It’s when there is a change in symptoms rather than an improvement after the first prescription that one can see the flexibility of the triad method. An easy example togive is the first case at a subsequent follow up.
***The patient did well on their first and second prescriptions but they have returned. Their joint pains have returned but they find that they are now worse at the end of the day when they are at rest. They have to keep moving to keep the pains at bay. They began again around the time their children were threatened with expulsion from school because they were late with school fees (Everyone has to pay school fees in Botswana whether government or private school). The patient became worried for their children's future and took on extra work. Nothing much else worries them aside from their families welfare and their responsibilities.
In this case the aetiology of the joint pains and their characteristic of being worse for rest and better for continued motion indicates not Bryonia but Rhus Tox. The patients underlying constitution and background remain unchanged so far so the prescription can be repeated with the Bryonia, the initial remedy for the patients joint symptoms being changed for Rhus. Tox. Calc and Carc can be repeated as before.
Showing posts with label Prescribing Methods. Show all posts
Showing posts with label Prescribing Methods. Show all posts
Thursday, July 26, 2007
More Medicine of Experience.
I’d like to let you know more about the triad method and how I am using it in the treatment of patients with HIV. I described it in an earlier post as being like an often repeated single remedy. It is like that but it is also a subtle and flexible therapeutic intervention.
To make this easier I’ll give you an example of triad prescriptions for the sort of cases we often see. The cases given below are outline examples as a full case taking would be too much to present.
*** A patient has begun to get joint pains which are worse on motion and better for rest, these areaccompanied by a terrible headache which makes them just want to sit still and not be bothered by anybody. They naturally have become very bad tempered. Their focus in life is their home and family as they had to care for younger siblings and older relatives from an early age their parents died of cancer. They have recently had to cope with a bereavement and now care for another family members’ children. They take this responsibility very seriously. Their major worries are the pains which prevent them from working and this in turn makes them worry about how they will cope with their responsibilities.
After repertorisation the well indicated remedies include Bryonia, Cal.Carb. and Carcinosin. In this sort of case we would usually give each remedy one day apart in the appropriate potency for up 3 weeks Bryonia on Mondays, Calc. on Wednesdays and Carc. on Fridays.
Case 2
*** A patient is seen at home and they present with with diarrhoea accompanied by burning pains, respiratory difficulties, generalized physical pains at night and a very depresed state of mind. This has been continuing on and off for a long time but is now a chronic state and they are rapidly emaciating though they are trying to eat.
The well indicated remedies repertorise out as Ars. Alb.; Carbo.Veg.; and Syph.
As the condition is long standing and day by day worsens the patients health the remedies would be given over the course of a day in an appropriately low potency for a week.
In these hypothetical cases the patients show a good response at the follow up, they’re not completely cured but they’re much better than before.
So far so good. In these two cases the triad prescription has acted like a single remedy. There’s been a good reaction in the patient on all levels and the prescription can be repeated with confidence that it will continue the curative response in the patient.
To make this easier I’ll give you an example of triad prescriptions for the sort of cases we often see. The cases given below are outline examples as a full case taking would be too much to present.
*** A patient has begun to get joint pains which are worse on motion and better for rest, these areaccompanied by a terrible headache which makes them just want to sit still and not be bothered by anybody. They naturally have become very bad tempered. Their focus in life is their home and family as they had to care for younger siblings and older relatives from an early age their parents died of cancer. They have recently had to cope with a bereavement and now care for another family members’ children. They take this responsibility very seriously. Their major worries are the pains which prevent them from working and this in turn makes them worry about how they will cope with their responsibilities.
After repertorisation the well indicated remedies include Bryonia, Cal.Carb. and Carcinosin. In this sort of case we would usually give each remedy one day apart in the appropriate potency for up 3 weeks Bryonia on Mondays, Calc. on Wednesdays and Carc. on Fridays.
Case 2
*** A patient is seen at home and they present with with diarrhoea accompanied by burning pains, respiratory difficulties, generalized physical pains at night and a very depresed state of mind. This has been continuing on and off for a long time but is now a chronic state and they are rapidly emaciating though they are trying to eat.
The well indicated remedies repertorise out as Ars. Alb.; Carbo.Veg.; and Syph.
As the condition is long standing and day by day worsens the patients health the remedies would be given over the course of a day in an appropriately low potency for a week.
