THE ART OF ANAMNESIS

“Much as I own I owe

The passers of the past

Because their to and fro

Has cut this road to last,

I owe them more today

Because they’ve gone away.”

- Robert Frost in ‘Closed for Good’

  The Book of Robert Frost, Holt Rine Haut and Winston, New York, 1969.

Homœopathy enjoins  everyone who would like to make a homœopathic prescription that thecomplete ‘case’ - as it is generally called - is recorded in all its minutiae, the symptoms that correctly depict the disease are then marked and drawn out and arranged in an order and then  these symptoms are taken to be for repertorisation and then comparison with the symptoms  in the Materia Medica.

All these are to be learnt, repeatedly applied in daily practice and drilled so that this becomes an easy work, a routine as such.  THIS IS VERY IMPORTANT. Twenty three Aphorisms in HAHNEMANN’s Organon of the Medical Art (VI Edition) §§ 82 - 104, direct the homœopath in theArt of Anamnesis.  The importance of the correct recording of the case - faithful to the patient’s expressions - cannot be stressed better than what HAHNEMANN in says § 104: “Once the totality of the symptoms that principally determine and distinguish the disease case - in other words, the image of any kind of disease - has been exactly recorded, the most difficult work is done.”

  We know that every practitioner of Homœopathy writes a record of every  case, but in his/her own fashion. We have seen  large varieties of these - right from a strip of paper, a post-card size, crown size paper to a foolscap size. 

Some contain a number (given to a patient) and a number (given to the remedy) with of course, the date - completely in numbers. 

Some write a two- or three- letter abbreviation of the diagnosis - OA, RA, UTI, PUO and other such codes and similarly the remedies whose abbreviations which the writer only can decode! 

Some write a few lines out of a whole lot of symptoms narrated by the patient - usually these symptoms so selectively jotted down are of no use whatever for a classical homœopathic remedy selection. 

Some have allotted one page only to a patient’s many visits.

On the other extreme are some who write lengthy and continuous lines which go on and would strain one on reading it. 

Yet some, scribble.

There must be transparency in all our actions and it should be most so in the Case Record. It should not be shrouded in mystery solvable only by the person who wrote it.  Apart from the fact that none of these ‘Records’ follow the instructions laid down by HAHNEMANN about faithful recording of the case (§§ 84 - 85 and footnote to § 104) such perfunctorily kept ‘Case Records’ may attract action by the courts if a homœopath is unfortunate enough to face the Consumer Protection Court.

To the best of our knowledge no physician of repute maintained Case Record of almost everypatient who came to him/her, as HAHNEMANN did; from 1800 to 1843 - 44 years - so that even today, over 150 years after his last case, we can see what HAHNEMANN did.  Is this not sufficient inspiration for every homœopath to ensure maintenance of proper Case Record?  Is it not  a serious-enough part of the work?  It may also be of interest to know that Dr. von BŒNNINGHAUSEN, whom HAHNEMANN himself certified, has also left for our scrutiny many volumes (more than 120) of his Case Records!

Keeping in  mind all the essential details that a Case Record must contain, a  ‘model form’ has been prepared and appended hereto.  This ‘model’ has been prepared after carefully going through the different models  suggested by earlier ‘masters’ and  followed by serious study circles in different parts of the world and one’s own experience of many years. It is also modeled in a manner that whatever method  - BŒNNINGHAUSEN or KENT - one would prefer to adopt in a given case, it would be useful.

Now some words by way of reiteration:

The Case Record Form is modeled so that all the features, to the extent they are relevant to the patient, can be filled in.  While the Case Form is orderly, the case itself may not be related by the patient in that order.  Hence “keeping silent himself” the physician records in the exact words of the patient. If the physician does not interrupt he can note the manner in which the patient’s thoughts occur - confused thoughts? jumbled? irrelevant? wandering? etc. 

All that the homœopath must do as soon as he receives the patient is to tell him/her to take his/her own time and tell everything about him/herself and his/her complaints.  Whatever the patient says must be recorded, noting the emphasis, the tone and tenor, the gestures, the expressions, etc.  While recording, as the patient speaks, we should not withdraw attention from the patient.  We must hear, listen and the patient must feel that this doctor is indeed listening to me.  This double action at the same time - listening and recording what he says - is difficult and must be practiced diligently so that it becomes easy.  Hearing and listening, seeing and perceiving, touching, feeling, observing, all at the same time must be cultivated if one desires to prescribe homœopathically.

We should learn to take a case slowly and systematically, if we were to learn the Art of Anamnesis.  Initially this would appear laborious, as indeed many other things are, but if we persist it becomes easy, quick.  Perception comes with use; practice makes it perfect.  Each one of us can and must become perfect.  Once we learn and practice, the whole thing becomes a reflex action.

  Since the Case Record is the only Record of what we did when we did it must be written clearly and not scribbled.  The verbalised expressions as also the non-verbalised but conveyed through gestures and otherwise, must all become part of the case.  This is very important since it is thequality of the symptom, for example, the intensity, the stress, or the indifference, etc. that is very important. All these are necessary since one cannot say as to where from the distinguishing symptoms for the remedy selection would express itself out - like the detective who examineseverything in the scene of the offense and then sifts them, because there has to be a clue, there is no clueless case.  Unless these clues are obtained and they are all linked, a case cannot be constructed.  Mind reveals itself even in small things.  Hence total attention must be paid. An analytical thinking has to be acquired by the homœopath to perceive the ‘clues’.

Whatever physical examination is made must be recorded.  The instruction that we give regarding diet and life styles, and other instructions/advice/caution etc., must also be written; so also about the withdrawal of any of the allopathic/other medicines, for example if it is a cardiac complaint have you taken into consideration the treatment already being taken and did you explain to the patient that there is no such specialty in Homœopathy and that you treat the whole, etc.?

