Acute Prescribing in Homeopathy–
Even You Can Learn to Do It !
Elaine Lewis and Kelly Young
Elaine, my daughter had swine flu! I wish I could write it up for you but I wasn’t able to help her much. I tried maybe 8 different remedies during the course of the illness but nothing really helped.
Why didn’t you call me? I can come up with wrong remedies too!
You’re probably right. My sister had the same symptoms when she stayed with me the month before. Poor thing was sooo sick- she’s still talking about it! I tried many remedies to no avail.
After she left, I bought 2 remedies that I thought would have helped her (that I didn’t have) just in case one of us came down with it. But, none of them helped my daughter.
I wondered what others have found helpful for this flu because:
and a bunch of others did nothing.
The symptoms were (in order) sore throat, high (104 F.) fever, severe body aches, severe chilliness, pounding headache.
Well, it sounds plooty, as my daughter Shana would say. Now Kelly, as you know, none of the symptoms you just mentioned mean anything to the homeopath!
Is that so?
And why do I say that? Because the Repertory rubrics for these designations (fever, sore throat, etc.) are so large, so huge, so generic that virtually every homeopathic remedy in the Materia Medica covers them!!! Homeopathy is a system of “peculiars”. What’s peculiar about your fever? What’s strange about your sore throat? That’s what we have to know! This is the only way we can find a remedy. Towards that end….
The Big 4!
The Big 4?
Yes, the Big 4:
Sensation, Location, Modalities, Concomitants
What are modalities?
Modalities are anything that make the complaint better or worse. For example, the sore throat you mentioned, it might be better for hot drinks, worse for outside air, better warm rooms, worse for the slightest draft….
Why do we care? Why should anyone care?
Your symptom of “sore throat” is a lot more than those two words if you stop to think about it. Do you have a “sore throat”? Or do you have a certain KIND of sore throat?! I recently had a client whose sore throat was actually better for talking! This symptom is so rare, so peculiar, so strange, that only three remedies covered it, making the remedy selection rather easy since I only had to take one other characteristic symptom (“desires oranges”) and pick a remedy that covered both! (Only one remedy did.) You’ll never get this level of confirmation if the rubrics you choose are so common, so general that they contain hundreds of remedies!
And what about concomitants?
Concomitants are the adjunctive symptoms in the case. They are highly valued because they are often the striking, strange, rare or peculiar ones which Hahnemann says the remedy simply must match or the likelihood of cure is rather slim; symptoms like restlessness, bad breath, salivation, food or drink cravings, unusual mental symptoms like not being able to answer questions, or screaming or rudeness and so on; symptoms that seem to have no relation to the chief complaint, occurring for seemingly “no reason”, they are just “there”! Take for example, menstrual cramps with burping. What does burping have to do with menstrual cramps? Burping, then, is the concomitant; meaning, to us, we need to find a burping remedy, never mind the cramps! Or, if we can find a cramps remedy that also burps, fine; but, suddenly the burping jumps out at us as being the key to unlocking the case !
Observing the patient is very important and can often give you the concomitant. Observe what the patient is doing and saying. Sometimes body language tells us what we need to know. Bryonia patients are lying perfectly still and won’t answer your questions (because the slightest movement aggravates). Colocynth and Mag-phos patients are bent over double. Gelsemium patients answer every question with “Huh…?” because they’re in a semi-stupor. Nux vomica patients are rudely making demands (“I’m still waiting for the glass of water I asked you for two seconds ago!”). Arsenicum patients are begging you not to leave! (“Can’t you just stay one minute longer?”) I’m reminded of how Andre Saine solved the case of a comatose girl by observing that a fan was blowing directly on her. “Why is that fan on?” he asked. “Because if you turn the fan off she becomes unsettled and restless,” the nurse said. Andre knew from that he was going to need a “hot” remedy like Sulphur or Pulsatilla; in fact, the remedy was Pulsatilla.
Do you need to know anything else besides the Big 4?
Which, again, are?
Sensation, Location, Modalities, and Concomitants!
