Case And Remedy Mapping by Mike Bridger (CCH Principal)

Magnetic compass on a world map

In the early days I was taught that I should find the constitutional remedy for my patients. This later developed into a mad hunt for either the ‘essence’, ‘centre’ or ‘main delusion’  and probably all three, but I can’t really remember since I was so punch drunk from it all. I took some Cocculus and realised that the only central delusion was my own, in believing that there was such a thing.

I didn’t even know my own constitutional remedy! How many people do? It’s a silly question: Natrum Murs’ won’t tell me. Arnicas’ think there’s nothing wrong with them anyway. Anacardiums’ haven’t decided. Pulsatillas’ say: ‘whatever you want me to be!’ Sepias don’t care and Thujas’ just tell me they’re Phos! So, I re-read Kent and saw how he refers in his materia medica to the movement of remedies :Pulsatilla – Silica – Kali sulph or Fluoric Acid in patients; Lyc, Calc and Sulph etc and then it all fell into place.

Poor old Kent. How he has been used and abused by the neo- classicists who claim him for their own. Why has he been cast as the great ‘mental’ and emotional prescriber when he hardly ever did any such thing? Why did he write the other sections of the repertory, apart from the ‘mind’ section, if he only thought mental and emotional symptoms were important? Maybe he was bored of a Saturday evening, didn’t have a telly’ and just wrote the other sections for a laugh. I digress…

For a long time my understanding of materia medica had been stagnant. It hadn’t allowed for the kind of movement that Kent had observed. My remedies were isolated entities, which were called ‘pictures’ or ‘portraits.’  I framed them and stuck them up in my inner gallery. The trouble was that hardly any of these pictures mirrored the patients who came to see me for help.

So I stopped looking at remedies like that. I wanted my prescribing to reflect those attributes that Kent attributed to the vital force particularly a sense of movement, adaptability and intelligence. Remedies became not ‘pictures’ in a material solid sense, but more like images you see on a TV screen never permanent but moving from one image to another. I started to see remedies as colours in the spectrum, without clear boundaries but merging one into another. When does red become yellow or Phosphorus become Arsenicum? I started to observe more closely the shifts my patients underwent from remedy to remedy and began to see those things that Kent and others have observed and written about.

Elizabeth Wright Hubbard  wrote:

It may be said that ideally “one remedy, one dose” should cure, but most cases are so mixed, so confused by miasms, drugging etc, that one should tack against the wind, using more than one remedy.’

The first prescription is a signpost. It gives an idea of the direction a patient is likely to go in. The first prescription is the start and not an end in itself. Knowing the remedy I’m going to give in a case is a good start, but a start to what? I don’t get in my car and go on a long journey to a new place without directions. I need a map.

Each remedy is at the centre of a map of related remedies. Once I know my first prescription I can apply this map to help me navigate my way through the course of a patient’s treatment. This is what I call  ‘Case Mapping’. It has helped me through some tricky clinical situations’. For example:

a) Where nothing happens after the prescription
b) < The remedy
c) Acutes appear
d) Patient improves but stops improving.

I am not suggesting that we start teaching a new method – ‘The Way of Zig-zag’. It is simply a common observation that a patient may get better on one remedy or more than one remedy. This is a matter for the patient and ought not to be to do with the ideology of the prescriber. Some patients move to different states quite quickly. This is true of the sicker ones especially. My job is to focus on the images a patient comes up with, prescribe on that image and have some idea where they might move to next. It is like the pause button on your DVD control. It freezes, you prescribe and the patient moves on, often to another remedy.

One example to illustrate how you can prescribe, the patient does very well and then suddenly starts to decline rapidly. I prescribed Calcarea  Carb  for a woman with ulcerative colitis who did well. She did well but then she seemed to <. I waited and matters got worse.  She started bleeding heavily from the bowel.  Her voice was getting weaker on the phone when she spoke to me and my voice was getting higher with terror. After a day or two I sounded like a pre- pubescent boy chorister.

Times like this you sit in your clinic waiting for the patient’s family solicitor to phone. I sat waiting and half reading a book. It was Hahnemann and on the page I opened, it said that if Calc Carb < then think of Mercury or Nitric Acid.

The patient’s haemorrhaging was bright red so I gave Nit Ac. Within half an hour the bleeding stopped. There were absolutely no other Nitric acid symptoms in the case apart from the bleeding. There are about 150 remedies in the rubric ‘haemorrhage- rectum’.

