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.

            Not only Bryonia but many symptoms from many medicines he generalized from the part to the whole. That is to assume that that which affects the part affects the whole, a radical idea in its time and perhaps still today.

            Before examining Bönninghausen’s work, let us look at the Kent Repertory.  (Note: The Complete Repertory and Synthesis are both based on the Kent repertory.)

            Kent’s opus contrasted sharply with 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[1]. For example, “HEAD, Pain, sun, from exposure to” or “Extremities, Pain, Knee, motion.” At the same time, borrowing heavily from Bönninghausen, 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.

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[2], 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.”

            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.

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, and 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 “Modalities, 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[3], 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.” Bonninghausen 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 that totaled 1161 symptoms.

            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, and 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 through 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. In Therapeutic Pocketbook it occurs only under “Modalities, Lying on left side,” as a general modality.

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 Bönninghausen Repertory (TBR) edited by George Dimitriadis.[4] 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.

 

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 considerably better with air circulating. As a result he avoided underpants and often wore nothing but a terry cloth robe indoors.

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

TBR 611[5]           Male genitalia                                        Sepia   3

            TBR 2683             Wet, by perspiration agg.                       Sepia   3

            TBR 2268             Clothing, pressure of, agg.                      Sepia   3

            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 preconceptions 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…” [6]

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 is to follow Bönninghausen’s urging to make each symptom as complete as possible. In an essay, “Directions for Forming a Complete Image,”[7] Bönninghausen does what today we would call a “Review of Systems” and he points out the importance of Location, Complaint, Modalities, and Concomitants.

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[8]. It should be recognized that Bönninghausen did not state it exactly as above. In “Directions for Forming a Complete Image” he wrote as follows concerning headache:

 

                                    V. Internal Headache

a.                   According to the sensations…

b.                  With respect to the time of the day.

c.                   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, from my practice:

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 vomited “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 but there was 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. Kent, J.T., M.D., Repertory of the Homeopathic Materia Medica, Calcutta: Sett Dey & Co., 1974.

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

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