A HOMOEOPATHIC DRUG PROVING OF THE VENOM OF BITIS GABONICA GABONICA A MINI-DISSERTATION SUBMITTED IN PARTIAL COMPLIANCE WITH THE REQUIREMENTS FOR THE MASTERS DEGREE IN TECHNOLOGY: HOMOEOPATHY AT THE DURBAN INSTITUTE OF TECHNOLOGY. I HEREBY DECLARE THAT THIS MINI-DISSERTATION REPRESENTS MY OWN WORK BOTH IN CONCEPT AND EXECUTION. Student:________________________________Date:__________ (Bruce Thomson) APPROVED FOR EXAMINATION Supervisor:_____________________________Date:__________ Dr Ashley Ross M.Tech.Hom (TN) B.Mus (UCT) i This proving is dedicated to the Glory of God and to all the volunteers who gave so selflessly of their time and comfort to advance the cause of Homoeopathy. ii ACKNOWLEDGEMENTS None of this would have been possible without the support of Paula, my wife, who always has more faith in me than I do. I would like to thank Dr Ashley Ross for all his guidance, good advice and inspiration through the years. And finally to all “those who have gone before”, the homoeopaths who did all the hard work and cut the path that we all walk today. iii ABSTRACT The purpose of this investigation was to determine the effects of the thirtieth centesimal (30CH) potency of the venom of Bitis gabonica gabonica on healthy individuals in order to elucidate the total morbid symptomatology produced by the drug so that it may be prescribed by Homoeopathic practitioners according to the Law of Similars, as is required by Homoeopathic methodology. It was hypothesized that the 30CH potency of Bitis gabonica gabonica would produce clearly observable signs and symptoms in healthy Provers. The homoeopathic drug proving of the venom of Bitis gabonica gabonica 30CH took the form of a double-blind, placebo-controlled trial on twenty subjects who all met the inclusion criteria. Five of the twenty subjects received placebo in a randomized fashion, so that neither the provers nor the researcher knew who had received placebo or verum. As an added control the provers were unaware of the substance or the potency they were proving. Data collection was via the journals that the provers kept in order to record their daily symptoms - data was later extracted from these journals. Data recorded by the researcher from case histories and physical examination was also considered. The study design was a single group with placebo control as well as intra- individual control - the prover serves as his or her own control by recording their state before the drug is taken; this serves as a baseline for comparison to their later state under the influence of the proving substance. The remedies main area of influence is the mental and emotional state. The most prominent symptom was the isolation, a sense of being alone, forsaken iv or a desire to be alone. Overall there is a feeling of social detachment, of being an „outsider‟. This and other aspects of the remedy reflect the „Divided‟ nature of the snake remedies. They feel panicked and as if they are under threat, like most snake remedies. They have a delusion that they are divided, that body and mind are divided, that they are separated from themselves in some way. Headaches were very common. They tended to be left sided, mainly in forehead and temples and tended to refer to the eyes, notably though the neck was also affected. Other areas of note are the Nose, Stomach and Generals. It can be concluded that the 30Ch potency of the venom of Bitis gabonica gabonica (Bit-g) is a remedy that should be considered in a range of conditions. If used accurately and precisely according to established Homoeopathic principles it could become a significant remedy in the clinical environment. The wide range of symptoms produced by the proving suggests an equally wide range of application for the remedy. Further provings and data from clinical experience are needed to confirm this remedy as a useful tool for the homoeopath in clinical practice. v THE DEFINITION OF TERMS LAW OF SIMILARS - "Similia Similibus Curentur", the fundamental law of Homoeopathy, formulated by Hahnemann. Meaning: let likes be cured (or treated) by likes (Gaier 1991:323). Any substance that can produce a totality of symptoms in a healthy human being can cure that totality of symptoms in a sick human being (Vithoulkas 1986:92). PROVING - the systematic procedure of testing substances on healthy human beings in order to elucidate the symptoms which reflect the action of the substance (Vithoulkas 1986:96). From the German 'Prufung', meaning test or assay (Gaier 1991: 390). PROVERS - people of average health (who) take repeated doses of drugs until objective or subjective symptoms