds of meeting. dreams first thing in the morning, or to record
By the time the patient is sitting opposite reactions to treatment when they happen.
you, you may have noted how they booked their
appointment, met them in the waiting room, seen Eye Contact
a referral letter or received information from a Some patients are self-conscious of eye con-
questionnaire. You may already know them or the tact. Some find it easier to express themselves
family; you might recognise their address or know more freely when there is a level of disassocia-
something about where they live, their occupa- tion from the homeopath (like psychotherapy
tion, age, and gender. patients talking on the couch with the therapist
The unspoken agenda of a consultation is often behind or beside them). If patient or homeopath
formed very quickly when the homeopath first is uncomfortable with eye contact it may point
meets the patient; it is influenced by your body to a need to clarify the contract, reviewing issues
language, your dress, your behaviour and your about intent, confidentiality, time, money, etc.
emotional state. The patient will gauge how seri- It almost certainly reveals some unease that needs
ously you are taking the consultation, whether to be understood and resolved. Making good
you are trustworthy, how strongly you have your eye contact can be difficult while keeping

170
 Styles of Consultation

appropriate records or referring to texts or computer. Paradox

Care must be taken not to allow these activities to Paradoxes or seeming contradictions often
detract from the quality of the homeopath’s ‘presence’ reveal important areas of a case. They may be
and attentiveness to the patient. suggested by being ‘over stated’ or by the release
of emotions when something is discussed. For
Pace example, a patient may say, ‘I’m really not
Many patients need to be invited to expand on like…’ often when they clearly are. Wherever
the history but in a way that does not interrupt appropriate, investigating a paradox will reveal
them. If you feel a symptom is incomplete then a deeper symptom. This is why the noticing of
holding in your mind the question you want to Freudian slips or contradictory information is so
ask will sometimes and, at first, rather surprisingly important, and why many deep cases only start
get it answered without you having to verbalise it. to be expressed when the patient is confident
Silence is also one of the most powerful tools as it to reveal themselves even if only unconsciously.
can invite more information, give permission for Being able as the homeopath to be ‘emotion-
reflection and deepen a case. Restating what the ally present’ is vital to establishing deep rap-
patient has said, using the patient’s own words or port and to modelling the expression of feeling.
in paraphrase, allows information to be checked Sometimes the emotional paradox is important
out and triggers the patient to recall more.

Constitution
such as the patient talking about a pain or upset

Totality and
in a trivial way or while smiling, as Peter’s case
Flow illustrates.
The consultation can be considered as a flow
of energy or information between patient and
homeopath. The patient’s information or energy
CASE STUDY 13.3 III
Peter, age 48, had attended several times to
blocks will often be apparent in the consultation, talk about his chest pain. He would talk about
and what is not expressed or spoken of is impor- his symptoms in a light-hearted way and when
tant in understanding complex cases. Often a hint describing his chest pain he smiled. Asked
of what is being avoided or not spoken about in how he felt when he had the pain, he said it
the consultation can be picked up in the early felt as if he deserved the pain. Peter gradually
stages of the consultation, and will influence how got in touch with the feeling and started talk-
the consultation evolves. Recognising where the ing with tears in his eyes about a deep-seated
energy or flow is blocked is central to understand- guilt that he had felt since childhood. When
ing the case. A homeopath who wishes to work at asked about his childhood he spoke about
a deeper level than the presenting symptom has ‘being sent away to school’ and feeling ‘inad-
to be sensitive to where the energy is in a con- equate.’ This pointed to the remedy Aurum,
sultation – what they and the patient are drawn for which there were several keynotes and to
to, what they and the patient are avoiding. In the which he responded well.
pattern of the case, what is not there that might
be expected, or what is there but not expected,
become the ‘strange, rare and peculiar’ symptoms Often at first sight the paradoxical expression
of the confused or masked case. is confusing, but this confusion is because some-
When the flow of a case becomes ‘stuck’ often a thing different and often deeper is touched on. For
different style of consulting or noticing something example, the Ignatia patient will often want to be
different will allow it to move on. A sign that the case loved unconditionally. To test out how much they
is ‘flowing’ is often that the patient is able to express are loved, they will say things that might cause the
and flow though different feelings in the consulta- object of their love to push them away. A typical
tion, perhaps shown by a sigh, a tear or laughter. Natrum muriaticum patient in love wants to love

171
 CHAPTER THIRTEEN Receiving the Case

from afar so will sometimes choose a completely matching can be thought of as how the homeopath
unsuitable and unavailable person to worship. passively receives information, then the same behav-
iour has an ‘active’ component that is part of a more
Matching dynamic communication. This more ‘active’ side to
If everything the patient does reflects part of matching is distinguished by calling it ‘enacting’.
the remedy state then even background noise or
movement the patient makes reflects that remedy Enacting
state – the more it is repeated the more important A particular behaviour that is frequently repeated
it is to the case. The patient might not regard it can be thought of as representing an aspect of
as a symptom, or even be aware of it. For exam- the case that stops something else from being
ple a Staphisagria patient may blink or grimace, expressed – a sort of ‘stuckness’. In consultation
a Sulphur patient may scratch, a Kali carboni- this ‘stuckness’ can seem like an interruption to
cum patient may clear the throat, a Phosphorus the sense of ‘flow’ in the consultation; in this way
patient may have a background cough and a the exact posture, mannerisms, words and expres-
Lycopodium patient may have a furrowed brow. sions the patient uses can present a block to the
If you are in doubt what a particular feature, natural flow of the case.
movement or mannerism might mean then try Enacting the behaviour, mannerism, sound or
copying or matching it yourself until you are movement can help shift these blocks to reveal
Constitution
Totality and

clear of the feeling that you get from doing it. By other aspects of a patient’s case. By mirroring or
repeating and matching it you may gain insight actively matching the patient’s movements, man-
into what the feature, movement or mannerism nerisms, words, etc. several things can happen.
III is expressing for the patient. You may not need
to actually make the movement and still find it
Not only can the rapport be deepened and the
homeopath gain an insight into what it is like to
helpful to reflect on why something happens at be the patient, but also the patient can, through
a certain point in a consultation. It may at first connecting with why they are behaving in a cer-
appear a novel suggestion to match a patient’s tain way, reveal deeper aspects of the case – often
movement, mannerism or choice of words but it leading to greater clarity for both patient and
often happens unconsciously when developing homeopath. One of the easiest places to start using
rapport (see ‘Projection’, Chapter 23). this is to enact hand movements or a mannerism
Understanding what the patient is expressing the patient makes when describing a symptom, as
through a repeated action, such as using a hand Sue’s case illustrates.
gesture or touching part of the body, can give a It requires confidence and some practice to
key pointer to a case as Jon’s case illustrates. While integrate these skills into a consultation, most
easily gained from supervised experience and try-
ing them out in careful and controlled ways (see
Chapters 23, 28). Often the matched and enacted
CASE STUDY 13.4
action, experience and feeling happen spontane-
Jon was big and quite threatening in his
ously in you and can inform you not only about
manner. He was sitting with arms and legs
your situation but also the patient’s. I am aware of
crossed, with what might be called very closed
many cases where noticing a cough, drowsiness,
body language. By ‘matching’ the same body
and a movement in my own hands or feet has
language I gained some insight into his vul-
drawn my attention to something that is happen-
nerability but it seemed to allow him to start
ing. When these behaviours remain unconscious
talking about his partner, who was threaten-
and become routine they can account for your
ing to leave him unless he resolved his drink
fixed response to particular or groups of patients,
problem.
such as the routine nodding of the head or tapping

172
 Styles of Consultation

(although often unconsciously) is the incomplete

CASE STUDY 13.5
sentence. For example, ‘I suppose often people do
Sue had many different symptoms coming on
this because…’ or ‘I wonder if…’ or ‘What would
over a decade. She kept swallowing and hold-
it take to…’ or ‘I suppose it feels…’. This is often
ing her throat when talking about her dead
combined with words the patient has previously
father. At first she resisted talking about him. By
used. So if a patient has been talking about a hard
repeating her movement I realised something
pain the homeopath might try ‘and a hard pain
was not being said. When I invited her to talk
might mean… or feel like...?’
some more about her father and said I won-
Withdrawing eye contact, when writing notes
dered what was not being said, Sue revealed
or looking things up, often gives patients a chance
that she had been unable to come to terms
to disassociate and talk more spontaneously.
with his death 10 years before and thought of
Some apparent ‘inattention’ within a consultation
him every day. She still had his clothes. She
is not always a bad thing. In many cases when the
had other Ignatia features, a remedy that might
homeopath looks something up in repertory or
have helped with her loss. When I pointed out
materia medica some new information emerges.
the hand movement she was making when
Other manifestations of this ‘disassociated
talking about him she repeated it and started
behaviour’ include the patient’s doodles and tunes
to cry. She then described how angry she was
they hum. The different style can be combined so

Constitution
Totality and
with how little care her father had received
that patients might ask to bring a picture with
and how she had never told her mother how
them or talk about the music or art they like.
angry she was. After Staphisagria she ‘found
Using projective techniques may also bring other-
her voice’ and her various problems started to
improve and her case moved on.
wise hidden thoughts forward. For example, using
‘ink blots’, doodles or practising disassociation
III
in supervision when talking about the case may
help you improve your own projective techniques
of the feet; saying ‘Yes’, ‘Um’ or ‘Oh’; or persis- and help you when you want to use them with
tent feelings of wanting the patient to hurry up or patients.
slow down. These can all be thought of as com-
pensated behaviour and can run not just through Drawings
an individual but also through a whole section of What children draw often communicates signifi-
a professional group (see Chapter 23). cant information and I find it helpful to both ask
Enacting and matching can reveal impor- children to draw in the consultation (as in John’s
tant but otherwise unconscious and unexpressed case) and to invite artists to bring copies of their
symptoms, especially linked to strong emotions. work with them.
They can be, and often are, used spontaneously by
parents to describe their children’s behaviour and CASE STUDY 13.6
expressions, or by owners describing pets. John was 8 years old and described as
hyperactive. On taking the case his mother
Disassociation commented that he was often anxious and
Inviting patients to imagine, in the safety of the con- agitated. He was interested in ‘machines’ and
sultation, how they might respond to different sit- I asked him to draw one. Figure 13.1 is a copy
uations can reveal aspects otherwise unexpressed, of what he drew. John said that the plane
e.g. asking patients to imagine conversations: ‘is flying straight at me and firing its guns at
‘I wonder how you would feel if your partner said me’. This is how he saw it. He responded to
this’ or ‘Is there anything you would like to say Stramonium.
to X about this?’ One technique frequently used

173
 CHAPTER THIRTEEN Receiving the Case

or failure to assert themselves – a patient finds it

difficult to engage emotionally with their problem
or to reflect on their feelings. This is often the
case where there are especially negative feelings or
where someone is emotionally closed or attached
to particular mindsets and feelings. By match-
ing the patient’s behaviour and words and then
taking them further, to over-emphasising them,
we can bring about a reaction in the patient that
Figure 13.1 John’s drawing unblocks the emotional or intellectual ‘stuckness’.
This provocation, of course, needs safeguards
but can add significantly to the case picture and
Where the Energy Is enhance the therapeutic consultation (Farrelly &
If we see symptoms as an expression of a block in Brandsma 1974).
the free flow of an individual’s vitality, then where
this block lies in a case, including any resistance to Finishing
enquiring about it and the difficulty the patient has When patients become aware that the consulta-
to access or recall symptoms, provides informa- tion is ending, then symptoms they were reluctant
Constitution
Totality and

tion about the block. Talking more abstractly about (consciously or unconsciously) to include in their
‘energy and blocks’, rather than symptoms, allows agenda might surface – the so-called ‘doorknob’
some patients to explore sensitive issues that might symptoms. Being clear at the outset about the
III otherwise be difficult to name. Similarly we may
be aware that something has changed as a patient
length of a consultation is an important part of
allowing these to come up. Of course, the whole
comes into the room, and just observing the change dynamic of the consultation can be thought of
without the need to name or comment on the shift as encouraging these to emerge. They frequently
can be an important part of receiving the case. point to the unconscious or non-contracted
agenda of the patient and indicate where the con-
The Use of Metaphor sultation might go. Sometimes the moment when
Metaphors are often used by patients, e.g. ‘I feel all they emerge is the critical moment to respond; at
at sea’, ‘It sticks in my throat’, ‘I feel I am on a roller other times they need at least to be acknowledged
coaster’, etc. When patients use these phrases it and a deliberate intention to address them at the
reveals something about the case and projects it on next appointment expressed.
to something else. When strong, unusual or persis- Endings are an important part of the homeo-
tent, a metaphor can provide access to information pathic consultation and treatment process. In
that is otherwise masked. You might ‘play dumb’ addition to the end of each consultation a broader
and invite the patient to describe what exactly the end-point of the whole treatment process needs
metaphor means, e.g. ‘What do you by mean “being consideration. It may be articulated in the impres-
at sea”?’. The feelings associated with it and what sion and plan in each case, even though this is
they might feel or imagine feeling in that situation reviewed and may be modified at each consulta-
are relevant, e.g. ‘How would you feel at sea?’. The tion. Like the doorknob syndrome, only after
metaphor itself may directly or symbolically have dealing with one problem and coming to the end
something to do with the remedy. of a treatment process might another set of symp-
toms and agenda emerge.
Provocative Approaches The ending of each course of treatment is
In some cases – often due to lack of an emotional important and should allow a review of all the
language, low esteem, low emotional competence treatment, and review the expectations and outcome

174
 Bibliography

of a particular treatment process. It should also done on learning styles (Chapter 12) and extends
permit discussion and decisions about any further this to thinking about your own style of consult-
treatment, especially how the patient will cope ing. No one style is ‘right’, but there is often one
with any residual symptoms and how to maintain style which will enable you to see a particular case
the improvement. more clearly. With experience, it is possible to
In some ways it is helpful to recognise that all ‘pick up’ a style of working and mix it with others
our cases, especially our interesting and challeng- that fit a particular patient, aspects of their case,
ing cases, stay with us as part of our ‘knowledge model of health or approach to treatment. While
and database’ to inform our experience and later it helps for the homeopath to separate out the dif-
work. This is why we need to talk about difficult ferent skills and approaches that might be used in
cases and those we are struggling with, rather their consultation, what is vital is experience in
than (or at least as well as) the inspiration we take using these techniques so they can be blended into
from our successful cases. By sharing difficulties a coherent and personally effective way of con-
and failures we can support and learn from one sulting holistically.
another (see Chapter 25). As the case deepens so the importance of rapport
and empathy increases – we explore this and work-
ing with difficult cases later (see Chapters 23, 25).
REFLECTION POINT As we will see in Section V, in more confused and

Constitution
Totality and
● Think of a recent consultation. How have you used hidden cases, those aspects that are not offered
some of the techniques detailed here to help you in that up consciously and spontaneously by the patient
consultation? To what extent are you aware of how the become increasingly important. A homeopath
patient makes you feel and how they feel during the
consultation? Reflect on your consultations and consider
who uses some of the techniques mentioned here
will realise that it is in the relationship between
III
what your consultation style is like. How does your the homeopath and the patient, including the
consulting room or other contact the patient has with homeopath’s own internal processes, that much
your practice complement this? valuable information emerges about the confused
● How are matching, enacting and the provocative and hidden case.
approaches mentioned following homeopathic principles
of like treating like?
References
Farrelly F, Brandsma J 1974 Provocative therapy. Meta
Summary Publications, Capitola CA

This chapter attempts to blend the science and art Kellas A 2006 Working with movement and dance in
healthcare. J of Holistic Healthcare 2006 3:24–28
of homeopathy into a cohesive approach in the
consultation. It explores how the case can cover Mercer S, Reilly D, Watt G 2002 The importance of
both those symptoms and causations so important empathy in the enablement of patients attending the
to the first two models of health and how it can be Glasgow Homeopathic Hospital. Br J Gen Pract 2002
52:901–905
extended to receiving the case through aspects of
the totality and constitution.
The ability to form a holistic impression of
a case has to precede the ability to manage the
Bibliography
case using totality or constitution. The homeo- Kaplan B 2001 The homeopathic conversation, the art
path who extends the case into these areas must of taking the case. Natural Medicine Press, London
remain centred and able to build on all informa- Neighbour R 1989 The inner consultation. MTP Press,
tion in the case. This chapter builds on the work Lancaster

175
CHAPTER FOURTEEN

Reaching Towards the Totality Case Analysis

David Owen

nosis’ needs to be worked through to identify a

Introduction best-indicated remedy, the simillimum. As case
Chronic illness can benefit from treatment based analysis proceeds information may emerge about
on causation and presenting symptoms. But gener- unfamiliar remedies that may fit the case better
ally, as cases become more complex, so causation than more familiar remedies. In this way the case
appears multifactorial and frequently becomes analysis is a dynamic process interwoven with the
obscured and presenting symptoms reflect only study of materia medica and the development of
part of the case. In these cases a prescription the case.
matched to the patient on their totality or consti-
tution, or a mix of both, will act more deeply and
give more reliable results. The repertory is a vital Case Analysis of Complex Cases
tool for finding which remedies fit which symp-
toms and constitutional features in complex cases.
Using Totality and Constitution
This chapter explores several different strategies The job of science is to explain observations by
of repertorisation. The confidence in any strategy way of the relationship of one thing to another.
and the likely response to treatment based upon it The role of the artist is to portray observations by
is always a consideration for the homeopath. How way of the observer’s relationship to it. As cases
well indicated is the treatment and how might become more complex so the homeopath requires
treatment progress? both the art and the science of homeopathy to
Of course, case analysis still takes place within make sense of what is observed, its uniqueness and
the context of the patient’s overall management, its complexity.
involving several important stages of case assess- When you have taken and received a complex
ment (see Chapter 4), before matching the case case you are likely to know your patient in a way
to a remedy picture. Different approaches to case that not many other people do. Often this process
analysis reflect different ways of looking at the sheds new light on the symptoms for the patient,
hierarchies of information in a case, and in turn who may know themselves better after the case than
provide strategies for exploring more difficult before. Once you understand what is wrong with
cases. Exploring some of the different strategies the patient you begin to understand what has led
at this stage will prepare you for working with the to what is wrong – and this in turn can lead you to
more confused and hidden cases covered in later understand what needs to happen for the patient
sections. to put right what is wrong. Remember that sharing
Case analysis frequently indicates several pos- a holistic impression of the case with the patient,
sible, similar remedies, and this ‘differential diag- including what they are really suffering from, how

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 CHAPTER FOURTEEN Reaching Towards the Totality

it evolved, and what can be done about it, is thera- remedies for every one of the patient’s symptoms,
peutic in its own way and frequently a start in the but it is also unlikely one remedy will ‘cover the
patient’s journey back to wellness (see Chapter 25). whole case’. There are two solutions. First, the
The total symptom picture and constitutional symptoms that are strong or characteristic of the
susceptibility often reveals a structure and order to patient or the illness are most likely to point to
the case. Matching this picture (with its structure ‘characteristic’ remedies that cover broader aspects
and order) to the remedy picture (with its own of the case. Second, choosing remedies that cover
story and pattern) is at the heart of case analysis. a balance of symptoms from the local, general and
As we have discussed before, the materia medica mental aspects of the case points to more ‘repre-
is written with much greater emphasis on symp- sentative’ remedies. A mix of these two methods
tomatology than in terms of the constitution and often provides a shortlist of remedies that include
susceptibility. Some constitutional features are the simillimum. The more deep-seated the illness
described in the materia medicas and a little are and the more complex the case, the greater the
included in repertories. One of the strengths of relative importance of ‘characteristic’ or ‘repre-
materia medicas that look at families of remedies sentative’ symptoms to the analysis.
is that they often identify themes that run through Different homeopaths give primacy to different
the susceptibility and constitution rather than just ‘characteristic’ and ‘representative’ symptoms and
the symptoms when ill. In an attempt for clar- to some extent the layout of different repertories
Constitution
Totality and

ity I have separated constitutional and thematic reflects the priority of the compiler; each has their
approaches while, in fact they are frequently used following. Boenninghausen, for example, gives
together and the materia medica overlaps. primacy to the generalised modalities and con-
III Differential Diagnosis
comitant symptoms. Kent does rather the oppo-
site and prioritises the psychological symptoms;
Although it is helpful to consider prescribing on Box 14.1 shows a common interpretation of his
causation, presenting symptom, constitution and hierarchy from the most important to the least. As
totality separately, in practice several approaches you will appreciate from earlier chapters there are
may be used in a case and may point to the same several different ways of assessing hierarchies in
remedy. Deciding which approach to use and when
depends on many things. It helps to be able to move BOX 14.1
between them and draw from each what lends itself Kent’s Hierarchy
best to the particular patient you are treating in that 1. Emotional and feeling symptoms
particular situation. The aim is to end up with a list 2. Disorders of intellect dysfunction such as,
of possible remedies that each fits as much of a case delirium, confusion
as possible – referred to as the differential diagno- 3. Symptoms of memory disturbance
sis of similars. There may be strong confirmatory 4. ‘Peculiar’ symptoms which are not expected
or exclusion indications for a remedy or group of as part of the pathology, e.g. ‘sensation of
remedies; by considering each remedy in turn the something alive in the abdomen,’ a key-
case may reveal new previously unnoticed symp- note of Thuja
toms. Looking at the remedies in more detail in the 5. General symptoms
materia medicas or provings may provide the fine 6. Modalities concerning reaction to bodily
detail necessary to distinguish between these simi- environment, e.g. temperature, time, posi-
lar remedies. hopefully leading to the simillimum. tion, motion, etc.
7. Peculiar symptoms
Which Symptoms to Choose? 8. Common, particular and pathological
In the holistic model no one symptom gives the symptoms
whole picture. Not only is it impractical to seek

178
 Case Analysis of Complex Cases Using Totality and Constitution

different patients (see Chapter 6). Part of the art and normal exposure and consumption, and to be
of case analysis is deciding what the appropriate truly marked they need to be distinctly different
hierarchy is in a particular case. from the average population.
In some patients a food may both produce an
Cautionary Note on the Primacy unwanted symptom and meet in some way a need
of Mental Symptoms the patient has. In those patients who continue
Using Kent’s idea of the supremacy of the men- eating the food, chronic symptoms develop and
tal symptoms, even when there are strong and the ‘food sensitivity’ becomes masked. Indeed, it
clear physical symptoms, can lead to problems. is not uncommon for the patient to crave a food
Although mental symptoms are often more indi- that is contributing to their symptoms. In this way
vidualising, it can be difficult to be really clear foods can be a maintaining cause; only after or
about the symptom from the proving or to be during treatment might a patient find it possible
confident all remedies that have that symptom to identify and give up a culprit food. In the prov-
are in the rubric. Many of the provings took place ings and clinical experience, remedies frequently
before detailed psychological types and profiles have both a craving and aversion to the same food.
were documented, hence a strong clear modal- This, and the incompleteness of rubrics based on
ity is worth many half-guessed or poorly matched foods, has led some homeopaths to include all
mental symptoms. Less definite mental symptoms remedies that have an affinity (craving/desire,

Constitution
Totality and
can then be used as concomitants in the case, to aversion, aggravation/agg or amelioration/amel)
distinguish between the similar remedies. with a particular food.
Remember when treating patients with mental
illness that the presenting symptoms are equivalent
to the local pathological symptoms of the ‘mind’.
Which Rubrics to Use
Once the hierarchy of symptoms is clear, choosing
III
Other symptoms that guide you to the individual which of these to look for as a rubric is next. This
susceptibility may be more important. will depend on the repertory available, the exact
rubrics and how closely they match the symptom.
Using Food Desires, Aversions, Box 14.2 lists factors (in no particular order) that
Aggravation and Ameliorations might be considered when selecting rubrics depend-
Kent considered food symptoms less useful than ing on the hierarchy and approach to treatment
other ‘generals’ and modalities. In his repertory a being used. Sometimes a compromise is needed
rather incomplete list of food symptoms appear in between choosing the most significant symptoms
the stomach section – perhaps in Kent’s time the and a manageable spread of rubrics. Often the more
available choice of food, and therefore the indi- individualising modalities of a specific symptom
viduality expressed by food symptoms, was much will not translate exactly into a rubric and a less
less. In most repertories now they are more com- specific symptom might need to be used. This is
plete and included as generals. A good case can helped by more modern repertories being hierarchi-
also be made to consider them as mentals – often cally accurate so that each rubric always contains all
they are expressed clearly and easily even when the remedies in its sub-rubrics. In some cases several
other mental symptoms are hard to establish and rubrics may each describe the symptom – in these
they may tie in with other areas of the case. For cases the rubrics can be combined, requiring atten-
example, in Sulphur cases the high body tem- tion as to how the remedies in the resultant rubric
perature may need a high energy, high fat diet. are weighted. In other cases a particularly individual
In Argentum Nitricum the high state of mental characteristic or unusual symptom and rubric can be
arousal will need ‘brain food’ provided by the weighted more strongly because of its uniqueness.
sugar that is craved. Weighting any food desires Knowing conventional diseases can help identify
and aversions needs to take account of fashions which rubrics are unusual for a particular patient.

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 CHAPTER FOURTEEN Reaching Towards the Totality

differently. A tension exists between how compre-

BOX 14.2
hensive a repertory is versus how easy it is to use.
Considerations in Selecting Rubrics
●
Spread the rubrics between mental, gener-
als, physicals
REFLECTION POINT
●
Choose some rubrics that pertain to the ● What rubrics might you use to describe any aspects of
disease, those that are part of the totality
your own condition?
and have come on since the patient has ● Look up these rubrics in some of the repertories
been ill – especially those things that have
mentioned in Chapter 9
changed most significantly ● What do rubrics that describe a healthy person tell you
●
Where appropriate include causation fac-
about them?
tors and strong symptoms or keynotes – ● Reflect on the tension between getting enough data for
both as confirmatory and exclusion
repertorisation to represent the totality and using only
rubrics
the most accurate data?
●
Consider less specific rubrics if they con-
tain a more representative collection of
remedies; also consider ‘permissive’ rubrics
(see below) Permissive Rubrics
Constitution
Totality and

●
Consider, depending on how repertorisa- Sometimes a local modality that has no rubric or
tion is taking place, the size of the rubrics only a small rubric can be looked up as a general
●
Consider rubrics that cover structural modality. For example, the rubric Throat, pain,
signs, functional processes and sensations,
III as these are another way of getting a bal-
warmth amel. is small but the general modality
Warmth amel. is much bigger and could be com-
ance to the totality; if there is a strong bined with throat pain rubric to give more reme-
indication in one of these areas, seek con- dies than in the rubric Throat, pain, warmth amel.
firmation in other areas Kent rather frowns on this, which is why he has
●
Distinguish between rubrics that pertain to been so careful to include all local symptoms with
strong features of the individual’s constitu- their own modalities, yet admits these are incom-
tion, i.e. those that have always been there plete. Boenninghausen, however, regards any
and others that have come on since the ill- local modality as reflecting the totality. Caution
ness and fit the totality is needed as in some remedies or symptoms the
local modalities are out of step with the rest of
The more similar a match between symptom the case and these might be keynotes due to this
and rubric, the more likely a successful outcome peculiarity, e.g. aggravation from warmth of the
to treatment will follow. A useful check on the Arsenicum headache in an otherwise chilly remedy.
individual value of the rubrics you have selected is It is a question of care and judgement in choosing
to ask, if you used these rubrics alone, how easily when it is helpful to ‘generalise’ a local modality –
you could separate out this patient from a group where possible this should be checked against the
of patients with a similar illness. materia medicas and a prescription influenced by
permissive rubrics more carefully confirmed.
Limitations Inherent in Rubrics Permissive rubrics also include those used but
Rubrics vary hugely in size and are never complete not offered in exactly the same way in the reper-
as new remedies are being added all the time and tories. For example, a patient may dislike slimy
no remedy has been proved on every type of sus- food, like snails – it may be permissive to consider
ceptible prover. Different repertories will include other foods that are slimy and rubrics with aver-
different numbers of remedies and weight them sion to those foods, such as oysters.

180
 Repertorisation

Large Rubrics
Some very common features of a patient can be BOX 14.3
represented by large rubrics that might not be par- Limitations to Strict Numerical Scoring of
ticularly individualising but can still point towards Rubrics and Remedies
some remedies and away from others. Including
●
Symptoms may not always accurately
these in repertory analyses has become easier with translate into rubrics
computer repertorisation (see Chapter 19).
●
Symptoms may not be accurately weighted,
and weighting itself seeks to give a fixed
numerical score to something that is
Repertorisation descriptive – for example, if a remedy is
In every prescription there are aspects of the rem- weighted 3 it does not mean that the symp-
edy that aren’t in the case and aspects of the case tom is three times as strong, or the remedy
that aren’t in the remedy. three times as likely to have that symptom,
Basic repertorisation has been described in as a remedy weighted 1
Chapter 9. In this chapter, to reflect the analysis of
●
Symptoms and therefore rubrics are not all
more complex cases, different strategies for reper- of the same importance; weighting rubrics
torisation are considered. Most of these calculate as 1, 2 or 3 is only a very rough approxi-
the relative strength of a remedy indication based mation of this

Constitution
Totality and
on the frequency of its occurrence in the reper-
●
If a remedy is not in a rubric it is not
tory, the weighting of the symptom that the rubric scored but it may actually be an important
is related to in the case, and the weighting of the eliminatory symptom (perhaps in these
cases the remedy should be given a minus
remedy in each rubric. The scoring and ways of
viewing and comparing different remedy scores is score) III
illustrated by the display of a computer repertory
●
Rubrics are often incomplete, in that
analysis in Figure 19.6 (p. 257) and Figure 21.1 they do not have all the remedies pres-
(p. 287). This scoring has several limitations which ent that can cause and therefore cure each
are noted briefly in Box 14.3 and which are impor- symptom
tant to understand if the homeopath is to make
●
Some remedies, such as Sulphur, are bet-
informed decisions based on repertorisation results ter proven and therefore have more occur-
– bearing in mind, despite sophisticated computer rences in the repertory and are more likely
programs, the art that lies behind case analysis. to occur in case analyses of many rubrics –
without this being taken into account
Analysis Using the ‘Three-Legged Stool’ polychrests like Sulphur are always likely
Given the number of different possible symptoms, to be favoured
rubrics and strategies there is much to be said for
including the most significant symptoms in the ‘centre’ of the individual case. It is not always
three main areas of the case – the physicals, generals possible to find strong or reliable symptoms in all
and mentals. Both this and other broad approaches three areas, and the choice has to be made whether
rely on using large but representative symptoms, to take several strong symptoms in the mental
like casting a net over possible remedies. Their suc- sphere, e.g. against less strong symptoms in the
cess depends on casting the net widely enough, and generals or locals. Judging this balance is part of
checking a wide range of possible remedies in the the art of the homeopath. The different strategies
differential diagnosis of remedies. below are mostly variations on this strategy; the
Some homeopaths feel many symptoms relat- exact strategy chosen may use elements of a num-
ing to the totality should be included; others that ber of these depending on the case, the symptoms
a few well chosen symptoms better represent the and rubrics. It is not uncommon to find homeopaths

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 CHAPTER FOURTEEN Reaching Towards the Totality

(particularly, but not exclusively, those new to Families

repertorisation in complex cases) using many dif- It is possible to emphasise family groupings of
ferent symptoms and many different strategies of remedies – so the occurrence of one remedy in
analyses, giving many indicated remedies. a family brings other family members forward in
Where it is difficult to see the well-indicated the analysis. For example, five different Carbon-
from the partially-indicated, it is useful to have in containing remedies may each occur only weakly
mind the use of the minimum number of symptoms in the repertorisation. Using this strategy the
with the maximum characteristic and representa- carbon remedies each emphasise each other and
tive value to the case. Choosing the right analysis the relative importance of each carbon remedy is
strategy is similar to finding your optimum style enhanced. It might lead to closer examination of
of consulting. Some strategies are better suited to each of them or other carbon remedies that are
some cases than others but it is equally important little known.
to find strategies you are most comfortable with
and with which you can most rapidly gain exper- Themes
tise, while remaining open to what other strate- Different rubrics that represent a single theme in
gies might offer. the case might be combined, e.g. all the rubrics
that have a quality of hardness or all those that are
Number of Rubrics linked to over-sensitivity – which might be mir-
Constitution
Totality and

If covering breadth of case is important, then for rored in physical, emotional, intellectual or gen-
each remedy the total number of rubrics covered eral symptoms. All the rubrics in one theme can be
by a remedy, rather than its absolute score, is more collated together, pointing to remedies that repre-
III important. So a remedy in three rubrics as a 1
would be more important than a remedy in one
sent that theme. Then several different themes can
be compared with each other to see the remedies
rubric with a score of 3. (or families of remedies) that share these themes.
Some themes are clearly indicated in the rep-
Small Remedies ertory, others used by some homeopaths are more
Small remedies may be emphasised either by disre- permissive. For example, a patient who wanted at
garding the polychrests or by weighting remedies any cost to escape their symptoms, even if it means
inversely to their frequency of occurrence in the doing something they strongly object to on princi-
repertory. This will emphasise small remedies that ple, might be found in the rubric ‘desire for escape’.
have few symptoms in the repertory. The fewer A patient high up in an organisation but frightened
the total occurrences of a remedy in the repertory, of being displaced and ‘falling from grace’ might fit
the more it is emphasised. the rubric ‘fear of high places or fear of falling’.

Small Rubrics Elimination

The smaller the number of remedies in a rubric the A sure, highly graded symptom that may be a
more peculiar (strange, rare and peculiar symp- local, general or mental symptom, is used to select
toms) that symptom might be, and so the more it a rubric (or combined rubric) that is assumed defi-
can be weighted. The smaller the rubric the more nitely to contain the indicated remedy. If a remedy
the remedies in that rubric are emphasised. is not in this rubric it is not considered further.
It is helpful when working without a computer
Prominence repertory (see Chapter 19) when including many
This emphasises remedies that are unusually large rubrics or when there are many similarly well
strong in a rubric, e.g. one remedy in bold while indicated remedies, to distinguish between them.
the other 20 remedies are in plain type. Such a It is, however, only as accurate as the symptom is
symptom is likely to be a keynote of that remedy. important and the rubric is complete!

182
 Repertorisation

Other Analysis Strategies Rubric Studies

While the importance of repertorisation should It is helpful and important at this stage to under-
not be under-played, there are many other ways to stand why different remedies share the same key
achieve a shortlist of remedies; some of these are rubrics. For example, if the patient is very anx-
explored in later chapters. A case may be divided ious about their health and their anxiety is out
into different aspects, e.g. different pathology, of proportion to their illness, then there is a
constitutional features, hereditary influences or strong likelihood that the rubric ‘anxiety about
themes, and a remedy shortlisted for each. This health’ or ‘hypochondriacal’ is going to be useful.
may be used singularly or combined. In parts of the Understanding the reason why each remedy has
world where there was for many years an absence this symptom and how the quality of the anxiety
of a well-translated repertory, other sophisticated is expressed differently in each remedy, will help
strategies of case analysis not dependent on reper- choose between them. When reading the mate-
tories have been developed. ria medica or studying the repertory it is helpful
to reflect on why and precisely how a remedy
Limitations of the Repertory, expresses a particular symptom. You might like to
and Compensating for This look through the rubric ‘anxiety about health’ and
In addition to the limitations above there are two ‘hypochondriacal’ and from reading the materia
other general limits. First, the repertory loses an medica consider why each remedy is in the rubric

Constitution
Totality and
element of context and detail compared to the – how uniquely does it get anxious and what
materia medica that themselves have already lost particular situation is likely to trigger it?
some detail from the provings; they are inevita-
bly an ‘abbreviation’ of the materia medica. For
example, several remedies may have anticipatory
Materia Medica Searches
Given the limitation of the repertory, searching
III
anxiety but each has slightly different things they original materia medica and provings may suggest
are more or less anxious about, and will manifest possible remedies for more unique symptoms.
the anxiety slightly differently. Indeed, the differ- With computers it is possible to search many
ence between an anxiety, fear and phobia is not materia medicas to find all occurrences of a par-
just determined by the word the patient or prover ticular word, e.g. to look for the words ‘fear’
uses but has qualities about wide or narrow focus, and ‘height’, when they occur next to each other
known or unknown cause, intensity and whether within a set number of words, sentences or para-
it is always there or only at times in response to a graphs (see Chapter 19). This generates a list of
particular situation. remedies, weighted according to frequency of
Second, the rubrics are laid out according to a occurrence, which may be exported to a reper-
particular structure and hierarchy determined by tory program or cross-referenced to the original
the author of the repertory. This helps us know materia medicas. It is also possible to add different
where to find the particular piece of information, synonyms, so we could compare fear of heights
but also can shape and constrain how we think of a with anxiety, vertigo or panic in high places. The
symptom and rubric. It is a testament to the insight ability to search large amounts of materia medica
of previous generations that we have such valuable and compare different symptoms and rubrics have
and versatile repertory tools. Although becoming allowed a clearer perception of the pattern behind
familiar with one repertory is enough for most symptoms that different remedies have and so has
homeopaths at the start of their studies, beginning encouraged the thematic understanding of reme-
to look at others that are structured differently dies and this in turn has helped the observation of
both broadens your analysis options and opens you themes running through cases. As the technology
to interpreting what you observe in other ways not has improved, so the ability to work thematically
constrained by one structure or another. has improved.

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 CHAPTER FOURTEEN Reaching Towards the Totality

Thematic or ‘Related’ Rubrics of their symptom by forcing themselves into situa-

As the disturbance in the patient that relates to a tions, perhaps sporting or performing, where it is
remedy state expresses itself in many aspects of acceptable to be anxious and where their anxiety
the case, it can be thought of as a quality or com- is expressed. They may ‘passively’ hold the symp-
bination of qualities that may express themselves tom by being anxious about a sport or situation
through many different symptoms (like an arche- where they might suffer anticipatory anxiety.
type or symbol that is expressed in many aspects A third way is also possible, that is to ‘compen-
of the conscious and unconscious world of the sate’ for the ‘anticipatory anxiety’ and to effectively
patient). It may be easier to identify this quality in avoid all situations where they might experience
some symptoms than others, e.g. a patient who is it, e.g. keeping to a very safe group of friends and
fearful of black dogs may be helped by remedies experiences. It is as if they withdraw from expres-
that have dreams of black dogs, anxiety around sion on that axis and instead express themselves
dogs, or imagines seeing or has fears of dogs of any tangentially. In these cases the more peripheral
colour. If this approach is extended, then they may symptoms and expressions of the themes may be
also be helped by remedies that have blackness in all that point towards the underlying state and
other symptoms, or in the source of the remedy, or right remedy (Sankaran 1991).
the mythology associated with the remedy. While You will see from this that one reason a case
these approaches appear quite far removed from might appear confused is that the symptoms are
Constitution
Totality and

traditional repertorisation they are valuable in diffi- presented in a way that does not directly reflect
cult cases where they may point to a much deeper- the deepest aspects; they may be passive or com-
acting remedy than would otherwise be found. pensatory symptoms. It may require the removal
III Active, Passive and Compensated Symptoms
of several layers to see the active aspects of the
case, although if the passive and compensated
It is not always possible to identify the most symptoms are known a remedy may be found
important symptom in a case. This is one of the that ties in many aspects of an otherwise confused
reasons why cases are confused and hidden and case.
is discussed fully in Section VI. It is helpful to
think of these cases as made up of several themes, The Four Elements
that each intertwines in several layers and where Different philosophers have attempted to define the
one symptom is often connected to another. How fundamental polar states. The idea of man ‘crucified’
the symptoms are connected reveals as much and on the two primary axes, vertical and horizontal,
often more than a single symptom, e.g. if all symp- spiritual and material, light and dark, is not new. And
toms appear on the left side of the body the sided- the idea of the four poles or elements occurs in many
ness may be most important. teachings including those of Paracelsus, Empedocles
In remedy pictures, several symptoms can (fire, water, air and earth), Hippocrates (melan-
appear as if they are on an axis that runs from cholic, phlegmatic, choleric and sanguine – gall, bile,
polar opposite symptoms. Often what apparently phlegm, blood) and Jung (intuition, thinking, sensa-
seem opposite symptoms in fact have a correspon- tion, feeling). Each of these poles, and the axes they
dence. They may be thought of as primary and create, reveals the way symptoms can be seen as an
secondary actions, inner or outer expressions, active or passive expression (Nux Vomica, for exam-
or as mirror or parallel images. It is these axes ple, has both an active choleric expression but also
that the themes describe and include apparently a phlegmatic need to relax). Understanding how dif-
polar symptoms that can be thought of as active ferent poles relate helps clarify and is another way of
and passive. These run through both cases and analysing what would otherwise be a complex and
the materia medica. A patient with, for example, confused mix of symptoms in both cases and rem-
anticipatory anxiety may have found expression edies (Reves 1993).

184
 Plan of Treatment

Repertorisation in More Difficult Cases repertorised are not always the deepest or stron-
Repertorisation and repertory data are only ever a gest symptoms; while a remedy indicated on this
guide to the possible remedies. They never cover basis may act deeply, it is more likely to lead to the
all the totality or all the constitution. Indeed, as emergence of other and hopefully deeper-acting
the data are predominately derived from proving remedies at future consultations (see ‘Treating
symptoms they include few constitutional fea- using several sequential remedies’, Chapter 15).
tures, and many remedies often share those that
are represented. In difficult cases, repertorisation When the Totality Is Not Enough
provides ‘pointers’ in the direction of remedies. When viewing the case holistically, with the whole
Repertorising during the consultation may reveal case not expressed in the totality, we are already
lines of enquiry to follow in the case, and becomes seeing the first signs of a confused and hidden case.
a part of the case-taking, in helping to clarify and As a case becomes more difficult, then it is more
develop symptoms. Sometimes it is this process likely to comprise several ‘layers’. This leads to
that starts to reveal the essence, themes and pat- both confused and hidden cases – confused where
terns running through a case. Extensions of the different symptoms (some that may be passive or
normal repertory that describe themes and their compensatory reactions) appear contradictory and
relation to different remedy groups are starting to no clear hierarchy is seen, hidden where the deeper
aspects are masked either by the overwhelming dis-

Constitution
emerge in some books (Sankaran 2002).

Totality and
ease process or because the deeper disturbances are
Clarifying Rubrics culturally masked (see Chapter 30).
By looking at rubrics and the remedies in a rubric When an aspect of a case is not expressed clearly it
during case-taking, ideas may emerge that allow you
to explore or clarify the symptoms and rubrics that
instead shows itself in the unconscious of the patient.
It is the unconscious and unseen aspects that contain
III
you might use. For example, scanning the rubrics much of the ‘potential susceptibility’ of the patient
about chest pain may inform you about the variety and that determine so much of the ‘constitution’.
of modalities that exist and that should be enquired Revealing and understanding the unconscious there-
about. Care must be taken that this does not bias fore holds the key to exploring these cases, initially
the analysis towards preconceived ideas. One way by understanding the patient’s constitution, then
to reduce this possible distortion, particularly use- by looking at what the patient projects onto others,
ful when first in practice, is to give the patient a list, and then by exploring what others project onto the
e.g. the different types of pain, and let them choose patient. The constitution is discussed further below;
the best description. Another is to have a period of projection is explored in Section VI.
time, perhaps without the patient present, to start
analysing and repertorising the case, then to ask the
patient back in to clarify and explore symptoms – it
Plan of Treatment
is at this time that confirmatory and eliminatory Illness is what the patient has on the way to see
factors can be considered. the doctor; disease is what they have on their way
home.
Different Analysis Strategies A plan of treatment is likely to indicate a pre-
It is useful to have different methodologies for ana- ferred homeopathic approach based on the impres-
lysing a case as each will explore or ‘explain’ the sion of the case. It will also include ideas about the
case in a different way. When different strategies overall management of the patient related to the 12
of combining and weighting rubrics and different stages outlined in Chapter 4 (page 40). In some cases
methodologies point to, or away from, the same it is possible to see a differential diagnosis that is
remedy or group of remedies it can clarify a case several remedies deep, with one remedy being
analysis. In some cases the symptoms that can be most clearly indicated, nearer the surface, but

185
 CHAPTER FOURTEEN Reaching Towards the Totality

some showing a deeper partial picture and oth- example, a patient may want to be treated consti-
ers offering just a glimpse of their potential. The tutionally before they enter a situation that might
deeper possible remedies are worth noting as they make them ill, or when pregnant to reduce the sus-
may become clear when a new hierarchy emerges ceptibility of the child. In practice, as symptoms,
and give information about the direction and even if only acute ones, are always happening, and
remedies indicated in subsequent consultations. constitutional features may be due to previous (or
This is particularly important when we consider inherited) illness, there are always connections and
that in many complex cases there is likely to be a overlaps between the two methods. Understanding
course of treatment that is going to need several the different focuses of the totality and constitu-
remedies. An awareness of how the remedies are tional approaches will allow you to see the relative
related to each other, and how one remedy might merits of both. How these are brought together in
follow another, is vital to managing these more different situations will shape how you work in the
complex cases (see Chapter 15). holistic model (see Chapter 11).
The exact plan of treatment may be influenced Each constitutional type prefers certain envi-
by quite practical factors such as the complexity of ronments and is predisposed to certain illnesses.
the case, the time available, how acute or chronic Some homeopaths see treating your constitution as
the illness is, if the patient will be able to attend like having your car regularly serviced. It is more
for follow-up, if the patient is using homeopathy likely to keep going in different environments and
Constitution
Totality and

as a one-off or as a therapy throughout their life. to have fewer problems. In this way constitutional
The expectation that one prescription will solve the prescriptions may be a way of maintaining the
majority of chronic diseases at a single intervention body in optimum health. However, even a con-
III is unrealistic and a potential cause of dissatisfaction
with, and disappointed expectations of, homeopa-
stitution that is completely healthy in one envi-
ronment may find itself susceptible in another. No
thy. Some patients may present with an acute ill- one type will be healthy in every situation!
ness or local symptoms that they require treating. While there may be a typical constitutional pic-
The homeopath may see that the case is deeper, but ture for a remedy not all patients who need that
until the acute problem or local symptoms have remedy will fit the typical picture. So constitution
responded to treatment the patient may be reluctant can be a good positive indicator but not as useful
to contract to work more deeply. It can sometimes as an eliminator.
seem that the patient needs first to experience the Many patients share common susceptibility,
benefits of homeopathy before undertaking deeper and so share some constitutional features. Not
treatment. This education and development of the surprisingly these often correlate with frequently
homeopathic patient and the cultural awareness of indicated remedies (polychrests). As you treat
what a deep homeopathic prescription entails is an more difficult cases it may be helpful, rather than
important part of helping patients reach a level of thinking of there being a single remedy that suits
awareness where they can obtain the deeper ben- all aspects of an individual at one time, to think of
efits that homeopathy can offer. there being several remedies, each of which may
cover some aspects of the case. Identifying these
The Totality Vs Constitutional Approach respective pictures often helps clarify the case and
While the totality and constitution are two sides of reveal new symptoms or hierarchy that allows the
the ‘holistic approach’, and are usually used together remedy that covers most or the deepest part of the
in some way, there are times when one approach case to be teased out. When a case falls between
or the other may be favoured – the totality if just two or more remedies that are quite different
the symptoms since the patient became ill are to be there is likely to be a third (often smaller) remedy
considered; the constitution if considering the state that is indicated. This raises the question of when
of the patient before any symptoms developed. For to use a sequence of remedies or to seek a more

186
 Plan of Treatment

specific remedy, often a small remedy that might more confused and hidden so those aspects of the
not have been well proved (see Chapter 15). totality displayed by the patient point less clearly
to the remedy. Hahnemann noted this difficulty
What is a Healthy Constitution? in treating much chronic disease and observed
A constitutional type will have characteristics that several patterns of symptoms related to the sup-
are habitually present in good health, but also be pression of common major illnesses; he called
prone to particular symptoms when ill. For example, these ‘miasms’. Prescribing on these is sometimes
while a Sulphur patient may need the fatty foods referred to as miasmatic prescribing.
they crave, over consumption may lead to diges-
tive problems. Those who need sugar might become Introduction to Miasms
diabetic or hypoglycaemic. When the constitution of Section III started by looking at symptoms and
an individual has all the characteristics they need (or susceptibility and how they theoretically deter-
the majority of them) to function well in their pres- mine the holistic picture. In practice, in our cur-
ent environment, then we refer to them as having rent culture of self and prescribed medication
a healthy or strong constitution. It is likely that if for every ill, most cases with chronic illness are
they find themselves in an environment that is only almost immediately coloured by suppression and
slightly different their vitality will be high and they palliation. In these cases, the picture changes and
will be able to generate a response that will enable the case can only be understood fully by seeing the

Constitution
Totality and
them to cope with the new situation. deeper layers of the case. This has been recognised
for as long as homeopaths have treated chronic
Previously Well Indicated disease. If the miasmatic aspects (or layer) of a
and Effective Remedy
The right constitutional remedy may help a
case are not treated then they provide an obstacle
to cure. Homeopaths use the concept of miasms
III
patient in a number of different acute or recur- as one of the ways to make sense of and manage
rent illnesses. If a remedy has acted well before it these deeper, more difficult, cases. (The word
should be considered again. miasm comes from the Greek word ‘mianein’
relating to a stain or taint; this is covered in detail
The Central Disturbance in Chapter 17.) When a disease is incompletely
In some cases and with some remedy pictures cured it generates a susceptibility that is passed on
there is a clear pattern to the whole picture that to others. These traits are inherited, but may also
stems from a single central issue or disturbance. be passed on through the cultures we evolve and
Prescribing on this is more akin to prescribing on inhabit. The three miasms Hahnemann described
the essence or central theme but when there is a relate to three fundamental disturbances of degen-
clear link between the central disturbance and the eration (destructive), over-activity (autoimmune)
peripheral symptoms the essence and constitution and disorder/proliferation (tumour).
may effectively be seen as one.
Miasmic Constellations
Classical Prescribing Different patients, disease processes and remedies
Many homeopaths describe a whole person, belong to each of these miasms. One model that
totality and constitutional approach as ‘classical is helpful when considering miasms is a pattern
homeopathy’, meaning that prescribing is based that connects different remedies and symptoms –
on strict principles (usually those of Hahnemann rather like a constellation of stars in the night sky
but with significant influence from others, most that are connected by a pattern. You might struggle
notably Kent), and they use a single medicine in to remember every star individually but find it eas-
a single prescription. Classical prescribing can be ier to remember the constellations it relates to. In
helpful in many complex cases but as cases become the same way that a constellation of stars has key

187
 CHAPTER FOURTEEN Reaching Towards the Totality

or central stars, so the miasms have key remedies. paper or computer, is like mastering the tools of any
Several constellations can overlap and one remedy trade. Remember, the finest painting is made from
can be part of more than one. As the homeopath perceiving clearly, knowing the fundamental colours,
becomes more experienced they see more patterns in a range of brush strokes and experience.
the remedies and more connections to each other. As cases become more difficult, so a range of
analysis strategies using the totality, constitution
Three Main Miasms and reviewing what is unconscious in the case
In Chapter 17 we look at the overall themes is vital. This is explored further in subsequent
running through the main miasms including exam- chapters. General guidance about the hierar-
ples of mental, general and local features of these chy of information in a case and the weighting
different miasms. The miasms tie in with both the of symptoms has been given, but there is always
constitutions of different patients and to themes a tension between the emphasis we give to very
that run through certain remedies. They provide a characteristic small individualising symptoms and
useful pointer to the relevance of important con- more representative symptoms that are seen to
stitutional features in a patient, e.g. patients with express themselves in many areas of the case. This
a saddle-shaped or turned-up nose (syphilitic), is reflected in the tension between using predomi-
too big a nose (sycosis) or a sharp and straight nantly broadly indicated polychrests and the spe-
nose (psoric). It raises the consideration that the cific and focused small remedy.
Constitution
Totality and

constitutional features and susceptibility of one Although the ideal situation in every case would
generation are shaped by the illnesses of a previ- be to identify the totality and constitution, the
ous one. They indicate the important effect that reality is that we can only approximate towards
III suppression of a disease can have, leading to the
development of susceptibility. Ultimately any dis-
this. In practice this means that patients will often
zigzag from one remedy to another as they move
ease that is not completely cured gives rise to new towards wellness. How to support patients and
susceptibility – acquired and hereditary illnesses maximise the ease of this journey back to well-
are in fact closely related and differ only in the being requires compassion, insight and persever-
time frame or time line over which they manifest. ance. In the next chapter we will look in more
Miasms are also used by some authors to convey detail at the practical tools of applying and using a
something about the general expression of groups constitutional and totality approach.
of remedies in terms of fundamental types of reac-
tion that are less directly linked to disease process
but provide one way of looking at how remedies References
are related to one another (see Chapter 22). Reves J 1993 24 chapters in homeopathy. Homeopress,
Haifa

Summary Sankaran R 1991 The spirit of homeopathy. Homoeopathic

Medical Publishers, Bombay
Looking in detail at the analysis of complex cases we
Sankaran R 2002 An insight into plants, 2 vols.
can recognise the important role of the repertory, for
Homoeopathic Medical Publishers, Bombay
which an accurate and full case with weighted symp-
toms is central. We are also reminded that analysis
cannot be isolated from the study of the case, the
patient as a whole and the materia medica.
Bibliography
For the homeopath, finding the way around the Norland M 2001 Origins of the Mappa Mundi. Am
repertory and learning how to repertorise is part of Homeopath 7:102–105
the apprenticeship. Understanding and mastering the Saxton J 2006 Miasms as Practical Tools. Beacons-
structure and strategies for using a repertory, whether field, UK.

188
CHAPTER FIFTEEN

Managing Complex Cases Case Management

David Owen

in terms of sensation (I feel, I sense, my senses tell

Introduction me) plus emotional and intellectual impressions,
This chapter explores first the practical manage- and a functional diagnosis in terms of physiology
ment of complex cases in the context of chronic (I do this, I’m too hot, I perspire). The impres-
illness, and second the ‘journey’ back into health sion is expressed as a summary of the narrative
as the treatment proceeds. The more complex the and may include an idea of how deep the illness
case the longer the journey and the more steps it is goes, what is happening now and is likely to hap-
likely to entail. The different ways in which a com- pen if untreated, and how it has evolved and
plex case can be analysed may suggest a number what has to happen to reverse it. The impression
of different remedies. Each might only partially is often closely tied in with the eventual remedy
fit the case and which, if any, of these are used is prescribed. This has led to the practice of using
determined by the knowledge of the homeopath, the name of the remedy prescribed in the place
the case, what is being treated and the analysis of the diagnosis, such as diagnosing someone as
strategies used. These all contribute to the context a ‘Phosphorous’ patient. This shorthand fails to
in which decisions about management are made reflect the full nature of the patient and their man-
(see Chapter 5). agement.
Each prescription is a stage in that journey The reality is that, with rare exceptions, chronic
and is informed by the overall impression of the illness and complex cases are rarely perceived
case and the overall plan of treatment being used. completely accurately at first – when they have
As we have seen, the impression is informed by had suppressive treatment they often are partially
the model of health, the plan is informed by the confused or hidden. So it is unlikely that a single
approach to treatment and the prescription is remedy will match the totality or constitution and
determined by the methodologies being used. All cure completely without the need for further pre-
these factors will influence the remedy selected, scriptions.
guide the optimal potency and frequency of dose The case, and therefore the choice of appro-
to use, and affect the possible and likely reactions priate remedy, may appear to change as the case
to treatment. unfolds over time – both in our understanding
of its evolution prior to treatment and in the
response to treatment. This may be seen as the
The Journey into Illness patient’s ‘journey into illness’ and, as they start to
There are many different ways of summarising the recover, their ‘journey into wellness’. In Chapter
impression of a complex case. It might include a 3 we discussed the ‘time line’ of a patient’s illness;
pathological or structural diagnosis, a description it is also possible to think of a ‘time frame’ for a

189
 CHAPTER FIFTEEN Managing Complex Cases

Over time much can be achieved by moving

CASE STUDY 15.1
things on one step at a time in the journey towards
Peter, aged 5, was brought for treatment of
health. Patients may have expectations of dramatic
his eczema that started at age 9 months.
cure from a single prescription, and explaining to
Increasing strengths of steroid creams were
them the idea of ‘journeying back to health’ can
not adequately controlling it. He had also had
help them have a more realistic view of the man-
asthma, controlled by inhalers, since he was
agement of more difficult cases. It also allows the
two and a half. He had unsuccessfully tried a
homeopath to point out that the journey is for the
dairy exclusion diet. Treatment based on the
patient to make, and to invite the patient to par-
presenting eczema symptoms was difficult as
ticipate consciously in this process and to accept
there had been suppression and modalities
that it may take some time. Of course, if the pic-
were unclear. There was an apparent absence
ture is clear and the remedy is strongly indicated
of general, mental and constitutional features –
it can happen much more quickly.
making a totality prescription difficult. There
It is common for a patient to ask how long it
was, however, a family history of allergic
takes to recover from an illness. One way is to
disease and of tuberculosis in the maternal
consider it as a proportion of the time over which
grandmother.
the illness has developed. It may well take one-
Prescribing the nosode Tuberculinum bovi-
tenth of the time that the patient has been ill for
Constitution
Totality and

num led to an initial aggravation (helped at

them to make a full recovery – if there has been
that time by reducing dairy intake), followed
significant suppression it may take longer. Part
by a clear picture of Phosphorous emerging
of the planning and the process of follow-up is
in aspects of the totality. This gave further
III improvement of the eczema and, in time,
identifying significant points along the way that
indicate the patient is improving.
a gradual reduction in the need for steroid
creams. The parents remained happy to use
inhalers for his asthma, which he appeared to
Does the Constitution Change?
grow out of at age 9. He re-presented age 14
The observation that a patient requires several rem-
with hay fever and a relapse of his asthma; at
edies, including constitutional remedies, raises the
this time he had a clearer general and mental
question of whether the constitution changes or
picture of Phosphorous that helped his hay
whether none of the remedies accurately enough
fever and asthma. After several prescriptions
match the underlying constitution or susceptibility.
his respiratory function improved and he cau-
While many basically healthy individuals appear to
tiously reduced his inhalers.
maintain what appears the same constitution for
many years of their lives, those who suffer chronic
disease and who have deep-seated cases, especially
when suppressed, seem to move through different
patient’s recovery. Peter’s case illustrates some of but linked constitutions. Rather than being repre-
these points. sented by a single remedy, the constitutional picture
Frequently one remedy is observed to ‘unlock’ is perhaps better thought of as being represented by
another. In more difficult cases the treatment may a group of remedies with overlapping susceptibility.
take some time to reveal the deepest aspects of Another way of understanding the constitution is
the case. In some confused cases several different that it reflects the simillimum – how the constitu-
remedies might be needed over a period of time tion evolves and changes in response to life experi-
and in hidden cases a remedy or several remedies ence reflects how the simillimum changes.
may be needed regularly to ‘unmask’ the case (see In the holographic model we can understand
‘plussing’ and ‘LM potencies’, Chapter 20). the case as a series of themes that run through

190
 The Journey into Illness

different layers – so important to understanding environment and life style. Likewise a shift in
confused cases. As such, different layers or parts the patient’s situation and life style can be a sign
of the constitution come into focus at different that a remedy has acted. Understanding what situ-
times in a person’s life. Often an apparent ations make different constitutional types ill and
change in the constitution corresponds with what symptoms they typically get is an impor-
when the life situation changes most; such as tant part of studying the materia medica and is
when first going to school, at adolescence, when a form of causation and local picture that each
leaving home, getting a job, getting married, remedy has.
having children, suffering bereavements, redun-
dancy, etc. Perhaps such events and life stages What sort of Patients Respond
tend to bring forward different susceptibilities to Totality and Constitutional,
within the constitution. For example, pregnancy Homeopathic Treatment
may make certain remedy pictures more likely. Patient decisions about what treatment to follow
There are different views as to how much differ- is often based on an incomplete picture of both
ent constitutions may partially co-exist or over- their condition and what treatment entails. The
lie each other and whether these follow clear totality and constitutional approach suits those
patterns. My own observation is that there is patients who realise the importance of taking into
frequently an order to this and that this reflects account all the symptoms and their susceptibility,

Constitution
Totality and
the commonly observed remedy relationships and who are prepared to spend time revealing the
– and also a connection between remedies of whole case. Patients who choose to see life holisti-
different families and kingdoms (see ‘Related cally might do this even though they have quite
remedies’, Chapter 27). localised symptoms. In some patients the motiva-
tion comes because they have conditions where
III
Constitution and Environment there is no conventional well-indicated treatment.
If the patient’s apparent constitution changes Other patients may have tried conventional treat-
when exposed to different situations and environ- ment that either has not worked or has caused
mental factors, then to understand the constitu- intolerable adverse effects.
tion it is helpful to see the connection between the Those patients where there has been (or is)
remedy and the situation in which it is required. much suppression or many different disease
This is why certain remedies often suit people in processes often present confused cases and are
certain professions or jobs, not that this is used likely to benefit from the insight that the the-
as a major indication, but it may be a confirma- matic approach to treatment brings (see Sections
tory. The homeopath who is aware of the major V and VI). They include patients with several
environmental and situational changes affecting systems, organs, or tissues affected by deeper
a patient should also be aware of the types of functional or structural disturbance. For some
constitutions that may become ill in these environ- patients with co-existing syndromes, realising
ments. This awareness presents homeopaths (and that a treatment that seeks common ground to
indeed all health care practitioners) a responsibil- all their symptoms makes sense, is the start of a
ity to inform society of the health consequences of long but worthwhile healing process. In patients
environmental changes. with gross structural changes including tumours
As patients move between diverse environ- and disease of more vital (or central) organs,
ments due to rapid social change, travel or living including those who have had much surgery
longer, so the constitution is increasingly chal- and deep-acting suppressive medication, their
lenged. Some individuals who maintain the same cases are more likely to be confused and hid-
constitution for many years of their lives do so den – often requiring thematic, miasmatic and
because they are good at maintaining a healthy reflective approaches.

191
 CHAPTER FIFTEEN Managing Complex Cases

The Plan of the Journey Back style changes that need to be made, the speed at
to Wellness which suppressive medication can be stopped, and
Planning a patient’s homeopathic treatment is the depth, time and cost of treatment with which
central to both the patient and homeopath having the patient or homeopath is able or comfortable
realistic expectations of what can be achieved. It to work. Unfortunately many patients (and some
sets objectives of the treatment in terms of medium homeopaths) see a partial improvement as all
and long-term goals and allows realistic short- that is required or desirable. If these patients stop
term goals of a particular prescription between homeopathic treatment part way through they are
each consultation. It allows the role of a single likely to relapse.
consultation to be understood in the context of
the treatment process as a whole. Attempting to Suppression and Palliation
manage cases without a plan is like setting off on a A homeopath in planning the course of treatment
journey with no idea of where you want to go, no is aware that the patient may need to work through
directions of how you are likely to get there, and symptoms that have been suppressed and to let
no idea of what you are likely to pass on the way. symptoms move in the direction of cure. Enabling
A common mistake is to think that treatment patients to work through these symptoms is both a
can be completed in a single consultation. That function of rapport with the patient and of under-
way lies the mistaken belief that there is ‘a magic standing the palliative and suppressive forces that
Constitution
Totality and

bullet’ for every case; it leads to unrealistic expec- are at play. Management includes, as appropriate,
tations and disappointments for both patient and reducing suppressive medication and making life
homeopath. style changes.
III Treatment and Maintenance
Understanding and managing palliation and
suppression is an important aspect of the homeo-
If the homeopath or patient is unrealistic about path’s role in more deep-seated cases. For example,
treatment they may become disillusioned before a patient brought up in an environment where
they have seen the journey through to its conclu- everyone suppresses grief may need to ‘get in touch
sion. Newcomers to homeopathy often fail to plan with’ their grief – which is why homeopaths need
adequate follow-up. The number of appointments to be aware of the culture and society that has
that a patient will need will vary greatly depend- shaped the patient’s life or that they now inhabit
ing on many factors; an average for a patient (see Chapter 30).
with a complex (but not confused or hidden)
case having an illness that has gone on for 4–5 Secondary Gain
years is between four and six appointments over 6 That a patient may gain some benefit from par-
months. In more deep-seated cases treatment may ticular symptoms or illnesses is well recognised.
go on for much longer, with the treatment some- Understanding how illness interfaces with the
times going through phases of just maintaining the patient’s needs is an important part of managing
patient and the improvement they have had so far. the patient, as Jan’s case illustrates.
It may take some time for a confused or hidden
case to unfold and reveal new information. The Somatisation/Sensation,
patient still requires support during this time until Function and Structure
a new prescription becomes clear. It is well recognised that psychological illness
The speed at which a case unfolds is influenced affects the physical body – the holistic model is a
by many things and it is not always possible for means of observing and treating both aspects. In the
the patient or homeopath to progress a case as holistic model all sensations, functions and bodily
fast as they would like. There can be issues about structures are connected and can be thought of as
the type and level of support a patient needs, life different but interconnected realms of symptoms.

192
 The Journey into Illness

reasons why many prescribers use several remedies

CASE STUDY 15.2
at different times (see unicist, inter-current and
Jan, age 48, presented in a wheelchair with
combined remedies – Chapter 30).
arthritis – she had found out that her partner
In many simple cases a single approach and
had been having an affair shortly before she
methodology may be clearly indicated. There is
had ‘worsened’ and had to start using the
often comprehensive information available in the
wheelchair. While this might be completely
materia medicas about causation and local symp-
coincidental, it was thrown into focus by her
toms to choose a remedy from. However, some
refusal to have any artificial drive to her wheel-
prescribers will mix several remedies together;
chair or to have anyone but her partner push-
sometimes because each covers an aspect of the
ing her. When this was explored in the case,
case, e.g. a mixture of Aconite, Belladonna and
her need to always know where he was indi-
Chamomilla (ABC) in a fretful child; at other times
cated a theme around control and betrayal.
to provide a ‘spread’ of remedies when the modal-
ities are unknown or the prescriber is unsure what
to give. These mixtures are usually used in the same
So a patient who initially suffers from anxiety potency. In some areas of practice closely related
(sensation) might start to fiddle with their hands to homeopathy, such as Bach flower remedies and
and bite their nails (function), and eventually their the tissue salts, using some mixtures of remedies is

Constitution
Totality and
nails might weaken and split (structure). In some normal practice.
ways the anxiety can be thought of as being held Sometimes different remedies indicated from
in the functional and structural changes of the different approaches and methodologies are mixed
fingers and nails. To treat the nails, the anxiety
will need to be addressed; if it is not, then it will
together. For example, in France and Germany
many clinically indicated prescriptions include a
III
effectively be transposed onto other symptoms. In mix of remedies for organ stimulation combined
this way it can be helpful in some cases to think with those for presenting symptoms, usually in
of symptoms as a form of ‘projection’ of some- different potencies.
thing that is unable to be held or integrated within As cases get more complex so it is often pos-
the healthy individual (see Chapter 23). Whatever sible to see several models, approaches and
realm the symptom is expressed in, it expresses methodologies each pointing to aspects of many
something of what is being projected. remedies. A best-fit prescription in one method-
For some homeopaths the origin of what is ology or approach might not cover all the case.
being disturbed is outside the patient, ultimately This leads to some prescribers using remedies in
more ‘spiritual’; for others it is understood as com- close succession or in parallel with each other,
ing predominately from choices the patient makes often using different potencies depending on the
about their environment and life style. One way approach being used (see Chapter 20). These pref-
extrapolates health matters into religious belief; erences are sometimes well established by differ-
the other extrapolates all causes as a consequence ent homeopathic schools such as that used by the
of the patient’s choice. Both perceptions need to Eizayaga school (Box 15.1).
be balanced in understanding and working with In the thematic and reflective approaches the
the totality. materia medica knowledge and how to represent
this in repertories is still evolving. This can make
One Remedy or Several Remedies confused and hidden cases hard to prescribe for
Many homeopaths aspire to selecting a single rem- with confidence unless there are good confirma-
edy that covers the complete case and will heal the tories. An awareness of how remedies can interact
patient from presentation to discharge. In practice with one another (see Chapter 27) and how poorly
this is frequently not possible and there are various indicated remedies, especially high potency ones,

193
 CHAPTER FIFTEEN Managing Complex Cases

BOX 15.1
Eizayaga’s Combined Approach
Developed in Argentina by Dr Eizeyaga, this is significant life events. After treatment at the fun-
offered as a well-tried way of combining dif- damental layer the patient will return to their
ferent approaches and methodologies into a original constitutional picture.
coherent management strategy. He categorised The constitution is based on healthy charac-
symptoms into ‘lesional’, ‘fundamental’, ‘mias- teristics that have mostly been present for a long
matic’ and ‘constitutional’ and then analysed time and include genetic factors, body hair, body
them separately, seeking a remedy for each. Each type, hair colour, basic personality etc. Features
is treated in its own right and may require a dif- that are taken here relate to the compensated or
ferent remedy. The lesional aspect correlates to socialised or normal behaviour of the patient.
the local disease that might be acute, chronic, Often a few basic polychrests, particularly min-
periodic or permanent, and may be reversible, eral remedies, are used for this layer and a patient
irreversible, curable or incurable. Prescribing moving towards this layer is perhaps a sign that
is based on local modalities, concomitants, and they are moving away from the confused case to
including mental and general symptoms that a more straightforward chronic disease.
have come on since the onset of the disease. The miasm as a deep-set theme remains even
Constitution
Totality and

The fundamental is based on features which after the presenting problem is cured; treating this
have developed during a person’s life and which helps to consolidate a cure to prevent a relapse.
relate to the person rather than the disease pro- It relates to the weakest and most susceptible
III cess (the totality minus the local). It overlaps
with the constitutional picture and includes
aspects of an individual – and that susceptibility
may be active, exposed or dormant.

can further confuse a case is necessary to prescribe tion. It leads frequently to the prescription of a
sufficiently cautiously (see ‘Treatment of confused single high potency remedy for the inside nature
and hidden cases’ – Chapter 29). As a general rule of the patient using themes or miasms, followed
most homeopaths are correctly cautious in pre- by a low potency remedy for the outer symptoms
scribing high potencies and reluctant to combine of the illness on local symptoms or causation.
high potency remedies.
When a remedy is well indicated by totality and
constitution a homeopath can confidently pre-
The Treatment Cycle
scribe a single remedy. As the indications move to Healing is a process that takes time.
either end of the range of models and approaches The different layers and realms of symptoms
so confidence often decreases – it is here that mix- create a multidimensional picture of the case that
tures of local remedies and two remedies, one builds and presents sequentially. Working through
for the person (or ‘inside’) and one for the illness this is not a linear process but may helpfully be
(or ‘outside’), are more often used. As these cases thought of as requiring a number of stages over a
‘clear’ so a single remedy covering the totality and cycle of a number of consultations and treatments.
constitution at that time often emerges. Although not every consultation will require a
In practice seeing an ‘inner’ and ‘outer’ rem- prescription, the stages of the consultation and
edy is more often the case if you are attempting to treatment process and what is learned from them
work simultaneously across the different models are very important. Patiently allowing the case to
of health with no one clear totality or constitu- unfold over time, and paying close attention as it

194
 The Treatment Cycle

prescription covers all aspects of the case a choice

The case-taking
and receiving has to be made on what is to be treated first. It is
informed by both the patient’s and homeopath’s
preference, and determines the therapeutic agree-
Review of Case analyses
therapeutic agreement (impression, plan) ment (see Chapter 25). Not uncommonly, patients
who fail to appreciate the potential depth at which
homeopathy can work request relief for their
Review most distressing presenting symptoms. Only when
of case
these symptoms have been addressed might they
Consent No consent be prepared to work more deeply. In other cases a
Managing cases to treat to treat
on allopathic or prescription may focus on just one or two aspects
antipathic treatment of the case; as these are resolved others emerge or
Homeopathic become the priority.
prescription
and dispensing Intercurrent
treatment
of medicine Consent to Treat
Once the plan of treatment is clear, the purpose and
probable effect of any prescription becomes clear.
With this information the homeopath can mean-

Constitution
Totality and
Referral Discharge
ingfully ask for consent to treat. In order to give
Figure 15.1 The treatment cycle informed consent the patient needs an idea of the
possible reactions to a management strategy includ-
does so, calls upon a number of different models of
health to reflect and interpret what is happening,
ing the remedy. As the holistic treatment will ideally
take into account all aspects of the case including the
III
and employs a number of different approaches to symptoms (totality), the susceptibility (constitution)
treatment – leading to a number of possible prescrip- and suppression that has taken place, these three
tions based on different methodologies. Figure 15.1 areas each need to be considered. In practice they are
illustrates this as a series of stages or phases. not separate entities but are dynamically connected,
Sometimes there is a single central disturbance that so advice will cover not only the indicated prescrip-
runs throughout the treatment cycle. At other times tion but other (suppressive) medication being used
there can be many different dimensions to the case and also life style.
that each need to be resolved. Some of the deepest
cases will only unfold over years or decades, some- Referral and Discharge
times there will be phases of active treatment where Patients also require information about ‘other
the case is changing, interspersed with maintenance treatment options’, so the homeopath requires
phases where the case appears static but may well be a familiarity with other health care systems the
consolidating improvements already made, before patient may benefit from. Deciding when to refer
being ready to move on and tackle deeper issues. a patient is often difficult and, despite realising
why it is advisable, the patient may experience
Case Analysis feelings of ‘rejection’ and the homeopath feel-
Case analysis involves forming an impression, ings of ‘failure’. Developing and feeling part of
making a plan and giving a prescription. In com- a team of different practitioners and advisers is
plex cases there are several possible ways of ana- often an important part of a homeopath’s profes-
lysing a case – matching the depth of the analysis sional support and in integrating homeopathy in
and methodology to the depth of the case is as a patient’s care.
much homeopathy as matching the remedy within Discharging a patient includes situations where
a methodology. When no one impression, plan or no clear consent to prescribing exists and no

195
 CHAPTER FIFTEEN Managing Complex Cases

follow-up is required. If the patient is to be fol-

Table 15.1 POTENCY, MODELS OF HEALTH
lowed up by phone ‘to see how the treatment goes’ AND DEPTH OF CASE
this is not a discharge – the homeopath and patient Modes of health Potency Case
remain ‘in relationship’. When discharging a patient
it is helpful to clarify who is now clinically respon- Relational 200c, 1M or 10M Hidden
sible for the patient, whether the patient has all the Holographic 200c or 1M Confused
information they need about their treatment, and
to invite the patient to give feedback to you. Holistic 200c Complex
If a patient relapses sometimes after an initial Biological 30c Simple
improvement then it may relate to a deterioration
in their condition, a lowering of the vitality (or Pathogenic 12c/6c Straightforward
increase in susceptibility) or a wearing off (or
antidoting) of the remedy. In many cases it is
because the initial treatment and arrangements for As a general rule the treatment approaches often,
maintenance were inadequate. but not always, correlate with the depth of the case
that is being treated and therefore the most appro-
Inter-Current Treatment priate potency (Table 15.1). When this is not the
Although ideally a patient will only need or receive situation then selecting the potency on the depth of
Constitution
Totality and

one homeopathic remedy that covers all their symp- the case, confidence of prescription or, more prag-
toms, in practice, especially in more complex cases, matically, what is available to you may be indicated.
patients seek out different inter-current treatment Other prescribers use other criteria, such as
III for particular symptoms. This may be provided by
other systems of medicine or by prescribing homeo-
when dealing with an illness that presents purely
on a physical level using a 12 potency, for func-
pathically using a different approach. This may be tional disturbance a 30, and a disturbance of sensa-
because a particular symptom needs controlling or tion a 200 or higher. For example, causation such
because of an overlying acute picture. What these as an insect bite might be treated with a 12c, while
inter-current treatments should be, when they causation or symptoms of shock/fright might be
should be used, and their possible interactions with treated with a 30 or 200c.
totality and constitutional treatment, is the subject Some remedies are described as working best
of much discussion. in different potencies. This is often due to how
the remedy is most commonly used. Lycopodium
Potency and Administration is sometimes talked about as working best as a
of the Remedy (See Chapter 20) 12c, which is true when used in local prescribing –
It can at times appear critical to choose the opti- but when indicated by totality or constitutional a 200c
mum potency and there are cases where one is more appropriate. As a general rule deeper treat-
potency acts while another does not. However, at ment for deeper cases indicates higher potencies.
other times the potency seems very much second-
ary to choosing the best remedy and ‘if the remedy Frequency
is right, the potency doesn’t matter’. Historically, How frequently the remedy needs repeating
higher potencies were developed to avoid toxic depends on how high the patient’s vitality is and
effects with the guideline that the minimum dose how frequently it needs stimulating to respond.
was all that was required. To try to reduce the Generally, the higher the potency and the clearer
variability and confusion to those new to home- the match to the complete case the less often it
opathy I invite you, when you start in practice, needs to be given. Frequently, high potencies are
to consider using the potency that matches the given in a split dose, often two or three doses at
model of health you are using. 12-hour intervals. While in some cases a single

196
 The Treatment Cycle

remedy given once may be sufficient, in other discussions in earlier chapters on suppression.
cases the same remedy may be needed several Knowing what symptoms are due to adverse effects
times particularly with more entrenched func- of conventional and recreational drugs is important
tional or structural disturbance. When to repeat in establishing the hierarchy of a case. Patients who
a remedy at follow-up is something that taxes have predominately used homeopathic remedies,
many homeopaths and is covered in more detail especially if over many years, are often more sensi-
in Chapter 16. As a general rule when a maintain- tive to conventional drugs, respond to lower doses
ing factor is still likely to be present, then a dose and are more susceptible to adverse effects.
may need to be repeated on a more regular basis. Some patients use allopathic or antipathic treat-
Remember if the maintaining factor is a causative ment for discrete symptoms while using home-
factor, as they often are, the patient may need to opathy for others. The management implications
be encouraged to address this or else a long lasting include understanding the potential interactions
cure will be elusive. The homeopath does more of different treatments and the need to communi-
than just find a remedy and an illness is often part cate with those supervising other treatments. It is
of life’s therapy. likely to alter both how deep and clear the case
When a maintaining factor is likely still to be is and possibly the action and duration of both
present, or the illness is particularly structural, treatments.
then a dose repeated on a more regular basis may Other patients will try several treatments for the

Constitution
Totality and
well be indicated – 12c potency twice a day is not same symptoms. This can make both the case and
uncommon. A 30c potency is often only needed as interpreting any response to treatment difficult –
an initial treatment, although repeating it for func- such patients are therefore not for the inexperi-
tional disturbances twice a week will sometimes
give more consistent responses. In the realm of
enced. As homeopaths become more experienced
they may feel freer to experiment with differ-
III
sensation a single split dose is usually adequate. ent models, approaches and methodologies in
these situations and be more able to interpret the
Administration responses to the different methodologies.
Remedies can be antidoted by strong smells and There are often several prescriptions that will
tastes, including some foods. The need to avoid shift the case in some way but knowing how these
these can be explained in terms of the potentised might relate to the overall plan of treatment,
remedy being a subtle energy whose action can including non-homeopathic interventions, is often
be inhibited. It is therefore advisable to take the the mark of experience.
remedy on a clean mouth, dissolved under the
tongue, and to avoid coffee, mint, etc. Remedies Reviewing the Case
often appear more easily antidoted when first During treatment, as rapport develops and in
taken but once they have acted they are harder to response to a remedy, new aspects of the case may
antidote accidentally. I find it particularly impor- become apparent, leading to more of the case being
tant to advise patients to avoid potential antidotes revealed. More complex, multidimensional cases
when taking high potency remedies. with symptoms on many levels and themes run-
ning through different layers gradually become
Managing Cases on Allopathic clearer during treatment. This can make it appear
or Antipathic Treatment at first as if the disease is getting deeper and new
Homeopaths need not be discouraged from treat- remedies are required. It is important to distin-
ing patients with a history of allopathic or antipa- guish between seeing more of the case and the
thic treatment, although the treatment cycle needs actual disease getting worse. Once the ‘full’ case
to take this into account at every stage. The effect is appreciated and the correct treatment started,
on the case and analysis is covered in the detailed the case will start to ‘clear’ and move towards a

197
 CHAPTER FIFTEEN Managing Complex Cases

simpler picture. This is indicated by a change of There are many different ways in which a
the existing symptoms following the laws of cure. patient may react to a treatment, but the key
Sometimes one remedy can help the case over responses are that the patient is getting better,
many stages of healing. In other cases the focus worse, or staying the same. To decide between
of the treatment can change significantly, and the these it is important to be clear about how closely
impression of the case and plan of treatment will the case reflects the patient’s true state, and to
require regular modification. distinguish between the disease and the patient’s
In cases where a seemingly well indicated rem- well-being. We have already seen that some treat-
edy fails to act then a number of factors have to ment may help reveal a deeper disease that was
be explored. Most often this happens because the not seen before – even though it was there.
remedy is not similar enough to the patient but
other reasons include obstacles to cure, antidot- Aggravations
ing, insufficient vitality and, occasionally, a failure It is only possible for a remedy in potency to unveil
in potentisation or preparation. and reveal a state that already existed in some way
before the treatment.
Review of Therapeutic Agreement Aggravations, or more properly therapeutic
At the end of each consultation it is worth being aggravations, are not uncommon phenomena in
specific about what has changed, and what is homeopathic prescribing. They indicate that the
Constitution
Totality and

being treated. For example, if a patient presents individual is responding to the medication by
with an apparently simple illness which, when the generating or increasing the symptoms, which in
case is retaken, proves to be more deep-seated and homeopathy are seen as part of the body’s way of
III complex, the treatment plan needs to reflect this.
The patient should be made aware of the implica-
coping with an illness. They normally consist of a
worsening of existing symptoms.
tions of this and that it will lead to re-analyses and This understanding within homeopathy that
new consent etc. The agreement is not a static, the symptoms are the body’s effective response to
legal document – it is a dynamic expression of the illness, rather than a failure of that response,
the relationship intentions of the patient and the is central to our understanding of illness and heal-
homeopath and contains the hopes, expectations ing. The duration of any aggravation depends on
and possible remedy reactions. Like the treatment the time the symptoms have been present, the
cycle itself, it is evolving and changing. degree to which they have previously been sup-
pressed or blocked, and the overall vitality or abil-
ity of an individual to heal. In acute conditions
REFLECTION POINT these aggravations will usually last for minutes or
● Reflect on a complex case you have seen and think hours; in chronic conditions for days or weeks or,
about the different components of the treatment cycle. rarely, even months.
Which stages are easy and which are hard or unclear? Aggravations must be distinguished from dete-
How, as a case gets increasingly confused or hidden, rioration of the patient’s illness according to the
might this change? natural history of the disease process and a wors-
ening of symptoms due to reduction of other
medication. Strictly speaking aggravations are a
worsening of symptoms already present and must
Remedy Reactions be distinguished from a return of symptoms from
When a remedy acts, although symptoms may appear the past, a change from a chronic to an acute pic-
to shift subtly there is invariably a deep and signifi- ture, and proving symptoms (see Chapter 16). In
cant shift in the patient’s vitality – it is clear to those a true aggravation the patient will often give some
around the patient that something has moved. indication of being better in themselves, either

198
 Remedy Reactions

emotionally, mentally or generally, often with an drop out of treatment – and when they later get
increase in energy or better sleep. This is why it is an improvement, they fail to attribute this to the
so useful to establish and record the basic energy remedy.
state of the patient at the first consultation.
Managing Aggravations
Suppression and Aggravations When patients have a severe aggravation, first seek
One way of thinking of aggravations is the clearing to understand if the reaction is one that fits with
out of things which are stopping the person from your understanding of the case. If so, support the
being well, e.g. a patient who had been smoking patient and encourage them to work through it.
for many years developed catarrh, going on for Second, review the different causative and contrib-
several months, after taking a remedy. In patients uting factors; if advice has not already been given
with much suppression or contributory life style on these then suggest environmental and life style
factors there is likely to be prolonged aggrava- modification, particularly if there are maintaining
tion. In the treatment of drug addiction a period causative factors. Third, consider local symptom-
of detoxification can go on for some time, during atic (homeopathic) treatment for the aggravation,
which the patient may need a great deal of support. e.g. Calendula tincture in an eczema flare-up or
Patients with inhalant, contact or food sensitivity Valerian tincture for an anxiety state.
will have less aggravation by minimising exposure It is in such cases that good rapport and con-

Constitution
Totality and
to the substances to which they are sensitive. After tracting enable the patient to come back to the
the homeopathic treatment has been completed, homeopath, rather than give up on a treatment they
they can often tolerate exposure without reaction. feel made their symptoms worse. It is not uncom-
It is as if the remedy initially ‘unmasks’ sensitivity –
indeed, this unmasking is similar to the revealing
mon for a patient who has had an aggravation to
‘give up’ on a homeopath, only to then try another
III
of hidden cases that is discussed in Section VI. In therapy or homeopath. And when the aggravation
cases with much suppression or that are likely to settles and they get better they often fail to attribute
aggravate, using LM potencies (see Chapter 20) it to the first homeopath!
lessens the likelihood of an aggravation. If the aggravation symptoms do not settle then
The key thing to understand homeopathically it may represent a remedy that has acted only par-
is that, as a general rule, an aggravation is a sign tially or not deeply enough. In this case repeating
that a remedy has acted. When a patient comes the remedy at a much higher potency may com-
and says ‘Since I took this remedy this, this and plete the action of the remedy.
this have been worse’ the first response of the In a small minority of patients where aggrava-
homeopath is ‘Good!’. tions cause significant and or prolonged distress
Some patients will seek relief for aggravations with no sign of abatement then the aggravation
with modest medicinal and life style palliation. may be antidoted. This may be achieved either
Others may use a great deal of palliation and with a specific homeopathic antidote, different for
suppressive medication and in these cases, it may each homeopathic medicine, or by using a general
lead to the expected improvement from a homeo- antidote – either material or homeopathic doses
pathic medication being lost. This is particularly of strong aromatic substance like Eucalyptus,
noticeable in higher potency remedies prescribed Camphor, Mint or strong coffee. Different practi-
on subtler indication and may lead to a well indi- tioners seem to favour different ways of antidoting
cated remedy being considered to have failed to and I suggest initially it is helpful to get advice
act. Following an aggravation, new symptoms in management of cases that have a prolonged
may emerge, and it may be necessary to retake and aggravation.
re-analyse the case. If patients are not expecting My personal experience is that about 10% of
or are unable to tolerate an aggravation they may cases get an aggravation that causes them concern

199
 CHAPTER FIFTEEN Managing Complex Cases

and may need some short-term support. Of these, of the response of the presenting symptoms but
about 10% require treatment, mostly either simple the overall well-being of the individual.
life style modification or local treatment. A small Remember that when a patient feels better at
number may require the use of the same remedy the deepest level do not change the treatment until
in higher potency, which completes the action of it has fully acted. That is, do not give a second
the remedy (see Chapter 16). In those where it remedy unless a symptom picture is clear – this
does not, then using strong aromatic substances usually requires the previous remedy to have com-
can ‘switch off ’ the aggravation. While dimin- pleted its action. It may take as long to reverse the
ishing the activity of the remedy and reducing case as it has taken to build up.
the aggravation, they do allow some subsequent
improvement. Obstacles to Cure
For the newcomer to homeopathic prescrib- ‘Man’s freedom to enjoy consciousness is affected by
ing in chronic diseases one of the most frequent disease. Life’s aim is to get rid of self made obstacles to
causes of spoiling a case, when all the hard work health.’
has been done, is to move from a correct remedy James Tyler Kent
because of an aggravation or healing crises.
When a well-indicated remedy fails to act, some-
Follow-up thing effectively blocks the remedy from acting –
Constitution
Totality and

Remedies provide the information needed by the this is referred to as an ‘obstacle to cure’. A com-
individual to heal. After a first prescription has mon obstacle is a maintaining cause, but a number
acted then the case will have changed. If the rem- of other factors commonly influence a remedy’s
III edy provides all the information then a complete
recovery is possible, although the journey back to
action. While in different patients and for different
remedies these can be diverse and idiosyncratic,
health may go through several stages. If the first there are some general or common obstacles (Box
remedy does not provide any information that res- 15.2). One practical way of categorising them is
onates with the case then nothing happens – and as physical, emotional or psychological. Obstacles
the case needs re-taking and re-analysis to find a to cure can also cause a well-indicated remedy to
first prescription that will act. If it provides some act slowly or incompletely. When a remedy acts
of the information needed there is a partial recov- partially, it may help its full action to be seen if
ery and a picture of the new state can be seen. the relevant obstacles can be reduced or removed.
Sometimes symptoms become clearer and others This is another reason why the homeopath is
are brought to the surface, in which case further advised to have a broad understanding of those
time may continue to improve things. If and when factors that influence a patient’s health.
this process fails to progress in a healing direction At times illness may remove the patient from
a second prescription is needed (see Chapter 16). the obstacle; it is only when they start getting bet-
If the new state that is revealed is deeper after ter that they come into contact with it again. The
the first prescription then the case is still being illness may be the patient’s way of making the
clarified and in some ways the first prescription changes necessary to avoid a cause or an obstacle
can be understood as part of revealing the full case to cure. This can lead to a relapsing pattern of
before the case is clear. This often has to happen in illness, e.g. a patient who is stressed at work may
confused and hidden cases. The aim of the homeo- relapse whenever they are well enough to return
pathic treatment process is the gradual reduction to work. In this way illness is one way that we
of symptoms and return to health. This involves a monitor our lives and seek out a balanced state
clarification of the case, a surfacing of old, often with our life situation. At other times it is when
suppressed, symptoms, and gradual recovery. It is we get ill that we are brought into contact with
important to remember to take account not only obstacles to cure, so a patient who is taking

200
 Remedy Reactions

antipathic drugs will not fully respond to the cor-

BOX 15.2
rect homeopathic remedy. Hence the need for the
Common Obstacles to Cure
homeopath to have an overview of all treatments
Physical Obstacles a patient is likely to be taking.
●
Mechanical – such as trauma or poor If a maintaining cause or obstacle continues
posture over much time it can traumatise the body or mind
●
Antipathic or allopathic drugs to the extent that it takes a significant time to
●
Exposure to harmful or antidoting chemicals heal, even after the cause or obstacle is removed.
●
Caffeine During this time a cure will not be possible and
●
Poor diet or nutritional deficiency,* over- the vital force can become depleted. For exam-
eating ple, post-traumatic stress can cause problems for
●
Inadequate or excessive exercise some time after the stress and it may require this
●
Sexual restraint or excess aetiology to be specifically treated before other
●
Use of recreational drugs remedies can act. Even after they have been cor-
●
Lack of fresh air rected some causes, such as nutritional deficien-
●
Extremes of temperatures, weather, draughts cies may continue to influence the body for years.
etc. Animal studies show that the effects can carry on
for generations after the deficiency is corrected.

Constitution
Totality and
Psychological Obstacles
This gives a hint to the long-term treatment nec-
●
Sabotaging any treatment (patient does
essary for hereditary illness and the benefit for
not want to be well)
future generations of treating illness fully in this
●
Secondary gains
●
Fixed ideas
generation!
In many cases it can be difficult to distinguish
III
●
Patients unwilling to admit they have been
between factors that prevent the case from being
helped
seen or factors that in some way block the remedy
●
Psychotherapeutic work running counter
from acting. In practice these can be considered
to laws of cure
as much the same. For example, a patient taking
●
Intolerance of any remedy reaction
corticosteroids for asthma may lose many of the
●
Pride and arrogance often masking the
modalities that would help indicate a remedy. It is
true depth of the case
this, more than the absolute obstacle or antidoting
●
Fear of the unknown leading to reluctance
factor, which makes prescribing the simillimum
to explore the case
difficult.
Emotional Obstacles
●
Dependency Managing Patients With Obstacles to Cure
●
Deep insecurity While identifying and reducing possible obstacles
●
Deep emotional traumas to cure is an important part of managing patients,
●
Bullying behaviour (victim or persecutor) it must be remembered that it frequently takes
●
Over sensitive people who suffer constant time for a remedy to act fully. In many cases it is
calamity important for the patient to be supported in their
●
Ostracised by society symptoms while a deep-acting remedy acts. Such
●
Emotional exhaustion or ‘burnout’ support needs to be offered in a way that mini-
*
mises the potential obstacles to cure. This may
Using the analogy of a building, for healing to take place
it requires both the information of what goes where (the involve treatment using more than one model of
architect’s plan), provided by the remedies, and the actual health at the same time. If the models of health are
building materials, that might include such things as adequate clearly distinguished and appropriate potencies of
nutrition, etc.
remedies used, my experience is that patients may

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 CHAPTER FIFTEEN Managing Complex Cases

receive symptom relief with homeopathic rem- Coincidental Symptom Changes

edies while undergoing concurrent deeper treat- New symptoms may arise during the course of
ment. If local homeopathic treatments are likely any treatment, coincidental to any medication
to block deeper-acting remedies or make interpret- being taken – these occur for a variety of causes
ing the response to treatment unclear, it is prefer- unrelated to taking the medication. An indication
able to use herbal or naturopathic remedies – or of whether symptoms might be unrelated to any
even conventional treatments. How patients are medication taken will be obtained from any chron-
managed using inter-current treatments is one of ological link between new symptoms and whether
the most controversial areas of practice. events taking place at the same time could pos-
Sometimes aggravations and healing reactions sibly cause those symptoms. Understanding the
can be sufficiently strong to necessitate support natural history and epidemiology of disease, and
for the patient in their own right. So a patient with knowledge of pharmacology, are important aids
eczema may get an increase in discharge or a flare to interpreting the possible causes of change unre-
up of symptoms when a deeper allergic sensitivity lated to the homeopathic intervention – or indeed
is being dealt with. Patients will often need sup- the failure to respond to it.
porting through such temporary deteriorations
of symptoms and there are several ways of doing Curative Changes
this – including the use of local treatments for There may be a change of existing symptoms fol-
Constitution
Totality and

support of eczema such as Calendula or Graphites lowing the laws of cure, including the return of
cream and reduction of causative factors. previous symptoms. As the case becomes simpler
and clearer it can give a more acute presentation,
III New Symptoms
There are a number of reasons why patients might
particularly if those acute symptoms have been a
precursor of the case. Chronic illness healing after,
experience new or modified symptoms in response or being displaced by, an acute illness is well docu-
to taking a course of homeopathic treatment; these mented. This phenomenon is sometimes known as
are described below. After prescribing a remedy it ‘syndrome shift’.
is important to note any new symptoms.
Proving Symptoms
Perception of the Case Deepening At times new symptoms emerge that were not seen
Initially new symptoms might become visible in the case before or are a more superficial mani-
because the case is being seen more deeply; these festation of a previous deeper symptom. If these
are not new symptoms or constitutional features symptoms are in the materia medica of the remedy
to the patient but become newly recognised. At given, then they may be similar to ‘proving symp-
times the degree of suppression is such that too toms’ – and indicate a close affinity between case
much of the case is masked to see it clearly – so the and remedy. More patients show proving symp-
suppression and state it sets up needs to be treated toms the more a remedy is repeated, but if used
first. It can involve organ support for organs judiciously then the stronger or more peculiar the
required to clear the suppression or repair of reaction, the stronger the indication in favour of
organs detrimentally affected by the suppression that remedy. Proving symptoms can also develop
(often the same organs) using organ remedies. Or when a remedy is a close match to a case but not
it may mean specifically working to reverse the close enough to bring about a therapeutic reac-
suppressed state by reducing or stopping the sup- tion. The longer the remedy is repeated the more
pressive medication (with appropriate care) and likely this is to happen. They may indicate that the
prescribing on the suppressed state, e.g. using iso- prescription was close and that a related remedy
pathic treatment (see Chapter 5). may be a more accurate prescription.

