No one thing in the method, practice and armamentarium of the strict homoeopathic physician has been more misunderstood than the repertory.
The repertory of the materia medica is peculiar to Homoeopathy; its employment, save in the crudest index form in any other school of medicine is impossible; the use of remedies in Homoeopathy being based upon provings, from which positive deductions and analyses may be made, whilst in other schools no such data are available.
The repertory has been decried as “taking too much time,” as being “mechanical,” as causing “neglect of the materia medica,” and in other ways spoken of with contempt. As is usual, this is done by those having little knowledge of or experience with it.
I except to show that it is not only useful, a thoroughly scientific procedure, and in the end a time-saver, but it also leads to-what is best of all- the more certain and rapid cure of diseases, because of the careful analysis and study of cases it necessitates, and the precision in the use of remedies it compels.
The word repertory means to find again, and it is, the dictionary tells us, an index or treasury in which things are disposed in an orderly manner, so they can be easily found. This is all that the first repertories of the homoeopathic materia medica were-indices or reference books-and while they were needed in the early days of Homoeopathy, we need them much more on account of the greatly increased size of the materia medica.
As time went on it was found that the utility of a repertory could be increased by making it not only an index, but analytic as well; so now we have two, kinds of repertories-the indexical and the analytical-these being commonly combined.
The index form is only valuable as a reference book or index. In it a symptom is given more or less in detail, with one or several appropriate remedies following little or no attempt at analytical arrangement being made. Examples of this class are Vol. III of Jahrs New Manual” and the repertory of Hulls Jahr”.
The analytical repertory is the result, so far as I know, of Boenninghausens genius, certainly in accuracy and completeness, though not including the latest remedies, no other repertory compares with it. It is the best general repertory extant and is both an index and analytic arrangement of remedies. With its aid Boenninghausen arrived at the remedy (simillimum) in a case with as much certainty as a chemist makes a chemical analysis.
Boenninghausen arranged drugs in classes, according as symptoms were emphasized in provings and (perhaps) more or less repeatedly verified in practice, by taking the Hahnemannian schema of the parts of the body and indicating under each rubric the different values of remedies by means of four distinct styles of type. For instance, in Allens Boenninghausen, which edition I take for illustration because of its more general use, in the medicines affecting the vertex are to be found Acon., Lach., PHOS., VERAT-A.; to these he gave numerical value. respectively, of 1, 2, 3 and 4.
Nor was this all. Boenninghausen observed that a complete symptom consisted of three parts:
1. The parts of the body affected, or location,
2. The kind of pain or discomfort experienced there, and
3. The modalities. i.e., the aggravations and ameliorations of time, temperature and weather, rest, position; motion, etc.; these three parts of the computer symptom being expressed by the words where, how, when.
In some cases of sickness a symptom-complex develops which is not to be found in the proving of any drug, but by following out this idea of the completed symptom of Boenninghausen a remedy may be discovered, by the aid of Boenninghausens Therapeutic Pocket Book, which will cure even though this remedy has not in its proving shown a similar symptom groups.
This is because the Therapeutic Pocket Book is based upon an analysis of the known general action of drugs which admits of more combinations than the provings have disclosed. Such a prescription is a synthetic one, as it results from the bringing together and harmonizing of what appear to be incongruous elements.
There are modern repertories arranged on the plan of Boenninghausens Therapeutics Pocket Book, the most recent being Kents which gives more details and sometimes symptoms in full. Lippes Repertory is to a limited extent analytical; on the other hand, Knerrs Repertory of the Guiding Symptoms, while it has the numerical value of the remedies indicated, is simply an index full of cross-references, but not well arranged for repertorial study.
The Repertory to Clarkes Dictionary of Materia Medica, while possessing novel and useful features, is only index, and not complete; the latter part of this statement is also true of the repertory of the Cyclopaedia of Drug Pathogenesy. Many other similar repertories are arranged on the Boenninghausen plan, and are correspondingly useful.
We may note, then, as the essentials of a good repertory completeness and accuracy, to which should be added analysis. It would seem, therefore, that the compiler of a repertory should not take upon himself, to decide as to the value of a symptom, nor the suitableness of a drug under certain conditions; everything should be incorporated; though he may point out symptoms which, in his opinion, are of questionable worth.
How can we make use of a repertory like the Boenninghausen Therapeutic Pocket Book? There are five necessary steps-four preparatory and one following the repertorial study.
