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Homeopathic Repertory |
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| Hpathy Ezine - March, 2009 | ||||
Introduction to the Repertory-- Todd Rowe |
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| What is a Repertory? A repertory is a place where information is stored or categorized so that it can be retrieved more easily. It is an index of symptoms, with a listing of all of the remedies known to be associated with each particular symptom. This information can be stored in a book format, on software, compact disc, or through a collection of cards (card repertories). The word "repertory" comes from the Latin word repertus, which means "to find." Purpose of the Repertory The purpose of the repertory is to help you find the right remedy for a given case. It is a tool. The repertory helps to individualize a case to find the right remedy for the right person. It also assists the practitioner find small and rarely used remedies and to link unusual symptoms with the appropriate remedy. There are some cases where using the repertory is crucial to finding the right remedy and other cases where it is much less useful.
History of Repertories Initially in homeopathy there were no repertories. Hahnemann had only proven a few remedies, and it was possible to remember the symptoms that were associated with each of the known remedies. As further provings were undertaken and homeopathic knowledge increased, it was no longer possible to remember all the symptoms associated with each particular remedy. Repertories became increasingly necessary. The first repertory was created by Hahnemann in 1805 and was handwritten. It was difficult to use, reflecting more an alphabetical index to the provings, and Hahnemann was never entirely happy with it. The next repertory to come out was written by Clemens Maria Boenninghausen in 1832. It was called Repertory of Anti-psorics and focused on the importance of modalities (something that makes a particular condition better or worse). Georg Jahr also wrote a repertory in 1835 called the Symptomen-Codex; it also was handwritten. This repertory was only based on proving symptoms. Hempel translated Jahr's repertory into English and added to it, creating a much more substantial repertory in 1848. The first French repertory was written by Lafitte in 1844 (Symptomatologie homoeopathique, ou tableau synoptique de toute la matiere medicale pure. Vol. I, Paris). Lippe was one of the first homeopaths to add more mental and emotional symptoms to the repertory. His repertory was expanded by Lee, who abandoned the effort when he went blind. Much of Kent’s Repertory is based on the work of Lee and Lippe. Card repertories were popular in India. There have been more than 125 repertories created. Many are complete repertories, while others focus on only a specific area, such as Boenninghaussen's repertory, devoted only to fever (Verushch einer homoopathicschen Therapie der Wechselfieber. Munster, 1833). These repertories are of varying quality and usefulness. Modern Repertories In more recent years efforts have been made to create repertories that are easier to use, which update the archaic language of many of the older repertories. Two of the most important of these are the Complete Repertory by Roger Van Zandvoort and the Synthetic Repertory by H. Barthel and W. Klunker. Both of these repertories are more expensive, but extensively researched, painstakingly constructed, and well designed. Robin Murphy's The Homeopathic Medical Repertory is also popular, although considerably shorter. Many of the newer repertories combine older repertories and add symptoms gained from more recent provings. Electronic versions of repertories are becoming increasingly common. Still, Kent’s Repertory of the Homeopathic Materia Medica remains the most common repertory used in the world today. This workbook uses Kent's Repertory as its main reference. How is Information Added to the Repertories? The repertories are incomplete. There is always more information that needs to be added. The repertories are primarily based on symptoms obtained from provings. Another method in which remedies and symptoms are added to the repertory is through cured cases. When homeopaths consistently see a symptom cured by a particular remedy, this may be added to the repertory. You may also see information in the repertory that is based on accidental poisonings. For example, one of the ways that we know about the remedy Heloderma suspectum (venom from the lizard Gila Monster) is from bites of the animal on humans and the associated symptoms that develop after the bite. These symptoms are then recorded into the repertory. One of the advantages of electronic homeopathic repertories is that this information can be updated much more quickly and regularly. Grading of Symptoms When a proving is completed, the symptoms of that particular remedy are added to the repertory on a graded