Homoeopathy case-taking – in search of the truth…

truthThe following is a post I originally put up on my general blog, aimed at the not-necessarily-homoeopathy-oriented public. However, as I’ve mentioned previously probably (possibly?) more than once, getting “true” answers and being aware of the less than “true” ones is so crucial to our case-taking that I decided to put this article up here too for your perusal.

I could also have titled this post “On homeopathy, marketing, treadmills and chocolate.” Read on. You will get my drift.

Modern culture is all about marketing and sales. How you present yourself has become all-important, and just being “you” seems to never be enough. It’s all about the spin.

When people come to me for treatment, I ask a lot of questions. But I’ve found that in many cases, certain questions are just asking for a marketing response, a how-does-this-make-me-look response, a spin. These responses are inventive, creative and make good marketing copy. But they are not true. The following examples relate to exercise and diet. Please note – I’m not talking here about whether people should or should not eat salad or exercise. I’m talking about how the responses may be so skewed for image and presentation that the questions themselves have become fairly useless in eliciting any truthful (and for homeopathy that means useful) response.

Q. Do you exercise?

In our times, regular exercise has moved right up there, next to cleanliness and godliness. From being a practical activity which some enjoy and some abhor, it has become a value-laden concept. If you don’t exercise regularly, you are lazy, a burden to society, doomed to suffer many unmentionable diseases, with no hope of salvation. The place of worship for this quasi-religion may be the gym, the track, or that little room at home where you keep your treadmill and personal rowing machine. If you do exercise regularly, you are demonstrating your value as a person, your sound willpower, your responsibility to your health, and your commitment to looking good reflecting a positive attitude to life. No pain, no gain is also part of the backstory here, denoting either serious masochism or the much-lauded ability to overcome limitations.

As with any religion, there are the exercise dissidents. Those for whom admitting to regular exercise means admitting to being uptight, uncool, addicted to lycra workout leotards. Gym membership (or “health club” as it is righteously termed nowadays) is tantamount to becoming “one of them”, someone who doesn’t think for themselves and lacks individuality, someone who follows the modern “quasi-gods” of the health and fitness columns, advocating toned bodies and cardiovascular wellbeing. The dissidents may well exercise regularly but they will find it hard to admit, often muttering something about a love for hiking in response to the question, while insisting that they would never give up smoking…

Here’s another loaded one:

Q. What do you like to eat?

As with exercise, we have the adherents of the food spin, and the dissidents. Some patients will wax lyrical about the Joy of Salads, describing their love of plant food in glowing terms. There are even those who make assumptions about my preferences, and seem to play to those assumptions. “I don’t eat any meat” they say shyly, looking at me for my approval. Others will inform me how healthy food is essential, and they always follow a healthy balanced diet, and will proceed to lecture me on what a healthy balanced diet is (don’t get me wrong, that doesn’t bother me). Then there are those who will describe how they never eat flour/carbs/meat/sugar/chocolate as they don’t like it/become instantly sick from it/can’t bear the sight or smell of it. One such patient, after expressing a deep seated love of raw vegetables in many colours, later came to me asking if I could do anything for weight loss. You will realize that I was slightly bemused – I had no idea that raw vegetables could have that effect. I have heard many descriptions of food preferences, which similarly have not been observed in practice. Like the lady who – in her desire to appear elegant, soignee and above such base pleasures – refuses dessert, the food preference responses often have more to do with image than truth.

And then we have the dissidents – those who insist that their eating habits are unhealthy because, let’s face it, there is nothing cool, or even slightly louche, about a salad. Some of these patients will assume that as a homoeopath, I could never, ever possibly have cravings for a really good, well done steak with chips, and they will declare their food preferences to me defiantly, with in-your-face aplomb. These people will tell me about their poor diets, their addictions to cake, chocolate, ice cream, burgers, pizzas, red meat. For some this is the truth. But for others – it’s yet another spin, plain and simple, and on investigating further, it turns out that their terrible diets are really not so bad after all.

This is why I prefer to ask very different questions, to get a more accurate picture of the patient’s state of sickness, and how it compares to their state of health. I have learned to ask questions where spin is irrelevant – where it’s more trouble to look for an alternative to the truth, and there isn’t really any perceived need to do so.

For example:
When you get a headache – can you turn your head? Can you move your eyes from side to side? Can you look up? Can you look up without moving your head?

