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Dr Heiner Frei-The Boenninghausen Method & Polarity Analysis (Part 1)
When I take a case, I make a few notes and from the same notes you can come to the same remedy with this method. So this is a very important thing. It’s not so much dependent on my personality as maybe other methods, even my intuition it is not so dependent, it’s more… let’s say, it works bit like a Swiss clockwork. It’s very precise and that’s what I want to show you.
So, why Polarity analysis? I don't know how you felt when you first were confronted with homeopathy. My feeling was about like this. It was a huge mountain. And my wife recalls that when I came from the first lecture, I said, Oh! I wish I would be 5 years later now. 5 years more knowledge. This is a huge thing. It’s as huge thing as may be seen as conventional medicine is at all and I felt even smaller than this fellow. So how can we handle this problem, that’s one of our basic questions in teaching homeopathy? How can we teach homeopathy to our students that they don't leave because they are discouraged because of this mountain? This is one thing.
And the second thing is, once we are successful Homeopathic doctors, there are very many people who want homeopathy. They run to your practice. We just had a flu epidemic in our country and we were working extremely hard and our neighbor says, it like a pilgrimage. They come and go and come and go to your practice. It’s amazing! He was like, what does he do, how does he do it. Well we caught, both, Lotti and I caught also the flu, so we are a bit hampered in voice. I beg you to excuse this. But how do we do this and that one possible way that I showed you know how we can handle patients.
Now in these days. I go up to 50 – 60 patients every day, I realised that this is nothing as compared to some Indian; what some Indian doctors are confronted with everyday. Even Rajan tells me, he also sees 60 patients a day sometimes. So that's amazing! How can we do such an individualized and demanding work with so many patients.
Well, we came up with the solution that how do we best start Homeopathic training. You must begin with method that can be readily applied. Simple method. And the simple method is Boenninghausen, Boger and Polarity analysis which is actually a perfectionised version of Boenninghausen. And then once we know how to work with this method and if it's necessary we go on to the more demanding things like Kent, Vithoulkas, method of our dear friend, Jan Scholten, Mangialavori. And we can even consider this specialization in homeopathy in to a certain direction. If we teach homeopathy this way the danger that we lose students in Europe is much smaller than if we go directly to more complex method. So in Germany they've decided now to start the basic education with Boenninghausen and Polarity analysis which I think is a very good idea. Now I’m teaching in Germany. I'm educating the teachers in this method.
What do we want to reach in the seminar. We want more the Boenninghausen method and Polarity analysis, and that you are able to apply it in acute disease. And module 2 is about chronic disease that will be in the afternoon. I will show you how you can apply in the chronic disease as well. And we will also solve cases together. So it will be very practical.
Now first to Boenninghausen. Now I don't know how well you are acquainted with the Boenninghausen method. So I make a very short introduction in to the method. For Boenninghausen, it was….. Boenninghausen had it's own ranking of symptoms for remedy determination, and the most important for him was the main symptom, the main complaint patients came to the doctor with, with it's characteristics. Then in second place the additional symptoms that are there too but not of the same weight for the patients. Also with their characteristics. And finally the changes in mind during disease. Not the change, not the mind, state of mind of a healthy person but the state of mind of a sick person. And the change of mind finally makes…. tips the scale for a certain remedy after we have made a differential diagnosis with the main symptom and eventual additional symptoms.
What are characteristics symptoms. We will shortly repeat this. You all know this of course. It’s localization, sensations and findings, modalities and accompanying circumstances. And of these, as Rajan told you already the modalities are by far most important feature of a symptom; the most characteristic. It’s the point that leads us to the core of the case.
What do we have to heal? We have to heal the totality of symptoms. And only this is what we have to cure. Hahnemann points this out because this is not very clear anymore in many methods where we have to aim at, we have to heal disease of the patient. I'm sure this is much clear here in India than it is in Europe, because in Europe there are many things done with homeopathy which are a bit difficult to understand.
There is one paragraph of the Organon which I think is very often misinterpreted and I also think I learnt it that way in my primary education in homeopathy. It's this paragraph 153 where Hahnemann writes that “more striking, exceptional, unusual and odd characteristics signs and symptoms of the disease must be especially and almost solely kept in view.” And this is interpreted as being really very rare, very odd symptoms. But in paragraph 133, Hahnemann writes that through the modalities what is peculiar and characteristic about each symptom becomes evident. So actually these two paragraphs should always be taught in conjunction together. This paragraph 133 explains what he means here.
So this was one of the key points of my work to realise that actually the modalities are the most important thing to look at if you want quickly to come to the core of the case.
Then the state of mind, as I said often tips the scales after the selection of possible remedy with the help of characteristic symptoms i.e. modalities.
Now we come to the first thing that might be new to you. Boenninghausen advised in his book; aphorisms, to check whether one or more aspects of the patient's symptoms set contradicts the genius of the remedy. That’s a very quick pick, very difficult to understand sentence. So what did he actually mean with that sentence? He has defined the genius of the remedy that it consists of the modalities, sensations, clinical findings that have repeatedly appeared in the provings and that has also been in different localizations and have also been healed clinically.
Now a contradiction may concern polar symptoms. Polar symptoms are symptoms that can have an opposite such as thirst/ thirstless or opposite modalities like movement better, movement worse, or desire for free air or open air or aversion for open air, these are polar symptoms.
A patient can only have one pole of the polar symptoms. He is either thirsty or he is thirstless. On the other hand, the remedy can have both poles of a symptom because the symptom set of a remedy is consists of the observations of many many provers. So some provers may have observed thirst and others may have observed thirstlessness. And normally one of these poles is much more frequently observed. So the frequently observed pole is the characteristic symptom for the remedy, and it appears in the high grade in the repertory. While rarely observed pole appears in the low grade.
This is Boenninghausen's grading; Grade 1 is the symptom that is observed only once in proving. Grade 2; symptom that is observed several times in proving. Then grade 3 is a symptom that is observed in proving and clinically healed. Grade 4; often observed in proving and clinically healed. And grade 5; even more prominent in grade 4 underlined by Boenninghausen.
Now what is a contradiction? Boenninghausen said, “if a Homeopathic remedy is to be optimally heal the patient, polar symptoms must be found in as high a grade as possible in this remedy i.e. 3rd to 5th grade. And the opposite pole of the symptoms should be found in a lower grade; first or second grade. Now if the opposite constellation of this is present, it is a contradiction or a contraindication for the remedy. That means if the opposite pole is in high grade, it’s typical for the remedy and the patient pole is in a low grade is incidental symptom of the remedy; this is a contradiction or a contraindication.
