Minutus

At 06:26 PM 5/18/2004 -0500, you wrote:

Hello everyone,

In India under the pressure of volume practice I have something have
had to take 25 or more cases in a row. One simply does not have time to
take a 1 or 2 hour case under these conditions! One learns how to use
*redline characteristic symptoms* very well under these circumstances.
Sometimes it is just one grand characteristic symptom that leads the way.
When I find a good redline symptom I check the materia medica for
confirmatory symptoms. If it all seems to make sense I give the remedy.
Being forced (at times) by circumstances I have learned the importance of
finding redline symptoms in which the remedy MUST be. This then becomes the
primary elimination rubric. These symptoms often carried defining
extensions, modalities and concomitants.

The modalities are often the defining symptoms of the particular
rubrics as the concomitants are the defining symptom of the totality. When
they come together often point to the remedy. One morning a patient
reported with a necrotic toe of which half turned black and was eaten away
(location and main complaint). It seemed they were going to have to
amputate. There were sensations like itching and burning and he felt better
if he moved his foot. As soon as the patient said he had to get up from the
bed after midnight and walk the floor I gave him Arsenicum LM 0/1 and the
toe responded rapidly.

The disease (the toe) and the patient (the person in general) felt
better in motion. Most people with a toe like this do not normally walk
around for relief after midnight. The black toe location, the itching
sensation and > motion in particular were linked concomitantly to the
general symptom getting up from bed and walking the floor after midnight.
As soon as I looked at the black toe and heard the concomitant "walks the
floor after midnight" I knew the remedy. Many case are presented like this
but not all.

There are many in India that use the redline characteristic method.
They have their successes and they have their failures too (just like every
other method)!. Nevertheless, it is an effective practice that is often
overlooked in the West because many associate it with keynote prescribing
in a negative way. I have cured many a case like this but it does not mean
that one should ignore every other methods of case taking. Not all cases
are solved by one method alone. To forget about causations, miasms, the
totality, layers, and everything else, IMO, is going too far. There is a
place for all these techniques. Not all cases are presented in the same
manner and not all cases can be cured with the same method.

I use Kent's, Boenninghausen's, Knerr's, Boger's and Phatak's
repertories besides the Synthesis and the Complete on computers. I use all
of these works because each one has their unique features and contains
different options. One has to know what type of symptoms are in these
repertories. For example, Boenninghausen broke up and redistributed the
symptoms of the provings and used generalization in the Therapeutic
Pocketbook. Hering did not like this idea all that much. He felt that the
complete symptoms should not be broken up, generalized and redistributed in
this manner. He wanted to keep the complete symptoms together as much as
possible and this is reflected in Knerr's Repertory. The approach of these
repertories are complementary opposites. For this reason, Knerr's very good
for single unique symptoms like the one the good doctor used above. This is
a great repertory which is based on Hering's Guiding Symptoms.

Nevertheless, there are symptoms that do not fit rubrics that are
already listed as one symptom in the repertories. The facets of the
symptoms come in a different pieces and contain fragments that are spread
out in several rubrics. These symptoms do not correspond to what is already
recorded in most repertories. This happens quite often. Here a more
particularized repertory like Knerr's Repertory of the Hering's Guiding
Symptoms may miss the mark.

This where Boenninghausen's Therapeutic Pocketbooks can be pressed
into service because one can use the generalized symptoms to build up
unique characteristic rubrics that may have never been seen before and
might not be seen again. One selects a location + sensation + modality +
concomitant with its locations + sensations + modalities, etc.. This
completes the circle. The end product may be completely unique but the
remedy has to potential to cure those symptoms. So in the end one has to
also individualize the repertory strategy to the patient and their disease.

If a case is represented by a group of mental symptoms the
Therapeutic Pocketbook may not help all that much. Here it is better to
look at Kent's and Knerr's repertories. These repertories have ample mental
symptoms including dreams and delusions. The Complete and Synthesis are
based on Kent's layout and approach. These repertories, however, sometimes
miss the mark in cases with strong pathological features and concomitant
symptoms. Back to Knerr or Boenninghausen depending on whether the case can
be cured with specific particular rubrics or composite generalization.

