Case analysis - R. Morrison - cum se alege remediul in functie de simptome

Case analysis - R. Morrison - cum se alege remediul in functie de simptome

Essence

Who can say what is an essence?
A: The soul of the remedy.
A: An idea, the idea of the remedy.
A: The true totality of the remedy.

The essence is a concept that was very much misunderstood, when it was first presented. Vithoulkas was sitting in Athens in the sixties and seventies and the world at large did not know this thinking at all. Bill Gray (who was my first teacher of homeopathy) brought this concept of essence to the States. And the essence became a type of mystique, a type of religion almost. There was a strong fight between people that said: "Totality" and people that said: "Essence."

Some people said: "You can only prescribe on essence."
Other people said: "You can never prescribe on essence, it is too mystical."
But there is nothing mystical about the essence. It is simply a deep understanding of the basic nature of a particular remedy. The flavour of this remedy and it includes many factors:

Causation:
- For Natrum muriaticum part of the causation is grief, so this goes into the essence.
- For Staphisagria part of the causation is suppression, so this goes into the essence.
Tempo:
Alumina is a remedy where the symptoms develop very slowly.
Aconitum is a remedy where the symptoms develop very suddenly.

The tempo of a remedy is very important in the essence of a remedy.
Centre of pathology:
Nux vomica you think mostly of the gastro-intestinal system.
Argentum nitricum you think mostly of the nervous system + gastro-intestinal system.
Natrum muriaticum you think mostly of emotions + headaches.

Each remedy has certain locations where it works. Each remedy will affect characteristic organ systems as well and this also goes into the essence of the remedy.
Physiognomy:
- We see a tall, thin, bright-eyed patient - we think of Phosphorus.
We see a plump, heavy, solid, wrinkled appearance - we think of Calcarea.
Physiognomy is the physical appearance that we see. The appearance goes very much into the essence of the remedy, as well as the personality of the person.
Whenever possible, Vithoulkas distilled all of this information down to one phrase or (trigger) word:
- Cowardice. He uses for Lycopodium the word cowardice, but within this is a whole understanding of what cowardice means within Lycopodium.
- Confusion and retention. He uses for Alumina the words confusion and retention.
Sometimes we can distill it down to just a few words. Another time it becomes more like a phrase or a sentence and sometimes it can't even be expressed so well.
The difficult thing is that oftentimes no essence appears in a case. Another problem with this concept of essence is, that it allows people to come to a superficial approach of homeopathy: you see somebody walk into the room and they say a few words and you go: "Oh, he is a Sulphur ...," or: "She is a Phosphorus type ..." etc. There is of course a type for each of these remedies, but just to prescribe on this alone is not good homeopathy.

The essence came about for a very important reason. A hundred years ago people were much simpler than they are today. People were much less complex as a whole and if we go out into the States in small and rural towns, still the people are quite simple, or more primitive, less refined. And for those people the information is given by our great homeopathic masters of the past: Kent, Farrington and so forth. The information in those books is almost completely sufficient to prescribe homeopathy. Or if you go to a country, that is more a third-world country, like Mexico or Nepal, where the people are more agricultural, more simple, then you see first of all that the symptoms which they have are not so suppressed. In our world if somebody has the slightest skin rash, it is immediately suppressed; we never see it. Like the patient with the dramatic skin eruption, you hardly ever see that. But in India you see this all over the place.
Now because the diseases push deeper into the inner regions of the body, we have to find new paradigms, new ways to understand how the pathology affects the system. And this is why we can understand and have to understand the deeper nature of e.g. Aethusa, Agaricus, Alumina; we have to find out what exactly is the type of these remedies to give us this extra piece of information that we need in a certain percentage of cases.

Totality

The second type of information that we may have is: the totality of the symptoms. The totality is a mechanical analysis of the information of the case. It is putting down all the information of the case, every rubric and then repertorizing.
We can say that the essence is three-dimensional, a living image.
We can say that the totality is two-dimensional, it is flat but it covers specific and concrete information.

The totality may include both psychological and physical symptoms; e.g. we can use fear of high places, it is a psychological symptom, but it still is included in the totality. Because whether or not somebody has a fear of high places, it doesn't fit into the essence of them.

