Transcript Confusion to Clarity

An Introductory/Advanced introductory lesson in homeopathic
practice
Molly Punzo, MD
NCH Annual Conference 2011
Alexandria, VA
Goals and Objective
 Learn the fundamentals of effective case-taking
 Make sure you get the characteristic symptoms you will need
to solve the case
 Learn common from characteristic symptoms
 Become familiar with the TCS:
 Totality of Characteristic Symptoms
 Repertorization of the TCS
 Learn Key Notes, Guiding Sx or Leaders of remedies
And finally:
 Match the TCS to the Key Notes or Leaders of a remedy!
Let’s start with a scenario
Your 10 yo wakes you up and comes into your room
and says she doesn’t feel well. She is wrapped up in
her blanket. She says her throat and stomach hurt
and she feels like throwing up.
 What are you thinking?
 Are you thinking of a remedy?
 What do you need to do next?
Homeopathic Pearls of Case Taking
Karen Allen, CCH
“Individualization of the case
through recognition of the characteristic
expression of the vital force is the single most
important skill in case analysis, and has the
greatest potential to immediately improve your
results!”
Homeopathic Case-Taking 101
 Get as many specific, unique and precise
symptoms as possible
 Observe the person if possible
 You need a minimum of 3-5 really good
characteristic symptoms to be able to solve an
acute case
 You will have LOTS of symptoms by the time
you’ve finished.
 A combo of common and characteristic
 But you need at least 3-5 solid precise symptoms
you can hang your hat on before you can begin to
repertorize.
What Does The Organon Say?
The Organon: § 7, 153, 154 and 258
Collectively describe how to
solve a case by identifying
the “Totality of the
Characteristic Symptoms”
The Organon says… § 7
…we can perceive nothing but the morbid symptoms,
it must… be the symptoms alone by which the
disease demands and points to the remedy suited to
relieve it - and, moreover, the totality of these, its
symptoms, of this outwardly reflected picture of the
internal essence of the disease, that is, of the affection of
the vital force, must be the principal, or the sole
means, whereby the disease can make known what
remedy it requires - the only thing that can determine
the choice of the most appropriate remedy - and thus, in
a word, the totality of the symptoms must be the
principal, indeed the only thing the practitioner has
§ 153: Characteristic vs. Common
symptoms
 In this search for a homeopathic specific remedy…, the
more striking, singular, uncommon and peculiar
(characteristic) signs and symptoms of the case of
the disease are chiefly and most solely to be kept
in view; for it is more particularly these that very
similar ones in the list of symptoms of the selected
medicine must correspond to, in order to constitute it
the most suitable for effecting the cure. The more
general and undefined symptoms; loss of
appetite, headache, debility, restless sleep,
discomfort, and so forth, demand by little
attention when of that vague and indefinite
§ 154
If the disease picture constructed from the list of
symptoms of the most suitable medicine contain
those peculiar, uncommon, singular and
distinguishing (characteristic) symptoms, which
are to be met with in the disease to be cured in the
greatest number and in the greatest similarity, this
medicine is the most appropriate homeopathic
specific remedy for this morbid state…
§ 258
The true practitioner…..must bear in mind the truth
that of medicinal agents, that one alone invariably
deserves the preference in every case of disease which
correspond most accurately by similarity to the
totality of the characteristic symptoms, and that
no paltry prejudices should interfere with this serious
choice.
1
Characteristic
symptom
THIS IS THE BARE MINIMUM
2
Characteristic
symptom
3
Characteristic symptom
What makes a
symptom
“CHARACTERISTIC?”
Characteristic Symptoms: §153
 CHARACTERISTIC SYMPTOMS are those symptoms which are
precise, strange, rare, peculiar, very strong, specific, uncommon for
that person (very important!), and UNCOMMON for that illness
and for that person (if acute)
 You must then match these CHARACTERISTIC SYMPTOMS with
the CHARACTERISTIC SYMPTOMS OF A REMEDY.
