Minutus

Hi Arthur,
One way to answer this question is to look at what we are prescribing for
– what needs to be cured. This is a judgement on what deviates from some
reference. But what reference to use? In a true acute, the reference in
contradistinction is the chronic state – this is easier.

But otherwise (a chronic remedy) it may be difficult to differentiate what
“deviates” from the “usual state”. We must use the reference of what is
the normal state of a healthy human in context of the species and a given
subculture.

And we must know what symptoms in the client are part of a characteristic
picture of a medicine. This latter is a matter of experience, intuition,
and being able to differentiate a smaller totality "layer" (which
resembles an acute but is embedded in a chronic picture)- from an
overarching totality situation.

OVERARCHING TOTALITY (cf Organon 191-193)
If we do not have an urgently pathological or otherwise obviously
“pointed” case, then the optimal remedy is often one that treats the
“whole” picture, or what can be called an “overarching” totality. We need
to find the true individuality of the miasmatic pattern on the surface of
the case (whether it is pointed or overarching).

In a typical functional (no severe tissue or psychiatric pathology) case,
the optimal remedy is usually the remedy “for the patient” or an
overarching one, and mental/emotional sx if findable are very important.
Any of Boenninghausens ingredients to a full case can add up to sufficient
legs of a stool to allow repertorization. Any of Sankaran’s indicators,
or Scholtens indicators can create a totality as well. We look for the
remedy which will provide pattern resonance and annihilate the miasmatic
layer on the surface of the case. I call the overarching type of
simillimum the “vector sum” of the peculiars or logical inputs to the
grounds for the prescription. We are treating the overall result of the
total combination of miasmatic distortions, which usually hinge around a
theme or nature, or (Sankaran) vital gesture or “sensation” or “core
delusion; or consistently appearing phenomena which run through the case.

The grounds for the prescrip (chosen sx) are arranged according to
importance to the case, intensity, and peculiarity (to the person, to
medicine, to society/culture, to the rest of the context of the case).

They can also be arranged according to para 153 peculiar(whether
sensation, location/radiation/extension, modality,
concomitant/alternation, etiology); mental/emotional; general or
particular in hierarchy.

Or, the generals may be irrelevant because they are not in bold relief or
germain to a particular medicine.

Symptoms can also be arranged by physical pathology in one group, and
functional symptoms in another, to see if a remedy comes out for the
pathology layer.

Plants/animals --They can also be arranged a la Sankaran – Kingdom theme,
Peculiar Vital Gesture/sensation =taxonomy, and miasm= remedy in that
taxon. That is the triangulation method using those categories to extend
the materiamedica.

Elements/compounds --They can also be arranged a la Scholten (Periodic
Chart) – Series (Period) matching theme; Stage (column) crossed to yield
remedy candidates.

Sankaran and Scholten methods allow use of remedies with little
pathogenesis available except clinical confirmation of the schemas used to
classify the taxons or x and y axes of the periodic chart. Essential to
the clients I attract. Yet there is no “magic” in a method of collecting
or arranging symptoms, necessarily. The remedy can be very difficult to
find and require pre-knowledge of the extent of the materiamedica and
recent provings in order to find regardless of symptom arranging.

There are other arrangements.

It may take playing with different symptom combinations, because a sx we
THINK is important may not be. If we can find ONE ironclad thing about
the case and then two other associated symptoms in the same space and time
context that are in a different arena of the case than that ironclad one -
then we may have a totality which “goes clunk”– we may be able to become
certain of a remedy we have been studying in the mm.

One complication is that the “bullseye” in a case may depend on an unusual
remedy with a small or little-known totality. We are also complicated by
the issue of the client being forthcoming and us obtaining the true info
we need. We need to have in mind “is this really a full case?” If not,
we need to dig more, give the pt a questionnaire, speak to their spouse
or a third party. Then we may find out more, or what the client is blind
to about themselves that may hinge the whole case…

The lynchpin symptom(s) of the overarching remedy will need to be
something very characteristic. Sometimes we don’t find that overarching
remedy first, as some layer of suppression or etiology may overlie it.
An etiology or NBWS (Never Been Well Since) may be the ONE ironclad that
leads to the remedy on the surface. Thus the case may hinge only on that
and a few other corroborating symptoms that we must hunt for. In that
instance, the “rest of the case” (e.g the Boenninghausen complete case) is
not germain for the first prescription, unless it elucidates a totality
that is complementary to the remedy on the surface. In that case the
complementary relationship with the underlying remedy (visible but not yet
prescribable) lends credence to the first prescription. Any of
Boenninghausens group or (shortcut):

Concomitant/alternation
Location/extension/radiation/alternation
Aetiology
Modality
Sensation

--with some core delusion or other gem artifact of individuality can
provide a key in an overarching functional prescrip. Or only ONE of them
can provide the basis for this overarching – or for a prescription which
is NOT overarching but which MUST be given as it is the current dominant
“layer” reflecting the active and blocking miasmatic combination which
yields the totality in the language of symptoms.

