Symptomatology


Hahnemann defines symptoms broadly as, “any manifestation of a deviation from a former state of health, perceptible by the patient, the individuals around him, or the physician.” We have here the basis of the common division of symptoms into two general classes- Subjective and Objective….


The Homoeopathic Materia Medica.- The Materia Medica of Hahnemann is an enduring monument to the genius of its author, original in its conception and design and unique in its form and contents. Its foundation is on the bedrock of natural law. It is constructed of the cut stones of accurately observed facts, laid up in the cement of irrefrangible logic. Over its portals are graven the words, *Similia Similibus Curantur; Simplex, Simile, Minimum.

Hahnemann, on apprehending a new general principle in therapeutics, was confronted with the problem of creating an entirely new materia medica by means of which the principle might be applied in practice. If diseases were to be treated according to the principle of symptom-similarity it was necessary to know what symptoms drugs would produce in healthy persons, since these would be the only symptoms which could possibly resemble the symptoms of sick persons.

There was no materia medica in existence which contained the facts or phenomena of the action of drugs upon the healthy. The existent materia medicas contained only the incidental observations, theories and opinions of drug action of men who gave drugs to the sick or treated cases of poisoning upon purely empirical and speculative assumptions; and these were given, not singly, but in such combination and mixtures as to render impossible any intelligent conception of what the action of a single drug might be.

Undismayed by the magnitude of the task, Hahnemann set about creating a materia medica which should embody the facts of drug action upon the healthy. He instituted “provings” of drugs upon himself, members of his family, friends, students and fellow practitioners, keeping all under the most rigid scrutiny and control, and carefully recording every fact and the conditions under which it was elicited. This work was continued for many years, parts of it being published from time to time, until the mass of material had reached enormous proportions.

Adopting the plan of arranging the drug symptoms thus derived according to the anatomical parts and regions of the body in which they occurred, as the most rational and simple method of classification for the purpose of comparison with disease symptoms, Hahnemann constructed and published, first, the Materia Medica Pura, and later, The Chronic Diseases, the greater part of which is composed of provings of drugs. Covering nearly three thousand royal octavo pages, they constitute one of the most stupendous works of original experimentation and research ever attempted and carried out by one man. To this original work of Hahnemann many and large additions have been made by later workers.

The vast collection of symptoms of which the materia medica of Homoeopathy is composed is incomprehensible without an understanding of the principles upon which it is based. In a good working homoeopathic library there are about two hundred volumes, by many authors, upon the subject of materia medica, including special collections and classifications, repertories, charts and indexes of symptoms. Confronted by such a mass of material it is no wonder that the student is at first confused and discouraged. But when the basic principle has been explained to him and he has learned the meaning of symptoms, their method of classification and interpretation, and when he has seen the means if ready reference provided, his bewilderment gives way to admiration.

The task of mastering the materia medica, vast and even impossible as it seems, is comparatively simple. The compass that points the way through the seeming wilderness of symptoms is the principle of *Similia – the remedial law of homoeopathy.

When the drug symptoms recorded in the homoeopathic materia medica are seen to be exact counterparts of the symptoms of disease, and it is explained that medicines cure disease by virtue of this similarity of symptoms, the reason for the existence of the materia medica in its characteristic form is evident. *The arrangement of symptoms according to an anatomical scheme is for the purpose of comparison – symptoms of drugs with the symptoms of disease. Given the basic principle and its corollaries, the rest is merely a matter of mastering the logical classification and interpretation of symptoms and the use of the manuals, indexes and repertories provided.

Symptomatology.- The first requisite to a correct understanding of the subject of symptomatology is to know the full meaning of the world “symptoms” and all that it involves.

Knowledge of the true nature and constitution of a symptom is necessary in proving or testing medicines; in the examination of a patient; in the study of the materia medica and in the selection and management of the indicated remedy. It is a standard by which to judge the reliability of a proving, a clinical case, an examination record, or the professions of a new coming *confrere.

Ignorance of the nature and constitution of symptoms on the part of provers, directors of provings and physicians has resulted in the production of certain provings and books on materia medica which are practically worthless, and the publication of reports of cases which have served no better purpose than to float their authors’ names on the sea of printer’s ink. Such productions, consisting largely of commonplace generalities, indefinite pathological names and pseudo-scientific instrumental and laboratory findings, reveal the ignorance of their authors of all that goes into the making of reliable cures and provings conducted under classic homoeopathic principles. The result is useless to the prescriber because it does not contain the elements upon which a homoeopathic prescription can be based.