202
 Bibliography

If new symptoms are not a return of old and not even receive a prescription; others will go
symptoms or proving symptoms then they are through the cycle several or many times, using one
revealing a shift in the case that needs re-taking and or many different prescriptions and using various
re-analysing to include the new symptoms. models of health and approaches to treatment.
Although the separating out into stages creates an
Return of Old Symptoms artificial perception of the treatment cycle, it is a
When old symptoms return it is invariably a good valuable way of examining the component parts,
sign and the patient can be reassured. If the hierar- so that you can explore and develop each in turn.
chy of the case is understood it will be clear why This naturally leads us to consider the remedy
old symptoms have returned. While the picture is reactions that a patient may manifest and whilst
still emerging it is prudent to wait, as sometimes some of these were included in this chapter, they
the symptoms will clear of their own accord, leav- are discussed in more detail in the context of the
ing the patient substantially improved. If the symp- second prescription in Chapter 16.
toms become fixed, then this will indicate a new
remedy that may be related to the previous one.
Bibliography
Summary Chappell P 2005 The second simillimum: a disease-spe-

Constitution
Totality and
cific complement to individual treatment. Homeolinks,
In this chapter we have explored homeopathic Haren, The Netherlands
treatment as a process and journey back into well-
Eizayaga F X 1992 Treatise on homoeopathic medicine.
ness. We are starting to move from homeopathy in Ediciones Marecel, Buenos Aires
relation to tasks and towards seeing it as a process.
As we move on to explore strategies to help with Hahnemann S trans Dudgeon R E 1852 The lesser writ-
III
ings of Samuel Hahnemann. W Headland, London.
difficult cases, we extend this further. The vital
Indian edition 1995. B Jain Publishers, New Delhi
role that suppression plays in the manifestation
of the totality in establishing the constitution has Henriques N 1998 Crossroads to cure, the homeopath’s
been further explored in this chapter. guide to second prescription. Totality Press, St Helena
The chapter went on to look at the ‘treatment Norland M, Robinson C 2003 Signatures, miasms
cycle’ and to identify those stages or phases of aids: spiritual aspects of homeopathy. Yondercott Press,
treatment that are repeated often cyclically (or Cullompton, Devon
perhaps spirally) over the course of time. Some Speight P 1961 A comparison of the chronic miasms.
patients may only attend for a single consultation Health Science Press, Rustington

203
CHAPTER SIXTEEN

The Second Prescription Philosophy

David Curtin

early changes or, if the illness is not improving, to

Introduction by David Owen become impatient. If an explanation of the inter-
Chapter 15 considered the remedy reaction within val between consultations is not given, the patient
the context of managing the complex case, although may lose confidence in the homeopath. A period
the principles to following up a case are the same for of 3–4 weeks will be about right for most com-
all cases. In this chapter I have invited David Curtin plex cases and chronic illness, but acute illness
to look in more detail at the second prescription – and may respond quickly and simple cases may only
by implication the, third and fourth prescription, etc. require a much shorter time scale in order for the
We move beyond the realm of one prescription picture to change.
fitting each case from start to finish. As you tackle
increasingly complex, confused and hidden cases Follow-Up of the Complex Case
you will face the challenge of moving from finding or Chronic Illness
a single intervention to understanding and guid- Many cases are spoiled or confused by inappro-
ing a treatment process. Grasping the principles of priate prescriptions at the first follow-up, usually
the second prescription is about understanding what due either to a lack of understanding or not tak-
happens to a patient and their vitality when they ing proper care. There are a number of questions
receive a remedy that acts. Like the thread through which one needs to ask oneself:
a necklace made up of a series of precious stones, 1. What has the effect of the first prescription
the process holds the remedies together as a whole. really been?
Conceptualising and navigating through a plan of 2. Has the remedy acted, and if so has it acted
treatment opens up the management of cases that curatively?
would otherwise be incurable. 3. Was it the simillimum or a partial similar?
4. Which symptoms have improved? Are
any symptoms worse? Are there any new
The First Follow-Up symptoms?
At the first follow-up consultation the prescriber 5. Does the patient feel better? Has the patient’s
has the opportunity to assess the progress the energy improved?
patient has made and whether or not the rem- 6. Has the remedy completed its action? If not,
edy given has acted. The timing of this consul- no remedy may be needed at this point.
tation must be carefully chosen. Sufficient time 7. Was the action good enough to warrant a
must be allowed for the remedy to produce some repetition of the remedy? Should the remedy
changes and allow the case to shift if it is going to. be changed? Or is no remedy needed?
Waiting too long allows the patient to forget any 8. Does the potency need to be changed?

207
 CHAPTER SIXTEEN The Second Prescription

Taking the Case at the First Follow-Up the patient has great faith in homeopathy or in
As at the first consultation, the patient must be the prescriber, and is convinced that the treatment
given the opportunity to speak freely – questions is working. Others may report that nothing has
asked should initially be open questions. If this happened, that everything is the same, when in
approach does not give you all the information you fact there have been major shifts. Perhaps even
require you may need to ask increasingly specific the presenting symptoms are no longer present.
questions. You need to know whether there have This can be because the patient is sceptical and
been changes to the case at any level including feel- reluctant to admit that the treatment has had any
ings, behaviour, thoughts, energy, sleep, desires and effect. More commonly it is simply that the symp-
aversions, as well as specific symptoms. toms with which they presented have gone and
It is then helpful to ask for a day by day, or week they have forgotten about them often because
by week account of the changes of symptoms in other aspects of the case have been revealed. This
order to establish a clear time line – it is especially may seem strange, but the curative process can be
important for the first few days after the remedy so subtle that sometimes the patient is unaware
was given. Explaining this and asking patients to that the remedy is acting or the picture ‘evolv-
note these early changes at their initial consulta- ing’. Vithoulkas’ (1978) description of this pro-
tion can help. It is useful to give this in writing as cess, ‘The follow-up interview’, is excellent and is
verbal instructions are frequently forgotten in the essential reading.
intensity of the first visit. It can also help if the
patient writes a daily record, like a diary, of the Inter-Current Events
response. Without this, patients will often jump Other factors which must be taken into consid-
about in time when recounting their symptoms, eration when assessing changes include any sub-
making it difficult to get a clear view of what has stantial deviation from the patient’s usual routine.
actually happened. Asking for a score out of 10 Going on holiday after taking the remedy, or a
for each symptom (for example, when zero would crisis in the family such as a death, or any other
Broadening our

be no problem and 10 would be the worst imagin- major change planned before the patient took the
Understanding

able) at each consultation, enables a comparison remedy, or an external event beyond the patient’s
with previous consultations. It can help to actually control all make assessing the effects of the rem-
record changes ‘over’ or ‘alongside’ the original edy difficult. Any major change initiated after the
case record, possibly in a different coloured pen, patient has taken the remedy must, of course, be
IV building a sort of three-dimensional record. considered a possible reaction to the remedy, such
as the patient suddenly deciding to take a holiday,
Analysing the Information or buying something they have always wanted, or
Knowing whether the remedy has truly acted cura- ending a relationship, or perhaps starting a new
tively requires careful assessment of all the infor- relationship. Careful consideration of every event is
mation the patient gives you. You cannot simply important as even something seemingly beyond the
take what the patient tells you at face value. patient’s influence – such as getting the sack at work,
or getting a new job, or meeting a new partner –
Change or No Change? may be the result of the action of the remedy and
It is surprising, when getting better, how a patient indeed may be central to the curative process.
can forget they ever had a symptom, so distressing Changes in prescribed or over-the-counter (OTC)
when they first presented. conventional medication and changes due to the
Some patients will report that the remedy has natural history of the disease process must also be
definitely worked and that they feel a lot better considered.
when, after detailed questioning, you discover that Thus in order to make a valid assessment of the
nothing much has changed. This can be because effect of a remedy it is necessary to have a clear

208
 Remedy Reactions

understanding of what constitutes cure in general, Remedy Reactions

and also in this patient in particular. This means you
will need to understand what needs to be cured in Having taken the case and analysed the informa-
the patient, and also how cure may proceed under tion, the prescriber must come to a conclusion
the influence of a homeopathic medicine. It includes regarding what the effect of the remedy has been
an understanding of the hierarchy of symptoms, and (see Chapter 15) and make a decision about what
the nature of an organism’s reaction to homeopathic the second prescription (if any) should be, taking
medicines – of which aggravation, amelioration, and into account the plan of treatment they had in
direction of cure are all a part. These issues have mind. There are many possible scenarios, and it
been covered in preceding chapters. is impossible to describe each and every situation.
A clear understanding of the homeopathic process
Re-Taking the Case is essential for the prescriber to make an informed
If it becomes clear that you do not have the infor- decision at this point. It is possible to give some
mation you need to find a good remedy for the general guidelines – I will do so under some broad
patient you will need to re-take the case. What headings.
this will involve will vary hugely from case to case
and the model of health you are using. It depends No Reaction
what is missing – it could be a simple modality or If there has been no change at all the homeopath must
it could be something profound. If you think that consider the following possible reasons for this.
the patient may have withheld some important
information you will need to elicit this somehow. Dud Remedy
The patient may not know what it is that you need The remedy has not been medicated for some rea-
to know, so it is not necessarily just a question of son (pharmacy error). Or the remedy may have
asking them what they have left out. Sometimes, been exposed to strong sunlight over time and
however, this may be what you need to do. It is been inactivated
not surprising that a patient may have not told you

Broadening our
Understanding
some deeply personal fact about themselves at the The Patient Did not Take the Remedy
first consultation. It may take time for them to trust This could be for a number of different reasons.
you enough for this to happen. All your case-taking They may have forgotten to take it, it may not
skills will be needed for this. have arrived in the post, they may have lost it, or

Follow-Up of Simple Case

they may have been suspicious of the remedy and
not wanted to take it. There are many other pos-
IV
The principles are exactly the same here as for sible reasons and it is always worth checking the
complex cases. The only difference is the time patient’s compliance.
scale. Hours become the equivalent of weeks,
so whereas you may have the first follow-up in Slow-Acting Remedy
a chronic illness after 4 weeks, in an acute illness Some remedies are known to be slow to act, and
you may have the first follow-up after 4 hours. may be especially likely to be slow in certain cases.
The exact timing will depend on the case and Kent describes a case where Silica produced one
may be shorter or longer than this. Certainly you of the best homeopathic reactions he had seen,
can expect to see changes within minutes or even but it took 6 months before there was any effect.
seconds in some cases such as a child with a high In modern life it is unlikely that either the homeo-
fever due to otitis media or tonsillitis, or a teeth- path or the patient will wait this long, but fortu-
ing child that is screaming. In the case of a cough nately such a long wait is rarely needed although
that has been going on for a few days you may fol- some remedies, e.g. Silica, do often take longer to
low-up after a day or two. act than others.

209
 CHAPTER SIXTEEN The Second Prescription

Wrong Remedy and duration of the pathology. Where there are

If you suspect this is the reason the next step is to structural changes in important organs, there is a
go back to the case and study it again. It may be greater possibility of serious or prolonged aggra-
that you already have a shortlist of close remedies vation – in these cases I usually prescribe a lower
and it is then simply a matter of choosing the best potency in order to minimise the aggravation. In
remedy on the list. Otherwise you may need to some cases it may take longer for the aggravation
re-analyse the case. You may decide that the case to begin after the remedy has been given, in oth-
you have is inadequate and you may then have to ers if the aggravation is only slight it instead goes
re-take the case (see below). on for longer. Some of the possible different reac-
tions are summarised in Figure 16.1.
Wrong Potency
Most patients will respond to some degree to any Aggravation
potency if the remedy is correct or at least a close The true simillimum could be said to be exactly the
similar, even though the ideal potency will work right remedy in exactly the right potency. In such
best. Occasionally a patient may be sensitive only to a case the aggravation (see Chapter 15) may be so
a narrow potency range but this is fairly unusual. subtle as to be hardly noticeable. A higher potency
may produce quite a strong aggravation of symp-
Remedy Antidoted toms, but even so the patient may not mind as they
The remedy may be antidoted either by accident will say that they feel better despite the aggravation
or on purpose. Antidoting factors may include a and the aggravation is over more quickly.
visit to the dentist, strong coffee, other medicines, A potency that is low may also produce an
a big shock or accident. None of these will always aggravation. This may occasionally be prolonged
antidote, and even if they do the effect of the rem- or happen each time the low potency is repeated
edy may pick up after a day or two. and a higher potency may be needed to complete
the cure. This may seem paradoxical. One way of
Types of Curative Reaction
Broadening our

looking at it is to think of the remedy as stimulat-

Understanding

Prescribing the most closely matched remedy (or ing the patient sufficiently to react but not strongly
simillimum) is ideally what the homeopath aims enough that this reaction is followed by ameliora-
for in every case, although finding this can be dif- tion. John’s case illustrates this.
ficult for a number of reasons. The case may not
IV be clear, or may not be properly understood by
the prescriber. There may be no remedy in the
CASE STUDY 16.1
homeopathic materia medica that closely matches
John, age 9, was brought to see me with
the case as it may have been inadequately proved
behaviour problems. He also had warts. His
or not be properly represented in the repertory.
health had otherwise been good for the previ-
Different methodologies may point to different
ous two years. Mother and father were sepa-
remedies, several of which might be close, but
rated. He was a very intense boy. According
only one is the simillimum. When the simillimum
to his mother, he would go totally berserk if he
is prescribed it will, if it is not blocked, produce
was angry. He was very jealous, particularly if
a reaction. The patient may just get better or may
his mother had a friend round. He was also
experience a homeopathic aggravation usually fol-
jealous of his younger brother whom he bullied
lowed by amelioration.
and would thump very hard. At school he was
The nature, intensity and duration of an aggra-
bullied. At home he was the bully. He was
vation will vary from case to case. It will be influ-
cautious, and fearful, especially of being alone.
enced by the potency of the remedy given, the
He was given Nux Vomica 200, single dose.
sensitivity of the patient, and also on the nature

210
 Remedy Reactions

Good remedy Precise simillimum Correct remedy

Action wait Action wait Action wait
Intensity of symptoms

Intensity of symptoms

Intensity of symptoms
Definite aggravation No aggravation Minor symptoms
followed by definite Marked improvement unchanged initially
improvement

Major
symptoms
better

Remedy Time (1 month) Remedy Time (1 month) Remedy Time (1 month)

Partial remedy or ‘incurable case’ Wrong or inactive remedy or wrong potency Much pathology
Action retake the case and re prescribe Action retake the case and re prescribe Action wait
Intensity of symptoms

Intensity of symptoms

Intensity of symptoms
Amelioration without No real change Long slow aggravation
aggravation of symptoms Slow improvement
Then full relapse

Remedy Time (1 month) Remedy Time (1 month) Remedy Time (1 month)

Irreversible pathology with gradual

Intensity of symptoms

deterioration of symptoms Slow worsening

Broadening our
Understanding
Action local support for patient.
May require a lower potency
or treatment focussing on local
symptoms in order to get
symptomatic improvement

Remedy Time (1 month) IV

Figure 16.1 Possible different curative reactions

First follow-up was two months later. He was described his new teacher as being a pain.
much better emotionally, was full of energy. He He was given Nux Vomica 200 single dose. Two
was ‘glowing’, as his mother put it. His warts weeks later his mother phoned and said that he
had gone. One got much bigger and then fell had been worse after the remedy with no sign of
off, the others disappeared. improvement. I suggested that she give him four
Nine months later in mid-September his doses of Nux Vomica 6. She phoned again 10 days
mother brought him back to see me as he had later to say that he had been temporarily better after
been getting angry a lot – screaming furies. He the Nux Vomica 6, but worse again since. I pre-
was wetting the bed, which made him cross. scribed Nux Vomica 1M. He was even angrier for
He had been fine until he started school. He 2 days after and then became very much better.

211
 CHAPTER SIXTEEN The Second Prescription

The following October, one year later, he better for a long time after Nux Vomica 1M.
began wetting the bed every night. He was really I prescribed Nux Vomica 1M.
angry about it and would not talk about it. He He was worse after the Nux Vomica 1M
used obscene language as if he was trying to and remained so, but I had no contact with
shock. He had lots of tantrums and socially he him or his mother until 1 month later. He was
was shy. He was grubby and dishevelled, also prescribed Nux Vomica 10M. He was quickly
lazy, but could not bear disorder in the house. much improved and remained so for another
Everything was unfair. He had been very much 2 years.

The main learning points from John’s case are aggravation that they do not tolerate well. It may
that you can get a prolonged aggravation if the come quickly, or it may take some time to appear
potency is not high enough. It is more likely to and may last a long time. Interfering with such a
occur in a case where the pathology is primarily reaction by making other prescriptions could spoil
mental or emotional. Giving a higher potency in such a patient’s possibility of cure. Alternatively,
this situation will push the patient out of aggrava- a patient with low vitality may show a good initial
tion into amelioration. This at first seems counter- response to a well indicated remedy, and then dete-
intuitive to the observation that an aggravation riorate because vitality is so seriously depleted.
is more severe if the potency is higher rather In severely ill patients, where the aim of care
than low. may be ‘terminal care’, a patient can get a dramatic
If you do get a prolonged aggravation in a case, improvement in symptoms (mentals, generals
you may rightly be concerned that giving a higher and locals) and find a more contented state. This
potency may make the situation worse. If there are improved state may be at the expense of long-
maintaining causes or the remedy is close but not term survival with worse symptoms. Weighing this
close enough then this may be the case. You may difficult balance raises important ethical issues
Broadening our
Understanding

have noticed that before giving a higher potency about the intention of treatment.
of Nux Vomica, I first gave a few doses of Nux
Vomica 6 which relieved – albeit temporarily. This
is a useful strategy to help you determine whether REFLECTION POINT
IV more of the remedy is needed, or whether you
have already given too much. If a few doses of 6
● How will you respond to the ethical dilemmas such as
how fully will you warn patients about an aggravation
or 30 potency aggravate further then you should and will you always tell the patient what you are
give no more of that remedy. If you get ameliora- prescribing? How do you feel about treating patients for
tion, even if it does not last, you then know that terminal care? These and other questions will benefit
more of the remedy is needed. I use the words from being fully discussed with colleagues and teachers.
‘more’ and ‘less’ here simply to indicate that fur-
ther doses are required, and you can be confident
that higher potency will work better. It is important to understand that cure is a process
The patient’s vitality is another factor that will and may take some time and several successive pre-
influence the nature of the aggravation. A patient scriptions to complete – if indeed complete cure is
with a strong vitality may have a strong aggrava- possible. In difficult cases the remedy can act to
tion, which comes on quickly (hours to a few days), clarify and reveal a case, showing a new picture
lasts a relatively short period of time (again hours and the need for different simillimum. There is
to a few days) and without long-lasting ill effects. much discussion about whether this means a first
A patient with a weak vitality may have a difficult remedy is just a similar, not the simillimum, and if,

212
 Remedy Reactions

in a confused and hidden case, it is possible to find or if a new remedy picture has emerged then it is
at the first visit a simillimum that covers all aspects the time to change the remedy. But be cautious
of the case – even those disguised or hidden in the unless or until a different remedy picture has
case. Perhaps it is more useful to think of the simil- become clear. The symptoms of the first remedy
limum as a dynamic state that can evolve in the will mostly have gone, so long as that remedy was
individual as a confused or hidden case becomes the simillimum at that time. You may have had
clear. glimpses of this remedy earlier, but it is better to
Aggravations need to be distinguished from wait for this picture to become clear in order to
healing reactions that might include the case being avoid choosing the wrong remedy, and also to get
expressed through more superficial symptoms or the maximum benefit from the previous remedy.
from previous unresolved symptoms. Skin erup- This will make your work simpler in the long run.
tions in particular may return or occur as healing Changing the remedy is discussed in more detail
progresses at a deeper level. Mental and emotional later (see Chapter 27).
symptoms frequently improve alongside or before
physical symptoms. Symptoms disappearing in the Partially Curative – Partial Similar
reverse order to which they appeared sometimes In much homeopathic practice it is probable that
bring a transient return of old symptoms. the majority of prescriptions are partial similars,
Remember the importance of differentiating also known as just ‘similars’. Frequently this is all
between return of old symptoms and the appear- that is possible when time is limited or in a con-
ance of new symptoms (see Chapter 15). The fused or hidden case as not all the symptoms are
patient may not always clearly remember old apparent. Similars can assist the healing process
symptoms – it is helpful to ask the patient specifi- just as the simillimum can; however, it may take
cally when a symptom appears to try and remem- several such remedies to complete the process.
ber if they have had it before. Often the return Homeopathy would probably die as a profession
of old symptoms is fleeting and may even appear if this were not the case. The following are charac-
in a dream. This kind of recall can include emo- teristic of the effect of a similar remedy:

Broadening our
Understanding
tional symptoms and the patient may dream of 1. Cures some symptoms and not others.
the original cause of an emotional upset or fear, 2. Action weakens when the remedy is repeated
after which the problem may be resolved. Old 3. Symptom picture may be different when the
symptoms which reappear may be the revealing effect of the remedy wears off.
of a deeper layer or other level that will not go so
quickly if it is not also covered by the remedy.
4. Partial proving – new symptoms appear that
are in the materia medica of the remedy given
IV
(as opposed to old symptoms returning).
Partial Relapse
When some time has passed after a successful first How well the remedy will act will depend on how
prescription and the patient gets a slight return of closely similar the remedy is to the case. A remedy
one or more symptoms – but overall remains well that is a very close similar may act almost as well
with the main symptom remaining better – you may as the simillimum. A remedy that has only a slight
wonder whether to repeat the remedy. In such cases, similarity to the case may have little or no action.
rather than waiting for a full relapse a few doses of Working with similars is slower, more complex,
the same remedy in a lower potency may be all that and involves several changes of remedy but it may
is needed to restore the patient to health. be all that is possible with some patients, and with
the repertoire of remedies available to or known
A Changing Picture by the homeopath. It requires close observation of
If repetition of the original remedy no longer has the patient and careful thinking over a period of
an effect, despite having tried different potencies time in order to make good progress.

213
 CHAPTER SIXTEEN The Second Prescription

It is helpful to think of the match of remedies Chapter 25). However, the goal of the simillimum
as a spectrum between no match and complete can keep the homeopath focused at all times on
match. If the remedy is closely similar the overall the best match of remedy to patient.
effect should be beneficial and there may be the
classic homeopathic aggravation followed by ame- Deterioration – Negative Change
lioration of symptoms. There may be one or two The most common reason for a patient deteriorat-
new symptoms appearing, but they should not be ing is the natural progression of the disease, but
troublesome and will soon pass off. The patient it is important to be aware that a homeopathic
will usually be pleased with the result. medicine can occasionally be responsible for the
If the remedy has only a slight similarity to worsening of a patient’s condition. This may take
the case there may still be improvement in some the form of a prolonged aggravation of specific
symptoms. There is less likely to be an improve- symptoms or a decline in the patient’s energy and
ment in overall well-being of the patient except well-being if vitality is already compromised. In
possibly for a day or two. This can be confusing these cases a choice has to be made whether to
for the inexperienced prescriber as the patient wait to see if a new picture emerges or if the remedy
may report that they felt a lot better for the first should be antidoted (see ‘Antidoting’ in Chapter 15).
couple of days and then relapsed to the previous A general decline can also be brought about by
state. The patient’s view may then be that the rem- prescribing too high a potency in a patient with
edy was good but it didn’t last. The patient may a very weak vitality – usually associated with pro-
ask for a stronger or more frequent dose. In such longed, severe and suppressed chronic disease.
a case repetition is unlikely to be of much ben- Care is always needed in prescribing for such
efit. On the contrary, new symptoms may appear cases. While homeopathy is a subtle form of treat-
after such a partial similar, not necessarily after ment its effects are very real and it is not helpful
the first dose but if the remedy is repeated new to patients or the student homeopath to think that
(proving) symptoms, typical of the remedy but not indiscriminate prescribing can do no harm.
Broadening our

of the patient, may appear. In some cases these

Understanding

proving symptoms may be burdensome and per-

sistent, requiring an antidote. Patients who are
sensitive and react easily to stimuli are more likely
Prescribing the Next Dose
to develop proving symptoms. If the first remedy was the simillimum then when
IV One way of looking at similars is to think of an
archery target, the bull’s eye being the goal, which
the patient relapses the remedy may be repeated
either in the same or a different potency. In my
is equivalent to the simillimum. Close similars are experience the same potency will usually act well
in the ring surrounding the bull’s eye, partial simi- for two or three repetitions (more in long-stand-
lars in the outer ring. Remedies that have no effect ing cases if the remedy suits the case deeply) after
whatsoever have missed the target completely. which the potency may need to be changed. One
While the bull’s eye or simillimum is the goal it indication when to change is how long each repeti-
cannot be achieved in every case. Hitting some- tion of the same potency acts. If it lasts longer than
where within the target range much of the time is the previous one, the remedy is still accurate and
a reasonable expectation. Remember also that the acting deeper. If shorter, another remedy state may
remedy is only part of the homeopathic process. be emerging. Common practice is for the potency
Every aspect of the patient’s encounter with the to be increased, usually by one step, e.g. from 200
homeopath can be therapeutic, including taking to 1M, or from 1M to 10M. Usually this will work
the case, and discussing life style options and other well. Occasionally I have found that increasing the
management strategies (of which homeopathic potency has not worked, as Jean’s case illustrates,
intervention is only one part) with the patient (see but I think this is the exception rather than the rule.

214
 Prescribing the Next Dose

CASE STUDY 16.2

Jean, age 49, had presented with rheumatoid all the time, always tired. At this point the case
arthritis and had responded well to Sulphur for changing the remedy is growing stronger.
1M, single dose. She felt better in herself quite However, in view of the excellent response of the
quickly, and there was a gradual improvement first dose of Sulphur 1M, and the lack of an obvi-
in her joint symptoms until they were about ous new remedy to give her, I decided to persist
60% better. The improvement lasted nearly five with Sulphur and gave her a 200 potency.
months, after which she relapsed. She felt flat After the 200 potency Jean had a remarkable
and the joint pains were getting worse. improvement. She felt much better within 2–3
I repeated Sulphur 1M and saw her 1 month days and her joint symptoms were 90% better
later when she reported, ‘Everything has gone for the first 2 weeks. She remained a lot better
wrong’. She had a headache like she had never for 8 months, although not as good as 90%.
had before, and then 3 hours after the remedy After 8 months she was relapsing again. Sulphur
she vomited, which made the headache worse. 200 was repeated, with no effect after 6 weeks.
She was then fantastic for a week, joint pains I then gave her Sulphur 1M which worked very
were very much better, but it was downhill from well, all symptoms much better within 2 days.
there on. This scenario suggests, of course, that ‘You have hit the nail on the head’ she said.
the remedy was a similar and not the simillimum The improvement lasted 7 months, albeit with a
so I studied the case again to see if another few ups and downs along the way. Sulphur 1M
remedy might be more appropriate. Sulphur still repeated – no effect. Sulphur 10M given – no
seemed to be the best choice so I decided to effect. Sulphur 200 given – better for 1 month.
increase the potency to 10M. Sulphur 1m given again, no effect. Sulphur 200
One month after Sulphur 10M Jean reported given again – slight improvement for the first
that she had a slight improvement in the first 10 days, then a lot better: ‘I’ve improved nicely –
week, and then she felt worse again. She lovely’ she said. This improvement lasted for

Broadening our
Understanding
also said that she felt on the verge of a cold several months.

The pattern of prescribing in Jean’s case con- If Sulphur had ultimately failed then re-taking the
tinued for a further 2 years, after which I lost case would have been the next option (see above).
touch with the patient. The main learning points
from this case are:
Another action I might have taken would have been
to prescribe a nosode as an inter-current remedy.
IV
1. Increasing the potency is not your only
option and is not always the right thing When to Repeat
to do. A lower potency may be needed The patient will often not be permanently cured
and may act better. Ideally the potency by the first dose of the simillimum. If this is the
of the remedy should be matched to the case, then when the reaction to the remedy finally
patient’s need – this need can move in either wears off some or all of the symptoms will gradu-
direction. ally relapse – when they do they will be the same
2. Do not be in too much of a hurry to change symptoms as before. However, they will usually
the remedy. The overall outcome of this case be less severe than before. J T Kent describes this
was good although not perfect. At no time very clearly in his Lesser Writings:
after the first dose of Sulphur 1M did the ‘After the curative impulse has entirely subsided, the
patient’s symptoms relapse by more than symptoms will appear one by one, falling into place to
50%. Her relapses were relative and she never arrange the image of the disease before the intelligent phy-
went back to her original state. sician for the purpose of cure. If the first prescription was

215
 CHAPTER SIXTEEN The Second Prescription

the simillimum, the symptoms will return, and when they have to be with getting the timing right? What hap-
return, asking for the same remedy.’ pens if you repeat the dose too soon? If you repeat
too soon you may cause a proving. This can be a
When the effect of the remedy has clearly worn problem because the proving symptoms may make
off it is then time to give another dose of the same you think the patient needs more of the remedy
remedy (see ‘Getting the timing right’ below). if you don’t understand what is happening. If you
There is some difference of opinion as to whether wait too long you simply delay the cure – better
the potency should be the same as the first pre- than prescribing too soon. But you don’t have to
scription or whether it should be slightly different. wait until all the symptoms have returned.
Certainly in The Organon Hahnemann says that In my experience you can repeat the remedy
potency should be slightly different – this, how- when the symptoms are beginning to return with-
ever, refers particularly to the LM method of pre- out causing any harm to the patient. But you need
scribing. Kent is clear that the same potency can be to wait long enough to be sure that the patient is
repeated, so long as it continues to act. Certainly not just having a bad few days or that a different
in my experience a repetition of the same potency picture is emerging. Most people’s symptoms wax
will act well in most such cases, usually for at least and wane a bit and there is no harm in waiting a
two or three repetitions. Any aggravation follow- few days to be sure. The time scale will give you
ing the first prescription is likely to be less on rep- another clue. If it is 3 months since the first pre-
etition, if the simillimum was prescribed. scription and the symptoms are returning then it
is highly likely that a repeat is needed. If it is only
Change of Potency 2 or 3 weeks and the patient has had a bad week
After a few repetitions (as and when indicated by then it may be only a temporary relapse of symp-
the symptoms of the case) the remedy may not act toms and it is better to wait.
so well, or the duration of action may be shorter. Some patients will plateau. That is to say their
This is the time to consider changing the potency. symptoms have improved, and they feel better,
If the relapsing symptoms remain the same then
Broadening our

but they have reached a point where they are not

Understanding

only the potency, and not the remedy, should be making any further progress. After some time has
changed. It may be that some new symptoms will passed the case needs re-taking to ensure there are
appear – these can be the first indication of a new no blocks to cure and new symptoms have not
remedy picture emerging. However, the remedy emerged. If not, then it is reasonable to repeat the
IV should not be changed at this point; the original
remedy should be given in a different potency,
remedy. The exact timing of this will vary from
case to case.
usually higher, and will usually work well.
‘When the picture comes back unaltered, except by the Changing the Remedy
absence of some one or more symptoms, the remedy There are some cases in which one remedy is suf-
should never be changed until a still higher potency ficient, and repetition of the same remedy, perhaps
has been fully tested, as no harm can come to the in different potencies, as and when called for by
case from giving a single dose of a medicine that has the symptoms, is all that is ever needed. However,
exhausted its curative powers. It is even negligence not many cases will need a change of remedy at some
to do such a thing.’ stage. The less the similarity of the first remedy
J T Kent, Lesser Writings to the case the sooner this will be. I have always
strongly expressed the view that if you have given
Getting the Timing Right a remedy that is working well, do not be in a hurry
The general rule is that you repeat the remedy when to change it (even if it is not the simillimum) as
the previous dose has completed its action, that is, a new remedy picture can take some time to be
when the symptoms recur. But how precise do you seen clearly. Often the first remedy will be ‘good

216
 Bibliography

enough’ and over time a cure can be established. The next remedy will often be related to the
I have seen so many cases, some my own, where first remedy in some way. It may be a complemen-
the remedy has been changed and the second tary remedy, or one that is known to follow well.
remedy given was not as good as the first. Often Studying the related remedies will usually make it
the first remedy has not been given enough time to easier for you to find the next remedy when it is
complete its beneficial action. It is easy then to lose called for by the symptoms.
sight of the first remedy and keep on changing to
yet another remedy – the case then becomes con-
fused. It is not necessarily the patient’s symptoms Summary
that become confused, but rather the prescriber
My intention in this chapter has been to give you
becomes confused and may end up giving so many
clear guidelines that you can work with and which
different remedies that he cannot see the wood for
I hope will make your work as a homeopath easier.
the trees.
They are guidelines – not hard and fast rules. Some
Suppose that you want to drive from London
cases will be simple and require few prescriptions.
to Leeds and you choose to take the A1. This is
Others will be more complex and require many
not a bad choice, but after 10 miles and several
prescriptions over time. Every case is unique, and
roundabouts you may get impatient with the A1
although many will follow the patterns that I have
and think that the M1 would have been better.
described, there will always be some cases that will
You may then take the next exit heading towards
be different in one way or another. If you take a
the M1. This is all well and good and you may
logical approach to your work, finding what these
reach the M1, which will take you directly to
differences are and responding appropriately will
Leeds. However, you may find that the road you
enable you to find your way through.
have taken passes directly over the M1 and you
end up meandering down side roads for ages. You
may end up completely lost. At least if you had
stayed with the A1 you would have been mak-
Bibliography

Broadening our
Understanding
ing good progress towards Leeds. Eventually, of Hahnemann S 1842 Organon of the medical art, 6th
course, the A1 bypasses Leeds, but it will have edn. Based on a translation by Steven Decker, edited
brought you quite close and at the right moment and annotated by Wendy Brewster O’Reilly. 1995
Birdcage Books, Washington.
will give you clear signposts to direct you the rest
of the way. This is the equivalent of the perfect
time to change the remedy. The A1 will take you
Kent J T 1926 New remedies, clinical cases, lesser writ-
ings, aphorisms, and precepts. Ehrart & Karl, Chicago
IV
no closer. The symptoms of the patient will at this Vithoulkas G 1978 The science of homeopathy. ASOHM,
time clearly call for a different remedy. Athens

217
CHAPTER SEVENTEEN

The Chronic Miasms Materia Medica

David Lilley

a dynamic understanding of the materia medica.

Introduction by David Owen These are fundamental to understanding suscepti-
Recognising that there are traits and patterns that bility, and it is no coincidence that they are linked
run through patients and that link together rem- to the suppression of deeply ingrained, disease
edies was, and still is, a turning point for homeo- states. David sets the groundwork for further
paths. For the homeopathic profession it enabled study of the miasms (see Chapter 22) and provides
an approach to cases that would not respond to a model for seeing miasms as a fundamental and
prescriptions based solely on presenting (disease) evolving tool for the homeopath ready to take
symptoms. For individual homeopaths it provides treatment to the inside.
the tools to move from seeing cases from ‘the out-
side’, focusing on the disease state, to grasping
the meaning of more complex and otherwise con-
Miasmatic Theory
fused cases ‘from the inside’. For many, the outer The highest calling of the homeopathic physician is
manifestations of disease including the cause, the facilitation of the individuation process of the
presenting symptom, even the totality, is more patient by harmonising homeopathic therapy with
familiar than the inner world of the patient’s suf- the spiritually healing power of illness.
fering. This inner world touches the patient’s con- Possibly the most precious jewel in the homeo-
stitutional susceptibility, patterns of susceptibility pathic philosophical crown is the theory of the
shared by many, and even our own inner state. To chronic miasms. It provides us with a profound
help navigate this transition, I am delighted that understanding of the evolution of chronic disease
David Lilley has agreed to share his insight into within the animal kingdom, and proves of inesti-
the miasms – the most historic and useful of the mable value in the clinical assessment of the patient,
patterns that homeopaths can tap into. in planning a strategy of therapy, and in the evalu-
Previous chapters have already introduced the ation of therapeutic response. It also gives clarity,
idea of themes within a case and remedy, reflect- meaning, and relationship to all the many and var-
ing and linking together aspects that might oth- ied manifestations of disease and their erstwhile
erwise not be seen as clearly. We revisit other arbitrary and disconnected, generic classifications.
thematic ways of looking at cases and remedies It invites you to see the essentially beneficent and
in later chapters, but first, it is part of a homeo- creative role of disease in the destiny of human-
path’s common understanding to see the major ity and its catalytic affect in the unfolding of the
miasmatic themes that influence our patients and spiritual qualities of the individual.
ourselves. Understanding how unique remedies I shall commence by introducing you to the the-
relate to each other is the next stage in developing ory of miasms, building on the brief introduction

219
 CHAPTER SEVENTEEN The Chronic Miasms

given in Chapter 14. Historically, the concept of a deeper, hidden, destructive force – and that only
the miasms was the chief element in determining treatment which addressed this underlying condi-
and understanding the homeopathic management tion would prove permanently curative.
of chronic disease. Despite modern developments Hahnemann called this a ‘miasm’, describing the
in homeopathic knowledge and diverse method- concept of an undermining, pervasive process of
ologies, miasmatic theory remains a major fac- contamination or pollution of the system, a blight
tor in case analysis and a major methodology for or stigma, acquired or inherited, which renders the
prescribing. In elucidating the miasms, I shall take individual susceptible to certain patterns of illness.
you through the evolution and the cardinal char- He identified the presence of three major miasms:
acteristics of the five miasms that play a critical the psoric miasm, presenting externally by way of
role in how chronic illness manifests. Although an itch or eruption, such as scabies, and the sycotic
only a few remedies can be mentioned here, these and syphilitic miasms, related to the sexually trans-
do reveal how the materia medica can be under- mitted diseases gonorrhoea and syphilis. After
stood in the light of the miasms, and illustrate a Hahnemann, other researchers identified the tuber-
way of discerning how themes and patterns run cular miasm, perceived as a combination of psora
through a case. Finally, I wish to show how the and syphilis, and carcinosis, the cancer miasm –
miasms relate to each other dynamically, and how a mixture of the other four miasmatic traits, with
perceiving miasmatic evolution as a spiral permits one or other miasm dominant.
us to anticipate and recognise therapeutic strate-
gies likely to be central in the treatment of new The Disease Continuum
and evolving diseases, such as Aids. These fundamental miasmatic patterns are pres-
ent within all of us in varying degree, influencing
Hahnemann’s Miasmatic Theory our feelings, thoughts, inclinations and behav-
Hahnemann observed that despite removing all iour. The miasmatic influence may be subtle or
hindrances to cure, and successfully treating acute starkly apparent. Other factors that contribute
Broadening our

conditions, such cases showed a repeated tendency to the unique make-up of the individual, and
Understanding

to relapse – presenting either a recurrence of simi- which are intermeshed with the miasmatic attri-
lar or more severe symptoms or, in many instances, butes, are endowed and inherited qualities and the
the emergence of a changed or different clinical effects of situational imprinting and conditioning.
picture. It was as if some underlying condition, These all combine to form filters through which
IV which had remained unaddressed by even the most
carefully selected and successful remedy, continued
the individual perceives a distorted image of real-
ity. Conclusions, prejudices and responses based
on its inexorable course. His experience with cases on distorted perception or delusion account for
of chronic disease proved similar – initial improve- much of humanity’s strife and misery.
ment would be followed by relapse and previously Homeopathic philosophy regards disease as a
successful remedies inexplicably lost their efficacy. continuum, or miasmatic sequence, which began
Intrigued by these experiences, and still con- in our distant, ancestral past, extending down to
vinced of the validity of the homeopathic principle us through countless generations. ‘The sins of the
of cure, with his characteristic thoroughness he set forefathers visited upon the children’ – each gen-
about searching for patterns of disease in patients eration adding its contribution to the disease leg-
and in their family histories to explain and solve acy. Palliative and suppressive methods of therapy
the problem of this phenomenon. After a period can only add to the continuum and its complex-
of intensive investigation, his conclusion was that, ity. Our constitutions may be considered as vessels
like waves on a vast ocean, both the manifesta- of water removed from the ever-flowing river of
tions of acute illness and the symptoms and signs life. Water drawn from the river has been polluted
of chronic disease were superficial expressions of upstream by the fears, grief, angers, jealousies,

220
 The Psoric Miasm – The Miasm of Deficiency, Deprivation, and Despair

nature of the psoric miasm. Box 17.1 names a few

PSORA
of the main features of the psora.
The Miasm of Deficiency
The inferior eg – guilt
Lack of basic trust
The Origin of Psora
Victim consciousness ‘The oldest history of the oldest nation does not reach
Resignation
Psychosomatic diseases its origin. Unless it is thoroughly cured, it persists in the
Functional diseases organism until the last breath of the longest life. Not
‘Never well since’
even the most robust constitution, by its own unaided
SYPHILIS SYCOSIS efforts, is able to annihilate or extinguish Psora.’
The Miasm of Destruction The Miasm of Excess
The inflated ego – pride The dissipated ego – shame S Hahnemann
Delusions of persecution The escape from Psora
Obsessive-compulsive disorder Reluctance to incarnate
Antisocial personality Duality and deceit
Destruction of tissues Control and fixed ideas
Loss of identity Hedonism and addiction
Morality and sanity Over growth of tissues
Profuse discharges BOX 17.1
Major Characteristics of Psora
●
Psychosomatic disease; emotions cause
functional disease
●
Disturbed homeostasis
Figure 17.1 The three main miasms ●
Functional disturbances without structural
change
resentments, and hatreds of our forebears, includ- ●
Psora and deficiency are synonymous:
ing those of our parents. Our miasmatic state is ●
food intolerances
the product of this pollution, and of our own dys- ●
inability to thrive
functional acting and thinking. ●
hunger and food cravings
By the same analogy, if the individual is the ves- ●
Weakness of the vital force – debility, ener-
sel, the family is the stream, the community is the

Broadening our
vation, and lack of stamina

Understanding
river and humanity is the ocean. Pollution of the ●
Lack of vital heat
vessel will inevitably pollute the stream, the river, ●
Lack of vital reaction:
and ultimately the ocean. Conversely, by address- ●
impaired immunity and impaired pow-
ing the causes of pollution in the individual, we ers of repair and recuperation
are able to modify the distorting, miasmatic filters
and positively influence the health, not only of
●
well-selected remedies fail to relieve or IV
permanently improve
the patient, but also of the family, the community ●
Alternating states
and ultimately of humanity – bestowing a legacy ●
‘Never well since’: conditions dating from
of improved health upon those who come after us. some previous, sometimes remote, mental,
Figure 17.1 gives a diagrammatic representation emotional, infective or physically trau-
of the three main miasms. matic event
●
Conditions following suppression of erup-
tions or discharges, or suppressed func-
The Psoric Miasm – The Miasm tion
of Deficiency, Deprivation, ●
Hypersensitivity of the immune system:
and Despair the atopic state
●
Hypersensitivity of the faculties
The name ‘psora’ derives from the Hebrew word ●
Psoric cases are relieved by skin eruptions
‘tsorat’ meaning a groove or a fault; a pollution and by natural eliminative processes
or a stigma. These words accurately describe the

221
 CHAPTER SEVENTEEN The Chronic Miasms

‘The greatest force to arouse the evils of the psoric dys- ences remained transient and mild, the vital force
crasia is grief and sorrow.’ was able to dissipate their effects without harm,
H A Roberts but when they proved recurrent, prolonged, or
intense, its tolerance threshold for maintaining
Psora represents the origin and foundation of dis- homeostasis was exceeded, and a centrally based
ease in the human species, and is reflected in the disturbance of the internal economy resulted. The
animal world, especially in those species which vital force displaced this imbalance outwards onto
have been closely associated with humankind. The the least harmful part, the skin, and a state of ‘itch’
miasm is of ancient origin. It is the most funda- developed, later followed by eruptions.
mental taint and hence has been described as ‘the With further emotional stress, extended over
mother of all disease’. It is the presence of psora generations, the skin could no longer suffice as
that makes all other diseases or miasms possible. It a superficial safety valve to alleviate the internal
is the beginning of the disease continuum. disturbance. Ever-deeper manifestations of psora
When archaic man first evolved from his homi- followed – in an invariable sequence – from the
nid predecessors, he was still an innocent child of periphery to the centre, from superficial parts to
nature, living in harmony with nature’s processes deeper parts, and from organs of less importance
and protected by the instinctive, animal will. There to organs of greater importance. The external
was no dis-ease of miasmatic form. Some 100 000 itch was symbolic of an internal itch – the first
years ago a vital transition point in human intel- susceptibility or vulnerability to disease. All sub-
lectual and emotional evolution was reached – sequent disease builds on this susceptibility, which
evidenced by a vastly more sophisticated tool remains as part of the human condition, is inher-
technology and anatomical changes required for ited, and displays itself in all the many and varied
complex speech. It was this expansion of emo- forms of functional and psychosomatic disorders
tional capacity and cognitive ability that provided characteristic of psora. Only later, with the sup-
the soil for dis-ease and subsequently for psora. pression of these disorders and the admixture of
While all animals experience what we under-
Broadening our

other miasmatic influences, would disease become

Understanding

stand as basic emotions, it is the ability to feel structural.

and suffer these emotions subjectively, vicariously, Because the vital force always seeks to exter-
empathetically, and sometimes for an extended nalise any dysfunction, diverting it away from
time, which distinguishes the emotional life of critical organs and systems, the manifestations
IV Homo sapiens. Interwoven with these profound
changes came that most wonderful human attri-
of psora are highly vulnerable to suppression.
If suppression should take place, the implosion
bute: the capacity to love in that singular and of morbid energy will prove detrimental to the
special way that only humans can. Such a love future health of the patient. This is very much the
intensifies fear of loss, and the grief and bereave- present situation of humanity – and the conse-
ment that follow loss. Psora is the inevitable price quences are alarming. Modern medicine, heedless
of innocence without enlightenment. of nature’s healing methods, and yielding to expe-
diency, is continually designing ever more sophis-
Psora and the Vital Force ticated means of suppressing the manifestations of
The cause of psora, and therefore of all endog- disease. The disease continuum is constantly being
enous, miasmatic disease, originated in the mind intensified.
of man with thoughts and emotions, which were
out of step and in conflict with nature’s harmony The Advent of the Sulphur and Psorinum
and balance. These incrementally impinged on Archetypes
the ordered frequency of the homeostatic vital The evolutionary unfolding of the human mind
force of the body. While these negative influ- created circumstances fraught with the potential

222
 The Psoric Miasm – The Miasm of Deficiency, Deprivation, and Despair

for psychosomatic disease. Archaic Homo sapiens, The Psoric View of Life
like other primates, was at one with his environ- For the psoric being, birth onto the earth plane
ment and compatible with his peers. Dominance may be likened to expulsion from paradise and
was strictly hierarchical; aggression and submis- descent into chaos. Common feelings, often
sion were ritualistic and essential for the propa- unconscious, are of being alone, abandoned, for-
gation of the strongest genes and for preserving saken, isolated, inferior, insignificant, puny and
the integrity and the security of the troop. On to vulnerable. They are at the mercy of an unfeel-
this idyllic stage stepped the first psoric arche- ing, unthinking, remorseless, clockwork universe.
type Sulphur: alpha man – aggressive, assertive, Life is not benign, nor does it have positive intent.
domineering, competitive, territorial, selfish and Tormented by legions of fears, frequently about
egotistical. His advent commenced the subtle and security and survival, they are pessimistic and
insidious process of empowerment of some at filled with foreboding, always borrowing trouble
the expense of others. Released from instinctive and anticipating failure and misfortune. Troubled
control, the egocentric nature of Sulphur asserted by a heavy sense of responsibility and duty, they
itself and behaviour contrary to the welfare of the are easily moved to feel guilty, unworthy, and even
tribe, and eventually the species, was gradually beyond redemption. Resignation is more common
initiated. than acceptance, and a sense of martyrdom may
Knowing the workings of the Sulphur mind offer them consolation. Some features of a psoric
and with the annals of human history before us, view of life are given in Box 17.3.
we can anticipate that domination became oppres- The causes of psora remain with us to this day
sion and eventually persecution; that aggression and are ever multiplying. Most important is the
became violence and eventually murder; that sub- lack of a loving, holding environment in early
mission became deprivation and eventually slav- childhood, and hence the failure to develop basic
ery. With the emergence of the entitled alpha-type trust. Other causes are: intense, prolonged or
and the disentitled beta-type, as revealed in the suppressed emotions; the stresses of modern life;
ancient texts, mankind arrived at the Cain and conditions that threaten the security and stability

Broadening our
Understanding
Abel stage of emotional evolution. Cain and Abel – of life; conditions that break the spirit; poverty,
alpha and beta man – Sulphur and Psorinum – squalor, overcrowding, malnutrition, and lack of
perpetrator and victim. A study of the materia education; loss of freedom; discrimination and
medica of these two remedies will provide further victimisation. On the physical plane the depriva-
insight into this critical relationship. The major
psoric remedies are given in Box 17.2.
tion of psora is manifested in a state of malfunc- IV
BOX 17.3
The Psoric View of Life
BOX 17.2 ●
Lack of basic trust
Major Psoric Remedies ●
Lonely, isolated, disconnected
Many remedies, but especially all the carbons ●
Vulnerable, defenceless
and carbonates; the psoric triad – Sulphur, ●
Inferior, unworthy
Calcarea carbonica, Lycopodium – all rem- ●
Abandoned, rejected
edies derived from elements and molecules ●
Pessimistic
vital for normal physiology. ●
Depressed, despondent, despairing, sui-
The nosodes: psorinum; the bowel nos- cidal ideation
odes: dysentery co; Gaertner; the Morgan ●
Apathetic, purposeless
group; mutabile. ●
Self-pitying

223
 CHAPTER SEVENTEEN The Chronic Miasms

tion – usually, but not always, an under-reaction, ciation, entertainment, indulgence, sensual grati-
resulting in deficiency, malnutrition and suscepti- fication, excitement, excess, ecstasy, and lust. By
bility to infection and infestation. Psychosomatic saturating the senses we attempt to ease or numb
disease and disturbed homeostasis are the basis of the pains of our reality and proverbially lose our-
psora. Despite all its negativity, psora is the begin- selves in ‘wine, women, and song’. To aid us in
ning of the individuation process of the evolving this quest, we have food, tea, coffee and tobacco,
human psyche. The individual is a spiritual being and more ominously, alcohol, cannabis, and other
on a mystic quest, in search of his, or her, divinity; mind-altering substances. In our flight from psora
their disease is a mystic experience with mystic we invoke Dionysos (Roman: Bacchus) the god
significance, it charts their course, their ascent to of wine, feasting, revelry, sexual rapture, ecstasy,
perfection. Working with disease and not against debauchery, and psychotropic drugs. Though we
it, deep homeopathy facilitates the process of self- may temporarily escape the doom and gloom of
realisation. This objective is the highest calling of psora, instead of liberation, we induce depen-
the homeopath. dency, addiction and destruction. In sycosis the
tendency for progressive emotional deteriora-
tion through habituation to vice is highly charac-
The Sycotic Miasm – The Miasm teristic. Although the concept of original sin is a
typical example of psoric thinking, sin began with
of Excess, Escape, and Decadence sycosis not psora.
‘Sycosis’ was the name Hahnemann gave to the
chronic miasm that is linked to gonorrhoea. It is Sycosis and Gonorrhoea
derived from the Greek ‘sykon’, meaning fig. Another layer of susceptibility is added to that of
Sycosis therefore means fig-wart disease, which psora and the predator – waiting opportunisti-
describes the frequent external manifestation of cally in the wings is the Neisseria gonorrhoea, the
the otherwise concealed miasm. pathogenic organism responsible for the sexually-
Broadening our

transmitted disease gonorrhoea. However, just as

Understanding

Sycosis: the Escape from Psora scabies is not the cause of psora, but a consequence
The oyster, the source of the remedy Calcarea of the psoric state of mind, so gonorrhoea, though
carbonica, metaphorically portrays the psoric intimately related to the sycotic miasm, is not the
response to a life experienced as inherently cause of sycosis, but a consequence of a promiscu-
IV threatening and hostile. It produces a shell or
shield to protect itself and anchors itself firmly
ous, delinquent, and reprobate mind. Reflect on
the sycotic view of life in Box 17.4.
to its rock. However, the evolutionary thrust in Gonorrhoea has a history going back into the
molluscs is towards emancipation and reaches its shadows of antiquity. Transmission occurs almost
greatest freedom of expression in the cephalo- exclusively by direct sexual contact. Remarkably,
pods: the cuttlefish, squid and octopus. Likewise the gonococcus is only pathogenic to humans. Our
in the individuation of the human psyche there inner nature provides the susceptibility; hence,
is an inevitable and unconscious urge to escape immunity to re-infection is negligible. Psora must
from the negativity of psora. Psora is human life be present in the constitution before gonorrhoea
under duress, existing in a delusion of separation, can be contracted. This susceptibility is not only
vulnerability, and mortality. It is intolerable. The linked to psora, but also to the degree of sycosis
desire to escape the psoric delusion lies at the heart already present in the constitution and an absence
of the sycotic miasm. of virtue or morality. Its contagious power is at
We now live in a sycotic age, dominated by its highest in promiscuous, illicit, and clandestine
escapism: an escape into distraction, denial, disso- sex; in sexual congress without a relationship,

224
 The Sycotic Miasm – The Miasm of Excess, Escape, and Decadence

permeates the entire constitution and becomes a

BOX 17.4
progressive, pathological influence throughout
Major Characteristics of Sycosis
life, and is capable of transmission to sexual part-
●
Escapism
ners and offspring.
●
Autism: refusal to incarnate fully
Sycosis may be defined as a constitutional, mias-
●
Duality: false front, closed, private, secre-
matic state that is either inherited or transmitted
tive
sexually and which is exacerbated by a neglected
●
Control: perfectionism, fastidiousness,
or suppressed gonorrhoeal infection.
obsessive-compulsive disorder
●
Fixed ideas
The Duality of Sycosis
●
Hedonism: high sexual energy, sexual perver-
Nature is the grand creator of symbols, through
sions, creatures of the night, ‘wine, women
which she transmits her silent knowledge. The
and song’, self-abuse: alcohol, recreational
gonorrhoeal organism is a diplococcus, symbolis-
drugs, excess, extremism, fanaticism
ing in its twinning the duality and duplicity of the
●
Passionate, intense
sycotic mental state. The symbol is of two kidneys,
●
Addiction and habituation
which points not only to these organs, but also to
●
Jealous, possessive, suspicious
the entire genitourinary tract, the pelvic organs,
●
Vindictive hate
and the water metabolism. These are the particu-
●
Deceitful; manipulative; exploitative
lar targets of sycotic disease. The sycotic may be
●
Overgrowth of tissue, infiltration, thicken-
the victim of sexual abuse. An unconscious sur-
ing, adhesions, tumours
vival strategy of victims is splitting, disassociating,
●
The mental state is relieved by the appear-
or disconnecting from the body with a sensation
ance of warts, growths, or abnormal dis-
of being split in two, of being double, or floating.
charges and aggravated by their suppression
These are symptoms to be found in major anti-
●
Sycotic discharges are green to greenish-
sycotic remedies.
yellow; fish-brine odour
Another example of sycotic duality is the

Broadening our
Understanding
●
Herpetiform eruptions
opening up of psychic awareness to other dimen-
●
Streptococcal infections and their compli-
sions. The hedonism intrinsic to the escapism
cations
of sycosis magnifies the inherent duality of the
●
Sycosis attacks tissues of mesodermal origin:
human psyche: the saint and the sinner, the
reticulo-endothelium, connective tissue
wholesome and the perverse, the ego and its
shadow. Conflict between the moral and the
IV
corrupt ensue. The sycotic personality is ever in
companionship, bonding, mutual respect, or love; contention with itself. In the Anacardium arche-
and where alcohol and cannabis are involved. type this sense of duality and conflict is experi-
The toxicity of the gonococcus appears to be enced as a devil on one shoulder and an angel on
entirely due to an endotoxin. Therefore, even suc- the other. They are often creatures of the night,
cessful antibiotic therapy results in the release of drawn to the bright lights, throbbing music,
endotoxin into the system and causes a thorough sleaze, sensuality, and places of ill repute where
gonorrhoeal intoxication. When a cure is affected they can indulge their hedonistic preferences.
by appropriate homeopathic stimulation of the As dusk approaches their complaints recede and
body’s defence systems, this complication is pre- they come alive, their minds energised, brimming
vented. Acute infections that remain untreated, or over with creative thoughts. This state continues
are chemically suppressed, add further sycotic con- into the early hours of the morning. They are
tamination to the existing miasmatic load. Sycosis passionate, intense, and extreme, always seeking

225
 CHAPTER SEVENTEEN The Chronic Miasms

new sensual thrills, often the forbidden and the

BOX 17.5
taboo, to stimulate their jaded appetites.
Major Sycotic Remedies
Alumina; Anacardium; Antimonium crudum;
The Shame of Sycosis
Argentum nitricum; Cannabis indicus; Cannabis
Whereas the psoric sense of responsibility and
sativa; Cimicifuga; Lachesis; Lilium tigrinum;
duty encourages guilt, the devious, clandestine
Lycopodium; Natrum muriaticum; Natrum
life of the sycotic fosters shame. The sycotic feels
sulphuricum; Nitric acid; Platinum; Pulsatilla;
soiled, blemished, and unclean, and may experi-
Sanicula; Sepia; Silicea; Staphysagria; Sulphur;
ence self-loathing. This is a rejection of self and
Thuja; all the Muriatics (chlorides).
is pathologically reflected in autoimmune disease,
The nosodes: Medorrhinum; the bowel
which is essentially sycotic. They are closed, pri-
nosodes: Morgan-Pure; Sycotic co; Proteus.
vate, and secretive. Whereas the fear of psora
requires a shield, the shame of sycosis demands a
mask. The mask we wear to conceal our rejected
shadow-self is the persona. Under the influence of Syphilis – The Miasm
sycosis we see the structures of the psyche becom- of Destruction, Degeneracy,
ing more clearly delineated. Despite appearances,
the individuation process gains momentum.
and Barbarism
Venereal syphilis probably arose many thousands
Sycotic Emotions of years ago in the Middle East or North Africa
The psoric being views the world as chaotic and from a continuum of non-venereal spirochaetal
out of control, the sycotic compensates for this by infections. It is regarded as a disease of advanced
the rigid control of perfectionism, often in every urbanisation and it is possible that sexual trans-
aspect of their lives, and these qualities become mission of the spirochete only occurs when a criti-
an important part of their mask. Taken to the cal mass of the adult population are involved in
multiple-partner sex. Such a proposition empha-
Broadening our

extreme, they may develop obsessive, compulsive

Understanding

tendencies. The sycotic is egotistical, selfish, and sises the association between non-bonding, non-
insecure, and is inclined to feel jealousy, envy, sus- loving, casual, and illicit sex and the destructive
picion, resentment, and vindictive hatred. In rela- energy of the syphilitic spirochaete. The breadth
tionships they can be terribly heartless and cruel. and destruction that exist in this miasm are repre-
IV By nature manipulative, seductive, and deceitful,
they comfortably move into politics and crime.
sented by some of the characteristics observed in
patients expressing this miasm (Box 17.6).

Sycotic Manifestations The Cradle of Syphilis

The excesses of the sycotic mind and emotions are The history of Europe re-enacts for us the evo-
reflected in the excesses of the miasm’s physical lution of miasmatic disease. After the fall of the
manifestations. There is overgrowth, thickening, Western Roman Empire, Europe descended into
and induration of tissues (warts, cysts, growths, the psoric desert of the Dark Ages, a culturally
adhesions, keloids) and profuse yellow-green dis- and intellectually barren period, which persisted
charges, all of which relieve the inner miasmatic for hundreds of years, characterised by severe
state and must not be suppressed. The nosode pre- winters, poverty, famine and misery. Towns were
pared from a gonorrhoeal, urethral discharge is overcrowded and filthy. In the 14th century the
Medorrhinum (mother of all discharges) and two continent was continuously ravaged by war; life
major sycotic remedies are Thuja and Nat-sulph was difficult and precarious. In 1348, out of the
(Natrum sulphuricum). Other major sycotic rem- East, the Black Plague, spread by black rats and
edies are in Box 17.5. their fleas, descended upon Europe, destroying

226
 Syphilis – The Miasm of Destruction, Degeneracy, and Barbarism

by armies, soldiers, prostitutes, abused and starv-

BOX 17.6
ing populaces, and enacted against a backdrop
Major Characteristics of Syphilis
of violence, burning, pillage, rape, debauchery,
●
Systems:
death, and destruction. Such is the cradle of syph-
●
the skin and mucous membranes
ilis. The syphilis of those early years was much
●
lymphadenopathy
more virulent and florid in its manifestations than
●
cardiovascular – endarteritis, arterio-
the disease we know today. It could rapidly prove
sclerosis, aneurysms
fatal and the pustular skin lesions were far more
●
central nervous system – conditions
gross and repellent. With all its repulsive hid-
affecting the parenchyma of brain and
eousness, syphilis soon supplanted leprosy as the
spinal cord
brand of pollution and sinfulness. From Italy, like
●
the eyes and optic nerves
wildfire, it spread worldwide, killing and maiming
●
the bones
hundreds of thousands and leaving a permanent
●
congenital abnormalities
miasmatic legacy in its wake.
●
Destructive lesions – ulceration, necrosis,
The word ‘syphilis’ derives from a popular,
gangrene
epic poem written by the Veronese physician,
●
Staphylococcal infections; recurrent boils
Girolama Fracastora, or Fracastorius. The pastoral
and abscesses
tells the unfortunate story of a shepherd, named
●
Inflated ego – delusions of grandeur; ego-
Syphilis, who having blasphemed against Apollo
tism; megalomania; narcissism; love of
was cursed with a loathsome disease.
money and power; ambition; avarice
●
Paranoia – delusions of persecution
The Pale Thread
●
Fixed ideas
The organism, which found the suffering, excesses
●
Monomania
and depravity of humanity ideal for its spread and
●
Obsessive-compulsive disorder; ritualism;
survival, was the inconspicuous, feeble Treponema
constantly washing hands, compulsive
pallidum: the ‘pale thread’. An almost transparent

Broadening our
Understanding
checking
bacterium with a body twisted into a spiral – the
●
Lack of identity
symbol of the serpent. It is as fragile as it looks,
●
Perfectionism, fastidiousness
totally dependent on its exclusive, intimate relation-
●
Need to control, dominate, dictate
ship with man. Despite its fragility it is one of the
●
Intolerant of contradiction, reproach, rep-
rimand; easily take offence
most virulent organisms known. It possesses remark-
ably few genes, and hence contains so few proteins
IV
●
Quarrelsome; insolent; defiant; rebellious
in its cell membrane that it remains undetected by
●
Fear: the night; sleep, insanity, disease,
its host’s immune system. This tenuous membrane
death, evil, of perpetrating violence, loss
is also able to bind proteins derived from the host’s
of control, falling
blood. The resulting camouflage permits the organ-
ism to remain invisible, free from attack, and able to
survive in its victim’s body for years.
millions, and leaving havoc, political disarray, and The psoric needs a shield, the sycotic wears
anarchy in its wake. Law and order were over- a mask, and the syphilitic, like the ‘pale thread’,
thrown, religious faith was shaken, and sycotic often remains hidden, the little grey person who
corruption and sensuality prevailed. The stage was blends with the environment. The syphilitic per-
set for the emergence of the Great Pox: syphilis. vert often successfully remains undetected and
In 1495, the siege of Naples by Charles VII of invisible in society. They are able to adopt the
France provided the match that fired a pandemic outer semblance and conservative customs of the
of horrific proportions. The tragedy was peopled society they move in, ensuring their anonymity.

227
 CHAPTER SEVENTEEN The Chronic Miasms

Syphilitic Manifestations nificant that these organisms are only pathogenic to

The primary lesion of syphilis is the chancre. Its appear- humans. Whereas sycosis is a marriage of psora and
ance occurs after the disease has become systemic and constitutional gonorrhoea, the syphilitic miasm is
is a demonstration of the externalising power of the primarily (sycosis is invariably present) a combina-
vital force. Unless natural healing is brought about, tion of psora and constitutional syphilis, in which
as with sycosis, the further development or chemical the syphilitic influence predominates. When psora
suppression of syphilis result in a miasmatic condition is predominant in this combination the tubercular
in the patient, which will be transmitted dynamically miasm manifests.
by inheritance and sexual contact, even in the absence
of the infecting organism. Syphilis, Fire and Hepar
The clinical pictures of primary, secondary, Sulphuris Calcareum
and tertiary syphilis give to us a clear indication Syphilis spreads like wildfire. Like fire, the disease
of the organ affinities of the syphilitic miasm, consumes, dissolves and destroys the tissues, the
which often provides a clue in selecting appro- morality, the identity, the intellect, and the sanity.
priate anti-syphilitic remedies or Syphilinum, the Fire is a symbol of syphilis. In a unique experi-
nosode. Most important are mucosal ulceration ment, which produced a unique anti-syphilitic
(e.g. Mercurius), lymphadenopathy (Phytolacca), remedy, Hahnemann took flowers of Sulphur
cardiovascular disease (Aurum), neuropathies (fire/syphilis) and the middle layer of the oyster
(Causticum), skeletal disease (Mezereum), oph- shell, Calc-carb (psora), and burnt them in a cru-
thalmic diseases (Kali-iod), congenital abnormali- cible. The resultant liver-coloured compound he
ties and the deterioration of the emotional, moral called Hepar sulphuris calcareum.
and intellectual life. Other remedies of the syphi-
litic miasm are given in Box 17.7. Syphilis and the Sociopath
The classic picture of general paralysis of the The profile of the syphilitic mind is a disturb-
insane (GPI), a severe form of neurosyphilis, which ing one. We see an awful potential for antisocial
often exaggerates previous personality traits to even
Broadening our

behaviour, criminal activity, extreme violence,

Understanding

grotesque proportions, provides a template for cruelty, brutality, murder, sexual perversion, and
recognising the presence of a dominant syphilitic, moral degeneracy, often aggravated by substance
miasmatic influence in patients. These characteris- abuse, and presided over by a chilling lack of con-
tics may be expansive – even grandiose, depressed, science or remorse, paranoia, and megalomania.
IV paranoid, schizophrenic, or dementing.
As previously noted, psora must be present in
When society descends into war, and anarchy
and lawlessness prevail, out of the woodwork of the
the constitution before the venereal diseases community emerge the previously pale, hidden, silent
gonorrhoea and syphilis can be contracted. It is sig- syphilitics, able at last to consort with their evil breth-
ren, and to indulge and gratify their dark, dread fanta-
BOX 17.7 sies and impulses in the light of day. In sycosis, the ego
Major Syphilitic Remedies and shadow are in contention; in syphilis, the ego and
Arsenicum album; Arsenicum iodatum; shadow are one, and the night is their nemesis.
Asafoetida; Aurum metallicum and its salts;
Causticum; Fluoric acid; Kalium-iodatum; Tuberculosis – The Miasm
Lachesis; Mercurius; Mezereum; Nitric acid; of Resurrection, Revolution,
Phytolacca; Silicea; Stillingia, and all the and Genius
Halogen salts.
The nosode: Syphilinum; the bowel nos- By the middle of the 16th century the original
odes: Bacillus no. 7; Gaertner. florid severity of the syphilitic pandemic had
begun to subside with milder skin lesions, less

228
 Tuberculosis – The Miasm of Resurrection, Revolution, and Genius

pain, less bone destruction, and fewer deaths. It lymph glands, bones, joints, serous membranes,
was as if a truce had been established as spirochete central nervous system, intestines, genital organs,
and host became more tolerant of one another. kidneys, adrenal glands, eyes, and the skin.
Nature, however, had achieved her objective.
Humanity had been thoroughly impregnated with The Tubercular Constitution
the syphilitic poison. The remission in severity sig- The miasm frequently creates a person who is
nalled the beginning of a miasmatic change, which inclined to elegance, refinement, and aesthetic sen-
would lead to the next wave of communicable sitivity. In keeping with this the features are often
disease – tuberculosis. aristocratic, finely drawn, and beautiful. Their
When we contemplate the deficient nature of eyes are magnificent, expressive, and framed by
psora, it is clear that to achieve expansion and long, silky eyelashes. In health, they are well pro-
drive without the decadence of sycosis or the portioned and athletic – fine-boned, lean-muscled,
degeneracy of syphilis, a critical stimulus and tall, long-limbed, and graceful. They can be fair
change was needed to urge the individuation pro- or dark, blonde, brunette or redhead. When the
cess of humanity forward. The change involved a constitution is weak, they are often too thin, nar-
receding of syphilitic dominance and the re-emer- row-chested, with bad posture, round shoulders,
gence of psora, now vitalised by the admixture a sway back, and lax muscles. Their energy and
of syphilitic energy. The stimulus was the modi- stamina are poor. The least exertion leaves them
fied fire provided by the embers of the syphilitic exhausted. Though they are chilly and seek the
pandemic. sun, they long for cool, fresh air. They may suffer
from night-sweats. Anaemia is common. There is
Tuberculosis – the Offspring a lack of resistance to infection and they are slow
of Psora and Syphilis to convalesce. Reflect on Box 17.8 to help you
The organism that profited from the conflagration appreciate the positive as well as negative qualities
of syphilis was the Mycobacterium tuberculosis. of the TB miasm.
We know that the evolutionary, miasmatic cycle

Broadening our
Understanding
we have traced so far has been enacted before The Tubercular Mind
in civilisations of the past. Tuberculosis (TB) is The tubercular mind is right cerebrally dominant:
a disease of ancient origin. From rural areas TB romantic, idealistic, imaginative, artistic, and cre-
spread to the densely populated cities and found ative. Tuberculosis was known as the pining or
its ideal circumstances among the crowded poor,
preying especially upon the young, the malnour-
wasting disease. The tubercular individual often
longs and pines for an ideal love and suffers terribly
IV
ished and the overworked, who often existed from unrequited and disappointed love. Yet they
without sunlight and fresh air. Later it affected all are also fickle, soon become bored with a relation-
levels of society. The incidence became extremely ship, and need to move on to new pastures. The
high, resulting in a thorough permeation of intellectual development and creative ability are
European genetic stock with this chronic miasm. often precocious and prodigious, but with a ten-
Anti-tubercular therapy may kill the bacillus and dency to burn out prematurely. The mind tends to
seemingly cure the patient, but the miasmatic be stronger than the body. The tubercular nature
contamination persists and may be handed on by is rebellious and defiant and will fight for justice,
inheritance, but, unlike sycosis and syphilis, not freedom, and reform. They have an intense love
by sexual contact. for animals, which they will defend and protect.
TB targets certain organs. M. tuberculosis, being Likewise, they are deeply concerned for the wel-
primarily inhaled, especially involves the respira- fare of the planet. Often, like the sycotic, they have
tory tract, while M. bovis, being ingested, espe- psychic awareness, are highly intuitive, and pick
cially involves extra-pulmonary organs and tissues: up on others’ thoughts and feelings. Their lack of

229
 CHAPTER SEVENTEEN The Chronic Miasms

BOX 17.8
Major Characteristics of Tubercular Miasm
●
Ailments from: unrequited, disappointed ●
Bipolarity: alternating, changing moods;
love; betrayal, infidelity; jealousy; bereave- cyclothymia; manic-depressive
ment, grief, sorrow; loneliness; homesick- ●
Fickle; short-lived enthusiasms; unreliable;
ness; boredom unpredictable
●
Right cerebral dominance: artistic, creative, ●
Need for change; restless, unsettled, discon-
imaginative, intuitive, romantic, idealistic tented; need to travel and see the world
●
Precocious, prodigious, gifted intellect, ●
Recurrent, relapsing states; at every return
which may burn out prematurely of complaints they have altered, calling for a
●
Refined, sophisticated, cultured new remedy
●
Altruistic: active concern for human, animal ●
Changing symptoms and states
and planetary welfare ●
Ailments jump from one area, organ or sys-
●
Intolerant of injustice, will fight for social tem to another; pains shift and wander
reform ●
Periodicity and intermittency
●
Challenge tradition, convention, authority; ●
Insidious, indolent conditions
rebellious, defiant ●
Hedonism; hyper-sexuality
●
Psychic awareness ●
Fears: dogs, dark, solitude, thunderstorms,
●
Hypersensitivity: to ambience, surroundings, disease, suffering, the future
people, climate ●
Indifference; withdrawn, reclusive

boundaries may prove stressful and exhausting. self-esteem and vanity, and have a flamboyance,
Broadening our
Understanding

Sensitivity is present on all levels of experience which they and others find captivating. They are
and to all sensory impressions. often at the cutting edge of fashion, opinions, and
There is restlessness, a need to escape bore- trends. Their minds overflow with an abundance
dom, and a constant desire for change and for of ideas, expressed through irrepressible verbos-
IV travel, to go somewhere new, and to do something
different. They are curious and enthusiastic. Life
ity and unbounded creativity. They sparkle and
shine with energy, exuberance, vivacity, and even
seems to hold so much promise and there seems ecstasy – but always with the danger of fizzling
so little time to enjoy all that is on offer. They out and plunging into melancholy and despair.
wish to drink every cup of experience to the very Typical tubercular remedies are Phosphorous and
dregs. They are adventurous, experimental, and Calc-phos; others are given in Box 17.9.
innovative. They will try anything at least once,
but are not as inclined to become snared by addic- Tuberculosis and the Romantic Age
tion as is the sycotic. Dangerous activities, which Fire, like speech, has always been a catalyst for
stimulate the flow of adrenaline, are irresistible man’s evolution and creativity. It is a powerful,
to them. Recklessness is a danger. The limelight multi-facetted symbol: divine energy, purification,
attracts them like a moth to a flame. revelation, transformation, resurrection, tran-
Naturally dramatic and expressive, they love scendence; patriotic, sexual and religious ardour;
centre stage and the applause of an audience. inspiration and creative power; passion and love!
They are not handicapped by modesty or inhi- As syphilis, it illuminated the human psyche. Out
bition. Indeed, they often possess a surfeit of of the long psoric night of the Dark Ages and the

230
 Carcinosis – The Miasm of Transcendence, Sublimation, and Individuation

most gifted and creative of the romantics. Many

BOX 17.9
of the symptoms of mania and depression became
Major Tubercular Remedies
accepted personality traits of the romantic genius.
Arsenicum album; Arsenicum iodatum;
Whereas the sycotic mind is characterised by dual-
Bromium; Calcarea carbonica; Calcium
ity, the tubercular mind is characterised by the ebb
phosphoricum; Causticum; China officinalis;
and flow of bipolarity: cyclothymia – hypomania
Coffea crudum; Drosera; Ferrum metallicum;
and depression.
Ignatia; Iodum; Kalium carbonicum; Lachesis;
Lycopodium; Manganum; Phosphoric acid;
The Tubercular Quest
Phosphorus; Sepia; Silicea; Spongia; Stannum;
The fire of syphilis has refined and inspired the
Sulphur; and all the Phosphates.
tubercular individual, filling an unsettled, dissatis-
The nosodes: the Tuberculinums; Bacillinum;
fied spirit with interminable restlessness, a sense
Psorinum; the bowel nosodes: Bacillus no. 7;
of unfulfilment, and an insistent need for change.
Gaertner; Morgan-Pure; Mutabile; Sycotic co.
The constant searching and longing, often with-
out a specific goal or objective, but sensed as an
impelling need, brings a quickening to the indi-
medieval period dawned the Renaissance, followed viduation process of the individual. The final sub-
by the Age of Enlightenment, which blossomed limation will bring the realisation that what they
into the prodigious creativity of the high roman- have sought for all their lives actually lies not in
tic period. Now, there was fire in the mind. This any outer world, or other dimension, but within
was the world of Chopin and Keats, the world of themselves. All they have suffered and enjoyed,
tuberculosis, and the tubercular miasm. all the longings and strivings, and all the suc-
The period of high romanticism in the arts cesses and failures were designed to bring them
coincided with the rapid and devastating spread self-knowledge, in which the limitations of ego-
of TB in Europe. Throughout history artists, personality are transcended, and oneness with all
poets, writers, and musicians have shown roman- is experienced.

Broadening our
Understanding
tic tendencies, but the Romantic Movement usu-
ally refers to the period from the late 1700s to
the mid 1800s (almost the entire lifetime of Carcinosis – The Miasm
Hahnemann). Romanticism in the fine arts and of Transcendence, Sublimation,
literature is a style, which emphasises emotion
and passion rather than reason, and imagination
and Individuation IV
and inspiration rather than logic and intellect. It is Disease is an expression of creation’s perfection;
usually a revolt against the rigorous restraints and it has meaning, deep significance, and is essen-
formalism of classicism. It was also a revolt against tially beneficent. The vital force is always work-
a society which had become abhorrent to the artis- ing at its optimal best. Even malignant disease is
tic mind; a society that seemed to be governed by a manifestation of the vital force’s efforts to bring
science, commerce, industry, power, and wealth. about the least harmful result in a profoundly
Artists escaped into exotic worlds of fantasy and disturbed constitution. It would rather produce
imagination, the medieval and the ancient past, a cancer than permit a process that impacts
and the realms of myth and legend. Politically, upon the emotional and intellectual spheres and
romanticism opposed tyranny and fought for free- impedes spiritual unfoldment. This is not always
dom and equality through revolution, liberalism, possible. However, when successful, the inherited
and social reform. legacy of disease is concentrated and encapsulated
Genius flourished in the romantic period. in a malignant lesion or process. Constitutionally
Manic-depressives were numerous amongst the a cleansing of the miasmatic state is achieved,

231
 CHAPTER SEVENTEEN The Chronic Miasms

which is manifested particularly in the emotional Carcinosin has a wide spectrum of indications and
life. Individuation is accelerated. When the cancer it is one of the most frequently indicated nosodes
miasm is dominant it often brings with it a state in homeopathic practice. Given the exploding
of increasing spiritual awareness, empathy, and a incidence of malignancy in most societies, this is
greater capacity for unconditional love. not surprising. Box 17.10 lists some of the point-
ers to this miasm.
Pointers to the Presence
of the Cancer Miasm Carcinosis and the C-type personality
The characteristics of the cancer miasm, carcinosis, By far the most common and defining face this
are to be found in the remedy picture of the nos- complex miasm presents is the psoric component.
ode, Carcinosin – a remedy prepared from breast When dominant, it produces the well-recognised
cancer. The remedy was defined and developed C-type personality profile and the characteris-
by Dr Donald Foubister. Carcinosis is a multifac- tics of the so-called ‘disease to please’. This type
eted miasm, which derives from a combination suppresses strong emotions, is diffident and self-
of the four other chronic miasms, often exacer- effacing, ever yielding sacrificially to the wishes of
bated and compounded by suppression. Foubister others, avoiding conflict and confrontation, and
recognised that certain physical characteristics behaviour that might impose on others or offend
pointed to the presence of the miasm, particularly them. Outwardly they appear controlled, unemo-
multiple moles, café-au-lait complexion, and blue tional and stoical, within they are a seething mass
sclerotics. In such cases there was often a higher of anxieties and emotions, which they repress.
incidence of cancer, TB, and diabetes in the fam- They are nice people and their niceness borders
ily histories. Other features, which later became on the pathological. Taking a strange satisfaction
apparent, were a history of many acute infections in denying their own needs, they equate selfless-
in childhood, especially pneumonia or whoop- ness with love and caring. Proper and conserva-
ing cough, or the complete absence of the usual tive, always conforming to established norms, they
Broadening our

children’s diseases, or the suffering of these only never complain, lack assertiveness, and maintain a
Understanding

after puberty. docile passivity. They are conscientious, fastidi-

The belief that psychological and emotional ous, meticulous perfectionists, and workaholics,
states such as grief, depression and stress can fos- who have a heavy sense of duty and responsibil-
ter the development of cancer has been with us ity, are self-critical, and easily take on blame and
IV since classical times. It has been observed that a
remarkably high proportion of cancer patients
guilt. Remedies linked to this miasm are Natrum
muriaticum and Lac caninum; others are noted in
have lived difficult lives, had much misfortune, or Box 17.11.
have experienced a particularly traumatic event
shortly before cancer was diagnosed. The loss of a The Syco-Tubercular Cancer Type
loved one, the termination of a close relationship, However, this compliant, meek, subservient type
and depression have often been linked to cancer. is not the only face of the cancer miasm. The
Homeopathic clinical experience with Carcinosin admixture of sycosis and tuberculosis often gives
has given weight to these conclusions. The nos- it a far more powerful and passionate expression.
ode is of particular use in the treatment of those The syco-tubercular types are high-energy people:
who have a history of dysfunctional parenting; active, intense, emotional, excitable, and passion-
an unhappy, often over-responsible childhood; ate, very expressive, open, and communicative.
emotional trauma and abuse, whether emotional, If the sycotic energy is dominant, they may show
physical or sexual; and long continued domination a tendency to extremism, high sexuality, and a
by others. Suppressed emotions are particularly love of ‘wine, women and song’. If the tubercu-
destructive, especially grief, anger and resentment. lar energy is dominant, they may show a restless

232
 Carcinosis – The Miasm of Transcendence, Sublimation, and Individuation

BOX17.10
Major Characteristics of Carcinoma Miasm
●
History of cancer in the patient – children’s illnesses experienced after
●
Family history of cancer, diabetes or TB puberty
●
The presence of blue sclerotics, café-au-lait – never well since viral infection (chronic
complexion, birth marks, dark or excessive viral fatigue syndrome):
moles – glandular fever
●
History of dysfunctional parenting, emo- – hepatitis
tional trauma, abuse ●
Overtaxed immune system:
●
Long history of domination by others – recurrent severe infections in childhood
●
Prolonged anger, resentment, grief, fear – severe whooping cough or pneumonia
●
Suppressed emotions, esp. grief, anger, resent- ●
Iatrogenic breakdown in resistance:
ment – recurrent or prolonged antibiotic therapy
●
When a number of polychrests seem equally – corticosteroids
well indicated – excessive immunisation
●
Lack of response to well chosen remedies, or ●
Strong emotions are suppressed – anger, fear,
when response is short lived grief
●
Constantly changing symptomatic picture ●
A veneer of calm, unemotional composure
●
Paradoxical and alternating states ●
An inward seething of anxiety and emotions
●
Symptoms and signs alternate from one side ●
Compliance with the wishes of others; pas-
of the body to the other sive subservience
●
Chronic insomnia; insomnia from birth; ●
Sympathetic, compassionate
insomnia since broken sleep, night-watching ●
Tales of suffering affect profoundly
●
Compromised immune system: ●
Weeps from sympathy with others; yet averse

Broadening our
Suggestive evidence: to sympathy

Understanding
●

– no history of children’s illnesses ●

Anxiety for others

BOX 17.11
discontentedness, romantic longings, a desire to
travel, and a need for adventure, thrills, and new
IV
The Carcinosin Remedies experiences. The cancer miasm has elements of
Arsenicum album; Arsenicum iodatum; Asterias both, but in its highest form it reveals a beauty
rubens; Bellis perennis; Cadmium metalli- of spirit that is unique.
cum; Cadmium sulphuricum; Carbo animalis;
Conium; Cundurango; Graphites; Hydrastis; An Elevated Being
Kalium iodatum; Kreosotum; Lac caninum; The Carcinosin subject has an abiding love of
Lachesis; Lycopodium; Mercurius; Nitric acid; nature, of animals, and of humanity, which moves
Phosphorus; Phytolacca; Silicea; Sepia; Thuja. them to altruism of the purest form. Their minds
The nosodes: the Carcinosins; Psorinum; and senses are aesthetically attuned to all that is
Scirrhinum; the bowel nosodes: Dysentery elevated, noble, and splendid in literature, music,
co; Mutabile. and dance. Their love and compassion are intense,

233
 CHAPTER SEVENTEEN The Chronic Miasms

selfless, universal, and unconditional. The miasm anticipate new evidence of a destructive, syphi-
of cancer facilitates the ascent of the human soul litic-type energy appearing. This is evidenced in
towards its divinity. the serpent-shaped, haemorrhagic filoviruses.
Finally, in the wake of Aids, we are witnessing,
especially in Africa, an alarming resurgence of
The Miasmatic Spiral tuberculosis, and everywhere in the world cancer
Our study of the miasms commenced with psora, is on the increase. Disease ever recapitulates.
followed by sycosis, syphilis, and tuberculosis,
giving us the first loop of a spiral. With the con-
sideration of the cancer miasm, the disease con- Summary
tinuum comes full circle (Fig 17.2). The carbons,
Knowledge of miasmatic theory is a powerful
which typify the psoric miasm, are carcinogenic
tool. It gives the physician better understanding
and we can easily recognise the similarity between
of the patient’s disease process, provides guidance
the emotionally deficient state of psora and the
in remedy and nosode selection, and helps in the
weakness of the C-type personality. After cancer,
interpretation of remedy response. It can even give
in the next sweep of the spiral, we should expect
insight into the emotional patterns and potentials
another wave of sycotic energy in the genesis of
of the patient. A miasmatic diagnosis is often vital
disease, once again linked to escapism, sensuality
to therapeutic success. Despite good case-taking
and profligacy. This has proved true in the wide-
and thorough case analysis, it is common experi-
spread Aids epidemic. Following this we should
ence during the course of constitutional treatment
for the physician to stand on pause and in doubt
as to which remedy to prescribe, how to deal with
lack of response or the failure of a previously suc-
Carcinosis
cessful remedy, and how to remove unseen obsta-
(sublimation) cles to cure. When in such doubt, it often pays to
Broadening our
Understanding

Tuberculosis mycobacterium
prescribe miasmatically by choosing an appropri-
(resurrection/renaissance) ate miasmatic remedy or nosode. Such a choice
Syphilis filovirus may sometimes provide the simillimum, but more
(destruction) frequently a reaction will be elicited, which opens
Sycosis HIV (Aids)
IV Carcinosis
(excess)
the case up. New emotional or physical symptoms
emerge, significant dreams may be experienced,
(sublimation/deficiency) and the patient’s constitution becomes responsive.
Tuberculosis Even in more straightforward cases, the occasional
Mycobacterium
(resurrection/ dose of the indicated miasmatic or bowel nosode
Syphilis renaissance) may facilitate the healing process.
Treponema pallidum
(destruction) Sycosis
Neisseria
gonorrhoea
(excess) Bibliography
Psora-scabies Allen J H 1908 Chronic miasms: psora, pseudopsora
(deficiency)
and sycosis, 2 vols. Privately published, Chicago.
Reprinted 1950 as 1 vol, M V Kulkarni, Bombay

The Miasmic Spiral Banerjee P N trans Banerjee P N 1931 Chronic disease:

its cause and cure. P C Chakravarty Homoeopathy,
Figure 17.2 The miasmatic spiral Prachar Kavjalaya, Calcutta

234
 Bibliography

Foubister D 1991 Tutorials on homeopathy. Beaconsfield Van der Zee H 2000 Miasms in labour. Stichtung
Publishers, Beaconsfield Alonissos, Utrecht
De Schepper L 2001 Hahnemann revisited. Full of Life Wills C 1996 Plagues: their origin, history and future.
Publishing, Santa Fe Harper Collins, London
Jamison K R 1994 Touched with fire: manic-depressive ill- Ziegler P 1998 The black death, 2nd edn. Penguin
ness and the artistic temperament. Free Press, New York Books, London
Leakey R 1992 Origins reconsidered. Little Brown,
London
Roberts H A 1942 The principles and art of cure
by homoeopathy, a modern textbook, 2nd edn.
Homoeopathic Publishing Company, London

Broadening our
Understanding
IV

235
CHAPTER EIGHTEEN

Veterinary Prescribing The Case

Peter Gregory

Third, homeopathy for pets covers many of

Introduction by David Owen the essential features of homeopathic treatment
Many students of homeopathy might wonder how of babies and children, including non-verbal com-
a chapter on veterinary prescribing is going to munication, the socialisation they go through
influence their training – in several ways, I hope. (including the not uncommon abuse) and the rela-
First, there is a need for non-human animals to tionship with third parties – in pets, owners and,
receive non-suppressive treatment. Man is not for children, parents.
alone in either his environment or illnesses. Many Fourth, and finally, veterinary homeopathy has
illnesses that affect mankind are also an expression developed a range of prescribing strategies that
of diseases that run through all animals (reflected can both challenge and inform human homeo-
also in the diseases of plants and imbalances in the paths.
environment). If homeopaths recognise and rise
to these broader challenges, not only may they see
illness in a new light, by being aware of influences
Veterinary Prescribing
on patients, but also they may contribute to reduc- Homeopathy represents enormous opportunities
ing the reservoir of illness that exists outside man- for improving the health of animals. Many condi-
kind. Reflect on whether, given animal husbandry tions for which there is no conventional treatment
practices, it is surprising to be facing illnesses that available can improve with homeopathy, and since
animal groups hold or mediate – such as ‘bird flu’ the latter half of the last century demand from the
or prion infections. public has burgeoned. Not only does homeopathy
Second, I have for 10 years been teaching with add an extremely useful modality to the skills of
and to veterinary homeopaths. Their approach to a trained veterinary surgeon, it is also enormously
the case and treatment has taught me a great deal empowering to the informed animal owner, who is
and I believe Peter Gregory reflects some of this in able to effectively treat simple ailments. Many veter-
his chapter. Often what human homeopaths might inarians attempt to integrate homeopathy into their
call ‘the inside’ of the case in terms of mental, emo- general practice, using it as the sole form of treat-
tional and relational symptoms might appear absent ment or in conjunction with conventional medicine;
but to the attuned homeopath the inside and out- however there are others, like myself, who concen-
side reflect one another. Seeing the deeper aspects trate on second opinion or referral work.
of the case revealed through what is carefully Veterinary homeopathy is practised in a broadly
observed of a patient’s behaviour and relationship similar way to that in humans, but individual species
to others is a key homeopathic skill that veterinary variations may require that a specific approach to
homeopaths such as Peter are champions of. homeopathic prescribing be made for an individual

237
 CHAPTER EIGHTEEN Veterinary Prescribing

animal. This may simply be a matter of a different is experiencing. When one considers the emphasis
emphasis, but at times an approach unique to the that most homeopaths place on the mental and
animal patient may need to be employed if it is to emotional symptoms in case analysis, it might
enjoy the full benefits which this form of therapy appear that veterinary homeopaths are at a disad-
can provide. vantage compared to their medical colleagues. But
For instance, as a consequence of the non-ver- as will become clear later in this chapter, most vet-
bal nature of the patient, the homeopathic history erinary homeopaths simply take such issues into
is wholly dependent on the observational powers account when deciding on which approach to use
of the owner. Furthermore, some animals, such in any particular case.
as free-ranging sheep, have minimal contact with In relation to the issue of obstacles to cure,
their keepers. the veterinary homeopath has to face problems
Many of the more subtle symptoms, so useful unique to this field of expertise. The feeding and
in the field of medical homeopathy, are of neces- management regimes which are imposed upon
sity absent from a veterinary history. For instance, domestic animals frequently create a situation
the quality of sensations, in particular of pain, is where homeopathic medicines struggle to act with
unavailable to the veterinary homeopath; indeed any consistency; this is discussed in more detail
the very presence of pain can often only be inferred later in the chapter.
rather than directly described. Consequently, In spite of the foregoing issues, homeopathy
most animals are presented for ailments which brings enormous benefits to animals wherever it is
have progressed beyond the stage of changes in practised. This is due in no small part to the inge-
sensation. Modalities, too, may be dependent on nuity of its practitioners in overcoming the chal-
subjective interpretation of observations, e.g. the lenges described above, and much of this chapter
symptom described by the rubric Generals Heat – is devoted to describing the approaches which vet-
‘lack of vital heat’ – may be exhibited in a dog by erinary homeopaths embrace in order to achieve
its propensity to lie by the fire, but this behaviour success with their patients.
Broadening our

might equally be taken to mean that the animal’s

Understanding

symptoms are ameliorated by heat, thus ‘Generals –

heat ameliorates’. Careful history-taking and
Categories of Veterinary Patients
observation coupled with experience in the nor- It is common practice to divide veterinary patients
mal behaviour of the species and individual may into four basic categories, each of which reflects
IV be needed to make the appropriate distinction.
While a veterinary repertory will undoubtedly
the differing situation of the animals within it.
There are inevitably areas of overlap, but as the
offer some assistance in selecting rubrics for needs of each category vary so significantly it is
animals, it is unlikely to overcome this problem helpful in a discussion such as this to use the fol-
completely. lowing categorisation:
When it comes to the mental and emotional ●
There are companion animals (‘pets’) that
symptoms, the subjective nature of the symp- range from the ubiquitous dogs and cats to
toms is exacerbated. In essence the animal patient small furry creatures such as hamsters, and
is incapable of providing a single direct mental exotic species such as spiders and reptiles
symptom; the best that the veterinarian can do (‘small animals’). However, this category also
is to try and interpret its behaviour in terms of includes ‘large animals’ such as horses, when
human emotions. Close observation can certainly they are kept primarily as pets, or for leisure.
yield much which can be useful to the veterinary ●
Second are performance animals, including
homeopath, but in the final analysis, the prescriber race horses, racing greyhounds and working
simply does not know what emotions the animal sheepdogs.