of a disturbance appear (Whitmont 1991:15). PLACEBO - a 'dummy' treatment administered to the control group in a controlled clinical trial in order that the specific and non-specific effects of the experimental treatment can be distinguished (Taylor et al 1988:1298). In this study the placebo will take the form of unmedicated lactose pillules. POTENCY - the stage of altered remedial activity to which a drug has been taken by means of a measured process of deconcentration, with succussion, or by trituration, of the medicinal substance, which is thus brought to a state of infinitesimal subdivision (Gaier 1991:432). THIRTIETH CENTESIMAL POTENCY (30CH) - the 30th step of serial deconcentration on a 1:100 scale with succussion (agitation) at each step, having an effective concentration of 1x10-60 . iv The Definition of Terms LAW OF SIMILARS - "Similia Similibus Curentur", the fundamental law of Homoeopathy, formulated by Hahnemann. Meaning: let likes be cured (or treated) by likes (Gaier 1991:323). Any substance that can produce a totality of symptoms in a healthy human being can cure that totality of symptoms in a sick human being (Vithoulkas 1986:92). PROVING - the systematic procedure of testing substances on healthy human beings in order to elucidate the symptoms which reflect the action of the substance (Vithoulkas 1986:96). From the German 'Prufung', meaning test or assay (Gaier 1991: 390). PROVERS - people of average health (who) take repeated doses of drugs until objective or subjective symptoms of a disturbance appear (Whitmont 1991:15). PLACEBO - a 'dummy' treatment administered to the control group in a controlled clinical trial in order that the specific and non-specific effects of the experimental treatment can be distinguished (Taylor et al 1988:1298). In this study the placebo will take the form of unmedicated lactose pillules. POTENCY - the stage of altered remedial activity to which a drug has been taken by means of a measured process of deconcentration, with succussion, or by trituration, of the medicinal substance, which is thus brought to a state of infinitesimal subdivision (Gaier 1991:432). THIRTIETH CENTESIMAL POTENCY (30CH) - the 30th step of serial deconcentration on a 1:100 scale with succussion at each step, having an effective concentration of 1x10-60. vi TABLE OF CONTENTS PAGE DEDICATION i ACKNOWLEDGEMENTS ii ABSTRACT iii DEFINITION OF TERMS v TABLE OF CONTENTS vi 1 THE PROBLEM AND ITS SETTING 1.1 The Statement of the Problem 1 1.2 The Hypothesis 1 1.3 The Delimitations 1 1.4 The Assumptions 1 2 THE REVIEW OF THE LITERATURE 2.1 Introduction 3 2.2 Background 3 2.3 Proving Methodologies 5 2.4 Potency Choice 6 2.5 Prover Population and Percentage Placebo 7 2.6 Bitis gabonica gabonica 8 2.6.1 Classification 8 2.6.2 Distinguishing Characteristics 8 vii 3 THE DATA: TREATMENT AND INTERPRETATION 3.1 The Experimental Design 11 3.2 An Outline of the Method 11 3.3 The Proving Substance 13 3.3.1 The Potency 13 3.3.2 The Dose and Posology 13 3.3.3 Preparation and Dispensing of the Remedy 13 3.4 The Duration 14 3.5 The Prover Population 14 3.5.1 Criteria for Inclusion in the proving 14 3.5.2 Monitoring of the Provers 15 3.5.3 Chronology 16 3.6 Group Discussion 16 3.7 Symptom Collection, Extraction and Evaluation 16 3.7.1 Criteria for acceptance of a symptom 17 3.8 Collating and Editing 18 3.9 Toxicological Data 18 3.10 Reporting the Data 19 3.10.1 The Repertory 19 3.10.2 The Materia Medica 19 viii 4 THE MATERIA MEDICA AND REPERTORY OF BITIS GABONICA GABONICA 4.1 Key 20 4.2 Materia Medica 21 4.2.1 Mind 21 4.2.2 Vertigo 34 4.2.3 Head 35 4.2.4 Eyes 41 4.2.5 Ear 44 4.2.6 Nose 45 4.2.7 Face 51 4.2.8 Mouth 53 4.2.9 Throat 54 4.2.10 External throat 56 4.2.11 Stomach 56 4.2.12 Abdomen 59 4.2.13 Rectum 61 4.2.14 Urine 62 4.2.15 Female Genitalia/Sex 63 4.2.16 Respiration 65 4.2.17 Chest 65 4.2.18 Back 67 4.2.19 Extremities 69 4.2.20 Sleep 71 4.2.21 Dreams 74 4.2.22 Skin 77 4.2.23 Generals 77 4.2.24 Toxicology 81 ix 4.3 Rubrics 83 4.3.1 Mind 83 4.3.2 Vertigo 88 4.3.3 Head 88 4.3.4 Eyes 92 4.3.5 Ear 93 4.3.6 Nose 94 4.3.7 Face 95 4.3.8 Mouth 96 4.3.9 Throat 97 4.3.10 External throat 98 4.3.11 Stomach 98 4.3.12 Abdomen 98 4.3.13 Rectum 99 4.3.14 Kidneys 100 4.3.15 Urine 100 4.3.16 Female Genitalia/Sex 100 4.3.17 Respiration 101 4.3.18 Chest 102 4.3.19 Back 102 4.3.20 Extremities 103 4.3.21 Sleep 104 4.3.22 Dreams 105 4.3.23 Skin 106 4.3.24 Generals 106 x 5 DISCUSSION 5.1 Discussion 108 5.2 Symptom Overview 109 5.3 Repertorization for Related Remedies 113 5.4 Other Considerations 113 6 CONCLUSIONS AND RECOMMENDATIONS 6.1 Conclusions 114 6.2 