The first, and most important, is the proper “taking of the case”, according to Hahnemanns instructions in the Organon(aphorism84 et seq). He tells us (aphorism 104) that “when all of the prominent and characteristic symptoms, collectively forming an image of a case of chronic, or of any other disease, have been carefully committed to writing, the most difficult part of the labor will have been accomplished”.
(2) The next step and one which may be made coincident with “taking the case,” is the selection of the symptoms useful for prescription purpose, according to aphorism 153 of the Organon, in which the two general types of symptoms are contrasted-(a) “the prominent, uncommon and peculiar symptoms,” sometimes called the idiosyncratic, hence the personal equation of the patient, useful in selecting the remedy, with (b)”the more general and indefinite common to every disease,” or diagnostic symptoms, of value, as a rule, only for indicating the nature of the affection.
Consequently for this reason alone, i.e. to be able to discriminate between these two kinds of symptoms, if for no other, the homoeopathic physician should be familiar with disease processes, familiar with disease symptoms, and skilled in the diagnosis of diseases.
(3) Third, is the decision as to the relative value of these prescription symptoms. Hering elaborates this is his comments on Hahnemanns Three Rules, which I abbreviate at discretion. He says “not only must the symptoms of the drug and disease be similar, they must also be of the same rank of value, as this often decides the selection of the curative remedy. To determine this “rank of value, ascertain, if possible, when examining the patient, the chronological order of appearance of symptoms, and give prominence to those which were the latest to appear, for to these especially must the remedy be similar,” i.e., to the complete disease picture.
“This holds good, also, in regard to patients who have been drugged; our antidotes to be most effective must be directed especially against those last given.” Many chronic cases require only careful antidoting in this way. Symptoms during the previous part of the illness should be, of course confirmatory and lead up to those last to appear therefore the development of the case will be in harmony with the unfolding of symptoms either in the pathogenesis of the remedy now needed, or in that of a remedy or remedies which would have preceded it sequentially.
When the symptoms which were the latest to appear are incomplete, for prescription purposes, we have to go back sometimes even to the childhood of the patient for sufficient data. The exception to this rule, of using the latest developed symptoms, is the
(4) Fourth requirement,-to discover, if possible, the origin or cause, exciting cause in many instances. The patient may know it, or, if not, symptoms may point to it. It is of use in both acute and chronic cases as it is the most satisfactory symptom to start with in the repertorial study, being the foundation many times upon which all the symptoms rest (Boger).
We have to consider, in general, two groups of causes:- the 1-External, as injuries of various kinds, effects of heat, exposure to sun or weather, etc.,- and the 2-Internal, as consequence of mental shock from fright, grief, etc., also effects of suppressions,- of emotions, of-discharges, not uncommon,-of eruptions, not less frequent and important,-of diseases from drugging, as intermittent with quinine or syphilis with mercury and potassium iodide. These are mostly to be found, in the Therapeutic Pocket Book, under “Aggravations” or in the section on the “Skin”.
This completes the four preparatory steps of (1) taking the case, (2) separating the idiosyncratic from the diagnostic symptoms, (3) determining the “rank of value” of the former, and (4) discovering the cause, so at this point the case will be ready for the repertory.
This may seem a tremendous amount of labour but an expert can usually do it all while taking the case. In acute cases all the symptoms appear at about the same time difference in rank is not as manifest though that depends altogether upon the rapidity with which the case develops and the changes occurring from day to day.
Definite rules for the order in which to use the symptoms thus selected are hard to formulate as each case must be studied by itself, but the systematic is way to begin with (1) the cause, as the foundation, and then follow the Boenninghausen arrangement of (2) the part involved, (3) how it is affected, and (4) the modalities, remembering that the principal group of symptoms of the case, whether of the head, chest, abdomen, or some other part, around which the case revolves, so to speak, is to be taken first and must be covered in its essentials by the remedy, after which the other groups, i.e. the concomitants are more or less available and confirmatory.
It may not be possible, in cases badly taken or partly developed,-the partial or one-sided diseases Hahnemann calls them,-to make use of the symptoms in this manner, consequently then we have resort to an irregular order of procedure and do the best we can. The old rule that “the remedy covering the greatest number of symptoms will cure” is correct, provided, however, that the symptoms covered be of the proper kind, i.e. idiosyncratic and recent. Mental symptoms are of high rank,- they are characteristic of the patient,-but the rules just given as to “rank of value” apply to them also.
The fifth step or rule, the one following the repertorial study, I will speak of later, in a more appropriate place.
I have several illustrative cases to offer, the first being one of my earliest successes with the repertory nearly twenty years ago:-this.