Here you have a contraindication. This man is very thirsty and this is a contraindication for Pulsatilla who we know is thirstless. But we also know that Pulsatilla also covers thirst only in first grade. So if we still use it in a patient which is thirsty, which we might if you only look at the totality of the symptoms, we fail to heal this patient. When I first realised that this is very important, I went to check cases that did not go well before, and I frequently found that I have missed contraindications. They had contraindications because I didn’t look at this aspect of the case.
Now if we summaries Boenninghausen's major insights, it is these :
• Current symptoms of the patients are the major signpost to the remedy.
• Then, modalities are the most characteristic aspect of the symptoms.
• Mind symptoms tip the scale after selection of the possible remedies with the help of modalities
• and we have observed contraindications.
So that the end of theory. Now we can go into a practical case.
It is a 6 year old girl who is very often ill. At the age of 18 months, she began to suffer from constitutional eczema; Neuro dermatitis. And at 3 years she started with allergic rhinitis. 2 years later pnuemonologist diagnosed allergic asthma and treats her with Beta-2 agonists and topical steroids. This is a very typical carrier of an allergic person on every level. The allergy symptoms are suppressed.
First Neuro dermatitis; the child received Cortico steroids and Neuro dermatitis disappears. But next thing it goes to the depth and it begins with hay fever. And the next step is hay fever is suppressed by Anti histamines and also topical steroids and we end up with asthma. So conventional medicine says we can’t heal an allergic patient, and this is very correct. That’s not the way to do it. Because the only thing they do is suppress all the symptoms. They now treat her with Beta-2 agonists and topical steroids. It may be that this patient's asthma disappears but the hay fever reappears. Means the hay fever is suppressed again, it may return to asthma or to Neuro dermatitis. This is really a vicious cycle which leads nowhere.
I see her first at the age of 6 years with an acute outbreak of allergy symptoms. She has red, watery eyes, red eyelid margins, she has an aversion to light and she has mild coryza. At night there is an intractable cough with breathing difficulties that keep her from sleeping. And on examination I just find the acrid conjunctivitis and blepharitis, red lid margins with an increased respiration rate and the prolonged exspirium. So what’s the diagnosis? What diagnosis do you make? It’s an allergic asthma in an atopic patient.
I give the mother the checklist for ENT, eyes and airways, and I get back the following symptoms :
We have the
• localizations; the conjunctiva, then the eyelid margins, interior chest.
• Sensations and findings; the vision is dazzled by light. We have watering eyes, fluent coryza, suffocation on breathing, quickened breathing – First polar symptom we have. Then cough with expectoration in morning, no expectoration in the evening. Second polar symptom.
• Then we have the modalities; breathing out is difficult means worse. It’s worse after sleep, worse in lying position and better in darkness.
Now if I work with Boenninghausen, the Boenninghausen method, not with Polarity analysis, I use all these symptoms. I use the localizations, then the sensations and findings and finally the polar, the modalities. We easily got what’s down here because this is already Polarity analysis. And you see I have only 2 remedies that cover all symtoms. One is Nux Vomica, the other one is Euphrasia. And Nux Vomica has a contraindication.
Here you see the contraindication. On the bottom you have the opposite symptoms; these are the patient's symptoms and here are the opposite polar symptoms. And you see here, better lying position is in 4th grade for Nux Vomica. That means the opposite of the patient’s symptoms; worse lying position is typical for Nux Vomica. So Nux Vomica has the contraindication and won’t heal the patient. So we are left with Euphrasia.
R = Dr Rajan Sankaran; H = Dr Heiner Frei
R : First you have to explain what is the checklist because they don’t know that.
H : You know we have checklist for acute disease; 8 different checklists. And on this we see that later on 2 in the course, but on these we have listed all the important especially polar symptoms. So I give that to the parents to get the precise information and not blah blah. Very often people tell you many things and that are not so relevant and if you don't have so much time it's very nice to be focused on what is really important. So that’s why we use these checklists.
R : It'll be good to see if you see if you have a checklist already on your computer. It will be good for them to have a look.
H : I don't know if I have one
R : I guess a checklist is where they just have to just tick mark.
H : Yes, on the line of this, the present thing in the patient.
R : Like open air, closed room, lying down, sitting up, standing. Worse, better, worse, better.
H : Here you have one. May be that's very nice that you brought it along. You passed it through the lines and.
R : We can just put it there. You can see it in the break, what a checklist looks like. Okay. So this is given to the patient in advance I believe. Even before they come.
H : Yes.
R : So they fill this out and they bring.
H : Can you pass it through there.
R : That one. And secondly, the second thing that he's talking about over here, this is very very interesting because all the symptoms are listed here. And the software automatically lists the exact opposite of that symptoms here. So you see this remedy has these many marks in these symptoms but it has these many marks in the opposite symptoms. Are you with me? Now if the remedy has less marks in the real symptoms and more marks in the opposite symptoms, it is considered as a contraindication for the remedy.
So Nux Vomica which has here, worse in lying position only 1 mark, but better lying 4 marks, therefore in this case Nux Vomica is contraindicated. This is the whole idea. This is the basis of polarity analysis. So this is a very important chart to understand first what has happened. Are you able to follow better now? If you can explain this little bit. I think once they get this, they'll get the rest of it easily.
H : Yeah. You know we come with many cases with it, and you will see step by step how it works. This is mainly to show you the Boenninghausen's system in which we do not have implemented already polarity analysis. We have only the contraindication here. But polarity analysis is much broader and you will see in the further cases.
Well I can show you this. Here you have these numbers. They show us how many remedies cover each symptoms. And you have also polar symptoms marked with a 'p'. These are most interesting for us because they may be a reason for contraindication. Here all the lower symptoms; the 5 lower symptoms are polar. And down here in the below the red line you have listed the opposite poles.
So you have breathing quickened and you have breathing slowed. Quickened is 3rd grade, slowed is 2nd grade. So this is a perfect constellation as we like it. Or you have this lying position 1st grade on the patient’s side and the lying position better on the opposite side. So this is now the contraindication. But you will get it as we proceed.
R : Can you explain what is the Polarity difference?
H : Comes later because this is only Boenninghausen. Polarity difference is a step further. This is a pure Boenninghausen case.