basis. Symptoms that are very strong, clear, and common are added as threes (3) (usually designated by dark and bold type); symptoms less common and only moderately clear and strong are added as twos (2) (usually designated by italics or plain type with underlining); symptoms that are infrequent and weaker in intensity are added as ones (1) (usually designated by plain type). For example, on p. 37 of Kent’s Repertory, you will find the heading of "Disgust". Puls(Pulsatilla) and Sulph (Sulphur) are listed in bold type for this particular symptom (3). Merc (Mercurius vivus) is the only remedy listed in italics (2) and Ars (Arsenicum album), Cimx (Cimex), Coloc (Colocynthis), Mez (Mezereum) and Phos (Phosphorous) are listed in plain type (1). Kent’s Repertory Kent’s Repertory of the Homeopathic Materia Medica was written in 1877. He was more of an organizer of other repertories, and much of his work was based on Lippe's work. However, he also added a great deal of information gleaned from his own experience. Kent’s Repertory contains 648 remedies. His repertory is perhaps best known for its Mind section, which was more complete than any previous repertory in this area. General Layout of Kent’s Repertory A particular symptom in repertory is called a rubric. For example, on p. 63 of Kent’s Repertory you will find the rubric "Loquacity". On page 766 you will find the rubric "Difficult Respiration". Remedies are listed alphabetically for each rubric. Abbreviations are used for each remedy (see Appendix D for a listing of abbreviations associated with each particular remedy). This helps to reduce the size of the repertory. The general plan of the book is to work from generals to specifics and from the top downwards. The book is based on anatomical divisions (see Appendix E for a listing of each separate section). There are thirty-one separate sections. Take a few minutes to familiarize yourself with the sections of the Repertory. Note that there are no sections for systems such as the circulatory system or the nervous system. Symptoms that relate to these systems are sometimes found in the Generalities section. The general format is to work from the top of the body to the bottom. For example, the Head section is followed by the Eye section, the Ear section, and then the Nose section. One of the largest sections of the Repertory is the Mind section, which is at the beginning of the book. The Generalities section lies at the end of the Repertory. These two sections are the most important and are used the most in prescribing. Take a moment to review the Word-Index section at the back of the Repertory. This is quite helpful when you are looking for a particular word that you cannot seem to find. Structure of Kent’s Repertory Each section of the Repertory is alphabetical and each main heading is followed by modifiers (see Appendix F for how these modifiers are structured). This format is the general rubric, followed by side modifiers, time modifiers, modalities, extensions, locations and ending with descriptors. This basic structure is followed over and over again in the Repertory and it is important to familiarize yourself with this. The most difficult section to follow in the Repertory is the Head Pain section. If you can follow through this and understand how it is structured, then everything else in the repertory will be easier. The "Head Pain" rubric starts on page 132 in the Head section which starts on p. 107. You will note that over 500 remedies are listed under the rubric "Head Pain". This is the largest rubric in the Repertory. Because this rubric is so large, it is not usually very helpful in finding the right remedy for someone with headaches. Everything following the rubric "Head Pain" from p. 132 until p. 221 is classified as a sub-rubric. Sub-rubrics are modifiers or descriptions of the initial rubric (in this case "Head Pain"). The first sub-rubric after the general rubric of "Head Pain" is "daytime" on p. 132. This is the first of the time modalities. This means a headache that occurs during the daytime. Following this is the sub-rubric "morning" which again means a headache in the morning. The next sub-rubric "in bed", is indented and therefore is a sub-sub-rubric that modifies the preceding sub-rubric. This means head pain in the morning in bed. Similarly, all of the following sub-rubrics until "10 p.m.’ on p. 133 are modifiers of the sub-rubric "head pain in the morning". For example the sub-rubric on p. 133 of "increases and decreases with the sun" means head pain that is worse in the morning and increases as the sun rises and decreases as the sun sets. The time modality section then continues with "forenoon" on p. 133 and finally ends with the sub-rubric "5 a.m." on p. 135. The next section of modifiers after time aggravations is Modalities. Modalities are basically modifiers or qualities that affect the basic symptom. This section begins on p. 135 with "acids from". This means head pain from