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((( Hi Simon.
My guesstimate of my success has also been around 70-80% (speaking only of chronic cases). The responses so far seem to suggest that 80-85% is probably a valid *best-case* assumption for a low-volume, open-minded practitioner who uses the entire materia medica, keeps abreast of new MM and all innovations (eg Sankaran, Scholten, seminar circuit, search engine programs) and takes much time with each client, and has a high standard (such as the standard of referring to another homeopath after 3 visits with failure).
However, these results are in general, guesstimates relative to the optimal rx for the client, as the remedy which can produce "results" in a chronic case may be one related to the optimal rx, but not the optimal rx. In most cases, the progression toward better health is trackable so it is only in cases of not well known rx ; and scantily indicated or subtle mental emotional cases; that the problem of exactitude becomes a problem. But most of us rely on only semiology, and use no other independent measure of similitude ---and similitude is our gold standard in homeopathy---of
which semiologic inference is only our best approximation.
Semiological Confirmation of "success"
If the Chief complaint(s) go, AND the client is generally and clearly experiencing higher energy and well being beyond expectation; AND at least one Hering/Vijayakar indication for a healing process (eg unexpected skin eruption, past sx which indicate center to periphery/UP to DOWN/NEW TO OLDER SYMPTOM motion of VF,etc etc) is present (which includes any indication of redux of he past--including one or more people from the past experience of the client calling on the phone out of the blue, recurrences of that type); AND the healing response continues without stalling or needing
frequent repetition---then this starts to speak to a good level of similitude.
Semiological confirmation is good, but it still relatively blind to optimal similitude.
As well, consider the rates of success cited by pracs (albeit in high volume practice) who use higher standards:
Mangialavori uses coming to a stable rx which over time will treat chronic and true acutes ---with this standard he says roughly 33% bullseyes, 33% so-so (ie unsatisfactory); and 33% no result whatsoever
Wansbrough and Linnane using biolumanetics photography along with classical casetaking claim 60% bullseyes.
Those of us in low volume practice report 80% success, but are using only semiology and general improvement as our standard. I suspect low-volume practice results are better--simply a matter of personal attention and time put in to study of the case---and the case often turns simply on the level of digging effort---and this is what I like about Sankaran's "aggressive" case taking technique rather than just sitting back and listening). But we have no uniform standard, really, to report results with.
We can take disappearance of he complaint as the operative criterion and make a uniform standard. But we all know that the operative mechanism of healing is degree of similitude and not symptoms going away. And symptoms can go away on a superficial rx which only changes the VF state or suppresses the VF state, actually worsening the case.
I suggest (first draft--additions welcome):
SUCCESS INDICES IN CHRONIC CASE
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Primarily functional case:
--increase in energy and relative joie de vivre
--unexpected change in the attraction of events and people into the life of the client; or unexpected volitive change (eg leaving an "unhealthy" relationship, job etc)
--unexpected change in appearance of client
--removal of chief complaint(s)
--Hering/Vijayakar phenomenon (evidence of VF acting up-to-down, in-to-out according to embryological layers, reverse temporal unfolding of symptoms and attracted events and people in the life of the client)
--lessening of indications of active miasm
In primarily pathological case (includes the above factors also of course)
--change in objective phenomena (bloodwork, scans, psychiatric index; tumor growth, etc)
In any case:
--change in TCM indicators; change in clarity of a biolumanetic photograph, etc
=============
I of course submit as did Whitmont that we need an objective measure of the level of similitude to back up our semiological determination of that parameter in unclear cases.