Recommendations 114 6.2.1 Further provings 114 6.2.2 Comparative studies 114 6.2.3 Clinical information 115 6.2.4 Development of a Southern African Materia Medica 115 REFERENCES 117 APPENDICES AND GRAPHS Appendix A: Suitability fo Inclusion in the Proving Appendix B: Informed Consent Form Appendix C: Case History Appendix D: Instructions to Provers Appendix E: Graph – Symptom Distribution Appendix F: Graph – Relative Prover Contribution Appendix G: Repertorization 1 CHAPTER 1-THE PROBLEM AND ITS SETTING 1.1 THE STATEMENT OF THE PROBLEM The purpose of this investigation was to determine the effects of the thirtieth centesimal (30CH) potency of the venom of Bitis gabonica gabonica on healthy individuals in order to elucidate the total morbid symptomatology produced by the drug so that it may be prescribed by Homoeopathic practitioners according to the Law of Similars, as is required by Homoeopathic methodology. 1.2 THE HYPOTHESIS It was hypothesized that the 30CH potency of Bitis gabonica gabonica would produce clearly observable signs and symptoms in healthy Provers. 1.3 THE DELIMITATIONS The study did not: Seek to explain the mechanism of action of the homoeopathic preparation in producing the symptoms in healthy individuals. Determine the effects of potencies other than the thirtieth centesimal. Seek to perform multi-centre trials of the drug. 1.4 THE ASSUMPTIONS The remedy was accurately prepared according to the standards of the German Homoeopathic Pharmacopoeia (1991:255,289) for the preparation of other snake venoms (for example: Lachesis muta, Naja naja) and that this was the correct method for this venom. 2 The provers took the remedy in the dosage, frequency and manner required. The provers conscientiously and closely observed themselves for the effects of the drug. The provers conscientiously, accurately and honestly recorded all symptoms so observed. The provers did not deviate from their normal lifestyle or dietary habits in a significant manner before or during the proving. 3 CHAPTER 2 - REVIEW OF THE LITERATURE 2.1 INTRODUCTION The extension of the Homoeopathic Materia Medica by proving new drugs is one of the three centres of homoeopathic research as described by Cook (1989:93). The other two are Proving the efficacy of remedies and Research into how Homoeopathy works. Provings are fundamental to homoeopathic practice; they are the only way to predict the remedial actions of any drug with any degree of accuracy (Little 1998:1). Jan Scholten has attempted to predict the effect of simple compounds based on their chemical composition by extrapolation from existing knowledge of other remedies and by analysing remedies in groups (e.g. the Ferrum group of metals, or the Acids, or the Carbonicums) and looking for commonalities (Scholten 1993:23) but it is not easy (assuming his method is valid) to make such predictions for very complex substances such as snake venoms. The import of continually adding to the list of available remedies is clear when one realizes that a well-proven remedy will be able to help in a range of cases that until then could only have been partially covered by the remedies at hand. Nothing can take the place of that remedy in the therapeutic context (Sherr 1994:8-9). 2.2 BACKGROUND The concept of testing of potential drug substances on healthy persons was systematized by Samuel Hahnemann (1755-1843), the founder of Homoeopathy. It was primarily his investigation of the mechanism of action of Cinchona bark (Quinine) in 1790 that lead him to develop this new system of medicine and systematize the proving method that underpins it (Walach 1997:219). In translating Cullen‟s A Treatise on Materia Medica from the 4 English he found himself in disagreement with the author's explanation of the drugs curative action in the treatment of Malaria. He decided to take large quantities of the drug and observed that he developed symptoms of Malaria that stopped once he had stopped taking the drug. Several years of further investigation led him to formulate the „Law of Similars‟ - one of the fundamental principles of Homoeopathy - that he published in his essay New Principles for Ascertaining the Curative Power of Drugs (Cook 1989:8). Provings are the logical extension of the law of similars - an idea known in the West at least as far back as Hippocrates in ancient times (Walach 1994:129). Galen in the 2nd Century A.D. tested his medicines on the sick and on the healthy. Paracelsus in the 16th Century observed the effect of substances on healthy people to determine their therapeutic properties, but neither he nor Galen undertook these