The aggravating question of aggravations

I recently posted a small case quiz on the IHM facebook group.  This is what I posted:

A short case management quiz…
A woman had been suffering from a bad dose of poison ivy. She had taken steroids, and some of the rash still persisted. She felt something still needed to heal and asked for treatment.

I gave Mercury LM1, which helped the rash immediately, but then within a day or so the patient started coughing. The next day, the cough went to the chest, productive cough with thick yellow mucus. The patient said this is chronic, and was very worried that the cough would get much worse and remain for months, as that is what usually happened.

What questions would you ask the patient at this stage? What’s the next step? Why?

This is a situation which we all deal with, in many if not most cases.  We have given a remedy which is doing well on the chief complaint but within several days, an old symptom emerges.  The patient may be extremely distressed, insisting that he or she be given a medicine to deal with the chronic, as now it will only get worse as it usually does.

And now we must understand what is going on, what’s the trail of activity and response here, in order to determine the next step.

Is the old symptom an aggravation from the remedy?  Or has the patient simply moved into a familiar chronic state as they suspect? and fear?

As people in the facebook discussion correctly responded, we want to look into the nature of the old symptom, and especially to see if the symptom is now presenting in the same way as always, or if there is something different about it.  We also want to see whether the old symptom is covered by the remedy we gave.

In this particular case, the old symptom was presenting slightly differently, and it was indeed covered by the remedy given.  I told the patient to wait.  It wasn’t what she wanted to hear.  Yes, we can always prescribe sac lac in these cases, but then the patient learns nothing.

As I and others have noted in the use of LMs, an aggravation of an old symptom often passes within hours, usually passes within one or two days, and occasionally drags on a little longer.  In these situations, usually after a day the patient will say the symptom is still there, but less.  In C potencies, the aggravation may take longer.

What we must be aware of is that when there is an aggravation triggered by the remedy, it is a substance symptom which is sitting on susceptible areas in the organism – treading on its corns, so to speak – and not a disease symptom.  And the symptom is challenging the immune system to address it.  It’s an opportunity to allow the immune system to finally recognize a symptom it has not been dealing with properly (resulting in chronic illness), and to deal with it as needed.  If we rush in with a remedy or even antidote, we are passing up on a vital opportunity for the organism to become stronger and more effective.

Obviously, if  the symptom persists, becoming more and more identical to the old chronic, it must be addressed – the case must be reviewed, symptoms chosen again, and the best remedy prescribed for the situation.

However – a word of warning.  Sometimes it is possible, especially when the dose given was too high, for the patient’s situation to slide into an acute flare-up of the chronic, something too intense for the organism to handle, especially when weakened by the heavy-duty symptoms it is experiencing.  For this reason, I believe it is essential to keep tabs on what is happening, to ask the patient to check in after 24 hours, to understand exactly what process we are looking at.

In this particular case, the old chronic symptom passed within two days, all in all around five days after one dose of the remedy was given.  It was already easing after 24 hours.  The patient expressed amazement at the strength and duration of the remedy.

One of the most important elements of this kind of situation is that when we prescribe, we must have a clear path in mind of what we want to see, of why we’re seeing what we’re seeing, and of the options available to us.  Most importantly, patients will insist on new prescriptions, different remedies, etc., but if we are to help them we must understand whether their insistence is based on deeper understanding of what’s happening, which can happen but is rare, or simply on their lack of knowledge about how homoeopathy works, mixed in with real fear of getting sicker.

Advertisements

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.

Workshop 15th November – and who’s in love with provings…

Earlier this week, I was accused of being in love with provings.  To be a bit more precise, I was told “you’re in love with them – but no-one else is interested.  Wake up and smell the antidoting coffee…” or words to that effect.

But, as I explained to my insistent interlocutor, I’m not in love with provings.  I’m in love with certainty in prescribing.  And one of the best ways to achieve that certainty is through – ta-da! – provings.

Even the best prescribers among us have to deal with some uncertainty – it’s part of what goes on in treatment.  We can’t know the exact level of resilience a patient has, how much he or she can be restored to health.  We can’t always know how sensitive the patient is to remedies at the outset.  And we can’t know what the patient has not told us – the vaccination he was embarrassed to report, the home herbal remedy he was convinced wouldn’t interfere with treatment.

So personally, I take whatever certainty I can get, and knowing how to study and work directly with provings helps me towards the certainty I crave…

A little girl, a newborn, was suffering from a rash.  There wasn’t much to go on and several remedies were indicated.  I went through them looking for the eruption, and Phosphorus turned up trumps, with a description  that fitted my little patient’s rash perfectly.  The remedy also contained several others of the few presenting symptoms in the case.  When I gave the remedy, I had a great degree of certainty that it would help my patient, because I knew for a fact that this substance can cause this symptom in a healthy person.  And that, dear readers, is what homoeopathy is all about.

I’ll be giving a workshop on the study of provings in a couple of weeks.  It will be a hands-on hard work seminar – you’ll come out of it knowing how to study provings and you’ll have a clearer idea of how to work with provings in prescribing.

Where?!  Jerusalem, exact location to be announced.

When?!  on Wednesday 15 November, from 9:45-13:30

How much will it cost?!  NIS 370

Any early bird reduction?!  Of course, NIS 320 for those who pay by Friday 10th November.

To register? Write to me on vera.homeopath@gmail.com.

---

I’m considering giving the workshop online at a different time.  Please write to me on vera.homeopath@gmail.com or using the contact form if you’d be interested in such a workshop. 

---

 

Preparation of medicinal solutions

I’m often asked about preparation of remedies for dosing, especially in connection with use of LM potencies.  I’ve quoted David Little’s article on Solutions Large and Small below in full.  You can read the original here.  David also describes the experiments he carried out.