 You find the characteristic symptoms (Key Notes or Leaders) of a
remedy by reading your materia medica(s) and picking them out,
or by reading books which have distinguished these for you
already: Nash Leaders; Allen’s Keynotes; Hering’s Guiding
Symptoms, Phatak, Boericke, etc…
This is the very essence; the MOST
FUNDAMENTAL TENET of Homeopathy
Describe “FLOWER”
What are the COMMON qualities of a
flower?
What helps you to distinguish one kind of
flower from another?
e.g. makes that flower
CHARACTERISTIC?
Now let’s describe “GUITAR”
Now let’s talk about human beings
 What are COMMON traits for a human?
 What are CHARACTERISTIC traits to help
you identify a particular human?
Let’s try and find someone in the
next picture
We are trying to find one particular person
in the picture to follow.
What clues or distinguishing features will
help us to find this person?
Test:
Rate the following symptoms on a scale of 0-10
0: symptom is not at all helpful
10: is a VERY useful, e.g. characteristic,
symptom
Here we go!
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I don’t feel very well
My throat hurts
The inside of my ear itches
I am cold
I am thirsty
I have a fever
I am tired
My throat burns like fire on the left side
My head hurts
Every time I cough, my head feels like it’s going to explode
My head feels better when I squeeze it with my hands like this…
I’m very thirsty and perfer ice cold water
A little while after I drink anything, I have to run and throw up
Qualities that Make a Sx. Characteristic
•Time of day/night when sxs are better or worse
Very helpful!
•Causation: Did anything bring the sx on? Grief; trauma;
diarrhea or some other illness; stress; bad news, etc..
•Concomitants: Are there other symptoms which are
present with the primary symptom?
•Headache AND cough
•Diarrhea AND headache
•Irritability AND pain
•Teething AND earache
•Rash and diarrhea? Etc…
•Thirst? Especially if a change from usual
 Temperature: Does the person prefer open air, closed,
fanning? Warm? Cold?
 Does the patient FEEL hot, cold, warm, chilled, etc…
 Pain? Make them DESCRIBE THEIR PAIN (sensation)
AND have them USE ADJECTIVES!
 Burning? Throbbing? Dull? Stabbing? Stitching? Needles?
Tingling?
Pulling? Hot poker?, etc…
• Desires: food and drink (warm, cold, spicy, bland)
• Perspiration? What part of the body? Odor?
• What if anything makes the person feel BETTER?
Worse?
• Time of day, position, warm or cool applications, binding
or wrapping, moving, resting, air temp, inside, outside,
drinking, weather, etc…
Mental/Emotional Symptoms
 Are VERY important to include
 Especially if different than “usual”
 Are they:
 Anxious?
 Angry?
 Irritable?
 Depressed?
 Dejected? Quiet?
 Want company? Want to be left alone?
Always try and include at
least one or more good
mental/emotional sx
in repertorization of a case
Repertorization:
 Repertorize mainly the Characteristic Sx. (§ 153)
 “Common” symptoms are NOT very helpful and
actually can confuse this process

Fatigue during illness; loss of appetite while ill; sore
throat without other qualifying symptoms; body
aches during a flu; pain with motion if there is a
fracture, etc…
 You CAN use these symptoms, but you must obtain
specific information relative to them….
 If you can’t solicit enough characteristic
symptoms, WAIT until a clearer picture emerges
TRUE OR FALSE
You have repertorized your
case. You can now choose the
remedy that comes up highest
(#1) in the repertorization?
You are NOT done yet!
Now you must study the top several remedies that came
up during repetorization
 You never ever select a remedy just because it shows
up first when you repertorize!
 You must narrow the case down to a handful of remedies
and STUDY them well in the materia medicas until one
“clicks.”
