One of the many things that the WA Branch of AHA did right when organizing the 2006 National Conference, was to engage Roger van Zandvoort, an international expert in repertorial compilation, as keynote speaker.
Roger has been working with repertorial development since 1982, and has compiled the largest and most complete repertory presently available – the Repertorium Universale (RUV). Who better to advise us on the use of the modern repertory?
Yet Roger’s four sessions at the conference were somewhat controversial. They sparked mixed reactions from the audience, and left some quite bewildered. I personally went through three stages; (i) he is wrong!!, (ii) what is he talking about??, and (iii) now I get it.
The aim of this article is to explain what I learnt from Roger’s presentations. As a practitioner and a teacher, I believe his material was both groundbreaking and invaluable in providing us with guidance on how to make the most of the powerful modern repertorial tools available. I learnt a lot from Roger, as I hope you will from this summary.
I will describe my three reactions in turn, in order to more fully explain Roger’s contribution.
2. He Is Wrong!!
Early on in his first presentation, I picked out what appeared to be three errors in Roger’s presentation.
(i) Roger began by saying that most homoeopaths didn’t use Boenninghausen’s repertorial method any more, and that it was no longer taught in the Colleges. Well, I knew that I had taught Boenninghausen in my own College since 1990, and that I knew it was being taught in Colleges in Melbourne, Sydney and Brisbane. So that didn’t seem to be a good start.
(ii) Roger then described Boenninghausen’s method as requiring the use of rubrics covering (a) the location of the patient’s problem (eg. if the patient had chronic headaches, the part of the head where the pain occurred was the location), (b) the sensations/conditions of the problem (eg. was the pain sharp, dull, constant, throbbing, etc, etc); Roger called these the phenomena of the problem, which I think is a useful term, and (c) the modalities of the problem (eg. were the headaches better or worse from movement, rest, hot or cold applications, the weather, pressure etc, etc).
I was taught that Boenninghausen’s method required four elements to make a complete symptom, which was needed to ensure that the analysis covered what was unique in the patient, and thus produce an appropriate short list of remedies to examine in the Materia Medica. George Dimitriadis in Sydney has claimed that Boenninghausen’s works have been incorrectly translated, and has challenged this view (1). However the standard teaching was that Boenninghausen’s complete symptom required four elements – location, sensation, modality and concomitant (eg. a symptom that occurred at the same time as the main symptom, but was apparently unrelated to it, eg. if the left leg of our headache patient became numb every time a headache developed, this would be regarded as a concomitant symptom, and something which made the complete symptom unique to that patient). According to Roger, the use of the concomitant was optional “because it simply does not happen a lot that a patient tells you all four key elements of a complete symptom. My approach, leaving in the middle if Boenninghausen mentions this or not, is simply a more practical one” (2).
(iii) Roger then presented some old cases where the validity of a remedy had been confirmed by results (3). He then showed a “reverse analysis” of each case, ie. he analysed the cases using RUV and the approach he described as the Boenninghausen approach, to see if his method would show up the needed remedy. But in his analysis he did something which at first also seemed questionable – he appeared to ignore the remedy weightings within each rubric, and concentrated instead only those remedies which appeared in every rubric. This raised many eyebrows in the audience, not only my own.
It seemed like our distinguished speaker had a few wires crossed.
3. What is He Talking About??
Roger’s cases, which he presented to support his method, apparently created confusion in some of the audience. Everything flashed on the board quickly, and even though the remedy which was used successfully in the original case ranked very well in Roger’s repertorial matrix, some of us were left wondering – how?
Roger explained that the problem with Kent’s repertory was that it would go into many levels of sub/sub/sub/sub rubrics, but that often only one or two remedies would appear, and that it was dangerous to assume that these few remedies were always going to contain the needed similimum. This point was clearly correct. So what Roger did was break up the single rubric with 3 or four “layers” of sub rubrics, into “blocks”, with just a single part of each symptom being covered in each block.
For example, during his presentation, Roger gave the example of a patient with a headache. The pain occurred in the left side of the forehead, and was worse when straining the eyes. In Kent’s repertory one would look for the rubric;
Head; Pain; Forehead; left; exertion/straining of eyes agg.
But this rubric does not exist. So Roger broke the symptoms into three blocks;
(i) location – left forehead; (ii) phenomenom – pain; (iii) modality – straining eyes.
Rubrics are available covering each symptom. By analysing the three rubrics together, 36 remedies appeared which fully covered the combined symptom.
This is very similar to Boenninghausen’s approach, minus the concomitant. It meant, however, that Roger used some large rubrics, which most of us familiar with Kent’s repertory have tended to avoid as being too large and “common” or insensitive to the analysis of the uniqueness of the patient.
