Blog - Shilpa Bhouraskar

The Ever Increasing Materia Medica - Does it mean improved success in practice?

A Student Query

I had a few interesting questions from one of my students last week who had recently graduated..
And one question in particular really got me thinking. She wrote - Has the increase in new remedies helped homeopaths today become more successful practitioners?
I decided to answer her question in my blog so I can share my personal experience with you all.
And also because I want your frank inputs and feedback on this as well.

So let me look at this question from three different perspectives -

Historically -

The first remedy Hahnemann introduced to Homoeopathy was the Cinchona Bark.
And obviously until some point in time the increasing number of provings meant better chance of matching newer disease expressions.
However it reached a stage when the increase in the remedy count did not necessarily translate into higher success.
At that point he discovered another factor that prevented cases from resolving completely.
And a whole new perspective on miasms was introduced with focus on treating the fundamental cause

This indeed led to an interesting direction in homoeopathy.
It is what I call the evolution of Stage 3 - the core understanding of the individual and hence the necessity of a deeper understanding of the remedy.
This possibly coincided with the emergence of polycrests - an entire group of remedies with well developed picture, multimiasmatic application and rich clinical symptoms.
Even today they continue to be extensively used, becoming more tried and tested with time as opposed to the non-polycrests with patchy information and less developed pictures.

So the bottom line is it was not new provings that translated into better success rate but it was the evolution of Stage 3 methods in homoeopathy and with this a deeper understanding of existing remedies that actually improved the success rate.
So it comes down to the quality rather than the quantity of remedy understanding.
Hence we can see how Hahnemann and other homoeopaths in the past such as Boenninghausen, Boger, Clarke etc
seemed to manage quite well with a few hundred remedies and still create a success out of it.

My Observations as a Student-

By the time I completed my training in 1997 we had studied about 250-300 medicines during those 5 and 1/2 years.
However what I observed in the Hospital OPD was that only the main polycrests were being used extensively.
The majority of the chronic cases were taken at Stage 3 using one of the classical approaches.

If the patient's state matched one of the common 15-25 known polycrests they were prescribed directly based on the practitioner's Materia Medica knowledge, skills and experience.
In most other cases, the basic Kentian or Boenninghausen repertory was used to find a more fitting remedy.
So with a kit of around a hundred remedies, they enjoyed a success rate of around 70-80% easily.

What happened in the remaining 20-30% cases -

Well in the cases where the main polycrests did not seem indicated or did not do the job,they looked for resources outside the box.
It could be in the form of removing an obstacle to cure, a miasmatic block. This led to used of intercurrent nosodes, sarcodes, isopathic remedies and giving specific therapeutics at Stage 1 and 2 to move the case forward.
At times a single keynote could bring up a rare forgotten remedy into action that dissolved the whole state.

So the bottom line was again clear - some of the most well known practitioners with decades of ripe experience under their belt managed a highly successful practice of around 80% using less than hundred remedies in their repertoire. All basically derived from the source books of the past.

So what was the role of new remedies?

Well some of the more contemporary homoeopaths in the OPD's used newer tools- ie using kingdom analysis or group analysis to find supporting information for prescribing the less well known or unproved remedies.
And it was fascinating to see unproved and new remedies being used successfully on completely unconventional methods when no known polycrest emerged in conventional repertorization.
However again most of these new remedies were still being used to cover the base in the remaining 20% of the cases.

So what about the new provings that are entering the repertories today!

I was reading Jeremy Sherr's beautiful article on "prover and repertoriser" where he has described the process of how a new proving should ideally enter the repertories.
He elaborates this whole diligent, laborious,intensive process that needs to be conducted after a proving so this remedy finds its place in the repertories as a reliable polycrest. It needs time energy and decades of effort.

Unfortunately of the thousands of new provings that are filling up our modern books, very few have gone through that process.
So most cannot be reliably used even when they emerge in traditional repertorization.
So what I have seen is at the most they can be used only as a SECONDARY reference. ie Only after that remedy has been confirmed at Stage 4 using the sensation or source method or some other unconventional process.

So until that happens the tried and tested polycrets will continue to dominate our clinical success.

My Personal Experience during my Own Practice as a Beginner.

When I started my own practice in Mumbai, I found the same pattern.
Majority of my success was still using a Basic Boenninghausen repertory. However it was out of sheer fascination of understanding the depth of a remedy using the kingdom analysis and classification, I started confirming the same remedy using contemporary approaches I was learning at the workshops and practices by contemporary practitioners. Unfortunately most of the failures were when I did not confirm the same remedy using both traditional and modern approaches.

