On Using the Repertory
NATIONAL JOURNAL OF HOMOEOPATHY 1998 Mar / Apr VOL VII NO 2.
Mr S M Gunvante
'Puls / Phos / Calc-c / Tell / Staph

Go for the Simplest Entry Point
Readers are requested to carefully understand and even work out a few cases according to the advice in this article. I have personally found it quite dependable in the last few years, but would be grateful if readers write to me a post card letting me know their comments -giving reasons for their opinion.
S M Gunvante. 

Consider the fact that a large number of Homoeopaths, even after a full term of academic education in colleges find it difficult to practice classical Homoeopathy and resort to poly pharmacy, alternation of remedies and finally allopathic remedies. Does it not mean that the present method of teaching in colleges, lectures, seminars and learned articles, leaves much to be desired, and naturally leads to inefficiency in practice? I did a lot of heart searching and have come to the conclusion that if true learning and easy, correct practice is to result, the teaching methods have to be in consonance with the Psychology of the learner. 

The Organon talks of the totality in a number of Aphorisms. In Aph 153, Hahnemann tells us that the "more striking, singular, uncommon, peculiar [characteristics] signs and symptoms of the case are chiefly and almost solely to be kept in view...." He affirms in Aph 211 that the "State of disposition of the patient, being decidedly characteristic, chiefly determines the selection of the remedy,." But in Aph 213 he modifies this statement by saying "We shall never be able to cure Homeopathically if we do not select a remedy, which is not only similar, but is also capable of producing a similar state of the disposition and mind." 

In aph 164 Hahnemann says "The small number of Homoeopathic symptoms present in the best selected medicine, is no obstacle to cure where these few symptoms are chiefly of an uncommon kind and peculiarly distinctive [characteristic] of the disease." 

2.Again in Aph 106 and 192, he says that the whole pathogenetic effects of the several medicines must be known, that is to say, all the morbid symptoms and alterations in health that each of the medicines is specially capable of developing, must have been observed, before we can hope to be able to select the suitable Homoeopathic remedy..." Valuable as all these directions undoubtedly are, I submit that they are all abstract and difficult to fully comprehend and apply in practice, without enlightening clinical experiences. 

3. Reading the Materia Medica and understanding it [various competing remedies] for application in practice is equally confusing, and difficult of application in individual cases. Despite Kent's learned and impressive Lectures, Vitholkas' Essences or Margaret Tyler's Drug Pictures, the fact is that each remedy has several facets which are not applicable in every case. This adds to the confusion. 

4. This situation was correctly recognized by Kent, who, on pg 3 of the booklet, "Use of the Repertory" says: The sick images in the M.M are too numerous and too varied to be named or classified...I have known often the intuitive prescriber to attempt to explain a so called marvelous cure by saying, "I cannot quite say how I gave the remedy..." 
Kent concludes, "It is growth of art...but if carried too far it becomes a fatal mistake, and must therefore be corrected by REPERTORY work done in even the most mechanical manner." 

5. The logic of learning behaviour is "From the known to the Unknown" Following a reverse order, thereby first even clinical experience is like putting the cart before the horse. Hence, all the lectures, teachings and articles produce no learning. Which again proves my contention in pedagogic terms, "If the learner has not learnt, the Teacher has not taught." 

6. What is the solution? THE REPERTORY. This is not the place to go into the problems faced by Repertory makers and the usefulness of different Repertories. I find Frederick Shroyen's SYNTHESIS to be the best: up-to-date, numerous additions of rubrics and remedies. The Complete Repertory is not yet easily available in India. Therefore, in this article, the page numbers given, refer to Synthesis. 

7. Use Of The Repertory: I advocate the massive use of the Repertory at every stage of a Homoeopathic practice, from case taking to the selection of the similimum. The reasons are: 1] Hahnemann has advised in Aph 155, "For employment of the Homoeopathic remedy it is only the symptoms of the medicine that correspond to the symptoms of the disease that are called into play.... but the other symptoms of the medicine which are often very numerous being in no way applicable to the case, are not called into play at all" and should be ignored. 

2] Margaret Tyler and J H Clarke referred to these symptoms "Which are not called into play" as negative symptoms.They advised us to take only the Positive symptoms into consideration while looking for a remedy. 

