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.
4-The aggravations-
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
Sadness.
Totals. 38
71 Remedies in
Rubric.
Agg. Pregnancy
Rt. Hypochondrium
Tearing Internally
Rawness Internally
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.
Sadness
Totals.
Calc-ph. 2
Caps. 3
Carb-ac 2
Caust 3 2 1 3 3 3 1 2 3 1 1 3 1 27
Cerium. 2
Cham 4
Ch.n. 2 2 2 2 1 1 2 3 1 1 1 1 2 21
Cici. 1
Cocc. 4 4 2 3
Coff. 2
Col. 2
Coloc. 2
Con. 2 3 4
Croc. 4
Cup 2
Dulc 1 1 1 1 1
Equis 2
Fer. 2 2 1 1 1 3 3
Glon. 2
Graph. 1 2 1 2 3 2 2 3
Hyos. 3 2 1 2
Ign. 2 2 3 1 1 2 2 2
Ip. 3
Jab. 2
K-br. 2
K-carb 1 4 2 2 1 1 3 2
Kalm 2
Kre. 2
Lyc. 2 4 4 1 4 3 4 3 4 3 4 3 3 4 3 42
Mag-c 2
Mag-m. 1 3 1 2
Mang. 1 1 2 2 3
Merc. 2 3 4 1 3 4.
71 Remedies in
First Rubric.
Agg. Pregnancy.
Rt. Hypochondrium.
Tearing Internally.
Rawness Internally.
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.
Sadness.
Totals.
Merc. i.f. 2
Mill. 2 1
Mos. 2 3 2
Mur.ac. 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
Raph. 2
Rhus. 3 2 1 3 3 2 3 3 (4) (4) (4) (32)
Sabi. 4 2 1.
Sang. 2
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
Tab. 2
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.
