Essentials of Homeopathic Medicine

Copyright notice

May 2015: Second Edition

Revised June 2017

January 2021: Third Edition

Revised December 2021

The Cover contains an image of the Hahnemann Monument at

Scott Circle in Washington D.C. taken by Timothy Fior

All pictures not otherwise attributed were taken by Dr. Fior.

This book is not intended as a substitute for the medical advice of

physicians. The reader should regularly consult a physician in matters

relating to his/her health and particularly with respect to any symptoms

that may require diagnosis or medical attention.

The author may be reached at [email protected].

Copyright © 2015 by Timothy Fior

Copyright © 2021 by Timothy Fior

All rights reserved. No part of this publication may be reproduced,

distributed, or transmitted in any form or by any means, including

photocopying, recording, or other electronic or mechanical methods,

without the prior written permission of the publisher, except in the case

of brief quotations embodied in critical articles and reviews.

Dedication

We would like to dedicate this ebook to those who have helped us to become the practitioners, teachers, and people that we are today. As Isaac Newton said, If I have seen further than others, it is by standing on the shoulders of giants. So we would like to acknowledge those giants in our lives. First, Dr. Andre Saine, who has been a mentor and a friend for several decades now. Dr. Saine’s Advanced Chronic Prescribing course is the basis for most of this work, and he graciously allowed us to use that material. He was the first teacher that I found who relied on the works and words of the great masters of homeopathy of the past like Hahnemann, Hering, Lippe, Boenninghausen, etc. He taught us that their works are the foundation for a successful homeopathic practice and we have been able to verify that in our own practices and in the practices of those of our students who have applied themselves to homeopathy. Second, we  would like to thank Dr. Joel Shepperd for his constant encouragement, patience, and for showing us the practicalities of homeopathic practice. When he started practicing homeopathy in 1974 as  a newly graduated MD, he was one of only a few doing this in the whole United States. Without  his pioneering practice, there would be a lot less homeopathic practitioners in the Midwest and other parts. We would like to thank the late Dr. Francisco Eizayaga from Buenos Aires, Argentina for teaching us the power of the homeopathic repertory. We would like to thank Dr. Fraser Smith who entrusted us with teaching homeopathy in the naturopathic program at National University of the Health Sciences, which lead to the creation of this book as a class textbook. We would like to thank all of our colleagues in the Illinois Homeopathic Medical Association who have inspired and supported us along the way. Also, Dr. Fior would like to thank Sant Darshan Singh for encouraging him as a young Family Practitioner to pursue homeopathy and his son, Sant Rajinder Singh for providing continuing support along the way. Last but not least, Dr. Fior would like to thank his dear wife, Janice, for putting up with him and supporting him during the many years involved in the creation of this book.

Table of Contents

Copyright notice

Dedication

Table of Contents

Preface

Chapter 1

Case Taking - History of Present Illness, Past, Family and Social History

Chapter 2

Case Taking - Physical Generals

Chapter 3

Case Taking - Mental Emotional History

Chapter 4

Case Taking - Physical Exam

Chapter 5

Case Analysis

Section 1

Genius of Remedies and Disease

Section 2

Dissimilar Disease

Chapter 6

Repertorization

Chapter 7

Repertorization Exercises

Chapter 8

Case Management:

One Remedy, Posology

Chapter 9

Case Management: Follow-ups

Chapter 10

Suppression

Chapter 11

Homeopathic Resources Online

Chapter 12

The Second Prescription

Chapter 13

Use of Homeopathy Concurrent with other Therapies

Chapter 14

Infant History and Physical

Chapter 15

Practice Cases

Section 1

Short Cases & The Universal Reactor

Section 2

More Cases and a Case of ALL

Chapter 16

Lycopodium Clavatum

Chapter 17

Calcarea carbonica

Chapter 18

Sulphur

Chapter 19

Pulsatilla nigricans

Chapter 20

Natrum muriaticum

Chapter 21

Sepia

Chapter 22

Ignatia amara

Chapter 23

Nux vomica

Chapter 24

Staphysagria

Chapter 25

Phosphorus

Chapter 26

Arsenicum album

Chapter 27

Silica

Chapter 28

Lachesis mutans

Footnotes

Preface

Homeopathy is  based on a simple principle of Similia Similibus Curentur¹ or like cures like. This is a simple enough statement, however it’s application can be quite demanding. This book is meant as the practical next step to the study of Hahnemann’s Organon where he lays out the philosophical foundation for homeopathy. In this book we first discuss how to take a complete case. Case taking is an art, but one which can be fairly rapidly mastered by homeopathic students. Next we discuss case analysis and repertorization which becomes the next bridge to cross after taking a complete case. With practice this too can be mastered. Then we begin discussing homeopathic case management which is a study that will continue for a lifetime for homeopathic practitioners. Finally we cover 13 major polychrest remedies in detail. These are remedies which homeopathic practitioners use at least weekly in practice, if not daily. Learning these major polychrests is a solid foundation from which to begin  the study of the rest of the homeopathic materia medica  which is quite vast. So let us begin our homeopathic journey…

Chapter 1

Case Taking - History of Present Illness, Past, Family and Social History

The physician’s high and only mission is to restore the sick to health, to cure, as it is termed.

– Samuel Hahnemann

There are three steps in homeopathic practice, namely:

Case taking²

Case analysis³ todetermine:

2.1.Diagnosis

2.2.Prognosis

2.3.The Simillimum⁴ or most similar remedy

Case management⁵, whichincludes:

3.1.Posology⁶-which is the potency selection, repetition, and means of giving the remedy (e.g. pellets in the mouth, in water, by olfaction or smelling the remedy, or by inserting a toothpick in remedy water and then touching it to the tongue or other body part )

3.2.Follow-ups

3.3.Hygiene changes which are recommended and how and when to implement them

3.4.Need for tests, surgery, referral, etc.