8. 1] While using the Repertory we have the advantage of examining only SINGLE RUBRICS each time, i.e., Positive symptoms. If we consult the Materia Medica, we will be confronted by so many symptoms - positive and negative. Then we are likely to regard the negative symtpoms also as essential the similimum. When we take this view point, we understand what a great advantage the repertory is!!

2] The repertory is the only place where we find the symptom broken up, ie analysed, which prevents us form getting confused with a combination of symptoms, like in the Materia Medica. These analyzed rubrics are like nuggets of gold, handy for use and when the need arises. Yet, they are also capable of being synthesized or combined with other symptoms found in the individual patient. A distinct advantage the Materia Medica! Failure to take advantage of this second factor is the major reason why many of us fai by not using the Repertory in every case is the major reason why many of us fail. 

3] The Repertory is a perfect replica of the MM with the presentation of symptoms in the anatomical as well as the alphabetical order, making for easy reference. The only "drawback" if one may call it so, is that in it "everything must be sacrificed for the alphabetical order" [Kent] and we do not get word pictures of symptoms of the remedies as we find in the lectures. Yet, Kent advises in How to use the Repertory: The use of the Repertory in Homoeopathic practice is a necessity if one is to do careful work. Our Materia Medica is so cumbersome without a repertory that the best prescriber must meet with only indifferent results."

9] The hierarchy of symptoms has been well described in various books from masters like Kent, Margaret Tyler, Lippe, Boenninghausen, Boger, Pulford, Guernsey etc, but the Homoeopath, especially in his early years of practice, finds it difficult to identify the classifications such as mental, physical , general, particular, causation, modalities, concomitants or generals, when a patient pours out his complaints with no order and sometimes even relevance. A proper detailed study of the repertory, chapter wise, complain wise [eg, nausea, vomiting, vertigo, menstrual complaints, urinary complaints , respiratory difficulties etc] will reveal to the physician all the relevant symptoms with their modalities, causations, concomitants, etc. 

A doctor, who has not cared to use the repertory extensively, will continue to grope in the dark, leading to haphazard prescriptions. Unsupported by the appropriate symptoms, he will continue to bungle and take to unscientific practices. Constant use of the Repertory makes him work, and continue to work, on the right track from the beginning leading to satisfactory results and correct habit. 

10] Stuart Close, on pg 2567 of his "Genius of Homoeopathy," has brought out a very important point: he says: "A prescription can only be made upon those symptoms which have their counterpart or similarity in the Materia Medica and the repertory.
Familiarity with the Repertory from beginning to end, will help us to immediately pick out a statement of the patient and connect it with its counterpart in the repertory. 

Acquisition of this ability to seize the "counterparts', helps us to weed out many complaints- ill defined or not qualified by modalities, and therefore of no great importance. We are thus able to sift the grain from the chaff -a facility of no mean order. 

This ability to identify symptoms from the patient which have their counterpart in the repertory, also facilitates our task of selecting the appropriate rubrics for repertorisation. This then makes repertorisation a pleasant and welcome task instead of boredom. 

11] Every Homoeopath knows, his principal task consists in finding the single remedy whose characteristic symtpoms are similar to the individualizing symptoms of the patient. Symptoms, which are common to many diseases, do not help us to identifying the curative remedy. As H C Allen says in the preface to "Keynotes and Characteristics": "The life work of the student of Hom MM is one of constant comparison and differentiation. He must compare the pathogenesis of a remedy with the recorded anamnesis of the patient; he must differentiate the apparently similar symptoms of the two or more medicinal agents in order to select the similimum. To enable the student /practitioner to do this correctly and rapidly, he must have as a basis for comparison, some knowledge of the INDIVIDUALITY of the remedy, something that is Peculiar, uncommon or sufficiently characteristic in the confirmed pathogenesis of the polycrhrest remedy, that may be used as a pivotal point of comparison. It may be called a key note, a "characteristic" the "red strand of the rope" and central modality or principle - as the aggravation from motion of Bryonia, the amelioration from motion of Rhus, the furious, vicious delirium of belladonna... some familiar landmarks around which the symptoms may be arranged in the mind for comparison." 