PATHOLOGICAL; ORGAN; AND OTHER “SMALLER” LAYERS
In cases where treating a pointed pathology, that “lesion” can be treated
as its own totality, when the overarching remedy “for the patient” is
clearly correct, but is NOT curing the pathology. Here we are not
treating the whole vector sum of miasmatic distortions, but a dominant
one which is a “rough edge” not covered by the best overarching remedy.
Without sufficient sx to go on, this remedy may be a known complement of
what had worked as the best simillimum. If there is no tried-and-true
complementary remedy in the literature which covers the pointed
pathology, then we are helped by some peculiar of the pathology itself.
If none is available, we may have to go to a “specific” found by
Ramakrishnan, or others guided by the homeopathic literature and clinical
experience. . This is a kind of “micrototality” prescribing, if you
will – when we consider the overarching totality to be the
“macrototality”.

In "pointed" situations there is also the the work of Parimal Banerji
(essential study for all homeopaths but currently unfortunately largely
out of print currently). Banerji has vast empirical experience in
matching pathological totalities which belong to ONE remedy but in
different DIAGNOSTIC situations and varying PRESENTATIONS. These have
been confirmed time and time again from a pool of 750,000 cases (from a
larger set of over 15 million cases taken over 90 years in Calcutta from
two generations of hom practice in a team-approach high-volume clinic).

The pathological layer is similar to the situation of a functional layer
(say from an etiological trigger) – EXCEPT that the remedy needs to
address the peculiar physical manifestation (pathology). Kent did not
discuss the remedy for the pathology. He discussed the remedy for the
pathology and the patient together. Otherwise, he gave no philosophical
basis for using a micrototality remedy for the path layer which had no
panoply of symptoms of the “patient” in its pathogenesis.

My own sense is that there are a lot of pointed lesional remedies in the
material medica that we do not use as such, as we are only using them
when they cover the overarching case. These same remedies can address
specific pathologies. Dr. Ramakrishnan, and people like Somenath Mitra
from this list are working on this underused angle, for example. Some
practically-oriented Indian prescribers see raw unsuppressed pathology
day and night in a culture in which homeopathy has an unbroken tradition
since 1850; and people both thus use homeopathy as a matter of course;
and it is more affordable and effective than allopathic treatment.
Pathological prescribing is thus an area Indian prescribers have moved
into by practical necessity and write about from clinical experience.
We must use this information, for it is just as Hahnemannian as "essence
totalities" are Guernsian/Kentian/Vithoulkian. These are just different
angles and different scale totalities. They all hinge on individuality
and peculiarity.

Pracititioners tend to be too smug about homeopathy. It is not complete,
always evolving. We must stay rooted in its fundamentals, but must make it
more consistently reliable and able to be practiced; more efficient; and
more easily confirmable before the client takes the remedy. We have a low
aggregate success rate. Our best practitioners do very well. But we need
more uniformity to qualify as a medical system that can replace the parts
of allopathy that we rely on while decrying.

In some cases pathological practitioners are not finding the overarching,
but treating pathological layers. Or, these two may be one and the same
in many cases. An overarching remedy may be found from the pathological
and Boenninghausen data, and not from the mental and emotional data,
unless those functional symptoms are marked. Conversely, a "layer" may
hinge on one mental/emotional symptom.

Any an all methods can lead to the pointed micrototality which leads to
what will annihilate the path layer. The finding of the overarching
remedy for the “patient” made famous by Kent is our final goal. This
remedy when found may however not be the "basement" of a case.

The miasmatic combination that is present and in force NOW is what must be
treated at the present time. As treatment commences, different layers may
ebb and flow, and come to the surface and need to be addressed.