Whether one is a novice homeopath or an intermediate practitioner or an expert, these are the three steps that are always followed in homeopathy on the first and each subsequent visit. For beginners, at first, taking a complete case seems like a daunting task. However, with time and practice, this becomes much easier. Then next hurdle then becomes perfecting case analysis which requires many skills such as a good knowledge of human nature/psychology, the common/pathognomonic symptoms⁷ of various diseases (which are generally ignored in case analysis), a good working knowledge of the repertory⁸ and the materia medica⁹. After a few years of practice, case analysis becomes easier and then for the remainder of one’s practice, case management skills are constantly being tested and refined. Here, clinical experience in general and with each individual patient is the ultimate guide. In fact, Samuel Hahnemann¹⁰, was constantly adding to the materia medica by doing new provings¹¹ and seeking the optimal posology (i.e. remedy potency and frequency and method of repetition of the dose) for managing his patients until he died in 1843.

When one is taking a homeopathic case, especially a new case, one has to be in a certain frame of mind which is perhaps best described by Hahnemann in an essay called the Medical Observer. In this article he states:

THE MEDICAL OBSERVER.'

From the Reine Armeimittellehre, pt iv, 2nd edit. 1825.

"In order to be able to observe well, the medical practitioner requires to possess what is not to be met with among ordinary physicians even in a moderate degree, the capacity and habit of noticing carefully and correctly the phenomena that take place in natural diseases, as well as those that occur in the morbid states artificially excited by medicines, when they are tested upon the healthy body, and the ability to describe them in the most appropriate and natural expressions.

In order accurately to perceive what is to be observed in patients, we should direct all our thoughts upon the matter we have in hand, come out of ourselves, as it were, and attach ourselves, so to speak, with all our powers of concentration upon it, in order that nothing that is actually present, that has to do with the subject, and that can be ascertained by the senses, may escape us.

Poetic fancy, fantastic wit and speculation, must for a while be suspended, and all overstrained reasoning, forced interpretation and tendency to explain away things, must be suppressed. The duty of the observer is then only to take notice of the phenomena and their course; his attention should be on the watch not only that nothing actually present escape his observation: but that also what he observes be understood exactly as it is.

This capability of observing accurately is never quite an innate faculty; it must be chiefly acquired by practice, by refining and regulating the perceptions of the senses, that is to say, by exercising a severe criticism in regard to the rapid impressions we obtain of external objects, and at the same time the necessary coolness, calmness and firmness of judgment must be preserved, together with a constant distrust of our own powers of apprehension.

The vast importance of our subject should make us direct the energies of our body and mind towards the observation; and great patience, supported by the power of the will, must sustain us in this direction until the completion of the observation.

…..

The best opportunity for exercising and perfecting our observing faculty, is afforded by instituting experiments with medicines upon ourselves. Whilst avoiding all foreign medicinal influences and disturbing mental impressions in this important operation, the experimenter, after he has taken the medicine, has all his attention strained towards all the alterations of health that take place on and within him, in order to observe and correctly to record them, with ever-wakeful feelings, and his senses ever on the watch.

By continuing this careful investigation of all the changes that occur within and upon himself, the experimenter attains the capability of observing all the sensations, be they ever so complex, that he experiences from the medicine he is testing, and all, even the finest shades of alteration of his health, and of recording in suitable and adequate expressions his distinct conception of them.

Here alone is it possible for the beginner to make pure, correct and undisturbed observations, for he knows that he will not deceive himself, there is no one to tell him aught that is untrue, and he himself feels, sees and notices what takes place in and upon him. He will thus acquire practice to enable him to make equally accurate observations on others also.

By means of these pure and accurate investigations, we shall be made aware that all the symptomatology hitherto existing in the ordinary system of medicine, was only a very superficial affair, and that nature is wont to disorder man in his health and in all his sensations and functions by disease or medicine in such infinitely various and dissimilar manners, that a single word or a general expression is totally inadequate to describe the morbid sensations and symptoms which are often of such a complex character, if we wish to portray really, truly, and perfectly the alterations in the health we meet with.

No portrait painter was ever so careless as to pay no attention to the marked peculiarity in the features of the person he wished to make a likeness of, or to consider it sufficient to make any sort of a pair of round holes below the forehead by way of eyes, between them to draw a long-shaped thing directed downwards, always of the same shape, by way of a nose, and beneath this to put a slit going across the face, that should stand for the mouth of this or of any other person; no painter, I say, ever went about delineating human faces in such a rude and slovenly manner; no naturalist ever went to work in this fashion in describing any natural production; such was never the way in which any zoologist, botanist, or mineralogist acted.

It was only the semiology of ordinary medicine that went to work in such a manner, when describing morbid phenomena. The sensations that differ so vastly among each other, and the innumerable varieties of the sufferings of the many different kinds of patients, were so far from being described according to their divergences and varieties, according to their peculiarities, the complexity of the pains composed of various kinds of sensations, their degrees and shades, so far was the description from being accurate or complete, that we find all these infinite varieties of sufferings huddled together under a few bare, unmeaning, general terms, such as perspiration, heat, fever, headache, sore-throat, croup, asthma, cough, chest-complaints, stitch in the side, belly-ache, want of appetite, dyspepsia, back-ache, coxalgia, hemorrhoidal sufferings, urinary disorders, pains in the limbs, (called according to fancy, gouty or rheumatic), skin diseases, spasms, convulsions, & etc. With such superficial expressions, the innumerable varieties of sufferings of patients were knocked off in the so-called observations, so that—with the exception of some one or other severe, striking symptom in this or that case of disease—almost every disease pretended to be described is as like another as the spots on a die, or as the various pictures of the dauber resemble one another in flatness and want of character.