12] Now, what are the tools at the disposal of the Homoeopath to compare remedies with apparently similar symptoms" and then differentiate between these similar remedies with the help of peculiar, individualizing symptoms, or with aggravations, or with keynotes or other characteristic symptoms - and this correctly and rapidly.

A little thought, even a search among the vast literature on Homoeopathic practice, will lead us to the conclusion that the only tool available to carry out these two functions [comparison and differentiation] is the repertory. Every rubric has against it a good number of remedies which are similar, in that they produced these symptoms /rubrics in the provings. The rubrics thus provide us with a ready list of comparable remedies. Now, a s for differentiating between two or more remedies, the sub rubrics in the repertory provides us this differentiation based on the characteristic individualizing modalities [agg or amel] or causation or peculiar symptoms [although they are not designated by this type of classification] For e.g. Diarrhea after fright [764] Rectum, passes stool easier when standing [759] menses, copious lying aggr. [897] chill with perspiration [1469] fever with shivering; Indurations of glands [1617 and so on. 

13] How to use the Repertory: in Day-to-day practice: Before going into details "how to" a few words on the philosophical approach, which explains WHY we advocate the approach given below are necessary. H A Roberts says in his "Principles and Art of cure by Homoeopathy" at pg 97 under the chapter " Chief Complaint" : "The chief complaint has a psychological value out of all proportion to its value in Homoeopathic prescribing; it brings the patient to the physician, and if the physician responds, and by careful questioning draws out the history or other symptoms, the patient feels a satisfaction and confidence that the physician is not treating his case was of no consequence.... 

The older prescriber, while giving due weight to the chief symptom, feels that in prescribing he must consider the totality of symptoms, and in order to do so he must give more weight to the other part [probably unexpressed] which is an even more necessary part of the case than the chief complaint, because it is that part which manifests more clearly the individuality of the patient and thus becomes the totality, if you prefer.

H. A Roberts defined the chief symptom thus: "The chief complaint, or the leading symptoms, are the symptoms for which there is clear pathological foundation; or the symptoms which first attract the attention of the patient or physician or which cause the most suffering; or which indicate definitely the seat and nature of the morbid process; and which form the "warp of the fabric" as it has been expressed.

14] Roberts further explained: "The group of which the patient complains, most ... cannot almost without exception, be relied upon for the definite selection of the remedy; it is the concomitant group of symptoms which, taken in conjunction with the major group of symptoms makes possible the definite selection of the remedy by greatly reducing the number of remedies indicated in such conditions; and upon closer analysis we can pick the similimum unerringly form this small group.

15] Roberts then warns us not to take the chief complaint as its face value, for behind it here may be lurking ALTERNATING SYMPTOM GROUPS, which the thoughtful Homoeopath should not treat separately because many remedies in our Materia Medica have alternative group of symptoms; and we cannot ignore any symptoms which the patient may recite.
"It is so obvious that Hahnemann never intended his directions to be taken that we do keynote prescribing.... it is to be remembered that Hahnemann never slighted any symptoms of a case in making a prescription. He had the genius of giving each symptom its true place in the picture without distorting the totality. While it is inconveivable that hahnemann ever did keynote prescribing. it is also beyond our knowledge of hahnemann's thorough mind that he eliminated the chief complaints in building up the symptom-image." 

16] H.A Roberts concludes: If we can find a remedy that has the "more striking, particular, unusual and peculiar [characteristic] signs and symptoms of the case" and in addition covers the chief complaint as well., we may consider ourselves as having a sound basis for the prescription of the similimum" [101] 

17] A careful study of H A Roberts views as expressed above will lead us to the conclusion that, in our daily practice, we have to take into consideration in every case the chief complaint, subject only to the provision that a remedy selected on the basis of the chief complaint must be supported by the generals, such as Mind, Physical generals, Concomitants, Peculiar and [characteristic] symptoms. 

