The Earthwise Herbal Repertory

by Matthew Wood

  Other modern research, found in Vitalism (Wood 2000), shows that Hahnemann used the medical pathology of his era in the analysis of patients, even though he claimed that the prescription should be based upon the symptoms. In two cases, Hahnemann diagnosed an abscess on the liver perforating through the pleura and emptying out through the lungs. This was a rare condition in the nineteenth century; today it is virtually unknown, thanks to antibiotics. In a case witnessed by Dr. Dunscomb, six doctors had made the mistaken diagnosis of tuberculosis before the patient was brought to Hahnemann. He changed the diagnosis to liver abscess and quickly and successfully treated the case. Dunscomb attributed the success of Hahnemann’s prescription to the correct pathological diagnosis.

  The next several generations of homeopaths were mostly educated doctors already trained to make these kinds of diagnoses themselves, so it should be granted that medical physiology and pathology played a larger role in homeopathy than is generally admitted. Modern homeopaths, by comparison, usually have very little medical training.

  Boenninghausen’s initial repertories (very different from his final arrangement) appeared late in Hahnemann’s career. Until then, the founder’s actual practice was based on the pathological presentation, the characteristic symptoms, and the “cheat sheet” of remedies he associated with each common presentation. (“I know many herbalists who practice exactly like this,” remarks Matthew.) Some herbalists also use an “opening formula,” like Hahnemann’s use of Sulphur. One thinks immediately of Samuel Thomson’s lobelia, cayenne, and bayberry formula.

  We assert that the real difference between homeopathy and herbalism is not the law of similars. As we have seen in the last chapter, similars and contraries are both present in the homeopathic provings and remedies because of the rebound effect. The differences in therapeutic approach between Hahnemann and herbalism, as just shown, is less dramatic than is commonly thought. The major innovation introduced by Hahnemann is the prescriptive accuracy that arises from careful cross-referencing of remedy symptoms with the client’s symptoms. He originally called his remedies “specifics” rather than “similars,” showing that he thought in these terms for a while, before adopting the law of similars as the basis of his new system.

  This prescriptive accuracy and symptom detail probably stimulated the eclectic thinking of John Scudder, and led to his development of specific indications. While the idea is similar, the execution is different, because Scudder’s specific indications are based on bedside experience and are almost never identical to homeopathic symptoms. Blending of homeopathy and Scudder’s specific medicine occurred in the next several generations, on both sides.

  The First Homeopathic Repertories

  When Boenninghausen began his studies and practice, keynote symptoms were poorly developed, and there were few shortcuts to prescribing homeopathic remedies. Taking a chronic case could easily overrun an hour, with many more hours needed to search for the right remedy in the Materia Medica Pura and journals containing new provings. Homeopaths desperately needed a way to arrive at the appropriate prescription quickly and reliably. A major weakness of the “new system” was the lack of a symptom index. Hahnemann realized this, and began a small “lexicon” of symptoms, but it was never completed. In his seventies, he knew he was not up to finishing the task, so he delegated the job to two of his top students, Boenninghausen and G.H.G. Jahr. The latter moved on to other projects.

  Boenninghausen’s first repertory (1832) covered only the agents in Hahnemann’s Chronic Diseases. He created a separate repertory (1835) for acute remedies and conditions. He then began to merge the acute and chronic repertories. However, halfway through the revision “it had increased in size beyond all expectation” (Boenninghausen 2007, vi). “I gave it up,” he explained, “as I saw it was extremely probable that a similar object might be attained in a more simple and satisfactory manner.” His grand insight is described in Roberts’ introduction to the Pocket Book:

  He conceived the figure of a great all-inclusive Symptom Totality, made up of the cardinal points of location, sensation, conditions of aggravation and ameliorations [modalities], and concomitance, under which all symptoms of the materia medica and all the symptoms of the disease as well should be covered (Roberts 2007, 26).

  Using this model, Boenninghausen found he could simplify symptoms into their four elemental components. This established not only the basis for an easy-to-use repertory but a model for case-taking and study of materia medica. It also allows hitherto unknown symptom combinations to be discovered, which led to previously unknown uses of remedies. It is therefore a dynamic, holographic, archetypal approach to symptoms. It is remarkable that Boenninghausen both divided symptoms into their components and also succeeded in bringing them back together into organic patterns. This is the basis of The Therapeutic Pocket Book, which first appeared in 1846. For practicality, he includes sections on mind or soul (German seele), sleep and dream, and fever, in addition to the basic sections on location, sensation, modality, and concomitant.

  Here is a rendering of the “Symptom Totality” into its four major corners, or parts, as conceived by Boenninghausen.

  Hahnemann tested and approved this method in his final years. Boenninghausen noted that “the late honored Founder pronounced my idea ‘excellent and eminently desirable,’ so I had no more misgivings about finishing the work” (Boenninghausen 2007, vi).

  At the time of his death, Hahnemann’s Organon and Chronic Diseases provided the theory; the ever-expanding homeopathic materia medica provided the remedies, and the Repertory provided the practical means for choosing remedies. These became the threefold foundation of the new system.