The most important of all human vocations, I mean the observation of the sick, and of the infinite varieties of their disordered state of health, can only be pursued in such a superficial and careless manner by those who despise mankind, for in this way there is no question either of distinguishing the peculiarities of the morbid states, nor of select- ing the only appropriate remedy for the special circumstances of the case.

The conscientious physician who earnestly endeavors to apprehend in its peculiarity the disease to be cured, in order to be able to op- pose to it the appropriate remedy, will go much more carefully to work in his endeavor to distinguish what there is to be observed; language will scarcely suffice to enable him to express by appropriate words the innumerable varieties of the symptoms in the morbid state; no sensation, be it ever so peculiar, will escape him, which was occasioned in his feelings by the medicine he tested on himself; he will endeavor to convey an idea of it in language by the most appropriate expression, in order to be able in his practice to match the accurate delineation of the morbid picture with the similarly acting medicine, whereby alone, as he knows, can a cure be effected.

So true it is that the careful observer alone can become a true healer of diseases."

Homeopathy requires the practitioner to be patient, tactful, skillful, alert to any clues, and objective. The practitioner must be patient, as they must allow the patient to reveal their story of illness as they feel comfortable. They must be tactful and skillful in their history taking and case analysis in order to get the information they need to come up with a suitable remedy for the patient. The practitioner must be alert to any clues which might be revealed through the history or physical exam or the observations of other family members. They must also be objective so they see things in their true light rather than through the lens of any biases the practitioner may have.

There are 13 key points which should be kept in mind when taking a homeopathic history.

Intake Form-It is extremely useful to have the patient complete a brief but thorough intake form at the first visit. One double-sided page as shown below is sufficient.  This form can then be attached to the front of the patient’s chart and be referred to on the first visit and subsequent visits as necessary. It contains a large amount of information which can be reviewed quickly. Below is the form that we use in our office. In the chapter on pediatric case taking there is included a pediatric version of this form. The form includes a referral source at the top (helpful to monitor any marketing efforts) and the date which can be confirmed and initialed by the practitioner to verify that the form has been thoroughly read. Next, there is some demographicinformation on the patient, including phone number (helpful for phone consults), occupation, and marital status. Then there is a list of major complaints (which the patient may augment with an attached list) in the order of their importance. Some patients may leave this blank which may indicate that they are coming in for a well visit or that their complaints are of a sensitive nature (e.g. sexual dysfunction, trauma fromabuse).

Next there is a list of medications they are currently taking as well as a list of other treatments/regimens they are using/following. If the patient is on a lot of medications or supplements, they may have to provide this on a separate list. There is also a box to check if they have taken steroid medications, the birth control pill (if female), and if they have had a transfusion (which puts the patient at risk of certain blood born illnesses.)



Next is a section for past medical history where the patient may check the boxes of previous illnesses that they have had. When the past history is reviewed, each checked item can be investigated to see if the patient remembers any characteristic symptoms from those illnesses. Even though resolved, these characteristic symptoms may help us to find a remedy for the patient at the time of the first visit if the same remedy has been needed all along. Then there is a blank for listing any other conditions which the patient has never been well since or which have been more severe or complicated illnesses. At the bottom of the page is a place to sign to indicate that the patient or guardian has received and reviewed a copy of the practice’s HIPAA required notice of privacy practices (in the US).

On the back side of the form is a list of operations and injuries, including when they occurred and any complications or long term effects.

Menstrual history and pregnancy history are listed next. Then immunizations and prolonged antibiotic courses and any adverse reactions.

Weight loss history (could be a sign of cancer if unintended), exercise history (could influence body temperature) and dental problems (which have a tendency to flare up during homeopathic treatment).



Next is a list of substances used including: tobacco, coffee, tea, alcohol and recreational drugs. A space is included to indicate how much is being used, although the practitioner may have to confirm the amount used for alcohol and recreational drugs as some patients do not want  to admit the true levels of their usage.

Finally, there is a place for family history, and then for other conventional and previous homeopathic practitioners that the patient has seen. If the patient has seen other homeopathic practitioners, then one can inquire about the remedies used, the potencies and what changed as a result of their use. It is not unusual for homeopaths to see patients who are doctor shoppers, and this part of the intake form may be your first clue to this.Generally, we make this form available to patients on our website so they can download it and fill it out before their first visit. If they come to the office without a completed form, we have them fill it out in the waiting room. We generally do not see patients for the first time until this form is complete.

Maintain a Pleasant office and Doctor-For the initial intake, the patient is going to be in your office for generally 1-3 hours or more, so it is important that the office is comfortable and conducive to the patienttelling their story without any unnecessary interruptions. The doctor’s demeanor also must be pleasant.  If the practitioner is having a hectic day, it is important that they are able to put this aside in order to be in the present for the patient. Otherwise the patient may not feel comfortable revealing some very important things aboutthemselves.

Allow Adequate time-This is generally two hours or more for an initial adult patient. If it is not possible to spend the necessary time at the first visit and it must be split up into two visits, then the practitioner should make good notes of where the interview ended and what still needs to be covered. It is also helpful to list a few key points of the case so it will be easier to pick up the history and physical exam where one leftoff.

Let the patient talk-The most reliable information is that which the patient gives spontaneously. Thus, let the patient tell their story with the least interruptions possible. If they stop talking, you can always ask, anything else?, in order to prompt them to offer more spontaneous information. Although simple in concept, this is often the mostdifficult aspect of the interview, and must be learned with experience. Studies have shown that in an average physician visit, the patient talks for only 18 seconds before being interrupted by the physician.However, the same studies show that if the doctor lets the patient talk for 3-4 minutes, they will tell the doctor 90% of what’s wrong with them. (Fam Pract Manag. 1999 May;6(5):23-28.) Also, never put words in the patient’s mouth, as the history obtained is then useless. If the patient is intent on repeating for you the opinions of other practitioners, tell them, Tell me in your own words. If they want to talk pathology, askthem, it feels as if . . .? The more a patient is disinclined to reveal some information, the more likely this information is vital to the case. If you treat the patient gently, eventually they will open up to you. For example, I had a patient I was treating homeopathically for 5 years, giving various remedies, when one day she cried for the first time and told me something that helped me to find a remedy that helped her for over 10 years. The patient’s inner feelings and impressions are very important to us. The patient has the key to the case, and through our history taking, we have to allow them to deliver it to us.