Of course, when we use the totality (which is two-dimensional), many times more than one remedy will appear. It will be divided: e.g. mostly Sulphur, partly Calcarea, partly Lycopodium. Oftentimes there will be a division, there won't be absolutely one remedy. But many cases will come out very clearly for one remedy or another. And then we can say that in this case the totality is clearly for e.g. Sulphur or Lycopodium. Just because the fact that in many cases it won't come out clearly; in some cases the totality will come out very clearly.

Keynote

The third type of information that we may have is a keynote. A keynote is two different things; there are many things to be said about a keynote.
- We have a keynote for a remedy, e.g. for Sulphur: puts feet out of the covers, during the night. We say: "It is a keynote for Sulphur."
- We have a keynote for a patient, e.g. a patient may say: "I'm warm." "You are warm, or are your feet warm?" "Yes, my feet are warm." "Your feet are warm, do you put them out of the covers at night?" "Yes ... sometimes ..., I think so ..., I put my feet out of the covers at night." So, we say: "Sulphur." He has the keynote for Sulphur.
We see that one thing is a keynote in theory; another thing is whether the patient has that keynote. To be able to say that a patient has a keynote, it has to be stated very emphatically and unambiguous by the patient, otherwise we can't use this information to guide us to the prescription of the remedy.
A: Does putting the feet out of the covers has to be every night?
R: No, the more nights, the stronger the symptom.
A: Once a week?
R: It is not that you can say: "Now I plant my feet on this and I prescribe on this symptom."
A keynote has to be something strange, particular and rare. E.g. Sulphur likes sweets, so the patient likes sweets and therefore give him Sulphur. No, because many other remedies will crave sweets very strongly. It has to be very particular to the remedy, to be considered a keynote.
In each case we have to decide, after the case is taken: what information do we have. Do we have a totality, a keynote, an essence? Of course, if we choose the remedy on the base of a keynote, like: sticks the feet out of the covers, it won't act so deeply as if we choose the remedy on the basis of the essence. Right? No! This statement is absolutely false. If we choose the right remedy, no matter how we choose the right constitutional remedy, it acts just as deeply with the same impact on the person in their emotional and psychological life, as if we choose from essence, or as if we choose from the keynote.
A: Question (...).
R: The essence is three-dimensional, it fits the whole of the person, but if we find the correct remedy and it is deeply the constitutional remedy, it doesn't matter how we arrive at this conclusion.
A: It might already have the essence in it and yet you choose it from the keynotes, so it still acts deeply.
R: Some people, they don't show the essence and many times we don't know the essence for remedies. Many remedies we have to choose from whatever information is available in homeopathy at this moment. We don't necessarily know the essence.

One reason that people have this misconception: if you choose from the essence it works deeper, is that if there are deep emotional problems and they express it, and you find the essence; then you identify the changes in this way. If they also have emotional problems and you don't see the essence at all and you choose on the base of totality and you get the remedy, probably you are not as much aware of all the facets of the personality that change. If you find the correct remedy, it is going to do the same good work. It has the same spiritual meaning, as if you found it from essence or as if you found it from keynotes. So, don't be an essence-snob.

A: If you find the essence of one remedy, but you find a keynote from another remedy, what do you do?
R: In the best of all worlds, the patient comes in, they have the essence of Nux vomica, the totality of Nux vomica and the keynotes of Nux vomica.

Steps in analyzing

A The first step: in the analysis the first step is to decide: what type of information do we have. Do we have an essence, do we have totality, do we have keynotes? And then we make the strongest prescription possible, on the basis of the information that is available. the analysis the fourth step is to note if there is a lack of confirmation. If there is a total lack of confirmation of a remedy. In other words, all the keynotes that you expect to see with a particular remedy, all the confirmatory symptoms you expect to see with a particular polychrest are absent. Then again you have to doubt your prescription.
Hierarchy in case analysis

No 1: essence + totality + keynotes
Frequency = 1 % of cases.
Cure rate = 99 %
Essence, totality and keynotes all indicate the same remedy. We can prescribe with 99 % certainty in such cases.

No. 2: essence + totality / essence + keynotes
Frequency = 15 % of cases.
Cure rate = 95 %
Essence and totality indicate the same remedy, but there are no keynotes for that remedy.
Essence and keynotes indicate the same remedy, but there is no totality for that remedy.
What if we have essence + totality, but there is no keynote? We have e.g. the essence for Sulphur, we have the totality for Sulphur, but there are no keynotes. Still it is very clear that it must be Sulphur anyway. We can prescribe with 95 % certainty in such cases.

