Qualifications of a Physician ?

[Julian Winston]

At 11:06 AM -0500 10/18/04, Bob&Shannon wrote:

I think folks are jumping ahead here.
We wwere talking of physical diagnosis.
Joe asked: "Now, as an educational test, what do you do?"

And, here you have a list of possible remedies.
THAT is not the answer.
The question is: WHAT is to be TREATED?

Too many homeopathy want to know, "well, what's the remedy?"
Ands I've been to too many seminars where the great gurus played the
"Guess the remedy" game.

The remedy is only a PART of what the case is about. You first have
to find out what needs to be fixed.

Best!

JW

[Shannon Nelson]

Ooooops, thankyou!!!!
Let me try again:
I would "casetake" -- Where exactly is the pain -- stomach or lower, and its
nature? When did this start? What was going on 18 months ago? Did the
abdominal pain < eating and the < fatty foods and the dry eyes begin then,
or if not, when?

I would find out whether *all* food causes pain, or whether some foods are
tolerated -- we have a type of food that agg, but I would also look for
foods that amel, or at least don't agg.

(I suppose grastroscopy rules out ulcer?)
But none of that is diagnostic... I guess I would assume there *isn't* a
physical diagnosis, and that it is either emotional or "functional". (Ouch,
I have a feeling that's not the right answer...)
:-/
on 10/19/04 3:25 AM, Julian Winston at jwinston@actrix.gen.nz wrote:

[andyh]

As far as how to keep all modes of thought (hom. casetaking; standard
med knowledge;chinese physiology) in operation simultaneously--my
approach is to put the data in mind by study and let observations
happen naturally. This seems to be what Dr. J describes--conscious
observation which is really only traditional homeopathic methodology.
But the more useful systems of knowledge of biology, psychology, vital
and physical physiology, vital and physical anatomy, vital and
physical pathology, med terminology one has studied, the more quickly
one can be certain of nothing being missed by the rx found from the sx.
Most of the TCM type info comes out in the CC's, thermal, sexual,
locus of pathology, personality info. In physical exam, can also
notice tender meridians, organs, for example. I would like to study
pulse and tongue diag if I am given the time as these are systematic
and valuable as well to offer hints when the rx is not obvious and when
there is time.

Beyond what comes as obvious sx, one must have an idea of the info one
wants to have in hand. Pre-and post casetaking questionnaires are a
concept I am working on refining. The pre questionnaires are
non-leading and requested of the client (more extensive) and 2 close
associates (spouse, parent, friend--returned independently and less
extensive)--- before the casetaking. These collect data which only
takes time to collect and takes away from the time and energy needed to
understand the case (eg what foods do you prefer, what position do you
sleep in, chief complaints, etc). The post-casetaking questionnaires
are tailored to situations and used when case appears to be difficult
and rx is really a mystery and have I have no clue even at end of
casetaking. These are very specific and more "leading". These
questionnaires are still under refinement.

There is usually plenty of opportunity to ask brief questions of
someone about the cardinal characteristics of Wood, Fire, Metal, Water,
and Earth--and organ type and condition characteristics. However, this
type of info usually comes out without asking from the pattern of the
reports by the client, and so leading questions should only rarely be
needed. But first one must learn all this TCM and standard diag
material systematically and thoroughly and develop a standard checklist
in one's mind--then integration should come naturally. I am only in an
early phase of this process myself.

Ultimately, our system depends on knowledge of materia medica and
repertory. What is offered by those of us who do not output diagnoses
or give anything but a homeopathic rx --is matching the genius of an rx
with the peculiar gestalt or specific needs of a case. For a
non-diagnostician, diag. is for thoroughness, and for screening to
refer to diagnostic specialist if something seems to be a warning sign
that indicates that a serious and rapidly developing health problem
could be present.

There is also another angle on finding remedies which I will discuss
here in the context of having "databases" in mind to allow to be
"piqued" by observation--and thus lead to insights which can help
understand the case and what would later indicate success or failure in
the action of a remedy. I am studying Sankaran "aggressive" case
taking methodology at the present time, and find that this is my method
of choice for all cases. This is a system which does not ask "leading
questions"--but aggressive "tell me more" queries when a hint surfaces
that is to be "pounced on"--RELENTLESSLY---UNTIL the "sensation" or
"feeling" or peculiar thought pattern comes into full view. It becomes
clear from the track record of Sankaran and Bombay folks that the
optimal rx in MANY cases may be so obscure from an informational
standpoint as to not be findable by straight match of pt semiology with
rx semiology. The full pictures of rx semiology are NOT YET KNOWN for
much of the materia medica. These methods have set up ingeniously
derived a priori schema for the groupings in the various categories of
nature from which we have inherited homeopathic remedies that are both
in common use--and not in use at all.

These schema thus become part of the possibilities for ways to view a
case--background knowledge. Then the models are tested and refined and
further fleshed out using clinical information about cured cases. In a
sense, this type of method when it is needed is a form of "in situ"
proving done only with the cured case portion of a proving. Systematic
experimental proving is also what we desperately need, but these
"inference by model categorization" methods are not a blighted or
blasphemous twin to systematic provings, but an essential helpful
sibling. These methods represent an extension essential to modern
homeopathy. We simply do not have the capacity and the time to prove
the entire materia medica, and will not in our lifetimes. Even after a
systematic proving experiment, it usually takes years for the widely
and easily usable clinical picture to evolve.