And it was a relief to see the same trend continuing when I started working with many of my teachers at Stage 4 in their OPD.
The majority of their patients still needed the basic remedies in their every day practice and new remedies remained a tiny portion of the entire clinical practice.

Their private practices would have a higher rate of new prescriptions because most patients were referred cases having taken lot of homoeopathics in the past.
These new prescriptions naturally got highlighted in seminars, leaving many new students perplexed and inadequate about not being able to think of these weird remedies in the first place.
Another fact is that new remedy would be one of the many prescriptions that patient had been given during their healing journey.
And to be fair it is impossible to cover everything in a short seminar.

Hence I have always been a big fan of teaching through courses rather than seminars because it is hard to get the whole patient's journey in a short weekend seminar. Unfortunately many students are left feeling that it was that new remedy that did the whole job and a sense of failure if they do not learn newer remedies.

And don't get me wrong. In fact for the first few years of my practice I was in that state too. In spite of knowing the facts I dreamt of prescribing a "Simillimum" for every case and wanting to create miracles with each patient. I was over the moon if my success was based on a rare and special prescription. I felt I was a failure if my patient needed multiple remedies to get better. However I had a wake up call very early on in my practice...

My Wake up Call - A Pivotal Time in my Practice.

I relocated to Nasik and started my private clinic. I also joined a charitable organisation and travelled to rural areas where hundreds of farmers and their families came in with their complaints in those tiny camps we set up.
Most of them had grave physical and pathological problems. Children had recurring fevers and infections that needed quick relief.
I had hardly been used to seeing such complaints before in Mumbai and I always had the luxury of taking a case for hours using the Kentian or Delusional methods predominatly in my Mumbai clinic.
So I was struggling to prescribe in most of the cases. There were hardly any mental symptoms here. There were definitely no delusions. The only person that was deluded was me!!

In fact most of the cases there were only objective symptoms that I could collect. And to add to it there was a language barrier.
It was heart breaking and I was close to giving up.

This was when I decided to get back on track. I started looking at all those archived cases from Boenninghausen, Boger Boericke and other masters of acute physical complaints from the past.
I started solving their cases to brush my repertorization skills on basic homoeopathy. It was impossible to do that on paper repertorization. This was the time when I started developing the HomeoQuest software with my husband Atul. In a way it was exactly what I needed at that point.
I started testing the core version of homoequest software on hundreds and hundreds of cases I recorded in those clinics. At the same time I repertorized the archived cases and compared my results to see if I got the same results. I used this learning of rubric selection in my rural cases.

The Lateral Thinking Software

So interestingly the HomeoQuest software developed in a very lateral way right from the start- it was not created to simply make paper repertorization possible on a computer or browse a repertory chapter on a screen for hours.
That would have been the easy bit.

I wanted exactly those features that were crucial for making prescriptions in minutes. During our brainstorming sessions we came up with using the inherent strenght of the computing process to complement human skill.
It developed into something like a google search where I could churn thousands of pages of information and exactly present the symptom with its remedies by the click of a button.

I did not have the time to waste on deciding what chapter to choose or what book to look at. The role was clear. The software needed to take care of finding the symptom or remedy as long as I have diligently put in the patient's keywords.
Hence the search engines had to be extremely powerful in the software to make it that effective under these conditions.

I was also very choosy about my books and remedies. The focus was never about the number of remedies but the quality of remedies and emphasis was on real clinical information and remedies from cured case studies of these past masters so I could leverage their wisdom and experience that I lacked.

This was EXACTLY what I got in that core HomeoQuest version.

In fact I used only the tried and tested repertories from the masters of acute prescribers like Boenninghausen, Clarke Clinical Boericke and their Materia Medica in my very first core HOmeoQuest version and then added the other Kentian repertories and source books later on.

Fortunately it all came together to help me create a success at the end of the year in that clinic using JUST A HANDFUL OF REMEDIES.

The Recipe for Success

While the software made sure I was working efficiently using an extremely powerful tool, what helped me tremendously to create success in my rural practice then was not the software.

BUT it was putting in the hard yard.
Modelling the skills, tried and tested tools of those Stage 2 and 3 practitioners two centuries ago!!
It was really mastering the repertorization as a process and technique.
and finally it was knowing my core remedies.

Conclusion

I am back to where I started.
Today I realise success is not about access to more remedies or more books. It is about access to more depth, quality and richness of the information in those books and the efficacy of your tools to find that information effectively. That is crucial.
That rural clinic opened my eyes and made me a more grounded practitioner using the best of all four stages.
So although I continue to enjoy my prescriptions that are rare and special, I know deep down that these patients would have done well even if that remedy wasn't available. It would have been a bit of zigging and zagging but we would have reached the destination no matter what.