As to the FAILURES
--the failures (at least 20% we are saying; Mangialavori essentially says 33-67%; and Wansbrough and Linnane say 40%--and they use an objective confirmatory---and those using semiology only are claiming a better result--this is suspect but both Mangialavori and Wansbrough-Linnane are high-volume practices--and that is a major factor IMO.) In any case, most difficult cases are probably insoluble without employment of nonsemiological aids--or waiting until the characteristic sx come out in the client---which can take decades in some cases. The failure mode requires an objective
confirmatory system of some type, and eventually a reliable remedy candidate generator which uses a comparator between simulated rx and the the pt vital force *in toto*. The failure mode of classical hom in my opinion:
---- no widespread use in hom. community of a reliable way to confirm or rule out a less than clear chronic rx candidate before administration (unless one uses biolumanetics photography, is a reliable AK practitioner, uses Points of Weihe or Degroote effectively for those rx that have these indications, uses pupillary response effectively, uses dowsing effectively, or has another reliable confirmatory method to eliminate using the client as a guinea pig when the remedy is not clear)
----limitations of semiology in finding and confirming bullseyes, which become "guesstimates"
----limitations of one-on-one casetaking---In chronic case I include an independently returned questionnaire to one or more third parties who know the client well
----limitations of time. I know Andre Saine, for example, has said that he keeps the client returning for visits until he is sure of the rx he wants to give ---- 2 or 3 sessions if needed--before he gives any rx in a chronic case (I assume the client pays for this, but maybe at some discounted rate)
Even using biolumanetics, the reported failure rate of bullseyes is 40%. And as shown in excerpt from earlier post, the biolumanetics folks showed a case that was Puls in every way semiologically but did not pass muster by bringing coherence to the vital force emanation (by changing the clarity of the biolum photograph); and the successful remedy ended up being Agathis (Kauri)---demonstrating the limitations of semiology. An apparent polychrest is not always that polychrest, in fact in the experience of the London clinic, there is no such THING as a polychrest when your
standard is the bullseye:
========================================
1. There are no major or minor remedies, only the correct
remedy for the patient.
Charles and I embarked upon our venture with high hopes of finding a
way to make homeopathy simpler and more effective. However, we soon
found ourselves feeling rather dispirited. This was due to the fact
that only very rarely did the polycrest remedies produce coherent
photographs. At this point we turned in desperation to Jan Scholten's
work on the mineral kingdom and without his input I think we might
never have got off the starting block. We discovered that every
patient entering our clinic needed a very precise prescription. There
appeared to be no short-cuts or handy specifics. Following on from
our study of Jan Scholten's material, we also were obliged to scan all
the newly proved remedies and to read all the back issues of
Homeopathic Links to hunt out unusual remedies. In some cases only
these would produce the clarity (in biolumanetic photograph) which we knew would provoke movement
in our patients.
We have, of course, given polycrests in our clinic
but these prescriptions do not constitute the majority of our
prescriptions. For instance, we have given Pulsatilla literally twice
over the last 3 years. This is not because we have not tested it. It
is just that the remedy often refuses to yield clarity even in those
cases where one would swear blind that this was a "Pulsatilla case."
I recall one particular case where any rational homeopath would
definitely have given Pulsatilla - indeed you would have been mad not
to - but the prescription which yielded total clarity was not
Pulsatilla but the newly proved remedy Kauri (Agathis australis).
Similarly with Natrum muriaticum. Often the remedy which was
eventually given was another Muriaticum salt, for example Cuprum
muriaticum or Aurum muriaticum This would explain to me how prior to
the technology often I would give Natrum muriaticum in what appeared
to be a classic Natrum muriaticum case, only to be severely
disappointed by the result.
====================================
There are rx with similar general and particulars, and even peculiars--but the key mental/emotional state and life metaphor is different, and the true bullseye is different. The remedy may act or not but it is not the bullseye, and we have not served the client and only cost them money and time. The "bullseye" is an elucidation of para 153 which states that it is the HALLMARK of the person's life which RULES in psychosomatic chronic cases; and the PECULIAR which rules in any disease, acute or chronic, as characterizing the entity to be resonated with, and which only an rx
with the same "peaks" of activity (as if looking at a spectral analysis graph) will in fact resonate and mimic the disease and if given in proper potency, annihilate it. It is only the bullseye which can truly be called a success:
======
§ 153 Fifth Edition
In this search for a homœopathic specific remedy, that is to say, in this comparison of the collective symptoms of the natural disease with the list of
symptoms of known medicines, in order to find among these an artificial morbific agent corresponding by similarity to the disease to be cured, the
more striking, singular, uncommon and peculiar (characteristic) signs and symptoms1 of the case of disease are chiefly and most solely to be
kept in view; for it is more particularly these that very similar ones in the list of symptoms of the selected medicine must correspond to,
in order to constitute it the most suitable for effecting the cure. The more general and undefined symptoms: loss of appetite, headache, debility,
restless sleep, discomfort, and so forth, demand but little attention when of that vague and indefinite character, if they cannot be more accurately
described, as symptoms of such a general nature are observed in almost every disease and from almost every drug.
=======
The "closeenoughicum" may handle the CC and change the VF, and if this is effective, then we may have done the client harm on the long term by changing them without stimulating their own VF to throw off complaints and continue to do so over time unaided. And also if the changed state persists and obscures the semiologic picture which reveals the true inner state and can lead to the simillimum of the time or layer or the bullseye for much of the client's life. Many times in such cases of obscuration by medicament we need to first give an rx to "clear the picture" of suppressions
(eg x-ray, sulphur, oak, psorinum, etc). Most relatively healthy people will throw off the wrong rx with a small proving or no result at all but low VF or sensitive people will not.