238
 Categories of Veterinary Patients

●
Third, there are food-producing animals. In so-called ‘behavioural disorders’. In these cases
the UK this category is confined to the clo- success rates are considerably higher.
ven-footed animals and poultry but in other
countries, particularly in the European Union, Performance Animals
horses are included. This category represents such animals as race
●
Finally, there are wild animals that include horses, racing greyhounds and working sheep-
exotic wild animals, e.g. captive in zoos, or dogs. If they are to perform to their full potential
native animals, either rescued or free. they must be in peak fitness, and homeopathy can
play an important role in maintaining this state.
Companion Animals In addition, the prompt homeopathic treatment
As veterinary medicine, certainly in the affluent of injuries can promote rapid resolution of the
West, has increasingly devoted its energies to condition and consequent early return to work.
the treatment of companion animals, it is in this Many performance animals in work are function-
sphere that homeopathy is perhaps most com- ing at the limits of their capacity and when these
monly practiced. Here the human–animal bond limits are exceeded damage to the physical body
is at its strongest and hence the influence of the ensues. Homeopathy can help speedy resolution
owner is at its greatest. It is also important for the and return to the racetrack. Compare this to the
human homoeopath to recognise the role of a pet situation of the human athlete or bodybuilder who
in a family, and hence the intensity of the emo- is working for fitness rather than health. In some
tions which surround its welfare. The diseases of cases preventative action may be taken; e.g. some
dogs and cats in particular are in many ways simi- thoroughbred racehorses suffer from epistaxis
lar to those experienced by humans and it is not when over-exerted. The condition is viewed seri-
surprising that the homeopathic treatment of their ously by the Jockey Club and repeat episodes will
ailments mirrors the medical model most closely. lead to disqualification of the horse from the race-
Referral practices dealing with small animals track. One of the homeopathic snake remedies,
are presented with a preponderance of animals usually Vipera, will not only treat the condition

Broadening our
Understanding
suffering from the chronic conditions which afflict but also reduce the propensity for it. Similarly,
aged dogs and cats, such as osteoarthritis, urinary many racehorses suffer from a chronic fatigue
incontinence and posterior paralysis. However, syndrome, possibly as a result of adrenal exhaus-
chronic skin disease is another common reason tion from the stress of racing. Homeopathy can be
for seeking homeopathy – many such patients
arrive as ‘desperation cases’, frequently after pro-
highly effective in treating this condition.
The stabling or kenneling of large numbers of
IV
longed courses of corticosteroids, and very often performance animals in a restricted area renders
dependent on them when presented. The symp- these populations particularly vulnerable to epi-
tomatology may be confused and vague, and con- zootic diseases – an outbreak of kennel cough, for
sequently these complicated cases are not easy to instance, can cause the complete closure of a dog
treat; indeed, a proportion of them prove to be track. Homeopathy can not only aid in the rapid
incurable. For a few the best that can be done is recovery of the affected animals but can also bring
to effect a reduction in the dose of corticosteroids the outbreak rapidly under control – either by the
(though this in itself can be life-saving) but in the use of homeopathy alone or by the use of isopa-
majority the symptoms can be relieved – and many thy in the form of nosodes. Further discussion of
cases of chronic skin disease can be cured com- this issue will be found in the following section on
pletely. Other conditions for which homeopathy food-producing animals.
is commonly sought include colitis and associated The horse as a species seems to be extremely
bowel disorders, chronic respiratory disease and sensitive to homeopathy, no matter under what

239
 CHAPTER EIGHTEEN Veterinary Prescribing

circumstances the treatment is given. This may be seen more as an economic unit rather than as a
due to an innate sensitivity to homeopathy, but sentient being. This impersonalisation is imposed
horses do often present with a very clear rem- to a degree which varies from farm to farm but
edy picture that reflects the deepest state of the the notion holds true to some degree for the vast
organism. As such, while they will often respond majority of food-producing animals. In addition
extremely well to medium potencies such as 30c, a herd or a flock may number in the hundreds,
the symptomatology can be so clear if there is no so the veterinarian simply does not have sufficient
suppression as to allow single dose prescriptions time to individualise every animal for treatment,
of M potencies with relative confidence. even if the necessary information were to be avail-
The strict training and feeding regimes inevi- able in the first place. Most of the following strat-
tably followed in racing establishments may limit egies for prescribing for groups of animals were
the management changes which may be made in developed in food-producing animals.
aid of the animal’s recovery, but an injured ani-
mal has to be rested, and an animal with digestive Wild Animals
problems has to be fed appropriately if homeopa- Homeopathy represents an ideal form of medi-
thy is to be fully effective. Similarly, due to the cine for wild animals whether rescued after injury,
rules which govern racing, no flexibility in vacci- or subjected to capture and transport for welfare
nation regimes is allowed. The homeopathic vet- reasons such as drought or flood. Not only are
erinarian thus simply has to operate within these the medicines cheap, but their availability is not
limitations, taking them into account in making restricted in the way that most orthodox drugs
the prescription. are. This makes them ideal for welfare organisa-
tions, most of which operate on limited budgets. In
Food-Producing Animals addition, many of the problems such as shock and
In recent years the burgeoning number of farms bruising which manifest in rescued wild animals
using organic management regimes has resulted in can be readily treated with homeopathy. Problems
Broadening our

an increasing utilisation of homeopathy on farms with administration are overcome by dropping

Understanding

throughout the world, nowhere greater than in liquid remedies onto the nose of a rescued animal,
the UK. Here the ruling body for organic farming or by the use of aqueous sprays – though with a
is the Soil Association and their regulations oblige dangerous animal administration by the water sup-
the use of homeopathic or herbal preparations ply can also be used. It is my opinion that all such
IV wherever possible. In order to meet the demands
of their clients an increasing number of veteri-
organisations should at least have Aconitum and
Arnica readily available for use in their patients.
narians are, therefore, finding the need to obtain
training in homeopathy. Many farmers are them-
selves attending courses designed to help them The Practice of Veterinary
understand homeopathy and use it effectively as
an integral part of their management systems.
Homeopathy
Advantages of homeopathy in livestock rearing The Importance of Causation
systems include the low cost of the medicines and Many veterinarians embark on their homeopathic
the fact that there are no residues. journey with the first aid remedies, based on cau-
The food-producing animal, however, perhaps sation. The treatment of the ubiquitous skin lac-
presents the most challenges for the veterinary erations and road traffic injuries with remedies
homeopath, for it is here that the concept of indi- such as Arnica and Hypericum is often their first
vidualisation is least relevant. In most modern experience of homeopathy.
systems of management animals are identified by In comparison with their medical colleagues,
numbers rather than name, and an individual is veterinary homeopaths perhaps tend to view cases

240
 The Practice of Veterinary Homeopathy

in the pathogenic model, as homeopathic histories Burnett who, in 1884, alerted the medical world
in animals often present with quite clear aetiolo- to the ill-effects of smallpox vaccination in his
gies. In my experience the most commonly identi- book ‘Vaccinosis’. The title consists of the term he
fied mental causality in animals is grief. Companion coined to describe the clinical syndrome induced
animals often create extremely close relationships by vaccination, and the substance of the book
with their family members, be they human or ani- details how the majority of these cases would
mal, and this leaves them particularly vulnerable to respond to homeopathic Thuja occidentalis. Ever
the effects of grief. The relationships may also cross since this time, homeopaths have been cognisant
other species barriers; friendships are commonly of the importance of vaccination as an aetiological
reported between dogs and cats, dogs and horses, factor in chronic disease.
rabbits and guinea pigs, and even dogs and sheep. In veterinary homeopathy the issue takes on
The loss of one of these companions can be added importance. Domestic animals, in particular
devastating to an animal and after such an experi- dogs and horses, are routinely vaccinated against
ence many such patients will go into a grief state a number of infectious diseases, using multiple
corresponding to the remedy pictures of Ignatia or vaccines administered from an early age. It has long
Natrum muriaticum, among others. A history of been standard practice to repeat the injections annu-
having been re-homed, be it privately or through ally, although recently there is a move to increase
a rescue kennel, should alert the practitioner to the interval in some cases to three years. While
the possibility of a long-standing grief state in the there is little doubt that the control of such serious
patient, and raise the possibility of prescribing one diseases such as canine distemper and feline panleu-
of the remedies with a reputation in this area. Such copaenia has owed much to vaccination, veterinary
a state is also commonly found in leisure horses; homeopaths consider that there has been a cost to
it can be heart-rending to hear, in the process of the general health of the animal population as a
taking a homeopathic history, how many changes whole. Such conditions as atopic dermatitis, colitis
of owner a horse may have experienced. and epilepsy seem at the very least to be exacer-
Where the animal itself does not appear to bated by vaccination. Veterinary homeopaths will

Broadening our
Understanding
have suffered a loss, sensitive questioning of the invariably scrutinise the histories of their patients
owner may elucidate that it is the grief state of for any such correspondences which would imply
the owner which is being played out in the patient. a causative role. As a rule of thumb, any condition
For instance, a cat belonging to someone who appearing within three months of a vaccination is
has just suffered a bereavement may pick up on
the owner’s emotions and develop symptoms
considered to be suspicious; within one month,
even more so. As a consequence of this, veteri-
IV
corresponding to the Natrum muriaticum state. nary homeopaths tend be very careful in the way
The specific reaction to grief is also important vaccines are administered, and frequently employ
in the analysis of the case. A normally placid fam- techniques to minimise their use. Such procedures
ily pet will sometimes apparently become aggres- include the measuring of antibody titres to assess
sive after the loss of the head of the family, be protection levels, and the use of nosode regimes for
it from bereavement or divorce; when the dog is protection (Saxton & Gregory 2005).
presented for arthritis and weakness of the hind
legs, the Causticum state, with its emphasis on
protection of the family unit, is easily identified REFLECTION POINT
from the aetiology alone. ● The reader is invited to consider the implications to the
A clear aetiology may also be recognised as immune system of frequent and intensive stimulation (or
being an assault on the physical plane – in this assaults) on the immune system represented by repeat
context a common aetiology in veterinary histories vaccination.
is that of vaccination. It was James Compton

241
 CHAPTER EIGHTEEN Veterinary Prescribing

Local Prescribing Working Holistically

One way of overcoming the difficulty in collecting (‘Getting at the Mentals’)
a complete history from the patient is to rely on As previously discussed, the interpretation of
prescriptions based solely on the directly observ- behaviour in terms of mental and emotional states
able physical signs of disease. In a profession where is problematic for the veterinary homeopath. This
‘they can’t talk can they?’ veterinarians are well can be exacerbated when the patient is a small
versed in the diagnostic arts; certainly the powers furry animal such as a mouse, or a reptile such as
of observation of the veterinarian are finely honed. a tortoise. In practice, careful observation of the
It is but a short step to the extension of these skills patient’s behaviour and listening sympathetically
to encompass the fine detail necessary for a homeo- to a sensitive owner can provide an assessment of
pathic prescription – though now a ‘full examina- the patient’s character and emotional state which
tion’ must, for instance, include the perineum and is certainly adequate for an effective homeopathic
the footpads (or hooves), despite the fact that the prescription to be made. However, it is important
patient has been presented with influenza. to make use of every opportunity to assess the
In many aged patients there is much pathol- animal’s behaviour – to this end it is useful to start
ogy and it is at this level that the disease process by observing the patient as it is taken from the
is exhibited. In such cases mental symptoms may owner’s car, and as it enters the waiting and con-
be even more obscure and it is here that local pre- sulting rooms. In the case of a cow, watch it as it
scribing can be particularly appropriate. If a local comes into the collecting pen and how it interacts
symptom is ‘strange, rare and peculiar’, then the with other members of the herd.
prescription is made with an even greater degree The history-taking must explore interactions
of confidence. with other animals and people in detail, along with
Concomitant symptoms may also be vital in the any obvious fears such as thunder or other loud
case analysis and the owners of pets are frequently noises. Nevertheless it should always be borne in
very good at describing these; similarly with time mind that the interpretation of this behaviour is
modalities and the characteristics of symptoms. subjective, and to some extent dependant on the
Broadening our
Understanding

Homeopathy thus brings the owner wholly within emotional state of the owner – and indeed that
the process of making a diagnosis and prescribing of the veterinarian. One observer may attribute
the medicine. As a result, the owner’s feelings and a particular pattern of behaviour to a completely
observations are often validated, for it is the very different mental state from that attributed by
IV minutiae which are considered to be irrelevant in
conventional medicine which are of such value to the
another – a dog’s apparent fear reaction to thun-
der may be due to a general sensitivity to noise or
veterinary homeopath. When a dog has diarrhoea a reaction to the atmospheric changes involved;
vital pieces of information may include the colour alternatively, it may simply be reflecting the fear
and consistency of the stool, the precise time of wak- of a companion. An accurate interpretation may
ing the owner in night, and the reaction of the dog also depend on a knowledge of the behaviour pat-
to being scolded – the proffering of this information terns which normally occur in a particular species
to an orthodox veterinarian would be seen largely as in a particular situation. It is normal for a small
a waste of valuable time, but the homeopath seeks prey species such as a rabbit to fear any object fly-
this information and is grateful for it. ing overhead as it will be interpreted as a preda-
tory bird, but this is not so normal in a cat – such
behaviour in the latter would be accorded greater
REFLECTION POINT significance in the case analysis.
● Reflect on the challenge of treating a patient who There is much debate among zoologists as
cannot speak. to what emotions animals are capable of feeling,
but suffice it to say that for the effective use of

242
 The Practice of Veterinary Homeopathy

homeopathy in animals, it is necessary to accept selection of individuals with mental and physical
that they experience the same range of emotions attributes which are relatively consistent through
as do humans. The section on ‘Mentals’ in the rep- generations.
ertory may at first glance seem of little relevance In homeopathic terms this has resulted in a
to the veterinary homeopath, but it is the imagina- specific breed tending to exhibit features of a spe-
tive use of this section which often holds the key cific constitution. Thus the majority of Golden
to a successful prescription in an animal. Labradors exhibit features of the Calcarea carbon-
icum constitution described above, the majority of
Constitution and Breed Irish Setters the exuberant nature of Phosphorus.
In more complex cases of chronic disease, espe- Relying on these breed–constitution correlations
cially where the symptoms are clear, a prescription alone is, of course, decidedly unsafe; while many
on constitutional lines is often sought. Putting this German Shepherds do respond to Lycopodium
concept to use can be another way of circumvent- there are many who do not – so this approach
ing the difficulties inherent in veterinary home- should be viewed critically and used with careful
opathy. Even if no other information is available, confirmatory and exclusion information.
an assessment of the general physical attributes of This raises the issue of how important one
the patient can lead to an accurate constitutional should consider the characteristics of the patient
prescription. For instance, a Labrador Retriever which are considered normal for the breed. For
who is fat, chilly, reluctant to exercise and suf- instance, if most Cavalier King Charles Spaniels
fering from swollen joints will probably respond are timid and affectionate, how should these traits
to Calcarea carbonica – the susceptibility of the be weighted in the case analysis of a specific patient
patient being to exhibit that remedy state. Further of that breed? It is clear to veterinary homeopaths
questioning of the owner should produce confir- working on this level that as breed tendencies
matory information – good appetite, aggravation represent an essential aspect of the patient they
by cold and damp weather etc. – but even without must be of significance to susceptibility (consti-
this a reasonably accurate prescription could be tution) – but also of great importance are those

Broadening our
Understanding
made. The more chronic the disease the more a characteristics which run contrary to the breed
constitutional approach is likely to be successful norm (totality). These latter should be afforded
compared to local prescribing. greater significance, and weighted more heavily in
All domestic animals are the product of selec- the repertorisation of a case to find the totality.
tive breeding. In the companion animals, sadly,
the fashion for showing has resulted in the selec-
Where animals have been selected for food-pro-
duction the concept can also be useful, e.g. in dairy
IV
tion of animals with attributes which, while cos- cows who can be observed as they wait in collect-
metically desirable, limit the functionality of the ing yards before and after milking. Sometimes a
animal as a whole. Examples include the exag- whole herd will exhibit the same constitution, and
gerated skin folds of the Shar-pei dog, which in this case a constitutional remedy may be chosen
compromise the integrity of the cornea, and the which will beneficially affect every individual in
flat face of the Persian cat, which limits its ability the group. This technique has merit when deal-
to breathe. These physical attributes may repre- ing with any type of herd, and I have even used it
sent serious obstacles to cure; it is, for instance, successfully in a pack of sled dogs.
often impossible to completely resolve the hind-
leg lameness in a German Shepherd with heredi- REFLECTION POINT
tary hip dysplasia, and symptom reduction may ● Reflect on the influence of family, race and gender on
be the best that can be achieved. However, on the symptom picture presented by any individual patient.
the positive side, the development of distinct Is this different for different species?
breeds of companion animal has resulted in the

243
 CHAPTER EIGHTEEN Veterinary Prescribing

Multiple Prescribing are particularly useful when a case covers more

In view of its deeper effect, most trained veteri- than one remedy or if well selected remedies are
nary homeopaths would consider prescribing on not having the desired effect. Reference to the lit-
the totality, and constitution, to be the ‘gold stan- erature (e.g. Saxton & Gregory 2005) will guide
dard’. The goal of most practitioners will be to the prescriber to the correct bowel nosode, based
administer such a medicine in a single dose of a on keynotes, or the remedies which appear to be
high potency preparation. This will be followed indicated, or on the provings of the bowel nos-
by a fairly lengthy period of observation before odes themselves. Administration of the appro-
repeating the dose. However, this is often not pos- priate bowel nosode will usually create a clearer
sible, and it is therefore quite common for more picture of the case and allow a more accurate
than one remedy to be given at the same time. homeopathic prescription to be made.
This may be to cover aspects of the totality or for Then there is the issue of commercial diets –
different local symptoms. Or it may be different the widespread promotion of processed (usu-
remedies are indicated by different approaches ally dried and pelleted) pet foods has resulted in
and methodologies (see Chapter 30). several generations of dogs and cats who have
In my experience these situations most often been reared exclusively on such foods. While it is
occur in aged animals – it is as if the vital energy beyond the scope of this chapter to examine all the
is too low to exhibit a coherent picture of a possible consequences of this, it seems obvious to
single remedy and instead only makes obvious many veterinary homeopaths that such foods can-
the local signs of the disease, each one relating not possibly support optimal health. As such, the
to a different remedy. In other cases treatment continued feeding of processed foods represents a
may start on a single remedy, but new symptoms most important obstacle to the patient’s recovery –
appear which necessitate a different one. In this wherever possible the veterinary homeopath will
way many aged patients seem to ‘collect’ rem- seek to change the animal’s diet onto a more ‘nat-
edies and may finish their days on a cocktail of ural’ plane. Having said this, it is not always easy
homeopathic medicines, each covering a differ-
Broadening our

to persuade the owner of the patient to change

Understanding

ent aspect of the case. the feeding habits. Often a compromise has to
In this context there are many commercial mix- be sought, either by accepting a partial change in
tures of homeopathic remedies, designed for use feeding regime or by the use of supplements to fill
in specific diseases. These sometimes are effective some of the nutrient gaps left by processing. The
IV but they focus on treating the local symptoms, not
dealing with underlying susceptibility.
more recent introduction of commercial foods for
horses raises the same issue in this species.
In performance animals the stresses associated
Removing Obstacles to Cure with the high performance expected can certainly
Many animals are presented for homeopathy affect the response to homeopathy. However, this
either following or in the midst of conventional is counterbalanced by the general health and fit-
medication. Their symptomatology may be highly ness of the patients, so in practice racing animals
suppressed and it may be necessary to employ respond very well to this form of medicine.
such techniques as isopathic/tautological use of
potentised drugs, or ‘clearing remedies’ such as
Sulphur or Nux Vomica before the picture is clear
Prescribing for Groups of Animals
enough to prescribe on more classical lines. This Animals are frequently kept in groups – in the case
is particularly true of companion animals. Bowel of dog boarding kennels they may number in the
nosodes are also useful in this context. These are tens, a dairy herd may consist of 200 or 300 cows,
potentised remedies prepared from organisms cul- whereas a flock of poultry may number in the
tured from normal human bowel contents. They thousands. Prescribing for such groups presents

244
 Prescribing for Groups of Animals

certain challenges, not least of which is the diffi- calves, for instance, the symptomatology can vary
culty in individualisation. The following strategies markedly, depending on the individual response of
have been designed to overcome these. the animal to challenge, and perhaps on the mix
of pathogens involved. In any group of animals
Simillimum for the Group there may well be three or four distinct symptom
Epizootic/Enzootic Disease pictures apparent, each one indicating a different
Many of the problems affecting groups of animals remedy. In this case, after making the homeopathic
are viral diseases, such as infectious bovine rhino- diagnosis for each type of individual, the selected
tracheitis (IBR) in cattle, orfe in lambs, or kennel remedies may be mixed together and the resulting
cough in dogs. The effects of these on the vital complex administered to the whole group. Often
force are frequently so strong as to produce a uni- this is done on the basis of the local symptoms
form response from a group of animals. In these exhibited by the patient; however, an experienced
cases a single simillimum may be selected to be practitioner can make the prescriptions on an
administered to all the animals in the group. In approach nearing the totality of symptoms, using
the case of orfe this would probably be Thuja, as general and mental symptoms as well as locals.
the symptomatology of this remedy corresponds This method of treatment should be distin-
to the majority of cases of orfe. Following this, guished from the use of ‘off-the-shelf ’ complexes,
any individuals who do not respond may be given many of which may contain tens of remedies in
more specific medicines. various potencies. These preparations can certainly
be effective, but the more specific the selection of
Non-Infectious Disease remedies to the symptoms actually exhibited by
Some functional conditions may appear as herd the animals under treatment, the more effective
problems, affecting each individual in an identical homeopathic medicine is likely to be. A mixture
way. In such instances, once again a single rem- of Kali bichromicum, Bryonia and Phosphorous,
edy may be selected for the group. Examples of prescribed on the basis of observed symptoms, can
this approach can be found in a trial on the pre- be expected to be more reliable than a commercial

Broadening our
Understanding
vention of stillbirths in sows given Caulophyllum mixture which may or may not include these specific
(Day 1984) and in others using Sepia to improve remedies, along with another 10 or so remedies not
the calving-to-service interval in a herd of dairy indicated in this particular group of animals.
cows (Williamson et al 1995).
Several metabolic disorders of cattle also lend
themselves to this approach. Examples include
Single Remedy Based on Group Totality
With this approach all the symptoms exhibited by
IV
copper deficiency, hypomagnesaemia and milk individual members of the group are collected, and
fever. Administration of the appropriate mineral analysis is performed, if necessary with the help of
in homeopathic potency can have a positive effect a repertory, as if the group were a single organ-
on the incidence of the problem in the herd. ism. On the basis of this analysis a single remedy
is selected and administered to all members of the
Combination Remedy for the Group group.
Most commonly, an outbreak of disease will affect
individuals in a group in different ways, depend-
ing on the individual’s response to the patho- REFLECTION POINT
gens. This individuality is further exacerbated by ● The reader is invited to reflect on the dynamics which
the fact that many infections are multifactorial, exist in a group to explain the effectiveness of this
with a combination of viral and bacterial patho- approach.
gens implicated. In an outbreak of pneumonia in

245
 CHAPTER EIGHTEEN Veterinary Prescribing

Nosodes those used for human patients. However, tablets

The use of isopathy does not necessitate the gather- and pillules have to be swallowed by the patient,
ing of any information on the patient’s symptoms; rather than sucked – and in any case oral admin-
all that is required is knowledge of the causal agent. istration is not always possible, especially in cats.
Where a specific pathogen is involved, this form For this reason, liquids and powders (or crushed
of therapy is therefore ideal for the treatment of a tablets) are popular in veterinary homeopathy,
herd of animals. While strictly speaking isopathy is and the use of liquid remedies, as drops or sprays
a form of therapy distinct from homeopathy, nev- to be applied directly to the oral or nasal mucous
ertheless it is generally included in the armoury of membranes, is widespread.
the homeopath and hence covered here. Several Occasionally mixing in food is the only practi-
trials have been performed which demonstrate cable method of dosing, and as long as bland food
the efficacy of nosodes in the control of mastitis is used as a vehicle (e.g. bread for dogs and apples
in dairy cattle (Day 1986) and the routine admin- for horses) the effect appears to be adequate.
istration of such products is becoming widespread However, more problematic is the administra-
in the UK. However there is a great deal of vari- tion of homeopathic medicines to large numbers
ation in the type of product and in the response of animals. Not only is the oral administration of
when they are used. By and large it seems that the solid medicines to cattle and sheep for the most
most effective nosodes are those which have been part impracticable anyway, the considerations of
manufactured using material specific to the farm time and stress on the animals of herding large
in question (‘isonosodes’). There is also a body of numbers through the necessary handling facili-
opinion which holds that, in the case of mastitis, ties make individual dosing an impossibility. One
using whole milk as opposed to bacterial cultures as exception to this is the dairy cow. At milking time,
the source of the remedy is more effective. Having animals become accessible for individual treatment
said this, where pure cultures of specific, properly and spraying a liquid medicine into the vulva is a
identified pathogens are used, these ‘off-the-shelf ’ feasible method of administration. Occasionally
Broadening our

nosodes do seem to be highly effective. an injectable form of the remedy may be used, but
Understanding

It is, however, important to be aware of the the extra equipment required, coupled with the
aggravations which can appear after a nosode is fact that there seems to be no advantage in this
administered to a herd of animals suffering from approach over other methods of administration,
a chronic, subclinical disease. This is of particular means that it is only rarely used. A liquid potency
IV significance in the case of mastitis in dairy cows,
where stimulation of the defence mechanisms of
may be sprayed onto the muzzle of sheep and
goats. However, by far the most common method
the udder can result in a flare-up of clinical cases of overcoming the problem of administration in
of mastitis and an increase in somatic cell count (a farm animals is to mix the (liquid) remedy in the
parameter used by commercial dairies to determine water supply. This may be accomplished either by
the suitability of milk for human consumption). dosing individual troughs or by adding the remedy
These effects are usually transient but on occasion to a header tank.
they can be so great as to necessitate the treatment
to be abandoned until the general udder health of
the herd has been improved by other means.
Repetition of Remedies
It is the experience of many veterinary homeo-
Administration of Homeopathic paths that animals generally seem to need more
frequent, and sometimes more prolonged, repeti-
Medicines to Animals tion of remedies than do humans. Opinions on the
In companion animals, homeopathic medicines cause of this vary – some veterinary homeopaths
may be administered by all the same routes as see it as a consequence of the routine neutering of

246
 The Veterinary Relationship

cats and dogs, which somehow renders the patient In addition, the newer miasms of tuberculosis and
more refractory to homeopathy; others consider cancer are also well represented, mirroring their
it to be an innate characteristic of the animal prevalence in the human population. Given the
metabolism per se, perhaps due to their higher energetic relationship between animals and man
metabolic rates which ‘consume’ the energy of described previously, it would be surprising if
the remedy more quickly. Whatever the reason, this were not so. It is also interesting to note the
an initial course of homeopathy in an animal can prevalence of the tubercular miasm in dairy cattle.
often consist of a 30c potency given daily for a The disease itself is still not completely eradicated
week. This will be repeated when necessary, but from some parts of the UK, and the inheritance of
may well require repetition a month later. Where this miasm leaves its mark in the ringworm, masti-
there is a risk of interference with the action by tis, pneumonia and chronic scours which so often
concurrent orthodox medicine the homeopathy afflict animals in the dairy industry
may be given continuously for some weeks, while The diagnosis of miasms in animals presents
gradually weaning the patient off the orthodox no more difficulty than that in humans, and
medicine. similarly can be an essential step in case analysis.
It should be mentioned, however, that there are Furthermore, an observant veterinary homeopath
veterinary homeopaths who find the sort of dos- can generally identify the mental and emotional
age regimes prevalent in medical homeopathy to basis of the various miasmatic patterns in animal
be perfectly adequate in animals – a single dose of patients, as well as the physical symptoms. Thus
a 30c potency or a single divided dose. As so often the delinquency of tuberculosis and the suppressed
with homeopathy, there is the opportunity to find emotions of cancer are represented perfectly well
a regime which suits the individual practitioner. It in the animal kingdom, along with the chronic
is increasingly popular to prescribe the LM poten- respiratory disease or post-viral syndrome with
cies in animals; in particular, the continuous dos- which these miasms are often respectively associ-
age régimes of a liquid remedy are found to be ated. As an example, cancer miasm is often evident
well complied with by owners. in dogs that have been highly trained for a specific

Broadening our
Understanding
purpose – its preponderance in Border Collie dogs
that have been ‘trained to perfection’ in agility or
REFLECTION POINT even sheep herding is a reflection of this.
● Why do you think animals might need more prolonged
courses of homeopathic treatment than humans? IV
The Veterinary Relationship
From a psychodynamic point of view the vet-
Miasms in Animals erinary consultation represents a complex triad,
There is much debate over the validity of the illustrated in Figure 18.1. It behoves the veterinary
concept of miasms in animals. An understanding homeopath to be aware of the opportunity for
of Hahnemann’s miasmatic theory leads one to projection (see Chapter 23) between owner and
realise that the named diseases which he chose to patient – understanding this dynamic can be vital
represent the three major miasms do not directly in assessing the case, as can the dynamic between
equate with the miasms themselves. Thus the owner, patient and veterinarian. Not only must
absence of these specific diseases in animals in no the veterinary homeopath be aware of personal
way negates the value of the concept of miasms feelings – such feelings must also be interpreted
in veterinary homeopathy. Certainly patterns of in terms of the owner and of the patient. It is not
chronic disease can be identified in animals which always easy to disentangle the one from the other,
correspond closely to psora, sycosis and syphilis. but attempting the process can be invaluable for

247
 CHAPTER EIGHTEEN Veterinary Prescribing

The psychodynamics of the homeopathic con-

sultation are dealt with in detail elsewhere in this
book. The concepts are equally valid when dealing
Patient Owner with animals but it must always be remembered
that here the homeopath is dealing with an ener-
getic triad – hence the interpretation is that much
more complex. While it is in dogs and cats that
this dynamic is most obviously relevant, the con-
Veterinarian
cept is just as true in the case of so-called ‘leisure’
horses, or indeed any species of animal where the
opportunity exists for the formation of such a
close relationship as that described above.
Figure 18.1 The veterinary relationship In relation to the above, many veterinary
homeopaths are uncomfortable with the concept
of ownership of companion animals, and prefer to
all parties concerned. Often the remedy state use such expressions as ‘steward’ or ‘companion’
of the patient is reflected in that of the owner. to denote the person responsible for the animal’s
Indeed, where there is obviously a close emo- welfare. For reasons of simplicity, I have cho-
tional relationship between the two, a degree of sen to remain with the conventional expression
correspondence may be considered as necessary of ‘owner’, but experience in this field has cer-
before a prescription on a fundamental level can tainly challenged my preconceptions of the role
be made with any confidence. Whether the animal of animals in a human’s life. Treating animals with
is reflecting something about the remedy state of homeopathy provides a learning opportunity of
the owner or whether the owner is simply project- immense value for the practitioner and one which
ing it onto the companion is a matter of debate can indeed change one’s world view markedly.
– but either way the relationship does often exist,
Broadening our
Understanding

and understanding this can yield useful and reli-

able information to the homeopathic case.
Summary
Notwithstanding this, such interactions must The use of homeopathy in animals presents cer-
still be viewed critically. It is, for instance, necessary tain challenges which, if not irrelevant in human
IV to establish whether the relationship is as close as
it appears – the dog may have been brought in by
homeopathy, at least have a different emphasis.
Overcoming these challenges is not always easy but
the neighbour, or it may be presented by the par- veterinarians worldwide have engaged with this
ent of the adolescent with whom it has the closest form of therapy with passion and vigour, with the
relationship. However, in the veterinary situation, result that modern veterinary homeopaths enjoy
where direct mental symptoms are lacking, under- remarkably high success rates in their patients.
standing these issues can be of immense help. There is still much opposition to homeopathy
Following on from this, it is worth reflecting within the veterinary profession. However, as
on what response the patient is likely to show if homeopathy is placed on a more scientific basis,
the owner does not receive corresponding homeo- more studies attest to its efficacy, and demand
pathic treatment or otherwise deal with their from the general public grows further, there is
problems – be they emotional or physical. For this no doubt that in the future this invaluable form
reason some veterinary homeopaths have been stim- of medicine will be truly integrated into gen-
ulated to gain experience in human homeopathy, eral practice, so that the patients of veterinary
or seek the co-operation of a medical homeopath surgeons worldwide will benefit fully from this
in order to deal with that side of the dynamic. remarkable therapy.

248
 Information Sources and Training

References Information Sources and Training

Day C 1984 Control of stillbirths using homoeopathy. British Association of Homeopathic Veterinary Surgeons
Vet Rec 114:216 www.bahvs.com
Day C 1986 Clinical trials in bovine mastitis using nos- International Association for Veterinary Homeopathy
odes for prevention. Int J Vet Hom 1:15 www.iavh.
Day C 1995 The homoeopathic treatment of beef and Academy of Veterinary Homeopathy (USA) www.avh.
dairy cattle. Beaconsfield Publishers, Beaconsfield, UK org
Saxton J, Gregory P 2005 Textbook of veterinary home- Recognised courses of training in veterinary homeop-
opathy. Beaconsfield Publishers, Beaconsfield, UK athy are found all over the world. The Homeopathic
Professionals Teaching Group (www.HPTG.org) based
Williamson A V, Mackie W L, Crawford W J, Rennie B
in Oxford, UK, currently provides UK Faculty-accred-
1995 A trial of Sepia 200: prevention of anoestrus prob-
ited tuition for veterinarians in the UK, Australia, Ireland
lems in dairy cows. Br Homoeopathic J 84(1):14–20
and South Africa. Elsewhere in the UK the Bristol and
Glasgow Homeopathic Hospitals provide accredited
courses www.hptg.org
Bibliography In the USA the Academy of Veterinary Homeopathy
Hamilton D 1999 Homeopathic care for cats and dogs. (AVH) runs courses and provides certification. Several
North Atlantic Books, Berkeley other countries have their own frameworks for accred-
iting veterinary homeopaths
Hunter F 2005 Everyday homeopathy for animals.
Beaconsfield Publishers, Beaconsfield, UK A list of IAVH accredited courses is available on their
website www.iavh.org
Day C 1998 The homeopathic treatment of small ani-
mals, 3rd edn. C W Daniel, Saffron Walden

Broadening our
Understanding
IV

249
CHAPTER NINETEEN

Homeopathic Computer Case Analysis

Programs
Phil Edmonds

to gain familiarity. Hopefully after reading this

Introduction by David Owen chapter you will be in a better position to weigh
Homeopaths have always made use of innova- up the pros and cons of computerised repertories
tive ways of presenting and searching detailed and and materia medicas.
extensive information – whether from the detailed In causative approaches the breadth of data
and structured materia medicas or the paper and showing association between symptoms and caus-
card repertories. At the same time a person’s abil- ative or contributing factors allows new ideas
ity to conceptualise something is always connected and patterns of causation to be considered. For
to how others in that culture think and how those example, searching for all aggravations from
thoughts are expressed. It therefore should be no milk, cheese and dairy throws up remedies that
surprise to realise that computerisation has shifted are susceptible to dairy allergy/sensitivity. Under
fundamentally how we think about and the tools local symptoms the ability to identify small rubrics
available to practice homeopathy. The ability to that equate to possible ‘strange, rare and peculiar’
recognise themes and patterns in different rem- symptoms can increase the confidence in which
edies and correlate them to botanical families or local prescribing is made; it is also easy to add
the ability to search large libraries of materia medi- confirmatory and eliminatory symptoms.
cas are just two such examples. Phil Edmonds has In totality prescribing, the ability to include large
used computers in his practice as well as training rubrics and search for particular symptoms that may
others to use them; he brings a practical and clear require combined rubrics allows the net to be cast
method to where and how computers can be used. wide for possible remedies. The use of small rem-
I particularly invite you to reflect on how comput- edy filters to emphasise small remedies or remove
ers can serve you in the analysis of your cases. In polychrests from the analyses can then ensure small
each model of health and approach to treatment but indicated remedies are not discarded without
they bring important resources that allow the consideration. The rapid cross reference to mate-
homeopath to focus on what only they can do ria medica eases the important comparison of the
while broadening, speeding up and making more remedies in the differential diagnosis. For consti-
accurate the process of case analyses. Some student tutional factors, features recorded in cases and
homeopaths and colleges feel that studying paper that run through remedies can be teased out and
repertories and doing longhand repertorisation searched for more quickly than in paper texts.
establishes the principles and orientation for rep- Thematic approaches have perhaps been most
ertorisation that can then be applied to computer greatly helped by computerisation. The develop-
repertories. Others feel that computerised reper- ment of thematic patterns in patients and themes in
tories can be used from early on in the training the remedy pictures track each other in a way that

251
 CHAPTER NINETEEN Homeopathic Computer Programs

is perhaps more than coincidence. The patterns

BOX 19.1
of families that make the use of themes so effec-
What can a Computer do for the Homeopath?
tive are illustrated and represented through mate-
●
Store rubrics in the computer memory for
ria medica and repertory searches. In addition,
analysis
computers provide a medium for rapid growth of
●
Search the repertory for a known symp-
information in a way that builds on existing infor-
tom (you know where it is in the repertory,
mation. Relational prescribing is partly informed
e.g. ‘mind fear dark’)
by the possibilities of a more dynamic and interac-
●
Search for keywords in the repertory (you
tive way of studying remedies and by the record-
don’t know where the rubric is for the
ing and searching of key emotional and sensation
symptom you are trying to repertorise)
words that might otherwise be lost in the minutiae
●
Look at cross references (find a more
of the printed texts.
appropriate rubric for a symptom)
I encourage you to read this chapter, if at all
●
Combine rubrics
possible, in conjunction with looking at and trying
●
Analyse a list of rubrics
one of the homeopathic computer programs, of
●
Extract symptoms of a remedy from the
which there are several. Most offer student dem-
repertory
onstration programs and as long as you are realis-
●
Search for themes/concepts, e.g. animals,
tic about how you use the programs then you will
accidents, otitis media
find they can aid your homeopathic studying.
●
Check repertory sources
●
Edit your analysis (change or delete rubrics)
●
Weight symptoms (underlining/selecting
What Can a Computer intensity)
Do for The Homeopath? ●
Analyse with expert systems
This chapter explores what a homeopathic com-
●
Analyse and search families
puter program can do and Box 19.1 lists the main
●
Search the materia medica from the reper-
Broadening our
Understanding

features that are covered in this chapter – the most tory

important being how it helps in analysing a case.
●
Search and analyse materia medica
I look at three main programs and illustrate using
●
Patient database
screen shots of each. This is not meant to be a
●
Multimedia (sound clips and photos)

IV detailed comparison of these or a ‘training’ ses-

sion. Rather it is a familiarisation of what is avail-
●
Help

able and should stimulate thinking about how Search the Repertory
computers might help in each of the five differ- for a Known Symptom
ent approaches to treatment that run through this MacRepertory and Radar use a pictogram (Fig
book and in each of the different methodologies 19.2) to find the chapter you wish to select your
to prescribing (see Chapter 5). rubric from. Say, for example, you want to search
for ‘fear of the dark’. Use the mouse to point to
Storing Rubrics in the Computer the relevant chapter. Clicking on this brings up a
Memory for Analysis (Fig 19.1) box in which all or part of a search word is typed,
All the programs use the drag and drop feature to e.g. fe for ‘fear’. This generates a list of sub-rubrics
move data from a search screen to a clipboard for for fear. Scrolling down the list to ‘dark’ allows the
storage and analysis. There is effectively no limit rubric ‘fear of the dark’ to be displayed, showing
to the size of rubrics or number of rubrics that can all the remedies contained within it.
be used – but more rubrics does not always more With any of the programs it is very easy to drag
accurately reflect the case. and drop symptoms onto a symptom clipboard

252
 What Can a Computer Do for The Homeopath?

and save it in the memory, and/or print out the This is especially useful in cases where you take
analysis. Indeed one of the disciplines you need to too many rubrics initially. Figure 19.3 shows the
learn with a computer is not to put in too many Isis Explorer tree used to guide you to the rubric
rubrics, as it is now so easy to do. Helping with you want, by book, chapter, and rubric.
this is the facility of having multiple clipboards – The different ways of entering the data, i.e.
you can copy all your rubrics onto one clipboard, keyboard or mouse, suit different people so it is
then select essential symptoms one at a time onto advisable to try different programs to see what
another clipboard, and see how the case builds up. suits your style best.

Figure 19.1 Drop and

drag rubrics

Figure 19.2 MacRepertory

pictogram

Broadening our
Understanding
IV

253
 CHAPTER NINETEEN Homeopathic Computer Programs

Figure 19.3 Isis explorer tree

Search for Key Words in the Repertory cross referencing. Additionally, you can add your
This is useful when you do not know where the own rubrics and set up your own cross references.
rubric that you want to use is located or would
Combining Rubrics
Broadening our

like to find a list of potential rubrics. In each

Understanding

program you can rapidly search for ‘key words’. A very useful feature of the computer repertory
All the programs have various repertories on is the facility to easily combine symptoms – you
offer and it is possible to use several repertories in lessen the chance of missing the right remedy
any one case. It is particularly helpful to be able to when you combine. For example, a keynote of
IV search for rubrics and key words. the remedy Alumina is to take a long time to
answer a question. In one repertory it might not
Cross References be present in the rubric ‘mind answering reflect-
Cross references are rubrics that may be related to ing long’ but will be in ‘mind answering slowly’.
the one you are searching. They can help guide you The advantage of combining rubrics, rather than
to other, sometimes more accurate, rubrics than just adding them individually, is that it widens the
the one you first considered. They are a quick way net, without overemphasising the remedies that
of navigating around the repertory but can skew occur in several rubrics. For example, if you take
any analysis if many rubrics representing the same the rubrics ‘dreams murder’ and ‘dreams killing’
or similar aspect of the case are used. To prevent you might overemphasise Aurum sulph, which is
this, rubrics can be combined. It remains impor- the only remedy common to both. If you combined
tant to know the structure of the repertory you are these rubrics this would not be the case.
using, as this will greatly improve both your use of Different repertories have different strengths
the computer and your choice of rubrics. All the and weaknesses. It is possible to combine differ-
programs greatly improve the ease of identifying ent rubrics from different repertories both in an
relevant related rubrics – Figure 19.4 illustrates this analysis and in a single rubric – if you use these

254
 What Can a Computer Do for The Homeopath?

Figure 19.4 Radar cross

references are hypertext
(13 shown)

regularly they can help to modify your person- adding together the total occurrence of remedies –
alised version of a repertory. scoring 3 for a bold type entry, 2 for italics and 1
for normal type.
Analyse a List of Rubrics This can be easily personalised to reflect a
This technique makes handling large amounts of variety of analysis strategies including the use of
data much easier, e.g. when using the largest rubrics. weighting of rubrics, prominence (e.g. taking into
With a computer, rubrics, irrespective of size, can account where a remedy is the only bold type rem-
be used, weighted, modified and combined at the edy in a rubric) and eliminatory rubrics. The infor-
click of a mouse. The rubrics are entered into a mation is displayed on a range of graphs (some

Broadening our
selection of clipboards that can, separately or in that look similar to Fig. 19.5) but various graph

Understanding
combination, be analysed and reviewed. If you styles can represent the results of the analysis very
want to work thematically you might, for exam- differently which suits those who like visually dis-
ple, put all the rubrics that link to a particular played information – helping to identify remedies
theme in one clipboard. It is easy to weight the that might otherwise not be picked out. Having
rubrics according to their emphasis in the case
and look at how a change in emphasis changes
entered the rubrics you want to use in a case, you
can easily change from one analysis strategy to
IV
the score and relative position for each remedy in another and look at the case from different per-
your analysis. spectives, e.g. small remedies, exclude polychrests,
This makes repertorising the case as part of the small rubrics etc. (see Chapters 9, 14). Figure 19.4
consultation, or immediately after, much easier – shows the Radar analysis screen, with three symp-
providing a shortlist of likely remedies and the tom clipboards open in the left foreground and
opportunity to explore these with the patient at the remedies from left to right – showing which
the time, thus confirming the prescription. Rather remedies occur in which rubrics.
than hold several possible remedies and rubrics It is possible to speedily move from your analy-
in your head they are recalled accurately from a ses to the materia medica you want to use or if
saved analysis and can be studied at your leisure you want to set up your personal keynotes (adding
or built up successively over several visits. things from lectures) – it is up to you. You may
All the programs use a standard ‘rubric score’ alternatively like to see what rubrics a particu-
to calculate the most well represented remedy, lar remedy features in and how strongly and/or
sometimes referred to as the ‘sum of symptoms’, uniquely it features (see below).

255
 CHAPTER NINETEEN Homeopathic Computer Programs

Figure 19.5 Radar analysis

screen

Extracted Symptoms of a Remedy ●

animals, rather than dogs, cats, wolves, etc.
from the Repertory ●
all the rubrics containing any reference to
Sometimes you may want to look at all the rubrics time, rather than morning, etc.
that contain a particular remedy. This can be useful
in a number of different situations: There is also the possibility of making your own new
●
To differentiate between remedies, e.g. look at all rubrics to represent themes, e.g. all remedies that
the food desires and aversions of Phosphorous have issues with money, rather than just taking fear of
compared with Natrum muriaticum. poverty, or avarice. Plus you can create rubrics for the
Broadening our

You are considering a small remedy and can- main organ remedies and limit your analysis to filter
Understanding

not find any materia medica information. out remedies that do not, for example, have a strong
●
You want to study a remedy and want to look liver affinity. Examples of rubrics you might create to
at, for example, all the bold type mentals, all act as filters include ‘money’, ‘liver’ or ‘obsessive’.
the unique rubrics, all the rubrics where the Each of the programs is keen to encourage reflec-
IV remedy is the only one in bold type. tion about cases thematically and each does so in a
slightly different way – perhaps reflecting the absence
●
You want to check the rubrics of a particular
remedy such as Bothrops lanceolatus. It is not in of one clear mechanism or tool for this approach
the rubric ‘weakness of memory for words’, but is that, while it uses the information in the repertory
bold type in ‘forgetful for words while speaking’. and materia medica, also looks for dynamic, living
relationships and patterns. In Radar you can search
Searching your materia medica and repertory is for all the rubrics that contain information related to
an excellent example of how you can rapidly store an idea, e.g. lack of self-confidence. In Isis there is
data from a variety of sources in one place and a list of predefined themes, and in MacRep themes
display it in a way that is relevant for you. and concepts can be displayed graphically.

Search for Themes/Concepts Check Repertory Sources

Computers now offer another new possibility – All the programs allow you to find out where
searching for themes, rather than just rubrics. This an addition to the repertory comes from. You
opens up a whole new world of possibilities for might trust one source more than another
searching, e.g. you can search for or you might also want to verify a particular

256
 What Can a Computer Do for The Homeopath?

addition, or check the context in the materia Expert and Personalised Systems
medica. All the programs have the option for advanced
users of defining their own way of working or
Edit Your Analysis using expert analysis strategies based on the
Once you have chosen your rubrics and placed them methodologies of experienced prescribers. This,
on a symptom/rubric clipboard you can then mod- and ways of emphasising little known or used
ify the selection in a number of ways (Box 19.2). remedies, can prompt consideration of smaller
Underlining or weighting a symptom will remedies that might otherwise not be considered.
change the way a computer deals with the rubric
in the analysis. For instance, if you underline a Analysis Strategies Using Families
rubric twice the program will treat the rubric, There are various ‘filters’ you can apply around the
for analyses and scoring, as if you had entered it general idea of remedy families (see Chapter 22).
twice. Underlining helps to give ‘light and shade’ For example, the computer can show you:
to a case and is therefore an important tool, as it ●
only psoric (or sycotic, etc.) remedies
helps you express your patient’s symptoms and the ●
only plant remedies (or mineral or animal)
emphasis of the case more accurately. If you find ●
only solanacea remedies (or any plant family)
you have taken too many rubrics, then by copy- ●
only salts
ing all the rubrics to a spare clipboard you can ●
only remedies from a particular part of the
rebuild the case from scratch with the most essen- periodic table.
tial features – noticing how the analysis changes as
you add more rubrics. This is certainly made easier using computers in
There are a variety of ways you might allocate homeopathy – you can look at all the plant/animal/
rubrics to different clipboards to reflect how you are mineral remedies with just a click of the mouse.
approaching the case. If you want to use the ‘three- For instance, in Figure 19.6 the graph particularly
legged stool’ methodology you might put mentals highlights the usefulness of a limitation to mineral
in one, generals in one, and physicals in another. If

Broadening our
Understanding
remedies, in a case of frightful dreams of choking,
you want a local treatment for a particular problem that did well on Calcium carbonate and then went
you might put all the relevant symptoms in a specific to Calcium silicata – a limitation to just salts makes
clipboard. Using the clipboards is one of the easiest Calcium silicata a stronger contender still.
ways of using themes and may enable the analyses of
different levels of symptoms or layers of themes. Search the Materia Medica IV
from the Repertory
In many ways the traditional role of the repertory
BOX 19.2 is being challenged by the ability to search large
Modifying Rubrics Selected libraries of cases and materia medica. There are
●
Change underlining (intensity or weighting) some clear advantages to being able to do this:
●
Move/copy rubrics to a different clipboard
●
The repertory always lags behind provings, as
●
Delete a rubric symptoms need to be organised, and put into
●
Combine rubrics into a group or a single the repertory structure – they can be made
rubric available to homoeopaths much more quickly
●
Eliminate remedies that do not occur in in materia medica format.
that rubric from the analysis
●
Because the materia medica is less structured you
●
Mark the rubric as a causation can search for the exact language of the patient.
●
View one or more clipboards at a time
●
The repertory was originally intended to be
●
Save or delete the clipboard a dictionary of materia medica, now we can
access the material directly.

257
 CHAPTER NINETEEN Homeopathic Computer Programs

Figure 19.6 MacRepertory

analysis limited to minerals

●
The libraries of materia medica and cases vary Multimedia
slightly from program to program but each All the programs have sophisticated displays of
offers what would otherwise be shelves full of illustrative materia medica, help screens and
materia medicas and journals. other information that often reflects recent devel-
●
You can search a whole library for a word or opments in homeopathy – where innovation is
group of words in a few seconds, and view the often easier and quicker to present in a computer
Broadening our

results.
Understanding

program than to publish in writing. Figure 19.7

illustrates such a screen.
Limit Your Search in Variety of Ways
It is possible to search for words that are definitely
linked, e.g. next to each other; separated by a speci- Help
IV fied number of words; in the same sentence, para-
graph or section. Equally you can search for words
Help comes from both printed manuals and online
help screens with audiovisual programs.
that are not linked, e.g. desire for fat but not meat.

Patient Database Summary

In the programs you can view a summary of all the
consultations, make brief notes, and look back over Computer programs are able to repertorise big
a summary of past repertorisation. Computers ease or multiple rubrics much quicker than is possible
the possibility of searching for certain cases you have with a book. They provide you with the resources
seen, e.g. asthma cases, and looking at cases where to analyse your cases in a variety of ways, using a
you have prescribed a particular remedy or cases variety of methods and strategies. Each program
with a particular outcome. There are many practice is well supported and training and familiarisation
management programs available if you wish to extend are recommended before using any of them in
the use of computers in your practice. practice.

258
 Summary

Figure 19.7 Isis multimedia screen

Broadening our
Understanding
IV

259
CHAPTER TWENTY

Homeopathic Pharmacy Case Management

Tony Pinkus

health, the approach to treatment, the methodol-

Introduction by David Owen ogy used and the remedy. Additionally, the risk of
It may seem strange to wait until this far into the aggravation, the certainty of the prescription, the
book before tackling the question of homeopathic aim of the treatment, the likelihood of any anti-
pharmacy – particularly potency and administra- doting factors and the ability to follow the case up
tion. However, I have found too many homeopaths will all shape the decision regarding potency.
distracted, confounded and constrained in their I am grateful to Tony Pinkus for providing the
study of homeopathy by different nuances in the background to how remedies are prepared and dis-
use of different potencies. I have in previous chap- pensed – so that you might conceptualise how a
ters made some very general and rather sweeping patient can hopefully be matched not only to their
statements about the use of potency such as recom- simillimum but also to their optimum potency. Tony
mending the novice homeopath confine themselves is equally at home talking about the material sources
to low potencies of 12 or 30 in straightforward of our remedies as when reflecting on their subtle
or simple cases. In practice, different homeopaths energetic qualities – homeopathic principles hold
develop different ways of using potency depend- true in whatever model they are used. I have found a
ing on the case, methodology and their own helpful analogy in matching potency to an individual
experience. To enable you to better develop your is to think of the remedies as ‘falling’ through the
own view on potency, we spend some time going patient’s subtle body. Different potencies resonate
through the basic principles of homeopathic phar- at different depths, hence the recommendation that
macy and the preparation of remedies so that you (generally) the deeper the case and model of heath
can make informed choices about potency. used to understand it the higher the potency.
I hope by this stage in the book you can under-
stand my concern for patients being given frequent
high potencies and that managing patients is made
harder by the inaccurate administration of remedies.
Homeopathic Pharmacy
By now I hope you are able to both appreciate The object of this chapter is to introduce all aspects
enough of the different models of health and have of homeopathic pharmacy, from the preparation of
an insight into your own competencies to match remedies from raw materials, to the description and
cases accurately to remedies through respective administration of dosage forms and over-the-coun-
methodologies – to both handle and prescribe the ter (OTC) prescribing. Homeopathy employs ultra-
higher potencies with the care they warrant. high dilutions, rendering its mechanism of action
As you will appreciate, the choice of potency is difficult to describe in the normal medical models
influenced by the clarity of the case, the model of of biochemistry and physiology. Instead the con-

261
 CHAPTER TWENTY Homeopathic Pharmacy

cept of the remedy as an ‘energy’ or ‘vibration’ will is an ineffable factor accepted without question and
be considered and how the remedy is prepared by underplayed within our culture, but clearly impor-
a process of potentisation. The chapter concludes tant when considered from both a pharmacy and
with a description of dispensing of drops, tablets practitioner’s viewpoint. It is the attention to detail
and pills by the practitioner or pharmacy. beyond the measurable that requires such integrity
Originally homeopathic remedies were prepared by the homeopathic pharmacist.
by the early practitioners themselves. Hahnemann’s Conventional pharmacy use pharmacopoeias
Organon is divided into three major areas: ‘prin- to manufacture and standardise medicines. A small
ciples’, ‘practice’, and ‘remedy preparation’ – thus number of homeopathic pharmacopoeias exist,
giving equal prominence to homeopathic pharmacy. although they are limited in the number of reme-
Knowledge of how remedies are prepared and used dies listed. In Europe there are German, French and
is crucial to the practice of homeopathy. British homeopathic pharmacopoeia and outside
Europe others such as the United States, Mexico
Pharmacopoeia – and India. Currently the European Pharmacopoeia
How Remedies are Made is incorporating homeopathic monographs har-
In order to make a homeopathic remedy we require monised from the pharmacopoeia of its member
knowledge of the properties and origin of the states. Pharmacopoeias are used extensively in the
source material together with a method of prepara- manufacture of remedies, although there is still a
tion. Materia medica, mentioned in other chapters, large gap between the number of pharmacopoeial
are clinical texts and contain detailed descriptions monographs and the number of remedies in use –
of usage but no methods of production, standardi- the main reasons being the proliferation of new
sation or testing of the raw material and finished remedies and the extensive range of small, rarely
product. This information is encompassed within used ones.
a homeopathic pharmacopoeia. Standardisation is Standardisation of remedy preparation is prac-
critical for manufacture – it tries to ensure the rem- tical in most cases but almost impossible in others.
Broadening our

edy will be identical irrespective of whoever makes Where a monograph describes a plant, the parts
understanding

it, providing they use the same starting material used and when to harvest them, it is relatively
and follow the same method. It is crucial that a easy for everyone to make an equivalent remedy
remedy matches its monograph in the materia that matches the expectation of the practitioner.
medica, otherwise the clinical response will be at However, there are wonderful anomalies in the
IV variance with that expected by the homeopath.
The homeopath therefore relies on the integrity of
materia medica that delight and surprise us. For
example, the original proving of Tarentula his-
the homeopathic pharmacy to provide remedies panica was conducted with a remedy made, unin-
which are not only standardised but also conform tentionally, from a decomposed spider. The single
to the original ‘proven’ substance. spider, sent across the Atlantic by ship, arrived dead
Conventional methods of standardisation are and mouldy. The remedy is invaluable but to repli-
limited to measurable physicochemical proper- cate the original material and thereby standardise
ties, and while these are important there are other production is impossible. Similarly, Causticum
equally relevant considerations for the preparation is made from burnt lime – a potash preparation
of homeopathic remedies. It is possible that how the whose exact composition is unknown.
person making the remedy feels and behaves has an The challenge for homeopathic pharmacy is
effect on the remedy being prepared. The intention to make remedies that faithfully match their cor-
and feeling may mirror the sensitivity of practitio- responding picture in the provings. Calcarea car-
ners and influence not only the choosing of a rem- bonica could be made very easily from a plentiful
edy but also the choice of homeopathic pharmacy to commercial source of anhydrous calcium carbon-
dispense that remedy. This ‘having the right feeling’ ate. However, the proving was conducted with a

262
 Homeopathic Pharmacy

remedy prepared by painstakingly scraping out mixture of foreign and host matter. With the
the calcified inner layer of an oyster shell. One is advent of bovine spongiform encephalitis,
a mineral, even if it was originally derived from autoimmune disease and hepatitis this is a now
ancient bones, whereas the other is clearly an ani- a controversial area. A French manufacturer
mal from a specific source – do these feel the same has established with the Pasteur Institute that
to you? Changing the source of starting material 8x or 4c (1 part in 100,000,000) is the lowest
is clearly unwise. non-pathogenic potency that could be guaran-
Colour is a form of vibration and we all have teed to be non-infective. The method currently
different responses to different colours – an exam- used is to prepare nosodes from purified and
ple encompassing both points is Cantharis made inactivated cultures of the pathogenic organism.
from Spanish Fly. The proving was conducted This satisfies many safety issues and ensures we
with Cantharis vesicatoria, a beautiful green iri- and our clients know exactly what the remedy
descent flying beetle, native to Spain and north- is prepared from. The plethora of commer-
ern Africa. The beetles nest in trees overnight and cial vaccines can also be prepared as nosodes,
are caught by shaking the trees early in the morn- popular for antidoting vaccine reactions, being
ing, before the sun’s heat has inflated their wings. purified samples containing the killed or live
A selective predator, they survive solely on a rare organism with a mixture of preservatives and
burrowing bee, which, in becoming extinct, has antibiotics. Not all nosodes are made from
threatened the beetle’s existence, making the rem- infected tissue. Some are made from diseased
edy difficult to produce. Many types of the drab tissue, e.g. Carcinosin and the large number of
brown and black striped Mylabaris beetle, being cancer nosodes are derived from tumours such
also Cantharis species, are plentiful in Asia. We as breast, testicle, lung and bowel.
could save a great deal of effort by accepting the Bowel nosodes isolated from stool cultures in
Mylabaris as an alternative source material, but the 1950s by the Pattersons – emulating the work
the remedy would clearly be at variance with that of Edward Bach – are a discrete group that can-
used in the proving. The remedy may have simi- not be replicated today. The over-use of antibi-

Broadening our
understanding
lar chemical content but its complete picture be otics and the changing classification of types of
different in important ways. bacteria mean we cannot identify with any cer-
tainity from which organisms each was isolated.
Range and Source of Remedies Although most nosodes are obtained from ani-
Remedies are prepared from all three kingdoms of
Nature, plants accounting for about 65%, minerals
mal tissue some are derived from plants, with
examples such as Secale (ergot) and Ustilago
IV
30% and animals 5%. In addition, there are a host of (corn smut).
new and miscellaneous sources including allopathic
drugs, allergens, chemicals, and foods. In my own Sarcodes
company, we have made over 3500 remedies over Sarcodes are obtained from healthy tissue such as
the last 25 years – each in three potency scales, with thyroidinum (sheep’s thyroid), folliculinum (rat
numerous potencies within each scale. Whereas we ovaries) and secretin (a gut hormone). Remedies
are all familiar with plants, animals and minerals, have been made from healthy tissues such as
there are some unusual remedy categories employed ligament, cartilage, bone, artery and hormones
by homeopaths. – some have been proved, many are used specu-
latively in an attempt to restore normal structure
Nosodes and function. You might like to reflect on the use
Nosodes are prepared from diseased biologi- of oestrogen in potency in the menopause or using
cal material. A nosode is a remedy made from potencies of TSH, thyroidinum or tetraiodothyri-
raw material of diseased origin containing a nine in thyroid dysfunction.

263
 CHAPTER TWENTY Homeopathic Pharmacy

New Remedies treated in water troughs or aerosoled in their pens.

The side effects of allopathic and antipathic Chickens are treated via drinkers fed from over-
drugs are sometimes used to give an indication head medicated water tanks – chickens treated
of their action in homeopathic form. However, for stress-related conditions like feather pecking
this will be considerably less informative than produce browner eggs with thicker shells as the
a proving (see Chapter 2). Often new remedies stress reduces. Many new nosodes have been pre-
follow a typical fad curve, practitioners being pared by making remedies from animal diseases;
naturally inclined to explore the latest discov- this avenue is becoming increasingly popular as an
ery yet consistently returning to tried and tested easy introduction to prevention and treatment for
polychrests. In recent years a tranche of new the novice prescribing on causation.
remedies have appeared, accompanied by new
provings, with well-reasoned extrapolations Over-the-Counter Prescribing
from known materia medica or clinical observa- Whereas a handful of dedicated homeopathic phar-
tions. Some have enjoyed wide success, such as macies supply a vast range of remedies in a wide
Jan Scholten’s ‘Elements of the periodic table’ spectrum of potencies, most retail pharmacies and
and Peter Tumminello’s ‘Twelve jewels’, whilst health shops offer over-the-counter (OTC) ranges
countless others remain obscure. A new classi- in a 6c or 30c potency The manufacture and mar-
fication of Imponderabilia is the term employed keting of OTC remedies within the European
to describe the oddities that do not fit elsewhere, Community requires licensing in accordance with
e.g. Tlacote water, obtained from a well in a small the Homeopathic Directive (see p. 272), although
Mexican village and reputed to be a panacea, unmarketed remedies are excluded from licens-
or vibrational remedies from the Nile temples, ing. Many countries outside Europe have adopted
pyramids and ancient sites, electricity, moonlight some form of licensing based on the European
and colours all fall into this category. model. Where access to a homeopath is restricted,
rare or too expensive, the availability of OTC rem-
Veterinary Remedies
Broadening our

edies is an important option for the public. Many

understanding

Many enquiries received by homeopathic phar- countries benefit from thriving homeopathic
macies are requests for remedies for cats, dogs, OTC markets and the remedies form an integral
rabbits and horses (see Chapter 18). Large num- part of their cheap and available self-medication
bers of cats and dogs receive homeopathic rem- products.
IV edies instead of conventional vaccinations and
treatments. The demand to treat livestock is
OTC prescribing is necessarily restricted to
minor self-limiting conditions and limited to the
also considerable – many UK farms use home- ability of the shop staff ’s knowledge and expe-
opathy routinely to treat and prevent disease in rience of homeopathy (Box 20.1). The usual
cattle, sheep, pigs and chickens. The advantage scenario is truly one of self-help with the aid
of a residue-free treatment makes homeopathy of a flyer or booklet – teaching yourself home-
an economical imperative for farmers. Remedies opathy and self-prescribing in a busy shop is not
are administered to a cow by spraying her vulva easy for anything but the most straightforward
during milking or added to the water troughs to or simple case. Unfortunately many people try
prevent common herd problems. to self-treat inappropriately and when it does
Constitutional treatment of cattle is similar to not work think homeopathy has let them down
that in humans and equally successful. A herdsman or failed!
who knows his cows can learn the major consti- The success of homeopathy on the high street is
tutional remedies surprisingly quickly. Sheep are variable, there being numerous competing products
sprayed on the nose as they run by a race or the and services in a conventional pharmacy. However,
remedy is sprayed on grass being grazed. Pigs are the greatest barriers to the spread of homeopathy

264
 Manufacture

with access to a homeopathic pharmacy. Many

BOX 20.1
homeopaths disparage the commercialisation of
Advice for Pharmacists New to
homeopathy because of the wish to prescribe for
Homeopathic OTC Prescribing
everyone holistically. In practice many patients
●
Approach a homeopathic pharmacy/man-
can be helped by prescribing on the cause (such
ufacturer who can supply both remedies
as Arnica for injury, Aconite for acute infection
and advice. The latter should be able to
or panic attack) or on the presenting symptom
offer both OTC products and an extensive
(such as Drosera for whooping-type coughs,
range of remedies in a wide potency spec-
Cuprum for night cramps, Hepar sulph for very
trum required for individual prescriptions.
tender boils).
Many homeopathic prescriptions will need
From a manufacturer’s point of view, mass-
to be individually prepared for you.
produced remedies have to be actively mar-
●
Stock a limited range of remedies for
keted. If you have invested in a manufacturing
common OTC complaints, ensuring this
site, employees, licenses, etc. you clearly have
is provided with adequate sales support.
to sell products in order to survive, as opposed
Consider this range carefully, taking advice
to waiting for patients to arrive with individual
from practitioners and suppliers.
prescriptions. In this respect manufacturing and
●
Consider studying an appropriate intro-
marketing a particular product can grow the
ductory or foundation course.
general awareness of homeopathy but is limited
●
Train your staff to provide homeopathic
(like all OTC prescribing) to certain, often self-
advice on minor self-limiting conditions,
limited conditions. Inappropriate OTC or self-
without going beyond their level of com-
treatment can delay and sometimes complicate
petence. Make use of self-help sheets and
treatment.
provide registers of qualified practitio-
ners.
●
Acquaint yourself with local homeopaths Manufacture

Broadening our
understanding
for referral and your own support. Be
Method of Trituration
aware that many local groups arrange
Remedies made from minerals are often insoluble
meetings for discussion and continued
and the initial phase of grinding the source mate-
professional development.
rial with lactose using a pestle and mortar, called
●
Knowledge comes with experience and
your progress will increase markedly with
trituration. Although considered to be an inert
medium, like water, lactose is perhaps less inert
IV
customer feedback. Great satisfaction will
in our age of milk allergies. Hahnemann, who
be gained in broadening your awareness of
was devoted to consistency and accuracy, dictates
the remedies by simple prescribing.
a method of triturating to 3c that embraces dilu-
tion and succussion called C3 trituration used for
all source material to manufacture the starting
are the lack of knowledge from the shop staff and potency for LM potencies. He cunningly includes
poor education of the public. Frequently, the driv- rest periods to allow recuperation between stages,
ing force is an enthusiastic assistant whose inter- so ensuring the same energy is employed from
est, borne of personal experience, has inspired an start to finish. Aphorism 270 states:
entire community. ‘Divide 99 parts lactose into three aliquots. Add one third
to mortar, add one part substance to be prepared. Mix
OTC Versus Practitioner Prescribing for a moment then triturate strongly for 6–7 minutes.
There is a world of difference between acute OTC Scrape mass in mortar for 3–4 minutes to make homog-
prescribing and a consultation with a homeopath enous. Repeat trituration for 6–7 minutes with the same

265
 CHAPTER TWENTY Homeopathic Pharmacy

force, followed by scraping for 3–4 minutes. Then add The Role of Water
second aliquot of lactose mix for a moment and repeat The preparation of a mother tincture involves
the stage above exactly. Then add the third aliquot and transferring the information or qualities of a
repeat again. Finally decant the triturate into a bottle plant into solution. Water and alcohol have fas-
and tightly seal and protect from light. Label with the cinating roles in this process. Water, a simple
name of the remedy and the attenuation 1c.’ liquid, is highly organised and much has been
written about its complexity and its importance
Mother Tinctures as a liquid, but, in my mind, none demonstrate
The starting point for any remedy of vegetable ori- how it absorbs vibration more clearly than
gin is the preparation of its mother tincture (MT), Masaru Emoto (1999). This Japanese scientist
similar to any herbal tincture prepared by herbal- became fascinated by the individuality of snow
ists. The quaint expression ‘mother’ reminds us flakes, and decided to photograph ice crystals
this tincture will soon give birth to a family of of water from a variety of sources and exposed
potencies. Calendula and Hypericum are used to various messages. He observed that vibration
topically in the form of tinctures and creams for uniquely shapes frozen crystals of water. In two
healing wounds, Thuja mother tincture is applied beautiful volumes he features stunning photo-
to warts and veruccas, Euphrasia tincture is diluted graphs demonstrating how gentle, loving vibra-
in freshly boiled and cooled water before bathing tions create harmony and beautifully complex
sore eyes, and Crataegus mother tincture is used crystals, whereas destructive vibrations, pollu-
in some cardiac conditions. tion and obscenities produce disorganisation,
A pharmacopoeial monograph provides the simple and chaotic structures. He concludes ‘the
method for mother tincture preparation. In the messages from water are telling us to look inside
absence of a monograph, an in-house method is ourselves’. The message is palpable and crucial
created from knowledge of the material’s physi- from a homeopathic perspective.
cochemical properties. The first consideration is
solubility of the raw material in water and alco- Alcohol
Broadening our
Understanding

hol. If insoluble it is prepared by trituration. Alcohol preserves the information or vibration

In plants, fresh material is used whenever pos- of a remedy in a solution and has an important
sible as they seem to produce superior remedies role from preparation of the mother tincture
to dried ones. Plant material is not completely to medicating tablets. It is both a preservative
IV soluble and requires mincing and soaking in
alcohol (a process known as maceration) for the
of the raw material and of the information and
vibrational properties of the remedy. In dispens-
active elements to be released into solution. The ing, alcohol transfers the remedy, coating tablets,
active soluble parts of the plant are separated pills or granules, in addition to acting as a drying
from inert cellulose structures, which are filtered agent of the coated medication. The alcohol used
off. Many substances are soluble in either water in the preparation of remedies is 95% ethanol,
or alcohol, the primary solvents used in homeop- from a vegetable rather than mineral origin. Plant
athy, providing a simple method of mother tinc- material varies greatly – some plants are more suc-
ture production. A notable exception is Carbo culent than others, or contain oily or less soluble
vegetabilis (vegetable charcoal), a common rem- constituents. Hence the pharmacopoeial methods
edy originating from a plant but prepared like a and individual monographs vary in the percentage
mineral. Carbo vegetabilis is made from beech of remedies, for example, ethanol and water to be
wood chips, which Hahnemann decided to car- used in the preparation of maceration of Calendula
bonise to an insoluble charcoal, which has then needs 33% and Crataegus 87% alcohol to obtain a
to undergo trituration. standardised mother tincture.

266
 Manufacture

Preparation of Mother Tinctures regularly agitated to ensure efficient maceration,

from Plants before filtration and pressing to remove insoluble
Composition components.
Fresh plant material decomposes quickly and must
be prepared immediately upon receipt. Raw mate- Labelling and Storage
rial, grown organically without chemicals, may be The mother tincture is labelled and given an expiry
in the form of leaves, flowers, roots, rhizomes, date in accordance with its monograph, generally
bark, fruit, seeds or whole plant. 5 years. In nomenclature a mother tincture is des-
ignated by the suffix MT or by the Greek letter
Concentration theta (θ). After labelling the container is stored in
The German pharmacopoeia specifies an alcohol: a cool, dark place to avoid sunlight accelerating
plant ratio of 3:1 whereas the French traditionally decomposition.
use 10:1 and their more dilute mother tinctures
are D1 or 1x by comparison. Testing
The mother tincture is tested in accordance with
Washing
its pharmacopoeial monograph to ensure that it
The first step is to ensure that plant material is
complies with the specification. The range of tests
free from dirt and insects and to clean it with the
for physicochemical properties includes appear-
minimum amount of water so as not to artificially
ance, odour, density, and thin layer chromatogra-
increase its weight or water content.
phy. Ironically no tests are available to assess the
Dry Weight Calculation crucial, if ineffable, vibration or information qual-
Mother tinctures are prepared with a specific ratio ity we associate with a remedy except proving and
of alcohol to plant, calculated for consistency using it.
as dry weight of plant material. Hence the sec-
ond step requires a calculation of the dry weight Mother Tinctures from
Non-plant Sources

Broadening our
understanding
of the plant material to establish precisely how
much water is lost and how much alcohol to add. Other non-plant source materials vary in their sol-
A small sample of plant is retained to calculate the ubility in water and alcohol. Most chemicals have a
loss on drying. The retained sample is weighed, known degree of solubility listed in reference texts
oven dried and re-weighed to establish water loss such as the Merc Index. Where the substance is
and therefore the correct volume of alcohol to be soluble a saturated solution can be prepared as the
mother tincture. Soluble biological materials, such
IV
added to make a 3:1 dilution.
as snake, spider and bee venoms, are made in this
Preparation manner. However, Sepia (dried cuttlefish ink) and
Plant material is weighed, minced and placed in most minerals are insoluble and must be prepared
glass preparation jars to which a small volume of by the traditional method of trituration described
alcohol is added to preserve the material whilst below. The recent method of Immersion has been
awaiting the result of the calculation above. The introduced to capture the vibration of an insolu-
addition of ethanol and water is made according ble material in water. An example is Diamond (by
to the pharmacopoeial monograph being adjusted Peter Tumminello), which can neither be dissolved
for each sample – the percentage of alcohol vary- nor triturated.
ing between remedies from 30% to 90% ethanol.
Potencies
Maceration Potentisation by attenuation (dilution) and dyna-
After adding alcohol the jar is stored in the dark misation (succussion) are descriptions used by
for a period of one month, during which it is Hahnemann to describe the two-phase process

267
 CHAPTER TWENTY Homeopathic Pharmacy

employed in making a homeopathic remedy from 12, to 100 strikes. Today we use 15 succussions at
its mother tincture. They describe the paradoxi- each stage of centesimal dilution and 100 succus-
cal enhancement of efficacy as source matter dis- sions with LMs (see below). An interesting feature
appears exponentially from the solution. Why a of the centesimal scale is the choice of exponential
remedy becomes more potent with sequential rather than linear potency sequence, with a range
dilution and succussion is indeed a paradox. To of 3, 6, 9, 12, 30, 200, 1000, 10,000, 50,000 and
further complicate matters we discover how in 100,000 dilutions of 1:100. The initial part of
some cases relatively inert substances take on this sequence was developed by Hahnemann, the
new properties as a consequence of potentisation higher potencies by his successors.
(Aphorism 269). Both dilution and succussion are A decimal dilution scale was introduced by
required to achieve the effect, although histori- Constantine Herring in which successive poten-
cally homeopaths have argued as to which has the cies are diluted one part in ten at each successive
more important role. stage. A comparison of centesimal and decimal
After his life-changing experience with Cinchona, scales is shown in Table 20.1.
Hahnemann strove to remove the side effects of his There are 6 × 1023 molecules in a mole of
remedies by diluting them. Although this worked, solution (Avogadro’s constant). By diluting the
it did so at the expense of efficacy and Hahnemann mother tincture beyond 12c we exceed this number
expended great effort in the pursuit of this goal. His and know there is unlikely to be a single molecule
somewhat apocryphal discovery of succussion was of source material in potencies of 12c and above.
said to have occurred when the liquid remedies in
his medicine case spilled out and bounced around
his carriage as it trundled down a cobbled street.
Discovering these agitated dilutions to be more effi- Table 20.1 COMPARISON OF POTENCY SCALES
cacious than his regular remedies was inspirational
Centesimal Decimal
to Hahnemann, who then had the means to revolu- Degree of Dilution Potency Potency
Broadening our

tionise medicine with safe and efficacious remedies.

Understanding

1:100 1c 2× or D2
Potency Scales 1:10,000 2c 3× or D3
The original scale of dilution was centesimal
1:1,000,000 3c 6× or D6
(1:100), in which one part of mother tincture is
IV diluted in 99 parts of pure water and alcohol. The
corked glass vial in which the remedy is prepared
1:1012 6c 12× or D12

1:1024 12c
is only filled two-thirds, allowing turbulent flow
from the action of succussion to energise the liq- 1:1030 15c 30× or D30
uid. Immediately after dilution, the remedy vial is
1:1060 30c
vigorously shaken in a particular manner described
as succussion or dynamisation. Held tightly, the 1:10200 200× or D200
vial is bounced, through a 90 degree arc, onto a
1:10400 200c
leather bound book or similar rebounding surface.
The force employed is that achieved by bending 1:102000 1M
the arm up to shoulder height and striking down-
1:1020,000 10M
ward as hard as possible.
Throughout his career Hahnemann experi- 1:10100,000 50M
mented with different numbers of succussions
1:10200,000 CM
used between dilutions, varying from 2, 8, 10,

268
 Manufacture

Paradoxically these ‘higher’ potencies are consid- have wanted not only more and more remedies,
ered more deep-acting than those below, demon- but also higher and higher potencies to impact
strating that remedy action has little to do with more efficiently at the subtle levels.
material content. Since the same therapeutic effect The influence of Kent considerably changed
is achieved above and below 12c we can conclude the limits of potentisation. Whereas Hahnemann
that the action is not due to material content. stopped at 200c, Kent encouraged the use of
The decimal scale is more commonly used much higher potencies, challenging the pharma-
in Germany and USA with only lower decimal cies to become more inventive in their means
potencies being popular in the UK. An example of producing remedies. Consequently, a variety of
describing the different effect of potencies is with potentisation machines appeared in the late 19th
the treatment of a boil with Hepar sulph. In low century to accommodate requests for potencies of
decimal potencies it will promote suppuration 1M, 10M, 50M, and CM, and higher – all imprac-
from a headless boil, having a simultaneously tical to produce by hand. These machines (Barker
mild anti-inflammatory action. As the potency 1992), produced between 1850 and 1920 and
is increased to 30c the remedy rapidly reduces coinciding with the Industrial Revolution, used
inflammation at the expense of the slower physi- various inventive methods for combining dilution
ological effect of expelling pus. This is important and succussion.
to remember if we are not to accidentally sup- Earlier, in 1829, the Russian Von Korsakoff
press a discharge. Energetically this makes per- had entered into a dialogue with Hahnemann
fect sense and can be employed to great effect in about a method of producing high potencies
infections. with a single vial machine. The vial was filled,
Biochemic tissue salts are a popular series of mechanically succussed and emptied, leaving the
mineral salt remedies prepared by trituration to residue of one drop to act as the starting point
a 6× potency. Although prepared homeopathi- for the next dilution. This method of ‘dry graft-
cally they are prescribed according to a perceived ing’ was approved by Hahnemann, although he
bodily deficiency in one or more of the mineral was concerned about the consistency of prepara-

Broadening our
understanding
salts – which they may help the absorption or tion and suggested limiting it to producing no
utilisation of, rather than acting according to the higher than a 30c.
Similia principle, although some have also been This advice was flaunted by the Kentians who,
proved and so might have ‘joint’ indications. without access or knowledge of Hahnemann’s

The Preparation of High Potencies

later work on LM potencies (see below), were
exploring the higher end of the centesimal scale.
IV
The higher the potency, the more it has been diluted In 1869 Bernhardt Fincke patented his method of
and succussed. The centesimal scale of poten- continuous fluxion, in which the pressure of water
cies is by far the most popular with homeopaths. dropping into a one-dram vial performed the dual
Hahnemann made some 200 remedies, all by hand actions of succussion and dilution simultaneously.
up to the 200th centesimal dilution. Homeopathic In 1878 Thomas Skinner refined continuous flux-
nomenclature designates these with a suffix ‘c’ or ion, insisting that attenuation (dilution) and not
‘cH’ (centesimal Hahnemannian), indicating that dynamisation (succussion) was solely responsible
each was prepared in an individual vial in the for the activity of the resultant potency. This was
method described above. This time-consuming countered by Julius Caspar Jenichen, whose hand-
process requires many vials and corks and a huge made potencies were considerably valued. It was
effort to maintain consistency of succussion. Jenichen who believed succussion gave a remedy
As homeopaths have worked with more dif- its strength and introduced the idea of potency as
ficult cases and subtler models of health so they opposed to simply dilution.

269
 CHAPTER TWENTY Homeopathic Pharmacy

High potencies from machines were described by the LM tincture; then one drop of the tincture is
a personal nomenclature, e.g. 10MK (Korsakovian) added to 99 drops of alcohol and succussed 100
or 10MS (Skinner) – other machines by Boericke, times. This 1:50,000 dilution of the 3c is potency
Swan, Tyrell and even Kent being similarly identi- LM01 tincture. Five hundred granules (the small-
fied. After Kent’s death in 1916 the use of high est granules, of maximum surface area to volume)
potencies declined, low potencies and triturated are moistened with the LM01 tincture and dried
tablets becoming the norm. US homeopathy fell on filter paper; this is the LM01 potency. One
into decline at this point. The machines also fell granule is dissolved in a drop of pure water and
by the wayside, with only isolated companies sup- added to 100 drops of alcohol and succussed 100
plying the industry – Boericke & Tafel being the times to produce LM02.
notable US supplier of Skinnerian remedies until Successive potencies are prepared by repeating
their demise in the late 1980s. the stages above. LM potencies are prescribed in
More recently several machines have attempted a linear scale starting with LM01, the 0 denoting
to faithfully replicate human hand succussion and the single granule dose dissolved in water and suc-
embrace both Korsakovian and Fluxion methods cussed by the patient before each dose. Patients are
to enable realistic production of ultra-high poten- given a 100 ml bottle of the remedy and instructed
cies. Korsakovian machines embrace a slow emp- to take one spoonful daily and shake the bottle
tying procedure which, when multiplied by the vigorously between doses. Different homeopaths
number of cycles, makes the preparation of CMs often adapt this precise methodology to suit their
impractical. The Fluxion process, which makes practice. LMs are often promoted as less likely to
the process less time-consuming, is used by pump- cause aggravations. The LM01 bottle taken by the
ing ultra-pure water into the vial at high pressure spoonful stirred in water lasts for 20 doses, after
and forcing it out after each succussion session. which the LM02 is started if required. There is a
big qualitative jump from the last highly succussed
LM Potencies dose of LM01 to the little succussed LM02;
Broadening our

The fiftymillesimal scale is described in Aphorism patients sometimes notice the different effect.
Understanding

270 of the sixth edition of the Organon, pre-

pared for publication in 1842 (a year before Plussing
Hahnemann’s death). The introduction of the LM Before the advent of LM potencies Hahnemann
method was so radical that his widow, Melanie, evolved a system of incrementally changing the
IV felt unable to compromise his life’s work and
blocked its publication. This edition remained
potency between doses by one degree at a time
to avoid repeating the same strength, e.g. 200 to
hidden until its discovery by Richard Hael who 201, or 1M to 1M+1. The use of ascending poten-
published it in 1921 – by which time the Kentian cies in a powder sequence is relatively similar,
influence had encouraged the alternative path of although the differences in potencies are greater,
high potency prescribing. i.e. 30, 200, 1M. This is used by some homeo-
The LM scale was, in some homeopaths’ eyes, paths when treating very stuck cases or those, like
the pinnacle of Hahnemann’s career, combining cancer, with much structural damage. The remedy
the maximum benefit to patients with the great- may be prepared in drop form and succussed and
est uniformity of remedy preparation. Rather than diluted slightly after each dose.
being prepared from mother tincture all remedies
are triturated to 3c (1ppm), a point at which all Practitioner Dispensing,
materials are considered soluble. Thereafter the Building a Dispensary
dilution scale of 1:50,000 is followed in a two- The methods described above yield medicating poten-
step process. One grain of the 3c triturated pow- cies in 95% alcohol that can be supplied directly to
der is diluted to 500 drops of alcohol to make practitioners or used to prepare prescriptions on

270
 Manufacture

their behalf. Potencies are run in either ultra-pure preferring tablets to pills or vice versa. Certain situ-
water or alcohol, with all but the final potencies ations demand a particular form, e.g. an ascending
and their immediate predecessors being discarded. series of potencies is ideally delivered with a num-
Potencies are made in 95% alcohol and stored in bered powder sequence. In the example below the
corked neutral glass vials protected from light. first four doses are medicated as indicated and the
Neutral rather than soda glass is chosen to prevent remaining powders are unmedicated (sl standing
residues leaching into the remedy; unbleached for sac lac or sugar of milk):
corks are used for the same reason. Light and
Rx Aurum 30, 200, 1M, 10M in 1–4, sl to 30
strong odours such as camphor, menthol and
eucalyptus are considered to antidote remedies, Important information can be gleaned from
so are avoided. patients with such a prescription of numbered
A homeopath can easily equip themselves with powders, e.g. exactly when and for how long the
a kit of remedies to dispense to patients. The con- remedy worked. Placebo doses can be helpful in
venience of being able to dispense in acute situa- some cases in improving compliance, reassuring
tions cannot be underestimated and portable kits the patient and clarifying at what stage in a treat-
of polychrest remedies are invaluable. A range ment programme the case starts to react. Some
of essential remedies and potencies are instantly homeopaths will use a placebo ‘lead in’ to separate
available for emergencies, enabling prescriptions reactions due to the consultation and reactions due
to be dispensed quickly. to the active treatment. Prescribing pattern change
and historically placebo was used more commonly
Dispensing Remedies and many patients were not told the name of the
Dispensing is extremely simple and involves medi- remedy they were taking. Patients are now much
cating a blank vehicle (pill, tablet, granule, pow- keener to know what they are taking and why, they
der or liquid) with the desired potency in 95% may well look it up in the materia medica.
alcohol. The shelf life of medicating potencies is
infinite but the product prepared in tablet or pill Routes of Administration

Broadening our
understanding
form is given a 5-year shelf life. This is more arbi- Oral dosage forms are the most usual presentations,
trary than accurate, no measure of potency being although other routes are employed. Topical prepa-
available. The remedy is dispensed by adding sev- rations such as creams and ointments containing
eral drops of medicating potency into a pre-filled 5% mother tincture are useful for external use in a
vial of tablets, pills or granules, or onto individual
powders. The alcohol carries the potency and
variety of symptoms such as bruises, haemorrhoids,
eczema, sprains and warts. Eye drops, nasal sprays,
IV
dries the remedy on the surface of the tablets or suppositories, pessaries and injections are also avail-
pills. Hence it is imperative not to handle the tab- able. Injections are very common in Germany,
lets or otherwise disrupt the film on their surface. where marketing directly to doctors ensures a steady
By medicating in the final container there is no demand. In addition, the remedy can be delivered
contamination from extraneous sources; no addi- by inhalation of alcoholic tinctures or applied to
tional heat drying is required since the alcohol acupuncture points on the skin. Remedies for babies
evaporates to dryness, coating each tablet in turn. can be given in freshly boiled and cooled potable
The ‘vehicle’ used to carry the remedy is com- water. Eye washes made up in freshly boiled and
posed of an inert medium such as lactose or sucrose. cooled potable water can also be used to dilute
Various pharmaceutical forms of the vehicle are Euphrasia or Cinneraria mother tinctures.
available; powders are pure lactose, tablets are a
lactose/sucrose mixture, and pills and granules of Patient Instructions
various sizes are pure sucrose. The choice of phar- Advice to not handle the remedy, but tip tablets
maceutical form is largely subjective with some or pills into the cap and then onto a clean, dry

271
 CHAPTER TWENTY Homeopathic Pharmacy

tongue, is important. These, and other instruc- remedies. Dr Edward Bach discovered a means by
tions, can be given to all patients on a simple which everyone can treat themselves according to
instruction sheet, perhaps combined with practice how they are feeling. His 38 flower essences from
information such as how to find out what to do if indigenous trees, shrubs and flower species, encom-
there is an aggravation, etc. pass the spectrum of human emotions familiar to
Remedies should be stored in a cool, dry place each of us. By honestly identifying and accepting
away from strong odours, mentholated sprays, and how one is feeling, a number of Bach flower rem-
perfumes. Certain substances antidote remedies edies corresponding to the feeling can be selected
although some patients, despite ignoring advice and mixed together. The resultant mixture is taken
about correct administration and antidoting, still orally by adding drops to water.
get good reactions to remedies! Many homeopaths Bach discovered each flower’s natural gift by
advise that peppermint and toothpastes contain- feeling the vibration of the plant on field trips. He
ing mint should be avoided when taking remedies. observed dew drops and felt how they captured
Coffee is considered to deplete the action of many and irradiated the essence of the plant. Originally
remedies and should be avoided during treatment he collected them early each morning but soon
and for some time after higher potencies. evolved two more practical methods – solarisation
and boiling.
The Homeopathic Directive The sun method achieves what sunlight does
After the thalidomide crisis, the 1968 and 1971 with dewdrops. The essence of the plant is cap-
Medicines Acts introduced three classifications – tured in water by floating flowers of the remedy
POM (prescription only), P (pharmacy only) and on a glass bowl of spring water for several hours
GSL (general sales list) – to control the marketing in bright sun. The remedy is made in situ so that
of medicines. Medicines that did not fit into these water accepts the vibration from both flowers and
three categories were assigned a temporary status, the growing plant. After the flowers have wilted
called PLR (product license of right), in which they the essence is strained and diluted with equal parts
Broadening our

could continue to be marketed until new legisla- of brandy.

Understanding

tion found them an appropriate home. This was The boiling method is employed when the
fine for companies that had PLRs but has made flowering period is less sunny, as with trees. The
it difficult for new companies to develop new flowers are collected, brought to the boil and sim-
medicines within the Medicines Act. Different mered for 30 minutes, then strained and preserved
IV countries have different challenges with their own
particular legislation.
with equal parts in brandy. Bach flower remedies
are then prepared by diluting the preserved essence
European homeopathic manufacturers deplored above 1:240 in brandy. Several drops are taken in
the absence of licensing for homeopathic medicines water and sipped as required. Water is required to
across Europe, resulting in an inability to market release the vibration and allow it to be accepted
unlicensed products in other member states. The into our body, the alcohol holds the vibration in
only way this could be achieved was to establish solution ready for release.
separate manufacturing bases in each country.
The activity of supplying an individual remedy to Material Dose
a practitioner is exempt from the Directive; this Ironically, homeopathy has become over-asso-
protects the supply of many thousands of remedies ciated with the use of highly diluted medicines.
that have little market demand. A remedy acts because it is homeopathic to the
case, not because it is highly diluted. A remedy
Bach Flower Remedies works in material dose, as Hahnemann’s initial
Bach flower remedies are flower essences prepared proving with China officinalis demonstrated. The
according to a different method to homeopathic potentised form of the remedy was introduced as

272
 Bibliography

a significant and necessary refinement to over- Barker R 1992 LM potencies, 2nd (revised) edn. The
come side effects and toxicity. Paradoxically, the Homeopathic Supply Company, Holt, Norfolk
remedy is known to be considerably more effica-
cious and safer through potentisation (dilution
and succussion).
Bibliography
Argumentation for Amendments of Council Directive
Summary 92/73/EEC, Nehoma, December 12, 1994
I hope you have gained an awareness of the scope Castro M 1995 The complete homeopathy handbook: a
of the homeopathic pharmacy and pharmaco- guide to everyday health care. Macmillan, Basingstoke
poeia, and the importance of integrity in prepar-
Hahnemann S trans Künzli J, Naudé A, Pendleton P
ing remedies that correspond to their monographs
1983 Organon of medicine, 6th edn. Victor Gollancz,
in the materia medica. An understanding of the London
process of preparation, from raw material to
mother tincture and potentised remedy, should Julian O A trans Mukerjee R K 1992 Treatise on
dynamized microimmunotherapy. B Jain, New Delhi
provide you with a clear idea of how the final
remedy is prepared and aid you in selecting the Lockie A 1989 The family guide to homeopathy. Elm
optimum potency or making informed choices Tree Books, London
when potency needs changing. Medicine and Healthcare products Regulatory Agency
2005 MHRA Consultation letter MLX312 20 June
2005
References
Emoto M 1999 Messages from water, vols 1 and 2.
Hado Kyoikusha Co, Tokyo

Broadening our
understanding
IV

273
CHAPTER TWENTY ONE

Signatures Philosophy

Misha Norland

symbols to allow us to perceive and interpret a case.