In these hypothetical cases the patients show a good response at the follow up, they’re not completely cured but they’re much better than before.
So far so good. In these two cases the triad prescription has acted like a single remedy. There’s been a good reaction in the patient on all levels and the prescription can be repeated with confidence that it will continue the curative response in the patient.
Monday, July 02, 2007
Trouble With Triad
The Triad Method is a little bit of a problem for me from the point of view of homoeopathic philosophy and here’s why. I’m classically trained so the basic prescribing method I am familiar with is one appropriate remedy, watch and wait. Whether prescribing for an acute or chronic case. Then repeat or change the remedy according to the response.
In the 6 months before I left for Botswana I’d been familiarising myself with Eizayager’s layers method and so when I was introduced to the Triad Method at my induction for the project it sounded like a reasonable way of going about things. In theory, that is.
In practice it is a lot different. You’ll see in the last post I added (below this one) I’ve given myself a few criteria to use to help me prescribe using the Triad Method, and I’ll use the method because I agreed to do so. Thus, it is possible to rationalise to oneself how to use the triad method. The most difficult thing I am finding in practice at the moment is working out which part of the prescription has worked.
My understanding of the practice of homoeopathy is that you don’t prescribe for separate parts of the case and this is what it feels like is being done here at the project. Having said that, I would feel more at ease with this prescribing method if we were prescribing only two remedies, one for the appropriate totality of symptoms and one nosode. The third remedy seems to me to be superfluous and I feel I’m prescribing it simply to cover bases. This is a scary thing to admit as people are coming to us for help and will surely expect us to know what we are doing.
The other source of confusion about this method is having a remedy for the ‘acute layer’. So far noone I have seen has presented with acute symptoms, either an acute exacerbation of a chronic condition or an opportunistic infection, acute miasm, etc. etc. so merely the name of this layer causes me confusion too.
As I’m sure you can see, I’m pretty confused about this but trying to deal with the confusion by using reflective practice and supervision. It helps me to think things through by writing them down and hopefully by the time I’m further through my stay here I’ll have resolved my questions about the method. I also hope that what I write is being read by other homoeopaths and I’m able to share my experience with them.
The major headache for me at present, after having taken the case and found a third remedy which I feel I can justify within the case is which part of the previous prescription has worked. Patrly this is due to summary sheets only having recently been introduced. 99% of cases have to be read through before the consultations and the key points of the case drawn together while doing this. This is quite a task as the notes are handwritten by several successive homoeopaths. You’ll see throughout the histories that some prescriptions work very well and the next prescription is changed for no apparent reason. Why? I think part of this is due to different practitioners from different backgrounds seeing different things in a case and responding the best way they can see. Another reasonn seems to be practitioners departing from the protocols that have been set by the project. Yet, I still ask myself, why wasn’t the last prescription which brought about a positive change for the patient repeated?
I’ll keep you all posted about how my understanding of the method and it’s application develops. I’m sure all the homoeopaths have been dying for me to actually get on to the subject of actually prescribing etc. The Triad Method is a little bit of a problem for me from the point of view of homoeopathic philosophy and here’s why. I’m classically trained so the basic prescribing method I am familiar with is one appropriate remedy, watch and wait. Whether prescribing for an acute or chronic case. Then repeat or change the remedy according to the response.
In the 6 months before I left for Botswana I’d been familiarising myself with Eizayager’s layers method and so when I was introduced to the Triad Method at my induction for the project it sounded like a reasonable way of going about things. In theory, that is.
In practice it is a lot different. You’ll see in the last post I added (below this one) I’ve given myself a few criteria to use to help me prescribe using the Triad Method, and I’ll use the method because I agreed to do so. Thus, it is possible to rationalise to oneself how to use the triad method. The most difficult thing I am finding in practice at the moment is working out which part of the prescription has worked.
My understanding of the practice of homoeopathy is that you don’t prescribe for separate parts of the case and this is what it feels like is being done here at the project. Having said that, I would feel more at ease with this prescribing method if we were prescribing only two remedies, one for the appropriate totality of symptoms and one nosode. The third remedy seems to me to be superfluous and I feel I’m prescribing it simply to cover bases. This is a scary thing to admit as people are coming to us for help and will surely expect us to know what we are doing.