Case 1, was a woman, six months pregnant, who developed a severely painful condition in the liver region. The pain was “tearing” and the at the same time a “raw” feeling. This came on each evening; then her clothes felt unbearably tight so she had to loosen them with some relief but she was worse again in bed. Some nights the pain prevented sleep; on others, after sleeping for an hour or two, she waked with the pains which generally diminished about midnight. She could not lie on the right side but was somewhat comfortable on the back.
When the pain was at its worst she had to get up and walk about, often till after twelve oclock, then she became easier and could lie down and sleep. The pain extended from the liver region over the epigastrium to the left side. In the morning only a sore feeling remained from moving, bending or stooping which again developed into the severe pain in the evening. Bowels were irregular. Disposition naturally mild, gentle, patient under suffering, now inclined to weep.
Pulsatilla 3x in water, every three hours, gave no help though suggested by the temperament, time of aggravation and relief from motion. Of course I had made a mistake most evident when the aggravation lying on the painful side, in the case, is considered as Pulsatilla conditions are as much relieved by lying on the painful side as are those calling for Bryonia. After several days of waiting for the remedy to relieve I turned to the Therapeutic Pocket Book.
The available symptoms were:
1 – The cause, “aggravation during pregnancy,” p. 294; next.
2-The part affected, “right hypochondrium,” p.82;
3- The kind of pain, “tearing internally.” p. 188, and rawness internally,”p. 175; then.
Of time-“worse fore part of night ,” p. 271; and “worse after sleep, p.300;
Of position-“worse lying in bed,”p. 289; “worse lying on painful side.” p. 290.;*(Not “worse on right side,” but because pain there “worse lying on painful side).”
from “pressure of clothes (worse). p. 295; also 5-The ameliorations of-
“better lying on back,” p. 316;
“better from walking,” p. 320;
“better from loosening clothes, p. 315.+(Almost duplicate, i.e., reverse of “worse from pressure of clothes,” and so it may be omitted if desired).
The extension of the pain across the epigastrium is not found in Boenninghausen under either “tearing” or “raw”, the bowel condition having no characteristics was not available, but the mental state.
6-“Weeping”-Sadness in Boenninghausen, p.19, is to be included, the whole working out as follows:
71 Remedies in First Rubric.
Acon Alum Ambr Amm.m Arn Ars Asaf Asar Bar-c Bell Bry Calc-c
Agg. Pregnancy. 2 1 1 1 2 1 1 3 1 4 3 3
Rt. Hypochondrium. 4 3 3 1 2 2 2 4 4 4 3
Tearing Internally. 2 2 3 1 2 2 1 2 4 4 2
Rawness Internally. 2 3 3 2 2 1 4 1 3
Agg. Forepart night. 1 1 2 4 3 3
Agg After sleep. 2 1 12 2 2
Agg Lying in Bed. 4 2 3 1 3
Agg. Lying on Painful Side. 2 1 2 3
Agg. Pressure, Clothes. 3
Amel. Lying on Back. 4
Amel, from Walking. 3
Amel, Loosening Clothes. 32
71 Remedies in
Agg. Forepart Night.
Agg. After sleep.
Agg. Lying in Bed.
Agg. Lying on Painful Side
Agg. Pressure, Clothes.
Amel. Lying on Back.
Amel. from Walking.
Amel Loosening Clothes.
Caust 3 2 1 3 3 3 1 2 3 1 1 3 1 27
Ch.n. 2 2 2 2 1 1 2 3 1 1 1 1 2 21
Cocc. 4 4 2 3
Con. 2 3 4
Dulc 1 1 1 1 1
Fer. 2 2 1 1 1 3 3
Graph. 1 2 1 2 3 2 2 3
Hyos. 3 2 1 2
Ign. 2 2 3 1 1 2 2 2
K-carb 1 4 2 2 1 1 3 2
Lyc. 2 4 4 1 4 3 4 3 4 3 4 3 3 4 3 42
Mag-m. 1 3 1 2
Mang. 1 1 2 2 3
Merc. 2 3 4 1 3 4.
71 Remedies in
Agg. Forepart Night.
Agg. After Sleep.
Agg. Lying in Bed.
Agg. Lying on Painful side.
Agg. Pressure, Clothes.
Amel. Lying on Back .
Amel. from Walking.
Amel Loosening Clothes.
Merc. i.f. 2
Mill. 2 1
Mos. 2 3 2
Nat. m. 2 3 3 1 1
Nux-m. 3 2 1 2.
