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Becoming familiar with a remedy

I don't think
we can hope to commit much materia medica to active memory. One of my mentors
in medical school, Larry Weed, encouraged us to never memorize anything intentionally.
After many years of study I've learnt that the first time I come across something
new, I look it up. The second and third time I look it up, it's easier to know
where to find it. The fifth and sixth times I look it up, I'm pleased to find
that it seems a bit familiar. Eventually the things I need to know daily are
easy to recall—and the things I need more rarely are at least easy to find.
My goal in studying the materia medica of a homeopathic remedy is to become familiar
with it, not to memorize it.

Studying along the way
I find it most useful to study remedies as they come up in my practice—that
is, as I'm considering possible remedies ("differentials") for a case. A few
years ago I came across Viburnum when working up a case of menstrual pain attributed
to endometriosis, with cramping pain extending down the thighs. When I repertorized
the case using computer software, Viburnum appeared on the small-remedies and
prominent-remedies weighting of my repertorization. I could have just looked
briefly at Viburnum and eliminated it as a possibility (I ended up giving the
patient Caulophyllum), but taking the time to study Viburnum in the context of
that case helped me to learn the characteristic aspects of it, compared with
Caulophyllum, Cimicifuga, Lilium tigrinum, Sepia, Trillium, Secale, Ustilago,
etc. It enabled me to recognize Viburnum and use it effectively in some later
cases where otherwise I might have missed it.

First things first
The first thing I like to know about a remedy is where it comes from and what
it is made from. Clarke's Dictionary of Practical Materia Medica is a
good place to start. Clarke tells us that Viburnum opulus, or Gueldres Rose,
is a shrub native to Great Britain and Europe. He goes on to tell us that Hale
(of Ohio and Michigan) introduced it as a homeopathic remedy on the basis of
its empirical uses by Native Americans and the Eclectic physicians, and that
H.C. Allen (also of the Midwest) proved it in 1881; so this is actually a North
American member of the genus Viburnum—probably Viburnum trilobum, a species
nearly indistinguishable from the European Viburnum opulus. In Maine, we call
it "snowball bush" for its white flower clusters or "highbush cranberry" for
its bright red berries in the fall (though it is not a cranberry by any means).
It's browsed by deer and moose, and the berries are eaten by partridge and cedar
waxwings, a beautiful bird of the northern forests.
     Other good resources for the sources of botanical
remedies include M. Grieve's A Modern Herbal and Charles F. Millspaugh's American
Medicinal Plants
(Millspaugh was a protégé of T.F. Allen who
wrote Encyclopedia of Pure Materia Medica). Both are available in low-cost
paperback versions from Dover Books, though lacking color in the pictures. Millspaugh
is strongest on the native plants of North America, Grieve on those of Great
Britain and Europe.

Close relatives and their similarities
I also find it helpful to look at closely related remedies. Viburnum prunifolium
and Viburnum tinus were described by Hale as well, and are ascribed similar actions
though neither has had an adequate homeopathic proving. These are in the family
Caprifoliaceae, along with Sambucus nigra and Sambucus canadensis, the European
and North American elderberries. If you've studied Sambucus, you'll recall that
it's known for its spasmodic action on smooth muscle, especially on the respiratory
tract and gut, and so we might not be surprised to see smooth muscle spasticity
in the Viburnum remedies as well.
     The related Viburnum prunifolium is traditionally
called "cramp bark," which should tell us something as well. Often the traditional
empirical uses of substances are interesting to us as homeopaths. The homeopathic
Law of Cure tells us that the any truly effective medicinal action is due to
the principle of similars—so any truly effective traditional use of Viburnum
should be due to a fortuitous homeopathicity. Hale introduced a number of traditional
North American medicines to homeopathic use on this basis; and Alfons Teste,
in France, wrote of this at some length as well. The North American Viburnum
species were traditionally used in "painful spasmodic diseases," particularly
in dysmenorrhea, false pains preceding labor, labor after-pains, and threatened
miscarriage.