Very good! Yes, yes it would help to know more; three more things:
1. Is there a time issue? Is the patient worse in the evening? Worse at 9 p.m.? Worse at midnight, etc.? Think of this as the Time Modality.
2. Did the complaint come on suddenly or gradually? Complaints that come on suddenly are often covered by just two remedies! Aconite and Belladonna!
Sometimes Baptisia, if the case is septic.
And what does that mean?
Sepsis is characterized by bad odors, like bad breath. If a septic condition comes on suddenly, think of Baptisia. Baptisia is thought of as a “worse” Gelsemium. Stuporous presentation, apathy, inclination to sleep; but, thirsty while Gels. is thirstless. Now for # 3. I’m leaving the best for last.
The cause! Am I right?
Yes. You have to know this! The remedy must cover it! Unless the etiology is something vague, like, “germs”, it alone could be so valuable as to solve the case for you! How often has this happened? You’ve taken the case, it looks really good for Belladonna, the patient is red, full of heat, burning; you’re just about to give Belladonna when you ask, “When did it start, after what?” And the patient says, “Oh! Allergy to peanuts!” Allergic???? That’s not Belladonna, that’s Apis! See, when you know the cause, it changes everything! Ladies and Gentlemen, take note:
Etiology Over-rules Symptomatology!
Consider the following:
Ailments from cold/dry winds–Aconite
Ailments from acute grief–Ignatia
Ailments from over-eating heavy, rich foods–Pulsatilla
Ailments from excitement and too much joy–Coffea
Ailments from cold/damp weather–Rhus tox.
Ailments from blunt trauma–Arnica
We scarcely need to know any details, such is the importance of etiology.
So, getting back to your daughter’s flu, when you say “sore throat”, I would say:
What was the sensation?
What makes it better or worse?
Where in the throat is it, right side? left side? whole thing?
We need to do this for every symptom. A properly delivered symptom sounds like this:
I have constipation with no urging which is chronic and causes much abdominal pain which causes me to bend over double and rub as hard as I can; it’s a sharp pain that shoots downward; a hot water bottle helps; plus, I also have burping with this and my stomach makes a gurgling noise.
This is a “complete” symptom. “I have constipation”, as a statement to the homeopath, is completely worthless! The “constipation” rubric contains over 200 remedies, which means practically every remedy has constipation, how’s that going to help you?
Does that mean almost any remedy will solve the case?
I didn’t think so.
It means you have no hope of finding the remedy unless you learn to talk in complete symptoms!!!!!!
Right: sensation, location, modalities, concomitants. What else does the homeopath need to know?
What makes the patient better or worse in general! We need to ask about the “generals”. For instance, better or worse for company, hot bath or shower, cold drinks? Fresh air? Better in the daytime? Better at night? What affects the patient in general? The “generals” are more significant than the “particulars”.
Kelly, think about it. If you’re sick “in general” or feeling bad “in general”, you’re a lot worse off than if you just have a sprained ankle or even a broken leg or some other complaint that’s localized. So that means if you had to make a choice between the remedy that covered the “generals” and the one that covered the “particulars”, the one that covered the “generals” would be more important. “General” symptoms start with the word “I”. “Particular” or “local” symptoms start with the word “my”. Example of “Generals”:
“I want the heat turned up.”
“I’m scared, I need someone with me at all times!”
“If I can just get out of this warm stuffy room and into the fresh air, I’ll be fine!”
Now, let’s say you’ve done all this fancy questionning, you’ve taken a proper case, and no remedy covers the flu picture really well; or, you tried every remedy known to man and nothing seems to work, then go to a nosode! Influenzinum or oscillococcinum would be appropriate in the flu. Nosodes represent Isopathy which means curing using the thing that’s wrong against itself, there may be some bodily fluid that you can make a remedy out of if all else fails. For example, if the saliva is thick and disordered, I would use that. I’ve written an article called “How To Make Your Own Remedy” which is on my website, scroll down to the “articles” section.
Anything else you need to know in taking an acute case ?