18] Cardinal Rules for a correct prescription [taken from Masters] 1] Totality of symptoms means the totality of characteristic symptoms. Stuart Close has clarified that the totality is not a mere jumble of symptoms thrown together, nor is it based on the numerical value of the symptoms. It is the totality of all characteristic individualizing symptoms. Lippe has summed this up beautifully in clear terms. The characteristic symptoms will consist in the result obtained by deducting all the symptoms generally pertaining to the disease with which the patient suffers, from those elicited by a thorough examination of the case. In other words, the characteristic symptoms are the symptoms peculiar to the individual patient, rather than the symptoms of the disease [S .C 158] 

2] Two or more symptoms may appear together, or synchronies with each other so frequently that they are really one symptom and must be considered as such in our analysis. As nothing in nature can be represented by a single property, no disease can be represented by a single symptom...The character of the Drug is represented not by a single effect, but by a group of effects. Very often the concomitant of circumstance is of greater importance to the whole case than the expressed sensation. That is why it has been well said that "The concomitant is to totality what the conditions of aggravation and amelioration are to the single symptom." It is the Differentiated factor." 

3] Remember that symptoms to be taken up for repertorisation must be [a] spontaneously expressed by the patient, as far as possible; [b] they must be intensely felt by the patient and [c] they must be clear, and unambiguous. 

[4] The hierarch [relative importance] of symptoms is in the following order: GENERALS: 
[A] disposition of mind - any departure from the normal; also state of subconscious mind [dreams]
[b] Physical generals [which relate to the whole patient], such as thermal modality, Cravings and aversions of foods and drinks, and foods that do not agree; nature of sleep and position in sleep; disorders in the sexual [genito-urinary] sphere, etc
[c]Causations -proximate, or deep-seated, or which have a life time effect;
[d] Peculiar symptoms, which characterize the patient and are not related to the disease he is suffering from;
[e] Concomitant symptoms, related in time to the suffering of the individual, but which have not pathological relation to the chief complaint.
[f] Physical particulars - local symptoms with modalities, characteristic of the patient;
[g] Past history: miasmatic co-relations -sycotic, syphilitic, tubercular. 

19] Analysis of the case to find the curative remedy: We now come to the crucial problem facing the physician, viz analysis of the case to decide the question as to which symptoms he should first take, as the "entry point" to facilitate easy and result oriented repertorisation, bearing in mind the hierarchy of symptoms described above. This question will be easily solved if the physician takes a careful note of Boger's advice in the Preface to his Synoptic Key namely : "The Prescriber has only to bear in mind that the actual differentiating factor belong to any rubric whatsoever" which means that the symptoms /rubrics which, in H A Roberts definition of Chief Complaint causes the most suffering, or which are most important and clearly recognizable etc. 

20] In Conclusion:
Get the strange, strong, peculiar symptoms and then see to it that there are no generals in the case that oppose or contradict. Nothing in particular can contradict Generals. One strong general can over rule all the particulars you can gather up. 

To cut short your work use the "Eliminative" method. The strong symptoms, which are indispensable to the case which are strong in the patient as well as the remedy, should be used as eliminative symptoms [to eliminate or throw out those remedies in the remaining rubrics which are not found in he first tow eliminative rubrics]. 

21] It is necessary at this stage to recall the importance of the ranking or grading assigned to remedies. Gibson Miller, Margaret Tyler, Yingling, E J Lee all has stressed that." it is important to bear in mind that they [peculiar and characteristic symptoms] must be equally well marked in patient and in the remedy. In other words, no matter how peculiar and outstanding a symptom may be, either in the patient or in the remedy, unless it be of EQUAL GRADE [2 and 3 marks] in both , we must pay little heed ot it" 

Nevertheless we cannot completely ignore this because since the repertories were compiled many years ago, some of the remedies may warrant their rank being raised from clinical experiences, which have not yet been incorporated in the Repertories. 

As such the low rank remedies may justifiably be taken as belonging to a higher rank, especially in small rubrics. Unless this precaution is borne in mind we may miss many small, ill-proved or rarely used remedies which could also be curative in certain cases.

Use the Repertory to find the curative remedy in every case: 22]. It will be seen from the above discussion that the "Symptoms which cause the most suffering, or which are most important and clearly recognizable" are those of the Chief Complaint. Now, the Repertory gives us details of various sections, complaint wise from Mind, Vertigo, Head, Eyes, Ear etc. giving remedies under various general rubrics, as well as sub rubrics of time, conditions of aggr and amelioration [alphabetically] and extension of the complaint to other parts. 

