From the beginning of homeopathic practice, the first obstacle the physician encounters is the impossibility of applying knowledge acquired in materia medica to each specific clinical case.
What actually happens is that studying each medicine according to allopathic clinical criteria learnt at the orthodox school of medicine, each pathogenesis in pure materia medica, and even in known clinical materia medica, produces a profuse catalogue of symptoms which it is impossible to remember or learn by heart and much less to understand in essence.
This is the reason why the fundamental condition for undertaking the study of materia medica is that of being clearly informed of the fundamental concepts of the doctrine.
Concepts of Pathogenesis
Pathogenic illness is no more than the surfacing of a symptomatology latent in a human being, caused by a medicine to which a certain person is particularity sensitive, which implies an individual, personal manner of falling iII, conditioned by a dynamic pathological constitutional disposition.
The detailed study of the Organon reveals this fact to us: though in aphorisms 32 and 33 Hahnemann states that the medicine administered in the pathogenesis at any time and in any circumstance has an absolute and unrestricted power to modify the physiological balance of a healthy person, in 36 and 38 he adds that “No medicine proved in a healthy person can show in one and the same subject all the subjective and functional alterations which it is capable of evincing in other subjects having a different constitution and temperament” and “although the symptoms made manifest depend on the medicinal substance used, it is necessary for the subject to have a special predisposition to make such symptoms appear.”
This is the only reason why symptomatology revealed in pathogenesis is curiously similar to individual symptoms preceding and accompanying illness. Homeopathy is possible precisely thanks to this similarity, which thus reveals the universal harmony existing between a human being, his natural illness, and its medicine or pathogenic illness.
Kent in his fourth lecture states: “A physician is supposed to be an expert in an illness as a result of having seen the symptoms of many different cases and, therefore, he is in a position to call forth the image of the illness. When he is perfectly familiar with the image of those illnesses of the human race, he will be in a position to study the materia medica and all the imitations of the miasms found in the medicines. There is no miasma in the human race which does not have its own imitation in a medicine. The animal kingdom contains within itself the images of illnesses and the plant and mineral kingdoms likewise, and if man were familiar with the substances of these three kingdoms, he could treat the entire human race.”
That is to say that for Kent it is not sufficient to know the medicines even in their smallest detail; it is necessary to be familiar with humanity, in the deepest interior, that is, in the affective and emotional values, there where the most exquisite individuality resides, and only then will it be possible to recognize the sick person in the pathogenesis. Because for Kent, “Science is knowledge. The application of knowledge is the Art.”
In spite of the organic roots of our medical genesis, any homeopath must be now far from considering illness purely as a material process of organic alteration. The integration of this illness in its anatomo-clinical aspect in the patient as a person enables us to discover the morbid dynamics underlying the pathological process. The “patho-biographical” case history assumes particular interest as it involves the entire psychic, emotional, affective life of the patient, his cravings, frustrations, achievements, anxiety to succeed, his perspectives. His patho-biographical past is no more than the process of psycho-physical adaptation of the individual to his circumstances and where physiopathological alterations are no more than the objective expression and the ultimate result of such adaptation.
Like many other aphorisms, 153 seems to be the key to the secret of an accurate prescription: “The most noticeable, singular, extraordinary and peculiar symptoms. Because it is precisely these symptoms which must correspond to the very similar symptoms on the list of the medicine selected.”
lt is important to remember that in the preface to the Repertory, Kent gives us precise instructions on its use. These instructions recommend that “after having completed the repertorizing, the resulting medicines must be compared with the materia medica to assess which one our patient seems most similar to.” This is what Hahnemann had in mind when he referred to one of the fundamental premises of the true physician, in his § 3: “If (a physician) also knows how to adapt in a convenient manner the most appropriate medicine, according to its modus operandi, to the case before him.” And it is quite clear that the similarity referred to by Kent, the modus operandi of Hahnemann, lies in the genius of the medicine which must be homeopathically similar to the genius or psycho-biological attitude of the patient. Now, just what is this similarity between patient and his remedy or more explicitly, what is this genius of the medicine which, notwithstanding the many times it is used, is still not fully understood? The “genius” is the way of being, the way of living, the attitude which arises from a medication at any moment, it is the vital reactivity of the ideal being which survives in the medication confronted by the circumstances in which each ideal subject is born, lives and dies. Hahnemann approaches this subject in § 5 of the Organon: “The most important points of the case history of chronic illness are useful to the physician as they place him in a capacity in which he can discover the fundamental cause, which generally is due to a chronic miasm. Moral and intellectual character, occupation, way of living, etc. must be taken into account.”