However the large rubrics used for each symptom “block” can be reasonably assumed to contain most of the remedies which have an affinity to the targeted symptom. When they are used, together with the requirement that the remedies short-listed have to appear in every rubric, this seemed to produce an effective short list of relatively few remedies, despite the largest rubrics being used. However it also produced a list which should contain a remedy that matched the patient’s unique symptom.
The confusion some of us felt occurred, in part, because we were being asked to use a Kentian style repertory in a non-Kentian way. One could have used either Boenninghausen’s Therapeutic Pocket Book, or the later Boger-Boenninghausen repertory in this way, but both of those books contained relatively few remedies, and Roger appeared to be finding small and uncommon remedies using his approach.
The matter became clearer when Roger explained what he had done in his new RUV. The RUV is based on a Kentian layout (with some internal restructuring), but includes Boenninghausen type rubrics showing location, phenomena and modality. In other words, it provides us with a Kentian style book with a Boenninghausen content, therefore allowing great flexibility, including the type of analysis described above. As well, Roger’s tireless work over decades has produced a reference including many more entries for the “smaller” remedies, new provings, as well as corrections. It is a massive work.
3. Now I Get It ☺
Finally the pieces began to fall into place.
Boenninghausen’s Method – I had a quiet chat with Roger in the first break, and asked him about the concomitant issue – is it really essential? He appeared to agree that the use of the concomitant was generally regarded as being part of Boenninghausen’s “classical” approach, but that it is not essential, as long as the location, phenomena and modality symptoms/rubrics thoroughly describe the symptom being targeted. Once I mentally classified his method as a “modified Boenninghausen method”, and later still as a “universal repertorial method”, my initial concern lessened.
RUV – to me, the use of the RUV seemed to be very necessary, as did the use of a computer system such as ISIS Vision or MacRep which are platforms for RUV. The method uses quite a few very large rubrics, making manual repertorisation extremely tedious, and I don’t believe RUV is available in book form anyway. It still is possible to use the method without RUV, but probably the results would not be as good. These computer-based requirements represent probably the major limitation of the method.
Rethink – even though I use the “classical” Boenninghausen approach occasionally whenever I see an outstanding concomitant in a case (and I have never known it to fail in such a circumstance), I am basically a “Kentian” in my use of the repertory – ie. find the rubrics which best describe the unique symptoms in the case, provided that there are not too few remedies in the rubric. Roger’s approach required a total rethink to the repertorial analysis; ie. don’t insist on a concomitant, break the symptom up into its basic blocks, use large rubrics which cover each block, and then examine the remedies which appear in every rubric in the final analysis, basically placing less emphasis on the weighting of the rubrics, and more on whether the remedy is covered in every rubric.
4. A Practical Example
The three point summary above is an oversimplification, but hopefully does justice to what I like to call Roger’s universal repertorial method. It is a method of analysis which I believe should be considered and tested by practitioners. My own brief experience with it has thrown up some interesting examples, two of which I will summarise below.
Patient: 70 y/o female.
Presented on 26.1.07 with burning legs, which were also prickling and tingling. Began 6 years ago. Started above the ankles then moved up the legs, and onto the arms (but not the trunk).
“Not so bad when I wake up, then worse from mid afternoon onwards”. A times will waken her and she needs to have a cool shower.
She had had asthma from 18 years of age.
Generally a happy person, sociable and gregarious. “I like to be around people”. Was a chef and used to dealing with people.
Family is very important.
Straight talker. “I am a yes/no person”. Not judgemental.
Her husband described her as thoughtful.
Preferred the warmer weather over her life until her legs started to get hot.
Likes cakes and chocolate. Averse to chillies and very spicy food.
Takes medication for asthma and for her heart (has a leaky valve for 5 years).
The first repertorisation I undertook using RUV had Bar-c 8/18; Nat-c 7/24; Lyc 7/22; Calc-c 7/21; Coloc 7/19; Kali-c 7/19; Mag-m 7/17; Chin 7/15.
I initially prescribed Bar-c 30 daily dose on the basis of the analysis.
9.2.07 reported that Sx were worse. Instructed her to stop the remedy for 4 days then repeat every 3rd day.
22.2.07 when she stopped the remedy Sx reduced to previous level, then no improvement when she took the less frequent dose.
I redid the repertorial analysis using ISIS Vision, and rubrics from RUV. The matrix shown in Table 1 was constructed using rubrics covering location, phenomena and modalities of the lower limbs (her most distressing physical symptom). On the basis of the analysis I prescribed Nat-c 30 daily. Note that this was the 2nd ranking remedy from the first analysis.
13.4.07 reported that the Nat-c has relieved symptoms considerably, and is out of medicine. Repeat.