Does your back hurt more when you bend backwards? Forwards? When you’re getting up from a chair? When you go from standing to sitting?

Do you get your stomach ache before a meal? During a meal? Afterwards?

Is your depression worse in the morning? Afternoon? Evening?

Are your sleep problems more connected to not being able to fall asleep? To waking frequently for no reason? To waking too early?

Even these questions could lead to some form of spin in the answer, but the chances of that happening are much less. And I challenge anyone to find a good reason to spin answers to questions about whether their runny nose is green, yellow or white, whether their haemorhoids are more painful sitting, lying down or standing, and whether that diarrhea is …. OK, I’ll save that one for a private conversation.

Viewed through proving: the seductive nature of Sepia storytelling

fairy storyNow you tell me, which of the following is more interesting:

“Sepia is suited to tall, slim women with narrow pelvis and lax fibers and muscles; such a woman is not well built as a woman… the remedy seems to abolish the ability to feel natural love, to be affectionate… she may even be estranged and turned aside from those she loves. This is on the border land of insanity… (Kent’s lectures)”


Sepia is suited to all men and women who exhibit symptoms pertaining to that remedy, to be determined first with reference to the proving and subsequently to other materia medicas. (VR et al, 2015)

Sepia is one of those remedies where the temptation to get into lyrical storytelling is often irresistible. I recall with much embarrassment a time when I used to teach the “washerwoman” characteristics of Sepia, drawing a pitiable and indelible picture of the suffering charlady (see Tyler’s Homeopathic Drug Pictures) that almost brought me to tears.

Because of these caricatures,  Sepia is one of the hardest remedies for case management. When patients learn they have received Sepia and are drawn to do some independent research on the remedy, they inevitably get to the “washerwoman” picture. I try to explain that I work from provings, not from the “easy reading” materia medica they are likely to find on the web. I try to explain that by prescribing Sepia I’m not pigeon-holing the patient as a washerwoman type, an exhausted mother of a large family type, the woman who is unable to feel natural love, the woman who is not well built as a woman…

Could the “washerwoman” identity of Sepia have begun with a case mentioned by Constantine Hering in his Guiding Symptoms, concerning a “washerwoman, aet. 23, affected since 3 years old; profuse sweating of hands”? Perhaps – it’s one of the few cases which have more identification than “man” or “woman”. One thing is clear – the “broken telephone” nature of the development and understanding of materia medica is very evident here.

Working from provings, beginning with the provings does not rule out subsequent materia medica. But it does give the homeopath a context for anything else he or she reads about a remedy. If you read about washerwomen and then read the proving – your take-away from this study is first and foremost the washerwoman image, and then the proving. It’s much more beneficial to work in the other direction.

When you begin with the study of the remedy in the proving, in ways I’ve suggested in previous posts, you’re actually setting up a context. When “washerwoman” comes up, you can see whether it fits into that context, in physical symptoms and psychological outlook. But when you are trying to fit your patient’s case into the context of “washerwoman”, so much of the proving of Sepia becomes inaccessible, and your patient now really has been well and truly pigeon-holed.

Sepia has many symptoms relating to the emotional and mental state in Hahnemann’s proving. I’ve copied some symptoms below. I recommend simply reading through, with the understanding that you are setting the context for the washerwoman, the slim manly woman or any other images you may read in later materia medica. To get the full context for these images, I recommend reading the proving in its entirety, and looking for the symptoms that could have given rise to such images. The context is both broader and more focused than these narrow examples of “personas” that are so seductive to so many homoeopaths, but as in most seductions which make use of an artificially built illusion – never a good basis for a long-term relationship…