The value of symptoms
In other words, Hahnemann and Kent inform us – and we fully agree – that symptoms have no value in themselves but a mere relative value in that they make up a part of the characteristic, evident, and particular entirety. Like any vital phenomenon, each symptom has a meaning, an intention and an aim. lt has meaning, as an expression, a personal and singular meaning of a personal experience, the way of being of a person; an intention – inner tension – which translates a peculiar mode of action for the achievement of an aim or a singular solution to an existential conflict. But the symptom as a literary expression or written word in the repertory, has no more value than a dead letter unless it stands for the idea of an attitude, a special mode of living and acting. lt is a grave mistake to expect the symptom or algebraic sum of symptoms to be a sufficient and indispensable condition for a correct prescription. Kent pointed this out when in a similar situation he told a disciple: You have registered a whole series of symptoms, that is true, but you do not have a case. And to have a case, it is necessary for the series of symptoms for which a remedy is chosen to function in the same manner in which the remedy functions.
“The sum of all symptoms and conditions of each individual case of illness must be the only indication, the sole guide, to lead us to the selection of the remedy”, Hahnemann stated in § 18.
lt is these “conditions of each individual case” which must prevail in the selection of the medicine according to its mode of action, following the words of Hahnemann. This way of acting, that is, the “genius of the remedy”, is certainly expressed in the symptoms, but it is above them, conferring a particular value and meaning which is different for each remedy and which is what in the last instance we must investigate and understand in each patient individually, in order to attempt a correct diagnosis.
This fundamental premise, the genius of the remedy, is the basis of the clinical contributions of the great masters of homeopathy. The reason for the symptoms is given by the human being who lives with them. No doubt this experience gathered on the innumerable cases of Pulsatilla treated by the great masters is what has contributed to the “genius” of Pulsatilla
Hahnemann confirms this affirmation in section 122 of § 213 of the Organon: “Thus, Aconite rarely or never produces a quick and permanent cure when the patients humour is quiet, even-tempered and smooth, neither does Nux vomica when the character is soft or phlegmatic, nor Pulsatilla when it is happy, gay and obstinate, etc.” In other words, it is experience, based on concrete observation, which has allowed homeopathic physicians, living alongside their patients, and “feeling” as they do, to become familiar with the lauded “genius of the remedy”.
The minimum symptom of maximum value
If we leave aside this dynamic meaning of individual entirety, it may be dangerous to study a medicine through the repertory. The temptation of believing that two remedies are similar because they have a practically identical group of characteristic symptoms can lead us to confusion. For example, the resentment, aversion to company and consolation, anger with moral grief, affection and constant return to the past of Natrum muriaticum do not have the same “genius” as in Lycopodium. If frustration and consequent repression constitute the clue to resentment, a definitive symptom of Natrum muriaticum, want of self-confidence constitutes the essence of the personality of Lycopodium. Natrum muriaticum is resentful because he is not loved, Lycopodium because he is not taken into consideration. Natrum muriaticum keeps away from people out of vengeance, out of spitefulness, Lycopodium so that his weakness is not discovered. Natrum muriaticum feels aggravated by consolation in view of untimely gratification of the love asked for and denied. For Lycopodium consolation is offensive to his pride. The anger with moral grief of Natrum muriaticum suffered in silence, like his pain, explain his emotional blockage, fixed in the past in constant ruminating and a song to a long-lost love; in Lycopodium these three symptoms reflect the aggression to his self-worship and genuflectory personality in an open competitive battle. The tone of Natrum mur. is discovered in the bitterness which abounds in the depth of his vital attitude; the tone of Lycopodium is discovered in the shade of impotence which lies in the depth of his ego and which makes him cry when praised. There is no similarity between the resentment of Natrum muriaticum. and the resentment of Lycopodium as neither is there similarity between the desire for solitude of Natrum muriaticum. and that of Lycopodium. We can never state that two remedies have a similar personality because their symptoms are similar, just as we could not say that two paths lead to the same port only because they cross at some point.