We should not be in conflict with the fundamentals, the basic principles.  Never should we forget the concept of the Vital Force, the Dynamis, the spirit-like, etc. as HAHNEMANN expresses it.  We should be completely in tune with what are taught in the Organon and Chronic Diseases.  No other Medical System uses such terms as ‘Vital force’, ‘instinctive’, ‘autocratic’, ‘conservatory nature’; that the ‘vital force’ is ‘dynamic’, ‘immaterial’, ‘in-dwelling’, ‘rational’, ‘spirit’, ‘soul’, ‘miasm’, ‘invisible’, ‘spiritual’.  All these have to be accepted in toto and the ‘clinical’ line of thinking must be kept aside.  Therefore the more the characteristic symptoms are removed from the materialistic plane, the  more they are representative of ‘the patient’, and hence valuable, as one’s experience would bear out.

The whole exercise - the drawal of the anamnesis, the hierarchising, the selection of the symptoms for repertorising, the choice of the medicine and the potency - are all, of course, laborious (Foot Note to § 148).  HAHNEMANN has said that if one was not willing to work laboriously then better one left Homœopathy and take to some other profession  Need  it be told that if one wanted to be perfectand excel, indeed in any profession or work, one has to learn by laborious practice?  Laboriousness, lack of time, too crowded clinic, the charms of diagnostic labels, Organopathy, Isopathy, short-cut mixtures, the tantalising offers of the pharmacies to push their products - all and/or more of these, cannot be excuses for bypassing the ground rules.  Breaking the ground rule is called ‘foul’ play.

The ‘ground rule’ further says that “every real cure proceeds outwardly, and a symptom is the external reflex of an internal distress, the stamp of which it bears”.  Also we must bear in mind that “cure must be in its totality; treating in parts will ruin the individual.”  All the manifestations of a particular chronic disease is attached to the most crucial ‘central’ symptom.  BOGER further says thatthe earliest evidences of the chronic disease is the subjective and therefore there must be a personal  bias.  “Individuality hides itself more and more as sickness advances and becomes more objective.  The more firmly disease is established, the objective  are its manifestations.  The relative time for the appearance of each symptom naturally varies with the pace of the disease.”  From this we reason that “the earliest mental manifestation are decidedly important”.  “If we have the acumen to detect these very early we will also soon discover that the later mental phenomena are simply variations, and that either  will lead you to the same remedy which will, however, be found with increasing difficulty as the case progresses!” (BOGER)

  In particular in all the ‘modern’ diseases - Hypertension, Heart pathologies, Diabetes, Arthritis, Asthma - one has  necessarily to go back into the biopathography of the patient, the individuality, which in  these cases cannot be found under physical modalities or food allergies but only in the precursing psychic trauma and that has to  be unravelled.  “Mind is nothing but an accumulation of the past”.  We must be able to observe the slightest deviation from the normal, for it is the irregularities of disease that furnish us with the surest clue to the indicated remedy, hence the cure.

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Now follows:

1.  ‘Outline of a Standard Consultation’ - 28 steps - which will help systematic study and evaluation. 

2.  This is followed by a ‘Model Form’ which, if followed, will ensure that the study of the patient is complete.

3.  A ‘quick reference guide’ mentioning the rubrics most often consulted, their page numbers in the KENT Repertory and Synthetic Repertory. It must be remembered that these are not exhaustive or comprehensive.  They are all only ‘aids’.

4.  Some ‘examples of ’Peculiar Symptoms’ are given at the end. We must remember that a symptom becomes ‘peculiar’ only in the context of the patient’s disease.

I feel that I have covered the entire subject - the most difficult part - of Homœopathic  Therapeutics - in as brief but clear a manner as possible.

Please convey your comments after studying and applying these.

May the spirit of Samuel HAHNEMANN be with you.

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For Communication:

Dr. K.S.SRINVASAN

1253, 66th Street,

Korattur, CHENNAI - 600 080.

(INDIA)

 OUTLINE OF A STANDARD CONSULTATION

Introduction

The intention of this ‘outline’ is to codify, in a standard way, the case history and case taking as well as to decide upon the treatment. This will facilitate the communication of clinical cases among homœopaths. Above all the goal is to have a standard way of taking a complete case, thus freeing the attention of the examiners for a fuller observation of the patient and a deeper comprehension of the meaning of the symptoms presented.

The sequence of the steps is far less important than the patient’s spontaneity

Spontaneity and order are of equal importance; spontaneity in the homœopath-patient dialogue and order from the homœopath’s point of view, allowing for a rapid and total vision of the biopathography of the patient and also future reference and communication.  ‘Listening’ to the patient must be with all the senses. (§84)

 Whatever the sequence of the steps, it is important that each be filled so  that a case history is complete.

 The approach will be different, of course, considering whether:

  a. the case is acute in a chronic patient necessitating immediate palliation;

  b. the case is acute and is the aggravation of a chronic diathesis;

  c. the case is a classical chronic case.

Note:  Since spontaneity must be preserved, blank spaces should be left in the case record for the family history and personal past history, the physician’s observations, the remedies that come to the physician’s  mind during the consultation, and for a synoptic table of the patient’s biopathography.

1.  Patient’s identity: Name, address, telephone, date of birth, sex, professional activities (occupation), physical activities, family and marital status.

2.  Detailed family history including grandparents, great-grandparents, offsprings, extended family. Experience shows that a family history, aside from questions about grandparents, parents and children, must comprise questions about many diseases that may need to be suggested to the patient, asking if anyone (close and not so close) has had these diseases. For example, has anyone in the family had: diabetes, heart disease, cancer, tuberculosis, asthma, eczema, stomach problems, intestinal problems, problems with liver, gall bladder, rectum, kidney, thyroid, rheumatism, nerve problems, etc.