Know when to interrupt-A loquacious patient may give you irrelevant information. Thus, you need to tell them exactly what you need to know, and what they can skip. For example, if a patient injured their back, and then they on and on about their trip when it happened, and then tell you that they were lifting and hurt their back. Tell them, all I needed to know was that your back pain started after you lifted something heavy. If patients tend to jump from complaint to complaint in their history telling, gently bring them back to the complaint that you are examining fully. When you are completed with that complaint, then move on to thenext.

Get clarification when needed-Sometimes the patients words will need clarification, for example, when they use incorrect anatomical terms. Patients will complain of pain in their leg. Have them point to where they mean, and they will often point to the thigh. Or they willsay stomach and point to the lower abdomen. Also, the patient may say they have back pain at night. But you need to ask if the back pain is worse at night, or is it worse lying, or worse lying on a hard or soft surface, etc. Experience and knowledge of the repertory and materia medica will help you to ask the proper clarifying questions. If a patient says they are depressed, you could ask what that means. For some it could be hopeless, for other it could be suicidal, or just anxious. Always continue asking until what the patient really means is clear to you.

Avoid leading questions-Avoid asking a question which can be answered yes or no, as the answer will be useless. One possible exception would be if you have a patient who cannot speak and can only nod yes or no. Another exception would be when you are trying to get the intensity of a symptom or are looking for further areas of investigation. For example, for a patient with headaches, if you are trying to determine the modality of time, you could ask, when is you headache better or worse? For concomitants¹²you could ask, What else happens when you have a headache? For etiology, you could ask, what was happening in your life when this problem started? For modalities, what makes the pain better or worse? For frequency and duration, how often does it occur, and how long does it last? If the patient has a hard time giving you spontaneous information, you might refer them to read an excellent pamphlet by Dr. J.T. Kent entitled What a Doctor needs to Know in order to make a successful prescription, which can be found at:http://homeoint.org/books2/kentwhat/Kentintus.htm.

Be objective-During the history, the practitioners job is to let the patient talk and ask questions so that the patient can reveal the truth about their case, which the practitioner can then view objectively to find a remedy. The practitioner must refrain from associating certainremedies with certain diseases, as then he will lose objectivity. The best homeopath is always the more objective one. Many beginners try to fit the few remedies they know to the patient.  Don’t do this.  If you think of a remedy early on in case taking, jot it down on the margin of the case history, and then forget about it or actively try to prove that that is not the correctremedy.

Adjust to the patient-If you have a loquacious patient and need to interrupt, you must not let your shyness prevent you from interrupting. If the patient is shy, delicate, fragile, then you need to be gentle in your case taking. If the patient is aggressive and controlling, then you have to let some of their words roll off you like water on the back of a duck. However, you can’t let them control you either. The patient must get the sense that you are there to help them, and that if they are acting aggressively toward you that their behavior is not correct. For a patient who is knowledgeable about homeopathy, you might not tell them the name of the remedy. This is to prevent them from second guessing you, or changing their reporting on the effects of the remedydepending on how they feel about the prescription. If they feel uncomfortable with this, give the the remedy with out the name in a bottle or envelope and have them take it when they are ready. If a patient is on the verge of tears, it is important to have a box of kleenex on your desk which you can gently push in their direction to let them know it is ok to cry. Then wait and let them respond when they are ready. If the patient isunsure of the process, tell them you are going to take a long (about 2 hour) history, and that you need them to be precise in their answers. If they are not sure of the answer, say so. If the answer is clear, then state it. If they don’t understand something, then tell you. Tell them that we are looking for what is unusual. Perhaps it’s something that they’ve never told anyone before. Perhaps it’s a secret. The more it is a secret, the more important it could be for us. For example, I had a healthprofessional patient who was friends with a colleague. However, he came to see me because whenever he saw a knife he had a sudden impulse to kill his family (who he loved) and didn’t want to reveal this to the colleague. The remedy Alumina very nicely removed this morbid impulse and the patient was greatly relieved.

Be alert for clues-The key to the case can be anywhere. Be alert to what the patient says and does. The way a patient says something may be more important than what is actually said. For example, if you ask about fears, and the patient emphatically says I am not afraid of anything, they may be really expressing that they are haughty or presumptuous. Be alert to the patients posture, manner, eye movements, etc. Books on body language can be helpful here. For example, in a class we had a 3 year old who was being seen for eczema. The key symptom of the case was the fact that the child did not like to be looked at. This lead to the successful prescription of Natrum muriaticum which greatly helped the child’seczema.

Horizontal and vertical vision-It is important to learn to perceive the whole picture of the patients symptoms (the forest-horizontal vision) as well as the details (the individual symptoms or trees or vertical vision). During case taking, we tend to get caught up more in the details of the case. However, at the end of case taking it is important to step back and view the case as a whole. It is analogous to our vision which is a combination of central and peripheral vision.  If one is lacking one or the other, then there is a distorted vision which prevents us from see- ing things as they are. For example, patients with retinitis pigmentosa retain their central vision but lose peripheral vision which makes it very dangerous for them to drive or even walk out intothe street. They can see what’s right in front of them, but they miss the car speeding at them from the periphery.