The minimum symptom with a maximum value of Calcarea carbonica for example, “fear, apathy and obstinacy” assumes a value when one perceives in such a symptom, the calculating, paused, slow thought process which Calcarea uses to solve his conflict faced by vital frustrations, as soon as we are in a position to see that his metaphysical fears are his answer to the reasoned manipulation of aggression. Everything in Calcarea falls under the scrutiny of his thought process, for there he feels secure and self-assured; his fears are magical: solitude, darkness, ghosts, fear something will happen, fear of the future and of illness, consequences of the horror felt of his own aggression which is projected into the outside world. Upset by horrible things, bad news, cruelty, sad stories, he talks only of criminals, fire and rats.
lt is these “conditions” of the symptoms which inform us of the “modus operandi of the remedies”, and which give the physician a “capability of discovering the fundamental cause, which is generally due to a chronic miasm.” This redundancy in § 3, 5 and 18 protects us from dangerous abstract speculations regarding symptoms. “The examination of an individual case of illness”, says Hahnemann in his § 83, “merely requires of the physician absence of prejudice, and perfect senses, attention paid to observation and accuracy in tracing the case history of the illness”. “But it is also true, on the other hand”, § 98 adds “that in all illnesses, especially in those of a chronic nature, the investigation of the complete and true case, with its peculiarities, requires special earnest attention, tact, knowledge of human nature, caution in completing the investigation and patience to an unending degree! lt is this knowledge of human nature which we must achieve as we stated at the beginning, through our own caring personality.
The miasmatic meaning of symptoms
We referred earlier to the relative value of symptoms subject to a considerable extent to the conditions or modalities under which the Symptom or group of Symptoms appear. The fundamental cause which is discovered in the pathobiographical case history of the patient who consults us defines a singular attitude which determines the selection of a remedy as close as possible in its way of acting. This relative value is conditioned as we have seen by its meaning, its intention and its aim. Being the expression of a vital phenomenon, a Symptom is as variable, dynamic and three-dimensional as the space in which we live. If any patient is tri-miasmatic in substance, the label of psoric, sycotic or syphilitic merely expresses a certain vital tendency. The group of symptoms of a patient will converge on that same tendency with an equally relative, dynamic and variable meaning.
Aversion to company in a Lycopodium patient can be predominantly psoric when fear of competition prevails; sycotic when it is the means of hiding his weakness in order to reassure him of his strength for the achievement of success; or decidedly syphilitic when invaded by weariness of life, total failure or indifference to everything.
The “sympathetic” symptom, extreme compassion and affection for others, is predominantly psoric in Phosphorus as a manifestation of his love with a universal meaning and hypersensitivity to all outside manifestations. lt is psoro-syphilitic in Nitric acid laden with tremendous bitterness, vengeance, hate, which does not admit apologies, with a tremendous destructive feeling which feeds his anxiety of conscience. The ulcer with sharply cut edges with outbreaks of granular tissue structure is a clear somatic image of this miasmatic coloring. But above all, the affliction of Lycopodium for others is sycotic when his overprotection for others is laden with a hidden desire for personal satisfaction and vanity.
From a miasmatic point of view, it is also “the idea of a vital activity”, of a way of living or of acting, the vital life meaning which is discovered by means of the patho-biographic case history of the patient, the meaning of his present attitude, the search for a particular achievement. In short, what our patient wants from life is that which in the last instance will give meaning and value to his symptoms, by underlining some, discarding others, according to whether or not they point to the idea, meaning, Intention and objective proposed. This is what makes for the sense of variability, what breaks all frames of reference, what qualifies the human soul or psyche.
lt is only in this manner that we will understand, for example, that conscientiousness about trifles, improvement through occupation, and intolerance to contradiction – symptoms which seem strictly sycotic – are not enough to offer us the image of a remedy. They must be referred to the fundamental cause, its substantial genesis, which will qualify its homeopathicity according to its “mood”, its way of acting. And we will see in this way that indifference towards everything will be in the pseudo-psoric substance of this psychotic Sepia. Or that the tremendous want of self-confidence, with timidity, fear of failure, modesty, will offer the tubercular base of this sycotic Silicea or that hypertrophy of the Id, the irritability, the anxiety of conscience with its obsessive ritualistic behavior will be the “genes” of the psychosis of Thuja. And we will understand, finally, that confronted by the first three present sycotic symptoms, the differential diagnosis will be determined by the patient’s patho-biographical case history where we will find the fundamental cause and the way of acting of the syphilitic indifference of Sepia, the timidity and psoric fear of Silicea and the sycotic emotional perversion of Thuja.