Over all we can say we have these 2 remedies; Nux Vomica and Euphrasia. And only Euphrasia has no contraindication and so it seems to be the remedy of choice. But to be sure, we go now into the Materia Medica and we compare it with the guiding symptoms of Hering. And you see Euphrasia has the sensitivity to light, then it has the inflammation of conjunctiva and eyelids, burning eyes with lachrymation; it's an acrid, water runs from them. Then it has a coryza with scalding tears and the margins of the lids are red so the eye is very irritated. While the nose is, the coryza is mild, has a mild secretion. Then we have also the symptom; deep inspiration difficulty, suffocation of the patient. Deep inspiration is difficult when the lungs are over inflated, so it's a very typical symptom of severe asthma. And we have the cough that is also described. So very typical Euphrasia symptomatology.
Do you know the plant? This is the plant that grows in the Swiss Alps, an altitude around 2000 meters. And you see carpets of Euphrasia in these meadows. It is interesting that you find the plant there because in the mountains, one of the problems we can have in winter is that you get snow blind; you get blinded by the bright light of snow. And Euphrasia is a perfect remedy against it.
You also find there in the same region, Aconite which is against illness by severe cold or by shock which can also happen out there. And you find Arnica in the same region which is a remedy against injuries. So I'm always amazed to find there we go very often in this region on vacation to find that the most important remedies for a few things that are very typical for this place.
So I gave to Anna this remedy Euphrasia 200 C. Her symptoms improved immediately and she is well for 2 weeks. And then she comes again with tonsillitis. I look again at the symptoms again and give her Sepia 200 C which heals the tonsillitis. But of course the cough starts now again. But this disappears with a second dose of Euphrasia 200 C. And this now, it's the last thing improved throughout the whole summer. She usually was ill for about 4 months during summer with hay fever and asthma.
The following year, no allergy symptoms. But a year later she comes, she comes again, and she has again milder allergy symptoms and I give her again Euphrasia 200 C that cures her again for 2 years. So I was very surprised that this small remedy whom we think of as a remedy for conjunctivitis and not much more, this small remedy cures a severe allergic disease, one dose, for 2 years. After another 2 years, 4 years after the first treatment, she comes again with very mild allergic symptoms and she gets again Euphrasia and now she's finally cured.
Do you have questions to this case?
A = Audience; S = Speaker
A : Is the checklist was given every-time she came ?
S : No. Well! normally I do that. I give every time the checklist when they come. I gave it again when she came with tonsillitis. But when she came again with exactly the same allergic symptoms as the first time, I just gave Euphrasia, because I knew it worked so well.
A : For symptoms of modality, for e.g. < lying down, how strong that was in the patient itself, because in the repertory it is given as one mark? Whether it was very strong in the patient or…. S : that a question that is frequently asked, but we never, so far we haven’t graded the intensity of the patients symptoms. I do that when I have sometimes the patient or the parents are completely overtaxed with this list of modalities and they underline everything. And if they do that, I am going to ask them now you must tell me what is really prominent, not only what is a bit the case. And like this I get the grading. But I do that only when I have too many symptoms. So I can’t tell you now what was the case here, if it was very very prominent or not. Because she had a normal amount of symptoms which we can handle easily. A : What was the indication for Euphrasia? Why did you change from Euphrasia to Sepia? S : That is a good question. I could have stayed with Euphrasia or do nothing because often we see if we give a good remedy that something comes up from earlier but this was during an epidemic of throat infections, so I thought it's a different thing. And that's why I looked for a new remedy. A : There was a change in the totality? S : Yes. A :What is the difference between the patient symptom and the polarity marked symptom? For eg if the symptoms in patient has got 1st grade and the polarity has 2, so will you take that as contraindication, or it should have a wide gap? S : No. the contraindication concerns only the high grade symptoms. So if you have here, if I understand your question right, you may have a constellation that you have here in the patients symptoms are grade 1 symptom and the opposite pole is grade 2. That means it's slightly higher but both symptoms are not in the realm of a genius symptom. So we don't consider this contraindication. If it's a level higher; if the opposite symptom is on the genius level; that is grade 3, 4 or 5 and the patient’s symptoms is grade 2, then we have the contraindication. The contraindication concerns only genius symptoms. A : Gradations are only of the repertory, so how do we grade the symptoms of the patients? S : Well, the grades are from the repertory. We don't grade ourselves what the patient says. The grades are the grades in the repertory. A : Yes, but the patient's symptoms are not graded. S : No, normally no, except the case I explained before where we have too many patient's symptoms. Okay. So not a question. A : Do you use remedy relationship in this case like what follows sepia? S : No. Question is do use a remedy relationship what follows Sepia or how does Sepia follow. I didn’t test that. Boenninghausen has suggested many of these relationships and I have tested it for a while and I found it is of no importance, that's is my experience. May be for Boenninghausen it was important but in my experience, it's only the symptoms you have right now that really indicate the remedy. So what can be learned from this case? We can learn that a very small remedy like Euphrasia can cure a big disease like this atopic suffering of this patient. So what does it really mean; a small remedy. A small remedy is probably a remedy about which we do not know everything. that my suspicion. And what really surprised me in this case was the prolonged effect of this remedy. That was really fantastic! So now we come to Polarity Analysis. Polarity Analysis has an element more to consider that is the Polarity difference. The Polarity difference indicates the level of congruence between patient symptoms and Homeopathic remedy. So it actually is indirect probability of healing we get from calculating the polarity difference. We calculate it by adding the grades of all polar patients’ symptoms and we subtract the corresponding opposite grades. That gives us the polarity difference. Now if you look at this case here, you have down here 5 polar symptoms. The last 5. Can you read it? Okay. And we have the grades here. We have breathing quickened grade, we have 2, 2 means 7 points, 8 points, 11 points. For Euphrasia, breathing quickened is in first grade and we have 4 points, 6 points, 12 points here. And we have here an opposite pole, it’s 1 point. So this is a calculation of polarity difference. Did you get it? It’s very simple. And the advantage of this is that now we use all the grades not only the contraindications, we use all the polar symptoms for determining the specificity of a remedy. The higher the polarity difference is, the better the match between the patient’s symptoms and remedy. And the more likely the remedy will heal this patient. R = Dr Rajan Sankaran; H = Dr Heiner Frei; A = Audience R : You are able to follow? We'll have to go one step back. So, this polarity difference he is explaining this part of it. So