The success of prescribing depends upon the view taken of the totality of the symptoms. The view of any given totality affords the indifferent or the marked success of any given prescription.
The grasp of the symptoms, in part or as a whole, is firm or lax in accordance with the view taken of the parts and the whole collection of symptoms. What else can be understood by the image of any case expressed in symptoms?
To be able to view the totality of symptoms so that the most similar remedy will appear to the mind is the aim of all healing artists. As the view varies, so varies the success.
The examination of the patient is always made in accordance with the view of the totality the physician is in the habit of taking. Some can never learn to examine a patient so that the symptoms, when written out, will have the form required for a review. Any successful prescriber would know by the reading the totality what is lacking to make up an image. But let us now suppose that the case has been properly taken, and that it is a full, well rounded case, with all the various symptoms that belong to perfect case taking.
One will view such a case from its pathology, or from its probable pathology.
Another will view it from the temperature, colour of hair and eyes, or what star he was born under.
Another will view it from the keynotes he can find in it.
Another takes the usually set phrases of the patient with the opinions and wordings of tradition, or the opinions of some previous physician.
In such a manner, a distorted view of the whole case is formed.
Again, it is observed that the totality contains an alternating image, or, one set of symptoms one time and a different set another time. The prescriber’s view may be formed from one group today, and from another after the change has come, which leads to change of remedy with every shift; but at the end of the year the patient has grown steadily worse. Yet he has cured (?) each group of symptoms to his and his patient’s satisfaction. Such work is a failure from the imperfect view had of the whole case. He fails to view the patient from the totality of the symptoms: from all the symptoms.
Removing symptoms may not restore health to the patient. Curing the patient will remove the symptoms and restore his health (ORGANON 8).
We have assumed that the symptoms have been well taken, and therefore the view of the case is possible, which must be, of the symptoms which represent the patient as a whole; the symptoms that represent all the organs and parts; all the symptoms and conditions and circumstances of the organs and part, all the pathology of the organs and parts; age, sex, habits and business.
Suppose the symptoms to be viewed come directly from the patient, what can be seen, heard from the patient and companions, all are presented without interruption. One reader will ignore all but the pathology; another will notice only the keynotes; another will notice only the diagnostic symptoms. In each instance, something is ignored or neglected; or, at least, the view of the case is absent.
Hahnemann’s teaching has never been improved upon. We must be guided by the symptoms that are strange, rare, and peculiar. How shall we do this?
By first fixing in mind what symptoms are common, then it will be easy to discover what symptoms are uncommon, or, in other words, strange, rare, and peculiar.
Common symptoms are such as, are pathognomonic of diseases and of pathology, and such as are common to many remedies, and are found in large rubrics in our repertories; e. g., constipation; nausea; irritability; delirium weeping; weakness; trembling; chill; fever; sweat.
When such symptoms have taken their places in any given case, it will be seen at once that what remains must be uncommon, therefore peculiar and, as such, are always predicated of the patient as a whole, and of his parts in particular.
However, some of these common symptoms may become peculiar where their circumstances are peculiar; e.g. trembling at any time or at all times all over the body and the limbs is a strong and most troublesome symptom, but it is not peculiar nor uncommon. But trembling before a storm, or during stool, or before menses, or during urination, is rare and strange.
Weakness is also common if constant, but it comes only before menses, or before stool, or during a storm, it is at once quite uncommon, and changes the view of the case.
Chilliness, if constant, is common to many people, and is a strong common general as it is predicted of the whole patient, but if it comes only before or during menses, before or during stool, or while urinating, or only when in bed in the night, or only while eating, then it is strange and peculiar, or uncommon.
All of these are common to no disease known to medicine, hence they become striking and help to form a view of any given totality.
It must now be seen that the physician who has in mind only the pathology as a basis for his prescription has only what is most common, and therefore has no view of the totality, and therefore violates the first principles of prescribing. He prescribes for results, for endings, and not for things first, not for causes.
It must be known that the symptoms that exist in childhood, and such as were present before any pathology existed, are the corresponding symptoms of causes, as all causes are continuous into effects. They are not causes, but they represent causes, and often are all that can be known of causes, and they furnish a view of the case from causes to endings; from causes to ultimates: to pathology. It is important to discover early these symptoms in any chronic sickness. The symptoms through childhood down to the present describe the progress of the sickness. These give an experienced physician a good view of the case, with its probable endings or pathology.
It is well to have all such results in view, but these ultimate symptoms are of the least value, and without the fullest representation in symptoms they are of no value as showing forth the view of the case by which to find the remedy. But a physician must have a good and full knowledge of all these, as well as of anatomy and physiology, or he will not have the basis for good judgment, and hence will form a distorted view of the totality.
The symptoms that represent the patient as a whole are of great, and often of the greatest value, especially such as are expressed in the patient’s own speech.
The mental symptoms, composed of his reasoning powers, loves and hates, and memory.
And then his general bodily symptoms and their circumstances, such as worse from cold, from warmth of every kind, from weather, wet and dry, from motion or rest, time of day, etc. These are of highest importance when they apply to the whole body.
Two sets of aggravations and ameliorations must come into view, viz: those that apply to the whole being and those that apply to his parts. These are often the opposite in parts or organs from what they are in general bodily states of the patient, and must be looked up in the repertory in sections that relate to the part mentioned.
A woman consulted me for a violent rheumatic pain in the shoulder. She came into my office with her arm bound to her side to prevent moving the arm, as the motion of the arm increased the pain in the shoulder, yet the patient walked the floor constantly to ameliorate the pain in that painful shoulder. The pain in the shoulder was worse before a storm. DULCAMARA cured at once. This shows how a part may have an opposite modality from the whole body.
Nothing has harmed our cause more than books that generalize modalities, viz: by making a certain aggravation or amelioration fit all parts as fell as the general bodily states. Cold air may aggravate the patient but ameliorate the headache. Stooping seldom aggravates headache, backache, cough and vertigo in the same degree, yet Boenninghausen compels you to look in one place for all of them, and they are marked with the same gradings.
The patient is often better by motion, but his parts, If inflamed, are worse from motion.
Lying aggravates backache, headache, and respiration in different degrees, and the patient in still another manner. If each symptom is not inspected, and considered with a view to it. own circumstance, the result will be widely different. Parts are better by heat when the patient is better from cold, and vice versa. The headache is better from cold, and the body is better by heat.
If we do not consider these circumstances, we do injustice to the patient and his parts. Therefore the circumstances that relate to the general bodily states and the circumstances that relate to the parts and organs must be vastly changed.
Ever so perfect an understanding of the pathology and pathological symptoms in a given case gives no view of the case for homoeopathic prescribing. The common symptoms, without the peculiar symptoms, may give a good understanding of a given case except for prescribing. Common symptoms alone, will lead to failure of the prescription. We might as well attempt to prescribe for nervous dyspepsia, gastritis, jaundice, gallstone colic, enteritis, constipation, or a bilious temperament. The beginner often fails because he has secured only the common symptoms.