It is not intended to belittle or ridicule laboratory and instrumental findings. Such observations are useful and necessary for certain scientific, particularly diagnostic and pathological purposes; but they are only a part, and a very small part of homoeopathic provings, or of clinical symptom-records designed for the use of the prescriber. They cannot take the place of the more important things which have been left out. What those things are will appear as the definition of symptoms proceeds.

Symptoms Defined. – In general, a symptom is any evidence of disease, or change from a state of health. In materia medica no relevant fact is too insignificant to be overlooked. There is a place and use for every fact, for science has learned that “Nature never trifles.” A symptom which appears trifling to the careless or superficial examiner may become, in the hands of the expert, the key which unlocks a difficult problem in therapeutics.

Hahnemann defines symptoms broadly as, “any manifestation of a deviation from a former state of health, perceptible by the patient, the individuals around him, or the physician.” We have here the basis of the common division of symptoms into two general classes- Subjective and Objective.

Hahnemann further defines symptoms as “evidences of the operation of the influences which disturb the harmonious play of the functions, the vital principle as a spiritual-dynamis.” (Substantial, entitative source of vital power and activity.)

Subjective Symptoms.- Subjective Symptoms are symptoms which are discoverable by the patient alone, such as pain and other morbid sensations of body or mind, presenting no external indications. With Hahnemann’s announcement of the doctrine of the Totality of the Symptoms as the basis of the homoeopathic prescription, it became possible for the first time in the history of medicine to utilize all the phenomena of disease. Prior to Hahnemann’s time two of the most frequently occurring and important groups of symptoms were practically ignored-the mental symptoms and the subjective symptoms. The “regular” practitioner of medicine even today is interested very little in subjective symptoms. They play but a very small part in governing the practical treatment of his case. To him they are merely inarticulate cries of suffering, serving only to suggest the direction in which investigations are to be made by physical and laboratory methods for discovering the supposed tangible cause of the disease, and the location and character of its lesions.

Under the new system of therapeutics devised by Hahnemann subjective symptoms naturally took their proper place in the study of the case. As expressions of the interior states of the organism, and particularly of the psychic and mental states, they take the highest rank. Nothing can supersede them. They constitute the only direct avenue of approach to that inner sphere which must otherwise remain closed to our investigation, except as it is indirectly revealed in certain automatic or involuntary objective symptoms from which more or less accurate deductions can sometimes be made. They enable the physician to view disease from the standpoint of the patient. How great an advantage they afford to the prescriber can be appreciated only when we are deprived of them, as in the case of infants and animals, and find how much more difficult is our task under such circumstances.

Before Hahnemann’s genius opened up the new way pain was merely pain. To discriminate between various kinds of pain; to analyze and classify pains, and not only pains, but all other subjective sensations and feelings, and to relate them as phenomena of disease to remedies, as Hahnemann did, had never been thought of before. It is ridiculed and scoffed at today by those who do not see that there is something radically wrong with a system of medicine that practically ignores the great bulk of the symptoms of almost every case and tantalizes the patient by learned explanations of their cause; by assurances that they are of no consequence; or, if his clamor becomes too loud, clubs him into silence with an opiate.

Objective Symptoms.-Hahnemann defines objective symptoms as. “the expression of disease in the sensations and functions of that side of the organism exposed to the senses of the physician and bystanders.” In this peculiar definition there is an allusion to his definition of disease as a dynamical disturbance of the vital force and of Medicine as, “a pure science of experience, which can and must rest on clear facts and sensible phenomena clearly cognizable by the senses.” There is also a reminder that there is more in an objective symptom than is perceptible to the eye alone. The subjective “sensations and functions” of the visibly affected organ or part are to be considered as well as the purely objective signs. Hahnemann here implies that functional and sensational disturbances precede organic changes; and this is consistent with his basic premise that all disease is primarily a dynamical disturbance of the life principle. He never loses sight of this fundamental conception of the nature of disease.

Totality of the Symptoms.- “Totality of this Symptoms” is an expression peculiar to homoeopathy which requires special attention. It is highly important to understand exactly what it means and involves, because the totality of the symptoms is the true and only basis for every homoeopathic prescription.

Hahnemann (Org., Par. 6) says:- “The ensemble or totality of these available signs or symptoms, represents in its full extent the disease itself; that is, they constitute the true and only form of which the mind is capable of conceiving.” The expression has a two-fold meaning. It represents the disease and it also represents the remedy, as language represents thought.

1. The Totality of the Symptoms means, first, the totality of each individual symptom.

A single symptom is more than a single fact; it is a fact, with its history, its origin, its location its progress or direction, and its conditions.

Every complete symptom has three essential elements:- Location, Sensation and Modality.

By *location is meant the part, organ, tissue or function of body or mind in which the symptom appears.