what he has done is taken those symptoms which have the opposite. All symptoms don't have opposite. Right. For example, coryza fluent running doesn’t have an opposite. So these 5 are the opposite of the last 5. Yes, good? Because; see for example; worse lying has an opposite; better lying. So these are the symptoms which have exact opposites. So for calculating so for example, in Euphrasia, you take these 5. Add this up. You'll come to 12. And in the opposite there is 1. So 12 minus 1= 11. Okay. So that is the polarity difference of Euphrasia. The greater the polarity difference, the higher it is indicated. Whereas in Nux Vomica….. But in Pulsatilla... Also you've to see how many symptoms are covered. Nux Vomica and Euphrasia cover all the symptoms. So they should be considered first. You got it? The 3 considerations as I understand. He'll explain you better. First is number of symptoms covered. So more indicated. This covers all. Second is polarity difference should be high. And third is there should be no contraindication. Contraindication means the opposite symptoms should not be found in a very high grade; 3, 4, 5. So if patient is for example, worse from movement, so better from movement should not be in the highest grade, then it is contraindicated, against the genius of the remedy. So 3 things in my understanding. Now you'll have to explain which is more important; number of rubrics covered, polarity difference or contraindication. I guess you look at all 3. Right. H : I look at all 3, but the most important is the polarity difference. R : This is the most important one. But you will not give Pulsatilla because it has less number of. H : Exactly. We have one symptom missing here. R : So this is also very important for you. Number of rubrics covered. Now clear? H : I think you must come in the future with me for my seminar. We are a perfect team. Thank you very much. R : Then you come in my seminar. Explain 'sensation'. H : You think I'd be able to? I wonder. Thank you. R : The concept is so new, repetition is not harmful. This is very fundamental. Everything is based on this. H : Now from all we have said now, result in a new approach for determining remedies. If possible, we make a repertorisation only with polar symptoms and their opposite poles. In many many cases this is sufficient to get a clear result for the best remedy. If it is sufficient, we make the next step; the Materia Medica comparison and finally choose the remedy. If it's not sufficient, to use only polar symptoms, we include non polar symptoms in the repertorisation to get the higher differentiation. And then we make a Materia Medica comparison and choose the remedy. R : Did you follow this one? So as I understand you, Boenninghausen included all the symptoms. Right. So what he has done to make life easier for everybody, eliminated from that, symptoms which don't have the polar opposite. Like in the last one we saw 5 symptoms have polar opposite. So in the next step, going ahead of Boenninghausen, he simply removed all the other symptoms. Only symptoms with polar opposites. Are you with me? So that is the first what he is showing here. That’s only with polar symptoms if you can get the remedy, then you don't have to bother. Give it. But if it's not clear, then go back to the Boenninghausen one, include all the symptoms. But mostly he is just depending on this side. This is the whole idea that simply you can remove. So therefore mostly modalities will be left, isn’t it? Because modalities will have opposites. Therefore, emphasis on modality in the polarity analysis. It's easy, isn’t it? And really, it makes life very very easy. So easy. H : It's really true. R : And that's why he is one of the most popular teachers of homeopathy in Europe at the moment. Everybody’s life becomes easy once he goes. Then I go and complicate it. So that's how we are a good team. H : You are fantastic. But that's the way if you teach advanced physics then you complicate it. The reason why we can do this, why we can omit normally or often omit non polar symptoms is that the result very often is exactly the same if we include them or not. So their influence is actually very small on the choice of the remedy while the polar symptoms have a very high influence on the choice of the remedy. So now we go to the treatment of acute disease. A : So in the previous case if the non polar symptoms were not taken then Pulsatilla would have been indicated? Because the polar. H : It would have come in, yes. In this previous case, it would not have been sufficient to take only polar symptoms for determining the remedy; that's correct. But I didn’t want to show you this actually because I wanted to show you how Boenninghausen functions. That was the purpose of this case there. Now we come to the treatment of acute disease. We have 3 criteria for the choice of the remedy. First criteria is the size of the polarity difference, the height of the polarity difference, Second criterion is no contraindication, And the third criterion is the completeness of coverage of polar symptoms. And now I show you first case history with polarity analysis. Since I make general emergency service, I have also adult patients and I have also quite many adult patients because the parents see that homeopathy functions well in their children, they come and they want to be treated also. So my practice is not pure Paediatric practice, I have about 10 to 20 % adults, and so I can show you also adult patients. Case Study 1 This is a 50 years old man who came in the emergency service with….. And he has been so far healthy. He comes because during a sporting performance at Grand Prix of Bern, it's a running competition. He had to drop out because he felt he was not able anymore to bring the effort needed. And this was a very big blow for him because he has on that very many times and suddenly he didn't go anymore. His current illness began shortly before this Grand Prix of Bern with the transitory pain in the right side of the neck, and this lasted a few days. And since then he suffers from palpitations and outbreaks of sweating as well as an intractable dry cough. On examination I find that he has a reduced general condition. He is rather thin, and has dark rings around the eyes. His blood pressure is normal, pulse also, neck and throat normal. He has an early meso systolic click on cardiac auscultation. You know this could be early meso systolic click, that can be a mitral valve prolapse but the mitral valve prolapse is usually asymptomatic. This is not an explanation why he could not complete this competition. The rest of the examination is quite normal. The only thing I also find is a flow murmur in the right lower abdomen. But that nothing very special. So I really don't find much in this patient. I give him the checklist for the airways, and he underlines the following symptoms. He has an aggravation with warm and he has a desire for open air. He is hot and has an inclination to uncover. His pulse is quickened and he has a sensitivity to external pressure on the neck on the right side. You see all these symptoms are polar. And you might say now this is a very meager symptomatology, and you are completely right. This is very meager. And now we see if this meager symptomatology is typical for something. Do you think it is? Could it be? We don't know. We see. Now you see you are completely right, we have a very broad differential diagnosis. If we look first at the number of it’s appear. We have 6 symptoms and we have 2, 4, 6, 8, 10 remedies that cover everything. But we have few remedies that are contraindicated. All the gray shaded ones are contraindicated. So we are left with 6 remedies without contraindications. And now you see we have a very high grade in Iodium and the second remedy that has moderately high grade is Senega. Now what do you think, what is….. what do you have to do now