Repertorisation procedure in Homeopathy step by step

As no one person can carry all the symptoms of all the remedies in his mind, a concordance or index is needed. We term a symptom index a repertory. There are about half a hundred of these, general or special, based on different systems of studying the case. The two most vital to know are the basic ones of the two main methods, the Kent Repertory and the Boenninghausen.

The Kent repertory : its construction
The Kent Repertory is a compilation of materia medica, certain prior repertories, such as Lippe's, and clinical symptoms verified. In order to successfully search in the Kent Repertory or the symptoms of your case as evaluated in accordance with our last lecture you must be thoroughly familiar with the plan of the book, its rationale, and also its inconsistencies. The plan of the book is to work from generals to particulars, a general rubric first in most instances. The book is based on anatomical divisions, (see Table of Contents, p. VII), with certain exceptions such as the first section on MIND; the last one GENERALITIES; discharges, such as STOOL, SWEAT, URINE and EXPECTORATION, which appear as separate sections next to the anatomical region producing them; and certain general conditions, such as VERTIGO, COUGH, SLEEP, CHILL and FEVER, which are also separate. Under each anatomical section the rubrics run in alphabetical order regardless of whether they are pathology, sensations, modalities, or objective symptoms (such as "bores head in pillow", page 108). Each such main heading is following by modifiers, (if there be such) in the order following : Tie, circumstances in alphabetical order extensions (the point from which a symptom extends is the one under which it will be found, not the point to which it extends), location with its time, circumstance and extension modifiers, and lastly, sensation with its modifiers. For instance, the main section HEAD is anatomical, but under that you will not find under the sensation in the occiput, as for instance, Coldness or Pain, Occiput, in.

It is to be noted that certain anatomical regions have no corresponding section in this Repertory, for instance, NECK, which is found under THROAT, EXTERNAL THROAT, and BACK. EXTERNAL THROAT contains the rubrics pertaining to the anterior neck, such as goitre, glands, torticollis, etc., and BACK contains nape and posterior cervical region. Furthermore lungs, heart, aorta, axillary glands, breast and milk appear under CHEST; posterior chest appears under BACK; pulse under GENERALITIES; head sinuses are divided between NOSE and FACE; salivary glands are found under FACE instead of under THROAT; lips under FACE instead of under THROAT, MOUTH; oesophagus is found under STOMACH; and liver under ABDOMEN. There is no section for the circulatory, glandular or nervous systems, as this book is not based on systems, (Boericke's Repertory is in part), but the parts of these systems are found scattered throughout the book under allied anatomical headings. Many symptoms which one would expect to find under the nervous system appear under GENERALITIES as they indicate a tendency of the whole organism, such as Analgesia, Chorea, Convulsions, Paralysis, Trembling, etc. Twitching of the parts appears under the anatomical part, such as FACE, EXTREMITIES. Nervous symptoms having to do with the spine appear under BACK, such as Opisthotonos. Meningitis appears in two places, under HEAD, Inflammation, meninges of, and BACK, inflammation, cord, membranes of.

Similar or allied rubrics often appear in two or more different places, as for instance; Dysmenorrhoea under GENITALIA, FEMALE, Menses painful; ABDOMEN, pain, cramping, bearing down, cutting, menses, during; ABDOMEN, Pain, hypogastrium, in, menses, during; and ABDOMEN, Pain, menses, during.
It must be noted that many rubrics which appear as particulars under the the proper anatomical sections or main headings also appear in the last section, GENERALITIES, in their relation to the body as a whole, for instance, under GENERALITIES, Menses, comes aggravation or amelioration of the whole person before, during or after menses, while under GENITALIA FEMALE appear the type and circumstances of the menses, or, so to speak, the particulars. Similarly under GENERALIIES, Perspiration, appears amelioration or aggravation of the body as a whole from sweat, whereas under the section PERSPIRATION are given the quality, occurrence and modalities of the discharge itself. Sweat of any special part is found under the anatomical section in which the part is located, such as, ABDOMEN, Perspiration on. Perspiration of the scalp is not under HEAD, scalp perspiration of, but under HEAD, Perspiration, scalp of, General amelioration by, or distress from, the act of eating appears under GENERALITIES, Eating; and under GENERALITIES, Food, are the aggravations and ameliorations from the different articles of food, but under the section STOAMCH, aversions and desires for special articles of food appear.

Pathological diagnoses are found frequently in GENERALITIES and occasionally as headings under other sections but more often as subheadings, under the the condition involved, for instance, pleurisy is found under CHEST, Inflammation, pleura of, and appendicitis under ABDOMEN, inflammation, appendicitis. On the other hand empyema is found under CHEST, Empyema, directly, and goitre under EXTERNAL THROAT, Goitre. Certain pathological states which are symptoms rather than diseases, such as chorea, Convulsions, Cyanosis, Dropsy, etc., appear under GENERALITIES. Objective symptoms are scattered all through the book an are often small unclassified rubrics, such as Brittle Nails, Gestures under MIND, Biting under MIND, and red lips under FACE, Discoloration, red lips.

