Having obtained a complete record of a patient’s symptoms one has next to consider the problem of matching the symptom picture of the patient with the recorded symptoms produced by some homoeopathic remedy. It is quiet impossible for anyone to memorize all the symptoms recorded in the Materia Medica Medica, and to attempt to examine the records to provings in order to find which drug will most accurately correspond with the patient’s symptom picture is like hunting for a needle in a haystack. That, however, is the problem one has to face.
This difficulty has been faced since the earliest days of homoeopathic practice, and has resulted in the production of Repertories of various types. A Repertory if simply an index to the Materia Medica. Just as the symptoms in the Materia Medica have been grouped as mental, or referring to one or other organ or system, so the Repertory, or the index has been arranged on a similar plan. In the earlier Repertories sufficient care was not taken to distinguish between modalities which affected a patient as a whole and those which applied to one specific symptom. It was not until the time of Kent that a clear differentiation between the two was attempted in the Repertory. For that reason Kent’s is the most accurate Repertory we possess to-day.
There has been considered disagreement as to what symptoms should be including in the Materia Medica and so in the Repertory. Some homoeopaths maintained that only symptoms which have been experimentally brought out by the administration of the drug to a number of healthy people, and which appeared in a majority of those people should be accepted as reliable.
Other maintained that it was permissible to include in the Materia Medica, and hence in the Repertory, symptoms which had been cured by, or had disappeared after, the administration of the drug to a patient. Others, again, maintained that symptoms developing in patients after the administration of the drug might also be included as evidence of the drug effect.
An attempt has been made to show the extent to which any particular symptom was characteristic of an individual drug, and also to show that the accuracy of this drug effect had been repeatedly confirmed. This has been done by the employment of different types in the printing of the Repertory Where the heaviest type is employed this is meant to convey that the symptom recorded under the particular drug has been produced experimentally and has appeared many times in the healthy persons to whom the drug was given. Where the second type is used it is meant to convey that the purely experimental evidence is less conclusive, but that the record of the curative value of the drug is absolutely convincing. Where the lowest type is used it implies that the evidence of the action of the drug is much more restricted, it may rest on an individual experiment, or it may have appeared in the course of treatment, or again it may be entirely clinical.
From the practical point of view the important thing to stress is that the first and second type drugs cab be relied on absolutely. When employing the lowest type drugs one has to use a certain amount of discretion.
When a patient is being treated with a drug that patient is certainly sensitive to that particular stimulus so it is not surprising that in response to the drug administered he should produce fresh symptoms of the drug which has been given. Among the provers it was the sensitives who produced the most valuable symptoms. It is obvious that anyone giving well-marked indications for a drug will automatically be in a sensitive state. Theoretically, therefore, those symptoms appearing in the course of treatment should be valuable. Again, where one is considering local symptoms these low type drugs re immensely useful. In the majority of cases provings have not been pushed to the extent of producing all the effects of which the drug is capable, and in the case of many of the less well-proved drugs the evidence of their ability to produce, or remove, these local symptoms is a most entirely clinical.
If follows from this that where one has well-marked general, or mental symptoms in a case one’s tendency is to seek for the drugs which are recorded in the first or second types, but where one’s case record shows only local symptoms one does get great help from the lower type drugs which are recorded under the appropriate headings.
It must always be clearly understood that a Repertory is nothing more than an index to the Materia Medica. To confine oneself to the study of the Repertory and to neglect the study to the Materia Medica is just about as sensible as to study the catalogue of a reference library and never to look at the volumes to which the catalogue refers.
Having considered how to arrive at a decision as to the most appropriate drug for any given case, the next problem, with which one is faced is in what form, and how frequently the appropriate medicine should be administered.
There are several factors which govern one’s choice of the form in which the medicine should be administered, or in other words, be potency which should be used. Hahnemann’s experience was that actual material doses administered to a sensitive patient produced an undue aggravation, he therefore diminished his dose, and finally discovered that by his special method of preparing his medicines he could reduce the dose to infinitesimal proportions and still keep the specific action of the drug constant in his day potentization was not normally carried beyond the 30th centesimal since his day there are practically no limits to which potentization has not been carried. My personal experience is that all ranges of potencies have their uses, but that in certain instances one potency is to be preferred to another.
Where one is endeavouring to treat a purely local condition one’s tendency is to consider those drugs only which have a definite affinity for that organ or tissue. There is no doubt that very beneficial effects can be produced by working along these lines, and when the is done only the lower potencies are found to be effective in the vast majority of cases. When a higher potency has been found to be effective in such a case it has always been found that in addition to the local similarity there has also been a general similarity present, even if it has not been recognized.
By a lower potency what I intend to convey is a potency from the mother tincture to the 12x or 9th. centesimal.
Where treatment is based on a general similarity in addition to the local indications my experience has been that the medium or higher potencies are much more efficacious. By the medium potencies I intend to convey anything from the 9th centesimal to the 200th.
There are certain well-marked guides which I have found to be very helpful in deciding when one of the medium potencies should be employed and when one can sagely and with benefit use one of the higher potencies. The first and most important of these is the gravity of the pathological condition from which the patient is suffering in the more chronic cases. Where there is danger which may result from any receive process set up by the medicine it is advisable to commence treatment with one of the lower of the medium potencies, say a 12 or 30 centesimal. A second type of case in which the administration of the higher potencies is undesirable, although not perhaps dangerous, is the one in which one is treating a very sensitive, highly strung, finely balanced patient. In such a case the administration of a high potency does produce a very marked reaction which is needlessly painful and from which the patient may take weeks or even months to recover. If in such a case one starts with a lower potency – in my experience a 30 is perfectly safe-one avoids these unnecessary and very undesirable reactions and starts the curative process right away.
A striking contrast to this is the case in which one is dealing with the lethargic, phlegmatic patient, of slow reaction time, as in these one finds that little or no effect is produced by the lower potencies and only the higher produce any satisfactory curative reaction.
There is another lead as to the most desirable potency to employ. This is the acuteness of the disease from which the patient is suffering. It may be taken as a reliable rule of practice that the more acute the disease the higher should be the potency which is administered. From experience I can say that this rule is of universal application, and my opinion is based not on theory, but on actual personal experience.
Finally. let us consider the question of administration, in other words, having declared on the potency, how often the medicine should be given. There is one universal rule which can be applied to every case, namely, allow the dose of medicine to act as long as it will.
When dealing with chronic cases the duration of action of the medicines is a very variable quantity and one’s success or failure chronic cases depends almost entirely, apart from selecting the right medicine, on one’s capacity to assess whether the reaction to the initial dose is still continuing or has ceased. In my experience, no harm ever results from waiting too long, but many, many, cases are spoiled by too early repetition. When repetition has been too early it is exceedingly difficult to straighten out the case again and it will often take months, during which one may have to wait for the harmful reaction to subside or may have to attempt to counteract the unfavourable reaction which has taken place.