(Note--the closenoughicum is I surmise really a description of an rx that works in an ACUTE case as close enough to stimulate the throwing off of a true acute (infectious or injury---IMO there is no such thing as a closeenoughicum in a chronic case). When we get close--if we have not given an inimical or the rx has not grafted on the case to skew the sx--- the case will usually and hopefully come to a valence revealing more useful symptoms. It will have been pushed by the close rx to the presentation of the actual symptoms of the case that were before not apparent (this is one
corollary of zig-zag, and Hahnemann mentions it in paragraphs 167-68 and 178-184). These paragraphs are a description of zig-zag which Hahnemann and his contemporaries had to be very good at, as they had only a couple of hundred rx to choose from in chronic cases---good enough for much of the "bell curve", but only good enough to push the case to some unmeasured better but not cured state; or fail in the case completely--when the simillimum for that client had not yet been minted). Especially cogent is paragraph 182, which we all have observed, whereby the incorrect rx pushes
out the very symptoms in relief that we need to find the true simillimum of the time:
Method of successive approximations (Zig-Zag; or in some cases traverse of true layers) according to the original description by SH:
=================================
§ 167
Thus if there occur, during the use of this imperfectly homœopathic remedy first employed, accessory symptoms of some moment, then, in the case of acute diseases, we do not allow this first dose to exhaust its action, nor leave the patient to the full duration of the action of the remedy, but we investigate afresh the morbid state in its now altered condition, and add the remainder of the original symptoms to those newly developed in tracing a new picture of the disease.
§ 168
We shall then be able much more readily to discover, among the known medicines, an analogue to the morbid state before us, a single dose of which, if it do not entirely destroy the disease, will advance it considerably on the way to be cured. And thus we go on, if even this medicine be not quite sufficient to effect the restoration of health, examining again and again the morbid state that still remains, and selecting a homœopathic medicine as suitable as possible for it, until our object, namely, putting the patient in the possession of perfect health, is accomplished.
§ 178
It will, no doubt, sometimes happen that this medicine, selected in strict observance of the homœopathic law, furnishes the similar artificial disease
suited for the annihilation of the malady present; and this is much more likely to happen when these few morbid symptoms are very striking, decided, uncommon and peculiarly distinctive (characteristic).
§ 179
More frequently, however, the medicine first chosen in such a case will be only partially, that is to say, not exactly suitable, as there was no
considerable number of symptoms to guide to an accurate selection.
§ 180
In this case the medicine, which has been chosen as well as was possible, but which, for the reason above stated, is only imperfectly homœopathic,
will, in its action upon the disease that is only partially analogous to it - just as in the case mentioned above (§ 162, et seq.) where the limited number of homœopathic remedies renders the selection imperfect - produce accessory symptoms, and several phenomena from its own array of symptoms are mixed up with the patient’s state of health, which are, however, at the same time, symptoms of the disease itself, although they may
have been hitherto never or very rarely perceived; some symptoms which the patient had never previously experienced appear, or others he had
only felt indistinctly become more pronounced.
§ 181
Let is not be objected that the accessory phenomena and new symptoms of this disease that now appear should be laid to the account of the
medicament just employed. They owe their origin to it1 certainly, but they are always only symptoms of such a nature as this disease was itself
capable of producing in this organism, and which were summoned forth and induced to make their appearance by the medicine given, owing to its
power to cause similar symptoms. In a word, we have to regard the whole collection of symptoms now perceptible as belonging to the disease itself, as the actual existing condition, and to direct our further treatment accordingly.
1 When they were not caused by an important error in regimen, a violent emotion, or a tumultuous revolution in the organism, such as the occurrence or cessation of the menses, conception, childbirth, and so forth.
§ 182
Thus the imperfect selection of the medicament, which was in this case almost inevitable owing to the too limited number of the symptoms present,
serves to complete the display of the symptoms of the disease, and in this way facilitates the discovery of a second, more accurately suitable,
homœopathic medicine.