Introduction by David Owen Perhaps they provide a way of encapsulating that
‘As above, so below’ understanding then giving it back to the patient in
a remedy through the information it holds. There
In Sections V and VI we move further to the are concepts in this chapter that ‘set the scene’ for
‘inside’ of the case, the remedies, the approaches this section and, although challenging, are illus-
and methods used homeopathically. As you look trated in the homeopathic tradition through the
into the centre of the case and the fundamental case example. Grasping the ideas helps us perceive
nature of the remedies, and reflect on how to make the case; preserving the case helps us grasp the
use of your own inner process in treating patients, ideas. Understanding what signs connect differ-
it is appropriate to revisit how the inner and outer ent remedies, whether atomic weight or botanical
nature of man reflect each other. This reflection of family, lays the foundation for understanding how
one thing onto and into another is at the heart of different remedies may be related to each other
the philosophical understanding of ‘like mirror- and by which pattern and theme.
ing like’, where one part of the body reflects other Finally, signatures offer an insight into how the
parts – as used by auricular acupuncturists and in world of the patient and the world of the homeo-
reflexology. I am very grateful that Misha Norland path are connected. By recognising, naming and
has provided this opportunity to reflect on how all agreeing on what is perceived by you and your
things carry a sign or ‘sign-ature’. For those who patient, connections and bonds are made between
choose to perceive it, this signature not only com- you both that reflect the healing process – some
municates one thing’s connection to all things, but might say determine it! The inner process that
it is a dynamic part of that connection; it represents you experience will, to the extent that you expe-
its ‘sign-ificance’. It is perhaps easiest to appreciate rience the patient, parallel the process taking place
this with the homeopathic remedies where the sig- in the patient. As all relationships, including ther-
nature of the source material communicates some- apeutic ones, are subject to this process homeo-
thing of the remedy’s potential. For all homeopaths paths seeking a deep insight into patients are well
it may aid in remembering a remedy picture. For advised to establish a clear insight of themselves.
some, the quality or theme ‘sign-aled’ in a remedy As homeopaths we share a clear language through
and its presence in a patient represent a deep con- the homeopathic remedies, although there are
nection between the patient and their environment, many ways of deepening and clarifying our under-
between the microcosm and macrocosm. standing of them. I wish you well on finding a way
In another way the signs that the remedies give that works for you and am grateful to Misha for
a homeopath provide the very language, ideas and sharing a method that has informed him.

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 CHAPTER TWENTY ONE Signatures

but the more he became captivated by illusive external

What is a ‘Signature’? appearances, the more this power became lost.’
The doctrine of signatures holds that the Creator Paracelsus, ‘The Aurora
marked each of His creations with a sign. This of the Philosophers’ (Waite 2002)
signature is an indication of the healing property
of the organism. Every ancient culture contains For those who knew this language of signatures
its own version of this doctrine, which was origi- in the natural world, not only was the inward
nally not just a medical principle but a way of power of a thing similar to its outward form, but
seeing the world. According to this world view, also its name reflected its physical form. This was
at the level of the dynamic life force or essence true, so it has been written, because the entire cre-
all things are interconnected. This is because the ated universe was continuously unfolding out of
same laws of nature that give form to plants, ani- the infinite source in terms of speech or sound.
mals and minerals and their medicinal properties The Saint James’s Bible translation of Genesis, ‘In
also give form to our bodies and the illnesses that principio erat verbum…’ states, ‘In the beginning
take root in them. By careful observation of the was the word…’. The source of creation was silent
form, behaviour and habitat of a substance, we but contained the entirety of all the diverse sounds
can learn how it interacts with our own bodies and forms of creation in seed state. From this the
and minds. name of each object or creature was brought into
Though there are allusions to the doctrine of being. The name was understood as a network of
signatures in the writings of the Greek physician subtle impulses or tendencies in which the entire
Galen (AD 129–c. 210), it was first applied sys- structure of the physical form is contained in seed
tematically to Western medicine by the great Swiss form, much as a great oak tree is contained in a
physician Paracelsus (1493–1541). Paracelsus was tiny acorn.
often referred to as the last alchemist and he was
undoubtedly a forerunner of homeopathy, though
it fell to Samuel Hahnemann to codify and name
Signature and Symptoms
it as such. Paracelsus said that our soul: Knowledge of a remedy’s signature is not merely
‘. . . intuitively perceives the powers and virtues [of herbs], a theoretical exercise that enables us to specu-
and recognises at once their signature. This signature is late about its homeopathic uses. The signature
a certain organic or vital activity, giving to each natural can bring together all the symptoms of a proving
object . . . a certain similarity with a certain condition into a cohesive remedy picture. For example, why
produced by disease, and through which health may be should a person needing Calcarea carbonica have
restored in specific diseases of the diseased part. fears about murder, fire and rats, and be worse
from exertion? Looking at the remedy substance,
‘This signature is often expressed even in the exterior Calcarea carbonica is made from the middle lay-
Deepening our

form of things, and by observing that form we may ers of the shell of an oyster. After passing through
Approach

learn something in regard to their interior qualities even an immature mobile phase of existence, the oyster
without using our interior sight. We see that the internal quickly transforms into a creature that sticks itself
character of a man is often expressed, even in the man- to a rock for the rest of its life. It is a filter feeder,
V ner of his walking and the sound of his voice. Likewise
the hidden character of things is to a certain extent
taking in passing food particles, and relying upon
its thickening shell for protection against crashing
expressed in their outward forms. waves and predators. Small wonder then, that the
remedy made from this creature, weighed down
‘As long as man remained in a natural state he recognised by its ever enlarging and heavy house, is useful for
the signatures of things and knew their true character; those who are worse for exertion.

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 Signature and Symptoms

Calcarea carbonica types in health feel as safe was further developed during the classical Greek
as houses, while in sickness they feel as vulnerable period – when the four elements were associated
as an oyster without its shell. Children in particu- with the four temperaments. This map of elements
lar are wary of leaving the protective shell (their is of the essence in astrology as well as oriental
home). They may fear murder, because it endan- and mediaeval Western medicine.
gers their own person; fire, because it endangers
their house; and rats and vermin, because they There are Five Elemental Levels Through
invade their house and eat their food. In this way, Which We Experience the World
the signature pulls together a remedy’s many seem- The ancient Greek philosopher Heraclitus, refer-
ingly disconnected physical and mental symptoms ring to the four elements other than ether, wrote:
to reveal the main themes and essence. ‘each of the elements lives by the death of the others:
The signature is expressed by the substance’s earth lives by the death of water; water lives by the death
experience of being what it is. This includes the of air; air lives by the death of fire.’
substance’s habits, form, and interactions with
humans. These elements are revealed by the prov- In other words, the essence of the superior ele-
ers, and are lived out by the patient as a character- mental force must die – that is play out, into the
istic complex of sensations and functions. Strange, matrix of its inferior elemental force in order to
rare and peculiar symptoms can frequently be imbue it with vitality and existence. The five ele-
particularly useful expressions of the signature. ments can be thought of as gradually moving from
For example, Ferrum metallicum’s characteristic spirit into matter and are:
of ‘shall not bend’ expresses the strength of iron. 1. Etheric energy – which is immaterial, reveals
Depletion of iron leads to the well-known anae- itself as primal non-verbal experience and as
mic symptomatology of lack of strength – bending intuition.
or ‘iron gone soft’. 2. Elemental fire – almost immaterial, the energy
To put signatures into a useful and practical of combustion, heat and light, reveals itself as
context, I would like to take you on a journey images.
exploring an ancient map which states that the 3. Elemental air – dense enough to fly in, reveals
manner of materialisation of objects from their itself as thoughts. These are products of the
source into form, from spirit into matter, may intellect, representing our discriminative
be expressed by elemental stages. It shows how awareness ‘playing’ over experiences and
objects and their qualities become visible and memory.
intelligible. It describes a way in which we experi- 4. Elemental water – yet denser, to swim in,
ence the world around us. reveals itself as feelings. These inform us of
Quantum physicists have stated that what our likes and dislikes.
appear to be particles (matter) are rather mani- 5. Elemental earth – solid, to build with, reveals
Deepening our
festations of electromagnetic waves – vibrating itself as sensations. These are experienced
Approach

fields of energy. Einstein has stated, ‘We may in the body directly by the five senses.
therefore regard matter as being constituted Physical pathology is the final outcome of
by the regions of space in which the field is derangement of the above elemental levels.
extremely intense.’
The model of spirit manifesting as ether, or First Level – Elemental Ether
V
fields of energy, playing out into the world of Elemental ether is apprehended as direct, non-
matter in terms of elemental fire, air, water and verbal experience. Like a telepathic resonance,
earth has been described in the dialogue of Arjuna ether is more related to the ‘vibrating fields of
and Lord Krishna in the Bhaghavad Gita. This energy’ referred to by quantum physicists, than to
informed the ancient Egyptians, while the map the lower levels of manifestation. At the etheric

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 CHAPTER TWENTY ONE Signatures

level we experience directly what is there. In the clairvoyance are differentiated by reason. This
therapeutic setting, it is understood to arise out of leads to the next level.
the ‘seed-state’ of the disease and communicates
its primal being, its disease signature. This is anal- Third Level – Elemental Air
ogous to a remedy’s signature, which is expressed Elemental air links to thoughts. These are prod-
by the substance’s experience of being what it is. ucts of the intellect, that discriminative faculty
This is, of course, the ‘like cures like’ principle which decides that something is this and not
in action; more than that, it is why homeopathy that. Examples of malfunction include confusion,
works – because the signatures of the substance being lost in thought, and deviations of memory.
and the disease match up in their original ‘seed Delusions and delirium states give rise to distorted
state’ as ‘vibrating fields of energy’. In health, ele- thoughts and confused awareness, while clear
mental ether manifests as intuitions and clairvoy- thinking helps us stay in touch with, and navigate
ance and gives us insights into interior ‘seed states’. according to, the higher purposes of our existence
In diseases these are the characteristic distortions (see paragraph 9 in Hahnemann’s Organon).
which we are in search of. Gestures often arise at Once we have established the truth of our intu-
this level (that is from etheric energy manifesting ition, we can respond appropriately – that is, in
in lower levels), as do images (that is from etheric the way of Homo sapiens (thinking humans) – and
energy manifesting in the second level). then cross the threshold (with human confidence)
into the more primitive, survival-oriented, world
Second Level – Elemental Fire of feelings. Feelings ascertain whether a thing suits
Elemental fire links to images. It is primarily us or not, whether we wish to accept it or not.
through intuition and clairvoyance (literally, This function has been developed and champi-
‘clear vision’) that the etheric level unhesitat- oned by animals.
ingly expresses itself in elemental fire as image
and the spirit world manifest to us. This can be Fourth Level – Elemental Water
seen because fire illuminates, as well as heats. Elemental water links to feelings that arise in
The heating aspect is related to passion and response to energy, sensations, thoughts and their
desire, such as are enacted in religious rituals, associated images and memories. Our empathetic
where the holy image is revealed upon the altar. resonance with each other and with animals is a
There is an equally compelling sexual aspect, feeling response brought to us by elemental ether.
where the imagery is erotic. It is also in the form Feelings include love, joy, rage, grief, jealousy,
of images – many experiences and their associ- isolation – they manifest as emotion giving rise
ated sensations and feelings are stored as picto- to actions (primary emotion). When suppressed,
rial memories. emotions turn inwards upon themselves (second-
References to images are mostly found in the ary or compensated state). Secondary feelings and
Deepening our

homeopathic repertory in dreams, fears, delu- emotions are complex derivations of the primary,
Approach

sions and delirium, where the boundaries of con- uncompensated source – this can make them
sciousness and sub-consciousness are blurred. Our difficult to navigate and of lesser value to the
dreams ‘talk to us’ in pictures, while we literally prescriber.
V talk in images whenever we use a simile or a poetic
analogy. In drawings, especially children’s fantasy
Just as intuition mediated by thinking and feel-
ing takes care of the soul, so instincts take care of
sketches, images abound. They are also expressed the body. Instincts are experienced as sensations,
in adults’ doodles when exacting attention upon which in turn drive actions and gestures. The
an object’s form is quiescent. As with dreams, organs of locomotion and, in humans, the hands,
their significance can be revealed using associa- are directly expressive of instinctive will and of feel-
tion and imaginative amplification. Intuition and ings as ‘e-motions’. For this reason, gestures and

280
 The Four Kingdoms and the Five Elemental Levels

body language are worthy of the case receiver’s we boil the fat off the bones of a case, what is most
closest attention. striking is the energetic, etheric experience in the
body, because this is how the disease expresses
Fifth level – Elemental Earth itself at its bed-rock, bodily interaction with the
Elemental earth is experienced in the body physi- organism’s spiritual vital force. This energetic
cally as sensations, directly by the senses or indi- experience, or ‘vital sensation’, as Rajan Sankaran
rectly through body memories. Sensations include calls it (see Chapter 22), is the uncompensated
descriptions of pain, such as clawing, shattered, as expression of the disease’s ‘seed’ state and is its
well as experiences of the other organs of sense, characteristic form signature.
such as red, shrill or putrid. The material level After this initial distortion of the etheric energy
or corporeal earth is where the five different ele- by the disease (primary action), the vital force
ments all meet and manifest. As they play out into fights back in an effort to restore homeostasis
the body, if each is not balanced, physical pathol- (secondary action). The complex of secondary
ogy is the result – its exact expression depending actions is what we call compensation. It is the cop-
upon the imbalance of the different elements. ing mechanism adopted by the organism in order
to survive, while labouring under the unvan-
quished influence of the disease. Only when the
The Four Kingdoms and the simillimum is administered will total cure occur,
referred to as ‘permanent eradication of the dis-
Five Elemental Levels ease,’ in paragraph 2 of Hahnemann’s Organon.
The kingdoms considered here are animal, plant, So this is the rub – how do we accurately match
bacterial and mineral. the remedy to the patient? I would argue that the
Etheric energy (level 1) is common to all things signature most closely expresses the uncompen-
in nature and represents their lowest universal, sated state. As we have noted, etheric energy and
shared spiritual connection, which at the highest sensation, along with associated imagery (often
and undifferentiated octave of being is pure spirit. articulated through gestures and drawings), most
Another common denominator of all four king- closely expresses the uncompensated disease ‘seed’
doms is the level of sensation, obviously, because state. Thus the simillimum is found when the rem-
they and we are formed of matter in the material edy’s signature equals the signature of the patient’s
world. So, top (level 1) and bottom (level 5) are in diseased state – the seed matching the seed. As an
common for all the kingdoms in nature. example of signature, consider the remedy Falco
To examine this further, we understand that a peregrinus (from a captive, stud peregrine falcon),
mineral or bacterium or plant does not generate which has the characteristic sensation of feeling
feelings or thoughts as an animal or human would. trapped, hooded, required to do things against
However, they do ‘share’ primal sensations with us its will and numb, versus the mobilisation of vital
Deepening our
because we all have bodies and physical structures aggressive energy to be the free spirit, which at
Approach

as well as an etheric field through which common their essence, they are – an energy and sensation
experiences are mediated. These experiences, that may be encircled by flying imagery.
supplemented by imagery, arise in the beginning.
Images, before they are grounded in the physical
realm, are energetic representatives of forms and
Animal Signatures
Patients experiencing the world in animal rem-
V
structures – they are precursors of physical forms edy states experience competition for resources
in much the same way as an architect’s plan is the and the need to establish their own territory. Key
precursor of the building. Because these are the expressions include: to stay alert; sexual display;
common denominators, they are worthy of our to be attractive; to make a performance and to
particular attention. To put it another way, when be seen as the best; avoiding humiliation and

281
 CHAPTER TWENTY ONE Signatures

shame. Relationships are typically experienced in the case of the cell, one organelle, cannot sur-
as challenging, vying for dominance and position vive without the other. They are locked together.
(predatory), or feeling subjugated and submissive Patients who need remedies from this vast and little
(prey) – feeling ugly, unattractive, used, abused explored kingdom have features of co-operation/
and worthless. maintenance/growth versus destruction/contami-
nation at the heart of their case.
Plant (Including Fungal) Signatures
Patients experiencing the world in plant remedy Mineral Signatures
states exhibit enhanced sensitivity to their sur- Patients experiencing the world in mineral remedy
roundings, they relate how they are affected by state have issues with material structure and main-
their environment, by others; they often express tenance of order. These patients tend to be system-
how they are hurt, injured, easily influenced; they atic; questions arise such as: how can I organise and
may like to actively explore their feelings and secure my goal?; what is my place and role in the
inner realities; relationships may be struck to pro- family? Relationships are forged to fulfill a yearning
tect against a perceived violation of inner vulner- for completion. This is analogous to compounds, in
ability. In short, plants are at the base of all food which elements bond together. Elements and com-
chains, they are eaten, they are passively respon- pounds, being the building-blocks of matter, form
sive and sensitive. Often they protect themselves, the structural components of all living systems.
becoming actively responsive, e.g. by developing Laws have been devised which allow us to predict
thorns and poisons, while flowers are attractive chemical reactions with accuracy. It is this capacity
to pollinating insects, developing colour, scent for ordering and structuring which is the signature
and nectar. Here their outward expression may for these patients. The fears are of breakdown and
mimic that of an animal remedy and express as weakness; lack of stamina; lack of the support of
active and aggressive. To tell them apart, we must others; lack of stability and security.
look to the inner state: the animal experiences the
world as a place to go-get in, the plant as a place Which Signature
to adapt to, the mineral as a place to find a bed Establishing into which kingdom signature a
rock of certainty. patient falls, narrows down remedy choices and
helps establish what the issues for a patient are.
Viral and Bacterial Signatures For example, we may note, ‘This patient is act-
Patients experiencing the world in viral and bacterial ing like a plant remedy because they are so pas-
remedy states, on the one hand exhibit features of sively sensitive to their surroundings, so easily
invading and destroying (living off plants, animals influenced and hurt.’ Therefore, we would look
and humans) and, on the other hand, co-operating at plant remedies before considering remedies
and developing interactive communities. In this originating from other kingdoms, this is discussed
Deepening our

respect there are similarities with plant issues – further in Chapter 22.
Approach

finding a safe place within which to adapt. Establishing an individual’s characteristic expres-
Bacterial evolution represents the first 400 mil- sions (function or output) is useful in differential
lion years of life. These organisms were respon- remedy analysis, however their characteristic key
V sible, amongst other feats, for developing mitosis
and radically changing the entire chemical compo-
signature (sensation or input) gives us primary data
for remedy selection. This is where the levels come
sition of the atmosphere. Co-operation is the key to in, because the schema indicates what is most useful
survival and symbiotic relationships the key to evo- in a comprehensible hierarchy.
lution. While this may seem contrary to Darwin’s To recap: in the beginning, as the disease
theory, it is of course its necessary corollary. Once entered the patient and made a take-over bid for
co-operation evolves into symbiosis, one species, or control of the vital force – attempting, as it were,

282
 The Four Kingdoms and the Five Elemental Levels

to impress the host organism with its will – the entities express as symptoms. Of these symptoms
host submitted more or less passively to the dis- the most idiosyncratic (strange, rare and peculiar –
ease. This is represented by the primary, acute SRP) are our surest guide to a curative remedy.
response, which, should the disease be congenital, Idiosyncratic expressions are those which origi-
is experienced by the mother and may result in nate from the unconscious, automatic responses
miscarriage or distorted functional changes such of mind and body at levels 1 (etheric energy), 1 +
as unusual cravings or aversions. If the patient sur- 2 (image), 1 + 4 + 5 (unconscious gesture) and
vives, then secondary action, unaided by remedies, 1 + 5 (sensation in the body). When at least two
should vanquish the disease. However, because of of these levels match up and are expressive of the
innate susceptibility, due to miasmatic and con- same state, then we may be pretty sure that we
genital factors, this exteriorisation does not occur are witnessing the disease entity. This entity is best
often enough (indeed it is usually suppressed by known by its signature because this is what it is
drugs and inoculations) and so the slate is not before the complexities of secondary functioning
cleared. Then the disease remains within. Now and compensation set in.
both it and the patient struggle to be in control. In order to see how knowledge of the signature
The disease state may be viewed, quite literally, can enable us to find the simillimum, we can now
as a spirit possession. The dialogue between the two consider the case of Sera.

CASE STUDY 21.1

Sera, age 7, had brown hair, tied back in a long Mother: ‘We smudged the house (burnt
ponytail, spot on nose, blotchy face, missing sage) but it didn’t help. She feels uncomfort-
all top front teeth. Pink and white zipped top. able in the house. She dreams about a little girl
Sits still, one hand in her lap. Turns head away calling to her.’
when embarrassed. Finds it hard to talk, looks Sera: ‘Sometimes I hear my name, “Sera,
towards mum most of the time. When mum Sera” and other kinds of names. I say, “Who
answers Sera appears uninterested. She does said that?” but no one answers, or they say,
not engage with her. Sera speaks easily and “No one says it”.’
well, once mother is out of the room. Keeps Mother: ‘Doesn’t like to go to school much,
mouth slightly open after talking. Seems bunged but does well there. Made one good friend, but
up. The corners of her mouth are wet. Sad eyes, then she left – that upset her. Her older brother is
cute face. Looks neglected – a bit of an Oliver aggressive and jealous of her. He jumps out on
Twist. She becomes quite fidgety towards the her and freaks her out. He does it on purpose.’
latter end of the case-taking. Misha: ‘How do you feel?’

Deepening our
Presenting complaints: bedwetting, eczema Sera: ‘I feel scared. I want to get on with him
in folds of elbow joints, head lice and thread- but he won’t let me.’
Approach

worms. Mother (butting in): ‘She was born five weeks

Mum is of thin build; has long black hair. Sera premature into a very tense family atmosphere.
hides behind mum to begin with. Rash in fold of A lot of rejection and confusion. Husband had
elbow joint. (Mother pulls up Sera’s sleeve.) a nervous breakdown – wouldn’t go out, afraid V
Mother: ‘It itches and she scratches.’ someone was waiting and would kill him. Won’t
Misha (thinking she will comment on her rash) communicate with the family, only talks about
to Sera: ‘How do you feel?’ what others are doing in their lives. Is someone
Sera: ‘I sometimes feel that my house is not else doing the “right thing”? His father is an alco-
my house.’ (She sucks her thumb.) holic. He was bullied at school. Sera has been

283
 CHAPTER TWENTY ONE Signatures

bedwetting quite regularly, started up again after ‘What do you want to do?’
I had my third child. Sera is the best behaved. ‘I feel like throwing stuff at my door. I feel like
She gets anxious when we all fall out. We have hitting and stamping. I feel like making a lot of
a lot of arguments in our house. I have a bad noise.’
temper. When my husband had mental health ‘What else makes you feel upset?’
issues, I took it all personally. I felt horrendous, ‘When my brother keeps on lying to me and
mad, insane, suicidal. I had feelings of such not giving me what I want. I feel like hurting him
terror. My husband would be quiet, almost back, but normally just go and tell mum. Brother
catatonic. I took the withdrawal as rejection.’ is stronger than me.’
Sera dances around the room, like a penguin. ‘Scared of brother?’
Mum says nothing. Then mum comments that ‘Especially when he jumps out. Normally call
Sera has to put up with a lot because she is the for help. First get angry. Feel like hurting some-
middle child. Older one gets attention because one. Might try and push him off me.’ (She wraps
he’s naughty, got very jealous of her when Sera a thread from her sleeve around her fingers –
was little. The younger one gets the most atten- goes into a dazed state.)
tion because she’s the baby. Then mother vol- Sera has brought along a picture, depicting
unteers that Sera is very concerned about her a blue monster with five ferocious heads with
appearance. Looks in the mirror at lot. She likes prominent red mouths and teeth. I ask her to
drawing animals, and has a dog. Misha takes show it to me.
mum into the next-door room and carries on ‘What does it do?’
with Sera alone so that Sera’s account is unhin- ‘It eats everybody and captures a princess.
dered by her mother’s interjections. I got the story from a fairy tale. Princess story –
Sera: ‘I like soft fur. I like puppies – I like hold- it has a happy ending. The monster protects the
ing them. I feel sad because Ruby (the pet dog) princess from people getting her, but the prin-
can’t have puppies.’ cess doesn’t want that, she wants to get free.’
‘Tell me about being sad?’ ‘How does the princess feel?’
‘Cry when I get sad, mum says, “That won’t ‘She feels sad. She feels lonely – she’s been
work.” Cry … When I am upset.’ forgotten. There is no one to care for her.’
‘Tell me?’ ‘Tell me your favourite stories?’
‘When my brother took the Halloween hat off ‘I like ones about lonely dogs, but then they
me and wouldn’t give it back. I felt sad. It made get a family and it has a happy ending.’
me feel unhappy.’ ‘How does it go?’
‘What else makes you feel unhappy?’ ‘The dog gets to run off and then some other
‘When I want something but can’t have it. It family gets to look after it.’
Deepening our

is really annoying. Then I have a tantrum.’ ‘Tell me more about this?’

‘How?’ ‘The people and the dog were always argu-
Approach

‘You’re noisy when you have a tantrum. I feel ing and they were looking after the babies and
guilty when I have a tantrum – I feel I’ve done not the dog, then someone left the door open
something wrong.’ and the dog went to another family. The people
V ‘You’ve done something wrong?’ didn’t have enough money to sell it. The new
‘Yes, because everyone sees me, everyone people didn’t mind that it was an annoying dog.
laughs. I feel they put me down. I feel hurt. I feel The happy ending is that the dog got a happy
like running away. When I’m upset it brings me home and was well looked after.’
around to having another tantrum.’ ‘Any dreams?’

284
 The Four Kingdoms and the Five Elemental Levels

‘They are about the sea, about crabs and fairytale books. Exciting stories. I like the princess
dolphins. The crabs are trying to pinch me, the and the pea.’
dolphins are trying to come back to see if they ‘Tell me about your favourite one?’
can stop the crabs from pinching me.’ ‘All these princesses, Queen says, they are
‘I had a scary one, has a bit of Harry Potter not real. Then a person comes and they think she
in it. I go to the toilet and there is a troll, and he is a pretend princess, so they put a pea under
chases the girls and he got me. I went into my 20 mattresses. She is sensitive enough to feel it,
mum’s bed. The troll looks big and blue, strong, she is a real princess – the prince marries her.
massive feet, he can crush people, and he can ‘Polly and the stupid wolf. Polly is clever, the
squeeze you really hard. He has no hair.’ wolf is stupid. Wolf thinks he can get her but
‘Anything else that scares you?’ he can’t.’
‘Dark in the room. Thought something ‘Any other problems?’
might jump out and get me, a monster or some- ‘Waking up is a problem. Don’t want to wake
thing.’ up and go to school. Had lie-in today because
‘What is it like?’ I’m not going to school. Saturday and Sunday
‘It is like a normal person and has really sharp are our sweetie days. If I’m bad only get one
teeth.’ chocolate, if really bad get nothing.’
‘How do you feel if you are alone?’ ‘What food do you love?’
‘Feels scary. If someone pops out to get you, ‘Chicken and I love the chicken bones. I like
there is no one to save you. If you’re alone and chicken noodles. I use chopsticks. Nanny taught
you’re walking down to school by yourself, you me how to use them. Two in one hand. I don’t
don’t know if anything will get you. I’m afraid of like Brussels sprouts.
the finger eater. You should never shake hands ‘Get travel sick in the car when stress is
with a troll. It has razor sharp teeth.’ going on.’
‘Favourite things?’ ‘Stress?’
‘I like the way penguins waddle about. I like ‘If we are having an argument or my sister is
crystals, especially rubies – shiny and red. I like being manic.’

Case Discussion then someone left the door open and Sera went to
Sera’s case shows an essential feature of the plant another family. Sera’s family didn’t have enough
kingdom: sensitivity (to hostile surroundings). In money to sell her. The new people didn’t mind
Rajan Sankaran’s miasmatic schema discussed in that she was an annoying girl. The happy ending
Deepening our
the next chapter, the case falls into the typhoid is that Sera got a happy home and was well looked
Approach

miasm, characterised by an intense short-term after.

effort to survive in a ‘do-or-die’ situation. After The dog/Sera is not being looked after; indeed,
such an effort, it is usual to rest, after which a full the family wishes to sell it/her, but not for a profit –
return to optimism and health is the expected out-
come. The dog story is by far the most important
they have to pay to get rid of it/her! The dog/Sera
is worth less than rubbish, or perhaps it is a situa-
V
of all the stories because it is Sera’s invention. If tion similar to that of a traditional oriental daugh-
we swap the word ‘Sera’ for ‘dog’, we get a vivid ter, sold off with a dowry. Later, Sera volunteers
impression of her situation. Let’s try it: that her favourite food is chicken bones. Usually
The family and Sera were always arguing and mums throw these into the garbage, while a dog,
they were looking after the babies and not Sera, given half a chance, would heave them out and eat

285
 CHAPTER TWENTY ONE Signatures

them! In contrast to the story of the dog, Sera tells down to school by yourself, you don’t know if
a princess story, but it too is sad. anything will get you or not.’
Misha: ‘How does the princess feel?’ And a little later:
Sera: ‘She feels lonely – she’s been forgotten. ‘I’m afraid of the finger eater. You should never
There is no one to care for her.’ shake hands with a troll. It has razor sharp teeth.’
Sera is neglected and lonely in her home. She Sera dreams of crabs trying to pinch her, and
looks forlorn, like a lost puppy. of being crushed by trolls. Another real danger
Sera: ‘I sometimes feel it is not my house.’ (She comes from her brother:
sucks her thumb.) ‘Scared of brother?’
Mother: ‘We smudged the house (burnt sage) ‘Especially when he jumps out. Normally call
but it didn’t help. She feels uncomfortable in the for help. First get angry. Feel like hurting some-
house. Dreams about a little girl calling to her.’ one. Might try and push him off me.’ (She wraps
Sera: ‘Sometimes I hear my name – “Sera, a thread from her sleeve around her fingers – goes
Sera” – and other kinds of names. I say, “Who said into a dazed state).
that?” but no one answers, or they say, “No one Sera’s response to her brother, and also her tan-
says it”.’ trums, fall within the typhoid miasm: an intense
Here a similar element enters in. Sera dreams short-term effort to survive in a ‘do-or-die’ situa-
and hallucinates voices calling her name, yet when tion. After the effort, it is natural to rest, however,
she responds, no one answers or she is told, ‘No going into a dazed state (as Sera does after tell-
one says it’. And there is also the reverse aspect to ing her story) is indicative of trauma. Is the finger
this: the voice calling out to her in her dream is winding, dazed state like her father’s catatonic
giving her attention, perhaps assuaging her feelings state? Speaking about tantrums, Sera says:
of rejection. I use the word ‘rejection’ because it is ‘I feel guilty when I have a tantrum – I feel I’ve
how Sera’s mum described her feelings during her done something wrong.’
husband’s psychosis. When Sera’s mum described ‘You’ve done something wrong?’
her husband’s nervous breakdown, she said: ‘Yes, because everyone sees me, everyone
‘. . . he wouldn’t go out, afraid someone was laughs. I feel they put me down. I feel hurt. I feel
waiting and would kill him. Won’t communicate like running away. When I’m upset it brings me
with the family, only talks about what others are around to having another tantrum.’
doing in their lives. Is someone else doing the ‘What do you want to do?’
“right thing”? . . . I took it all personally . . . My ‘I feel like throwing stuff at my door. I feel like
husband would be quiet, almost catatonic. I took hitting and stamping. I feel like making a lot of
the withdrawal as rejection.’ noise.’
Sera’s father felt paranoid about being mur- We are reminded of the story of the annoying
dered and was almost catatonic. dog who makes trouble. Worse, we are told that
Deepening our

In cases where information from the primary she feels put down and hurt because she has done
Approach

carer is available, and certainly in cases of chil- something wrong. (It is interesting that Sera’s
dren, I take the parental situation as paramount. mum reports that her husband asked, ‘Is some-
It is the crucible within which the children are one else doing the “right thing”?’ because ‘right
V fused. Sera’s situation at home has led to her feel-
ing neglected and threatened by omnipresent dan-
thing’ and ‘wrong thing’, being exact opposites,
express the same concern.) There’s no running
ger of a sudden, unexpected, menacing type. This away for Sera – small wonder she feels that her
is an intense type of danger, requiring outside help home is not her home. It is a hostile home, which
to ensure survival. contains a psychotic father, a dangerous brother
‘If someone pops out to get you, there is no one and a mother who tells her that crying ‘won’t
to save you. If you’re alone and you’re walking work’.

286
 The Four Kingdoms and the Five Elemental Levels

Receiving the Signature is narrowed down to the Solanaceae. The trio of

When receiving and probing a child’s case it is Belladonna, Stramonium and Hyoscyamus are all
often difficult to penetrate into the vital sensation disposed to bite and strike when in delirium. They
(where etheric forces act out in the material body) act out in this way because their inner impressions
along a verbal track of association, but it is easy are of being attacked and bitten (e.g. ‘I’m afraid
to do so with drawings. In children’s art, where of the finger eater. You should never shake hands
imagination is not constrained by habits of record- with a troll. It has razor sharp teeth.’).
ing, it is often easy to read the subconscious sub- This case might have been solved using sev-
script. Sera obliges us by bringing along a drawing eral different methodologies; however, signatures
(requested by me), depicting a blue monster with offer an insight into the inner nature of Sera and
five ferocious heads, prominent red mouths and a remedy that matches this is likely to act deeply.
teeth. The feeling which emerges is consistent A repertorisation of rubrics derived from Sera’s
with her stories of danger and imminent attack. statements leads to the need for differential analy-
When we rake though the case, looking for key sis between contesting remedies, shown in Figure
impressions, we get: attack, pinching crabs, razor 21.1. Here, knowledge of the signature comes
sharp teeth, crushed by trolls, scared, I have done to our aid because our repertorisation throws up
something wrong. In response to these ‘inner’ three members of the Solanaceae family alongside
impressions (sensations), her active expressions other remedies. We need to plumb the depths of
(functions) are to run away or to have a tantrum. remedies to find the true fit:
She feels like throwing stuff at her door, hitting
MIND; DELUSIONS, sold; being (1): hyos.
and stamping, making a lot of noise.
There are also passive expressions in the form The chosen remedy was Hyoscyamus (henbane)
of dreams and hallucinations of voices calling in 1M potency.
her name and she wraps a thread from her sleeve
around her fingers while going into a dazed state. The Signature of the
These sensations and passive and active expres- Remedy – Hyoscyamus
sions fall into the picture presented by the family This plant’s favorite habitats are middens, waste
Solanaceae, although a case can be made for other ground, and old dumps. Here too it is that
families also. However, when we examine Sera’s Hecate (queen of the Underworld and protector
drawing with its five biting heads, then the choice of witches) lurks and the dogs and strays of the
Carbn-s.
Rhus-t.

Cann-i.

Mag-c.
Nat-m.
Stram.

Staph.
Sulph.
Nux-v.

Arg-n.
Bar-c.
Nat-c.
Alum.
Verat.
Hyos.

Lach.
Merc.

Puls.

Deepening our
Bell.

Sep.
Ars.

Aur.
Op.

Sil.

Total 11 8 6 6 6 6 6 5 5 5 4 4 3 3 3 3 6 4 4 4 4 4 4 4
Approach

Rubrics 6 6 4 4 4 4 4 4 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2
URINATION; involuntary; night, incontinence in bed (143) 3 1 2 1 2 3 2 1 3 3 2 2 1 1 1 3 2 1 3 3 3 2 3
MIND; DELUSION; deserted and neglected (42) 1 1 2 1 1 1 1 1 3 2 3 1 1
MIND; DELUSIONS; imaginations; injury; receive, will (14) 1 1 1 1 2 1 1 1 1 1 1 1
MIND; ESCAPE; attempts to; run away, to (22)
MIND; DELUSIONS; imaginations; calls; someone (19)
2 1 2 1
1 1
1 1 2
1 1 1 1 1
1 1
1
V
MIND; NOISE; inclined to make a (8) 3 1 1 1
MIND; STRIKING; desire to strike (18) 1 3 3 1 1 1 2

MIND; DELUSIONS, sold; being (1): hyos.

Figure 21.1 Repertorisation of Sera’s case

287
 CHAPTER TWENTY ONE Signatures

community seek scraps of food or plunder what demonstrates the mineral kingdom theme of
others have rejected. (We are reminded of the dog yearning for a partner to complete itself, but
in Sera’s story.) In European witchcraft lore, the this yearning is enhanced by its catalytic quality
juice of henbane mixed with lard was rubbed into of remaining alone and unchanged. Hence such
the armpit and groin to produce the infamous rubrics as:
flight of the witch. Waste ground and witches tell ●
MIND; DELUSIONS; alone, she is alone in
us a story of exclusion from society – those who the world
are thrown out, reviled, destroyed, or simply rub- ●
MIND; DELUSIONS; great person, is a
bished (the opposite of the princess in Sera’s fai- (above others and therefore alone).
rytale). In Shakespeare’s Hamlet, the old king was
betrayed and killed by henbane juice being poured On the physical level, the sensation is hyperaes-
into his ear while he slept. thesia and its opposite is numbness, especially of
The patient for whom Hyoscyamus is the rem- sexual organs and lips – the most intimate (cata-
edy feels deeply endangered; they may have been lytic) of organs. Hence the primary polarity is
betrayed or otherwise devastatingly injured. The between isolation and intimacy. Therefore, this
feeling most often is of having been neglected, has to be the marked feature in a case for Platina
rejected and rubbished by loved ones. Thus this to be the simillimum. This polarity is consistent
remedy is famous for the treatment of jealousy with the rubrics:
(when one feels dumped) and for old people who ●
MIND; KILL, desire to; sudden impulse to;
have been dumped in a home. One often hears husband, her beloved (leaving her alone)
stories of double incontinence or sexual exposure ●
MIND; KILL, desire to; child, her own (the
which single out such individuals as problematic – a ultimate estrangement).
particularly negative form of attention-seeking!
In Sera’s case these trends are as yet light- Imagery consistent with the Platina picture is bright
weight; yet one can see that, untreated, the roots and unreactive on the surface, a polished front,
of the henbane pathology would surely strike while inwardly the imagery is dirty or corroded.
deeply into a fertile soil of threat and neglect. The story could be one of sexual abuse.
Sera’s mother reported that one week after the We all need a good working knowledge of
remedy the bed wetting had ceased. One month materia medica, complete with proving symptoms.
after the remedy, the nits had gone and the skin But as these examples show, knowledge of the sig-
eruptions had healed. Sera felt much calmer and nature gives us the clearest view of the interior,
happier about going to school. the uncompensated state of a remedy. Looking for
the prevalent sensation and imagery in a case gives
us an insight into the uncompensated (primary)
Summary disease state of the patient, which is matched by
Deepening our

As we saw in the case of Sera, knowledge of the the remedy, which is in turn best known through
Approach

signature helps us cut through the stereotypi- its signature.

cal portrait of Hyoscyamus (the jealous nym-
phomaniac). As another example, knowledge of
References
V the signature of Platina can help us cut through
the stereotypical portrait of that remedy (the Hahnemann S 1842 Organon of the medical art, 6th
haughty nymphomaniac). Platinum is the most- edn. Based on a translation by Steven Decker, edited
used catalyst, a property that implies the most and annotated by Wendy Brewster O’Reilly. 1995
intimate involvement with reactive substances Birdcage Books, Washington
but also the capacity to return as if unchanged to Waite A E 2002 Hermetic and alchemical writings of
its former state after the reaction is over. Platina Paracelsus, vol. II. Bertrams, London

288
CHAPTER TWENTY TWO

A Journey of Discovery into Materia Medica

Kingdoms, Families and Miasms

Helen Beaumont and Maggie Curley

that represent these themes are the vital sensation

Introduction by David Owen and the quality that is expressed by the miasmatic
For many students of homeopathy the move from the state (see Chapter 28 page 386).
useful but outer and disease-orientated approaches One plan, or map, does not suit every remedy.
of treatment towards the inner person-centred It should come as no surprise to you at this stage
approaches is a challenging one. In the materia in your studies to find the plan that is most struc-
medica it can at first appear that whole new areas tured and based on the atomic make up of the
of information about the remedies need to be learnt source material fits the mineral remedies that have
thematically, while in fact what you learn about the themes so connected to order and ‘structural rela-
inner qualities of the remedies connect and comple- tionships’. Plant and animal remedies equally have
ment the outer detail. While learning the remedies plans that reflect their respective ‘sensitivity’ and
often presents a challenge to the memory, you will ‘relationships’. Some homeopaths will find some
find it much easier if you can see the plan or pattern models, like some remedies, easier to study, learn
that underlies each remedy. Studying these, like all and recognise; the challenge and opportunity for
materia medica studies, does far more than just pro- you in this chapter may be to reflect further on
vide the tools of the homeopathic trade; they allow your materia medica strengths and weaknesses.
us to see and recognise our patients, they inform the Helen and Maggie do a superb job of reflecting
concepts through which we analyse our cases and something of the rebirth that has happened in
reveal how different remedies relate to each other in homeopathy over the last 20 years – and which
differential diagnosis, and guide in the navigation of the homeopathic profession has been moving
cases that might require management over a number slowly towards over the last 200 years.
of years and remedies.
I am grateful to Helen Beaumont and Maggie
Curley for undertaking the important task of clearly
and succinctly drawing together some of the different
Kingdoms, Families and Miasms
ways the themes and patterns that run through the Rajan Sankaran describes the state of homeopathy
materia medica can be understood. These represent 20 years ago as:
some of the most recent developments in homeopa- “. . . likened to a man with an air gun, standing in a field
thy and will build on the idea of remedies having a and shooting up in the air randomly. Once in a while a
key signature that is reflected in the material from bird flew in the path of his aim and was shot. The homeo-
which the remedy is made (see Chapter 21). The path would say ‘What a great shot that was!’Patients
remedies and patients can be understood from the had to struggle to get in the line of fire! There was lack
perspective of their key themes. Two of the axes of consistency . . . one case would be a success and the

289
 CHAPTER TWENTY TWO A Journey of Discovery into Kingdoms, Families and Miasms

next five were failures . . . prescribing cannot be so arbitrary destruction, despair and suicide. Alumina is a syphi-
and such a matter of chance. My effort all along has been litic mineral remedy from the third row of the peri-
to find a method . . . that is consistent and reproducible”, odic table, with main issues around identity. Some of
R Sankaran, ‘The Sensation in Homeopathy’ the well known symptoms include suicidal thoughts
of killing self with a knife, despair of recovery and
The recent developments in classical homeopa- delusions of personal identity.
thy would appear to provide a three-dimensional After receiving a case, having explored what
map to get to the centre of the case, the similli- the patient means by their expressions and
mum, by using the concepts of kingdoms – animal, descriptions, it is useful to underline words that
plant, and mineral – families and miasms. Over belong to the miasm and kingdom. When looking
the last two decades, original thinkers such as at the acute miasm it will be possible to identify
Massimo Mangialavori, Jan Scholten and Rajan times of extreme panic – where the patient will
Sankaran have realised that remedies fall naturally describe how ‘all of a sudden’ terrifying events
into groups based on criteria of their natural king- happen where they feared for their life and they
dom, botanical family and symptom themes. This have had to get help or escape. When this episode
chapter explores the work of these contemporary passes, their life then returns totally to normal
homeopaths who have made such huge advances with no sequelae, until the next time. An example
in the development of these concepts. It will look of this would be the Stramonium child who wakes
at the three kingdoms, how the theory of miasms all of a sudden, screaming, terrified, inconsol-
has been extended, case-taking, and the source of able and clinging to their parent – and who has
the remedy. This chapter will illustrate how it is no recollection of the event in the morning. To
possible to move from a position of ‘shooting ran- start identifying the miasms it is helpful to review
domly’ to one of a more precise aim that more a successful case where the remedy is known and
consistently leads to an accurate prescription. pick out expressions and words associated with
that miasm. It is possible to very quickly see the
pace of the case from the words the patient uses
Miasms and how they react to their situation.
In the search for maps in homeopathy Sankaran stud- An abbreviated explanation of the 10 miasmatic
ied Hahnemann’s theory of miasms and concluded states is given in Table 22.1 but further reading of
that each miasm represented one way of experienc- Sankaran’s work is recommended.
ing a situation. In ‘The Sensation in Homeopathy’
he describes the miasm as a ‘measure of how much
or how intensely or how acutely or chronically or
The Kingdoms
how deeply or desperately the situation is perceived’. Our remedies are derived from the natural world of
The miasm is identified by how a person copes with plants, minerals and animals. The whole aim of the
Deepening our

situations, their perception of the problem, their practitioner is to understand and find the source of
Approach

reaction, the level of hope and despair, and the pace that remedy as expressed by the patient. The art of
and pattern of their pathology. arriving at the correct prescription has relied heav-
Taking the five previously described miasms of ily on knowledge of materia medica and mechanical
V psora, sycosis, syphilis, tuberculosis and cancer (see
Chapter 17), Sankaran has expanded the miasmatic
repertorisation. Both of these tools are essential but
are greatly helped using recognition of the themes or
spectrum by adding acute, typhoid, malaria, ring- patterns running through a case and a remedy.
worm and leprosy. He identified which remedies This ‘pattern recognition’ in turn benefits not
belonged to which miasm by studying the rubrics just from themes and essences but from a system
of a well known remedy from that miasm. If the or map of these patterns. With the new work
syphilitic miasm is looked at, the key words include on kingdom classification, such maps have been

290
 The Kingdoms

Table 22.1 AN ABBREVIATED EXPLANATION OF SANKARAN’S TEN MIASMS

Remedy
Miasm Sensation Reaction Key Words Examples
Acute Sudden life-threatening Instinctive flight or fight Acute Aconite
dangerous situation response. Sudden Belladonna
Child-like clinging, Panic Arnica
helplessness Violent Stramonium
Terror
Fright

Typhoid There is a feeling of a critical An intense struggle needing Crisis Bryonia

situation which if properly concentrated effort for a Emergency Rhus Tox
handled will end in total short duration Sub-acute Nux Vom
recovery but there is a threat Sinking Baptisia
of death or collapse Recover

Malaria There are episodes of acute This sensation is experienced Intermittent attack Colocynth
intermittent attack with an at a depth of being fixed Stuck Capsicum
underlying fixed feeling of and permanent like sycosis Unfortunate Cina
being deficient Harassed
Hindered
Persecuted

Psora A difficult situation but there A struggle to succeed but Struggle Sulphur
is hope and the problem is make the effort Confidence Psorinum
solvable. Failure would not be Difficult Calcarea
the end of the world Hope carbonica
Anxiety

Ringworm Lies between psora and sycosis, Alternating between struggle Trying Calcarea Sulph
sharing characteristics; a and resignation, constantly Struggle Teucrium
difficult situation beyond easy trying, then sits inactive Irritation Dulcamara
reach before trying again Discomfort Sarsaparilla

Sycosis There is a fixed weak spot within Keep weak spot hidden from Fixed Thuja
me which I must hide or cover others. Avoid Medorrhinum
up Fixed ideas or ritualistic Accept Natrum Sulph
behaviour Hide Pulsatilla
Secretive

Cancer Chaos which is going out of Total control of self and Control Carcinosin
control and heading to environment. Perfectionist Arsenicum
destruction. Everything is going out of Fastidious Album
Task is beyond the individual’s control and it is impossible Order Staphysagria
limit to do anything about it Chaos Nitricum Acidum

Tubercular Feeling of intense oppression and Hectic activity. Put all efforts Hectic Tuberculinum Deepening our
Approach
desire for change. into getting out leading to Trapped Drosera
Suffocating and time is short burn out and destruction Closing in Phosphorus
Desire for change Many insects
and spiders

Leprosy Hunted down and isolated, feels

dirty, disgusting and as is
Avoids the sight of people.
Despair
Disgust
Contempt
Hura
Aloes
V
shunned or cursed Isolation Iodum
Repulsion Curare

Syphilis There is no hope. Complete despair. Destruction Mercury

Have committed an unpardonable Suicidal or homicidal Despair Aurum
crime Murder Platinum

291
 CHAPTER TWENTY TWO A Journey of Discovery into Kingdoms, Families and Miasms

developed which we believe more reliably lead the The periodic table is comprised of six horizontal
practitioner in the direction of the simillimum. rows, or series, and 18 vertical columns or stages,
Much as a strong Parisian accent is an indication each with its own themes. These series have been
of French nationality, so each kingdom has its own named by Scholten after their most characteristic
language, its own themes and its own sensitivities element and are outlined in Table 22.2.
to situations. To understand these concepts more He explains the columns as 18 different stages
clearly, each kingdom will be described. in a continuous process of development. Each ele-
ment in the row represents a stage in the develop-
The Mineral Kingdom ment of its theme, going from growth on the left, to
The mineral patient feels something is lacking, success in the middle, to decline and decay on the
that their structure is incomplete and something right. These different stages are given in Box 22.1.
is missing within them. This can be clearly seen in
the Kali salts with their backache – their structure
will not support them. Patients requiring mineral Table 22.2 THEMES OF THE ROWS OR SERIES
remedies will often quantify, categorise and anal-
Series Theme
yse situations in a very organised and systematic
way. General themes and language of the mineral Hydrogen series Conception and existence – do I
kingdom are as follows: exist?
●
Structure Key words: Backbone, foundation, Carbon series Separation – I exist but am I one with
cement, crumbling the mother or am I separate?
●
Complete–incomplete Key words: Fragile, Silica series Identity, individuality – I am separate
rock solid, permanent, circle, square but what is my identity as a
●
Dependent–independent Key words: Family, separate person?
partner, husband, nice home, relatives, stand- Ferrum series Security, protection and task – I have
ing on your own two feet an identity, but what is my task in
life? Am I secure?
●
Lack–need Key words: my weakness, so disor-
ganised, loss, failure of exams, financial Silver series Creativity and performance – I am
●
Stable–unstable Key words: solidity, stand secure, but am I creative?
firm, collapsing, brittle. Gold series Standing on your own feet,
responsibility – I am creative but
The map or a tool that helps define the rem- am I a leader, am I responsible?
edies from the mineral kingdom is the periodic Lanthanide series Disintegration and death
table of the elements. In the 19th century Dmitri
Mendeleev put the 65 known elements of his time
into a table based on their atomic weight and left
Deepening our

BOX 22.1
unoccupied the places where he was confident Themes of the Stages or Columns
Approach

other elements as yet to be discovered would ulti- 1 Beginning 10 Lord and master
mately fit. Time proved him right! 2 Finding a space 11 Preserving
Jeremy Sherr has explored the periodic table 3 Comparing 12 Division
V as a source of homeopathic remedies and this has
resulted in some excellent provings, e.g. Iridium,
4 Establishing 13 Withdrawal
5 Preparing 14 Pretending
Germanium and Plutonium to name just a few. 6 Proving 15 Loss
However, the idea of predicting the qualities of 7 Practicing 16 Remembering
a homeopathic remedy from its position in the 8 Persevering 17 Letting go
periodic table has more recently been defined by 9 Success in sight 18 Rest
the work of Jan Scholten and Rajan Sankaran.

292
 The Kingdoms

Hence in the Gold series there is the dependence

and inability to take responsibility of Barium and REFLECTION POINT
the Baryta salts, moving to the obvious leadership
● Using the above tables and boxes reflect on a mineral
of Platina and Aurum, to the downfall and col- remedy you know to see how its materia medica reveals
lapse as there is progression across the periodic its themes.
table, seen in Plumbum and Bismuth. These two
axes of series and stages allow each element to be
placed in relation to these and each other. In addi- The case of a 35-year-old business man who
tion, different mineral remedies can be divided presented with symptoms that had been present for
into various groups each with different qualities some time illustrates how this approach to treat-
(Box 22.2). ment and prescribing methodology can be used.

BOX 22.2
Different Groups of Mineral Remedies
Metals ●
Need to bond with a positively charged
●
Concerned with performance and defence cation to become complete
●
4th row more concerned with defence – ●
The energy is focused on maintaining rela-
battle of Ferrum and Cuprum tionships, a desire for company (Arsenicum)
●
5th row with performance – Palladium and ●
At stage 17, the Halogens have a feeling of
silver-tongued Argentum being totally let down or betrayed
●
6th row have very strong issues surround-
Salts
ing both performance and defence – they are ●
This is the union of cation and anion
not just protecting their family but take on ●
The two bring their own individual charac-
responsibility for the whole world – Aurum
teristics to the relationship and they express
the King
qualities of both – although they may also
Cations have qualities of their own
●
Elements which give away electrons to ●
The cation and anion may be from the same
become positively charged row, as in Nat mur (row 3), or from completely
●
Occupy the left-hand side of the periodic different rows, as in Arg Nit (Silver from row 5
table; the most reactive being the Alkali met- and Nitrogen and Oxygen from row 2)
als like Sodium, Lithium and Potassium
Deepening our
Acids
●
Need to bond with negatively charged anions ●
The acids show a struggle followed by collapse
Approach

to become complete ●
The type of struggle will depend on which
●
This is reflected in the homeopathic picture
element is involved
of the need for relationships and bonding ●
In Phosphoric acid the struggle is to con-
Anions stantly care for others in order to be loved V
●
Elements which accept electrons to become and accepted
negatively charged ●
In Muriatic acid it is the struggle to avoid dis-
●
Occupy the right-hand side of the periodic appointment which drives them to be more
table, like chlorine (muriaticum) nurturing

293
 CHAPTER TWENTY TWO A Journey of Discovery into Kingdoms, Families and Miasms

In this case the issues of responsibility and series. However, he is not at the pinnacle – he is
performance are brought out at every level. He not yet supersonic! The element in column 9, just
talks of being indestructible, challenged, of his before the top, is Iridium. He was given a single
business and his achievements. This places him in dose of 1M and now feels able to take his business
Row 6 of the periodic table, the metals of the Gold further with less sense of burden of responsibility

CASE STUDY 22.1

(P – Patient; D – Doctor) important. I want everyone to love and like me
P: ‘I was as fit as a fiddle. I was indestructible and I have 40 mortgages to think of.’
but now I feel sick and there is numbness and a Trapped for him is not that of being a caged ani-
feeling across my upper body. All the tests are mal or having a plant sensation such as tight and
normal so I cut out wheat and things improved stiff, it is about business, about not being super-
but I’m not 100%. I run my own business and sonic. He describes ‘an element of restriction’.
there have been difficult challenging times. I am [Deep sigh again and he shudders as sensa-
responsible for 40 people. I’ve not got one mort- tion returns.]
gage I have 40. It is a shock to find I am not D: ‘And the opposite of this?’
indestructible.’ P: ‘To be free, sitting in a café, with people
From the outset, the language is in terms of I want to be with, chatting, putting worlds to
percentages, responsibility, not being indestruc- rights, no one judging me, no guilt, not having
tible. to achieve anything.’
D: ‘Tell me a little bit more?’ D: ‘Tell me more about being judged?’
P: ‘There is an unpleasant numbness and P: ‘It’s to do with self-esteem. I need other
my body tingles, I have to sit up straight and people to say I am good. I use a business excel-
take a deep breath. [Throughout the interview lence model and I am very good at it. I am asked
the patient took deep sighs.] I get a tingling feel- to do talks. It gives me a personal high; these
ing and I just want to get rid of it, I have work to are really big companies, 500 people at the con-
do, a life to lead. I am irritable with inner frustra- ference. Blimey what a challenge – let’s see how
tion. I thought I was indestructible, this is not good you really are. I rehearsed the first seven
me. Walking is a challenge, I feel I will fall over words and knew if I could get them out I would
or collapse.’ be OK. I pictured everyone cheering and in the
Again the theme of indestructible and col- end I got top marks as a presenter. Bring it on –
Deepening our

lapse – mineral themes. it was amazing. Next two years I got full marks
D: ‘Any fears?’ but then had a group of 50 people, and felt more
Approach

P: ‘Of being trapped. It would be a nightmare challenged, I only got average score. Bugger!
to be buried alive, you could not move in the I wasn’t the best; I wasn’t the top. I was not good
coffin.’ enough because I know I am better than aver-
V D: ‘Tell me more about being trapped.’ age. Business has not flourished as it should, if
P: ‘Business-wise, I feel frustrated; I set things people judge the business they judge me. I have
up as a one man band but it has not grown as more to do, more to achieve. In 20 years time I
I hoped, I have not turned it into something want to have sold the business for millions, and
supersonic. There is an element of restriction as be widely successful doing talks and helping
I can’t do what I like. How people think of me is other businesses grow.’

294
 The Kingdoms

for his 40 employees. Interestingly, many of the ●

victim/aggressor
words he used, and the continuous deep sighing, ●
inferior/superior
correlated well with the proving of Iridium done ●
sexuality
by Jeremy Sherr. ●
jealousy
●
dreams of animals, strong like or dislike of
The Animal Kingdom animals
All animals depend on plants or other animals ●
‘something is being done to me’
for their existence. Unlike the plants, they cannot ●
‘it is killing me’
make their own food, and in order to survive they ●
‘he affects me’.
have to compete. For the species to be maintained,
The specific characteristics of each sub-group
they have to compete in terms of territory, sexual-
depend on their mode of existence in nature and
ity, food source and habitat. Some are predators,
it is these characteristics which will be exactly
some are prey, but the issue is always one of ‘I ver-
reflected in the patient. The keynotes in Box 22.3
sus you’. The issue of the victim or the aggressor,
give the main themes which emerge.
the weaker and the stronger, will be voiced clearly
The case of a delightful, highly intelligent
by a person needing an animal remedy, whose
6- year-old boy (see Case Study 22.2) who was
‘non-human song’is from this kingdom.
brought for treatment of eczema illustrates how
Mention must be made here of the work of
themes of the animal kingdom can be used in
Nancy Herrick (1998), Jonathan Shore (Shore et al
prescribing. Itchy, sore eczema of both elbows
2004) and Jeremy Sherr (1997, 2002) and whose
had started four months previously, when he
animal provings have contributed enormously to
been under a lot of pressure to be well behaved
the materia medica. Some of the general themes of
at school. It soon emerged that the eczema
animal remedies include:
itself was less of an issue than his behaviour
●
survival – the threat comes from outside
problems.
●
competition

CASE STUDY 22.2

(D – doctor; C – child; F – father) C: ‘I am the only one in my family who wasn’t
D: ‘Tell me about his behaviour?’ born in England, so I am the odd one out and I
F: ‘He was suspended from school five times don’t like that. Maybe that’s how I got my love
for lashing out at the teacher, striking and being for animals, it’s huge.’

Deepening our
aggressive. He couldn’t behave the way the This is extraordinary from a 6-year-old child
school wanted him to.’ and needs to be understood more fully.
Approach

C: ‘I want to be grown up and independent.’ C: ‘I’ve always loved animals, cats particu-
Already there are some peculiar character- larly; I admire them for their stealth. They creep
istics – he wants to be grown up and indepen- up and pounce with their skill. They hunt and
dent at the age of six and is also aggressive and feed and defend their territory. Wild cats kill V
‘lashes out’. and hunt. Tigers and leopards are my favourite
D: ‘Tell me more about being grown up?’ because they are pretty. Cats like me and they
C: ‘I like adventures and grown-up things.’ don’t like change of routine. I don’t like changes
F: ‘He ran away from home when he was 3 – either. Cats like being up at night, they are semi-
curiosity led him out, he’s a great explorer.’ nocturnal. I like being up at night.’

295
 CHAPTER TWENTY TWO A Journey of Discovery into Kingdoms, Families and Miasms

D: ‘Tell me more about being grown up?’ young to a certain age, great love of animals,
C: ‘I like making food for myself, like being especially cats. Further questioning is needed
able to tell people what to do. I don’t often get to lead to the source.
the chance to do what grown-ups do like going D: ‘Tell me more about being at school?’
out at night. We went bat watching once and F: ‘It was torture for him, he wants to have
I could stay up and have fun in the dark.’ his own way and finds it difficult to do things he
D: ‘What would you like to do when you doesn’t want to do. He will scream and lash out
grow up?’ and run away. He tried to climb over the wall
C: ‘Something to do with animals. I’m not to escape. He loves climbing trees and is quite
really like most people, I’m different. I want to fearless, will go up until he gets stuck. He’s not
put understanding into people about animals.’ by nature aggressive, just lashes out with frus-
F: ‘He is very scientific about animals. He tration. He went through a phase of biting when
was terrified of her grandfather’s Alsatian.’ he was three.’
C: ‘I got up and looked angry at him.’ D: ‘What things do you like doing for
F: ‘He is very protective of young children fun?’
but by the time they are 2 or 3 they aren’t so C: ‘I love pyjama parties; you can do good
attractive.’ things in the dark. I want to be nocturnal. I want
C: ‘If there is a baby in the house I protect to be a wild animal. I think my Mum or Dad is a
it.’ cat, a big cat. I’d love to be a leopard…’
The strong animal themes are coming And with patience and a trust in the method,
through, both in his interests and his behaviour. he names the animal – the source!
Nocturnal, independent, aggressive, nurturing

BOX 22.3
Remedies from Different Animal Sub-Groups
Mammals ●
Jealous
●
Dependence ●
Camouflage
●
Independence ●
Attention seeking through music, dance, sex
●
Dependence on group or master ●
Loquacious
●
Nurturing young ●
Increased mental activity
Deepening our

●
Feels he has suffered wrong ●
Feel dirty and guilty
Submissive
Approach

●
●
Clairvoyant
●
Aggressive ●
Strong leprosy and syphilitic miasms
●
Usually sycotic miasm
Birds
V Snakes
●
Malicious
●
Desire for freedom
●
Opposite sensation of restriction, suffoca-
●
Deceitful tion, trapped
●
Scheming, manipulative ●
Desire to travel

296
 The Kingdoms

●
Dreams of flying ●
Vindictive
●
Responsible, dutiful ●
Jealous
●
Spiritual ●
Fear of being crushed
●
Caring for young ●
Feel looked down upon
●
Cancer and tubercular miasms (raptors syph- ●
Feel small
ilitic) ●
Mostly tubercular miasm
Spiders Sea creatures
●
Predator ●
Suffocation
●
Revengeful ●
Belonging to a group
●
Impulsive (snakes are sly but not impulsive) ●
Protection (shellfish)
●
Hectic, restless ●
Water
●
High sexuality ●
‘Clamming up’
●
Tubercular miasm ●
Strong sycotic miasm
Insects
●
Fruitless activity
●
Rush of flow of thoughts and speech

He was given Panthera pardus (leopard) 200c bark, plants have been widely represented in the
three doses. Within a week of taking the remedy, materia medica. They have been studied from
the eczema cleared but, more importantly, his their known effects, from their toxicology and
sleeping and his mood were much better and he from provings, but never very systematically.
was able to start at a new school. He said: ‘I only There were no maps.
wanted to get out of school once. Sometimes That is until in the early 1990s, when several
I want to live alone, to be completely free. I’d live homeopaths, aided by the computer repertories
on the fields behind our house and go from place and materia medica programs available, started
to place. Indoors seems like a stuffy little shed. to explore plants according to their botanical
Night is when I most like to be out. I’d like to be family, their similar properties and themes and
awake and doing something at night.’ therefore similar clinical effects. Plants are able
This was an extraordinary case, not only to make their own food, chlorophyll, by reacting
because of the child himself but how it demon- to sunlight and drawing water and minerals from
strated the deeper understanding of the homeo- the ground. As this finely-tuned process depends
pathic process; of being able to take the patient on great sensitivity to the environment, Sankaran
Deepening our
right to the energy of the source. He gave the hypothesised that each plant family had its own Approach
whole description of the leopard – independent, unique expression of that sensitivity. He studied
wild, nocturnal, climbing trees – and then for the individual families, and came to the conclu-
good measure he named the animal! sion that it was possible to classify them according

The Plant Kingdom

to their sensations and reactions.
Refining the map lead to the question of why
V
Unlike the animal kingdom, where the behav- different remedies from the same family have such
iour of the source material is easily observable, differing symptomatology. It seemed that the sen-
the plant kingdom presents more of a mystery to sation was common to the whole family but that it
the homeopath. From the very beginning, when was expressed in differing degrees of pace, depth
Hahnemann did his first proving on Cinchona or desperation. In other words, different plants

297
 CHAPTER TWENTY TWO A Journey of Discovery into Kingdoms, Families and Miasms

Table 22.3 SENSATIONS, REACTIONS AND COMPENSATIONS OF TWO WELL KNOWN PLANT FAMILIES
Family Sensation Passive Reaction Active Reaction Compensation

Compositae Injured Numb Insulting Tough guy, can take all the
Hurt or insulted Anaesthetic Hurting others beatings
Shocked, burnt or scalded Stupor Cruel Protective of others
Fear to be touched, hurt Catalepsy Violent
or approached Strikes

Liliacaea Forced out, squeezed Must hold on tight Must move Attractive behaviour
Oppressed Belonging, being included,
Constricted being part of
Excluded, left out, neglected

of the same family belonged to different miasms. second suggests how plants from these two families
It was this breakthrough which initiated the devel- can be perceived according to their miasm.
opment of a chart of the botanical families and the You might like to reflect on how the remedies
remedies related to the miasms. you already know something of can help inform
This is a ‘work in progress’and therefore nec- you about the other remedies in these families.
essarily incomplete. A more detailed look at the The case of a 50-year-old woman with chronic
plant kingdom using two well known families and abdominal pain illustrates how this method can be
a clinical case will help to explain the concepts used (Case Study 22.3). She was given Aloe 200c,
behind the method. General themes and language three doses. On follow up, her exclamation as
of the plant kingdom are: she walked through the door was: ‘It’s a miracle!
●
sensitivity Everything came out of my bowel and I haven’t
●
reactivity had any pain since. I’ve lost weight, bought some
●
impression of the environment
●
sensation and action are equal and opposite
and experienced at every level
●
no importance of predator/prey as in the ani- Table 22.4 PLANT REMEDIES FROM EACH OF THE
FAMILIES ACCORDING TO THEIR MIASM
mals or of the structure/order of the minerals
●
I am affected by… ‘Things affect me’ Compositae Liliacaea
●
‘I am sensitive to…’ Acute Arnica, calendula Veratrum
●
‘I feel … heavy, compressed, brittle, contracted…’
Typhoid Chamomilla Paris
For every sensation there is an equal and oppo-
Deepening our

Malaria Cina, Eup. perf Colchicum

site reaction, both in physical and emotional expres-
Approach

sions. The reaction can be either active or passive, Ringworm Taraxacum Sarsp.
or in some cases can be seen as compensation. The Sycosis Senecio Crocus, lil. tig,
common sensation of the Anacardacia family for sabadilla, helonias
V example, is ‘caught’, ‘stuck’, ‘can’t move’. The
opposite or active reaction is to want to move, to be
Tubercular Abrotanum Agraphis

restless, while the passive reaction is that of being Cancer Bellis Ornith
immobile or unable to move. The compensation is
Leprosy Lactuca, inula, Aloe
to be constantly on the move. Tables 22.3 and 22.4 lappa
are extracts from Sankaran’s book ‘An insight into
Syphilitic Echi
plants’. The first illustrates two families and the

298
 The Kingdoms

CASE STUDY 22.3

(P – patient; D – doctor) in our toilet. At times I get diarrhoea and it pours
P: ‘I’ve had a desperate weekend. Problem is out of me, it happened in the bed once, I was
my stomach ever since hysterectomy 21 years mortified, it was just horrible.’
ago. The man who did the operation couldn’t The sensation she is describing is of pushing
give a damn and my stomach was in a terrible down, dragging, something going to fall out, a
state. I’ve had terrible trouble with my bowel, pressure – the sensation of the Liliacaea family.
sometimes diarrhoea, sometimes constipation. We need to confirm this in other areas of her
Sex was painful. I didn’t like myself because of story.
my looks. My breasts are big and heavy. I’m now D: ‘Have you had the same pain in other situ-
a size 18 and my stomach is so sore. I just don’t ations?’
like me. I hate dressing myself, I’m huge. I see P: ‘My periods were agony, unbearable pain,
no end to it. If I could stay in the house I would screaming. The pain in the vagina was like a
because I’m so uncomfortable.’ knife being pulled out slowly, I would have to
D: ‘Tell me about your stomach?’ press hard in to it to push it up or it felt it would
P: ‘It feels so full I have to undo everything; come away.’
I press my knuckles in to my stomach. [Clenches Her active reaction is that she must hold on
fist] If I go to the toilet properly I feel clean from tight.
the inside and it feels great.’ P: ‘One time I asked Mum to sit on my stom-
D: ‘Opposite feeling?’ ach to push the blood out. As soon as the blood
P: ‘Dirty, disgusting, horrible.’ came out it was nice.’
These are words of the leprosy miasm; she D: ‘Dreams?’
perceives everything as dirty and disgusting and P: ‘Yes, the most horrendous ones. Snakes,
hates herself. There is a degree of desperation I hate them, they are ugly – my sister put one in
here which she voices as she comes through the bath once and I stood on it, my whole body
the door. felt frozen and I suddenly had a period, everything
P: ‘I think a lot of my problem is my bowel, came out of me. My faith is important to me, I fear
I feel if I pushed it down it would be better God, I have to answer to Him, and I don’t want
[clenched fist]. It’s a wonderful feeling when to do bad things. I enjoyed sex a lot but not so
I release the bowel movement, I feel clean. I’d much now even when we watch porn. When my
love the inside of my stomach to be cleaned out husband had an affair and I thought about them
then everything would be pushed out [fist]. When having sex it was horrible, disgusting.’
I have a good bowel movement I feel there is a D: ‘How did you feel?’
down pressure and I have to sit on something P: ‘I felt pushed out.’

Deepening our
to stop the pushing out. I get the same feeling Here the miasm and the sensation come
sometimes after sex, like something is going to together – she feels disgusted, pushed out of
Approach

fall, it’s dragging. When it all goes back to place her marriage and her physical symptoms also
the feeling is wonderful. I hate the embarrass- have the sensation of pushed out. The rem-
ment of going to the toilet; it’s horrible, disgust- edy which comes in the leprosy miasm of the
ing, stinks. I have every cleaning product known Liliacaea family is Aloe. V

299
 CHAPTER TWENTY TWO A Journey of Discovery into Kingdoms, Families and Miasms

new clothes and I even like looking in the mirror It is much like setting out to find the source of
now’. This case demonstrates that using the map a river, not making do with reaching the widest
of kingdoms and miasms can take us to a known part rather, patiently taking the windy route to the
remedy which may well also be indicated by rep- little village on the hill, carefully looking for the
ertorisation of the presenting symptoms. second field on the right next to the church, going
through the gate and looking for a small puddle of
water – the spring itself.
Case-Taking It is as the patient brings you closer to this
The approach to case-taking illustrated in the source, where the story can appear to be making
above cases reveals the deeper patterns that can no sense to you, that each patient will reveal their
make sense of otherwise confused cases. When the uniqueness, the world of the source.
cause, symptoms of the presenting complaint, and Animal cases often provide clear source words.
mental and general symptoms (especially the emo- A patient who did well on Lac caninum used the
tional) are described in the same terms, this points words ‘snap,’ snappy’ and ‘bitch’on several occa-
to a pattern which links both mind and body, to sions throughout the consultation. During the
what Sankaran terms the ‘vital sensation’. proving of Dama Dama (the fallow deer, J Sherr
Any aspect of the case can reveal this pattern unpublished), a number of provers came up with
and different homeopaths find different aspects of words and images such as ‘rutting’and ‘fallow’. A
the patient’s case most clearly or easily reflect this case of Iridium said ‘I always thought of myself
theme. On a more cautionary note, this approach as hard and indestructible’– Iridium is the hardest
to case-taking can often point to a pattern that metal known. This expression of the source in
does not match any known remedy. In these cases the patient is what Sankaran refers to as the ‘non-
either the closest remedy must do or another human song’, which is out of place and therefore
model may decide which remedy is indicated. a cause of turmoil.
‘The chief complaint is the microcosm of the . . . vital
sensation and energy . . . and having touched this most
central point right at the outset, one can see the rest of
Summary
the case branching from this core.’ Having studied in some depth the developments
R Sankaran, The Sensation in Homeopathy of the last decade, what conclusions can be drawn
as to the value in practice of this three-dimen-
Reaching the Source sional map? Once the method is understood, the
By now, the reader will have gained some insight case received clearly and the remedies known, this
into the process of ‘map reading’– a process which is a system which, with experience, is both repro-
involves both leading and being led by the patient. ducible and consistent.
It is too easy to stop the journey of understand- It must be emphasised that everything hinges on
Deepening our

ing the patient at a level we are comfortable with. the case-taking process. When witnessing an expe-
Approach

Using our repertorisation to home in on the big rienced prescriber in action taking a live case it can
rubrics like ‘ailments from grief ’, it is easy not to appear effortless. To be confronted with your own
progress beyond the superficial layers – but it is patient and have the courage, belief and patience
V central to treating confused cases that we do; that
we go towards the centre of the case and core of
to let the centre of the case unfold is another story.
Although some of the concepts are new, this is not
the remedy. We must be open to the patient tell- a method which dispenses with solid homeopathic
ing us ‘how the grief feels now’ or ‘my personal teaching. In fact, the foundation stones of materia
experience of it is…’. If it is the most central thing medica, repertory and philosophy remain at the
it will relate to every other aspect of their life. heart of the practice.

300
 Bibliography

Using this method, the materia medica is Sankaran R 2004 The Sensation in Homeopathy,
expanding as never before – we are able to use Homeopathic Medical Publishers, Mumbai
remedies we would never have dreamed of using Sankaran R 1994 The Substance of Homeopathy.
a decade ago. It makes so much sense that when Homeopathic Medical Publishers, Mumbai
remedies are studied they are done so in the Sankaran R 1991 The Spirit of Homeopathy. Santacruz
framework of kingdoms and families. To teach (West), Mumbai
Belladonna in isolation, without discussion of the
Scholten J 1993 Homeopathy and Minerals. Stichting,
whole of the Solanaceae family, or Calcarea car-
Utrecht
bonica without mention of the position of its ele-
ments in the periodic table, is limiting the range of Scholten J 1996 Homeopathy and the Elements.
approaches you have available to treat patients. Stichting, Utrecht
Shore J, Schriebman J, Hogeland A 2004 Birds, homeo-
pathic remedies from the avian realm. Homeopathy
Bibliography West, Berkeley CA

Herrick N 1998 Animal mind, human voices: prov- Sherr J 1997 Dynamic provings, vol 1. Dynamis Books,
ings of eight new animal remedies. Hahnemann Clinic Malvern
Publishing, Nevada City Sherr J 2002 Dynamic provings, vol 2. Dynamis Books,
Sankaran R 2002 An Insight Into plants Vol 1 and 2. Malvern
Homeopathic Medical Publishers, Mumbai

Deepening our
Approach

301
CHAPTER TWENTY THREE

The Homeopathic Relationship The Case

David Owen

through a case and how the patient is affected by

‘To heal requires the patient to act with trust and the
and effects their environment (including us, their
doctor with integrity’
homeopath). Exploring working this way is a nat-
Dr Lee Holland
ural extension and deepening of seeing patients
from a holistic perspective.
‘The physicist does not discover, he creates his universe’
A theme we return to throughout this chapter is
Henry Margenea
that there is ‘no external reality separate from the
observer of that reality’. Any change in the observer,
the observed, or the medium through which per-
Introduction ception takes place alters what is perceived. This
The homeopathic relationship is at the heart of any raises fundamental questions about how we under-
homeopathic process that sees health and illness stand and explore our reality. For instance, if there
as more than external causes and local effects. The is a different reality for each observer, then how
therapeutic interaction cannot be separated from legitimate are measurements and experimentations
the therapeutic relationship. This chapter invites of one observer’s reality in interpreting the reality
you to see illness and treatment as more than the of another? As no two observed events are truly
label of a disease and a medicine. It explores dis- independent of the observer it throws into conten-
eases and remedies as aspects of perception and tion the idea that any event is disconnected from or
advocacy in homeopathic relationships. It exam- randomly associated with any other perceived by
ines the idea of perception and objectivity in the the same observer.
homeopathic relationship before trying to under-
stand the relationship from the points of view of
both the patient and the homeopath. I hope that
Relationship
this exploration into the homeopathic relationship Every patient and every illness has a story.
will allow you to take a fresh look at the homeo- Listening to that story you only truly hear it if, to
pathic process. some extent, you enter into it.
Understanding the homeopathic relationship If patients are happy to work with their feeling
increases the ability of the homeopath to make there are many styles of consulting that can help
sense of confused cases and to reveal hidden cases. the patient to be ‘physically, mentally and emotion-
By ‘reframing’ these difficult cases in terms of our ally present’. Many depend on a good relationship
relationship with the patient, rather than as a pre- between patient and homeopath and its impor-
scriber of remedies, we glimpse the case in new tance increases as cases get more confused and hid-
ways – making it possible to see themes that run den (see ‘Style of consulting’ in Chapter 13). How

303
 CHAPTER TWENTY THREE The Homeopathic Relationship

patient and homeopath perceive and communi- ‘It shows that our ordinary ideas about the world are
cate with each other is an important dynamic of somehow profoundly deficient even on the macroscopic
the relationship. In every case there is what the level’
patient says, what the homeopath hears, and what H P Stapp (1971)
the homeopath and patient think was said and
heard. What the patient and homeopath antici- Homeopaths perceive patients and patients perceive
pate will be said and heard will determine what homeopaths as if through a lens. The lens (as illus-
they are able to say and hear. It will colour their trated in Fig. 23.1) allows the patient to focus needs
objectivity. onto the homeopath and for the homeopath to focus
healing onto the patient. The ‘lens’ allows the patient
What is Objectivity? to expresses their suffering and the doctor to relate
‘A change in the spin of one particle in a two particle to the patient’s suffering through the symptoms. The
system would effect its twin simultaneously, even if the patient arrives with an illness and goes away with a
two had been widely separated in the meantime’ disease. The patient brings their case and receives
A Einstein, B Podolsky, N Rosen 1935 a remedy. The two sides mirror each other, and as
we gain deeper insights into one, so we gain deeper
The relationship and interaction between the insights into the other. The ‘lens’ also ultimately pro-
observer and the observed are always to some tects both the patient and homeopath, permitting an
extent determined by the attributes, attitudes and openness between each other but also constraining
experiences that each brings to the encounter – the and limiting the influence of one on the other.
‘filter’ through which you perceive a patient. This is
acknowledged in both modern physics and psycho- As if through the homeopathic lens
therapeutic practice. Like coloured glass or a lens,
the filter through which perception takes place will
colour, distort or focus what is perceived. While
the ideal may be to see through ‘clear glass’, in real-
ity the medium is created and tinted by both the
observer and the observed. While the homeopath
may hope to consult with absolute objectivity, in Disease Illness

practice there is always an element of subjectivity. Homeopath Patient

Symptoms Suffering
The observer can never be unbiased while there is
any anticipation of events or attachment to out- Case Remedy
come. The more the observer can be conscious of
their subjectivity, the more they can allow for and Projection Projection
onto patient onto
reduce their bias – the more unconscious the bias, homeopath
Deepening our

the more difficult it is to account for. By under-

Approach

standing the relationship between the patient and

ourselves we begin to make conscious, and allow
for, this lack of objectivity.
V The Medium of Perception / The ‘lens’ allows the homeopath to see the patient as the
homeopathic case and to focus those aspects of the relationship
The Remedy and Disease that might not be brought to awareness in another relationship. It
‘If the statistical predictions of quantum theory are true, also allows the patient to focus their expectations and projections
through the homeopathic lens onto the homeopath. It is the lens
an objective universe is incompatible with the law of that allows the perception of both the carer and the patient as
respectively the homeopath and the homeopathic patient
local causes’
Summary of Bell’s Theorem Figure 23.1 The medium of perception

304
 Relationship

The closer the two sides accurately reflect or The homeopath follows the patient and the symp-
match each other, the clearer the case is. The more toms they ‘play out’ in the case and ‘moves’ things
detail that is expressed (in the patient’s account of on. I invite you to think of the homeopathic relation-
the illness), the more complete a picture it is pos- ship as like a dance – finding the ‘rhythm’ and ‘steps’
sible to describe (the more accurate the diagnosis). to the case and looking for the remedy that ‘strikes
Using only the conventional (pathological) diag- the right chord’ or ‘hits the right note’. To extend this
nostic labels of disease often inadequately expresses metaphor, ‘the music’ is created by the patient and
the patient’s illness. By attempting to summarise an the homeopath ‘tunes in to’ the patient. The homeo-
overall impression of the patient’s case, the homeo- path can observe the patient’s dancing in a detached
path is attempting to express their overall percep- way – and in many simple cases this may be sufficient.
tion – which may include reference to disease, In more confused and hidden cases you may find it
symptoms, remedy and the relationship. helpful to enter into a metaphorical dance with the
The medium through which the range and patient to understand the dance and what the patient
breadth of a patient’s suffering is communicated is communicating. By mirroring the patient’s move-
is informed by the concepts and remedies the ments you can glimpse the world from the patient’s
homeopath has to hand. If they know 10 different view and hear the tune the patient is dancing to.
remedies for claustrophobia they know 10 differ-
ent ways it can be experienced – and perceive it The Homeopath’s Ability to be Present
more accurately than someone who thinks all claus- The art of the homeopath is to be able to observe
trophobia is the same. In this way understanding the what is happening around them while being fully
materia medica is fundamental to the homeopathic present in it, to pay attention. You are required to
process. The homeopath aims to see disease in its hold the intention of something happening with
broadest and most descriptive sense and to develop the possibility that anything could. Attention actu-
competencies to receive a wide range of what the ally creates possibilities, e.g. noticing that a par-
patient offers. Reflecting this to the patient gives ticular patient uses the words ‘right and wrong’
them permission to share and invites them to in the consultation leads to exploring what these
reveal more of themselves in the consultation. The mean to the patient, who may then, for example,
effect of any remedies prescribed (specific effects) start talking about their sensitivity to criticism.
and the effect of the therapeutic relationship (non- The aim is to become skilled at linking what is hap-
specific effects) are related – and cannot, in prac- pening in ‘the here and now’ with what has come into
tice, be meaningfully separated (see Chapter 24). the consultation from outside, ‘the there and then’.
There are techniques for doing this such as work-
Communication ing with a tentative statement – ‘I notice that. . .’ or
The more you wish to perceive, the more present ‘I wonder if. . .’. Or by describing what is happening
you need to be. to you as part of the consultation – e.g. ‘I notice that
Deepening our
Communication is the interplay of the differ- when you say this I feel. . .’. Often by being able to
Approach

ent factors allowing expression and perception, articulate these feelings the homeopath’s ability to be
frequently leaning heavily on language and verbal present in the consultation is greatly increased. This in
communication. One part of cases being difficult turn models the ability for the patient also to become
(confused or hidden) is that what is being commu-
nicated is not explicitly said or declared, another is
fully present. Inviting the patient to imagine how they
might act in other circumstances, or to remember
V
that what is being expressed is not perceived clearly. how they have acted or felt in the past, can also reveal
When talking about allopathic approaches to things about them that they might otherwise choose
health care doctors talk about ‘fighting illness’ and not to present to you. For example, ‘I wonder how
‘the battle to be well’, where the illness needs to be you might feel if. . .’ or ‘I wonder how you reacted
‘beaten’, the medicines will ‘kill’ off the disease etc. when. . .’ or ‘I wonder if you ever feel this. . .’.

