20 April 2012

Analysis with Boenninghausen. Part 2

Posted by Jody under: Aches & Pains .

Boenninghausen started with the observation that *any complete symptom* contains 4 elements – these being (1) location, (2) sensation, (3) modalities (aggravation, amelioration, causation), and (4) concomitant symptoms (simultaneously occurring symptoms that do not necessarily follow obviously from the symptom in question). To define the totality of the disharmony in the person presenting to us, we do best if we can base our understanding on the four legs of these four “parts” of a complete symptom.

Constantine Hering used the following visual scheme to illustrate these four dimensions of a complete symptom, and he gives it to us in his introduction to ‘The Guiding Symptoms':
– –
– Sensations –
– –
– –
Localities – – Modalities
– Causation
Tissues – – Conditions
– –
– –
– Concomitants –
– -

It was Boenninghausen’s observation, however, that in the provings recorded in Hahnemann’s Materia Medica Pura (the original source record of provings of the remedies of his day), the recorded symptoms were often “incomplete”, that is, the recorded symptoms of any one prover may be lacking modalities, or well-described sensations, etc.

Now each of these provers presents an incomplete symptom, but taken together, we have location (hypogastrium), sensation (sore, cutting, grasping, severely clawed, colic-like), modalities (bent-forward, >tobacco), and concomitants (distention, flatus, restlessness).

Boenninghausen also observed that, in provers, these “parts” of a complete symptom were sometimes assorted differently. For example in one prover, the mental/emotional concomitant of restlessness would be seen during headache; in another, the amelioration by tobacco would be seen with the irritability; in another, the grasping, colic-like sensation would be felt in the bladder in what looked like a cystitis.

Similarly to these provers, in patients presenting with illness, symptoms are often stated incompletely, or modalities may not be clearly expressed.

Based on his extensive experience with clinical work and with provings, Boenninghausen concluded that this problem of “incompleteness” of individual symptoms in both provings and clinical cases could be solved by “analogy.” That is, that symptoms in one part of the case or proving which existed in an incomplete state could be reliably completed by analogy, by applying the strong & reliable conditions of other parts of the case. For example, when we look at the pains (whatever kinds of pains) of a Colocynthis state, we see some consistency in their being almost always cramping, grasping and colicky, better from pressure, and most often ameliorated by bending double and by heat, and we usually see restlessness as a mental/emotional concomitant symptom with the pain. So perhaps we see someone with a headache that is grasping in character, better by squeezing the head with the hands and accompanied with restlessness. Even though we might not find this exact symptom in a Colocynthis prover, we can consider Colocynthis as a possible remedy, by analogy of the sensation, modality and concomitant of their headache with those seen in pain in other locations of Colocynthis provers.

So (in this example) the strong, reliable & characteristic “parts” of the abdominal pain symptom – the sensations, modalities, and concomitants – can be considered as general symptoms of the whole person, rather than just as peculiarities of that specific symptom, and can be applied in their various combinations to other localities and tissues as well.

To deal in the Repertory with this issue of “incompleteness” of symptoms, and to be able to apply his notion of symptom completion by analogy, both in the provings on which we are basing our identifying of a simillimum, and in the clinical case we have before us, Boenninghausen divided up symptoms into their “parts” in his repertory. Rather than looking up “abdominal pain better bending double,” you will have to look up “abdominal pain” and “better bending double” to assemble your symptom.

Boenninghausen has been sadly misinterpreted as de-emphasizing the importance of mental/emotional symptoms, largely because of the difference in the way he and Kent recommended working with them in repertorization. The mental/emotional symptoms did not take to being “broken up” as elegantly as the physical symptoms did. So in his repertory he emphasized only more general states, to be used in the later stages of repertorial analysis when they were marked as strongly in the case as in the repertory listing, and suggested confirming mental/emotional symptoms of the patient directly with the words of provers as a late step in case analysis after repertorization provided a list of remedies to consider. This is not because Boenninghausen assigned a lower value to mental/emotional symptoms in the totality, but rather because he felt that the mind was a complex entity not as easily understood as the physical symptoms in this manner of breaking down symptoms into their “parts.”

Pain medicines can be effective and successful in treating a lot of types of pain, such as back pain, earaches, pain from arthritis and pain after surgery. Pain medication are medicines that you may order no prescription.

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