===============================
Example of Case of overarching rx found and doing good work which has not
addressed a lesional layer
===============================

Case of man, 70 yrs (severe lumbar spinal problems, sexual function
problems, depression, Basal Cell Carc on sun-exposed skin in intellectual,
health-oriented guy whose father was taken by Nazis when he was age
three.) The case as a WHOLE has responded beautifully over a number of
months to an “overarching” remedy chosen by Scholten’s periodic chart
themes and empirical method – in this case a Lanthanide :Thulium-sulph.
Thulium fit the “theme” of his whole life – it was the peculiar in the
case – this guy’s issues seem to revolve around that event, in germany,
and he has not suppressed that layer down much if at all as he takes a
naturopathic view of healthcare (good diet, chiropractic, TCM, etc). The
sulph compound of Thulium was chosen because he is <<<< heat and has
lumbar problems, and is a bit theorizing and willful about it. This is
Scholten’s “thematic essence” method of constructing grounds for a
prescription – which he adapted from Vithoulkas, who extended its
development from Kent’s foundation. Kent stood on the shoulders of the
keynote systems which moved toward summarizing the "genius" cluster of a
medicine. This case is an example of legs of a stool that started by
recognizing the Lanthanide group (guy trying to do significant good in the
world independently - in a structured thinking client (i.e. probable
element remedy as opposed to animal, plant, nosode).

However, while the skin BCC was “controlled” by the Thul-s, it was not
annihilating it. The path layer became troublesome and not in a “Herings
rule” type of way. It had been “pushed to the surface” (cf Organon
179-182) by the overarching “vector sum” or functional simillimum. At
this point the overarching was discontinued (with idea that it might come
into use again later) and a micrototality rx to address the pointed and
urgent sx of the pathology was chosen using one peculiar (heat in skin ca
lesion led to euphorbium officinalis). Finding this rx was assisted by
that remedy being in the appropriate pathological category and backed by
clinical experience (Dr Ramakrishnan’s book). Thul-s is a fairly new
remedy and has no listed known complements or (Hahnemann’s term)
clinically confirmed typical “antipsoric” relatives. But fortunately he
was putting out a local keynote of heat/burning in the skin lesion.
This case is far from over. But both the layer and the whole case are
showing blatant and nearly constant Hering’s signs by use of a protocol of
one week of Euph LM6 (one dose only during that week) and one week of
Carcinosin nosode (three doses of 200 in that week). This is a
Ramakrishnan/Eizayaga-type protocol tailored to the client and adjustable
accordingly. The individualized “operative” remedy is the euphorbium off
(euph) which is the layer on the surface of the case, and the most urgent
item to be cured. The Carc is a nosode which as adjunct in any CA case,
provides an isopathic treatment of the genre of nonphysical decomposer
microbe (inherited miasm or foreign inimical vital force entity cf Organon
148-sixth) which creates neoplasms.

“Malignant” tumor formation probably ensues because of invasion of the the
nucleus of a specialized host cell by that nonphysical microbe body --
without killing the host cell. The invading vital program of the cancer
microbe then does what a decomposer microbe does best: consume and
reproduce USING the physical organelles of the specialized host cell that
it has commandeered. Other types of nonphysical microbes passed by
gametes of the parental lineage or remnants of unresolved illnesses
(syphilis, HPV/gonorrhea/Sycosis, Leprosy, Malaria, etc) influence cells
by induction, but do not take them over. The CA miasm does, however, and
eventual starvation of the host and grotesque cell growths vaguely
resembling the usual product of that specialized cell will result -- if
the miasmatic picture is not annihilated by resonance.

The nonphysical cancer microbe has a malleable identity. Its peculiar
nature is its ability to commandeer (in a real sense “possess”) the
etheric (quantum) operating system which is the life force of a cell.
That cell then behaves like a decomposer microbe. It drives that cell to
express its genes in a way that reflects a combination of vital programs –
the specialized cell and the cancer nonphysical microbe body. Its
reproduction and nutritional needs are out of proportion, its cells and
their specialized products contributing to the multicellular host are
perverted.

In this case we have moved from an overarching totality to a
micrototality prescrip. We have markedly *focused* the choice of sx to
use. A pathological layer not being covered by the overarching remedy
must be approached directly. This ca layer is now “on top” of the
combination of miasmatic distortions that we can define as this clients
“thematic” and overall (some would call “constitutional”) remedy. It has
not responded to that remedy sufficiently, and is a “rough edge”. Some
may say that another overarching remedy in the form of a complement would
finish the case, and this may be true, but we have little experience with
Thul-s and no convenient list of complements and diagnostic situations
with clinical confirmation.

The choice of rx in this example is based on stool legs of 1. pathology
type (BCC); 2. one pathological peculiar, and that is all. Seems like a
“local treatment” – yes? Yet, as Hahnemann says, if the prescrip is
successful, we affect the whole organism. Any local manifestation that is
not a true acute or chronic that we cannot treat with the overarching
remedy – also must have its base in whole-organism susceptibility (ie
miasmatic disposition). In this case, the ca layer is throughout the
organism, and has been pushed to the “surface”. It was “vying” for the
surface position with the rest of the case and the overarching did much
good work in removing inimical microbial vital force. But the CA
microbial vital force that was not being addressed by the overarching
remedy then became the dominant layer, indicated through the language of
manifested symptoms.