So the bottomline is that we can be perfectly successful with less than a handful of remedies or we can still be frustrated with every remedy in the world at our disposal.

What is more important is knowing what to do with them.

I would really love to know what your thoughts and experiences on this….

Further it would be great to know your version of the answer to my student's question.

Has the increase in new remedies helped homeopaths today become more successful practitioners?

Discussion:

Please login or register to post your comment. Registration is free.

Hi Shilpa,
I concur with your conclusions - that the quality of remedy selection is more important, than quantity.

I would like to add that what makes at least the other half of a successful prescription, as well as the selection of the Simillimum, is the optimum potency selection and the ongoing management of this prescription with the patient, beyond the first prescription. A well selected Simillimum given at an underwhelming potency results in a disappointment, but how do you detect where the mistake was made? Would most prescribers then go on and change the remedy, rather than the potency?
Best wishes,
Peter Berryman

The vast number of proved remedies has added mostly confusion. I slowly came to the conclusion that if I learned a handful of remedies, mostly those from the past, I'd be able to treat whatever came my way. The key would have to be my own skill and not the number of remedies available. Since I treat mostly animals, mentals exists only insofar as they can be observed by physical behavior; i.e. a cow bawling long and loudly after her calf is removed, a dog refusing to eat or drink after its owner dies or is hospitalized, a cat that develops breathing problems when a new, aggressive cat enters the household, a goat follows someone around like a dog, just seeking companionship.

I have on hand about 100 remedies and have mostly used only a handful, and rarely need to order a remedy I don't have. When I first started seeing all the new provings, I was excited. When they increased in number by leaps and bounds (over 3000 today, another homeopath told me), I have to wonder what the purpose of the provings really is.

Hi Joy
Thanks for bringing this up. I would like to add something more on the purpose of new provings. I think we absolutely need new provings. They add new choices and tools into a system that is dynamic and evolving.
What we need is the diligent effort and time after a proving that ensures they can go on to become new polycrests with a rich clinical picture.

And is not fair to just leave the entire responsibility on the proving team. They need our support. Possibly we as a community need to find ways of creating better collaboration with the master provers, repertory makers and clinicians to make that possible.
Food for thought...

Joy, I weigh in here to thank you for your contributions to the discussion regarding veterinary homeopathy. My introduction to homeopathy was with my veterinarian, who uses a range of holistic methods to treat her patients. Like you, she keeps about a hundred homeopathic remedies on hand; I've not asked her how often remedies other than the classical polychrests are indicated in her practice (but you've sparked my interest!). The value of keen observation and interpretation seems to be the key in veterinary homeopathy, as well as "training" the human client to develop those skills, particularly in cases of chronic illness. Potency selection, repetition, and adjustment are crucial, as well. For patients who cannot speak for themselves the practitioner's intuition is truly a gift.

Oh, I do like this blog, Shilpa. You call the new remedies 'Fascinating' - and that is exactly the trap!

We can get so lost in all those weird and wonderful new remedies and symptoms, that we totally lose sight of our beautiful traditional approach.

It's just so tempting to stroke our ego by being ever so psychological, with-it and interesting, when we play with some new pundit's unproven approach. It's the patient that suffers.

In one of my cases, a patient came from a very experienced homoeopath, who, it seems, had got somewhat bored with the 'the usual', like polychrests. This patient had been treated for quite a while with (amongst other things) Swan's Blood (Cygnus Cygnus), and similar.

One prescription of Arsenicum went through like a ball in a pin-ball machine, going: "Ding!" in every layer. That was years ago, she never needed another remedy.
Remedies used to be included in the repertory only after there were a certain number of confirmations from homoeopaths using them in their practice.

Nowadays we get so impressed by some travelling guru's clever way with words (funny how they're so often males...), that we throw out important guidelines like that.

