Mr. President and Friends,
I have chosen as the subject of my remarks this afternoon, the typing and ranking of symptoms in the selection of a homoeopathic remedy. The necessity of typing and ranking is to economise labour without compromise of results. A homoeopathic symptom composed of its three elements of location, sensation and modalities, requires in the first place to be typed, i.e., it is necessary to see whether it corresponds to the type of the symptom in the patient as well as in the repertory.
You should type the symptoms according to their respective values and not act as a mere mechanical symptom-coverer. The typing of a symptom is fixing the relative value between a disease-symptom and a drug-symptom, i.e., assessing their relative value or correspondence in type, while ranking is finding where a typed symptom should be placed in a catalogue of such symptoms. The three essentials to be considered in typing are:
(a) Intensity of the symptom:
(b) Frequency of the symptom; and
(c) Its occurrence under unexpected circumstance.
Let us consider intensity and frequency. For example, occasional and slight burning of the palms and soles; “this symptom would not be of much use in selecting Sulphur, because in that drug this symptom appears in such a vigorous and outstanding way that provers report that their feet burn like fire at night.” From the occasional and slight heat in the soles of the feet you could not select Sulphur at all, because its frequency and intensity are not in big type in the patient, while they are in very heavy type in Sulphur. When you repertorize such a symptom Sulphur must go out of the place to make room for smaller types.
If symptoms are typed, repertorization and study of materia medica will not become mechanical and mistakes will be fewer. The numerical method of selecting the remedy will fail if we do not type the symptoms and therefore this consideration is the greatest objection to the numerical method, No matter how peculiar and outstanding may be the symptom either in the patient or in the remedy, unless it be of equal type in both we must pay little heed to it. A patient is only a little restless; Ars. and Rhus. superlatively restless remedies will not fit in.
Big types in the repertory will never help you unless the symptom is in big type in the patient too; it musts be in corresponding types. It has got to be in Capitals, Italics or Romans in the patients as well as in the repertory and materia medica. The third essential whether a symptom occurs under unexpected circumstance: Thirst in fever, diabetes, hot weather, occupational conditions, are not under unexpected circumstances and therefore of no value in such a case.
Having discussed the comparative values of disease and drug-symptoms, we will turn to the question of ranking them in a group of reactions of the patient to disease. A symptom which ranks very high acts as an eliminating symptom. In disease we come across three weeks of symptoms:
1. Those that pertain to the patient ;
2. Those that pertain to the disease ; and
3. Ultimates or results of disease.
Symptoms of 2 and 3 do not help you to individualise but have to be considered to see whether they fall in line with the drug picture derived from No. 1. They take you to large groups of drugs which have produced these diagnostic or pathological symptoms produced in such a disease but they dont tend to individualise the patient. Symptoms are ranked according to their order of manifestation. By far the mind reacts to the disturbed economy first and therefore a mental symptom usually ranks high.
The individual behind the disease is shown in what we call the generals of the patient, i.e. his reactions as a whole, mental and physical, to environment. These general symptoms, both mental and physical, are especially important when they denote a change from the patients normal. The generals are so called because they affect the patient as a whole and are naturally of a higher rank than the particulars which only affect an organ or a part.
The generals are divided into (1) Mentals and (2) Physicals. The mental state in disease reflects the innermost image of the picture drawn by disease and therefore is of uttermost importance. Examples:–The lack of natural affection of Sepia and Phosphorus: the presentiment of death of Apis; the suicidal promptings of China, etc. Dont forget to apply the Consolation test which is a strong mental-symptom test, markedly < consolation would rule out many of lesser importance-Natr.m. ; Plat. Lil. t. Even among the mentals there are symptoms of various ranks:
Emotion–impulse to jump
/ out of the window.
Symptoms of the Will
Metals \ Affection, desires or loves,
\ aversions or hatreds.
\ Symptoms of the Intellect and Memory–they rank very low as they are special gifts.
Among the mentals are also to be considered :
1. Effect of sleep: Aggravation after sleep of Lachesis and Sulphur. Agg. from sleep of Cocculus. Great amel, form keep of Phosphorus and Sepia.
2. Symptoms referred to the subconscious mind, i.e. dreams and delirium.
REACTION TO TEMPERATURE:
Of very great importance is the physical general reaction of the patient to temperature. This has impressed Miller to such an extent that he takes it as an eliminating symptom when dealing with hot-remedy-patients and cold-remedy-patients, but is a dangerous thing to do unless you question your patient very thoroughly, and will be of great use at least in the final consideration of the repertorized remedies.