1. Dejected, sad.
2. Sad, especially in the evening.
3. Sad and troubled, most of all when walking in the open air.
4. Very sad with unusual weariness.
5. Sad about her health.
6. Troubled thoughts about his disease and about the future.
7. Melancholy, especially in the morning.
8. Troubled about her health, anxious, irritated and very weak.
9. She has none but troubled thoughts about her health, thinks she is getting the consumption and will die soon.
10. All her troubles present themselves in a very sad light to her mind, so that she is despondent.
11. If he only thinks of his past troubles, his pulse is quickened and his breath fails him.
12. Great sadness and frequent fits of weeping, which she could hardly suppress.
13. Lachrymose.
14. Irritably lachrymose.
15. She might have wept for displeasure at every thing, without cause.
16. Melancholy, she feels unhappy without cause.
17. Dread of men.
18. She wishes to be by herself and to lie with closed eyes.
19. He must not be alone for a moment.
20. Solicitous and anxious, with peevishness.
21. Apprehensive trembling, with cold sweat on the forehead.
22. Anxiety, in fits.
23. Intense anguish in the blood.
24. Anxiety, apprehension, at various times.
25. Anxious, toward evening.
26. Anxiety in the evening, she becomes quite red in the face, and the flushes of heat keep alternating from time to time.
27. Great internal restlessness, for many days, with hastiness; he wants to be done with his work even as he begins it.
28. Restless and lacking serenity, for many days; occupied with sad memories, and anxious, she has not the patience to stay long in a place.
29. Discouraged and peevish.
30. Entire lack of spirits (aft. sever. h.).
31. Extreme loathing of life; he felt as if he could not any longer bear this miserable existence, and as if he would pine away unless he made away with himself (aft. 24 h.).
32. Very easily frightened and timid.
33. Discontent.
34. Very readily offended.
35. Peevish and indisposed to all work.
36. Depression, especially in the morning.
37. Sorrowful mood, as after secret vexation.
38. Excitableness.
39. Very much excited all over her body.
40. The nerves are sensitive to every noise.
41. Very much affected from playing the piano.
42. The remembrance of past trouble puts him into extreme ill humor.
43. Vexatious occurrences from past times keep recurring of themselves, which makes him so irritable that he gets quite beside himself, and cannot contain himself, with anguish, palpitation, and perspiration all over the body (15th d.).
44. She finds fault with everything, does not wish what others desire; with weeping and heat of the face.
45. She finds fault with everything, approves of nothing.
46. He gets vexed at every trifle.
47. Peevish and disposed to quarrel.
48. Vexatious sensitiveness.[Gff.].
49. Peevish, especially in the morning.
50. Great inclination to get vexed.
51. From vexation, she is so excited that she fears an apoplectic fit, and everything turns black before her eyes.
52. Inclined to anger.
53. Angry, peevish.
54. Very morose and violent.
55. A trifle may produce a violent ebullition of anger, with trembling (especially of the hands).[Gff.].
56. Very sensitive at the slightest cause; a fit of desperately furious gestures with sobbing; she throws herself on the bed and remains lying there all day, without eating (just before the menses).
57. Indolence of spirit and dejection (aft. 23 d.).
58. Indolence of spirit (aft. 6 d.).
59. Great indifference to everything, no real vital feeling.
60. Indifference.
61. Very indifferent to everything, insensible and apathetic (aft. 6, 7, 8 d.).
62. No disposition to work, inattentive, distracted (aft. 6, 7 d.).
63. Alternately merry and sad.
64. Alternate involuntary laughing and weeping, without corresponding moods.
65. Weak memory (aft. 20, 48 h.).
66. He often makes mistakes in writing.
67. He was distracted, talked incorrectly, using the wrong words (aft. 9 d.).
68. He thinks, what he does not wish to think, uses expressions which he himself knows are incorrect; he resolves to do what is against his intention, and is thus in conflict with himself and, therefore, in a disagreeable, restless mood (aft. 24 h.).

Book version of the P&W Boenninghausen Therapeutic Pocketbook

The IHM is releasing the English version of the P&W Boenninghausen TPB today. Retail Price is $85 + postage. The first 100 purchasers can obtain the book for $55+ postage.

63 books remaining at the $55 price. (26-October 2015 at 11:43 GMT.)

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Dry-dose envy…

glass cup street musician

glass cup street musician

I envy dry dose prescribers in chronic cases. There, I’ve said it.

When you prescribe dry dose, you (frequently) get to give the patient a remedy to take and send them away for 4-6 weeks.

Aggravation? Of course there’s aggravation, as you explain carefully to them. No pain, no gain, right? And painfulness is right up there with godliness, correct? But the amelioration is so worth it…

As long as something’s going on, you don’t repeat. Nada. Kent gives you permission to stand firm – for once echoing Hahnemann’s instructions (from the 4th Organon, that is…)

You know you won’t be repeating till it’s absolutely certain that the remedy is no longer acting – so you don’t need feedback, or to make decisions in-between appointments, or to call patients in for additional appointments because the symptom picture seems to be changing. You see them, take the case, prescribe, and then you and the patient basically sit back and watch and wait…

And you give the dose in dry form! At the risk of sounding like a teenager – how cool is that! No messing with bottles, succussions, dilutions, more dilutions, sensitivities and yet more dilution cups, until the patient could start his own glass cup orchestra.