The method used to treat the patient also has to be individualized.
There is no one method that suits all circumstances. Sometimes the case is
solved because of one grand guiding symptom points directly to a remedy
that can be confirmed in the MM. Others fit a well known constitutional
portrait that is build up through a totality. Sometimes the symptoms must
be pieced together form fragments. At other times the miasmic
characteristic lead to a remedy. In other situations it is a group of
mental symptoms that lead the way. It may be the causation points to a
remedy. It is best to be open minded and flexible and use an integrated
approach that can be tailor to suit the time and circumstances.

Remember the importance of aphorism 153 and the striking, exceptional,
unusual, and odd (characteristic) signs and symptoms. Too many common
symptoms used in a totality only lead to polychrest remedies and too many
partial simillimums. It is far to easy to run up too many low grade
symptoms on a computer and miss the essence of the case. One must judge the
characteristic value of symptoms. Select the *redline symptoms * that the
remedy MUST be in and use them at the center of your case. Most cases will
only have a small number of such symptoms. The other symptoms may or may
not be all that useful.

Sincerely, David
---------------
"It is the life-force which cures diseases because a dead man needs no more
medicines."

Samuel Hahnemann

Visit our website on Hahnemannian Homoeopathy and Cyberspace Homoeopathic
Academy at
http://www.simillimum.com
David Little © 2000

Dear David, an excellent reply. And, although, as you say, this method
should not be practised without deeper regard to other ruling aspects of
each individual case, and even though you use this method due to pressure of
time and client numbers, I actually think this method is always worth trying
out on many cases. It helps to train the focus on absolutely what needs to
be cured, on the real objective facts of a case and reduces the temptation
of interpretation to a minimum.

And what is wrong really with using this technique more generally, even if
one is not pushed for time - so called redline symptoms are utterly
characteristic. I always try to take cases back to where they can be taken
no further in as much as there will be one rubric which begins to summarise
the case, the leading rubric, where you know the simillimum will be - you
just have to tease it out somewhat.

All students should try this sometime with a case, just to see what results
they arrive at. It works equally with acute and chronic cases

Best, Joy

www.homeopathicmateriamedica.com
on 19/5/04 7:16 AM, David Little at little@simillimum.com wrote:

Hello everyone,

In India under the pressure of volume practice I have something have
had to take 25 or more cases in a row. One simply does not have time to
take a 1 or 2 hour case under these conditions! One learns how to use
*redline characteristic symptoms* very well under these circumstances.
Sometimes it is just one grand characteristic symptom that leads the way.
When I find a good redline symptom I check the materia medica for
confirmatory symptoms. If it all seems to make sense I give the remedy.
Being forced (at times) by circumstances I have learned the importance of
finding redline symptoms in which the remedy MUST be. This then becomes the
primary elimination rubric. These symptoms often carried defining
extensions, modalities and concomitants.

The modalities are often the defining symptoms of the particular
rubrics as the concomitants are the defining symptom of the totality. When
they come together often point to the remedy. One morning a patient
reported with a necrotic toe of which half turned black and was eaten away
(location and main complaint). It seemed they were going to have to
amputate. There were sensations like itching and burning and he felt better
if he moved his foot. As soon as the patient said he had to get up from the
bed after midnight and walk the floor I gave him Arsenicum LM 0/1 and the
toe responded rapidly.

The disease (the toe) and the patient (the person in general) felt
better in motion. Most people with a toe like this do not normally walk
around for relief after midnight. The black toe location, the itching
sensation and > motion in particular were linked concomitantly to the
general symptom getting up from bed and walking the floor after midnight.
As soon as I looked at the black toe and heard the concomitant "walks the
floor after midnight" I knew the remedy. Many case are presented like this
but not all.