Since you mention it, you should know what you have! I mean, is it the flu or is it food poisoning? Knowing the diagnosis gives you some direction. Which chapter of the Repertory are you supposed to look in if you don’t know what’s wrong with you? If it’s ailments from bad water, I’m not going to give Gelsemium, even if the patient does look stuporous, I’m going to give Zingiber, homeopathic ginger, an excellent remedy for ailments from bad water. Take it to Mexico with you!
Should we recap before succumbing to information-overload?
Good idea! You’ve got a sick patient. The first thing you want to know is….
WHEN DID IT START, DID IT COME ON SUDDENLY or GRADUALLY?
DO YOU KNOW WHAT CAUSED IT?
(Don’t forget to observe the patient; what’s he doing, what’s he saying, what does he look like?)
WHAT MAKES YOU BETTER OR WORSE IN GENERAL?
(this includes time of day when person is better or worse)
THE LOCAL SYMPTOMS with THE BIG 4:
sensation, location, modalities, concomitants
(You need to know this for each local symptom that’s part of the case.)
Remember that Concomitants are any symptoms that are unexpected, unexplainable or just curious. They may be “normal” but out of place, or in excess, or less than what you’d expect like lack of thirst during fever. But let me clarify that if there are numerous complaints in a case, you won’t expect each one to have a concomitant, that would be cumbersome and anyway there would be no way of discerning what was a concomitant to what! Take the flu with fever, sore throat, body aches and headache; is the fever concomitant to the sore throat? Is the headache concomitant to the fever? It gets messy. Just remember to keep asking, “What else? What else? Anything else? What’s different?” and so on. Remember to do: Sensation, Location, Modalities for each of the complaints (e.g., pounding headache, left side, better consolation and hand-holding–if all the complaints turn out to be better consolation and hand-holding, this, then, becomes a “general”, and remedies like Arsenicum, which need company and hand-holding, come to the fore).
Is there a hierarchy of symptoms?
I’m glad you asked that question, Kelly! It so happens there is! We’ve already said that etiology overrules symptomatology, and that Generals are more valuable than Particulars in terms of remedy selection. So, here it goes:
Diagnosis/name of the condition–also known as “The Chief Complaint” (ask patient to describe in his own words)
Onset–sudden or gradual
Etiology (what caused the complaint, and when)
The Appearance–what does the patient “say” and “do”? (He may say things like, “I’m doomed!” or “Bring me some ice!” all clues to the remedy; he may be tossing and turning; or, conversely, lying perfectly still; all important information.)
Particulars (the big 4, which are, again?)
Are you askin’ me? Are you talkin’ to me?
Who are you, Robert DeNiro? No, don’t answer that! Let’s move on to discharges. If there are discharges, you’ll want to know their color, odor and consistency. You’ll also want to know if they create a sensation–like burning, irritation or itching, etc.
Plus, for heaven’s sake, don’t mix up acute and chronic symptoms! Don’t tell the homeopath you’re thirsty if you’re ALWAYS thirsty! Don’t tell him you’re irritable if you’re ALWAYS irritable!
Oh my God, more information! My head is starting to spin!
OK, this would be a good place to stop. I would welcome the hpathy readers to write in and ask whatever questions they have regarding acute prescribing. Did you know, Kelly, that Acute Prescribing and Emergency Prescribing are the highest levels of homoepathy?
I did not know that.
By knowing how to solve acutes, you can stop a complaint from going chronic! You can save a life! You can stop a person’s suffering! Even people with chronic disease develop acutes of one kind or another, and the practitioner can’t ignore these flare-ups with, “We can’t interfere with your chronic remedy. Here, have a Tylenol.” Egads! Well, don’t get me started. That’s another topic for later.
Every month we have a quiz in the Quiz section of the ezine. Every month we submit an acute case; but, very few of you readers actually participate!
So, how about it? Will I see all of you in the Quiz section from now on? How about you, Kelly? Kelly?
Mom, Kelly just left to get her nails done. She said something about her head exploding.
I hate it when that happens.