The Significance of Cured and Sequelae symptoms in Choosing the Homeopathic Remedy

Sequelae symptoms cannot be causally linked to remedies with any certainty during provings. Therefore, they must be used with caution when repertorizing a case.

Translated by Katja Schütt and Alan Schmukler

Abstract: Based on a solved case for which a sequelae-symptom was used (ailments from grief) the significance of consequential, cured and sequelae symptoms for homeopathic case analysis is analyzed.

Key words: case analysis, consequential symptom, cured symptom, confirmation of cure, Phosphorus, Sequelae symptom*

In the Zeitschrift für Klassische Homöopathie 4/2005 (Journal for classical Homeopathy), an article by Thomas Genneper describes two cases under the title “Ailments from grief in Phosphorus”, with which he meant to substantiate this rubric.[1] The method of case analysis and above all the general considerations and conclusions drawn by Genneper, are the starting point for some fundamental thoughts about the significance of the confirmation of cure in homeopathy. [2]

The first of two published cases examined, was of a young woman who developed symptoms of vertigo during stress from a financial problem. According to Genneper, he found the curative remedy, Phosphorus, only because it was listed in a high grade in the rubric “Ailments from grief” in the Synthetic Repertory (Barthel and Kluncker). As he explains, “Phosphorus only had a numerically incomplete similarity to the totality of the symptoms of the patient, wherefore a classical homeopathic remedy choice would not have considered Phosphorus.”

The missing similarity between the remedy picture of Phosphorus and the totality of the patient’s symptoms is, according to Genneper, a necessary precondition for the intended “verification of a sequelae relationship” ( between Phosphorus and the sequelae symptom of “ailments from grief”).

Sources of knowledge of homeopathic remedies

Besides finding and formulating the similarity principle, it is without doubt Hahnemann’s greatest accomplishment to have been the first in the history of medicine to establish clear rules for recognizing the curative properties of medicinal agents. This played a major role in his thinking and writing. Only a few other basic thoughts are to be found with such regularity in different passages of his works. According to Hahnemann, nothing could be perceived “from these remedial powers even by the most perceptive observer … than the power to bring about evident changes in the human economy, specifically that they provoke a number of definite symptoms in and upon the healthy […].”[3]

The clarity with which Hahnemann delimits himself against the usual prescribing methods derived from “speculative, a prioric pondering” [4] used in the pre-homeopathic time, leaves nothing to be desired. Already the “preface“ to the first edition of the “Organon”, published in 1810, begins with the statement that until this date, practicing medicine has only been an “ars conjecturalis”, an “art of speculation”.[5] The source of knowledge of homeopathic remedies and therefore the foundation for the homeopathic remedy choice, can therefore only be signs or symptoms which the remedy caused in a proving on a healthy human being. Not without cause does Hahnemann dedicate more than forty of 291 paragraphs of the last edition of the “Organon of the Healing art” just to the performance of these provings.

Significance of Sequelae Symptoms

When considering this problem, it becomes obvious that the sequelae symptom, “ailments from grief”, as mentioned by Genneper, does not relate to this kind of remedy knowledge. Grief and sorrow itself as a changed conditions of the state of health has been described in numerous provings. However, Genneper refers to possible ailments following this mistunement. Suppose there was a prover who experienced a grief provoking event during the proving (as the Phosphorus proving) and subsequently developed new signs and symptoms, such as vertigo for example. Were these symptoms caused by the event, namely “ailments from grief“, or caused by the given remedy? A clear, causal attribution to the proven remedy in terms of the Hahnemannian proving, would not be possible. Generally, it would also be absurd in terms of the examined problem, because the supposed vertigo would then be a “result of Phosphorus” and not an “ailment caused by grief”. Therefore, these sequelae-symptoms, which are increasingly considered in comprehensive rubrics of modern repertories, deserve to be considered with a completely different valuation. They are usually mere observations of cure, “useful information” (ab usu in morbis)«[6].