Hi Shilpa: The addition of innumerable unconnected half-proven, semi-proven, mind only meditative proving remedies, is in my opinion, self defeating to Homeopathy and makes something meant to be pure and simple unnecessarily complicated. A popular homeopath was once asked why so many new remedies are needed and the reply was that each individual is unique and with the advent of allopathic suppression, stress, lifestyle, increase in patient population seeking homeopathic treatment etc, the new uniqueness cannot be fitted into the previously known familiar remedies. But if we try to find a remedy to match each individual in the world, it will be a logistical nightmare. Let's say a country has 100K individuals and 10% (or 10K people) seek homeopathic treatment. Lets say 50% of them (or 5K people) fit into known remedies and remaining 5K people need an unique remedy. Right there, we would have increased the MM by a need for 5K new remedies. Homeopathic pharmacies would run out of space and practioners would need supercomputers to run our repertorial searches. This may sound funny but I say it with much sadness as I don't think I can stop the trend going on now. Hiroshima trees, Berlin wall, T-Rex dinosaurs etc are all proved. Why stop with that, why not prove the Great Wall of China, Moon rocks, Elvis's music? I am not trying to be facetious, in fact, it breaks my heart why folks don't stop, think for a minute of where this road will lead. No doubt, each of these has its own energy, but one is better off to do full fledged provings of remedies from each genus, species, family and if one must prove the basic notes of music, so be it. But if one starts proving each song (a a young Elvis tune, a middle aged Elvis tune, then an older Elvis tune etc)..well, you get my drift. I mean no offense, just trying to keep Homeopathy alive for future generations. Vithoulkas' software uses only the well proven remedies and does not ascribe to every remedy under the Sun. In conclusion, my experience is that one remedy rarely covers the same patient from birth to death, new provings are necessary but lets try to stick to the things as close as occurring in natural state as possible. Thanks - Philip

Hi,
Until we don't have a nice tool (software/repertory) for new remedies we should rely on completely proven remedies. Though some new remedies have made their space in practices but it is difficult to retain them in memory like wonderfully proved remedies.
Thanks Shilpa for a thoughtful article.

Dear Shilpa
I find your blog interesting,and debateable.I use only basic remedies in my practice.Of course new research and remedies a may be useful in clinical practice.We should at least learn new remedies and their repertorisation for the symptomology.
I uses rubric selection in my rural cases and some handful remedies are most important in everyday practice.Before using new remedy ,we must know well about the effect of the remedyIn every scientific field research is going on and new
medicines are coming in the pharmocology, but time will show us that how much new remedy is useful in the treatment.We must know well about the remedy and its effect on the individual person while treating the patientBest selected simillimum gives good results but some times we have to change the potency from low to high one.Only one remedy does not prove and cover the same patient.I agree with your opinion that the quality is important then quantity.I like your blog and want to know more about your experiences.
Thanks Shilpa and regards.
Asefa.

Great discussion, by the way if there is an Elvis proving (early years please) then I'm IN!

Hello Dr. SHILPA,
Thanking you very sincerely for highlighting this important issue in a open forum for discussions !
While sharing my experience during the period of last 35 years, I must mention that most of my difficult cases have been cured with the well proven remedies.
2. However, I must admit that in some cases, there were needs to look for some other remedies,as per requirement of the patients - where the patients' picture did not match the classical drug picture of the well proved remedies. Then, I had to search for the similar remedy amongst the newer remedies.
3.The real difficulties I felt in my search was dearth of accurate clinical picture of the newer remedies in most of the books available in the market ( where as very beautiful clinical pictures are available in the classical Books of DRs. Kent, Farrington, or G. Vithoulkas' Essence etc.).Probably, this is the main reason for our failure with the use of the newer remedies.
4.But with the increasing complexities of the modern life and widespread uses of ultramodern antibiotics/ steroids, I strongly believe that there are increasing need of the newer well-proved remedies with sufficient clinical verifications.
With best wishes and regards to all concerned !
-Sreejit Dutta Gupta, Kolkata

Hi Shilpa,

I would like to confirm that I am a staunch fan of HomeoQuest software and have been seeing impressive results using it. I specifically like the quest feature in the software that can go into several repertories and MMs on the search criteria entered and help me find which could be the more matching remedy. Thanks again for developing such a wonderful piece of software which I feel is a hidden gem among homeopathy softwares that I have seen. Convey my regards to Atul for taking interest in developing this software.

Maruti

Hi again Shilpa :)
On the point of quality versus quantity of remedies, may I try and make a plug for the quality of remedy preparations.
A Homoeopathic Pharmacopeia is considered the legal standard for preparing our remedies, so most of our manufacturers follow along these lines, more or less. But when we prescribe even a well known remedy to what seems an obvious patient profile, and NOTHING significant happens, usually we think it's our fault - some hidden obstacle went undetected, maybe even something so simple as the potency and dosing weren't optimal, etc. Does it ever cross your mind that the fault was actually in how the remedy was made! Hahnemann recommended making our own remedies so we could be thoroughly responsible for all our patient outcomes, rather than rely on the Apothecaries preparations. I'm not challenging the integrity of our Homeopathic Pharmacists - they're following a Homeopathic Pharmacopeia, which is where we could be led to do this dance of discontent. Having taught Homeopathic Pharmacy, and made remedies for extemporaneous dispensing for many years I know a little about what can go wrong here that the novice practitioner may not realise.
So, rather than having more new remedies, how about making our faithful polycrest remedies better, so they work better, and we all experience less discontent :)
Cheers,
Peter Berryman

Thanks for flagging this Peter.
I agree that as clinicians the quality of remedy preparations are one of the last thing that crosses our mind when a remedy does not do what it intends to do.
However I do not believe the answer is making our own medicines.
I am all about leveraging expertise within the homeopathic community. While as a clinician we have our own expertise, I am happy to leave the task of creating quality medicines to a good reputable pharmacy.

