The homeopath forms a conceptual image of the disease by collecting data from the patient, patient’s relatives and from his own observations. The totality of a case is the basis for repertorization and serves the purpose to find out the most similar medicine of the Materia Medica. The success of repertorization depends on the ability to deal with symptoms and on the balance of the information collected and translated into rubrics.
Based on a different conception of the Totality of Symptoms there are different repertorization method. The four major influences in the art of repertorization are Hahnemann, Kent, Boenninghausen and Boger. Each of them emphasizes different aspects to form the totality of a case, yet they all have their origin in the Organon. “It is possible to obtain the needed correspondence in a great variety of ways and degrees, and one practitioner will find it in one way and another in another”. It is important for a homeopath to be familiar with these subtle differences so that he may apply them depending upon the prescribing data elicited from the patient. Each case is to evaluate as a whole in order to see which of these repertorization methods is best suited to the case in hand.
A thorough understanding of the plan and construction of the different repertories is indispensable for the application of the appropriate repertorization method.
The Totality of Symptoms
The foundation for ALL these methods is the TOTALITY of symptoms, which in homeopathic practice is the true diagnosis of the disease, and at the same time the diagnosis of the remedy. Totality is the qualitative sum total of all the symptoms presented by the patient.
Hahnemann defined the Totality of Symptoms as the outwardly reflected picture of the inner essence of the disease and the sole means whereby the disease can make known what remedy it requires. Symptoms are the outward and visible signs of the inward disturbance of the vital force and when these symptoms are removed the disease ceases to exist.
Among those medicines whose human condition-alternating power has been investigated, the medicine whose observed symptoms are most similar to the totality of symptoms of a given natural disease will and must be the most fitting, the most certain homeopathic remedy. In this medicine is found the specificum for this case of disease.
§ 147 Organon [emphasis added]
Strange, Rare, Peculiar and Characteristic Symptoms
There is much carbon, but few diamonds. To distill the essence out of all symptoms Hahnemann’s criterion were the more striking, exceptional, uncommon, unusual, and characteristic signs and symptoms. He states:
In the search for a homeopathically specific remedy, that is, in the comparison of the complex of the natural disease’s signs with the symptom sets of the available medicines, in order to find among them an artificial disease potence that corresponds in similarity to the malady to be cured, the more striking, exceptional, unusual, and odd (characteristic) signs and symptoms of the disease case are to be especially and almost solely kept in view. These, above all, must correspond to very similar ones in the symptom set of the medicine sought if it is to be the most fitting one for cure.
§ 153 Organon
This has been found to be applicable to any component of the totality, irrespective of whether it is location, sensation, modality, or concomitant, or the symptoms of mind and disposition or even the symptoms of the parts of the body (particulars). The peculiar, unusual and striking symptoms represent that which is curable in each case of sickness and are the foundation of the homeopathic prescription.
Hence it is for the totality of the characteristic and peculiar symptoms that the similar remedy must be found, rather than for those symptoms which appear commonly in almost every case and remedy. They are peculiar to a few drugs and to a few patients suffering from similar diseases, reveal the individuality and are guides in the differentiation of remedies.
Hahnemann categorized the symptoms broadly into common and uncommon symptoms. Common symptoms are pathognomonic and found in many disease manifestations and remedies. They have some diagnostic but least prescribing value as they do not show how the patient reacts to the particular “morbific agent”. They are useless as they do not serve to distinguish, and you need to distinguish, to pick out the remedy. So with all common symptoms, whether general or particular, they will not help you. Never start on these, they are absolutely useless unless you can get something that qualifies and distinguishes, that is peculiar to this patient.
Uncommon symptoms however are peculiar or particular to a patient or a remedy. They cannot be explained by physiology, pathology and anatomy. The stranger the symptom is the more valuable it becomes because it makes the patient unique. They are graded by their uniqueness and rarity accordingly. “The truly characteristic symptoms of the patient exist exclusively outside of the pathological groups of symptoms of the discerned disease; nay more, they are symptoms which never necessarily belong to the disease or any form of it, but which appear as absolutely accidental”.
The key to the enigma is the GRADING OF SYMPTOMS, hence the first step is to understand that which is common to all diseases, and that which truly individualizes the patient.
The Importance of the MIND
Hahnemann clearly stated that:
The psychic condition of the patient is often the decisive factor in choosing a homeopathic remedy, because it is a particularly characteristic symptom and one that can least of all remain hidden from the carefully observant physician.