Ailments from grief and sorrow

According to Hahnemann, mental and emotional strain play a major role in the development of chronic diseases, to which Genneper refers rightfully with his quote from “The Chronic Diseases” : “By far the most frequent excitement of the slumbering Psora into chronic disease, and the most frequent aggravation of chronic ailments already existing, are caused by grief and vexation.”[7]. Genneper concludes from observation that these factors have to be considered when choosing the remedy by means of sequelae-rubrics. However, Hahnemann considered the continuous existence of mental and emotional strain as one of the major impediments to the cure of chronic diseases, which finally can make homeopathic treatment impossible. [8] “If at all, then these cases are to be treated by means of the anti-psoric remedies, which are at the same time suited to the rest of his chronic disease”[9], as mentioned in the footnote of the quoted text.

Therefore, according to Hahnemann, the occurrence of grief or displeasure in the history of the patient, does not influence the choice of the homeopathic remedy, but generally deals with the question of whether a homeopathic treatment would be possible at all. The requirement that the remedy should already have proved itself useful in the treatment of these after-effects in terms of a cured symptom [10] – and only then it appears in the respective sequelae rubric in the repertory – is not to be found in Hahnemann’s writings.

Significance of cured symptoms

This leads to the question of what importance Hahnemann attached to the so-called curative confirmation of proving symptoms. This has been of minor significance, as he points out in the preface to the famous case of the washerwoman: As the treatment principles always remains the same for each single case, the consideration of cured cases were “not of much use“[11], and nothing was to be learned from them for the “treatment of other cases“[12].

Only a very few passages of his writings mention the possible confirmation of proving symptoms by means of cured cases, as in the preface to the remedy picture of Conium [13]. It is interesting in this regard, that he quotes cases which also showed “sequelae symptoms” (results from bruises and blows). However, Hahnemann relates them to the known primary effects of Conium in provings.

This relation of cured symptoms to proving symptoms is a necessary requirement for their value, although it remains less significant. According to Hahnemann, they should only be used for “the confirmation of the remedy choice made according to the pure action of the remedy”[14] if they occurred during the proving on a healthy human being. Hahnemann vehemently opposes choosing the remedy based on cured symptoms.[15]

Hahnemann‘s closest disciples, Jahr and v. Bönninghausen, valued cured symptoms somewhat differently. Although Jahr explicitly argues against the remedy choice based on cured symptoms in his “Therapeutic Guide”[16], we find in his materia medicas – namely the “Handbuch der Hauptanzeigen“ and “Symptomenkodex” – a separate, characteristic grade for signs and symptoms [17] which constitute “quite excellent, and characteristically proven cured [..] symptoms” [18] without having appeared in provings.

Also in v. Bönninghausen‘s “Therapeutic Pocket Book” symptoms are found in two grades (the 3rd and 4th grades), which did not appear in any of the known provings, as for example “labor like pain”, which is listed in the third grade for Opium [19,20]) [21].

As can be shown, both, Jahr and v. Bönninghausen, classified mere cured symptoms as characteristic, and therefore as indicating the remedy in terms of § 153 Organon, contrary to Hahnemann. Contrary to Jahr and Bönninghausen, Hering required, like Hahnemann, that we always compare the cured signs and symptoms with those from the proving [22]. He even required a “symptom index”, namely a clearly arranged compilation of signs of a remedy, as only this would allow the necessary comparison of cured with “produced”[23] symptoms (as they were called by Hering), with sufficient certainty.

Like Hahnemann, Hering limits the value of cured symptoms and clearly opposes seeing in them the “core or essence of the materia medica” [24]. Without confirming one’s remedy choice by comparing symptoms with proving symptoms, there remains the risk of drawing wrong conclusions from cured cases, as “The symptoms cured by a remedy are often only resulting signs which disappeared after the removal of a conditioning circumstance.” [25], a fact which Hahnemann already discussed in detail in the preface to the remedy picture of Opium: “As the remedy Opium did not cause any primary effects of pain during the proving, nevertheless it is used successfully to treat painful conditions homeopathically (Hahnemann mentions ileus as an example), wherefore the alleviation of pain can only be considered as an indirect effectin these cases [26].

Only checking the proving symptoms of Opium in the materia medica, in which such signs and symptoms are clearly missing, protects us from committing the mistake of seeing the alleviation of pain as a characteristic effect of Opium (as Bönninghausen did).

This required comparison is surely difficult and cumbersome with the Materia Medicas offered by Hahnemann and Hering, due to their schema head-to-foot organization. For example, sensations of pain could be listed in every organ chapter. Nevertheless, the comparison is necessary to avoid ascribing wrong effects to homeopathic remedies which can cause false future prescriptions.

