LILIUM AND THE EMERGENCE OF OUR 

GUIDING SYMPTOMS

George von KELLER

INTRODUCTION:

         Today I will play tapes recorded by me during my consulting hours.  They are not cases which immediately recall the remedy in the mind of everyone but I will show that sometimes only small, inconspicuous leads, yes, often only one hint or catchword is needed to recall the medicine to mind.

         At the same time I would like to further call your attention to a historical fact which may not be well-known to all, that is, the manner in which the Proving Symptoms have crystallized as guiding Symptoms in the course of time.

GUIDING SYMPTOMS ARE NOT THE SYMPTOMS APPEARING FREQUENTLY:

         The symptoms which appear frequently in the Provings cannot be taken as guiding symptoms.  It may superficially appear that important symptoms are those which appear more times in the Provers but the actuality is otherwise.

         Such symptoms observed frequently which appear regularly in every Prover are of course reliable, that is, they are attributable doubtlessly to the action of the medicine but all the same, they are ordinary and common, they do not represent anything individual.  We can certainly establish the action of the medicine in pharmacological sense from these symptoms observed in the many patients – the toxicological symptoms well-known in pharmacology are mostly so we cannot, however, construct our homoeopathic medicine from them.

         Then, the remedy choice in homoeopathic sense is not founded upon the symptoms which appear in many patients but they are founded exactly upon the rare symptoms which occur only in the one patient sitting before us.  Such unique, strange symptoms are also naturally rarely observed in the Proving; mostly they appear only in the Prover – a symptom not common but somewhat exceptional and will therefore become a guiding symptom because it appears rarely.

THE GUIDING SYMPTOMS HAVE BEEN CONSTRUCTED IN THE COURSE OF TIME:

         Sometimes a leading symptom has not been described in its entirety by one Prover alone.  A

symptom like this one of Argentum nitricum: “Headache with the sensation as if the head is enlarged, caused by dancing and ameliorated by tying up the head with a towel” was not observed in association with one Prover, but one Prover experienced only the enlarged sensation, another headache after dancing and a third the relief by typing up tightly.  All that belong together and the complex symptoms characteristic for that medicine, has been set forth in the course of time, after knowing well the Proving symptoms by using the medicine at the bedside.

         It is frequently even so, that in the Proving only location and sensation were noted while modalities and accompanying symptom and the individuality which actually make the symptom as something peculiar and become guiding symptom became better known when the remedy was tried in practice.

         Only in rare cases have our guiding symptoms been furnished in a completely made manner.  Mostly they are got from Provings combined with practical applications over a period of time.  Only from practical use it would be known as to which peculiarities in the Provings are correlated and which peculiarities crystallize as essence of the Proving symptoms and can therefore be added.

WE WILL NEVER HAVE A COMPLETE SYMPTOMS COLLECTION:

         Both sources, Proving and practical application proceed further on and an end will never be achieved.  We will continue to reprove our medicines and continue to publish successful case reports, know more and more peculiarities and correlations and in this way develop the well-known guiding symptoms and also construct new guiding symptoms.

         That is again the reason that we do not have a completed collection of symptoms for our medicines.  Of course we have Allen’sEncyclopaedia; we find in it only the pure Proving symptoms.  We also have Hering’sGuiding symptoms wherein we find only a small essences of the Proving symptoms drawn from some of the brief case reports.  HERING expired in 1880; everything acquired after that in the clinical cases are lying scattered all over in the literature, difficult to be assembled; they have never been assembled at one place.  And when I attempted to do so for my monographs for a small number of these medicines it is only a preliminary work.  As you will be seeing, always more material come up from our daily work, that is, we learn individually – and when we publish our cases, as a body – the symptoms better and we constantly elevate more symptoms which were lying shut out, to the level of a guiding symptom.

         HERING (3) has once written very tellingly about this process, how the older physicians were eager about every new Proving and how with great pleasure these new source material were assimilated straight away; “as often the symptoms manifested in Provings so much probable were their genuineness.  The next step was to give the medicine to the sick person.  The cures were the verification of the symptoms.  And lastly, after repeated cures we obtain the guiding symptoms, the characteristic symptoms, the ripe fruit hanging on the tree.  With what anxiety indeed did the first builders of our Materia Medica awaited for the printing of the Provings so that they can compare their own symptoms with those of others and deriving enjoyment from the verification of their own symptoms”.

