Analysis of symptoms - Homeoresearch.com

9 Apr 2013

– BENERJEE.P,

Before I actually take up the matter of a detailed analysis of symptoms and prescription, I think, I should finish, in a few words, telling you about those patients (referred to at the end of the previous chapter) that are in the habit of changing their doctors too frequently. In fact, much improvement to such patients is seldom possible. Their cases are never well defined and are on the contrary full of disorder. Behind this disorder again, there are differences in different cases. In some the symptoms are almost suppressed, while in others the original symptoms have come to be substituted by newer symptoms, while in still others there are aggravations when they are on their way to cure. Suppose, for example, a patient comes to you after a long course of Allopathic treatment, and you find that almost all his symptoms have been suppressed, while some very few hazy symptoms of a really indescribable nature-such as, mental uneasiness, sleeplessness, want of appetite etc. are only still remaining. From the study of such a case, you will find that the symptoms of it have only been forced to disappear-forced by strong medicines-while the patient has not been really cured. In such a case, there is no means of curing the patient unless the suppressed symptoms are brought out, but the difficulty is that there are no indications on which to proceed to prescribe a medicine for bringing out the suppressed symptoms. Not only this, but the patient himself also does not agree to such a course of treatment, both because of the course of temporary suffering that such a process of treatment means as also of the fact that he considers himself to have been cured in all respects, except in respect of the few uneasy symptoms, such as-mental uneasiness, sleeplessness, want of appetite etc. If you tell him that a true course of curative treatment will bring back his old symptoms and then cure them, he will take you for a cheat and walk home. The fact is that he does not understand true cure, and you can not therefore help him. Suppose, a patient comes to you for some heart troubles. You take his history and find that he had rheumatism and that it was treated allopathically. There is no rheumatic pain now; but how can you cure the heart trouble, without bringing back the rheumatic pain? It is only the suppressed rheumatism that has settled on the heart. Then again, suppose another patient walks into your office. He had fever which was stopped with strong doses of quinine. He has no trouble now but he wants you to do something so that the fever may not return, because he knows that fever checked with quinine is ever in the habit of returning at the slightest provocation. Then again, suppose a third patient comes to you for having some lasting benefit done to him for some disease of which he has been cured (?) with some injections. These are really trying cases, in which you cannot do anything without bringing back the suppressed symptoms, to which however the patients are not agreeable. They have spent months after months in Allopathic treatment. They have spent purses of money. But they must have immediate cure in the Homœopath’s hand. Very little time will be given to Homœopathy, very little money, and there must be no coming back of the old symptoms, but “cure” straight, after waking in the morning! If one single dose of Homœopathic medicine can not cure the case, and that in the course of a single night, what is Homœopathy worth?

There is another class of such patients yet. They have been perhaps to Homœopaths, and as soon as some of the old symptoms have re-appeared after the medicines given by them, showing that the process of cure had begun, they have left their previous doctors and come to you. If however, all these facts are placed before you,-the name and potency of the medicine and the date of use etc-you can do the rest of the business necessary for completing the cure. But unfortunately this is never done and you have to make your way out of darkness. This is a difficult affair, and prescribing for such cases is a really weighty business. The treatment of chronic cases in our country is not in progress and the main reason is ignorance of the people, ignorance of the very fact that a really curative method of treatment of diseases is in existence.

However, the analysis of symptoms recorded has now to be done and the prescription made. Symptoms are not all of them of the same importance and value, and some hint on this has already been given, while explaining the necessity of eliminating superfluous symptoms. It is only necessary here to study up the importance of those symptoms that make up the picture of the case. These may be divided into two classes,-(1) those felt by the patient himself-subjective, and (2) those perceived by the physician and others around the patient-objective. The subjective symptoms again are of two classes-(1) Personal or relating to the whole of the personality of the patient e.g. , “I like to sleep in the open air,” “I am feeling thirsty”, and (2) Local or relating to only certain localities of the patient’s body, e.g. , “There is a pain in the liver”, “There is a swelling in the knee” etc. Now, amongst the subjective symptoms, those that relate to the whole of the patient’s personality are by far the most important. In fact subjective symptoms are all mental symptoms, and it is the mental symptoms that are most valuable. Amongst them, those that relate to the whole of the patient’s personality i.e. the personal symptoms are of greater value for purposes of prescription than those that relate only to certain parts of the patient’s body i.e. the local symptoms. Let me clear up the point still further by a tree.

