Hahnemann insists that cure results from a similar match between the symptoms displayed in disease and the symptoms demonstrated by a particular remedy.
In order to ascertain a similar match between the disease and the remedy, we must know the total picture of the symptoms expressed by the person in that disease state. This is called a totality, a complete picture of the disease in that particular individual.
However, without some comprehension of both the disease and the vital force of the person affected, we would just be left with a list of symptoms and no idea how to procede. We may find a match with a remedy, but can we be sure of our remedy? What is it in the list of symptoms that characterises the disease, and what particulars characterise the remedy? In an epidemic, for example, why does one person need one remedy and another person need a completely different remedy?
Hahnemann emphasises “the more striking, singular, uncommon and peculiar signs and symptoms of the case of disease are cheifly and most solely to be kept in view…” Paragraph 153 The Organon.
Common symptoms, for example a runny nose in a cold, are “to be expected”, and so are of little use in choosing our remedy. Runny noses are found in many types of illness and can mean all sorts of different things in different cases.
Kent says that we could easily end up with plenty of symptoms, but no case! It is easy to leave out the image of the sickness and fail to find the essence. We are looking for the symptoms which characterise both the disease and the remedy. Common “to be expected” symptoms, eg. an itchy rash in chickenpox or a runny nose in a cold are not going to guide us to a remedy, or to explain the individual nature of the disease or of the person so affected by that disease.
So, symptoms which cannot be explained, eg. thirst absent in a fever, laughing at serious matters, intense thirst with no urination or laughing that causes vomiting, are the more striking and the most characteristic symptoms of the disease, and they point to the remedy. We are looking for a peculiarity that relates to the individual to help us find the remedy.
Thus we need to know what is common and what is strange. We need to know what affects the person, generally permeating the whole economy of that person, and we need to know the local symptoms that affect only a part of the person. So we can begin to see the major expression of the person’s defence mechanisms and begin to formulate a heirarchy of symptoms from the totality of symptoms we had previously listed.
The philosophy of the heirarchy of symptoms is our guide through our total list of symptoms. With this to guide us, we can begin to see which symptoms are significant and which symptoms must be ranked less significant.
Vithoulkas emphasises the intensity of the symptoms and how deeply they penetrate the person. Mental and emotional symptoms are considered most important, because they are central to the person and affect them generally. We say “I am…in pain, hot, miserable, happy etc.” These states are individual and peculiar to the person and will guide us to the centre of the person. Then we need to ask “is this a symptom to be expected?” or “is this a peculiar symptom?” If a person laughs at serious matters, this is peculiar and we can rank this as very significant. If a person cries on bereavement, we think this is to be expected, whereas if they get angry when consoled, we can begin to characterise the person and sense the intensity of the disease.
And so we begin to rank and order our previously meaningless list of symptoms into a heirarchy. The symptoms can be sorted into mental symptoms, common and peculiar; emotional symptoms, common or peculiar; physical symptoms, common or peculiar; general symptoms, common or peculiar, and then we can note the modalities of each symptom (modalities = better or worse from eg. heat, pressure etc.)
We are asking here general questions that affect the whole person. Are they generally better for heat or cold? What ameliorates their pains? What is their appetite like? Are their headaches better in the open air or in a closed room?
Then we ask if this is to be expected or is it a peculiar symptom? How intense is each symptom? The remedy arsenicum has burning pains that are better for hot applications. This is peculiar. The remedy bryonia has pains that are better from being lain upon. This is also peculiar, and the symptom characterises the disease and indicates the remedy. So we can follow Hahnemann’s instructions in Paragraph 153 of The Organon completely.
Vithoulkas places the sexual sphere next in the heirarchy, as this is an area which permeates the whole nature of the person. It can tell us much about the person when we are taking the case. Similarly, sleep affects the whole person, and the position they sleep in, their rythms and routines and dreams express the whole state of the person.
Then we look for local symptoms and take note of these carefully, asking which is common and which is peculiar. What are the modalities of the local symptoms? Do they differ from the modalities of the general symptoms? Do they reflect the defence mechanisms of the person, or are they merely common menifestations of the disease?
All the time in case taking, we are collecting a totality of symptoms, looking for what characterises the disease to guide us to our remedy. We are comparing general states affecting the whole person with local symptoms, “to be expected”, with “strange, rare and peculiar” symptoms “not to be expected” from the disease. All the time, we are noting the intensity of the symptoms, trying to locate the centre of gravity of the person and the disease, trying to identify the “central disturbance” and to find out the identity of the disease culprit, an identity as individual as a finger print. Without the heirarchy of symptoms to guide us, we would be lost in a hopeless list of symptoms leading us nowhere.
Sankaran says that if you simply compare symptoms, you will be lost. He maintains that no patient can hide their characteristic state from the careful observer, and that we should follow the heriarchy of symptoms outlined by Hahnemann and by Kent.
Sankaran quotes a case with no symptoms! A case with only common, to be expected symptoms! However, he found the remedy by noting the person’s mental state.This person liked to jest and was very loquacious, even though she was so ill!
Another case of Sankaran’s showed how to find the remedy from local symptoms, a case of a painful goitre with an aggravation from the least motion. Though this was a local symptom, the intensity ranked it very high. It epitomised the centre of gravity, the central disturbance, because this person could not even bear the curtains behind her to move almost imperceptibly in the draft. The point was aggravation from the LEAST motion! This intense symptom is only found in the remedy bryonia. In such a case, the remedy must cover the mentals, the generals and the particulars, and Sankaran points out that when a remedy covers the mentals and the generals, it is often seen to cover the particulars as well.
We must know the heirarchy of the vital force as it defends the body. Knowledge of the law of cure is also very important here. We must also have a thorough understanding of physiology. Our remedies are dynamic and they affect the mental state. The mental state affects the central nervous system which affects the endocrine system (emotions), and from this the whole physiology of the body flows. The extremities and local physical symptoms are a reflection of this totality at the end of the chain of events. On every level the disease is seen, alongside the person’s characteristic defence reaction to each part of this chain.
We are matching a totality of a disease state to a totality of a remedy picture, not simply matching symptoms to symptoms in a random manner.
Thus the importance of the heirarchy of symptoms in case taking is fundamental. Without this philosophy to guide us, we would be lost in a jungle of symptoms with no guidance at all.
I got 92% for this essay in my first year at homeopathy college in 1988!
Pearls of Wisdom from my teachers on the Heirarchy of Symptoms:
“This thread of understanding runs through the case – straight to the central disturbance.”
“The central disturbance is energy concentrated at the centre, which will affect the whole ecomony from the inside out as the central state is reflected on all levels of functioning and the heirarchy of symptoms points directly to the focus of the problem.”
“The heirarchy of symptoms puts shape back into the case when shape has dissapeared. The remedy holds a vibration that the body has forgotten or lost, and so the dis-ease symptoms vibrate at that frequency and intensity in the hope of attracting the right remedy or medicine.”
“The body is trying to do something when it is ill. By stimulating this vibration with a remedy, you are aiding the body in the direction it wishes to go.”
“So often, modern society disrails us when we wish to be whole – ‘don’t think about it dear!’ Distraction away from any discomfort is society’s norm, fragmenting us and divorcing us from full experience and action, hence the need for so many therapists to connect us up again!”
“Fear is one of the main reasons why we block the vital force through suppressive acts. Fear of true resonance and true experience – distoted reality is the norm. The one true seer will freak everyone!”
“By allowing the body to overbalance enough in the desired direction, the balance of health can be grasped, regained by the vital force. Unfortunately, often the vital force is too weak to achieve this without help.”
Amanda Bingley