Installment 8 of a series on case analysis
© Will Taylor, MD 2001 (bio)
On our Knowledge of the Materia Medica:
Part 1; Quantitative knowledge of remedies
Sections: 1 | 2
It is interesting to look at the various portions of the plot generated on the previous page. Below is a detail of the left-most portion of the analysis, focusing on the 40 best-known remedies; the "polychrests and a few more". It is obvious that there is no sharp discontinuity between "polychrests" and "the rest of our remedies" in the quantity of information we posses. The only real discontinuities in the plot are between the 3 best-known of our remedies, the 3 points at the far left – Sulphur (way ahead of the pack at 12,326 rubrics), Phosphorus (10,367) and Lycopodium (9,420).
Extending this plot (below) to the 204 best-known remedies (those listed in at least 1,000 rubrics) still reveals a continuum of information with no sharp discontinuities between well-known and lesser-known remedies:
Even the "tail" of this analysis – the 1176 least-known of our remedies (from rank-order 458-1633, those remedies listed in fewer than 200 rubrics) reveals no discontinuity in the quantity of our knowledge of our "small" remedies and that of those somewhat better-known:
Grading of Symptoms
It is instructive to more closely examine the nature of our knowledge of remedies along this continuum of quantitative information. One finding that stands out on close inspection, is that the better-known remedies not only have more recorded symptoms, but that there has generally been more attention paid to accurately grading these symptoms.
For example, for Silica (rank-order 11, a classic polychrest), 56% of the rubric listings are for 1st degree (plain type) symptoms; 44% of symptoms are listed grade 2 (italics) or better; 12% grade are 3 or 4.
In contrast, for Ptelia trifoliata (the "Wafer-Ash," rank-order 203), 90% of the rubric listings are for 1st degree symptoms; 9.8% are grade 2 or above, and only 0.5% grade 3 or 4. For Mitchella repens ("Twinberry," rank-order 641), 93% of listed symptoms are 1st degree.
This is an important point to note in the reportorial analysis of a case. There will generally be a bias against the "smaller" remedies when symptom-grade is taken into account; these remedies will often rise in the analysis when grade is ignored.
What makes a "small remedy" a "small remedy"?
There are two plausible explanations as to why a remedy may have only a small number of recorded symptoms. The first is that the remedy in truth has a limited sphere of action, that it engages the economy of the organism only in a focal and limited manner. The second is that the remedy is just poorly described – having had an inadequate proving, or known only from some limited toxicological symptoms, or adopted into our practice purely on the basis of clinical recommendation from the botanical or eclectic traditions.
It is difficult to provide a convincing example of the first possibility – a remedy with a truly limited sphere of action. There are many contemporary proponents of the notion that such a critter just does not exist.
We can find many examples of remedies for which our knowledge is dominated by strongly-expressed focal or regional symptoms; e.g., Ceanothus americanus (rank-order 680, 77 rubrics) with its prominent splenomegaly; Equisetum hyemale (#459, 199 rubrics) with its prominent urologic symptoms; Aletris farinosa (#499, 168 rubrics) with its specificity of seat in uterine affections; Arundo mauritanica (Ampelodesmos mauritanicus #316, 439 rubrics), viewed as a "hay-fever remedy;" Rumex crispus (#192, 1055 symptoms), rarely prescribed in situations other than the characteristic cough so well-known for this remedy; etc.
Such "small" remedies are most often prescribed on the basis of their strongly marked local symptoms, and come to be known as "near-specifics" or "superficially-acting" remedies in these indications. Yet examination of such remedies consistently reveals that our knowledge of their activity has been obtained in only fragmentary fashion. Aletris farinosa has not had a proving; E.M. Hale relates 2, "…no proving has been made of it. The clinical indications for its use were all obtained originally from eclectic practice." Arundo mauritanica has had only a fragmentary proving, in crude dose. Ceanothus americanus has had no proving, but was adopted as an "organ remedy" on the basis of old-school clinical experience.
Examination of our "small remedies" consistently bears out similar observations – remedies remain "small" when unproven, proven only in crude doses, or proven in fragmentary fashion on only one or two subjects. It is possible that the dominating regional symptomatology of many of these remedies is merely an artifact of our uneven knowledge of them, blindsiding us into accepting them as regional specifics or superficially acting remedies.
Next month -
How we obtain knowledge of our remedies; proving v/s clinical symptomatology
Sections: 1 | 2
2. Edwin Moses Hale, Special Therapeutics of the New Remedies; chapter on Aletris farinosa