activities systematically (Coulter 1975:442). In the East the court of Emperor Shen Nung is thought to have seen the first known provings of remedial agents on healthy people, circa 3000BC (Little 1998:1). Hahnemann probably took his lead from Paracelsus but he also offers credit to the efforts of Albrecht Von Haller (1708-1777), who in the preface to the Pharmacopoeia Helvet (1771) proposed the testing of pure medicines on the healthy and then applying the results to the sick (Little 1998:1). He further gives credit to the likes of Anton Storck (1731-1803), Alexander, Menghini and Fontana who all experimented with the method before him (Walach 1994:129; Stephenson 1960:47-49). Hahnemann, with his various disciples and acolytes, investigated about 140 remedies in the course of his career (Wieland 1997:229). The fervour of his followers produced vast amounts of proving data that were collated in the Materia Medicas of Allen in 1874 and Hering in 1892 (Demarque 1987). 5 2.3 PROVING METHODOLOGIES The reliability of most of these early provings has been called into question especially as they were largely uncontrolled (Fisher 1995). However, the concept of controls is not a recent introduction to homoeopathy. For example blinding was introduced into Homoeopathic provings in 1843 by Gerstel when he was proving Aconitum napellus (i.e the provers were unaware of what they were proving). Bellows introduced the double-blind technique in 1906 when reproving Atropa belladonna (i.e. provers unaware of what substance they are taking and observer does not know who has been given what) (Demarque 1987). The double-blind placebo controlled proving method has become the method of choice in recent years (Vithoulkas 1986;Nagpaul 1987). Raesides treble-blind technique (1972) has been used by both Sherr (1994) and Riley (1995a,b) (i.e. there is a placebo control, the observer is blind and the substance is unknown to both prover and observer). There has been much debate about the best protocols to be used for provings. The growth in interest in provings and the need to present a consistent front to a sceptical scientific community has led to attempts to develop general guidelines and minimum standards for drug proving protocols, such as the effort by the Drug Provings Group of the European Committee for Homoeopathy at five symposia since 1992 (Wieland 1997:231). The aim is to produce a scientific standard for good homoeopathic drug provings (Wieland 1997:229). Walach (1997:223) has suggested that an attempt at quantitative analysis of the raw data is required as opposed to the traditional qualitative analysis, not to negate qualitative analysis, but in order to further the scientific debate and clarify the foundations of homoeopathy. Nonetheless, as Wieland (1997:230) points out, the purpose of the proving is primarily to generate symptoms of quality not quantity. 6 Of note in terms of contribution to the literature on proving methodology are the following authors: Vithoulkas (1986:143-156) in a chapter of his Science of Homeopathy; Demarque (1987); Nagpaul (1987); Bodman (1987); Koppers (1987); Sherr in his Dynamics and Methodology of Homoeopathic Provings (1994) (providing probably the best structure on which to plan a proving); Riley (1996,1997) has further contributed to developments in the field. 2.4 POTENCY CHOICE Raeside (1964) used the 6X, 6CH and 30CH to prove Hirudo medicinalis and noted that most symptoms appeared at the 30CH and least at 6X. Koppers (1987) used a range from mother tincture to the 30CH and found that the latter produced the widest range and most peculiar symptoms as well as effecting mental changes. He subsequently used only the 30CH, confirming Hahnemanns position. Sherr (1994) found the 30CH to produce the most mental/emotional symptoms in his proving of Hydrogen. Walach et al (1995) compared the effects of Belladonna 30CH and 12CH in healthy volunteers and found the 30CH to be more effective. Vithoulkas holds that, ideally, a remedy must be proven in both low and high potencies, the toxicological data noted and the study carried out in three different locations with provers of different nationalities before it can be said to have been fully proven (1986:147-150). This, however, takes many provers and much time to complete and is beyond the resources of most. Sherr (1994) states that it is as valid to use one potency only, such as 30CH, or a single dose of 1M. “Any drug which in its natural state disturbs the bioenergy to destructive manifestations should be proven only in a dynamized form” (Gaier 1991:267). That is to say they should