 Look for the “keynotes” or “leaders” of the remedies
and match these to the sx you are trying to cure
Back to that first case…
Your 10 daughter yo wakes up and isn’t feeling
well. It’s close to midnight. She looks ill and is
clearly not her usual self. She comes in
wrapped up in a blanket; she says her throat
and stomach hurt; she feels like she is going
to throw up. She begs you to let her come into
your bed because she doesn’t want to be by
herself. You ask her why and she says because
she feels so bad. She wants to be with you in
your bed.
Observations and events:
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She is pale
She is quite upset and anxious (not usual for her)
She cannot get comfortable in the bed and keeps stirring, tossing and
turning. At one point she wants to go back to her room. She comes
back to your room a few minutes later
She is wrapped up in blankets and says she still feels cold, yet she
feels warm to touch and has a temperature (101.5)
She wants to wear her pajamas, robe and still be covered in multiple
blankets
 She asks for something to drink. You get her some water and
she drink some. A few minutes later, she drinks more. She
does that on and off all night.
 She says her throat is burning.
 She stirs most of the night and finally falls asleep around 4 am
 In the morning, you fix her give her some warm cereal and
toast. She eats a little, not much…a few minutes later, she runs
and throws up; is tearful and very distressed. She said she had
diarrhea, too…was vomiting and had diarrhea at the same
time….poor kid!
What symptoms would you
choose to repetorize?
Remember to think about:
 Timing of sx
 Thirst
 Concomitant sx
 Mentals (mood and other mentals)
 What makes sx better or worse
 Observations
 Temperature preferences of the person
 Anxious
 Restlessness after midnight…
 Vomiting after eating (how soon after eating or
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drinking?)
Throat BURNING
Thirsty for small sips, often
Vomiting AND diarrhea
Cold, feeling internally: Strong sx. Desires warmth,
feels cold despite having multiple blankets
Aggravation around and after midnight (till 4am it
says)
 Arsenicum
 Sulphur
 Phosphorus
 Calcarea
 Lycopodium
 Veratrum
Arsenicum: From Nash Leaders
 Very great anguish and restlessness; cannot rest
anywhere, moves from place to place; wants to go from
one bed to another; fear of death, of being left alone,
great restlessness and utter prostration.
 Burning in mouth, pharynx and esophagus; drinks
often but little at a time.
 Unquenchable thirst; drinks often, but little at a time;
the water disagrees.
 Vomiting and stool simultaneous.
 Vomiting immediately after eating or drinking.
Nash’s Testimony: Arsenicum
 1. Great anguish and restlessness, driving from place to place.
 Fear of death, of being left alone, great restlessness and utter prostration.
 Very great anguish and restlessness; cannot rest anywhere, moves from
place to place; wants to go from one bed to another. (Nash:Leaders)
 2. Great prostration (sometimes sudden), sinking of vital forces.
 3. Intense burning sensations.
 4. Intense thirst, drinks often but little at a time; cold water disagrees.
 5. Vomiting and stool simultaneously, worse after eating or drinking.
 6. Modalities, worse in cold air, from cold things, cold applications and
1 to three AM. Better in warm air or room and hot applications to
affected parts.
Sulphur: So Many Symptoms!
Lippe materia medica
 Mind And Disposition
 Peevishness; irritability; restless, quick temperament.
 Melancholy, with great inclination to philosophical and religious
speculations; with anxiety about the salvation of one's soul, and great
indifference to the welfare of others.
 Hypochondriac mood (through the day, in the evening he is inclined to be
merry).
 Dullness: difficulty of thinking; misplaces, or cannot find the proper words
when he speaks.
 Fantastic illusions.
 Qualmishness; nausea (in the morning).
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Vomiting: first of water, later or solid food, or sour; of the ingesta, sour or
bitter, with cold perspirations in the face, or of blood.
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The region of the stomach becomes very painful when pressing upon it, even the bed - cover causes pain.
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Burning in the stomach.
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Spasms in the stomach immediately after a meal.
Sulphur: Sleep sx.
 Totally disinclined to rise from bed in morning, nor refreshed by sleep.
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Sudden jerking of limbs when going to sleep.
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Child kicks clothes off at night.