THE HAHNEMANNIAN PROVING SYMPTOMS AND EDITED SYMPTOMS:

         HAHNEMANN (2) was the first, who worked out the guiding symptoms from the raw material.  A striking example is found in the Foreword to Pulsatilla.  In the text under Pulsatilla we find only two symptoms which explain the crystallized essence of the ripe guiding symptoms worked out by HAHNEMANN; (Pure Materia Medica, No.1129) “from an unpleasant news he falls into deep sadness and despair” and (No.1134) “he is very silent” – what has been given in the Foreword was built up as a guiding symptom by HAHNEMANN out of extensive clinical experience; “Therefore the medical use of Pulsatilla will be all the more helpful when in affections for which this plant is suitable in respect to the corporeal symptoms there is at the same time in the patient a timid, lachrymose disposition with a tendency to inward grief and silent peevishness, or at all events a mild and yielding disposition, especially when the patient in his normal state of health was good-tempered and mild.  It is therefore especially adapted for slow, phlegmatic temperaments: on the other hand it is but little suitable for persons who form their resolutions with rapidity and are quick their movements even though they may appear to be good tempered”.

              When we look at the HAHNEMANN publications in the “Pure Materia Medica” and very particularly in the “Chronic Diseases” we observe that here already the individual symptoms have been processed.  Every single “Proving symptom” is indeed the result of a processing of the entire series of symptoms in the Provings protocol.  We can see it when we compare these HAHNEMANN Provings with the later ones like for example the one on Dioscorea by Cushing (1) who published merely the full unprocessed Provings.

WE TAKE UP THE EXERCISE OF PROCESSING THE GUIDING SYMPTOMS OF LILIUM:

         It is similarly so with our remedy Lilium.  Here we have a number of Provings and clinical cases at our disposal which we take up to process.  The guiding symptoms for this medicine have not been well processed as in the case of well known medicine.  Up to now we know much less guiding symptoms of Lilium than of other remedies; therefore it becomes sometimes difficult for us to recognize Lilium cases.  But it should not remain so and we can augment the number of guiding symptoms in the course of time.

         We also have the task to elevate more symptoms to the rank of leaders by adding the crystallized essence of individual symptoms from the Proving symptoms and unite more of the crystallized essences into a complex.  It is also found that in the Provings protocol we come across surprising symptoms which have been written so graphically and which contain so many peculiarities that one wondered as to why these have not become well known.

THE DOWNWARDS PRESSURE IN LILIUM:

         One female Prover has noted down on 20^th day after taking Lilium, as follows: “A sensation in the Pelvis as if everything would come out through the vagina.  The drag downwards in the region of the pelvis is felt up to the stomach”.  Three days later the same Prover had the following sensation.  “In Pelvis feeling of dragging out as if the whole content is pressed into a funnel whose lower end coincided with the vagina”.

         By comparing my Lilium cases with the Sepia case (4) I have often observed that here an essential difference, a possible differentiating between the two remedies came to light on occasions.  With Lilium the movement is from above downwards that the whole contents in the abdomen is grasped and all that is concentrated below through a thin central duct.  The patients explain it with a motion; wide above, small below or use the catchword “funnel”.  For Sepia the characteristic is approximately the opposite; When a female patient explains to us that she has a downward movement in the pelvic region or when a downward movement and at the same time a pressure from within to without is also expressed then we think of Sepia.  Now please listen to my first case.

CASE 1:

              Mrs. S.E., on 15.6.1979.  “I probably have a low blood pressure, I am so tired, constantly, right from mornings when I get up, irrespective whether I have slept well or less, simply so much beaten down, I must force myself, it is not so every day, it depends on the weather probably, if it is hot and sultry, so damp.  It may be lovely weather but then it does not at all attract me.  At times I have something as if stitching in heart on the left side.  It is not, however, regular.  More in day time, less in bed.  Back aches there (in the lower dorsal vertebrae) I always have.  That is I go to gymnasium regularly and it helps me much.  Recently this was interrupted due to holidays but I have it while lying.  I then wake up cheerfully in morning.  But when I go to gymnasium regularly, it helps me, also I do not have it then so badly, or it goes off completely from work”.