be rendered safe by serial deconcentration and succussion. This drug, being a snake venom, should therefore be proven in a high potency (Roberts 1993:139). Roberts explains further that the reason for this is that, if used in too low a potency (less than 6CH) or in crude form, the outstanding symptoms are likely to be the result of mechanical disturbances 7 and characteristic symptoms do not come to the fore because they are outshone by the gross symptomatology. Paragraph 128 of the Organon (Hahnemann 1992:111) states that the 30CH potency be used for provings. This position was endorsed by Kent (1990:221) once the Homoeopathic Society of Vienna had tested this potency in reprovings of Hahnemanns remedies and found that it produced the strongest results. 2.5 PROVER POPULATION AND PERCENTAGE PLACEBO There is much variability in the number of provers used and the percentage of provers who get placebo in the literature. Walach argues against the necessity for using placebo controls, saying they are invalid in the proving context – he says that there are so many variables at play in the development of symptoms that only parallel group provings with very large numbers (several hundred) could have a chance of controlling the variables (1994:130). One might argue that it is the very existance of all those variables that makes the use of placebo essential. Hahnemann used 60+ provers in his early trials, with no controls, but modern re-provings have not shown any inaccuracy in his results. Large numbers have been used in some provings - such as the 226 used for the proving of Arsenic (Demarque 1987). Sherr has found the use of 100 provers or more to be too much because it results in the remedy being inflated out of proportion to the others. He feels that 15-20 will produce a very full remedy picture. He has adopted a policy of using 10-20% of the provers as placebo controls (1994). Raeside used 15-20 provers of whom one third received placebo (1972). Royal suggests 10 as a minimum (1991) while Vithoulkas (1986:151-152) suggests 50-100 with 25% placebo control. Nagpaul (1987) suggests 20-30 provers with 25-30% placebo control. 8 2.6 THE PROVING SUBSTANCE: BITIS GABONICA GABONICA 2.6.1 CLASSIFICATION (FITZSIMONS 1980:190-191) Group: Solenoglypha Family: Viperidae Genus: Bitis Species: gabonica gabonica Common: Gaboon viper, Butterfly adder 2.6.2 DISTINGUISHING CHARACTERISTICS The Gaboon viper is the largest and most beautifully marked of the African adders and by bulk the largest viper in the world. Adults average 120cm in length, but specimens of up to 2m are found. There are two races of Bitis gabonica described in terms of their morphology and geographic distribution: the variant found in West Africa, Bitis rhinoceros, has a pair of horns on the snout and keeled scales, while the East and Southern African variant, Bitis gabonica gabonica. The colouration of the two variants is the same as is the composition of the venom (Marsh et al:764). Colouration is as follows: - on the body is a ground of rich brown to purple, superimposed on which is a series of quadrangular yellow to buff markings over the middle of the back with brown interspaces; the head is pale buff to chestnut with a dark median line; underparts are yellowish and the eyes are silvery grey. For the most part the Gaboon viper is found in the moister rainforest areas where its camouflage is adapted to the dappled light of the forest floor. It is said to be very sluggish and can strike swiftly when provoked, as with other adders (FitzSimons 1980:190). However, that it is nocturnal and conceals itself during the day (Marsh et al 1997:764) and is considered rather docile in temperament must account for the short list of victims, since a bite from Bitis gabonica is 9 invariably rapidly fatal due to the quantity of and depth to which the venom is injected by the massive fangs - see below (Visser & Chapman 1978:35-36). It is this which must account for it‟s fearsome reputation as the volume of venom delivered is “extravagantly in excess of anything they might need for killing their prey” (Lane M,cited in Marsh et al 1997:764). Prey is usually ambushed and generally consists of rodents, monkeys, mongooses, hares and birds. The snake is viviparous, the young are large and the litters are large - often up to 60 in West Africa, but smaller (16-30) in Southern Africa. Its‟ venom is similar to the puffadder (Bitis arietans) but yields are between 450- 600mg in a single bite as compared to 100-350mg for the puffadder - 100mg being a fatal dose in humans. Bitis gabonica can be said to produce the largest