3.  Personal past history from conception to the present, going over the labor, birth, childhood diseases, vaccinations and their consequences, operations,  their modalities and effect, important or recurring diseases of childhood, adolescence and adult ages and their consequences, past and present treatment; also, the salient life experiences, places where the patient lived, studied, and professional activities at each different period of his life. 

 The interest of the family and personal history is threefold:

  i.  Classical allopathic value noting the important family and personal pathology

  ii.   Particular interest in pædiatrics, where at times the modalities of the family

    can be used for a similar disease in the child;

  iii.  The miasmatic understanding of a patient within the family context.

Note: Since this long personal and family history can hinder spontaneity, the page reserved for past history should have blank spaces where information can be added during various consultations.  The suggested way is to keep the first page of the case record for the following information: identity of the patient, family history and a synoptic, chronological table of the patient’s personal past history and a short summary of each consultation.

4.  Main present complaints, important present pathology and probable initial diagnosis.

5.  Introductory explanation by the physician: 

At this point in the consultation, it can be helpful if the physician can explain to the patient the difference in homœopathic approach.  He will need to explain that the patient’s present symptoms, either acute or chronic, are a part of his personal and family make-up and that the exact reactional modalities are of utmost interest for an accurate homœopathic prescription.

6.  Spontaneous personal history.

At this point, the patient is asked to explain what characterizes him, so that the physician may know the patient (Organon §84)

This spontaneous anamnesis must be as detailed as possible until the spontaneity is exhausted.  HAHNEMANN and KENT insist that one use a line for each symptom in order to have space to complete each symptom with modalities, etc.

- a typical day as he spends it;

- his work and his interest in it, his relationship with his superiors, subordinates and 

  colleagues: 

- his family situation, who he lives with and what the relationships are; 

- his hobbies;

- his environment : physical, climatic, emotional and religious;

- his past and present aspirations and desires, what he has done about them, his successes, 

  failures and obstacles faced and how he reacted to these, his feelings

[All unique, unusual symptoms in the history of the patient even if they have faded away since long, belong to pathobiography of the patient and are as valuable as those of the recent period.  They belong to the patient’s biopathography; they indicate to us the individual nature of reaction of the patient in the view-point of his  organism over a period of time.]

Note:  At this point, some patients may become aware and be able to express why they are sick and what keeps them from getting well.

9.  Information obtained from close family members and friends.

10.  Systematic questioning (Organon §88): 

Following KENT’s Repertory, starting with Vertigo through Generalities, finishing with Mind and Genitalia.

Note: HAHNEMANN  and  KENT remind us that these questions must be as nondirective as possible, never giving the patient opportunity to answer Yes or No, nor to choose between two alternatives (Organon § 87)

11.  The physician’s own observations (e.g. Expressions of the patient, gestures, fidgetiness, loquacity, behavioral peculiarities, palpable pathologies, etc.)

12.  Physical examination with regard to the problems  detailed (by patient) and observed (by  physician)

13.  Laboratory tests, X-rays etc.

14.  Probable diagnosis with eventual criteria of urgency.

Note: At this point, the physician must be sure of having gathered the totality of symptoms.  If this is not so, the prescription should be only placebo and the patient should be given proper advice in life style, hygiene, habits etc.  The missing links in the totality may be filled in at a future consultation.  (The physician does not give any moral advice nor does he make any judgment of the patient.  He advises the patient rather on the basis of spontaneous information given, supplementing what is required, for example nutrition, forbidding what in the physician’s judgment is an obstacle to cure, for example, smoking, etc.)

15.  Estimate the curability/ incurability of the case.

16.  Outline the past and present evolution of the illness.

Comment: Sometimes it is important to prescribe placebo in the initial consultation so that the physician learns to make the distinction between the four therapeutic results that can take place after a consultation.

a) Better understanding and awareness of the patient of his biopathology;

b) The physician’s sympathy received by the patient or actually given by the physician    

  himself;

c) Possible corrections in the patient’s life hygiene or environment;

d) The remedy.

17.  The physician’s reflection of what must be cured in the patient (Organon § 3)

1. What actually are the complaints and sufferings?

2. Why does the patient complain?

3. How has the patient’s ailments come about (aetiology)?

4. Have I (physician) understood everything about the patient’s sufferings?

5. Reflect: Is the disease functional - curable?

  Is the disease pathological - reversible? irreversible?

  Prognosis: good/grave

  Miasm

There are several types of analysis.  Roger MORRISON explains the following types that  are adapted according to the individual case before:

1. Essence

2. Totality

3. Keynote 

Here is a kind of ‘check list’ that will aid in selection of symptoms for repertorisation (they are worth repetition):

1. Pick up voluntarily-told, clear, complete symptoms.(whether general, mental, particular)    Remember that a symptoms is complete only if it delineates the location, sensation and    

  modality.  Too many vague symptoms means much confusion.

2. Identify the Peculiar, Queer, Rare, Strange symptoms.

3. Identify the ‘general’ running through the case

4. Identify the aetiology

5. Identify the complaint which the patient is stressing and seeking immediate relief.

6. Identify the pace of the disease (slowly developing/rapidly developing)

7. Identify the most recent symptoms - are they deep and have they culminated in the  

  present disease.

8. Identify how the patient has, in general, qualified his sufferings.  Exaggeration, under

  -statement?  What kind of adjectives/adverbs have been used to describe his sufferings?

1. Acute or chronic characteristics of the patient’s pathology; (Organon§§ 148, 149; 

  KENT’s Lecture 31)

2. Total or partial symptoms that the physician has decided to act upon;

3. Curative or palliative intent of the therapy decided;

4. Peripheral or central action of the therapy decided upon; this depends on the lesional or 

  functional nature of the symptoms.