§ 211 Organon
He advises us in § 213 Organon that “one will never be able to cure according to nature – that is, homeopathically – if we do not, in every case of disease, even in such as are acute, observe, along with the other symptoms, those relating to the changes in the state of the mind and disposition, and if we do not select, for the patient’s relief, from among the medicines a disease-force which, in addition to the similarity of its other symptoms to those of the disease, is also capable of producing a similar state of the disposition and mind”. Moreover, Hahnemann points out that the emotional and mental state is always altered, both in emotional and mental diseases as well as so-called physical diseases. The altered mental and emotional state is closely related to our active miasmatic state.
Hence the psychic condition of the patient should be written down among the totality of symptoms as one of the most important, if one desires to have a faithful picture of the disease from which to make a successful homeopathic cure. But, the mental symptoms do not exist in isolation but are part of the totality of symptoms. Mental symptoms can be more common to all human beings or truly characteristic, strange, rare and peculiar.
Hahnemann’s followers, namely Kent, Boenninghausen and Boger, all placed emphasis on the totality of symptoms, the prime importance of peculiar, uncommon and striking symptoms as well as the symptoms of the Mind. A case may be workable by any of the methods, but the arrangement of the repertorial syndrome will be different due to their different approach in the evaluation of symptoms. Kent emphasizes Mentals, Boenninghausen points out the Modalities and Concomitants. Generals (physical, pathological, mental) Boger tells us.
“The art of repertorization lies in reconciling and getting the benefit of one or more of these viewpoints, depending upon the nature of the case before us, and the characteristic symptomatology we have been able to observe and elicit…. It is the unanimous opinion of leaders, however, that the symptoms of the disease that may be of diagnostic and prognostic value, which are common to the disease as such, have to be scrupulously kept out of consideration in our search for the curative remedy. Their positive value lies only in the fact that, when separated, the remaining symptoms are those which are characteristic of the individual sufferer“.
Process of Repertorization
1) Proper case taking including clinical, homeopathic and miasmatic analysis: taking the case fully and correctly is of crucial importance, as the choice of the remedy will entirely depend on how effectively the case has been taken.
2) Recording of the case.
3) Defining the problem: What has to be cured (see § 3 Organon).
4) Classification and evaluation of symptoms according to Boenninghausen’s, Kent’s or Boger’s type, i.e. grading or ranking of different symptoms in order of their value in order to completely frame the totality and match them with the drug symptoms to find the simillimum.
5) Selection of the repertory: the final choice of the repertory depends upon the gained symptom picture.
6) Conversion of symptoms into rubrics and sub-rubrics.
7) Repertorization (permutation and combination of rubrics) and preparation of the repertorization form.
8) Analysis of repertorial results and final selection of the remedy: higher matched and graded medicines are analyzed. Repertorization is a means to an end, never an end itself. The mechanical use of repertories and accumulation of remedies which run through all or most of the rubrics only approximates the choice and is greatly overshadowed by the relative standing of the individual symptoms. Emerging remedies have to be studied in the materia medica for differentiation and the final selection of the remedy.
The simillimum is not necessarily the remedy securing the numerically highest number of marks. The number of rubrics covered is more important than the number of marks. If one finds an unusual remedy coming through for even one or two important symptoms, the physician should check it up in the materia medica if that could be the indicated remedy. Not having fully proved or represented in the repertory, it may not come through as the indicated remedy in repertorization. Kent also teaches us that we do not shall expect a remedy that has the generals must have all the little symptoms.
Different approaches – same remedy ?
It is always the whole patient who is sick, and as there is only one remedy most similar to the case all three methods should come to the same indicated remedy in a given case. However, the symptom picture of the patient is seldom complete and forces us to chose the best approach depending upon the presenting symptom picture.
Pocket Book (BTPB)
|Boenninghausen’s Characteristics and Repertory (BBCR)||Kent’s Repertory of Homeopathic Materia Medica|
|The philosophical background is based on the following concepts|
All methods have their origin in the Organon and prescription is based on the Totality of Symptoms.
|Doctrine of Complete Symptoms,|
Doctrine of Analogy,
Modalities, Evaluation of
Principle of Grand
modality) present in
one part is
predicated to be a symptom of the whole.
|Doctrine of Complete Symptoms,|
Causation and Time,
present in more than three parts).
|From Generals to Particulars, with highest emphasis on the Mental Generals and strange, rare and peculiar|
Particular symptoms are used for further differentiation and the final selection of the remedy. They must be qualified.