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 CHAPTER TWENTY THREE The Homeopathic Relationship

While the homeopath at one level simply hears pen outside, their delusions are how they construct
the patient’s story, engaging and relating to the their world from inside to try to prevent their
story often increases the detail and quality of the fears.
story being told. However, there are risks in this As illness moves deeper, symptoms often
process if the homeopath is insistent on getting become more structural, unconscious or sup-
their own story told or if they are unaware of pressed. As they do so they express fewer individ-
what their own story brings and how it colours ual nuances of the patient. In deep-seated chronic
what they see (see Chapter 25). illness the whole state of the patient reflects how
Using the techniques of ‘enacting’ and ‘match- they have adapted to the situation they are in now.
ing’ (see Chapter 13) to mimic the patient’s body Symptoms that were present previously or might
language or some of their phraseology enables you have been present in a different situation are hid-
to meaningfully engage with your feelings. These den or masked. In the consultation it is possible to
feelings will, surprisingly often, mirror or high- explore these past symptoms and to see how the
light the patient’s feelings and frequently enable patient imagines things might be in different situ-
the patient to engage and express them, often ations. The situations the patient desires to create
allowing deeper symptoms to surface. and avoid are expressed through what we refer to
respectively as the patient’s ‘delusions’ and ‘fears’.
The Patient’s World and Their As the case gets more confused and hidden so
Ability to be Present these become increasingly important; they are a
Observing patients – how they sit, how they move, way of seeing what is otherwise masked. In the
how they are dressed – gives indications of how consultation the skilled homeopath can not only
open they are to relating to you. Many patients are invite the patient to consider what their symp-
unfamiliar with the invitation to engage in a ‘rela- toms would be like in different situations, but also
tionship of this sort’ with a practitioner. They need take the patient through their imagination, hopes,
to develop trust in you before they can do this; if dreams, ambitions, fears and anxieties into such
you can model this open and trusting relationship to situations so they can experience what it feels like.
them, it greatly helps and demonstrates some of the Frequently this reveals new and previously hidden
values you choose to work with (see Chapter 25). features of the case.
Inviting the patient to be present and make
their feelings conscious requires a rapport and
trust that has to be consciously created. If patients
are unwilling or unable to share emotions in the
Projection of the Unconscious
consultation it makes observing deeper aspects of Difficulties arise when there are unmet expecta-
the case difficult. If a patient is avoiding emotions tions or hopes in either the patient or the homeo-
it is worth reflecting on why they are doing this. Is path.
Deepening our

this their way of keeping control, do they not trust It is normal for us all to have aspects of our
Approach

their own feelings or you? Sometimes the feelings personality that are unconscious. Some of these
expressed by a third party, like a pet owner or par- are more hidden or ‘in shadow’ than others but
ent, can ‘surrogately’ point to important aspects of all of them can influence our everyday relation-
V the case. The closer and more exclusive the rela-
tionship, the more likely there will be synchronic-
ships and everyday lives. This influence can be
understood as the unconscious seeking to be
ity or overlap of the remedy states. recognised or manifest in the conscious, or as the
conscious attempting to keep some things ‘out of
Why Cases are Confused and Hidden sight’ in the unconscious. We can all be considered
There is a close relationship between patients’ fear to be acting out aspects of our unconscious and
and delusions: their fears concern what will hap- suppressing aspects of our conscious – with the

306
 Projection of the Unconscious

potential for particular aspects of our unconscious patient or the homeopath (often both!) – perhaps
to be brought to the surface (our buttons pushed) reflecting a cultural predisposition (or miasm) that
by certain people or situations. both the patient and homeopath share.
If what are acted out or suppressed coalesce
around social norms they are considered nor- Staying Centred
mal and may not stand out. Others that do not ‘Physician heal thyself ’
coalesce around social norms might be considered When working with projection it is important
unhealthy, odd – or even mad. While this is more to be aware of where your feelings originate. Part
easily observed and described in the psychologi- of the personal development of any homeopath
cal realm, the same happens with physical charac- is realising the cultural and social factors they are
teristics – some are expressed as symptoms, some influenced by.
are hidden and only manifest in certain situations. It is important to realise if feelings arise from
In hidden cases often the homeopath and patient your own state, and not in response to the patient,
share the same cultural and population norms, so they can confuse and confound the case. It is
making it harder to recognise a patient’s symp- therefore important for you to be centred and in a
toms. In these cases the patient’s illness reflects balanced state. This requires professional support
the health of the culture and population as much and supervision (see Chapter 25).
as the patient (see ‘Public health homeopathy’,
Chapter 30). Projection by the Patient
Transference is caused by seeing the present situ-
Projection (Transference ation through an emotional lens shaped by past
and Counter Transference) situations. It relates particularly to aspects of a
Those aspects of the patient that are not expressed relationship from the past being projected onto
explicitly are always reflected in some way in the relationships of the present. It is often our sig-
patient’s situation or the people around them. They nificant past relationships, such as with parents
are important to perceive and can be thought of and siblings, which affect our present ones and
as the unconscious projected on to others around become central to our character. The case of Mary
them (transference). In response to this transfer- illustrates this and you might like to consider Box
ence there will be a reaction in those that experi- 23.1 before you read her case. It lists some of
ence it. The homeopath who realises this attempts the techniques that can help identify projection,
to consciously notice this projection and channel including transference and non-verbal expression
it through the treatment process. What is not con- of suppressed or unacknowledged feelings.
sciously noticed will be passed on in some way into Transference is strongest while it remains
your situation or the people around you – and is unconscious. The more strongly it is hidden the
liable to be projected in some way onto the patient stronger the emotion (both positive and negative)
Deepening our
(counter transference). it can generate, and the more significant to the case.
Approach

It is normal to experience projections in a con- As a general rule a good indication to significant

sultation. If it is conscious it is less likely to bias transference taking place is if you register strong
the case – and can give important pointers. If pro- feelings in the consultation. Acknowledging these
jection appears absent it may be that the case is
progressing straightforwardly. In a difficult case it
is both therapeutic and provides an essential guide
to prescribing – especially in confused cases.
V
is more likely that the homeopath is unaware of In confused and hidden cases the patient’s symp-
it and may be an indication that the patient and toms do not express all aspects of the disease state.
homeopath are unconsciously colluding with each The less the symptoms are expressed, the greater
other, acting out their unconscious agendas. A case the transference. For the homeopath it is important
may be difficult due to projection either by the to understand projection as being generated not

307
 CHAPTER TWENTY THREE The Homeopathic Relationship

BOX 23.1 CASE STUDY 23.1

Techniques That Can Help Identify Mary, aged 45, consulted for help with catarrh
Projection by the Patient (Transference) and postnasal drip. Her husband was a patient
●
Ask patients specifically how they are feel- and had been disabled from an accident in his
ing in the consultation and when discuss- teens. She had a history of depression from
ing aspects of the case – especially if you her 20s and recounted, without obvious feel-
notice feelings in yourself. ing, when as a child (she couldn’t recall the
●
Look for any signs of feelings surfacing exact age) her parents separated. While talk-
(eyes watering, laughing, avoiding eye ing about her parent’s separation she stroked
contact, touching a part of the body) her throat and kept swallowing. At this
●
Invite patients to imagine they are talking moment the homeopath became aware of an
to the people that they feel generated these increased intensity in the consultation. Mary
feelings in the past. For example, you can became angry at the homeopath and asked
invite the patient to talk to you as if you why she was being asked ‘all this’.
are a parent or a sibling. You might encour- The homeopath asked her how she felt
age them (give the courage) to think about and mirrored the same hand movement to the
what they would like to say to them now, neck back to her. She said she felt she was
how they feel saying that, and what they suffocating when talking about her father. She
might need to hear when they say that. went on to say she felt very angry and resentful
●
Consider the feelings behind the patient’s that he didn’t leave the family home at an ear-
language, for example ‘heartache’ ‘under lier age. She remembered that he had left after
the skin’ ‘weak at the knees’ etc. Feelings she and her sister had ‘left home’ and gone to
have correlations to parts of the body. At university. Some of this anger was transferred
times these appear obvious but warrant onto the homeopath; the homeopath offered
being stated consciously, such as when a to ‘role-play’ Mary’s father and she was able to
patient with angina describes feeling bro- ‘get in touch’ with her anger. Encouraging her
ken hearted about a relationship, a patient to talk about and express her feelings of anger
with indigestion feels gutted after a disap- provided information to distinguish between
pointment, a patient with backache talks those remedies with suppressed anger and
about a disagreement like being ‘stabbed this in turn helped the homeopath and Mary
in the back’, a patient with a rash saying a see that she had a deep insecurity around
person who irritates them gets ‘under my men. She responded well to Sepia.
skin’ or with hay fever describing someone
as ‘getting up my nose’. hidden cases, including cases where the vitality is
Deepening our

low and where the totality and constitution are

Approach

just by unexpressed feeling but also by suppressed not expressed, then the case is revealed through
symptomatology and from any unexpressed feature the unconscious behaviour of the patient. The
of a patient. The sum total of what is unexpressed deeper the disturbance, the more forcefully it
V or unresolved from the past (the there and then)
contributes to who we are and how we project our-
has to express itself in some way – if not through
conscious symptoms then through projection.
selves in the present (the here and now). Working with projection frequently requires
Some cases are difficult because they initially clear emotional communication. The homeopath
appear to lack symptoms or modalities. When the may find ideas developed in work on emotional
case is sensitively received it may reveal additional intelligence (Goleman 1995) and through non-
symptoms (see Chapter 13). In truly confused and violent communication (Rosenberg 2003) helpful as

308
 Projection of the Unconscious

they explore how, when something is observed, it affect their perception of the case. The more the
gives rise to feelings that if not expressed gener- homeopath is attempting to identify the themes
ate needs and lead to actions. Likewise the unmet that run through a confused case, the more useful
needs a patient has will determine the feelings these projections are. When the case is effectively
they are most likely to experience. Patients will masked or hidden then even the projections of the
recreate situations and relationships that generate patient can be difficult for the homeopath to con-
the unexpressed feelings and reinforce their unmet sciously recognise. In these cases the homeopath’s
needs when that is what they are familiar with. If reciprocal projections (including counter transfer-
the consultation and treatment allows insight into ence) back to the patient (or to others) provide
those unmet needs, and expression of those feel- vital clues to understanding the case.
ings, longstanding patterns of behaviour can shift. Counter-transference, in its psychological defi-
nition, relates to what the therapist transfers to
the patient in response to the transference the
REFLECTION POINT patient is projecting on to the therapist. A much
● Consider what different experiences of transference you broader interpretation can enable the homeopath
have experienced in different consultations. How has to use all that they notice about how a patient
this affected your relationship with patients? influences their own posture, behaviour, choice of
words. It also influences their behaviour to others
and, if ‘unresolved’, will unconsciously be acted
Projection by the Homeopath out on friends, colleagues or family – or helpfully
Feelings generated in the homeopath during a be engaged with in supervision (see Chapter 25).
consultation fall into three main groups. First are The case of Sarah illustrates how projection
those feelings generated on a coincidental basis in and reciprocal projection shed light on a confused
the homeopath at the time. These are likely to vary case. You might like to read through the points in
from consultation to consultation and day to day, Box 23.2 to help identify when projection is hap-
e.g. if the homeopath had recently experienced an pening in the homeopath.
upset in their personal life. We can see how Sarah’s tendency was to proj-
The second group will be those that reflect ect her remedy state onto the homeopath. For
the steady state of the homeopath and which may some patients and homeopaths this can become
persist over some period of time. For example, a comfortable state of ‘collusion’, in which both
someone who is in a deep state of grief will find patient and homeopath can become ‘stuck’. As
those feelings emerge easily in consultations. If the homeopaths see these confused cases differently it
homeopath regularly experiences the same feelings is often helpful to have a colleague who can help
it may have more to do with their own state than by seeing and advising on difficult cases. Some
that of the patient’s – and may require some reso- pointers to help identify when reciprocal projec-
Deepening our
lution for the homeopath’s own benefit. tion is taking place include the homeopath fanta-
Approach

The third group of feelings is those that emerge sising or having strong feelings about the patient,
in response to the patient’s projection (transfer- breaking boundaries, behaving differently, making
ence) and if they remain unconscious, may lead Freudian slips or forgetting things. It can include
to a reciprocal projection (counter transference).
In confused and hidden cases the patient’s pro-
physical or behavioural changes before, during
and after a consultation.
V
jections are frequently strong – as are potentially It is also important to realise that by making the
the feelings generated in the homeopath and the reciprocal projection conscious there is a chance
reciprocal projections. to deepen the consultation, e.g. ‘when you talk
A homeopath who is open to, and indeed like…, I feel…’. This is one of the best ways of
invites, patient’s projections will find that these getting patients to address their own projections

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 CHAPTER TWENTY THREE The Homeopathic Relationship

BOX 23.2 CASE STUDY 23.2

Techniques That Can Help Identify Sarah, aged 43, presented for treatment of
Projection by the Homeopath (Counter her depression. She had had many courses of
Transference) antidepressants and the case was confused.
●
Reflect on who the patient reminds you Exploring her life history it transpired her father,
of. In what way are they similar to this who treated her very specially, doted on her.
person?’ When she married, her husband also treated
●
Is your relationship with them different her as very special until her first child was born
from other patients? Are you over-familiar when she was 27 – after which she felt he was
or over-distanced? neglecting her. She became depressed and
●
Would you feel comfortable if someone presented with postnatal depression that was
was watching you in the consultation? severe and persistent. Sarah ‘looked down’
If not, there is likely to be projection. on her friends and spoke about her ‘murder-
●
How would you feel if you were watching ous feelings’ towards a previous boyfriend
someone else who was behaving like you? who had rejected her.
●
What is going on between you and the She consulted a male homeopath and
patient? The stronger the feelings, the enjoyed being the centre of attention in
more likely the projection is to be uncon- the case-taking. She started to flirt with the
scious and is going to colour how you see homeopath. The homeopath noted these ‘pro-
the case. jections’ and prescribed Lachesis that failed to
●
How easy do you feel it would be to share act. Sarah continued on her antidepressants
your projection, if not with the patient and wanted to consult frequently. The homeo-
then in supervision? The more difficult it path noticed he would note the days she was
is, then the stronger the projection is likely due to attend and at times consultations with
to be. her would run over. The case became increas-
●
Do you commonly experience a particu- ingly hidden. When the homeopath presented
lar feeling? The more common, the more this case in supervision he realised that Sarah
likely it is that this is part of your own made him feel special.
state. The more uncommon a feeling is At the next consultation he observed
for you, then the more likely it is to be a Sarah’s need for special treatment, while not-
specific response to the patient. ing his own need to give it. It lead to Sarah talk-
ing about feeling special and expecting others
and to examine where it is coming from. It requires to see that she was special. The homeopath
skill and courage for a homeopath to address issues noted for the first time her haughtiness and
Deepening our

related to projection, although it can be rehearsed in that he had had jealous feelings about her
husband, perhaps unconsciously leading to
Approach

supervision. The less the case-taking and treatment

process in confused and hidden cases encompasses the prescription of Lachesis. She responded
the perception and reaction of the homeopath, well to Platina and at a subsequent consul-
tation was able to explore her wish to find a
V the greater the homeopath’s unconscious projec-
tion and the more difficult or even incurable a case father replacement figure and a need to have
will seem. When able to recognise and work with someone around who made her feel special.
these feelings the homeopath gains insight into
the otherwise confused and hidden aspects of a
case. If they are not able to work with these feel-
ings then they will often find these patients hard

310
 Projection of the Unconscious

to work with and may, like many health care prac- feel a sense of ‘possession’ by the patient – as if the
titioners, dismiss them with labels such as heart patient’s remedy is proving itself on them.
sink, hypochondriacs, incurable, etc. At its most basic, projective identification is
one way of sharing how you feel. But it can also
be a way of attempting to deny negative feelings
REFLECTION POINT by putting them onto someone else – which can,
● Reflect on a recent consultation when strong feelings for a short time, make the person who is project-
have arisen. What are these and what is being ing feel better. Projection may be a mutual condi-
projected? Who did the patient remind you of and how tion that leads eventually to co-dependence and
might another homeopath have responded differently? mutual lack of objectivity. While it may distort our
● Do you draw a particular sort of patient to you? What perception in a therapeutic situation, it is never-
might this say about you? Do you believe that if you theless common socially, and contributes to feel-
deny aspects of yourself you are likely to find yourself ings of belonging and security. When dependence
being confronted by patients who have similar issues? is eventually broken there can be strong negative
● Think about different remedy types – what projections reactions, and care is needed to manage it as a
are they likely to generate and what counter-projections conscious stage in a maturing therapeutic relation-
would they generate in you? ship. It is one of the reasons why you should be
● You might have positive or negative feelings in the cautious when treating family or friends becoming
consultation. Which is likely to be harder to recognise increasingly cautious as the case becomes more
and name? Is one more useful or relevant than the complex, confused or hidden.
other? If you spend enough time in the company of
someone in a particular state you start to expe-
rience that state. When, during a consultation,
you experience a particularly strong feeling, e.g.
Projective Identification hopelessness, anxiety or uncertainty, it is impor-
Patients in a particular remedy state will see the tant to consider the possibility that these feelings
world through that remedy state’s eyes. They project exist within the patient. When carefully moni-
aspects of the remedy state onto their environment tored and observed it allows you to experience the
and select an environment where they feel most com- patient’s remedy state as if you are proving it –
fortable and that matches their remedy state. The and contributes to the ‘feeling and living materia
projector has the unconscious fantasy of depositing medica’ picture it is possible to build with experi-
unwanted aspects of themself in another in the hope ence. When poorly monitored or handled it leads
that the other person will be able to process what to being pulled into unhealthy or unprofessional
the projector could not (Ogden 1979, 1986). For relationships and obscures the patient’s case. The
example, a Nux Vomica patient will seek to create a more susceptible you are to a particular feeling
Deepening our
Nux Vomica world. Patients consciously and uncon- in many settings, the more likely it is to be part
Approach

sciously induce feelings in others that are part of of your make-up and to reflect the remedies you
their remedy picture. How you feel with a particular might be most sensitive to.
patient will be influenced by your susceptibility to It is worth considering that in every consulta-
those projections, and you are likely to draw to you
patients that create or reinforce familiar feelings. It is
tion the patient’s remedy state in a way proves
itself on us. It is the degree and individuality of
V
therefore quite consistent for patients to be attracted that ‘proving’ and its recognition that indicate
to a homeopath who both suits their particular view the remedy. It is possible to see that in the case of
of the world and whom they believe they might con- Sarah above. A susceptible homeopath might have
trol and manipulate. The homeopath who uncon- moved further into a remedy state (proved it) in
sciously identifies with what is being projected will response to her projection. Homeopaths needing

311
 CHAPTER TWENTY THREE The Homeopathic Relationship

a particular remedy will find similar patients can

CASE STUDY 23.3
move them further into that state.
Simon presented because he was fed up with
his migraines, and came on the recommenda-
Understanding Ourselves tion of his wife – who had been ‘nagging him’
to see a homeopath. At first he seemed brittle,
‘Writing a prescription is easy, but coming to an under-
sharp and irritable and I felt threatened and
standing with a patient is hard.’
insecure. Exploring his irritability it became
Kafka (1949)
clear that he was frightened of expecting too
much and finding it didn’t work. This con-
The homeopathic relationship is unfamiliar to
nected with his fear of rejection. The irritability
many patients who are not used to being invited to
and brittleness was an effective way of keeping
tell their story in such detail or to being heard with
people at a distance. This theme of wanting to
such intensity. Some come with expectations that a
be alone because of a fear of being let down
pill will allow them ‘magically’ to return to a pre-
(or letting others down) is a consistent part of
vious state, to ‘turn the clock back’. If this expec-
the picture of the remedy Bryonia, a remedy
tation of magician is projected, the homeopath is
I missed for sometime because my response
unwise to except it. Much is possible but it is for
to the patient’s irritability was to withdraw and
the patient to undertake their healing journey – not
not probe deeper – concentrating instead
for the homeopath to take it from them.
purely on the local symptoms. I now know that
patients in the Bryonia state of chronic disease
The Homeopath’s Perception
often make me feel this way and this can alert
‘The first duty of the physician is to perceive what is to
me to the possibilities of them being a Bryonia
be cured in the case of disease.’
case – something we will return to when we
S Hahnemann, Organon, Para 3
talk about emotional materia medica.
Whatever we perceive is influenced by our own
state of mind, emotions, culture, race and family. (based on cause and effect) and psychotherapeutic
When we observe a patient it is in the context of ones. Homeopaths work both with ‘process and
the homeopathic relationship, including our part in task’ and with ‘content and outcome’. It is inter-
it. The more confused and hidden the case the more esting how development in homeopathy over the
of it is in the unconscious – and the more important last 200 years has run in parallel with the psycho-
the homeopathic relationship is in revealing this. dynamic developments so important to an indi-
To be emotionally present brings certain chal- vidual understanding of patients.
lenges, including developing insight and recognis-
ing emotions in you. Identifying and learning to Monitoring the Projection
Deepening our

manage issues of projection is a key skill in work- ‘Your psychological and physical reactions to
Approach

ing with confused and hidden cases. Learning patients provide useful and as you get to know
from successful cases is often easy but learning yourself reliable information about the patient’s
from those cases that have not gone well is often condition and remedy’.
V harder – but provides much greater opportunity
for growth (see Chapter 25). The case of Simon A homeopath may simply experience the
illustrates how identifying transference and coun- projection as a ‘tingling in the neck’ or a feeling
ter-transference can help. If this case had been that something is important. At this level these
supervised it may have been recognised earlier. things can guide the homeopath in receiving
The homeopath occupies a unique position, the case; the more these feelings remain uncon-
being able to incorporate medical models of health scious in the homeopath the more likely they

312
 Summary

are to lead to ‘reciprocal projections’ or counter- or studying a remedy, you energetically and subtly
transference. For many homeopaths and other prove it. The more depth it is taught in, and the
health professionals, there are certain, sometimes more the remedy is ‘brought alive’, the more some-
common, situations in which counter-transference thing of the remedy state is projected on to you.
occurs. Sometimes these are feelings that the prac- The effect of this is to generate reciprocal projec-
titioner becomes quite attached to such as feeling tions in you to the remedy. It can stay active for
special, but they can also produce feelings of being some time after your teaching and is why you see
in a rut, going through the same thing again and that remedy more after you have been taught it.
again or feeling worthless or put upon. Once the projection has been processed, and
For many health care practitioners, including you can distinguish the remedy state arising in
homeopaths, how projection is handled (or more yourself, you will have gained a deeper under-
importantly not handled) is a major factor influenc- standing of both the remedy and yourself. Some
ing personal, practice and professional morale and teachers advise students not to prescribe a particu-
behaviour (see Chapters 25 and 30). Knowing your- lar remedy for at least a few weeks after studying
self is the key to detecting projection, to prevent it it because you are probably not seeing the patient
remaining unconscious and you buying into it and clearly. Other teachers feel you are more likely to
making it your reality. Projection and reciprocal pro- recognise the remedy and patients who need it
jection lies behind much abuse of power and both – and they are more likely then to seek you out!
patients and homeopaths being taken advantage of.

Implication for Studying Materia Medica REFLECTION POINT

‘When the patient is ready the homeopath will appear. ● Think of a difficult case you have seen. How does this
When the homeopath is ready the patient will appear.’ patient make you feel and what are they communicating
David Lilley but not saying? What types of cases might make you
feel ‘dumped on’ and what can you do to prevent this?
When studying the materia medica, just as when ● Reflect on the unique position homeopaths have (with
studying the patient, what you see will depends on skills in a number of models of health) in understanding
the perspective you see it from. Your ability to per- the psychological and somatic interface of illness. To what
ceive remedies will be influenced by your own ability extent does the mind and body each reflect the other and
to recognise that remedy in yourself. So, for exam- how does disease limit the free expression of mental and
ple, from the outside an Arsenicum Album proving physical creativity? How does the artificial separation of
may look like fastidiousness and controlling, but them restrict what we can know of others and ourselves?
from inside the patient it may feel like a need to cope ● How might your consulting room and practice
with the insecurity and be clear who is in control. A organisation reflect what you are unconsciously
patient may present with irritability but underlying projecting, what might this tell you about the patients
Deepening our
this state may be an anxiety. Part of understanding you will attract and those you won’t?
Approach

the materia medica and the remedy pictures is being

clear from where you are seeing the remedy.
If the homeopath is in a particular remedy state
Summary
at a particular time this will colour how they are
able to prescribe for their patients. At times you We are only homeopaths because there are homeo-
V
may think you are attracting patients who need a pathic patients.
particular remedy, at other times it is all you can
see in patients. If you continue to recognise a single This chapter develops the central role of the
predominant remedy in cases it is quite likely you homeopathic relationship when working in greater
need this remedy yourself. When you are taught depth with patients. It has looked at how both the

313
 CHAPTER TWENTY THREE The Homeopathic Relationship

perceiver and what is perceived mutually define For both the patient and homeopath it invites
each other; that each observer has their own unique a shift in how they relate to each other and illness.
prejudices and that by understanding and knowing A patient with a chronic illness can understand that
these, you are better able to work with them. illness is telling them something about themselves
In the same way that we talk about homeopathy and their situation, so they can make the changes
as an individualised system of health care where that mean they no longer need the illness. In the
five patients with the same condition might each same way, the homeopath can welcome the diffi-
require a different remedy, so we have to be open cult case as an opportunity to explore their way of
to the fact that a patient may present a difficult case working and of knowing themselves more deeply.
to five different homeopaths who each may see and
bring to light aspects of several different remedy
pictures. These different remedy pictures will often References
be related, but the way they emerge will be depen-
Einstein A, Podolsky B, Rosen N 1935 Can quantum-
dent on the dynamic inter-relationship between
mechanical description of physical reality be considered
the patient and the homeopath. The homeopathic complete? Phys Rev 41:777
relationship in this way is not separable from the
description of the remedy, the effect of the remedy Goleman D 1995 Emotional intelligence. Bantam
Books, New York
and the effect of the consultation.
This chapter has explored how projection from Hahnemann S 1842 Organon of the medical art, 6th
the patient to the homeopath and from the homeo- edn. Based on a translation by Steven Decker, edited
and annotated by Wendy Brewster O’Reilly. 1995
path to the patient provides vital information to the
Birdcage Books, Washington
understanding of difficult cases. We go on in Section
VI to explore in more detail how to work with con- Kafka F 1949 A country doctor. In the penal settlement.
fused and hidden cases. Working with projection Secker and Warburg, London
requires intellectual and emotional competence Ogden T H 1979 On projective identification. Int J
and links to seeing the remedies as emotional, situ- Psycho-Anal 60:357–373
ational and living materia medica (see Chapter 27). Ogden T H 1986 The matrix of the mind. Object rela-
The feelings that patients experience in particular tions theory and the psychoanalytic dialogue. Jason
remedy states are an important and significant part Aronson, Northwale, NJ
of that remedy’s materia medica. Equally, patients in Rosenberg M 2003 Nonviolent communication – a lan-
different remedy states can generate (or draw out) guage of life. PuddleDancer Press, Chicago
particular feelings in the homeopath. Depending on
Stapp H P 1971 S-matrix interpretation of quantum
the state of the homeopath, these feelings may be
theory. Physical Review D3:1303
different. So, for example, a Nux Vomica homeo-
path will experience a Pulsatilla patient differ-
Deepening our

ently from a Pulsatilla homeopath. However, if the

Bibliography
Approach

homeopath is aware of their own state and develops

an experience of working with different cases, the Kleinman A 1988 The illness narratives. Basic Books,
feelings that they experience in particular consulta- New York

V tions can give a reliable indication to the remedy

state of the patient. This is explored further when
Hawkins P Shohet R 2000 Supervision in the help-
ing professions, 2nd edn. Open University Press,
discussing the reflective approach to treatment. Buckingham

314
CHAPTER TWENTY FOUR

Homeopathic Research Case Analysis

Iris R. Bell

torted perception that too many in the conventional

Introduction by David Owen Western paradigm project onto the evidence base
“Truth lies in the achievement of a contact with real- for homeopathy. There are, of course, many argu-
ity – a contact destined to reveal itself by an indefinite ments that conventional scientists might put up in
range of yet unforeseen consequences” response; some of these – such as the lack of objec-
M Polyani tive enquiry by homeopaths into what they practice
– do have some substance to them.
Different homeopaths will have different reasons While qualitative enquiry and research does
to reflect on and study the research and evidence not necessarily extrapolate (or linearly progress) to
base for homeopathy. All of us owe it to ourselves quantitative research, it dose nonetheless address
and our patients: many important questions about patients and inter-
1. to ask why we might do something ventions. If this chapter acts as a reminder to homeo-
2. to enquire into what others have done and if paths that critical and thoughtful enquiry into the
it worked homeopathic process is an important responsibility,
3. to monitor the outcomes of our treatments then it will have served its purpose. If, in addition,
and it furthers your individual understanding and stim-
4. in the light of this, ask how we might modify ulates an enquiry into how you work and might
what we do. research the models of health, approaches to treat-
ment and methodologies for prescribing, then it
This, similar to the learning cycle, is the cycle around will have served you well. In the evolution of our
which we can refine and develop our experience. profession, critical thinking and systematic enquiry
Much of this text is concerned with only the first have a long tradition and provide us with both an
step of this cycle and I am indebted to Iris Bell for opportunity and a responsibility.
so comprehensively addressing stage 2 of this. More As you read this chapter, you might like to reflect
than that, if the basic principles can be grasped this on the different research tools necessary to evaluate
chapter gives a solid foundation for monitoring the range of outcomes each approach and method-
the outcome of every patient you treat. There are ology offer, and on the matrix of different types
many diverse ways of enquiring into the homeo- of research and experience that are most likely to
pathic process and if the most appropriate questions influence your practice of homeopathy. Remember
can be asked there are a wealth of meaningful and that as you move between the different models of
worthwhile techniques for examining both the art health, different methods of enquiry and research
and science of homeopathic practice. Iris has made are appropriate. Some models are more open to
a formidable start in redressing the skewed and dis- ‘scientific enquiry’ with separate objective events

315
 CHAPTER TWENTY FOUR Homeopathic Research

that can be measured. Whereas others require a clinical practice are inherently qualitative rather
more artistic system of enquiry where objectivity is than quantitative in their processes. However, rela-
relative, populations are not distributed according tively little homeopathic research has adapted the
to a fixed pattern and events do not happen ran- available methodologies from qualitative disciplines
domly or in a disconnected way. Confusing these (Verhoef et al 2002, Bell et al 2003, Thompson
two leads to the nonsense of ‘trying to measure the 2004). At face value, for instance, the data from
beauty of a rose with a ruler’ (David Reilly). homeopathic provings and case-taking interviews
involves identification of qualitative patterns rather
than simplistic tallies of symptoms (Sherr 1994,
Rowe 1998, Sankaran 2005). Consensus panels
Homeopathic Research have emphasised the need to honour the nature of
This chapter addresses: the CAM intervention in study design (Levin et al
●
the scope of the types of research relevant to 1997), but many investigators have failed to do
understanding homeopathy so in testing homeopathic treatment (Bell 2003).
●
the complex issues in designing, performing, and The global and multidimensional nature of homeo-
interpreting research studies on homeopathy pathic outcomes also points to the likelihood that
●
emerging theoretical models for elucidating the mechanisms of action for homeopathic rem-
the nature of healing in homeopathy (Mathie edies and treatment overall differ from those of
2003, Walach et al 2005). pharmaceutical agents (Bellavite & Signorini 2002,
Hyland & Lewith 2002, Bellavite 2003).
Researchers consider homeopathy to be one of the In turn, such differences should inform the direc-
leading whole systems of complementary and alter- tion of basic and preclinical science studies on the
native medicine (CAM), i.e. a complex intervention nature of the remedies and their actions. These con-
involving multiple elements in an integrated package siderations have led to emerging theories in home-
of care (e.g. the patient–provider relationship/alliance opathy that invoke macro-quantum entanglement of
and the remedy), as contrasted with mainstream phar- closed systems and complex non-linear dynamical
maceutical medicine in which the focus is the purified systems and network science models for the nature of
single drug (Ritenbaugh et al 2003, Verhoef et al 2004, healing in homeopathy. Scientists have also pursued
2005). Whole systems of CAM, like homeopathy, also basic science research looking for succussion-depen-
typically generate global and broad multidimensional dent, persistent changes in the network structure
local outcomes in a patient-centered way (non-spe- and interactions of solvent (water) molecules (water
cific effects) (Schulman 2004, Oberbaum et al 2005). clusters), rather than molecular properties of the ani-
In contrast, conventional medicine evaluates itself by mal, mineral, or plant source molecules in studying
its singular ligand-receptor/mechanism-specific, dis- the remedies diluted beyond Avogadro’s number in
ease-centered therapeutic outcomes. Converging evi- potency. Presumably then, remedies would catalyse
Deepening our

dence also suggests that the advantages of CAM over self-organising changes throughout the body water at
Approach

mainstream medicine may fall particularly in the areas the interface with the physical body (Watterson 1991,
of greater safety and lower cost (van Haselen 2000). 1996, 1997). Biofield and/or electromagnetic mecha-
Thus, at the outset, assessing homeopathy using con- nisms may also help mediate the interface between
V ventional drug-oriented efficacy study designs is a
poor fit from the perspective of external, ecological
the remedy and the physical body (Del Giudice 1988,
Rubik 2002). However, dissenting opinions question
validity (Bell 2005a, Jonas 2005). whether or not homeopathy acts by any local (rem-
A core feature of homeopathy is individualised edy specific) as opposed to non-local effects, or both,
treatment, but conventional drug testing relies in the first place (Walach 2000, Walach et al 2005).
upon averaged group effects. Although systematic, In short, homeopathic research is in its infancy in
homeopathic remedy development (provings) and the development of testable models and appropriate

316
 Overview

methodological approaches. The field has already proposed that CAM research shift from an evidence
encountered serious, albeit overly biased, chal- hierarchy, in which meta-analyses of randomised
lenges, such as a controversial meta-analysis (a sys- controlled trials are at the top of a pyramid, to an
tematic review of many different studies) of a small evidence house, in which the broad scope of pos-
number of efficacy studies with good internal but sible study designs are all valued, depending on the
poor external validity (Shang et al 2005), as a result nature of the question asked and the information
of premature acceptance of the assumptions and needed ( Jonas 2001, 2005). For example, well-
methodologies that are better suited for mainstream done observational or audit studies on effectiveness
medical drugs than for homeopathic research. may be far more relevant to clinical practice than are
efficacy studies because they reflect the patient pop-
ulations who seek homeopathic treatment ( Jacobs
Overview et al 1998, Honda & Jacobson 2005) and the mul-
Homeopathic research encompasses many different tiple factors that contribute to outcomes in the real
types of investigations, from basic science to preclini- world (Freeman & Sweeeney 2001). Even studies
cal to clinical in nature, as shown in Table 24.1. Jonas from allopathic medicine increasingly support the

Table 24.1 TYPES OF RESEARCH APPLICABLE TO THE HOMEOPATHIC METHOD

Approach Potential relevance to homeopathy

Case reports Expansion of clinically essential information on individualised treatment

Qualitative studies Design and analysis of provings

Description of therapeutic aspects of the homeopathic interview
Characterisation of patient and provider experiences of homeopathic care

Observational outcomes Understanding treatment factors and outcomes in the context of real-world practice
studies Quality of life and disease-specific outcomes can be assessed

Health services Documentation of costs and access to homeopathy in different health care systems
research studies

Epidemiological studies Identification of features of users of homeopathic self-care and practitioner-provided care
Evaluation of longitudinal outcomes of persons treated with homeopathy with and without
concomitant treatment from conventional and other CAM interventions

Individual difference Determination of personality traits, genetic/biological, life event histories, and environmental factors
studies in differential outcomes in homeopathic treatment
Psychophysiological correlates of exceptional, usual, and poor outcomes for individual patients in
homeopathic treatment

Deepening our
Preclinical and plant Animal and plant studies and dose-finding studies in human subjects (e.g. is there a difference
studies between LM dosing and C potency dosing?; do sequential potencies have non-linear effects in
Approach
opposite directions on the same type of organism?) can reveal properties of remedies not
otherwise understood as factors in clinical trial studies

Clinical trials Comparison of effects of verum homeopathic remedy treatment with placebo
Comparisons of effects of homeopathic interviews with conventional psychotherapeutic interviews
and sham therapy V
Meta-analyses Assessment of combined multiple trials on a given disorder or intervention, with quality ratings of
internal validity; limited by biases inherent in the trials chosen for inclusion and quality criteria
(meta-analyses do not evaluate external validity of each trial)

Basic science Determination of physical chemistry and materials science properties of homeopathic remedies
in vitro

317
 CHAPTER TWENTY FOUR Homeopathic Research

importance of effectiveness rather than efficacy Bertani et al 1999, Ruiz-Vega et al 2000, 2002,
designs for generating clinically meaningful infor- Bellavite & Signori 2002) and that homeopathic
mation (Concato et al 2000). The emphasis on indi- treatment has shown largely beneficial effects on
vidualisation in holistic, holographic and relational thousands of patients with a variety of allopathic
methods of homeopathic diagnosis and treatment conditions (Goldstein & Glik 1998, Riley et al
also suggests the importance of including individual 2001, Anelli et al 2002, Thompson & Reilly 2002,
difference research in the total portfolio of studies van Wassenhoven & Ives 2004, Sevar 2005, Spence
and in the design of ‘group’ studies as well. et al 2005, Witt et al 2005a,b). The data support
For meta-analyses of efficacy research, studies the concept that homeopathic remedies are not the
based on different models of health (causation and same as allopathic drugs in terms of actions on dis-
isopathy, local prescribing, totality and constitu- ease-specific local mechanisms and that the dynam-
tional approaches etc.) are usually combined, as are ical effects and neurophysiology of active remedies
studies that use a single prescription with those using differ from that of placebo (Hyland & Lewith
a combination of remedies. This has little defensible 2002, Lewith et al 2002, Bell et al 2004c,f). The
rationale other than the lack of sufficient studies evidence to date shows that remedies are generally
in the literature using any one model or clinical safe, especially in comparison with conventional
approach. Both positive meta-analyses, such as the drugs (Dantas & Rampes 2000, Riley et al 2001,
Linde et al (1997) study that was originally favour- van Wassenhoven & Ives 2004).
able to homeopathy in its conclusions, and negative The data also suggest, however, that homeopa-
meta-analyses, such as Shang et al (2005), combined thy, or at least those approaches and methodologies
studies from several different types of clinical treat- studied, do not work in all cases under all circum-
ment models and on multiple different diagnoses. stances for many reasons (Frei & Thurneysen
While it is usually possible to draw conclusions, it is 2001, Frei et al 2005) – only some of which have
difficult to draw valid inferences about homeopathy been formally investigated. Furthermore, as in any
from such heterogeneous datasets. clinical intervention, placebo effects play a varying
Methodological shortcomings have plagued basic role in real-world outcomes (Bonne et al 2003,
science studies of homeopathic remedies, though Bell 2005b, Jacobs et al 2005, Pilkington et al
some investigators have proposed standards for 2005). The evidence implies that certain types
minimising factors that confound and contaminate of people out of the general population gravitate
the data (Becker-Witt et al 2003). With their clinical to homeopathic treatment ( Jacobs et al 1998,
interest in patient-centered individual cases rather Honda & Jacobson 2005) and that homeopathy
than disease-centered group interventions, homeo- may be more effective for a subset of patients than
paths themselves publish and study single case for all patients with a given allopathic diagno-
reports far more than do allopaths. sis (Bell et al 2004c), although studies have not
Sceptics of homeopathy periodically publish looked at how different groups of patients use
Deepening our

papers with various methodological flaws that are different homeopathic approaches. As in most
Approach

proclaimed to be the ‘final proof ’ that homeopathy clinical fields (MacPherson et al 2003, Caspi
is nothing more than placebo (Lancet 2005). The et al 2004, Aikens et al 2005, Hirsh et al 2005),
reality of science is that no one study or published limited data also suggest that the patient–pro-
V paper is sufficient to dismiss an entire field, despite
the wishful biases of some sceptics, whatever the
vider relationship (e.g. empathy favouring patient
empowerment and self-efficacy) – largely unin-
topic. The body of research on homeopathy indi- vestigated to date for homeopathy (Mercer et al
cates that homeopathic remedies have properties 2002, Jacobs et al 2005, Thompson et al 2005) –
different from placebos in test tubes and animals plays some therapeutic role apart from that of the
(Sukul et al 1986, 1999, 2001, Endler & Schulte remedies in favourable homeopathic outcomes
1994, Ruiz & Torres 1997, Schulte & Endler 1998, within the clinical setting.

318
 Qualitative Research

As a parallel, research in acupuncture that over-

Qualitative Research laps with homeopathy in essential philosophical
Qualitative research is typically focused on words tenets and potential clinical impact (Vithoulkas
rather than numbers, often using in-depth indi- 1980) has begun to document global and multidi-
vidual or group interviews, observations of people mensional changes during treatment. The changes
living in their own real world environments, and/ that patients report extend far beyond the dis-
or analysis of archival sources such as those on ease-centered, single complaint focus of allopathic
philosophy, literature, and history. The multiple clinical studies. Rather, acupuncture patients are
methods of qualitative research have different reporting changes in life style, sense of meaning
purposes, which Tesch (1992) summarised as ask- in life, energy, improvements in symptoms not
ing the following three types of questions: mentioned originally at intake, and so on (Gould
1. What are the characteristics of language itself? & MacPherson 2001, Paterson & Britten 2003,
2. Can we discover regularities in human Schulman 2004). These are also the broad changes
experience? that homeopaths reported in a published qualita-
3. Can we comprehend the meaning of a text or tive study of possible outcomes in patients with
action? chronic diseases on constitutional treatment (Bell
et al 2003) (Box 24.1). The multidimensionality
Qualitative research has an established, though of the changes during homeopathic treatment,
undervalued, place in health research, especially as well as the global improvements in sense of
in nursing and medical anthropology (Lincoln
& Guba 1985, Denzin & Lincoln 2000, Pope &
Mays 2000), and to a growing extent in CAM BOX 24.1
(Verhoef et al 2002, Bell et al 2003, Paterson et al Practitioner Views of Multidimensional
2003). Scope of Patient Outcome Categories
In contrast with allopathic medicine, which is mainly in Constitutional Homeopathic Treatment
quantitative in its orientation, much homeopathic for Chronic Diseases (after Bell et al 2003)
practice is qualitative by nature. The goal of the ●
Adaptiveness
case-taking is to answer the three types of questions ●
Coping
above in understanding the essential dynamic dis- ●
Creativity
turbance in the patient as a whole indivisible system ●
Dreams
(Sherr 1994, 2002). Most successful homeopathic ●
Emotional
treatment goes far beyond resolution of a chief com- ●
Energy
plaint and does not even hold as a goal suppression ●
Freedom/unstuckness
of a symptom or disease manifestation. Whether or ●
Life changes
not they formalise their procedures with qualitative Life style
Deepening our
●

analysis per se, homeopaths routinely use qualita- ●

Mental functioning
Approach

tive approaches in provings research and in clini- ●

Perceptions by others
cal case-taking and analysis. Thompson (2004) has ●
Physical generalities
called for awareness of the potential of qualitative ●
Physical functioning: specific
methods to enrich homeopathic research and prac-
tice, including in presentation of case reports. An
●

●
Personal perception
Recall
V
unexplored opportunity is for homeopaths to col- ●
Relationships
laborate with experienced qualitative researchers ●
Sleep
to improve the data collection and analysis tech- ●
Spiritual function
niques applied to provings and to clinical informa- ●
Well-being
tion gathering and assessment.

319
 CHAPTER TWENTY FOUR Homeopathic Research

well-being and energy that homeopaths expect to often not objective with regard to new discoveries
observe in their patients, are often ignored in the and theories (Barber 1961).
design of clinical studies (Oberbaum et al 2005) in
favour of the types of narrow, specific outcomes Observational and Effectiveness
that mainstream conventional medicine expects
from its drugs.
Research
In fact, one of the emerging points in homeo- Another issue in homeopathic research is that
pathy research is the necessity of re-examining the complex nature of the intervention and the
assumptions used in performing allopathically multidimensionality of outcomes fit better with
driven studies. Researchers need to ask: ‘What is research designs that examine effectiveness in
homeopathy?’ ‘What happens during homeopathic the real world of practice rather than efficacy of
case-taking?’ ‘What happens during homeopathic isolated interventions and their specific effects
treatment?’ on disease. In conventional medicine, effective-
When sceptics review homeopathic studies ness studies, especially those with a quality of life
and conclude that homeopathic treatment has emphasis, are typically done after, not before, an
non-specific effects, the conclusion is true, in allopathic drug has undergone extensive testing in
a sense (Walach 2001). The problem lies in the efficacy trials.
interpretation of the meaning of ‘non-specificity’. However, it is becoming clear that the more
To mainstream investigators, non-specific effects appropriate sequence of research approaches for
are undesirable and are a synonym for placebo whole systems of CAM, which already have his-
effects. The reality is that homeopathy is non- tories of hundreds to thousands of years of wide-
specific in its nature (Walach 2000, 2001, Walach spread use, is to study the intact packages of care
& Jonas 2002), and the convergent data sug- with large scale observational trials first, then per-
gest that the non-specificity goes beyond placebo haps to dissect their components to understand
effects and reaches to the heart of the therapeutic their relative contributions to the net effects. For
encounter (see Chapter 25) (Walach 2002, 2003). homeopathy, the package of care includes at least
Qualitative research offers a way to go back to the homeopathic interview process itself and the
first steps in the research endeavour and to describe alliance between homeopath and patient in addi-
the homeopathic process. Then investigators can tion to the individualised remedy. Some investi-
proceed to design studies with features that honour gators have argued that the package of care also
the true nature of homeopathy, including its philos- includes the symbolic meaning of the remedy
ophy, medicines, practice, and clinical experiences. (Walach 2000), apart from any physical agent, as
Moreover, because of the nature of homeopathy part of a closed, entangled macro-system involv-
and the insights it offers to different therapeutic ing patient, the patient’s symptoms, practitioner,
approaches, it may be that qualitative research remedy, and the remedy’s symptoms (Milgrom
Deepening our

developed this way will play a more important role 2002a,b, 2003a,b, 2004a,b,c,d, 2005, Hyland
Approach

than quantitative research in advancing not just 2003, Walach 2003, 2005a). It is also becoming
the field of homeopathy but the broader questions clear that the nature of the outcomes is individu-
about ‘healing’ rather than ‘curing’. It is the politi- alised and extends into global and local outcomes
V cal paradigm (including commercial and profes-
sional power issues) that influences, in subtle and at
far beyond those involved in the presenting com-
plaint of the patient, such as overall well-being,
times unconscious ways, conventional medicine’s energy, social role functioning, and so on.
emphasis on quantitative research. Box 24.2 lists observational studies reported
If the aim is to improve clinical practice and on homeopathy. Most of these data converge on
patient outcomes then newer qualitative methods the conclusion that the majority of homeopathi-
may be the best suited; however, scientists are cally treated patients, i.e. 70–80%, experience

320
 Observational and Effectiveness Research

a wide range of conventional diagnoses – what

BOX 24.2
conventional researchers would label as ‘non-
Representative List of Observational/Audit
specific’ as well as subjective rather than objective
Studies in Homeopathy
in nature. It is usually not possible to determine
●
Anelli et al 2002
presence or absence or degree of specific outcomes
●
Goldstein and Glik 1998
in allopathically homogeneous sub-samples, e.g.
●
Neville-Smith 1999
use of rescue medications and number of emer-
●
Relton et al 2005
gency room visits for uncontrolled asthma break-
●
Richardson 2001
throughs, from the observational studies available
●
Riley et al 2001
to date on homeopathy.
●
Sevar 2000
While these types of non-specific quality of
●
Sevar 2005
life outcomes potentially matter a great deal to
●
Spence et al 2005
patients, public policy decision-makers and third-
●
Van Wassenhoven and Ives 2004
party payers are likely to view an outcome such
●
Witt 2005
as a greater sense of well-being as unhelpful or
●
Witt et al 2005
insufficient in deciding whether or not to pay
for homeopathic treatment for all patients with a
moderate to substantial improvements in their given conventional diagnosis. It is certainly possi-
overall condition and high levels of satisfaction ble to design well-controlled observational studies
with care. When compared with allopathic drugs, to examine not only global quality of life out-
side effect rates appear lower, and patients often – comes, but also disease-related objective clinical
but not always – report the ability to reduce and health services outcomes. Greater clarity by
their reliance on conventional drugs. Two retro- investigators on the purpose of a given study will
spective studies (Frenkel & Hermoni 2002, van help guide these types of design choices ( Jonas
Wassenhoven & Ives 2004), but not a recent large et al 2001, Jonas 2005, Walach et al 2005).
scale comparative cohort prospective study (Witt Table 24.2 provides a list of brief subjec-
et al 2005b), observed substantial cost savings for tive outcome measures that may prove useful in
allopathic drugs in homeopathically-treated patients. assessing global and individualised outcomes in
In terms of safety, most of the observational studies observational studies. You might like to reflect
on homeopathy support the conclusion that side- on how you might use such scores to assess and
effects are lower with homeopathic than with allo- interpret the response of your own patients to
pathic treatment. Future studies should explore the homeopathic treatment. They include measures of
implications of lower side-effects with homeopathy global change ratings (the Glasgow Homeopathic
for patient adherence to treatment – a major prac- Hospital Outcome scale on global well-being and
tical issue for real-world allopathic clinical care of chief complaint); global physical health ratings, a
Deepening our
many chronic and acute diseases. These observa- predictive factor for morbidity, service utilisation,
Approach

tional trials have occurred in a variety of countries and even mortality (Idler & Benyamini 1997,
and cultures – from multiple European nations to Menec et al 1999); individually-described symp-
Germany, Belgium, the UK, and the USA – across toms (the MYMOP) (Paterson 1996); and overall
which acceptance of homeopathy varies a great
deal, perhaps reflecting that the benefits can be
well-being (the AIOS) (Bell et al 2004a). Quality of
life scales (such as the SF-36) are commonly used
V
seen in a wide range of cultures. in outcome studies, but are prone to insensitivity
An important methodological point, however, to change over time (Kane 1997) and potentially
is that observational outcomes have often derived low relevance for patients’ values of functionality
from quality of life ratings and/or global assess- and symptomatology. Multidimensional quality of
ments of overall improvement across patients with life scales for homeopathic outcomes are not as

321
 CHAPTER TWENTY FOUR Homeopathic Research

Table 24.2 RATING SCALES OF POTENTIAL RELEVANCE TO HOMEOPATHIC OBSERVATIONAL AND EFFICACY
STUDIES THAT CLINICIANS MIGHT FIND USEFUL FOR PROGRESS ASSESSMENTS
Scale Variable(s) Reference

Glasgow Homeopathic Hospital Scale Positive or negative change in overall condition Reilly 1997
rating

Global health rating scale Physical health rating Idler & Benyamini 1997

Measure Your Own Medical Outcomes Leading individual symptoms ratings Paterson 1996
Profile Scale

Arizona Integrative Outcomes Scale Global well-being (bio-psycho-social-spiritual) Bell et al 2004a

visual analogue rating

Patrick Quality of Life Scale Satisfaction ratings with multiple dimensions Patrick et al 1988
of life, including but not limited to health

Connor-Davidson Resilience Scale Resilience to life stressors Connor et al 2003

yet available, but some scales from the allopathic plaint have improved. This situation highlights
literature may cover a sufficient scope of change the importance of carefully selecting more than
in health- and non-health-related domains to be one outcome, based on the nature of homeopathic
useful (Patrick et al 1988). healing and the constraints of the study design.
At the same time, differences in the nature Although politically dominant Western medi-
of the outcomes assessed in these observational cal systems value efficacy studies over effectiveness
studies versus the much more narrow, disease- studies, clinicians and some researchers have begun
focused often singular clinical outcomes in effi- to point out in the allopathic literature that effec-
cacy trials may help explain, in part, the discrepant tiveness is what matters most in practice to both
findings for homeopathy in observational trials the provider and the patient (Wolfe 1999) and
(all favourable) and efficacy trials (mixed positive efficacy outside of a realistic and practical clinical
and negative findings). Clinical trials are typically context may mean little. Furthermore, allopathic
brief, e.g. 8–16 weeks in duration, whereas follow- researchers have looked closely at the quality of
up periods with observational studies are often information that well-done observational stud-
measured in many months to years. Homeopaths ies, e.g. those with case-control or cohort designs,
agree that it can take at least a year or two, or offer in comparison with efficacy studies (Concato
even more, to see marked and lasting changes in et al 2000, Concato 2004, Concato & Horwitz
persons who initially present with chronic dis- 2004). The findings are that properly-performed
Deepening our

eases. Modern texts of homeopathy report the observational studies of real-world practice out-
Approach

expectation that patients will experience global comes generate similarly valid findings to those
improvements in well-being and energy, for exam- of efficacy studies that do not inflate the apparent
ple, before necessarily reporting improvements in effect size of the intervention.
V physical symptoms (Vithoulkas 1980). Under such
circumstances, it is quite possible for short-term
studies to find no apparent effect of homeopathic Efficacy Research
treatment in a given allopathic diagnosis because
the symptoms of the presenting disease have not
and Meta-analyses
yet changed, even though the patient as a whole Efficacy studies are where conventional medi-
is better or symptoms other than the chief com- cine places its highest confidence in testing its

322
 Efficacy Research and Meta-analyses

drugs, and this is the area where homeopathic conditions treated, usual length of treatment for
researchers express their greatest methodologi- chronic disorders, or the usual homeopathic clini-
cal and theoretical concerns (Bell 2005a, Walach cal practices in the community. Only one study, a
et al 2005). Whereas observational and qualita- negative trial of homeopathy in chronic headache,
tive studies suggest a highly favourable profile of made any attempt to address one major criticism
homeopathy in real-world practice, at least for of most efficacy designs, i.e. short study duration,
the majority of patients who choose to undergo by following patients for up to a year with no
this form of care, efficacy studies and the meta- emerging evidence of benefit from homeopathy
analyses that combine these trials are far more (Walach et al 2000).
mixed and unconvincing in their findings for For the better-designed efficacy studies, CAM
homeopathy. researchers have adopted a dual selection proce-
Box 24.3 provides a list of conditions for dure for subject inclusion criteria. That is, investi-
which homeopathically-prepared remedies (seri- gators first recruit an allopathically homogeneous
ally diluted and succussed) have been tested using group of patients who share a given diagnosis,
efficacy study designs. The mode of prescribing then they assign the patients to treatment by the
varies a great deal. Overall, the results of such individualised diagnosis each patient requires
placebo-controlled research are mixed, with both within the CAM system (Bell et al 2002b, Bell
positive and negative evidence for the efficacy of 2003). Unfortunately, many efficacy studies on
homeopathically prepared remedies. Of signifi- homeopathy are flawed by a failure to take the
cant concern is the fact that, unlike observational second step or by compromising on the scope of
trials, the study designs of these efficacy stud- remedy choices. For example, researchers have
ies often fail to reflect the full range of medical limited themselves to studies of first aid uses of

BOX 24.3
Representative Efficacy Trials in Homeopathy or Isopathy for Conventional Diagnoses*
●
Allergies/asthma: Reilly et al 1986, Taylor ●
Headache: Walach et al 1997, Straumsheim
et al 2000, Lewith et al 2002, White et al et al 2000
2003, Kim et al 2005 ●
HIV/AIDS: Rastogi et al 1999
●
Arthritis: Gibson et al 1980, Shipley et al ●
Premenstrual syndrome: Yakir et al 2001
1983, van Haselen et al 2000, Fisher et al ●
Postpartum bleeding: Oberbaum et al 2005
2001 ●
Otitis media: Harrison et al 1999, Jacobs
●
Attention deficit/hyperactivity disorder: 2001
Lamont 1997, Frei et al 2005, Jacobs et al ●
Pruritis in renal dialysis: Cavalcanti et al

Deepening our
2005 2003
Chronic fatigue syndrome, fibromyalgia: Sequelae of cancer therapies: Balzarini et al
Approach
● ●

Fisher 1989, Bell et al 2004b, Weatherley- 2000, Oberbaum et al 2001, Jacobs 2005,
Jones et al 2004 Thompson et al 2005
Depression, anxiety: Bonne et al 2003, Katz Sepsis: Frass et al 2005
V
● ●

et al 2005 ●
Trauma: Hart et al 1997, Vickers et al 1997,
●
Childhood diarrhea: Jacobs et al 1994; 2000, 1998, Ramelet et al 2000, Stevinson 2003
2003 ●
Traumatic brain injury: Chapman et al 1999
●
Flu: Vickers et al 2004 ●
Vertigo: Weiser et al 1998
●
Warts: Kainz et al 1996
*Note that most trials are small sample studies lacking the statistical power to avoid Type II error.

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 CHAPTER TWENTY FOUR Homeopathic Research

remedies such as Arnica in acute injuries (some topic, rather than testing the null hypothesis in a
of which are not the clinical situations in which methodologically unsound way.
Arnica would be the first-line choice of experi- Conditions in which placebo response rates are
enced homeopaths) or of isopathically-prescribed high in allopathic research studies, such as depres-
(albeit homeopathically-prepared) remedies such sion, are particularly prone to false negative errors
as dust mite or other allergens in asthma and (Type II error) in small sample research. It simply
allergy patients. takes far more subjects in a study than investiga-
Another major problem with the body of effi- tors can run within budgetary and resource con-
cacy research studies in homeopathy is that inves- straints to test the null hypothesis properly. Of
tigators have not followed the usual sequence of course, a given small sample study might have
conventional research from small feasibility and positive results that proponents of homeopathy
dose-finding (phase I and II) studies to large-scale will applaud and sceptics ignore. However, when
(phase III) studies on the same allopathic disor- another small sample study turns up negative, the
der by multiple independent laboratories. Because sceptics declare the end of homeopathy (Lancet
of funding limitations, the need for individu- 2005) and the homeopathic proponents cry foul
alised treatment, and other factors, homeopathic (Various 2005). This problem has occurred in the
researchers have never mounted a large scale effi- study of homeopathy in depression and should
cacy trial of homeopathically-prepared remedies serve as a caution to researchers in their selection
prescribed homeopathically, i.e. the Lewith et al of clinical conditions and sample size (Bell 2005b,
(2002) dust mite study in asthmatics was large, Katz et al 2005, Pilkington et al 2005). Given the
but involved isopathic prescribing. For phase I/II politicised context in which homeopathy research
efficacy studies, only conditions such as childhood usually occurs (Aickin 2005, Various 2005), it is
diarrhoea ( Jacobs et al 1994, 2000, 2003), atten- essential for homeopathic researchers and prac-
tion deficit-hyperactivity disorder (Lamont 1997, titioners to recognise and point out the meth-
Frei & Thurneysen 2001, Frei et al 2005, Jacobs odological limitations of small sample studies in
et al 2005) and fibromyalgia (Fisher et al 1989, their field, regardless of the positive or negative
Bell et al 2004e) have more than one, typically implications of the findings.
small-sample, study published using individualised A number of efficacy studies of proprietary prod-
remedy selection. ucts such as Traumeel or Oscillococcinum have been
Small feasibility or pilot studies suffer the com- well done, and sometimes repeated by independent
mon risk of being statistically underpowered in laboratories. However, sceptics increasingly ques-
sample size to find an effect (if present), i.e. they tion the reliability of data supported by industry in
are prone to false negative errors, in which investi- conventional medicine, an issue that carries over to
gators fail to demonstrate an effect that is actually CAM manufacturers as well. Studies on proprietary
there. Sceptics are quick to jump to negative con- products typically only represent the causative and
Deepening our

clusions about the value of homeopathy from such local approaches to treatment found in over-the-
Approach

negative pilot studies, but doing so is scientifically counter self-care applications for acute, self-limited
incorrect. A primary rationale for phase I and II problems rather than practitioner-provided care
studies is to determine the feasibility of success- for chronic diseases.
V fully performing the study procedures in a sub-
sequently larger study of appropriate sample size Meta-Analyses
to detect an effect, if present. Aickin (2004) has As a result of the limited amount of replication in
even proposed an alternative statistical approach the literature, meta-analyses of homeopathy have
to analysing data from these smaller studies using typically relied on combining results of highly dis-
separation tests to determine whether or not there parate clinical trials on different patient popula-
is any value in pursuing further research on a tions and clinical practices (Kleijnen et al 1991,

324
 Individual Differences Research

Reilly et al 1994, Linde et al 1997, 1999, Cucherat

et al 2000, Ernst 2002, Jacobs et al 2003, Shang et
Individual Differences Research
al 2005). The results of the meta-analyses vary, as Homeopathic practitioners often express bewilder-
do the clinical efficacy trials. Many are positive, ment at the failure of efficacy studies to demonstrate
some are negative. None informs us in a definitive what they ‘know’ to occur everyday in their prac-
way as to the value of homeopathy for any given tices. That is, many patients get better, many times
patient. As Walach et al (2005) have commented undergoing transformational experiences in every
this approach is parallel to asking the question, aspect of their lives. Thus far, homeopathic research
‘Is conventional medicine a placebo effect?’ Bell has not begun to address these widely reported out-
(2005a) has offered another analogy, i.e. ‘does comes and phenomena. Yet, the group averages in
penicillin work for all patients with fevers?’ many studies do not capture the quality of these
In certain situations, conventional medicines are outcomes. Clearly, the discussion of qualitative and
no better than placebo, or so the evidence sug- observational methods above should open the door
gests, but in other clinical situations, conventional to future studies of exceptional, usual, and poor
medicines are superior to placebo (Kirsch 2001). outcomes in individual patients.
It is thus highly premature and methodologically However, there is an intermediate method-
risky to attempt meta-analyses of the homeopathic ological approach for quantitatively-oriented
literature as a whole, without more careful differ- investigators. Researchers can borrow from the
entiation into better defined questions, clinical individual difference literature in health psychol-
subpopulations, and clinical treatments. ogy and behavioural medicine (Neff et al 1983,
A key point about meta-analyses is that they Owens et al 1999, Bell et al 2004d, Honda &
typically rely on a ‘quality’ rating score for a given Jacobson 2005), the growing literature on sub-
study. While such ratings facilitate inter-study typing patients for triage to optimal treatment
comparisons of internal validity issues, none of programs (Turk 2005), and new trends in epi-
the ratings used in meta-analyses include weighted demiology (Ben-Shlomo & Kuh 2002). Even the
items assessing the external validity of the trial. cutting-edge research on human genomics and
That is, given that the quality of the homeopathy proteomics is beginning to facilitate biological
delivered is highly dependent on the ability of the identification of individuals with different genetic
practitioner to establish rapport with the patient polymorphisms and environmental factors in phe-
and determine the simillimum remedy, were the notypic expression of genetic potentials (Haley
practitioners qualified and experienced homeo- et al 1999, La Du et al 2001). In general, data
paths? How many practitioners were involved in indicate that even within a given allopathic medi-
the trial? Did the fate of homeopathy hang on the cal diagnosis, patients fall into different subtypes
skill of one or many providers? Was the treatment on the basis of both their psychology and their
delivered in a manner comparable to that of usual biology. These baseline individual differences
Deepening our
clinical practices in the field of homeopathy? beyond basic demographics may represent some
Approach

Were the outcomes assessed fully representative of the different themes, even perhaps miasms,
of the clinical claims in the field? For homeopa- which homeopaths recognise in patients and are
thy, these outcomes would include global well- important for determining outcomes.
being, energy, changes in multiple symptoms in
patterns outlined by Hering’s Law of Cure, and
People who find their way to homeopathic treat-
ment may differ from those who do not (Honda
V
resolution or improvement in the chief complaint. & Jacobson 2005), for example, in a national US
In summary, the limitations of meta-analytic tools sample of over 4200 adults, found that persons high
for homeopathy research at the present time ren- on scores for the stable personality trait of openness
der this approach much less useful than it is for had an increased odds ratio for using a whole system
conventional drugs. of CAM such as homeopathy or acupuncture of 3.55

325
 CHAPTER TWENTY FOUR Homeopathic Research

(95% confidence interval: 1.33–9.44). A personality question is not whether homeopathy is useful for
trait highly correlated with openness, i.e., absorption, all persons with a given allopathic diagnosis (a
also predicts greater use of CAM in general (Owens broad public health question), but rather whether
et al 1999) and the likelihood of staying with treat- homeopathy is useful beyond placebo for the
ment – active or placebo – once patients begin subset of the population with both the allopathic
treatment (Bell et al 2004d). Such findings raise diagnosis and the inherent tendency to choose
the possibility that the patient samples who end up treatments like homeopathy in the first place (a
in observational trials of homeopathy are funda- treatment triage question).
mentally different in psychology and behaviour – Additionally, patients’ life experiences can
and perhaps even biology (absorption is a geneti- interact with the psychobiological factors intrin-
cally-determined trait (Tellegen et al 1988) – sic to the individual to favour expression or non-
from patient samples who end up in efficacy trials. expression of disease. That is, multiple prospective
Such patients have a differential capacity for shifting longitudinal studies have shown that persons with
and focusing attention and its electrophysiological adverse childhood experiences (Felitti et al 1998,
correlates (Davidson et al 1976). Surtees et al 2003), poor nurturing from parents
In addition, Honda & Jacobson (2005) also (Russek & Schwartz 1997, Russek et al 1998),
found that individuals who rely on secondary and/or adult life traumatic events (Boscarino 1997)
coping strategies involving modifying the self are are at greater risk of expressing serious chronic
more likely to use whole systems of CAM such as diseases later in life. Consequently, the coping
homeopathy or acupuncture and mind-body inter- abilities of the individual, as emphasised by many
ventions than are non-users of those interventions. different homeopathic teachers, will come into
Notably, persons who rely on primary coping play in influencing the specific individualised rem-
involving changing the environment rather than edy choice and the patient’s capacity for respond-
the self are less likely to use most forms of CAM ing to homeopathic treatment. These types of data
other than manual manipulation modalities. from the non-homeopathic world may be crude
Such findings raise the testable hypothesis that approximations of conceptual models proposed
persons who participate in observational trials are by contemporary homeopathic thinkers such as
markedly different from those who do not. The Scholten or Sankaran. Both of the latter homeo-
latter patients have chosen to undergo homeo- paths suggest that there is a triangulation between
pathic treatment, often to pay out of pocket for the dynamical life themes of a given remedy fam-
the care, and may likely be high on trait open- ily and specific remedy (see Chapter 22) and the
ness and/or absorption and in secondary control quality or nature of the coping strategies that the
coping strategies. Their biobehavioural character- individual manifests in reacting to life stresses
istics in turn may differ significantly from those (Scholten 1996, Sankaran 2003).
patients with an allopathic disease label who end Conventional epidemiological research is actu-
Deepening our

up recruited to an efficacy trial, willing to partici- ally beginning to intersect with homeopathy in the
Approach

pate in a double-blind clinical trial costing them sense of a shared interest in understanding multi-
nothing. These baseline differences, which are factorial disease aetiology in individuals. In epide-
never assessed in most clinical studies, could con- miology, for example, some researchers are also
V tribute to the gap between findings from observa-
tional versus efficacy designs.
looking at what they term the ‘life course approach
to chronic disease epidemiology’, i.e. examining
The evidence also suggests that a modified clin- the full time-line of effects from bio-psycho-social-
ical trial design for testing the efficacy of home- behavioural pathways on the evolution of chronic
opathy might involve recruiting people whose disease over the lifespan (Ben-Shlomo & Kuh
profiles better match those of patients who end 2002). These types of research are highly relevant
up in observational studies. Then the research to the issues that homeopaths consider routinely in

326
 Basic Science and Preclinical Research

their clinical practices, but these are not studies that water solvent molecules that were generated dur-
homeopathic researchers have as yet undertaken. ing remedy preparation. Other investigators in
Based on the above considerations, can constitu- the materials science field have pointed out that
tional homeopathic treatment, for instance, delay weak bonding forces such as van der Waals forces
the timing, lessen the severity, and/or minimise the could contribute, in addition to any changes in
complications from a chronic disease that genes and hydrogen bonds, to the ability of water as a sol-
environmental stressors may otherwise predispose vent to retain information. It is important to note
an individual to develop? Might groups of homeo- that, in contrast with the sceptics’ positions that
pathic patients respond to particular homeopathic all solvents are homogeneous in their molecu-
approaches and prescribers? Epidemiological stud- lar network structure, the proposed phenomena
ies could address such questions. involve the non-random, heterogeneous network
restructuring of the solvent at the nano-level by
Basic Science the process of homeopathic remedy preparation
(Roy et al 2005).
and Preclinical Research The phenomenon of epitaxy, for example, is
Relatively recently, two different research labora- widely-known in the field of materials science,
tories have reported replicable findings on homeo- but not medicine. Epitaxy is the transmission of
pathic remedies versus controls, using different structural information from the surface (hence
technologies. Elia & Niccoli (1999), for example, epi) of one material (usually a crystalline solid) to
demonstrated that the addition of an alkaline another (usually but not always a liquid). Newer
material to a homeopathically-prepared liquid technologies such as transmission electron micros-
preparation of a given remedy diluted and suc- copy may assist in evaluating the physical proper-
cussed beyond the point where statistically there ties of homeopathically-prepared solutions versus
are any atoms of the material present (Avogadro’s remedy-free solvent controls. Thus, the limited
number) leads nonetheless to the release of excess, theory and evidence on the nature of homeopathic
calorimetrically-measurable heat compared with remedies suggests that the focus should remain on
controls. They also published evidence that the changes in the solvent as a function of remedy
changes induced in the homeopathically-prepared preparation using specific source molecules, but
remedy-solutions may evolve with time, i.e. the the key changes may more likely be at the level
remedy ages and generates an even larger capac- of dynamical network structures rather than static
ity for heat release over a period of months (Elia molecular species.
& Niccoli 2004). In a different approach, Rey Although some investigators doubt that basic
(2003) found that irradiating a homeopathic rem- science will ever demonstrate reproducible local
edy solution that has been frozen to an extremely physical properties of homeopathic remedies
low temperature and then gradually re-warmed (Walach et al 2005), the research area of physical
Deepening our
leads to the release of excess, measurable light or chemistry of remedies is still too unexplored to
Approach

thermoluminescence. abandon as a viable direction at this time. At some

These research groups both concluded that the point there must be an interface at the physical
release of energy (heat or light) following treat- plane between the remedy and the human body,
ment of the remedy solution by extreme changes
in pH or x-ray irradiation suggests a presumptive
even if the process ‘begins’ at a different, non-
local plane of organisation or occurs as an emer-
V
disruption of some type of ordered structure in gent property in the larger system as a network
the remedy liquid (e.g. water clusters) not pres- (Barabasi & Bonabeau 2003, Vasquez et al 2004).
ent in the plain solvent controls. One working Even in mind-body research, for example, there
hypothesis is that the experimental procedures is some translation of an individually salient psy-
disrupt hydrogen bonding patterns between chological experience within the psyche into mea-

327
 CHAPTER TWENTY FOUR Homeopathic Research

surable biological events (Phan et al 2003). The This peculiar variability – especially the bidirec-
argument as to whether consciousness precedes tional quality of changes (Bertani et al 1999) –
mind, which precedes body, or vice versa is an age- in empirical findings that occurs in homeopathy
less philosophical debate. Nonetheless, it is possible could be the simple result of poor quality control
to measure events when they occur in the physi- from study to study, or it could be a clue as to the
cal plane. Because of the obvious likelihood that true nature of homeopathic remedies and how they
homeopathically-prepared remedy liquids (water act and interact with living systems. One animal
or, more likely, water-alcohol mixtures with silica study, for example, supports the core homeopathic
contaminants) hold some information for the indi- concept that remedies can cause symptoms in a
vidual patient, continued efforts to understand the healthy individual and cure them in a sick person.
physical translation of that information are still That is, the direction of effects of a homeopathi-
reasonable. The possibility of important new dis- cally-prepared mineral remedy mixture depended
coveries in the area of basic science remains despite on the state of the animal, i.e. the timing of remedy
many theoretical and practical challenges. administration before, during, or after the experi-
In vitro research with homeopathic remedies mental injury (Bertani et al 1999). As in other areas
also suggests that remedies have effects different of homeopathic research, the field is in its earli-
from plain solvent controls, but that the effects est development, and much more systematic and
are less reliably reproducible from trial to trial, for hypothesis-driven work is needed.
unclear reasons, than are those of molecular-based As in clinical research on homeopathy, basic sci-
conventional drugs. Homeopathic phenomena ence and preclinical research also has suffered con-
appear to be probabilistic rather than certain at fusing variability in study quality and outcomes.
any given time. This observation in itself may offer In basic science studies, careful investigation often
insights into the nature of homeopathic remedies reveals that the process of succussion in remedy
and how they affect living systems. For example, preparation contributes indeterminate amounts of
the multisite European study re-testing the famous silica contaminants from the glass containers into
Benveniste studies demonstrated that ultradilu- the test solution (Walach et al 2005). With the use
tions of histamine affect basophil degranulation, of proper standardisation of sample preparation
but not all the time (Belon et al 2004). Rather, and succussed controls for comparison, lessening
the evidence suggests that the phenomenon occurs some of the contaminant issues is possible (Becker-
more often with remedies than with controls, but Witt et al 2003, Linde et al 1994). According to
not on all trials at all sites. Animal and plant stud- newer data from Jonas et al’s laboratory using an
ies have also shown this pattern of demonstrable, enzyme model system, the silica itself may con-
but less than reliable and often non-linear, effects tribute, along with the water and alcohol in the
(Endler & Schulte 1994, Schulte & Endler 1998, solvent, to the effects of the remedies (Walach
Bellavite & Signorini 2002). et al 2005). Nonetheless, certain technical meth-
Deepening our

Isopathic treatment is protective against adverse ods from physical chemistry such as NMR (nuclear
Approach

effects of toxic material doses of agents such as magnetic resonance) tests have produced disap-
arsenic, with treatment by the same, but homeo- pointing and inconsistent results on the character-
pathically-prepared, material as a remedy in ani- istics of homeopathic remedies.
V mal models (Datta et al 1999, Mitra et al 1999,
Brizzi et al 2000, Kundu et al 2000, Mallick et al
2003). Homeopathically-prepared and isopathi- Proposed Scientific Frameworks
cally-chosen remedies may also exert a protective
effect in animal models of glutamate toxicity in
for Homeopathic Research
the brain ( Jonas et al 2001) or exogenous biologi- Various investigators have offered two different,
cal warfare infectious agents (Szeto et al 2004). system-based conceptual models for how homeo-

328
 Proposed Scientific Frameworks for Homeopathic Research

pathy acts. The first is complex adaptive systems Hering’s Law of Cure leads to a testable prediction
and network theory, and the second is macro- that true homeopathic healing will follow a self-
quantum entanglement theory. It is beyond the reorganising pattern of the system as a whole,
scope of this chapter to discuss these models in which is not seen with placebo responses.
depth. However, they provide promising frame- No research to date has looked for such differ-
works for reconciling the conflicting findings in ences, but systems science would predict that
the research literature and for guiding the design Hering’s Law of Cure would occur and could be
of future research studies on homeopathy. documented.
Networks (e.g. the internet, social networks,
Complex Adaptive Systems etc.) are a type of complex system in which the
A system is a set of interrelated parts. Complex sys- inter-relationships and interdependencies are
tems, including living organisms (Bell et al 2002a, the focus of study (Barabasi 2003, Barabasi &
Bellavite & Signorini 2002, Hyland & Lewith 2002, Bonabeau 2003, Vasquez et al 2004). Nodes are
Milgrom 2002b, Bellavite 2003, Bell et al 2004b), the points of connection between the parts. Hubs
are those in which the interactions between the parts are nodes that have the greatest number of inter-
generate properties of the larger organisational level connections. In complementary medicine, the
of scale that are not predicted by understanding the meridians (interconnections) and acupuncture
properties of the separate parts. Knowing the behav- points (hubs and nodes) in acupuncture are an
iour/properties of a liver, a heart, or a brain will example of understanding the person as an indivis-
never reveal what a living human being can do in ible network system. However, even biochemical
terms of behaviours. That is, a person’s behaviour is pathways organise into networks of relationships.
an emergent property of the person as a whole, indi- Interestingly, a leading network researcher has
visible system. Complex systems are self-organising; pointed out that treatments targeting the hubs of
they find some optimal way of organising their parts a network should have the biggest impact on the
within the environmental context (fitness landscape) network as a whole. Water is a major hub mole-
in which they exist. Properties of the global system cule across most biochemical reactions in the body
can have self-similarity at every level of scale, down (Barabasi & Bonabeau 2003). Therefore, network
to the local (parts) level. science would lead to testable prediction that
This self-similarity concept is parallel to the modifying the body water (and human beings are
clinical notion in homeopathy that deep exami- made up of 70% or more water) could have sys-
nation of any symptom will reveal the larger dis- tem-wide effects on a person. Taken together with
turbance in the person as a whole, for which a the concept of water clusters in the active remedies
single remedy is indicated. As a result, given the that retain the information of the source material
interactions between the global and local levels without the persistence of its physical molecules,
of a system, investigators should be measuring the network model for healing in homeopathy
Deepening our
both global and local outcomes, not just specific points to the body water as a useful starting place
Approach

allopathic drug-relevant outcomes. for research on the interface between remedies

Homeopaths also use the self-organisation and living systems.
concept when they apply Hering’s Law of Cure Furthermore, biological systems are generally
to evaluating the nature of patient outcomes
(Vithoulkas 1980). Placebo researchers have no
non-linear, i.e. output is disproportionate to input.
In homeopathy, it is obvious that a remedy is a
V
predictions about the patterning of shifts within small input whereas the clinical changes reported
the person as a whole that will occur in the constitute a large output, i.e. homeopathic effects
course of treatment, but homeopaths do, i.e. from are inherently non-linear. Non-linear complex
within outward, from above downward, and in systems are also dynamical, i.e. constantly chang-
reverse order of appearance of symptoms in time. ing. This concept could help us understand the

329
 CHAPTER TWENTY FOUR Homeopathic Research

difficulty in replicating or reproducing the findings the active remedy in comparison with the placebo.
from one study to another, as well as from one point The remedy group fluctuated up and down on the
in treatment to another. In reality, the person as a outcomes much more than did the placebo group.
living system has moved on dynamically from the Again, even if the isopathic treatment did not differ
starting point at which it encountered a particu- from placebo at the end, the dynamics of the pro-
lar remedy and potency in the past. It is therefore cess did differ. Rather than rejecting homeopathy
not surprising that homeopaths sometimes report from a negative isopathy study, perhaps the data
a minimal response or even lack of response to the can teach researchers more what to study and how
same remedy at some future time when the situa- to study it.
tion seems close to the original. It is never identi- At a clinical level, homeopaths and patients
cal to the original situation because of changes in report that effective constitutional treatment helps
the state of the person as a dynamical system at patients become unstuck from customary dysfunc-
the time they take a dose of a remedy. The bidi- tional ruts or patterns in their lives (Sherr 2002,
rectional, state-dependent nature of responses Bell 2003). This may translate fairly literally into
to homeopathic remedies are an example of the a shift in the non-linear dynamical patterns of the
non-linearity (Bertani et al 1999). person as a complex system. In systems theory,
The nature of systems also suggests that recurrent but non-identical patterns of motion
homeopathic researchers should be testing the organise themselves into what are termed ‘attrac-
capacity of the system to respond to environmen- tors’. The basic trajectory appears similar dur-
tal change or stress, before and after homeopathic ing each run of the system, but the system never
treatment. Right now, most investigators settle for goes through exactly the same place during the
measuring static endpoints at rest (as they do in repeated runs. When homeopathic treatment gets
allopathic medical research) that cannot reveal if a person ‘unstuck’, it may be that the person’s
the system is more resilient when a stressor arises. dynamics have shifted from a less healthy attrac-
Yet, clinically, such resilience is something that tor pattern into a healthier one. Complex systems
patients often report. To do fair tests of homeopa- can also have critical points at which their dynam-
thy, we need to design research studies that can ics make a qualitative shift into a new pattern, e.g.
show what clinicians and patients claim happens self-organised criticality, with a possible clinical
during homeopathic treatment. Both self-report parallel of ‘never well since . . . [a flu, a death in
rating scales on resilience and systematic con- the family, an accident, etc.]’. For example, Sherr
trolled tests of psychophysiological recovery after (1994, 2002) and Sankaran (2002, 2005) have
environmental stressors in the laboratory or the both highlighted the importance of movement,
field would facilitate evaluation of the resilience change, and dynamics, i.e. the ‘verb of the case’
hypothesis. for Sherr or the non-verbal gesture for Sankaran
What is the evidence for the non-linear effects in their respective clinical approaches to determin-
Deepening our

of homeopathic remedies in research studies? No ing the correct homeopathic remedy for a patient.
Approach

studies have explicitly focused on the effects of Non-linear dynamical analyses of both subjective
homeopathy on the dynamics of the individual. and objective outcome measures on homeopathic
However, a relatively recent study of homeopathi- remedies versus placebo may help clarify the rel-
V cally-prepared dust mite administered isopathically
to adult asthmatics documented relevant findings
evance of systems models to understanding how
remedies might act (Bell et al 2002a).
(Hyland & Lewith 2002, Lewith et al 2002). In this
study, active remedy and placebo did not differ in Macro-Entanglement Theory
the final values of the clinical endpoints measured. A more radical theoretical possibility for using
However, throughout the study, the graphs of the systems models, but also suggested by some of the
outcome measures followed a different pattern for data in homeopathy, is that the therapeutic process

330
 Summary

in homeopathy is non-local in nature. That is, in in coming years. The usual pace of homeopathic
quantum mechanics, there is a peculiar but well- sessions is far less frequent than that of conven-
replicated finding of entanglement. Several differ- tional psychotherapy. If the patient–provider rela-
ent theoreticians have proposed that homeopathy tionship constitutes a significant aspect of the net
acts via a macro-entanglement process (Milgrom clinical benefit seen with homeopathic treatment,
2002a,b, 2003a,b, 2004a,b,c,d, 2005, Hyland then identification and systematisation of the non-
2003, Walach 2002, Walach et al 2004, 2005). remedy components of the intervention would be
In entanglement within a closed system, change clinically valuable in themselves in order to facili-
in one element is associated instantaneously with tate development of more cost-effective delivery
change in the other element, independent of dis- methods for psychotherapy. In the clinical realm,
tance or time, assuming that one element describes there is an obvious need for cross-cultural and health
the global and the other element the local features services research studies to determine the general-
of the system. Walach (2005b) notes that entan- isability of findings between different countries.
glement occurs ‘between those local elements of Differences in access to homeopathy as a function
a system that are complementary to the global of health care payment systems and availability of
description or observable of that system’. homeopaths, as well as the lay public’s familiarity
Walach has presented some indirectly support- with homeopathy, also merit study. This is a time
ing evidence for a macro-entanglement model of for exploratory research as much as for confirma-
homeopathic remedy actions in his re-analysis tory studies in homeopathy, as investigators begin
of data from a provings study. The usual quanti- to map the territory of science and life into which
tative statistical analysis of the symptom findings homeopathic phenomena fall.
showed no significant difference between active
remedy and placebo. However, the symptom
patterns in the verum/active and placebo groups
Summary
were remarkably similar. Without entanglement, In summary, individual differences in preferences
Walach asserts that the placebo group should have and in capacity to respond, together with major
shown random symptoms, rather than what he methodological concerns about the ecological
found – the placebo group reported the symp- validity of many efficacy studies in homeopathy,
tom patterns of the active remedy despite the have led to a growing challenge to the useful-
double-blind protocol. Perhaps this also explains ness of conventionally-designed randomised con-
the observation that even those given placebo in trolled trials for testing homeopathy. Increasingly,
proving studies generate some symptoms consis- homeopathic researchers are calling for:
tent with the proving (see Chapter 2). There are ●
utilisation of qualitative research methodolo-
some empirical manoeuvres that might provide gies to characterise the nature of the prac-
further indirect evidence for the macro-entangle- tice and the lived experience of the patients
Deepening our
ment model (Walach 2003). In any event, this the- undergoing homeopathy, as a foundation for
Approach

oretical stance would help explain the discrepancy subsequent patient-centered outcomes studies
between findings from open observational studies ●
large scale observational studies to document
(where entanglement is not likely operative) and the real-world outcomes of homeopathically-
closed, placebo-controlled efficacy trials (where
entanglement is more likely). ●
treated patients
innovative study designs to accommodate the
V
unique features of homeopathy
●
applications of scientific constructs from fields
Other Research Issues outside conventional medicine, such as complex
Direct studies of the psychotherapeutic effects systems and network science, and even from
of the homeopathic interview will be important quantum mechanics and entanglement theory.

331
 CHAPTER TWENTY FOUR Homeopathic Research

Homeopathy falls under the CAM umbrella of the practitioners and the patients concerning their
whole systems research, an emerging field that experiences of homeopathy and adapting the
endeavours to go beyond reductionism to study concepts and quantitative methods of non-linear
complex packages of care without first dissecting dynamics rather than static variables as outcomes,
them on the input side, and whole person-level are foundational first steps toward developing a
outcomes beyond disease-specific biomarkers on true research science for homeopathy.
the output side of the treatment process.
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Deepening our
Approach

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CHAPTER TWENTY FIVE

The Therapeutic Encounter Case Management

and Supervisory Relationship

David Owen

●
How does the homeopath establish and obtain
Introduction this support?
The homeopathic relationship is built up through ●
How do you develop the practical experience
many layers of communication between patient and competence to work with increasingly
and homeopath (see Chapters 3, 8, 13). This complex, confused and hidden cases?
relationship is in its own way therapeutic and is ●
How do you work with the subtle patterns
an integral part of the homeopathic process (see (themes) and projections (onto and by you)
Chapter 23). Being clear and making explicit the that are an important part of managing the
therapeutic agreement is a vital part not just of patient and yourself?
developing and deepening this relationship but
also of using this relationship to help the patient. These are challenges facing many of the healing
This agreement or ‘contract’ includes how infor- professions and homeopaths are no exception.
mation from the case is used, the boundaries of To work with projection in an effective and sus-
the relationship, what is expected or provided by tainable way you need to pay attention not just
each party, and at what points the treatment is to to the application of the homeopathic process but
be reviewed and ended. These are essential com- also to your own state. It requires the ability to
ponents of a reliable and beneficial therapeutic observe the homeopathic relationship clearly – to
encounter. The therapeutic encounter fundamen- use ‘super…vision’. At different times you may
tally alters not just what is perceived homeopathi- need additional support, training, resources and
cally but provides non-remedy specific effects opportunity to reflect. Supervision is one way of
(including placebo effects) with the potential to providing these reference points to the homeo-
summate or deplete the specific treatment effects. path. It is well developed in the psychological
Recognising the importance of, and at times and social work professions and we in the homeo-
difficulties in, the therapeutic relationship and pathic profession can learn much from their mod-
encounter raise important questions for the prac- els and experiences of supervision. These include
tising homeopath, such as: sharing and exploring cases with colleagues (peer
●
How to both invite and yet be protected from supervision), with a more experienced prescriber
patient’s projections? (facilitated supervision), or alone through reflec-
●
How to enable patients to reveal their inner tion (self supervision). Not only do these processes
nature without pushing too hard or inappro- enable the patient’s treatment to be reflected on
priately? carefully, but also the very issues that are confus-
●
What support (personal, practice and profes- ing or hidden are frequently mirrored onto and
sional) is required? can then be explored in the supervision process,

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 CHAPTER TWENTY FIVE The Therapeutic Encounter and Supervisory Relationship

through what is known as ‘parallel process’ (see congruent whole emerges. When this happens you
Chapter 28). start to gather a clear sense of what is happen-
ing in the case and hopefully start to see a single
coherent wholeness to the case. Reaching this
The Therapeutic Encounter point allows you to encounter the patient in a way
Balancing the process of the consultation and the that will both facilitate the matching of a deep-
task of finding a remedy is the art of the thera- acting remedy and offer the opportunity to reflect
peutic relationship. Rapport, empathy and the this ‘wholeness’ back to the patient.
therapeutic agreement are informed by qualities What you, as a homeopath, set out to achieve
of authenticity, honesty and compassion. These in will be influenced by the models of health through
turn are informed by non-judgemental acceptance which you predominately see a case. It may not
and unconditional positive regard of the patient be the same in each case or for each homeopath.
(Rogers 1971, Kaplan 2001). How we work will be determined by the implicit
The consultation can be thought of as moving and explicit therapeutic agreement. Our ability to
through several stages (Box 25.1) where each con- form and develop an agreement with the patient
nects to the next, and the whole process may be on why we are there and what we are doing will
repeated several times. In practice these are not determine how we practice. The roles we play may
separate or sequential steps but part of a flowing include witness, confidante, remedy seeker, carer,
and evolving process. Establishing rapport and healer, physician, etc. – each will influence how the
empathy enables the patient – it includes agree- consultation and therapeutic relationship unfolds.
ing on the aims of treatment and our various roles Even in our role to find the simillimum there will
as a homeopath. Care, compassion and establish- be sub-roles determined by the approach to treat-
ing consent lead to greater revelation and focus- ment and methodologies we are working with. It
ing the case. When received in a non-judgemental is important not just to be competent in a number
way it allows greater honesty and a sense of what of roles but to be able to articulate them, negoti-
is truly important to the patient to surface. This is ate, and agree what most appropriately meets a
reinforced and made safer by naming and clarify- patient’s needs – which is not always the same as
ing what is and what is not expected to happen what the patient at first wants!
– what we might call the boundaries. As this hap-
pens, what at first appears as a case made up of Rapport, Empathy and Enablement
disparate pieces of information starts to converge; The homeopath’s ability to empathise with the
over the consultation, or several consultations, a patient is a major factor in establishing rapport.
This stems from a synchronous trust and confi-
dence between the homeopath and patient – lack
of trust, fear of failure, disapproval or judgment
Deepening our

BOX 25.1
Stages of the Therapeutic Relationship undermine this confidence. Typically the patient
approach

1. Rapport, empathy and enablement may feel at risk if they perceive that you are not
2. Therapeutic agreement and contracting sincere and professional, and you may be defen-
3. Care, compassion and consent sive if there is an unfair risk of criticism, litigation
V 4. Deepening the case or being taken advantage of.
Rapport is the ‘coming alongside’ of the patient
5. Non-judgemental acceptance
6. Authenticity, honesty and boundaries and homeopath, accompanied by awareness and
7. Congruence shared understanding of each other and of what
8. Reflecting back to the patient and selecting each can expect from the other. If rapport is com-
a remedy ing alongside, then ‘enablement’ is the extent
that the patient is able to move together with

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 The Therapeutic Encounter

the practitioner in a therapeutic direction, and is sion and explanation can be offered. It is failure
a significant factor in having a positive outcome to establish a clear agreement that is the cause of
of treatment (Mercer et al 2001, 2002). Rapport, most dissatisfaction for patients and homeopaths.
empathy and enablement (see also Chapter 28) in The checklist in Box 25.2 shows some of the
a homeopathic consultation require realistic levels factors to consider when developing a dynamic
of confidence in each other. This balance is easier and evolving therapeutic agreement. Some of
to achieve if the homeopath and patient both feel these are more straightforward than others and
they have adequate time, agreement on what they some patients and homeopaths will find it more
are doing, and realistic expectations. important to agree certain points than others.
Even in a simple case, if the task, expectation
The Therapeutic Agreement and process are clear, treatment is easier. In more
At some point in the consultation the patient has complex cases, an established contract makes
to revisit the past and glimpse the future, enter- it easier to focus the consultation and, if neces-
taining both the reality of being ill and the pos- sary, to explicitly modify or alter it at a later date.
sibility of being well. Exploring the agreement may reveal aspects of the
The therapeutic agreement between patient case that are not otherwise offered in the consul-
and homeopath provides the ‘ground rules’ about tation. It can help to reflect on what the patient is
the consultation and treatment process. It may frightened or wary of contracting for, and what
develop gradually and informally at the begin- the patient imagines might happen but will not
ning of a consultation and becomes more detailed ask the homeopath about.
and formal as the consultation progresses. It may It may help to consider separately those parts
be referred to as the therapeutic contract and of the agreement that cover issues like confidenti-
includes information about the practice and pro- ality, cost of treatment, the number and duration
cedures followed. Practitioners vary in how much of consultations and interval between them, com-
are unspoken assumptions and how much are munication with third parties, and what happens
recorded; often it is a verbal agreement, although if things go wrong or if the expectations of either
aspects may be written in practice information or party aren’t met. Having a formal complaints pro-
recorded in the notes. cedure for patients to follow is an important way
As the consultation progresses the agreement of ensuring the patient is ‘heard’ – and you and
may include a discussion about the different your practice learn from any mistakes.
approaches to treatment possible and the likely
outcomes, including the need for follow-up. It Getting the Agreement Right
will address things like the patient who wants a It is not uncommon for someone to arrange an
cure without addressing the cause and what the appointment for someone else – maybe for a
homeopath feels unable to provide, e.g. an obese child, for a husband, wife or partner, or for an
Deepening our
patient might want to lose weight without want- animal in a veterinary practice. In these cases it
approach

ing to make any change to their diet but needing is important to be clear about what contract you
some specific nutritional advice. The contract may have with whom. In some consultations there can
also address issues about compliance, what to do if be more than one contract at play – conflicts will
there is a reaction to treatment or treatment is dis-
continued, and when and how the patient should
arise when these two contracts give rise to differ-
ent expectations, as Jonathan’s case illustrates. It
V
contact the homeopath if an urgent problem is important that whether and how other people
arises. There is no harm in patients being sceptical are influenced by or influence the treatment is
about what homeopathic treatment might offer, clarified in the consultation. These others may be
but where this exists it is tremendously helpful for employers, family or friends, and may be actively
it to be made explicit, so that appropriate discus- involved or not.

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 CHAPTER TWENTY FIVE The Therapeutic Encounter and Supervisory Relationship

BOX 25.2
Some Factors to Consider When Developing a Dynamic and Evolving Therapeutic Agreement
About the Consultation ●
Experience and competence of the practitio-
●
Availability of appointment – how patients ner
can go about making an appointment and ●
How to deal with complaints or broken con-
changing it tracts
●
Time keeping, arriving and ending on time ●
What support of colleagues and professional
●
Confidentiality body does the homeopath have?
●
Duration of consultation and duration of ●
How to handle seeing other therapists and
treatment communication between you, the patient and
●
Regularity of appointments them
●
What does the history entail, what areas are ●
How will we know when the patient is bet-
you going to talk about? ter and how will we know if they are not?
●
Will you see a patient alone or with a part- It is important to contract with patients to
ner, a parent or other? let you know if they discontinue treatment,
and preferably why. It is not uncommon for
About the treatment
patients (especially those with acute and sim-
●
Details of consultation times, duration and
ple conditions) to ‘not want to bother you’
an outline of what a consultation involves
once they are ‘better’
●
Times when you are available to be contacted
●
Are life style changes necessary and expected? About the Contract
●
What does the patient want to happen? ●
What has been agreed from both the patient’s
●
What is the homeopath’s expected response and the homeopath’s perspective
to treatment? Is it the same as the patient’s? ●
How is it agreed and recorded – verbal or
●
An explanation of why aggravations are written?
sometimes necessary and what they mean ●
How does it protect the patient and homeo-
●
Incorporating other treatment strategies. path from dependency and being taken
What about conventional treatments, and advantage of?
other complementary treatments? ●
When during treatment does the contract
●
How will complaints be dealt with and by need revisiting?
whom? ●
How might each consultation have its own
goals and how do these tie in with overall
About the Management
treatment goals?
●
Patient’s and their families’ choice of ●
Are confidentiality and consent clear?
approach and expectations
Deepening our
approach

CASE STUDY 25.1 appeared untroubled by his not sleeping but

Jonathan, aged 10 months, was brought was waking up hungry and wanted breast
for homeopathic treatment by his mother, feeding. Once Sue had a chance to talk about
V Sue. He would not easily go to sleep, woke her concerns, which included some ambiva-
at nights and wouldn’t settle unless he came lence about stopping breast feeding, the con-
into his parents’ bed. Sue was in a lot of dis- tracts relating to both Jonathan’s and Sue’s
tress about Jonathan’s sleep pattern, partly needs were clearer. A remedy was prescribed
because she was worried about what was for Sue and some general advice on feeding
going on and was very tired herself. Jonathan given.

344
 The Therapeutic Encounter

CASE STUDY 25.2 CASE STUDY 25.3

Mark presented with a right-sided ‘frozen Paul has indigestion due in part to a poor
shoulder’ that he thought was caused by ten- diet; he feels unable to contract to change his
nis. When he spoke about work, where he diet but is prepared to look at why he eats so
felt criticised, he clenched his right hand and many stimulant foods (coffee, spicy and sug-
pushed it into the palm of his left hand with ary). After acute treatment for his indigestion,
a screwing movement. When invited to talk taking into account his desire for stimulants,
about his feelings about work he was at first he returns wanting to prevent further attacks
reluctant. When he was made aware of the and now feels better able to change his diet.
importance of how he felt and the homeopath
‘mirrored’ the hand movements he was mak-
ing while talking, the consultation moved on to
explore his feelings of resentment. CASE STUDY 25.4
Jill, age 46, has anxiety and panic attacks, but
enjoys the attention from her husband, doc-
tor and therapists because of it. When she
explored her need for attention she realised it
In some cases, the patient will see the illness at one related to a deep fear of being alone that tied
level, while the treatment requires an understanding in with her children leaving home.
of the illness at a different level. The patient who
understands the different approaches to the treat-
ment of their case may become happy to treat at a
deeper level, as Mark’s case illustrates. Care, Compassion and Consent
When establishing a contract, a patient may What the patient believes they have agreed to with
wish to be rid of a symptom but be reluctant to the homeopath forms the basis of their consent
modify their life style – even if it is the causative for treatment. The extent to which the homeo-
factor. The limitation of treatment needs to be path informs the patient about what is likely to
explained and the contract may need to be modi- happen and what might possibly happen governs
fied to support the patient with their symptoms the extent to which the consent is ‘informed’.
or to help minimise the damage of the causative Ultimately the exact outcome cannot be known
factor. As Paul’s case shows, some patients are beforehand and so consent can never be fully
reluctant or feel unable to change their life style or informed. What we can share are the qualities
life situation – sometimes patients need to be suf- and values of the treatment process and the direc-
ficiently ill before they will make these changes, tion treatment is aimed in. The agreement fosters
Deepening our
with others the homeopath works to these limita- the goodwill between the patient and homeopath
approach

tions hoping in time to treat more deeply. Often, that helps develop trust and rapport. It allows the
experience of a positive response to limited treat- patient to be clear about what to expect from the
ment, and the change in well-being that accompa- homeopath, and what the homeopath expects
nies it, will encourage the insight and willingness
to address these health needs more comprehen-
from the patient. Ultimately all freely given con-
sent is dependant on trust and goodwill.
V
sively. Communicating the impression of the case and
Some illnesses provide secondary gains for the the plan of treatment back to the patient lays the
patient, who may then wish to contract to remove foundation for the patient to understand the pos-
the presenting problem while wanting to maintain sible reactions to treatment and, as far as possible,
the secondary gains, as Jill’s case illustrates. to consent to the treatment.