5. Does the remedy concur with the clinical diagnosis?

6. Is the potency chosen well adapted to the curative or palliative intent?  What are the

  possible dangers of this remedy (e.g. does the physician foresee an aggravation?)

- Is this useful?

- Is this necessary?

- Is this kind within the context of this patient?

26.  Administration or prescription of the remedy or a placebo (make an outline of the next consultation: What one really wants to look for).

27.  Decision on the time interval until the next consultation.

28.  Hygiene instructions (mental, life, dietary).  Removal of possible obstacles to cure.

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[This ‘Outline of a Standard Consultation’ and the following ‘Model Form’ have been prepared after a thorough study of the literature from Masters (past & present). = K.S.SRINIVASAN]

 CASE  RECORD  FORM

Case Record No.   Date :

Name and Address of the patient :

Telephone No.

Age:   Sex :  Marital status :

Children :  M  F

Height :

Weight:  Stature:

 (Lean, thin, obese, short, etc.) 

Occupation :

Provisional diagnosis :

  Marital relationship - Emotional and Sexual :

  (Wait for voluntary complaint by patient, approach with discretion)

  Use of contraception:

  Habits  :  Smoking (How much);  Alcohol  (How much);

  Coffee/Tea,(How many cups?); Chewing paan;

  Tobacco; Snuff; Cosmetics, etc.

Present Occupation :  Involving Physical/Mental Exertion; Sedentary; Handling of Chemicals, etc.     Working in sun, night-keeping; in water etc.

FAMILY HISTORY :

Brothers  Sisters

Paternal  (Grandparents, great-grand parents extended family)  Maternal

  T.B.,  Nerve Problem, Asthma,  Stomach / Abdominal,  Liver,  Intestinal problems, Cancer, Malaria, Diabetes, Epilepsy, Allergy, Skin (Eczema, Ringworm), Heart, etc. Gout / Arthritis, Rheumatism of Joints, Thyroid, Venereal, Gall stones, Kidney stones, Mental (including Alcoholism, Suicidal disposition, etc.) Longevity, Surgeries, Others.

PAST PERSONAL HISTORY : (in chronological order)

	Exact Period when ill	Medical Treatment	Surgical Treatment
CHILDHOOD   Birth (Normal, Surgery, etc.) Development, crossing of milestones -learning to talk, walk, dentition, etc.
ADULTHOOD  Injuries, accidents, recurring illnesses, Small-pox, Chicken-pox, Measles, Whooping Cough, Diphtheria, Herpes, Tonsillitis, Inflammation of throat,  Gland enlargements, Tuberculosis, Typhoid, Jaundice, Others. Surgical problems like, Appendix, Hysterectomy, Piles and if so with what effect.
Vaccinations/Immunisations (how many times and how did it 'take'?)
Skin ailments, suffered and treated, any suppressions, if so, how suppressed or how treated?  Others

Salient life experiences, places where lived, professional activities and their effects at different periods of life.

Spontaneous narration, interrogation, observation; co-ordinate all these and work out a hierarchy in order of generalities, particulars, mentals. Pick out the peculiar, queer, rare, strange symptoms.

Complaint - Symptoms (Sensations, signs) with exact location, extension and radiation

History :  Time and season of commencement (at what stage of life) of presenting ailment - nature,  onset:  whether sudden, gradual, etc.

Duration of the presenting ailment

Precipitating factors (cause : e.g. Injuries, (SR II 535, 302, 706) shock, (SR II 532), wetting (SR II 703), including the cause of present ailment).

Pathological Diagnosis if already made or made now.

Modalities of the presenting complaint :Agg. Amel. 

Heat  Cold, Dry / Wet, Chill, Snow

Wet / Damp / Rain 

Movement

on / after waking

Times of day -  Morning, forenoon, afternoon, evening, night, before mid-night, after mid-night

Touch  Pressure (Hard ? Light?)

Seasons :   autumn / spring / summer / winter / storm / thunder / cloudy /

change of weather / change of temperature / dry / wet weather /

working in temp. controlled atmosphere.

Air,  Open  Closed

Sun  Sea

Food & Drinks

Covering / Uncovering, whole or part of body

Cold / warm, application /Washing whole / affected part 

Sleep

Associated General Symptoms

Associated Mental symptoms

Physician’s own observations to be added at appropriate places.

Physical examination details to be noted

Pulse

Blood Pressure

Urine   Sp. gr. increased / decreased

Deposits / Organisms

Stool

Sputum

Blood :  T.C.  D.C.  E.S.R.  Hb.

Sugar  Others

X-ray

Others

Estimate curability of the case

Modalities :

Heat and cold (SR II / 85);  Heat (SR II / 296);  Heat, sensation of (SR II 305) Warm (SR II / 684);  Cold (SR II / 77); Heat, vital, lack of (SR II / 307) Change of temperature (SR II / 62);  Change of weather (SR II / 751);  Sun (SR II / 616); Sea (SR II / 30); Weather (SR II / 751); Seasons (SR II 569) Periodicity (SR II / 488); Position : Lying (SR II / 352) Pressure (SR II / 517);  Touch (SR II / 639); Jar/Stepping (SR II / 334); Standing (SR II / 602);  Sitting (SR II 592);  

Motion (SRII / 370); Rest (SR II / 561); Walking (SR II / 678); Urination, amel. after (SR II / 672) Constipation, amel. (SR II / 92); Diarrhoea amel. (SR II / 156); Stool (SR II / 604); Warm bed (SR II 687); Ascending / descending (SR II / 37; II / 155); Moon (SR II / 369); Air, draft (SR II / 25); Air, open (SR II / 27) Air, open, aversion to, desire for (SR II / 29), Bath,desire for/dread of/cold/hot(SR II/40)Close room/warm room (SR II / 566) (SR II / 688) Appetite,wanting/ravenous/increased (KR 477 - 479).