  The Complete Symptom

  Boenninghausen’s approach to the symptom was based on teachings that go all the way back to the ancient Hippocratic physicians. They determined that there were seven basic questions that needed to be asked and answered in order to arrive at a complete understanding of a case. In the twelfth century, the Latin churchmen reduced these to a simple verse that Boenninghausen adopted: Quis, quid, ubi, quibus auxiliis, cur, quomodo, quando. This formed the basis of his mature vision of the repertorial template. Here is an expansion and explanation, based on John Henry Clarke’s Clinical Repertory (1904) and the work of David Little (2015):

  I. Quis (Who): Who is the patient (constitution, temperament, mind)?

  II. Quid (What): What is wrong (sensations, complaints, clinical conditions)?

  III. Ubi (Where): Where is the problem (location)?

  IV. Quibus auxiliis (With what): What accompanies the problem (concomitants)?

  V. Cur (Why): How did it start (etiology, causation)?

  VI. Quomodo (In what way): What makes the complaints better or worse? (This was the origin of the term “modality” as used in homeopathy.)

  VII. Quando (When): What is the pathological timeline, including changes that occurred?

  Robin Murphy stresses that the entry complaint—what the person wants taken care of (quid)—should come first. Clarke makes the same adjustment in his Clinical Repertory. Without question, the first fact to be established in a case is the goal of the client. What is it we are doing? If, during the course of the case, the practitioner feels a different goal is preferable or attainable, he or she must inform the client and change the goal.

  This list is a good guide for any type of holistic case-taking. It reminds us of the “ten questions” or “ten-asking song” in Traditional Chinese Medicine.

  Boenninghausen’s Advice on Using the Repertory

  The baron’s advice on using his repertory holds true for other repertories as well, including this one. Boenninghausen wrote:

  Much depends upon whether one is entirely a beginner, or is already somewhat skilled.… But he who knows nothing whatever must, indeed, make a most careful search for everything without exception. The more he knows, the less he has to look for and, finally, only to use it here and there to help his memory (Boenninghausen 2007, x).
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br />   The “prince of repertory-makers” then gives a case example to illustrate the difference between how a beginner and an experienced homeopath might take a case. It happens that the example fits our purposes, because the remedy is commonly used by herbalists and can also be found by searching the current repertory.

  E.N. of L., a man of about 50 years, of a blooming, almost florid complexion, usually cheerful but during his more violent paroxysms inclined to outbreaks of anger with decided nervous excitement, had suffered for a few months with a peculiar kind of violent pain in the right leg after the previous dispersion allopathically of a so-called rheumatic pain in the right orbit by external remedies, which could not be found out; this last pain attacked the muscles of the posterior part of the leg, especially from the calf down to the heel, but did not involve the knee or ankle-joint. The pain itself he described as extremely acute, cramping, jerking, tearing, frequently interrupted by stitches extending from within outward; but in the morning hours, when the pain was generally more endurable, it was a dull burrowing with a bruised feeling.

  The pain became worse towards evening and during rest, especially after previous motion, while sitting or standing, particularly if he did it during a walk in the open air. While walking the pain jumped suddenly from the right calf into the left upper arm, if he put his hand into his coat pocket or his breast and kept the arm quiet, which was relieved by moving the arm, and then the pain suddenly jumped back into the right calf. The greatest relief was experienced while walking up and down the room and rubbing the affected part.

  The concomitant symptoms were sleeplessness before midnight, frequently recurring attacks in the evening of sudden flushes of heat with thirst without previous chill, a disagreeable fatty taste in the mouth, with nausea in the throat, and an almost constant pressing pain in the lower part of the chest and pit of the stomach, as if something there were forcing itself outward (Boenninghausen 2007, xi).

  Boenninghausen gives examples of how several homeopaths might analyze the case. The wandering pains, fatty taste in the mouth, and sleeplessness before midnight, suggest a condition calling for Pulsatilla, but this remedy is not prescribed for anger or the florid, blooming complexion. “Another person who has studied more [thoroughly] the peculiarities of the pains,” continues Boenninghausen, “distinctly remembers that China [quinine] corresponds to the paralytic and bruised pains as well as to the jerking tearing [pains], and stitches from within outward, and to the pains jumping from place to place.”

  Looking further, “sleeplessness before midnight, the aggravation during rest, as well as the relief from motion and rubbing, together with the flushes of heat with thirst, correspond to this drug.” However, further research would find contradictions; China is not recommended for persons of florid, blooming health. The more experienced physician, says the baron, recognizes the symptoms of an “infrequently used remedy,” looks up the “few doubtful symptoms,” and concludes that the indicated remedy is Valeriana. And, indeed, a single dose of “high potency” (30c or 200c) in water, removed “the whole trouble, with all the concomitant symptoms,” in three days (Boenninghausen 2007, xi, xii).