In other words, it is the idea, the meaning, the intention, the search, which will give the psoric, sycotic or syphilitic nuance to a given case. The psycho-patho-biographical case history including hereditary and family background, previous illnesses, vaccinations, therapeutic suppressions, etc, will inform us of the miasmatic predominance in the patient from past diseases up to the present. But it will be, above all, his vital psychological attitude, his program and intentions in life, which will give us the information we require regarding prevalence of one or another miasm at present.
Attending only to the miasmatic conception, the criteria according to which a Symptom is in itself psoric, sycotic or syphilitic without taking into consideration the entire symptomatic context, and above all that of the human being suffering from such Symptoms, is what leads to erroneous conceptions and, in the last instance, to therapeutic failures. The secret lies in the fact that any frame of reference is in itself rigid, but in application must be elastic, variable, conditioned to the dynamics of the symptom in vital function.
it is not sufficient, therefore, to study the symptoms of the miasm in activity, to ensure a correct diagnosis, if these symptoms and signs are not referred to the fundamental cause in the patho-biographical case history. Therefore, I believe that the study of each medicine by means of the pure materia medica, of clinical materia medica and of repertories according to an analytic or miasmatic criteria constitutes frames of reference which are too rigid and unreal, being convinced that the more perfect instrument has its limitations where the art begins, according to Kent – that is, grasping the essentials. And the essentials of a human being, the paramount work of life, are like life itself: dynamic, variable, with an important quota of mystery and wonder.
On a certain occasion a patient said to me: “I adore homeopathy, doctor, because it is the medicine closest to life. And if I had to give “E.T.” something as a keepsake of his stay in this world, I would give him a book of homeopathic materia medica; because in it all of humanity is described in its pains, its happiness, its failures, its ambitions, its anxieties, illnesses, miseries and qualities; that is to say the drama and mystery of life itself.”
Each remedy may be studied as an ideal being. Symptoms are not information to be analytically memorized, but an expression of the personal and specific manner in which the ideal personality which is the core of each remedy suffers existential anxiety, takes pleasure in achievements and lives the plentifulness of existence.
But each remedy is not ‘the being in itself, but rather each human being suffers and carries the cross of his remedy like a sign, like a particular mode of pathology, and like a mistaken way of calming his existential suffering which prevents him from achieving the transcendental aims in life as Hahnemann wished in his § 9.
Will and understanding
Kent explains in his third lecture on philosophy that “From a more internal point of view, will and understanding form a unity inside man, secondly the vital force which is immaterial and lastly the body which is material. In this manner the will directs from the most intimate part through the vital force towards the outside, the material substance, which is in any and all cells, directing them. There is no cell which lacks its own will and understanding, its soul substance, the vital force, and its material substance.”
Therefore, when we study a remedy we must do so considering that each of the symptoms which constitute its pathogenesis, are not isolated, accidental facts, which must be memorized but, on the contrary, must be understood within the indivisible entirety of that ideal being which they represent.
Kent continues in his first lecture: “Therefore, the sole obligation of a physician is to place the interior economy in order, that is, will and understanding jointly.” The changes in the tissues refer to the body and are the effects of the illness, strictly speaking.
Therefore, when we study a remedy we must do so as if it were a person, discovering firstly, through the mental Symptoms, its way of being, and of acting out its addictions, its feelings, in short all that which constitutes its temperament and character, all that I mentioned earlier as the genius of the remedy. We must study its mental Symptoms, thinking just what they represent, what they mean for this individual, understanding the meaning of a Symptom as a function of others, and under what inter-relation one same symptom acquires a different meaning for each remedy. After this we will study the general symptoms, those referred to the individual in his entirety as a function of the environment. But we will try to remember only those that are most noticeable as a result of his desires and aversions regarding food, climatic variables, position, hour, schedule, etc. Thirdly we will fix our attention on localized symptoms, not only as an expression of the pathology, which is important, but above all with its most singular modalities, as these give the peculiar nature to the symptom.