              In this case we have heard two representative symptoms, once the tiredness and the beaten sensation in the mornings, from waking up and then the back pain in the morning in bed, better from waking up.  Both are symptoms which occur frequently, they are not much differentiated, not provided with many details.  When we search for the corresponding rubrics, we find a lot of medicines which have the two well known symptoms mentioned above.  If we were not to get further symptoms from these female patients then we must choose one remedy which has both these symptoms in the highest grade in Repertory which indicate that these remedies, statistically viewed, have been used in the past with repeated successes because of these two symptoms being present prominently, so that we eliminate the less frequently successful remedies or eliminate the remedies with negligible value in the gradation.  The remaining major ones are Lachesis, Nux vomica, Petroleum and Pulsatilla. Sepia also appears in this list if not in so high grade.  But we should include Sepia in our consideration, because of the reference to gymnastics, the fact that the patients apparently enjoyed gymnastics and vigorous physical work and found her ailments better from these, makes us think of this remedy from the other side.  Let us hear our case further:

FURTHER CASE 1:

         In the mornings, or no – in the night also I have suddenly such very severe abdomen pains, actually on both sides.  And then also I feel as if distended and after I am able to pass wind few times it becomes better.  The pressure is less while passing stool than on the bladder.  If it is retained again it is very painful.  But when it is passed and when as I have already said, I go to the toilet it passes if completely”.

         The patient said that downward pressing abdomen pains come from both sides, she made the funnel-type gesture with her hands while describing her complaint and the catchword “funnel” was also mentioned.  “Funnel” is a catchword which when we have understood well, must strike us a Lilium.

THE OTHER SYMPTOMS OF THE CASE:

         Now further: the Prover (female) from whom we have earlier obtained the funnel type downward pressure expressed during the Proving, as follows: “Downwards pressing and burning in the genitals, accompanied by pressure upon the bladder”.  In HERING’s Guiding Symptoms you will find the following cured report: “Downwards pressing pains, abdomen as if distended”.  A male Prover discharge of very stinking flatus”.  We see that the further peculiarities about the abdominal complaints of the patient namely the pressure on the bladder, the sensation of distension which is ameliorated by discharge of flatus all described by our patient agree with the Proving symptoms word for word.  The entire complex of this abdominal complaints as also a mass of symptoms of our patient are similar to the appropriate Lilium Proving symptoms so that we do not any more have any doubt the appropriateness of this remedy.

         Now it does not matter whether any other medicine has, in the past, cured the first two symptoms, namely the tiredness and back pains.  These symptoms were not so very characteristic, they were just usual, because the tiredness in the morning in bed and the backaches are found often in many medicines and in many cases.  It may be only interesting whether Lilium has produced these symptoms, independent of the statistical frequency of appearance in the repertories.  When we refer in the repertories we find nothing of the kind, but, that is not unusual because our repertories have not been made complete: KENT andBOENNINGAUSEN have mainly picked out only the very definite symptoms.  If we would like to carry on with the investigation of the sources, as we have done here, if we wanted to say with certainty whether a definite symptom had been explained once irrespective of whether it has been confirmed by reProving or through cures we have to look into the Materia Medica, and so the complete symptoms collections in the entire literature.

         And here (5) we find as a matter of fact, for Lilium: “Trembling and weak while awaking in the morning” and “gnawing backache in lumbar region, worse in bed”.  I shall explain with 3 cases of mine out of the total ten cases processed in the monograph: “Backache before getting up”, “back and left middle of abdomen painful better being up, worse in bed” and “Backache worse in mornings in bed, better from getting up”.  If we take note that over 30% of these cases have suffered this symptom we can reckon that this symptom has been confirmed.

         Perhaps I should also explain that later after I had given the monograph for printing I had in another case the location of this pain as “the lower dorsal vertebrae” If more such cases come up then the symptom “pains in lower dorsal vertebrae, worse in mornings in bed, better by rising up” can be registered as newly drawn guiding symptom of Lilium, just as the already well known “funnel shape downward pressure”, the accompanying sensation of distension, the amelioration from passing flatus and the pressure upon the bladder could be added if these accompanying symptoms are frequently observed in the future.