FOOD AND DRINKS: DESIRES/AVERSIONS

Desires / Aversions (SR II / 217) Agg. / amel.

Sweets (SR II / 274); Salt (SR II / 266); Sour (SR II / 270); Spicy (SR II / 271)

Salted things (SR II / 266)

Strange things  (SR II / 273); Lime (SR II / 252); Chalk  (SR II  / 227)

Indigestibles  (SR II / 250)

Fat (SR II / 240); Fried (SR II / 244); Fruits (SR II / 245); Milk (SR II / 256) Meat, Fish, Eggs etc. (SR II / 254, 242, 239) Vegetables, Onions (SR II / 277; 259); Potatoes etc. (SR II / 263); Alcohol, Coffee, Butter-milk etc. (SR II / 226, 216, 229); Cold (SR II / 232); Hot (SR II / 247); Juicy  (SR II / 251); Eating, Worse / Better, After (SR II / 166); Drinking Worse /Better, After (SR II / 158);

Thirst, Extreme / Unquenchable /  Small sips / Frequent / Long intervals (KR 527-530)  for cold/hot; Thirstless (KR 530); Fasting / Hunger, agg. / amel. (SR II / 211, 311)

Intolerance of ; (SR 75)

Loose ; (SR II / 75); Tight (SR II  / 75); Agg. / amel. (SR II / 75)

Uncovering

Scanty / profuse / absent ; (KR 1300);  Inability to perspire (KR 1308)

Agg. / amel. (SR II / 491); Type of sweat (SR II / 493 - 507); Partial (SR II / 507 - 511); 

Uncovered / Covered parts (SR II / 508, 510); Parts lain on, etc. (SR II / 509); Odour (SR II / 500); Suppressing perspiration, from (SR II / 513)

Onset : (SR III / 500)

Menses :Absent (SR III / 522);  Early (KR  / 649) Late (SR III / 547);

Intermittent (SR III / 545) Irregular (SR III / 546); Protracted (SR III / 560)   Copious (SR III / 530); 

Scanty (SR III / 564) Suppressed (SR III / 569);

Clotted (SR III / 529); Black (SR III / 526) Bright red (SR III / 527);    Dark (SR III / 538) Pitch - like (SR III / 560); Bloody mucous (SR III / 527);

Offensive (SR III / 553); Pale (SR III / 559); Painful (SR III / 555);

Moon (SR III / 552); Tenacious (SR III / 563); Short, too (SR III / 567);   Wash off, difficult to (SR III / 577); Thick (SR III / 575);  Thin (SR III / 575)

Leucorrhoea (SR III / 494); Before menses (SR III / 494);

After (SR III 494): During menses (SR III / 494)

Abortion (SR III / 449); Causes (SR III / 451 - 454); 

Abortion, tendency to (SR III / 454); Parturition (SR III / 598); 

Premature (SR III / 598)

Of the body, in general (SR II / 587); Sides, left / right (SR II / 587 - 590)

Alternating (SRII / 587); Crosswise (SRII / 587); Left upper, Right lower (SR II / 588)

Faintness (SR II / 177);  With modalities (SR II / 177 - 210); Vertigo (KR / 96)

Formication (SR II / 283) Full feeling, externally / internally (SR II / 285);

Heaviness, externally/ internally (SR II / 309, 310); Heat, flushes of (SR II / 296)

Numbness, ext./int., (SR II / 388); Single parts; parts lain on, etc. (SR II / 391)

Orgasm (SR II / 396);  of blood  modalities (SR II / 396, 402)

Swollen (SR II / 626); Weakness; Enervation (SR II / 693)

MENTALS:

Worries : Future, anxiety about (SR I / 78)

Health (SR I / 80); Others of (SR I / 86); Cares, full of worries (SR I / 121)

Business (SR I / 66);  Trifles (SR I / 97, 529, 551); Conscientious (SR I / 180)

Irritable (SR I / 653); Reactions : Impatient (SR I / 600); Hurry (SR I / 579)

Restlessness( SR I / 835);  Touch (SRI / 907)

Noise, to (SR I / 901);  Music (SR I / 901);  Contradiction (SR I / 184)

Resentment (SRI / 720); Anger (SRI / 26); Throw (SR I / 225)

Reproach (SR I / 832); Curse (SR I / 191) Strike (SR I / 963); Kill (SR I / 682)

Easily offended (SR I / 791);  Scream (SR I / 911 - 921); Bite (SR I / 110);

Company (SR I / 144);  Desire for / aversion to

Consolation (SR I / 181); Sympathy (SR I / 985); Moods: Variable Changeable

(SR I / 760); Depressed, Morose, Broods (SR I / 864; 764; 115)

Despair (SR I / 391); Indifference (SR I / 609); Apathy  

Shy (SR I / 1026 Bashful); Timid (SR I / 1023); Timidity - Bashful, Shy, Clinging

Mild (SR I / 743);  Consolation (SR I / 181) Confidence, Lack of (SR I / 159)

Discouraged (SR I / 406);  Sympathetic,  (PH 267); Sympathy Agg. (PH  / 181; 985);   Jealous (SR I / 674); Suspicion (SR I / 983); Obstinate (SR I / 787);

Suicidal (SR I / 974); Lamenting, Complaining (SR I / 688; 152)

Dissatisfied, Discontented, Displeased (SR I / 402); Loquacious (SR I / 713)

Time passes too quickly / Slowly / Fritters away to (SR I / 1022, 1023)

Death, Agony before (SR I 194), Contempt of (SR I / 194);

Conviction ( SR I / 195); Desires (SR I / 195); Presentiment (SR I, 197)

Sensation of (SR I / 198); Thoughts of (SR I / 199)

Fears, apprehensions (SR I / 473); Examinations (SR I / 498); Strangers (SR I / 525)