The Kent repertory : its use
This Repertory is built to work the the cases from general symptoms to particular symptoms. WE have already spoken in our lecture on the evaluation of symptoms of Kent's method of grading, MENTALS being the most important, and GENERALS next. Most chronic cases and many acute ones can be worked out by the Repertory on the MENTALS and GENERALS alone to within three to five remedies. The beginner should take at least eight of these symptoms, although experts often solve the case on three to five. The beginner must be very sure that these MENTALS and GENERALS are really true of the patient, and that he has not warped the symptom in translating the patient's colloquial expressions into the language of the rubrics. Moreover a symptom must have the same mass or importance in the patient's case as is assigned to it in the symptom hierarchy. If an important symptom cannot be found in the Repertory it can often be found under a synonymous rubric. It is to be understood that the headings under GENERALITIES which are not pathological and not marked "ameliorated by", or otherwise explained, and which are not sensations or conditions mean "aggravation from", for example, Eating, before, means worse before eating, Coition, after, means aggravated after coition, etc. Many of the ameliorations are omitted and you must look for them under aggravation under their opposites, for instance, there is no better in summer. This is considered equivalent to worse in winter. Sometimes two or more rubrics must be combined in order to be equivalent to a given symptom. If the rubrics are very small it may be wise to ad all the remedies. If at least one of the rubrics is large and the others fair size, only such remedies as run through all the component rubrics of this symptom should be taken. Certain symptoms have so large a group of remedies that they are almost useless except as eliminating symptoms. Such a one is cold bloodedness of the patient, which appears under GENERALTIES, Heat, lack of vital, and would serve to eliminate any markedly hot blooded remedies which had otherwise come through the generals high in a given case.

The student will recall from our previous lecture that the common symptoms, or the unqualified big, main rubrics, such as Sadness, Vomiting, etc., are of little or no use in repertorizing, and that among both GENERALS and PARTICULARS, a strange, rare and peculiar symptom ranks high. A strange, rare and peculiar general would be "during cold stage craves cold", or "during hot stage craves heat", as in Camphor; a strange, rare and peculiar particular would be "thirst for ice water only during chill" (Eup. per.).

We have said that the beginner should located in the Repertory his eight or more main GEENRALS and chart the remedies appearing under each of these, putting 3 for the bold face (heavy black type), 2 for italics and 1 for roman (plain type), this being done for all the symptoms chosen, the remedies appearing in more than half the rubrics are listed with their fractions, the numerator of the fraction being the numerical totality of the remedy grades, and the denominator being the number of symptoms in which the remedy appears. Now the PARTICULARS come into play, beginning with the most peculiar ones, an care should be taken not to use too small rubrics. In fact it is safer to use a more general, medium sized rubric than the more exact particular rubric. The occurrence of these particulars in the few remedies which have stood highest in the GENREALS, and in these only, being taken, you can now see which few remedies are fairly similar to the GENERALS of your case, and which few of those most resemble the PARTICULARS of the case. Add the particular to the general fraction and reduce your list to the three to five remedies which stand highest in their grand total. If one remedy totals 16/7 and another 15/8, the former is to be preferred. As you have taken your symptoms in the strict order of their importance according to the Kentian schema your first two or three symptoms should appear in the remedies that come high, and where they do not the remedy should be looked on with suspicion. It is to be remembered that certain remedies, like Sulph., Calc., Nux., Puls., etc. almost always come out high numerically because they have been so thoroughly proved and unless the beginner discounts this and bases his final judgement on materia medica he will prescribe these well proved polychrests too often. Conversely, it must not be forgotten that some remedies, like Tub., have but a fragmentary part of their proving in the Repertory, and that only a little more than 500 remedies are mentioned in the Repertory, and very few of the nosodes and double salts are adequately stressed. When the remedies have been reduced numerically to from three to five, these must be read in the materia medicas, especially their MENTALS, and the original case as taken reviewed and compared to each of the remedies. The miasmatic relationships of the patient and of the remedies that come out high must be considered. For future reference in treating the case, in acute as well as chronic prescribing, a list should be made on the chart of the constitutional remedies which come high, of the nosodes which most nearly apply, and of the acute remedies ranking highest. These, or complements of these, will often be found to fit any illness of that patient in the future, unless an epidemic remedy be called for.

Ideally, on the repertorizing record each symptom should be stated in the words of the patient in the symptom column, restated in the exactly corresponding rubric in the rubric column, and the page where this is found after it. There are repertorizing sheets on graph paper with the main remedies printed in, numbered places for writing in symptoms, etc., which are a great convenience and a time saver.