Classical – homeopathic case analysis

Now let us go back to the first case described by Thomas Genneper. Why did Phosphorus cure the patient, if, according to Genneper, the remedy choice “essentially” depends on the presumed causa (grief and sorrow), but the remedy choice obviously remains uncertain, if only chosen according to cured symptoms as described above?

According to Hahnemann’s requirements as described in §153 Organon, the homeopathic remedy choice has to consider “mainly and almost only” the characteristic signs and symptoms of the case, and to compare them with those of the remedy. Therefore, the characteristic signs of the proving finally determine which symptoms of the patient‘s anamnesis can be used. A very differentiated ailment, well described by the patient, is not of much use if it cannot be identified with the respective sign of a remedy! The patient suffers from two characteristic ailments according to Genneper’s detailed and precise anamnesis. Vertigo and nausea both appear together and are paroxysmal. If the paroxysmal occurrence is considered as a modality of the complaint, then it is characteristic according to Jahr, if it modifies very different ailments [28]. That factor is in our case, if the very different ailments appeared paroxysmal in very different organ systems.

As vertigo and nausea cannot appear in different organs or organ systems, they are only characteristic according to Jahr, if they accompany one other in very different ailments – as the characteristic blush of Aconite which is given by Jahr as an example (and not the merely perioral blueness of Cina – which is therefore not characteristic[29]).

Therefore, the sought after remedy should have produced vertigo and/or nausea in a proving, accompanied by many other different symptom which agree with the symptom combination of the patient in a characteristic manner. In this context, the patient’s perspiration also deserves to be defined as an “accompanying ailment”, as it only occurred since the appearance of vertigo and nausea.

Further assurance of these particular “local” sign and symptom combinations is given by checking their “essentiality” [30], that is, for example, whether a remedyrepeatedly produced the symptom combination of vertigo and nausea or paroxysmal vertigo.

In summary, we are looking for a remedy which:

  • Produced several paroxysmal appearing symptoms.

  • Vertigo, nausea and perspiration, each in connection with many possible varying symptoms, and ideally also:

  • Vertigo accompanied by nausea (the combination of the patient) and/or

  • Paroxysmal vertigo more than once and in more than one prover.

Using this type of case analysis, it soon becomes obvious how right Hering was with his requirement for a “symptom register”. Finding the possible remedies in a materia medica arranged according to the usual head-to-foot scheme is almost impossible, as this would have to be read from the first to the last page. As we are looking, in this case, for the symptom of vertigo in connection with, as much as possible, other different ailments, the respective proving symptoms could also be found in any possible organ chapter of each possible remedy.

For such an examination it is “a virtually irremissible requirement: to clearly arrange the single signs” [31], as proposed by Hering and realized in the “Symptomlexicon of the Materia Medica” [32]. Only such an overview makes it possible to identify those remedies with practicable efforts, which have produced vertigo in connection with other signs in a proving, as well as those for which this applies for nausea. Even listing those symptoms which “paroxysmally” occurred in proving, is easily done in this way. If we proceed in this way for all signs and symptom combinations of the patient which were identified as relevant above, and list the respective number of discovered proving symptoms in a table, we get the following results [33].

1.

2.

3.

4.

5.

6.

Alum

18

12

19

8

3

1

Bar-c

17

5

9

5

1

1

Bell

26

13

19

20

2

2

Borx

5

5

18

3

1

1

Calc

18

15

32

11

1

1

Carb-an

10

6

7

4

1

2

Cocc

11

3

9

3

1

1

Graph

17

7

27

11

2

1

Mag-c

12

6

28

4

4

1

Nat-c

19

8

16

5

1

2

Phos

18

24

43

14

8

4

Plat

16

6

6

4

1

1

Puls

14

8

28

11

1

1

Sep

32

13

32

6

2

3

Sil

21

14

26

11

4

2

Zinc

20

7

12

4

1

1

  1. Paroxysmal (without pain[34])

  2. Vertigo with accompanying ailments

  3. Nausea with accompanying ailments

  4. Perspiration with accompanying ailments

  5. Vertigo with nausea

  6. Vertigo, paroxysmal

We see at first glance that only a few remedies have caused all of the four – in terms of Jahr’s characteristic symptom combinations, with a high number of proving symptoms, in connection with other very different signs and symptoms, and are therefore characteristic.