Keep legible records and underline-It is important that your records are complete, precise and clearly written. Some are shifting to electronic medical records which are typewritten, however, one must then negotiate the various forms and templates available to become comfortable with the new documentation format. For some, hand writing on paper may provide a freedom to document using one’s own style, however it must be legible. Hahnemann skipped lines when he took a case, so he could fill in the lines later if needed.  I learned to take a history on unlined paper, so that I can fit things in later if  needed. Always write in the patient’s language, but you may correct anatomical terms if needed. You can use for direct patient quotes as needed. You can place a ? after a symptom obtained by direct questioning or which the patient states with uncertainty. Each sheet should have the patients name and the date. It is useful to have a list of remedies given in the chart with the remedy, potency and date given.  I use a yellow sheet for this in a handwritten chart. Also, it is sometimesuseful to have a 1-2 page summary of the case, perhaps written on a different color sheet. For follow-up visits, please see the section on follow ups.

A simple table on how to underline while taking a history follows. Underlining is used to give emphasis to symptoms as the patient is talking depending on: Frequency, Intensity, Peculiarity, and Spontaneity. Just remember the acronym: FIPS. The last two, Peculiarity and Spontaneity are useful if you can’t decide between two levels. If the symptom is Peculiar or Spontaneous, then you would use the higher level. For example, if a symptom were common or non-spontaneous, you would generally keep it as a one or no underline. However, if you are between a 1 and 2 underline, or a 2 and 3 underline, and the symptom is Peculiar or Spontaneous, then you would use the higher underline. (See also the case analysis chapter-Intensity of a symptom/ underlining.)

Develop an order to questioning the pt.-The following is a suggested order to questioning the patient. Especially when one is new to case taking, it is important to follow this order. As one becomes more experienced, then the order can become more flexible, but just be certain that all the major areas arecovered.

Chief Complaint:

History of Present Illness(es):

Past History:

Family History:

Social History:

Physical Generals¹³:

Temperature-Heat, chill, perspiration, sun, weather, season

Energy-time, aggravating, ameliorating factors

Sleep

Appetite/Thirst-Desires, Aversions, Sensitivities, Bowel movements, Digestion

Menses/Sex

Review Of Systems: (optional) This is a review of symptoms from head to toe. It is not a physical exam. If a homeopathic history is well taken, it is rare that a review of systems needs to be done. Thus, this part is optional and only to be included in history taking if required for other reasons (e.g. documentation requirements) or if one is fishing for further information in a case.

Mental/Emotional: General, Fears, Sensitivities, Affection, Anger, Pathobiography¹⁴

Physical Exam: This is where the physical exam findings are recorded. First there is a general description of the patient, then vital signs are recorded, and then a head to toe exam is recorded with the amount of detail determined by the circumstances. Note, that this is different from the review of systems described above.

*****

Case taking-overview-the acute case

In taking an acute case, the same process of taking a history and then doing a physical can be followed. However, the history and physical can both be focused on the acute problem.

Acute History

You would ask for all the symptoms, since the onset of the acute disease(s). Generally, in homeopathy, there is a hierarchy of symptoms which goes as follows from most to least important:

Mental/emotional symptoms-e.g. weepy,irritable

General/ Physical General symptoms-e.g. chilly, desires ice cold drinks

Local/Specific/Physical symptoms-e.g. burning pain in the stomach better with hotdrinks

This hierarchy is only relative, however, and the most peculiar or characteristic symptoms always are most important even if they are local symptoms.

As previously mentioned, it is important to let the patient talk. Thus, when the patient is done talking, you may often ask, Anything else?

Let the patient talk

Keep asking Anything else and remember the value of spontaneous symptoms.

Physical exam

Objective symptoms can be a small part or 100% of the case (e.g. in an infant, animal, or patient in coma).

Always remember that The key to the case can be anywhere!

Case taking-History of Present Illness (HPI)

Begin by going through the complaints on the intake form in the order found on this form or from the most important to the patient to the least important.

Do one complaint at a time until you are satisfied that you have obtained all the important characteristic information.

You can start with medical history of the complaint-e.g. when was the condition diagnosed, by whom, what labs were done, treatments and their effects, etc.

Or you can start by asking: Tell me about your …

Keep writing, and keep asking anything else until you are satisfied that you have obtained all the important information possible about that complaint, then move on to the next complaint.

At the end you can ask if there is anything peculiar about each complaint.

You can give the patient feedback if they are giving you the information you need (e.g. Good, that’s precisely the information I need.) For each complaint you want to obtain enough information so that you satisfy your 4 objectives in case taking, namely: clear diagnosis, simillimum, prognosis, and case management.

HPI-Complete symptom-

For each complaint in the HPI, especially if it is a pain syndrome, you want to obtain a complete symptom. A complete symptom consists of the following 7 elements. The four in blue were first described by Constantine Hering in his Guiding Symptoms. The 7 elements of a complete symptom are as follows:

This diagram should be recalled as it is so that all pertinent areas of the HPI can be covered with each complaint. Some of these points the patient will spontaneously tell you; however, the others should be covered by questioning. If enough of these elements are present, you may be able to narrow your choices down to a few or even one remedy.

That is, the HPI alone may lead you to the simillimum! HPI-7 elements-some examples

Etiology,precipitatingfactors

Weather/ Temperature - cold dry wind (Acon, Bell, Heparsulph), change of weather (Rhus tox), cold wet weather, heat of thesun

(Note that when remedies or remedy abbreviations are listed after a symptom, this means that these are some of the remedies to consider for that symptom, but that for a full listing of remedies you should consult a modern repertory. For a full listing of remedy names and abbreviations consult a repertory.)

Trauma or stress - strains, blows (Arnica in general, blows to the eye-Arnica, Symphytum), lifting, emotions such as: fright (Acon) or grief (Ign) or humiliation (Lyc or Staphys). You may have to wait until the pathobiography to obtain some of thisinformation.