SOME LILIUM MENTAL SYMPTOMS:

         To bring you a further example as to how our pure symptoms are worked out as guiding symptoms and how they could be developed further in the course of time, provided with further individualities or looked at from different angles.  I will show by two more cases.  You have heard in the first case what is often a catchword or a condensation of a complex guiding symptom which immediately on hearing would recall to mind the remedy.  In the first case the hand gesture of the patient of funnel shape caused immediately the idea of Lilium and the almost instantaneous recognition of the guiding symptoms which we have heard like the patient mentioning about the distension sensation, the amelioration from discharge of flatus, the expression “abdominal pains from both sides” and the pressure on bladder, the four other facets of the same guiding symptom.

         In the second case you will hear such an abridged version, this time a mental state of Lilium.  First I will detail the Provings symptom which expresses similar sensation: “Feeling of being agitated, as if she was compelled to work”, “Feeling as if she would go crazy if she did not hold herself in control” and “anxiety that she has a fearful disease internally which has already established itself”.  They all appear to be entirely different sensations, which do not permit any logical connection.  You will hear identically that the patient connects all the three, that is, the urge for being occupied, the sensation of becoming crazy and the fear of suffering from a disease, and summarizes in one sentence.  This single sentence holds, despite its brevity a very exact correspondence with two well-known and one less-known Lilium symptom that one recalls to mind Lilium as soon as one hears.

CASE2:

         Mrs. W.F. on 7.12.1989: “My legs are so trembling, the things, exactly.  I can work, I must say, I have cut wood, it causes aches in the muscles, of course, but doctor, if I do not do any work, I will go crazy.  Then I think: you have the Cancer then: My bowels are so tense.  I think constantly, there was ball there, as we say, something there.  Yes it presses downward, but I do not have any complaints at all in passing stools and so.  I have the sensation, that it simply is so tense.  I have once experienced and in the summer when there is occupation then I do not think of it at all”.

         You have, of course, heard this sentence: “When I am not at all occupied, I will go crazy and then I think I “you have the cancer”. – This sentence has drawn your attention, since you knew that the three Lilium symptoms are contained.  But when one does not know about Lilium symptoms, when it is least known that there is a medicine which has a pathological urge for occupation and pathological fear of having a serious internal disease, as a leading symptom, one can easily miss this statement.  One may then be advised to repertorise from the beginning; so that a remedy may be found for the following symptoms which has more often, statistically more often, cured or have produced in the Proving (1) and (2) urge to be occupied or “feels compelled to be occupied” (3) fears of becoming crazy (4) fear that he has some disease (5) feeling as if a lump in rectum.   One would then obtain Lachesis, Natrium muriaticum, Platina, and Sepia for choice and one would probably choose Sepia as the more frequently used remedy in this conditions.  These remedies in which Lilium is not contained is obtained when the second symptom, the urge for occupation, is used in the small rubric in KENT, “Exertion am”.

REPERTORISATION:

         If we repertorise in this way and we must do so whenever no similarity to a specific remedy known well to us strikes us, we are then forced out of necessity to place all symptoms besides each other with the same value.  We search only whether in this way we recall a medicine which could satisfy in all aspects if we examine it thoroughly, that for example not only the amelioration by movement or from exertion is there but also the sensation is as close as possible to what the patient meant with the expression “When I am not at all occupied, then I become crazy”.  Only to that end is this primary repertorisation to be used; to bring to our attention a couple of remedies which we can study with reference to our case. The remedy which we finally decide to choose is, often, not the one with highest marks statistically and more often it is not even found even once in all the rubrics selected.

         Our remedy Lilium has not been so well recognized since long like our earlier remedies and therefore its symptoms have not been so frequently covered and verified.  As a consequence it has not been included in all the repertorial rubrics to which it properly belongs.  Our work is not merely to elaborate the leading symptoms but also that we should parallelly extend our Repertory.  A small example in this regard we see from this case.  The BOGER’sRepertory presents a further development of the BOENNINGHAUSEN’sRepertory, it has been extended further after KENT and Lilium has been represented in it fully.  If in this example instead limiting ourselves to the small rubric in KENT, “Exertion am”.  We select the larger rubric in BOGER “Physical exertion, am.”  Lilium immediately catches our attention although we do not find the remedy in “trembling of legs”.

