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Wednesday, April 24, 2013

The boenninghausen method

Posted by Drdevendra Kumar MD Homeo

- The boenninghausen method (J. Winston)

Boenninghausen  Therapuetic Pocket book
Over the ten days in March 2000 that I spent with K. H. Gypser in Germany, we discussed many topics including the methodology of Boenninghausen who, Gypser says, was (along with Lippe in the USA) the best of the old prescribers. He said it very clearly: Hahnemann was the experimenter. If you want philosophy, look to Hahnemann. But if you want to see the Method in practice, look to Boenninghausen.
 Unfortunately, much of Boenninghausen's work is unavailable in English. His Lesser Writings was printed in English in 1908, but several of his pieces did not appear in this compilation. His largest work, The Aphorisms of Hippocrates, with the Glosses of a Homoeopathist was due to be published in the US in 1863, but the Civil War intervened and by the time the War ended in 1865, Boenninghausen had died. Although extracts were printed in some English language journals about 25 years ago, the book in its totality remains only in German. It is filled with insights into Boenninghausen's Method. The final source of information is found, of course, in Boenninghausen's casebooks which are preserved at the Bosch Institute in Stuttgart.
 Boenninghausen is credited with having produced the first homeopathic repertory in 1832, The Repertory of the Anti-Psoric Remedies. His Therapeutic Pocket Book was first printed 14 years later in 1846. It is a book that, over the years, through poor translations and lack of understanding, has ceased to be considered useful. But buried within the book is the germ of a wonderful methodology.
 Until Hering's death in 1880, most homeopaths were using Boenninghausen or Jahr. The problem was then, as now. The Boenninghausen Therapeutic Pocket Book was the ultimate expression of Boenninghausen's thoughts but to use it effectively, you had to understand how to sort the case as Boenninghausen did-and not many did. The poor translations into English did not help much. The Okie translation from 1847 leaves out all the concordances because the translator says he didn't understand them.
 In 1879, Constantine Lippe came out with his repertory that was based on the "Allentown Repertory" of Hering's which, in turn, was based on Jahr's earlier work.
 By this time, few of the homeopathic schools were teaching any philosophy and were concentrating totally on therapeutics-so the need for the repertory diminished, and its use was hardly mentioned.
 Into this mix comes James Tyler Kent who had his own way of thinking about what symptoms were and how to order them. The Boenninghausen Method was, dare I say, too abstract for him. He did not comprehend the idea behind it. Furthermore he was not a German reader-and the majority of Boenninghausen's work was in German. So Kent worked with the Lippe repertory and began to compile his own repertory based upon his idea of how one sees a case and symptoms. Meanwhile, the schools were falling apart, and the only folks teaching real casetaking and homeopathy were Kent and H. C. Allen in Chicago.
 There were not many who understood Boenninghausen at that time. Boger, the grand old Germanic autocrat, was one of the few. Case was another and Close was another. After the death of Boger in the 1930s, the only folks who understood Boenninghausen at all were the pupils of Boger and Close-the prime one being H. A. Roberts. After Roberts died, the only one who continued the Method was his pupil, Allan Sutherland, and when Sutherland died in 1980, the use of Boenninghausen virtually stopped.
 The introduction written by Roberts in the T. F. Allen translation of the Pocket Book (1935) still was unable to adequately explain the Method. The closest most folks came to using Boenninghausen was to look for the rubrics outlined by Elizabeth Wright-Hubbard in her article "Rubics in Boenninghausen Not to be Found in Kent."
 Even the computerized repertories which offer a Boenninghausen repertory have picked the big one that Boger put out in 1905- which is an update of Boenninghausen's original repertory without the systematic structure of the Pocket Book. Until recently, no one taught the Method or even knew about it. I was not fully aware of it until I spent time with K. H. Gypser last March.
 In April 1995, K. H. Gypser presented a seminar in Sydney, Australia, during which he discussed the methodology of the Pocket Book. In the years since a committee, which includes both Gypser (in Germany) and George Dimitriadis (in Australia), has worked to revise the Therapeutic Pocket Book and to re-introduce the Method.
