The Logic of Bönninghausen – Dr. Karl Robinson

THE
LOGIC OF BÖNNINGHAUSEN
Dr. Karl
Robinson

THE
LOGIC OF BÖNNINGHAUSEN
PART ONE

The twentieth century saw the ascendancy of the repertory as the most
used tool in homeopathic analysis. Since it is so widely used and so
widely esteemed it is useful to look at one created by C.M.F. von Bönninghausen
in 1846 and contrast it briefly with those that followed.

Bönninghausen created three repertories, the last of which, Therapeutic
Pocketbook, most expressed his genius. He constructed this
masterpiece from the idea that symptoms could be taken apart, separated
into categories, and then reconstituted to form new symptoms. A
sensation or modality, he found, affects not only a single part of the
body, but any part in the same way. That is to say, he intuited that if
a homeopathic medicine in its proving affected the patient in a local
area, it would similarly affect the patient in other areas. So if Bryonia
was known to be useful when a pain in a knee increased on moving,
similarly it would prove useful when movement increased pain in any part
of the body.

This must have been a radical idea in its time as it suggested that
the human body was vastly more integrated and interconnected than had
ever been conceived of before. Even today it remains a radical concept
among the homeopathic community that has chosen, overwhelmingly, to use
repertories such as Synthesis [1] and The Complete Repertory

[2]
both based on James Tyler Kent’s Repertory [3]
created late in the nineteenth century.

[1] Dr. Frederik Schroyens, ed., Synthesis, Repertorium
Homeopathicum Syntheticum.

[2] Roger Van Zandvoort, The Complete Repertory.

[3] J.T. Kent, M.D., Repertory of the Homeopathic Materia
Medica.

Before examining Bönninghausen’s work, let us look at the Kent Repertory.
Kent’s opus contrasted sharply with Bönning-hausen’s Therapeutic
Pocketbook as Kent tried to present fairly complete symptoms
catalogued under various parts of the body. Kent tied the complaint to
the location plus a circumstance

[4].
For example, “HEAD, Pain, sun, from exposure to” or
“Extremities, Pain, Knee, motion.” At the same time, borrowing
heavily from Bonninghausen, Kent created a final chapter,
“Generalities” in which one finds the entry “Sun,
exposure to the sun” and “Motion agg.” It has never been
fully explained if the homeopath is to refer to a specific chapter or to
Generalities making both Kent and those who use his repertory uncertain
if not schizoid. Perhaps Kent, fearing his repertory, section by
section, was incomplete, decided to cover all bases by creating the
final Generalities chapter.

[4] The words, circumstance, condition, and modality,
are often used interchangeably in this article.

Bönninghausen from the outset created a very different kind of
repertory. Selected proving symptoms were dissected into their
constituent parts and catalogued under an appropriate heading. If a
medicine was known to affect a specific part of the body strongly then
it was listed under that part of the body with no modifiers. The
modifiers – sensations or descriptions [5], and modalities
— were each given their appropriate heading. So one proving symptom
could easily be broken into three or four parts and catalogued in three
or four different sections of the repertory. For example, if the prover
complained of a sharp pain in the forehead worse from motion and worse
from the sun, the medicine would be listed first under “Internal
head, Forehead”, then under “Generals, Stitching in inner
parts” and then under “Modalities, Sun” and
“Modalities, Movement, during.”

[5] A description of a complaint can often be verified
through the senses and is therefore objective whereas a sensation
is subjective.

Bönninghausen grasped the great idea that that which affects the
part can affect any part and thereby affects the whole. It was then and
still is a revolutionary idea that surfaced in the latter twentieth
century with the discovery of holographs. (short explanation)

So when he put together his Pocketbook he deconstructed
symptoms into fragments, viz., location, complaint/sensation, and
modalities.

A careful homeopath in analyzing a patient’s symptom parses,
separating out location, sensation/complaint, modalities: as
follows: I have a burning pain in my right knee that is worse when I
sit and improves when I walk. Here we have the location, right knee;
the sensation, stitching pain; and two modalities, worse sitting and
better walking. If this symptom had been brought on during a proving of
medicine X Bonninghausen would have deconstructed it with X
appearing in “Lower Limbs, Knee joint” as well as “Lower
Limbs, Right.” It would also have appeared under “Generals,
Burning in outer parts” and “Modalities, Sitting” and
“Modalties, Walking, during amel.”

Bönninghausen generalized all sensations and modalities. An abnormal
sensation felt in a single part could, he suggested, be felt in any part
whether that sensation appeared in other locations in the proving. For
example, Alumina CD831

[6],
reads, “Pain in the back, as if a red hot iron was thrust through
the lowest vertebrae.” A bit later, CD867, “Burning in the
arms and the fingers, and in the left elbow, as from a red-hot
iron.” Bönninghausen inserted it into his repertory under
“Generals, Hot-poker (hot-iron forced in), sensation of a;”
though only two provers reported the symptom in a proving totaling 1161
symptoms.

[6] In Materia Medica Pura (MMP) and Chronic
Diseases (CD) each symptom of every proved medicine is
numbered.

Kent, on the other hand, took CD831 and placed it under “BACK,
Pain, Spine, as if a hot iron were thrust through lower vertebrae”
but did not do the same for arms, fingers, elbow. Nor did it appear in
“GENERALITIES, Pain, Burning, Bones.” Kent’s Repertory
is consistently inconsistent in what symptoms appear where.