The relationships I use are not to be confused with those explored by others in relation to families of remedies, either through the periodic table, or the animal, vegetable or mineral kingdoms. I work through symptom similarities or if you like, clinically.

I sometimes base prescriptions on chemical constituents. If I have a Silica child with enuresis or urinary problems I will often give Equisetum with confidence because the plant contains high doses of Silica. If I see equal symptoms of both Aluminium and Lycopodium in a case, I will first give Lycopodium because the plant contains large amounts of Aluminium. A very useful tip because usually time dictates an urgent prescription is where you cannot differentiate Mag Phos and Colocynthis.  Often I am confused and the patient is suffering those agonising neuralgic pains similar to both remedies so I give Coloc because it contains Mag Phos.

It is also worth knowing some of the chemical constituents contained in remedies: Hyos, Strum and Bell contain Atropine; Selenium, Ignatius and Nux contain strychnine. Sepia contains salt and Phosphorus.

 

I have often had to differentiate between Aluminium, Calc and Silica and could never understand why, until I was told by my friend, Lionel Milgrom, that while Silica is inert, part of its job is to mop up aluminium. Aluminium can imitate Calcium in the organism and take its place in the nervous system with dire results. Silica, by mopping up Aluminium, allows Calcium to do its job. Hence their observed close relationship. Essentially though I work from clinical relationships.

There are remedies that sit in materia medica like the joker sits in a pack of cards. They get you into that situation described in books as ‘when the apparently indicated remedy fails to act’. This really means that the patient sits opposite glaring at you, saying that nothing happened and they don’t want to pay you. Of course there are several options open to you. You can say it’s their Karma and that they must have murdered someone in a past life, you can say they must have had Gonorrhoea and not told you or you can call them a liar but none of these options is good for business.

Rhus Tox. is one such trickster remedy.. ‘Useful, particularly in arthritic conditions,’ it says in the textbooks. But Rhus Tox is not deep acting. It can help inflammation of muscles and small joints but it is unlikely to help much where bone and cartilage are involved. If there is severe pathology in the case, it will only ameliorate for a short time, or do nothing at all. You need to follow it with remedies like Calc., Calc. Fluor. Kali Iod. Med., Rad. Brom. or Thuja – whichever is closest to the case. The symptoms in the case may not have changed and they still seem to be Rhus Tox.  But if you don’t give one of these related remedies, there’s nothing else you can do.

Here’s a case example. Girl aged eight had damaged her knee by falling off a swing. I gave her Rhus Tox. It helped a bit. I tried all the potencies to no avail. The only change was that she had got hotter in herself. I prescribed Kali Iod. The knee completely recovered but the miasm will often have the last word. Six months later she falls off the swing again and lands on the same knee. Syphilinum 10m. Knee happy. Girl happy. Mum happy. Most important, I’m happy.

Other examples of these trickster remedies to watch out for are Arsenicum, Pulsatilla, Colocynthis, Mag Phos., Bryonia, Natrum Mur.  They will often need to be followed by a more deep acting prescription.

You might be thinking, ‘But Natrum  Mur is a deep acting remedy!’ It is deep acting in some areas but how many times do we see Natrum Mur indicated in back problems, uterine problems such as endometriosis and yet it hasn’t helped much and needed Kali Carb to do the job.

Sometimes too, you prescribe Natrum  Mur on physical symptoms that started from an emotional trauma. Natrum Mur cannot digest grief at all and does anything to avoid feeling it i.e. develop physical pathology. After the remedy sometimes the physical symptoms improve but the patient shifts to become emotional, hopeless and  anti- social. This isn’t a suppression but probably a return of the original state. You may need Aurum. I have seen Nat Mur shift to Aurum quite quickly. Nat Mur is NOT a good heart remedy. It has very few heart symptoms and is unlikely to help with heart pathology. We assume it is good for the heart  because it has such grief but you would be better looking at remedies such as Naja or Aurum where you have the two elements of grief and heart pathology.

Here’s a relationship that might surprise you – you can see a patient move from Lachesis to Lycopodium. You might see this on the physicals but it’s true mentally too. Lachesis we know is a remedy of enormous primitive instinctual energy, which must find an outlet. For example, they might start thinking their spouse fancies the next door neighbour. They can get venomous; perhaps they want to strangle or poison their neighbour. As they know this is wrong and illegal, they attempt to suppress these destructive impulses by becoming overly mentalised and analytical. This moves them into a chronic Lycopodium phase.