 The German edition of the book was printed in May 2000. The English edition, entitled The Boenninghausen Repertory (Pocket Book Method), was printed in Australia in August 2000 and its release heralded the appearance of George Dimitriadis in Auckland, presenting an introduction to the TBR Method. Since the information from the Dimitriadis seminar reinforced that which I learned from Gypser a half-year earlier, I'll weave what I gleaned from both into a single unit.
 The entrance point into the Boenninghausen Method is simply stated in Paragraph 95 of the Organon:
 Chronically ill patients become so accustomed to their long sufferings that they pay little or no attention to the smaller, often characteristic accompanying befallments which are so decisive in singling out the remedy....It hardly occurs to them to believe that these accompanying symptoms, these remaining smaller or greater deviations from the healthy state, could have a connection with their main malady. (O'Reilly)
 This describes the two natures of the case: the main symptoms and the side symptoms. After the case is taken, the next step is to sort it into the main symptoms (those of the major complaint) and the side symptoms (those other symptoms that apparently are unconnected to the major symptoms).
 We have always been told that a complete symptom has Sensation, Location, Modality and Concomitant, and it has confused us endlessly as we search for the concomitant. Dimitriadis points out that those four characteristics describe a complete case. A complete symptom, in fact, has only the Sensation, Location, and Modality. A concomitant will have all three as well, and it becomes a concomitant by its nature of being another symptom in the case (other than the main symptom), even though it may appear unrelated to the main complaint.
 So the patient has headaches (the main complaint) and this complaint has sensations, locations, and modalities. The patient also has (upon further questioning) stomach/digestive pains-and this side symptom also has locations, sensations, and modalities. As a whole symptom, it becomes a concomitant to the main complaint. And it is the combination of these two that point to the remedy.
 It was the genius of Boenninghausen to be able to put together a repertory that allows one to look at the case in this way. Boenninghausen, aside from being a lawyer, was a botanical taxonomist (one who studies the general principles of scientific classification). He knew how to put "this" here and "that" there. Using this skill, he was able to generalize the rubrics in a way which few since have been able to master. And it is these generalized rubrics that are used in the Pocket Book. (As an aside, Boger, a master of the Boenninghausen Method, further generalized the rubrics in his 1928 General Analysis, a repertory of 222 remedies that was available as a card repertory.)
 Generally, only two complete symptoms are needed to find a remedy. But-and it is a big but-the Method works only with the rubrics in the Therapeutic Pocket Book. You can probably find similar rubrics in Kent, but the Kent repertory has a different structure and looks at the symptoms differently. Finding out from Gypser about the Boenninghausen Method was a real eye-opener for me.
 To best explain the methodology, let's look at a case taken from the "Introduction to the Method of Boenninghausen" from page 13 of TBR:
 Male, age 22, presented with a sub-acute, itching eczema, initially affecting only the dorsa of both hands and having spread up the arms to the elbows. The eruption became more inflamed and itchy when he became hot and sweaty (better by washing and drying the areas).
 That's the case:
 • We have a location: Dorsa of hands.
 • We have a complaint/sensation: Itching eczema.
 • We have a modality: Worse from perspiration.
 • The rubrics used in TBR are these (the numbers refer to the number of the rubric):
 • Location: Hands, Dorsum (328)
 • Sensation: Tetters, itching (1835)
 • Modality: Wet, by perspiration, aggravates (2683)
 "Tetters?" you ask. Obviously it is important to read the extensive endnotes in TBR which explain (in a half-page exposition) that "tetter" is the translation from the German Flechten which "has no exact meaning or translation." It goes on to say that Jahr, in his Diseases of the Skin, used the term to describe a number of skin disorders including ecthyma, impetigo, psoriasis, etc. Several sources are quoted including Kippax who, in his 1890 work on skin diseases, describes dry, scaly tetter as "Psoriasis," and moist tetter as "Eczema."
 The remedy in common to the three symptoms used in the case was Sepia. Improvement was noticed during the first 24 hours and the skin was almost normal within two weeks. There was no recurrence after five months.