There are many in India that use the redline characteristic method.
They have their successes and they have their failures too (just like every
other method)!. Nevertheless, it is an effective practice that is often
overlooked in the West because many associate it with keynote prescribing
in a negative way. I have cured many a case like this but it does not mean
that one should ignore every other methods of case taking. Not all cases
are solved by one method alone. To forget about causations, miasms, the
totality, layers, and everything else, IMO, is going too far. There is a
place for all these techniques. Not all cases are presented in the same
manner and not all cases can be cured with the same method.

edited

Remember the importance of aphorism 153 and the striking, exceptional,
unusual, and odd (characteristic) signs and symptoms. Too many common
symptoms used in a totality only lead to polychrest remedies and too many
partial simillimums. It is far to easy to run up too many low grade
symptoms on a computer and miss the essence of the case. One must judge the
characteristic value of symptoms. Select the *redline symptoms * that the
remedy MUST be in and use them at the center of your case. Most cases will
only have a small number of such symptoms. The other symptoms may or may
not be all that useful.

Sincerely, David

Hi Joy,

"One rubric which begins to summarize the case"... sounds like a great
direction to take! How many rubrics do you typically use to rep a case?

Shannon
on 5/19/04 2:14 PM, Joy Lucas at joy.lucas@ntlworld.com wrote:

Dear Shannon, when I say this I would also include aetiology if it is a
dominant feature of the case - sometimes is, sometimes isn't. Otherwise I
look for what is driving the case and this can be anything from the main
presenting complaint, a sensation or type of pain, an emotional aspect of
the case, an intellectual one, i.e. mental sx etc. Sometimes it might be a
specific diseased state. But either way it will be a leading rubric, the
most important fact of the case. Then I will select just a few other facts
of the case - facts are the case and facts will give you the rubrics and you
don't really need too many, so I aim for about 6 or 7, but it depends on the
case - as few as possible but as many as it takes

Keep it simple.

Best wishes, Joy

www.homeopathicmateriamedica.com
on 21/5/04 2:10 AM, Bob&Shannon at shannonnelson@tds.net wrote:

Hi Joy,

"One rubric which begins to summarize the case"... sounds like a great
direction to take! How many rubrics do you typically use to rep a case?

Shannon
[Non-text portions of this message have been removed]

At 08:14 PM 5/19/2004 +0100, you wrote:

Dear Joy et al,

When I first came to India I met a senior doctor name Dr Isaac (30
years of experience) who was the head of a hospital and homoeopathic
college. At times he would prescribe for 100 cases in the out-patient
clinic with his students. He did most of his work without a repertory or
materia medica. Once in a while he would stop and pull out a very battered
copy of Kent's Repertory out of his desk and look up a symptom or two and
then prescribe. He would look at the patient very closely, ask what was
wrong, ask a few questions and prescribe....then NEXT. He also had a
private practice at home where he took more time with each patient. Even
here, however, he did not take any longer than he needed to.

I was fresh from the West and was used to taking 1 hour or so to take
a case and I was shocked!!!! I decided to stay at the hospital and observe
the follow ups over a longer period of time. I was amazed how well he did
with only a few minutes to spare for each case. He was definitely getting
good reactions from around 80% + of his first prescriptions while moving at
this speed. If he missed the first time he would make the person sit down
at his side while he worked the "line" , and at every spare moment, ask
questions. After however long he needed he would write the script and then
NEXT. I said "how are you doing this?" He said get Allen's Keynotes,
Lippe's Keynote, Nash's Leaders, etc and "learn all these symptoms". He
told me the Repertory was graded in 1, 2, 3 (Kent's) but some of the
symptoms in these old books were worth 100 points!

One day I was sitting next to Dr. Isaac while working and he
said..."give him Calc"....then...."give her Cycl"....then give him Olean".
I said "why?" He said "go take a patient to the other side of the room and
take their full cases". Well, I did and out came the symptoms.....chilly,
numbness, sour sweat, > motion, headstrong, etc., etc. I went back and
asked..."How did you know". He said, "after 30 years your patients become a
living materia medica you can use for reference Many remedies just walk in
the door". This was the fruit of taking 10, 000s of cases over the years.

Well it is 26 years later and I now understand how he did it!
Sometimes, when I do village campaigns, I have see 50 or more patients with
a team of 2 or 3 persons to help me (often my family). One or two persons
start taking the cases before I see the patient and the other makes the
medicine and tells the person how to take it. Sometimes, I take 5 cases at
the same time with all the papers spread out over a table. I usually just
look at the basic notes, ask a few good questions, find the most
characteristic symptoms and prescribe.....then NEXT. First I try to find
that special symptom that the remedy HAS TO BE IN. Then I review the rubric
and eliminate in my mind the remedies I know it CAN'T BE while I look for
the one remedy it CAN BE. I do not do my best work under these conditions
but I do good work.