if you find such a constellation? Thus, is there any suspicion arising in you when you see this? Thyroid? Exactly. Iodium , thyroid, very typical are very special actually. This is very special. So what do you do? What do I have to do or what did I do. Next step? TSH determination. Exactly. Very important; Thyroid Stimulating hormone. And what I find? It is extremely low (0.01). Much too low. So what’s the diagnosis so far? Hyperthyroidism. I give him Iodium 200 C and I refer him to the Endocrinologist for further exploration. Now what happens? Maybe first the Materia Medica comparison; you find this neck symptoms of course on the right side, the thyroid gland, the acute pain in the gland upon pressure and slightest movement of the head, palpitation, you find even the cough. So you see these very few polar symptoms lead us exactly to the right place. I was very thrilled by this case. I really liked this because this is so typical for polarity analysis. It seems so bland, so common and yet you come exactly to the core of the problem. He has an immediate improvement of well being; cough disappeared. General condition and physical fitness normalize after Iodium 200 C. The Endocrinologist sees him 10 days later, and the hyperthyroidism mass disappeared within these days. TSH is normal, fT4 is still slightly lower. Final diagnosis of the Endocrinologist was Thyroiditis, an acute inflammation of the thyroid. Well, we already said that this is really what is thrilling about the case. Now what is the practical procedure with polarity analysis in acute disease? We need some tools. We need a software, the one I showed you now, and we need the checklist. You can download the checklist from our website. Doesn't cost anything. It's good, you have a good Materia Medica. I like to use Hering 's Guiding symptoms because I have it in digital form. And so it's very quickly available. And you need the remedies of the pocket book. Then you can function. That’s all. It’s a cheap way to make medicine. We have 8 checklists for acute. This is all. Everything also in the script you'll find practically everything that is important in a script. We have 8 checklists for acute disease from top to toe, head to toe; Headache and vertigo, ear nose throat and eyes, airways, gastro intestinal tract, urinary tract, musculoskeletal system, then we have one for influenza and influenza like disease and one for infants and small children. And it is very easy to make such a checklist for your own purposes. Now if you need for obstetrics for instance, you just go into the repertory; the Boenninghausen Pocket Book. Look which obstetric symptoms are important for you. You take them out and the modalities and you have it. So everyone can do that for his own use. The structure of a checklist is that it first contains a field where you, where the patients can read or can write the main symptoms, a free description of main symptoms. And below you just have list of polar symptoms, sensations and mind symptoms. Polar symptoms are highlighted in blue on the checklist and we exclude it from the checklist symptoms with less than 10 remedies. Why do we do this? Why don't we take symptoms which have less than 10 remedies? What is the danger if we use them? A = Audience; S = Speaker A : Chance of elimination. S : Yes, we have too many; a small repertory rubric excludes too many remedies. So if possible we don't use them. My consultations are organized like this. I normally have 12 minutes for a patient with an acute disease, my presence is 12 minutes. The patient is about 20 minutes in the practice. And they have. I have 2 consulting rooms. In consulting room 1 we have patient 1, I come in, take a case history, examine the patient, make a diagnosis and give them the checklist if they haven’t brought it along already which I try to tell them. They can download it from our website, fill it in and bring it along. And the more clever patients, they found out and they bring it along. This is a big advantage because they can observe the symptoms at home. The checklist offers also what is important for me to know. So the patients can observe symptoms at home. We have an increasing number of patients who do this or parents who do this. If they haven’t brought it along, they fill it in while I go to the next consulting room to the same thing with patient 2. And when they are filling in the checklist, I return to the first one, look at the symptoms, question them, make a repertorisation and choose a remedy, give it to the patient and let him go. And then I go back to consultation room 2. So this is a very efficient way to do it. I can normally see 5, 6 patients an hour without being in stress. It's a very calm way even though we see many patients. S : Yes, you have a question. A: How many checklists just one patient fill, if they have more than one complaint? S : In acute disease they only use the one for the major complaint. In chronic disease we might need. There you have questionnaires. We come to that in the afternoon. We might need more than one. Normally we take one for the main complaint and one for additional complaints. And in very complex disease, we take for every complaint one questionnaire. A : and the question which is on mind, is every patient filling that questionnaire? S : On mind? No, no questionnaire for mind symptoms. It's only for those who have mainly mind problems. And I don't like so much to use it because I have found that people have quite difficulties with their mind symptoms. They are not accurate. They describe them in this or that way, so it's very difficult to use polarity analysis on mind symptoms. If possible I try in mental disease to find physical symptoms, physical modalities to lead me to the right remedy. This is very special and it functions normally well. Is there another question? A :What is the importance of pathological or disease symptoms to decide about the modality? For example a person having osteoarthritis has got aggravation on climbing stairs, will you give that as a…. you will take that as a modality or you will discard it? S : In principle I take all the modalities. If they are pathognomonic or not, I take them because this doctrine on pathognomonic symptom is a very critical point. You know the problem of pathognomonic symptoms? In the 19th century; Dunham and hart said that we should not use pathognomonic symptoms for repertorisation. At that point, in the 19th century, pathognomonic symptoms were severe irreversible organ damage, which we perhaps cannot influence with homeopathy. But I say perhaps because sometimes I hear stories that I am really surprised and I think we in some cases can influence them. But the today's meaning of the term pathognomonic is entirely different. Today we understand the typical symptoms for osteoarthritis for instance, those who make for diagnosis, the clinical conventional diagnosis, and if we don't use them, we violate the principle of Similars. So this is a very fatal link that has made from an old meaning to a new one. So I think the best way to treat this dogmatism in homeopathy is to throw it out of the window. Don’t consider it. A : But all the cases of osteoarthritis will have the same set of modalities. S : They don't have the same, they have the similar. But you know. I showed yesterday in my college lecture for ADHD patients. They also very often very similar symptom sets. And yet if one symptom is different, you have completely different remedies. So this is not the problem. A : Sir, one more question please! You make a grand generalization of the modalities or you take the location wise? For example, headache aggravation in the sun, will you take it or aggravation sun as a general? S : I do not distinguish between general and local modalities. I think they are equally important in polarity analysis. Any other question? A : In this method should we consider the