The Art of Remedy Differentiation

The following article is extracted from my new book Comparative Materia Medica: Integrating New and Old Remedies. It explores the way in which we compare remedies and the challenges of doing this with the added integration of many new remedies into our materia medica. It uses a three-stage process for each remedy in order to classify symptoms, provide remedy comparisons, and give a perspective to the range of action of the remedy. The three stages are described as Intrinsic, Compensated, and Decompensated, which can be related to the three main miasms of Psora, Sycosis, and Syphilis. The intrinsic/psoric stage relates to more constitutional features seen in a person and identified in a remedy; the compensated/sycotic stage is used for more functional changes and exaggerated or reactive symptom pictures; and the decompensated/syphilitic stage relates to the more broken-down, structurally changed, pathological end point. Many people mainly present symptoms in one or two of these stages, and the skill of a prescriber is to identify the symptoms in each stage.

The ability to identify and differentiate remedies is based on many factors. Every case demands a unique identification process. No single method of analysis works in all cases. Whatever the innovation of analysis methods, strategies, and classifications used, they will only work some of the time. A competent homeopath needs to be flexible in their analysis. The following criteria needs to be considered in the reflective qualities of the homeopath and in the objective skills required:

Knowledge of each remedy from a detailed understanding of the essence or central themes of each remedy and its sphere of action. One needs to be able to identify a remedy from a certain sliver of information given in any case. For example, the ability to know that a case has to be Nux vomica from only the quality of reflexive impatience and anger (the central theme) along with one or two physical keynotes. This quality of “seeing” is part of the daily practice of experienced homeopaths, where the overall “gestalt” of the case is seen and confirmed with one or more keynotes. Each remedy has its own unique pattern, with one or more central qualities that often define its specific image. A knowledge of these qualities of the polycrest remedies needs to be achieved for consistent practice.

Knowledge of the physical symptomatology and pathological limits of each remedy. The study of materia medica has to include these features. Every remedy has a potential sphere of action. One must recognize this unique pattern in a representative selection of important symptoms in a case, whether psychological or physical. This can especially be the case when considering “constitutional” qualities of a remedy, including physical characteristics that clearly lead to certain remedies e.g. keloid scars in Graphites, Silicea, Fluoric acid, and others. This knowledge can be helpful when deciding whether a plant or mineral remedy may be needed. For instance, mostly chronic physical problems with structural compromise need a mineral remedy; acute inflammatory conditions often need a plant remedy.

The ability to see the unique pattern of the qualitative symptoms of each case. Often, the uniqueness is not in the numeric totality of characteristic symptoms but the overall uniqueness that the specific combination of symptoms gives. For example, knowing that the remedy indicated is Phosphorus is based on the body type with long, fine features, a history of pneumonia, a fear of the dark, and a sympathetic nature. Unless there are some other important aspects of a case, it has to be Phosphorus. This is an example of what can be called a “default” analysis. This means that unless there are other qualifying factors in the case, the information listed naturally leads to Phosphorus. In many cases, with seemingly limited data, a good choice can be made by identifying a few characteristic symptoms, keynotes, and qualities of the person. Again, the ability to identify the key characteristics in the case, along with the essential qualities of the remedy, is the key to successful prescribing.

The ability to identify the specific relationship between mental/emotional and physical symptoms. Confidence in prescribing for a case often comes from identifying characteristic symptoms in both mind and body. Most mistakes are made in misinterpreting and misidentifying mental/emotional characteristics. Projection happens in this area, and therefore, greater accuracy is achieved when physical and general characteristics that have an objective quality to them are included in the analysis. However, when you can uniquely combine the mental and physical characteristics, it gives you a greater perspective on many cases, and this balances the analysis with the most holistic view of the person. If possible, all repertorizations should attempt to include both mental and physical symptoms. This is not always possible; at times only mental symptoms may be chosen, and other times, only physical characteristic symptoms may be chosen.