The place of Generalization and
Concomitants is very limited in Kent’s view of the totality.
|Arrangement of symptoms|
The evaluation of symptoms is a must in all methods, and depends upon their value.
All methods emphasize the prime importance of characteristic, unusual, uncommon, strange, rare and peculiar symptoms as
Mentals are used for differentiation and the final selection of the remedy.
|The arrangement depends on the availability of data and their peculiarity:|
(agg. and amel.),
Mentals are used for differentiation and the final selection of the remedy.
chill, heat, sweat as to Type/partial, Time, Aggravation, Amelioration, Concomitant.
|Strange, rare and|
Symptoms have to be graded according to their value.
Complete symptoms, prominent
marked sensations and modalities,
when generals are lacking or strongly marked mentals are not available,
suffering in few parts but no modalities for all the suffering parts
with paucity of
symptoms (if the totality of the state can be filled out),
useful to get related remedies by working on the chapter on Concordances
|Cases rich in|
particulars with marked modalities and concomitants,
one-sided diseases (if the totality of the state can be filled out),
objective symptoms and pathological
cases without many mental symptoms,
useful to get related remedies by working on the chapter on Concordances
|Cases having generals and characteristic|
when mental symptoms or physical general
symptoms are marked,
useful in treating mental or emotional disorders,
In cases with lacking Mentals, the Physical Generals and
Characteristic Particulars will make the totality. If Generals are lacking, Characteristic Particulars should be used for repertorization, or,
Boger’s repertorization methods.
James Tyler Kent
Kent’s concept of totality
Kent also emphasized the detailed study of the expressions of the whole person which must be given primary importance to understand the nature of the disease. He studied all symptoms to understand the disease, which proceeds from center to circumference, from inward to outward. The totality of a case is formed by Mental Generals, Physical Generals and Characteristic Particulars.
Kent’s Totality of Symptoms is erected by the following hierarchy:
STRANGE, RARE AND PECULIAR SYMPTOMS
These may occur among mentals, generals, or particulars and must therefore be of varying importance and rank !
2. PHYSICAL GENERALS
Things affecting the whole body.
Ailments from, agg. and amel.
Symptoms related to sex, appetite, desire and aversion to food, weather, positions, food aggravations and amelioration’s, reactions to heat and cold, etc.
Symptoms related to the parts. (These must be qualified.)
From Generals to Particulars
Kent argues that â€žthe whole problem, like any other scientific problem, must be gone into and followed from generals to particulars”, what is in correspondence with his rule of government from center to circumference. There is one center that rules, controls and is supreme. All true diseases flow from center to circumference and the order of repair in the economy is also from center to circumference.
Man is prior to organs and the home in which he lives is his body. What is expressed in parts is always preceded by a deviation in the state of health of the person. Such a deviation can be known only through expressions at the general level.
J.T.Kent in Lectures on homeopathic philosophy
The homeopathic physician must use discrimination, must individualize things dissimilar in one thing and yet similar in other ways. This is done by the Generals, for without Generals of a case, no man can practice homeopathy; without these he will not be able to individualize and see distinctions. Kent points out that â€žin ninety-nine cases of a hundred you can leave out the particulars, for the particulars are usually contained within the generals”.
Kent argues that the method of working out a case from Generals to Particulars is the most satisfactory. However, if a case is worked out merely from the particulars it is more than probable that the remedy will not be seen due to the fact that the particulars may not have been observed yet. Thus to depend upon a small group of remedies relating to some particular symptom is to shut out other remedies which may have that symptom, although not yet observed.
Particulars (local symptoms) are common to many remedies and patients and cannot help us at all to differentiate remedies. Being “scanty”, i.e. incomplete, they cannot be given the highest rank. Yet Kent did not ignore them provided they were qualified by modalities of aggravation or amelioration or by concomitants.
By working in the other direction, however, i.e., from general to particular, the general rubric will include all remedies that are related to the symptoms, and, if after having done this, the particulars are then gone into and the remedy which runs through the general rubrics is found to have the particular symptoms, this will aid in its choice as the one to be prescribed.
