Acute Prescribing in Homeopathy–Even You Can Learn to Do It!

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?

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:

• gels.
• bry.
• ars.
• acon.
• eup-per.

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!

What?

And why do I say that? Because the Repertory rubrics for these symptoms (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….

Yes?

….always remember…

Yes?

The Big 4!

The Big 4? 

Yes, the Big 4:

Sensation, Location, Modalities, Concomitants

Isn’t that a doo-wop song?  

Kelly, our readers from India have nooooooooo idea what you’re talking about; but, maybe it’s high time they, as a nation, got into “doo-wop”!  (After all, we got into Ravi Shankar in the ’60′s, didn’t we?  Not to mention the Maharishi!)  So, the song you’re thinking of  is “Every Day of the Week” by the Students.  No really!  Just substitute “Sensation-location, modalities-concomitants” for “Sunday to Monday, Tuesday to Wednesday, Thursday to Friday, Saturday to Sunday!”  Go on, try it, click here, or go to YouTube and type in “The Sudents Every Day of the Week”: 

http://www.youtube.com/watch?v=RbJ1ikRnG10

Elaine, people are going to think we’re crazy!  But I love that song!  I can’t stop singing it! 

While you’re doing that, I’ll tell everybody what modalities are–they are REALLY important to us; if we don’t get the modalities in a case?  Forget it!  Modalities are all the factors that exert an influence on the complaint!  For example, if you have the flu, believe it or not, there will be factors that make it better or worse and these are called “modalities”; you may be better for cold drinks, or, worse from fresh air, or better for hot bathing or hot drinks like tea, or better from hand-holding and sympathy, or worse from all company and conversation and better for lying perfectly still.  These little details could not possibly be more important to the homeopath!  Try and think of EVERYTHING that makes your complaint better or worse!

And what about “concomitants”, what are they?

Concomitants are the adjunctive, extra, symptoms in the case.  “Additional symptoms”.  They are highly valued because they are often the striking, strange, rare or peculiar ones which Hahnemann says we need to know or the likelihood of cure is rather slim.  Take for example, menstrual cramps with burping.  What does burping have to do with menstrual cramps?  Nothing, that’s what makes it the concomitant!  I need a remedy that burps and hopefully also has cramps!  When Shana had menstrual cramps one time and started burping, I went right for the Carbo veg (our major burping remedy) I didn’t even stop to think about it!  It worked too!

Observing the patient is very important and can often give you the concomitant. Observe what the patient is doing and saying.  This is so important, it’s part of my questionnaire:  What are you doing?  What are you 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–even talking). 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 for two seconds ago!”). Arsenicum patients are begging you not to leave! (“Can’t you just stay one minute more?”)

Do you need to know anything else besides the Big 4?

Which, again, are?

OK, singing now:  Sensation-Location, Modalities-Concomitants/Sensation-location, modalities-concomitants!

(Boy, I’m going to regret this!)  Very good Kelly! 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!

Really?

Sometimes Baptisia, if the case is septic.

And what does that mean?

Sepsis is characterized by bad odors, stuporousness, confusion, etc. If a septic condition comes on suddenly, think of Baptisia. Baptisia is thought of as a “worse” Gelsemium with the addition of thirst; plus, stuporous presentation, apathy and inclination to sleep. Now for # 3. I’m leaving the best for last.

What’s that?

3. Etiology!

That means the cause! Am I right?

Yes. You have to know this! The remedy must cover it! Unless the etiology is something vague, like, “germs” or something really common, 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 a certain remedy, like 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 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? the whole thing?

We need to do this for every symptom. A properly delivered symptom would sound something 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”  is a completely worthless statement! The “constipation” rubric contains over 200 remedies, which means practically every remedy has constipation!

Does that mean practically any remedy will solve the case?

NO!!!!!

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?