Infection - ? Epidemic (look for genusepidemicus)

Concomitants- symptoms that occur together with the main symptom - often PG/ME (Physical Generals/Mental Emotional) symptoms. Ask what occurs with the migraine or fever? Or, Is there anything that started at the same time as the illness? Is there any other symptom that increases or decreases with thecomplaint?

Body aches, twitching in sleep (e.g. duringfever-Bell)

Change in vision, urination (e.g. copious urination with headache-Gels)

Fever, chills (the time, location, extension and triggers are all important), perspiration (the time, location, triggers and aggravating and ameliorating factors areimportant)

Desire for or aversion to air/drafts, covers (e.g. aversion to un- covering with fever-Bell, Nux-v,Puls)

Energy/weakness (trembling weakness withflu-Gels)

Thirst (especially if different than usual), appetite, bowels/ digestion (e.g. increased appetite with headache-Phos)(e.g. with fever thirst for frequent sips-Ars, for large gulpsinfrequently-Bry)

Moods-Often the mood or a change in mood is the key to the case with a physical illness, e.g. if the patient changes from irritable to mild and weepy with an acute. Mild, irritable (Cham), anxious, sensitive (to light, noise, clothing), restless (Acon, Ars, Rhus tox), desire or aversion to company, indifference with fever, confusion, weepy, desires quiet (Bry,Gels)

Modalities- aggravating (worsening) or ameliorating (improving) factors. First ask, Which factors affect the pain? Then ask Which factors make the pain better or worse? Then ask about warm and cold (room, drinks), motion (rocking, being carried), pressure (Bry is better lying on the painful side), touch, position. Look in the repertory for more examples of modalities to ask about. Try to ask in an open ended way so that the patient can’t answer with a yes or no. For example, In what position is the pain better or worse? rather than Are you worse lying on the leftside?

In pain cases, the modalities are often times the leaders which guide you to aremedy.

Be as precise as possible, and look in the repertory forhelp.

Time aggravation-When does the symptom occur, and when is it better or worse? (> or the greater than symbol is often used to denote better from and < or the less than symbol is used todenote worse from.) Be precise. Don’t confuse worse night with worse sleep or worse lying. Some examples:

Fever/chill at 3pm-Bell

Fever or generally worse at 4-8pm-Lyc

Fever at 9pm-Bry

Fever aboutmidnight-Ars

Fever atnight-Merc

Worse at 11am-Sulph

Worse at 2-4am-Kali-c

Onset - slow or rapid. Onset of fever over several days-Gels. Rapid onset of fever over a few hours-Acon, Bell, Ferrumphos

Location-Have the patient point to the location. If they point with a finger, then it is a localized pain in a spot. If they use their entire palm to denote the area, then it is a deeper, more vague pain. The location of warts can be important, such as on the palm (Nat-m) or near the fingernail(Caust).

Extension-someexamples

Sore throat extending to the ears (Phyt, Nuxv)

Headache extending to theneck

Chills extending up and down the spine(Gels)

Have them trace out where the painis.

Rollin Gregg’s Illustrated Repertory may be helpful to find such extensions of pain which are not found in Kent’s or theComplete Repertory.See  https://www.narayana-verlag.com/advanced_search_result.php?search_redirect=&queryFromSuggest=false&search_area=&keywords=Gregg%27s+illustrated+repertory

Sensationsas if-Ask, What does the pain feel like? Then you can ask, Is it stitching, tearing or burning, etc.? Boring pain is usually found in the bone, stitching pain in the chest, and gnawing pain in the stomach/abdomen/pancreas. I once had a patient who had a bubbling pain in the abdomen and chest which is a characteristic of Berberis.

The sensation could be the key to the case, or it could be a false leader which leads younowhere.

Other examples: headache like a vise, pain like a nail, sensation of the eyes being pulledbackward

Remember that you are always looking for symptoms which are strange, rare, peculiar, uncommon, striking, distinguishing, exceptional, characteristic. If these symptoms can be found in the repertory or the materia medica, then they often become the leading symptoms which guide your choice of a remedy.

HPI Other Key points-the following information should also be obtained on each complaint as it is important for determining prognosis and for determining progress at follow-up visits.

Diagnosis-Find out who made the diagnosis (a specialist?), what tests were done, and was it confirmed by others. Diagnoses are commonly incorrect. A friend’s Aunt was diagnosed with pneumonia and treated with antibiotics with no results. She had no fever or cough. She was only short of breath at night on lying and had to lie with her head on several pillows. When I suggested they should check for Congestive Heart Failure, they did so, started treating her for it and she finally started to improve. If the tests are equivocal, then other diagnoses should be considered. It is important to be aware of diagnoses that could get you into trouble medico-legally, especially if missed, e.g. heart disease, cancer, peripheral vascular disease, stroke, pregnancy related issues,etc.

Onset-Find out when the illness started and what were the first symptoms.

Get a date if possible. The more exact the date of onset, the more likely your are to identify precipitating factors for the illness, e.g. grief, a new drug, disappointment, etc. The patient may not be aware that these factors could affect their healthand may even deny it.

You could ask what was happening in their life when the illness began.

Without this information your case may be defective (i.e. it will be difficult or impossible to narrow the prescription down to one remedy).

Evolution of the condition since onset. The order or progression of the symptoms over time is important as you want the symptoms to disappear in the reverse order of their appearance. Sometimes making a timeline while taking the history can behelpful.

Treatment and effects-Prior homeopathic treatment that the patient received could change some symptoms which might be important in your case analysis. If some of the symptoms are common side effects of a drug that the patient is taking, then these symptoms become less important. If a symptom is gone, but it has been suppressed, it may be important to make a complete case. Prior treatments can eliminate symptoms and create a defective case¹⁵ (i.e. one in which you can’t find a suitable remedy). You may have to hold a treatment for a while so that suppressed symptoms can appear in order to clarify the case and allow for successfultreatment.