The other source of confusion about this method is having a remedy for the ‘acute layer’. So far noone I have seen has presented with acute symptoms, either an acute exacerbation of a chronic condition or an opportunistic infection, acute miasm, etc. etc. so merely the name of this layer causes me confusion too.
As I’m sure you can see, I’m pretty confused about this but trying to deal with the confusion by using reflective practice and supervision. It helps me to think things through by writing them down and hopefully by the time I’m further through my stay here I’ll have resolved my questions about the method. I also hope that what I write is being read by other homoeopaths and I’m able to share my experience with them.
The major headache for me at present, after having taken the case and found a third remedy which I feel I can justify within the case is which part of the previous prescription has worked. Patrly this is due to summary sheets only having recently been introduced. 99% of cases have to be read through before the consultations and the key points of the case drawn together while doing this. This is quite a task as the notes are handwritten by several successive homoeopaths. You’ll see throughout the histories that some prescriptions work very well and the next prescription is changed for no apparent reason. Why? I think part of this is due to different practitioners from different backgrounds seeing different things in a case and responding the best way they can see. Another reasonn seems to be practitioners departing from the protocols that have been set by the project. Yet, I still ask myself, why wasn’t the last prescription which brought about a positive change for the patient repeated?
I’ll keep you all posted about how my understanding of the method and it’s application develops. I’m sure all the homoeopaths have been dying for me to actually get on to the subject of actually prescribing etc.
In the 6 months before I left for Botswana I’d been familiarising myself with Eizayager’s layers method and so when I was introduced to the Triad Method at my induction for the project it sounded like a reasonable way of going about things. In theory, that is.
In practice it is a lot different. You’ll see in the last post I added (below this one) I’ve given myself a few criteria to use to help me prescribe using the Triad Method, and I’ll use the method because I agreed to do so. Thus, it is possible to rationalise to oneself how to use the triad method. The most difficult thing I am finding in practice at the moment is working out which part of the prescription has worked.
My understanding of the practice of homoeopathy is that you don’t prescribe for separate parts of the case and this is what it feels like is being done here at the project. Having said that, I would feel more at ease with this prescribing method if we were prescribing only two remedies, one for the appropriate totality of symptoms and one nosode. The third remedy seems to me to be superfluous and I feel I’m prescribing it simply to cover bases. This is a scary thing to admit as people are coming to us for help and will surely expect us to know what we are doing.
The other source of confusion about this method is having a remedy for the ‘acute layer’. So far noone I have seen has presented with acute symptoms, either an acute exacerbation of a chronic condition or an opportunistic infection, acute miasm, etc. etc. so merely the name of this layer causes me confusion too.
As I’m sure you can see, I’m pretty confused about this but trying to deal with the confusion by using reflective practice and supervision. It helps me to think things through by writing them down and hopefully by the time I’m further through my stay here I’ll have resolved my questions about the method. I also hope that what I write is being read by other homoeopaths and I’m able to share my experience with them.
The major headache for me at present, after having taken the case and found a third remedy which I feel I can justify within the case is which part of the previous prescription has worked. Patrly this is due to summary sheets only having recently been introduced. 99% of cases have to be read through before the consultations and the key points of the case drawn together while doing this. This is quite a task as the notes are handwritten by several successive homoeopaths. You’ll see throughout the histories that some prescriptions work very well and the next prescription is changed for no apparent reason. Why? I think part of this is due to different practitioners from different backgrounds seeing different things in a case and responding the best way they can see. Another reasonn seems to be practitioners departing from the protocols that have been set by the project. Yet, I still ask myself, why wasn’t the last prescription which brought about a positive change for the patient repeated?
I’ll keep you all posted about how my understanding of the method and it’s application develops. I’m sure all the homoeopaths have been dying for me to actually get on to the subject of actually prescribing etc. The Triad Method is a little bit of a problem for me from the point of view of homoeopathic philosophy and here’s why. I’m classically trained so the basic prescribing method I am familiar with is one appropriate remedy, watch and wait. Whether prescribing for an acute or chronic case. Then repeat or change the remedy according to the response.
In the 6 months before I left for Botswana I’d been familiarising myself with Eizayager’s layers method and so when I was introduced to the Triad Method at my induction for the project it sounded like a reasonable way of going about things. In theory, that is.