345
 CHAPTER TWENTY FIVE The Therapeutic Encounter and Supervisory Relationship

Deepening the Case and or perpetual anticipation of ‘being found out’, as

Non-Judgemental Acceptance might be seen in a Lycopodium patient. At other
‘The perpetrator is a victim of a victim.’ times they may acknowledge anxiety but not
think that you want or are able to help. In these
It is helpful in the planning stage to clarify with cases they won’t ‘contract’ to work with their
the patient what they believe the aim of the treat- anxiety – to find out why the anxiety is there and
ment to be. Understandably they may wish simply so reveal which anxiety remedy they might need.
to be rid of the symptom, but the reality is that This will relatively mask or confuse a case.
a new state of health may be needed which will
have implications above and beyond the simple Authenticity, Honesty and Boundaries
removal of symptoms. This process may itself In some cases ‘curative’ treatment might only be able
deepen the case. to achieve so much at one time. At a certain point in
Some aspects of the therapeutic agreement are the treatment a patient may change from ‘curative’
easy to establish – where the consultations will be to ‘supportive’ treatment, to maintain an improve-
held, how long they will last, how much they will ment or reduce deterioration from an ongoing dis-
cost, etc.; some, such as how the homeopath will ease process. These are both aspects of the ‘healing’
respond if working at the limits of their experience role of the homeopath – the patient will go through
or competence, are more difficult. Other aspects of phases where supportive or maintenance treatment
behaviour such as honesty, confidentiality, open- is more relevant than curative treatmentenance.
ness, goodwill, and non-judgemental attitudes may
be established as part of rapport or as part of a Boundaries
professional code of practice (see Chapter 30). For the contract to become clear then the rela-
All patients arrive at a homeopathic consulta- tionship between the homeopath and patient
tion with some belief about what will happen and needs also to be clear. One important aspect of
how. It can be helpful at the beginning of each this relationship is expressed in terms of social
follow-up to refresh your memory of the agree- and professional boundaries. Establishing bound-
ment with the patient. It can set the direction and aries includes discussion of confidentiality, who
tone of the consultation, deepen rapport, and else the patient consults with, notification and
address problems before they become too serious. correspondence with other health care profes-
At the end of a consultation modifying if necessary sionals, access out of hours, and what happens if
and restating the agreement can act as a summary you know or meet the patient in other settings. In
of what has happened ‘so far’, clarify any com- more difficult cases awareness of and maintaining
munication needed with third parties (e.g. other boundaries become an important way of identi-
carers or family), and both set up the next consul- fying and managing projection (see Chapter 23).
tation and establish what support the patient may Contracting is one way of moving from work-
Deepening our

need between consultations. ing to an unconscious agenda to working with a

approach

The patient may desire a very clear outcome – clearer, more purposeful, agreement.
understanding this is an important part of under-
standing the patient. It may or may not be what Reflecting Back to the Patient
V the homeopath wants to contract to do. The
greater a patient’s expectations then the greater
and Selecting a Remedy
In many ways our professional lives are a series of
the patient’s fear of them not being met or fear of therapeutic encounters. It is through these sepa-
being judged or rejected – allowing these issues to rate encounters that we help patients to express
surface deepens the case. For example, the patient what is, for them, struggling to emerge. Our
may present seeking relief from diarrhoea, but work is in facilitating this revelation – allowing
won’t tell you that it is linked to a state of anxiety the patient to move towards who they really are

346
 Supervision – Super…Vision

and to balancing what is inside with what is out- ‘Supervision: A Quality of looking without attach-
side. Like a gardener, we help reveal the beauty ment, fear or favour at “what is”. Over view. The meta
and balance in a situation; our intentions, like the commentary, “observing I” …aspirational and ‘good
idealised picture that a gardener may hold, will enough’…It begins with embodiment – being present to
shape and inform our work. This is why respect experience.’
for others and a freedom from the need to ‘work Sheila Ryan, 2004
our own stuff out’ is so important.
If you only work with patients you like and There are many ways you might get support and
easily understand you are unlikely to really chal- resources to deal with cases. In a developmen-
lenge yourself or face what you are unfamiliar tal and training sense you may find your teach-
with. Encountering what is deep inside a patient ers will observe your work, or you may have
requires a freedom from expectation of what you opportunities for apprenticeship, or a more or
will find and a freedom from avoiding what you less formal mentorship. Your needs will change
don’t want to see. If you solely ‘hunt the remedy’ as you gain experience – different individuals,
then you will limit what you can find. groups and organisations will provide different
We see that a dynamic and healing contact things at different times. The desire and need to
between you and your patients requires an aware- ‘get better’ at what we do needs to be balanced
ness of and connection to yourself, an openness to with ‘being good enough’ at what we do. This is
receive what and who the patient is, and an ability reflected in the journey from student to novice,
to express this both in the homeopathic relation- to apprentice, to mentee, to independence, to
ship and through the homeopathic remedies. teacher and mentor.
Aspects of ourselves will always be hidden or
unconscious, however expert we become, and there
REFLECTION POINT will be situations where we have to face our limits
● How clearly do you agree aims of treatment with a and the unknown. It is not a question of training
patient? If you were a patient consulting with yourself to reach a point where we might be all things to
what would you like agreed? all patients – rather it is recognising that we all, at
● Are there some patients that you find it especially easy times, require ongoing support, development and
or hard to develop a rapport with? Why is this and how education. When important issues remain uncon-
might you address this? scious and give rise to problems they must be
● Write a guide for treatment that all patients can be given allowed to surface or they will leak out onto col-
and a checklist of points you might like to cover when leagues, family and back to your patients. For this
making a therapeutic agreement. reason we all require opportunities for support,
reflection and (lifelong) learning. Individuals from
some health professions seem reluctant to recog-
Deepening our
nise this, perhaps reflecting their ‘buying into’ the
Supervision – Super…Vision
approach

illusion of omnipotence, where nothing is left in

‘A formal process of professional support and learn- the unconscious.
ing which enables individual practitioners to develop As the homeopath treats more complex and hid-
knowledge and competence, assume responsibility for
their own practice and enhance consumer protection and
den cases, seeking to know the deeper aspects of
a patient’s case, so the homeopathic relationship –
V
safety of care in complex clinical situations. It is central the dynamic between the patient and homeo-
to the process of learning, to the scope of the expansion path seen through the lens of the remedies –
of practice and should be seen as a means of encouraging becomes more central in the healing process. To
self assessment and analytical and reflective skills’ keep the homeopathic relationships focused and
A Vision for the Future, 1993 clear, attention needs to be paid to any areas of

347
 CHAPTER TWENTY FIVE The Therapeutic Encounter and Supervisory Relationship

difficulty. The quote below is from a member of a part of a group or one-to-one with a colleague or
homeopathic supervision group: supervisor.
‘A supervision group gives me the opportunity to study
my cases and reflect deeply while presenting them to oth- Self Supervision
ers. The group provides peer feedback and support and ‘When treatment difficulties arise which a therapist
poses questions I need to consider. Areas of my work that cannot resolve the therapist develops unconscious iden-
require deeper study and change are highlighted. So much tification with his patient. Unable to verbalise these
is about my attitudes and awareness – when these are indications they become enacted.’
transformed my way of working and my effectiveness Sachs & Shapiro (1976)
are also transformed. It takes courage to show my work
with honesty – the highs and the lows. The validation and Personal reflection is a cornerstone to homeo-
acceptance from the group is liberating. The reminders pathic practice, which is one reason why reflec-
of my purpose are inspiring. The combined wisdom and tion has been encouraged throughout this book.
guidance of the group clarify my direction. The dynamics To be able to observe and reflect on something
of the group provide the shift and movement forward of that happened or is happening is an important
my journey of personal development. part of clinical practice. Box 25.3 suggests some
questions you can ask yourself after a ‘difficult
‘The group gently illuminates my blind spots and moni- consultation’; with experience you will be able to
tors my safety and the safety of my patients. The added reflect on these during a consultation.
advantage of group supervision is the opportunity to Consider how you might feed back the results
witness how others are working and to learn from their into the consultation, taking into account how the
success and failure. The common experience that bonds patient might be feeling. It can help to consider a
the members of the supervision group encourages deeper range of possible responses available to you in any
processing of my difficulties in the safety of friends and
colleagues who really listen and understand. I tend to
BOX 25.3
lack confidence in my ability and approach the group
Self-Supervision Questions
with feelings of inadequacy. However, I am swiftly put ●
What did I feel at this point?
at ease by expert facilitation. I liken the encouragement ●
What was I thinking?
I receive to the best effects of the homeopathic remedy. It ●
What bodily sensations did I have?
really does have the wow factor! So that my indwelling ●
What was most obvious thing I didn’t
reason-gifted mind can freely employ this living healthy
notice?
instrument for the higher purpose of my existence.’ ●
What would I rather have done?
●
What problems or risks were there if I had
Even in cases that are not confused or hidden it done things differently?
is important to have a place where one can feel
Deepening our

●
What sort of person does the patient see
supported, can benefit from the experience of me as?
approach

others (education), and can develop homeopathic ●

How does this episode remind me of past
knowledge. It is important for each of these three situations?
aspects (support, education and development) to be ●
What is my fantasy (delusion) about the
V addressed. At a personal level the homeopath has
to be educated to learn the information and apply
situation and what am I fearful of?
●
When else have I had this feeling?
the technique, supported in coming to terms with ●
What am I expecting to learn from this
what is not known (and the feelings this brings), situation?
and helped to develop a personal style of working. ●
How can I acknowledge the patient for the
Supervision happens in three main settings – opportunities this difficulty gives me?
as part of personal reflection (self supervision), as

348
 Styles of Supervision

situation. For example, you might give yourself three path, but will be able to reflect back to the super-
options about what to do next – they may range from visee something of their own internal processes
the safe and sensible, to ‘thinking outside the box’ and and patterns. It enables you to gain insight into
imagining a more extreme possibility. Sometimes, assumptions and biases in the way you work and
when re-examined, the extreme ideas actually provide allows your projections and unresolved feelings to
quite practical and useful strategies. be played out, identified and explored in a safe
but conscious way.
Facilitated supervision can also be the place to
Peer Supervision ‘try out’ different approaches and interventions, par-
‘When the therapist does not understand the meaning
ticularly the more extreme of the range of options
of a patient’s enactment he conveys the meaning to his
mentioned in self supervision. Once you are com-
supervisor by a parallel enactment.’
fortable using something in a supported setting and
Interpretation of Freud
have received feedback on it, it is often possible to
use it during a consultation.
When a case is discussed in supervision, aspects
of it – particularly those that are unresolved in
the consultation – come alive. Issues that cause Styles of Supervision
difficulty or which are hidden in the consultation
Without supervision, do not be surprised if your
may be enacted; peers can observe this and com-
mistakes keep repeating themselves.
ment on the dynamic. For many practitioners this
There are many different styles of supervi-
peer supervision gives support and allows sharing
sion that lend themselves to different settings,
of issues, but if it lacks formality, safety or clarity
issues, supervisors and supervisees. They range
it can avoid exploring and revealing each other’s
from the informal ‘chat’ about a case to a formal
blind spots. It can easily default to sharing successes
structure applied rigorously. It may take place
and ‘miracle cases’ – and the hiding away in the
‘between consultations’ or in a dedicated session
collective unconscious of the difficult cases.
that may be a one-off or regular meeting. It may
be organised individually or established as part
Facilitated Supervision of a ‘network’ of advanced teaching and pro-
‘Emotions experienced by a supervisor, including even fessional development that may or may not be
his private subjective fantasy experiences and his per- linked to revalidation or appraisal. Supervision
sonal feelings about the supervisee, often provide may or may not be a requirement to practice or
valuable clarification in processes currently character- be monitored by an educational, representative
ising the relationship between the supervisee and the or regulatory body.
patient.’ In addition to the different styles of receiving
H Searles (1955) or giving supervision there are a variety of models
Deepening our
or structures. Most models seeks to understand
approach

When we start to talk about a patient we spon- the therapeutic relationship and intervention
taneously bring to the surface the feelings that through a series of processes or stages – such as
have been projected onto us and that we have identifying restorative, formative and normative
accepted (often unconsciously) from that patient.
These issues will be mirrored in the relationship
elements (Proctor 1987), that mirrored earlier
work looking at support, education and manage-
V
with the supervisor, who will aim to observe the ment (Kadushin 1976). A process model of super-
unconscious, unacknowledged behaviour in the vision I have found most helpful, and have most
supervisee. An experienced supervisor will not experience in as supervisee and supervisor, is the
only reflect the content of the consultation and seven-eyed model of supervision (Hawkins &
strategies and interventions used by the homeo- Shohet 2000).

349
 CHAPTER TWENTY FIVE The Therapeutic Encounter and Supervisory Relationship

The Seven-Eyed Model of Supervision Supervision happens in a broad context of

Supervision is helpfully understood by thinking practice that includes explicit and implicit norms
of it in terms of the worlds of the patient, homeo- of professional behaviour, codes of practice,
path and supervisor. Figure 25.1 is a model of organisational and management issues – part of
supervision showing the focus of supervision for the supervisor’s agreement with the supervisee is
patient, homeopath and supervisor, and from the to clarify their importance and the extent to which
perspective of the homeopathic relationship and these are included. When supervision is provided
the supervisory relationship. as a practice management or professional organi-
Level 1 examines the patient’s presentation; sation tool it can lead to revealing inconsisten-
level 2 reflects on the treatment given. In level 3 the cies and conflicts between personal, practice and
homeopath’s relationship to the patient is exam- organisational priorities. Although supervision is
ined. These first three levels are informed by what usually driven by, and centred on, personal and
has happened in the homeopathic consultation. practice issues it also informs and is informed by
Level 4 invites the homeopath to explore the professional organisations the homeopath
their own internal process. What do they notice works within (see Chapter 28). The different ‘eyes’
when they recount the case and what do they or ‘plains of focus’ within this model of supervi-
feel towards the patient? Level 5 looks at what sion inform an understanding of the therapeutic
is brought in parallel into the supervision session, encounter, so are discussed more fully.
what is enacted when talking about the case. Level
6 is the supervisor’s own internal process. Levels Level 1
4 to 6 focus on and are informed by what happens On many occasions when reflecting on a case it is
in the supervision session. Level 7 focuses on the apparent that there just wasn’t enough detail pres-
context in which both the treatment and supervi- ent to provide the information necessary to make an
sion are taking place. accurate prescription. Something needed to happen
to ‘bring the patient into the room’. The content of
the consultation, when reflected on in supervision,
is frequently much greater than first appreciated. It
includes information about how the patient dressed,
moved, sat, how exactly they looked, and how this
changed as they talked about their symptoms. By
inviting homeopaths to sit, walk, talk, or move like
the patient insights are gained to how the patient
might be feeling and what they are communicating –
revealing, for instance, an apparently masked case.
Deepening our

Level 2
approach

It is not uncommon to find that highly competent

homeopaths appear far from competent when dis-
cussing a difficult case in supervision. When they
V have seen no clear strategy or intervention indi-
cated they often fall back on old patterns of inter-
vention, rather than recognise why they find this
case difficult. Reflecting on what ‘buttons’ have
been pushed by a patient and what you would
Figure 25.1 The seven-eyed model of supervision (after really like to do or say to the patient can sometimes
Hawkins & Shoet 2000) offer new possibilities.

350
 Summary

Levels 3 and 4 important. How the supervisor reacts to what they

Clues to projection taking place are when the con- perceive and feel in supervision gives valuable
sultation suddenly becomes emotionally charged information. However, if it remains unresolved,
or contracted boundaries are broken. Level 3 the supervisor will need to address it in his own
focuses on the homeopath’s relationship to the supervision.
patient and the conscious and unconscious inter-
ventions. It is here that the patient’s possible pro- Level 7
jections are often revealed and their transference The supervisor may have a responsibility to an
clarified. Sometimes looking back at a case it is employing or professional community. Balancing
seen very differently, hence the value not just of this responsibility to the responsibility to the
thinking back to the case but also of videos of supervisee and the patient is one that needs con-
consultations and detailed analyses of both the tinual monitoring so that the interests of all par-
obvious case and also the smallest nuances of the ties are protected and served. It is through the ears
patient and homeopath. and voices of the supervisors that our professional
Exploring how the homeopath and patient inter- bodies can develop and evolve.
act can be helped by imagining the consultation as
a ‘documentary’ or as if a ‘fly-on-the-wall’ camera
is observing it. What would it look like, how would REFLECTION POINT
you feel watching it and what would you suggest to ● Think of the most common difficult situation you find
someone else in the same situation? Indeed, invit- yourself in as a homeopath. Go through the self-
ing the homeopath to observe their own internal supervision exercises in Box 25.3. What are the factors
process frequently sheds light on what is being in you that ‘invite’ this difficulty? What is your attraction
projected onto the homeopath and their reciprocal to and avoidance of working with this issue in facilitated
projections (see Chapter 23). The physical sensa- supervision? What does this tell you about this issue?
tions and the feelings the homeopath has both dur- ● Why do you think some health carers have a resistance
ing the consultation and also in supervision reveal to obtaining and using supervision?
the deepest projections that contribute most to ● Remember – over time patients who get better will
cases appearing confused and hidden. be discharged, while those that are difficult may keep
One of the benefits of taking part in supervi- returning!
sion, even while relatively new to practice, is that
it helps develop an awareness of projection in oth-
ers and thence in you.
Summary
Level 5 Being clear on the factors that determine the
What is mirrored in the supervision often reveals therapeutic agreement, and how these influence
Deepening our
those things that have been transferred, often the consultation and therapeutic encounter, can
approach

unconsciously, by the patient onto the homeo- guide how you both take and receive the case.
path. Dealing with this projection is an essential Uncertainty about the therapeutic agreement, the
part of maintaining one’s focus and clarity. boundaries, the expectations and the projections

Level 6
causes many of the difficulties homeopaths expe-
rience when managing cases. By exploring and
V
The supervisor’s own internal process (including understanding the factors that shape and influ-
emotions and sensations) will, if made conscious, ence the agreement and encounter it is possible to
reflect (and possibly clarify) what is happening to undertake, explore, make sense of and help situa-
the supervisee. At this level the supervisor/super- tions and patients that otherwise would be at best
visee and supervisor/patient relationships are both untreatable by you and at worst harmful to you.

351
 CHAPTER TWENTY FIVE The Therapeutic Encounter and Supervisory Relationship

Developing and extending your competence, Mercer S W Reilly D, Watt G C M 2002 The impor-
while at the same time paying attention to the tance of empathy in the enablement of patients attend-
day-to-day ‘housekeeping’ that being a practitio- ing the Glasgow Homeopathic Hospital. Br J Gen Pract
52:901–905
ner requires, is all part of supervision. The impor-
tance of the projection (both from the patient to Proctor B 1987 Supervision: a co-operative exercise in
the homeopath and from the homeopath to the accountability. In: Marken M, Payne M (eds) Enabling
patient) enacted in the relationship between the and ensuring. Supervision in practice. National Youth
Bureau, Leicester
homeopath and the supervisor and the supervisor
and the homeopath is vital to working with more Rogers C R 1973 On encounter groups. Pernguin,
challenging confused and hidden cases. Harmondsworth
Ryan S 2004 Vital Practice, the homeopathic and super-
visory way. Sea change, Portland
Acknowledgement
Sachs D M, Shapiro S H 1976 On parallel processes in
Robin Shohet and the centre for staff team develop- therapy and teaching. Psychoanal Q 45(3):394–415
ment.
Searles H F 1955 The informational value of the super-
visor’s emotional experiences in psychiatry. Psychiatry
18:135–146
References
Shohet R 2005 Passionate medicine – making the transi-
Fowler J 1996 The organisation of clinical supervi-
tion from conventional medicine to homeopathy. Jessica
sion within the nursing profession. J Adv Nursing 23:
Kingsley, London
471–478
Hawkins P, Shohet R 2000 Supervision in the help-
ing professions, 2nd edn. Open University Press,
Buckingham Bibliography
Kadushin A 1976 Supervision in social work. Columbia Freeman R 1998 Mentoring in general practice.
University Press, New York. Butterworth-Heinemann, Oxford

Kaplan B 2001 The homeopathic conversation. Natural Ryan S 2004 Vital practice. Sea Change, Portland, UK
Medicine Press, London A Vision for the Future 1993 Department of Health,
Mercer S W, Watt G C, Reilly D 2001 Empathy is London
important for enablement. Br Med J 322:865
Deepening our
approach

352
CHAPTER TWENTY SIX

Holographic and Relational Philosophy

Models of Health
David Owen

how the different models, approaches and meth-

Introduction odologies present in this textbook are part of a
There is no such thing as perfect health, just good spectrum, often needing to be integrated for the
enough health. optimum management of the patient.
Having explored in previous sections the The holographic model recognises that any
rationale for causation, local, totality and con- part (of the whole) reflects the whole. So facets
stitutional approaches to treatment, it is now of a case or remedy tell us something about the
important to return to thematic and reflective patterns running throughout and reflect some-
approaches. These have been described in pre- thing of the whole case or remedy. The patterns
vious chapters and have been found to work we observe running through a case or remedy will
well in cases that are otherwise confused or be influenced by our own state.
hidden. When the holographic and relational Working with the holographic and relational
models of health that underlie them are under- models uses the ‘state of the homeopath’ and relies
stood, the homeopath is more likely to be able to on the insight you have into your own norms. This
use thematic and reflective approaches and ‘make raises important questions about self awareness and
them your own’. They bring with them slightly development as part of a homeopath’s training.
different ways of studying the materia medica, As a relationship is often communicated by feel-
a different emphasis in the case, different meth- ing, it is frequently the feelings in the patient and
ods of analysis and different management issues – homeopath that reveal the consistent themes in a
each of which is described in subsequent chapters confused case and the dynamic of the hidden case.
in this section. For this reason, emotional intelligence is explored
While approaches to health and illness based further in this chapter.
on causal and holistic perspectives are well estab- To help understanding difficult cases and why
lished, the holographic and relational views are the approaches presented here are so important we
less well described. The description of the holo- start by exploring further what makes a case appear
graphic and relational models of health, the confused or hidden. This leads on to the broader
approach to treatment they bring, and the meth- cultural context that influences our work, especially
odology for prescribing they offer are therefore the collective unconscious and cultural suppression
offered more tentatively. They are separate and (linked to society and hereditary predisposition) that
distinct but are presented together for reasons of is developed later in this section. The confused and
space and because both are informed primarily by hidden cases in any population tell the homeopath
the homeopathic relationship. Considering them about the health of that population. And while the
together also offers us the opportunity to explore most usual contract for the homeopath is with an

355
 CHAPTER TWENTY SIX Holographic and Relational Models of Health

individual patient, we also play an important role ceptibility and the potential to get symptoms in the
in the health of a population (see ‘Public health future, illnesses the patient would otherwise have
homeopath’ in Chapter 30). been expected to get may be prevented.

Difficult Cases The Holographic Model

Difficult cases are difficult to see clearly – it fol- ‘…the classical contrast between the solid particles and
lows that these are difficult to manage. Cases that the space surrounding them is completely overcome.
do not respond easily and quickly to treatment The quantum field is seen as the fundamental physical
and cannot be seen clearly in the causal biologi- entity; the continuous medium which is present every-
cal or holistic models of health are often con- where in space. Particles are merely local condensations
fused or poorly expressed (hidden). These unclear of the field; concentrations which come and go, thereby
and shadowy aspects of the confused and hidden losing their individual character and dissolving into the
case are detected by the way they are projected underlying field.’
on to the things around the patient (see Chapter Fritjof Capra 1975
23). Even if you choose not to work this way, it
is important to know about it as negative feel- A natural progression from the holistic model,
ings can be ‘dumped’ by the patient on those where one symptom cannot change without affect-
around them – including the homeopath. If you ing all aspects of the case, is to see each symptom
are unaware of this you may project back to the that an individual expresses as containing and
patient and/or become drained and feel manipu- reflecting aspects of the whole case. The way in
lated. Paradoxically, there is often a form of col- which each symptom expresses one facet of the
lusion when this happens, with each ‘blaming’ the whole pattern is similar to the way every piece
other – often preventing you or the patient from of a hologram holds the whole picture, and the
seeing and addressing what is going on. genetic code in one cell holds the information for
Once the case is accepted as confused or hidden the whole individual. This principle is observed
you may feel a lessening of the pressure to get the and used in many diagnostic systems (including
simillimum in one consultation as it may require a reflexology, auricular acupuncture, and tongue
phase of clarifying the case. There may be no single or iris diagnosis) where one part of the body is
well indicated remedy or a number of partially indi- related to others. If any one symptom could be
cated remedies. You may have to accept that the case understood in its entirety it would explain the
will only become clear over a period of treatment whole case. Understanding the pattern (also called
and that it is not necessary, or indeed possible, to see the essence or theme) that lies behind the symp-
the whole case from the outset. toms of an otherwise confused case reveals some-
Understanding why cases are confused and hid- thing more fundamental that often runs through
den, and how the holographic and relational mod- several layers of the case.
els make working with these easier, is an important Several different themes may run through a case
part of increasing the number and difficulty of cases but the most central themes run deepest and link
that you can treat effectively. Initially you may only many symptoms. The most consistent or deepest
explore the holographic or relational model when a theme is sometimes referred to as the most central,
detailed case history and analysis fails to point to the fundamental or essence. They express themselves
totality or constitutional remedy. In time you may in the local, mental and general symptoms of the
find these approaches becoming the foundation of case and the remedy. The more central (or uni-
a reliable and repeatable approach to treatment. As versal) the theme to the patient the more impor-
Confused and
Hidden Cases

confused and hidden cases often reflect a deep sus- tant it is to match it to the theme running through

356
VI
 The Holographic Model

the remedy. Matching these themes is the basis of set of symptoms overlies another. They have a
essence and thematic prescribing and in confused number of layers – some of which might be clearly
cases these more central themes provide reliable visible, others not. Figure 26.1 illustrates the com-
information to prescribe on. parison between confused and hidden cases. In a
The different themes we are able to recognise, confused case the picture presented in the totality
and ‘make sense of ’ depends on how we interpret does not reveal an accurate reflection of the hier-
our world. By studying the themes of the materia archy and depth of the case. The deeper symp-
medica and by creating a map from cross referenc- toms are not the most noticeable and the patient
ing themes of different remedies we can be helped may be unconscious of them.
to recognise different patterns that run through In the same way as there is a continuum of cases
cases. We may categorise them in many differ- running through the complex, confused and hidden,
ent ways, examples include using yin and yang, so it can help to think of consciousness and uncon-
the three kingdoms, four humours, five elements, sciousness not so much as black and white as a scale
seven rays, twelve star signs, etc. Similarly we may of greyness. In confused cases some symptoms may
use three, five or any number of miasms to reflect be unconscious but easier to bring to the surface;
susceptibility and themes that run through a case other features may be deeply unconscious and the
or remedy picture. In different cultures, the mias- patient may deny or rationalise them. In hidden
matic influences an individual is subject to may be cases there is often more that is deeply, even instinc-
slightly different. In cultures where thrush or glan- tually and culturally, unconscious.
dular fever are more common, or have been sup- Understanding confused cases is possible from
pressed more than ringworm or malaria, it may be themes that express themselves in the present-
more relevant to work with the former rather than ing symptoms. But if these have been suppressed
the latter miasmatic groups. However, there are then the expression may be in other areas of the
connections and similarities to miasmatic groups in case, such as childhood illnesses or family history.
different cultures – reflecting illnesses that we are There may be several stages to treating these con-
all susceptible to and identifying common threads fused cases; each stage may reveal new symptoms
and miasms that run through the materia medica is as the picture is clarified. If deeper symptoms sur-
expedient. Remember, miasms will evolve as differ- face then new themes may emerge.
ent illnesses occur and are suppressed. As a symptom moves inwards to a deeper
level (due to suppression), the outer expression
becomes a less accurate reflection of what is really
REFLECTION POINT happening to the individual. The extent to which
● Rather than themes determining how a patient (or suppression disturbs the body’s ability to react to
remedy) expresses themselves in different situations, a stimulus depends on the extent to which the sup-
consider instead that patients (and remedies) ‘seek out’ pression can produce a new pattern of symptoms
particular situations where these themes can express (or illness). This new pattern has its own themes
themselves. How might a patient with a theme of being that reflect the cause of the suppression – set-
accident-prone seek out situations where accidents are ting up patterns or layers of illness such as, for
more likely? example, the steroid, the Prozac, the antibiotic,
the alcohol layer. These layers distort and confuse
the picture and may need removing before deeper
Confused Cases aspects of the case can be seen. Each layer may
In a complex case the picture may have many need to be removed before other layers become
aspects compared to a simple case, but ‘what you visible. This may be achieved just by removing the
Confused and
Hidden Cases

see is what you get’ (see Fig 10.2). In a confused suppressive agent or may require treatment based
case the symptoms appear muddled because one on what can be seen – and may include isopathic

357
VI
 CHAPTER TWENTY SIX Holographic and Relational Models of Health

A Confused case

From outside From above In cross section

Patient’s
inner state
Patient’s
inner state

Defence layers
or symptoms
Defence layers
or symptoms

B Hidden case

From outside From above In cross section

Patient’s inner state

Patient’s
inner state

Defence layers
or symptoms
Defence layers
or symptoms

Figure 26.1 Figurative comparison of a complex, confused and hidden case

and organ-based prescribing to reduce a particular when those factors that led to the construction
wall and see a deeper layer. of the wall are no longer present. Of course
the protective role of the wall should be noted
Walls and Layers and (like the benefits of secondary gain) taken
As suppression increases so the case becomes less into account in patient management. Treatment
transparent, as if a wall is built around the patient does not necessarily entail the dismantling of all
(Fig. 26.1). Like all walls it keeps some things inside these walls but can involve enabling the homeo-
(and hidden) and other things outside. As cases get path to see through ‘windows’ in the walls and
more confused and hidden, yet more walls hide and the patient to move through ‘doors’ in them at
confuse increasing proportions of the case. Working the appropriate stage of treatment. Dismantling
with these cases is a matter of gradually removing the wall before the patient has managed to
one wall after another. In many cases it can be hard make changes to the situation in which they
to tell just how many layers or walls there are. In needed to develop their walls is akin to de-com-
these cases it is difficult for the patient and homeo- pensating the patient. In different situations
path to know exactly how much treatment is going different aspects of a case are expressed –
to be required as it depends on what surfaces. it is possible to imagine situations where a
Confused and
Hidden Cases

Sometimes just removing one wall is enough patient would develop a wall for protection, as
for the patient to start improving, particularly Fran’s case illustrates.

358
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 The Holographic Model

It can help to think of each symptom, like a wall, that appear like two or more illnesses but in fact
as having four aspects: the theme itself [hardness], are one and the same – even if no single anatomi-
the two sides of the wall (one the active protec- cal or pathological disease entity can be identified
tion it offers the patient [brittle], one the passive as underlying or explaining all the symptoms.
block to the patient’s free and healthy expression
[broken]), and finally the patient’s compensated Essence and Themes
behaviour or view of the situation from behind ‘The human soul responds to the processes and sub-
the wall [cautious, safe]. A theme or pattern run- stances of our world with myth, legend and poetic imag-
ning through a case may include symptoms in the ery and these can be understood as the revelation of the
active, passive, or compensated form. So a con- higher reality lying latent, like a sleeping princess, within
fused case with a theme such as hardness may the natural phenomena. They constitute, one might also
have some symptoms showing brittleness (active), say, a homeopathic proving in a very clear and height-
others appear broken or snapped (passive), and ened form … In contemplating these images and sym-
some an avoidance or cautiousness even to the bols we may be led deeper into the hidden genius of the
point of softness (compensation). This explains substance and its remedial actions than by confining our
why in some confused cases there are paradoxical attention strictly to the realm of material effects and the
co-existing or alternating symptoms (Saine 2000) rubrics of official provings.’
Ralph Twentyman

CASE STUDY 26.1 The essence is the single central pattern of infor-
Fran, age 49, presented with a multi-sys- mation that expresses itself in any symptom of a
tem connective tissue disease that included remedy or case. In practice one consistent pat-
rheumatoid symptoms. She talked of how tern or essence is not always recognisable; instead
hard it was being ill. Over the first two con- the pattern observed in the case and remedy can
sultations she glimpsed for the first time that be understood in terms of a number of different
all had not been well as a young child. She themes. For example, in the remedy Nitric acid
realised a series of difficult and bullying rela- there is an essence of ‘dissatisfaction’, but there
tionships reflected the physical and emotional are also the themes that run through the Nitricum
abuse she saw her mother suffer from at the and Acid remedies of ‘sensitivity’ and ‘weakness
hands of her father. She felt she had to ‘walk to respond’ – together contributing to its unique
on egg shells’ or else he’d go for her. This left expression of dissatisfaction. Each remedy may
her understandably cautious about revealing have several themes, not all of which have to be
her feelings. Once she found she could talk observed in the same patient at the same time, to
about this without being criticised, she started the same degree. In many confused cases the deep-
to reframe her view of her parents’ relation- est aspects are projected (or leak out) in the con-
ship and behaviour and was also able to start sultation without necessarily being consciously
talking about her own history of broken rela- named by the patient. They may be reflected in
tionships. She had to feel very ‘secure’ and the words used or movements made, the sensation
‘safe’ with her homeopath before she could or ‘feelings’ they experience, or those they gener-
fully open the door to her emotional pain. As ate or stimulate in you.
she revealed more, including her anger with In less well-known remedies only some themes
her mother for putting up with the abuse, so are clear and how the themes come together to
deeper-acting remedies could be prescribed. form an essence is uncertain. Themes may appear
Only then did her presenting symptoms sig- contradictory, for example, a Natrum muriaticum
Confused and
Hidden Cases

nificantly improve. patient is sensitive but by appearing withdrawn

and introverted may appear at first glance as ‘thick

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skinned or indifferent’. Understanding the themes the homeopath to work ‘relationally’, adding what
expressed in a remedy often helps the homeo- is to many a new dimension to the understanding
path to extrapolate and interpret the remedies in of patients and remedies.
situations that are very different from the origi- Identifying and matching the patient’s emo-
nal provings. While this brings certain risks until tional state to the ‘feeling’ state of remedies
provings are repeated in contemporary situations, requires emotional awareness and the ability to
it does allow us to open up the materia medica to communicate emotionally. It is important to stress
situations patients are in now. that while this is most easily perceived as a psy-
chological interaction, what is expressed psycho-
logically mirrors what is present at a somatic level.
REFLECTION The homeopath (and patients) working with con-
● Suppression is a major cause of symptoms moving fused and hidden cases must be prepared to work
to a deeper ‘layer’. The suppression of eczema often as much with the psychological realm of illness as
precedes the onset of asthma. I invite you to reflect on the somatic. If one was to work with these cases
the possibility that it is the suppression of illness rather using the model of aetiology then it would be fair
than the disease itself that sets up a miasm – to say that many difficult cases, and multi-system
so it is the suppression of syphilis that set up the long-standing chronic illnesses, have an emotional
syphilitic miasm. cause. That is to say, at the time when a patient is
● How does a miasm compare to the walls or layers developing their first symptoms or shortly before,
around the patient in Figure 26.1? there has been a significant change in their emo-
● Given their importance, can you name the main themes tional state. It is not uncommon to see patients
and essence of the main miasms (see Chapter 17)? whose symptoms flow from bereavements, rejec-
● Looking at Figure 26.1 how might different tions, abuses, promotions or failings. The emo-
consultations reveal different views of the same patient tional reaction to these events is a more subtle,
and how will you know when you are really seeing the individual way of understanding the trigger than
centre of the case? the event itself. Unfortunately suppression and
lack of comprehensive emotional pictures of the
remedies make the aetiological model poorly
suited to these cases.
The Relational Model A frequent cause of cases being hidden is that
The relationship between the patient and their the symptoms fail to fully reflect the susceptibil-
world (including the homeopath) reveals the themes ity. It may be that the illness has become overly
at play in the patient; what happens to the homeo- functional or structural, or because the homeo-
path in the homeopathic relationship can reflect path is unable to see the case clearly. Frequently
the patient’s state. The more ‘intense’ the experi- these two problems go together to give what are
ence or stronger the feelings in the homeopath, the known as ‘one-sided’ illnesses, where significant
more likely it represents something of importance parts of the totality are unconscious to the patient
to the case. It is particularly useful when the case is or unseen by the homeopath. The susceptibility
otherwise masked or hidden, as such cases invari- may be further challenged and the case masked by
ably project more on to their situation and those deteriorating disease, maintaining causes, insuf-
around them. Thus the greater the problems for the ficient vitality, inherited predisposition or cul-
homeopath if they are not effectively integrated into tural suppression. In practice these often happen
the consultation and management of the case (see together and may be the result of an untreated or
Chapter 23). These projections are most often sen- suppressed confused case, congenital disease or as
Confused and
Hidden Cases

sitively communicated and most easily detected by a result of an unrecognised illness (often a cultur-
‘feeling’. The use of emotional intelligence enables ally endemic disease).

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Many homeopaths are informed by their rela- these phases over days or many years and can get
tionship with the patient, even if they do not use ‘stuck’ in any of them. These different phases cor-
it explicitly. It is my observation that many practi- relate with different remedy pictures – patients in
tioners who describe themselves as working ‘intui- each give quite a different feeling.
tively’ (Brien 2004) are in fact manifesting many
aspects of working relationally. How you feel in a Emotional Intelligence
consultation can guide you to the deepest aspects ‘We promise according to our hopes and perform accord-
of the patient’s case, correlate with the patient’s ing to our fears’.
remedy state, and be a reliable pointer towards Francois Duc de la Rochefoucauld
the simillimum. Put simply – what happens to
you, especially the feelings you experience, can Emotional intelligence is an important attribute if
help choose a remedy. we are to function supportively in, and sustain, any
Different homeopaths experience different emotional relationship. It is important when work-
feelings in response to patients fitting a particular ing in any model of health or using any approach
remedy. For example, an Arsenicum album patient to treatment – but it is particularly important when
will generate specific feelings that may be different working predominantly in the relational model or
for each homeopath depending on their state. If using the reflective approach. It is important in
the homeopath himself is in an Arsenicum album establishing empathy, especially if working with
state those feelings are likely to be very different confused and hidden cases. It is distinct from
to those they would experience if they were in a academic intelligence – which is about ordering,
Phosphorus state. sorting, measuring and comparing pieces of infor-
To use this approach requires a steadiness and mation. The intellectual and emotional intelligences
insight into your own state. Learning the emotional involve the activity of different parts of the brain.
reaction you have to different remedies is part of The intellectual activity is sited predominantly in
developing a ‘living materia medica’ – a natural the neo-cortex, emotional intelligence in the sub-
extension of essence and thematic prescribing. cortex. Different hemispheres of the brain are more
The attuned homeopath will be interested in how active in one form of intelligence than another,
patients in different remedy states can make them with left brain activity equating to academic intelli-
feel – producing changes in their own feelings or gence and right brain activity relating to emotional
subtle physical signs, such as a prickling up the intelligence. Some individuals are more left-brain
spine, a catch in their own voice or throat, a misuse dominant and others more right-brain dominant.
of a certain word or a certain feeling arising when Some authors have attempted to differentiate
the patient is talking about a particular issue. this intelligence in relation to gender, describ-
In order to work reliably in this way with a high ing emotional intelligence as more feminine and
level of competence the homeopath needs to be academic intelligence as more masculine. Most
aware of and develop a language for their own and researchers in the field report that men and
others’ emotional state; to be able to invite, identify, women are equally able to use either or both
communicate and work with emotions and behav- intelligences – their dominant style will depend
iours that are the result of projection. It requires on their background and upbringing (Goleman
awareness of how different feelings relate to each 1995). Factors that are important in developing
other and the patient’s state. For example, after a and using emotional intelligence include personal
significant loss such as a bereavement a patient will and social competences; these are not developed
often go through phases of grieving (Kubler-Ross as a result of learning facts but are a vital part
1970) that very roughly can be described as denial, of entering into a therapeutic relationship as a
Confused and
Hidden Cases

sadness, anger, heightened sensitivity to further health professional. They contribute hugely to
loss, and resolution. Patients may cycle through your ‘self awareness’, self-confidence, self-control

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 CHAPTER TWENTY SIX Holographic and Relational Models of Health

and personal motivation – without them you risk

BOX 26.1
damaging yourself and the patient.
Aspects of Emotional Communication
That are Particularly Helpful When
Working Relationally
REFLECTION POINT
●
Ability to express feelings
● You might like to reflect about what in your training is
●
Ability to make observations related to
specifically helping you develop these skills. Likewise
feelings and to check out the observations
I suggest you score out of ten how aware you are of
with the patient
others feelings, concerns, needs and wants (empathy);
●
Ability to discuss and contract with a
and also your more general social skills, including your
patient about working with feelings
communication skills, the range of people you have
●
Ability to model working with feelings and
an easy rapport with and your ability to influence and
inspire others to work with feelings
enable others.
●
Ability to trust feelings
●
Ability to use feelings in balance with goals
and outcomes
Empathy ●
Ability to support patients to become emo-
‘Mortals can keep no secrets. If their lips are silent,
tionally competent
they gossip with their fingertips; betrayal forces its way
●
Ability to ask for support
through every pore.’
●
Ability to work with negative and sup-
S Freud
pressed feelings without becoming trapped
in these feelings
Empathy (see Chapters 13 & 23) is an awareness
●
Ability to be aware when patients are pro-
of others’ feelings, needs and concerns. It is the
jecting feelings on to you and when you are
way we connect with each other emotionally. It is
counter-projecting feelings back to them
known that a good level of empathy enables rapport
●
Ability to be honest about feelings
and that it depends not only on our self-awareness
but also on the cultural, social and personal rela-
tionship that exists between individuals. Empathy
enables patients to acknowledge, work with and, in Emotions as Part of the Totality
time, express their underlying feelings – which can The patient’s emotional state is connected to all
in its own right be a healing process. other aspects of their totality. So too is the homeo-
path’s emotional state connected to what is going
Developing Empathy on for them physically and psychologically. It is
The ability to work with empathy is related to possible that small body movements, phrases and
the awareness of how your own feelings can be facial movements of the homeopath and patient will
affected by others and others’ feelings affected by influence and reflect the emotional state. Patient
yours. High levels of empathy often give confi- and homeopath behaviour, including body posi-
dence to deal with situations where there are high tion, where they look, how they move etc., offer
levels of challenge and risk. Although aspects of insight into what is happening in the patient. This
empathy are certainly influenced by family history does not preclude there being changes in other areas
and early experience, all homeopaths should be of the body and mind that may include subtle shifts
able, through experience and personal develop- of ‘energy’ that are currently not directly measur-
ment, to work reliably and meaningfully with their able. Perhaps the small movements that influence
and other’s emotions. Box 26.1 details aspects of the swing of a pendulum or changes in pressure of
Confused and
Hidden Cases

emotional communication that are particularly electrical connections (and therefore current flow)
helpful when working relationally. lie behind some of the ‘subtle’ techniques such as

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 The Relational Model

Dowsing, Radionics, Emanometer (Boyd 1923), iour’ is not recognisable as symptoms. Sometimes
Vega, bioelectrical, kinesiology, etc. – used by some an illness may present as one-sided, when the
to reflect what is happening to the patient. case is presented on the patient’s behalf by a third
party, such as a parent or pet owner.
The Hidden/One-Sided Case In hidden cases prescribing may be based non-
(Organon, Paras 172, 190) specifically on the presenting symptom (local pre-
We learn more from our difficult cases than our scribing) but this rarely gives marked or permanent
easy ones. They teach us about our therapy, our results. Or it can be based on subtler indications of
self and our world. the case – where treatment and support over some
Some serious diseases first emerge with no time may reveal the deeper aspects. It may take
apparent or gradual build up of symptoms, e.g. some time before a complete case emerges – and
the sudden onset of heart disease, cancers, schizo- even then it may be confused. In these patients an
phrenia, multiple sclerosis, epilepsy, and alcohol initial response to treatment with an acute illness,
and drug abuse. These hidden, or one-sided, dis- aggravation or return of old (often forgotten)
eases are usually disorders of function and struc- symptoms, giving more prescribing information,
ture – where the disorder is not expressed fully, or is a positive response.
at all, in the realm of sensation. In most of these In Peter’s case, after receiving local treat-
a complete case with local, mental and general ment (Crataegus) his blood pressure improved
symptoms is absent; the patient attends with their slightly but at follow-up he was frustrated that
presenting symptoms and not a lot else. There he was not ‘better’. He spoke of his frustration
may be an absence of any history of acute illnesses about his homeopathic treatment and wanted to
and the sense of being ‘stuck’ in a certain situation know when he would be better. The homeopath
or life style. By the time these problems present felt a little ‘bullied’ and realised that this might
to the homeopath they are often quite advanced be how the patient felt. When the patient was
(as Peter’s case illustrates) and may even be life asked if he was ever bullied he at first denied
threatening. it and then admitted it was a recurring pattern
Hidden cases range from those that are slightly – running from childhood, through several jobs
obscured (but in which a careful history may reveal and in his first marriage. He ‘always felt put
some features), to those where all the details of upon’. He made a significant improvement after
the symptoms are swamped by a single prominent Lycopodium 10M.
symptom. It is as if the patient’s ‘normal behav- Figure 26.1 illustrates a hidden case where a
‘wall’ masks what is happening. Sometimes all
that can be seen is the mask. The more the homeo-
CASE STUDY 26.2
path buys into the same walls and defences as the
Peter, age 54, a financial director, presented
patient, the harder it is to see through them or ‘see
with marked hypertension. It was detected
over the wall’ to view the case more clearly.
at an insurance medical and he is ‘otherwise
Patients are frequently unaware of symptoms
100% well’. On investigation he is found to
of sensation and feeling, especially when they
have early coronary artery disease. He works
are ‘somatised’ into symptoms of function and
long hours and may be made redundant in
structure. Revealing the sensation and feeling is
the near future. He knows many people in this
one way of ‘seeing into’ the hidden case. The
position. He remarried 5 years ago and does
homeopath who is able to draw out the sensa-
not see his first wife; he sees his children occa-
tion and feeling by, for example, ‘matching and
sionally. He has no fears, has no temperature
enacting’ (see Chapters 13, 23) may be able
preference and eats what ever he is offered.
Confused and
Hidden Cases

to unmask them. In the same way as a garage

He says there are no symptoms.
mechanic may detect early problems with a car,

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so a homeopath may detect illness before the The more people in a population suffer from
patient is aware of it. This is one of the benefits a particular one-sided illness, the more it points
of regular ‘check ups’ and is why the homeo- to a cultural predisposition and suppression that
path’s role is as much to prevent more serious individuals in the culture face. In our current
illness as to treat it when it’s there. Good rap- Western culture, heart disease frequently relates
port, psychological awareness and perceptive to unresolved issues about relationship, control
case work is necessary to identify and treat these and power. The prevalence of cancer corresponds
issues while they manifest as subtle changes of to issues around excessive growth, overburdening
sensation and feeling – and before they pres- responsibility and duty. As homeopaths we can
ent with functional disturbance and structural have a role in helping a culture, community or
damage. Many patients benefit from improved family to learn from the illnesses they are prone
long-term health and reduction of chronic ill- to, especially those of the one-sided/hidden type
ness when they have had homeopathic treat- (see ‘Herd immunity’, Chapter 18).
ment over some time. This long-term benefit is
often not assessed when evaluating the benefits Inherited Disease
of homeopathy (see Chapter 24). While simple and even complex cases can be
understood in terms of the symptom, personal
Cultural Predisposition susceptibility and suppression, the more confused
The feelings and sensations that patients put up and hidden cases need to have their cultural and
with, or are unconscious of, are often those preva- inherited factors considered (see Chapter 28).
lent in their family, community or culture. They One-sided illness is an issue not just for the patient
do not stand out and are often not considered but also their community, culture and generation.
pathological until the disease is expressed in a One view of hidden cases is that they represent
functional or structural way. So, for example, in illnesses incompletely dealt with in the parents’
Peter’s case the feeling of being ‘put upon’ was generation; conversely, how illness is treated in
one that he assumed (possibly correctly but not today’s patients will determine the illnesses that
healthily) many business executives felt and ‘came are hidden in future generations.
with the territory’. There is a spectrum of inherited influence in
As the homeopath, if you unconsciously patients’ histories, ranging from their appear-
accept cultural norms you may find it hard to ance through a slight predisposition to full blown
see when these are contributing to illness. For congenital disease. The degree of influence corre-
example, in patients with the ‘C’ type person- lates with how strongly miasmatic tendencies are
ality that are prone to cancer (see Chapter 17) expressed in the individual. They are most marked
there is a strong sense of duty and responsibility. when structural, but can also manifest on the level
If the homeopath unconsciously ‘buys into’ the of sensation and function. The less structural, the
same sense of duty and responsibility, they (like more reversible the predisposition is likely to be –
many others) will struggle to recognise it – per- and the more preventable and treatable inherited
haps until the structural changes of cancer are illness is. Some susceptibility is normal; each of us
manifest. In different cultures the difficulty in will have resistance to some illness at the expense
expressing some symptoms and the prevalence of of susceptibility to others.
others (often particularly of sensation and feel- Homeopathy, through the treatment of inher-
ing) is a form of cultural palliation, and ‘suscep- ited susceptibility and miasms, along with the
tibility’. Understanding the culture that you and reduction of cultural suppression, has huge scope
your patients are part of will often shed light on in preventing and minimising inherited diseases.
Confused and
Hidden Cases

the one-sided and hidden illnesses you are likely Untreated inherited susceptibility will be passed
to see. on to future generations.

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 The Personal and Collective Unconscious

The Personal and Collective content of these complexes is often unconscious to

the individual, they cause the individual, in differ-
Unconscious ent situations, to be susceptible to and experience
‘In the time span of a century, after centuries of enquiry specific feelings. If a homeopath is able to identify
the concept of the unconscious psyche was realised and a particularly strong or unusual feeling or emotion
eventually established by these physicians. Although this in a patient, then it may reveal important aspects
vital realization has been made available to all, it has of the patient (complexes) that can be matched to
not yet been integrated into consciousness by the medi- remedies that cause a similar emotional charge. In
cal profession in general.’ this way complexes may be compared to themes
A Maguire (2004) running through a patient’s case.
Figure 26.2 illustrates the patient’s personal
In psychology, patterns of behaviour are explained conscious as being informed by their personal
through the idea of complexes and archetypes. unconscious, which in turn is informed by the col-
The work of Jung, amongst others, provides the lective unconscious. The patient’s conscious self
homeopath with a model for exploring the per- is what a patient perceives of themself reflected
sonal unconscious, so important in confused cases, through thoughts and symptoms. The personal
and a way of understanding the collective uncon- unconscious is composed of a number of com-
scious, a large part of hidden cases. Understanding plexes and the emotional charge that goes with
the remedies as containing or representing infor- these is reflected in the feelings of the patient. The
mation that can be matched to the patient’s per- collective unconscious has a number of ‘patterns’
sonal and collective unconscious is an important or archetypes that are common between different
part of working with otherwise confused and people. These archetypes are both influenced by
hidden cases. different situations and influence the situations the
Jung developed the idea of ‘complexes’ that are individual seeks out or creates. The main themes
groups of ideas (or aspects of the individual) bound (including the miasms) observed in the case rep-
together by a single emotional charge. While the resent fundamental patterns and relationships

Patient’s conscious self

Thoughts and symptoms

Patient’s unconscious self

Complexes The ‘collective unconscious’

Archetypes The inner nature

Outer nature
Confused and
Hidden Cases

Figure 26.2 Representation of the patient’s conscious self, informed by the personal and collective unconscious

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 CHAPTER TWENTY SIX Holographic and Relational Models of Health

between the archetypes and determine the shared the homeopath. The response in the homeopath
behaviour and experiences of different races and reveals aspects of the collective unconscious that
cultures. It is interesting to consider how this is are important in the hidden case.
also reflected in the unconscious of non-human By exploring the emotional charge in the
animals (see Chapter 18), with some themes run- homeopath – and how this connects to the domi-
ning (like remedies) through all life forms, and all nant archetypes in the patient – the patient’s state
aspects of our ‘world’. and, indirectly, the remedy can be explored.
Different cultures recognise and name arche- An individual’s personal unconscious connects
types differently. They may be represented as to and reflects the collective unconscious of which
an aspect of the divine (Aphrodite), a star sign they are part. The more accurately the deepest
(Virgo), or as a type of behaviour (playboy, hero, inner state of the patient matches the collective
healer, warrior etc). Each of us has our own dif- unconscious, the better adjusted or more ‘nor-
ferent balance of complexes and archetypes. mal’ they are considered. This ‘normality’ is in
Complexes are likely to be more ‘individual’ and turn expressed in each culture’s ‘collective uncon-
so approximate to a more individual remedy state. scious’, through the myths, fables and fairy sto-
Archetypes often relate to states that are shared or ries that are embedded in that culture. Frequently
found in particular groups of people or at particu- we can see remedy pictures run through these
lar times of life. This explains why some remedy archetypes, e.g. the fairy princess (Phosphorous);
states present at particular life stages or in particu- the washerwoman (Sepia); the knight in shining
lar situations patients find themselves in, such as armour (Aurum or Patina); Cinderella (Pulsatilla),
the Pulsatilla and Calcaria child, the Sepia mother, etc. Some archetypes are more common in partic-
or the Natrum muriaticum widow. For this reason ular cultures and are represented by the polychrest
understanding the ‘typical’ remedy states of dif- remedies of that culture – these remedies are fre-
ferent stages of life can help in understanding the quently indicated and touch many aspects of both
remedies that are frequently helpful to patients the patient’s case and the collective unconscious.
at that stage of life and in recognising the truly
unique qualities of a case. Psychological Complexes
The homeopathic materia medica represents Examples of Jungian complexes that can help
concepts and states that may be likened both to the homeopath’s work include the shadow and
complexes and archetypes. The remedies often the anima and animus. The shadow contains
offer a ‘symbolic’ connection between the source those things that are not easily acknowledged or
of the remedy and the remedy picture. This adds expressed – mainly qualities the individual believes
to the subtle language of the homeopath, allow- are undesirable or unacceptable and therefore
ing them to distinguish between patients on not should be hidden from view. It can influence many
only their conscious and personal unconscious aspects of a patient’s behaviour and health; the
symptoms but also those aspects of the collective conscious disguising or witholding of information
unconscious that influence and ‘initiate’ the case. needs to be distinguished from truly unconsciously
In confused cases distinguishing between these hidden cases.
is important; by allowing the emotional charge The anima is the complex of female qualities
and feeling to surface, elements of the personal that exist in men. The animus is the male complex
unconscious, and hence the theme and remedy, in women. They provide a valuable model for
can be perceived. When the personal uncon- understanding the power and influence of sexual
scious is allowed to surface, and the linked emo- behaviour. When projected onto those the patient
tional charge is experienced in the patient, then is close to, they feed the world of passion, attrac-
Confused and
Hidden Cases

this emotion will not only be projected for the tion and dislike. They may be suppressed when
homeopath to detect but also cause a response in the expression of a feeling is taboo, leading to

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 The Personal and Collective Unconscious

sexual shame and guilt (given the historic cultural patients. For example, in England many patients
sexual repression, it is not a coincidence that two internalise their grief, especially the sadness of
of the three core miasms are related to sexually loss – the so-called ‘stiff upper lip’. Many patients
transmitted disease). They may then connect to present aspects of this essence and it is easy to see
the shadow to be ‘enacted’ – leading to abhorrent aspects of the remedies that have this theme, such
sexual behaviour such as masochism and sadism. as Natrum muriaticum. These remedies need to be
Understanding the influences of a patient’s per- particularly well known so that they are appropri-
sonal and collective unconscious can greatly help ately prescribed.
in explaining patterns of behaviour and symptoms In any culture, family, stage of life, or even
that would otherwise appear confused. Using psy- species in veterinary practice, understanding the
chological models that enable the homeopath to common complexes and archetypes, essence and
perceive what is otherwise masked is an important themes helps understand those confused and
part of working with hidden cases. hidden cases. Many of the polychrests have well
described fundamental essences with common
Archetypes and Symbols pictures that present in different environments or
‘It is not uncommon to find a “mirror that breaks, or stages of life, e.g. Sepia in downtrodden women or
a picture that falls, when a death occurs; or minor but at ‘hormonal’ times. Learning these is an impor-
unexplained breakages in a house where someone is tant part of deepening the homeopathic materia
passing through an emotional crisis”.’ medica.
C Jung Some circumstances of life are more favour-
able to patients with particular complexes or
Archetypes are often related to objects that have archetypes. In the same way, in some situations
a ‘symbolic connection’ to the ideas they repre- a particular remedy type may function well. To
sent. To the homeopath these symbols can be be a successful popular musician will require
intimately related to a patient’s remedy state a different remedy profile from being a librar-
(objects, acts, thoughts, feelings or situations) ian. Each remedy will fit a certain situation, but
and include the source material of the remedy health requires the ability to function in changing
itself. How the patient relates to these symbols, environments. In some ways being in a particular
even (or especially) unconsciously, provides situation ‘brings out’ the corresponding remedy
important information about the patient (and (Cicchetti 1993).
the remedy).
Some archetypes reflect qualities about how
we experience, or operate in, the world. We can REFLECTION POINT
use these to communicate complex ideas about ● How might dreams of an object or symbol point to a
each other and ourselves – so we might talk about remedy or group of remedies? After a homeopathic
the ‘angelic’ child or the ‘ratty’ child. When prescription how might dreams be affected? To what
patients enact these archetypes it is understand- extent is a changing environment important to you; how
able that they generate feelings in us; recognising is your vitality influenced by change and how does it
these can often reveal otherwise hidden aspects relate to creativity? How much does studying different
of a case. remedy pictures facilitate a good case history?
● In what way might Jungian complexes relate to different
Fundamental Essence thematic and miasmatic states?
Some psychological complexes and archetypes ● How does an understanding of archetypes, complexes
are so dominant in a particular cultural group and symbols linked to ‘the snake’ help you explain or
Confused and
Hidden Cases

of patients that they represent an essence and a remember common features of the remedy Lachesis?
corresponding remedy that runs through many

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 CHAPTER TWENTY SIX Holographic and Relational Models of Health

Cicchetti J 2003 Dreams, symbols and homeopathy,

Summary archetypal dimensions of healing. North Atlantic Books,
This chapter has brought us back to the central Berkeley
idea of there being different models of health Goleman D 1995 Emotional intelligence. Bantam
through which the homeopath can view people. Books, New York
Homeopathy bridges many different systems of
Jung C G 1979 Man and his symbols. Aldus Press,
health and borrows from many empirical sys- London
tems – but has resisted claiming its own diag-
Kubler-Ross E 1970 On death and dying. Tavistock
nostic model. While conventional diagnosis
Press, London
partially serves the pathogenic and biological
models of health, the ideas of psychotherapy Maguire A 2004 Skin disease: a message from the. Free
inform the understanding of more complex and Association Books, London
difficult cases. Psychotherapeutic concepts offer Saine A 2000 The method II. Lutra Services, Eindhoven
much towards an understanding of the holistic,
holographic and relational models. Confused
and hidden cases offer the greatest challenge to Bibliography
homeopaths and the rest of this section looks at Carlyon J 2003 Understanding homeopathy. Helios
these in more detail, building on the concepts Homeopathy, Tunbridge
introduced here – including the importance of Dossey L 1982 Space, time and medicine. Shambhala
situational, emotional and ‘living’ materia med- Publications, Boulder
ica; and the role of the homeopath in managing
Jung C 1970 Collected works. Routledge and Kegan
cultural and inherited factors in individual and Paul, London
groups of patients.
Schadde A 1995 Intuition, and dream-work. Am
Homeopath 2:100–104
Shore J 1999 The kingdoms in homeopathy: a prac-
References tical technique for everyday consulting. J Am Inst
Boyd W E 1923 Emanometer. Br Homoeopath J 13:55 Homeopath 92(4):236–242
Brien S, Prescott P, Owen D, Lewith G 2004 How Twentyman R 2004 Medicine, mythology and spiritual-
do homeopaths make decisions? Homeopathy 93(3): ity. Sophia Books, Forest Row
125–131
Whitmont E 1980 Psyche and substance, essays on
Capra F 1975 The tao of physics. Shambhala homeopathy in the light of Jungian psychology. North
Publications, Boulder Atlantic Books, Berkeley
Confused and
Hidden Cases

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CHAPTER TWENTY SEVEN

Emotional and Living Materia Medica

Materia Medica
David Owen

‘To know that what is impenetrable to us really exists, can match this closely to a remedy the case starts
manifesting itself as the highest wisdom and the most to become less hidden. Broadening our knowledge
radiant beauty which our dull faculties can comprehend of a wider range of medicines and developing a
only in the most primitive, symbolic form – this knowl- deeper understanding of medicines we may already
edge, this feeling, is at the centre of true religiousness.’ know helps ‘make sense’ of more cases. While an
Albert Einstein understanding of the miasmatic constellations and
the family map of remedies are essential tools in
this process, different homeopaths find a number
Introduction of ways to build both the breadth and the depth of
Dealing with more difficult cases requires a deeper their materia medica knowledge.
understanding of the patient, ourself and the rem- Experience of observing closely when a remedy
edies. Lack of understanding of any of these three has acted is a major factor not only of consolidat-
factors can, alone or in combination, cause a case ing knowledge but also extending your under-
to be difficult. In this chapter we will continue to standing. When this is shared and confirmed in
develop the way remedies may be understood. As the homeopathic community, as with the maps
deeper illness is treated it does, however, become of the different kingdoms and families, it leads
increasingly difficult to view the materia medica to a wisdom that the homeopathic profession
in isolation. This chapter looks at how knowledge as a whole can access. Ultimately the practice of
of the materia medica grows from experience and homeopathy is not just a technique, or a skill in
how remedies frequently relate to and follow each applying a technique, but a body of shared knowl-
other. It explores the importance of the emotions edge constantly evolving. This includes a relevant
and being ‘sensitive’ to the remedies to develop and effective materia medica that is dynamically
an emotional and ‘living’ materia medica; and dis- related to the skills of consulting, analysing and
cusses how this process relates to the homeopath’s managing patients. It reveals an interconnected
own development. and overlapping materia medica where not only
Ultimately the difficult case is just where the are the unique qualities of individual remedies
homeopath, patient and remedy do not fit neatly important, but also those features that run, like
together. Confused cases have many layers, each threads, through several related remedies. These
partially visible, but if a remedy is found that cov- insights are central to the differential diagnosis of
ers all the parts that are visible the case starts to remedies.
become less confused. A hidden case has impor- Just as emotion is an important component of
tant aspects masked, but if the homeopath is sen- a patient’s case, so is the emotional picture of the
sitive to other key information in the patient and remedies important. Appreciation of this requires

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 CHAPTER TWENTY SEVEN Emotional and Living Materia Medica

an emotional intelligence and competence in the

A theme of a circle
homeopath in order to develop an ‘emotional
materia medica’. The realisation and understand-
ing that certain remedies can generate certain feel-
ings in you is the basis of a ‘living materia medica’.
To move from the formal teaching of remedy types Plus a theme of a –
to the personal knowledge of remedies frequently Triangle Rectangle On no other theme
involves a shift in your perspective, which requires
support. If you choose to engage with this process
I would advise you to identify a trainer, mentor or
supervisor who can help.

Gives a –
Thematic Approaches Cone Cylinder Sphere
to the Materia Medica
If all we have is a hammer then everything looks
suspiciously like a nail.
The more remedies available and the more
information available about each remedy, the
greater the potential for the individualisation of
each patient to their simillimum. Recording this Figure 27.1 How themes build a picture
information in a way that can easily be used and
shared is a very real challenge to the homeopath.
Seeing patterns to the proving, toxicological can build an overall picture. The theme of a circle
and clinical symptoms is a way of extending and might represent a cylinder, a cone or a sphere, as
remembering the large amounts of data about each all resemble a circle from one view. From another
remedy available to us. It also allows one symptom angle or with the addition of another theme they
to reveal a pattern running through the whole pic- are less likely to be confused. We might, for exam-
ture. Some patterns or themes (see Chapters 21, ple, describe the essence of a cylinder as having
22) run like a thread through several remedies, the theme of both a sphere and a rectangle, the
shedding light on how one remedy is related to essence of a cone as having the theme of a circle
another. As much of this information comes from and a triangle. When studying remedies themati-
clinical experience some is better validated than cally it is the combination of themes that make a
others and there are issues about the reliability of remedy unique – what is not there is as important
the information. This is another area where per- as what is there. For example, if a circle has no
sonal experience and the ability to judge the reli- other theme it must have an essence of a sphere.
ability of your own observations are important.
As with all methodologies prescribing themati- Themes in Remedies
cally depends on the information in the case and ‘…When a person presents a peculiar symptom, a dream, a
remedy being matched accurately. The greater modality, or an experience, clearly, intensely and sponta-
the number of areas of the case and remedy that neously: find it directly in the materia medica or repertory;
match, the more likely the remedy will act. If see the feeling it creates and connect it with the overall
themes in the remedy cover several ‘angles’ or case; it is directly connected to the source of the remedy.
Confused and
Hidden Cases

themes in a case, then it is more likely to be accu- Any marked thing can be understood in this way.’
rate. Figure 27.1 represents how different themes Rajan Sankaran

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 Thematic Approaches to the Materia Medica

At different times in each patient different themes Changing Miasms

of a remedy are dominant and expressed. These We have already touched on miasms and their
can be thought of as representing the ‘life cycle’ of deep connection to the themes that run through
each remedy. In some patients the theme expressed cases and remedies (see Chapters 14, 17, 22).
most strongly will depend on the disease process, Miasmatic states develop not only because of the
in others it relates to the stage of life they are in. diseases suffered and suppressed within a popula-
A remedy may have several different themes that tion but also due to other more subtle forms of
themselves are related and a patient may express suppression and changes in susceptibility in a pop-
these in different ways, e.g. the theme of height- ulation. It is why some cultures are more prone to
ened sensitivity in Causticum may first show as certain miasms than others. So, for example, the
being impressionable, but later as worn out. Sepia Tubercular miasm relates not just to the suppres-
(Box 27.1) illustrates the way different themes can sion of tuberculosis (TB) but also to the prevalence
express themselves differently at different times. of TB within cattle. This correlates with the major
Building up the different themes and their industrialisation of agriculture, where ceaselessly
expression in a remedy will benefit from having wandering animals have been confined to limited
observed a number of different patients at differ- areas and subject to agricultural husbandry and
ent stages of life and with different illnesses. It breeding procedures that do not always have the
also helps to know how related remedies express animals’ best interests foremost in consideration.
their themes – the picture may also be reflected The miasms each culture is particularly prone to
in the way the source material of the remedy is will be reflected in all expressions of that culture
expressed in myths, and cultural and other uses and will change not just as disease patterns change
and applications. This information is added to but as that culture alters. In this way the art,
information from provings, toxicology and clini- music, architecture, values of a culture all reflect
cal experience. and inform the miasmatic status.

BOX 27.1
Sepia
A patient needing Sepia may at puberty be con- right but in which they are fatalistic and do
cerned about body image, after pregnancy have nothing about it.
difficulty bonding to their child, at the meno- Third, and I believe we are seeing more of this
pause feel ‘fagged’ out. now because of our cultural and social values, is
For Sepia, made from the ink of the cuttle- the individual who seeks to survive by detaching
fish, the underlying issue is reconciling the themselves from many ‘feminine’ aspects of their
male aspects of their nature. This is often more lives and throwing themselves instead into a few
difficult for a woman, so Sepia is more com- other areas of life – whether business pursuits or
monly indicated in women. It can show itself very focused physical endeavours. This latter pic-
in a number of ways including the ‘worn out ture is often seen in women who deny their femi-
washer woman’ who becomes a burnt-out and ninity and project themselves into activities that
exhausted type and eventually survives because take them away from sexual intimacy or family
she becomes ‘too tired to feel’. life to succeed. It includes some individuals who
Second, some Sepia patients escape into a find a ‘community’ or ‘monastic life’ eases the
Confused and
Hidden Cases

complaining nature, where the world is never reconciliation of the anima or animus.

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 CHAPTER TWENTY SEVEN Emotional and Living Materia Medica

Different ‘Maps’ of the Remedies help us to navigate through a case (revealing the
Identifying themes that relate to the kingdoms, patient’s totality and constitution on a subtler,
families and miasmatic groups to which remedies deeper level), but also add qualitatively and quan-
belong is one way of ‘mapping the territory’ of rem- titatively to how different parts of a confused case
edies (see Chapter 22). There are other ways, too, can be connected through a theme or pattern.
of identifying and ordering themes. Other systems Working emotionally, both with cases and with
and models by which we interpret and order our remedies, enables many facets of a big picture
environment often inform these. Understanding the with a vast amount of information to very quickly
remedies as they relate to the different elements of be connected and communicated. The emotional
fire, earth, water and air is one example. Another materia medica seeks to understand the key
is the use of colour. Yet another uses the astrologi- important feelings in a remedy, often connected
cal zodiac or phases of the moon. In each of these to important themes. (‘Feelings’ in this book is
models different themes can be found in the materia used to refer to ‘the emotions’, not the perception
medica to order and structure the diverse informa- or sensation of touch – although the connection
tion the remedies represent. A detailed evalua- between the two reveals a coherence in patient
tion of the pros and cons of these various ways of and remedy between the sensations experienced
characterising remedies is beyond the scope of this and the emotional state. One informs the other.)
book, but you are likely to come across them in Often it is the strongest feelings that relate to
your studies. Where these reveal or help you recall the deepest themes – these are the feelings we see
thematic connections they will usefully serve your expressed time and again in the remedy’s materia
own appreciation of and practical use of the mate- medica and in the cases of patients of these ‘rem-
ria medica in a thematic way. However, it is unre- edy types’. It is no coincidence that when a patient
alistic and idealistic to expect one way of looking talks about how a symptom ‘feels’ they often
at and comparing themes in remedies to suit all move from describing a sensation with words like
homeopaths or every remedy (‘Other relationships ‘it feels like…’, ‘it is as if…’ and ‘its quality is…’ to
of remedies’, see p. 377). expressing an emotion with words like ‘I feel…’, ‘
I am…’ (see Lucinda’s case).

REFLECTION POINT
● Reflect on the connection and symmetry between CASE STUDY 27.1
illness, the environment and the theory of miasms. Lucinda, aged 34, presented with severe vari-
What new miasms do you see developing now or in the cose veins and she had put up for years with
severe symptoms of premenstrual tension and
future? What remedies might these relate too?
diarrhoea. Asked to describe how her veins
● Reflect on a new or emerging illness. How does this
felt, she said: ‘they are irritating and feel as
illness relate to changes in the environment and/or even
if they are going to explode’. She then went
behaviour?
on to talk about her own irritability, anger and
frustration, saying, ‘I’m angry and ready to
explode’. She put this down to her stressful
Emotional Materia Medica job where over several years she had com-
Emotion is frequently connected to the expres-
peted with colleagues for promotion. Despite
sion of deep symptoms and can easily communi-
her irritability she ‘really wants to be liked’.
cate itself to the receptive homeopath. Frequently
When she said this she was near to tears.
a feeling in the patient – such as unexpressed
Inviting her to stay with her feelings she talked
anxiety, sadness, irritation, loneliness, jealousy,
for the ‘first time in ages’ about her adoption
Confused and
Hidden Cases

envy etc. – can point to an important symptom

and her feeling with her adoptive parents that
and theme in the patient. These feelings not only

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 Reflective Approaches to the Living Materia Medica

ter of where the case is expressed, and how the

‘they might send me back if I’m not good homeopath is attuned to the case and their knowl-
enough’. She says ‘I’m fighting to stay on top edge of the remedies. It is as if each new aspect of
of it all’. This started to make sense of her a remedy builds on the previous pictures you have
competitive nature and what might otherwise learnt, moving from what has caused a remedy
be a confused picture. She responded well to state, right through to what a remedy state can
Nux Vomica, a remedy state often established cause in you!
in children when there is a relative absence of When we develop our living materia medica it is
daily affection with a need to compete. It is informed by our own sensitivity. How we feel will
a state that can easily be generated in those inform how we relate to a patient; each remedy
who feel they have to compete for affection – will feel slightly different and generate a different
a not uncommon ‘boarding school’ remedy. feeling in us. However, for a particular homeopath
the feeling we experience with a patient suiting a
particular remedy is relatively consistent, as long
Reflective Approaches as the homeopath’s state is relatively consistent.
To work this way reliably the homeopath needs to
to the Living Materia Medica be aware of their own emotional make-up, which
Knowing yourself is the key to understanding the will be influenced by their own health.
living materia medica.
‘Living materia medica’ is about ‘how it feels to Importance of the Homeopath’s
be this remedy’. It frequently involves the homeo- Own Well-Being
path’s reflection on their emotional reaction to a The patients whom homeopaths find hardest (usu-
patient needing a particular remedy. It is generated ally the most confusing and hidden) are often mir-
in response to what is projected by the patient and/ rored in the remedies that are least well known or
or by what the homeopath projects reciprocally to those we most need to study. This is true not just
the patient (see Chapter 23). It is especially useful for the community of homeopaths and the reme-
when contrary feelings are expressed by the patient dies we need to develop but also for us individually.
(confused) and when the patient finds it hard to We will find it hardest to recognise the remedies
reveal deeper aspects of the case (hidden). that we are relatively blind to – these are likely to
As one might expect, there is a spectrum be the remedies we, personally and culturally, are
between the confused expression of the symptoms most likely to need ourselves. Remember – there is
in one or two aspects of the case on one hand a connection between you, the patients you attract
and the almost totally hidden case on the other. and the culture that patients and you live in.
There is accordingly a spectrum of approaches Perhaps in the same way as an Aurum (gold)
one might use in confused and hidden cases. It is patient will seek to keep gold or the equivalent
a simplification to say that all confused cases ben- as money and external markings of their value
efit from thematic prescribing and knowledge of around them, we as homeopaths must be alert
the ‘emotional’ materia medica, or that all hidden to the risk of dependency on what we receive
cases benefit from relational prescribing relying through the projections of our patients. If we are
on the ‘living’ materia medica picture. In practice unable to recognise cases they perhaps represent
both the emotional picture of the patient and the features of our own remedies.
living reaction of the homeopath are intimately The preparation and protection that allows
related and often perceived together – in the same us to be sensitive to the patient’s remedy state is
way as both are intimately related to the totality, important. It includes being well; having sufficient
Confused and
Hidden Cases

constitution, local symptoms and causes to which time, good boundaries, support and supervision
they are susceptible. Which is most useful is a mat- with difficult cases; and the ability to recognise

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 CHAPTER TWENTY SEVEN Emotional and Living Remedies

the features that belong to the patient and those channelled in a balanced way can be very healthy
that belong to you. for a business. The loyalty of the Aurum patient
is second to none. The determination of Calcarea
Studying Emotional and Living carbonica will carry through projects that would
Materia Medica otherwise never be finished. While these features
The teaching of materia medica is like breathing can all be problematic in some settings, in oth-
life into substances, bringing them alive. ers they are strengths. These strengths are just
Reading the materia medica introduces us at as important in pointing to an indicated remedy,
the simplest level to remedies and the sensations, but are often not well represented in the materia
feelings and signs that each might have. How you medica. A living, personal materia medica looks
feel reading the remedy and reflecting on what ‘life at the jobs different remedies excel at, the sort of
is like’ for this patient type is an important part partner or parent they are, etc. Every remedy has
of knowing the remedy. When a remedy is well positive attributes that compensate the negative
taught it brings to life aspects of the remedy, and and when treated these positive states are not lost
can through the projection that takes place create but rather a better balance is achieved.
a similar, if mild, state in the student. The emo- There are many examples of exciting and evoc-
tional state generated is, in fact, the projected rem- ative writers revealing the themes of the remedy
edy state acting in the homeopath. When treating pictures. The challenge for us when we are privi-
a patient in a remedy state it brings that state for- leged to work with these and difficult cases is to
ward in the homeopath, as if the patient’s remedy gain a greater personal insight not only to the case
is ‘proved’ on us. If you spend enough time with a but also into the remedies and ourselves. With this
Sepia patient it will elicit first your reaction to Sepia personal development allied to a personal materia
qualities, and then start to set up Sepia qualities in medica many confused cases become clearer and
you. This principle underlies how people ‘rub off ’ hidden cases more visible.
on one another, how pets and owners, parents and
children often grow in likeness and share qualities
of the same (or closely related) remedies. REFLECTION POINT
In addition to the keynotes, modalities, gener- ● Think of a remedy that you know well. What would it
als and mentals as reported in a variety of materia be like to live your life as that remedy, what sort of
medicas, your own personal materia medica will clothes would you like to buy, how would you socialise
include an awareness of the themes and emotional and work, and what would you do well and what sort of
states that commonly occur in those remedies in situations might trigger you becoming ill?
different situations. It will give an idea of patients, ● Think of a remedy you find hard to recognise, learn or
friends or characters in books or films that suit prescribe. What personal and/or cultural blind spots
this remedy, and how these make you feel, and might this represent?
will include your own clinical experience. It will
be an evolving dynamic record of a personal ‘liv-
ing’ materia medica.
Related Remedies
Positive and Negative Features Remedies do not act in isolation from the patient
As symptoms are usually presented as something state or the homeopath’s state. Remedies can be
the patient wants to be rid of, most materia medica understood by understanding their relationship to
are presented as the negative or unwanted symp- each other.
toms. Each remedy picture also has an equally Understanding how remedies relate to each other
Confused and
Hidden Cases

positive side. The ambition of Nux Vomica can be is an important part of the overall management of
the seeking of approval and affection – and when patients – especially when a series of remedies is

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 Related Remedies

necessary to help the patient to complete recovery, Remedies that Follow Well
and to offer comparisons of remedies that should be Homeopaths have historically noted how some
considered in a differential diagnosis. Recognising remedies follow others frequently and effectively;
the relationships of one remedy to another facili- they perhaps reflect the common levels of frequent
tates working with patients over a period of time, pictures observed in cases. This can help when
extending both the breadth and depth of materia deciding between several partially indicated rem-
medica. This is especially useful when working edies. At all follow-up consultations new observa-
with differential diagnosis if a full remedy picture tions about the patient, and any partial obstacle to
is not known. Given the absence of well docu- cure, must be taken into account before looking at
mented information about the holographic and a new remedy. It is dangerous to use ‘follows well’
relational picture of remedies (especially less well as a short cut, because although a related remedy
known remedies) it is of particular importance might be partially indicated there may well be
when using thematic and reflective approaches to others that are better suited.
treatment. In the new and emerging materia medi- Most lists of remedies that follow well are lists
cas, looking at remedies in families, it is particu- of remedies that follow the main remedy well. But
larly helpful and compliments what we know of in some materia medicas, for example Clarke’s,
the remedies from provings and other sources. there is a list of remedies that the named remedy
Sometimes just considering the related remedies will frequently follow. Often the remedies in both
will raise angles to the case history or case analysis categories are the same, and looking at the themes
that might otherwise not have been thought of. in the different remedies can give insight into a
Patients who are keen and ready to understand theme running through a remedy picture. Just to
their own case better may find it helpful to read confuse matters, however, remedies that follow
some materia medica themselves. Indeed, if used well sometimes also appear in the antidoting rem-
cautiously patients can make clear and helpful edy sections. But it is possible for a remedy in one
distinctions between remedies in their differential situation to complete the cure that another rem-
diagnosis and between related remedies. edy has begun, while in another situation the same
When making a second prescription, if a remedy remedy might antidote the first remedy.
isn’t a recognised complementary remedy but the
indications for it are clear, then you should not hold Complementary Remedies
back from prescribing it. If it is listed as an antidote A subset of those remedies that follow well will be
or inimical remedy then it may cause you to take a directly complementary to the action of the previ-
second look at the indications for it. Remedy rela- ously acted or partially acted remedy. Sometimes
tionships can be used as one of the features pointing these are called ‘synergistic’, as using one remedy
towards or away from the simillimum – but not as a after the other gives a better effect than using either
sole pointer to a prescription (Rehman 2004). remedy on its own. Frequently complementary
Many remedy relationships have been con- remedies are deeper acting remedies that are better
firmed clinically over time; some of the different known, so it may just be that they can be matched
relationships are described below. Some materia at a deeper level. In many cases complementary
medicas give lists of remedies that follow one remedies are the acute or chronic of each other. For
another well, and other relationships of remedies example, Natrum muriaticum is complementary to
as part of the materia medica (Gibson Miller Bryonia; it will often complete the action and deal
1993). Some repertories list the relationship of with the underlying chronic predisposition to the
remedies – using these in case analyses can pro- acute conditions that Bryonia cases present. It does
vide relative inclusion and exclusion information. not mean that all acute Bryonia cases will have an
Confused and
Hidden Cases

Boenninghausen drew up a list of remedy affini- underlying state that fits one of the complementary
ties, which he also referred to as concordances. remedies; rather, the complementary remedies are

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 CHAPTER TWENTY SEVEN Emotional and Living Remedies

slightly more likely to be needed and should be of Natrum muriaticum, Aluminium as the mineral
considered when looking at the chronic treat- analogue of Lycopodium. Interestingly, the min-
ment of a Bryonia state, although, of course, eral analysis of Lycopodium shows it as contain-
Bryonia might be the remedy that fits the case ing high levels of Aluminium. It is worth reflecting
at the deepest level, or that represents the most on the overlap of themes between the kingdoms –
fundamental layer. One remedy may have more that in one way all plant remedies will express
than one acute and chronic complement, e.g. part of the picture of their constituent minerals,
Natrum muriaticum is also a ‘chronic’ of Ignatia and that all animal remedies reflect the plants they
and of Apis mel. or their prey have eaten.
Sometimes complementary remedies share Certainly it is possible to see a simple theme
similar symptomatology. In confused and hidden or axis running through remedies made from the
cases where the deeper aspects of the case are not elements and to gradually discover more different
clear, the complementary remedies can hint at or but interconnecting themes in the salts, plants and
point towards a possible underlying state of the animals. In confused cases, as the remedy picture
patient, and allow this to be explored. becomes clearer the number of axes or themes
When reading the materia medica of comple- running through the case often reduce, at times
mentary remedies and those that follow well, it correlating with the remedy moving from animal
is often possible to identify shared themes or pat- to plant, to mineral salts, to elemental remedies.
terns that run through the related remedies. It This might be behind Hahnemann’s observation
is common for these shared patterns also to run that many cases end up needing Sulphur.
through botanical, mineral or zoological fami-
lies of remedies, and to run through other rem- Cycles of Remedies
edies related to the same miasm. Identifying the There is often a natural cycle of states that people
miasmatic tendencies in a case can help point will flow through in different situations, one natu-
towards complementary and remedies that follow rally flowing into another. Related remedies can
well. For example, in an allergic case that fitted reflect this cycle. So in grieving Ignatia often pre-
Phosphorous partially, there were several traits of cedes Staphisagria, which precedes Natrum muri-
the tubercular miasm; when other remedies in the aticum – correlating to the stages of denial, anger
tubercular miasm were considered a stronger case and sadness in the grieving process. Some cases
for Silica could be made. move through these cycles a number of times, giv-
ing a spiral or helical relationship of remedies.
Collaterals It is important to understand these remedy rela-
Collaterals are remedies that have a similar picture tionships as they tell us about the way cases often
but are not necessarily complementary or following unfold. One of the ways we can make sense of
well, such as Mercurius and Kali iodatum, Cina and complex and hidden cases is through an observa-
Chamomilla. These comparisons can, however, be tion of the spiral of symptoms that manifest over
useful in the differential diagnosis of cases (Sankaran a long period of time.
1975). They sometimes include remedies belonging Few homeopaths would use this cycle or order
to the same family (Arnica and Bellis perennis) or in the absence of clear indications, or hesitate to go
one remedy source containing high levels of another against the order in the presence of clear indications
(Colocynthis and Magnesia phosphorica or Sepia to the contrary. They can, however, be useful both
having Phosphorous and Sulphur in it). to illustrate how themes often develop and unfold
For some remedies there are collateral relation- in patients (and therefore need to be reversed), and
ships between the three different kingdoms: ani- also as pointers to how several remedies are often
Confused and
Hidden Cases

mal, vegetable or mineral – sometimes referred to indicated as part of a curative process. Examples of
as ‘analogues’, e.g. Ignatia as the plant analogue these cycles of remedies are given in Box 27.2.

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 New Remedies

cated remedy would not be a contraindication.