According to Jahr’s understanding, none of these remedies except Phosphorus covers essentially the symptom combination of the patient “vertigo with nausea” (which is not possible to characterize in detail for obvious reasons), and “paroxysmal vertigo”. Only Silicea would have to be considered for differential diagnosis.

Discussion

Genneper uses his own definition of “Sequelae-Symptoms” [35] without confirming them with respective passages from the classical homeopathic literature. His only required criteria of a time sequence between an event and the symptoms of the patient, independent from any causal relationship, is problematic, as it finally opens – by using respective repertory rubrics – the floodgates to a completely arbitrary remedy choice [36] and does not meet Hahnemann’s requirement to chose the remedy according to “clearly comprehensible principles”[37].

The case described by Thomas Genneper can only give evidence for the correctness of the remedy choice based on the sequelae symptom “ailments from grief”, if, as Genneper rightfully mentions himself, the remedy could not have been found by means of a conventional, homeopathic case analysis, namely the totality of signs and symptoms (and if it cured in spite of this as in this case).

The conclusion that cure happened only because of the prescription based on the supposed grief etiology, necessarily presumes a “(numerically) incomplete [..] similarity to the totality of symptoms” [38]. Otherwise, the remedy must have cured independent from the postulated relation to the results from grief, according to the basic homeopathic understanding.

This impression of an incomplete similarity between the symptoms of the patient and the known proving symptoms of Phosphorus, is easily received when analyzing cases superficially with Kentian style repertories. Considering this case from a classical, homeopathic view of characteristic signs and symptom combinations however, demonstrates, that no other remedy than Phosphorus covers the “totality of subjectively felt symptoms by the patient“ [39] in such completeness, and which therefore cured her cito, tuto et jucunde [40].

This case demonstrates the danger which Hahnemann already pointed out, when choosing the remedy based on cured symptoms. In this case it is not the resulting choice of the wrong remedy, as Phosphorus was chosen (by chance?) with this type of case analysis. However, in future cases the conclusion that Phosphorus cured the case just because Phosphorus is a remedy for ailments from grief and would therefore, independently from a possible similarity to concrete symptoms, also cure other cases, provided there is a presumed “etiology of grief”[41], could be a problem.

As demonstrated, Phosphorus cured the case because it is the remedy that most characteristically covers the similarity of the symptom combination “paroxysmal vertigo with nausea“.

Considering these facts, the necessary conclusion from this case is that Phosphorus cures signs and symptoms which were characteristically caused in a proving. This also confirms Hahnemann’s skepticism towards published cases, because “the inner procedure of treatment always follows the same principles which are already known, and cannot be concretized or definitely determined for each single case, cannot be made clearer by the history of a cure than already done by describing the principles.“[42]

Conclusion

The consideration of cured signs or symptoms for the choice of the homeopathic remedy is at best of a limited confirmative value, and only when they are related to symptoms of the respective proving. As it is usually not possible for most so-called sequelae-symptoms, utmost caution and reticence are necessary when considering them for the remedy choice.

Dr. med. Steffen Rabe

Germany

Footnotes

[1] Thomas Genneper: Folgen von Kummer bei Phosphorus, in: Zeitschrift für Klassische Homöopathie, 49 (2005), 4, p.163–166.

[2] In the beginning I want to emphasize explicitely that this article is not about criticising the publishing colleague but about the examplary examination of these nowadays often used types of repertory rubrics (cured- and sequelae symptoms).

[3] Samuel Hahnemann: Organon der Heilkunst; nach der handschriftlichen Neubearbeitung Hahnemanns für die 6. Auflage, published by Richard Haehl, Ulm, 1958 (ORG VI), § 21.

[4] Samuel Hahnemann: Reine Arzneimittellehre [RAL], Vol. 4, second, increased, Dresden und Leipzig, 1825, p.19.

[5] Samuel Hahnemann: Organon der rationellen Heilkunde, Dresden, 1810, Vorerinnerung, here quoted after: ORG VI, S. 71.