Frequency and Duration-You need to know how often a symptom occurs. Also, how long does it last. This information is importantfor assessing changes on follow-up visits. Have the patient be specific-e.g. the migraines occur twice monthly and last 24 hours. If there is a lot of variation of the symptom, then ask for an average and/or maximum and minimum for the symptom. If on follow-up the patient is able to say that a certain symptom is 30-40% better, this gives you an idea about the prognosis (generally good). The problem is patients tend to view things subjectively, but we need to be objective and to confirm what we find.

Severity-Ask for severity on a scale of 0 (no pain) to 10 (excruciating pain to the point of passing out) so that you can objectively follow the symptom. Some patients prefer a 0 to 5 scale. Others will say that they cannot give it a number and prefer to describe the severity in anotherway.

HPI other points-

When done with one complaint, go on to the next. Start with the most important and work down from there.

If there are many complaints, you may be dealing with a hypochondriac. Then you may only need to investigate first few complaints and then you can move on to the rest of the history.

Remember, that after one complaint or another you may have an idea for a remedy. You will use other parts of the history such as the Physical Generals (PGs) to confirm or refute your choice of a remedy. Or if there are only common symptoms present in a complaint, you’ll know that you will find the clues to a remedy elsewhere.

At end of all the complaints, ask if there is anything else they forgot. This is often where the patient will tell you about impotence, a venereal disease, or suicidal thoughts. These symptoms could become the focus of the entire case!

Remember that Characteristic symptoms can be found anywhere in the case!!!!

Family History (FH)

The Family history can give an idea of severity of a condition and/or the prognosis. For example, a patient with a 2 or 3 generation history of depression will be more difficult to treat than a patient with a recent depression and no FH of depression.

Severe allergies or asthma in FH also indicates a more severe and difficult to treat condition. Generally, with allopathic treatment these conditions become more severe from generation to generation. With good homeopathic treatment, the reverse should be true.

If there is a strong FH of Cancer, then you should have the patient consider a change of lifestyle and consider cancer screening at an appropriate age.

If there is a FH of heart disease at an early age or sudden death, then lifestyle changes and heart disease screening should be considered.

Social History (SH)

Drug and alcohol use can interfere with successful homeopathic treatment. This includes use of marijuana which is becoming increasingly common with the trend toward medicalization and legalization in the US.

Jean-Pierre Gallavardin was a French homeopath who specialized in the treatment of alcoholics. His free ebook is available on Google books.  See

https://www.google.com/books/edition/The_Homoeopathic_Treatment_of_Alcoholism/STI4AAAAMAAJ?hl=en&gbpv=1&dq=Jean-Pierre+Gallavardin+the+homeopathic+treatment+of+alcoholism&printsec=frontcover

Coffee and tea use should be noted from the intake form. Either one could interfere with homeopathic treatment if the patient is sensitive to them. A sensitive patient will have withdrawal symptoms if they try to decrease intake (e.g. headaches if they decrease coffee intake) or symptoms from consumption (e.g. insomnia from coffee or palpitations from tea).

The family situation could be a clue in difficult to treat cases. If one is constantly under stress from an abusive family relationship, then the course of treatment will be more complex, and lots of remedies and doses could be needed.

Past History (PH)

Characteristic symptoms may be found in the Past History if you investigate carefully. Especially in defective cases (i.e. where you are not able to find a remedy), old characteristic symptoms may be of value.

You are Looking for any past illnesses that the patient has been never well since, or that were more severe than usual, or were illnesses with complications.

For example, a patient could be never well since surgery, injuries, or immunizations.

If you find such a condition, investigate it fully as you may find a picture for a remedy the patient still needs.

Although more recent characteristic symptoms generally have more value, older characteristic symptoms can be of value as well, especially when there are a paucity of characteristic symptoms in the current case.

In the PH portion of the intake form we have:

Abscesses-the location (esp. dental) is important as they are likely to recur if not previously resolved at some point during homeopathic treatment. If the dental abscess recurs, ask the patient to call you so there is an opportunity to treat the abscess homeopathically.

Alcoholism-if there is a history of this, then the patient may still be alcoholic. Denial and lying are common in this condition. Ask for the quantity consumed to confirm what is on the intake form. Sometimes it helps to suggest a larger number that expected in order to get a more accurate amount.  For example, if the patient drinks beer, you could ask how many cases of beer they consume per day. This way they are more likely to tell you about the 10-12 beers a day that they drink than if you just ask how many beers a day they drink. The condition may return during treatment and other impulses may be present as well.

Allergies-if allergy shots were given, these are generally similes¹⁶ (i.e. not the simillimum or most similar remedy) and thus during treatment the allergy symptoms may return. Also, multi-dose allergy shots could contain thimerosal (ethyl mercury) as a preservative. Allergy symptoms may be useful to find the remedy in a defective case.

Anemia-ask what is the cause? It may return during treatment.

Arthritis-may be climate or location (e.g. by the ocean) related

Asthma-may be seasonal or a past symptom which is gone or has been suppressed. Even if gone, look for characteristic aspects of the asthma (e.g. worse at 3 am) as this could be a key to the case. I have a patient with a Tic disorder, who had asthma at 3 am in the past which was a clue to Kali carbonicum which helped cure the Tic disorder.

Bleeding

Cancer-can recur so make sure the patient is being monitored, and also look at the FH to see if other family members have had cancer, and what the course of treatment was.

Chicken pox-look for never well since, more severe than usual or complications with it, as with any previous infectious disease.

Cold sores-i.e. herpetic eruptions (small clustered vesicles) on the lips or around the mouth. This does not mean aphthous ulcers in the mouth. Find out the frequency, duration and intensity of attacks. If the cold sores are not changing with treatment, then a deeper acting remedy is needed. Two of the main remedies for cold sores are Natrum mur and Sepia.

