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 -
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.
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.