[6] Samuel Hahnemann: Die chronischen Krankheiten, ihre eigenthümliche Natur und homöopathische Heilung, first part [CK I], second, increased edition, 1835, p. 151.

[7 ]CK I, p.140.

[8 ] “But if the relations of the patient cannot be improved in this respect, and if he has not sufficient philosophy, religion and power over himself to bear patiently and with equanimity all the sufferings and afflictions for which he is not to blame, and which it is not in his power to chenge; if grief and vexation continually beat upon him, and it is out of the power of the physician to effect a lasting removal of these most active destroyers of life, he had better give up the treatment and leave the patient to his fate, for even the most masterly management of the case with the remedies that are the most exquisite and the best adapted to the bodily ailment will avail nothing, nothing at all, with a chronic patient thus exposed to continual sorrow and vexation, and in whom the vital economy is being destroyed by continuous assaults on the mind […]“(CK I, S. 140 f.)

[9 ] “*) Unless the patient should have little or no cause for his grief and sorrow, or hardly any incitement from without to vexation, and in consequence would need more particularly to be treated with respect to his mental disorder, by means of the anti-psoric remedies, which are at the same time suited to the rest of his chronic disease. Such cases are not only curable, but often even easily curable.” (CK I, S. 177)

[10] The term „cured symptom“ is used in this article according to the understanding of Georg H.G. Jahr: in terms of a sign or symptom which disappeared after the application of the homeopathic remedy without having appeared during the respective proving.

[11] RAL, Bd. 2, third, increased edition, Dresden und Leipzig, 1833, p.31.

[12] ibidem.

[13] cf. RAL, Bd. 4, p.238.

[14] RAL, Bd.1, third, increased edition, Dresden und Leipzig, 1830, p.5.

[15] cf. CK I, p. 151; CK II (second, increased edition, Dresden und Leipzig, 1835), p. 92.

[16] Georg Heinrich Gottlieb Jahr: Therapeutischer Leitfaden für angehende Homöopathen, Leipzig, 1869; unchanged new edition, Hamburg, 2003 (TLJ), p. 166: “If they would only start to recognize that not all signs which were casually to find in a given cured case, or whose recording seemed accidentally important to the reporter, and are therefore characteristic signs for the remedy choice.”

[17] Indicated by the sign º and spaced letters.

[18] Georg Heinrich Gottlieb Jahr: Handbuch der Hauptanzeigen für die richtige Wahl der homöopathischen Heilmittel, Leipzig, 1851; unchanged new edition, Hamburg, 2005 (HHJ), S. 528.

[19] cf. Clemens von Bönninghausen: Therapeutisches Taschenbuch, Stuttgart, 2002, S.192.

[20] see below for the special importance of pain symptoms in Opium

[21] The supposable consideration of Hahnemann’s cured symptoms in the »Uebersicht der Haupt-Wirkungs-Sphäre der antipsorischen Arzneien und ihrer charakteristischen Eigenthümlichkeiten«, written by v.Bönninghausens, and the supposable ironical criticism written by Hahnemann’s in his letter from 12/15/1832 cannot commented on in detail here. (cf. Martin Stahl: Der Briefwechsel zwischen Samuel Hahnemann und Clemens von Bönninghausen, Heidelberg 1997, p. 76)

[22] cf. Constantin Hering: Herings Medizinische Schriften, published by Klaus-Henning Gypser, Göttingen 1988, S. 1206.

[23] ibidem.

[24] “Contrary to this most modern homeopath have set a very high value on cured symptoms. They were even extracted from the materia medica as their core or essence and printed specially. By the way, this is a great error which limits the pure, free view of the materia medica more and more, and which leads in the same, prejudiced physician to the same uncertainty as shown by the old schools.” (Herings Medizinische Schriften, p.1017/1018)

[25] ibidem.

[26] cf. RAL, Bd.1, p.270 ff.

[27] ORG VI, § 153.

[28] cf. HHJ, Sp529.

[29] cf. Georg Heinrich Gottlieb Jahr: Die Lehren und Grundsätze der gesamten theoretischen und praktischen homöopathischen Heilkunst [LGJ]; new edition, Euskirchen, 1998, § 105.

[30] cf. Steffen Rabe: Charakteristische Zeichen bei G.H.G. Jahr, in: Neues Archiv für Homöopathik, 1 (2006), I, p.35–46.