The remedy must thus be considered as the truest imitation of the illness which disturbs the entire self and therefore must be studied as a sick person. Of these three groups of symptoms, mental symptoms revealing the disturbance of “will and understanding” are those most characteristic of each remedy, and effectively represent what is most substantial and effective in the human being. We must always follow this order pointed out by Kent in his prologue to the Repertory: mentals, generals, and particulars.
The first great difficulty a physician runs into, on starting his homeopathic practice, as I have said, is the incapacity of applying knowledge acquired in materia medica to each particular case. The study of pathogenesis becomes hard work which, although it offers us, as a result of a considerable effort, a catalogue of symptoms which is more or less complete, is insufficient to allow us to understand its essence, that is, that which we refer to as the genius of the remedy.
Nevertheless, after some time, orderly and conscientious practice of repertorizing has revealed to me an unsuspected volume of information. Indeed, it is there that one discovers symptoms of remedies which one was not aware of before. One finds that frequently several cover a group of symptoms; one finds the similarities and differences in the presence or absence of other symptoms; in short, the repertorizing allows us to compare and perform the diagnosis supported by sound and accurate knowledge.
In 1963 I had in mind studying remedies by means of Kent’s Repertory. Just as in an ideal sick person, the four hundred and sixty symptoms of Lycopodium appear from A to Z, appearing necessarily in alphabetical order. Many of them confirm what is learnt in materia medica, some are absolutely novel and others remind one of symptoms found in Lycopodium patients which were not related to the remedy simply because they did not appear in the texts within one’s reach.
Nevertheless, taken into consideration in isolation, they extended my knowledge objectively, but nothing more. Whereas, on observing them in full, as delicate notes of a strange symphony I was able to perceive the main theme, around which all the symptoms added up obediently, in logical sequence. I was then in a position to understand in its full breadth, the words of my teacher, when he states almost literally: “The mental symptom is an antechamber of the clinical case history. The individual attitude reveals the singular solution given by a human being to the conflict between the biological psycho-physical wealth and its circumstance. lt is here that mental symptoms acquire greater relevance, surfacing beyond the individual’s singular way of handling himself when confronted with his psycho-biological and pathobiographical conflict.”
This new, recreated, materia medica makes possible a comparative study of symptoms, interrelating them with a true logical and homeopathic meaning which offers a clear understanding of the mental picture of the remedy instead of its difficult, and almost “dead” memorization, with no understanding. In this way I learnt, as I will repeat further on, that each Symptom has a meaning, an intention, and a purpose, but that these suppositions are only personally experienced when taken in their entirety and that, from a homeopathic point of view, what is referred to as the attitude or genius of the remedy is expressed, not by the symptom, but by its inter-relational dynamics.
In this way, for the first time, the image of the remedy appears through Kent’s Repertory. In a second step, in a summary which is no doubt quite extensive, he tries to synthesize as much as possible the symptomatology revealed, to facilitate its understanding and essential knowledge. A third stage consists of the drafting of a frame of reference, an abstract of abstracts where the symptoms are coded in numerical form to express the fundamental dynamics of the remedy. This stage is the one which has proved the most difficult without any doubt, and running the risk of not innovating and sometimes with a strict literality verging on plagiarism, I have been guided by the accurate concepts of Dr Paschero in works on the same subject. Lastly, as a fourth stage, I have undertaken the study of comparative materia medica which justifies the title of this work. By repertorizing, as if dealing with an ideal sick person, the 30 or 40 symptoms established in the frame of reference, the remedies make their appearance, thus allowing a comparative study. Previously, however, 5 or 10 symptoms have been extracted from those 30 or 40 symptoms according to each case, and have been grouped under the subtitle Minimum Characteristic Syndrome. I have initiated the repertorization only with medicines which cover at least 50% and have set aside the rest. In some cases, as an exception, I have included same remedies I have thought of interest, with a lower percentage than that established.
This article is reprinted with permission of Dr. Eugenio Candegabe and The Homoeopath, Journal of the Society of Homoeopaths, where this article originally appeared. In preparing this article for publication Roger Savage, RSHom corrected errors of English translation or grammar, but has not attempted the task of changing the Spanish-oriented thought structures into native English patterns, because to do so would lose the tone of Dr Candegabe’s own individual presentation.