Bönninghausen did the same thing with modalities. He predicted that
if a medicine made a part better or worse, it could make any part better
or worse.

If we turn to Hahnemann’s Chronic Diseases(CD)and open to
the proving of Phosphorus we read the following: CD1725: “He
can only lie on his right side, at night.” CD1726: “Lying down
on his left side, at night, causes him anxiety.” Of 1915 symptoms
recorded for Phosphorus in CD only 1725/1726 speak of this
modality. Yet from those unobtrusive entries it grew to become a grand
modality presumably though countless clinical observations by many
homeopaths. Nowhere in the proving is there mention of coughs,
respiration, headaches, or pains in general, worsening while lying on
the left side. Yet every beginning homeopath is taught this famous
modality and every experienced homeopath has verified it repeatedly.
This one modality is an outstanding example of how what affects a single
aspect affects any aspect and affects the whole.

So, in light of Bönninghausen’s method as one rereads Kent’s Repertory
(or those based on it) one notes the following symptoms of Phosphorus
all worse lying on the left side: vertigo, difficulty breathing, cough,
general chest pain and stitching chest pain, palpitation and sciatic
pain. In addition, it is in bold type in “Generalities, Lying on
left side agg.”

So what is one to surmise? Do we believe the entry under
“Generalities”? If so, it should be listed throughout the
repertory with all pains and morbidities worse lying on the left side.
It is not. Therefore, just what are we to assume? It is impossible to
know. But

all
of Kent’s Repertory is so constructed. When approached from
this viewpoint Kent’s Repertory becomes eminently confusing.

As mentioned earlier, Bönninghausen built his repertory in a very
different way. He took apart symptoms into their constituent elements (sensations,
descriptions and modalities). Each element, he
extrapolated, could apply to more than one part. So if a medicine
produced a burning pain in the stomach it could, he predicted, cause
(and, therefore, cure) a burning pain elsewhere. If movement improved a
painful knee joint, movement could then improve other painful joints or
other painful tissues.

He did not, however, slight anatomy. If a medicine appeared to
strongly affect a given location, it was listed under that location.

Anatomical areas are represented as follows: External head, Internal
head, Eyes, Ears, Nose, Face, Mouth, Neck, external, Chest, Abdomen,
external, Abdomen, internal, Back, Upper limbs, and Lower Limbs.

Functional systems appear next: Alimentary, Urinary, Reproductive,
Respiratory, Cardiovascular, and Thermoregulatory.

I am referring here to the categories as they appear in The
Bonninghausen Repertory (TBR) edited by George Dimitriadis.

[7]
The Therapeutic Pocketbook and TBR contain the same information
and differ only in the arrangement. TBR is a reformat of the Therapeutic
Pocketbook and is more user friendly. Rubrics have been rearranged
so they appear under more appropriate categories. Rubrics containing
identical medicines in Therapeutic Pocketbook (and there are
many) were collapsed in TBR into a single rubric with one rubric being
primary and the other in parenthesis. From here on, all references are
to TBR.

[7] George Dimitriadis, ed., The Bonninghausen Repertory (TBR).

RECOMBINANT
FRAGMATA

The truly daring insight of Bönninghausen was he understood that
symptoms, once separated into their component elements, namely, location,
sensation/complaint, modalities, could be

recombined
in an original way. When the importance of a symptom fragment is
indisputable, the repertorization of that fragment will yield a medicine
that will act even if heretofore it was not known to act in such a
condition.

An example: A 55 year old man treated successfully with Ferrum
metallicum came in two years later with inflammation of the scrotum,
inguinal areas, ventral surface of the proximal penis, and part of the
upper medial thighs. These areas were bright red and “burned.”
Occasionally there was “uncontrollable itching.” The lesion
worsened during sweating and was consid-erably better with air
circulating. As a result he avoided underpants and often wore nothing
but a terry cloth robe indoors.

What is important here are the modalities: that the lesion worsened
wearing underwear and with sweating. The location, male genitalia, must
also be taken into account.

TBR 611

[8]

Male genitalia

Sepia 3

TBR 2683

Wet, by perspiration agg.

Sepia 3

TBR 2268

Clothing, pressure of, agg.

Sepia 3

[8] All rubrics in TBR are numbered.

He received Sepia 30 in water, five drops once daily. Within
two days there was “significant improvement.” It continued and
within a few weeks it cleared completely.

A careful reading of Sepia in Chronic Diseases will not
yield this exact skin lesion with those modalities. But the

combination
of the location and two modalities clearly pointed to Sepia.
Since there were no mental symptoms and no generals none were taken into
account.

The above is an example of how it is possible, using the Bönninghausen
method, to approach pathology with no precon-ceptions other than the
idea of similitude. There is something quite clean about the case,
namely, only three symptoms were required and no ideas about how a Sepia
patient should present.