causative factors? S : Yes, very often causative factors are modalities or even important modalities. So we consider them if we know it. A : Okay, thank you. A : Sir, how is polarity difference, the symptom which grades highest in this analysis different from eliminating symptom? When we say eliminating general or eliminating rubric, how do we relate that understanding with polarity difference? S : I didn’t understand question. A : What’s the difference between polarity difference and eliminating symptom? That’s what she is asking. S : Polar symptoms in general are eliminating symptoms. So they are the most specific we even get in a case. Then we continue with the next case. It's another adult patient. A 44 years old woman. She's a mother of 3 children whom I treat. And she’s a very highly industrious person. She works extremely much for her family and in addition she works as a speech therapist , a full time. Now she comes in, also in the emergency service with an acute hearing loss which she suffered from while riding out previous day. She suddenly felt a loud whistling in the left ear followed by severe ear pain and then acute hearing loss. On examination, I find the normal ear drum and considerable loss of hearing on left. And otherwise there is nothing in pathology. So what's the diagnosis? Acute hearing loss on left side. I start Homeopathic treatment and I send her also to the ENT physician for an objective diagnosis. And here you see her first audiogram . You see the right ear has a normal hearing; this is all within normal and you see the left ear has very severe hearing loss in the realm of lower frequencies. On the checklist for ENT and eyes, she underlines the symptoms left ear, noises in ear, whistling, ringing. That’s what she writes. And the feeling; stabbing, pricking inward, And hard of hearing on the left side. Then she has some modalities like uncovering worse, cold in general worse means aggravates, Lying on painful side is better, Movement is worse, Physical exercise worse, and external pressure worse. So we proceed. As we said just take the polar symptoms for repertorisation after we have made sure that she really means what she underlined. Now you see here we have only taken polar symptoms. Every symptom here is marked with a 'P', and we have 4 remedies. These 4 here; Rhus Tox, Arnica, Bryonia, Ignatia. And you see we have only 2 remedies with high polarity differences; Arnica and Bryonia. And these 2 have contraindications. So we have to choose between Arnica and Bryonia. We go into the Materia Medica comparison for Arnica. We find the great sensitiveness o loud sounds with pain in ears. Buzzing, humming before ears with difficult hearing. Hard hearing from concussion. Rushing in ears with deafness of right and stitches through left ear. If we compare that to Bryonia, there is an intolerance of noise, roaring, humming in left ear resembling water pouring over dam. Head feels light with constant wobbling in both ears. So if we compare these two texts, it’s clearly Arnica and not Bryonia. Here you see the plant. Does it grow in India too; Arnica? It’s a very typical plant of the Alps. Also of the same region that we found for Euphrasia. I give her one dose of Arnica 200 C. The next day she feels much better but there is still some pressure in the ears and she has a headache. By the 4th day, the pressure in the ears has gone and her hearing is almost normal. When standing up from seated position, she still feels slightly dizzy, and she rates her recovery as 85 % better. On the 11th day, I send her again to the ENT physician for a checkup and an audiogram. And here you see the audiogram. It’s completely normal. So very impressive recovery. The ENT physician had told her to take Corticosteroids and medications that improve the vascularisation of the ear. But she didn’t take it. So he was very proud of this success. But didn’t know that he didn’t take it. Now what are the teaching points? The main teaching point is that we come to Arnica in this patient. It is very special. She is hardly over worked. So this being over worked actually is the reason for loss of hearing. So what I want to show you with this case is again how with a few polar symptoms we come to the central problem a patient has. Are there questions to this case? It’s simple, isn’t it? A : Audience; S : Speaker A : The nature or the state of disposition of the mind, do you enquire? S : Of course I know her state of the mind because I know her since a long time. I know that she is very stressed and all that. That she would like to work less but actually does more. And all this, I know this problem because I know her well but I didn’t include this symptom in any way into the remedy determination. A : Sir, in all these cases what you showed, there were no mental symptoms. S : I try to avoid them because they are tricky. I can’t always avoid them. You will see cases where I have to use them. But if I can, I try to get around them and thus take them in the Materia Medica comparison. Another question? A : Sir, can you just brief us about the procedure without the software. Before the software came on, how did you proceed with this on paper? S : Okay. The question is can you brief us on the procedure how you did it before we have the software. Well! it was very special. I first had the idea while working on a patient. It slowly came to me from somewhere. Then I made table in which I wrote by hand the polar symptoms and the opposite symptoms and I wrote all grades in it, calculated it by hands though it was very time consuming. And I was very lucky that the Boenninghausen working group of which I am not the member, said we adopt this your system into our program. And then we added. So it was from then on it was very easy. But in the beginning I needed 15 minutes for every patient just to make the polarity analysis. So it’s much easier to do it with the program. R : So we'll take a break now. And fantastic no? What do you feel? And people keep asking about mental symptom you take or you don’t take. But I tell you in Switzerland, very difficult to get any mental symptoms. He has very cleverly avoided this area totally. Very reserved people. S : Yes, it’s true. R : In India you only get mental symptoms. S : That’s interesting. Well this is really true. R : Every woman here will straight away without…... She'll come with headache but she'll only talk about mother-in-law. Yeah, we have only in India for women we have 3 remedies. Before 15; Pulsatilla, after 15; Natrum Mur, after marriage; Sepia. And for men, only 2 remedies; before marriage Nux Vomica, after Staphysagria. So our differentiation very simple. When everybody mentals. But Switzerland very difficult. So 2 things. One is mental symptoms more difficult to obtain, more difficult to be precise about. Can’t be sure. And modalities more sure. So his idea that in the initial stages of teaching if we can get people successful, get them started with this, at least they get some success. Then the faith develops, the confidence develops. So then you can go on to mental symptoms. So at that level be careful. That’s the idea. S : Exactly. R : So, so wonderful just to hear and how he has contributed to giving confidence to early practitioners and how we can also use this idea and how wonderful remedies came out; Arnica, Iodum. Unbelievable! Otherwise we think that in our repertorisation, we always get Sulphur. Any case we get Sulphur. But in this you see because of contraindications. So then many remedies get ruled out. So when in Pune they ask about eliminating symptom. So the contraindication is a kind of elimination. The moment the remedy is contraindicated, it gets eliminated, that is what it happens over here. Because here we use eliminating symptom, means the symptom, remedy should have that otherwise it gets eliminated. That’s called eliminating symptom. But here you use contraindication as the eliminating factor. So more wonderful things to hear after the break. Now we colleagues I hope you have a bit time to digest what I told you this. I know this is quite a bit revolutionary what you hear here. But you know it's going also back to the roots. We are going back to the roots of homeopathy. At the beginning homeopathy was a lot easier than it is today because of possibilities were not so great. So let’s go, let’s continue to go back to the roots. R = Dr Rajan Sankaran; H = Dr Heiner Frei R : For the live case, we need a live case. So first requirement is you should have something acute, right? And you should be live. So if anybody here would like to? Anybody here if you like to, if you have some acute situation at the moment or in the other room, then you can tell and we'll give you a checklist. It will take you some 15 minutes to fill it out. Then he will sit and take your case live in front of the audience. Is there somebody here? Cough. Okay. What do you have? Pain in the neck; acute or. 3-4 days. Anybody else something more serious? Somebody has a heart attack, somebody is in coma? How bad is the cough? 