Taking Symptoms for Repertorization and Learning the Criteria for Underlining -by George Vithoulkas

Taking Symptoms for Repertorization and Learning the Criteria for Underlining

The Third Dimension in Homeopathic Prescribing
by George Vithoulkas

One can usually never find the remedy in a case when one simply looks at the totality of the symptoms in a flat way, without making an evaluation of them. Every case has some depth, has individuality, has peculiarity but most of all a center of action. To find out these factors I would ask my students: "Tell me what is the most important thing that you saw in that patient?" They would then tell me what impressed them the most, such as, "I felt there was so much grief in that person's life, or, his face was so vacant looking." This, then, is the information that has to be underlined three times.

Then other symptoms need to be underlined twice, or there may be some which are not strongly expressed by the patient and will need only one underline. The same is true when I am taking a case. "What are the symptoms that are expressed with the greatest intensity and how are these symptoms being expressed." Sometimes important symptoms can be hidden, as when a person withholds information because he or she fears ridicule as a mental case.

Perceiving this hesitation is crucial, as one has to assure the patient they will not be judged, and have a safe and supportive environment in which to speak freely. These difficult-to-express symptoms are often the center of the case. Once put into the language of the repertory they become strong, unusual and clear symptoms that will help to solve a case. In this way one can come to an authentic evaluation of the symptoms and build a three-dimensional understanding of the illness.

The Vithoulkas Expert System (VES) software program
is based on this same three-dimensional idea. It is programmed to search for the same three-dimensional picture of each case that is fed into it. If the symptom is underlined three times it tells the computer to take this symptom strongly into consideration and give a high value to the remedies that also are listed as three points for that symptom. The remedies listed as "two" and "one" underline will be given lower confidence scores for that symptom. In effect, if you tell the computer to look for Mount Everest by describing the most characteristic trait of its height then it will come up with "this is a picture of Mount Everest" and not "this could be any mountain in the Himalayas."

The program will also give stronger values to remedies in small rubrics. Therefore if we tell the computer to look for a tall, thin, black-haired man with a white beard it will find him, because although the "tall" and "thin" give some help, the black hair and white beard is strongly characteristic.

Now if this man has one blue eye and the other brown then this becomes a super characteristic symptom and it is a real keynote, which will be of immense help in finding this "remedy" in the program. So this is the type of information we must try to put into the computer for each case so that it has an opportunity to "think" of all the possibilities and come up with suggestions not possible in a regular flat repertory process.

This program works best when underlining is done according to the severity and frequency of the symptom. One underline means a symptom happens sometimes and with not much severity. Two underlines mean the symptom is either severe or frequent but not both. Three underlines mean the symptom is both severe and frequent. Four underlines mean the symptom is very severe and very frequent. Other criteria that influence underlining are clear mental symptoms, peculiar symptoms, strong general symptoms, clear and strong modalities, causation symptoms, spontaneous symptoms or clear symptoms. One or two additional underlines can be given if one or more of these criteria exist for a symptom, and definitely one is encouraged to repertorize these symptoms first.

Once you have made a decision on the underlining, then you can take a look at the remedies in that rubric. It is better not to look at the remedies first because there is a tendency to choose the underlining that fits the remedy you want to give. The whole exercise is to get a second opinion from the computer, based on facts, and then seriously consider the insights given to you. This is how you will make a breakthrough in your prescribing habits and discover prescriptions you never considered before.

First scan the rubric, look at its size and what degrees the remedies are in. If there are any remedies that are in bold capitals and underlined, it means this remedy is listed as four underlines. This is significant, and a special mental note should be made to check out if the patient is needing this remedy. This is especially true if you have underlined that symptom four times in your cases notes.

Find the rubric, "fear of thunderstorms" and you will see Phosphorus listed as four underlines. Next look at the remedies written in capitals, which is the designation for three underlines. Again ask questions to see if the patient could require one of these remedies.

These remedies are more significant if you have underlined that symptom three times. Last of all, look at the remedies written in italics for the first letter designating two underlines and the plain type remedies as one underline. It is especially important to look at the remedies with two and one underlines if you have not been able to confirm a common or polycrest remedy. For example, I had a case of a patient who experienced a rejection in a relationship. For months after she could not get out of a severe depression from this experience. I gave her the common remedies for grief and abandonment with no success.

Then one night she called me to say she had some severe vomiting, diarrhea and weakness. In the rubric: forsaken feeling, I saw Camphor listed with one underline and then I asked her if she was cold or warm. She said: "I am cold to touch but I want to lie on the cold bathroom floor." I knew I had found her remedy for the grief and that remedy for the acute symptoms. Within an hour she was feeling better. This case illustrates how valuable the remedies listed as a "one" or "two" can be, especially if they are mental symptoms. There are often too many remedies listed for common symptoms such as vomiting, diarrhea and weakness.

A symptom can also be taken for repertorization by clicking on 1, 2, 3, or 4 on the icon bar. This can be used to save time if you know exactly which rubric you want to use and you are not interested in looking at the remedies of the rubric.

Another method of taking symptoms is to click on the File icon to the right of the magnifying glass. Here you can choose the intensity, the qualification and the group you want it to be in. The number of clipboards you would like each symptom to be in can be chosen from the screen. Move the cursor to the rubric you want and then type: (+1, 2, 3 or 4)

While taking a case, I usually start to repertorize when I have two symptoms that I can rely upon to give useful information. For example, a child has an ear infection and has a very irritable temperament. Even without a repertory the remedy Chamomile is an obvious possibility, but in order to keep the case open and one's mind flexible to other choices, it is a good idea to repertorize these two symptoms and then ask questions to rule out all the possibilities. The idea is to add one distinct, clear and definite symptom at a time and see the effect it makes on the analysis. Then one can ask confirming questions as the recommendations are made by the computer. It is better to ask for at least three confirming symptoms for each possible remedy, as this will allow a remedy to be more fairly considered. If the patient is missing one or two keynotes for a remedy it does not necessarily rule out that particular remedy possibility as it may be the remedy with the highest confidence and the simillimum.

Preferably one will ask these confirming questions in a way that does not lead the patient to know what you are looking for. Therefore, if one wants to know if a patient has a strong thirst for water it is better to ask: "Most likely you don't like to drink very much?" If he responds with "No, I really do in fact like to drink a lot," then it is more certain the person does, in fact, have a strong thirst. If thequestion had been asked: "So I suppose you really have a strong thirst?" and answers: "Yes, I suppose I do", then you cannot be as sure he has given accurate information. Perhaps he is just telling you what you want to hear to please you.

It is also a good idea to check if the factual symptoms you are using for repertorization are in actuality as certain, frequent and severe as you had previously thought. To create greater certainty one can ask about the symptom again in another way, such as: "How many drinks do you take between meals?" In some cases I have missed giving the correct remedy on the first prescription because I did not interpret their remarks with enough accuracy and therefore the underlining was inaccurate or biased to what I wanted it to be.