  Matthew’s experience illustrates how an herbalist might take this case: The man appears florid and blooming, so he has a “full” or “excess” physique, indicating some degree of heat/excitation. This is his constitution. However, the disease is seen in the cramping, changeable symptoms, indicating predominance of the wind/tension tissue state. The mind displays anger and nervousness, a combination of tension and excitation. Tension frequently relates to gall bladder symptoms (in both Greek and Chinese medicine). Gall bladder symptoms appear in this case—the fatty taste in the mouth, nausea in the throat, and pain in the stomach. However, this conclusion might be too simplistic: the symptoms also look like tension stretching throughout the autonomic nervous system (ANS). That puts the emphasis more on the stomach than the gall bladder.

  At this point the experienced herbalist would probably be thinking of a predominately acrid (relaxing), somewhat cooling remedy with an affinity to the gall bladder or stomach and wind conditions. The major remedies that would probably come to mind are Valeriana, Lobelia, and Nepeta (catnip). The repertory would also lead in this direction.

  Lobelia and Valeriana are both found in the repertory as acrid, cooling remedies with affinities to the ANS. They are often recommended for full-bodied, muscular people. Neither is specifically a gall bladder remedy, and there is no specific information available for the ANS (perhaps in the next edition of this repertory?) Both act very strongly on the stomach, so the guess about the ANS may be right. The sleeplessness suggests Valeriana. Not many people recognize the mental state for this remedy, but it is given in the Herbal Repertory and it cinches the case. In the “Emotions” section, under Concentration, we find “anxiety producing upset stomach in children; aggressive behavior”; under Nervousness, “anger and nervousness”; under Anger, “acute, chronic; holds anger inside, causing knots in stomach, lower back.” (Also see “Stomach Problems from Stress.”) The notation “in children” shows that sometimes the repertory can be too exact. In repertorizing it is better to include a close or doubtful symptom, rather than to ignore it.

  Through this process we arrive at Valeriana as the most likely candidate for this case, with Lobelia as another possibility. Anyone who also suggested Nepeta should be considered a winner; Nepeta is an acrid relaxant that contains valerianic compounds and has affinities to the stomach, spasms, anger, and nervousness. Since Lobelia enhances the action of other remedies, especially ones to which it is similar, an elegant approach (for an herbalist) would be to combine a small amount of Lobelia with the Valeriana—see the section on “Adjuvants, Accelerators, and Synergists.” Adding Nepeta to Valeriana would have produced an awkward, redundant formula.

  What if the practitioner had given Lobelia or Nepeta rather than the Valeriana? Palliation or cure may have occurred using these remedies. Clarke addresses such a near-hit:

  In most cases there are more remedies than one that will benefit; and if the exact simillimum [related remedy] is not found, the next or the next to that will give a measure of help; so the beginner need not abandon the ideal as too difficult of attainment. Then there are many different kinds of similarity, as well as of degrees, and every kind is available for the prescriber’s use. There is similarity between drug and disease in organ affinity; in tissue-affinity; there is similarity of diathesis [constitutional imbalance]; similarity of sensations and conditions—all these and other kinds of like-ness are available for the prescriber (Clarke, 1886).

  This “non-perfectionist” advice is much more helpful than idealism.

  The Repertory Matures

  Boenninghausen’s Therapeutic Pocket Book soon became a necessary companion for the practicing homeopath. Contributors in succeeding generations wrote additional material to accompany and update it. These included Clarke’s The Prescriber (1886) and Clinical Repertory (1904), and Cyril M. Boger’s Characteristics and Repertory (1905) and Synoptic Key (1931).

  All these books are useful for an herbalist wanting to use homeopathic repertories and prescribers; but if only one were chosen, I direct herbalists and budding homeopaths to Boger’s Synoptic Key. The author omitted a lot of useless symptoms by only including those that were clinically verified. The core is a mere two hundred pages long, compared to five hundred in Boenninghausen’s full Pocket Book. Boger also focuses on the most important physical symptoms, specifically called the “physical generals,” which relate to the whole physical being rather than only the mind or local physical symptoms. Once one understands the Synoptic Key, an almost indispensable addition would be S.R. Phatak’s Concise Repertory, which adds many new remedies and indications.

  Laypeople, herbalists, and some neophyte homeopaths are confused by the almost comical detail in traditional descriptions of homeopathic symptoms. To combat this tendency, Boger introduced “physical generals,” a category emphasizing broad, systemic
symptoms, easy to observe, allowing us to now look up a general condition such as the color and nature of the skin, modalities, temperature, excess or deficiency, etc. This quickly leads to a few remedies, or just one. This is very compatible with the approach taken in this book.

  Boger gives a description of his approach to case-taking:

  The spirit of the clinical symptom picture is best obtained by asking the patient to tell his own story, whenever this is possible. This account is then amplified and more accurately defined by the questioner, who should first try and elicit the evident cause and course of the sickness, to which he will add all the things which now seem to interfere with the sufferer’s comfort. Especially should the natural modifiers of sickness—the modalities—be very definitely ascertained. The following are the most vitally important of such influences: Time, Temperature, Open Air, Posture, Being Alone, Motion, Sleep, Eating and Drinking, Touch, Pressure, Discharges, etc.

  A consideration of the mental state comes next in order of importance. Here the presence of Irritability, Sadness, or Fear is the ruling factor.