2 weeks. Okay. Good. Cough is good. You live with your pain in the neck. That’s okay. That checklist you have is for what? What checklist we have already printed? Is there one for respiratory? What is this? Airways. Airways is good? H : Perfect. R : Okay. You fill this out. When you are filled it out just say, indicate and we'll start your live case. H : Okay, then we continue with case history 3. An 8 years old boy. And his mother realizes that her son's face looks slightly asymmetrical since a few days. And looking closer at him she notices several small pea like nodes under the skin of the occiput. And the asymmetry of the face comes always more prominent. So she comes to our practice. When you see him, he has open eyes and tries to smile. Only the left angle of the mouth goes up while the right one stays down. When he closes the eyes, the right eye does not close completely. What’s the diagnosis? It's a facial paralysis. So what do we do? 2 things we have to do. We make a Homeopathic case taking but we have also to know why he has a facial paralysis. So first we do the first thing. I get on the Neurology questionnaires the symptoms paralysis one sided, on the right side of the face. Then I have the symptoms, that he has difficulty to speak, he has difficulties while drinking and during sleep because he cannot close the eye completely. He has an aggravation by touch, he does not like touch on the paralyzed side of the face. He is sensitive to light, and eye closing does not work so it gets worse. And he is thirsty and he has no appetite. Also quite the simple symptomatology. And if we enter it into the repertory, you see we have only 2 remedies that covered all symptoms. Belladonna and Phosphorus. And Phosphorus has a contraindication. You see Phosphorus is normally improved by touch and he has an aggravation by touch. So this is a contraindication for Phosphorus. What do you think of this remedy? Belladonna for a facial paralysis. Could it be? We don't know. Perhaps yes. It could be. If you make a Materia Medica comparison for Belladonna, we see that we have sensitivity to light which hurts in the eyes. Then, child sleeps with half open eyes, mouth is half open, distortion of mouth, Paralytic weakness of muscles. We have these dissociated symptoms. Paralytic weakness is not described for the facial nerve, not the locality. But this is one of the special things about Boenninghausen that he dissociates the symptoms. He takes them apart, and so you get the much greater variety of remedies in question for each case. You understand what I mean by that? Like here, with the Kent repertory, we would take paralysis of right side of face in one rubric. And I don't know how many remedies there are? Perhaps 20 or so. And here we have this dissociation into the elements of the whole symptoms and we get more remedies to choose from. But it's a clear confirmation of Belladonna what we find in the Materia Medica comparison. Here you see the plant. Does it grow in India, Belladonna? In Europe it's a very frequent plant. We have a castle in Laupen (In Switzerland)where I have my ice where we live. And there are around the castle several Belladonna species. So I give him at once Belladonna 200 C and nothing happens for 3 days. Then on the 4th day he can close the right eye again. And on the 5th day, the paralysis of the angle of the mouth disappears. So is he cured? Is that victory? Let’s have a look at him. That’s the way he looks now. You see the mouth angle comes up again, he can close the eye. Well! what came out as a cause? Neuroborreliosis. Do you know this disease in India? Does it exist? Borreliosis is a tick borne infection that makes first the skin rash; very very typical skin rash around the bite. that grows slowly to a circle and finally disappears. After a few months or years, there comes second stage of the disease which consists of headaches, neuritis; nerve inflammation and arthritis; articular inflammations. And if you don't treat it, the patient gets severely disabled. So it's a very severe disease actually if remains untreated. In Europe, I am in the opinion that we have to treat also the Borrelia; the infectious agent which is something similar to syphilis; Treponema pallidum. It's a spirochaete or so. It must be treated because otherwise we violate a principle of homeopathy, namely aphorism 3 of the Organon in which Hahnemann writes, “If in each case he(that means the physician), he knows the obstacles to cure and how to remove them, so that recovery is permanent, then he knows how to treat thoroughly and efficaciously and is a true physician.” So Hahnemann says that we must go on, we cannot stop at the recovery of the symptoms. Do you have questions to this case? A = Audience; S = Speaker A : Should you take side, right side in generalities or face right side? S : Face; right side. But you know if I would have now difficulties to find the remedy that has face right side and I don't have one that fit's everything, I'm going to test also right side in general. So this is a thing you have to do because this is a real art. It seems very simple what I tell you here. Actually it is very simple but sometimes there situations that are tricky and then you begin to experiment. You look another formulation of the symptoms. Better to get a picture that where everything fit's well. We go to the next case. Other question, yes. A : What was the subsequent follow up because we have a disease like Borreliosis in this?S : Subsequent follow up? He got 14 days of antibiotic treatment and he is completely cured. He is very healthy. Now it's about one and a half years ago, he has nothing anymore. A : Sir, Belladonna was used as a single dose or was it repeated? S : I gave him later Belladonna M in addition; 1M in addition. But that’s all. A : Single dose of 200. After that single dose of 1M. S : Yes. A : Sir, but since Borreliosis express itself as Neuroborreliosis, and we were able to tackle it with Belladonna, then I believe the whole disease would have been taken care of it. Why give antibiotic? S : Well, this is a legal problem. You know. If I. I think in India you have more possibilities to make pure homeopathy. If I would not do this, I can easily get into trouble. If we don't have this comfortable situation of homeopathy being accepted, widespread, supported by the government as you have it here. So actually we envy you. I must say it's fantastic you can do it here. It’s really great. R = Dr Rajan; H = Dr Heiner; S = Speaker; Pt = Patient R : Our live case is ready. Shall we do it? H : Yes S : So will you tell us your suffering? Pt : I have cough since almost 2 weeks now. It just started all of a sudden. Dry cough with a little mucus which I cannot expectorate so