No. 3: totality + keynotes
Frequency = 25 % of cases.
Cure rate = 80 - 90 %
Totality and keynotes indicate the same remedy.
This is the case where there is no real essence, but the totality comes out very clearly for e.g. Sulphur and we have some keynotes for Sulphur. So it is very clear, even though there is no essence, or the essence may look partly like Pulsatilla, partly like Lycopodium: it is fragmented. But what we see very clearly is the totality + the keynotes. We can prescribe with 80 - 90 % certainty in such cases.
For these first three methods of looking at the case we can say, that these cases are confirmed by more than one type of information. These three are confirmed cases and therefore more certain.

No. 4: essence only
Frequency = 20 % of cases.
Cure rate = 70 - 80 %
These are cases which have a very clear essence (for e.g. Causticum). But when we take the totality of the symptoms, it comes up many different remedies. And when we look at the keynotes, there are keynotes for several different remedies. We don't have a totality and we don't have clearly a remedy from the keynotes. Here we prescribe only on the essence
.
No. 5: totality only
Frequency = 30 - 40 % of cases.
[mrr2] Cure rate = 60 %
[mrr2] No essence. No keynotes. We are forced to prescribe only on the totality. Here we don't have anything else to support it, but just the totality. This means that when you find the remedy that covers the totality, you give the remedy, and in about 60 % this is the correct constitutional remedy. In the other 40 % it doesn't work. Then you have to find another remedy based on some other type of information.
[mrr2] You can see that only in about 40 % (36 %) of the cases, we use the essence. In only about 40 % (36 %) of the cases you have enough evidence of the essence to use it (20 % essence only, 15 % essence + totality / essence + keynotes, 1 % essence + totality + keynotes). So in most cases we don't use the essence at all. I just want to make this very clear to you, that we don't always use the essence. If we have the essence it is very nice, it is something that we can use. If we don't have the essence, we find another way to find the remedy; instead of to make up an essence where no essence exists!

No. 6: reliable symptoms
The totality doesn't (clearly) give a solution and there is no essence.
Or essence and totality seem to contradict. The next step is to take the most reliable symptoms of the patient. Often this will be three or four strongly underlined symptoms in the case. Or it may be a peculiar, or characterizing symptom in the case. You have to base your choice of symptoms on: which symptoms are absolutely reliable? No matter if the symptoms are mental, emotional or physical, if only they are reliable in the case.

No. 7: main pathology
Here we take the main pathology in the case and we may even ignore reliable symptoms, if they don't give clearly a solution. We concentrate only on the main pathology of the case. We use e.g. only the modalities of the headache.

No. 8: recent pathology en my real problems started."
Here we ignore the case as a totality, or even the most important pathology and we have a look at the most recent symptomatology. In these cases you often look at what has caused the drop in health. Oftentimes the patient will say: "I was alright, until ... then my real problems started."

No. 9: 3 keynotes, different areas
Three keynotes from different areas indicating the same remedy. You know this idea: three legs of a stool? You have to have at least three legs for a stool. Three keynotes, but here in number 9 the keynotes have to be from different areas of the case. In other words: it can't just be all in one specific area, it has to be spread out in the case.

No. 10: keynote essence
Here one symptom in the case becomes so strong, that it is a keynote. But the keynote becomes almost an essence. We call it a "keynote-essence". So much that this keynote is the whole case, without this one fact there is no case.

No. 11: doublets, triplets
Number 11 is related to number 10. It is when you find doublets or triplets. That is when two or three things go together very strongly for a particular remedy. Little combinations of symptoms that fit for one specific remedy. This is similar to number 10, but it is more specific little pieces of data. Specific combinations of symptoms. You only get these from the materia medica and from somebody that has seen many cases of a specific pattern of symptoms for this particular remedy.
- If I say a case has great mental dullness + severe constipation, then we say maybe Opium or Alumina.
- If I say a person has severe back pain, worse from cough + worse from sneezing + worse from pushing at stool, then we say maybe Tellurium
.
No. 12: 3 keynotes, one area
Here you see one area of the case, where there are three keynotes, but sometimes it can be two. Sometimes it can even be four keynotes pointing to one remedy. But all from one area. Remember before we had them from different areas (number 9), now it is all from one area:
- It can be in the fears.
- It can be in the food cravings.
In these type of cases a case seems very vague. But then you come to the food cravings and it gives you strong information and all keynotes. Or it may be a case where everything is very vague, but with three very strong fears.
This is a less reliable method than when keynotes come from different areas in the case, from different organs. But it will often lead to the right solution. This is another way of analyzing a case. It is less reliable, so if you have other information to use, if you have another way to put the case together, you want to use that better way to combine the informati
on.