 Remember: we are looking for a complete symptom of the main complaint and, ideally, a concomitant symptom which Hahnemann calls an "accessory symptom."
 Here is another case from page 16 of TBR:
 A female, age 43, presented with acute on chronic recurrent allergic rhinitis, from which she had suffered for many years. Typical symptoms start with sneezing and a bland watery nasal discharge (dripping) with development of stuffed coryza if conditions persist. These symptoms are aggravated in fine dry weather, by changes in weather (including seasonal changes), and from becoming heated near a heater. Attendant symptoms were a dry cough, which would develop as a result of change of weather, and which was aggravated by inhaling cold air.
 That's the WHOLE case.
 As pointed out in the endnotes, "coryza" refers to head cold-like symptoms. It is more than a nasal problem and the rubric is found under "Respiratory System" rather than under "Nose." The German word is Schnupfen-a head cold.
 The rubrics used in the Boenninghausen repertory are these (again, the numbers refer to the number of the rubric in the book):
 MAIN COMPLAINT: Coryza, obstructed (716)
 MAIN MODALITY: Worse, fine (bright) weather (2085)
 MAIN MODALITY: Worse, heated, radiant heat source, near (2105)
 MAIN MODALITY: Worse, changes of weather (2067)
 ACCESSORY COMPLAINT: Cough, without expectoration (736)
 ACCESSORY MODALITY: Worse, respiration, inspiration, air, drawing in cold (2539)
 Since the main complaint and the accessory complaint both have the modality "worse from changes in weather" this becomes a "grand characteristic" of the case.
 The remedy was Bryonia. It was given in a twice-daily dose of the 30th in liquid. There was "unbelievable" improvement in two weeks, excellent health after three months.
 I can hear (and I have heard) the question, "Yes, but where are the mental symptoms? Where are the Strange, Rare, and Peculiar?" This question serves to underline how we have often twisted Hahnemann's work and Kent's teachings.
 If there are changes in the mental state (from the norm) that accompany the complaints, then one can use these changes to distinguish between several possible remedies. But often, the case has no mentals and to dig for them is not needed. I can hear the voice of Jack Borneman, homeopathic pharmacist extraordinaire, when he said, chuckling, "Yes, I know you have terrible menstrual cramping, but was your grandmother afraid of cantaloupes?" Strange, Rare, and Peculiar, and all it implies, is a discussion for another day.
 What Dimitriadis did point out is that the uniqueness in a case is often seen as the combination of two or three (or more) very common symptoms. The running nose may be common. The desire for warmth may be common. The lack of thirst may be common. But all three in a single person could be a unique combination to that person and can point clearly to a remedy.
 When I was discussing the Boenninghausen Method with K. H. Gypser, he said that he found it best to select symptoms that have a polarity. "Better in a warm room" has a polarity of either "worse in a warm room" or "worse outdoors." The reasoning is this: What you want (ideally) are symptoms that express the genius of a remedy. The genius can be derived by looking at the symptoms in the provings-but it has to be across the whole proving. You might look at a remedy in a repertory and see that it has headaches on the left, and shoulder pain on the left, and chest pain on the left, and knee pain on the left-and come to the conclusion that this is a leftsided remedy. But first, look at the proving. You might find that all those symptoms happened in one prover. So, it was the prover that was left-sided! If you find that all those symptoms happened in different provers, you can conclude that the genius of the remedy is left-sidedness.
 It is part of Boenninghausen's brilliance that he was able to look through the provings and understand the quality of a remedy that would become a grand characteristic or genius. Whereas Kent would have each symptom listed by itself, Boenninghausen was able to draw many symptoms together under a single idea.
 If you select a symptom that is capable of having a polarity, you should then look for the polarity in the repertory. This is easy to do in TBR because the Aggravations and Ameliorations have been grouped in a single chapter, thus making such comparisons very easy. In the German edition, those rubrics that have polarities are marked with a circled "P."