amount of venom of any poisonous snake and yields in excess of 2 grams of dry venom per milking have been documented (Whaler B.C, cited in Marsh et al 1997:764). As stated above, bites from this snake are rare but serious. Large amounts of venom are injected deep into the tissues resulting in rapid swelling at the site and then the whole limb. Pain is intense, haemorrhagic oedema and blistering at the bite follows rapidly and hypotension, cardiac damage, dyspnoea and unconsciousness may occur; there is haemorrhage, with haematuria and haematemesis possible sequelae; necrosis and the need for amputation are possible; death is not rare (Spawls and Branch 1995: 116-118). The four main modalities of toxicity are disseminated intravascular coagulation (DIC, with the production of large thrombi in the vacular tree and thus the potential of fatal embolism), haemorrhage, hypotension and cardiotoxicity. Ultimately, death will most likely be the result of cardiac damage. One of the early effects of the haemorrhagins may be pulmonary oedema and dyspnoea. In the case of a successful hunt, haemorrhage is unlikely to occur in the short time it takes for the prey to die so the purpose of the haemorrhagins is most likely to aid in digestion of the carcass (Marsh et al 1997:768). 10 [ NB: These are the toxicological symptoms of the venom itself, they will not appear in the proving. The venom will be rendered safe by the process of serial deconcentration according to the method specified by the German Homoeopathic Pharmacopoeia (GHP), 5th supplement (1991) to the 1st edition (1978) for the other snake venoms (GHP 289/255) ]. BITIS GABONICA GABONICA 11 CHAPTER 3 – THE DATA: TREATMENT AND INTERPRETATION 3.1 THE EXPERIMENTAL DESIGN [This followed that of Wrights' 1999 proving of Bitis arietans arietans] The homoeopathic drug proving of the venom of Bitis gabonica gabonica 30CH took the form of a double-blind, placebo-controlled trial on twenty subjects who all met the inclusion criteria. Five of the twenty subjects received placebo in a randomized fashion, so that neither the provers nor the researcher knew who had received placebo or verum. As an added control the provers were unaware of the substance or the potency they were proving as suggested by most writers (Walach 1997:221; Sherr 1994). Data collection was via the journals that the provers kept in order to record their daily symptoms - data was later extracted from these journals. Data recorded by the researcher from case histories and physical examination was also considered. The study design was a single group with placebo control as well as intra- individual control - the prover serves as his or her own control by recording their state before the drug is taken; this serves as a baseline for comparison to their later state under the influence of the proving substance (Vithoulkas 1986:150). 3.2 AN OUTLINE OF THE METHOD Provers were recruited mainly from the departments student body but the study was open to qualified homoeopaths, medical practitioners, pharmacists or any other interested persons. 12 The initial interview screened the potential provers for suitability according to the inclusion criteria. (Appendix A) The provers received all the information pertinent to the manner in which the trial was to be conducted at the pre-trial consultation. What was required of them was explained and they had an opportunity to ask questions on any aspect of the trial they did not understand fully. A thorough case history and physical examination was performed on each prover by the researcher. (Appendix C) The provers signed the consent form. (Appendix B) Provers were each assigned a prover code, a list of instructions (Appendix D), a journal, a list of contact telephone numbers, a starting date and medication in the form of powders. The provers were asked to record their symptoms 3 times a day, or as they occurred, in their journal for the first 7 days (Sherr 1994:60). This established the provers' baseline state. The provers began taking the powders 3 times a day and recorded their symptoms as they appeared. The researcher was in regular contact with the prover during this time. The prover ceased to take the substance when symptoms began to appear - noticed either by the prover or the researcher. If no symptoms were noted after finishing the powders they would continue to record their state for an agreed period nonetheless. Provers continued to keep a record until all symptoms abated. After the first week, contact with the provers decreased from daily to every 2 days to every 3 then to weekly. When no symptoms had been noted for 1 week then the proving was considered to be complete. This will be followed by a one week post- proving observation period. The journals were then recalled. The group discussion then took place. 