In practice I find it especially useful to focus on the clinical relationships as defined by the similarity of symptoms between remedies. This way if I give a remedy and it does nothing or only a little I know the remedy that will do the trick is similar and related to the one I’ve given.

I spoke a little of Colocynth earlier. You can have a patient who throws those typical colics – > pressure, heat etc.. You give colocynth and it works a little or deals with the pain, but nothing else in the case changes. Here you may need to follow with Kali Carb; in physical acutes the two remedies are hardly distinguishable. On the mental level, you may need to follow Colocynth with its chronic – Staphisagria.

I mentioned earlier the colitis case. This illustrates how a deep acting remedy can < badly and you need to find an acute. I prescribed too deep in that case.

It works the other way around of course. Sometimes I’m prescribing too superficially. I often find Mercury and Nitric Acid holding hands in cases of colitis and similar conditions. My differentiation is often based on the fact that Nitric Acid will be focused around the rectum or close which explains its bright red feature. Mercury can focus anywhere and is likely to be dark blood. Sometimes these remedies do good work but fail to cure. On careful examination I find that the case has shifted- often to Phos. Calc. or Syphilinum.

CASE EXAMPLE

Male aged 22 cut hand on glass. 8 stitches. rx Arnica 200 followed by Hypericum 30.

Day 2) less painful. Patient weak. Hand swollen, yellowy finger i.e. pus.  Rx hep sulph 30.  (hep follows Arnica well)

Day 3)  fingers yellow and swollen, aching joints, tongue dirty, slight temp, restless.

Rx  Arsenicum 200.

6hrs later. No change. Worse. Rx Tarentula 200.

Pains went within one hour, hand less swollen.

Day later. Hardly any yellow. Feels ok. Temp normal.

Day later, clear.

The remedies here were given less on symptoms because many remedies cover each stage so choice was a related remedy.

Some more useful and common examples:

ACONITE                     THE ACUTE OF: SPONGIA, PHOS, SULPHUR.

APIS                             THE ACUTE OF NAT MUR.

ARSENICUM               THE ACUTE OF THUJA, TARENT, PHOS, SULPH.

BACILLINUM               CALC PHOS

BELL                            MERC; CALC CARB; SULPH; KALI MUR.

BRYONIA                     NAT MUR; KALI CARB

CHAMOMILLA              MAG CARB

CHEL                            LYC

CARBO VEG                LYC; KALI CARB.

COLOC                        STAPH

HEP SULPH                 SIL

IGNATIA                       NAT MUR

IODUM                         LYC

LACHESIS                   LYC

NUX VOM                    SEPIA 

PETROLEUM              SEPIA

PULS                           MED; KALI SULPH; SILICA; CALC; AUR; ARG NIT

The remedies above are a ‘pocket guide only’. People see lists in the back of repertories etc but they don’t know how to use them or use them routinely. They are signposts where no new symptoms appear to tell you which path to take. You’ve prescribed an acute remedy and the problem > or goes away to keep returning, but the symptoms have hardly changed from the remedy you chose. Then you can do nothing unless you look to the related remedy. Often this is the chronic or the more deep acting remedy. For the purposes of actual practice both terms are interchangeable.

The process is reversible!  If you prescribe a deep remedy and you get an < without any amelioration but the symptoms haven’t changed but worsened you can look to the acute remedies related to the remedy you have given. (This is often true although in some cases if the acute does little, it’s worth looking at nosodes or causative factors in the case) Others have suggested giving the remedy in different potency but personally I have found this makes matters worse.

The best tip I can offer is to stop looking at cases as if all the remedies that come up are nasty little tricksters apart from the one which is the simillimum. The remedies that come up in the case are probably related whether you know it or not.  Instead of being confused and torturing yourself while you try to select the correct one, see them all as hints as to where the case may go. Maybe these remedies will all be needed at a later date. If you do know your relationship stuff (and if you don’t, you can start by buying my CD!) and you see a group of remedies in your case that are related then it means there is a good prognosis. It means there is a clear constellation or pattern to the case and it can probably be sorted out.

If you would like to learn more about case mapping and remedy relationships Mike Bridger and Dion Tabrett run a post-graduate course – The Orion – once a year over 5 weekends. http://www.conhom.com/orion-postgraduate-homeopathy-course.php. Email info@conhom.com to register your interest and for further details.

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