Hahnemann, in # 152, of the Organon, gives explicit directions for its selection; he tells us how the choice should be made from among the drugs which exhibit effects simulating those of the whole disease picture at hand and shows how the final differentiation depends upon the individualistic or peculiar symptoms. A truly scientific procedure.
The interpretation of what constitutes a striking or singular symptom, except as pointed out in \ 86 and the following, is left to the judgment of the physician, but is elucidated in the following seven considerations:
1. Changes of personality and temperament are particularly to be noted, especially when striking alterations, even if rare, occur; the latter often supplant or by their prominence may obscure the physical manifestations and consequently correspond to but few remedies. Taking written notes of every case gradually drills the mind into recognizing types (personalities) and their corresponding remedies.
The expressions of the intellectual and moral proclivities are inter-dependent and their combined character affords the best and almost sole indication in the choice of remedies for mental affections.
2. It is self evident that the nature any peculiarities of disease, as well as the virtues of drugs, must be thoroughly known before we can hope to give practical aid in sickness. The homoeopath soon realizes that for him everything in medicine is generalized too much; the most diverse diseases needing quite different remedies are designated by a common title which excludes every precise indication that might lead to the most suitable remedy, hence he can make only a limited use of diagnosis. For the same reason every allopath orders a different medicine or mixes his drugs to cover the various indications.
The most accurate and indubitable diagnosis of a disease form as depicted in pathological (allopathic) treatises can seldom or never sufl&ce for the sure selection of the similar (homoeopathic) remedy in a concrete case. It can, at most, but not invariably, serve to exclude from the comparison all medicines which do not correspond to the nature of the disease, but which on the contrary seem to expend themselves upon other parts of the living organism.
3. The seat of the disease frequently points to the decisive indication, for almost every drug acts more definitely upon certain parts of the organism, the whole body seldom being affected equally, even in kind; differences occur in the so-called local disease, as well as in the affections designated as general; such are gout and rheumatism. At times the right, then again the left side suffers more, or the pains may appear diagonally, etc., etc.
The amount of attention to be given to the affected part is necessarily proportioned to the magnitude of the general illness of which it is a portion. Such general terms, therefore, as headache, toothache, bellyache, etc., even when the nature of the pain is expressed, cannot contribute even the least towards a rational choice of the remedy.
It is essential to ascertain the seat of the local disease with accuracy ; for every experienced homoeopath knows how, in toothache for instance, it is necessary to select the remedy which in its provings has repeatedly acted upon the very tooth that suffers. The specific curative power of Sepia in those stubborn and sometimes fatal joint abscesses of the fingers and toes is extraordinarily conclusive evidence upon this point, for they differ from similar gatherings in location only, while the remedies so suitable for abscess elsewhere remain ineffectual here.
Had the niceties of physical diagnosis of our times been known during the age of t See Organon, § 104.
Hahnemann he would doubtless have localized his remedies more accurately than merely giving such vague designations, as above, below, right or left, etc. It would become our contemporaries infinitely better to fill up these gaps than to keep on repeating well known symptoms or discovering others which are almost invariably of no importance.
In the treatment of disease the value of modern methods is far less therapeutic than prognostic. The internal physical signs and objective material changes never represent the dynamic disease, but are its product, developing as it progresses. When, as is often possible, such disorganizations can be nipped in the bud by well selected remedies it is unpardonable to await their appreciable ravages. This is equally true of homoeopathic prophylaxis.
4. In finding the similimum for the whole case the concomitants, above alt, demand the most thorough examination. While carefully elucidated characteristics strikingly portray the leading features of a case they are always modified by the peculiarities of the relief before the picture can be said to be accurate. Common-place or well known accompaniments are unimportant unless they are present in an extraordinary degree or appear in a singular
We must, therefore, examine carefully all those accessory symptoms which are:
(A). Rarely found combined with the main affection, hence also infrequent under the same conditions in the provings.
(B). All those belonging to another sphere of disease than that of the main one.
(C). Finally those which bear the distinctive marks of some drug, even if they have never before been noted in the preceding relation.
A concomitant may so distinctly and decidedly depict the nature of a drug, and consequently indicate it, as to acquire an importance far outranking the symptoms of the main disease; it then points to the most suitable medicine. Such symptoms above all others evidently belong to those which Hahnemann called striking, extraordinary, and peculiar (characteristic) and are to receive our almost exclusive attention because they lend their individuality to the totality. A number of efficient and partly specific remedies for various disorders are almost solely discoverable from among them because the disease symptoms proper, for lack of peculiarities, offer no possible assistance in the choice. The system of concomitants also makes Homoeopathy distinctly safer, rendering it less dependent upon a previously constructed diagnosis which is often deceptive.