The ability to identify and differentiate objective symptoms with subjective symptoms of the mind (the latter requiring more interpretation and analysis by the homeopath). Objective symptoms are ones that are possible to see merely by the words the patient uses or by the direct observations of the homeopath (or others). They often include qualities such as haughtiness, reserve, mildness, timidity, impatience, sadness, cheerfulness, wit, loquacity, anxiety, fears, etc. Subjective symptoms require more interpretation based on what the patient tells us. Is this grief or mortification, indignation or suppressed anger, forsakenness or mere loneliness, etc.? The ability to recognize the significance of any mental symptom is also very important. The tendency to give vague mental symptoms too much significance can often lead to confusion and mistakes in treatment. Mental symptoms need, ideally, to be strong, and it should be understood whether these qualities are intrinsic to the individual’s constitution or whether they are states of mind that reflect a deviation from the person’s normal state. Even though the latter may in fact be just another reflection of the constitutional disposition, its significance is greater when it is a deviation from the normal mental state of the person. However, reversely, when the prescription is addressing the basic constitutional root of the person, then identifying key intrinsic qualities of the personality can be very useful in confirming a remedy choice. Knowing how to distinguish between the complexity of symptoms and possible layers of remedy images in a case is very important.

The ability to recognize characteristic physical symptoms and differentiate common physical symptoms. Characteristic physical symptoms can relate to the following:
– Anatomical and physiological function, e.g. quality of nails and skin – warts, eczema, scarring.
– Body typology, e.g. head size, obesity, emaciation, narrow chest, etc.
– Specific sensations, which are both characteristic and often of a general nature of the whole case, e.g. burning, splitting, stitching, needle-like pains, etc.
– Symptoms with clear modalities that often relate to a general state of the whole person, e.g. worse or better for motion, heat or cold, pressure, time of day, etc.
Knowledge of pathology can be important in distinguishing common from characteristic symptoms. The importance of qualitative physical symptoms should not be underestimated. The tendency to overfocus on mental/emotional symptoms at the expense of identifying characteristic physical symptoms is a common mistake. This leads to the overuse of common polycrest remedies that are easy to give based on generalized patterns, or obscure little-known remedies based on a few thematic qualities. Both tendencies tend to be based on projection, rather than the facts of a case.

The ability to understand the significance of one keynote in a case. A keynote can be in any area, whether a modality, sensation, focal point of pathology, a mental symptom, or general quality. The importance of this keynote often depends on its intensity, its repetition in different parts of the case (both mental and physical), its unique SRP quality and whether it may be a prominent symptom for a particular remedy. To clarify the last point, a keynote of a remedy may manifest from being the only remedy in bold type in a rubric or the only remedy at all in a rubric. As well, if the remedy is a well-known remedy or a so-called small remedy, and it has a specific affinity for a particular pathology, then it can be an important keynote in the case.

The following remedy is given as an example of the way materia medica is presented in the book, using the three-stage categorization: Intrinsic, Compensated, and Decompensated. Not all the descriptions of the remedy are included due to the amount of information.

Phosphorus
Idea: My survival depends on my ability to know who I am, to balance my need in order to connect and to have space and not burn out and lose myself.

Keynotes:
Openness, sensitivity, excitability, naivety, innocence.
Connecting, clairvoyance, sympathy.
Sensitivity, fragility, thinness. < slight causes, emotions.
Spacey, floating, psychic, disconnection. Out of body.
Fears, phobias, anxieties, particularly being alone and the dark.
Rapid growth, delicate features.
Burning.
Lungs, asthma, bronchitis, pneumonia.
Digestion, liver, gallbladder, intestines.
Bones, spine.
Nerves.
Blood, blood vessels.
Aggravated by cold, better by heat.
Aggravated by changing weather, thunderstorms.
Desires salt, spicy, cold drinks.

Intrinsic stage:
Open, sensitive, sympathetic, connecting, clairvoyant.
Naive, innocent.
Imaginative, creative.
Passionate, sexual.
Anxious, fearful nature.
Chilly.
Thin, delicate, vulnerable.
Aggravated by cold weather. Easily takes cold. Tendency to coughs.

Compare: Argentum nitricum, Bacillinum, Causticum, Dysentery co., Gaertner, Lachesis, Parathyroid, Pulsatilla, Silicea, Thymus, Thyroidinum, Tuberculinum, Tuberculinum aviare.