13 The proving was then unblinded to the researcher so he could distinguish between placebo and verum. Data was then extracted and collated. Statistics: these were impractical in this study. No formal statistics were used other than age and sex analysis. The proving was written up into Materia Medica and Repertory format and published. 3.3 THE PROVING SUBSTANCE 3.3.1 THE POTENCY The nature of the substance to be proved and the common use of the 30CH and its promising effects support the use in this study of the 30CH only (see 2.4 above). 3.3.2 DOSE AND POSOLOGY One powder was dissolved sublingually 3 times a day until the onset of symptoms and for no longer than 1 week. No powders were taken after onset of symptoms (Sherr 1994:53). This is the rule of Drug non-repetition in pathogenetic experiments (Gaier 1991:267). Nothing was taken by mouth for 20 minutes before and after each dose. 3.3.3 PREPARATION AND DISPENSING OF THE REMEDY Potencies of the fresh venom of Bitis gabonica gabonica were prepared from samples obtained from a healthy female Gaboon viper by Gavin Carpenter, a professional snake breeder, according to the method specified by the German Homoeopathic Pharmacopoeia (GHP), 5th supplement (1991) to the 1st edition (1978) for the other snake venoms (GHP 289/255). It should be noted that the researcher used fresh, rather than freeze-dried, venom. The verum was 14 dispensed as lactose granules that had been triple impregnated at 1% v/v with Bitis gabonica 30CH in 73% ethanol. The placebo was dispensed as lactose granules as above but impregnated with 73% ethanol alone. The dispensing was done in such a way that the researcher did not know who had received verum or placebo (see 3.5 below). 3.4 THE DURATION A one-week observation period preceded the start of the proving. Provers took their powders until the onset of symptoms but for not longer than 1 week. They recorded their symptoms until they abated and the proving was complete once there had been no unusual symptoms for one week. A one-week observation period followed. 3.5 PROVER POPULATION AND PERCENTAGE PLACEBO This double-blind placebo-controlled drug proving used twenty provers with 25% (five provers) placebo control assigned in a randomized fashion. This was achieved by writing the prover codes (1-20) on pieces of paper, folding them over and mixing them together in a container. The papers were then removed one by one and assigned to Piles A and B in the ratio 3A:1B to give each pile the required number in a random fashion. Pile A was the verum group and Pile B the placebo control. This procedure was carried out by the laboratory technician who also dispensed the powders so that the researcher remained blind as to which provers were in which group. 3.5.1 CRITERIA FOR INCLUSION IN THE PROVING The subject: Was between the ages of 18 and 65 years. 15 Was in a general state of good health as judged by the researcher and the subject (Koppers 1987). Had no gross physical/mental pathology (case history) (Sherr 1994:44). Was neither on nor in need of any medication of any sort (Walach et al 1995). Had not been on oral contraceptives or HRT in the six months prior to the proving (Sherr1994:44). Had not had surgery in the last six weeks (Riley 1995a,b). Did not consume more than 2 measure of alcohol, 3 cups of caffeine- containing beverages/herb teas or 10 cigarettes per day (Sherr 1994:29). Was not a user of recreational drugs such as LSD and Cannabis (Sherr 1994:44). Was not pregnant or nursing (Sherr 1994:44). Was able to adhere to the protocols (Royal 1991). Was acquainted with the principles and methods of homoeopathic drug provings. Was considered competent and had signed the consent form (Riley 1995a,b). 3.5.2 MONITORING THE PROVERS Provers began the proving as close together as possible. The researcher was in daily contact by phone with each prover during the initial stages as detailed above (3.2). As the symptoms began to abate the contacts decreased to every 2, 3 then 7 days (Sherr 1994:58). This ensured that the researcher knew when to tell the prover to stop taking the substance, the prover did not neglect to record important symptoms and any adverse reactions could be monitored and antidoted if necessary. 