I think the answer is better communication with our pharmacies and ensuring we get the best quality.

Thanks Maruti for being a part of the HomeoQuest Family.
Really glad that it is effectively contributing your success.

Best Wishes
Shilpa

I learnt from the new Homeopaths at college & this way has helped me to delve deeper with many cases BUT I soon realised that I needed the old masters teachings on Materia Medica. We can get carried away with all the new remedies

Nice blog, Shilpa. Thanks for sharing.
I struggle to remember materia medica pictures. I was so relieved when i was studying homeopathy when one of our lecturers told us that 'you don't have to remember the whole MM - that is why we have the repertory" It was such a relief to me.
I once sat in with Fran Sheffield, who has one of the most successful practices in Australia. I was really surprised that most of her prescriptions were using basic polychrests. No complicated prescribing. Just good, solid, old fashioned prescribing.
I think that what makes you progress the most is not more and more new remedies. It's the patients that keep coming back. That make you go back through their case again and again. So, alongside the learning of new MM, we need to develop the art of inspiring confidence and trust in clients and business skills to ensure they follow up correctly at healthy intervals.
Learning in this way helps you become a great prescriber, which leads to word of mouth referrals and a more successful practitioner!

Hi Shilpa,
With your success rate of up to 80%, what is your understanding today of your 20% fail rate? Is this completely explained by the need of non-polycrest remedies, and so the necessity of 'new remedies'; or obstacles to cure; or chronic disease theory; or the much maligned 21st century health issues; or all of the above; or what?
I went to a seminar years ago and the presenter said that around 10% of the sick population would never be cured, even by the very best of our practitioners, so maybe only half of your 20% of failures might be ever improve-able. Even Vithoulkas only claims an 85% success rate! So might a 90% success rate be as good as it ever can get for any mere human? I really wonder how well Lippe or Boenninghausen did? I wonder if we could we do an audit on their past practices, and calculate their success and failure rates?
Cheers,
Peter Berryman

Most of my cases do fine with the polychrests plus any of the top 100 older remedies plus Carcinosin. I'm a Kentian homeopath, which is my training. However, if I'm having trouble with a case, after changing the potency and changing the remedy, I look to the newer methods and/or the newer remedies.

Yes it has. It has deeper homeopaths understanding about human, life and energy. They don't use more different remedies today but know better what and why they do that they do...

Regards Tuija

Great blog subject Shilpa, thankyou. I went to India and sat in at an opc for 4 weeks a few years ago and was amazed that they seemed to only use about a dozen remedies. i came away from that experience thinking that all I needed to do was put my self to the grind stone and get on with it. No magic here, just get to know your remedies and what they can do. It is the difficult 20% of cases that I post up for others to comment on and where I ask for help. And it helps.

Thanks Sally. It's such a joy to have you as a part of my core group.
You are an inspiration when it comes to learning from networking and communicating.

Hello Shilpa,

What a pertinent question! And what an interesting answer. I will need some time to digest all the information.

In my practice, at is half yours, I find that my most successful cases are those that I understand thoroughly. Sometimes it is a case where the patient walks into my office and so completely expresses a remedy that case taking was simply an exercise in confirmation, sometimes it was a hard and thorough search that led to a remedy I had never heard of before.

If the remedy proving was done right, the information well presented... if I have the MM of the Homeopath that really "gets" this remedy, then the match is a good one and the patient is returned to health.

In short, I don't think it is more remedies, I think it is well trained Homeopaths.

Dear Shilpa,
wonderful blog and comfortable interface, thank you for the chance to be here!
Regarding the topic we are discussing: I guess the new repertory might be connected somehow with the requirements of modern times, without of course excluding the traditional approach to the work. Today we have new poisons, new vaccines, new allopathic medicines, this sometimes requires inclusion of new homeopathic remedies. The key point is the personal responsibility and increasing the professionalism of the therapist.
There is always something to learn and new proposals are not always meaningless.
This site offers access to old but still valuable books and everyone can find a text that lacks in his personal library: https://openlibrary.org/search?q=homeopathy&has_fulltext=true
Kind regards,
Marinella