Relative section sizes come next
The next thing I do is to take off my reading glasses and look at the symptoms
sections in Clarke's Dictionary of Materia Medica, Boericke's Materia
Medica
and/or Vermeulen's Concordant Materia Medica. The reason for
taking off my reading glasses is that I don't want to be bothered with detail—I
just want to see the relative sizes of the sections for each body system. I notice
that in Viburnum there is a pretty big section under the "Head," and the sections
on "Abdomen," "Female Sexual Organs," and "Back" are pretty big as well.
     Putting my reading glasses back on, and scanning
these sections, I notice that the head section is mostly about head pain and,
in fact, that the whole remedy is pretty much all about pain. The terms "cramping" and "colicky" come
up again and again—in the stomach, abdomen, anus, bladder, pelvic organs,
chest and heart, back, legs, and feet, but especially in the pelvic organs—the
uterus and ovaries, related to menses and pregnancy. Boericke tells us it is "a
general remedy for cramps."
     I get the sense that the center of gravity of a
Viburnum case would most often be gynecological—there's so much about colicky
pain in the pelvic organs, it is the largest single section in these texts by
a long shot. Boericke tells us, "Female symptoms most important ... Spasmodic
and congestive affections, dependent upon ovarian or uterine origin."

Jumping modalities
Modalities [factors that cause a patient's symptoms to improve or worsen] haven't
jumped out at me yet so I go to Phatak's Materia Medica for these, then
I go to Hering's Materia Medica to find some more. I find "worse fright," "worse
sudden jar or misstep," "worse in a warm room," "better for open air," and "better
moving about."

Don't be misled
It is important also to not let the above information mislead you. I recall a
Viburnum case in which the patient presented with asthma as her only present
health concern. She was taking oral contraceptives, started in adolescence for
severe menstrual pain that was now only a distant memory. But she did have "suffocative
spells at night"—a symptom in the pathogenesis [disease process] of Viburnum,
as well as its botanical cousin Sambucus. The most important clue to her case,
however, was the description of her adolescent menstrual cramps, now suppressed
on hormonal therapy.

Back to the sources and some more reading
For the pure pathogenesis of the remedy, I like to go to the primary sources— the
symptoms from the provings. Allen's Encyclopedia is the gold-standard,
but Viburnum is not included, so I go to my next choice, Hering's Guiding
Symptoms
. Hering has 8 1/2 pages on Viburnum, and over 1 1/2 pages are gynecological
symptoms. I read the whole remedy from start to finish a few times, not with
an attempt to memorize anything, but rather to carry on familiarizing myself
with the whole picture of the remedy.

Comparing and contrasting
I take one of the strong symptoms next and compare Viburnum with remedies of
similar known action using my repertories. I look up the strong gynecological
rubrics for Viburnum including the bearing down pains before and during the menses.
I go through each remedy in each of the rubrics, comparing and contrasting how
each remedy compares with Viburnum. I continue this process choosing one characteristic
or strong symptom after another.
     Farrington's Clinical Materia Medica is
a jewel at this stage of study. He has two entries for Viburnum comparing it
with Sepia, Caulophyllum, Cimicifuga, and Secale in pelvic pains. As I compare
and contrast, I read the "Female" section in many different materia medica.
     The "Relationships" section of the materia medica
is another useful place to find remedies to study in comparison. Boericke and
Clarke suggest comparing Viburnum with Cimicifuga, Caulophyllum, Chamomilla,
Sepia, Secale, Gossypium, Lilium tigrinum, Ustilago, Belladonna, Pulsatilla,
Sulphur, and Calcarea carbonica. Hering more concisely suggests Cimicifuga and
Caulophyllum.

Digested materia medica
Only after I have completed the above process will I go to a heavily-digested
materia medica like Margaret Tyler's Homeopathic Drug Pictures for a "summary
description" of the remedy. I expect to find nothing new here, and I look simply
for a re-statement of the image I'm already forming. If there is unfamiliar material
here, it serves as a nudge to go back to the primary sources to check the symptoms
again.
     I'm now beginning to develop an appreciation of
the "essence" of Viburnum. I hesitate to even try to put this into words, because
each person has to go through the same kind of process that I've just described
to gain their own sense of familiarity with a remedy. This is what I ended up
concluding for Viburnum: "spasmodic cramps and congestive, colicky pain."

Familiar friends and relatives
Each time Viburnum (or another unfamiliar remedy) comes up for consideration
in a case, I repeat this process. Each time the process is quicker, and each
time I add a new dimension to my understanding, until this unfamiliar remedy
becomes a bit like a familiar friend or relative—which happens to reside
in the homeopathic materia medica.

