Vithoulkas Ch 14 Case Taking and First Prescription
It may seem as if there is a set of rules and algorithms that may correctly calculate the correct remedy for a case, but this is not something based on concrete rules.
The laws and principles upon which decisions are made are definite and verifiable.
The application of laws and principles is open to interpretation. The results are a fusion between art and science. The laws and principles are solid and the application of them to the individual is artistic.
This process requires a great deal of mental effort and insight into the patient.
There is always the temptation to find "keynotes" in an attempt to shortcut the system. The results are poor in the long run. It is important to commit yourself to intense study in order to gain true understanding and good results in practice.
Homeopathic treatment costs are higher. However more time is spent on each case and results are better than in allopathy. In the long run costs are less for homeopathy because the level of health is higher and medication is less costly.
Once a homeopath has mastered prescribing and is demonstrating reliable results he or she can make an excellent living and be assured of a busy practice.
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Initial Prognostic Evaluation
During the initial interview, a crucial decision must be made in regards to the seriousness of the case.
Some people may have same complaint but with a totally different impact on their life. It may not hinder them in any real way or it may have great mental and physical repercussions related to the complaint.
The patient looks to the homeopath not only for treatment, but for education. There are questions regarding expectations on how long it will take to treat their symptoms, what they can expect, etc.
Incomplete or unrealistic expectations may discourage the patient, and may cause them to abandon homeopathic treatment.
The homeopath should be able to assess the situation, and determine what level of impact the complaint has on the patient. They must give the patient practical advice and expectations, while not depriving them of hope. Patient should be taught to expect some difficulties and to be patient, as well as the importance of adhering to the treatment process.
How to make this determination?
1) A limited degree of freedom of expression in life : Determine how limited the patient is by their complaint. Able to do so by how they present themselves.
2) The center of gravity for symptoms : If the center of gravity is emotional or mental problems, a poor prognosis can be expected. Patients move towards cure very slowly over time. Other patients who do not have this center of gravity will improve much more quickly.
3) The degree of hypersensitivity to stimuli : People who are oversensitive to their environment, react strongly to interactions with others, are sick frequently- if this is the case it is signifying that their defense mechanisms are constantly being brought in to maintain equilibrium, signifying that their systems are unable to remain stable.
4) Past history and family history : People with a past history of deep and serious diseases, who have had a lot of suppressive therapy are more likely to encounter problems on the way to cure.
If any of the above factors are observed, the index of suspicion should be raised immediately. Typically if one of the factors appears, more than one is present.
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Case Analysis for the Beginner
After the initial prognostic evaluation, the next task is to find the simillimum.
The initial remedy given is the most crucial decision made in homeopathy.
The first remedy is the one which opens up the case, which brings out the true healing potential of the defense mechanism.
Occasionally the initial case is very obvious, but this is not the norm.
If the remedy is clearly indicated, the first remedy will often give dramatic results. It is then very important to wait for a long time before either repeating the remedy or giving another one.
A more common pattern is a mixture of of symptom pictures.
More thought and study is required to make a decision for a remedy that truly covers the totality of symptoms.
If the beginner is unsure on how to go forward, the best procedure is to "repertorize" the case.
Begin with the SRPs, continue to listing and grading the rubrics.
Never give a remedy just because it scores highest on the rubrics.
Repertory sheets, or any similar tools are not recommended for the beginner- it is best to write it out longhand as a learning tool.
Attention should be paid to "small" remedies which run through a few rubrics. "Small" remedies are those whose provings are as yet incomplete, and therefor the number of symptoms listed for them is small.
Often a particular remedy runs through all rubrics except 3 and 5, when they are listed in order of importance.
It is frequently found that the simillimum does not cover all the important symptoms in a case.
After years of practice the repertorization process may be streamlined a bit, using "elimination" techniques. This must be done with extreme care. Symptoms are listed in order of importance and severity, arranged with great care. The remedies listed with the first symptom are written down. Only remedies which appear in the rubric for the second symptom are written down, etc. until all but a few remedies are eliminated.
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Case Analysis for Advanced Prescribers
With more experience, less reliance is placed on formal repertorization. Often techniques are used which appear simple but are highly sophisticated and which are formed from years of experience.
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Selection of a Potency
Once a remedy is selected, the next choice is the potency. There are no set rules, experience and observation will play a large role in making this decision.
Potency selection is less important than the remedy chosen.
If the correct remedy is selected then it will act curatively in any potency, although a correct potency will act more gently.
Incorrect remedies can be either inactive or disruptive to a case, regardless of potency.
Low potencies (12X to 200) are generally indicated:
- patient has a weak constitution
- elderly people
- hypersensitive people
Risks include overstimulation of weakened defense mechanisms, resulting in aggravations.
Frequency can be higher with lower potencies, with instructions to stop if any dramatic aggravation or amelioration takes place.
Oversensitive people should begin with a 30 or 200 - such people are very reactive to low potencies on a physical level and high potencies on an electrodynamic level.
Cases with known malignancy should not go over 200. Suspected malignancy should not go over 1M.
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Single Remedy
One of the fundamental principles in homeopathy is to prescribe only one remedy at a time.
Multiple remedies or correlating treatments obscures results- both positive and negative.