In practice it is a lot different. You’ll see in the last post I added (below this one) I’ve given myself a few criteria to use to help me prescribe using the Triad Method, and I’ll use the method because I agreed to do so. Thus, it is possible to rationalise to oneself how to use the triad method. The most difficult thing I am finding in practice at the moment is working out which part of the prescription has worked.
My understanding of the practice of homoeopathy is that you don’t prescribe for separate parts of the case and this is what it feels like is being done here at the project. Having said that, I would feel more at ease with this prescribing method if we were prescribing only two remedies, one for the appropriate totality of symptoms and one nosode. The third remedy seems to me to be superfluous and I feel I’m prescribing it simply to cover bases. This is a scary thing to admit as people are coming to us for help and will surely expect us to know what we are doing.
The other source of confusion about this method is having a remedy for the ‘acute layer’. So far noone I have seen has presented with acute symptoms, either an acute exacerbation of a chronic condition or an opportunistic infection, acute miasm, etc. etc. so merely the name of this layer causes me confusion too.
As I’m sure you can see, I’m pretty confused about this but trying to deal with the confusion by using reflective practice and supervision. It helps me to think things through by writing them down and hopefully by the time I’m further through my stay here I’ll have resolved my questions about the method. I also hope that what I write is being read by other homoeopaths and I’m able to share my experience with them.
The major headache for me at present, after having taken the case and found a third remedy which I feel I can justify within the case is which part of the previous prescription has worked. Patrly this is due to summary sheets only having recently been introduced. 99% of cases have to be read through before the consultations and the key points of the case drawn together while doing this. This is quite a task as the notes are handwritten by several successive homoeopaths. You’ll see throughout the histories that some prescriptions work very well and the next prescription is changed for no apparent reason. Why? I think part of this is due to different practitioners from different backgrounds seeing different things in a case and responding the best way they can see. Another reasonn seems to be practitioners departing from the protocols that have been set by the project. Yet, I still ask myself, why wasn’t the last prescription which brought about a positive change for the patient repeated?
I’ll keep you all posted about how my understanding of the method and it’s application develops. I’m sure all the homoeopaths have been dying for me to actually get on to the subject of actually prescribing etc.
On another tack altogether…It’s ten past nine on a cool June’s night. Julia has, within the last hour recovered from an energy sapping cold type thing, thanks to homoeopathy and Hilary-Coffee-Shop’s thoughtfully sending Julia some Butternut Squash Soup and Carrot Cake. Julia is blasting out tunes on the Lutheran Church’s guitar which she borrowed to restring. We’ve had I’ve Been A Miner For A Heart Of Gold, Lady Darbanvilles, the song which begins Ziggy Played Guitar, and several others that went in one ear and out the other while I was typing.
So, when the working day is done we get a good opportunity to relax and re-energise like good, hard thinking, hard working, reflective homoeopaths should.
So, when the working day is done we get a good opportunity to relax and re-energise like good, hard thinking, hard working, reflective homoeopaths should.
Tuesday, June 26, 2007
Work Experience
Where am I now?
I'm still in Maun, of course. I'm just beginning my third week here and I've just begun taking cases on my own. Last week I was alternating with Julia. Having her there to discuss case analysis and remedies with me made things a lot easier, it felt a lot less pressurised than thinking alone.
Since I arrived we've been working at a reasonable pace and our days have been varied for one reason or another. As you'll see from the photo's, last Monday we were invited to Boseja Kgotla to explain what the project is about. Usually we are at the Lutheran Church Clinic on a Monday from 0800 - 1600 with an hour for lunch. That afternoon we could go home early as noone had come to clinic that afternoon.
Tuesday's we're at WoMen Against in the morning and seeing private patients in the afternoon. That's a very different kettle of fish altogether as we do not have to use the Maun Homoeopathy project triad method. You'll have read about that in the post above this. I'm going to try and fix it so that My postings run chronologically from oldest at the top to most recent at the bottom. It doesn't make sense, the way it is now.
Wenesdays we do home Visits for Lutheran Church Clinic Patients and Thursday's were back at the Lutheran Church Clinic all day. Friday is always varied as we go on a thrice weekly rotation to Boseja Kgotla Clinic, Maun Conselling Clinic or Sennonori, which is run by the woman who comes each week to sweep our yard and do our washing. A good example of the blurred boundaries we are always warned about!