         Now please compare what this patient said with what another patient has described about this urge for occupation:

CASE 3:

         Mrs. C.R. an 10.3.1977: “very often the situation is that I have the feeling that I must work terribly much or I would like to work terribly much and then I actually know that now I must do everything patiently but that somehow does not happen.  Then I get a sort of agitation and terror.  The colic generally comes only in such a situation.    Actually objectively there is not more work than otherwise but it is rather what I do.  For example, summer does not at all suit me.  In spring I get more often the sensation of: I must now renovate the entire house and I do not know this and that …………. so periodically and in bouts.

              After this patient received Lilium and during the process of cure she said as follows:

              “The next day I was extremely tired, much more weak than otherwise, I could not so rightly defend myself against it and that tiredness did me unexpectedly good overall that I now feel a bit weak and feel somehow it is pleasant”.

              You can now judge better why our second patient has said: “When I am not occupied I feel that I would go crazy”.  Also she experienced this almost psychotically strange agitation, which in the other patient appeared in bouts and coupled with the sensation of being powerless.

         That in this case the other frequently observed guiding symptom of Lilium, the fear of disease, is coupled with the agitation, is very particularly interesting.  In no other case of Lilium is it so clearly impressive as here, that the fear of disease can be formed with agitation at the same time, that both the symptoms can be put gather as a leading symptoms complex.  So we have again learned from the case a new facet of Lilium condition and thus we have thereby got a further possibility of recognizing easily the future Lilium patients and perhaps the blind repertorisation easily above may be done away with.  Perhaps we may now directly consult the Materia Medica and compare the other mental peculiarities of Lilium with our patients.

         The fear of disease in lilium shows itself frequently that the patients extradinary understanding that they would like to be reassured that they do not have the disease feared to be having, they clam down after that ………only to forget everything after the lapse of some time again begin with the fear of disease and readiness to be assured of the contrary.  This periodicity is deep in the medicine overall.  This sexual excitement for example, another guiding symptom, which with the above cited condition becomes a complex picture, alternates frequently with periods of deep remorse and bad conscience because of that.  In our case the periodical appearance of the symptom are not perceptible, but perhaps you heard of the willingness to be understanding.  Another case would perhaps recall the periodically – the other facets of a complex guiding symptom are thus constantly appearing before the observer.  As frequently we have learnt of these facets in the course of time so much easily can we see the symptoms in our patient.

THE MATURING OF THE GUIDING SYMPTOM:

         The mental symptoms of Lilium have so frequently been obtained in Provers and confirmed by cure reports and recorded that we come to the end of the development and form of the mature guiding symptoms.  The two symptoms in the second case is different, the “ball” and the sensation of tenseness in bowel which is much less felt in summer and the trembling of the legs or things.  For the later we find Proving symptoms: “much trembles from pelvis down the things downward” and “felt light trembling and weakness especially in the legs”, but this, what the patient said does not give us anything further.

              With the other symptom however one sees clearly through, this case how the unfurling process of the maturing of the Proving symptom is guiding symptom takes. Till now only the authenticity of the probability of the symptoms by their appearance in two different Provers has been confirmed; “sensation as if a hard object was pressing backwardly and downwardly against the rectum and anus” from Prover No.5 and “sensation as if pressure from something against front wall of the rectum at the anus and about 2-3 inches above it” from Prover No.7.  Now a clinical confirmation is secured through the above case, and the symptom through addition of further peculiarities further unfurled and it becomes plastic and graphic: we learn that the patient has the sensation of tenseness together with the feeling of a foreign object or “ball” and we find a modality, the amelioration in summer when one has more work to do.  Recall that the third patient also has spoken about amelioration in summer.

         That is what HERING meant when he said of the ripe fruit hanging in the branch.  In this way the Guiding Symptoms mature and develop.  In this way every successfully treated case is much significant for us.  Not merely that the patient is thankful to us, but that we experience thereby gratification that we can contribute something to the Materia Medica and also we ourselves improve our knowledge.  Every case of ours adds something to our knowledge, to the knowledge of the individual and when we publish our cases, to the common knowledge of all of us.  That is the fascination of Homœpathy that it is not a finished, closed system but that everyone of us, the youngest and the oldest, can contribute to its development.