Arthritis
Submitted by George Vithoulkas
This is a rheumatic case and I have entered all the rheumatic symptoms first as they were quite strong symptoms.
* * Pain in the joints (2).
* * Extremities, pains worse from motion (3).
* * Pains worse wet weather (2).
* * Stiffness in the joints (2).
* * Stiffness in the knees (2).
If these symptoms are evaluated on a flat repertorization one is given the following idea to consider:
* * Lyc., Led., Bry., Kali.bich., Nux vom., Cocc., Phos., Phyto., Lac.ac., Rhus tox., Colch.
From the symptoms given so far it cannot be established if this is a Lycopodium case, a Bryonia case, etc. however, it is still useful to get an evaluation of the case so far by the Expert System which came up with Colchicum as a first choice and Ledum as a second choice. It is an interesting point to note here that if one enters local symptoms the system will bring out remedies that are concerned with local symptoms, i.e. if one enters heart symptoms, it will bring out arthritic remedies rather than the usual polycrest remedies.
I then asked the patient what other symptoms she had and she said she had headaches, starting at 10 a.m. continuing till 3 p.m. and then they subside. This was a wonderful symptom because it was so strong. On checking the repertory, I saw, of course, Natrum muriaticum was the remedy. Immediately I wanted to discount all the other remedies previously indicated because it was possible that this may be a Natrum muriaticum case, but I was not sure yet. So I turned to the flat repertorization again and it showed that Natrum muriaticum was in fourth place. Using the Expert System, Natrum muriaticum is given as the first choice with 194 points and a confidence rating of 90, close to 100. In effect the Expert System was duplicating the way my mind was thinking. The computer was telling me to think of Natrum muriaticum. I now needed to either confirm or negate this possibility.
* * Aversion to the sun (1).
With this symptom added, the confidence rating of Natrum muriaticum dropped by 20 points! This was interesting as one must recall that Natrum muriaticum patients are usually very aggravated by the sun and one is more confident to prescribe it when this symptom is underlined three times. So now I started to be careful. If, on the other hand, the patient indicated that she really loved salt, then one can be sure that Natrum muriaticum would be the correct remedy and a satisfying cure would come about.
However, this question was asked and she stated that she was not very keen on salt, but
* * she liked sweets very much (2).
This new symptom was inserted. Now the confidence rating of Natrum muriaticum dropped even further and all the remedies like Lycopodium, and Calcarea moved up in score. Now one has to rethink the case.
On further investigation it was found:
* * The headaches came every 28 days (3).
This was said with great clarity. This symptom is found in the General section of the repertory, as this modality is not shown in the Head section. One will see this rubric contains Mag. carb., Nux mosch., NUX VOM., puls., SEP, and Tub.
Immediately on looking at this rubric my mind went back to the fact there was no desire for salt and a strong desire for sweets, combined with the 28-day periodicity. Sepia became a good possibility. Now when the computer made the evaluation it again duplicated my thinking and suggested I investigate Nux vomica. and Sepia.
My next question was whether all her symptoms and her general state felt better or worse at any time of day. She advised me that
* * she felt better in the evening (2)!
The remedies in this rubric are: AURUM., Sepia, Med, Lyc. This was interesting. Lycopodium is better in the evening, desires sweets and has some rheumatic symptoms. Normally though, Lycopodium is worse in the evening, only some-times better in the evening and generally worse 4 p.m. to 8 p.m. After 9 p.m. they feel better. This case had different modalities. If she was definitely Lycopodium she would have said, "I am much worse early in the morning on waking". So Lycopodium did not even come into my mind. Natrum muriaticum had also been left far behind.
On further questioning she revealed:
* * she also got headaches early in the morning in bed (1).
As I wanted to check further for Sepia I wanted to know if she was affected by storms and so asked her how she felt in a thunderstorm. She replied that:
* * she felt very happy, full of energy and joy and that she liked them very much (3).
She was quite definite about this! As this was a direct question I had to make sure that this was a strong symptom before I took it and entered it into the computer. Sepia, Carcinosin, Lyc. Are all in this rubric. I had not thought of Carcinosin so far in this case, but I definitely became even more interested in the idea of Sepia. The computer reflected the idea of Sepia, making it the first choice.