Unfortunately, modern homeopathy has taken a direction that makes
such an approach difficult if not impossible. Students, worldwide, are
taught about the typical Sepia patient and how

she
(almost always Sepia is gender-skewed) looks and behaves. She is
yellow-faced, has menstrual problems characterized by a bearing-down
sensation, is indifferent to her husband and kids and is dog-tired
rallying only when she runs her three miles every day. Of course, such a
description is a caricature, but one all too familiar to all homeopaths.
Though it is, of course, true that Sepia can so present it
becomes a hindrance when, as in the above case, we have a man with a
skin lesion and none of the ‘typical’ Sepia features.

Any preconception about Sepia would have made the prescription
in this case impossible.

But as long as there are any preconceptions about how any
patient should look and act it makes ‘clean’ homeopathy impossible.
To be ‘clean’ suggests gathering data from the patient and other
observers in an unbiased way and then using that data inductively as
much as possible. Hahnemann is quite explicit on this point when he
writes, “The individualizing examination of a case of disease……demands
of the physician nothing but freedom from prejudice……”

[9]

[9] S. Hahnemann, Organon, para. 83.

The phrase, “freedom from prejudice,” is the cornerstone of
taking and analyzing a case of disease. Prejudice is insidious and it
creeps into every moment of case taking. We hear something or note
something; there is a flash of recognition, “Aha! That reminds me
of _____.” And the mind is off. Perhaps we have ‘recognized’ a
characteristic of the mineral kingdom, or the plant or animal kingdoms.
Perhaps we see ‘spider’ or ‘snake’ appearing or perhaps a
specific remedy. Who among us has not fallen into this snare? Who has
not then begun asking leading questions to confirm whatever it was we
‘recognized’? Who has not stacked the data by entering into the
computer numerous rubrics to support one’s preconceived idea? But it
can be a slippery slope leading to yet another wrong prescription.

Fortunately, there are ways of getting back on track, one of the best
of which is to follow Bönninghausen’s urging to make each symptom as
complete as possible. In an essay, “Directions for Forming a
Complete Image,”

[10]
Bönninghausen does what today we would call a “Review of
Systems” and he points out the importance of Location,
Complaint, Modalities, and Concomitants.

[10] C.M.F. Bonninghausen, “Brief Directions for Forming a
Complete Image of a Disease for the Sake of Homeopathic
Treatment,”(BLW) p. 285 ff.

Each symptom becomes “complete” when it contains as many of
these four aspects as possible. ‘Complaint’ (though not specifically
pointed out by Bönninghausen) consists of sensation which is
subjective and description which is objective. Sensation
is how the problem feels as in “a burning pain,” and description
is what it looks like as in “an ulcer with raised, red edges
seeping yellow pus.”

‘LoCoMoCo’

A complete symptom then has four aspects:

1. Location

: the part of the body affected.


2. Complaint

:(Sensation/Description): how the problem
feels subjectively and/or looks objectively.


3. Modalities

: what makes the complaint better or worse.


4. Concomitants

: associated complaints, e.g., with the menses
there is headache and dizziness.

As a mnemonic they can be abbreviated to

LoCoMoCo.
It should be recognized that
Bonninghausen did not state it exactly as above. In “Directions for
Forming a Complete Image” he wrote as follows:

V. Internal Headache

1. According to the sensations…
2. With respect to the time of the day.
3. With respect to position and circumstances.

1. Aggravated.
2. Relieved.

d. Accompanying ailments.

However, one can easily spot location, complaint/sensation,

modalities,

and concomitants.

Another example:

A pregnant woman, six days shy of her 38^th birthday, came
in September 24, 2002, with moderately severe nausea. Conception
occurred mid-July with the nausea beginning five weeks ago. Until last
week she had dry retching and now vomits “some days.”

The nausea was mild in the morning with the severe nausea beginning
around 3 p.m. It peaked every day around 5 to 6 p.m. when she might
vomit. The vomitus was watery. No food.

Increased salivation prior to vomiting.

She disliked water, new with the pregnancy.

She noted her body had become warmer.

She sweated a bit during sleep on the upper body.

She had an increased desire for fruit since the pregnancy, especially
for oranges.

Analysis:

Here we have a complaint, nausea and vomiting, and several
concomitants. The complaint found its way into the analysis only as a
description, watery vomitus. The fact the problem was periodic was
confirmatory for China, but not included in the analysis. Nor was the
desire for fruit included.

TBR 464

Water, avers.

China 4

TBR 249

Saliva, increased

China 3

TBR 501

Vomiting, watery

China 3

TBR 963

Perspiration, upper body, on the

China 3

She improved briskly from the first dose onward which she took daily
in a 30c potency in water. As per the Bönninghausen method, disparate
symptoms, each certain, were

recombined
resulting in China.

BIBLIOGRAPHY

1. Bradford, Thomas Lindsley, M.D.,
ed., The Lesser Writings of C.M.F.von Bonninghausen (LWB), “Brief
Directions for Forming a Complete Image of a Disease for the Sake of
Homeopathic Treatment”; New Delhi: B. Jain Publishers(P)Ltd., 2000,
p. 285 ff.

2. Dimitriadis, George, ed., The
Bonninghausen Repertory (TBR) Therapeutic Pocketbook Method, Sydney:
Hahnemann Institute Sydney, 2000.

3. Hahnemann, Samuel, Organon of
Medicine, New Delhi: B. Jain Publishers(P)Ltd., 1991,
Paragraph 83.

4. Hahnemann, Samuel, The Chronic
Diseases Their Peculiar Nature and Their Homeopathic Cure, New
Delhi: B. Jain Publishers Pvt. Ltd. 1998.

