Dilemma in perception of Keynotes

bookDr Abhishek Udani

One of the greatest challenges of homeopathy is the sheer volume of information the student or practitioners has to contend with. The quantity can be so overwhelming that sometimes the only way to understand case taking, case analysis, material medica and our patient is by breaking the pieces down and looking at them from different angles -even lookin g at things we thought we understood.

In every field of endeavor, it is the things we assume we understand that often lead us to failure.

These problems of perception are the blind spots we frequently came across in our experience of busy practice. We often think that learning another rubric or a new remedy will solve these difficult cases but generally speaking, going back and addressing the blind spot is much more rewarding.

The subject of keynotes perfectly illustrates one such problem. The understanding and definition of keynotes has numerous variations, many of conflict with each other. Many homeopaths claim that keynotes are strange, rare and peculiar symptoms that point to a specific remedy. After going through different books (Guernsey to Murphy) on keynotes some of them represent the common symptoms of remedy.

Others say that keynotes are symptoms that fit only one remedy or a few select remedies, and yet many of our best keynotes fit many remedies. It seems a keynote can in fact, be strange, rare and peculiar, and it can be common, it can fit one remedy or many remedies, it can be a pathologic symptom that fits the disease or a physiological symptom that does not.

So what is Keynote?
According to Webster dictionary keynote means: The basic ideas or ruling principle as of a speech or policy etc. Every patient has keynotes of various remedies. The more remedies you know the more keynotes you can find in any one individual. To be specific, in any individual case did not have 3 or 4 keynotes of a dozen remedies, let alone a single keynote of scores of remedies? So the problem is which knots do we use, if we can even agree on the definition of a keynote?

It appears fact, in our profession, that the definition of keynote is rather ‘fluid’. We believe that understanding this fundamental issue in homeopathy is essential to helping our patients get better.

If you look at any remedy in our materia medica, you will be struck by the fact that three are larger general trends running through the symptoms. This point has struck every classical homeopath from Boenninghausen onward. You could in fact, make list of very one of those large trends and find that some of them fit into even large trends.

For example, Sulphur’s 20, 000 symptoms can be classified into a couple of dozen main trends, and from there into less then ten main ideas. For sulphur, the heat of the head, eyes, face, lips, throat, etc can all be compressed into the general trend of heat.

By looking at the large general trends of a remedy, the landscape becomes uncluttered and it becomes clear why certain symptoms are keynotes. In fact keynotes have nothing to do with how rare a symptom is, as is sometimes mentioned. Keynotes are examples, sometimes chief examples of symptoms that point to large general trends in a remedy.

The reason ‘Sticking the feet out’ is a keynote of sulphur has little to do with how rare the symptom is. In fact, when we come across the different cases, about 15% of cases have this symptom. Rather ‘Sticking the feet out’ is a keynote because it is chief example of the heat sensation of sulphur.

Once we see a keynote as an example of a large trend we can understand how to use them and how they have been misused. Kent says, “The great trouble with keynote is that they are misused, the keynotes are often characteristic symptoms, but if the keynotes are taken as final and the generals don’t confirm there will come failures”

According to Boger running after keynotes while paying scanty attention to the general harmony of the picture has spoiled many cases and it leads to polypharmacy.

Other great stalwarts like Guernsey, Hering, Lippe, Boenninghausen, all used keynotes but only when the keynote represented a larger general process of the patient or remedy in question. This is the point that has been misused by our Homeopaths, and the point that has led to many errors in prescribing.

There are some references keeps in mind dealing with keynotes
oday many people have been studying keynotes as a one way Process. They study the remedy and when patient comes in with those same keynotes, they “ recognize” the keynote and prescribe on it.

Once we find the keynotes that represent the larger issue of the patient we can investigate those. We do not have to pay attention to symptoms that exist in the patient if they do not fit their general state. Every patient has many keynotes of many remedies. This process shows you which symptoms to pay attention to and which ones to avoid.

One of the biggest problems that this model highlights is that we often ‘wrap’ our patient’s symptoms into a preconceived notion rather than trying to understand the whole patient and their general trends as described by Hering and Boenninghausen. We have left out the step of finding the general symptoms of the patient and then finding the keynotes of those general trends.

We can finally understand why symptoms make it into keynote books. Look at the material medica in this fashion: not as a haphazard list of symptoms but as symptoms that represent large, general trends. Then you see that keynote books are listing examples of those large trends, having little or nothing to do with how strong, weak, rare or common symptoms is.

Let’s look at a case, which demonstrates this point:
Mr. JVP is a twelve-year-old boy. His main complaint is chronic headache. They begin in his right occiput and extend to the right temple. They eventually settle over the right eye. The headaches tend to occur after a sports activity (cricket), whether he pitches, or after hard work at school; both situations are due to his competitive nature.

During the headache he becomes sensitive to light, noise and conversation and wants to be alone. He becomes irritable and snaps at his mother if she tries to comfort him in any way. At times he vomits with the headache. Hot showers or hot application to the head ameliorate the pain.

He is sensitive to cold, and shivers easily, even with the headaches. He also has growing pains, mostly around his right shin and knee; though they could be due to an injury he endured playing cricket. The leg pain feels worse at night., when he can also develop cramps in the leg. It feels better if he massages the area or takes a bath (lukewarm water). He likes wram food.

There are two famous keynotes in this case-headache, extending from the occiput to the right eye and vomiting with headache, both keynotes of sanguinaria, which has been given by another homeopathic physican which did not help.

Likewise there are keynotes of Rhus toxicodendron , which also did not help. There are keynotes of many other remedies listed in this short description. Think how many keynotes there are in a full case, where we have 10 pages of notes.

However, looking at the general trends in the patient first, we can list the following points:

1. Right sided complaints, especially headaches
2. Competitive nature
3. Extreme sensitive to stimuli
4. Irritability
5. Warmth ameliorates.

Once we have referred from radar keynotes, we can go to the materia medica and see that Nux vomica represent a good match by having the same keynotes. This process helps us discard keynotes of other remedies because, even though they are keynotes of those remedies, they are not part of a general trend of the patient in question and therefore not keynotes of the patient.
There is a great deal more to say about this topic. By taking the large subject of keynotes and separating it into its parts, we can put it back together and develop a deeper understanding. In most case, it is not the lack of knowledge of a remedy but rather the lack of understanding of how to apply the remedy that creates the problem.

After the different view from stalwarts we should come to the conclusion that “ We have to more emphasize on general picture of case and keynotes use as differentiating point just like we would use as modalities.”

References: –
1 Allen’s keynotes with leading remedies of the Materia Medica & Bowel nosode- H.C.Allen
2 C.M. Boger’s Collected writing-
3 The Genius of Homeopathy-Stuart Close
4 The genius of Homeopathic remedies by ‘Gunavante’
5 The lesser writing of C.M.F Von Boenninghausen- T.L.Bradford
6 The principle and practice of Homeopathy – Richard Hughes
7 Robin Murphy’s Commentary on orgnon of medicine

Dr Abhishek Udani MD (Homeopathy)
Lecturer, Dept of Repertory
Dr V.H.Dave Homeopathic College.Anand. (Gujarat)
Email : abhishek_udani@yahoo.com

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