By *sensation is meant the impression, or consciousness of an impression upon the central system through the medium of the sensory or afferent nerves, or through one of the organs of senses; a feeling, or state of consciousness produced by an external stimulus, or by some change in the internal state of the body. A sensation may also be a purely mental or physical reaction, such as fright, fear, anger, grief or jealousy.

By *modality we refer to the circumstances and conditions that affect or modify a symptom, of which the conditions of aggravation and amelioration are the most important Dr. William Boericke well said:

“The modalities of a drug are the pathognomonic symptoms of the Materia Medica.”

By *”aggravation” is meant an increase or intensification of already existing symptoms by some appreciable circumstance or condition.

“Aggravation” is also used in homoeopathic parlance to describe those conditions in which, under the action of a deeply acting homoeopathic medicine (or from other causes), latent disease becomes active and expresses itself in the return of the old symptoms or the appearance of new symptoms. In such cases it represents the reaction of the organism to the stimulus of a well selected medicine, and is generally curative in its nature.

*”Amelioration” is technically used to express the modification of relief, or diminution of intensity in any of the symptoms, or in the state of the patient as a whole, by medication, or by the influence of any agency, circumstance or condition.

2. The Totality of the Symptoms means *all the symptoms of the case which are capable of being logically combined into a harmonious and consistent whole, having form, coherency and individuality. Technically, the totality is more (and may be less) than the mere numerical totality of the symptoms. It includes the *”concomitance” or form in which symptoms are grouped.

Hahnemann (Org., Par. 7) calls the totality, *”this image (or picture) reflecting outwardly the internal essence of the disease, i.e., of the suffering life force.”

The word used is significant and suggestive. A picture is a * work of art, which appeals to our esthetic sense as well as to our intellect. Its elements are from, color, light, shade, tone, harmony, and perspective. As a composition it *expresses an idea, it may be of sentiment or fact; but it does this by the harmonious combination of its elements into a whole – a totality. In a well balanced picture each element is given its full value and its right relation to all the other elements.

So it is in the symptom picture which is technically called the Totality. *The totality must express an idea. when studying a case from the diagnostic standpoint, for example, certain symptoms are selected as having a known pathological relation to each other, and upon these is based the diagnosis. The classification of symptoms thus made represents the *diagnostic idea. Just so the “totality of the symptoms,” considered as the basis of a homoeopathic prescription, represents the *therapeutic idea. These two groups may be and often are different. The elements which go to make up the *therapeutic totality must be as definitely and logically related and consistent as are the elements which go to make up the *diagnostic totality.

The “totality” is not, therefore, a mere haphazard, fortuitous jumble of symptoms thrown together without rhyme or reason, any more than a similar haphazard collection of pathogenetic symptoms in a proving constitutes Materia Medica.

The Totality means the *sum of the aggregate of the symptoms: Not merely the numerical aggregate – the entire number of the symptoms as particulars or single symptoms – but their sum total, their organic whole as an individuality. As a machine set up complete and in perfect working order is more than a numerical aggregate of its single dissociated parts, so the Totality is more than the mere aggregate of its constituent symptoms. it is the numerical aggregate *plus the idea of plan which unites them in a special manner to give them its characteristic form. As the parts of a machine cannot be thrown together in any haphazard manner, but each part must be fitted to each other part in a certain definite relation according to the preconceived plan or design – “assembled,” as the mechanics say-so the symptoms of a case must be “assembled” in such a manner that they constitute an identity, an individuality, which may be seen and recognized as we recognize the personality of a friend.

The same idea underlies the phrase, *”Genius of the Remedy.” Genius, in this sense, being the dominant influence, of the essential principle of the remedy which gives it its individuality.

The idea of the Totality as an abstract form, or figure, has been applied to the materia medica as a whole. The materia medicas as a whole is the sum total of the symptoms of all proved medicines – a grand, all inclusive figure which may be imagined or personified in the form of a human being or “super-man,” this conception being based upon the anatomical, physiological and psychological plan or framework of the materia medica.

The idea is applicable in exactly the same way in pathology. Disease in general, considered as a whole, is composed of the totality of all the symptoms which represent it to our senses. The pathological totality, also, can be personified or pictured by the imagination in the form of a human being.

Starting with this conception some of our ingenious writers have amused themselves and added to the gaiety of the profession by personifying medicines, microbes and maladies and casting them in all sorts of roles – a dramatic whimsy which has its value as an educational expedient for a certain type of mind.

The materia medica from this point of view becomes a portrait gallery of diseases, a sort of medical “Rogues Gallery” by means of which we may identify the thieves who steal away our health and comfort and bring them to justice. In homoeopathic practice to carry out the simile, we merely “set a thief to catch a thief.”