Sidebar:
Materia medica What is it? Why study it?
The term "materia medica" is Latin for "medical materials." In homeopathy, our
medical materials are homeopathic remedies, and "materia medica" refers to the
indications for using these remedies. The term also describes the books in which
these indications are compiled; they are essentially dictionaries or encyclopedias
of homeopathic remedies, giving detailed indications for the uses of these remedies.
     The indications of each remedy are discovered primarily
through provings. A "proving" involves the testing of a substance on a group
of healthy volunteers for its effects. The symptoms are recorded and compared
to produce the information that defines that particular remedy. Each homeopathic
remedy has its unique symptom expression and these symptom profiles are recorded
in the homeopathic materia medica.
     After taking a patient's case (i.e., interviewing
them and recording their symptoms), the homeopath will analyze this and, by comparing
the symptoms to the remedies in the materia medica, seek to find the single remedy
that best covers the patient's mental, emotional, and physical symptoms.
     There are currently some 3000+ remedies listed
in the homeopathic materia medica. This list is continuing to grow as new medicines
are proved for their therapeutic potential on groups of healthy humans.
     Familiarity with the keynote symptoms of at least
two hundred of these remedies constitutes the basis of a good professional homeopathic
practice. To practice effectively, homeopaths continually add to their knowledge
base by increasing the numbers of remedies with which they are familiar.

Sidebar:
Studying materia medica. Advice from the NCH Summer School
by Julian Winston

One of the big questions students always ask, when confronted with the sheer
size of the homeopathic materia medica, is, "How do I study this?"
     Back in 1987, Jacques Imberechts, MD, of Belgium
was one of the teachers at the NCH Summer School. One day he discussed a methodology
for studying a remedy. This is it: Pick a remedy you want to learn about. On
Monday, read about the remedy in the introduction (the narrative) in Clarke's Dictionary
of Materia Medica
. On Tuesday, read the remedy in a materia medica such as
the ones by Boericke or Phatak. On Wednesday, read it in a narrative materia
medica like Kent's work. On Thursday, read it in Hahnemann's Materia Medica
Pura
or the materia medica in his The Chronic Diseases. On Friday,
read it in Hering's Guiding Symptoms. On Saturday read it in another materia
medica, such as Allen's Encyclopedia, Nash's Leaders, Dunham's Lectures,
or Farrington's Lectures. On Sunday, write down all you know about this
remedy. What you write is what will remain with you.
     A few years later, I heard André Saine,
ND, talk about the methodology he suggested: Learn one remedy in depth. (He usually
starts his classes with Lycopodium.) When you have learned that remedy, go to
another. Contrast and compare them (e.g., that one is right-sided, this one left-sided,
that one has an aggravation from heat, this one has an aggravation from cold,
etc.). André Saine said that when you've learned about 10 remedies by
comparing and contrasting in this way, the next 90 remedies take about the same
amount of time to learn, because you are looking at contrasts not at detail.
You read a new remedy and can say, "It is similar to remedy 'X' in the time modalities,
but like remedy 'Y' in the cravings." So when you are presented with a case,
you have that information readily available in your knowledge base. And then,
learning the next bunch of remedies is even faster. This method focuses on seeing
the underlying characteristic symptoms of the remedies.
     Stephen Messer, ND, DHANP, taught the concepts
of materia medica in an interesting way. He had the class read the materia medica
of a remedy, say Nux vomica, in Boericke's Materia Medica. He then asked
the class of practitioners, "For what conditions would you prescribe this?" When
the list was written, he then asked, "Why this remedy and not another?" The class
immediately began to see the unique nature of the remedy based upon the modalities
(e.g., the headache came on after a night of drinking, etc.).
     Remember J.T. Kent's dictum: "Memorizers have no
perception." You do not want to memorize. You want to understand.

About the author:
Will Taylor, MD, is a board certified family practitioner whose own intractable
case of shingles led him to homeopathy 12 years ago. Since then, he's earned
a reputation as an exceptional teacher. He recently moved from rural Maine to
Portland, Oregon, to chair the National College of Naturopathic Medicine's Homeopathy
Department. He also teaches regularly at the School of Homeopathy, New York.
He is publishing his book on case analysis strategy, Taking the Case,
in monthly installments online at www.wholehealthnow.com.