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Yawning and sleepiness during day.
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Dropsy in afternoon and after sunset, wakeful at night.
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Irresistible drowsiness in daytime, wakefulness at night.
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Sleepiness in evening, but night is full of unrest, tossing, nervous excitement, orgasm
of blood, pains of various kinds and but little sleep throughout night.

Difficult falling asleep: on account of great flow of thoughts, with inclination to
perspire, with itching on skin.
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Wakes as with fright from a fearful dram, and after waking was still occupied with
anxious thoughts, as of ghosts, from which he could not free himself.
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Anxious, frightful dreams of dead and dying, speaks, weeps and shouts in her sleep, so
as to wake herself, and after waking remains long in a confused state.
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Much sighing and groaning in sleep.
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Sleeping with half-open eyes.
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Frequent turning over in bed without waking.
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Wakes up at 3, 4 or five AM, and cannot fall asleep again.
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Screaming out in sleep, lamentation and moaning, talks loudly.
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Dreams of fire and death.
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Heavy, unrefreshing sleep.
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Jerks and twitches during sleep.
Sulphur: Time sx (Hering GS)
 3, 4 or five AM: wakes, cannot fall asleep again.
 Five AM: painless diarrhea, driving out of bed.
 6 or seven AM: sweat, after waking.
 8 or nine AM: every second day, febrile attacks.
 9 or ten AM: febrile attacks, postponing ten to fifteen
minutes each day.
 Ten AM: pain at left eyebrow to superciliary ridge, feeling
of hunger, faintish feeling.
 Between 10 and 11 AM: gone feeling.
 11 AM: weak, empty, gone or faint feeling in stomach,
hungry and faint, in pregnancy.
Sulphur: Temp: Heat usually agg
 Wants doors and windows open. ~ Asthma. ~ Pneumonia.
 Susceptibility to temperature, warm things feel hot. ~
 Warm room: rush of blood to head better, dejection worse,
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headache worse, eyes dry..
Wishes to be fanned: during labor.
Warm bed: itching in chilblains worse.
Is obliged to uncover feet.
Feather covering: worse pains in limbs.
Warm applications, pulse becomes rapid.
Burning everywhere, general and local, especially feet;
has to stick them out of bed to cool them.
Phosphorus
 Anxious and fearful before and during a thunderstorm
 Fear of being left alone
 Anxious, universal restlessness, can't stand or sit still,
worse in the dark or when left alone and before a
thunder storm.
 Burning prominent in every part, as in mouth,
stomach, small intestines, anus, between scapulae;
intense running up spine, palms of hands
 Craving for cold things, ice cream, which agrees, or
cold water, which is thrown up when it gets warm in
the stomach.
Phosphorous: cont’
 Aggravation. Evening, before midnight (Puls., Rhus);
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during a thunder - storm; weather changes, either hot or
cold
Cold air relieves the head and face symptoms but
aggravates those of chest, throat and neck.
Before midnight: restless.
Twilight: anxious, sees more distinctly
Evening: fear and dread, as if horrible faces were looking
out of every corner, in bed, scraping in pharynx worse,
stitching pain in stomach worse, pains and vomiting
towards, chilliness
Most symptoms appear in the morning and evening,
while in bed, as well as after eating.
Can you begin to FEEL one remedy
emerging from the pack???
 If not, that’s ok….keep on reading the various remedies and
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several different authors….Lippe, Nash, Allen, Clarke Kent,
Boericke, Phatak, etc..
Become very familiar with the “polycrests”
Compare and Contrast them! How are they alike; how are they
dissimilar…
Get to know them like intimately: They are polycrests for a
reason!
Nash: Leaders in Homeopathic Therapeutics is excellent: It
is written in prose by remedy…not alphabetically. They are
written in their own order for a reason.
 While you are reading one remedy, he is contrasting and comparing
many other remedies at the same time…
 This comparison and contrast is very useful in learning
Discussion
Questions?
Molly Punzo, MD
[email protected]