[31] Herings Medizinische Schriften, p.1206.

[32] Uwe Plate: Symptomen-Lexikon der Materia Medica, Braunschweig, 2004.

[33] According to the required totality of symptoms and for a clear arrangement those remedies have not been considered which don’t cover all investigated signs.

[34] In this counting the „pains occuring in spasms“ have not been considered as a number of symptoms and signs which occur in spasms during provings describe pains of a different quality, however not the in this case investigated sign „vertigo“.

[35] »The term sequelae symptom (lat. For consequential symptoms) is somewhat strange and therefore not often used. But it defines the facts better than the terms of etiology or causa which frequently cause confusion in terms of causality. Homeopathically relevant is just the phenomena of a chronological sequence between an event and a subsequent occuring symptomatology. Causality in terms of scientific thinking is not necessary but may exist.“ (Genneper, p. 166)

[36] In which case there couldn’t be observed any chronoligical relations between the symptoms of the patient and any chosen external circumstances ?

[37] ORG VI, § 2 and 3.

[38] Genneper, p.165.

[39] ibidem.

[40] rapid, gently, and permanently

[41] Genneper, p.165.

[42] RAL, Vol. 2, p.31.

* note by the translator: a sequelae symptom is often referred to as a Never-well-since related symptom in English literature

References

Bönninghausen, Clemens von: Therapeutisches Taschenbuch, Stuttgart, 2002

Hahnemann, Samuel: Organon der Heilkunst; nach der handschriftlichen Neubearbeitung Hahnemanns für die 6. Auflage, herausgegeben von Richard Haehl, Ulm, 1958

: Reine Arzneimittellehre, Bd. 1, dritte, vermehrte Auflage, Dresden und Leipzig, 1830; Bd. 2, dritte, vermehrte Auflage, Dresden und Leipzig, 1833; Bd. 4, zweite, vermehrte Auflage, Dresden und Leipzig, 1825

: Die chronischen Krankheiten, ihre eigenthümliche Natur und homöopathische Heilung, Theil 1 und 2, zweite, viel vermehrte Auflage, Dresden und Leipzig, 1835

Hering, Constantin: Herings Medizinische Schriften, herausgegeben von Klaus-Henning Gypser, Göttingen, 1988

Jahr, Georg Heinrich Gottlieb: Handbuch der Hauptanzeigen für die richtige Wahl der homöopathischen Heilmittel, Leipzig, 1851; unveränderte Neuausgabe, Hamburg, 2005

: Klinische Anweisungen zu homöopathischer Behandlung der Krankheiten, Leipzig, 1867; unveränderte Neuausgabe, Hamburg, 2005

: Die Lehren und Grundsätze der gesammten theoretischen und praktischen homöopathischen Heilkunst; neugesetzte Ausgabe, Euskirchen, 1998

: Ausführlicher Symptomen-Kodex der homöopathischen Arzneimittellehre, Leipzig, 1848; unveränderte Neuausgabe, Hamburg, 2001

: Therapeutischer Leitfaden für angehende Homöopathen, Leipzig 1869; unveränderte Neuausgabe, Hamburg, 2003

Plate, Uwe: Symptomen-Lexikon der Materia Medica, Braunschweig, 2004

Journals

Neues Archiv für Homöopathik, 1 (2006), I

Zeitschrift für Klassische Homöopathie, 49 (2005), 4

@This article was first published in NAH Bd.2 (2007) I Methodik: Heilungs- und Sequelaesymptome

About the author

Steffen Rabe

Steffen Rabe

Dr. Steffen Rabe was educated and studied medicine at one of the largest children’s hospitals in Germany. He specialized in pediatrics and the treatment of problems in adolescence. For the last fifteen years he has maintained his children’s practice in Munich, and, as far as the diseases of his patients permitted, prescribed according to Hahnemann's principles of classical, unicist homeopathy.

1 Comment

  • dear dr,
    there are many methods which can be used for finding an exact curable remedy. i have in my practice found that the cause of the disease must be traced and i have cured a case and have found that the patient had come again with same disease because he had not been able to control the cause and then the previous remedy had not worked. it seems that his disease had become immune to the previous selected remedy. so in that case a new remedy has to be selected thanks

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