§ 183
Whenever, therefore, the dose of the first medicine ceases to have a beneficial effect (if the newly developed symptoms do not, by reason of their
gravity, demand more speedy aid - which, however, from the minuteness of the dose of homœopathic medicine, and in very chronic diseases, is
excessively rare), a new examination of the disease must be instituted, the status morbi as it now is must be noted down, and a second homœopathic remedy selected in accordance with it, which shall exactly suit the present state, and one which shall be all the more appropriate can then be found, as the group of symptoms has become larger and more complete.1
1 In cases where the patient (which, however, happens excessively seldom in chronic, but not infrequently in acute, diseases) feels very ill, although his symptoms are very indistinct, so that this state may be attributed more to the benumbed state of the nerves, which does not permit the patient’s pains and sufferings to be distinctly perceived, this torpor of the internal sensibility is removed by opium, and in its secondary action the symptoms of the disease become distinctly apparent.
§ 184 Fifth Edition
In like manner, after each new dose of medicine has exhausted its action, the state of the disease that still remains is to be noted anew with respect to its remaining symptoms, and another homœopathic remedy sought for, as suitable as possible for the group of symptoms now observed, and so on until the recovery is complete.
==================================
An interesting point made in the below excerpt is that even today with 3000-4000 rx, there are people that might have to be zig-zagged at this point in the development of homeopathy as we have no way to ferret out a simillimum efficiently using our current methods and technology--or the simillimum (as Paul Booyse said in a recent post)--"is still in the Amazon Rainforest":
By Kieran Linnane
6. The issue of the simillimum
The above leads me on to a discussion of the simillimum. This is a
very complex issue and Charles and I discuss this ad infinitum with no
absolute conclusions. We have read Massimo Mangialavori's beautiful
cases where he finds a perfect remedy for his patients and then this
remedy is repeated on and off over a period of years, with the patient
advised to take the remedy whenever he suffers from an acute.
Unfortunately, this does not reflect our own practice. We have found
that if a very precise remedy is given, the "state" for which the
patient is being treated tends to dissolve rather rapidly. Obviously,
if the state is very engrained this process might take a little
longer, but it usually does not take years and years. If the state
has been dissolved we do not understand why the same remedy should be
given again. It is our experience that once this state has dissolved,
another state (underlying this state) will rise to the surface
requiring another prescription. It is almost as if all the patient's
energy is going into coping with a particular problem. Once this
problem is resolved, another deeper issue will arise to the surface
requiring treatment.
To give an example from our own practice: we took the case of a
woman who had problems with anxiety and guilt around the rearing of
her baby son. We gave her Calcarea bromatum which successfully
reduced both the anxiety and guilt. She was a different woman when
she returned after a month. However, about four months later she
returned to our clinic wishing for more treatment as a sexual issue
which was a problem for her had not been touched by our prescription.
We knew that our patient required another remedy to heal this
particular layer which led us to prescribe another remedy, Natrum
fluoricum. Now, I suppose Massimo would argue that had we been better
homeopaths we would have been able to find a remedy which encompassed
all aspects of this case: the guilt, anxiety and sexual issues. We
are now back with the tyranny of the "constitutional remedy". Whilst
Charles and I attempt to give prescriptions based upon as much of the
totality of the case as we can, this is not always possible. Either
it is because of our lack of knowledge, or perhaps in a lot of cases
it is because there is no one remedy which covers such a totality. It
is perhaps significant that Massimo acknowledges that only a third of
his cases do wonderfully, another third are mediocre and the remaining
third do nothing at all. Perhaps this is more a reflection of my last
point, that in certain cases it is impossible to find a remedy which
covers the totality.
=======================
I agree with others that low volume/high care/high standard/high education practices can probably be around an 80% bullseye level in chronic human cases--although that is a bit of a soft number as it is unconfirmed by objective measure of the VF such as biolumanetics or other measure.
As usual
my rant is that we are to some great extent blind assessing success only on semiological indices, if we do not employ a "little helper" such as biolumanetics or other confirmatory (in some cases this could be superior intuition (instrumented or not)--but intuition to be reliable must be free of subjectivity--and this is not a commonly attained level of discipline).
Unlike science devoid of consciousness and investigation of the unseen (James Clerk Maxwell called this "Scientism"--obviously rampant today and throughout the "Age of Reason")--homeopathy investigates and alters conciousness as well as material signs of disease. Thus we have to use criteria to measure consciousness parameters while guarding against subjectivity.
And we see "cure" as a much more complex phenomenon than removal of a symptom, which in much of pharmaceutical internal medicine is only a stopgap measure, often detrimental to the client.
But we should be able to come up with a standardized set of criterion. Maybe that would be a good legacy of this discussion.
Hope this did not ramble too much. There are points in here that relate to the measurement of "success" and its pitfalls, if one reads carefully.
Best,
Andy
