In Aphorism 3, Hahnemann discusses what you need to know to be a homeopath: The physician has to know:
…what is to be cured in diseases, that is to say, in every individual case of disease (knowledge of disease, indication)…
We have to remember here that Hahnemann is talking about individual cases of disease, and what is to be cured. For this we need careful, accurate case taking. While knowledge of common disease pathways is important, and understanding of physiology, anatomy and pathology is crucial, Hahnemann stresses the “individual case of disease”. It’s not the nature of the injury, it’s the way the patient is experiencing it, the unique symptoms and physical-emotional-mental symptom mix that the patient presents which leads us to appropriate remedies.
Next?
…what is curative in medicines, that is to say, in each individual medicine (knowledge of medical powers)…
How do we learn what is curative in medicines? First from tests conducted on healthy volunteers – i.e. provings. That is our primary source material for understanding what a medicine can do. Here we must also distinguish between poisoning (giving crude arsenic will give information perhaps more useful for killing than curing), and proving (who knew what table salt in homeopathic preparation could do to help cure?). Furthermore we must understand the true place of clinical experience within understanding what is curative in a medicine. When the individuality of each case is perceived and grasped, it should be clear that because a remedy helped five people with the flu, it doesn’t necessarily follow that the same remedy would be curative in all cases. There is a vastness in the individuality of each person, whether in terms of personality, remedy response, resilience, and response in general to the outside world. Many traits may be shared, but the individuality of the combination brings snowflakes to mind in their diversity. So we can see a certain hierarchy: provings, poisonings (frequently included in Hahnemann’s provings) and last, clinical sources. Many materia medica don’t distinguish between these sources of information in describing remedies. Which is why you should look at provings first.
Next?
…how to adapt, according to clearly defined principles, what is curative in medicines to what he has discovered to be undoubtedly morbid in the patient…
This requires case analysis, which can only be effectively conducted when the case has been properly taken and the individual case of disease understood, and when there is clarity about the principles for prescribing. This clarity about principles also indicates clarity about case management, which can often be much more complex – and rewarding and informative – than the first prescription.
And Hahnemann continues, when giving a remedy we must also take into account:
…the exact mode of preparation and quantity of it required (proper dose), and the proper period for repeating the dose…
How large should the dose be? Understanding how much and why is a crucial part of learning how to practice homoeopathy. As a rule, the size of the dose should be the smallest amount required to trigger a response. And that can be a very small amount indeed.
How often should a remedy be repeated? Confusion regarding repetition is one of the greatest pitfalls in practice. Repeating too often may muddy a case. Not repeating often enough may lengthen the time it takes to recover. When the principles of practice are clearly defined, this will give the practitioner a “road-map” for managing the case.
And one last thing? The practitioner must know
…the obstacles to recovery in each case and … how to remove them…
This often requires sleuthing (I recommend reading Sherlock Holmes…). Is there an obstacle we know nothing about? Apart from elements not reported by patients for “don’t judge me” reasons, there are many things that patients don’t report because it just doesn’t occur to them – whether it’s use of essential oils or that extra healthy supplement they started taking that contains a mix of homoeopathic remedies which will interfere with the case. Sometimes the obstacle can be a toxic relationship, sometimes a damp apartment or poor diet, or working occasional night shifts.
So any solid homoeopathy course curriculum should include all of these elements in its foundation course. To repeat the whole aphorism here:
If the physician clearly perceives what is to be cured in diseases, that is to say, in every individual case of disease (knowledge of disease, indication), if he clearly perceives what is curative in medicines, that is to say, in each individual medicine (knowledge of medical powers), and if he knows how to adapt, according to clearly defined principles, what is curative in medicines to what he has discovered to be undoubtedly morbid in the patient, so that the recovery must ensue – to adapt it, as well in respect to the suitability of the medicine most appropriate according to its mode of action to the case before him (choice of the remedy, the medicine indicated), as also in respect to the exact mode of preparation and quantity of it required (proper dose), and the proper period for repeating the dose; – if, finally, he knows the obstacles to recovery in each case and is aware how to remove them, so that the restoration may be permanent, then he understands how to treat judiciously and rationally, and he is a true practitioner of the healing art .
Hepar Sulph, provings, and a rant in a teacup…
winking? or dry eye…
I was recently working with a patient suffering from dry eyes. The patient would wake at night unable to open his eyes, and said the condition was ameliorated by cupping his hands gently over his eyes. Among the symptoms – worse during sleep, worse in artificial light, sensation of dryness and burning in the eye, unable to open the eye at night. I had given Rhus Tox which had helped somewhat but it was stalling. And we homeopaths expect more from our remedies – don’t we now…
I used the rubric worse for uncovering as an expression of the hand-cupping amelioration but based the center of the case on all the other symptoms and modalities where the rubrics were more precise. I reviewed everything again and saw that only two remedies covered all the symptoms – Rhus Tox and Hepar Sulph. I looked closely at the provings of the two remedies, thinking that if Hepar Sulph didn’t look like a better match I’d go up in potency on the Rhus-Tox. The eye symptoms were very well represented in the Hepar proving, but I could not find clear mention of hand-cupping ameliorates.