Compensated stage:
Fearful, anxious, < alone, dark, horrible things, health.
Desires company, needs support.
Too exposed, over-sensitive, suffering from sympathy, cares, psychic awareness.
No boundaries.
Physical fragility, vulnerability, easily fatigued.
Burning pains.
Recurrent bronchitis, pneumonia, coughs.
Throat, larynx and trachea, voice easily lost.
Liver, digestive problems, hepatitis, nutritional problems.
Nose bleeding and easy hemorrhaging.
Degeneration of bones, nervous system, organs. Tuberculosis.

Compare: Argentum nitricum, “bird” remedies, Calcarea phosphorica, Causticum, China, Ferrum phosphoricum, Kali phosphoricum, Lycopodium, Natrum muriaticum, Natrum phosphoricum, Oleum jecoris, Neon, Silicea, Stannum.

Decompensated stage:
Paralyzing fears and phobias.
Spacey, floating.
Anger, rage, losing control.
Exhaustion, great depletion of mind and body.
Mental exhaustion, indifference, difficult thinking.
Neurological conditions: multiple sclerosis, ALS, Parkinson’s disease.
Bone degeneration, caries.
Great burning pain of parts, bones, spine etc.
Lung destruction, T.B.
Destructive blood disorders, leukemia.
Many cancers: stomach, liver, bones.

Compare: Argentum metallicum, Argentum nitricum, Carcinosin, Causticum, Conium, Hydrogen, Kali phosphoricum, Lac maternum, Manganum, Mercurius, Phosphoric acid, Picric acid, Silicea, Stannum, Tuberculinum.

Progression:
As long as boundaries are known, there is freedom and light, and the imagination and feelings can roam free. Once the boundaries are lost, instrinically they identify with the suffering and feelings of others. There is too much sympathy. Physically there is a vulnerable and delicate constitution. There is no strength to resist, and as more compensation is seen, there are increasing fears and anxieties, especially of the dark and of something horrible happening. As decompensation takes over there is greater depletion and weakness with lung, stomach, blood and nerve problems. The body is breaking down with no stamina or reserve. Destructive forces dominate the body.

Characteristics:
Peter Pan
Phosphorus is often described as being like Peter Pan, which has these connotations: eternal youth, flying, floating, ephemeral. Phosphorus has qualities of a mineral, vegetable, and gas. It is one of the broadest and deepest of homeopathic remedies and also can be compared with many other remedies, both well-known and smaller remedies.

Phosphorus is one remedy where the physical characteristics can help identify the remedy–fine features, elegant and refined, the face having an open and delicate quality, or a vulnerable fragility. The bone structure is often small and refined, even in those people with extra weight. Phosphorus people are generally very open but not necessarily extroverted. There is a sense of vulnerability there. This vulnerability, openness, sensitivity, and often refinement creates the foundation for the remedy and its stages of development. When in the intrinsic state, the person can be enthusiastic, passionate, open, responsive, engaged, sympathetic, often artistic and full of life. They are sensitive to what is happening around them and can respond to people and situations in a full way. They can be a bit too vulnerable and even naïve in their relationship with people and become easily anxious and fearful. As the compensated stage develops, they can become too sensitive, too sympathetic, and their boundaries are not clear. They can get spacey, easily tired, and not have enough stamina to endure doing things for a long time. They need to withdraw to recoup their forces, as they easily feel burnt out. Their fears can become stronger, and their imagination can run wild. Physically they may have a vulnerability in the respiratory region, the digestion, or the nervous system. As the decompensated stage develops, they become much more broken down, especially physically with degenerative changes. They become mentally unstable, fearful, angry, and full of rage; they lose all boundaries and become seriously depleted.

Openness, Sensitivity, Vulnerability
The natural, enthusiastic, and open disposition needs distinguishing with Argentum nitricum, which is often more extroverted and expansive than Phosphorus. Argentum metallicum and nitricum may share certain areas of affinity with Phosphorus, including the larynx/trachea and digestive tract. The Argentums can have the same characteristic burning, but they are not as delicate as Phosphorus generally. The fears of Phosphorus tend toward areas where the imagination runs amok–when alone, at night, that something will happen, disease, etc. whereas Argentum focuses more on phobias such as claustrophobia, agrophobia, heights, (see Argentum nitricum chapter).