So why go for 6th Organon medicinal solutions? Why go for more frequent repeating? Why go to the trouble of explaining to our patients as their eyes glaze over that they must succuss the bottle, no, not percuss, not discuss, succuss, which means…please read the leaflet, didn’t you read the leaflet, watch the clip, you’ll see exactly how…

Don’t get me wrong, some patients are amazing. They get it, they get into the rhythm of 6th Organon repetition, understanding when to stop and when to restart, but infinitely more patient understanding and compliance is needed than when you just gently introduce two pills under their tongues in the clinic and send them away for an interesting 4-6 weeks…

Having worked with both dry and medicinal solutions, I have to say that medicinal solutions are more complicated to operate. So why bother?

– reducing aggravation: this was important to Hahnemann – why should it not be important to us? I do not believe that pain and suffering is an essential part of the process (and I was brought up on British NHS dental treatment, so I know whereof I speak…) I think Hahnemann meant “gentle” when he wrote “gentle”, not just “gentle versus medieval practices of his day”. The fact that he worked on formulations which would cause less aggravations, and that he taught the importance of assessing and relating to patient sensitivity I feel is proof of this.

– Aggravations appear later on: Typical use of LMs using increased dilution cups where necessary in order to avoid pushbacks in sensitive patients enables a situation where you see aggravations later rather than earlier, when the patient is also somewhat stronger and better able to deal with them.

– Speed: you can go faster in chronic cases when your remedy format allows you to repeat as long as there is gradual improvement and no drastic change in symptom picture.

– Fine tuning the remedy: whether using 6th Organon medicinal solutions for LMs or even for C potencies, you can ring the changes in dilutions and succussions, changing the potencies very slightly every time. In this way, you can work with sensitive patients more effectively, fine-tuning remedies as needed.

– Opportunity knocks: sometimes a symptom picture change will happen in-between appointments. If your style is to sit behind a large desk and only see or speak to your patients every 4-6 weeks, you may also be missing those opportunities, when a symptom picture change is reported during regular feedback which can send a case into a glorious swoop towards resolution and cure.

– Better use of resources: There are around 250 tiny grains (approximately) in one single dose vial. Although some homoeopaths actually only dispense 3 or 4 grains to the patient, many instruct their patients to chug-a-lug the entire vial… A patient experienced the benefits of Arnica after using up a small Arnica 30C sample he had received with 12 pills.   He ran out after three days because he had been taking 4 pills dry every day, when he could have made up a medicinal solution with one pill, added some brandy, and used that for the entire period.

I have to admit that writing this piece has been very therapeutic. I don’t envy 4th Organon practitioners any more (well, not really, just occasionally…)

Viewed through proving: Sulphur and the art of map-reading

Sulphur is a huge remedy.  With 1969 symptoms listed in the Chronic Diseases proving, it is unwieldy to “just look at”.

You can work with provings just as you would use maps to get to know a new city.  Perhaps Sulphur is an ideal proving to show the importance of this way of working.  When visiting a place you have not been before, it’s often interesting to get to know it on foot, with no prior information, absorbing the sights and sounds and getting interestingly lost. Continue reading

Viewed through proving: Sulphur stand-outs

Sulphur has 1969 symptoms, covering every area and system of the organism.  Especially noticeable in the proving are symptoms dealing with the stomach and the hepatic region (approx.  189 symptoms), the lower extremities (180 symptoms) Cough, chest and respiration symptoms (around 142), and symptoms relating to sleep, dreams, and the night time (137). Continue reading

The Homeopathic Diet – Coffee and Cigars..

cappucinoThe Homeopathic Diet – Coffee and Cigars…

Many practitioners struggle with the question of how much to limit patients in terms of diet. Patients ask quaveringly “does this mean I can never have coffee any more?” as they clutch cans of caffeine-laden Coca-Cola with whitening knuckles. Is Homeopathy intended to be draconian in food and lifestyle restrictions? Continue reading