eating acid food. The section ends finally on p. 152 with "when yawning". The next section is Extensions. This means a symptom that extends from one place in the body to another. For example, the first extension is "extending to the back" which means head pain extending to the back. The section ends with "zygoma" (cheekbone) on p. 153. The next section is Locations. The first location is "Bones". This means head pain that seems to localize in the bones of the head. This section continues until p. 173 when it ends with "Vertex and Forehead". Note that each location, such as forehead on p. 153, goes through the same cycle of structure as the larger sections including a general rubric (153), followed by side modifiers (154), time modifiers (154-5), modalities p.p. (155-158) extensions (158-159), and ending with locations (159-161). The last section of the "Head Pain" rubric is Descriptors. Descriptors are qualities of the pain (see Appendix G). This starts on p. 173 with the subrubric "boring" and ends on p. 221 with "wedge like". Note that for each type of pain the same cycle of general rubric, sidedness, modalities, extensions, and locations continues. Amelioration and Aggravation You can assume that everything in the Repertory means "worse from" unless "amel" is notated. "Amel" stands for ameliorates and means to make the condition better. Therefore the sub-rubric "daytime" on p. 132 means a headache worse during the daytime. The sub-rubric on p. 133 of "amel" means head pain that is less in the morning. Common vs. Uncommon As you look through the Repertory, you will find that some remedies are much more common than others (see Appendix A). Some remedies were very well proven at the time that the Repertory was written, and there is a wealth of information available about them (these are also known as polychrests). Others only came into usage later in the development of homeopathy and are poorly represented in the Repertory. Many of the remedies that have been proven more recently such as Saguaro (Carnegiea gigantea), Neon, or Dolphin's Milk (Lac delphinum), are not contained in the Repertory at all. Information on newer remedies can be found in proving transcripts or in more recent materia medicas (e.g., The Synoptic Materia Media Two, by Vermeulen). Periodically, the more modern repertories are updated with information from the most recent provings. The most common remedy in the Repertory is Sulphur. See Appendix A for a listing of the most common remedies found in the Repertory. What is Contained in the Repertory? The Repertory generally represents states of pathology or disease. The most important symptoms used in prescribing a homeopathic remedy are symptoms that are based on disease states. The healthy areas of the individual's life are usually not as helpful in finding the correct remedy. Disease represents limitations of freedom in the individual's life. The following are rubrics listed in the Mind section of the Repertory: Benevolence (9) Cheerful (10) Laughing (61) Tranquility (29) These represent qualities that become symptoms when they are out of balance in the person's life (limitations of freedom). For example, the rubric "Benevolence" could be used for someone who constantly gives their possessions and money away at the cost of being poor and in continuous ill health. Confusing Rubrics Rubrics are sorted using the first word of the rubric, while the remainder of the rubric is used as a modifier. For example, on p. 63 you will find the rubric "Love, Ailments from Disappointed" which actually means ailments from disappointed love. On p. 12, you find the rubric "Clinging, children, of, awake terrified, know no one, scream, cling to those near." This refers to a child who awakens terrified and clings to anyone who is near. The sort is on the word "Clinging." How Is the Repertory Used? Cases are seldom solved by using a single rubric or symptom. The process of choosing rubrics and combining these to choose the right remedy is called repertorization. Generally between three and ten separate rubrics are chosen to solve a case. Appendix I contains a sample blank repertorization sheet. You may want to make copies of this sheet to use in repertorization. Each rubric chosen is written on the top of the repertorization sheet. The remedies are entered into the corresponding columns as either grade one (1), two (2), or three (3). Finally the numbers are totaled up to see which remedy(s) are best represented in the repertorization. The last step in analyzing a case is to study the materia medica of the most well-represented remedies in the repertorization and to choose one that best fits the case. Ideal-sized rubrics to choose are often ones that are neither too large or too small. Using rubrics that are too large takes a great deal of time to repertorize and often results in a repertorization that leads only to the most common remedies (polychrests). An example of a rubric that is too large to be useful