If there is already data "by inference" of the possible alchemical
nature of a substance by relation to similar substances, then this data
should be used. The clinical route of data collection, with enough
volume and reporting in the literature, "sketches" the materia medica
and allows us a powerful tool. It is not the "end point", but allows
enough of a foothold to utilize what is otherwise useless. Homeopathy
is a science that uses all data inputs to act on all knowledge in the
prescribers mind and then this impression can be extended by use of
category to improve reliability and certainty. The case is often as
simple as a few observations (eg keynotes) which can then be confirmed.
But a more systematic approach also fits the case into
categories--this backs up the idea of the remedy sometimes; other times
is the only way to find the remedy; but always allows a backdrop in
which to anchor the case. Homeopathy is sleuthing. Prejudice of
method is not helpful, though the methods known must be used correctly.
We must try all methods and experiment.

Sankaran/Scholten/Mangialavori methods of inference via categorization
are an advance of a form of logic used by Farrington and others. These
approaches do not by any means replace traditional semiology, but add a
deeper reach which enhances observation. These methods create
additional "stool legs" to allow "triangulation" to come up with an rx
which could be found no other way. These "legs" which supplement our
other observed semiology are vital crux "sensation" or CONCEPT (eg
exploding sensations; or delusion being pursued for example); GROUPING
(Linnean or periodic chart- alchemical knowledge of characteristics of
GROUPS of related remedies and not just their constituent rx); and
MIASM (Sankaran posits one dominant miasm for each remedy, and has
differentiated miasms further using Hahnemannian-type observational
data collection of hundreds of cases). The dominant miasm for an rx is
very difficult to determine, and it remains a question whether the
concept of a remedy having ONE dominant miasm only is valid. As of
yet, the confirmed reliable miasmatic ID of remedies trickles down from
Rajan and we have to rely on that judgement. However, so far the
miasmatic categories made by Sankaran have solved MANY insoluble cases,
and thus been helpful in making homeopathy more reliable. Only a small
portion of the mm has yet been categorized by "dominant miasm" as of
yet.

These categorization methods do not replace straight semiological
matching. However---very significantly--they allow utilizing remedies
by way of an ingenious system whereby categorization extends the use of
the materia medica--even when the actual "materia medica" is not known.
Inference by category is revolutionizing use of the unfathomed regions
of materia medica. Beyond this, the aggressive case taking method of
Sankaran unturns stones that do not get unturned if we "only listen".
We must probe without "tainting the data". "Please tell me more".
"Please expand on that". "Go on with that please in that vein". "More
detail about that please".---until the elucidating point is reached.
In order to know it has been reached, we need to have the known data
already loaded in mind--to know if what is being expounded fits in
something known in materia medica or categorical schemas or not--so we
can make a connection with a clue or not.

We must have the database of the developing schemas of the periodic
chart and the plant taxonomy in our mind FIRST in order to make this
really work best. Just as we must have as much as possible physical
and nonphysical physiology, path and anat knowledge in mind as for the
observations to "strike" us as meaningful.

Standard diagnosis gives us yet another leg to a stool--suspected
clinical named disease allows some quantification of pace and level of
danger to health and life. If manifested pathology--"ultimates" as
Kent referred to them-- have developed a life of their own, so to
speak, then the this may beg a needed intervention even beyond the
simillimum. Diagnostic methods which are adjunct to the homeopathic
method can yield meaningful insights about danger --when something is
really wrong that a client must know about so they can make a decision
about how to proceed, whether we can ultimately help them best or not.
It is a good idea for any practitioner to get good at this recognition
of danger, to minimize what HC Allen, I believe, called "clinical
reproaches on our conscience".

My own father recently went for a test and 90% left coronary blockage
was found and the doctor sent him right into bypass surgery without
"letting him" go home. Fortunately he is doing well. It would have
been better to have been able to avoid this horribly invasive and
expensive step which did not solve the original problem, only
temporarily its ultimate. But it is what he chose, and it was a good
and reasonable choice. It has bought time, and there is no
complaining about that seeing as how he chose a superb surgeon.
Fortunately bypass surgery has been refined down to 2% or so fatality
despite its unbelievable trauma ("radial-arm sawing" the sternum in
half and prying open the chest cavity).

Getting to know more about all ways to DETERMINE the nature of
dangerous conditions that might be present in a client is key
knowledge--I am pursuing several methods of improvement of my ability
in this area at present. We must fill the database through study in
order to become better rounded so as to serve people in the most
reliable way. In the case of Dr. J, he has lots in his database--a
good place to be.

Hope that is not too much commentary, Ellen. Just answering the
question. Unfortunately there is a lot to be said about homeopathy
which I do not currently have an opportunity to publish about on paper.
So I here am describing my own process of thinking by way of
answering your question. Thanks for your question.

Best,
Andy
[Non-text portions of this message have been removed]

[Dale Moss]

Hum, how about tasting urine to see if it's sweet (diabetes)?

There are some good diagnostic handbooks describing specific manual tests
and what they tell you. I particularly like "Professional Guide to Signs &
Symptoms" (Springhouse Publishing) and "DeGowan's Diagnostic Examination"
(McGraw-Hill).

Peace,
Cinnabar

[Ellen Madono]

The more basic question is "Is homeopathy the appropriate treatment.?" :-
Blessings Ellen

[Dr. Leela Dsouza - Francisco]

I HAven't read all the posts yet, but this is excellent differential
Diagnosis, Robyn.
I had only zeroed in on a possibility of pernicious anaemia - with an
associated immune complex or autoimmune disease.
dr. leela
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[Dr. Leela Dsouza - Francisco]

I HAven't read all the posts yet, but this is excellen differential
Dianosis, Robyn.
I had only zeroed in on a possibility of pernicious anaemia - with an
associated immune complex or autoimmune disease.
dr. leela
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