Evaluation of Symptoms

A useful guide to the Evaluation of Symptoms as Mental and General Symptoms, Common and Uncommon, Subjective and Objective, Pathological and Clinical Symptoms.

The value of basic symptoms has been indicated. They are those which establish the diagnosis and are given in any standard medical textbook. It may be remembered in passing that such symptoms are all that are necessary for physiologic medication or the ordinary use of drug effects. Thus, sleeplessness calls for a soporific, pain an anodyne, constipation a cathartic, diminishing urinary elimination a diuretic. The physician simply picks out the most important complaint and mitigates this with the least possible harm.

The second large class, determinative symptoms, are necessary only if we expect to prescribe Homoeopathically and a thorough understanding of this group of symptoms and their relative value is now in order.

Mental Symptoms – If well marked, mental symptoms are of the highest grade and importance in Homoeopathic prescribing. If a person has a well-marked mental symptom of a drug and a well- marked absolute symptom of another, the drug with the mental symptom takes precedence over the other. The mind is the highest form of cellular activity and changes here are always individual. Moreover, it is recent changes brought about by disease which are significant, not the ” natural nature of the beast.” Thus, a sunny disposition becomes markedly irascible during illness. Phobias may develop or apathy or the patient becomes sad and weepy. Again, a word of caution – do not ” fish ” for mental symptoms – they must be very obvious to be reliable and then they take precedence over all other types.

General Modalities are second in importance. We remarked above, that these are the reaction to environment and, as a whole, how that particular individual reacts to season, heat and cold, to time of day, etc. Again, these should be well marked. Cravings and aversions are helpful if they are really longings or loathings, not simply likes and dislikes. We refer here to food and drink, especially the changes brought by disease in our desires are often valuable characteristics and express the individual urge. Menstrual function, especially as to whether other ailments are aggravated before, during, or after this function, may serve as a general modality. The type of flow and regularity are suggestive symptoms but only when pathology such as Polyps and fibroid can be eliminated. If present, treat the cause direct, since pathology per se is not a sound basis for Homoeopathic medication.

Basic or absolute symptoms which are qualified, also come under the class of determinative symptoms since by this process they become individual. By qualification, here is meant describing by location, sensation and modality. Thus, headache is a basic symptoms common to many drugs. Suppose we locate it in the occiput, the sensation is dull, heavy and the modality is worse from movement of the eyeball. Now, this is an individual symptom group and a few drugs have this type of headache. So we see by this process we have raised the rank of inferior symptom.

The last class of determinative symptoms are the strange, rare and particular ones about which Hahnemann has spoken. Not all cases exhibit this type. Indeed, the patient will often overlook them not thinking that they are germane to the history. It may be a particular sensation or a well-marked modality or a concomitant symptom (see below). Nothing is too trivial if it is well marked. On the other hand a rather common symptom becomes rare. Thus, fever without thirst is rare (Belladonna). Emaciation with excessive appetite is uncommon (Iodine). Chilliness and yet aggravation from heat (Pulsatilla) is contradictory. Often these rare symptoms take the form of temporary food and drink perversions.

Other terms used to describe symptoms sometimes are as follows : Concomitant Symptom is one which is felt simultaneously with or accompanies another symptom. Thus headache with blurring of vision, constipation and haemorrhoids, delirium and fever. Many of these can be explained readily from our knowledge of physiology and pathology. It is a good rule always to inquire into the mechanism of a symptom. We, thereby, save ourselves looking up individual symptoms which have a common physiologic origin.

Pathologic Symptoms are self-explanatory. They are basic or absolute – anaemia, hypertension, hyper-chlorhydria, fibrillation, bleeding, expectoration are examples.

Objective and Subjective Symptoms have been the usual classification of symptoms for many years. Objective are those symptoms which the physician observes and, therefore, consist of: physiological findings, laboratory findings, and his observations. Subjective are those symptoms which the patient feels and speaks about. We see no particular advantage in this classification as it does not help to evaluate symptoms.

Clinical Symptoms

Definition – A clinical symptom is one which does not appear in the proving of a drug yet nevertheless has been inadvertently relieved by that same drug, given for another purpose. It is to be assumed that, had the proving been extensive enough, such a symptom would have been produced. Academically, there is a difference between clinical and curative symptoms, although they are usually taken to mean the same thing.

A clinical symptom is simply a manifestation, subjective or objective, that the patient shows while under the influence of a drug. Obviously it may be either the result of the disease or the result of the drug, and decision on this matter rests entirely with the experience of the physician.

A curative symptom, on the other hand, starts out like the above, but subsequently disappears – and here the assumption is that such a disappearance was due to the drug then being taken. The definition given above applies to this last interpretation, since they are far more common than the other. As an example of the first class – Granatum always produces dizziness when given for intestinal parasites. Thus inadvertently one of its main characteristics was discovered, and since then, in a case of dizziness, one always thinks of Granatum Homoeopathically – a purely clinical application.

For instance, take the pleurisy and pleural pain of Bryonia – this set of complaints were not at all marked in the proving but, when Bryonia was given for other symptoms, it was found that Bryonia regularly relieved afflictions of the pleura, so much so that, undoubtedly, it is the most important drug in these cases. Later on, in animal work, it was found that Bryonia readily produces pleurisy. There has always been controversy regarding the propriety of admitting such symptoms into our Materia Medica.