5. The cause. Pathological explanations and speculations are too far removed from our entirely practical method to have any great value in a therapy and cure. Diseases are logically divided into internal and external. The former arise from the natural disposition, which is sometimes highly susceptible (idiosyncrasy). The latter can excite disease principally by means of external impressions, when there is already a natural
The modified natural tendency to disease depends, according to Hahnemann, upon the uneradicated miasms of psora, syphilis and sycosis. When it does not originate in these it is mostly composed of remnants and sequels of the acute affections which so largely go to make up drug diseases and poisonings; but we not infrequently see both factors combine to undermine the health, thus presenting a proportionately deeper rooted disease just that much harder to combat. In such cases antipsoric remedies very much excel all others in efficacy. (The scrofulous diathesis — psora — is constantly being extended by the practice of vaccination; our view of the matter receives confirmation from the fact that in very many cases of such diseases which are essentially acute in character it is only by the administration of our so-called antipsoric remedies that rapid and durable cures can be effected) .
Whether or not we believe the psoric theory, the fact remains that the best selected remedy is often ineffectual unless preceded by the proper antipsoric, antisycotic or anti- syphilitic, as the case may be, but because of their almost identical symptom lists it is gen-
erally chosen with difficulty by differentiating and searching out the few true characteristics.
Drug diseases and poisonings do not differ in their health destroying power. The drug given should be ascertained and properly antidoted. Simple poisons are easily detected by their effects, but a drug disease is generally a compound result which fails to show a clear and accurate picture, hence a knowledge of the contents of former prescriptions taken is a necessity and lightens the labor.
Practice has extracted and rendered ihe anamnesic symptoms easy of access, thus greatly restricting the list from which the selection is to be made, so that attention to but a few characteristics quickly determines an accurate choice. This is especially true of sprains, bruises, burns, etc. Colds are more complicated, because of the diverse manner in which they are contracted and the different parts which they affect point to different rem-
edies; for instance, it makes a great difference whether they are contracted while sweating, by exposure of a part, being drenched all over or partly, etc. Various remedies must be considered according to whether the symptoms localize themselves internally (stomach, chest, abdomen, etc.), or externally (head, feet, back, etc.). Such remedies are not to be too readily thrown aside unless certainly found dissimilar in other respects. — So much depends upon knowledge of the cause (Anamnesis) of disease, that without it the choice of a homoeopathic remedy cannot be made with safety: Aphorisms of Hippocrates, VII., 12.
Homoeopathic prophylactics are tested and sure. The very remedies which cure the fully developed diseases will protect exposed persons. This is very important for the reason that incipient diseases are generally very lacking in the characteristics which determine the choice.
6. The Modalities are the proper and most decisive modifiers of the characteristics, not one of which is utterly worthless, not eyen the negative ones. They have developed in importance with the growth of Homoeopathy.
A superficial examination of any completely proven drug will reveal the common symptoms of all diseases, such as headache, bellyache, diarrhoea, eruptions, etc., etc. A little closer inspection of their sensations and relations to the different parts of the body establishes undoubted differences in the manner of their appearance, the modality. All experienced homoeopatlis pay great attention to this point. It is self evident that the modality must be specialized; it is not sufficient, for instance, to note the general effect of motion in a given case, but the various kinds of motion, and whether they arise during continued or at the start of movement must be known. Likewise, the general effect of position, such as lying on the side, back, crosswise, horizontally, etc., as well as the special discomfort or ease caused from lying on the painful or painless side, must be elicited in order to apply the most suitable remedy.
The cravings and aversions to various foods furnish some of the most important points in deciding upon the remedy.
When the symptoms seem to point out a particular remedy with which the modalities, however, do not agree, it is only negatively indicated and the physician has the most urgent reasons to doubt its fitness; he should, therefore, seek for another having the same symptoms.
7. The time is hardly less important than the aggravation and amelioration itself and could be of great use were the different stages of disease left undisfigured by drug influences, for they constantly produce the most devious effects upon the natural course of disease. I hope no one will say that periodicity necessarily indicates Cinchona (Quinine), for there is hardly a single homeopath who has not treated numerous victims of this error. This homoeopathic objective concerns two points which have a direct bearing upon the choice of the remedy.
A. The periodical return of the symptoms after a shorter or longer period of quiescence.
B. The hour of the day when they are better or worse.
The former coincides with epochs having special, accidental causes, such as menstrual disturbances, all seasonal or temperatural influences, etc. Where it is impossible to discover such secondary causes, or where, as is usually the case, their time of recurrence is not more accurately designated they have no value for homoeopaths because they are lacking in precise indications.
The general or special modalities referable to the time of day are of much greater importance, for hardly any disease lacks this feature and the provings supply the same peculiarity, qualifying them for the best and most comprehensive uses. To illustrate this we need only refer to influences which the time of day exerts upon coughs, diarrhoeas, etc. A considerable list of remedies exhibit typically recurrent effects, unless these are clear and decided (like Hell, and Lycopod. at 4-8 p. m.), or return at exactly the same hour (Ant. c, Ign., Saba.), they are unimportant.
Reference: Excerpt from Boenninghausen’s Characteristic Remedy