is the rubric "Head Pain" on p. 132, which contains over 500 different remedies. Using rubrics that are too small can also create problems. This may result in excluding the right remedy from the field. When a rubric contains ten to twenty remedies, this is generally thought to be ideal-sized. Repertorization can be a time-consuming process. In recent years, the use of computers has made this whole process automated and almost instantaneous. There is no right or wrong way to repertorize a case. Some homeopaths tend to use many rubrics and others use just a few. Many different strategies may ultimately lead to the selection of the right remedy. Again, what is most important is that the repertory is a tool to suggest to you possibilities for further study of remedies leading to the best remedy selection. A sample case is as follows: John is a forty three-year-old single male who has had an acute, severe sore throat for the last three days. The pain is markedly worse when swallowing liquids, and is only on the left side. The pain is also worse when swallowing warm fluids. There is significant pain in the throat pit. There is a very strong craving for pasta. He says that he is afraid to take any medication for this because it might poison his system. The rubrics that were used in the analysis are as follows: Throat, Pain, Swallowing on, Liquid (459) Throat, Pain, Left (458) Throat, Pain, Swallowing, Warm Drinks (459) Throat, Pain, Throat Pit (473) Stomach, Desires, Farinaceous (485) Fear, Poisoned of Being (46) You can see the repertorization in Appendix I. The remedy that comes through most strongly is Lachesis. Lachesis is a remedy that is noted to have severe sore throats that are worse on the left side. One of the keynotes for this remedy is pain that is worse when swallowing liquids. People who need Lachesis also tend to be warm and are worse from heat. A single dosage of Lachesis 30C was administered, and the symptoms resolved completely in six hours. How to Choose the Most Important Symptoms The best rubrics to use are those that most characterize the symptoms of the case. Avoid symptoms that are common for the particular pathology of a case and choose rubrics that are uniquely characteristic of the individual person. Common symptoms of a particular disease do not tell you about the person who has the disease. Homeopaths prescribe for the person and not for the disease. Also, mental symptoms and general symptoms are often more helpful in finding a remedy than physical symptoms are. Common symptoms of various diseases can be found in many medical books, such as Current Medical Diagnosis and Treatment A Lange Medical Book by Tierney, McPhee, Papakakis, and Schroeder. Some homeopathic software also has this feature. For example, when someone has a urinary tract infection, the symptom "pain in the bladder" is common and much less useful than the symptom "pain that is only better when the individual is taking a warm bath." Another example is someone with a migraine headache associated with vomiting. The symptom "head pain with vomiting" is very common in migraines and would be less useful than the symptom "head pain associated with violent twitching of the right eye" (a symptom that is not commonly associated with migraines). Finally, the symptom of "anxiety" is common, whereas the symptom of "fear on waking of something under the bed" is far more characteristic. Additions When new information is found about a remedy or new provings are performed, this information is then added to the repertory. This is the reason that many of the more modern repertories are larger than the older repertories. There also are published additions that can be written into the repertory. One example is the Additions of George Vithoulkas. Also, remedies can be added to rubrics when we see a particular symptom repeatedly cured in our cases, even if this is not listed in the materia medicas. How Can I Learn to Use the Repertory More Effectively? The best way to learn to use the repertory is to practice. The more you look up rubrics and find your way around the repertory, the easier it becomes. Repertorization exercises such as those recommended in the next several lessons can be helpful. Ultimately, however, the best way to learn the repertory is through study of cases. There are also several courses available in the further study of repertory. ---------------------------------------------- Dr.Todd Rowe is a licensed homeopathic physician in Arizona. He teaches extensively and has written several books on classical homeopathic education including Homeopathic Methodology and the Homeopathic Journey. He is the past-president of the National Center for Homeopathy and serves on the Board of Directors for the Council for Homeopathic Education. He is the director of the American Medical College of Homeopathy and the Society for the Establishment of Research in Classical Homeopathy.
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