As a constructive principle, therefore, the idea of the Totality enters into the formation not only of the materia medica as a whole, but of every remedy and every symptom.

Each disease, each individual case of disease and each symptom of disease has its totality or individual form.

If the “day books” or records of a good proving are examined it will be seen that the symptoms of each prover are set down chronologically in the order of their occurrence; that each symptom is as complete as possible in its elements of locality, sensation and modality; that the symptoms are stated mostly in the vernacular, the plain simple language of the layman, who describes phenomena as they appear to him, simply, graphically, or by analogy or homely comparison. The record of these facts with the remarks and observations of the director of the proving constitutes a “proving,” in which exists the elements from which the Materia Medica is constructed.

*The Day Books of the provers are not the Materia Medica. Not until this mass of material has been analyzed, sifted, classified according to its anatomical, physiological and pathological relations and had its general and particular characteristics logically deduced, does it become materia medica for practical use. Many things in a proving must be interpreted in the light of anatomy, physiology, pathology, or psychology before they are available for therapeutic use, just as the statements of patient in regard to his sufferings must be interpreted in making a diagnosis or in making a prescription.

The true Totality, therefore, is a Work of Art, formed by the mind of the artist from the crude materials at his command, which are derived from a proving or from a clinical examination of the patient.

It is important that these points should be understood, because, otherwise, there is liability to err in several directions.

1. Error may arise in placing too much emphasis upon a single symptom, or perhaps actually prescribing on a single symptom as many thoughtless do.

2. Error may arise in attempting to fit a remedy to a mass of indefinite, unrelated or fragmentary symptoms by a mechanical comparison of symptom with symptom, by which the prescriber becomes a mere superficial “symptom coverer.”

3. Failing in both these ways the prescriber may fall to the level of the so-called “pathological prescribers,” who empirically base their treatment upon a theoretical pathological diagnosis and end in prescribing unnecessary and injurious sedatives, stimulants, combination tablets, and other crude mixtures of common practice.

The physician who known what a symptom is from the homoeopathic standpoint and how to elicit it; who knows what the totality of the symptoms means and how to construct it, and who has the intelligence, the patience and the honesty to study his case until he finds it will not be guilty of such practice.

Characteristics and Keynotes.- In paragraph 153 of the Organon, Hahnemann says that in comparing the collective symptoms of the natural disease with drug symptoms for the purpose of finding the specific curative remedy, “the more striking, singular, uncommon and peculiar (*characteristic) signs and symptoms of the case are *chiefly and almost solely to be kept in view; for it is more particularly these that very similar ones in the list of symptoms of the selected medicine must correspond to, in order to constitute it the most suitable for effecting the cure. The more general (common) and undefined symptoms; loss of appetite, headache, debility, etc., demand but little attention when of that vague and indefinite character, if they cannot be more accurately described, as symptoms of such a general nature are observed in almost every disease and drug.”

This seems a sufficiently clear description of what Hahnemann meant by “characteristic” symptoms; and yet the term has been the subject of much discussion and many have differed as to what constitutes a “characteristic.”

Confusion arose and still exists through the inability on the part of many to reconcile the teaching of this paragraph with the apparently conflicting doctrine of The Totality of the Symptoms as the only basis of a true homoeopathic prescription. These have taken refuge either in the mechanical “symptom covering” already referred to, as fulfilling their conception of the “totality;” or in what is knows as “keynote prescribing,” which, as they practice it, means prescribing on some single symptom which they (perhaps whimsically) regard as the “keynote” of the case.

Stuart Close
Stuart M. Close (1860-1929)
Dr. Close was born November 24, 1860 and came to study homeopathy after the death of his father in 1879. His mother remarried a homoeopathic physician who turned Close's interests from law to medicine.

His stepfather helped him study the Organon and he attended medical school in California for two years. Finishing his studies at New York Homeopathic College he graduated in 1885. Completing his homeopathic education. Close preceptored with B. Fincke and P. P. Wells.

Setting up practice in Brooklyn, Dr. Close went on to found the Brooklyn Homoeopathic Union in 1897. This group devoted itself to the study of pure Hahnemannian homeopathy.

In 1905 Dr. Close was elected president of the International Hahnemannian Association. He was also the editor of the Department of Homeopathic Philosophy for the Homeopathic Recorder. Dr. Close taught homeopathic philosophy at New York Homeopathic Medical College from 1909-1913.

Dr. Close's lectures at New York Homeopathic were first published in the Homeopathic Recorder and later formed the basis for his masterpiece on homeopathic philosophy, The Genius of Homeopathy.

Dr. Close passed away on June 26, 1929 after a full and productive career in homeopathy.