5. Kent, J.T., M.D., Repertory
of the Homeopathic Materia Medica, Calcutta: Sett Dey & Co.,
1974.

6. Schroyens, Frederik,
M.D.,editor, Synthesis Repertorium Homeopathicum Syntheticum,
London: 1998

7. Van Zandvoort, Roger, The
Complete Repertory, The Netherlands: 1996.

* * * * *

THE
LOGIC OF BÖNNINGHAUSEN PART TWO

Bönninghausen had an exceptionally logical mind as he had been
trained both as a lawyer and a botanist. When he fell ill with
tuberculosis and was cured by homeopathy courtesy a physician friend who
was a recent convert to the new science he plunged into its study and
within a few years became a brilliant prescriber though he himself had
never studied medicine.

It was Bönninghausen who realized that proving symptoms could be
deconstructed into their constituent parts and then recombined in new
and ingenious ways making possible startlingly original cures

[1].

[1] Refer to case at end of article.

In 1846 he published Therapeutisches Taschenbuch. The English
version, Therapeutic Pocketbook,

[2]
was translated the same year by Dr. Johann Ernst Stapf.

[2] The Bonninghausen Repertory (

TBR)
edited by George Dimitriadis is a reformat of Therapeutic
Pocketbook. TBR is referred to through this article.

As a botanist he appreciated taxonomy, the classification of plants
into various categories based on some common factor. This knowledge he
put to good use creating a rigorously logical system of categories in
his new repertory. The repertory is divided into four great sections:

1. Regional Symptoms.
2. Systemic Symptoms.
3. General Symptoms.
4. Modalities.

Each large category is further subdivided into more specific ones. He
was able to so organize because of his ability to discern the parts of a
proving symptom.

DECONSTRUCTION

To illustrate we take Clematis CD69

[3]:
“He cannot pass the urine at one time; it was frequently
interrupted in its stream before it was all discharged, then the rest
kept dripping out involuntarily, and while the urine was interrupted he
felt, by jerks, a burning and tearing in the anterior part of the
urethra.”

[3] Chronic Diseases

,
Clematis, symptom 69.

Bönninghausen deconstructed as follows:

Urethra, TBR550 [4]

Clematis 4

Flow of urine by drops, TBR552

Clematis 3

Urination, interrupted, TBR553

Clematis 4

Generals, Smarting, TBR1399

Clematis 3

Note that the sensation, smarting, Bönninghausen located under
Generals which contains sensations and descriptions of
various complaints. This signifies that Clematis can produce a
burning or stinging or smarting pain anywhere in the body.

[4] All rubrics in TBR are numbered.

Another example: Clematis CD101: “An indurated gland
below the nipple; it is painful when touched.” Parsing this symptom
leads to its entry in the following categories:

Mammae, TBR279

Clematis 3

Mammae, cancer, TBR280

Clematis 3

Swellings, localized, TBR1943

Clematis 1

Touched, from being, TBR2642

Clematis 2

The last entry occurs under “Modalities.” A modality
modifies a symptom making it better or worse. If it could do so in one
circumstance, he reasoned, it could modify one or more symptoms. It was
out of this sort of logic that Bönninghausen came to the idea of a complete
symptom, one that had location, complaint (subdivided into
subjective and objective), modalities, and concomitants
(associated complaints). A medicine that covered these four aspects,
thought Bönninghausen, stood an excellent chance of curing.

THE HEXAMETER

Bönninghausen, the lawyer, went further in his search for a simple
yet systematic method to capture all aspects of the patient. In an
essay, “Concerning the Characteristic Value of Symptoms,”

[5]
he writes that in his literary studies he came across some verses in the
form of a hexameter dating to the beginning of the twelfth century
attributable to theological scholastics.

[5] C.M.F. Bönninghausen, “A Contribution to the Judgement
Concerning the Characteristic Value of Symptoms,” The Lesser
Writings of C.M.F. Bönninghausen,(BLW) pp. 105ff.

It was used by the monks to judge “a moral disease,” that
is to say, “the peculiarity and grievousness of various moral
lapses.” It immediately struck Bönninghausen that it contained
“all the essential momenta which are required in the list of the
complete image of a disease.”

[6]

[6] Ibid.

, p.107

The verse is: “Quis? Quid? Ubi? Quibus auxiliis? Cur?
Quomodo? Quando?” These seven are translated: “Who?
What? Where? What else? Why? What modifies? When?”

Quis?

or WHO?

It includes: gender, age, bodily constitution, temperament
(personality) and individuality (nature). “The greatest and most
important variations are here found mostly in the states of the mind and
spirit…”

[7]

[7] Ibid.,

P.107

Bönninghausen, ever the careful student of Hahnemann, here echoes
his mentor’s words, “…and in all cases of disease we are called
upon to cure, the state of the patient’s disposition is to be
particularly noted along with the totality of the symptoms…”

[8]

[8] S. Hahnemann, Organon of Medicine, section 210.

Modern students are wont to suggest that Therapeutic Pocketbook/TBR
is all right for pathological prescribing but lacks when it comes to
mental/emotional diseases. Clearly, Bönninghausen emphasized the
importance of the mental state. He wrote, “In all such cases
[states of the mind and spirit] we have all the more cause to fathom
these states with all possible exactness, as in them frequently the
bodily ailments recede to the background…”

[9]

[9] BLW, p.107.