 

Solutions Large and Small
Preparation of the Medicinal Solution

The question of how to make a medicinal solution has been raised. Our research group uses the Hahnemannian Standard as discussed in The Chronic Diseases and The 6th Organon of the Healing Arts. The reason for this is twofold.

Video presentation: Case-Taking in Emotional Trauma

Case-taking in emotional trauma can be much more effective if we have more clarity about what we want to learn from the patient.  I’ve set out a more focused way of working with cases involving emotional trauma in the video below.  I’ve disabled comments as I don’t always have time to keep track and reply, but if you’d like to comment please drop me a line on the contact form.

I hope you find this presentation helpful.

Viewed through repertory: Senega

VIEWED THROUGH REPERTORY: SENEGA

There are often remedies which show up in repertorization which we overlook – remedies which we aren’t familiar with, have never used and are just not part of our prescribing “vocabulary”.

Senega is such a remedy.  I have never prescribed it, but I do see it showing up on occasion in repertorization.

Polygala Senega, or snake root is of North American origin. From Wikipedia:
This plant had many uses among Native Americans. The Cherokee used it as an expectorant and a diuretic, and for inflammation, croup, and common cold. The Chippewa used preparations of the root to treat convulsions and bleeding wounds. The Cree chewed the root for sore throat and toothache.[5] According to Canadian botanist Frère Marie-Victorin, the Seneca may have been inspired to use the tortuous root to treat snakebite by its resemblance to the tail of a rattlesnake. It’s still in use for treatment of pneumonia.

Senega was proved by Massie in 1803. More detailed results of the proving can be found, among other sources, in Hughes’ Cyclopaedia of Drug Pathogenesy. The following are some examples from the proving:

1. Dr. MASSIE took 10 dr. of gum dissolved in water.
In 5 minutes sensation in esophagus as if membrane had been abraded, lasted 1 hour.
Pulse, 84 before experiment, at 15 minutes was 78, 20 minutes 73, 30 minutes 70, 35 minutes 68, thence gradually rising to 76.
He then took 20 gr.
Irritation in esophagus was again felt, with some nausea; the drug also operated slightly as a purgative. (Inaug. Thesis, Penns. Univ., 1803; from ALLEN.)

2. Mr. L. took 20 gr. of powdered root. In 10 minutes burning sensation in esophagus with considerable discharge of mucus from trachea (still continuing in slight degree 1 1/2 hour later).
Pulse, 65 before experiment, in 10 minutes was 70 and fuller; later 72, whence it fell again. (Ibid.)

3. Mr. L – took same.Had similar feeling in esophagus, with much hawking of mucus.
In 30 minutes nausea, which increased up to 40 minutes.
Pulse, 65 before experiment, gradually rose in 5 – 40 minutes up to 90, and was still 80 – 86 after 1 – 2 hours.
In 1 1/2 hour skin became very hot; in 1 3/4 hour profuse perspiration set in, and disagreeable symptoms were quite removed. (Ibid.)

4. Mr. W. took same. Same irritation in esophagus; pulse, 68, was 80 at 30 – 40 minutes, and only returned to its starting-point in 2 1/2 hours (Ibid.)

So what does Seneca look like in the repertory?

Seneca appears in four points in the following rubrics. However, it takes its place among many other remedies, and does not appear in four points in any rubric with less than 50 remedies.

What about rubrics with less remedies?  Seneca is prominent in the following, and appears in three points:

So far this gives us a picture of a remedy state where the patient has a tendency to dryness, lack of perspiration and to an increased production of mucus in the larynx and trachea. There is very clear aggravation from mortification in this remedy state, and also relaxation of the body (pathological) and very deep sleep. In its appearance in three points in “Mortification” Senega is accompanied by Chamomile and Phosphoric Acid, with Colocynthis, Ignatia, Natrum-Muriaticum and Staphysagria in four points.

Where does Senega stand in terms of relationships with other remedies? For this I’ve done a search of its position in the Concordances section.

From this search we see Senega is noted as an antidote to Arnica and Bryonia, as having some connection in terms of modalities with Angustura, Crocus Sativus, Kali Carbonicum, Kali Nitricum and Rhododendron Chrysanthum. In Generalities we find it in concordance with Aurum, Caladium, Carbo Vegetabilis, Causticum and Digitalis. The only remedy where we see Senega appearing twice is in Kali Nitricum, in modalities and in body parts.

This is just the tip of the iceberg in terms of what can be learned about a remedy through searching through the repertory. I did one last search, to see where Senega appeared in any grade, in rubrics with 10 remedies or less, and got the following result:

Senega’s only partner in the symptom Amelioration from Chewing is Bryonia. Its only partner in the symptom of Imaginary Odors resembling Pus is Sulphur.

In the concordance symptoms and in this last search, for the most part Senega appears in one point, indicating that Boenninghausen did not have much clinical experience with the remedy for these symptoms. However, its appearance in the TPB means it has definite significance in such cases, where it matches the totality of the disease state.

Aphorism 224 – mental disease

These days so many situations are classified as mental disorders, from defiance in children to reasonable depression (where it is normal to be unhappy, due to  temporary or changeable situations of loss, firing etc.) in adults.  So many people are on anti-depressants these days, and the age of those taking the drugs is constantly dropping.

But where will these mental states fit into our prescribing?  Are we looking at early stages of a mental disease, which is part of a systemic problem, or at a reasonable mood change resulting from events and lifestyle where what is really needed is encouragement and advice from friends or professionals?  I am of necessity simplifying a complex differential for this article, as when a reasonable mood change becomes prolonged and entrenched, encouragement and advice may no longer be of use.