BOX 27.2
Prescribing an incompatible or inimical remedy at
Frequently Observed Cycles of Remedies
the same level as a previous remedy can cause the
●
Calc., Lyc., Sulph
case to become more confused and hidden. Take
●
Nux-v., Sep., Psor.
the example of an eczema case where Apis mel has
●
Bell., Merc., Hep.
acted partially. If Rhus toxicodendron is then used
●
All-c., Phos., Sul.
when the case is no clearer at a deeper level, the
●
Puls., Sil., Fl-ac.
Apis symptoms often return or the case generally
●
Sulph., Sars., Sep.
gets more confused. There are many other sug-
●
Caust., Coloc., Staph.
gested incompatible or inimical remedies observed
●
Ars., Thuj., Tarent
by different authors, but they should not stop a
●
Berb., Nux-v., Sars.
prescription if a remedy picture is clear and seen
●
Ign., Nat-m., Sep.
deeply. If, however, two incompatible or inimical
●
Bell., Nux-v., Sars.
remedies are equally indicated in a case, often a
●
Acon., Spong., Hep.
deeper level of understanding will reveal which
of them is best suited, or another layer of the case
may be seen pointing to a different remedy.
Antidotes
Remedies may be antidoted by other remedies (see Other Relationships of Remedies
Chapters 15, 16). It is possible that the benefits of There are, of course, many other ways of not-
one remedy will be partially lost if followed by ing and using remedy relationships in prescrib-
an antidoting remedy. Others suggest that using a ing. Different homeopaths and different schools
homeopathic antidote for an aggravation caused of homeopathy have their favourites. Some will
by a remedy can resolve the aggravation without cross reference to other health care systems (e.g.
stopping the healing process (see Chapter 15). My the five element theory), others to ways of under-
experience is that if a deeper picture is revealed standing the body (e.g. the chakras). Each in their
after one remedy, the next remedy can be given own way is an attempt to see the patterns in an
with no worry about antidoting. If on the other otherwise difficult case and to see relationships
hand a remedy acts partially but no deeper picture between remedies and sometimes indicate other
is seen, then prescribing on the remaining symp- remedies that would otherwise not be consid-
toms (if just as superficial as those treated by the ered. These systems are outside the scope of this
previous remedy) it is likely, if the second remedy text, although you are advised to look into some
acts, to lead to a loss of the partial response to the of them as they can provide helpful pointers and
previous remedy. Knowing the antidotes to a rem- management approaches, particularly in confused
edy reinforces the need to make sure a follow-up and hidden cases. One such system is the bowel
prescription is only given when a deeper picture nosodes that I have found useful in managing
is obtained. Some remedies have many reported cases where several remedies appear equally indi-
antidotes, others only few. cated or where there is a lack of reliable symptoms
(Paterson 1950).
Incompatible or Inimical Remedies
Incompatible or inimical remedies are those that
are recommended not to be prescribed in succes-
sion. However, it is quite possible to see a patient
New Remedies
at follow-up or to re-take a case and to see a rem- As you seek to work with more confused and
Confused and
Hidden Cases

edy that previously was not visible. In this case, hidden cases you will discover a tension between
knowing that it was inimical to a previously indi- expanding the breadth of your materia medica by

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learning new remedies and exploring in greater that made from magnetism have been used since
depth the remedies you already know. Both are the time of Hahnemann.
important and can be combined – but the exact The extension of the materia medica into new
balance is a matter of individual choice and may remedies and the understanding of old remedies
well evolve and change during your career. in new ways is connected to our ability to use this
information. The extension of the homeopathic
Reframing the ‘Living Materia Medica’ art from the grossest causes and symptoms into
‘We don’t do homeopathy, but we co-operate with the the deepest aspects of a patient’s psyche requires
process of homeopathy.’ an understanding of the materia medica from the
Anne Clover most material of effects to the subtlest influences.
Sometimes new remedies bring with them
As patients’ understanding of ‘the self ’ has evolved, an appreciation of subtle points of difference in
so too have their expectations about health. established remedies that would not be distin-
Homeopathy has reacted to this by deepening guished otherwise. For example the remedy Lac
the way we understand our remedies through the caninum from dog’s milk has been used for many
development of holographic and relational models years. Proving of other animal milks has revealed
of health. In the art of homeopathy while rem- important and subtle differences between these
edies might traditionally have been thought of as remedy pictures and provided a new comprehen-
the colours on the homeopath’s palette, they can sion of the thematic and reflective aspects of Lac
also now be thought of as a ‘living installation’. caninum.
The voice, actions, even the intentions of the artist New remedies often fill important gaps in the
while at work, influence how the art is conveyed materia medica. For example, when we consider
and seen. Seeing the remedies as part of a living, grief remedies there appears a group of patients
evolving materia medica is one of the greatest tools that seem to be grieving something internal, some-
you have to counter the relatively limited and fixed thing that may never have happened externally to
perspective that causes cases to appear difficult or them. Ignatia helps this grief but it may only seem
even incurable when they are just many layered to act at a superficial level. The proving of Cygnus
(confused) or hard to see (masked and hidden). olor, the swan, has shown a remedy that can often
act in this type of grief much more deeply.
What Can Be a Remedy?
In the same way as no two patients are identical, How Information on New Remedies
so no two patients will present exactly the same is Obtained
need. If we take everything in the universe as rep- The student homeopath should be aware that
resented by a point, then the information of that not all sources of information about remedies are
point is unique. Possibly each point could be a equivalent. Some authors, for example, recount
remedy. For example, a remedy may at a subtle dream provings or meditative provings (see
level be influenced not just by its plant, animal or Chapter 2). Some include the effect of the proving
mineral origin but also by where it was obtained, on those around the prover. This innovative type
the time it was collected, perhaps even the inten- of proving is regarded with suspicion by more tra-
tion of those who prepared it. As remedies are ditional homeopaths, but as long as the source of
understood as more energetic than matter so it the information is given for any proving data, the
becomes easier to recognise how remedies may practitioner can decide on its usefulness and reli-
be made from electricity, moonlight, colours or ability. Some repertories and materia medica now
sounds – the so-called imponderables. These pres- indicate the origin of each piece of information.
Confused and
Hidden Cases

ent challenges of standardisation and have not If we return to the idea of illness (or remedy
always been proved fully, but remedies such as state) as lacking certain information (see Chapter

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 New Remedies

6) then patients may either seek to manipulate their recognise in ourselves. In practice, we recognise
situation in a certain way, so they can function in it in patients remedy states that we in some way
with the information they have or seek to draw the know ourselves. When we study we merely con-
information to themselves in some way. This may be nect to what is already inside us, we rediscover
why patients are drawn to certain plants, minerals things. Hence the feeling of discovery mingled
and animals that relate to their remedy – the Aurum with familiarity when learning new remedies –
case drawn to gold, the Sepia patient who may but also the potential for inaccurate perceptions if
love the colour sepia, the Coffea patient craving working with remedy states we are unconscious or
coffee. As we broaden our understanding of the unfamiliar with.
remedies we begin to recognise that all the infor- If we consistently find it hard to recognise a
mation in a remedy picture can be interpreted as remedy, then we should reflect on what we may
a pattern or essence – every aspect of the environ- not be seeing in ourselves. These ‘blind spots’
ment that a patient in a remedy state lives in reflects can often be detected when sharing difficult cases
something of the remedy state. This tradition of with colleagues and provide opportunities for the
seeing a connection between our environment and homeopath to develop. In some ways it is possible
the remedies we might need runs through many to see the difficult patient as representing some-
indigenous medical systems, from herbal cures to thing the homeopath needs to recognise, and the
shamanic healing. The greater the affinity for that same difficulty may be drawn to you repeatedly
substance in ourselves or in our culture, the more until it is recognised.
likely it is to be useful as a remedy.
Remedies as Vectors
Remedy and What Is Absent One way to think about the remedies is as an infor-
By considering susceptibility to illness as being mation vector, each with their own uniqueness
similar to lacking certain information, then we can represented by the ability to move a case a certain
see health as being the presence of all the neces- distance in a particular direction. Figure 27.2(a)
sary information. A remedy state can therefore be illustrates a remedy as a vector that is capable of
thought of as having all the information ‘minus’
that which is lacking. I invite you to consider that
a remedy state might be helpfully understood as, A B
on a subtle level, having all the other remedies
except for the remedy needed. This is the same
as when we see a colour – what in fact we are A

seeing is the visual spectrum without that colour

(the colour is actually absorbed and all the other
wavelengths reflected). Maybe in the same way as Patient before Patient after Remedy as
remedy remedy vector
when we see the colour red we see all the other
colours because red has been absorbed, when we B A B
see the remedy Pulsatilla it is because Pulsatilla is 1 remedy
held in the patient and we are seeing everything
but the Pulsatilla-ness.
2 remedies
Health, then, is a combination of the informa-
tion from all the remedies necessary in a particu-
lar situation. This would be consistent with the 3 remedies
idea that when we recognise something in others
Confused and
Hidden Cases

it is because there is some recognition of it in our-

selves. We cannot see in others what we cannot Figure 27.2 Remedies as vectors

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 CHAPTER TWENTY SEVEN Emotional and Living Remedies

‘moving’ a patient from state A to state B. Figure an emotional and living materia medica. That, in
27.2(b) illustrates how one, two or three vectors turn, makes the remedies more personal. It raises
might combine in moving a patient in a particular many interesting and important questions for us
direction for a particular distance, from A to B. and invites a reinvestigation of basic homeopathic
A further development of this model is that the principles.
vector representing a remedy may differ depend- Remedies can have both a material effect and a
ing on the potency. In a higher potency the vec- subtle effect – understanding the remedies in the
tor might be thought of as longer and thinner different models of health can help in separating,
(needing to be more accurate), in a low potency in understanding and in learning their broadest
as shorter and broader (with a wider range of picture. Of course, in one way this separation is
action). High potencies are sometimes thought of artificial and each aspect of a remedy manifest in
as ‘rifle shots’ compared to the ‘shot gun’ of a low one model of health parallels the others.
potency. Lower potencies may also need repeating It is an exciting time to be studying homeop-
several times to ‘go as far’ as a single high potency athy and materia medica, so we must be aware
remedy. of how our own state will colour our objectivity.
There are many ways of developing and extend-
ing your understanding to help you explore and
REFLECTION POINT extend the materia medica – not only for your
● What is the most useful way for you to develop your own practice but also for the profession of home-
knowledge of emotional and living materia medica? opathy as a whole.
What can you do to extend your theoretical knowledge Working with confused and hidden cases helps
of the remedies so that you start to understand how in seeing the remedies as dynamic, feeling and ‘liv-
those remedy types might relate to you and how they ing’ entities. Supervised clinical practice and sitting
make you feel? in with experienced homeopaths are important
● Reflect again on how remedies can bring out a remedy experiences for developing your knowledge; as
state in you when you are taught them and study them is your gradual introduction to managing increas-
(remember that in a healthy state we might contain all ingly confused and hidden cases.
the remedies). How does studying the remedies help in By knowing the remedies in more detail and
your personal development and how will it influence the in a broader range, it is surprising how often a
way you approach cases? difficult case that would otherwise be confused
● When you consistently fail to recognise the need for a or hidden reveals itself simply as a multi-layered
particular remedy, or when you regularly see a particular case. If one layer is taken at a time the confusion
remedy indicated in lots of patients, what does it tell you in the eyes of the beholder can diminish. When
about your relationship to that remedy state and indeed you can perceive the case sensitively, and incor-
your own remedy? How will you address this? porate your own reaction to the patient as a living
materia medica, the hidden case can be unveiled.
Understanding our materia medica in new ways
opens up a case that would otherwise be impos-
Summary sible to treat – and would in the past have been
As we might expect when we start looking at the called incurable.
materia medica in terms of energy, information,
emotion and life experience, the solid foundations
start to move slightly. Understanding the remedies
as entities that both have coherent themes and References
Confused and
Hidden Cases

patterns within themselves and create an effect Gibson Miller R 1993 Relationships of remedies.
on those who perceive them is part of developing Homoeopathic Publishing Company, London

380
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 Bibliography

Paterson E 1950 The bowel nosodes. Br Homoeopath Henrrick N 1998 Animal mind, human voices.
J XL No3 July Hahnemann Clinic Publishing, Nevada City
Rehman A 2004 Encyclopaedia of remedy relationships Sankaran R 2002 An insight into plants, vol I and II.
in homeopathy. Thieme, Stuttgart Homoeopathic Medical Publishers, Mumbai
Sankaran P 1975 The clinical relationship of homeo- Scholten J 1993 Homeopathy and minerals. Stichting,
pathic remedies. Homoeopathic Medical Publishers, Alonnissos, Utrecht
Bombay
Scholten J 1996 Homeopathy and the elements. Stichting,
Alonnissos, Utrecht
Shore J 2004 Birds: homeopathic remedies from the
Bibliography avian realm. Homeopathy West, Berkeley
Bailey P M 1995 Homeopathic psychology. North Vithoulkas G 1980 The science of homeopathy. Grove
Atlantic Books, Berkeley Press, New York
Clover A 1990 Homeopathy reconsidered – a new look Vithoulkas G 1988 Essence of materia medica (Indian
at Hahnemann’s Organon. Victor Gollanz, London edition). B Jain, New Delhi
Coulter C R 1986 Portraits of homeopathic medicines, Zaren A 1993, 1994 Core elements of the materia med-
vols I and II. North Atlantic Books, Berkeley ica of the mind. Ulrich Burgdorf Publishing, Gottingen

Confused and
Hidden Cases

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CHAPTER TWENTY EIGHT

Understanding the Dynamic The Case

of Confused and Hidden Cases

David Owen

‘The meeting of two personalities is like the contact of What is not said becomes more important, as
two chemical substances: if there is any reaction, both does the influence of the patient’s family, com-
are transformed.’ munity and culture. The limitations of our per-
C G Jung ception due to our own bias and attitudes shape
what we perceive and how clearly we see the
patient (see Chapter 23). Understanding ourselves
Introduction is a prerequisite to understanding our patients.
Complex cases that do not heal (especially if the Confused and hidden cases provide the homeo-
cause is maintained or symptoms suppressed) path with the opportunity to understand the case
gradually become more deep-seated. As the case (and ourselves) in a dynamic way. This explains
goes deeper it often appears more confused. As the patient in terms of themes, layers and projec-
less and less reliable and individualising informa- tion – where what happens in one area of the case
tion is expressed it becomes hidden. As the case is ‘holographically’ reveals the underlying patterns
internalised it moves into the deepest realm of the in the case and where what is projected, reflects
individual, leading eventually to functional and what is masked.
structural symptoms. If, in turn, the symptoms are Exploring the deeper aspects of patients’ cases
suppressed, then new susceptibility patterns are set in this way leads naturally to an exploration of our
up – leading eventually to hereditary predisposition own nature. The influence of what is projected on
in subsequent generations (see Chapters 15, 17). to you, and those things you are unconscious of in
Patients view and shape their environment yourself, will colour what you see and how you act.
according to their state, including the treatment How we manage ourselves and our own health is
and even the homeopath they choose. Every aspect vital to working well and sustainably. Your ongoing
of the patient’s life situation reflects something of education, support and development opportunities
them. In any family, community, tribe or race the are all vital to working competently and success-
values and behaviours projected by its members fully (see Chapter 25). While your early training
will determine what that group considers normal. will be focused predominately on your personal
From this perspective of normality those illnesses knowledge and skills (and attitudes), as you start
that have contributed most to the unconscious managing more difficult cases the context in which
norms will be least apparent and most hidden. you practice becomes increasingly important. As we
When the actual case is confused or hidden from take up a place alongside others working with the
the homeopath then we must look at our patients health of the individual, and have insights to share
in new ways to notice such things and work with and learn from in the communities we serve, so
their cases. the organisational structures we operate in and the

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 CHAPTER TWENTY EIGHT Understanding the Dynamic of Confused and Hidden Cases

professional bodies we belong to become increas- are not able to tell several possible similar rem-
ingly important. edies apart, it is just a matter of giving the analyses
more time and comparing the differential materia
medicas. In many cases that at first appear chal-
The Difficult Case lenging, it is just a matter of lack of materia medica
‘I have often been asked to prescribe in cases where the knowledge, incomplete case-taking or inaccurate
symptomatology was beautifully presented but not an case analyses.
idea could be drawn from it to betray the state of the In other cases that appear difficult it is because
patient … The case is incurable until it can be taken in a the homeopath’s or patient’s expectations are
manner to present what is true of the patient.’ unrealistic. You may just be working outside of
J Kent, Lesser Writings your competence zone. A complex case may just
take time to respond or have a number of levels of
In an ideal world all homeopaths would be able symptoms that each need treating in turn. These
to decode the pattern of illness in all cases. The are fundamentally different from confused cases,
reality is that some homeopaths see some cases where what is happening in the different layers
more clearly than others and what is difficult to of the case distorts what can be seen, and from
treat in one approach is easier with another. Any hidden cases, where much of the case exists in
cases will be difficult if you do not know the rem- the unconscious. Now and again after proving or
edy or how to find it, and these cases will present learning new remedies it is possible to see what
your greatest challenges and biggest opportuni- would otherwise be confused cases as just com-
ties. Of course what can start out seeming to be plex ones, where a single totality encompasses all
a simple or complex case may transpire, as new of the otherwise confusing layers in the case.
information emerges or as the case changes, to When there are several diverse symptoms that
be a confused or hidden case. The experienced fit no clear totality, then it is often possible to see
homeopath will move between different models a theme or pattern running through the symptoms
of health to understand the case and seamlessly that reveal several layers of the case. It may be
‘blend’ approaches to treatment and methods of necessary to treat these layers one at a time, allow-
prescribing to find the simillimum. But it is impor- ing the patient to gradually get more in touch with
tant to recognise that while each prescription rep- the deeper aspects. Often it is through enquiring
resents a point in the treatment process that may about a patient’s sensory aspect of a symptom that
be curative in practice, more difficult cases need the patient’s emotional feelings and the deepest
to be understood and allowed to reveal themselves patterns in the case are revealed, as Beryl’s case
over time – and may need a sequence of remedies illustrates (Case Study 28.1).
that each move the case in a healing direction. Ironically, once the deepest theme running
If we know just a few common remedies, then through a confused case is seen, or what is being
any cases that present outside the pattern of these projected in a hidden case is revealed, the case is
remedies will be difficult. Expanding your knowl- no longer so confused or hidden – although it may
edge of the materia medica is the starting point for take some time to clear completely. Put simply, the
working with those cases where the picture and its confused and hidden case is an internalisation of
evolution are perfectly clear, but you just do not the illness – the initial job of the homeopath is to
know the corresponding remedy picture. When let it surface. This sometimes requires a cautious
there is no confusion or ‘hidden-ness’ but you just reduction of the suppressive or palliative treat-
do not know the materia medica needed then it is ment to see what symptoms emerge. While there is
just a matter of studying harder. In patients where a continuum between the complex, confused and
Confused and
Hidden Cases

the case history has been incompletely taken, then hidden case, it is helpful to think of them in differ-
it is just a matter of re-taking the case. When you ent ways as they each require a slightly different

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orientation to the case and a slightly different the same way as several different sounds made
focus of the treatment. However, the factors rele- at the same time create a confused noise or one
vant to each impinge on the other and it is helpful sound is ‘drowned out’. If the sound can be under-
to build up your competence gradually, dealing stood as coming from several different individuals
with increasingly confused and hidden cases as or instruments, then a pattern behind the confu-
you become more experienced. sion may be seen and heard. In a confused case
there are several levels of symptoms and layers of
themes that need to be teased out. Recognising
Untangling the Confused Case these different layers and levels is like recognis-
Understanding the patient must come before decid- ing the different instruments and the different
ing the remedy. strands (harmonic motifs) that might run through
In confused cases there are many symptoms an orchestral piece. If you can only recognise one
that have no clear pattern or appear to lack a clear instrument or strand, appreciation of the music
hierarchy. Sometimes the different symptoms will will be more difficult.
include contradictory qualities and modalities – in Occasionally one remedy that fits a particular
theme will cure the case and go straight to the cen-
tre. Initially each layer may appear unrelated, but a
CASE STUDY 28.1
carefully taken case can sometimes reveal an obvi-
Beryl, age 68, presented with difficulty sleep-
ous and clear pattern. In looking for ‘the centre
ing, general tiredness, multiple joint pains and
of the case’ homeopaths aim to get to the heart of
increasing anxiety since her hip replacement
the matter – the fundamental source of the distur-
(after she had tripped on an uneven pavement
bance in each individual patient. In confused cases
and fractured the hip) 6 years previously. She
the centre of the case may just not be visible but
had been on sleeping pills for 6 years. She
the intention is still to perceive the case as deeply
had a lot of pain that necessitated walking
as possible. What may appear at one consultation
with a stick and was using regular anti-inflam-
as the centre of the case may, in fact, be covering
matories that gave her indigestion, that was in
a deeper level of disturbance. During a period of
turn being treated with drugs. When asked to
treatment things that were initially unconscious or
describe the pain she was unable to describe
not apparent at all may surface.
it accurately – as if she was reluctant to get
Themes are expressed and noticed in a num-
in touch with it. She responded initially to
ber of ways. They may run through the case as
Aconite 30 and Valerian tincture that helped
specific or similar words, phrases, movements
her anxiety and sleeping.
or sounds that the patient uses a great deal. For
At follow-up she was able to reduce her
example, in a case requiring the remedy Secale
sleeping pills. At a subsequent visit, when she
(from a mould), the words blast, stink and rotten
was invited to think about the sensation and
appear. A Phosphorous patient might use visual,
feeling in her leg, she described it as feeling
insightful and ‘sensitive’ words and expressions.
like the leg might break again at any time, ‘as
These themes are increasingly represented in the
if it were made of glass’. She became fearful
thematic materia medicas (see Chapters 22, 27)
while talking and said that since her fall she
and emerging from searching the materia medica,
had been ‘worried about everything’, ‘obses-
made easier by computers (see Chapter 19) and
sive about the smallest thing’. Silica was pre-
from clinical experience. As more homeopaths
scribed cautiously (due to its reputation for
work this way so the detail in the remedy, and case
exuding foreign bodies); over several months
pictures that can be used this way, are increasingly
her symptoms and general health improved
Confused and
Hidden Cases

being recorded. As little known remedies become

and she reduced her drug treatment.
better known, so we find that they do, in fact,

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cover many cases in which we would otherwise be between the situation and the patient’s symptoms is
unable to see a simillimum. vital to understanding confused cases. For example,
someone who is expansive will be fine while they
The ‘Common Thread’ can continue to expand and flow in their life, but
In the holographic model of health every aspect of if they are in a contracted or constrained life situ-
the patient and their interactions tells us something ation, perhaps from poverty, then they will get ill.
of their real nature. The homeopath is part of the Here the ‘activation from poverty’ is an important
tapestry on which the patient plays out and projects symptom. Someone who is very self-contained
their themes. The pattern underlying the themes will be fine while they are in an environment that
represents a thread that connects the themes, but allows them to remain sheltered and protected, but
also can be thought of as a connection between the when they are vulnerable or required to be expan-
internal themes and every part of a person’s exter- sive they may get ill – so they may have aggravation
nal life. It is these we are referring to when we from or fear of crowds. Due to the speed at which
talk of ‘cutting the ties’, ‘no strings attached’ and patients’ lives can change, symptoms can be con-
being ‘tied down’. The themes can be thought of fused because patients may move rapidly, and quite
as having at least two threads, both a unique sensa- profoundly, from one situation to another.
tion (feeling or essence) and also a ‘verb’ or ‘pace’ Part of managing these cases is to gather informa-
(order or mode). When working thematically (the tion about how they function in different situations.
level of the vital sensation in Sankaran’s hierarchy For a patient who avoids a certain situation (palliation)
see page 69 and Chapter 22) we match the case to that would otherwise cause symptoms, the homeo-
the materia medica not just on the qualities of the path can invite the patient to imagine they are in that
sensation but also the order or pace with which it situation. For example, a patient with a fear of heights
is expressed. These two qualities reflect the two could be asked to imagine they are in a high place and
axis of family and miasm used for classification of to explore how that feels both as a sensation and an
remedies in Chapter 22. Sensation and emotional emotion. Taking the complex case is both about estab-
feelings are like two sides of the same thing. As lishing the deepest themes and about those that run
the sensation becomes more vital to the patient most broadly. Hence we talk of layers that intertwine
so the emotional feeling connected with it and through a confused case, rather than merely levels of
released when discussing it becomes more central symptoms (see Chapter 6).
to the case. As the symptoms sink into the more
functional and structural aspects of the case, so the Suppression
sensations become more difficult to elucidate. At The more suppression there has been, the more
the same time the emotional feelings become more layers there are likely to be – and the more con-
ingrained and projected by the patient, offering fused the case is likely to be. There is a significant
opportunities to perceive the case. As this happens difference between taking the case of a child who
patients increasingly projecting their symptoms manifests a chronic symptom and has had no sup-
onto their world including the homeopath causing pressive treatment compared with one who has
greater and greater transference and counter-trans- had much suppressive treatment. Equally, there is
ference. Generally as cases get more deep-seated so much difference between treating chronic symp-
understanding the feeling and the projection gets toms in someone with a healthy, balanced fam-
more important. ily history, compared with someone with strong
miasmatic taints.
Periodic Disease and Symptoms Frequently those symptoms and syndromes
Some confused cases are due to periodic symptoms, that have received the least suppressive treatment
Confused and
Hidden Cases

where symptoms come and go depending on the sit- give the least confused picture. This is why in
uation the patient is in at the time. This relationship patients presenting physical symptoms that have

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been treated allopathically or antipathically it is other symptoms may emerge in the consultation.
often in the psychological sphere that the case A choice then has to be made, with the patient, on
is clearest (including the emotional feeling). For the focus of the case and treatment. Initial treat-
those presenting psychologically and who have ment might focus on the diarrhoea, or on the total-
been suppressed by psychiatric drugs the physical ity, or explore the themes in the case that perhaps
symptoms may be the clearest indicator (includ- connect with deeper issues the patient wants help
ing the physical feeling or sensation). Inviting the with. If a deeper picture is to be explored the case
patient to discuss symptoms in areas of the case may need to be re-taken. The hope is that after
that ‘do not bother’ them often requires a greater treatment the patient will have undergone trans-
degree of explanation and an openness to see the formative healing at a much deeper level than they
broader implications of homeopathic treatment – ever intended when they first sought help for their
as does recognising the need to sometimes reduce diarrhoea.
drug treatments to establish a clear picture.
Retaking the Case
Deepening the Case We only understand the remedies as well as we
‘A sigh might tell you more about the deeper aspects of understand our patients, and vice-versa.
the patient (and the patients willingness to go deeper) Each model of health presents a slightly differ-
than any words.’ ent view of the optimum consultation. Seeking the
themes and sensations in a case or even recognis-
The importance of good rapport and empathy, ing and processing the projections going on will
allowing the case to be discussed at a greater depth, require a different focus from seeking the ‘cause’
has already been discussed but presents particu- or ‘presenting symptom’, or even the ‘totality’ and
lar challenges in confused and hidden cases (see its hierarchy. As the case unfolds within a consul-
Chapters 13, 25) tation, or at different consultations, choices about
As the carer demonstrates their ability to ‘hold’ where it is going and on what it is focusing are
the patient’s distress and symptoms, so more is able constantly taking place in the homeopath and
to surface – sometimes including problems and patient. Many of these flow naturally, some (e.g.
symptoms the patient did not initially intend to whether the case needs to be re-taken) are more
reveal, or indeed was not conscious of. If empathy conscious decisions.
is high, then the patient is more likely to feel able Re-taking the case allows new information to
to both ‘get in touch with’ and share distressing and emerge, and may bring out qualitatively different
deep-seated symptoms. This revealing of deeper information from the previous case. Moving from
information may be enough to clarify a confused one model of health to another when seeking to
case. While this deepening of the case can shed light understand a case can mean changing and blend-
and clarify a confused case, it can also sometimes ing different consulting styles. When a patient is
lead to deeper aspects emerging that seem paradox- seen by two different homeopaths it is not uncom-
ical and can make a case more confused. As cases mon in more confused and hidden cases for quite
unfold we may therefore see confused cases becom- a different case to emerge. A practitioner using a
ing clearer and complex cases appearing to become thematic approach can often ‘make sense’ of a case
confused. A patient might at different times move that a practitioner using a symptomatic, or even
through the different types of case – even mov- totality, approach would find impossible. In the
ing backwards and forwards as deeper issues are confused case a thematic approach may be cura-
revealed and healing at different levels takes place. tive or clarify the case so that after several layers
For example, a patient may present with a have been peeled away a new simillimum based
Confused and
Hidden Cases

simple case of diarrhoea, but a deeper more com- on the totality, or even on a presenting symptom,
plex case with allergies, familial susceptibility and causation, or mix of these can be perceived.

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At times the contrast between the different case Using the Emotions
histories that may be elicited from a patient can Perceiving emotions means knowing your own
be extreme – this fact itself sheds light on what is emotions as well as those you are observing.
happening in the case. A good prescription based Everything the patient ‘brings with them’ to
on a theme or miasm may mean a confused case the consultation is of relevance; not only are all
that seems to be ‘all over the place’ re-presents the physical senses important to the homeopath
with great clarity. Remember, re-taking a case but also the ‘emotional sensitivity’. Often the
not only informs us about the new state of the deepest themes in a case connect to the emotions
patient, but can also be used to inform, educate the patient feels – this, in turn, connects with the
and develop our knowledge of a remedy that has emotion the homeopath feels. Hence the impor-
acted. Hence your study of materia medica goes tance of asking the patient not only ‘what is the
hand-in-hand with your case experience. In some sensation’ of a symptom, but also ‘how does it
cases retaking the case suggests different remedies feel’ emotionally when they have this sensation.
that can ‘unlock’ a stuck case, as Linda’s case illus- Reflecting on the physical sensations you have
trates (Case Study 28.2). while taking a case and on how you feel emotion-
ally can guide the case, especially when working
relationally.
Remember – the deeper the theme runs in a case
CASE STUDY 28.2 then either the stronger the expressed symptom
Linda presented with a persistent skin or the more the projection that takes place. The
rash and had been seen by two previ- stronger the projection the stronger the emotional
ous homeopaths over a number of years. feeling. Experience of interacting with patients
She had responded to both Phosphorous and noting the sensations and feelings is one of the
and Lachesis in the past but presented most important parts of the training of the homeo-
in a Pulsatilla state with strong features of path who wants to work with confused cases.
the other two remedies. It was agreed that Often a consultation only gets going when tears
at the next consultation the case would be or laughter are expressed; when they emerge, they
re-taken and the psychological themes par- are often defining points in the case history. The
ticularly explored. She spoke spontaneously release of emotion often coincides with the best
about her psychic and emotional sensitivity time to glimpse the patient’s projections.
as a child. When her brother had been ill she
had been the one that had been expected to Common Pitfalls in Confused Cases
take responsibility for caring for him. As she It is often not easy, in practice, to work with con-
describes this, her shoulders sagged and fused cases. There can be elements of both the
she grimaced. The homeopath could feel the complex case (a lot of diverse information) and
sense of weight on her shoulders. Linda felt elements of the hidden case (important symptoms
responsible for keeping everything together often masked). Some of the common difficulties
in the family and felt deep resentment about that arise are noted in Box 28.1.
it, which was mirrored in her deep resent-
ment about her skin – ‘Why me?’. After
Staphisagria, based on this theme and sev- REFLECTION POINT
eral keynotes, she reported it ‘gave me more ● Reflect on how you identify and approach confused
energy’. She developed two new keynotes cases. What aspects of working with confused cases
of Phosphorous that then acted more deeply (Box 28.1) do you find hardest and how might you
Confused and
Hidden Cases

than before. address each of these in your own practice?

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it is the homeopath who is unconscious of what is

BOX 28.1
being expressed in a case.
Common Pitfalls in Confused Cases
●
Viewing the case too pathologically or too
The Apparently Hidden Case
psychologically
A common cause for a case to appear hidden is fail-
●
Thinking all complex cases are confused
ure to communicate clearly, such as a young child
●
Failure to agree with the patient what has
being unable to communicate their modalities.
to be treated and how you will treat it
A patient may be reluctant to reveal information
●
Trying too hard to be objective – leading
because they do not feel safe to do so, or because
to blind spots (failure to be present) and
they don’t understand you need to know more. For
unconscious judgements
example, a patient on benefit or claiming compen-
●
Unable to re-take the case with ‘fresh eyes’
sation may think that if they reveal emotional or
because of an inability to leave past impres-
personality symptoms it may undermine their sick
sions behind
role status. These patients might need reassurance
●
Failure to identify patients’ projections and
through a clear agreement, e.g. assumptions the
work with feelings; often due to uncer-
homeopath takes for granted about confidentiality
tainty or discomfort
may need to be made explicit. Another patient may
●
Being too comfortable or too uncomfort-
play down their symptoms, talking about a ‘touch
able in the case, not ‘sitting with’ or ‘hold-
of flu,’ or mask their unhealthy complexion using
ing’ the ‘creative tension’ required
cosmetics.
●
Failing to get support or supervision
These apparently hidden cases can often be
●
Allowing the patient to ‘tell their story’
addressed by carefully ‘setting the scene’ for
without inviting them to ‘be in it’
the consultation, including contracting clearly.
Sometimes the patient has so adapted to their state,
or adapted their situation to their state, that they
Revealing the Hidden Case cannot describe symptoms. It is as if the whole case,
Invariably the hardest part of seeing a difficult case except for the one-sided symptom, has been palli-
is seeing those parts that the patient doesn’t want ated. In these cases it can help to invite the patient
or can’t show. To touch a patient’s vulnerability to imagine what they would be like in different set-
you need to be vulnerable yourself. Being vulner- tings or if they didn’t have the symptom. Although
able means getting to know yourself – but to be less reliable, the answer to a question about ‘how
vulnerable you will need support. might you react if…?’ is better than no answer at
Understanding what is going on in a case has all to the question ‘how did you react when…?’.
to precede treatment. Frequently in a hidden case, When exploring the possibilities in a case, aspects
the illness is projected on to one small area of the of the apparently hidden case can be revealed.
person’s life or body (one-sided disease). As the What is not there can be as informative as what
symptoms go deeper it is not uncommon for them is there. The detective type role of the homeopath
to get harder to understand. Either symptoms get is like that of Sherlock Holmes who solved a case
more ‘personal’ and harder for some patients to by reflecting on ‘the dog that did not bark’ (in Sir
communicate or they can slip into the uncon- Arthur Conan Doyle’s short story ‘Silver Blaze’).
scious – making it hard for the patient to even It is possible that some aspects of a case may be
recognise them. A patient may start off by saying, hidden while others are part of a simple case. For
‘I’m normal in every way, but. . .’ or ‘this lump just example, a patient with heavy periods may not
came up’ or ‘I’m completely OK’. In each case an reveal her changed sex drive or other symptoms
Confused and
Hidden Cases

invitation to reveal more may be met with a quiz- she feels embarrassed about or does not think are
zical, almost shocked, look. In other hidden cases relevant. In many such cases just deepening rapport

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over time and using all available information When a symptom is unnoticed by the patient
sources can reveal what was otherwise hidden. For it represents a sort of shadow side that the patient
this reason I refer to them as ‘apparently hidden’ – is unconscious of. When it is are not noticed by
using the case-taking and receiving techniques the homeopath, it may be because it corresponds
covered previously they can usually be revealed. to an aspect of the homeopath’s own personal or
collective unconscious.

REFLECTION POINT Parallel Process

● Reflecting on your learning style (see Chapter 12) can ‘Parallel processes are complex, interlocking systems.
you see what types of patients you might most easily Resistances, stalemates and impasses occurring at an
communicate with to reveal their case and those that unconscious level are communicated by enactment.
might find working with your ‘default style’ the hardest? The enactment when brought into awareness is a way
of identifying or resolving the stuckness which is then
re-enacted in the reverse direction.’
True Hidden (Or One-Sided) Cases Gediman & Wolkenfeld (1980)
While improving communication can reveal some
hidden symptoms, others are not communicated Parallel process is one of the richest tools the
because the patient or homeopath is unconscious homeopath has available for finding out and
of them. The unconscious symptoms that hold the exploring, through ‘correspondence’, what is hid-
key to understanding the case are hidden – and den in the patient and homeopath’s personal or
these are the ‘true hidden’ (or ‘one-sided’) cases collective unconscious. It uses the fact that when
that are the focus of this chapter. Due to the sym- one thing changes it affects other things; and if
metry between the patient’s emotional, intellectual change in one of these is not consciously recog-
and physical symptoms, if the case is unconscious nised it is often possible to see the change through
or hidden in one of these it may be more avail- parallel changes that can be recognised.
able in another. This requires the homeopath to We find that when issues are not made con-
be able to communicate effectively intellectually, scious, but are masked or hidden, they are acted
emotionally and by close physical observation out through the behaviour of the individual or the
and examination. It can help to separate those society of which they are a part. This is why case-
symptoms that the patient is unable to show, pos- taking must take account of where patients live,
sibly because they are unconscious of them and and the families and the culture they belong to.
those the homeopath is unable to perceive or see Understanding how one thing projects onto other
because the homeopath fails to recognise them. areas, through a corresponding or ‘parallel’ pro-
In practice the two are interconnected and often cess (even if a patient or homeopath is unconscious
go together – reflecting the cultural blind spots, of it), plays a vital role in understanding hidden
illnesses and susceptibilities that the patient and cases. It is also one way of explaining how personal
homeopath are subject to. behaviour, attitudes and health influence cultural
The skill of the homeopath in masked and hidden and social norms, including the socialisation and
cases is to judge the right time to examine the ‘hid- normalisation of behaviour, and vice versa.
den-ness’ and the right intervention to make. The Aspects of the patient that are ‘in conflict’ and
time to consider making an intervention in the case have been unresolved for years are often hidden
is usually when the energy in the case is becoming and may instead be reflected in parallel conflict
stuck. The patient may be ‘retreating’ into minutiae in other relationships – sometimes with parents,
or repeating a pattern that has been repeated sev- friends or lovers and at other times with the
Confused and
Hidden Cases

eral times before; the homeopath will feel things are homeopath. Inviting the patient to explore ten-
going in circles without deepening (Kaplan 2001). sions and conflicts in their relationships, including

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with you, reveals much about the inner tension intervention. You may have to resist the tendency
they carry. One technique useful to identify or to intervene until you are clear which is the right
explore this is to ask the patient to talk to you as intervention to make – just as it is best to wait until
if you were the parent, sibling or partner. I have you are clear which is the right remedy to give.
found this ‘role play’ at times allows a huge shift The use of free association (see Chapter 13),
in an otherwise confused or hidden case. asking the patient to say the first word that comes
It is the pressure to ‘belong’ that unites people to mind in response to your choice of word, can
with similarities and enables cultures to oper- express the hidden aspects of the mental picture.
ate collectively. While this has obvious strengths For example, you might ask the patient to say the
in relation to the stability of a culture there are first thing they think of when you say ‘black’ or
potential hazards, particularly in regard to the ‘home’. Using drawings and doodles can also help
health of the individual. It explains why certain to bring out what is otherwise hidden. For exam-
cultures are susceptible to certain illnesses and ple, a patient who suffered from cancer found
epidemics. In this way the illnesses that individu- it hard to talk about herself. She is an artist and
als within a culture are susceptible to tell us about paints with ‘a mathematical theme’ and precision –
the strains and changes that culture as well as the discussing this she was able to talk about her ‘issue
individual are facing – or need to face. with structure’ and ‘fear of losing control’.

Casting the net, Catching the Symptoms Common Pitfalls in Hidden Cases
Your house, garage, car and clothing, the books, It is a challenge working with hidden cases but
television, films and jokes you like and dislike, all recognising something is missing is the first step.
say something about you. Consultations which use the relational model of
Everything a patient tells you reveals something health reach out to connect both the patient and
about them. If you cannot glimpse the themes and you in a much deeper way than in other models.
symptoms you may notice the ‘unconscious shadow’ It is as if we not only invite the patient to go on
of the patient. The shadow, and those parts that can- a walk to meet their fears, delusions and dreams
not be named, may point to those areas that have but we also go on the walk with them – being pre-
been hidden the longest. The patient may need time pared to meet not just their fears, delusions and
and encouragement to notice their dreams, to explore dreams as aspects of their unconscious but our
their personal relationships or their childhood his- own as well. We work together to recreate, in a
tory. Some patients find that an exercise to complete more conscious way, what is already there but
between appointments allows things to surface that is hidden in the case. We navigate through the
remain hidden when the patient feels scrutinised in projection of symptoms in order see where they
the consultation. This ‘home work’ is a reminder that are unconsciously enacted, to witness them and
treatment is a process that continues between consul- observe their effect on us. Some of the common
tations and prescriptions of remedies. difficulties that arise are noted in Box 28.2.
Remember that patients may reveal non-
verbally what is not being said. They may move
their body in a certain way, become restless, even REFLECTION POINT
tap or hit parts of their body. Whenever a physi- ● How easily do you engage with patients whose cases
cal sensation is expressed as a functional or struc- are partially or completely hidden? Looking at Box 28.2,
tural disturbance it is a form of somatisation. They what might you do when working with hidden cases
may cry or laugh, and they may withdraw into to see the case more clearly and to ‘protect’ yourself?
previous familiar feelings or situations. The skill What does the incidence of heart disease and cancer in
Confused and
Hidden Cases

of the homeopath is in judging the right time to Western society say about that society?
offer any intervention, as well as offering the right

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be that you have to take more cases to supervision,

BOX 28.2
you need to identify those cases that need refer-
Common Pitfalls in Hidden Cases
ral, or that you ensure you are clear about those
●
Not recognising or learning from our mis-
patients who you are supporting and maintaining
takes but repeating them
and not expecting more. There will be times when
●
Identifying ‘why you?, why this?, why
you will need treatment yourself. It can be both dif-
now?’ for the patient but not for yourself
ficult to ask for help, and difficult to help yourself.
●
Failure to establish clear boundaries, so
In difficult cases due to projection it can be hard to
getting ‘sucked into’ the case
maintain a healthy balance between subjective and
●
Failure to persist when the patient or your-
objective views of yourself. It is therefore prudent
self feels discomfort
to establish clear avenues of support and, if neces-
●
Missing or ignoring off-hand or off-the-
sary, treatment, before you need them.
cuff remarks
●
Failure to connect and to work ‘relationally’
Be Realistic
●
Having inadequate time to take or reflect
An established and experienced family doctor was
on the case
troubled by homeopathy because he felt it implied
●
Lack of support for your own vulnerability
everything he had been doing up until now must
●
Failure to set up adequate supervision
have been wrong.
●
Over-identification with our need to heal,
Different treatments, such as other complemen-
leading to striving too hard to ‘fix’ patients
tary and conventional medical approaches, each have
rather than helping patients to help them-
their own expectations. Encouraging patients to make
selves
clear choices informed by what they can expect from
●
Allowing patients to become overly critical
each is an important part of any patient’s treatment.
or overly idealistic towards you – both of
Being secure about what the patients can expect from
which reduce your ability to be objective
the treatments we suggest, and the patients’ ability
and to be self-aware
to make informed choices about their treatment, is
●
Confusing wants and needs, requests and
important. If we cannot do this we are likely to be
demands
intolerant of other health care systems, the patients
who use them and even other homeopaths who work
differently from us. We need to inform practitioners
Managing Yourself of other health care systems about what we do and
Life and living are the best therapy. why – so that they can see where homeopathic treat-
At the end of each episode of treatment you ment interfaces with their own and which outcomes
might like to reflect on the lessons you have learnt are likely from which treatment. If we can explain
about the patient, the illness, the remedy, yourself what we do and how it relates to other therapies, we
and the culture you are working in. It should not be are much more likely to help in the overall develop-
surprising if you find certain recurrent difficulties ment of health care models that can integrate differ-
or find a particular sort of case or patient difficult. ent treatment modalities. No one therapeutic system
The nature of our work is that those who get better meets all of a patient’s needs all the time.
no longer need to see us, while those that don’t con- Each model of health, approach to treatment
tinue to attend. This, combined with more difficult and methodology has its limitations. Between them,
cases often seeking out homeopaths who are more most cases can be understood and a plan of treat-
experienced, means that over time you are likely to ment formulated. Only rarely is a case untreatable
be working with a growing proportion of difficult – but the possible outcome of treatment needs to
Confused and
Hidden Cases

cases. It is important not just for your patients but be realistically assessed. In some conditions, such
also for your own well-being to manage this. It may as some patients with degenerative and metastatic

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 Practice and Professional Organisation Issues

illnesses, the structural damage cannot be reversed There are many other practitioners and homeo-
– although the disease process may be slowed down. paths available to the patient – and many super-
In some cases the focus of treatment may be the con- visors available to you. Knowing when to make
trol of a particular symptom, even if the overall dis- use of them to support the patient or yourself is
ease process is not significantly altered. In these cases important. A patient may reach a point where
the patient and homeopath need to be clear on what they are partially better but need, for example,
they agree to treat, especially when other treatment to change their diet or look at a relationship they
modalities that may alter the picture are being used are in before they are ready to work at a deeper
alongside homeopathy. For example, a patient with level. Being clear which phase the management is
metastatic illness receiving chemotherapy and radio- in, and what other treatments the patient is using,
therapy may want help to tolerate these – so focusing is important both for you and the patient.
on cause and local effects may point to the necessary
remedy. The most frustrating and difficult cases are Endings
often those where you and the patient have different At the point when the patient will remain well
and/or unrealistic expectations. (unless there is new causation) and may be dis-
charged, it is worth reflecting with the patient
Know When to Rest what has been achieved and how they will moni-
and When to Get Help tor their health, how the patient’s life has changed,
Many patients with difficult cases seek only relief and what further support they might need. For
from their worst symptoms. Treatment might give example, with life style or dietary change, how
this relief, only to reveal other symptoms that you will the patient know if there is a relapse? What
believe require treating. It may be that these symp- feedback does the patient have to offer on the
toms represent a deeper aspect of the case that, if treatment and your practice? While some patients
untreated, means relapse is more likely. Equally, choose to use homeopathy to actively maintain
in the homeopath’s mind the relief might be only health, many realistically only seek help when
partial and, without consolidating treatment, their illness prevents them from doing something
likely to relapse. You and the patient must agree they want or when symptoms become too uncom-
on what to do when these points are reached and fortable. By giving patients warning of the ending,
it helps to be clear on the options at this time. It it allows them to work through any important or
is helpful to clarify with the patient when the aim unresolved issues relating to their treatment. Often
of treatment is curative and when maintenance or when patients are warned that a course of treat-
prevention of deterioration is the aim. ment is coming to an end then issues surface that
In confused and hidden case it is often appropri- they might want help with but have not previously
ate and realistic to have phases of treatment that just asked about. Frequently these are deeper issues
aim to maintain an improvement or allow a case to and problems that may have been quite longstand-
become clear. This may go on for some time until ing. For some patients ending treatment without
the case is clear, or until the patient or you are ready due care is experienced as a withdrawal of support
to tackle other aspects of the case. When you have or even a ‘rejection’.
worked hard with a patient to obtain an improve-
ment it is reasonable to want to see it maintained. As
a general rule if symptoms have not gone completely, REFLECTION POINT
relapse will occur at some time if no maintenance ● If you find you are frequently in a difficult situation
treatment is offered. As part of any maintenance or have difficult feelings I invite you to reflect on why
treatment follow-up appointments help to identify this might be so. By working through these difficulties
Confused and
Hidden Cases

the earliest signs that the patient is relapsing and we can develop as homeopaths and extend our
allow for repeat treatment if necessary. competence.

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● It is interesting to ponder to what extent the issues and organisational issues such as time keeping,
we face in practice reflect the issues we need to financial management, clinical governance, work-
address for ourselves. Perhaps the patient is not just ing with other health professionals and ethical
the ‘bringer of the difficult case’ but also the bringer of guidelines. Equally, while it is easy to see how
our opportunity for our own personal and professional personal development is linked to your training,
development? the development of your practice and the contri-
bution you can make to the development of your
professional organisation are important parts of
Practice and Professional being a homeopath. Although many of the issues
that you as a student might want to address relate
Organisation Issues to your personal understanding and prescribing of
Much that is taught can be learnt but only a frac- homeopathy, as you start to see more patients so
tion of what can be learnt is taught. To practise the practice and organisational issues emerge.
health it helps to be healthy, to have a healthy The reverse is also true, in that if you create
practice and to belong to a healthy organisation. a difficult practice or professional tensions it will
In difficult cases much of the picture is informed make more cases appear difficult. Such things as
by the environment and situation the patient having enough time; being valued or paid enough;
chooses to live and the family, community and cul- being liked or disliked; being able to share your
ture they belong to. It therefore should come as no work, relating to colleagues or staff; feeling you
surprise to you – if you understand the idea of par- belong balanced by enough autonomy; and feel-
allel process and holism – to realise that when man- ing your professional body is connected, relevant,
aging difficult cases it is not just the personal issues supportive and developing, are all important in
relating to a patient’s case and analysis that present seeing cases clearly. To be aware of the breadth of
a challenge. They are also reflected in what we find issues that affect how you see and manage cases,
difficult to structure and organise in our practices it helps to think about the different development,
and the political and cultural issues professional support and education challenges that regularly
organisations are likely to struggle with. occur in the personal, practice and professional
These are as much aspects of our work that organisations areas of your work. This is illus-
need support as our individual patient work. It trated in Table 28.1, which draws on just some of
is an important part of our education, especially the issues that regularly arise in supervision and
in managing difficult cases, to address practice can each influence how you work (Owen 2002).

Table 28.1 EXAMPLES OF FACTORS TO CONSIDER IN YOUR WORK AS A HOMEOPATH

Education Support Development

Personal Being told new information. Being heard. Coming to terms Having your case taken.
Learning from successes with what you do not know Changing views, e.g. what
and mistakes health and illness are

Practice Clinical governance. Practice problems. Finding your Reflecting on difficult cases.
Understanding different own style. Having others Continued professional
styles of case work. around you to support your development (CPD).
work Competence. Finding a
career path.

Professional Establishing best practice. Finding a role model or mentor. Examining critical events.
Organisational Codes of practice. Sense of belonging Relation to other
Confused and
Hidden Cases

Population issues, organisations, government

e.g. vaccination policy and public heath

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 Bibliography

In the same way as it is possible to see illness tion as much as on an individual. For example
as something that is essential in a dynamic and if you are in a meeting that is exhibiting many
changing world – not the opposite of health, but Lycopodium features, you might try interacting as
an integral and necessary part of being ‘healthy’ – a Lycopodium type would.
then at a practice level the challenges and difficulties There are, of course, many situations that are
we encounter inform the development of a reward- difficult to teach about in textbooks or the class-
ing, sustainable and ‘healthy practice’. At an organ- room. This is why careful supervision, mentor-
isational level, the differences and tensions that are ing and practice-based teaching are so helpful.
acted out by the different communities and schools The individuals providing such services to you
of homeopathy parallel and inform fundamental should be in a good position to help you observe
and important questions our community needs to the issues that are common to those starting in
reflect on if it is to respond to new challenges in a practice and identify problems that you are par-
healthy manner. In the same way as symptoms are ticularly susceptible to. A supervisor makes these
necessary for health, so difference and diversity are issues available for you to consciously explore and
necessary for strength and stability. learn from, rather than allowing them to be sub-
How you work through these issues appears merged and re-enacted indefinitely. Supervision
to be a personal choice but will often be strongly can play an important, I would say transformative
influenced by parallel issues in your practice and role, in the development of your practice and ide-
profession. It is not surprising, therefore, to see the ally is informed by and feeds back to the profes-
values that run through the relationship between sional organisations you belong to.
homeopaths and their patients being reflected
in their practices and professional organisations. Different Practice Settings
Problems that are identified in the personal, prac- When starting in homeopathic practice it is impor-
tice or profession are likely to be reflected in each tant to realise that different practice settings have
other. Dysfunction in an organisation will affect inherent limitations. So, for example, general
members of that organisation and vice versa. practitioners who use homeopathy often complain
Given their expertise with individual patients, about being constrained by the time limits of their
it is surprising to me how few homeopaths use consultation. You can use homeopathy effectively
homeopathic principles in the understanding or in these situations, but the models with which you
running of their practices and the organisations are able to perceive the case have to be carefully
they are part of. focussed. You may have to adjust your way of
Projection of unresolved and unconscious working so that you build up a case picture over a
issues, parallel expression in groups, and projec- number of visits, perhaps with the benefit of know-
tive identification can all shed light on ‘the case’ – ing other family members and the home environ-
whether an ill patient, a failing practice or dys- ment. Ultimately the structure and organisation of
functional organisation. For example, projection your practice will reflect how you can work and
in an organisation is often used to displace nega- what you are realistically able to achieve.
tivity onto a susceptible person – making the indi-
vidual a scapegoat and giving the organisation the
illusion of power, cohesion and control that lasts
Summary
until either the scapegoat is ejected, the scapegoat As you can see, in understanding confused and
declines to carry those feelings, or the organisa- hidden cases, the dividing lines between the case
tion becomes conscious of what it is doing and history, the materia medica, the case analysis and
decides to change. Homeopathic principles and the actual prescription are becoming blurred. While
Confused and
Hidden Cases

techniques of mirroring back using like to treat to understand homeopathy as a science we need
like can have a powerful effect on an organisa- to keep things separate – so keeping it measurable

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and able to be analysed – to work with homeopa- its reconsideration as a triadic system. Psychoanal Q
thy as an art we are required to see the intercon- 49(2):234–255
nections and be aware of where the issues run Kaplan B 2001 The homeopathic conversation. Natural
together and how treatment is a process. We con- Medicine Press, London
front our limitations when working with difficult Owen D 2002 Learning experiences – what works for
cases and therefore learn more from cases that postgraduates. Homeopathy 91(2):95–98
appear confused or hidden than we do from our
easier ones. Ultimately, our difficult cases give us
something that allows us to understand others – Bibliography
and ourselves – better.
Hawkins P, Shohet R 2000 Supervision in the help-
ing professions, 2nd edn. Open University Press,
Buckingham
References
Morrissel J, Tribe R 2001 Process in supervision.
Gediman H K, Wolkenfeld F 1980 The parallel- Counsell Psychol Q 14(2):103–110
ism phenomenon in psychoanalysis and supervision:
Confused and
Hidden Cases

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Approaches to Treating Confused Case Analysis

and Hidden Cases

David Owen

‘Health exists when there is a perfect harmony between are clarified, it makes interpreting the action of
soul and mind; this harmony alone must be obtained a remedy used more difficult, leading to the not
before cure can be accomplished.’ infrequent ‘spoiling’ of cases.
While several homeopaths may reach the
Dr Edward Bach
same or similar conclusions about a simple (or
even complex) case, there are often several dif-
Introduction ferent strategies for the management of confused
Homeopaths working with confused or hidden and hidden cases. The remedy eventually selected
cases draw on information about the remedies and depends on many factors, including the ‘pros and
the case from every possible source. Using this dis- cons’ of each methodology, your practice situa-
parate information we practice our art and apply tion, the patient’s expectations and your agree-
our science to achieve a rational, replicable and ment with them, your knowledge of the materia
curative approach to treatment. As more patients medica, perception of the case and experience of
use suppressive treatments and live longer in a rap- the different approaches. Why you use some rem-
idly changing culture, more confused and hidden edies more than others, and why some cases are
cases develop. Combined with patients’ increased hard for you but not necessarily hard for another
expectations of well-being – meaning not just an homeopath, are important questions to reflect on.
absence of morbid pathology, but a positive sense It is both liberating and frightening to explore the
of physical, intellectual and emotional balance – uncertainty that there might not be one ‘best’ way
this will lead to an inevitable increase in the num- to treat a patient; rather there may be a choice of
ber of difficult cases that will present to us for ways for you to treat this patient in this setting at
treatment. this time!
In this chapter the different methodologies, Rarely will one remedy bring the most hidden
management strategies and issues raised by man- and confused case all the way back to health. Over
aging confused and hidden cases are explored. time, as treatment of a difficult case unfolds, dif-
The essence, thematic and reflective approaches ferent approaches may be used at different stages.
that relate to the holographic and relational mod- Hidden and confused cases move to complex cases
els of health are considered in more detail – each and become gradually less complex and eventually
bringing their own management issues. In practice simple. If this is possible in some cases it raises
several approaches to treatment are frequently important questions as to whether it is possible
combined and, unless the analysis strategies used in all cases – if so, perhaps there are no ‘incurable
and your expectations of a particular treatment cases’.

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may be partially covered by several remedies leads

Essence and Thematic Approaches to looking more closely at the materia medica of
One day a case and remedy may be unclear to you; all the remedies in the ‘differential diagnosis’.
you go out of the room briefly or come back to the If one remedy clearly covers the majority of the
case the next day and the case and remedy needed themes in a case it may be ‘good enough’. Even
at that moment is clear. if it does not cure it will reveal more and deeper
In confused cases several patterns of symptoms aspects of the case, allowing a better prescription
can be understood as a series of themes. These to be made. It may also reveal new information
themes may intertwine like strands in a rope to give that invites a different model, approach or meth-
a single essence or be composed of different themes odology that in turn points to a different rem-
that are mixed together and appear superimposed edy. When looking at the themes in a case where
one on top of another through a series of layers. there is no clear simillimum several strategies are
The different themes (strands) run between differ- useful:
ent levels of symptoms in a case and connect these ●
You may choose a remedy partially indicated
horizontal levels by vertical themes which often in several models or approaches. For example,
provide a way of integrating many different parts if several remedies of the Ranunculacae family
of the case or contradictory aspects into a coherent are partially indicated thematically but there
whole. So a patient with a single or predominant was a traumatic aetiology, then Arnica might
essence of blandness running through all physi- be selected.
cal, mental and emotional expressions of the case ●
You may take into account confirmatory
will point to the essence of the remedy Graphites. and exclusion symptoms and themes to both
A patient with a theme of anticipatory anxiety can promote and demote a possible remedy in
indicate several Carbon remedies; if they also have your analyses. What might at first appear as
this theme running deeper – perhaps as a fear of minor or less prominent symptoms or themes
something awful happening – it may again point can become very significant in choosing one
to Graphites. The methodology used is to match remedy over another one.
a patient’s picture or ‘pathograph’ (Swayne 1998) ●
You may choose a remedy that fits the most or
to the picture or ‘monograph’ of the remedy pic- strongest themes and it is possible to weight
ture. If all the themes in a case match a single and score themes in a similar way that symp-
remedy the case often becomes clear. If several toms are scored. It is possible to collate all the
different themes run in contrasting directions or aspects of the case that relate to each theme,
point to several different remedies, then the case and to effectively consider them like one
often appears confused. ‘combined rubric’. These different combined
rubrics can then be analysed to see which
Thematic Analysis remedies and groups of remedies have the
and Treatment Strategies themes. In effect the themes, each of which
Thematic analysis therefore goes through several might include several rubrics, are being anal-
stages – matching what features of the case are ysed rather than the individual symptoms (see
thematically connected to what other features of Chapter 19).
the case, then deciding which themes are most ●
You may choose a remedy that best represents
important or central to the case, then matching the the themes that run most broadly through the
most important themes to a remedy. Identifying physical, mental and emotional layers of the
the themes is an important part of the case and the case. For example, the theme irritability could
analysis. A confused case often has several differ- include mental and emotional irritability but if
Confused and
Hidden Cases

ent themes that do not point to a single remedy. tissue sensitivity/irritability was also seen this
This recognition that a case that fits a clear pattern theme would be considered more strongly.

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●
You may weight the theme that runs (or deeper levels of the case can be seen more clearly.
appears to run) most deeply, or has been there Sometimes a thematic remedy can run through even
the longest. the suppressed level, i.e. the remedy that matches
the susceptibility of the patient determines how and
In practice (as with repertorisation) a combina- to what suppressive drugs they will react. There
tion of these different strategies is used, taking into are two reasons why conventional drugs provide
account how well known the remedies being con- important remedy pictures – one is that they rep-
sidered are and where and how easily information resent levels of illness that overlie suppressed cases,
about the themes of those remedies can be obtained. the other is that those drugs that have most toxicity
It is not uncommon for a confused case that falls and side effects often match patients’ susceptibility.
between several remedies to match another, some- Some conventional drugs are likely to owe some
time related, possibly little known, remedy that of their effectiveness to working homeopathically
allows many of the themes to be integrated in a single (or isopathically) – e.g. lithium, gold, adrenaline,
remedy picture. Many of the polychrests have clear desensitisation and even some vaccinations – but
essences and thematic pictures built up from prov- the doses that are used and the failure to match
ings and clinical experience but the thematic picture them accurately to the patient can cause frequent
of less well used remedies is understandably slower unwanted effects. It is therefore not surprising
to develop, although this has changed over the last that the side-effect profile of drugs often reflects
few years with the introduction of materia medica their homeopathic remedy picture and that many
by family and kingdom. Although some homeopaths conventional medicines used historically are
feel that until these pictures are validated by prov- today deep-acting homeopathic remedies, such as
ings, they are not reliable. The researchers and writers Mercury, Gold, Belladonna and Digitalis. To man-
who actively endeavour to clarify these pictures are age a patient’s confused case it helps to be com-
owed a debt of thanks by all homeopaths. The pro- petent to monitor their conventional medication
fession is at a time of huge growth which needs to be and to understand the lesional level set up by these
supported by a sound development of the resources drugs, as in Sam’s case. These deep cases obvi-
available. If homeopaths can develop new thematic ously need careful consideration and contracting
materia medica knowledge reliably it will greatly that may include liaising with other carers of the
help the management of difficult cases. Remember patient. Remember, when conventional medicines
that while an essence or theme may belong to a single
remedy it may also be in common within a family or
CASE STUDY 29.1
group of remedies (see Chapter 22).
Sam had been on a mix of sleeping tablets
and tranquilisers for 50 years and his case
Suppression of Themes was multilayered and confused. By reducing
Suppressive treatments often change the active
his tranquiliser and prescribing it in potency,
expression of a symptom. A suppressed symptom
deeper aspects of a case emerged – including
may come out in a deeper way or become a passive
dreams about an episode in the war when he
or compensated manifestation of the original symp-
had to kill someone by hand. He was enabled
tom, sometimes these determine the adverse effects
to stop the tranquilisers and worked through
or toxic effects of the suppressive drug (in their own
the withdrawal effects more speedily than (it
way a type of proving). This change in the original
is likely) he otherwise would have. A strong
symptom expression along with new symptoms from
feeling of remorse that he had not previously
medication often adds to the confusion in a case.
been aware of emerged, with a clear remedy
In confused cases where adverse effects impose
indicated. He slept well after this and his many
Confused and
Hidden Cases

another symptom level over the case it can be

symptoms all eased.
necessary to remove this lesional level before the

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work powerfully, with adverse effects, it means as a fundamental layer – although once
that they are acting in a sensitive individual. It is removed a deeper layer may become
common to find patients who have avoided much apparent. Not only might the ‘miasmatic
allopathic and antipathic dosing are more sensi- layer’ obscure the case, but also it can
tive as provers and may react more sensitively to actually block the case from responding,
allopathic and antipathic drugs. as in Jill’s case. Any layer can block a clear
Due to the nature of confused and hidden picture and/or a remedy acting. Sometimes
cases, even when you feel you have a good match these layers can have a specific trigger, e.g.
of remedy to case, it is quite likely that after treat- after vaccination or an illness, as Peter’s
ment or over time new information will emerge case illustrates.
that points to a different remedy at a subsequent
re-taking of the case. Homeopaths differ in the
extent that they use successive remedies to ‘clarify CASE STUDY 29.2
or clear’ the case or where they wait until the Jill, 35, presented with postnatal depression.
picture is completely clear before they prescribe. She had put on weight, lost her libido and felt
One way to think of hidden cases is that they detached from her child. There was a previ-
have become ‘frozen in time’. It is as if the dis- ous history of menstrual problems, and her
ease process has led to, or required, the individual appearance and confirmatory craving for vin-
to become solidified in other ways; to freeze or egar indicated Sepia. This gave a transitory
fix the illness in one particular aspect of themself. improvement in mood but she had become
When these cases are carefully managed they begin colder and tired. After a time with no improve-
to thaw and issues and symptoms begin to surface ment she was prescribed Psorinum for the
in other aspects. At first the patient is likely to be miasmatic layer of under-activity, flatness and
more bothered by these new symptoms than by its correlation of Sepia. After Psorinum she
those that had been ‘frozen’. became warmer, had more energy and felt a
little better. At a subsequent consultation she
Miasmatic Prescribing was able to talk about her own childhood and
Miasms and miasmatic prescribing have been cov- her feelings of loss when her parents sepa-
ered in Chapter 17. However, there are several rated – she had previously avoided this. She
important considerations when thinking about was prescribed Sepia again and this substan-
miasms and thematic prescribing, as there are two tially helped the case.
groups of remedies that can be indicated by the
miasmatic theme running through a case. First,
when a miasmatic theme is particularly strong CASE STUDY 29.3
in the absence of other clear themes the nosode Peter, age 35, presented with post-viral fatigue
of that miasm may be specifically indicated, e.g. with onset after vaccination to Hepatitis B. He
Medorrhinum for Sycosis. Second, the miasmatic failed to respond to a totality and constitutional
theme may indicate or favour one of the already approach and so a treatment based on cau-
partially indicated remedies that have an affinity sation from the vaccination was considered.
to (or belong to) a miasmatic group. Some exam- This causation was considered alongside his
ples of miasmatic themes and remedies and how ‘miasmatic’ susceptibility to the aetiological
they can be used are given below. agent. After treatment isopathically with a nos-
1. A miasmatic remedy may be used for a ode of Hepatitis B 30c split dose, new symp-
specific layer that confuses or hides the toms developed that indicated a remedy that
Confused and
Hidden Cases

case. It may be for the deepest ‘visible’ acted deeply.

layer of a case, sometimes referred to

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2. The miasm may describe a theme that runs Reflective Approaches to Managing
through several layers in the case, e.g. the
general under-activity of Psorinum might
Otherwise Hidden Cases
be seen in many symptoms, even though Before embarking on the management of the truly
other remedies are each partially indicated, hidden case it is important to remind ourselves that
as in John’s case. symptoms might be expressed as active, passive or
3. Each miasmatic remedy also has a compensated (see Chapter 14). The active symp-
remedy picture in its own right and can tom might be difficult to see but if the passive and
be prescribed on this alone – although compensated state is visible this may give the best
in practice it is usually supported by indication of the remedy. In cases where symptoms
trends from that miasm running through are there but are mostly passive or compensated,
the case. The case of Joanna illustrates they can be difficult to draw out and see, hence
this. they are often only ‘apparent’ one-sided cases.
In cases that are ‘truly’ hidden all the symptoms,
except for just one or two major or common symp-
toms, are masked. Once you recognise this you can
shape the consultation and explore the strategies to
CASE STUDY 29.4 reveal the hidden case accordingly. By registering
John, age 48, had chronic skin problems and this you become more aware of other information
Sulphur, Calcarea carbonica and Lycopodium offered by the patient including projection.
were each partly indicated. Sulphur was, on
balance, best indicated although his profound
chilliness and food preferences relatively con-
CASE STUDY 29.6
traindicated this. He was prescribed Psorinum
Mark, age 57, presented with angina that was
as it covered several features connecting dif-
being treated conventionally; he had common
ferent layers of the case. He got a significant
angina modalities but otherwise appeared
aggravation of the skin and a clearer psycho-
asymptomatic. Describing his angina he used
logical and physical picture of Lycopodium
a clenched fist and hit his chest. Mirroring this
emerged that later acted deeply.
movement back to him led to him discuss-
ing how he felt ‘thumped in the chest’ and
‘winded’. He went on to describe a feeling
that he had lost his freedom and whenever
CASE STUDY 29.5 he ‘metaphorically’ stood up to these feel-
Joanna, a 16 year old girl, was brought to me ings he was ‘hit in the chest’ and ‘knocked
by her parents. She had several episodes of down’. The homeopath who presented this
binge drinking, had twice taken an overdose case in supervision was able to describe his
and had a history of cutting herself. She bites own feeling of being trapped by this case and
her nails, is emaciated, self-critical and feels a wish to escape – in supervision he explored
she is a disappointment to herself and her par- what this meant for him and how he could feel
ents. She comments: ‘I want to make them free to enquire about this. At follow-up Mark
pay, they will be sorry when I am gone’. She talked freely about how he used to use rec-
is cold, chilly and craves coffee. The keynotes reational drugs and had never felt free since.
along with the theme of failure, despair and This theme contributed to selecting the rem-
flatness led to a prescription of Psorinum that edy that greatly reduced the frequency of his
Confused and
Hidden Cases

gave significant benefit. angina attacks.

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way in different situations and to different homeo-

CASE STUDY 29.7
paths. As you increasingly understand yourself and
Catherine, age 38, had interstitial cystitis but
reliably appreciate how patients in different rem-
with few modalities. She had not responded
edy states make you feel you can use this to much
to local treatment. There was no clear total-
effect, as Catherine’s case illustrates. I suspect this
ity or themes. Whenever the case history got
is behind much of what is called ‘experience’.
close to anything other than the presenting
symptom, Catherine started talking about
other people’s problems, which she worries Managing Confused
about. The homeopath reported in super- and Hidden Cases
vision that the patient is ‘frustrating’. She
There are two parts to analysing difficult cases.
makes the homeopath feel ‘manipulated’ and
First, different approaches and methodologies give
she holds back from talking about herself. At
a number of possible remedies in the differential
a subsequent follow-up when Catherine is
diagnosis. The second part of analysing the case
asked about her interest in helping others and
is deciding between these possible remedies. The
the homeopath is guided by their own frustra-
two stages of finding the remedy are like tuning a
tion, Catherine offers that she finds it hard to
radio – the first stage, often using the repertory,
ask for help herself. Others had hurt her in the
is like roughly tuning in to the close remedies;
past. She has suppressed her anger towards
the second stage, of differentiating remedies in
those that hurt her because she felt vulner-
the differential diagnosis, often using the materia
able; she talks about her inner ‘excruciating’
medica, is like fine tuning to the exact frequency.
hurt and ‘stifling’ rage. The theme of hurt and
However, at the heart of managing confused and
vulnerability was compensated by her wish
hidden cases is realising that cases take time to
to ‘throw’ herself in to help others. A fuller
unmask and clear – the management is a process
but confused picture emerged. After a par-
not a single intervention.
tial response to Staphisagria a clearer picture
There are two main implications – first, it is
emerged and she was more able to talk about
unlikely a single prescription will ‘help’ the patient
herself – although it took six months before her
back to full health; second, that your responsibil-
presenting complaint improved significantly.
ity for a patient extends beyond just a single con-
sultation and intervention. When working with
Remember, when important aspects of the confused and hidden cases it is helpful to aspire to
case are masked or hidden they must always show find a single remedy that fits the case most closely
themselves in some other way – most often through at that time but at the same time to realise that a
somatisation (see Chapter 15) and projection, series of remedies are likely to be needed as the
often a form of compensation (see Chapter 23). It case unfolds (see Chapters 15, 30). Sometimes
is perhaps not surprising, then, that the most hid- those different remedies can be glimpsed at an
den cases are also those with the most structural or earlier consultation. When just one remedy is seen
life-threatening illnesses and that have the strongest then it can be an indicator that the case is no lon-
projections and/or generate the strongest counter- ger masked or confused.
projections in us, as Mark’s case illustrates. Commonly in confused cases different method-
When you are conscious and able to reflect on ologies indicate different remedies – some homeo-
what is happening ‘in relationship’ with the patient paths will use more than one remedy together or
and appreciate the remedies as ‘living materia med- in close succession (e.g. in veterinary prescribing,
ica’ you can match otherwise hidden cases. Cases Chapter 18). For example, a child who has long-
Confused and
Hidden Cases

and remedies have both positive and negative attri- standing and suppressed eczema may receive a
butes and will respond in a different and dynamic miasmatic or thematic remedy in high potency, say

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a 200C split dose. But if a local remedy is also indi- in deeply hidden and confused cases, which have
cated it may be prescribed as a low potency either often been developing over a long time, the vitality
orally, as a 12C daily, or as a local cream. Different is often low and the case appears quite stuck.
homeopaths like to separate out each course of Even slightly unmasking the case increases the
treatment in different ways, both by time and by patient’s vitality and may be enough to generate
potency. The main considerations are the extent to new and clear old symptoms. The bigger the mask
which one remedy may block the action of another, then the more it ‘protects’ – but the more vital-
the need to get a local improvement before the ity it takes to maintain it. The homeopath often
patient (or parent) agrees to working at a deeper has to balance when to lift the mask so that the
level, and the extent to which other suppressive case can be manifest more clearly without remov-
medication would be used if local treatment was ing the vital protection (decompensating the case)
not given. Although ideally a single remedy would that can lead to the patient give up on treatment.
be used to cover the whole case, in practice the Choosing when to unmask a case is influenced by
patient may benefit from both a deeper-acting rem- the therapeutic relationship and agreement (see
edy and one that helps manage local symptoms so Chapters 23, 25), including the patient’s choice,
they can reduce or stop allopathic drugs. the symptoms that are apparent, the amount of
In confused cases treatment can be like untan- suppression, the support available to the patient
gling a knot or tangle of kite string – if you just and homeopath, and the homeopath’s competence
pull the end the knot gets tighter. Treatment must in terms of ability, knowledge and experience.
often loosen the string first so that the tangle can In some masked cases simple life style changes
be seen clearly. In hidden cases, where the cause of can support the patient and help increase the vitality,
the tangle is invisible, treatment is like following so making it easier to reveal the case in a gentle and
one end to free the string, while keeping an eye caring way. For example, in patients with cancer,
on the whole mess as it becomes apparent. Often juice diets, nutritional supplements and psycho-
hidden cases have to move through a stage where logical support can all help a clearer, less masked,
they appear confused (with several symptom picture emerge without the patient feeling blamed
complexes and themes at different layers) before or guilty or disempowered. If the vitality is very low
a complex case (where a totality and/or a constitu- in debilitated patients, then remedies may initially
tion can be seen clearly) emerges. need to be given in low potency and suppressive and
palliative treatment change gradually. But if the vital-
ity is adequate the deep-seated case that is revealed
REFLECTION POINT behind the mask benefits from high potencies. I have
● In managing confused and hidden cases there are many found it helpful in hidden cases with much structural
different factors that affect how confused or hidden damage, but that have adequate vitality to use 200c
the case is. Reflect and revise how the patient’s illness, plussing potencies (Ramakrishnan & Coulter 2001)
family and culture; the patient–homeopath relationship; (see Chapter 20).
and the homeopath’s knowledge, experience, practice
set-up and professional culture can each affect how Psychiatric Illness
clearly a case is seen. Psychological symptoms can be considered like
any other symptoms. The suppression of symp-
toms may hide or confuse the case and adds to
Low Vitality the tendency of many patients to withhold symp-
The masks and walls that an individual creates toms to which they feel a stigma is attached. It
around them, that to a greater or lesser extent both is interesting to reflect on how the hidden nature
Confused and
Hidden Cases

protect and hide them, each draw on the vitality to of some symptoms mirrors how society seeks to
be sustained. Consequently, it is not surprising that hide away, institutionalise and avoid these symp-

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toms. Severe depression, psychosis, schizophrenia

CASE STUDY 29.8
and organic brain disease can all present as seri-
Jenny, age 27, presented with psychotic symp-
ously masked and hidden cases. Unmasking these,
toms following recreational drug use. Much of
especially those on much allopathic medication, is
the case was at first hidden. After homeopathic
difficult to manage in an outpatient setting – inten-
treatment based on a potency of the hallu-
sive monitoring and residential support is often
cinogenic drug she had used, her psychosis
required. Without the benefit of hospital care in
improved slightly and she gained a number of
a collaborative context the most deep-seated of
insights into herself following the remedy and
cases are effectively incurable.
consultation. Her new view of herself enabled
her to explore her jealousy with her sister and
Awareness and Longstanding Illness
mother that, with a local symptom, pointed
Treatment of longstanding conditions often leads
to Lachesis. Some time after this she spoke
to a rebalancing of what is conscious and what is
about unresolved issues with her father, around
unconscious to the patient. The state that initially
whom she felt anxious. She was able to express
arose, perhaps as an adaptive defence, can gradu-
her anxiety and to speak about why she had
ally be changed and replaced by a more appro-
attracted and put up with rather abusive relation-
priate state. This parallel between health and
ships. She developed food cravings of Calcarea
awareness is sometimes used by those seeking a
carbonica that she remembered having as a
greater awareness of self. Each new state involves
child and responded deeply to this remedy.
the revelation (unmasking) of information that
may point to a new remedy. As the patient moves
through different states of health, so they may
need support to adjust to their health state and Hereditary Factors
‘connect to’ a sociably acceptable version of real- and Congenital Illness
ity that incorporates a new sense of self, taking The susceptibility (including hereditary and con-
into account what has been revealed. This takes genital) of today and how it is managed will influ-
place through changes, sometimes dramatic ones ence the susceptibility (including hereditary and
in the perception and interpretation of reality. congenital) of tomorrow.
It may include changes in how they see others In hereditary and congenital illnesses the
and how others see them and how they interface homeopath is interested in the susceptibility
with their life situation, as well as the symptoms that one generation ‘bequeaths’ to another (see
they express. In this way patients move gradually Chapters 13 & 17). While the illness symptoms are
through states that might be equated to stages of clear, other aspects of the case are often hidden –
health that interface with the patient’s awareness perhaps because the illness or susceptibility has
(Laing 1990). Jenny’s case illustrates this. always been present and the psychological and
This journey into a new state of health can lead physiological adjustment to it has always been
to an extreme change of awareness – the deeper there or has developed unconsciously. Hereditary
the illness the greater the shift, i.e. it is often illnesses often appear intractable, fixed and
greatest when treating hidden and confused cases. incurable, as the maintaining cause is considered
These changes may require your time and support to be the genetic information that is immutable.
as much as finding a remedy. In a small way the However, the expression of any genetic suscep-
same re-adjustment to normality happens with tibility can be influenced by homeopathic treat-
each journey into wellness. Perhaps this is why ment, although this is often symptomatic. For
the role of healer has often been closely associated example, many Down’s children appear to have
Confused and
Hidden Cases

with such roles as spiritual and religious advisors fewer infections and less severe symptoms when
in communities. successfully treated homeopathically.

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Although difficult to evaluate, it appears that may also appear like you have the answer – a more
by treating the parents before or during pregnancy inviting style might allow you and the patient to
illnesses that might otherwise be expected can be explore what projections are taking place but may
reduced. For example, allergic illness often has invite unwanted projections.
a hereditary element that appears to be prevent-
able. On the same basis a young child or baby can Combining Different Approaches
be treated using information from the case of the How much time and energy do you spend trying
parents. If miasmatic susceptibility is treated it can to make sure things don’t get worse versus making
reduce the expression of inherited susceptibility things better?
and reverse the trend of hereditary predisposition Many different factors influence a person’s
and susceptibility over generations – thus decreas- health. They include physical factors that are inher-
ing the risk to future generations ited (vascular, immunological, anatomical) and
The genetic code of one generation is shaped by acquired (infection, environment), and physiologi-
the health of previous generations. The environmen- cal factors that are situational (light, diet, exercise,
tal factors we set up for ourselves are also influenced relaxation) and cultural (sanitation, work, habita-
by our genetic make-up. So these two are artificially tion). These may all reveal different priorities and
separated and it is more useful to consider them as attitudes to treatment. The patient, their family, dif-
an inseparable connection that binds the genetic pre- ferent health carers and government may each have
disposition of one generation to the environmental different priorities – not just with respect to what
exposure of another generation. As one of the major models of health are in fashion or dominant, but
influences on predisposition in one generation is the when to use different treatment modalities (con-
suppression experienced by previous generations, ventional or complementary). In most patients the
then the main groups of susceptibility that we see homeopathic remedy is just one step in a treatment
in individuals are related to common diseases that that not only might use several remedies but also
have been suppressed in previous generations. The involve many factors that influence our health in a
symptom patterns and diseases that we are exposed matrix of interconnecting processes. The homeo-
to now and that are suppressed will establish the path attempting to focus only on ‘their bit of the
miasms of the future; this is not just genetically puzzle’ and who thinks ‘the right remedy will cure
mediated but is transmitted by social, cultural and everything’ risks being idealised by patients and
environmental influences. falling into the trap of feeling they have the answer
to every problem – both are frequently observed in
Relating in the Different Models health professionals.
of Health Idealisation occurs because of a patient’s wishes
Each model leads to a slightly different style of the to locate all the answers to their health needs in
relationship between you and the patient; each someone who can help them, rather than accept
style communicates slightly different information. uncertainty about the answers or their responsibil-
The way the patient and homeopath relate to ity to find them. It is a type of projective identifi-
each other is influenced by the balance of listen- cation (see Chapter 23). It is not uncommon for
ing, inviting, clarifying, questioning, summaris- patients to identify with their doctor or homeo-
ing, suggesting and advising that takes place in the path, claiming they have power and influence that
consultation. You might like to reflect on which of exceeds their role. When patients project high
these are more suited to the relationship in each expectations the homeopath can be tempted to
model of health. And to reflect on the different buy into this idealisation, feeling special or privi-
levels of control and dependence using each might leged and thinking ‘Oh yes, I’m the best’, or ‘I can
Confused and
Hidden Cases

bring. So while quite a questioning style might cure this’. It sometimes is accompanied by the giv-
reveal what a patient did to ‘cause’ the illness, it ing of gifts. It is easy to accept the patient’s sincere

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need of help, especially if no-one else has been teacher you risk demoting your own inner wisdom,
able to help, but it is important to recognise our blocking your own creativity and feeding a low
own place in the patient’s care. opinion of yourself. This low opinion leads to the
By helping patients get themselves better we need to promote teachers, over-identify with the
step back from the ‘divine role’ and instead apply need to do better and attract idealisation. Another
our knowledge to help patients heal themselves. If symptom of idealisation is, I believe, only focusing
we are not in touch with our own humility about on teaching and sharing successful cases. For many
what we can and cannot do, we can start to think homeopaths talking about those cases they find dif-
we have the answer to every problem – often accom- ficult or where expectations were not met is a vital
panied by a need for perfection and called ‘omnipo- step in their balancing being a good homeopath
tence’ by psychotherapists. The idealisation we invite with aspiring to be the best homeopath.
from patients when we project omnipotence at first Idealisation and a sense of omnipotence are
can make the patient secure and trusting. But it is a common in many health professions, perhaps
precursor for the patient feeling their health is not reflecting the therapist’s own pain and need for
their responsibility – and when treatment fails their healing. It is important for preventing and manag-
(often high) expectations, that the homeopath is to ing these and other projections that time is made
blame. When prevalent in a health care profession it to process them. It is why supervision and atten-
is accompanied by passive aggression and a litigious tion to your own health is necessary not just for
culture of blame. The omnipotence we briefly feel your patient’s best treatment but also for your own
from a patient’s idealisation is, of course, a precursor well-being. Paying attention to the health of our
to feelings of not measuring up, failure, disappoint- profession provides a place where what is hidden
ment and, for many, the need to work harder until and compensated for can be seen and addressed,
they are exhausted. for the benefit of all.
This ‘wounded and hurting healer’ is an all too
common state for all health care professionals, and Step-by-Step Approach to Treatment
homeopaths are no exception. The practitioner goes Once it is accepted that the management of a diffi-
from one ‘success’ to another, relying on the next cult case may take several stages, that may include
patient to praise them for getting them better and different remedies or the same remedy several
to renew their fading ideal picture of themselves. times, it is clear that the treatment process involves
This gradually increases their expectations of what several steps. Deciding when a remedy has fully
they should be able to do and the failure they feel acted and when and whether another treatment is
if they don’t achieve it. It is reflected in ‘flipping’ indicated occupies as much of the analyses of more
between feelings of power and powerlessness, being complex, confused and hidden cases as deciding
needed and being alone, feeling important and feel- what the next remedy could be. These steps are
ing ignored. These are dangerous feelings that can illustrated in Figure 29.1 and build on the ideas of
lead some therapists into unexplained depression remedies as a vector (see Fig 27.2).
and even suicidal states – one reason, perhaps, for If the overall treatment process requires mov-
high rates of suicide in health professionals. ing the case from A to B it may be possible with:
As you might expect, the tendency to idealise 1. a single remedy (that may need repeating) or
others and to invite idealisation go together. It is 2. moving through several layers as a confused
therefore a dangerous sign for a student of home- case becomes clear or
opathy to idealise any one teacher and for any 3. several consultations and remedies may be
teacher to receive unchecked a student’s idealisa- needed to clarify the case or
tion. The real insights that teachers give and can be 4. initial treatment might seem to move the case
Confused and
Hidden Cases

respected for are the revealing of what students can away from the desired outcome, this may be a
connect to as their own inner truth. By idealising a stage in revealing the case.

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One remedy may be sufficient to take the patient to a complete cure In some cases, a number of remedies may only move the case on
1. to move them from A to B. The more difficult the case, the less likely 3. slightly until the picture is clear enough to find a remedy that can act
this is to happen and the longer it is going to take to resolve. more deeply. This can be the case in hidden cases where initial
remedies can be as much about revealing the case as finding the
Representing several remedies each moving the case on partially. true simillimum for the deeper case.
2. The remedy may be prescribed for different reasons according to
different models, approaches and methodologies in each case. Its 4. Some remedies may initially move the case in the wrong direction.
is likely that as the case progresses, new information will surface, It is then a matter of retaking the case, in an attempt to move the
representing the deeper aspects of the case. Some remedies case in the right direction.
frequently follow others.

4
2 B

3
Patient at start of Patient at end of
treatment suffering treatment process or
an illness journeying to wellness

Figure 29.1 A step-by-step approach to treatment

Different approaches and methodologies might be removing or reducing symptoms that could help
needed at each stage. For example, a patient with point to the true simillimum.
a confused case of respiratory disease may become In some cases that have received many rem-
clearer after an organ remedy that supports the lungs edies it is as if the case becomes more confused,
(see Chapter 15). A hidden case of heart disease may possibly including a shift in the patient’s suscep-
benefit from remedies that support the heart while tibility. I have previously invited you to reflect on
the case is being revealed or indeed if no therapeutic the homeopathic remedies as having an informa-
agreement exists to work at a deeper level. This may tion quality. If a healthy person is thought to have
be because the patient is reluctant to reveal deeper a certain resistance or susceptibility determined
aspects of the case or the homeopath does not feel by the ‘information’ they have at their disposal it
experienced enough or is not in an appropriate set- raises important questions as to what the effect on
ting with the time or support necessary. an individual is when new information is added.
There are potentially an infinite number of
Using too Many Remedies possible situations a patient could be exposed to
or ‘Over Dosing’ that would require an infinite amount of informa-
When a number of remedies are used in succession tion to cope with. It is reasonable to consider that
there are several possible effects. As we have illus- the overall capacity of the individual for different
trated above the case may gradually be revealed pieces of information is limited. If each piece of
and a curative response followed. It is also pos- information represents something that the patient
Confused and
Hidden Cases

sible that a remedy that covers the case incom- is resistant to, then perhaps the flip side of this is
pletely may distort the case picture, perhaps by that each also gives a reciprocal susceptibility.

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homeopath’s personal, practice and professional

Perhaps the information an individual needs
development.
can sometimes be obtained from the situation they
As an artist will blend together different colours –
are in. Is this why poisons and antidotes, like net-
so, in practice, the homeopath will blend together
tles and dock leaves, are often found near to each
different methodologies to manage patients. There
other? If the homeopathic remedies are another
are many different combinations of approaches
way of providing this information (there is no
and methodologies, each with a different likeli-
reason why they cannot have a material action as
hood of success in different circumstances, and
well), then if remedies keep getting added it may
each suiting different patients, different situations
be at the expense of other information. In this way
and different homeopaths. With experience, you
‘over medication’ may be to the detriment of the
will develop your own preferred styles of work-
individual’s overall susceptibility. This may also
ing, remembering that if one approach does not
explain why sensitivities and allergies may occur
suit there are other models and approaches that
when the patient is in a new situation or following
may. There is not one way of ‘doing homeopathy’,
drug treatment (or vaccination).
rather there are many ways of ‘co-operating with
patients and homeopathic principles’.
Difficult cases provide opportunities not just
REFLECTION POINT for patients and homeopaths, they also enable
● Reflect on a recent patient whose management you the homeopath to start exploring the health of a
found difficult. Were you clear about your impression community and population for present and future
of the case, and did you plan their treatment taking generations – ideas that are developed in the next
into account that it might take several treatments? Did chapter.
the patient clearly understand the plan of treatment?
Were the patient’s feelings communicated clearly, and
were you able to get in touch with your own feelings? In References
experiencing the case as ‘difficult’, what feelings arose
Laing R D 1990 The politics of experience and The bird
from this and how did they help or hinder you as the
of paradise. Penguin, London
homeopath?
Ramakrishnan A, Coulter C 2001 Homeopathic approach
to cancer. Quality Medical Publishing, St Louis

Summary Swayne J 1998 Homeopathic method. Churchill

Livingstone, Edinburgh
Confused and hidden cases make up a significant
proportion of the chronic illnesses that patients
present to homeopaths. As thematic and reflective Bibliography
approaches are used to treat these cases, so they
Hahnemann S 1835 trans Tafel L 1896 The chronic
become clearer and the opportunities for work- diseases, their specific nature and homoeopathic
ing with multilayered and hidden cases increase. treatment, 2 vols. Boericke & Tafel, Philadelphia.
Managing these cases brings opportunities and Reprinted 1998. Homoeopathic Book Service,
challenges not just for the patient but also for the Sittingbourne
Confused and
Hidden Cases

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CHAPTER THIRTY

Managing the Bigger Picture Case Management

David Owen

‘As our institutions are so are our people.’

JH Allen

edies, combining with other treatments and using

Introduction machines to help indicate the treatment. Some of
In this chapter we re-examine the management these are described below.
of those cases that at first appear difficult. We The practice of medicine always takes place
explore integrating different therapies and differ- within a cultural context, which is influenced
ent homeopathic approaches, and reflect on illness by the family, community, national, racial and
from the broader perspective of public health. For ‘world’ view of that time. Our own practices and
many difficult cases there is not one answer or one professional organisations will not only shape
protocol that must be followed, rather there are a how we practice but also will determine how eas-
number of strategies that you might use to manage ily what we do sits within these different views
difficult cases – using the models and approaches so at any time. We have already touched on the role
far described. It may at first seem a weakness in the of the homeopath in treating illnesses that affect
science of homeopathy that there is no one answer the health of the communities we live in and
but the art of homeopathy has evolved in a number in determining the burden of inherited illness
of ways and can be integrated with other therapies and the well-being of our children’s children. It
to suit the illnesses, patients and communities it is interesting to reflect on the dual role of the
serves. Not all patients (or homeopaths) agree on homeopath – not only treating an individual
the outcome they want or on how far they want but also serving society and influencing ‘public
any treatment to go – it may range from treating an health’. This dual role can at times be the cause
episode of acute illness, to relieving a symptom, to of some conflict and tension and so warrants fur-
removing every symptom, to preventing an illness, ther discussion. It reintroduces the idea that ill-
to having a ‘positive sense of well-being’, to being ness may not only reflect the imbalance between
able to maintain wellness in different situations. an individual and their situation but between a
As treatment unfolds the agreement between population and its environment.
homeopath and patient on what is being treated,
and how, is likely to change. As a result what is
‘best practice’, and what is required to practise it, Integrating Different Models
is going to be subject to change and your compe-
tences to deliver it need constant monitoring. In
and Treatments
the attempt to provide the best care, homeopaths Until a patient has learnt what they have to from
have developed a number of ways of working an illness it should not be a surprise if they are
with remedies including using mixtures of rem- difficult to manage or if it reoccurs.

409
 CHAPTER THIRTY Managing the Bigger Picture

At times different approaches will simultane- The danger in treating before the case is
ously indicate different remedies – in these cases completely clear is that treatment may alter the
you must decide which remedy and approach best expression of symptoms in a way that further
fits the overall management. The ideal of finding confuses the case, leading to prescriptions that
one remedy that fits the case in all the models of may give short-term benefit but fail to act deeply.
health is rarely achieved but will, if there are no While to the homeopath it is obvious that until
obstacles to cure or maintaining causes, give a good the deeper level is dealt with the superficial level
prognosis. A case is difficult to manage because won’t resolve on any permanent basis, the patient
the case is unclear or is hard to analyse, often due may require some symptomatic relief before they
to lack of time or the remedy not being known reveal the centre of the case.
in the appropriate models of health. In practice, If a patient has distressing, even if superficial,
over a period of time deepening and revealing the symptoms they may feel a need for some local
case makes the patient’s case more visible, allows treatment and symptom relief. This can put the
analyses using the totality and constitution, and homeopath in a difficult position if they feel the
allows obstacles to cure (and maintaining causes) symptoms are just an expression of a deeper state.
to be identified and treated. Much of the art of managing confused and hidden
cases is balancing these two aspects – drawing on
Treating the Inner and Outer the skills of the homeopath to relieve immediate
Manifestations of the Case suffering and to treat the ‘inner state’.
In confused cases it is not uncommon to observe Some homeopaths require the patient to take no
that the outer case, consisting of local symptoms, symptomatic treatment. Unfortunately this means
and the inner case, reflecting themes running more some patients are reluctant to be treated homeo-
deeply, at first appears at odds; and, depending on pathically. Some homeopaths prefer that patients use
the approaches used, different remedies may be indi- ‘local’ natural remedies, including herbal remedies
cated. What this means for many difficult cases is that and low potency prescribing, to support and control
the homeopath has to approach the case from either those symptoms. Other homeopaths recommend
the outer manifestations of the illness or the inner allopathic and antipathic (conventional) drugs and
susceptibility of the patient. In an attempt to do both treatments if symptoms need treating. For a patient
some homeopaths use both a local prescription and to follow what may be a lengthy course of treatment
a partially suited constitutional, thematic (including it may be necessary to allow patients to experience
miasmatic) or relational one. These are usually given initial tangible benefits, albeit sometimes superficial
in different potencies – lower potencies for the local ones, while the deeper case is gradually unfolding.
and higher for the susceptibility. The aim is to both In patients who are initially reluctant to work at a
relieve local symptoms and establish a clearer case. deeper level, the homeopath may choose to meet
As the case becomes clearer it often becomes the need to reduce the most superficial symptoms
possible to see one remedy that matches both the while gradually making the patient more aware of
outer and inner aspects of the case – where the inner the deeper underlying aspects of their illness.
and outer aspects mirror each other and the total- Homeopaths who use remedies on the one
ity and constitution clearly and accurately reflect hand to fit more superficial levels, while on the
the patient’s true state. Such a remedy acts reliably other hand prescribing for the deeper levels,
and deeply and while most homeopaths would give sometimes refer this as ‘inter-current’ prescrib-
this remedy in single high potency, others will repeat ing. This is also used to treat acute conditions that
regularly at high potency and some will accompany occur while a chronic is being managed – but tak-
this with the same remedy in lower potency on a ing care that any inter-current acute is recognised
Confused and
Hidden Cases

daily or weekly basis – perhaps working on the more if it is a healing reaction and is not suppressed
material and structural components of the illness. to the detriment of the patient. Knowing when

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to leave an inter-current acute alone, and when experience in this way and to attract patients who
and how to support the patient in recovering want to work that way – leading to different
from such an acute, is often difficult and benefits ‘schools of thinking’ that without an understand-
from the experience of knowing how different ing of why different strategies exist can become
remedies in different potencies act. The point at dogmatic and inflexible.
which an inter-current acute needs treating and While I have depicted a hierarchy and struc-
how it is managed will often play a large part in ture to the different models of health starting with
how successfully you manage more difficult cases. causation and ending with relational, in practice,
Remember that many patients might also receive each of the models of health can be observed to be
or try other treatments for symptoms that emerge at play in all of the others. The cause does not hap-
during treatment – these will alter what you see pen independently from the effect or the suscep-
and how the case progresses. Knowing something tibility – nor is it unaffected by the observer and
of these other treatments is an important adjunct the relationship in which the cause is observed. It
to your homeopathic knowledge. is helpful to think about each model of health as
By now you will appreciate the tension between containing aspects of all of the others. While we
two schools of thought. One extreme is represented can study each model or approach or methodol-
by homeopaths who feel that if no common rem- ogy separately it is important to realise their con-
edy covers all the predominant themes and symp- nectedness. For example, causation does not only
toms, or reflects all the qualities of the inside and happen in the realm of individuals with respect
outside of the case, it is best to re-take the case and to their situation. It also happens in relation to
re-study the materia medica until a best-fit rem- their ancestors through inheritance, through their
edy can be prescribed. Once prescribed, no inter- family, through acquired and learned behaviour,
current treatment should be given. This approach through their community and culture. These
is sometimes referred to as ‘unicist’ prescribing. causes all influence the symptoms, the susceptibil-
At the other extreme are homeopaths that might ity, the themes and relationships of the patient.
use several remedies concurrently – sometimes
referred to as ‘pluralist’ prescribing. Remedies Mixtures of Remedies
may be used in a specific order to cover different Figure 30.1 revisits the idea of remedies as vectors
aspects of the case in turn or, in some schools, (see Chapter 27). When remedies are combined
mixed together in the same preparation – some- they might set up a third remedy, perhaps with
times referred to as a complex prescription. recognisable aspects of the component remedies.
However, if that combination remedy has not been
Interconnection of Different Models proved, unique symptoms specific to that mixture
of Health and Approaches to Treatment will not be known and how the component parts
However you choose to work it is important to might interfere with each other is unknown – mak-
reflect on why you choose to work in one way and ing it difficult to interpret the outcome. The infor-
not another, and on the strengths and weaknesses mation in a remedy may be better understood like
of your management. It will be influenced by many a sound wave that, when combined with another
factors, including the context and culture you are sound wave, creates a new wave form and sound
working in. As such it is informative to be aware contributed to by the parts.
of our homeopathy history (Campbell 1984), how Single or ‘unicist’ prescribing uses one prescrip-
different medical systems have evolved and inter- tion of a single remedy at a time. It is usually not
twine (Sutherland1920), and to be aware of the repeated or changed until specifically indicated.
political implications (Coulter 1981) that implic- Complex prescriptions may be combinations of any
Confused and
Hidden Cases

itly or explicitly affect your choice. Homeopaths number of remedies, sometimes including herbal and
working in a particular way are likely to gain more nutritional supplements. An example of a complex

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approach provides opportunities and has limita-

A
1st remedy tions. Those favouring unicist prescriptions some-
times report that when many remedies have been
Theoretical estimate used in close succession the case is more confused –
of effect of 1st and 2nd sometimes referred to as ‘spoilt cases’.
remedy combined
One of the criticisms of mixtures is that when two
apparently similar remedies are mixed together the
2nd remedy resultant remedy may act unpredictably. This seems
As more remedies are added, so the estimated vector becomes to be particularly true the higher the potency of the
more difficult to estimate and so it becomes harder to predict what
effect such a mixture of remedies will have remedies mixed. Perhaps this is why it is more com-
mon to see low potencies and herbal medicines used
B together than high potency medicines. In any mixture
Ultimately if every remedy or combination if the indication for each constituent
representing every sector
is combined, the resultant part is known it is easier to see how those compo-
‘superpill’ has a vector of nents might cover different aspects of the case and to
zero i.e. they cancel each
other out interpret the response to treatment. This is qualita-
tively quite different from using a mixture based on
Figure 30.1 The effect of combining remedies just pathology without knowing why each compo-
nent is indicated or how it might shift the case.
If all mixtures were an addition of the qualities
is the combination of Ruta grav, Rhus tox of one remedy to another, with nothing lost, then
and Arnica in a remedy for painful joints. An one pill with all the remedies in it would cover all
example of pluralist prescribing is a patient with cases (Fig 30.1b). Consider how many remedies
a chest infection receiving initially a miasmatic combined in one pill might be drawn as a vector –
prescription of Tuberculinium bovinum followed effectively they would ‘cancel’ each other out.
closely by a local remedy of Rumex crispus. The important issues that you will need to address
In one way all remedies are mixtures of com- about each prescription have been covered pre-
ponent parts, whether of atomic components, viously but the points in Box 30.1 are to allow
different atoms, salts or ingredients. A plant rem- you to reflect on and revise these. It is for each
edy may be thought of as containing a number of homeopath to decide practically what best suits
mineral salts, and remedies from animal sources their patient and themselves, based on the princi-
often have themes that run through the plant rem- ples you are using, the therapeutic agreement and
edies. However, when each individual remedy is your level of competence and confidence.
proved, it always has aspects of its own unique Generally, and understandably, it will be easier for
picture. While a case may have indications for homeopaths to reach a consensus on the management
several closely matched remedies, and each cover of simple cases – as cases get more difficult so there
aspects of the case, only one will fit it most closely. will be greater variation in practice. Different homeo-
If one remedy that covers the case is not found, paths will, depending on their knowledge, experience
then different schools of homeopaths respond and preference, use different models, approaches
differently. Some use inter-current remedies to and methodologies. Being explicit about them, and
cover the component parts, some may combine recording them clearly in the notes when you record
different remedies, and some will use a remedy to the impression, plan and prescription, along with
seek to clear the case. Others will wait and re-take establishing how you monitor the outcome, will help
the case or study the materia medica until they you (when you review a case) to repeat your successes
Confused and
Hidden Cases

identify one clear remedy – possibly considering and explore different management strategies in those
the case incurable if one cannot be found. Each that do not initially respond.

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BOX 30.1
Issues to Address With Each Prescription
●
What type of case are you treating? ●
What support and information does the
●
What model of health and approach to treat- patient need?
ment are you using? ●
What potency and frequency of administra-
●
Have you a therapeutic agreement that you tion is needed?
and the patient are happy with? ●
When will you know if you need to change
●
Does this prescription reflect the depth the prescription?
of causation, the level of the symptoms, ●
What is the patient’s vitality like?
the breadth of the totality, the layers of ●
How will you manage relapses?
the essence and/or intensity of the projec- ●
If using several remedies, what are the indica-
tion? tions, instructions and potential interactions
●
Are there confirmatory or exclusion fac- for each?
tors? ●
How will you know when to seek supervi-
●
How reliable is the prescription? sion?
●
What methodology are you using and what is ●
If the patient’s symptoms are relieved, will
your confidence in the prescription? they have made a transition to a better state
●
When to prescribe and when not to of health?
●
What advice to give about inter-current treat- ●
When would you consider you have done all
ments you can for a patient?
●
When to follow up the patient ●
How will you discharge a patient; and will
●
How changes will be elicited and monitored they need, or will you offer, long-term sup-
●
Is there a risk of an aggravation? port or ‘health maintenance’?

Integrating Different Types of Treatment indication might, like a homeopathic approach,

As some patients are increasingly seeking a pos- have certain key points to recommend it. For
itive state of health and are increasingly wary example, if her headaches were worse from mov-
of suppressing symptoms, so they are pursuing ing the head into certain positions or if there was
an increasingly varied range of complementary restricted movement of the neck, then manipu-
treatments. In order to integrate these treat- lation of the neck would be relatively more
ments and to manage patients who are using important to consider. If she had tenderness over
them at the same time as receiving homeopathy, acupuncture points, this might indicate she was
it is important to be familiar with their basic likely to respond to this treatment. In addition,
principles and where, particularly, they inter- a case could be made for herbal treatment based
face with homeopathy. It can help to identify on possible hormonal imbalance – especially if,
those that influence health in different ways. say, her headaches had been much better in preg-
You might find it helpful to consider them in nancy. Further dietary work might have helped
terms of whether they work predominantly on her, including further food exclusion – as might
susceptibility, vitality or life style (as illustrated ‘naturopathic’ advice from fasting to ‘detox’
in the boat analogy in Figure 6.1). and ‘cleansing’ programs. Her own initial reluc-
If you read through the case of Susan you may tance to look at psychotherapeutic approaches
recognise a variety of non-homeopathic interven- might be considered either a contraindication
Confused and
Hidden Cases

tions that might be used in addition to the con- or an indication that she needed this! In prac-
ventional treatment she received. Each different tice you are often in the position of having to

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advise patients who might benefit from several be more likely to have an accident and develop
possible interventions. At times it is necessary to a whip-lash, etc. Where a particular therapist
‘blend’ these together into a coherent integrated intervenes will depend on their training and the
package. Of course in many cases the patient's patient’s choice but in more difficult cases inter-
case can be understood as a number of intercon- vening in several ways with several therapeutic
necting events or factors. So a headache might tools can often get results more quickly, that hold
affect posture, ongoing pain make the patient for longer and sometimes in cases that will not
depressed, a depressed and tense patient might respond to a single intervention.

