Review of Boenninghaussen’s lesser writing the characteristic value of symptoms

Dr Appu Gopalakrishnan

Bönninghausen, the lawyer, went further in his search for a simple yet systematic method to capture all aspects of the patient. In an essay, “Concerning the Characteristic Value of Symptoms,”  he writes that in his literary studies he came across some verses in the form of a hexameter dating to the beginning of the twelfth century attributable to theological scholastics.

THE HEXAMETER
It was used by the monks to judge “a moral disease,” that is to say, “the peculiarity and grievousness of various moral lapses.” It immediately struck Bönninghausen that it contained “all the essential momenta which are required in the list of the complete image of a disease.” 

The verse is: “Quis? Quid? Ubi? Quibus auxiliis? Cur? Quomodo? Quando?” These seven are translated: “Who? What? Where? What else? Why? What modifies? When?” 

  1. Quis? or WHO?

It includes: gender, age, bodily constitution, temperament (personality) and individuality (nature). “The greatest and most important variations are here found mostly in the states of the mind and spirit…” 

Bönninghausen, ever the careful student of Hahnemann, here echoes his mentor’s words, “…and in all cases of disease we are called upon to cure, the state of the patient’s disposition is to be particularly noted along with the totality of the symptoms…” 

Modern students are wont to suggest that Therapeutic Pocketbook/TBR is all right for pathological prescribing but lacks when it comes to mental/emotional diseases. Clearly, Bönninghausen emphasized the importance of the mental state. He wrote, “In all such cases [states of the mind and spirit] we have all the more cause to fathom these states with all possible exactness, as in them frequently the bodily ailments recede to the background…”

Bönninghausen was reluctant to prescribe a medicine that simply repertorized well. He wrote, “A great number of medicines are thrust aside, just because they do not correspond to the personality of the patient.” 

On the other hand, it is very possible to prescribe successfully recombining symptoms without regard to the mental state. 

2.Quid? or WHAT?

This refers to the disease, its nature and peculiarity and the need for pure observation. The homeopathic medicine, he stated, “must correspond with the common genius of the disease”  which is to say it must match the salient, characteristic  symptoms.

The word, ‘characteristic’ is used frequently in homeopathic literature to mean a distinguishing trait or quality.

 3. Ubi? or WHERE?

This part of the hexameter refers to location. Pure observation, hallmarks of Hahnemann’s method, noted that homeopathic medicines can and do favor specific parts of the body. To the extent that location does matter, one cannot accuse Bonninghausen of ignoring it. He was quick to observe that various medicines affected one or the other side of the body, that perspiration could be of the part, etc. What Bönninghausen generalized was sensation and modalities. A symptom of Sepia that Bönninghausen assumed was well-known was “sores on the upper side of the joints of fingers and toes,”  noting, “every homeopath knows the efficacy of Sepia in these ulcers of the joint.”  Strange, that no modern homeopath ever mentions this symptom

4.Quibus Auxiliis? or CONCOMITANT (accessory) symptoms.

These are symptoms accompanying the main complaint. Grasping the idea of concomitance is often daunting for the beginning homeopath as, clearly, all symptoms in a disease are appearing together. Why then would one want to mention something so obvious? Bönninghausen was quick to point out that “those ailments which are wont to appear as constant concomitants or at least as usual in the disease” can be omitted unless they are “distinguished by some rare peculiarity.”

A familiar concomitant is when the menses are attended by headache or gastrointestinal complaints, etc. Sometimes a concomitant symptom rarely appears in connection with the main complaint or it can “belong to another sphere of disease than the chief ailment.”  Kali bichromium is an example of the latter as it can have sinus problems and stomach problems or sinus problems and sciatica. 

            5.Cur? or WHY?

The causes of disease are varied and are often a factor in deciding the remedy. Some proximal causes: trauma, toxic exposure, drugs, emotional, ‘never well since’, exposure to inclement weather (cold and wet, sun, etc.). Miasms: psora, sycosis, syphilis.