I learned in India that homoeopathy can be a front-line medicine in
the busiest of third world practices with really horrific cases. In the
West many of these people would be the allopathic hospital! What is
necessary to do this type of work is to learn the keynote, characteristic
and redline symptoms of the best proven 300 or so remedies. First you must
find a symptom the remedy MUST be in and then refer to the repertory and
materia medica for confirmatory rubrics. If the generals and concomitants
agree with the patient - give the remedy. If the rest of the symptoms do
not fit and you cannot confirm....keep looking for the right
symptoms! This is one of the places that keynote characteristics related
to (oh, no, not again) constitution and temperament come in handy!

This type of "volume practice" is very good for the prescriber because
it makes them apply their knowledge and look for what is most essential in
the case. I have found this type of training very valuable to my "regular
practice" because it has taught me how to find what is most important in
each case directly. Anytime I seen one of the "golden oldy symptoms" I go
right to the material medica and seek confirmation. As I said, some in the
West look down on such "keynoting" but these keynotes are no more than pure
characteristic symptoms that are marked or of an uncommon nature.

Old Homoeopaths like Lippe and Hering used to quiz each other about the
strange, rare and peculiar symptoms from the MM at any opportunity. It was
a game they played. Kent said there was nothing wrong with using the
classic keynotes as long as generals and other confirmatory symptoms agree.
If you study Kent's cases you find he did this quite often. So as Joy says,
these are not symptoms only for volume practice. They are the most readily
usable symptoms in the MM. It is a matter of looking for those symptoms
that are the most important homoeopathically for finding a remedy. They may
or may not have anything to do with patient's main complaints.
Yes, Joy, I use the redline symptom method every day I am in the
clinic. The idea of one rubric summarizing the case or at least
representing the most important aspect of the case is helpful.
Nevertheless, Hering's three legged stool is still important. We like to
get at the remedy through at least three vectors. Many times the other
vectors are confirmatory symptom found in the MM. This is why Kent said to
make sure that the generals agree with the keynote.

Otherwise one might fall into one-sided keynote prescribing on a
single symptom. This said, however, there is often one symptom that breaks
the case open because the remedy just HAS to be in it. Once this is known
the rest is finishing work. I always feel best when I have a nice little
"redlined" group. These comments are in general as I know Joy understands
very well what makes up a balanced case. I am making a bit of a "keynote
disclaimer". A keynote can not make a melody all by itself any more than
one note can make a cord, etc.. It may be the most important note but it is
not the only tone.

The grand classic symptoms are not present in every case, but once
one understand what they are looking for, they are present in many cases. I
underline such symptoms with red pen (at least mentally). Many times I look
over cases in which they practitioner has written a host of symptoms yet
they can not see the forest through the trees. The symptom of the patient
is right there in front of them but they are looking too abstractly for
some theme, essence, concept or some special interpretation when a little
more old fashioned common sense might do. The golden redline symptoms are
often dancing right in front of their eyes if they would just look!
I am going to repeat what I said at the end of my post. Remember the
importance of aphorism 153 and the striking, exceptional, unusual, and odd
(characteristic) signs and symptoms. One must judge the characteristic
value of symptoms. The symptoms in the repertory are graded 1, 2, 3 in
Kent's and 1, 2, 3, 4, 5 in Boenninghausen's but there are symptoms in the
materia medica that are worth 100! Learn these symptoms by heart!!!! Then
look for the *redline symptoms* that the remedy MUST be in and use them at
the center of your case. These are you true elimination rubrics. Then look
in the materia medica for confirmatory symptoms. If the generals and
concomitants agree - give the remedy!

Sincerely, David

---------------
"It is the life-force which cures diseases because a dead man needs no more
medicines."

Samuel Hahnemann

Visit our website on Hahnemannian Homoeopathy and Cyberspace Homoeopathic
Academy at
http://www.simillimum.com
David Little © 2000