The euphorbium layer is not really “local”, but extends throughout the
whole case. It has become the layer on the surface during tx, but here it
only has ONE MANIFESTATION, not MANY as does the combination representing
the overarching totality. Yet that manifestation becomes our only surface
clue to the underlying bulk of the iceberg. At the present point in this
case, Boenninghausen’s hexameter is being used only for the SENSATION
piece of data. When no known complement or (Hahnemann) appropriate known
“antipsoric” exists which covers the pathology, we must find the peculiars
of that pathological layer if available.

CONCLUSION
This is an attempt to illustrate the answer to your question, Arthur by
showing that there is not any one rule to how to select symptoms. There
is a context of wholism and sometimes nonwholism in a case, and symptoms
of varying and only conjectured weight and thus value in the lexicon of
symptoms, the language of the vital force. We must judge the value of
these symptoms as per their relation to the true pattern on the surface of
the case for which we wish to find a resonant match. The chosen symptoms
must be in the correct context. In other words, a symptom of an etiology
30 years before may not be on the surface now – and we must judge whether
its manifestations are one or more “layers” down. We must place symptoms
in time as well as space, and judge what is on the surface and what is
below the surface. We must judge what is a layered case and what is a
case for which we can find one overarching totality that corresponds to a
remedy.

The Baron von Boenninghausen was a man of logic, a lawyer; and a natural
scientist (botanist) - like Hahnemann (a chemist among others). His
categorizations (so well presented for us by David Little as interpreter
on his educational website; and in Boenninghausens writings) are gold for
us. But the whole of a Boenninghausen complete case must be taken in the
context of the case. There are smaller more pointed totalities; and
larger more overarching ones. Keeping these endmembers in mind can provide
a mental framework to work from in conceptualizing the types and number of
symptoms which comprise a “full” case at any given juncture.

When we are looking for an overarching totality we may need a more
fleshed-out case. The smaller totalities are not limited to tissue
pathologies. Quite often we may see them in Etiologies (final stressing
affront to the cellular subsystem already under longterm stress by
nonphysical inimical foriegn vital force (inherited miasm)- causing its
breakdown into organic pathology); and in NBWS (remnant miasm associated
with a previous infectious disease or trauma in the present life). These
may be true “layers”, and are like a "case within a case" but represent
the *current* state to be treated. In a case of NBWS or triggering
cause as lynchpin symptom - or a micrototality (which seems local but
when it is on the surface, it is systemic) – we may have only ONE or two
pieces of logical basis for a prescription. In reference to your
question posed, it may be that these DO NOT include much that involves
the will or personality of the client – or the general symptoms. Or they
may. Every case is an expression of a unique combination of foreign
vital force expressing itself through the host in the form of peculiar
distresses.

In your case of Shy and Chilly (to oversimplify), these symptoms are not
as individualized as they could be; and not yet a recognizable cluster
(gestalt based on pattern signature). We wish to use litmus of
peculiarity to define a total case. This an be peculiarity of a single
symptom; or peculiarity of a recognizable totality of
(e.g.)Boenninghausen’s “total case” that we know in the materiamedica as a
“remedy picture”. Does that picture have enough legs to support a
prescription that has a chance of doing at least some annihilation by
resonance if not being the “bullseye”? If we are close but not dead on
the mark, the case at followup will be changed and we can then select
again. An overarching totality (Kent’s remedy for the “Patient”; or a
micrototality (the remedy for a layer) may EACH be what we are looking for
in any given situation.

There is more to be said and other listees have covered some of these.
But this is the way I wanted to answer your important question. We listen
and observe the semiology of the patient and try to match a remedy which
can produce that same pattern. The pattern may manifest in the client in
one theme or symptom, or the whole puzzle may be solved for us in a
“typical” expression of a particular remedy that we know well.

So we gather what symptoms we find, observe by examination or otherwise
elicit, and (in Sankaran’s technique) relentlessly pursue. Knowing the
Chief Complaint and surmising what needs to be cured otherwise, we try to
create a stable chair to sit on in ANY WAY WE CAN. Each type of case
requires perceiving the proper approach angle– though in all cases in
homeopathy we are always pattern-matching.
I hope this was comprehensible and helpful to answering your well-posed
question, as an addition to what other list members have written.

Best,
Andy