Bönninghausen was reluctant to prescribe a medicine that simply
repertorized well. He wrote, “A great number of medicines are
thrust aside, just because they do not correspond to the personality of
the patient.”

[10]

[10] BLW, p.107-8.

On the other hand, it is very possible to prescribe successfully
recombining symptoms without regard to the mental state.

[11]

[11] See my Sepia case in Part One.

Quid?

or WHAT?

This refers to the disease, its nature and peculiarity and the need
for pure observation. The homeopathic medicine, he stated, “must
correspond with the common genius of the disease”

[12]
which is to say it must match the salient, characteristic [13]
symptoms.

[12] BLW, p.110.

[13] The word, ‘characteristic’ is used frequently in
homeopathic literature to mean a distinguishing trait or quality.

3.

Ubi?
or WHERE?

This part of the hexameter refers to location. Pure
observation, hallmarks of Hahnemann’s method, noted that homeopathic
medicines can and do favor specific parts of the body. To the extent
that location does matter, one cannot accuse Bonninghausen of ignoring
it. He was quick to observe that various medicines affected one or the
other side of the body, that perspiration could be of the part, etc.
What Bönninghausen generalized was sensation and modalities.
A symptom of Sepia that Bönninghausen assumed was well-known was
“sores on the upper side of the joints of fingers and toes,”
[14] noting, “every homeopath knows the efficacy of Sepia in
these ulcers of the joint.”

[15]
Strange, that no modern homeopath ever mentions this symptom.

[14] Ibid.

p.110.

[15] Ibid.

p.110.

Quibus Auxiliis?

or CONCOMITANT
(accessory) symptoms.

These are symptoms accompanying the main complaint. Grasping the idea
of concomitance is often daunting for the beginning homeopath as,
clearly, all symptoms in a disease are appearing together. Why then
would one want to mention something so obvious? Bönninghausen was quick
to point out that “those ailments which are wont to appear as
constant concomitants or at least as usual in the disease” can be
omitted unless they are “distinguished by some rare
peculiarity.”

[16]

[16] Ibid.

p.113.

A familiar concomitant is when the menses are attended by headache or
gastrointestinal complaints, etc. Sometimes a concomitant symptom rarely
appears in connection with the main complaint or it can “belong to
another sphere of disease than the chief ailment.”

[17]
Kali bichromium is an example of the latter as it can have sinus
problems and stomach problems or sinus problems and sciatica. [18]

[17] Ibid.

p.113.

[18] Kali bichromium

is an important remedy not included in Therapeutic
Pocketbook.

Cur?

or WHY?

The causes of disease are varied and are often a factor in deciding
the remedy. Some proximal causes: trauma, toxic exposure, drugs,
emotional, ‘never well since’, exposure to inclement weather (cold
and wet, sun, etc.). Miasms: psora, sycosis, syphilis.

Quomodo?

or MODALITIES
(modifying influences)

Often the most useful of the seven momenta. It includes: food &
drink, weather, position, heat, cold, etc

6.
Quando?
or WHEN?

Time or onset; time of aggravation

[19];
sequence of events.

[19] Quando can often be included under Quomodo unless
it refers to the sequence of events or chronology.

THE HEXAMETER AS THE ‘WHODUNIT?’ OF CRIME

It is interesting that five of these are the sine qua non of
all criminal investigation, viz., Who? What? Where? When? Why? and all
crime stories reported in newspapers utilize those five often in the
first paragraph. A fictitious example: “A 35 year old
white male last night held up a convenience store on the corner of 5^th
and Main escaping with over $2,000.”

The seven elements of Bönninghausen’s Hexameter provide a careful,
systematic way of investigating an entire patient but often one complete
symptom is sufficient. The following case is illustrative:

In October, 2002, a patient of many years appeared at my door, driven
there by a friend. With the friend’s help she gingerly walked up the
walk and with great effort carefully stepped up the single step into the
house. She was holding the head with her two hands.

An hour earlier she had been rear-ended while stopped at a light.
There had been no loss of consciousness; the impact had caused no damage
to her vehicle, but she had been badly affected.

She managed to sit down in my study all the while holding her head
with both hands. The fingers of the left hand were pressed into the
inner canthus of the left eye while the fingers of the right hand were
pressed into the center of the upper cervical spine. She did so, she
explained, because it helped the severe pain between these two points.

Her left upper extremity was shaking quite markedly, a kind of
convulsive trembling which, in turn, caused her head to shake as that
hand was pressed hard into the corner of the eye. She said she felt
somewhat faint.

The pain, she said, went from the upper central cervical spine
through to the inner aspect of the left eye,. It was “like a
rod,” she said. She also said it was “sharp,”
“stitching,” and “throbbing.”

“It’s like a round thick bar with a point on it,” she
said.

There was a second, less severe pain, from the same spot in the
cervical spine, which traveled to the left shoulder and down the arm.

She said the left side of her face and shoulder felt warmer than the
right side though on examination I could detect no difference. The feet
did feel cooler than the hands or head, however.

“I feel like my brain is shaking,” she said.