Physically, Silicea can look like Phosphous and may be compared with Phosphorus when the area of symptoms is in the bones and joints. They have sensitive and delicate constitutions, often thin narrow bodies, and can be quite vulnerable in physical and mental disposition. Both remedies have destructive metabolisms, leading to bone and nerve degeneration. However, the pains of Phosphorus are mainly burning in nature, whereas Silicea has more stitching pains. Silicea often looks paler than Phosphorus and lacks the symmetry in physical features. The Phosphorus physical characteristics tend to be more refined. In the periodic table, Silicea and Phosphorus are next to one another, with Alumina coming before Silicea. Here we see a movement from the confusion and doubt of his identity of Alumina, to the fixed identity of Silicea and the ephemeral identity of Phosphorus, which merges with its surroundings. Following Phosphorus is Sulphur, which also often has a fixed “ego” identity and like Phosphorus can be somewhat self-centered and narcissistic in their concerns about themselves.

On the mental level, the open, charismatic, compassionate, and passionate qualities of Phosphorus can also look like Lachesis, as well as Medorrhinum. The main difference between them though is that with the latter remedies, they are more obsessive and intense, with a somewhat heavier feeling to them, and generally they are not as sensitive as Phosphorus. Lachesis in particular is one of the most extroverted remedies in the materia medica, often expressing itself with wit, jesting, charm, and seductiveness. There can be a sexual quality to all three remedies, Lachesis and Medorrhinum being more aggressive in their sexual presence, but the sexual nature of Phosphorus is well known too (Mind, lascivious; amativeness). In Phosphorus they may give themselves to sexual exploration, looking for more ways to connect to people.

Both Lachesis and Phosphorus have a strong affinity for blood conditions, with conditions such as epistaxis, easy bruising, heavy menses, metrorrhagia, internal bleeding, and destructive processes of tissues. Phosphorus, however, affects the bones and nerves more, with more actual destruction of tissues on a chronic level. The destructive qualities of Lachesis and other snakes tend to be more acute. When describing the two remedies, mention has to be given to Crotalus horridus, often seen as having equal qualities of Lachesis and Phosphorus.

Medorrhinum can similarly have a passionate side and be very sensitive, yet the feeling with Medorrhinum is one of extremism and obsession, a somewhat unpredictable and unstable feeling. Medorrhinum is more likely to have addictions, be it drugs, alcohol, gambling or sex, whereas Phosphorus often doesn’t have the stamina for such indulgences, at least not for long.

Tuberculinum and Optimism
Tuberculinum is perhaps the closest remedy to Phosphorus, along with Calcarea phosphorica, all significant remedies of the tubercular miasm. Mentally, both Tuberculinum and Phosphorus look alike: the imaginative, creative spirit that is always seeking new experiences, that relishes travel, that always sees the positive in all things (Mind, optimistic, Mind, hopeful). Only Tuberculinum is found in these rubrics, but it is a central quality of the Tubercular miasm and therefore, can be seen in Phosphorus (and Calcarea phosphorica) too. The Tubercular miasm want to see the optimal potential of situations and hates to consider limits. The main difference is that the person needing Tuberculinum is more intense and desperate to seek the next thing and is willing to risk it all, whereas Phosphorus has more self-preservation in general and less extreme drive. Both remedies may be indicated in bone and nerve problems, though Phosphorus is seen more in distinct neurological conditions such as multiple sclerosis. They can both have the classic tubercular chest, which is thin and sunken. There is a strong vulnerability in the lungs, and Tuberculinum is often used to complement the action of Phosphorus and address the underlying tubercular miasm. This is often seen in children who always tend to get a cough when the weather turns cold or have a tendency to bronchitis each year, or have chronic asthma.