I need to swallow it. Aggravated talking. And almost after a week my voice had become a little hoarse which has apparently got better now because I had taken Causticum for 3 days. Thirst has increased than what it was before, Thermally chilly. I think that’s it. S : That’s it. Okay. And now you have the modalities. You have a desire for open air? Pt : Yeah. S : Cold in general is worse, Warmth is better. That’s the same. These 2 rubrics are same in Boenninghausen's repertory. So we may use only 1 of them. If we use 2, we make an... augment the polarity difference artificially. Then wrapping up warmly is good. You like that. It improves. Warm room improves. Pt : This is all general sir. Wrapping with warm is general. Not that the cough gets better. It’s generally that I like warm climate. So it's a general. S : Is that always like this? Pt : Yes, always like this. S : Okay. It’s not the symptom then. If the symptom you have. You have only a symptom if it has an influence on your cough. Pt : No, it has no influence on my cough that I have noticed. S : Okay, then we may not take it. But warmth in general is improving the cough? Pt : Warmth in general is something what I like. I have not noticed whether it improves my cough or it aggravates. S : That’s not a symptom. Pt : But warm drinks ameliorates the throat. S : Okay. Then it is your cough is worse when you are walking. Pt : Yeah. S : And with mental effort it is worse also. Okay. After drinking warm drinks you said it's better. And you are thirsty now? Pt : Than normal. Yeah. Than before. More thirsty than before. S : You have a loss of appetite? Pt : Yes. S - You have more salivation? Pt : Yes. S - And talking is aggravating the symptoms. Pt : Yes. S : And it's worse after getting up and better when you breathe deeply? Pt : Yes. S : That’s a special symptom. You breathe deeply is like when you make physical effort? Pt : It's like a sigh. I mean. This is the way you deep breath. S : Okay. A sigh. Pt : I know it's not a sigh that I have. If I’ve to just explain how a deep breath is, it's like a sigh. S : Okay. I would be careful with this symptom. Perhaps we take it but perhaps we take it not; we'll see. Then we have nose on the left side. it's only on the left side of the nose? Pt : Yeah. Occasionally. S : And external pressure is better? Pt : Yeah, now this external pressure is better in terms of my headache which I had apparently got in the last 2 days. So if I tie, hard pressure or a band, you feel better. S : And you are more irritable than normal. You are also more happy than normal. Pt : Yes. Very much. S : When you are ill? Pt : not when I am ill. Right now. This is my. S : In general. Pt : Not in general. Right now. In the last 2, 3 weeks maybe. S : Okay. I probably will not take mind symptoms. And you feel worse when being alone? So now we have. Perhaps I'll read you what Dr. Shah wrote. 2 weeks, dry cough, needs to clear the throat, irritation in the throat, little mucus, so which is swallowed, cannot expectorate, talking aggravates cough, thirst increased, thermally chilly. Taken Spongia. Pt : Spongia 200 one dose. S : And Causticum. Okay now we go. Here in the program we have a field where we can search symptoms within the text. R : Heiner, can you explain this one thing because it's little difficult. You said that if the modality does not have an effect on the compliant, so it's not important. Am I right to understand this? H : Right. R : What about if it's a general modality like aggravation from cold in general. Better by covering in general. H : If it causes an aggravation of a condition, it is a symptom. R : But suppose it is uncomfortable for the person as a whole. Suppose she says in general I feel better by lying down, so it may not influence my cough but I feel better. Is this not important? S : Well if it's in the health this state, it's not a symptom. If it is in a state of disease, it is a symptom. But you said that you always like wrapping; to be wrapped up warmly even if you have nothing. Right? Pt : That’s while sleeping. Not in general. S : You like to be covered. You like to be wrapped up when you are in a healthy state. Not more now when you have some pathology. Pt : Yeah if it is cold, I like to be wrapped up even when I'm in healthy state. S : Okay. So now we take those things that we clearly can identify. R : Only changes. Only the changes. If it is the original state, so not important. Does this apply also to chronic disease or only acute? Because in chronic you see the person on the whole for a long time can have a modality. S : That really depends. If it fits in well, I can take this maybe as an additional symptom to help me to determine a remedy but sometimes it is very critical not that you take things that are more, what you call that, they are part of the personal being and feeling, nothing to do with pathology. The only thing I not rarely use, especially use in ADHD children is their sensitivity to temperature because there it is very important deviation among the remedies. So I should treat myself actually. This is a bit difficult thing. So now we take. You have now an increased desire for open air?Okay. I give in the search termed down here, get the list of possible symptoms and I click on the one I want and there it is. So now I have given in Air open and I have here the choices and I click on the one I want; desire for open air, and here it is. Then cold in general aggravates the cough. Pt : Yes. S : Okay. Then we give in Cold in general. Here it is. Warm room is better. Pt : Warm room is better. S : Then we have walking worse. Mental effort worse. that is special. Pt : Special means it was; stress or thinking something, the cough is aggravated. S : Then you must. Okay. Then you have warm drinks. Yes, we have warm food and drink is better. prefer this because all the others have much less remedies and if I take one with only like Drinking better, you see 13 remedies, I don't like that too much. Just few remedies. Then you are thirsty. And what else do we have? You have loss of appetite. And you have salivation and talking aggravates the symptoms. And after getting up it is worse. Is it while or after getting up worse? Pt : As soon as I get up. So it's immediately on waking. My voice also becomes hoarse at that time. It takes around half an hour or around 15 minutes to get back to normal. S : Is it already on waking worse before getting up? Pt : No. On waking. On waking right? I'm just sitting on my bed and I cannot just talk. It takes around 15 minutes for me to start talking. S : Before getting up. Pt : Before getting up means? S : You are still in bed? Pt : Yes, I'm still in bed. S : So it is actually. Here we have to be very exact, you know. I throw this out and I take after sleep worse. R : I think it's like more after rest and better by exertion. Something like that. It’s like beginning motion aggravates and continued ameliorates. Initially on talking it's more right and it gets better over the day. Pt : When I wake up, for 10 minutes if I get a call, my voice just does not come. R : When does it improve? Pt : It takes around 10 minutes for me to start talking. R : And as you talk? Pt : As I talk it becomes better. R : Yeah, that’s the. S : it's like beginning motion. R : Beginning motion. S : But that symptom I don't like too much because it is a bit narrow. I can show you. Movement beginning; it is not polar. That’s is one thing and it has well, 37 remedies. Okay, I don't. I usually avoid it because it's not polar. So let's take first after sleep worse and we see how these thing fits together. Breathing deeply better. I like that away. External pressure is better on the headache. So now we have the main symptoms without taking mind symptoms. And now I click on this icon and we see what comes out. So I have a bit difficulties to show you ev
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