6.Quomodo? or MODALITIES (modifying influences)

Often the most useful of the seven momenta. It includes: food & drink, weather, position, heat, cold, etc

7. Quando? or WHEN?

Time or onset; time of aggravation ; sequence of events.

Quando can often be included under Quomodo unless it refers to the sequence of events or chronology.

KENT’S VIEW

Kent divided symptom in to

  • General
  • Particular
  • Common
  • General symptom

General symptoms are those where patient says I feel

General symptom divided in to mental generals and physical generals

  • Mental generals

1st grade – will and understanding

2nd grade – intellect and understanding

3rd grade – memory

  • Physical generals

1st grade – reffering to sexual sphere including menstrual generals

2nd grade –symptom refering to appetite ,desires etc

3rd grade – things affecting entire physical body ,eg weather ,climate ,bathing

  • Particular symptom

Symptom related to particular parts or organ or function of the body

  • Common symptom

These symptom are common to all particular disease or are found in several patients as a common factor .they are usually of secondary importance and play no much role in selecting simillimum

Common symptom are diagnostic of disease

  • Characteristic symptom

Characteristic symptom are diagnostic of individual suffering from disease

They are strange ,rare , pecuilar .

  • Grading of symptom

Symptoms are ,Recorded- in proving ,Confirmed-by reproving ,Verified- by clinical use on sick

  • Grading of symptom

Grade 1 –symptoms proved ,verified and confirmed

Grade 2 – symptom that are proved on some provers ,but have been confirmed and sometimes verified

Grade 3 –provers have brought out a symptom which has not been confirmed but has been verified clinically by some 

H.A ROBERT’S VIEW

In evaluation of the case, the value of symptoms must be taken into consideration on several points

             GENERALS-MENTAL &PHYSICAL

             LOCATION

             CONCOMITANT SYMPTOMS

             CAUSATIONS

MODALITIES

             CONTRADICTORY SYMPTOMS

             DIAGNOSTIC SYMPTOMS 

GENERALS 

STUART CLOSE’S CONCEPT

  • A symptom is any evidence of disease, or change from a state of health.

• A symptom which appears trifling to the careless or superficial examiner may become, in the hands of the expert, the key which unlocks a difficult problem in therapeutics

  • We have here the basis of the common division of symptoms into two general classes –
  • Subjective and Objective. 
  • Subjective Symptoms. –

        Subjective Symptoms are symptoms which are discoverable by the patient alone, such as pain and other morbid sensations of body or mind, presenting no external indications. 

  • Prior to Hahnemann’s time two of the most frequently occurring and important groups of symptoms were practically ignored-the mental symptoms and the subjective symptoms.
  • Totality of the Symptoms” is an expression peculiar to homœopathy which requires special attention.  It is highly important to understand exactly what it means and involves, because the totality of the symptoms is the true and only basis for every homœopathic prescription. 

” The Totality of the Symptoms means, first, the totality of each individual symptom.

  •   A single symptom is more than a single fact; it is a fact, with its history, its origin, its location, its progress or direction, and its conditions.
  •     Every complete symptom has three essential elements:-Location, Sensation and Modality.
  • By location is meant the part, organ, tissue or function of body or mind in which the symptom appears. 
  • By sensation is meant the impression, or consciousness of an impression upon the central system through the medium of the sensory or afferent nerves, or through one of the organs of senses; a feeling, or state of consciousness produced by an external stimulus, or by some change in the internal state of the body.
  •   A sensation may also be a purely mental or physical reaction, such as fright, fear, anger, grief or jealousy. 

By modality we refer to the circumstances and conditions that affect or modify a symptom, of which the conditions of aggravation and amelioration are the most important.

 REFERENCES

  1. THE LESSER WRITINGS OF C.M.F. VON BOENNINGHAUSEN
  2.  LECTURES ON HOMOEOPATHIC PHILOSOPHY –J.T KKENT
  3.  THE PRINCIPLE AND ART OF CURE BY HOMOEOPATHY – H A ROBERTS
  4.   THE GENIUS OF HOMOEOPATHY – STUART CLOSE