Calcarea phosphorica will often be compared with Phosphorus, in children and adults, based on the dominant mental and physical characteristics. The Phosphorus component of both remedies will lead them to being compared when a person shows a sympathetic, sensitive character with a strong desire to travel. As known with Calcarea phosphorica, there is a greater dissatisfaction and discontent, as if they can never find what they want. It may be seen as state of ennui (Mind, ennui) or a somewhat depressive, peevish angst, as nothing ever seems to satisfy. When at home, they want to be away and vice versa. This is seen often in young children and especially in teenagers, but can also be seen in adults. Phosphorus has more affinity for the lungs and the liver, whereas Calcarea phosphorica affects the joints and bones more.

This quality of openness and vulnerability is not always easy for a Phosphorus person to handle, so although they are naturally drawn to the “light” of other people’s energy, they easily lose their own sense of identity when around people a lot and therefore need to retreat into their own world. So the natural enthusiasm and responsiveness is often tempered with more of a withdrawn quality in which being on their own is needed. When in a healthy state, they know when they need to protect themselves, but like other tubercular remedies, they tend to burn themselves out and push the envelope, leading to more destructive physical and emotional consequences.

Sympathetic, Naivety, Innocence
When the oversensitive, sympathetic side is prominent, then Phosphorus will often be compared with Causticum and Pulsatilla. Causticum is said to be inimical to Phosphorus and that it should not follow or be followed by Phosphorus. However, keep in mind that this may not be entirely true, in every case. Nonetheless they often need to be compared, based on both the mental picture and their strong affinity for the nerves and joints. Both are indicated in multiple sclerosis and other neurological remedies. Although Causticum can be seen as being open, extroverted, passionate, and sympathetic, this is only in the early stages when they still have the energy, passion, and enthusiasm for life. Later, they become more pessimistic, cynical, and burnt out, and then they look much less like Phosphorus. One distinction between Causticum and Phosphorus is that Phosphorus is often much more connected to people than Causticum. For Phosphorus types, connecting to people is central, whereas for Causticum abstract ideas and notions of fairness and justice predominate. The sympathy of Phosphorus makes it where they feel another’s pain. It becomes their own pain. Causticum is more about the ideas of unfairness, injustice and suffering that they feel themselves, not an individual’s pain. Causticum types are essentially more closed and eventually more suspicious. Phosphorus types are more naïve and innocent. With their boundary issues, they sense the energy around them and pick up on both positive and negative things. It is an energetic oversensitivity, leading them to easily become burnt out. In Causticum, the oversensitivity is more like a wound, a vulnerable state of rawness, which they react to, sometimes by becoming involved in political or social projects or sometimes by becoming hard and cynical (as in the deepened state).

This feeling of naiveté and innocence makes one also think of Pulsatilla, which can often look like Phosphorus–open, sympathetic, passionate, caring, and pleasant. The main distinction mentally is that the Pulsatilla type is often needy for love and care. Phosphorus wants only connection and perhaps consolation, whereas Pulsatilla needs that extra feeling of exclusivity in their connection and consolation. The moods of Pulsatilla are more unpredictable with the characteristic easy weeping or inability to weep. Phosphorus moods are usually more predictable. Physically there are major differences between the two, found in the weather and food modalities. Also, the physical pathology differs. Phosphorus acts deeper in the system, and Pulsatilla is more limited to the mucous membranes, digestive system, menstrual issues and acute and chronic inflammation of the joints.

Natrum muriaticum can also, strangely enough, be mistaken for Phosphorus. While they are both sensitive and sympathetic, Natrum muriaticum characteristically has the opposite type of personality, being more closed and hidden, without the naïve openness of Phosphorus. However, some people needing Natrum muriaticum can appear quite open initially and even over-friendly, which can be compared with Phosphorus. Natrum muriaticum is much more indicated than Phosphorus for unresolved grief or disappointed love, but if that is not strong in the case, then differentiation is not always easy. In that case the differentiation may need to be made on the physicals and generals in the case. If Natrum muriaticum is being considered then Natrum phosphoricum has to be thought of. This remedy is often ignored as a constitutional remedy but is probably needed much more frequently than Natrum muriaticum and can look like Phosphorus. Although Phosphorus often desires company, especially if anxious or not well, at other times they like to be alone and can also feel lonely and isolated, again making a comparison with Natrum muriaticum and Natrum phosphoricum.

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