Undertaking (SR I / 529); Failure (SR I / 499); Dark (SR I / 482)

Thunder (SR I / 528); Height (SR I / 505); Alone (SR I / 194, 477);

Death (SR I / 487); Animals (SR I / 479); Evil spirits (SR I / 502);

Disease (SR I / 493)

Names (SR I / 738); Forgetful own name (SR I / 738);Things done (SR I / 735)

Heard (SR I / 737); Seen (SR I / 740); Read (SR I / 739); Things to do (SR I / 735);

Forgetfulness of old people (SR I / 544)

Grief (SR I / 566); Shock (SR I / 23); Anger, suppressed (SR I / 15)

Foreboding (SR I / 15); Anticipation, Bad news (SR I / 15)

Cares, worries (SR I / 16); Death of child, parents, friends (SR / 16)

Disappointment (SR I / 17); Disappointed love (SR I / 20); Fright (SR I / 18)

Emotional excitement (SR I / 17); Fear (SR I / 18); Homesickness (SR I / 19);

Jealousy (SR I / 20) Excessive joy (SR I / 20);   Mental work (SR I / 23);

Mortification (SR I / 21); Pecuniary loss, loss of place (SR I / 21)

  Awkward (SR I / 101)

  Aversion to be looked at (SR I / 712);  to be touched (SR I / 1028)

  Bashful, shy, timid (SR I / 1026, 562, 1023)

  Approach, fear of,  Aversion to  (SR I / 101, 103)

  Cold / Warm / (KR 1304 / 1326); Dry, inability to perspire (KR 1307)

  Chappiness, Cracks (KR 1304 -1305);  Rough (KR 1330)

  Mole, Naevi (KR 1330); Warts (KR 1339)

  Uncleanliness, dirtiness, untidy, aversion to bathing,

  Indifference to ext. things; (SR I / 1062, SR I / 616)

  Nails distorted (KR - 984); Brittle (KR - 954); Corrugated (KR - 970)

  Fastidious (SR I / 472); Dropsical (SR II / 159); Dwarfish (SR II / 166)

  Emaciation neck, lips, see relevant sections (KR)

  Emaciated (SR II / 171); Emaciated children (SR II / 173)

  Emaciated old  people (SR II / 174); of single parts  (SR II / 174)

  Forehead - wrinkled (KR - 396); Anaemic (SR II / 32); Answers (SR I / 47)

  Pale ( SR I / 34);  Rickety (SR II / 563); Obese (SR II / 393)

  Thin / lean (SR II / 345);  Gait (SR II / 286);

  Restless, fidgety, agitated, nervous (SR I / 835, 582  impatient waiting)

  Sour / foul smell / offensive smell (KR 1298);  Stoop - shoulder (SR II / 606)

  Swellings, Tumours etc.; Hard / tender / colour / location (SR II 620 - 626)

  Symmetry (parts equally developed or different)

  Deep (SR III / 9);  Disturbed (SR III / 15) Interrupted (SR III / 48);

  Restless (SR III / 68); Sleepiness / Sleeplessness (SR III 82 - 128, 129 - 185)

  Agg. during / amel. during (KR / 1402),  (SR II / 597); Waking agg. (SR III / 183)

  Position of sleep (SR III / 54) agg. / amel. Dreams ( SR III / 242)

  Heart : palpitation : (KR 873);  On exertion : (KR 875)

  Ascending / descending (KR 874);  Anxiety causes  (KR 874)

  Lying amel. / walking about amel. (KR 839);

  Pains in region of heart : type of pain  and extension of pain  (KR 849 - 850)

  Pains, in : (KR 894) Cervical  (KR 899); Dorsal  (KR 901)

  Lumbar (KR 905); Sacral  (KR 909); Lumbosacral (KR 909)

  Sacroiliac (KR 912); Coccyx  (KR 912);  Between scapulae (KR 903)

  Better by pressure (KR 858); Spine (KR 912)

  Constipation amel. (SR II / 92); Diarrhoea amel. (SR II / 156)

  Constipation / diarrhoea (KR 606 / KR 609)

  Stool : agg. amel. before, during, after (SR II / 604 - 606)

STOMACH / ABDOMEN:

  Flatulence (KR 547); Indigestion (KR 503); Fullness  (KR 498)

  Heaviness (KR 501); Rumbling (KR 600); Distended (KR 487 / 544)

  Pyrosis (KR / 447); Eructations (KR 489); Taste (KR 421); Smell (KR 409)

  Fullness, eating least quantity (KR 499)

  Pains : Location, laterality, nature of pain  (KR 511 / 554)

  extension of pain, modalities

  Nausea and vomiting :

GENITO - URINARY:

  Urination; (KR 655); Urination, amel. after (SR II / 672); Frequency (KR 658)

  Involuntary (KR 659); Retarded

  Urination (KR 379); Quantity (KR 380); Copious (KR 608) ; Scanty (KR 606)

  Specific gravity (KR 614)

  Discharge(KR 669)

  Urine : Colour(KR 683)

  Frothy (KR 608); Milky etc. (KR 610); Sediments / Deposits (KR 613);

  Bloody (KR 604); Burning (KR 604); Cloudy (KR 606); Odour (KR 610)

  Sugar (KR 607); Albumin (KR 604); Pus (KR 611)

COITION :

  Desire (SR III 433 - 447); Aversion  (SR III 460; 461 - 464);

  Genitalia, cold (KR 693)  (KR 617); Unable to, despite desire ( SR 400 III)

  Ejaculation, premature / wanting (SR 379)  (SR III 378) ;

  Orgasm, premature / wanting (SR III / 380)

RESPIRATION:

  Difficult : (KR 734)

  Inspiration difficult (KR 740) ; Expiration difficult (KR 739)

  Times of day / night (KR 778); Position (KR)