4.5.07 was going well, but has worsened again last week (coincided with a flare up of asthma).
8.5.07 Second consultation. Rx Nat –c 200 daily as required.
17.5.07 reported that the new potency has removed the leg symptoms. Asthma has settled down.
This elderly patient has serious pathology, and the prescription has not attempted to take all symptoms into account. She came to me for palliation of the leg symptoms which were greatly compromising her quality of life. Using the technique which Roger described, two remedies were ranked 1st and 2nd each time (Bar-c and Nat-c). Bar-c was selected only because it ranked top in the first analysis. It did not help. Nat-c was then selected, and appears to have provided the relief which the patient requested. In many ways the analysis is superficial, but does indicate that Roger’s method using large rubrics can provide an effective short list of remedies to consider, which is the point of the example.
Patient: Female, 65 y/o, solid build.
Presented on 6.3.07 with fibromyalgia, 7 years duration. Began on L upper leg, then spread to large muscles of thighs. Now has spread to both legs, both arms, and the pectoral area.
Pains are burning, very intense at times.
< load bearing, < during motion and exertion, > sitting down.
< morning then < as the day progresses.
Occasionally a muscle “gives way”. Occasionally, stabbing pains whilst sitting.
The pains were first triggered by a stressful event, and are currently < stress.
Good general health over her life. Sleeps very well.
Relationship problems 11 years ago, and still is under stress from this. Has lead to anger,
< feelings of being imposed upon by another person. “I can feel my body tighten up”. “I try to let things go these days, but it is still hard to do”.
Hot all the time over the last 7-8 years (since the fibromyalgia). In general, now < heat.
Using ISIS Vision, and only rubrics from RUV, the following matrix was constructed using rubrics covering location, phenomena and modalities of the lower limbs (her most distressing physical symptom).
The two remedies which covered all rubrics were Nux-Vom and Bryonia. Her general thermals clearly pointed to Bryonia, which was given daily in 200c.
First follow-up 9.3.07 reported less pain, more energy, but sleeping poorly. Upon questioning reported that she is dreaming much more, and despite less sleep she is waking more refreshed. “I feel lighter”, more relaxed.
This response was interpreted as positive, and the remedy is probably working deeply, releasing inner tensions as well as helping with the physical pain. She was advised to begin slowly reducing the frequency of the dose.
Second follow-up 3 months later on 4.6.07, reported that she is feeling very good. “There has been a big improvement”. Is now taking the remedy a few times each week…
Time and again, when we disagree with someone who has “done the hard yards” in an area of knowledge, we eventually find that we are wrong and they are correct. I was personally fortunate to have that learning experience happen in the space of two days (rather than months or years) at the 2006 AHA National Conference.
No one on the planet would understand the construction of repertories better than Roger van Zandvoort, and while the ideas he presented certainly were challenging in the beginning, what he said is of great importance to homoeopaths wishing to expand their repertorial armoury.
I don’t intend to use the universal repertorial method for every case, but I have no doubt that it does provide an immensely powerful tool for analysing complex and difficult cases. It effectively deals with the potential problems with both the Kentian approach of using multi-layered rubrics with too few remedies, as well as the difficulty with the “classical” Boenninghausen approach of needing a strong concomitant to make a complete symptom.
In my own teaching from now on, I intend offering students four repertorial methods to master, and to consider when analysing a case:
Basic repertorial method: especially useful for simple acutes, when the few main symptoms are repertorised in a simple matrix, and a remedy short-list developed.
Kent’s repertorial method: especially useful in cases with strong mental/emotional (M/E) symptoms, where an initial matrix using M/E symptoms is constructed, from which a short list of remedies covering the patient is prepared. The remedies in this short list are then the only ones used in a second matrix which covers mainly the physicals of the case. The results from the two matrices are then brought together for analysis
Boenninghausen’s classical method: Where a location, phenomena (sensations), modalities, and a concomitant symptom must exist, and be used in the repertorial analysis.
Universal repertorial method: where one or more key symptoms are broken down into their “symptom blocks” of location, phenomenom, and modality (with optional concomitant), which are then incorporated into the matrix, using rubrics that thoroughly cover each block, and where the short listed remedies are those that are present in (preferably) every rubric.
None of these methods does away with the need for thorough Hahnemannian case taking. None eliminate the need to try to understand the essential why the patient has the problems they present with (to me, this is the most important question to be answered).
Both the beginner and the experienced practitioner can be confident that we are well supplied with analytical methods to use when the needed remedy is not immediately apparent in our cases. For his contribution to homoeopathy over nearly three decades, Roger van Zandvoort deserves our heart-felt thanks and appreciation. He certainly has mine.