Nux-v. 2 4 4 4 1 2 3 3 4 2
Petrol. 2 3 1 3 2
Phos. 1 1 3 4 4 3 4 3
Plat. 3 1 1 1 1
Puls. 4 2 4 3 4 3 4 2 1 4 4 1 3 39
Rhus. 3 2 1 3 3 2 3 3 (4) (4) (4) (32)
Sabi. 4 2 1.
Sec-c. 3 3 1
Sele. 2 3 2
Sep. 4 3 4 3 3 2 4 2 3 1 3 3 3 38
Sil. 1 3 4 1.
Spig. 2 1 4 1 3 2 3
Staph. 2 1 2 2 3 3 2 2
Sul. 3 2 4 4 1 4 4 1 1 2 4 1 4 35
Sul-ac. 2 2 1 3
Valer. 2 1 2
Verat-a. 2 3 1 3.
First begin with the list under “aggravation during pregnancy,” which comprises seventy one remedies, and write the names of all these medicines, in a column, indicating in the next column the value of each remedy, according to its type, in figures. This is the foundation, the orderly starting point of the cause.
Second, take the remedies under the rubric of the “part affected,” here the right hypochondrium, and indicate their value numerically in the next column. This rubric of “location” is the logical starting point in the study if no cause can be ascertained. If a remedy does not occur under this rubric it is a vital lack, because the medicine to be useful in the case must cover (have acted on in its pathogenesis) the “part affected,” and consequently if it does not occur it is henceforth dropped in the study; see Asarum, Calc. ph., Cham, etc.
Some in a repertorial study carry all remedies clear across, i.e. put them in wherever they occur, (see Rhus above), then can be noted what important symptoms they do not cover.
Third, under “kind of pain,-here “tearing internally” and “rawness internally,-take the remedies in the way. This is again a vital point and here remedies also drop,-and so on through all the rubrics.
Now the vital places, as I have indicated, are all the rubrics in the principal, group of symptoms, in this case, as there is only one general symptom complex, the rubrics are all essential, though the minor aggravations and ameliorations need not all necessarily appear in the pathogenesis of the remedy.
Note that Rhus, which seems in general suited to the case, running well under the first eight symptom-parts (except the tearing pain) comes to grief in regard to the pressure of the clothes, which is perhaps of as little importance as any rubric, but on the whole Rhus does not total high. I have carried if through, wherever it occurs after the ninth column, in parenthesis to illustrate.
Having taken the case thus far we come to the- (5) Fifth step-the appeal to the materia medica, – the comparison of the results of the repertorial study, i.e. the remedies which run through all the essential rubrics, and especially those that total high, with their pathogenesis. This should always be done as several medicines may, from lack of distinguishing characteristics, work out about equally strong; they do in this case.
The criticism that the use of the repertory is a mechanical process, is true if attention be not given to the values of symptoms as I have pointed out, but when this is done and the analytical element added, the mechanical part becomes comparatively minute, especially if this fifth step of a final appeal to the provings be carried out, the process then being one of logical induction, i.e. reasoning from particulars to generals-from the particulars of symptoms to the one remedy for the case.
Thus incontrovertible facts only are used and theorizing and supposious reasoning is avoided, for the proper use of Boenninghausen automatically, as it were, sorts the symptoms and excludes those not of prescription worth, working in a simple, efficient and logical order from cause to effect.
If several remedies have worked out about the same a careful study of them in the materia medica may show that one which is not numerically the highest is the simillimum; hence the importance of this fifth and final step. This is where the “rank of value” may come in particularly; as Hering said, “it often decided the selection of the curative remedy.” Here we may say that there is a double or triple rank of value because these important symptoms selected in accordance with the rule are now emphasized by the analytical repertory and confirmed by comparison with the provings.
On looking up Lycopodium in the materia medica I found not a duplicate of the case but enough congruence to warrant its exhibition, it was particularly in the general conditions that it agreed; evidently then this was a “synthetic.” prescription.
Lycopodium was given every three hours (3x one trituration tablet in a half glass of water and two teaspoonfuls at a dose) for one day and it helped at once. Twelve days later it had to be repeated, in the same way, as she took a slight cold and the pain returned, this time in the left side, extending clear around the body, other characteristics as before; once more relief in twenty-four hours and no return.
Sometimes instead of the “numberical value” being indicated just a mark is made against each remedy in the different columns in so doing the analytical value is lost,-Bry., Caust., Lyc., Puls., Sep., and Sul., would each in that way have totalled thirteen and Rhus eleven. This is one difference, and perhaps the prime one, in the way to use the Therapeutic Pocket Book and the results from an index repertory.