Now, for purpose of prescribing, the subjective symptoms are more important than the objective, because they (the subjective) relate to the mind. And again, amongst the subjective symptoms, the personal subjectives are more important than the local subjectives, because they (the former) relate to the whole patient. The objective symptoms are thus of the lowest class.

So far, the method of selection of medicine in chronic and acute diseases is the same. I will therefore finish this subject in a few more words, and then take up that factor of difference in the two methods that makes chronic selection quite a different matter from acute selection. The main basis of selection both in chronic and acute diseases is the “totality of symptoms”. But the meaning of the expression “totality of symptoms” is one in the case of acute diseases, while it is quite another in the case of chronic diseases. The totality of symptoms that suggests the remedy in an acute case does not suggest the remedy in a chronic one. The totality of symptoms in a chronic case is a different totality. But wherein dose this difference lie?-It lies in that which makes a disease chronic. And what is that?-That is the tendency to continue. Now, why has a chronic disease a tendency to continue?-Because, in it there are the miasms-Psora, Sycosis and Syphilis, which have the inherent tendency of continuing in the patient. It is these miasms that make diseases chronic and deprive them of their tendency to end and give them on the contrary, a tendency to continue. From the record of a chronic case, you have to judge out which of the miasms are there. You have to understand the difference in the manifestations of the different miasms, (these differences and the characteristic ways of expression of the three miasms will be dealt with later on), and also to make your inference as to which of the miasms are there in your case. Though you may not have direct evidences of the existence of the miasms from the history of your patient, you must discern their stamp on him-in his mind and body and in the different organs. The evidences of the existence of latent Psora have been exhaustively detailed by Hahnemann in his remarkable book “Chronic Diseases” and you have to study up the indications of latent Sycosis and Syphilis also in the same way. Unless you know that, you cannot possibly treat chronic cases, just as you cannot treat cholera or malaria without knowing the general symptoms of them. If you know the general symptoms of these acute diseases, then and then only you can be led to the remedies that have those general symptoms, and then only you can pick up the particular remedy out of them by seeing the particular symptoms of the particular case agreeing with the particular symptoms of one of those remedies. The general symptoms of cholera or malaria will suggest to you the names of all the remedies that have those general symptoms, and the particular symptoms of the case in hand will enable you to select the one particular remedy (out of all those remedies) that has those particular symptoms. Similarly, you have to know first of all the general symptoms i.e. the very images of Psora, Sycosis and Syphilis, and unless you know this you cannot treat chronic diseases at all. The miasms have shaped your chronic patient-from his mind the finest to his body the coarsest part of him, and you must find out which of the miasms have done the shaping. And when you have ascertained this, you have to select an anti-miasmatic remedy. The difference between acute and chronic prescriptions is therefore this that, in chronic the medicine has to be miasmatic, while in acute it need not be so. If in the chronic case before you, there is a stamp of Psora, the medicine you will select must be an anti-Psoric. The stamp of Psora on your patient will suggest all the Anti-Psoric remedies, because the Psoric manifestations are general symptoms, but you will select only one out of all those anti-Psoric remedies by ascertaining the particular symptoms of your patient and finding out which one of those anti-Psorics has those particulars. Thus, the difference between acute and chronic prescriptions is that, in an acute case any medicine that agrees with the totality of the symptoms of the case can be selected, while in a chronic case, the remedy besides agreeing with the totality of the symptoms must also be anti-miasmatic i.e. anti-Psoric, anti-Sycotic or anti-Syphilitic, as the case may be. There is no other difference between acute and chronic selections. If however, instead of Psora alone, there are some more miasms in a given case, the task of selection is much more difficult, and a special method has to be adopted there. But before I explain that method, it is necessary to say something more about the first prescription in chronic cases.

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9 Nov 2010

– Phyllis speight.