Kent, Repertory of the homoeopathic Materia Medica, p.vii
The importance of the MIND
Among the Generals the symptoms of the Mind are of prime importance based on the assumption that disease has its origin in the mind, and on Swedenborg’s philosophy, in which Mind was seen to occupy a higher position than the physical body, and in the hierarchy extending from the dynamic plane to its ultimation in physical disease.
On the Value of Symptoms
Kent classified disease symptoms into three main categories whose value is classified into three grades:
Symptoms are classified into generals and particulars to evaluate their importance and â€župon correct generalizing depends all successful work as a homeopathic prescriber”. Both kind of symptoms can be either common or uncommon. All symptoms must be judged as to their value as characteristics, in relation to the patient, and “the student and physician must work to settle the generals, common symptoms and particulars to the fullest extent, if he wants to save work”.
Kent has developed a more sophisticated hierarchy of symptom-values which takes more time and greater application in understanding the various shades of differentiation of symptom-values and then to utilize the same for the repertorial analysis. It is to emphasize that each individual case and its symptoms requires evaluation according to its own requirement. “When you have taken a case on paper you must settle upon the symptoms that CANNOT be omitted in each individual“.
He gave very definite guidelines regarding the value of symptoms. In his evaluation of symptoms, Mentals occupy the highest place, followed by Physical Generals, and lastly the Particulars (particulars must be qualified by modalities).
Strange, rare and peculiar symptoms belong to the highest generals “because strange, rare and peculiar must apply to the patient himself”. Hence, these must take a high place in the search for the remedy. But Kent also says, “Get the strong strange, peculiar symptoms, and then SEE TO IT THAT THERE ARE NO GENERALS IN THE CASE THAT OPPOSE OR CONTRADICT”, as to prescribe on them exclusively is easy, but often fatal. “They may put you straight on to your drug (if the rest of the case fits!) – they may put you straight off it “, if they have never been recorded as having evoked. “When looking over a list of symptoms, first discover three, four, or five or six (or as many as may exist) symptoms that are strange, rare and peculiar: work these out first. These are the highest generals, because strange, rare and peculiar must apply to the patient himself. When you have settled upon three, four or six remedies that have these first generals, then find out which of this list is most like the rest of the symptoms, common and particular.”
General symptoms relate to the patient as a whole. They characterize the patient and are therefore of higher value than the particulars which affect only a given organ. With generals the patient refers certain symptoms or conditions of symptoms to himself, inner consciousness and ego, by saying â€žI am…”, â€žMe..” or â€žI feel…” or â€žI do” thus and so etc. The highest rank of all belongs to those symptoms, that are not only peculiar, but also general. They are broadly classified in mental and physical generals.
All mental symptoms are classified as Generals as they reflect the inner self and individuality of the patient, the subconsciousness or involuntary action of the mind. Kent regarded Mentals as belonging to the highest grade as they express the inner-most of the patient most absolutely and the symptoms around which other symptoms revolve – hence, they are most characteristic of the individual. They, if they are marked, dominate the case. If a mental trait is marked, and especially if it denotes change from patient’s normal, it is of the utmost importance to the case, and must be in the same type of rubrics as in the patient, i.e. if the symptom is very marked, the remedy you are in search of must be among the remedies in that rubric. They are of highest value in case taking and are frequently the key to the whole case.
But even the Mental Symptoms are graded. Of the highest importance are those that relate to the will. Of second grade, those that affect the understanding, and of the third grade, those that relate to the memory. Will and emotions deal with excitements, determinations, weaknesses, loves and hates, moods and temperaments, traits, suspicion, fear, jealousy etc. These are of the highest importance among the mentals. Understanding deals with perversions of understanding, intelligence, perceptions, illusions, delusions, dreams, loss of sense of proportions etc.
Physical generals are an expression of the reaction of the patient to the environment. They stand next to mentals and deal with the body as a whole under various physical conditions or circumstances, like disorders of sexual function, cravings and aversions of food and drink, menstrual state, sleep, symptoms caused by external influences like heat, cold, weather, climate, motion, time, position, posture etc. Kent also writes, that â€žmodalities, or conditions of aggravation and amelioration applying to the case as a whole or the patient himself, are generals of high rank”.