The “Generals”!  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 just a local complaint, like a sprained ankle or even a broken leg or some other complaint that’s localized.  You can still get on with your life even if you have a broken leg; but, let something effect you “in general”, and heaven help you!  Your life comes to a screeching halt!  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 to match. “General” symptoms start with the word “I”. “Particular” or “local” symptoms start with the word “my”. Example of “Generals”:

“I’m nauseous.”

“I’m cold.”

“I’m scared, I need someone sitting right here!”

“I need to have a fan blowing on me!”

“I need a cup of ice.”

“I’m cold but I don’t want a blanket, get rid of it!”

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 all you’ve got are common symptoms/diagnostic symptoms and nothing else; 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:  using the thing that’s wrong against itself, there may be some bodily fluid that you can make a remedy out of. 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 you can do a search for; plus, it’s on my website.

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?

Should we recap before succumbing to information-overload?

Good idea! You’ve got a sick patient. The first thing you want to know is….

WHAT’S WRONG!

Followed by…

WHEN DID IT START, AND, 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?)

then…

WHAT MAKES YOU BETTER OR WORSE IN GENERAL?

(this includes time of day when person is better or worse) Plus, all the “I” symptoms.

followed by…

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!  Don’t tell your homeopath, “My leg hurts!  My scalp itches!”  Say, “My leg hurts in the calf area, I got it from over-stretching, it’s better from rubbing.”  “My scalp itches.  Scratching makes it worse!  Very hot water makes it stop.”)

Remember that Concomitants are any symptoms that are unexpected 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. 

IF THE CASE HAS A MENTAL/EMOTIONAL CONCOMITANT, THE REMEDY MUST MATCH THAT (unless it’s vague or common)!

I apologize if I’ve already said that; and oh, by the way, your homeopath is going to ask you to describe your symptoms anew each time you get the same complaint because she — or he — knows that just because you’ve had cramps before, or you’ve had PMS before, or you’ve had a headache before, doesn’t mean that THIS headache and THESE cramps are exactly the same!  So don’t say, “I’ve got a headache again!”  Talk in complete symptoms!!!!  “I have a headache on the right side (location) that came on suddenly (onset) after being out in the sun (etiology) and it feels like little men are hammering on my head (sensation) and it’s worse lying flat, better sitting up, worse in bright light (modalities), I’m also nauseous (concomitant) and I’m not thirsty (general).  What remedy is this?  Belladonna, of course!

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 matching. So, here it goes:

Diagnosis/name of the condition–aka, “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 look like?  What does he ”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.)

Generals

Particulars (the big 4, which are, again?)

Are you askin’ me?  Are you talkin’ to me?

So now you’re Robert DeNiro all of a sudden? 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!! 

OK!  Enough!  I’m starting to get irritable and thirsty!

This would be a good place to stop, I guess.  Did you know, Kelly, that Acute Prescribing and Emergency Prescribing are the highest levels of homoepathy?

I’m sorry, I did not know that.

By knowing how to solve acute cases, 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; this is why we have to treat chronic disease in a manner that allows us to stop the chronic remedy during an acute, give the acute remedy, and resume chronic treatment when the acute resolves.  Obviously high-potency, one-dose chronic prescribing does not lend itself to this!  We can’t let people suffer, they’ll leave homeopathy and go right to their doctor!

Good point!  I’m leaving.

Will I see you in the quiz section, Kelly? Kelly?

Mom, Kelly just left. She was singing some sort of doo-wop song on her way out the door.

Shana, I’m afraid I’ve ruined “Every Day of the Week” by The Students!

———————————————–

Elaine Lewis, DHom, CHom

Elaine takes online cases.  Visit her website:

hpathy.com/office/ElaineLewis.asp

Elaine Lewis

Elaine Lewis, D.Hom., C.Hom Elaine is a passionate homeopath, helping people offline as well as online. Contact her at LEWRA@aol.com Elaine is a graduate of Robin Murphy's Hahnemann Academy of North America and author of many articles on homeopathy including her monthly feature in the Hpathy ezine, "The Quiz". Visit her website at: http://elainelewis.hpathy.com/ and TheSilhouettes.org