I now needed a confirmatory symptom for Sepia. I asked her the obvious question about whether she desires sex/enjoys sex. She said:
* * sex was O.K. but afterwards she felt very irritable (3).
So now we have another interesting symptom; very strong, very prominent. I went to the Expert System and again it advised me that Sepia also has as a symptom: Irritability after sex. I had forgotten this and the system reminded me.
The computer then advised me that I had given it a case where it would be confident to prescribe Sepia. However, I was not happy at this point and wanted to ask further questions. She gave me another three symptoms in which Sepia did not appear at all:
* * Dribbling urination (1).
* * Pain in the lumbar region especially in the morning (1).
* * Weakness in the morning after rising (1).
This did not change my thinking for Sepia because these were not strong symptoms. I was also still making considerations for Carcinosin, Nux vomica, Natrum muriaticum and the other choices given by the computer. Then she gave me a peculiar symptom:
* * A feeling as if the humerus was broken (2).
Because this was a peculiar sensation I underlined it twice. Sepia was not in this rubric either and so the absolute score of Sepia began to come down.
* * Cramps in the legs (1).
I then inquired again about her sexual interest and she admitted that
* * her enjoyment of coition was minimal (3).
This was the final confirmation for me, but even without this symptom I would have had enough to prescribe Sepia. On checking the flat repertorization, Nux vomica, Natrum muriaticum and Lycopodium had more symptoms, Sepia had to be the remedy to give because it fit the symptom picture of Sepia.
This case illustrates how one can interact with the computer in the most beneficial way. Taking the case and then putting in 20 symptoms would not be an intelligent use of the system. This is a refined toll which must be used accordingly. The most intelligent way is to add the symptoms step by step and see the results as they appear. There is a much less chance of missing the remedy in this way. One has to pick out the most important symptoms and then work with these to see what the computer brings out. Unfortunately we cannot cure everything. Some cases are incurable and extremely complex.
Submitted by George Vithoulkas
This is a rheumatic case and I have entered all the rheumatic symptoms first as they were quite strong symptoms.
* * Pain in the joints (2).
* * Extremities, pains worse from motion (3).
* * Pains worse wet weather (2).
* * Stiffness in the joints (2).
* * Stiffness in the knees (2).
If these symptoms are evaluated on a flat repertorization one is given the following idea to consider:
* * Lyc., Led., Bry., Kali.bich., Nux vom., Cocc., Phos., Phyto., Lac.ac., Rhus tox., Colch.
From the symptoms given so far it cannot be established if this is a Lycopodium case, a Bryonia case, etc. however, it is still useful to get an evaluation of the case so far by the Expert System which came up with Colchicum as a first choice and Ledum as a second choice. It is an interesting point to note here that if one enters local symptoms the system will bring out remedies that are concerned with local symptoms, i.e. if one enters heart symptoms, it will bring out arthritic remedies rather than the usual polycrest remedies.
I then asked the patient what other symptoms she had and she said she had headaches, starting at 10 a.m. continuing till 3 p.m. and then they subside. This was a wonderful symptom because it was so strong. On checking the repertory, I saw, of course, Natrum muriaticum was the remedy. Immediately I wanted to discount all the other remedies previously indicated because it was possible that this may be a Natrum muriaticum case, but I was not sure yet. So I turned to the flat repertorization again and it showed that Natrum muriaticum was in fourth place. Using the Expert System, Natrum muriaticum is given as the first choice with 194 points and a confidence rating of 90, close to 100. In effect the Expert System was duplicating the way my mind was thinking. The computer was telling me to think of Natrum muriaticum. I now needed to either confirm or negate this possibility.
* * Aversion to the sun (1).
With this symptom added, the confidence rating of Natrum muriaticum dropped by 20 points! This was interesting as one must recall that Natrum muriaticum patients are usually very aggravated by the sun and one is more confident to prescribe it when this symptom is underlined three times. So now I started to be careful. If, on the other hand, the patient indicated that she really loved salt, then one can be sure that Natrum muriaticum would be the correct remedy and a satisfying cure would come about.