I noted she kept her eyes shut. As I wished to look at her pupils I
asked her to open her eyes but try as she might she could not bear the
light which was exquisitely painful.

She said her vision was dimmed or blurred. “It’s like a veil
or mist.” On closing the eye she felt the pain deep in the left
eye. Her mouth felt very dry.

Assessment:

Complaint:

head pain.

Sensations:

boring and stitching

Modality:

pressure amel.

Concomitants:

trembling of left upper extremity

photophobia

[20]

[20] hotophobia can be considered a modality or a concomitant

There are other symptoms but the above are distinctive and cover the
case. Note: location, the head, is common and therefore omitted in the
repertorization.

Analysis:

TBR 1200

“boring outwards”

Bell 2

TBR 1421

“stitching outwards”

Bell 3

TBR 1448

“trembling, outer parts:

Bell 3

TBR 2519

“pressure amel.”

Bell 2

TBR 2432

“light in general, agg

Bell 3

Though Belladonna comes through the repertorization clearly,
it is prudent to confirm with the original proving found in Materia
Medica Pura (MMP) under Belladonna:

MMP 125: Excessively violent headache of obtuse or aching shoots,
which dart through the brain from all sides.

MMP 127: Some obtuse stitches in the left side of the occiput.

MMP 129: Stabbing through the head as with a two-edged knife, in
the evening.

MMP 135: Cutting tearing pain in the head that extends from one
part to another.

MMP 236: When she closes the yes, an aching pain deep in the
eyeball.

MMP 273: Dimness of vision, dryness of mouth…

MMP 275: Along with dulness of sight trembling in all the limbs.

MMP 280: As if mist were before the eyes, obscuration.

What is fascinating about this case is that it is not a ‘typical’
Belladonna presentation, i.e., it is not what is taught and it is
not in any of the usual secondary

[21]
materia medicas. It is an example of l) how nicely The Bönninghausen
Repertory works, 2) how nicely the inductive method works and 3) how
important it can be to consult the original proving symptoms.

[21] A ‘secondary’ materia medica is one written by a
homeopath emphasizing characteristics he deems important. Only a
proving can be considered a primary materia medica.

She was given Belladonna 30c in water and responded within a
few minutes. The trembling of the left arm ceased and she stopped
pressing into the eye and nape as the pain eased. She

needed some repetitions over the next few days but recovered well.

BIBLIOGRAPHY

1. Bradford, Thomas Lindsley, M.D.,
ed., The Lesser Writings of C.M.F. Bönninghausen, (BLW)
“A Contribution to the Judgement Concerning the Characteristic
Value of Symptoms,” New Delhi: B. Jain Publishers(P)Ltd., 2000, pp.
105ff.

2. Dimitriadis, George, ed., The Bönninghausen
Repertory (TBR) Therapeutic Pocketbook Method, Sydney:
Hahnemann Institute Sydney, 2000.

3. Hahnemann, Samuel, Organon of Medicine, New
Delhi: B. Jain Publishers(P)Ltd., 1991.

4. Hahnemann, Samuel, Chronic Diseases, New
Delhi: B. Jain Publishers Pvt. Ltd. 1998.

* * * * *

THE
LOGIC OF BONNINGHAUSEN
AS A DEVELOPMENT OF THE LOGIC OF HAHNEMANN —
PART THREE

Bönninghausen, possessed of a brilliant legal and scientific mind,
was quick to grasp the inner logic of the new system of medicine called
homeopathy. He became a trusted colleague of Hahnemann who had complete
confidence in him. In 1853 Hahnemann wrote, “…Bönninghausen of Münster
has studied and grasped my homeopathic system of treatment so thoroughly
that as a homeopath he deserves to be fully trusted, and if I should be
ill myself and unable to help myself I would not entrust myself to any
other physician.”

[1]

What does it mean to “grasp” the logic of the homeopathic
system? Hahnemann railed repeatedly against those apparent followers who
were either unwilling or unable to adhere faithfully to his ideas. Over
two hundred years later these ideas continue to present difficulties.
What follows is a synopsis of several of Hahnemann’s core teachings
followed by key contributions by Bönninghausen.

[1] Richard Haehl, M.D., Samuel Hahnemann His Life and Work,
vol. II, p.483.

FIRST TIER CONCEPTS

Homeopathy is characterized by a few great concepts. Central to
homeopathic doctrine is the idea of the Vital

Force

. [2]
It is postulated that 1) it exists, 2) it is a subtle energy not
discernible through the senses, [3]
3) it maintains the organism in health, [4]
and 4) when disjointed it causes disease.[5]

[2] S. Hahnemann, Organon of Medicine, §9 “…the
spiritual vital force, the dynamis that animates the material body,
rules with unbounded sway, and retains all parts of the organism in
admirable, harmonious, vital operation…”

[3] Ibid., §11 “…the vital force…a power
invisible in itself…”

[4] Ibid., Introduction. The “proper function” of the
Vital Force is “the maintenance of the life and health of the
organism.” p. 67

[5] Ibid., “It is the morbidly affected vital energy
alone that produces diseases.” §12.

The second great idea is that medicines prepared in a homeopathic
manner through dilution and succussion can affect the Vital Force.