Depression-is common with stress. See if there are characteristic aspects to the depression. If depression was present in the past and it returns with treatment (ROOS=Return Of Old Symptom), this could be a good sign.

Diabetes-if insulin dependent, the insulin dose may change with homeopathic treatment.

Emphysema-once it is there, it does not go away.

Epilepsy-Look for characteristic aspects, e.g. seizures after trauma to the head.

Gallstones-gallstone colic may return after surgery or with homeopathic treatment. A common cause of gallstone colic in thin young women is oral contraceptives.

Goiter-there are many causes, e.g. Graves’ disease.

Gonorrhea-looking for never well since, difficult to treat, or sequelae after.

Gout-a change of diet may be needed.

Hayfever-if it returns, a new remedy may be needed.

Heart disease-if there is a history, it is probably still present. Again a change of diet may be necessary.

Hepatitis, Herpes, Jaundice, Influenza-looking for never well since.

Kidney disease-renal failure can present with very subtle symptoms so be sure to do a blood test for BUN and creatinine if there is even slight suspicion.

Leukemia-after treatment the patient is at increased risk for secondary cancers like lymphoma.

Malaria-can recur. In 2012, the WHO estimates that about 627,000 people died of malaria, mostly African children, and there were about 200 million cases of malaria worldwide.

MMR (Measles, Mumps, Rubella), Mononucleosis, Scarlet fever, Strep throat, Tonsillitis, Syphilis, Typhoid, Yellow fever-looking for never well since.

Miscarriage-if recurrent, the stage of pregnancy at which it occurs (i.e. number of weeks) can be important in choosing a remedy.

Parasites-lab testing may be needed to see if the patient is cured.

Peritonitis-looking for never well since. Pyrogenium is a remedy often needed in this condition.

Pleurisy, Pneumonia-the location can be important in helping to choose a remedy.

Prostatitis/PID (Pelvic Inflammatory Disease)-often becomes chronic and is often a dissimilar disease.

Rheumatic fever-looking for never well since. Patients with a history of this in childhood tend to be difficult to treat and can take years of homeopathic treatment to gradually regain their health.

Sexual Abuse-is common, but this may have to be investigated later in the history taking, or in a subsequent visit.

Skin disease-if it disappeared with drug treatment, it will recur and could last a long time. If you forewarn the patient of this, the patient will trust you more. Some skin conditions like psoriasis are harder to treat.

Sinusitis-if chronic and recurrent and the patient has another serious disease (e.g. Multiple sclerosis) you may need to give the patient homeopathic prophylaxis.

Stroke-Again a change of diet may be in order.

Sunstroke-looking for never well since or a severe or recurrent episodes.

TB (tuberculosis)-it may return with homeopathic treatment. At some point you can consider Tuberculinum.

Warts (venereal too)-their location can be characteristic.  For example, I had a patient with a wart on the buttock. Only one remedy is found in the repertory for this, Conium, which also fit the rest of the case. When given, the wart fell off painlessly within 2 weeks.

Whooping cough-also known as the 100 day cough, it is often recurrent.

Worms-can recur after the remedy, the simillimum may need to be repeated with the recurrence.

Intake form-other items

Menarche and LMP (Last Menstrual Period-date the bleeding started)- both important for tracking menstrual irregularities.

Pregnancies (GPAb)-i.e. Gravida or number of times the woman has been pregnant, Para or Parity or the number of times she has carried a pregnancy to a viable gestational age (i.e. > 20 weeks), and Abortus or the number of pregnancies that were lost for any reason including induced abortions or miscarriages.

Vaccinations-looking for never well since, or strong reaction to a vaccination. The nosode¹⁷ related to the vaccine reaction can be considered as a remedy. Unfortunately, with the ever more complicated vaccination schedule and the administration of multiple vaccines on one day, it is sometimes difficult to know to which vaccine the patient is reacting.

Antibiotics-looking for prolonged use and side effects (e.g. rash, diarrhea).

Weight loss-important in chronic disease and may be a sign of an undetected cancer.

Exercise-important to know for lifestyle and it also affects the patient’s temperature evaluation (i.e. people who exercise more tend to be warmer). So if a patient exercises for 1 or more hours daily and is slightly chilly, they are in fact very chilly. If you are suspecting a chilly remedy, but the patient exercises a lot and is somewhat warm, you could still consider the chilly remedy as the exercise will raise their temperature perception.

Chapter 2

Case Taking - Physical Generals

The physical generals are rather unique to homeopathic history taking.

The template for Case Taking is as follows:

Chief Complaint:

History of Present Illness(es):

Past History:

Family History:

Social History:

Physical Generals:

Temperature-Heat, chill, perspiration, sun, weather, season, mountains, seashore, moon

Energy-time, aggravating, ameliorating factors

Sleep

Appetite/Thirst-Desires, Aversions, Sensitivities, Bowel movements, Digestion

Menses/Sex

Review Of Systems: (optional)

Mental/Emotional: General, Fears, Sensitivities, Affection, Anger, Pathobiography

Physical exam:

So the next item to be covered in the history is the physical generals (PGs) which will be covered in this chapter and are noted in blue above. In transitioning in the history to asking about the PGs, you could say something like this to the patient. We are now going to be asking questions about your body as a whole. This part of the history is rather unique to homeopathy, but elements of it (e.g. temperature and food cravings) are covered in other disciplines such as Chinese medicine and Ayurveda.

Begin by asking about Temperature. The various aspects of temperature are noted below. Always ask the most general question first. Then if more detail is needed you can ask more specific questions later.

PG-Temperature

Warm or chilly

Sun sensitivity

Perspiration

Weather

Season

Mountains/seashore

Moon

PG-Temperature

There are 3 aspects of temperature which