Pimples Pustules and Boenninghausen’s Questions
I was recently asked about Phosphorous in eruptions. Specifically I was asked why Phosphorous doesn’t appear in the TPB symptom Eruption, pustules (symptom no. 1426 in P&W Synopsis), when the word “pustule” appears twice in Hahnemann’s proving.
In the proving “Pustules” appears in the following contexts:
431 – Eruption of pimples in the face
432 – Eruption of pimples on both of the cheeks.
433 – Frequent pustules and scurf from suppuration in the face, after the least lesion of its skin.
434 – Rough, red, mottled eruption of the face, slightly elevated. [Ng.].
459 – Burning pain on the red of the lower lip, with white blisters on the inner side of it, with burning pain (aft. 11 d.).
460 – The lower lip is cracked wide open, in the middle.
461 – An itching spot on the left lower jaw, he had to scratch it raw.
462 – Itching of the upper lip, with pain after rubbing.
463 – Swollen upper lip, every morning.
464 – Eruption on the red of both the lips, at times with stitches.
465 – Pustules on the commissures of the lips.
Trawling through Merriam Webster revealed that although pustules usually refer only to blister-like eruptions, and not always to pus filled ones, it is often used interchangeably with pimples, used to imply a more impressive presence of the eruption.
So bearing in mind that when looking through provings we are dealing with several levels of translation – from sensation to words in German, from words of the prover to Hahnemann’s collated and edited proving in German, and from Hahnemann’s German to modern (fairly) English – we probably have to include pimples in this. This is P&W’s footnote on the TPB rubric:
 Pustules, any type of skin eruptions, which elevate over the skin and can be filled either with pus or pus-like fluid and form crusts that may or may not erode the skin.
Why have I put you through so many pimples and pustules? Because this kind of question is why so many people miss the point when starting to work with the TPB.
The TPB is essentially a practical manual, a guide to materia medica. It reflects how Boenninghausen used the provings in his clinic, how he searched for information and how he deduced the symptoms to use and the remedies to investigate.
So you may be dealing with pimples. Or pustules. Or pimples which are turning into pustules. In the case I was asked about, the practitioner seemed fairly sure of the Phosphorous for the other symptoms, but found the absence of the remedy in pimples gave him reason to hesitate.
In such cases the issue is not whether the eruption is a pimple or a pustule. The issue is far more about the nature of the pimple/pustule.
– Is it crusted?
– Is there fluid in the pimple/pustule?
– Is there a colour, a texture, a smell?
– Is there pain on touching?
– Is there constant pain, and what is its nature? Burning, aching, stitching?
– Is the patient crippled with embarrassment about the pimple/pustule, much more than usually?
– Is it before/during/after menses?
– Is it after binge eating?
Do you see where I’m going with this? The remedy will become clear not from the question “what is it, pimple or pustule?” but from all the other questions. To remind you of Boenninghausen’s questions:
Quis – Who is the patient, what does he do, what’s his usual state of health
Quid – What is the complaint – sensation
Ubi – Where is the problem – location
Quibus Auxilibus – with what/concomitants
Cur – Why, trigger, maintaining causes
Quomodo – Modalities, aggravations and ameliorations
Quando – Time modalities, occurrence, aggravation and amelioration.
My main point here is that learning to work with Boenninghausen means learning to think very differently about symptoms and case-taking. If you’re starting out with Boenninghausen from a Kentian background – as I did – looking for rubrics can feel like hunting for a tooth which has been pulled out. You will not find the rubric you’re looking for if you’re searching for Face, eruptions, cheeks, pustule, yellow, excoriating. If you’re lucky – as you will be here, you will find Face eruptions cheeks. And you’ll have to look for the rest step by step – Eruptions yellow, eruptions excoriating, pustules (and pimples). My preference is to look more for the smell, the color, the modalities – and then once I’ve narrowed things down to several remedies, to search for the other qualities through the reversed materia medica and through the proving itself.