Indeed, ” Allen’s Handbook ‘ does not include them but Dr. Hering in his – ” Guiding Symptoms ” does. We believe this is justified. Hahnemann points out that such symptoms should only be used after most careful and repeated observation and then only by a master of experience in the field of clinical medicine. The older text-books denoted a clinical symptom by a cipher to distinguish it from pure drug effects, but, in all the recent books, these have been included without such designation. The Totality of the Symptoms

A positive understanding of this third principle of Homoeopathy is much to be desired. Many failures result from a “sketchy ” totality, for it stands to reason that any prescription based on symptoms as its foundation, the more symptoms the better the prescription. All symptoms both basic and determinative (objective), should be considered. Moreover, due regard to Pathology and its effect on the case present must be considered. This is because pathology may modify the quality of a symptom, sensation, or a modality.

Well-trained modern medical students have a great advantage over the older Homoeopaths in this way since their knowledge of disease processes is more profound and, hence, they should be able to evaluate and discount the complaints of the patient. Thus, Blood Chemistry would help us to interpret symptoms which might on their face be either heart or renal in origin – Basal Metabolism gives us the diagnosis and hence a clear group of basic symptoms in Thyrotoxicosis. X-ray and gastric analysis help in differentiating a functional from a organic Gastro-intestinal Syndrome. If we know the ” why ” of a symptom, it helps construct a true totality and often furnishes clues for Homoeopathic prescribing.

To illustrate further; Nocturia may be a symptom but it makes a vast difference in our prescribing as to whether it is caused by a heart, kidney, metabolic, or prostatic cause. Neuritic pains down the left arm have a cardiac or toxic basis and would probably call for a different group of drugs according to cause. The modality from motion is not of great moment is acute arthritis as one must necessarily suffer from this modality due to the inflammation and oedema. Something has been said along this idea before and it enters into estimating the totality.

Another point that needs emphasis is that the Homoeopathic totality is a relative thing. We strive for perfection but seldom obtain it. It is relatively seldom that the absolute simillimum is selected. When it is, results are truly marvellous. But a more or less indicated drug will also give curative response and on this fact depends the success of ordinary daily office practice. The Homoeopathic law says ” Similar ” not necessarily an exact counterpart of the diseased picture.

Of paramount importance, however, in this conception of totality is the necessity of matching up what is prominent in the complaint with what is prominent in the drug selected. Thus, “burning pain” is a sensation of a number of drugs but especially of Arsenic, Phosphorus and Sulphur. Now, if this were a special complaint of the patient, it should be a special factor of that drug’s pathogenesis.

Depression is seen under numberless drugs but is particularly marked under the heavy metal group-such as Aurum. If the symptoms are matched according to degree, in this way often an abbreviated totality suffices, as every practical Homoeopath knows.

Mention should be made here of other factors that go to make up the totality of symptomatology although possibly these should come up under the chapter on Applied Homoeopathy.

Etiological Factors – The immediate cause of the patient’s illness, if determinable, or its exciting factor, may be a great aid in the selection of the remedy. Thus, there are many cases which owe their onset to exposure from cold and damp. Drugs such as Rhus, Natrum sulph. and Calcarea come to mind.

Again, the Traumatic Etiology of Arnica has been verified many times. Such causes may even be quite remote but deserve serious consideration especially in Chronic cases. In passing, it might be remarked that present day tendencies regarding patent medicines and often misguided physiologic medication may also be casual factors. Apparent antidotal Homoeopathic drugs have a field here. (Nux vomica, Hepar, Bryonia, etc.)

The totality in acute diseases is simpler. Much of this investigation is necessarily dispensed with. The physician recognizes the symptomatology and the case is quickly disposed of. Epidemic conditions come to his aid here for rapid and usually successful prescribing. This will be further taken up under the chapter on ” Applied Homoeopathy.”

Single Remedy

The Homoeopathic practice of using a single drug and noting its effects rather than multiple prescriptions whose ultimate effects may only be surmised is so logical both from a scientific and practical point of view that modern medicine tends to this direction. It is the one beneficial reform universally conceded to Hahnemann by the most fervent opponents of Homoeopathy. Poly- pharmacy has had its day, and a colorful one it was. We have in the Homoeopathic prescription no use for directives, correctives, or adjuvants, as such.

The single remedy does not mean a simple remedy. All chemical salts are compound substances, as are also the juices of plants like Opium and Belladonna. But all are single remedies and used as such in Homoeopathy. Any single substance, which has been proved upon the healthy as an entity and its pathogenesis known, can be administered.

Alternation or rotation of remedies is reprehensible since it leads away from accurate and definite knowledge of drug effects and sooner or later to poly-pharmacy which is the most slovenly of all practice. Since we have no provings of combinations of drugs, it will be impossible to prescribe them with scientific accuracy.

In some cases, tissue salts are given on deficiency indications and at the same time the totality is met by another Homoeopathic remedy, for instance : Kali phos, and Ignatia. But this is because indications for the tissue salts are largely clinical and their mode of action subject to some controversy. (See Tissue Remedies.).

Garth Boericke
Dr Garth Wilkinson BOERICKE (1893-1968)
American homeopath - Ann Arbor - Michigan.
Son of William Boericke.
A Compend of the Principles of Homeopathy.