Installment 5 of a series on case analysis
© Will Taylor, MD 2001 (bio)
Symptoms by Analogy
Sections: 1 | 2
One form of "particular knowledge" is clinical verification. Following up on the "amelioration by pressure" modality for Colocynthis, generalized from the proving symptom of "abdominal colic ameliorated by firm pressure" and applied by analogy to headache, Samuel Lillienthal described the following for Colocynthis in his Clinical Therapeutics:
Bilious headaches; gouty or nervous headaches, of excruciating severity; violent tearing pain, digging through the whole brain, increased particularly when moving the upper eyelid; frontal and coeliac neuralgia alternating; intermittent headaches; severe boring burning pain in one or both temples; compressive sensation in forehead; worse when stooping or lying on back; aggravation afternoon and evening, with great restlessness and anguish, especially when the sweat smells urinous; little urine is passed, or very foul-smelling during the interval, and copiously and clear during the pain, amel. by firm pressure and lying on affected side; great restlessness and anxiety.
Here we have two separate pieces of information, each standing on somewhat shaky ground (on one hand, a complex symptom created by analogy; on the other hand, a clinically-derived symptom). Each gains strength, however, by its association with the other. Our ability to create the symptom of "headache ameliorated by firm pressure" by analogy supports our accepting it as a clinically-derived symptom; and the clinical verification of this symptom conversely supports the validity of our creation of it by analogy. I believe it was Sherlock Holmes who said "an improbable piece of evidence gains in strength by its association with known facts".
Another form of "particular knowledge" is based on a deeper appreciation of the pathogenesis of our remedies. Farrington gives some excellent examples of this in his essay Modalities as Arranged by Boenninghausen1. One example he gives, is the well-known "amelioration from violent exertion of the body" for Sepia. Is this equally applicable to Sepia's lumbosacral pains and to its pelvic congestive symptoms? A thorough knowledge of Sepia tells us that it is not. Sepia's amelioration by vigorous motion appears to apply to those physical symptoms that have to do with vasomotor relaxation and impaired venous and lymphatic return, and to those mental/emotional symptoms that have to do with emotional stasis. Its lumbosacral pains are markedly aggravated by motion. Therefore, we can really apply the modality "ameliorated by vigorous exertion" only to symptoms of Sepia that originate with venous, lymphatic or emotional stasis.
The Use of Symptoms by Analogy
in Case Analysis
Use of General Sensations and Modalities
Here's a fragment of a case, successfully cured with Argentum nitricum, a prescription that was nicely confirmed in the characterizing totality of the entire case. I'd like to focus now, though, on just the local presenting complaint, in a case-fragment.
This was a carpenter, who presented with multiple small pimple-like skin lesions widely distributed on his trunk and limbs, which would occasionally head up and express a tiny amount of discharge. He was not too concerned otherwise, but they were very painful - "like splinters, very sharp". He obtained some relief from applying cool compresses.
Here is a repertorization of this case-fragment, using the "pain-stitching" and "cold applications-ameliorate" rubrics from the Generals section of the Repertory. Argentum nitricum comes through nicely. (The rubrics "Skin-eruptions-pustules" and "Skin-eruptions-pimples" were combined for the purposes of this analysis). I would have missed this remedy using local modalities and sensations, because Argentum nitricum is not listed in the Skin section under any "stitching" or similar rubrics, or any "cold ameliorates" rubrics. These are strong symptoms observed in other localities in Arg-n's provings, which have been generalized and applied by analogy to the skin lesions of this case.
(Note - final selection of the remedy for this case required attention to more than just this local complaint - clearly, with just the information given here, Bryonia and Cantharis remain in consideration).
Combining Local and General Modalities or Sensations
Where Local and General modalities or sensations exist, the local rubric can be combined with the general rubric, to assure inclusion. This may be important, in cases where there is a "paradoxical" local modality or sensation in the remedy needed for the case. I've already mentioned the "paradoxical" modality of Arsenicum album, of head pain ameliorated by cold applications (paradoxical, because Arsenicum is generally worse cold). Were we working up an Arsenicum case, and used only the general modality:
GENERALS - COLD APPLICATIONS - amel.
We would risk missing Arsenicum in the case, as it is not present in this general rubric; while it is prominent in the special local modality:
HEAD - PAIN - cold - applications - amel.
It is simple to combine rubrics in RADAR. The rubrics will appear separately in the analysis clipboard and analysis graph, but will be calculated as one combined rubric in the analysis. Rubrics may be combined when selected, or after they have been collected in the analysis clipboard. To combine them when selected, type "+(grade)(group_letter)" - e.g., "+1a" when the pointing hand is on the desired rubric:
You can then go on to add any number of additional rubrics to this rubric group, by including the group letter (here, "a") after the grade in the addition command.
For rubrics already selected in the analysis clipboard, control-click on the rubrics you wish to combine, so that they're both (or all) highlighted. Press <RETURN> to open the Edit Take Options dialog box, and enter a letter in the "Add this symptom to group" box:
Searching for Rubrics
Often it is not clear which rubric(s) apply best to the case at hand. In the case of the stitching pimples above, there is no obvious rubric for the local sensation of "stitching pimples" or "stitching pustules". A convenient way to find local (skin) sensations rubrics that might be of use is to use RADAR's search command. Typing a question mark automatically brings up the dialog box, and the terms "skin" and "stitch*" (using the asterisk as a wildcard to find "stitch," "stitching," etc.) are entered:
Pressing <RETURN> gives us a list of "skin stitching" rubrics. Note that none of these really refer directly to the complex symptom of our case; we will be using them only for the local (skin) sensation of "stitching," which they include as one of their dimensions; and will be applying this by analogy to the pimples/pustules:
These can then be combined as a group, along with the General "pain-stitching" rubric, so that they will collectively be considered as a single combined rubric in the analysis. Here the letter "b" is chosen for the group, as "a" has already been used to combine the pimple and pustule rubrics:
The Thread of Truth that Runs Through
Boenninghausen has offered us a creative method of making up for the inadequacies of our provings and clinical observations of cure, by the generalization of sensations and modalities, and their recombination into complex symptoms by analogy.
Hering and Farrington remind us that this liberty demands of us some attention to detail, requiring a deep knowledge of the particulars of drug effects, and an awareness of the frequent importance of truly local or locally paradoxical modalities and sensations.
If we are cautious in these ways, and remember always that the final selection of the remedy requires careful discernment while placing the case next to the primary Materia Medica, then Boenninghausen's approach will offer us a tool simultaneously creative and safe from excesses.
Bonninghausen's Therapeutic Pocketbook
The challenges met in producing a new translation of the Boenninghausen Repertory for RADAR Software, taken from the original German version.
Next month - James Compton Burnett, and the Generalization of Locality.
1 Farrington, Earnest A.
Modalities as Arranged by Boenninghausen in Lesser Writings with Therapeutic Hints by E.A. Farrington MD; B. Jain Publishers, New Delhi
Sections: 1 | 2