Since diseases, as dynamic derangements of the vital character, express themselves solely by alteration of the sensations and functions of our organism, this alone can be the object of treatment in every case of disease. For, on the removal of all morbid symptoms nothing remains but health.’

Nobody has ever seen Anaemia’, Scarlatina’ or a Headache’, stalking abroad as a separate entity. Symptoms are the language in which the disturbing forces, which we know as disease, speak to us.’

Thus Hahnemann and Clarke describe symptoms the language of nature telling of the internal disturbance of the sick person. From these quotations we realise:

1. That disease cannot be recognised except by its morbid signs and symptoms.

2. Disease can manifest itself in many different forms and under different conditions.

The problem, then, is how to find the remedy which will extinguish a disease manifesting itself to our senses by these morbid signs and symptoms. It is essential to consider the following points:

1. A selection must be made from the mass of symptoms presented, and the remedy must be based on this selection.

2. The symptoms presented must be graded according to their respective values.

3. In order to match the remedy to the symptoms it is essential to know the remedies intimately and recognise those symptoms which characterise the patient.

Various Symptoms in a case.

Most reliance then, should be placed upon the symptoms which signify the individual patient, and particular attention must be paid to those symptoms which are peculiar to or characteristic of the patient, and not those which are common to the disease.

For this purpose symptoms can be graded into three main groups:

1. Generals those general to the patient as a whole.

2. Particulars those particular, not to the patient as a whole but to some part of him.

3. Common those which are common to all cases of a certain disease.

Generals: These are the symptoms which are general to the patient as a whole. When a man is unwell, he usually refers to himself as I’ feel this or that. For example, he states I cannot stand the hot weather’, or I always feel worse in the mornings.

There are three grades of Generals:

1. The mental symptoms, if well-marked, are of the greatest importance, taking preference over all other indications.

This is of such importance that the mental disposition of the patient often determine the selection of the remedy which will be homoeopathic to the whole case. For example, the emotional tension and fear of death of Aconite; the feeling of brittleness of Thuja.

2. Next ion importance come on the Modalities the reaction of the patient to bodily environment, to heat and cold, damp and dry, position,time, etc. Examples of these indications are found in the pains of Bryonia and Rhus Tox. the one being aggravated while the other is improved by motion. Aconite is aggravated by cold East winds Belladonna is aggravated by noise and lying down but better in a sitting position.

The times of day at which symptoms occur or are aggravated have been listed separately as these are often of great value in determining the homoeopathic remedy.

We must also bear in mind that drugs often have a more pronounced action on one side of the body than the other, and where this phenomena is observed the remedy chosen should have that same modality.

3. The third grade of Generals relate to Desires and Aversions. There must be recent changes and must be distinct longings and loathings. For example, when a person states that he has never drunk beer, but since he felt unwell he longs for a glass, then it is a reliable indication. But a mere like or dislike is of little value.

Particulars: These are the symptoms which bring the person for treatment, but are of less value when finding the remedy. They are applicable only to some part of the patient, hence his remarks will be prefixed with My’. For example, My shoulder is very stiff, or My headache is always worse when I go out in the wind.

It is important to remember that sometimes the generals are made up of particulars. For example, if after examining the particulars of every region it is found that there are certain symptoms running through the particulars, those symptoms become generals. For instance, the patient has a dry cough, his stool is hard and dry, he has a large thirst when we can see that the characteristic symptom Dryness runs through the whole case.

Common Symptoms: These are the symptoms you would expect to find in a person with a particular complaint. For example, if the patient had a fever you would expect him to be thirsty. If the case were Scarlet Fever you would expect the rash to appear. These are diagnostic symptoms and are useful only if qualified in some way. For instance, the fact that a patient is thirsty as a result of his illness is of no particular value in deciding the remedy, but if it is observed that although thirsty he only takes small sips of water at any one time, then the symptom becomes qualified.