Tell Us About The Triad
OK. The triad ought to be fairly easy for most homoeopaths to understand as it seems to be based on Eizayagers 'Layers Method'. However, rather than treating each layer of the case sepparately we prescribe concurrently. At present i'm not quite sure of how the Triad came to be used. I feel a bit of an idiot because of that. Why didn't I bother asking? Hmmm.
I'm still in Maun, of course. I'm just beginning my third week here and I've just begun taking cases on my own. Last week I was alternating with Julia. Having her there to discuss case analysis and remedies with me made things a lot easier, it felt a lot less pressurised than thinking alone.
Since I arrived we've been working at a reasonable pace and our days have been varied for one reason or another. As you'll see from the photo's, last Monday we were invited to Boseja Kgotla to explain what the project is about. Usually we are at the Lutheran Church Clinic on a Monday from 0800 - 1600 with an hour for lunch. That afternoon we could go home early as noone had come to clinic that afternoon.
Tuesday's we're at WoMen Against in the morning and seeing private patients in the afternoon. That's a very different kettle of fish altogether as we do not have to use the Maun Homoeopathy project triad method. You'll have read about that in the post above this. I'm going to try and fix it so that My postings run chronologically from oldest at the top to most recent at the bottom. It doesn't make sense, the way it is now.
Wenesdays we do home Visits for Lutheran Church Clinic Patients and Thursday's were back at the Lutheran Church Clinic all day. Friday is always varied as we go on a thrice weekly rotation to Boseja Kgotla Clinic, Maun Conselling Clinic or Sennonori, which is run by the woman who comes each week to sweep our yard and do our washing. A good example of the blurred boundaries we are always warned about!
Tell Us About The Triad
OK. The triad ought to be fairly easy for most homoeopaths to understand as it seems to be based on Eizayagers 'Layers Method'. However, rather than treating each layer of the case sepparately we prescribe concurrently. At present i'm not quite sure of how the Triad came to be used. I feel a bit of an idiot because of that. Why didn't I bother asking? Hmmm.
So, I'll tell you about what I know about the triad method so far and what my experience is of it, so far. My opinions are bound to change as I have only been here two weeks so far (today is Tuesady 26th of June) and I have not been in touch with Hilary to get an idea of how the method developed. Anyone reading this from top to botom will read my most recent insights first.
The Triad Layers
The Triad Layers are - 1) Acute; 2) Constitutional; 3) Miasmatic.
At present I'm finding this method a little unwieldy, mainly because very few people we see have acute illnesses, their symptoms are long standing. Because of this I could understand prescribing a remedy for the chronic illness and another for the miasm but having to work in a third seems to me to be a bit of a contrivance.
But, we have to prescribe this way as Hilary wants to see the results of long term Triad prescribing. Things probably wouldn't be so rigid but for characters like me turning up and saying 'I'm not prescribing like that!' and doing their own thing. Luckily for the project I am not in a rebellious mood and I am happy to follow the protocol and see where it takes me
So that I feel happpy using the Triad method I've worked out a few ways of justifying to myself why 3 remedies are being prescribed.
My idea of how to Prescribe for "Acute" Layer = 1) remedy for totality of an acute miasm or exacerbation of chronic disease; 2, As a support for acute mental emotional states if Px has chronic symptoms.
Constitutional Layer: Patterns of Health / Ill Health & Menatal Emotional Reactions.
Miasm: Can an appropriate miasmatic link be made between acute and chronic symptoms? Which miasm is most obvious in the case?
And it feels even better prescribing this way if the remedies used can be related. Still, at present I'd feel less of a headache using just one or two remedies at a time.
So that I feel happpy using the Triad method I've worked out a few ways of justifying to myself why 3 remedies are being prescribed.
My idea of how to Prescribe for "Acute" Layer = 1) remedy for totality of an acute miasm or exacerbation of chronic disease; 2, As a support for acute mental emotional states if Px has chronic symptoms.
Constitutional Layer: Patterns of Health / Ill Health & Menatal Emotional Reactions.
Miasm: Can an appropriate miasmatic link be made between acute and chronic symptoms? Which miasm is most obvious in the case?
And it feels even better prescribing this way if the remedies used can be related. Still, at present I'd feel less of a headache using just one or two remedies at a time.
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