So I went on an obsessive hunt for the symptom – even though I knew I didn’t really need it. I found it in Kent’s repertory – but no Hepar. The only remedies there were Aur-Mur and Thuja. I went through the books I used many years ago, in the olden pre-TPB days – Phatak, Kent, Clarke, Boger Synoptic and others, and finally tracked down the symptom in Vermeullen’s Prisma given as Eye, pain, better for lightly covering eyes with hand. But where did it come from?
I looked in Schroyen’s Synthesis, and there I found Eye Pain, covering eyes, hand with, amel with the previous suspects from Kent – Aur mur and Thuj. And then – Eye pain, covering eyes, lightly, amel – Hepar.
Various materia medicas do report that some light covering amel with Hepar. Vermeullen is the only one I found in my search who specifically states the symptom, and the source is unclear. It appears in the Rubrics section of his Prisma, which he writes gives symptoms taken from the Synthesis, and further states that he made corrections and additions in this section where he felt symptoms had been misinterpreted or overlooked. So no certainty there…
And as I was on this hunt which was unnecessary as I could already see that Hepar was indicated but by this time I couldn’t stop – I realized that this was a kind of reversed engineering of the way I used to work, a way that has become completely unnatural for me.
I started out on my homoeopathy studies with an impressive (and heavy) hardcopy of Schroyen’s Synthesis, in a scholarly dark red binding with gold lettering. I studied out of town, and this huge book, together with other weighty tomes, were my constant companions and back-straighteners (in a reinforced backpack for hikers). I would take symptoms, rummage around in the Synthesis to repertorize the case, and hunt through Kent, Phatak, Tyler, Boger, Vermeullen, Sankaran et al to see if I could make a case for a remedy. The work was imprecise and frustrating. There was no certainty, no clear path through all this literature – even though eventual purchases of a laptop and software eased the back pain somewhat but little else…
Which brings me to a conversation I had recently with a colleague (this is the “rant-in-a-teacup” part). I had mentioned that I was thinking of putting together an online course for the study of provings. Wake up, he said, don’t you get it? No-one is interested in provings. And I had to admit he was right. I can see from the interest in various posts on the IHM sites. Readers of our sites really like the articles on vaccinations, and damning materials quoted from other sources. Scandals in the conventional medical world are a particular favourite. Readers, hopefully many of them homoeopaths, like case presentation and analysis, methodology, posology, repertorization, and even discussion of materia medica, and this is good. IHM rants are quite popular as we can on occasion be quite amusing… But while articles on provings have their devotees (thank you, you know who you are), they garner much less interest in the world of modern homoeopathy.
But then I thought further. If the mass of people in this field are not interested in provings, then they are also not interested in doing homoeopathy properly. Because the principle of like cures like rests on provings, without provings homoeopathy as a scientific medical method would not exist.
Until you’ve read a remedy proving you really know very little about it, about its diversity, potential for healing. You will be forever mired in the prejudices passed from teacher to student, prescribing Pulsatilla for needy, weepy blonde women with blue eyes, and Hepar only where the patient is extremely chilly. Men and children would never be given Sepia. Everything would rest on what was learned from teachers rather than primary sources. And so much would be lost.
And if you start with software, speculative materia medica, and the mass of material from the older homoeopaths which has simply been copied from work to work as can be seen from the exact repeats in wording – it’s a mess. You don’t know what symptoms come from provings, clinical or poisoning. What is central and certain and what is at best confirmatory. You don’t know where to start and where to finish. And in my obsessive sleuthing, when I started with the proving and ended with the synthesis, I realized just how little these materia medica reflect the proving, how disconnected the investigation became.
Since I had started out on this rather senseless quest with Hahnemann’s provings on Hepar and Rhus Tox, and with Boenninghausen’s therapeutic pocketbook which is based on primary sources and not on a cacophonous centuries-long game of Chinese Whispers and creative writing, I recognized that my sleuthing was, for the most part, a waste of time. I was confident that Hepar would help my patient. My process today, for which I am totally grateful to P&W and the IHM, is much easier, and more sure-footed. But it also reminded me of those early days, how literally back-breaking it was to rely on these hefty tomes which just didn’t seem to add wisdom, only to dilute it, to shatter what little knowledge they contained into tiny unrecognizable fragments.
Homoeopaths should be interested in provings. Homoeopaths should want to go to original sources, and to have the ability to do so. But I have come to the point where I feel I have to recognize and accept the reality. Very few (undeniably intelligent) homoeopaths are interested in provings.
Unless I’m wrong? Whether I do an online course on the study of provings or not – I would be delighted to be proven wrong.
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