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Installment 9 of a series on case analysis

© Will Taylor, MD 2001 (bio)

On our Knowledge of the Materia Medica:
Part 2: Qualitative knowledge of remedies proving vs. clinical symptoms

Section 3

Sections: 1 | 2 | 3

Category 4 -
Clinical Context of Symptoms Revealed in the Provings

Vioa odorataWilliam Boericke recorded for Viola odorata, "Acts upon frontal sinuses." This is a clinical observation, which originates in John Henry Clarke's record: " Cooper considers V. od. has a very specific relation to the lateral sinuses and their vasomotor nerves." We find in the provings:

" Pressure on the malar bone
[Gross], "

" Violent drawing pressure from the malar bone to the temples, immediately

Clinical symptoms of this sort, again, gain credibility by standing on two legs - on one foot, the dynamic symptoms of the proving; and on the other foot, the descriptive symptomatology of observant clinicians.

Category 5 -
Clinical Confirmation of Symptom Completion by Analogy

Boenninghausen introduced the practice of symptom completion by analogy - the combination of disparate symptom fragments to create a new, complex symptom. For example, Colocynthis is known for its amelioration of colicky pains by hard pressure. This derives from the proving symptom:

"Constant severe constriction of the viscera for ten or twenty minutes, relieved by violent pressure with the hand; Pinching pain in the abdomen, as if the bowels were pressed inwards, with cutting extending toward the pubic region, so severe below the navel that the muscles of the face are distorted and the eyes drawn together; the pain is only relieved by pressure upon the bowels with the hands and bending himself inward."
[Hornburg, in Hahnemann's pathogenesis]

Boenninghausen, in his Therapeutic Pocketbook, generalized from this specific symptom the modality General Ameliorations; Pressure, external; and by generalizing this modality, rather than expressing it as a modality specific to the local symptom of abdominal colic, he opened the possibility of applying it by analogy to pains of other characters and locations.

In Kent's Repertory, one can find Colocynthis in the rubric {HEAD - PAIN - pressure, external - amel.}. This complex symptom has not appeared in the provings of Colocynthis, but is derived from clinical experience. Samuel Lilienthal recorded the clinical symptom for Colocynthis:

"Bilious headaches; gouty or nervous headaches, of excruciating severity; violent tearing pain, digging through the whole brain, … amel. by firm pressure and lying on affected side; great restlessness and anxiety." 6

Complex symptoms created artificially by analogy in this manner may not always make sense. Arsenicum album has a general aggravation by cold, yet it has headaches ameliorated by cold application. In the example given above, Colocynthis' complex clinical symptom of headache ameliorated by firm pressure once again gains validity by resting on two legs - construction by analogy from pure symptoms of the provings, supported by the experience of a respected clinician.

Category 6 -
Advanced Physical Pathology

We find in our materia medicas and repertories many symptoms that represent the physical ultimation of disease, as opposed to the dynamic symptoms of disattunement of the dynamis. One obvious example is {Female genital/sex - tumors - uterus - myoma}; uterine fibroids most certainly have never been observed as a pure symptom in a remedy proving.

These symptoms are derived purely from cured cases. This category could be merged with category 2 above (The Experience of Weighty Authors), differing though in the nature of these symptoms - as fixed ultimated pathology, in contrast to the dynamic nature of the symptoms considered above.

These are perhaps the most problematic of the clinical additions to our literature. Considering the manner in which these symptoms are collected, reportorial rubrics such as the one above are necessarily incomplete, and are of little real use in the analysis of a case. They can however be reassuringly confirming, affirming that the ultimate pathology of a case is covered by the chosen remedy.

For example, when the dynamic symptoms of a case in which uterine fibroids are present indicate Calcarea phosphorica, the observation that this remedy has cured cases of uterine fibroids in the past can be reassuring in the choice of this remedy. However, the absence of this recorded clinical symptom in an otherwise-indicated remedy cannot really disaffirm the choice of a remedy based on the dynamic symptoms of the case.

Dymanic symptoms of the provings (such as Calc-p's "Weakness and distress in the region of the uterus … Menses every two weeks, black and clotted; menorrhagia" [from Hering's proving]) offer credibility to such symptoms of advanced physical pathology.

Category 7 -
Compensatory Mental / Emotional Symptoms

As is true of advanced physical pathology, there are symptoms in the mental/emotional realm that one would not expect to see in provings. Compensatory symptoms develop commonly in chronic cases, which permit a person to better tolerate their primary pathology. These compensatory symptoms have their roots in the same disharmony-giving rise to the primary symptoms, and as such, fail to really normalize behavior. These will seldom have the opportunity to develop in the rather brief context of a proving, but should make sense in light of the primary proving symptoms.

For example, Argentum nitricum appears in the Synthesis rubric {Mind - Fastidious}, as a clinical addition from René Dockx and Guy Kokelenberg. Although fastidiousness does not come out in this remedy's provings, it can be understood in the context of Arg-nit's primary symptoms of morbid impulses and fear of losing self-control:

Primary SymptomsCompensatory Symptom

IMPULSE; morbid
FEAR - self-control, of losing

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Category 8 -
Introductions from the Eclectic and Botanic Traditions

Edwin Moses Hale wrote,

"Our course, as consistent homoeopathticians, is, to CLAIM ALL CURES AS MADE BY THE LAW OF SIMILIA, AND PROVE THEM TO BE SUCH, as did Hahnemann. The law discovered by our great master is all embracing, universal, and the sooner his followers adopt this proposition, the better it will be for the honor and influence of our school." 7

- a belief which led him to investigate the cures claimed by the Eclectic botanic practitioners of his day, involving many of the herbal treatments of the Native American healing traditions.

CaulophyllumWe employ Caulophyllum today, e.g., in many gynecologic complaints, largely on the recommendations of the Native American herbal and Eclectic medical traditions.

These recommendations gain credibility in light of the proving symptoms:

"Sensation as if the uterus was congested, with fullness, heaviness, and tension in hypogastric region ... Spasmodic pains in the uterus, and various portions of the hypogastric region." 8

We gain distinctly different, and complementary types of information about a remedy from the records of traditional and eclectic use, and from provings. The record of traditional cure may give us the general realm of function of a remedy, while the proving symptoms provide us with the essential individualizing features that characterize a remedy.

breech birthThe issue of clinically derived symptoms in homeopathy is often reduced to a simplistic accept them / reject them argument. The actual situation is considerably more complex. Not all clinical symptoms are created equal - we need to evaluate those in our traditional and contemporary literature carefully, to assess their relative value to us in understanding remedies and matching similitude in our cases.

Although the pure symptoms of provings will continue to be the gold standard of homeopathic practice, we can find great value in these symptoms described by Constantine Hering as born by "breech presentation".

Sections: 1 | 2 | 3

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6. Samuel Lilienthal, Homoeopathic Therapeutics
7. Edwin Moses Hale, Special Therapeutics of the New Remedies
8. Edwin Moses Hale, Special Symptomatology of the New Remedies