The rank of this symptom is inordinately raised if the body as a whole is markedly affected by one temperature and some special organ by the opposite.
Phos: Head and stomach symptoms better by cold but there is a general shrinking of the patient from cold. Lycop: Stomach nd rheumatic symptoms better by heat but here is a general aggravation of the patient caused by the heat.
The general effect of the various weathers or seasons.
Worse from damp and worse from dry weather, are deep- seated general reactions and are very important and may act even as eliminating symptoms when strongly marked.
In Fibrositis we expect to have aggravation from weather changes, but when there is amelioration it ranks very high.
When the patient as a whole is markedly so influenced; but when only one part is affected it assumes a low rank, being a particular. Examples, Sulphur, Valerian, Merc., Phos.
TIMES AND PERIODICITY :
It is well known that times influence diseases and drugs. This cannot be explained and is a feature which makes it important. If you diagnose a disease and realise that periodicity is a feature of it, hence not a peculiarity of the patient, such a periodicity assumes a low rank and the prescription has to be based on other facts of the case.
CRAVINGS OR LONGINGS AND AVERSIONS OR LOATHINGS:
These exhibit some deep seated need of the body as a whole and always take a high rank. Aversion to fats and oils of Puls. Craving for salt of Natr. m.
GENERAL SYMPTOMS CAUSED THROUGH ORGANS OF SPECIAL SENSES:
If the smell of food sickens a patient this becomes a general of value, but if this is only a perversion of olfaction, it becomes a particular and of a lower rank.
Among particulars your first class symptoms will always be anything peculiar, unusual, unexpected or unaccountable. Symptoms must be qualified to be transferred into “the strange, rare and peculiar” otherwise particulars are of minor importance, especially in chronic cases they fall in line with and confirm the choice of the remedy. In hysteria we have an illustration of the danger of prescribing for the symptoms that are common to the disease and not peculiar to the patient.
A well marked strange, rare and peculiar particular may appear in one rubric in the whole of the repertory but there in black type. You may need one or other of these symptoms only once in half of dozen years but when you do need it nothing will take its place if there are no generals to oppose. Such a symptom if not taken heed of, will land the case into a polycrest and not into its invaluable remedy only half proved. Common particulars may in certain circumstances assume a comparatively high rank.
Two common symptoms appearing singly will not individualise, but when associated at once are raised to a high rank, e.g., coryza with polyuria of Calc.
COMMON SYMPTOM COUPLED WITH A PECULIAR MODALITY:
e.g., chilliness of Puls. worse near a fire.
UNUSUAL APPEARING OF A COMMON SYMPTOM:
e.g., overwhelming sleepiness of Nux. m.
THE LAST APPEARING SYMPTOMS OF A CASE:
These may take precedence over the peculiar and general symptoms.
THE PRESENCE OF CHRONIC SYMPTOMS IN A SUPERVENING ACUTE DISEASE:
An acute supervening disease never forms a complex with a chronic one, the latter being suppressed until the former has run its course. Care must be taken when ascertaining the symptoms of the acute disease to exclude from consideration the symptoms of the now latent chronic disease. According to Kent, at times some symptoms of the chronic disease may persist and be acute during the acute disease, such symptoms are peculiar because they have not disappeared and are often guiding in the choice of the remedy for the acute disease.
PARTICULARS AND GENERALS EXACTLY REVERSED:
Examples : Ars., Phos., Lycop.
A common symptom ranks high when it occurs perverted from either on a physiological basis, absence of thirst in high fever, and with profuse continuous sweating; or on a pathological basis, an inflammed part feels better on pressure.
Unqualified common symptoms assume importance when a number of drugs compete in a case. In such a case the remedy that has also the common symptoms best represented must come in.
The reaction of environment to the end products of a pathological process, ranks very low, e.g., the bleeding in a polypus, fibroid and piles.
Last but not the least is the greatest of all the generals and particulars a constitutional state called after the drug, e.g., “Sepia” constitution; the leucophlegmatic constitution of Calc. It is difficult to recognise some of these subtle states and therefore require a very minute study.
Gentlemen, this is only an imperfect presentation of the very important subject of Typing and Ranking of homoeopathic symptomatology.