[6]
When a person is healthy and takes a homeopathic medicine it can disturb
the Vital Force causing symptoms [7]
and when ill a homeopathic medicine that corresponds to that
illness can remove it allowing the Vital Force to once again
maintain health. It can do so, said Hahnemann, because medicinal
diseases are stronger than natural ones. [8]

[6] Ibid., §19 “…medicines…possess the power of
altering man’s state of health…”

[7] Symptoms so obtained are called provings. Hahnemann
also called provings “medicinal diseases.” Ibid.,
§32, §155.

[8] Ibid.,

§30,
footnote 15: “…artificial morbific forces, which we term
medicines,…are stronger than the natural diseases…”

SECOND TIER

Hahnemann maintained that a curative homeopathic medicine
corresponded to an illness when it caused symptoms similar to
that illness. This is the third great idea that has become known as Similia
Similibus Curentur or Let Likes Be Treated by Likes.

[9]

[9] Ibid., §25 “…that medicine which…has
demonstrated its power of producing…symptoms similar to
the disease…does also…remove [them].”

THIRD TIER

Third tier
ideas have to do with the methodology of

finding the correct homeopathic medicine. Out of a mass of
information gathered from the patient and others

[10]
the physician is to cull what is less valuable from what is more.
Initial valuable clues appear in sections 83-90 of Organon where
Hahnemann instructs on how to take a case. Of particular note is §86
where, for the first time, Hahnemann mentions sensation, location and
modalities though not in those words [11].

[10] Ibid., §84 Beside the patient “…those about
him tell what they heard him complain of, how he has behaved and
what they have noticed in him.”

[11] Ibid., Hahnemann speaks of what, where, when, and how as
follows: “…at what period did this symptom occur? What kind
of pain, what sensation exactly, was it that occurred on this
spot? Where was the precise spot? At what time of day or
night?…what position of the body was it worst, or ceased
entirely? What was the exact nature of this or that event or
circumstance…?”

He is beginning to differentiate between symptoms ‘common’ [12]
and ‘uncommon.’

[13]
It is the latter that Hahnemann begins to emphasize.

[12] Ibid., §153 “The more general and undefined
symptoms…demand but little attention when of that vague and
indefinite character…as symptoms of such a general nature are
observed in almost every disease and from almost every drug.”

[13] Ibid., §153 “…the more striking, singular,
uncommon and peculiar (characteristic) signs and
symptoms…are…most solely to be kept in view…”

In my hierarchy of concepts the ‘Law of Similars’ is in the
second tier. How can it not be the central tenet of
homeopathy?

It is my view that the ‘Law of Similars’ was constantly being
modified by Hahnemann throughout his long career. As originally stated,
it was the best explanation of the observable fact that homeopathic
medicines acted. If the idea of similarity were unambiguously true then
any remedy that covered all aspects of a disease would cure all the
time. Hahnemann said as much in the Organon:

“…the totality of the symptoms must be the principal, indeed
the only,[italics mine] thing the physician has to take note of in
every disease and to remove by means of his art, in order that
the disease shall be cured.”

[14]

[14] Ibid., §7.

That did not happen all the time as so stated. So Hahnemann gave
further indications on how to proceed in

§83-90
as mentioned above. In §153
Hahnemann is crystal clear on what is most important. He exhorts us to
emphasize the “more striking, singular, uncommon and peculiar (characteristic)
signs and symptoms” both in “the case of disease” and
“the selected medicine.”

It is interesting that he never abandoned the idea of “the
totality of symptoms.” He just refined it. By

§154
he states,

“…the most suitable medicine contains those peculiar,
uncommon, singular and distinguishing (characteristic) symptoms, which
are to be met with in the disease to be cured in the greatest number
and in the greatest similarity, this medicine is the most
appropriate homeopathic specific remedy for this morbid
state.”

So, as Hahnemann’s experience deepened, his idea of similitude
changed. ‘Common’ symptoms were dismissed, no matter how similar,
and the ‘totality of symptoms’ while not forgotten was trumped by
‘uncommon, singular and distinguishing’ symptoms. So it is not everything
similar that is useful, it is really only distinguishing features
of the disease that can be matched with distinguishing features of the
proved medicine.

These later ideas could not have been present at first. Bönninghausen
said as much in Lesser Writings

[15]
when he alluded to the progression of Hahnemann’s understanding
suggesting that it was “impossible” in the first provings to
know which symptoms would be most valuable. [16] As a result of years of
careful experimentation and observation it became obvious that:

[15] C.M.F. Bonninghausen, The Lesser Writings,

(BLW) p. 320

[16] Ibid., “But it was impossible at the first entrance on
the course of provings by Hahnemann to know that almost every
medicine acts on most of the parts of the living organism,
frequently indeed in a very similar manner…”

“…the individual differences between the different kinds of
action [of medicines] are almost only indicated by the various
combinations of the symptoms with each other, but most distinctly in
their modifications which cause a difference in the time, the position,
and the circumstances with respect to the alleviation or
aggravation of the ailments caused.”[17]

[17] Ibid. p. 320

It is here that Bönninghausen, trained as a botanist and a lawyer,
added clarity to the practice of homeopathy. The aforementioned elements
add up, he said, to “a useful symptom”

[18]
consisting of location, complaint, modalities. and
concomitants. A ‘useful symptom’ became, for Bönning-hausen,
the sine qua non of homeopathic diagnosis because it was
“complete.” He wrote, “For every single symptom, complete
in all directions may be considered as a diagnosis in itself.” [19]

[18] Ibid. p. 319

[19] Ibid. p. 320

It was Bönninghausen who figured out that one could take apart
proving symptoms, classify them according to location, complaint,
and modality and then reconstitute them in an original
arrangement.