Finally you will see that the remedy will act very well. Most often you will see that it opens up the case and you have to wait a long time in those circumstances: you give Sulphur and you wait about three, four months. Potency 200 C; it depends on if the person is very sick.

No. 13: combination remedy
When you want to use a combination remedy, you have to have symptoms from two different remedies + also one keynote for that specific combination remedy.
E.g. it has to be:
- Symptoms for Sulphur.
- Symptoms for Calcarea.
- One keynote for Calcarea sulphurica also.
Now we are getting further down and you will see that these cases are much harder to solve and that they usually need smaller remedies.

No. 14: 2 keynotes
Here we have just two keynotes for the remedy. At this point of course the prescription is very shaky, if you reduce your prescription on just two keynotes. You don't know if it is going to work.

No. 15: nosode

Here we give a nosode.
You hear many homeopaths who say: "Give a nosode and you clear the case." You don't do that, unless you are really forced by the circumstances.
A:What about giving a nosode when the remedies that you have given failed?
R:This is another circumstance where you can give a nosode. You may do this sometimes the first prescription, or as for example the fifth prescription. But it is in these circumstances:
- You can't find the remedy intellectually.
- You have tried several remedies and they didn't work.
Then you have some indication of a miasmatic condition: either they had gonorrhoea, or the father had tuberculosis and they have something about the case that goes for that nosode, then you can give it. But if it is this way that there is no symptom for Tuberculinum, but the parents had tuberculosis and you can't find a remedy, most likely Tuberculinum is not going to work. But if you can't find the remedy and they have: allergy for cats, frequent colds; any little thing would be enough then.
Or you can't find the remedy and he has warts and you ask: "Did you have gonorrhoea?" They say: "No." "Did your father have gonorrhoea?" "I don't think so. He is dead." "At what age?" "Forty-five." "From what?" "Heart attack." Then you can give Medorrhinum, because early heart attack is a sign for Medorrhinum. Or they had cancer at a very early age. Then you may try Carcinosum.
Of course we may prescribe a nosode in any of the above steps (1 - 14).

No. 16: 1 keynote
Here there is only one keynote for a remedy and nothing else in the case. We may unhappily be forced to prescribe on one keynote. If we are lucky, especially if the keynote is very strongly stated, we may still have a good result.

No. 17: clearing the case

Here we use a remedy to clear the case. You may still get a cure with number 17. You use one of the three remedies: Sulphur, Nux vomica, or Sepia to clear the case. I do this maybe once in two or three years. When you decide that the case is complete confusion.
This will happen in cases where you see the Voll-treatment (I don't want to put it down) where they connect the person to machines and they give sometimes ten, fifteen or twenty remedies and the person comes back in a month and they give again ten, fifteen or more remedies. Over and over again and the case comes in, in a complete confusion. The main pathology that they had usually is gone now. Whatever it was, they fixed it: they 'cured' the main pathology. But the case is in a complete confusion:
- No symptoms.
- Vague symptoms: weakness, fatigue, mental confusion.
This kind of case. Here you may be trying one of these remedies.
It also could happen with allopathic drugging.
If I see a case that is totally confused like this and:
- They are very warm, mostly I give Sulphur.
- They are very cold, then I may give either Sepia or Nux vomica.
* If they are weak I give Sepia.
* If they are irritable I give Nux vomica.
It is this kind of prescription and occasionally you will see that the remedy will act very well. Most often you will see that it opens up the case and you have to wait a long time in those circumstances: you give Sulphur and you wait about three, four months. Potency 200 C; it depends on if the person is very sick.
A: Do you ever prescribe placebo as the first remedy?
R: I don't. Maybe if you don't see the remedy and you want to give him something and you want to bring him back to get more information, then you can give placebo first. Usually if I find myself in that position, I say: "I don't understand what to give you yet." I think about the case for a long time; I repertorize it and I say: "Come back when I want to ask you some more questions to clarify the case." But I haven't ever given placebo as the first remedy.