Particulars express the disturbance and suffering of some part, organ or function of the body, indicating the concentration of the disease in a certain part of the body. They can be qualified by location, sensation, modalities and concomitants. In these symptoms the patient speaks of â€žMy”. They assume importance in cases where generals point to more than one remedy or are not well marked or when particulars are characterized by outstanding peculiar locals, sensation, modalities or concomitants.
Common particulars may in certain circumstances assume a comparatively high rank when two common symptoms appear associated, i.e. when two symptoms, insignificant otherwise, combine. Then they can be the differentiating factor, even when the components were observed by quite different provers.
Generals are sometimes made up of particulars. If there are certain symptoms running through several particulars then these symptoms have become generals as well as particulars.
Kent writes, that â€žnothing in particulars can contradict or contra-indicate strongly marked generals, though they may appear to do so…” because the whole is greater than it’s parts. General symptoms rank higher simply because they relate to the man as a whole that, and if it is a strong and well marked one, it can overrule any number of even strong particulars. On the other hand, a number of strong particulars must not be neglected or under-estimated on account of one or even more weak generals. It is this question of the rank of symptoms that is the chief objection to the numerical method of selecting the remedy and all the mechanical methods are to end in failure for quality will ever be of more importance than mere quantity.
How to work out a case
First, differentiate the symptoms between generals and particulars, common and uncommon symptoms. As Kent gives more importance to Generals these should be found out in the first instance.
In the introduction to his repertory Kent offers the following suggestion:
After taking the case according to the lines laid down in the “Organon” (§§83-140), write out all the mental symptoms and all symptoms and conditions predicated of the patient himself and search the Repertory for symptoms that correspond to these.
J.T.Kent, Repertory of the homoeopathic Materia Medica, p.vii
All cases should be worked out according to Kent’s above hierarchy, using the uncommon, characteristic, rare and peculiar symptoms. Thus, first work out the Mental Generals, then Physical Generals and finally the Particulars.
Write out all the Mental Symptoms and all the symptoms and conditions pertaining to the patient himself, and search the repertory for the symptoms that correspond to these. Then we are advised to search for such Physical Symptoms that include the whole being, i.e. Physical Generals, as are predicated of the blood, color of discharges, bodily aggravation and amelioration, as well as desire for open air, desire for heat, cold air, for rest, motion which may be only a desire or a general feeling of amelioration. Circumstances that make the whole person feel better or worse is of much greater importance than when only a part is affected, and these are often quite opposite. The case is further individualized by using the Particular Symptoms predicated of the organs, functions and sensations, always giving importance to their modalities, especially the time of occurrence of every symptom, until every detail has been examined.
Then the symptom picture has to be examined collectively and individually, and lastly the closest fit remedy or remedies have to be studied in the Materia Medica until there is no doubt about the most similar remedy. In each case one must necessarily refer to the Materia Medica to confirm the choice of the remedy. You will generally find, that one drug stands out more and more pre-eminently, it may not be in all the rubrics, “but is has got to be in all the important ones, i.e. those best marked in the patient and of highest grade”.
Using eliminative rubrics
This standard method can be bypassed by the use of Eliminative symptoms, which are expected to contain positively the indicated remedy. Only the remedies covering this symptom are taken into account for further elimination. It is usually a short rubric and belongs to the highest ranks in Kent’s evaluation. A marked mental symptom that cannot be omitted can be used as an eliminating symptom, to compare with all the subsequent rubrics you consult. With this strong eliminating symptom you can go through the rubrics of the patient’s symptoms in their order, i.e. mentals, first, then generals, then particulars with modalities – taking from each list only the remedies that appear in this first rubric. In this way you can work down, till you are satisfied that the remedy is found that fits the patient as a whole. But to eliminate with safety you must be sure that the symptom is real and marked and actually expresses the patient.
Dr.Gibson Miller used “Hot and Cold Remedies” as eliminative rubrics to work out the case (see appendix).
These principles also apply for “Kent’s Final General Repertory of the Homoeopathic Materia Medica”, written by Dr.Pierre Schmidt, as well as “Kent’s Repertorium Generale”, written by Jost Künzli von Fimmelsberg. Both are revised editions, taking the effort to complete and correct Kent’s repertory.
Some notes on Kent and Constitutional prescribing
Kent also mentioned a time component which is to be considered in the evaluation of symptoms. He writes that symptoms persisting from childhood are of high importance and can point to possible causation’s for the developing pathology and to the indicated remedy. However, the pathological result itself is not of much help in selecting the simillimum.