The boenninghausen's therapeutic pocket book, one of the earliest repertories, is based largely on hahnemann's materia medica pura and the idea of it was approved by hahnemann himself. the book falls into seven distinct parts. although each of these is complete in itself, "yet each one gives but one portion of a symptom, which can be completed only in one or several other parts". for example, the seat of pain is found in the second section, the kind of pain in the third, the aggravation or amelioration according to time or circumstances in the sixth, and the necessary concomitants in the various sections. the seven sections are : 1. the mind and disposition; 2. parts of the body and organs : 3. sensations and complaints in alphabetical order, in general and then specially, of the glands, of the bones, and of the skin and exterior parts; 4. sleep and dreams; 5. fevers with chill, circulation and sweat (the 2nd, 4th and (th sections have concomitants); 6. Aggravations and Ameliorations from time and circumstances; 7. Relationship of Remedies. In section seven under each drug the previous section headings, 1 through 6, are given and under each the remedies applying in that section which are related to the drug in question. At the end of each drug is given a list of other related remedies and the antidotes.

The Boenninghausen repertory : its use
This Repertory is based on GENERALS even much more than the Kent. The rubrics in the different sections dealing with the different aspects of one symptom are used to eliminate all remedies but such as run through them all. This is a swifter, easier method than the Kent, but too general, and a great many symptoms cannot be found in it at all. Also there are very few rubrics under MIND, only seven pages out of 482. Boger's General Analysis is based on this repertory and his unique method of working cases by it is also deserving of study.

The Boericke repertory
The Kent Repertory in its present form is unwieldy for the physician to carry with him to the bedside. Neither the Boenninghausen nor Kent repertories have any materia medica. Two books which combine materia medica and repertory are handy in the pocket or medical bag. One of these is Boger's Synoptic Key, of which his General Analysis is an abridged form, and the other is Boericke's Materia Medica with Repertory. The Boericke Repertory resembles the Kent rather than the Boenninghausen but Boericke has reclassified some of the anatomical sections. For instance, vertigo appears under HEAD; sinuses are grouped together under NOSE; lips are under MOUTH instead of FACE : tongue has a section to itself as have gums; oesophagus is under THROAT instead of STOMACH; foods that disagree are in STOMACH with the cravings and aversions, rectum and tool are under ABDOMEN. All the URINARY SYSTEM is together under that heading; breasts are rightly classed under the FEMALE SEXUAL SYSTEM; there is an admirable section on PREGNANCY, LABOR and LACTATION; after GENITALIA comes the section on the CIRCULATOY SYSTEM including pulse; hen comes the LOCOMOTOR SYSTEM including extremities, gait, neck, inflammatory rheumatism and arthritis, back, and axillae; then comes RESPIRATORY SYSTEM, including lungs, cough, expectoration, larynx, voice and respiration; following the is the SKIN. The FEVER section includes chill and sweat, the exanthems and various fevers such as influenza, typhoid, malaria, etc. The NERVOUS SYSTEM follows and includes epilepsy, paralysis, sleep, dreams, weakness, convulsions, goitre, sea-sickness, neuralgia, sciatica, spine, meningitis, etc. The GENERALITIES section is much reduced and contains mainly diseases, tissues, poisonings, suppressions(under Checked discharges), glandular affections including mumps, goitre, a very interesting section on Complaints from winds, damp places, sudden, gradual, injuries, prophylactics, and tumors. This section has been relieved of much misplaced matter and has added to it a great deal of interesting and valuable material. The last section is MODALITIES, first aggravations and then ameliorations, and time under these appears in alphabetical order under morning, night, periodicity, etc., instead of altogether at the beginning of the section as in Kent.
Under all extensive headings, such a HEADACHE, appear definite captions in the following order : Cause, Type, Location, Character of Pain, Concomitants, Modalities, i.e. Aggravations and Ameliorations.
This book is a clinical rather than a symptomatological index and has many technical terms as main headings. A tremendous number of remedies are given in the materia medica section, and well given, with plentiful mentals. Owing to its small size a great many symptoms have had to be omitted from the repertory. Its pretensions are not great but its usefulness within its sphere is tremendous.
This gives the beginner a bird's eye view of three of the most usable general repertories. It is strongly advised that every student master the Kent method, as it will reward familiarity ore than any other. To the advanced student it should be added that many strange and peculiar symptoms cannot be found in these three repertories and must be searched for in Gentry's Concordance, Knerr's Repertory, Lippe, Jahr, or some of the special repertories.

Card repertories have not been mentioned. There is one by Field, based largely on the Kent, but inaccurate. It is useful for hurried, acute prescribing in the office. A new card repertory, exactly following Kent, is now under construction by the Doctors Pulford of Toledo, Ohio. Boger's cards closely follow his Synoptic Key.

These different methods of repertorizing will appeal to different types of minds and will also be suitable for different types of cases, the Boger method suiting those with much pathology and few other symptoms; the Kent method suiting those with marked mentals and an intricate anamnesis; the Boenninghausen suiting conditions with acute pains and clear cut modalities, cases without subtleties. In closing this brief, suggestive method of repertory study we would reiterate, STUDY THE KENT METHOD FIRST, LAST AND ALL THE TIME.

Author: Dr. Anand Dharsenda
Source: homeopathy

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