CASE STUDY 30.1

Susan, aged 56, has had headaches (worse Medication
over the last 8 eight years) since she was 12. Currently on Pizotifen and Cafergot. In the past
Some pain is present over the eyes most of has used Sumatriptan, which helped initially.
the time, although this gets very much worse
Social History
approximately twice a week for six hours. The
Parents separated when she was a child. After
worst pain is usually unilateral, spreading from
road traffic accident lost contact with her daugh-
the occiput to the forehead. It is a sharp, stab-
ter. Her husband has a busy job as a university
bing pain.
lecturer and has raised blood pressure.
Modalities
Dietary Factors
Initially the headaches came monthly and were
Likes fruit, dairy products. Dislikes fish.
relieved with aspirin. In her 20s migraine was
diagnosed and she was given medication that Family History
helped for a few months, after which the pain Mother had migraines, maternal grandmother
returned and was worse. Headaches relieved in died of tuberculosis, daughter used to suffer
the past when coming off cheese, coffee and from asthma, eczema and hay fever.
fatty foods. She is currently trying to keep these
General Symptoms
to a minimum. Worse from bright lights and
Hot and perspires easily.
damp weather; better from local pressure and
warmth Temperament
Susan is unable to ‘show feelings’ but very sen-
Past Medical History
sitive. Previously she changed her family doctor
Susan fell off a horse aged 11. She was driving
when he suggested counselling. She says she
when involved in a road traffic accident aged 47.
is a ‘loner, particularly if I’m feeling ill, when I just
Her granddaughter, a passenger in the car, was
want to be left alone’. Her husband says she’s a
injured. This has left unresolved issues between
perfectionist. She enjoys playing the piano and
her and her daughter. She describes her meno-
music makes her feel better. She belongs to the
pause as ‘horrific’, although it was relieved by
church, which is her ‘main comfort in life’.
hormone replacement therapy that she stopped
Susan was initially treated on a totality pic-
three months ago. She had a gall bladder oper-
ture with essence and keynotes informed by
ation aged 46.
the repertorisation. It pointed to Natrum muri-
Symptoms Review aticum, prescribed as a 200c split dose (two
Constipated all her life. Bowels open once or doses one that night and the other next morn-
twice a week. Hay fever since children were ing). At follow-up Susan is slightly more engag-
Confused and
Hidden Cases

born. ing and (either because of the remedy, improved

414
VI
 Integrating Different Models and Treatments

rapport or both) is able to talk about ‘periods also because there are several pointers to both
of depression’ that she gets; her headaches Sulphur and Natrum muriaticum and the aetiol-
are unchanged. She feels ‘responsible’ for her ogy of head injury, for which Natrum sulphuricum
parent’s separation and finds herself think- is well indicated. She returns after a month ‘much
ing about this often, especially on ‘rainy days’. much better’. Susan is seen after three months
She is prescribed Natrum sulphuricum 200c and has come off all conventional drugs and
split dose, partly on the new information but started to go to a counsellor with her husband.

As with other cases presented in this book only harmful chemical factors, or reducing negative
key extracts are offered to illustrate the learning psychological factors, including stress manage-
points. In Susan’s case the time-line is important ment, hypnosis, relationship counselling and
in revealing aetiology and the effect of suppressive other interventions that can break damaging psy-
medication that was probably responsible for turn- chological patterns.
ing an occasional acute picture into a permanent I have found many patients where a remedy
chronic one. Indeed, overuse of analgesics is well becomes clear or a well indicated remedy acts
recognised for changing an occasional acute head- much deeper (when maintaining causes and obsta-
ache to a frequent chronic one and I suspect this cles to cure are removed or reduced) by using the
suppression happens in many other conditions. additional support and advice from other comple-
mentary medicines. Identifying colleagues that
Modifying the Patient’s Situation can give this advice, and who themselves under-
While case-taking reveals the relationship between stand the homeopathic process, is an invaluable
a patient and their life situation, both its role in resource. For example, I have found acupunctur-
their condition and as a potential obstacle to cure, ists and reflexologists able to guide and inform
it does not necessarily do anything to change that about ‘organ damage’ and the monitoring of out-
situation. However, a slight shift of emphasis in come in severely handicapped patients who have
the case-taking can help patients make clear links difficult communicating verbally.
between their symptoms and facilitate a change in In many cases of advanced disease, such as met-
life style. In the holistic model it may help patients astatic disease, I find it helpful to be explicit to the
understand their susceptibility; in the holographic patient about the role of different interventions.
and relational models it may help them become While the homeopathic treatment frequently
conscious of aspects of themselves and aware enables (and is enabled by) the other interventions
of how they project themselves and how others the patient is making, it also requires careful inter-
might project onto them – an insightful and pow- pretation so that the contribution of each interven-
erfully therapeutic process. tion can be understood. It does, however (unless
In a way every illness offers the patient an you make the interventions yourself), require the
opportunity to notice and change themselves and ability to work with and communicate with a vari-
their situation in some way – in the same way as ety of professions – sometimes using diverse con-
ecological problems provide important lessons cepts, language and models of health.
and opportunities about (and for) environmen- I find it helps patients with advanced disease to
tal change. Homeopathy has a long tradition of plan such integrated care by thinking of the compo-
working alongside interventions suggested to nents of the care like the four sides of a square. This
Confused and
Hidden Cases

modify a patient’s life style, whether it be dietary can be drawn out for the patient in order to remem-
advice, advice on exercise, removing potentially ber how different interventions may help and to

415
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 CHAPTER THIRTY Managing the Bigger Picture

see how different aspects of their care connect. There are many other systems of medicine in which
On one side are the vitality treatments that include remedies are prepared in a similar way to homeo-
the homeopathic prescription. On the second are pathic remedies, such as the tissue salts, that you
the ‘structural and bio-mechanical treatments’ that may be interested in – or that patients may expect
include assessment of the musculoskeletal system you to know something about.
and often include advice on environment and life
style. The third side is ‘functional’, where important The Homeopath as a Machine
bodily functions and organs can be supported using The subtle appreciation of illness from a homeo-
herbal remedies (or homeopathic mother tinctures) path’s perspective is often inadequately expressed
and nutritional products. The fourth side is the by a gross conventional diagnosis. But integrat-
psychological advice and support that can help the ing psychotherapeutic models to understand the
patient. In some cases a homeopathic remedy might patient’s mental state and to describe the homeo-
act more deeply and ‘hold’ for longer if other treat- pathic relationship provides a sensitive tool to
ments are integrated into the patient’s care. describe the individual. However – as you are
In some cases it is appropriate and helpful to finding – this requires substantial reflection, devel-
name a fifth aspect (that I sometimes draw as the opment and support. It is therefore not surprising
top of a pyramid running up from the four-sided that (like many health care professionals) homeo-
square). This reflects the spiritual or religious paths and patients are drawn to diagnostic and
dimension that may be addressed by the patient treatment tools as a channel, or even an alternative,
in many ways – including healing, pastoral care, to exploring and expressing their own sensitivity
prayer, meditation, etc. So, for example, a patient and influence. Many homeopaths and patients are
with advanced cancer may receive advice from a drawn to forms of diagnosis (whether dowsing,
number of sources – on homeopathic treatment, bio-electronic techniques, applied kinesiology or
on diet and nutritional supplementation, on organ others) in an attempt to perceive more easily, reli-
support (particularly liver) and on psychological ably or deeply.
support (such visualisation or relaxation tech- Although some practitioners use these tech-
niques). Each side may include a review of their niques successfully, I see little reason why any
conventional medical treatment. The spiritual machine or gadget might reveal anything more
dimension is helpfully named for many patients, useful for the careful selection of a remedy than
especially when death is near, to connect their can be achieved by the homeopath interacting
healing journey with their spiritual one. A fear of with the patient in a dynamic way. The ability to
death in both the patient and homeopath, reflect- stay alert to your own movement, phrases, body
ing the fear in society, is one of the major obstacles language and feelings, and to perceive and moni-
to seeing the case when managing severe illness. tor their significance in relation to the patient and
Clarifying for yourself, and understanding for their case, is your own instrument. When you
others, what life and death mean is a precursor to are actively and consciously in a consultation the
seeing these cases more clearly (Levine 1987). homeopathic relationship is a powerful part of
A ‘homeopathic’ treatment that requires partic- not just selecting and advising a treatment but of
ular mention in the treatment of cancer is Iscador, the healing process itself.
made from mistletoe. It can provide both material When machines and instruments are used
organ support for the patient and a direct benefit to select a course of treatment without a clear
for the vitality, leading to increased survival times understanding of the case (whether you use con-
(Leroi 1962, 1965). Iscador is an example of a rem- ventional investigations, bio-electrical, dowsing
edy prepared in a similar way to homeopathic rem- or indiscriminate repertorisation), the case per-
Confused and
Hidden Cases

edies but used traditionally through a related school ceived is going to be limited by the sensitivity
of thought and practice called Anthroposophy. of the machine employed. All machines bypass

416
VI
 Cultural Issues and Public Health?

aspects of human sensitivity and reason, risking If health is the ability to maintain the integrity of
the relationship that is the fundamental differ- the organism in new situations and facing new
ence between being a technician and a homeopath. challenges, then illness is an inevitable side effect
While machines can help to gain a snapshot image of growth and change. When healthy we have the
of part of the whole, they risk perpetrating the ability to accept, invite or take on greater changes
myth of the case as a series of disconnected parts – in our environment. The healthier we are, the
and the illusion that treatments (often multiple more we are able to explore different life styles
when prescribed using these machines) which and accommodate to different situations. This
attempt to correct a range of disconnected abnor- is true for individuals and communities – even
mal results will bring health. More dangerously, as populations. The health of one affects the health
with any tests, they can raise inappropriate con- of the others. An individual’s susceptibility, resis-
cerns leading to irrelevant treatments – and taking tance and immunity is directly linked to the sus-
the patient away from the true opportunity they ceptibility, resistance and immunity of the whole
have to heal. population. The homeopath, like all health carers,
has a role in society and public health by identi-
fying environmental triggers and causes of illness
REFLECTION POINT and promoting healthy life styles. Indirectly we
● To what extent do you feel it is true that a patient can also have a role in identifying how the illnesses
only suffer one illness at a time? A number of different patients suffer from now will contribute to the
styles of working, ways of prescribing and issues that susceptibility of future generations – and how
relate to the integration of homeopathy in difficult cases correct treatment can reduce this susceptibility
have been described. How aware of developing your own reflected in inherited predisposition.
preferences are you and what has most influenced these? While the patients we treat focus on individual
● Before embarking on the management of severe, care, our practices provide care in a community
life-threatening and terminal illnesses, it is important and our professional organisations should have
to have reflected on the place of palliation, healing and a voice and role in the health of the population,
cure. Palliation has already been discussed and may ensuring that the broadest perspectives that home-
prevent the full expression of an illness. Healing is a opathy offers about health are communicated
process that takes place over time. Cure is a place or effectively. For example, amongst the growing
state where the organism is balanced. Reflect on the numbers of patients with a susceptibility to heart
role of each and when each is appropriate as a goal of disease, there are frequently psychological issues
treatment – how might management be difficult if you around stressful and difficult relationships that are
and a patient have different aims? increasingly recognised as contributing to heart
disease. The homeopathic community, through
working with patients, is one of the professional
Cultural Issues groups most aware of the broader issues related
to these frequently masked and hidden cases, and
and Public Health? could champion social change to address this in
‘Establishing connections with others is not merely a the population. The deepest illnesses and the most
matter of participating in a particular pattern of per- hidden cases often reveal a great deal about the
sonalities. It is a matter of realising our nature. If we culture the patient is in – offering important pub-
adopt a style of aloneness in our relations with others, lic health insights.
we contradict a fundamental life process; we defy the One issue that often reoccurs for homeopaths
bio-dance, the ebbing and flowing pattern that connects, is the tension between ‘belonging’ to a commu-
Confused and
Hidden Cases

without which life would cease.’ nity and being on ‘the edge’ of a community. As a
L Dossey (1982) therapist you provide something of a conduit for

417
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 CHAPTER THIRTY Managing the Bigger Picture

both individuals and communities. You both have at the same time and many insights occur because
to belong to know what it is like to experience and change in one thing allows us to see other things
share what is taking place, but at times you have differently. There are times when it is right for
to operate outside of it. It is not always easy to ‘ideas to emerge’.
be free from the bias and hidden and unconscious It is an important responsibility of our profes-
influences that a community chooses – belonging sional bodies to ensure that the role and value of
to strong professional organisations can support the homeopathic community they represent is
you and in some ways compensate for this. recognised. The knowledge resides not only in
a few individuals but also within our profession.
Cultural Illness The checks and balances that our professional
Traits and issues that are poorly expressed or dealt bodies offer can help in validating emerging ideas
with in society may explain why certain symp- and reinterpretations of observation.
toms go unnoticed or unacknowledged by some
patients and therapists. This is a major contributor
to hidden cases that often present with the most REFLECTION POINT
serious of illnesses. By developing and challeng- ● To what extent do you think the sum of illnesses in a
ing attitudes to health, the homeopath, in the best community defines that community’s well-being? To
tradition of scientists and artists, invites the popu- what extent do you feel you have a responsibility to a
lation to reflect on what it believes and express community as well as individual patients? Is it likely to
what it feels. be easier or harder to see confused and hidden cases
Although we focus our treatment on individu- and to identify the projection in patients from a similar
als, the treatment can also have a dynamic effect cultural background to yourself?
on those around them. It is interesting that often
a ‘stuck’ case can shift when other members of the
family receive treatment. Just as an ill person can
affect those around them so can a healthy person –
Summary
health is as ‘infectious’ as illness! In this context, In this chapter we have looked at the wider context
and as a profession, we have a responsibility as of homeopathy, how the different ways of prescrib-
homeopaths not only to heal our patients but also ing connect, and how homeopathy can integrate
to try and heal our health care system. with other treatments. We have named but a
few of the many interventions that you and your
Teaching of Homeopathy patients might try to integrate. Each, like home-
Ideas are developed in a symbiotic way between opathy, has their own system and knowledge –
an individual’s personal insights, their practice part of the management of any difficult case is real-
and their professional culture. So in homeopa- ising how different pieces of advice and advisors
thy the ideas and teachings that evolve depend can work together.
on and belong equally to the individuals who Given the importance of the context in which
articulate them, the patients and colleagues that we work and the situation any patient is in,
are part of their practice, and the homeopathic I have discussed some of the community and cul-
profession past and present. The knowledge of tural factors that influence our work. Realising
any individual must always be seen in the context the importance of this to our health, the health of
of the wisdom of the community as a whole. It our patients, and the health of future generations
seems to me that while there is no doubt about the raises many questions – I hope those questions,
transformative role some individuals bring to our like others that this book has asked you to reflect
Confused and
Hidden Cases

understanding, there are ideas that are expressed on will contribute to the foundation of your prac-
synchronously through several different teachers tice in homeopathy.

418
VI
 Conclusion

your practice. For those who have been in practice

Conclusion for some time it can appear that there is no clear
The last patient will never be healed. direction or path to follow, no best way to prac-
In this book I have set out to describe a struc- tice – at times it can feel like crossing a wilderness!
ture that I have found useful in understanding and Hopefully this book will have helped you identify
applying a series of views (or models) of health, some key tools to seeing the uniqueness of each
approaches to the treatment of illness, and meth- patient and to find a new direction for your work –
ods of prescribing remedies. These have helped to move out of the wilderness. If you have
me to co-ordinate the many different ways home- reflected on and clarified the central homeopathic
opathy can be used and to manage patients in a principles that are true to you, then this book will
rational and repeatable way. It is important to me have served you well.
that you realise it is my intention for you to take To my experienced colleagues I offer this book
from this framework only what is useful to find as a collection of ideas, some of which you will
your own styles of working. My wish is that the be familiar with, some of which you will easily
book may inspire you to find the balance of art agree with and which may serve to make you feel
and science that suits you, to actively and enthusi- less alone. If there are some you are unfamiliar
astically enquire into the mystery our patients so with, then I am pleased to have shared a little of
generously bring to us, to courageously apply that how I see things – but I remain enthusiastic and
enquiry to your own self, and to record and share eager to hear of your experience and insights that
your successes and – perhaps more importantly – I am currently unfamiliar with. If there are ideas
what appear to be your failures. you do not agree with but if reading this book
At all times remember the importance of expe- helps clarify and strengthen your own views, then
rience in your training and development – not only I encourage you to share them.
the experience of present and past teachers but I hope you have reflected a great deal while
also your own. When what you have been taught studying this book. Although each model is
(including what is written here) is not consistently described separately I believe we are all influenced
borne out by your experience, then I invite you to by each of them, to some extent, in every encoun-
take it as an opportunity to explore and elucidate ter. Determining and shaping every encounter
the homeopathic principles underlying them for is our ability to be in a relationship; our ability
yourself. In training, it can appear that you are to relate to others is shaped by our awareness of
showered with a variety of ideas, styles and advice ourselves. We cannot but be influenced by cause
– if this book enables you to integrate just some of and effect, susceptibility and the total expression
this knowledge it will have served you well. Once of those we are in contact with, the patterns we
you start in practice you can often feel quite alone recognise or how they resonate with our own, the
with the suffering that presents to you on a daily projections we are influenced by and the way they
basis. When you feel isolated I hope this book are reflected in us. If we do not consciously attend
will provide some common ground and a basis of to how each of these affects us we will remain
respect between yourself and a wide range of col- unconsciously influenced by them.
leagues from whom you can receive and to who I encourage you to do all you can to be aware
you may offer support. of the personal, practice and professional refer-
Many homeopaths appear to fail to establish a ence points that reflect and influence our attitude
practice that matches their initial ideals – often see- and state of mind. Once aware of these, they
ing few patients or struggling to make ends meet. can operate at all times, and in any situation, to
By returning to the principles and practice detailed help you perceive yourself and others clearly.
Confused and
Hidden Cases

in this book I believe you will find different and Understanding the homeopathic relationship is at
relevant ways to engage with patients and build the heart of understanding how our unconscious

419
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 CHAPTER THIRTY Managing the Bigger Picture

needs, fears, delusions and desires are expressed – long tradition of teachers evolving their thoughts
and central to perceiving the case without becoming and appearing to change their mind. I will be hon-
stuck in it. For me, the more difficult the case, the oured if you permit me the same opportunity.
more that can be learnt from it, but also the more
important it is to have a place and context to re-
examine that case so that you can explore other References
ways of working with that patient, identifying
Campbell A 1984 The two faces of homeopathy. Jill
the projection and clarifying what at first is not obvi-
Norman and Hale, London
ous. I wish you well in finding both small groups
of colleagues and the individual supervisors and Coulter H L 1973–1977 Divided legacy; a history of
mentors who will help you with this. the schism in medical thought, 3 vols, 1994 vol 4.
Wehawker Press and North Atlantic Books, Berkeley
This book has attempted to present a structure
that will help you practice homeopathy. It has Dossey L 1982 Space, time and medicine. Shambala
invited reflection in your learning, pointed out Publications, Boston
the development that is enmeshed in your train- Leroi A 1962 Progress in iscador therapy of malig-
ing, and encouraged you to establish the support nant tumours (I – Brain and Skin). Br Homoeopath J
necessary to tackle difficult cases and learn from 51(1):31–37, 176–185
the experience. There is much that is theoretical, Leroi A 1965 Iscador therapy of cancer. Br Homoeopath
but it is informed by the experience of my col- J 54(1):27–35
leagues and myself. One thing is certain, in the
Sutherland J P 1920 The idealism of homeopathy. John
future – and perhaps very rapidly – a number of Bale, Sons & Danielsson, London
the premises explored in this book will be out-
Levine S 1987 Healing into life and death. Gateway,
dated. It is not that the truths we work from
Bath
change, rather that our perspectives of them do.
Disease is changing and the challenges the homeo-
path faces now are very different from those even
50 years ago. We are fortunate to have a diligently Bibliography
recorded homeopathic legacy of much wisdom Kent J T 1929 Lectures on homeopathic philosophy.
and experience. How we take this forward is our Ehrhart & Karl, Chicago IL. Reprinted 1981 North
responsibility and while the attitudes and practice Atlantic Books, Berkeley Lecture 37
described in this book represent my current clini- Cicchetti J 1993 Dreams, symbols and homeopathy.
cal experience, the practice of homeopathy has a North Atlantic Books, Berkeley
Confused and
Hidden Cases

420
VI
INDEX

Air, elemental, 280

A Alcohol, 266, 328 Archetypes, 365–366, 367
Absorption, 325, 326 dispensing remedies, 271 Argentum Nitricum, 87, 179, 226
Accident proneness, 131 LM tincture preparation, 270 Arnica, 30, 31, 32, 39, 47, 52, 131, 240, 265,
Acids, 294, 359 medicating potencies, 271 323, 376, 398, 412
Aconite, 31, 47, 62, 87, 193, 240, 385 mother tinctures from plants, 267 Arnica state, 31
Acquired predisposition, 9, 188, 405, 411 Allen’s Encyclopaedia of Pure Materia Medica, Arsenicum, 47
Activist learning style, 159 88 Arsenicum Album, 86, 87, 102, 104, 111, 228,
Acupuncture, 69, 413, 415 Allergens, 58 231, 233, 313
auricular, 356 isopathy, 57 Arsenicum iodatum, 228, 231, 233
patient characteristics, 325, 326 sensitivity, 56 Asafoetida, 228
research approaches, 319 Allergy, 58 Associations, 46, 101–102
Acupuncture points, 329 Allopathic reactions, 24 Asterias rubens, 233
Acute or chronic illness, 131 Allopathic treatment, 132, 305, 410 Astrological zodiac, 6, 357, 372
Acute illness, 62, 63, 67, 81, 123, 125, 128 management of cases, 197 Attentiveness, 36, 37, 170
aggravations, 198 suppression, 147, 148 homeopthic relationship, 305–306
change over time, 134 Aloe, 298, 299 Attenuation see Dilution
chronic illness relationship, 131–132 Alumina, 226, 254, 290, 376 Attractors, 330
follow-up, 209 Amelioration, 179, 210, 212, 214 Audit studies, 317, 321
inter-current prescribing, 410–411 Amphetamines, 56 Auricular acupuncture, 356
local prescribing, 110 Anacardacia, 298 Aurum, 158, 171, 228, 293, 366, 373, 374,
masked, 131 Anacardium, 20, 226 379
matching case to remedy, 112 archtype, 225 Aurum metallicum, 94
mental, 130 Analogues, 376 Aurum sulph, 255
partially expressed, 131 Anamnesis, 30, 32 Authenticity, 346
patient–homeopath (therapeutic) Androctonus, 20 Autoimmune disease, 226
relationship, 135 Anima/animus, 366 Autoregulation (homeostasis), 8
plan of treatment, 186 Animal kingdom, 295
practitioner dispensing, 271 Animal milks, 378
relapse/recurrence, 128, 130, 131 Animal patients see Veterinary homeopathy
situational, 131 Animal research studies, 328 B
suppression, 144 Animal signatures, 281–282 Bach, Edward, 58, 272
treatment on causation, 47 Animal-derived remedies, 84, 263, 290, 295, Bach flower remedies, 58, 193, 272
types, 129–132 296 manufacture, 272
use of repertories, 120 Anions, 293 Bacillinum, 231
Acute miasm, 290, 291 Anthroposophy, 416 Bacillus no 7, 228, 231
plant family remedies, 298 Antidotes, 44, 197, 210, 214, 271, 272, 375, Bacterial signatures, 282
Adherence see Compliance 376–377 Balance, 10, 11, 14, 142
Administration routes, 271 aggravations, 199 functions of illness, 13
Aethusa, 75, 91 Antimonium crudum, 226 Barium, 292
Aetiological prescribing, 39 Antimonium tartrate, 132 Baryta carbonica, 62
see also Causation treatment approach Antipathic reactions, 24 Baryta salts, 293
Agaricus, 94, 191 Antipathic treatment, 132, 410 Basic science studies, 316, 318,
Aggravation, 24, 44, 134, 179, 198–199, management of cases, 197 327–328
210–212, 214 obstacles to cure, 200 Bee venom, 267
antidoting, 199, 376 palliation, 148 Belladonna, 34, 62, 77, 84, 86, 115, 134, 193,
LM potencies, 270 suppression, 148 287, 399
management, 199–200 Apis mel, 47, 375, 377 Bellis perennis, 233, 376
nosodes, 246 Appearance, 87, 155 Benzodiazepine withdrawal, 56
suppression, 199 Appointment times, 170 Bioelectrical techniques, 362, 416

421
INDEX

Biological model of health, 5, 8, 10, 11, 29, 42 comparison/picture matching method, physical examination, 104
illness concept, 68 113–114 place in package of care, 320
prescribing methodology, 7 complex cases, 195 plan of treatment/management, 105
symptoms, 67–68, 69 using totality/constitution, 177–181 prescription, 105
treatment approach, 7 computer use, 252, 256–257 psychological space creation, 106
Bismuth, 293 conventional/differential diagnosis, 42 questionnaires, 107
Boder’s Synoptic Key of the Materia Medica, core principles, 39–45 review of systems, 103
89 questions to answer, 40 significant life events, 103
Boenninghausen, 178, 180, 375 difficult cases, 384, 402 symptoms
Boericke’s Materia Medica, 89, 92 flow diagrams, 112–113 classification, 106
Boiling method, 272 follow-up requirements, 45 general, 103–104
Borland, Douglas, 158 general management factors, 44 mental, 103–104
Bothrops lanceolatus, 256 local symptoms, 112–113 presenting, 99, 101–102
Boundaries, professional, 36, 309, 341, 342, matching case to remedy, 112 Castor Equi, 56
346, 350, 373 models of health applications, 42–43 Cations, 293
Bowel nosodes, 228, 231, 263, 377 patient–homeopath contract, 45 Cats, 239, 241, 243, 246, 247, 248, 264
veterinary prescribing, 244 potential outcomes, 44 Cattle, 244, 245, 246, 264, 371
Bromium, 231 prescribing methodology, 43–44 mastitis, 246
Bryonia, 87, 245, 312, 375 themes, 398 remedy administration, 264
Burnett, James Compton, 58, 241 treatment approaches, 43 tubercular miasm, 147
vitality, 41 Caulophyllum, 245
Case, homeopathic, 29, 123 Causation, 3, 5, 7, 69, 72, 143, 411
anamnesis, 32 anamnesis, 32
C assessment see Case analysis case analysis, 40–41, 112–113
C type personality, 232, 364 categories, 123, 124, 125–128 complex cases, 150
Cadmium metallicum, 233 matching to models of health/treatment depth of penetration, 71
Cadmium sulphuricum, 233 approach, 123, 124, 128–129 hierarchy, 32
Calcaria, 366 centre (deepest disturbance), 59, 70, 187, history-taking, 98
Calcaria carbonica, 84, 99, 115, 223, 224, 385, 410 levels, 31, 32, 47–48
231, 243, 262, 278–279, 374, 401, clarification, 200, 212, 346, 356, 387, 400, materia medica selection, 82
404 410 modalities, 46
Calcium carbonicum, 77, 104 diagnosis, 123 models of health, 30
Calcium phosphoricum, 230, 231 matching to remedy, 112 biological, 5, 8
Calendula tincture, 199, 266 patient’s narrative, 30–31, 32–33 holistic, 5–6, 8, 142, 144
Camphor, 26, 199, 271 non-verbal clues, 33 holographic, 9
Cancer miasm see Carcinosis recording, 33 pathological, 5, 7, 8, 14, 29–30, 67
Cannabis indicus, 94, 226 Case reports, 318, 319 multifactorial, 8
Cannabis sativa, 226 Case-receiving, 163–175, 290 patient’s narrative, 30–31, 33
Cantharis, 113, 263 constitution, 163, 164 remedy correspondences, 46, 47
Carbo animalis, 233 place in package of care, 320 simple cases, 62
Carbo vegetabilis, 266 Case-taking, 97–108, 300, 319, 415 symptoms, 72, 143
Carbon remedies, 292, 398 beginning consultation, 97, 100 case-taking, 100
Carbonic constitution, 156 case overview, 99–100 trigger factors, 7
Carcinosin, 47, 48, 146, 169, 232, 233, 263 deepening level of working, 107 veterinary homeopathy, 240–241
Carcinosis (cancer miasm), 220, 231–234, diagnosis, 104 see also Maintaining causes
247, 290, 291 difficult cases, 384 Causation treatment approach, 7, 30, 40, 53,
C type personality, 232 documentation, 105 54, 55–58, 110, 194
characteristics, 232, 233–234 expression of source, 300 acute illness, 47
nosodes, 232, 233 follow-up consultation, 208 anticipating causes, 57–58
remedies, 232, 233, 298 hearing the symptoms, 100–102 case analysis, 45–48
syco-tubercular type, 232–233 history, 97–98 chronic illness, 47
Care, 342, 345 family, 103–104 detoxification treatment, 58
Caricature, 157–158 past medical, 102–103 drainage treatment, 58
Case analysis, 39–49, 177, 185, 319 social, 103–104 isopathy, 56–57
best indicated remedy selection, 44, 47 treatment, 103 maintaining causes, 58
case duration/depth (stuck cases), 41–42 homeopath styles/skills, 105 matching case to remedy, 15, 112
causation, 40–41, 112–113 impression, 97, 105 nosodes, 57
maintaining causes, 41 investigations, 104 organ treatment, 58
treatment on, 45–48 models of health relevance, 97–98 prophylactic/preventative treatment, 57–58

422
 INDEX

simple cases, 62, 63 Collective unconscious, 20, 355, 364–367, susceptibility, 140, 144
straightforward cases, 125 390 symptoms, 124, 125, 126, 127–128, 357
tautopathy, 56 see also Unconscious processes hierarchy, 140
trigger events, 55–56 Collusion, 309, 356 new, 202
Causticum, 94, 228, 231, 262, 371 Colocynthis, 46, 376 remedy selection, 178–179
Centesimal potency scale, 268, 269 Communication strange/rare/peculiar, 171
Centre of the case, 59, 70, 187 hidden cases, 389 totality, 146, 177, 178
confused cases, 385, 410 homeopathic relationship, 303–304, 305 treatment approach, 76
cH, 269 Communities, 4, 417–418 treatment cycle, 194–195
Chamomilla, 46, 86, 87, 193, 376 susceptibility, 129, 130 trigger event, 143–144
Change, 3, 11 Companion animals, 238, 239 types, 150
in ‘state’, 3 administration of medicines, 246 Complex prescribing, 411–412
Chelidonium, 58 constitution–breed correlations, 243 Complexes, Jungian, 365, 366–367
Chi (Qi), 13 grief states, 241 Compliance, 209, 271, 321, 343
Chickens, 264 Comparison process Compositae, 298
China officinalis, 231, 272 case analysis, 113–114 Computer programs, 251–259
Chlorine sensitivity, 56 matching case to remedy, 112 case analysis, 252
Chocolate, 20 Compassion, 342, 345 editing, 256–257
Chronic Diseases, S Hahnemann, 88 Compensated symptoms, 173, 184 expert systems, 257
Chronic illness, 57, 67, 123, 128, 140, 169, hidden cases, 401 materia medica, 93, 183
187, 306 Compensation claims, 389 multimedia, 259
acute exacerbation, 132 Competence, 53, 134–135 patient database, 258
acute illness relationship, 131–132 Complaints procedure, 343 personalised systems, 257
aggravations, 198 Complements (complementary remedies), practice management, 258
constitution, 140 375–376 remedy families, 257
change, 190 Complete symptom, 82, 100–101, 114 repertories, 93, 118, 119, 253–256
core emotional state, 60 local prescribing, 111 rubrics
deterioration, 214 Complex adaptive systems, 328, 329–330 combining, 254–255
emotional causes, 360 Complex cases, 67, 123, 125, 126–128, 135, lists analysis, 255–256
epidemiology, 326–327 139–151, 177, 384 scoring, 255
follow-up, 207–208 case analysis, 39, 177–181, 195 storing for analysis, 252
longstanding conditions, 403–404 case-taking, 98 searching
maintaining causes, 41 causation, 30, 31, 150 checking sources, 256
miasmatic theory, 219, 220 consent to treat, 195 cross references, 254
patient characteristics, 326 constitution, 177, 178 key words, 254
patient outcomes, 319, 322 consultation, 35, 170, 171 limitation, 257–258
plan of treatment, 186 curative changes, 202 remedies, 256
susceptibility, 144 differential diagnosis, 177, 178 symptoms, 253–254
syndrome shift, 202 discharge, 195–196 thematic, 256
totality of symptoms, 140 duration of treatment, 192 uses, 252
treatment on causation, 47 expression of source, 300 Concomitant treatment, 200
types, 150 follow-up, 200, 207–208 Concomitants (extensions), 59, 111
veterinary homeopathy, 243 holistic diagnosis, 189 Concordances, 375
Cimifuga, 226 impression, 189 Confidentiality, 343, 346, 389
Cina, 376 management, 189–203 Confirmatory (inclusion) symptoms, 87,
Cinchona, 15, 268, 295 materia medica selection, 83, 84 111–112, 119, 185, 193, 398
Cinneraria, 271 obstacles to cure, 150 Confused cases, 123, 124, 128, 141, 150,
Clarification, 200, 212, 346, 410 one/several remedies, 193–194 185, 189, 190, 355, 356, 369
confused cases, 387, 400 plan of treatment, 185–186, 192 causation, 143
difficult cases, 356 potency of prescription, 47 centre of case, 385, 410
Clarke’s Dictionary, 89, 115, 375 prescribing change in constitution, 191
Classical prescribing, 187 classical, 187 clarification, 200, 400, 410
Clinical governance, 394 thematic, 60 communication issues, 305
Clinical prescribing, 110 recovery time frame, 189–190 complementary remedies, 375–376
Co-ordinator (master prover), 23 referral, 195–196 consultation, 169
Coffea, 47, 57, 379 remedy frequency, 197 conventional medication, 399
Coffea crudum, 231 repertorisation, 181–185 deepening the case, 386–387
Coffee, 199, 210, 272 review, 197–198 disentanglement, 385–388, 403
Collaterals, 376 suppression, 140, 147, 148, 149, 189 duration of treatment, 192

423
INDEX

Confused cases (Continued) morphological, 141, 155–156 therapeutic agreement (contract), 342,
dynamic ways of understanding, 383–395 prescribing, 194 343–344, 389
emotional intelligence, 361 psychological, 166 review, 198
essences, 398 receiving the case, 163, 164 third party presence, 35–36
holographic model of health, 356, 357–359 relation to totality of symptoms, 141 time requirement, 35, 170, 343, 346, 395
homeopathic relationship, 303, 306 treatment approach, 53, 54, 59, 191 trust, 342, 345
inappropriate change of remedy, 217 types, 59, 155–156 unspoken agenda, 170
initial treatment, 384–385 veterinary prescribing, 244 veterinary homeopathy, 247–248
inner/outer manifestations, 410–411 breed correlations, 243 videotaped, 351
living materia medica, 373, 378 Consultation, 29–38, 304–305 see also Therapeutic encounter
low vitality, 403 beginning, 100, 170 Consulting room, 35
maintenance of improvement, 392–393 initial impressions, 97 Contagious illnesses, 129–130
management, 402–403 blocked energy, 171, 173–174 Context of practice, 383–384
miasmatic prescribing, 400 case-taking, 97–98 Continuous fluxation, 269
pitfalls, 388 children, 173 Contract see Therapeutic agreement
projection, 307, 309, 312, 356, 359, 388 complex cases, 170, 171 Contributing factors, 46
supervision process, 351 confused cases, 169 Conventional diagnosis, 42
protective walls, 358–359 disassociation, 173 Conventional treatment
remedy selection (simillimum), 212–213 drawings, 173 medication see Medication, conventional
re-taking case, 387 enacting behaviour, 172–173, 306 monitoring, 133
social history, 168 end of treatment, 393 Coping strategies, 326
suppression, 140, 148, 149, 357, 358, environment, 35 Corks, 271
386, 399 eye contact, 170, 173 Cornium maculata, 85
symptoms, 124, 128, 184, 308, 357, finishing, 174–175 Correspondence, 390
358–359, 385, 387 flow, 171, 172 Costs of treatment, 321, 343
layers, 357, 358–359, 384, 385, 386, 398 follow-up, 207, 343, 346 Countertransference, 61, 307, 309
periodic, 386 taking the case, 208 see also Projection
quality, 146 timing, 207 Crategus, 363
totality, 150 hidden cases, 169 tincture, 266
themes, 191, 357, 359, 372, 385, 386, 410 homeopath factors, 36 Creams, 271
emotions, 387–388 impression, 105 Cultural factors, 192, 364, 383, 405, 417–418
prescribing, 373, 398 listening skills, 36, 171 hidden cases, 418
timing of intervention, 403 matching behaviour, 171–172, 174, 306 masking, 185
treatment approaches, 191, 397–408 metaphor use, 174 miasmatic states, 371
unconscious processes, 357, 365 observation, 164–165, 304, 306 parallel process, 390
Confusion, 280 pace, 164, 171 susceptibility, 390
Congenital illness, 404–405 paradoxes, 171 Cultural illness, 418
Conium, 91, 233 patient factors, 35–36 Cultural suppression, 355
Consent for treatment, 195, 342, 345 emotions, 166–167, 171 Cundurango, 233
review, 198 patient’s narrative, 30–31, 32–33, 306 Cuprum metallicum, 43, 265
Constitution, 6, 72, 104, 139, 141, 144, 145, non-verbal clues, 33 Curative reactions, 210–211
147, 185, 186 recording, 33 Curative treatment, 346
breadth, 71 patterns of causes, 29–30, 34 Cygnus olor, 20, 378
case analysis, 177–181 physical examination, 104
change, 156 place in package of care, 320
over time, 190–191 presence, 164, 170, 171, 303, 305–306,
complex cases, 177, 178 312 D
consent to treat, 195 projection, 307–310 Dama Dama, 300
effects on susceptibility, 141, 155 provocative approaches, 174 Death, 212, 416
environmental factors, 191 questionnaires, 107 Decimal potency scale, 268, 269
general features, 166 rapport, 100, 105 Decision-trees in case analysis, 112–113
healthy characteristics, 186–187 receiving the case, 163, 164 Decompensation, 403
influence of palliation/suppression, 149–150 records, 36–37 Deepening the case, 107, 346
matching to remedy’s constitutional picture, repertories use, 120 confused cases, 386–387
59, 94, 156 seating, 35 Deeper level prescribing, 410
materia medica, 154 stages, 342 Deepest disturbance see Centre of the case
miasmatic influences, 188, 220–221 styles, 169–175 Degeneration (destructive miasm), 187
sycotic, 225 supervision process, 350, 351 Delirium, 178
tubercular, 229 tentative statement technique, 305 Delusions, 167, 180, 306

424
 INDEX

Depth of disease, 144 Drawings, 173, 180, 281, 287 Empathy, 105, 280, 318, 342–343, 362–363
Depth of symptoms, 71 hidden cases, 391 confused/hidden cases, 386
Dermatitis, 46 Dreams, 167–168, 180, 306, 390 development, 362
Deterioration, 214 Drosera, 231, 265 emotional intelligence, 361
Detoxification treatment, 58 Drugs Enablement, 342–343
Diagnosis, 104 clinical trials, provings comparison, 23 Enacting behaviour, 172–173
Diamond, 267 recreational, 56 Endemics, 130
Dietary advice, 41, 77, 413–414, 415 see also Medication, conventional Ending treatment, 174–175, 392
veterinary homeopathy, 244 Dry grafting method, 269 Endomorphic appearance, 156
Differential diagnosis, 42, 112, 114–115, 177, Duration of treatment, 192 Environmental factors, 13, 40, 74, 75, 76, 107,
178, 185, 369 Dust mite allergens, 324, 330 145, 417
difficult cases, 402 Dynamic materia medica, 83, 94 aggravations, 199
thematic analysis, 398 Dynamisation see Succussion constitution, 191
Difficult cases, 123, 175, 356, 369, 384–385, Dysentery co, 223, 233 diagnostic labels, 104
392 endemic illnesses, 130
clarification, 212 hereditary/congenital illness, 405
companion animals, 239 impact on symptoms, 75, 76, 77, 165
emotional causes, 360 E materia medica evolution, 94–95
higher potencies, 269 Earth, elemental, 281 pseudo chronic illness, 150
holographic treatment approach, 8, 9 Ectomorphic appearance, 156 Environmental modification, 76, 77, 148, 149
inner/outer manifestations, 410–411 Effectiveness studies, 317, 320–322 Epidemics, 129
management, 409–420 Efficacy studies, 316, 322–324 Epidemiology of chronic disease, 326–327
steps, 406–407 evidence hierarchy, 317 Epitaxy, 327
practice/organisational issues, 393–394 meta-analyses, 317–318, 323 Epizootic/enzootic diseases, 245
projection, 307 participant characteristics, 326 Escapism, 224, 225
reflection, 348 rating scales for outcome assessment, 322 Essences, 9, 26, 33, 81, 185, 290
repertorisation, 184–185 sample size, 324 fundamental, 367
supervision, 348, 349, 350 validity, 316, 325 holographic model of health, 356,
suppression, 360 Eizayaga approach, 193, 194 359–360
symptoms, 384, 392 Elemental air, 280 homeopathic case-taking, 99
themes, 384 Elemental earth, 281 materia medica selection, 83
therapeutic relationship, 135 Elemental ether, 279–280 polychrests, 367
Digitalis, 399 Elemental fire, 180 prescribing, 43, 357
Dilution (attenuation), 267, 268, 273 Elemental levels, 279, 281 signatures, 278, 279
continuous fluxation method, 269 Elemental water, 280–281 treatment approach, 53, 54, 60–61, 397,
higher potencies, 269 Elements of periodic table, 264, 292 398–401
procedure, 268 Elements theory, 6, 69, 184, 279, 357, 372 Etheric elemental level, 279–280
Disassociation, 173 Elimination, 87, 182, 186 Etheric energy, 281
Discharge from treatment, 195–196, 392 Emanometer, 362 Ethical guidelines, 394
Disease discharges, isopathy, 57 Emotional communication, 362 Eucalyptus, 199, 271
Disease, reactions of healthy organism, 11 Emotional intelligence, 61, 308, 355, 360, Euphrasia, 86, 271
Disease-specific treatments, 134 361–362, 370 tincture, 266
Diseased tissue Emotional materia medica, 370, 372–373 European Pharmacopoeia, 272
isopathy, 57 effects of study, 373–374 Euthanasia, homeopathic, 212
see also Nosodes Emotional remedies, 369–380 Evidence hierarchy, 317
Disorder/proliferation (tumour miasm), 187 Emotional support, 41 Exclusion symptoms, 87, 111–112, 119, 185,
Dispensing, 271 Emotional symptoms, 68 398
Dogs, 239, 241, 243, 244, 246, 247, 248, 264 remedy reactions, 213 Expert patients, 168
Doorknob symptoms, 174 return of old, 213 Expert systems, 257
Dose Emotions, 166–167, 222, 280 Extensions (concomitants), 59, 111
material, 272–273 animal patients, 238, 242–243 Eye contact, 170, 173
minimum, 16, 196 complexes, 365 Eye drops, 271
provings, 25 confused cases, 387–388
Double blind provings, 23 homeopathic relationship, 306
Double matrix (seven eyed supervisor) model, projection, 307, 308
349–351 relational working, 361 F
Doublet symptoms, 111 personal/collective unconscious, 366 Facilitated supervision, 341, 349
Dowsing, 362, 416 sycotic, 226 Falco peregrinus, 281
Drainage treatment, 58 Emoto, Masaru, 266 Families of remedies, 289, 376

425
INDEX

Family history, 57, 168–169 General symptoms, 68, 165 Hidden cases, 123, 124, 128, 141, 150, 185,
homeopathic case-taking, 103–104 case-taking, 103–104 189, 190, 355, 356, 369
Family materia medica, 83 repertorisation, 181 apparently hidden, 389
Fears, 31, 75, 167, 180, 306 themes, 356 causation, 143
of death, 416 Genus epidemicus, 129 clarification, 200
Ferrum metallicum, 231, 279 Germanium, 292 communication issues, 305, 389
Ferrum Phosphoricum, 77, 86 Gestures, 172, 173, 280, 281, 330 complementary remedies, 375–376
Ferrum salts, 104 emotional communication, 362 consultation, 169
Ferrum series, 292 Glass containers, 271 cultural factors, 364, 418
Financial management, 394 silica contamination, 328 duration of treatment, 192
Fincke, Bernhardt, 269 Goats, 246 emotional intelligence, 361
Fire, elemental, 280 Gold series, 292, 293, 399 holographic model of health, 356
First aid, 47, 81, 98, 110, 240 Gonococcus (Neisseria gonorrhoeae), 224, 225 homeopathic relationship, 303, 306
efficacy studies, 323 Gonorrhoea, 9, 60, 220, 224 inherited predisposition, 364
matching case to remedy, 112 Granules, 271 initial treatment, 384–385
prescribing, 52 Graphites, 233, 398 living materia medica, 373, 378, 402
Fitness, 9, 10–11, 41 Grief states, 361, 376, 378 low vitality, 403
Flow diagrams for case analysis, 112–113 companion animals, 241 maintenance of improvement, 392
Fluoric acid, 228 Group studies, 317 management, 402–403
Fluoric constitution, 156 Growth hormone, 264 miasmatic prescribing, 400
Fluxation, 269, 270 GSL (general sales list) medicines, 272 parallel process, 390
Folliculinum, 263 Guiding symptoms, 87 pitfalls, 391
Follow-up, 192, 195–196, 375 projection, 307, 309, 312, 356, 360, 401
acute illness, 209 supervision process, 351
analysis of change, 208 protective walls, 363
case analysis, 45 H psychiatric illness, 403
chronic illness, 207–208 Hahnemann, Samuel, 15, 168, 220, 265, 267, reflective management approaches,
complex cases, 200, 207–208 269, 270, 290 401–402
consultation, 207 Hallucinogenic drugs, 56 relational model of health, 360, 363–364
diary records, 208 Halogen salts, 228 relational prescribing, 373
inter-current events, 208–209 Healing process remedy selection (simillimum), 212–213
maintenance treatment, 392 discovery, 77 somatisation, 391, 401
prescribing, 377 first indications, 73 suppression, 140, 148, 149
re-taking case, 209, 210, 215 laws of cure, 73 susceptibility, 360
simple cases, 209 lifestyle treatments, 77 symptoms, 124, 128, 184, 307, 308, 360,
taking the case, 208 multiple treatment modalities, 77 363, 389, 390–391, 401
Food desires/aversions, 179, 180, 256 research approaches, 316 totality, 150
Food-producing animals, 239, 240, 243, Healing reactions, 213 themes, 390
264 Health, 3–16 timing of intervention, 389–390, 391, 403
mineral deficiencies, 245 as balance, 10 treatment approaches, 397–408
prescribing for groups, 244–246 definitions, 4, 13, 379 unconscious processes, 384, 389, 390
remedy administration, 246, 264 fitness comparison, 10–11 collective unconscious, 365, 366
Foubister, Donald, 232 laws, 3–4 understanding dynamic (revelation), 383,
Free association, 391 models see Models of health 388–391
Functional disturbance, 145, 146, 192–193 natural, 4–5 Hierarchy of symptoms, 67, 70–71, 73, 78,
hidden cases, 363, 364 sustainability, 8 178–179
potency selection, 196 Hearing the narrative, 32–33, 303–304 causation, 143
psoric miasm, 222, 224 Hearing the symptoms, 100–102, 164 complex cases, 140, 141
remedy features, 154 Hepar sulphuris calcareum, 228, 265, 269 Kent’s, 178, 179
suppression, 148 Hepatitis B nosode, 400 local prescribing, 111
Fungal signatures, 282 Herbal medicines, 379, 410, 412, 413, 416 use of repertories, 118
Hereditary factors, 145, 404–405 Histamine, 328
see also Inherited disease; Inherited History-taking
predisposition models of health, 97–98
G Hering, Constantine, 73 veterinary homeopathy, 238, 242
Gaertner, 223, 228, 231 Hering’s Guiding Symptoms of our Materia Holistic model of health, 5, 8, 10, 11, 12, 15,
Galen, 278 Medica, 88 29, 42, 43, 69, 70, 139–151, 186,
Gelsemium, 62 Hering’s laws of cure, 67, 73, 197, 202, 213, 192–193
General paralysis of the insane, 228 325, 329 breadth of constitution, 71

426
 INDEX

causation, 142, 144 Horses, 239–240, 241, 244, 246, 248, 264 Insight, 36, 374
features, 142 Hubs, 329 Instructions for patients, 271–272
illness concept, 68, 70 Hughes’ Cyclopaedia of Drug Pathogenesy, 88 Integrated care, 195, 415–416
prescribing methodology, 7 Humours theory, 6, 357 Inter-current treatments, 196, 201, 410–411, 412
receiving the case, 163 Hydrastis, 233 Intuitive working, 6, 361
susceptibility, 70, 142, 144 Hydrogen series, 292 Investigations, 104
symptoms, 68, 69, 71, 72 Hyoscyamus, 287–288 Iodum, 231
treatment approach, 7, 15 Hypericum, 240 Ipecac, 58
veterinary homeopathy, 242–243 Hypericum tincture, 266 Iridium, 292, 293, 295, 300
Holographic model of health, 6, 8–9, 12, 15, Iris diagnosis, 356
29, 355, 356–360 Iron deficiency anaemia, 76
confused cases, 356, 357–359, 386 Iscador, 416
constitution change over time, 190–191 I Isis, 253, 254, 256
essence and themes, 9, 53, 356, 359–360 Idealisation, 405–406 Isopathy, 56, 132
illness concept, 68, 70 Ignatia, 20, 32, 171, 172, 231, 241, 375, nosodes, 57
prescribing methodologies, 7, 60 376, 378
symptoms, 68, 356 Illness, 74, 75
treatment approach, 7, 15, 53, 397 biological model of health, 68
Homeopathic case see Case, homeopathic definitions, 13 J
Homeopathic case-taking see Case-taking holistic model of health, 68, 70 Jenichen, Julius Caspar, 270
Homeopathic continuum, 123–125 holographic model of health, 68, 70 Jewels theory, 264
Homeopathic Directive, 264, 272 onset, 68–69 Jung, 365
Homeopathic euthanasia, 212 opportunities for insight/learning, 12 Jungian complexes, 365, 366–367
Homeopathic interview pathological model of health, 68
psychotherapeutic effects, 331 reframing, 12–13
see also Case-receiving; Case-taking; relational model of health, 68, 70
Consultation
Homeopathic reactions see Remedy reactions
self-healing, 76 K
see also Acute illness; Chronic illness Kali bichromicum, 164, 245
Homeopathic relationship, 9, 10, 30, 104, 135, Immersion, 267
303–314, 320, 347, 416 Kali carbonicum, 107, 172, 231
Imponderables, 84, 264, 378 Kali iodatum, 228, 233, 376
communication, 303–304, 305 Impression, 105, 345
consultation, 36 Kali salts, 9, 292
complex cases, 189 Kennel cough, 245
expression of emotions, 306 plan, 6
hearing patient’s narrative, 32–33, 303–304 Kent, James Tyler, 59, 269
Inclusion (confirmatory) symptoms, 87, Kentian method, 59
hidden cases, 389 111–112, 119, 185, 193, 398
holographic model of health, 355 Kent’s hierarchy of symptoms, 178, 179
Incurable cases, 150 Kent’s Lectures on Materia Medica, 89
medium of perception, 304–305 Individual difference research, 317, 325–327
non-specific effects, 341 Kent’s repertory, 93, 115, 116
Individualisation of simillimum, 370 Key emotions, 58
objectivity, 304 Individuality, 325
presence Keynotes, 44, 81, 86–87, 134, 154, 156, 157
response to symptoms, 4, 8 confused cases, 124
homeopath, 305–306, 312 susceptibility, 75
patient, 303, 306 exclusion, 87
Infection, 47–48, 69 importance, 87
psychotherapeutic effects, 331 contagious illnesses, 129–130
rapport, 100, 105 local prescribing
epidemics, 129 several keynotes, 111
receiving the case, 163 recurrent/relapsing, 130
relational model of health, 355, 360 single keynotes, 110
Infectious bovine rhinotracheitis, 245 modalities, 87
research issues, 318 Infective organisms, 58
stages, 342 provings, 25, 26
isopathy, 57 relative inclusion, 87
subjective bias, 304 Informed consent, 345
supervision process, 351 symptoms, 43, 72
see also Consent for treatment Kinesiology, 362, 416
therapeutic agreement, 341, 342, 343–344 Inherited disease, 186, 364
therapeutic encounter, 341, 342–347 Kingdoms, 6, 281, 289, 290, 292–300, 357, 372
long-term treatment, 201 animal, 281–282, 295
trust, 306, 342, 345 Inherited predisposition, 9, 188, 360, 383,
unconscious projection, 306–311 collateral relationships, 376
411, 417 fungal, 282
Homeostasis (auto-regulation), 8 hidden cases, 364
Homework, 170 mineral, 282, 292–295
miasms, 404 plant, 282, 295, 297–298, 300
hidden cases, 390 see also Hereditary factors
Honesty, 346 signatures, 281–282
Initial impressions, 97 viral/bacterial, 282
Hormesis, 16 Injections, 271 Kreosotum, 233

427
INDEX

Local symptoms, 68, 72, 103, 410 Materia medica, 81–95, 262, 290, 305, 366,
L environmental factors, 145 369, 402
Lac caninum, 232, 233, 300, 378 history taking, 98 clinical experience, 86
Lachesis, 62, 102, 226, 228, 231, 233, 310, plan of treatment, 186 comparative aspects, 91
388, 404 themes, 356 complementary remedies, 375–376
Lactose vehicle, 265, 266, 271 treatment approaches, 194 completeness, 154–155
Lanthanide series, 292 aggravations, 199 computerised, 93, 257
Law of similars, 15, 16 Long-term benefit, 364 constitution, 154, 178
Laws of cure, 67, 73, 197, 202, 213, 325, Longstanding illness, 403–404 dynamic, 83, 94, 153–162
329 Lunar phases, 372 emotional, 370, 372–373
Laws of health, 3–4 Lycopodium, 172, 196, 223, 226, 231, 233, evolution, 94–95
Learning activities, 160 243, 346, 363, 376, 401 family, 83
Learning cycle, 160–161 features, 88–90
Learning styles, 159–160, 161 historical aspects, 90
Ledum, 47 homeopath knowledge, 84, 157, 159, 369,
Leprosy miasm, 290, 291, 299 M 384, 387
plant family remedies, 298 Maceration, 266 learning styles, 159–160, 161
Licensing regulations, 272 plant materials, 267 information sources, 84, 85, 378
Life events, 103 Machine-based homeopathy, 416–417 layout, 89, 91
Life-long learning, 347 MacRepertory, 253, 256 levels of detail, 81–82
Life style factors, 40 Macro-entanglement theory, 329, limitations, 91
aggravations, 199 330–331 living, 361, 373–374, 402
influence on constitution, 191 Magnesia phosphorica, 376 positive features of remedies, 374
pseudo chronic illness, 150 Magnetism, 378 projection influences, 313
Life style modification, 7, 13, 42, 76, 77, 192, Maintaining causes, 41, 77, 148, 200 provings, 19, 21, 26
195, 344–345, 403, 415, 416 aggravation, 212 psychology, 156–157
complex cases, 383 causative treatment approach, 58 remedies that follow well, 375
self-healing, 76 difficult cases, 360 searches, 183, 257
Like treating like, 15, 16, 19, 51 foods, 179 selection, 83, 91
Liliaceae, 298, 299 recurrent/relapsing acute illness, on causation, 82
Lilium tigrinum, 226 130 essence and themes, 83
Listening skills, 36 remedy dose repetition, 197 on presenting symptoms, 82
see also Hearing the narrative; Hearing the Maintenance treatment, 392 relational approach, 84
symptoms Malaria, 48 totality approach, 83
Lithium carbonica, 133 Malaria miasm, 290, 291 situational, 84
Livestock see Food-producing animals plant family remedies, 298 symptoms, 86–87
Living materia medica, 361, 402 Management plan, 105 thematic approaches, 83, 357, 360,
effects of study, 373–374 Manganum, 231 370–373, 385
reflective approaches, 373–374 Mangialavori, Massimo, 290 totality, 154
reframing, 378 Manipulation, 413 toxicology, 85–86
Living remedies, 369–380 Mannerisms, 104, 172, 173 Materia Medica Pura, S Hahnemann, 88
LM potencies, 270 Manufacture, 265–273 Material dose, 272–273
LM tincture preparation, 270 alcohol, 266, 267 Medical history, 102–103
Local prescribing, 58, 62, 109, 110–121, 133, Bach flower remedies, 272 Medication, conventional, 103, 208, 410
402, 410 immersion, 267 adverse effects, 148
case analysis, 112–113 insoluble materials, 265, 266 monitoring, 133
complete symptom, 111 maceration, 266 palliation, 148
exclusion symptoms, 111–112, 119 mother tinctures, 266 psychological illness, 166
hidden cases, 363 non-plant sources, 267 research methodologies, 316
inclusion (confirmatory) symptoms, preparation from plants, 267 suppressive effects, 147, 148, 169
111–112, 119 plant materials, 266 confused cases, 399
keynotes potencies, 267–268 management, 192
several, 111 trituration method, 265–266 symptoms/adverse effects, 197, 202,
single, 110 water, 266 399
matching case to remedy, 112, 119 Marketing regulations, 272 tautopathy, 56
methodologies, 110–112 Master prover (co-ordinator), Medicines Acts, 272
reactions, 134 23 Medorrhinum, 168, 226, 400
single main symptom, 110 Matching behaviour, 174 Memory, 280
veterinary homeopathy, 242 Matching case to remedy, 112 Mendeleev, Dmitri, 292

428
 INDEX

Mental illness, 403 Modalities, 46, 87, 101, 102, 111, 112, 178 Nasal sprays, 271
acute, 130 animal patients, 238, 242 Natrum muriaticum, 35, 41, 60, 171, 226,
Mental symptoms, 166–167, 179 confused cases, 385 232, 241, 256, 359, 366, 367, 375,
animal patients, 238, 242–243 emotions, 166 376, 414
homeopathic case-taking, 103–104 general, 180 Natrum sulphuricum, 131, 226, 415
remedy reactions, 213 local, 180 Natural health/healing ability, 4–5
repertorisation, 181 Models of health, 5–12, 51, 142, 384 Natural history of disease, 42
themes, 356 appropriate potency selection, 196 Necessary illness, 6, 11, 126
Menthol, 271 biological see Biological model of health Neisseria gonorrhoeae (gonococcus), 224, 225
Mentorship, 347, 370, 395 case analysis application, 42–43 Network theory, 329
Mercurials, 376 categories of homeopathic case, 123, 124 New remedies, 377–378
Mercurius, 228, 233, 399 causation, 30 Nickel sensitivity, 56
Meridians, 329 combined approaches, 72–73 Nicotine, 56
Mesomorphic appearance, 156 conflicts, 11 Night cramps, 43
Meta-analysis, 316, 324–325 element theory comparison, 69 Nitric acid, 226, 228, 233, 359
dataset problems, 317–318 general trends, 68 Nitricum, 359
efficacy studies, 317–318 holistic see Holistic model of health Nodes, 329
Metals, 9, 293 holographic see Holographic model of health Non-specific effects, 316, 320, 321
Metaphor use, 174 homeopathic case-taking, 97–98 therapeutic encounter, 341
Mezereum, 228 illness concepts, 68–69 Non-verbal communication, 33
Miasms, 6, 9, 57, 60, 187–188, 219–234, influence on therapeutic agreement, 342 gestures, 172, 173, 280, 281, 330, 362
285, 289, 290, 291, 307, 355, 357, integration, 409–410, 413–415 mannerisms, 104, 172, 173
366, 372, 387 interconnection, 411 movements, 104, 172, 173, 305, 362,
animal patients, 247 materia medica selection, 82–84 390–391
cancer see Carcinosis pathological see Pathological model of health Non-judgemental acceptance, 342, 346
changing status, 371 patient–homeopath relationship, 405 Nosodes, 57, 215
complementary remedies, 376 perception/information depth, 71 aggravations, 246
constellations, 187 relational see Relational model of health carcinosis, 232, 233
cultural differences, 357 Sankaran’s levels comparison, 69 pharmacy, 263
disease continuum (miasmatic sequence), symptoms, 67–68, 71–72 psoric miasm, 223
220–221, 222 depth, 71 safety issues, 263
Hahnemann’s theory, 220 treatment approach relevance, 6, 7, 69–70, sycotic miasm, 226
inherited susceptibilities, 364, 404 411, 413–415 syphilitic miasm, 228
major, 220 Molluscum contagiosum, 129 tubercular miasm, 231
plant family remedies, 298 Morgan nosodes, 223 veterinary prescribing, 239, 244, 246, 264
prescribing, 191, 194, 400, 402, 410 Morgan-Pure, 226, 231 Nutritional deficiencies, 7, 8, 41
inter-current, 412 Morphological constitution, 141, 155–156 cattle, 245
psoric see Psoric miasm Morrison (1993), 92 Nux vomica, 30, 47, 58, 76, 94, 170, 184,
recurring similar acute illness, 131 Mother tinctures, 266 210, 211, 212, 244, 361, 372, 374
sycotic see Sycotic miasm concentration, 267
syphilitic see Syphilis expiry date, 267
tuberculosis see Tubercular miasm labelling, 267
Mind maps, 98 non-plant source materials, 267 O
Mineral deficiencies in cattle, 245 preparation from plants, 267 Objectivity, 304
Mineral kingdom, 292–295 storage, 267 treatment approaches, 53–54
Mineral remedies, 263, 290 testing, 267 Observation, 164–165, 304, 306
groups, 293 Movements, 104, 172, 173, 305, 390–391 Observational studies, 317, 318, 320–322
manufacture, 265, 266, 267 emotional communication, 362 follow-up, 322
Mineral signatures, 282 Multimedia computer programs, 259 outcome measures, 321–322
Minimum dose, 16, 196 Muriatics, 226 rating scales, 322
Minor ailments, 131 Mutabile, 223, 231, 233 participant characteristics, 326
prescribing, 52 Mycobacterium bovis, 229 Obstacles to cure, 42, 148, 200–202, 415
Mint, 199, 272 Mycobacterium tuberculosis, 229 animal patients, 238, 244
Mirroring, 172, 305 complex cases, 150
confused/hidden cases, 360 patient management, 201–202
supervision process, 341 Oestrogen, 263
supervisor–supervisee relationship, 349, N Ointments, 271
351 Names, 278 Omnipotence, 405–406
Mixed pollen, 47 Narrative see Patient’s narrative One-sided cases, 10, 360, 363–364, 389–390

429
INDEX

Onset of illness, 68–69 Patients Plan of treatment, 105, 185–186, 345

complex cases, 126 characteristics, 318, 325–326 complex cases, 192
simple cases, 125 compliance, 209 Plant families, 297–298
Open-ended questions, 106, 208 constitutional categories, 155 Plant kingdom, 295, 297–298
Openness, 325, 326 diversity, 12, 325 Plant materials, 84
Opium, 131 education/development, 186 composition, 267
Oral dosage forms, 271 expectations, 346, 378, 392, 405 maceration, 267
Orf, 245 expert, 168 manufacture, 266
Organ treatment, 58 individual susceptibility, 75 concentration, 267
Organon of the Medical Art, 15, 16, 262, 270, insights from illness, 12 dry weight calculation, 267
281 instructions on remedies, 271–272 mother tincture preparation, 267
Organotrophic remedies, 58 motivation, 191 provings, 24
Oscillococcinum, 324 projection (transference), 307–308 washing, 267
Outcome Patient’s narrative, 30–31, 32–33, 303 Plant signatures, 282
assessment, 321–322 homeopathic relationship, 303–304 Plant-derived remedies, 263, 290
case analysis, 44 receiving the case, 164 families, 297–298, 300
chronic illness, 319, 322 recording, 33 Platina, 26, 293, 310, 366
efficacy studies, 322 Peer supervision, 341, 349, 351 Platinum, 226
observational studies, 320, 321–322 Perfectionism, 226 PLR (product license of right) medicines, 272
Over dosing, 407–408 Performance animals, 238, 239–240, 244 Plumbum, 293
Over-the-counter prescribing, 264–265, Periodic symptoms, 386 Pluralist prescribing, 411
324 Periodic table of elements, 264, 292 Plussing, 270
advice for pharmacists, 265 Persona, 226 Plutonium, 292
marketing, 265 Personal unconscious, 365–367, 390 Points of view, 3
practitioner prescribing comparison, 265 see also Unconscious processes Poisonings, 85–86
Overactivity (autoimmune miasm), 187 Pessaries, 271 Polychrests, 83, 157, 186, 271, 367, 399
Pharmacopoeia, 262–263 POM (prescription only medicines), 272
Pharmacy, homeopathic, 261–273 Potency, 44, 47, 55, 62, 63, 196, 199, 207,
nosodes, 263 210, 214, 215, 216, 267–268, 272
P over-the-counter prescribing, 264–265 aggravation of symptoms, 210, 212
P (pharmacy only medicines), 272 remedies changing, 216
Palliation, 148, 164 Imponderabilia, 264 higher, 193, 194, 269
cultural, 149 new, 264 basic science research, 327
disease continuum (miasmatic sequence), preparation, 262–263 preparation, 269–270
220 veterinary, 264 LM scale, 270
effects on vitality, 149 sarcodes, 263–264 material content relationship, 269
hidden cases, 389 source materials, 262, 263 model of health considerations, 68
influence on constitution, 149–150 Phatak’s repertory, 115 over-the-counter prescribing, 264
management of symptoms, 192 Phosphates, 231 plussing, 270
totality of symptoms, 149–150 Phosphoric acid, 231 prescribing mixtures, 193, 194
Panthera pardus, 295 Phosphoric constitution, 156 provings, 25
Paracelsus, 278 Phosphorus, 35, 72, 87, 94, 104, 141, 155, research approaches, 316
Parallel process, 342, 390 172, 190, 230, 231, 233, 243, 245, scales, 268–269
Partial similars (similars), 207, 213–214 256, 366, 376, 385, 388 Potential energy, 3, 4, 13
effects, 213, 214 Physical appearance, 87, 155 Potentisation, 16, 267–268, 273
matching, 213–214 Physical examination, 104 by hand, 268, 269
thematic prescribing, 398 Physical symptoms dry grafting method, 269
Partial treatment, 133 potency selection, 196 machines, 269, 270
Partially expressed acute illness, 131 remedy reactions, 213 Poverty, 8
Pathological model of health, 5, 7, 8, 11, 14, repertorisation, 181 Powders, 271
29, 40, 53 sycotic miasm, 226 Practice
homeopathic case, 29 Phytolacca, 228, 233 management issues, 393–395
illness concept, 68 Pigs, 264 setting, 395
prescribing methodology, 7 Pills, 271 Pragmatist learning style, 160
symptoms, 67 Placebo effect, 271, 318, 320, 324, 325, Prana, 13
treatment on causation, 7, 8, 40 329 Precipitating/provoking causes, 7
case assessment, 45–48 proving symptoms, 23, 26, 331 Preclinical research, 327–328
veterinary homeopathy, 240–241 Placebo-controlled research, 323 Predisposing causes, 7
Patient database, 258 see also Efficacy studies Predisposition, 62–63, 364

430
 INDEX

Pregnancy, 186, 191, 404 patient expectations, 405–406 Psorinum, 223, 231, 233, 400, 401
Prescribing, 6, 51–63 practice/organisational issues, 395 archetype, 222–223
aetiological, 39 relation to causation, 30 Psychodynamic prescribing, 10, 15, 61
classical, 187 remedy states, 374 Psychological space, 106
clinical, 110 veterinary patients/owners, 247, 248 Psychological symptoms, 102, 166, 178, 403
complex, 411–412 within therapeutic encounter, 341 Psychosomatic disorders, 223, 224
complex cases, 193–194 Projective techniques, 173 psoric miasm, 222, 224
essence, 357 Proteus, 226 Psychotherapeutic approaches, 414
first aid situations, 52 Provers, 24 Public health, 409, 417–418
follow-up, 377 completion of proving, 26 Pulsatilla, 31, 36, 72, 84, 128, 154, 156, 158,
hidden/confused cases, 402–403, 406–407 sensitivity, 24–25 170, 226, 361, 366, 379, 388
over dosing, 407–408 Proving symptoms, 75, 84–85, 202
steps, 406–407 following partial similars, 213, 214
homeopathic case-taking, 105 following symptom recurrence, 216
homeopathic relationship, 304–305 Provings, 15, 19–26, 81, 82, 84–85, Q
inter-current, 410–411, 412 262–263, 316 Qualitative research, 316, 318–320
local see Local prescribing co-ordinator role, 23 Quality of life ratings, 321
methodologies, 55 collation, 26, 85 Questionnaires, 107
case analysis, 43–44 conventional drug trial comparisons, 23 strengths/weaknesses, 108
models of health, 7 definition, 19
within treatment approaches, 52–61 dose, 25
miasmic, 187 double blind, 23
minor ailments, 52
mixtures of remedies, 411–413
editing, 26
external factors, 25
R
pluralist, 411 extraction, 26 Radar, 253, 256
potency selection, 44, 47, 196 fast track, 22 Radiation exposure, 7, 32
practical aspects, 61–63 first group meeting, 25–26 Radionics, 362
records, 61 full, 22 Radium Bromide, 47, 82
regimen, 44, 47 grading of remedies, 116 Ranunculaceae, 398
second prescription, 207–217, 375 meditation, 22 Rapport, 100, 105, 164, 167, 171, 197, 199,
simple cases, 62–63 mental symptoms, 179 306, 342–343, 346, 362, 363
systematic management strategy, 54–55 methodology, 22 communication issues, 389
thematic, 357, 370, 398–399 new remedies, 20–21, 264, 378 confused/hidden cases, 386
unicist, 411 partial (informal), 22 matching behaviour, 172
veterinary homeopathy, 244, 246–247 participation, 19–20, 21 Rays theory, 6, 357
Presence, 164, 170, 171, 303 placebo use, 23, 26, 331 Re-taking case, 209, 210, 215, 216, 384,
homeopathic relationship, 303, 305–306 plant materials, 24 411
Presenting symptoms, 99, 101–102 projective identification, 310 confused cases, 387, 400
Prevention, 57–58, 363 qualitative analysis, 319 Receiving the case see Case-receiving
constitutional remedies, 59 records, 23, 24, 25 Receiving the signature, 287
Professional codes of practice, 346 remedies from disease agents/drugs, 57 Records
Professional organisations, 393–395, 417, remedy reactions, 24 case analysis, 44
418 remedy selection, 23–24 case-taking, 105
supervision, 350 safety, 21–22 prescribing, 61
Projection, 9, 61, 185, 193, 306–311, 346, on a sick person, 86 provings, 23, 24, 25
401 supervisors, 24 Recurrence, 7
anima/animus, 366 types, 22 acute illness, 130
by homeopath, 309–310 unintentional, 22 minor ailments, 131
by patient, 307–308 Pseudo chronic illness, 150 similar, 131
case supervision, 349, 350–351 Psoric miasm, 220, 221–224, 228, 229, 234, following partial treatment, 133
confused cases, 356, 359, 388 247, 290, 291 Referral, 195–196
effects on homeopath, 392, 405–406 causes, 223–224 Reflection, 348
hidden cases, 360 functional disorders, 222 exercises, 165
homeopath self-awareness/balance, 307, influence on vital force, 222 Reflective treatment approach, 10, 53, 54, 61,
373 major characteristics, 221 191, 355, 397
identification techniques, 308, 310, 311 major remedies, 223 emotional intelligence, 361
influence on prescribing, 313 origins, 222 hidden cases, 401–402
living materia medica, 373 psychosomatic disorders, 222 Reflector learning style, 159
monitoring, 312–313 view of life, 223 Reflexology, 356, 415
Regimen, 44, 47, 55, 62–63

431
INDEX

Relapse, 192, 196, 200, 214 homeopath emotional response, 361, 372, time required for response, 134
difficult cases, 392, 393 373 tubercular miasm, 231
following partial similars, 214 homeopath knowledge, 84, 153, 154, 157, unfavourable response, 134
maintaining causes, 58 159, 373, 374, 377, 384 as vectors, 379–380, 411, 412
miasmatic theory, 220 learning styles, 159–160, 161 Remedy reactions, 24, 134, 198–200,
partial, 213 inactive/dud, 209 209–214, 343, 345
repetition of remedy, 215–216 incorrect selection, 210 aggravation, 210–212
timing, 216 information quality, 76–77, 142, 154, allopathic, 24
Relational model of health, 6, 9–10, 11, 12, 15, 378–379, 407 antipathic, 24
29, 32, 61, 161, 355, 360–368 levels, 81–82 curative, 210–211
emotional communication, 362 information sources, 84, 85, 378 homeopathic, 24
emotional intelligence, 360, 361–362 inimical/incompatible, 375, 377 no change, 209–210
empathy, 362–363 instructions for patients, 271–272 provings, 24
hearing the narrative, 32–33 keynotes, 44 to local treatments, 134
hidden cases, 356, 359, 360, 363–364, kingdoms, 372 Remedy states, 6, 31, 32, 35, 75, 171–172
373 law of similars, 15 archetypes, 366, 367
homeopathic case-taking, 99 living, 369–380 complexes, 366
homeopathic relationship, 355, 360 manufacture see Manufacture homeopath blind spots, 379
illness concept, 68, 70 material dose, 272–273 homeopath feelings, 361
materia medica selection, 84 mixtures, 193–194, 411–413 projection, 374
personal/collective unconscious, 364–367 veterinary prescribing, 244 projective identification, 311
prescribing, 7, 10, 60, 193, 373 new, 377–379 Repertories, 26, 92, 112, 114, 115–121, 154,
reflective treatment approach, 7, 10, 15, provings, 20–21, 264 177, 402
53, 397 number of rubrics, 182 card systems, 116, 118
symptoms, 68 organotrophic, 58 computerised, 93, 118, 119
depth, 71 place in package of care, 320 rubric combinations, 255
Relationships, 168, 390 plan of treatment, 185–186 computerised searching, 256, 257
Religious issues, 416 polarity, 155 checking sources, 256
Remedies, 19, 81 polychrests see Polychrests key words, 254
administration, 196, 197, 271 positive/negative features, 374 materia medica, 257
antidoting see Antidotes potency see Potency remedies, 256
basic science research, 327 potentisation, 16, 267–268, 269, 270, 273 symptoms, 253–254
best indicated selection, 44, 47 preparation, 262–263 constitutional features, 178
carcinosis, 232, 233 prescribing see Prescribing evolution, 116
caricatures, 157–158 previously well indicated, 187 examples, 117–118
case matching, 112 prominence, 182 grading of remedies, 116, 119
categories, 33, 263 psoric miasm, 223 limitations, 183
causation correspondences, 46, 47 psychological profile, 156–157 rubrics selection, 179–180
changing, 213, 214–215, 216–217 range, 263 structure, 115
timing, 217 related/relationships, 115, 158, 217, 371, themes, 182
collaterals, 376 374–377 use, 118–119
complementary (complements), 375–376 repertories see Repertories in consulting room, 120
complex cases, 193–194 repetition, 207, 213, 214, 215–216, Repertorisation, 109, 115–121, 134, 177,
selection from symptoms, 178–179 246–247 287, 290
constitutional picture (remedy picture), 59, timing, 216 analytic strategies, 119–120
94, 141, 153, 154, 155 scoring, 181 complex cases, 181–185
completeness, 154 selection, 109, 282, 283, 346–347 computerised rubric analysis, 255
matching individual’s constitution, 156 sequence, 384, 402, 406, 407 difficult cases, 184–185
cycles, 94, 371, 376, 377 shelf life, 271 elimination, 182, 186
difficult cases, 384 signatures see Signatures physical symptoms, 181
dispensing, 271 slow-acting, 209 technique, 118, 181–183
emotional, 369–380 small, 83, 119, 182, 186, 256 Repetition of remedy, 62–63, 207, 213, 214,
essences, 9, 26, 359 source materials, 158, 262, 263 215–216
failure to act, 198 standardisation, 262 timing, 216
family groupings, 182, 257 sycotic miasm, 226 veterinary homeopathy, 246–247
favourable response, 134 synergistic, 375 Research, 316–332
that follow well, 375, 376 themes, 9, 60, 182, 356, 357, 359–360, basic science, 316, 317, 318, 327–328
frequency of treatment, 196–197 370–371, 398–399 case reports, 318, 319
grading, 116, 119 maps, 372 confounding factors, 318

432
 INDEX

effectiveness studies, 317, 320–322 Salts, 293–294 relation to symptoms, 278–279

efficacy studies, 316, 322–324, 326 Sanicula, 226 remedy selection, 282, 283, 287
evidence hierarchy, 317 Sankaran, Rajan, 281, 285, 289, 290, 292, Silica, 91–93, 209, 226, 228, 231, 233, 376,
individual difference, 325–327 297, 298, 300, 326 385
meta-analyses, 317, 322, 324–325 Sankaran’s levels, 69 contamination from glass containers, 328
dataset problems, 317–318 Sankaran’s Situational Materia Medica, 89 Silica series, 292
non-specific effects, 316, 320, 321 Sarcodes, 263–264 Silver series, 292
observational studies, 317, 318, 320–322, Sarsaparilla, 113 Similars see Partial similars
326 Scabies, 9, 60, 220 Simillimum, 207, 210, 212–213, 214, 281,
outcome measures, 321–322 see also Psoric miasm 283, 384, 407
overview of investigations, 316–317 Scholten, Jan, 290, 326 difficult cases, 356
preclinical, 327–328 Scholten’s Homeopathy and Minerals, 89 group prescribing for animal patients, 245
proposed frameworks, 328–329 Scirrhinum, 233 homeopath feelings, 361
complex adaptive systems, 329–330 Seating for consultation, 35 individualisation, 370
macro-entanglement theory, 329, Secale, 263, 385 therapeutic encounter, 342
330–331 Second prescription, 207–217, 375 Simple cases, 67, 123, 125, 126
qualitative, 316, 318–320 Secondary gains, 192, 345 causation, 62
remedy-specific effects, 316 Secretin, 263 treatment approach, 62, 63
study design, 316, 317, 320 Self-awareness, 403–404 follow-up, 209
Resilience, 330 Self-healing, 61–62, 76 management, 76, 132–135
effects of constitution, 141 stimulation prescribing, 62–63
Resistance, 11, 14, 42, 75, 132, 142, 144, 149 following homeopathic prescription, suppression and movement towards
effects of constitution, 141 127 complex cases, 147
Rhus tox, 101, 377, 412 following partial treatment, 133 symptoms, 76, 125, 126, 127
Ringworm miasm, 290, 291 straightforward cases, 125 presenting, 101, 124
plant family remedies, 298 Self-management, 391–393 types, 129–132
Role play, 390 Self-organisation concept, 329 Situational acute illness, 131
Rubrics, 92, 114, 154, 183 Self-realisation, 224 Situational factors, 8, 405
clarifying, 185 Self-supervision, 341, 348 modification, 415–416
combined, 254–255, 398 Self-treatment, 7 Situational materia medica, 84
computerised generation, 118 over-the-counter prescribing, 264 Skin eruptions, 144
computerised management, 253–257 Sensation disturbance, 111, 145, 146, psoric miasm, 222
cross references, 254 192–193, 281 Skinner, Thomas, 269
lists analysis, 255–256 hidden cases, 363, 364 Sleep, 41, 167–168
modification, 256–257 potency selection, 196 Slow-acting remedies, 209
storage, 252 remedy features, 154 Small remedies, 83, 119, 182, 186, 256
elimination, 255 suppression, 148 Small rubrics, 119–120, 182
large, 180–181 Sensations as if, 114 Snake venom, 267
limitations, 180 Sensitivity, 24–25, 75 Social history, 168
mental symptoms, 179 Sepia, 20, 36, 43, 48, 87, 104, 133, 158, 226, homeopathic case-taking, 103–104
number, 182 231, 233, 245, 366, 367, 371, 374, Sociopathy, 228
permissive, 180 376, 379, 400 Sol, 47
remedy prominence, 182, 256 mother tincture preparation, 267 Solarisation, 272
repertorisation technique, 119 Shadow, 366, 390 Solonaceae, 287
repertory structure, 115, 118 Shamanic healing, 379 Solubility of raw materials, 265, 266, 267
scoring, 181, 255, 256 Sheep, 246, 264 Somatisation, 363, 401
selection, 179–180 Shelf life, 271 hidden cases, 391
small, 119–120, 182 Sherr, Jeremy, 292 Source materials, 262, 263
thematic/related, 182, 183–184, 256 Sick role status, 389 Spider venom, 267
weighting, 255 Signatures, 277–288 Spiritual care, 416
Rumex crispus, 412 definitions, 278 Spoilt cases, 412
Ruta grav, 412 kingdoms, 281–283 Spongia, 231
animal, 281–282 Stannum, 231
bacterial, 282 Staphisagria, 87, 146, 172, 226, 376, 388, 402
fungal, 282 Stillingia, 228
S mineral, 282 Storage
Safety, 318 plant, 282 instructions for patients, 272
observational studies, 320, 321 viral, 282 medicating potencies, 271
provings, 21–22 receiving the signature, 287 mother tinctures, 267

433
INDEX

Straightforward cases, 125 differences in miasms, 357 major remedies, 226

remedy frequency, 196–197 palliation, 149 physical manifestations, 226
Stramonium, 173, 287, 290 difficult cases, 360 plant family remedies, 298
Strange/rare/peculiar symptoms, 72, 87, 120, disease continuum (miasmatic sequence), Symptoms, 5, 11, 13, 67–69, 74, 283
134, 155, 156, 283, 407 220 active, 184, 359, 401
animal patients, 242 hereditary/congenital illness, 405 aggravations see Aggravations
complex cases, 171 influence on constitution, 149–150 animal patients, 238
local prescribing, 110 management of symptoms, 192, 202 axes/polar states, 184
remedy signatures, 279 miasmatic states, 371 case-taking, 97–98, 99, 100–102, 106
Structural disturbance, 145–146, 192–193 projection (transference), 307 causation, 70, 72, 100
hidden cases, 363, 364 psoric miasm manifestations, 222 central (deepest disturbance), 70, 187
remedy features, 154 susceptibility following, 132–133, 140, 188 characteristic, 178
suppression, 148 themes, 399–400 classification, 106
Stuck cases, 41–42, 330, 418 totality of symptoms, 149–150 coincidental changes, 202
collusion, 309 treatment history, 148 compensated, 184, 359, 401
Subjective approach, 9 vaccination, 149 complete, 82, 100–101, 111, 114
prescribing, 60 Susceptibility, 6, 8, 9, 11, 12, 14, 32, 48, complex cases, 124, 125, 126, 127–128,
treatment, 53–54 62–63, 67, 70, 74, 106, 144, 147, 177, 357
Subjective bias, 304 186, 283, 411 concomitants (extensions), 59, 111
Succussion (dynamisation), 16, 267, 268, 273 acute mental illness, 130 confirmatory (inclusion), 111–112, 398
fluxation methods, 269, 270 chronic illness, 144 confused cases, 124, 128, 184, 308, 357,
higher potencies, 269 collective/community, 129, 130 358–359, 385, 387, 398
LM potencies, 270 complex cases, 140, 144 management issues, 410
mechanical, 269 consent to treat, 195 periodic, 386
number, 268 contagious illnesses, 130 situational factors, 386
procedure, 268 cultural factors, 390, 417 curative changes, 202
research studies, 316, 328 effects of constitution, 141, 155 deep (case deepening), 164, 202
Sucrose vehicle, 271 effects of suppression, 132–133, 140, 188 difficult cases, 384, 392
Sulphur, 87, 172, 179, 186, 215, 223, 226, epidemics, 129 doorknob, 174
231, 244, 376, 401 family history, 57, 169 doublet, 111
archetype, 222–223 finite limits, 149 environmental factors, 75, 76, 77
Supervision, 341–342, 347–352, 370, 373, hereditary/congenital illness, 404 essence, 359
392, 393, 395, 406 hidden cases, 360 exclusion, 111–112, 398
development, 348 holistic model of health, 70, 142, 144 expression, 144, 164, 169
double matrix (seven eyed supervisor) model, impact on symptoms, 70, 75, 76, 77, 102 emotions, 68, 387–388
349–351 individual variation, 75 function, 145, 146, 192–193
education, 348 inherited predisposition, 145, 364 sensation, 111, 145, 146, 192–193
facilitated, 341, 349 masked acute illness, 131 structure, 145–146, 192–193
peer, 341, 349, 351 miasmatic states, 188, 371 follow-up see Follow-up
projection (transference/countertransference) sycotic, 224 general, 68, 103–104, 165, 181
issues, 307, 309, 310, 312 modification by treatment, 76 guiding, 87
self, 341, 348 partial treatment, 133 hidden cases, 124, 128, 307, 308, 360,
styles, 349 potential, 185 363, 389, 390–391, 401
support, 348 proving remedy reactions, 24 hierarchy, 67, 70–71, 73, 78, 111, 118,
Supervisor–supervisee relationship, 349, 350, recurring similar acute illness, 131 140, 141, 143, 178–179
351 significant life events, 103 Kent’s, 178, 179
Supervisors, provings, 24 simple cases, 125 individuality of response, 4, 8
Supportive treatment, 346 straightforward cases, 125 intensity, 101
Suppositories, 271 totality/constitution treatment approach, as interface between patient and situation,
Suppression, 41, 52, 102, 132–133, 144, 53, 59 126–128
147–150, 164, 169, 187, 283, 357, Syco-tubercular cancer type, 232–233 internalised, 131
383 Sycotic co, 226, 231 keynotes, 72, 86–87
aggravations, 199 Sycotic miasm, 220, 224–226, 228, 229, 234, law of similars, 15
animal patients, 244 247, 291, 400 laws of cure, 73
causes, 147–148 duality, 225–226 layers, 71, 102, 144
complex cases, 140, 189, 190, 202 emotions, 226 level/depth of penetration, 71
confused cases, 357, 358, 386 escape from psora, 224 local, 68, 72, 103, 145, 410
consent to treat, 195 feelings of shame, 226 see also Local prescribing
cultural, 355, 364 major characteristics, 225 main, 102

434
 INDEX

materia medica, 81, 82, 86–87 major characteristics, 227 Therapeutic agreement (contract), 45, 341,
medication adverse effects, 197 major remedies, 228 342, 343–345, 346, 389
mental, 102, 103–104, 166–167, 179, 181 manifestations, 228 checklist, 344
minor, 62 organism (Treponema pallidum), 227 difficult cases, 392
modalities, 87, 101, 102 sociopathic potential, 228 lifestyle modification, 344–345
models of health, 71–72 Systems review, 103 records, 343
biological, 5, 67–68, 69 third party involvement, 343–344, 346
holistic, 8, 68, 69, 71, 72 Therapeutic encounter, 341, 342–347
holographic, 6, 68, 356 boundaries, 346
pathological, 67 T deepening case, 107, 346
relational, 6, 68 Tablets, 271 enablement, 342–343
new, 202 Taints see Miasms rapport/empathy, 342–343, 346
palliation, 148, 149 Taking the case see Case-taking reflecting back to patient, 346–347
passive, 184, 359, 401 Tarentula hispanica, 262 remedy selection, 346–347
physical, 181 Tautopathy, 56 see also Consultation
pictures, 82, 113, 153 Teaching of homeopathy, 418 Therapeutic relationship see Homeopathic
categories of case, 123–124 Tentative statement technique, 305 relationship
matching to simillimum, 124, 125 Terminal care, 150, 212 Thuja, 103, 226, 233, 245
placebo, 271 Tetraiodothyrinine, 264 mother tincture, 266
presenting, 99, 101–102 Themes, 9, 43, 72, 81, 161, 182, 185, 290, Thuja occidentalis, 241
provings, 19, 21, 23, 24, 25, 30, 75, 84, 398, 411 Thyroidinum, 263, 264
202, 213, 214, 216 animal kingdom, 295, 296 Time keeping, 393
extraction, 26 change over time, 190–191 Time line, 14, 34
records, 25 computerised analysis of rubrics, 255 follow-up, 208
psychological, 102, 103–104, 166, 178, computerised searching, 256 Timing of intervention, 403
403 confused cases, 124, 357, 359, 373, 385, Tissue salts, 193, 269
registers (repertories), 26 386, 410 Tlacote water, 264
remedy signature relationship, 278–279 emotions, 387–388 Tongue diagnosis, 356
remedy state, 75 projection, 309 Topical preparations, 271
repertorisation, 181 difficult cases, 384 Totality of symptoms, 6, 8, 15, 72, 103, 139,
representative, 178 hidden cases, 390 140–141, 177–188
return of old, 202–203, 213 holographic model of health, 356, 359–360 case anaysis, 177–181
scoring, 101 homeopathic case-taking, 99 complex cases, 146, 177, 178
secondary gain, 192 materia medica, 83, 370–373, 385 consent to treat, 195
separate treatment, 69 miasms, 188 emotional states, 362
simple cases, 125, 126, 127 mineral kingdom, 292 environmental factors, 145
skin, 144 patterns of causes, 30, 33 general features, 166
somatised, 363 periodic table of elements, 292–293 influence of palliation/suppression, 149–150
strange/rare/peculiar, 72, 87, 110, 120, plant remedies, 298 materia medica, 83, 154
134, 155, 156, 279, 283, 407 prescribing, 124, 193, 194, 357, 370, 373, prescribing, 194
stuck cases, 41 387, 402, 410 provings, 19, 21, 22, 24
suppression see Suppression miasmatic, 400 receiving the case, 163, 164
susceptibility relationship, 70, 75, 76, 77 reframing difficult cases, 303 relation to constitution, 141
themes, 359, 370 relational model of health, 360 symptom hierarchy, 71
therapeutic agreement, 346 remedies, 356, 357, 370–371 treatment approach, 53, 54, 59, 62
totality approach see Totality of symptoms cycles, 376 patient characteristics, 191
treatment approach, 53, 54, 58–59, 62, maps, 372 veterinary prescribing, 244
76–78 signatures, 279 Toxicology, 85–86
like treating like, 15 suppression, 399–400 Traits, 9, 57, 60
matching case to remedy, 112 symptoms, 370 Transference, 61, 307
triplet, 111 axes, 184 supervision process, 350–351
weighting, 82, 86, 92, 106, 111, 154 layers, 71 see also Projection
Syndrome shift, 202 treatment approach, 53, 54, 60–61, 355, Traumeel, 324
Synergistic remedies, 375 397, 398–401 Treatment approaches, 53
Syphilinum, 87, 228 analysis, 398 case analysis, 43
Syphilis (syphilitic miasm), 9, 60, 220, patient characteristics, 191 causation see Causation treatment approach
226–228, 229, 234, 247, 290, 291 treatment strategy, 398–399 interconnection, 411
fire as symbol, 228 weighting/scoring, 398 matching to categories of homeopathic case,
historical aspects, 226–227 Theorist learning style, 159 123, 124, 128–129

435
INDEX

Treatment approaches (Continued) Unicist prescribing, 411 veterinary relationship, 247–248

no prescription, 62 Ustilago, 263 wild animals, 239, 240
other therapeutic systems, 135 Vipera, 239
integration, 413–415 Viral signatures, 282
prescribing methodologies, 52–61 Vis medicatrix naturae, 13
subjectivity/objectivity, 53–54 V Vitagram, 14
Treatment cycle, 197 Vaccination, 132, 408 Vital force, 13, 16, 278, 281
complex cases, 194–195 animals as patients, 240, 241 psoric miasm influences, 222
Treatment goals, 192 suppression, 149 Vital sensation, 300
Treatment history, 103, 149 Vaccine damage, 56 Vitality, 3, 13–14, 16, 34, 58, 70, 73, 74, 75,
Treatment, homeopathic, 132 Vaccine reactions, 263 144
Treatment on symptoms, 76–78 Valerian tincture, 199, 385 case analysis, 41
see also Local prescribing Validity, efficacy studies, 316, 325 diagnostic labels, 104
Treponema pallidum, 227 Vega, 362 effect on aggravation, 212
Trigger events, 7, 32, 34, 55–56, 128 Venoms, 267 effects of environmental manipulation, 149
acute miasm, 131 Veterinary homeopathy, 237–248 effects of suppression, 147, 148
complex cases, 143–144 administration of medicines, 246, 264 fluctuation, 14
simple cases, 125 causation, 240–241 low, 403
Triplet symptoms, 111 challenges, 238 masked acute illness, 131
Trituration, 265–266, 267 companion animals, 238, 239, 241, 243, patterns of change, 14
LM tincture preparation, 270 246 remedy reactions, 198
tissue salts preparation, 269 constitution–breed correlations, 243 scoring, 165
Trust, 306, 342, 345 consultation, 247–248 Vitoulkas, George, 60
Tubercular miasm, 220, 228–231, 234, 247, dietary advice, 244 Vitoulkas’s Essences, 89
290, 291, 371, 376 epizootic/enzootic diseases, 245 von Grauvogl, Eduard, 156
constitution, 229 food-producing animals, 239, 240, 243, Von Korsakoff, 269
major characteristics, 230 244–245, 246
major remedies, 231 history-taking, 238, 242
nosodes, 231 holistic approach, 242–243
origins, 229 local prescribing, 242 W
psychological features, 229–230, 231 mental symptoms, 238, 242–243 Water, 266
relation to psora/syphilis, 229 miasms, 247 elemental, 280–281
Tuberculinum bovinum, 190, 412 modalities, 238, 242 medicating potencies, 271
Tuberculinums, 231 multiple prescribing, 244 research approaches, 316, 327, 329
Tyler’s Drug Pictures, 89, 92–93 nosodes, 246, 264 Well-being, 9, 73
Typhoid miasm, 285, 286, 290, 291 obstacles to cure, 238, 244 environmental factors, 75
plant family remedies, 298 pathological model of health, 240–241 of homeopath, 373, 392, 406
patient categories, 238–239 as outcome measure, 321, 322
performance animals, 238, 239–240, 244 Whole systems of CAM, 316, 320
prescribing for groups of animals, 244–245, patient characteristics, 325, 326
U 246 Wild animals, 239, 240
Unconscious processes, 185, 306–307, combination remedies, 245
365–367 single remedy on group totality, 245
confused cases, 357 remedies
hidden cases, 389, 390 pharmacy, 264 Y
one-sided illness, 360 repetition, 246–247 Yin and Yang, 6, 357
see also Collective unconscious; Personal strange/rare/peculiar symptoms, 242
unconscious vaccination influences, 240, 241

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