  Drinking water amel. (KR 786); Restlessness, during :

  Seasons (KR)

COUGH :

  Paroxysmal (KR 799); Day / night (KR 778); Morning (KR 778)

  On waking (KR 810); Rinsing mouth (KR 802); Dry (KR 782)

  Loose (KR 795); Expectoration difficult (KR 815);

  Not amel. by expectoration (KR 790); Scanty (KR 818); Copious (KR 814)

  Taste (KR 818); Odour (KR 817); Tenacious, Ropy  (KR 820); Colour (818 KR)

FEVERS:

  Time:  Day  (KR 1278)  Night (KR 1279)

  Anticipating (KR 1281); Alternating, with : (KR 1280)

  Autumnal (KR 1281); Summer (KR 1292); Winter (KR 1292)

  Heat of sun (KR 1292); Perspiration (KR 1289); Dry (KR 1285);

  Chill (KR 1283); Thirst small sips / larger (KR 402)  (KR 1085)

  Thirstless (KR 1099); Thirst unquenchable (KR 1099)

  Restlessness (KR 1084, 1098); Heat internal (KR 1288) Partial

  Heat external (KR 1286) ; Pulse (KR 1393); Temperature Pulse-temp. ratios :

  Covering / uncovering desires to:  Agg. / amel.

  Desires to uncover during chill / cover during heat (KR 1275)

  Warmth agg. (KR 1292);  Washing agg./amel. (KR 1292)

HAIR:

  Dry, brittle, rough etc.; much, little; red, blonde; brown - black;  thick, thin

  Baldness;  Premature (KR 165),  in patches etc. (KR 165)

  Splits on ends (KR 165); Tangles (KR 166); Falling profusely (KR 165)

HEAD:

  Large, sweaty : (KR 129; 221)

EYES:

  Pupils Dilated / contracted (KR 263); Dull (KR 238)

  Discharges (KR 287); Red (meatus) (KR 287)

  Pointed (KR 349); pinched (KR 349); Motion of nostrils (KR 329; 340)

  Discoloration (KR 334); Sooty (KR 351); Shiny (KR 349)

  Perspiration (KR 348); Sunken (KR 351)

  Lips dry KR 364);  Cracked (KR 357); Greasy, Oily (KR 375) 

  Old - looking (KR 374); Pale / red (KR 359 / 361)  wrinkled (KR 396)

  Facial expression (KR 374);  Flushed (KR 375); Cachetic (KR 355)

  Yellow saddle across cheek (KR 364); Yellow brown (KR 359) 

  Inconspicuous hollow - eyed,

MOUTH :

  Dry (KR 403),  but thirstless (KR 403); Moist (KR 417)

  Bad breath (KR 409);  Corners, Cracked ( KR 357)

  Gums bleeding, detached from (KR 398, 399 418)

  Discoloration gums (KR 400), Tongue (KR 402, 403); Gums bleeding

  Smooth tongue glazed, shiny (KR 419); Tongue coasted (KR 400 - 403);

  Mapped (KR 407); Tongue, movement difficult (KR 407);

  Hanging out (KR 407); Lapping to and fro (KR 407);

  Protruded  (KR 415);  Constantly darting in and out (KR 415)

  Oscillating (KR 415); Cannot protrude (KR 415); Pointed tongue (KR 415); Trembling         (KR 427); Ulcerated (KR 429); Salivation (KR 418)

  Discoloration (KR 450);

  Tonsils, (KR 451; 454; 469); Uvula (KR 454, 469)

  Caries, decayed, hollowed (KR 431);  

  Premature (KR 431); Crumbling (KR 431)

  Discoloured (KR 431); Cupped (KR 431); Serrated (KR 447)

  Wedge shaped (KR 447)

  Distended (KR 487; 544);  Swollen (KR 602)

  Enlarged (KR 547);  Dropsical (KR 546)

  Pendulous (KR 599); Protrusion here and there (KR 599)

  Discoloration, (KR 829); Dropsy (KR 829)

  Emaciation above the clavicles (KR 829)

BACK:

  Head bent back (KR 946);

  Opisthotonos (KR 946)

  Emaciation (KR 985; 1233)

  Ataxia (KR 953);  Awkwardness (KR 953) (1223)

  Arthritic nodosities (KR 953); Finger nails brittle (KR 954)

  Curved (KR 978);  Distorted (KR 984);  Spotted (KR 1191)

  Thick nails (KR 1207);  Thin nails (KR 1207)

  Cold, one hot, other cold (KR 959 ; 964);

  Discoloration (KR 978);Dryness (KR 984); 

  Knobby finger ends (KR 1031);Phlebitis (KR 1033)

  Thrombosis (KR 1207); Motion (KR 1033); Restlessness (KR 1187)

  Twitching (KR 1215 - 1220); Oedema (KR 1196 - 1202)

  Cold (KR 1305);  Cracks (KR 1305); 

  Dirty (KR 1325); Unhealthy (KR 1339)

  Bright (KR 1189);  Clean - Unclean; 

  Discoloration (KR 1306); Dry (KR 1308)

  Hard, like callosities (KR 1326);  Parchment like (KR 1326)

  Peeling off (KR 1326); 

  With thickening (KR 1326);

  Indurations, nodules etc. (KR 1326); 

  Moisture (KR 1330);  in spots (KR 1330)

  Net-work of blood-vessels (KR 1330);  Petechiae (KR 1315);

  Purpura haemorrhagica (KR 1330);

  Shining (KR 1331); Swelling (KR 1332);

  Warts (KR 1340); Moles (KR 1330); Wens (KR 1340);

  Wrinkled (KR 1340).

  1.  A symptom is peculiar by itself 

  One foot cold, another hot:  Lyc.

  Oily, greasy face:  Nat-mur., Rhus-tox.