When patient complaints come under any of those sections, we may take it as his chief complaint and treat it as the entry point. We now have to consult only that particular section and get as complete information as possible about the complaint, so as to be able to locate the appropriate sub- rubric. If by chance we do not find a particular modality, causation or concomitant symptom in the said Section, we must refer to the Generalities.

Example, if we do not get "Agg pressure" or "agg before menses" we will be able to find the rubric in the General Chapter. Although in all these cases we are not starting with Mental symptoms [as advised by Kent] but if we find that there is a strong mental background to the case, it would indeed be our duty, and entirely correct, for us to make careful enquiries about the mental disposition which preceded or accompanied the Chief Complaint.

When we are required to cover the totality of Characteristic symptoms including the chief complaint, it makes little difference whether we start from the mind[as Kent advised] or from the Physical Generals or Qualified particulars with the section of chief complaints. One thing is certain, we must not neglect to take a complete case and be guided by whatever characteristic/peculiar symptoms are outstanding and indispensable especially the Generals.
We shall give a few cases to illustrate our point. 

Case 1: A 38 year old lady complained of "fear of insanity" after she saw an old lady in the house dying. Because of this fear occasioned by seeing a dead body she was given Stram 10M one dose. She was quite well for 15 days, at the end of which she said that she is getting the fears again. It was obvious that Stram was not giving lasting results. So she was asked what she did when she gets those fears. She said that she could not control her weeping at the thought of what will happen to her young children if the worse happens to her. Temperamentally a mild person, she felt better in open air and worse in the warm air at home. On the basis of these symptoms she was given Puls 10M one dose and that was more than a year ago. I rang her up about six months after the medicine was given and she said she was perfectly all right. 

Case 2: A boy of 8 ½ years was brought by his mother, carried on her shoulders because the boy was suffering from acute asthma. The boy had passed through a number of doctors, Allopathic and Ayurvedic without avail. The mother was in tears. The symptoms were: respiration difficult agg. Walking [Syn 952]; Respiration panting [755]; Respiration with cough [949] . As the mother was stroking or rubbing the boy on his back while she was waiting, I took it as consolation amel. [36] and Rubbing amel[ 1674] The difficult respiration was also worse at night [948] He was given Phos 1M one dose on the spot, and I could see within 5 minutes he was feeling much better. He continued to be quite well for 15 days when for slight recurrence, he was given one more dose of Phos. He has not needed any further medicine. 

Case 3: A gentleman aged 65 complained of weakness in his lower extremities, which prevented him form walking freely on the rough roads, His rubrics were: Lower limbs weakness of [1385]; agg ascending [1385] ; agg. Exertion [1385] respiration difficult agg. Ascending [948] also from exertion [949] He was given Calcarea Carb 1M 3 doses at 5 days intervals, and he reported after 15 days as feeling very much better. 

Case 4: A 45 years old man complained of sciatica on the right lower extremities [1234]. The pain was worse coughing [1236], worse jarring [1234], worse even laughing [1234] It was also worse lying on the painful side [1235] , as well as sneezing [1235] He was given Tellurium 1M 3 doses at five days intervals, and he reported 90% better after 15 days. Two more doses given at 10 days intervals put an end to the complaint. 

Case 5: A 42 year old man complained of insomnia for the last 15 years. Asked about the cause he said there is none. He was asked to describe his situation in life, job, etc when he said that he was treated unjustly in his job about the time the insomnia commenced. He went to the labor court, but there again the delay frustrated him. he said he could not stand injustice. Even in the next job he took up, he and to take up the cause of colleagues and argue with the management on their behalf. His sleeping hours were taken up with thoughts as to how to fight for his colleagues. The rubrics selected were: Sleeplessness [1414] covering 1 1/2 column in the repertory, The sub rubrics [10 pages] did not contain any suitable modality or causation, except sleepless from thoughts [1425] with more than 100 remedies. His mental symptoms were "injustice cannot support"| [127] Ailments from anger with indignation and anger suppressed [3] A F Mortification [5] On the basis of these rubrics he was given Staph 10M one dose [Sleeplessness also includes Staph highest grade. ] he reported after 15 days that his sleep had much improved.