British Homceopathic Journal January 1991, Vol. 80, pp. 39-41

Hidden paradigms in homteopathy LEX RUTTEN, MD

The fundamental principle in homoeopathy is to find a drug picture that has the most resemblance to the 'picture' of the patient. This principle meets three major difficulties in its practical application:

- -What is most important in the patient's story. - -The use of language to present this story. --Techniques to find the matching drug picture.

The first problem will always depend on the skill and the knowledge of the homoeopathic doctor. The second and third problems can partly be resolved by Information Retrieval Techniques using computer technology.

However, before Information Retrieval can help us we have to define our methodology bet- ter than we did so far. Hahnemann and Kent taught us what is important in the patient's story. But it appears that experienced homoeopaths use certain other methods to find the right drug pic- ture. In the interest of homeeopathy it is vital to define these methods and make them useful to every homoeopath.

Does experience make any difference? The most striking difference between an experi- enced and a inexperienced hom~eopath is that the experienced homoeopath can tell you colour- ful stories about a patient that should fit a certain homceopathic medicine. He can even tell you what the patient would do in a situation that has not been described before. The inexperienced has to think hard to reproduce phrases from books that he has learned by heart. Another difference is that the experienced can show you pieces of text from materia medica that we could not find.

This means that there is something missing in the instrument we use today to find the right text: the repertory.

It also appears that experienced hom~eopaths use the repertory in a different way. Inexperi- enced users put some rubrics alongside each other and prescribe the drug that covers most symptoms. Experienced people can find more

rubrics, know more about cross-references, and look more carefully at each rubric. They are able to prescribe minor drugs that inexperienced people can never find.

If we want to make a better instrument than the repertory, we have to analyze carefully these differences and the shortcomings of the repertory.

Some figures By making a graph of some rubrics from the rep- ertory we perform a statistical analysis on these rubrics. If the structure of the repertory is not uniform in every respect we may expect bias from its use. Here are some figures to think about concerning Kent's Repertory:

- -The Repertory contains some 650 homeeo- pathic medicines.

- -The Repertory contains more than 60,000 rubrics.

- -The size of these rubrics is very variable. - -The occurrence of medicines throughout the

Repertory is variable: �9 43% occur in less than 100 rubrics. �9 32% occur in 100-1000 rubrics. �9 The largest, Sulphur, occurs in 8800

rubrics. �9 The other polychrests occur in 5000-7000

rubrics. �9 The polychrests occur in 400-450 'Mind'

rubrics. �9 About 180 drugs have no 'Mind' rubrics. �9 More than 120 drugs have 5-10 'Mind'

rubrics.

This variability must have consequences when we try to reconstruct the patient's story into a drug picture using the repertory. Most problems will arise concerning small rubrics and minor drugs.

Using mind-symptoms Kent taught us how to hierarchize symptoms: First peculiar symptoms, then Mind symptoms, then General symptoms. This means that we

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40 British Homceopathic Journal

strongly emphasize Mind symptoms in our search for the right drug using the repertory. From the figures mentioned above we can deduce that it will be very hard to 'hit' about half of the materia medica performing this way, because these drugs have few or no Mind symp- toms in the repertory.

Apart from this, Mind symptoms are often hard to define and have many cross-references. Symptoms which are semantically very much alike are represented by very different rubrics in the repertory.

This means that it is hazardous to rely too much on Mind symptoms when searching for a drug. This definitely does not mean that Mind symptoms are not important. They are very important to confirm a drug. However, when a drug has no Mind symptoms there is nothing to confirm this way.

- -They belong to the essence of a drug, e.g. pain in and around the eye in Spigelia.

- - W h e n the symptom persists in otherwise suc- cessful treatment.

- - I n combination with other local symptoms specific to a drug.

There are drugs that prove to have specific combinations of local symptoms, while the symptoms themselves are not peculiar:

--Graphites: Hoarseness with skin eruptions. --Viscum album: Dyspnoea and rheumatism or

gout. --Bufo: Skin-symptoms and neurological

symptoms.

These combinations of symptoms will not strike us like, e.g. the alternation between erup- tions and asthma. They are also very hard to detect.

P A R A D I G M

To find a drug using the repertory we must not lay too much emphasis on the Mind symptoms. Use Mind symptoms to confirm a choice.

Essences When we ask hommopathic experts to describe a drug in a few words, they are able to do so by describing a type of person and his most com- mon symptoms. This short description is enough to confirm a drug we consider. It is useless to go through the complete lists of symptoms when we try to differentiate between some drugs; this way we can confirm any (polychrest) drug we like.

When a picture is not very clear and we have to differentiate between some we can interro- gate the patient concerning the essences of these remedies.

The essence of a drug can also be used to eval- uate a single rubric when the patient has a pecu- liar symptom. When we investigate the drugs that cover this symptom by their essences it is sometimes possible to confirm one of these drugs. It takes however some discipline to con- clude that no drug can be confirmed.

P A R A D I G M

The essence of a drug can be used for differential diagnosis. A single rubric has more 'depth' using these essences.

Local symptoms Local symptoms have few value in hierarchy except when they are peculiar. But this is not always true. Local symptoms get more value when:

P A R A D I G M

Local symptoms can have more value in certain situations. Mostly this is not as a general rule but depends on the drug.

Consequences for knowledge retrieval These are only three 'tricks' that must be con- sidered when designing a knowledge retrieval system. Investigating our methodology more closely we will probably discover more of these tricks. These paradigms can be translated in rules for a Knowledge Retrieval System--

--Corrections must be made for the unequal occurrence of a drug in different chapters. This can be done using the relative occurrence in a chapter compared with the total occurrence.

--Symptoms that belong to the essence of a drug must be upgraded. The current grading of symptoms in the repertory is not correct in this respect.

- -The repertory must be linked to the materia medica. The essence of a drug must be sum- moned to 'screen' a symptom rubric or the possibility of a drug after repertory analysis.

- - Important combinations of local symptoms must be prompted when the possibility of a drug arises.

Consequences for clinical records The possibility that these and other paradigms can be confirmed or discovered by evaluating clinical records must be foreseen. This could have consequences for the system that is to be developed to perform this task, e.g.:

Volume 80, Number 1, January 1991

- - T h e possibility to indicate the problem solving strategy which is used, along with the possi- bility to indicate new strategies.

- - T h e need to register as many symptoms as

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possible and to indicate the weight of each symptom.

- -Pa t te rn Recognition techniques, also able to detect symptoms which are related by seman- tics, organ-system and so on.

Address for correspondence Dr Lex Rutten

Unard 10 4813 Breda Holland