[20]

[20] The Therapeutic Pocketbook

and its reformatted version, The Bonninghausen Repertory (TBR)
are arranged in this way.

To use The Bönninghausen Repertory (TBR) successfully it is
necessary to think abstractly as follows: If during the menses a
woman has nausea or vomiting or diarrhea or headache or fever or chills
or perspiration or any combination thereof, one abstracts to the rubric worse
during menstruation as there is no way to look up the specific
complaint. This is totally unlike Kent’s Repertory where each
specific complaint can be looked up under the appropriate section.

Similarly, if the patient is worse at any hour after midnight there
is no looking up the exact time as there is in Kent. Instead, there is
only the modality, “Time, after midnight.” TBR2057. Highly
abstracted.

It can be daunting, at first, to use TBR because the entries are so
abstracted but one becomes accustomed and it soon becomes simpler.

The following case illustrates how, using the Bönninghausen method,
a recalcitrant ulcer was healed.

A COMMON REMEDY
USED UNCOMMONLY
IN A BROWN RECLUSE SPIDER BITE

2 Oct. 02

A 27 year old man was in severe pain from an insect bite (the doctors
concluded it was from a Brown Recluse Spider) on the right posterior
thigh eight days earlier. By the fourth day the area was grossly swollen
and infected and it was lanced. He was placed on antibiotics. Again
yesterday it was lanced and much dark green pus was released. He was
instructed to pack it with a long strip of gauze which he did though it
was very painful to do so.

On inspection the skin around the ulcer was reddish purple. He said
that five days earlier the center had been black with a reddish
perimeter. It was no longer black.

The area was quite painful especially while sitting when a sharp pain
shot downward.

After a period of intense pain his hunger increased. For the last
four days he had increased thirst for “7up” or fruit juice. He
had started falling asleep during the day, very unusual for him. Since
the insect bite he had been feeling warmer than usual. “I find
myself turning the fan on.”

He said he wanted to be left alone.

He noted some trembling in the last four days.

Analysis:

This is a case of pure physical pathology. The ulcer contained all
the elements of a complete symptom.

• Location

: here the direction of the pain is most important.


• Complaint/Sensation

: stitching pain, striking because of the
intensity.


• Complaint/Description

: a black ulcer with red perimeter.


• Modality

: pain worse sitting (not used)


• Concomitants

: trembling + hotter than usual + wanting air.
(only the trembling used)

The important factors were the nature of the discharge, the
sensation of the pain and its direction, and a description of the ulcer.
One concomitant was selected. The following rubrics were taken:

TBR2007 pus, green Puls (3)

TBR1423 pain, stitching, downward direction Puls (3)

TBR1448 trembling, inner Puls (3)

TBR1979 ulcer, black with red perimeter Puls (4)

Plan:

Pulsatilla 30c (pellets) three times a day.

Note that he was warmer than usual and wanting air, both general
symptoms of Pulsatilla. As they were not the most uncommon
symptoms they were omitted though they helped to confirm Pulsatilla.

Follow up two
days later:

Considerably better. The shooting pains down the legs were 80%
better. Some of the redness around the lesion was gone. The increased
hunger following the pain was less.

The wound continued to heal up nicely over the next week. He refused
to discontinue his antibiotics.

Below, the full repertorization using TBR:

2007

1423

1448

1979

ars

1

0

0

4

asaf

3

0

1

3

aur

2

0

0

0

carb-v

1

4

2

0

caust

3

3

3

0

clem

2

0

0

0

creos

1

2

1

1

merc

2

0

0

3

nat-c

1

0

0

1

nux-v

2

1

2

1

phos

1

0

3

2

puls

3

3

3

4

rhus

2

0

4

3

sep

2

1

1

2

sil

3

0

2

4

staph

1

0

4

3

This case was quite simple using TBR requiring only 20 minutes
total. Using a repertory based on Kent it would have been nearly
impossible. It nicely illustrates my contention, mentioned in all three
parts of this article, that symptoms, once deconstructed can be
recombined in an original way and act curatively.

The Bönninghausen Hexameter

Who? (the
patient: sex, age)

What? (the
complaints)

Where? (the
location)

Why? (causation)

When? (time of
appearance; time of aggravation and amelioration. Also, the
sequence of events.)

Modalities
(modifying influences)

Concomitant
(accessory) symptoms.

To simplify, we can condense the above seven into 4:

Location

Complaint

Modalities

Concomitants

As a mnemonic it can be shortened to:

‘LoCoMoCo’

“Complaint” or “What?” can be both subjective
and objective.

Subjective:

“I have a
burning pain.” or “I feel sad.”

Objective:

“I have a ulcer
with a red rim and green pus is coming out of it.”. It could also
refer to what the physician observes as in the color of the face , the
sound of the cough, the manner of breathing, weird behavior,
uncoordinated movements, etc.s

Copyright
© Karl Robinson, M.D. 2005