Respected Sir,
How should we proceed in treating a case (Say, throat diseases)
1.Select all medicines affecting throat and differentiate among them as per local modality,concomitants,causation etc;.
OR
2.Consider mentals, physical generals etc; and individualise only those in this list and AFFECTING THROAT.
OR
3.Take only mentals and generals and leave out throat symptoms altogether if that data alone is sufficient for arriving at the remedy.

The approach will vary from case to case. You may need either of the 3 approaches. There can not be an absolutely rigid guideline for finding the similimum. There are lot of variables involved. I have also discussed this in your previous query related to pathology. No doubt, the ideal similmum should not only cover the physical and mental generals but also the local complaints. But if you do not have a full case due to any reason (lack of time or cooperation from patient or large no of patients/day etc), there is no option but to prescribe only on the presenting complaints. There are homeopaths who would consider every acute as a seperate disease requiring seperate medicine. Then there are homeopaths who say whatever be the acute complaint, give the chronic similimum only. Both such practices are extremely polarized and often not in the benefit of the patient. The first one is not able to see the chronic-tendencies behind acute complaints and the other totally ignores the presenting symptoms of the chief complaint in acute conditions.

I personally appreciate the middle path used by Vijayakar. It basically states that very often the medicines required by a patient for acute complaints will be in relation to the chronic similmum. And such medicnines can be given for acute conditions in chronic cases. For e.g. A calcarea patient may need Bell in an acute and a Sulphur patient may find Aconite indicated in an acute. But here is a word of caution. Many times it happens that when a true similimum is administered, an acute involving a less important organ can occour as an eliminative or healing response. This should not be interfered with. Let it run its course and the patient will recover in a day or two. But this will happen only if you are confident about the similmum and it needs lot of experience to differentiate between an isolated acute and a healing response.

Good wishes,
Dr. B