  Knobbed nasal tip:  Aurum.

  Mapped tongue: Tarax.

  2.  A symptom is peculiar in its modality 

  A watery stool after perspiration:  Bell.

  Yellow discharge, evening:  Puls., Sulph. 

  Vertigo on entering a dark room:  Agar., Arg., Nit-ac., Stram. 

  Diarrhoea during dentition:  Calc., Dulc., Sulph.

  Nausea amel. by cold drinks:  Bism., Phos., Puls.

  3.    A symptom is peculiar due to is localisation 

  Warts on soles:  Calc., Nat-mur., Sep., Sulph.

  Eruptions only on bend of joints:  Caust., Hep-sulph., Nat-mur., Sep.

  4.  A symptom is peculiar by a ‘sensation as if’ 

  As if the heart is hung by a thread:  Kali-c., Lach., Lil-t. 

  Sensation of an eye lash in the eye:  Puls.

  As if the tongue is very wide:  Nat-mur. 

  Sharp stones in stomach rubbing against each other:  Cocc.

  5.  A symptom peculiar by its extension, by its radiation 

  Headache upto base of tongue:  Ipec. 

  Headache from neck rising up to the head:  Gels., Sep. 

  Pain in heart region extending down the left arm:  Kalm.

  6.  A ‘pain’ or other symptom peculiar by its beginning and ending 

  Ailments begin and end suddenly:  Bell., Nit-ac. 

  Ailments begin and end slowly:  Stann. 

  Headache in waves:  Bell., Sep. 

  Pain begins slowly and lets up suddenly:  Arg-m., Caust., Puls., Sul-ac.

  7.  A symptom peculiar by combination of two contrary symptoms 

  Sleeplessness with sleepiness:  Op.

  Ice cold skin but will not cover:  Camph. 

  Freezing but warmth is unbearable:  Sec. 

  Sadness but cannot endure consolation:  Nat-mur., Sep. 

  Says well when very ill:  Apis., Arn.

  8.  A symptom is peculiar by its periodicity 

  Chill every 2nd day:  Ars., Ipec., Nux-v., Puls. 

  Chill postponing:  Bry., Ipec. 

  Chills anticipating:  Nux-v. 

  Neuralgia every day, same hour: Kali-bi.

  9.  A symptom common to the disease but is absent = negative general, is peculiar 

  Thirstlessness in fever:  Gels., Puls., Lyc., Rhus-tox., Sep., Sulph. 

  Eruption without itching:  Cic., Cupr-ac.

II.  ‘PECULIAR’ MENTAL SYMPTOMS

  1.  The symptom relates to the Will and Mental attitude 

  Suicidal disposition:  Aur., Nat-s. 

  Aversion to family members:  Sep., Calc., Fl-ac. 

  Aversion to presence of strangers:  Ambr., Cic., Sep. 

  Indifference to pleasure:  Puls.

  2.  The symptom relates to understanding 

  Alterations of reasoning and understanding:  Confusions 

  Violent delirium:  Bell., Hyos., Stram. 

  Anxiety as if he has committed a crime:  Alum., Aur., Chel., Psor.

  3.  Symptoms derived from intellect 

  Speech errors:  Nat-m., Lyc. 

  Memory weakness for names:  Lyc.

III.  ‘PECULIAR’ GENERALS

  1.  Ailments which are conditioned by climate, water, sun, moon and so on 

  Changes of health by external influences 

  Wet weather agg.:  Nat-s., Lach. 

  Cannot tolerate sun’s rays:  Calc., Nat-m., Puls., Sulph. 

  Full moon agg.:  Lyc. 

  Headache before thunderstorm:  Phos., Sep. 

  Seasickness:  Cocc., Petr.

  2.  Peculiarity of Injury reactions, haemorrhage, laterality, secretions 

  Small injuries bleed much: 

  Every injury suppurates: 

  All complaints on one side/alternate/diagonally appearing: 

  Secretions are sticky/fishy odour, etc.

  3.  Peculiarity in food(agg./aversions/desires) 

  Agg. Onions:  Lyc., Puls., Nux-v.

  Aversion to fish:  Nat-m., Phos., Sulph. 

  Desire for chocolate:  Lyc., Sep.

  4.  Sleep symptoms 

  Sleeplessness after 3 a.m.:  Rhus-tox., Nux-v., Sep., Sulph. 

  Overwhelming sleepiness after supper:  Calc.

  Sleep position: Knee-elbow:  Med., Lyc., Sep.

5.  Menstrual, pregnancy and sexual symptoms 

  Late menarche:  Puls., Caust., Nat-m. 

  Menses only at night:  Nat-m. 

  Leucorrhoea during pregnancy:  Kreos., Con.,  Sep.   

  Metrorrhagia during labor:  Erg., Ham., Ipec., Sabin., Sec. 

  Flushes with perspiration:  Con., Lach., Psor., Sep., Sulph.

IV.  ‘PECULIAR’ CAUSATION/ORIGIN

  Ailments from concussion:  Arn., Nat-s. 

  Ailments since death of husband:  Nat-m. 

  Ailments after Sea-bath, cold:  Ant-c. 

  Ailments after mortification:  Staph.

V.  ‘PECULIAR’ ACCOMPANYING SYMPTOMS

  Pains in the Right hip while coughing:  Caust. 

  Burning coryza, bland lachrymation:  All-c.

  Vertigo with yawning:  Agar., Petr. 

  Coryza with joints:  Acon., Gels., Puls. 

  Nausea with foul breath:  Ipec. 

  Sensitive to fresh air before stool:  Mez.

VI.  ‘PECULIAR’ ALTERNATION

  Diarrhoea and headache:  Podo.,  Sec. 

  Headache with stomach pains:  Ars. 

  Skin eruptions and asthma:  Mez., Rhus-tox., Sulph.

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