 If you find that the remedy you have selected for a case has the opposite polarity symptom in grade 3 or 4, then, in Gypser's experience, that remedy is not going to be curative. You must find a remedy that exists in a rubric that is capable of having a polarity, but does not have one.
 Using several case examples, Gypser showed me that, if you can't find a remedy that does not have a polarity, then the best choice you have will probably not be curative. But as the case progresses, another remedy will become clear that will be curative.
 Gypser stressed that the rubric used to look for a polarity should not be one used to select the remedy, but rather one which exists in a side symptom and is not used in the repertorization.
 The example he gave was a case in which one of the symptoms was "very brief menses." Although that symptom was not used to find the remedy, he checked to see if the polarity "protracted menses" contained the remedy selected for the case, in a grade 3 or 4. It did not, and he felt confident in prescribing his selected remedy.
 Gypser, who has read many of Boenninghausen's casebooks, said that in Boenninghausen's actual practice several remedies were often given. Boenninghausen understood the relationships of the remedies so well that when he found a remedy that covered the side symptoms, which was different than the remedy that covered the main symptoms, he did this:
 • On the first day, he gave the remedy for the main symptoms.
 • A few days later, he gave the remedy for the side symptoms.
 • A few days later, he repeated the remedy for the main symptoms.
 • A few days later, he gave a fourth dose-a placebo.
 • He always used the 200th potency.
 We can see this today in the formulation of the Boenninghausen "croup powders." Originally sold in five envelopes to be used in the order as numbered, they were:
 1. Aconite
 2. Spongia
 3. Hepar sulphuris
 4. Spongia
 5. Hepar sulphuris
 This grouping was used by the late Dr. Panos who told me that she always gave three envelopes containing the first three remedies to a mother upon the occasion of the birth of a child. She told me that only in rare cases had a mother progressed to the third envelope of the series. Number one usually cleared the croup, and if it remained, number two finished it. Note that this is not an example of prescribing for croup, but of understanding the nature and progression of the disease and prescribing for the symptoms that are seen.
 The Boenninghausen methodology works well, but it needs the newly revised Pocket Book to really make it go. You can't take a case by the Boenninghausen Method and then use Kent's Repertory to find the rubrics. Furthermore, TBR has only 135 remedies represented-about a fifth of what is in Kent. In looking at the cases Dimitriadis presented in his Auckland seminar, the remedy just popped out-whereas if you try looking for it in Kent, the remedy gets buried in the morass of others.
 The problems, of course, are several:
 • You need to have cases that are suitable to the Method. Patients who come in with fuzzy mental symptoms, no marked modalities, and depression are not going to be successful candidates for the Method!
 • You have to understand how to analyze the case.
 • You have to use the Therapeutic Pocket Book to solve it.
 When generations of homeopaths have been trained in using the Kent Repertory (or its more modern offshoots, the Complete and the Synthesis), the Boenninghausen Pocket Book is a whole other world. How many are willing to take the time to learn a new language?
 Yet, after going to so many seminars where "guess the remedy" was the game being played, it was a pleasure to attend the Dimitriadis seminar which was filled with solid, useful, information.
 Perhaps the Boenninghausen Method will be revived and get the use it so richly deserves.
 George Dimitriadis is available for similar seminars. He can be contacted at: gdimitrihermes. net. au
 The Boenninghausen Repertory: Therapeutic Pocket Book Method. Ed. George Dimitriadis. Sydney: Hahnemann Institute, 2000.
 Elizabeth Wright-Hubbard. Rubrics in Boenninghausen Not to be Found in Kent. Homoeopathy as Art and Science. Beaconsfield, Bucks: Beaconsfield Publishers, 1990. 75-77.
 Julian Winston trained as an industrial designer at Pratt Institute in Brooklyn and taught the University of the Arts in Pennsylvania, until he discovered homeopathy in 1980. He taught at NCH Summer Schools and in 1982 was elected to the board. He has been the editor of Homeopathy Today since 1984. In June 1995 he moved to New Zealand where he codirects the Wellington College of Homeopathy with his wife, Gwyneth Evans, and edits the newsletter he founded, Homoeopathy NewZ.


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