However, this question was asked and she stated that she was not very keen on salt, but
* * she liked sweets very much (2).
This new symptom was inserted. Now the confidence rating of Natrum muriaticum dropped even further and all the remedies like Lycopodium, and Calcarea moved up in score. Now one has to rethink the case.
On further investigation it was found:
* * The headaches came every 28 days (3).
This was said with great clarity. This symptom is found in the General section of the repertory, as this modality is not shown in the Head section. One will see this rubric contains Mag. carb., Nux mosch., NUX VOM., puls., SEP, and Tub.
Immediately on looking at this rubric my mind went back to the fact there was no desire for salt and a strong desire for sweets, combined with the 28-day periodicity. Sepia became a good possibility. Now when the computer made the evaluation it again duplicated my thinking and suggested I investigate Nux vomica. and Sepia.
My next question was whether all her symptoms and her general state felt better or worse at any time of day. She advised me that
* * she felt better in the evening (2)!
The remedies in this rubric are: AURUM., Sepia, Med, Lyc. This was interesting. Lycopodium is better in the evening, desires sweets and has some rheumatic symptoms. Normally though, Lycopodium is worse in the evening, only some-times better in the evening and generally worse 4 p.m. to 8 p.m. After 9 p.m. they feel better. This case had different modalities. If she was definitely Lycopodium she would have said, "I am much worse early in the morning on waking". So Lycopodium did not even come into my mind. Natrum muriaticum had also been left far behind.
On further questioning she revealed:
* * she also got headaches early in the morning in bed (1).
As I wanted to check further for Sepia I wanted to know if she was affected by storms and so asked her how she felt in a thunderstorm. She replied that:
* * she felt very happy, full of energy and joy and that she liked them very much (3).
She was quite definite about this! As this was a direct question I had to make sure that this was a strong symptom before I took it and entered it into the computer. Sepia, Carcinosin, Lyc. Are all in this rubric. I had not thought of Carcinosin so far in this case, but I definitely became even more interested in the idea of Sepia. The computer reflected the idea of Sepia, making it the first choice.
I now needed a confirmatory symptom for Sepia. I asked her the obvious question about whether she desires sex/enjoys sex. She said:
* * sex was O.K. but afterwards she felt very irritable (3).
So now we have another interesting symptom; very strong, very prominent. I went to the Expert System and again it advised me that Sepia also has as a symptom: Irritability after sex. I had forgotten this and the system reminded me.
The computer then advised me that I had given it a case where it would be confident to prescribe Sepia. However, I was not happy at this point and wanted to ask further questions. She gave me another three symptoms in which Sepia did not appear at all:
* * Dribbling urination (1).
* * Pain in the lumbar region especially in the morning (1).
* * Weakness in the morning after rising (1).
This did not change my thinking for Sepia because these were not strong symptoms. I was also still making considerations for Carcinosin, Nux vomica, Natrum muriaticum and the other choices given by the computer. Then she gave me a peculiar symptom:
* * A feeling as if the humerus was broken (2).
Because this was a peculiar sensation I underlined it twice. Sepia was not in this rubric either and so the absolute score of Sepia began to come down.
* * Cramps in the legs (1).
I then inquired again about her sexual interest and she admitted that
* * her enjoyment of coition was minimal (3).
This was the final confirmation for me, but even without this symptom I would have had enough to prescribe Sepia. On checking the flat repertorization, Nux vomica, Natrum muriaticum and Lycopodium had more symptoms, Sepia had to be the remedy to give because it fit the symptom picture of Sepia.
This case illustrates how one can interact with the computer in the most beneficial way. Taking the case and then putting in 20 symptoms would not be an intelligent use of the system. This is a refined toll which must be used accordingly. The most intelligent way is to add the symptoms step by step and see the results as they appear. There is a much less chance of missing the remedy in this way. One has to pick out the most important symptoms and then work with these to see what the computer brings out. Unfortunately we cannot cure everything. Some cases are incurable and extremely complex.
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