Characteristic Symptoms: Hahnemann, in the Organon, stressed the importance of securing resemblance above all things in those symptoms which are peculiar to each individual drug. He wrote In search for a Homoeopathic specific remedy the more striking, singular, uncommon and peculiar (characteristic) signs and symptoms of the case of disease are chiefly and almost solely to be kept in view; for it is more particularly with these that very similar ones in the list of symptoms of the selected medicine must correspond,in order to constitute it the most suitable for effecting the cure If the antitype constructed from the list of symptoms of the most suitable medicine contain those peculiar, uncommon, singular and distinguishing (characteristic) symptoms, which are to be met with in the disease to be cured in the greatest number and in the greatest similarity, this medicine is the most appropriate Homoeopathic specific remedy for this morbid state.’

Characteristic symptoms, then, are individual symptoms, and when studying Materia Medica one should endeavour to memorise the peculiarities of each drug which are not met with in any other and which serve consequently to individualise and give character to the drug which produces them.

Dr. Kent summed up this class of symptom graphically when he wrote: The things that characterise are things to make you hesitate, to make you mediate. Suppose that you have been acquainted with a large number of cases of measles, for instance, but along comes one of which you say to yourself That is strange, I never saw such s thing as that before in a case of measles. It is peculiar.’ You hesitate, you mediate, and at once recognise it as something individual, because it is strange and rare and peculiar. You say. I do not know what remedy has that symptom.’ Then you commence to search your repertory, or, consult those of more experience, and you find in the repertory, or upon consultation, that such a medicine has that thing as a strong feature, as a high grade symptom, and it is as peculiar in the remedy as in your patient, though you have never seen in before. You may have seen a hundred cases of measles without seeing that very thing. That peculiar thing that you see in measles relates to the patient and not to the disease, and as the sole duty of the physician is to heal the sick that peculiar thing will open the whole case to the remedy. When you find that the remedy has that symptom, along with the other symptoms, you must attach some importance to it, and when there are two or three of these peculiar symptoms they form the characteristic features.’

So we see that all symptoms have value, the more characteristic of the patient they are, the more valuable on which to prescribe.

Sometimes it is difficult to decide which are the general and which are the peculiar symptoms. Let us refer again to Dr. Kent:

To distinguish between what is predicted of the patient and what is predicted of a part is an essential in the study of Materia Medica. Everything that is predicted of the patient is general, everything that is predicted of a part is a particular. The two may be opposite and hence the student of the Materia Medica will sometimes be worried because he will find aggravation from motion and relief from motion recorded under the same remedy. It is only from the sources of the Materia Medica i.e. the provings, and from the administration of the remedy that we may observe what is true of a part and what is true of the whole. We find at times a patient wants to be in a hot room with the head out of the window for relief of the head. In that case the head is relieved from cold and the body is relieved from heat. This is a typical symptom of Phosphorus, which has relief from cold as to the head and stomach symptoms but aggravation from cold as to its chest and body symptoms. I want to go out in the open air and I want to take cold things into my stomach’; but if he has chest symptoms and in pain in the extremities he says: I want to go into the house and keep warm.’ And just as we see this in patients it is so in the study of a remedy; we must discriminate.’

Finally, though of great importance, come those symptoms designated by Hahnemann as being Strange, rare and peculiar. These are the symptoms which characterise this illness in this patient, whether they be generals of particulars.

Note: the student will find the word Keynote’ mentioned in many Homoeopathic books. The word appears to have been used by Dr. H.N. Guernsey originally and refers to the characteristic symptoms or symptoms of a drug. He stated: The keynote is only meant to state some strong characteristic symptoms and on referring to the Symptom Codex (Materia Medica), all the others will surely be there if this one is. There must be a head to everything; so in symptomatology if the most interior or peculiar, or keynote is discernible, it will be found that all the other symptoms of the case will be also found under that remedy which gives existence to this peculiar one, if that remedy is well proven. It will be necessary, in order to prescribe efficiently, to discover in every case that which characterises one remedy above another, in every combination of symptoms that exists. There is certainly something, in every case of illness, which pre-eminently characterises that case, or causes it to differ from every other. So in the remedy to be selected, there is or must be a combination of symptoms, a peculiar combination, characteristic or, more strikingly,keynote. Strike that and all others are easily touched, attuned or sounded. There is only one keynote to any piece of music, however complicated, and that note governs all the others in the various parts, no matter how many variations, trills, accompaniments, etc.’

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