16 3.5.3 CHRONOLOGY The prover noted down the time elapsed since the beginning of the proving with each recorded symptom (Hahnemann 1992:116). This was recorded as DD:HH:MM, where DD= number of days since the proving began (day1=00), HH= number of hours and MM= number of minutes. The top of each page of the journal was marked with the appropriate day code. After 24hrs the minutes become redundant (=XX). After 2 days the hours were redundant and shown by XX. Where time is unclear or considered insignificant, XX:XX:XX was used. Symptoms that occur after each dose were recorded with the time after the dose. Actual time of day was only included where it was definite and significant. All irrelevant time data was erased in the initial extraction (Sherr1994: 73-74). 3.6 GROUP DISCUSSION Once the journals were handed in a group discussion was held. This was a valuable source of information as it helped stimulate the provers’ memories to remember symptoms that they had forgotten or neglected to record, or which they were unsure of. The discussion added a useful dimension to the proving experience without which many valuable symptoms would have been lost. It clarified issues and allowed the researcher to confirm or discard doubtful symptoms (Sherr 1994:66). 3.7 SYMPTOM COLLECTION, EXTRACTION & EVALUATION This stage of the method converts the diaries into the format of the Materia Medica. Symptoms are studied and validated or rejected, according to the criteria 17 below, then edited into a format which is coherent, logical and concise (Sherr 1994:67). Each provers journal was analyzed separately at first, and the extractions recorded as follows: A new page for each system or body part, clearly marked. The prover number is recorded at the top of the page. A minor column on the left records time elapsed since the start of the proving. The main column on the left is for text. Accounts are written in the first person in plain English, not repertory style. Retain the actual expressions of the prover (Close, 1981:56). Avoid contemporary terms (slang) that may be confusing in future (Sherr, 1994:67-68). 3.7.1 CRITERIA FOR ACCEPTANCE OF A SYMPTOM This involved the qualitative analysis of symptoms using these criteria as guidelines (Sherr 1994:70). The symptom did not appear in a prover in the placebo group. The symptom appeared shortly after taking the substance (Riley 1995a,b). The intensity of the symptom (Sherr 1994:72; Nagpaul 1987). The duration of the symptom (Nagpaul 1987; Riley 1995a,b). The number of subjects experiencing a symptom (Riley 1995a,b). The modalities and concomitants associated with a symptom (Riley 1995a,b). The symptom was strange, rare or peculiar either for that prover or in general (Riley 1995a,b). The cure of a pre-existing chronic symptom (Sherr 1994:71;Riley 1995a,b). If a prover was under the influence of the proving substance (seen from the general appearance of symptoms), then all other new symptoms were proving symptoms (Hahnemann 1992; Sherr 1994:70) 18 The symptom was not usual or current for the prover, unless intensified to a marked degree (Sherr 1994:70). The symptom did not occur in the prover in the last year (Sherr 1994:70). The symptom did not appear naturally or spontaneously i.e. did not have a clear extraneous cause (Sherr 1994:70). A current symptom that has been modified or altered - the altered and current parts will be clearly described (Sherr 1994:70). Accidents, coincidences and synchronistic events that happen to more than one prover (Hahnemann 1992:115; Sherr 1994:70). The symptom occurred a long time previously (5 or more years) and there is no explicable reason for its reappearance at the time of the proving (Hahnemann 1992:115; Sherr 1994:70). 3.8 COLLATING AND EDITING This was the actual process of uniting all the fragments of the proving accounts into a comprehensive whole. The data first had to be ordered into relevant sections and subdivisions (mind, vertigo, head, etc). Then each section from each prover was put together and sorted according to subject and time of appearance; identical or similar symptoms from different provers were listed separately and consecutively having been sorted by the following criteria: The nature of the symptom The prover The sequence development of the symptom The time of appearance of the symptom 3.9 TOXICOLOGICAL DATA Toxicological data was taken into account to provide a more complete picture of the remedies action on healthy people in order to widen the possible therapeutic 19 spectrum of the preparation. It was incorporated into the data before it was written up in materia medica and repertory format. 3.10 REPORTING OF THE DATA 3.10.1 THE REPERTORY Data was converted into Rubrics of a form compatible with a modern Repertory (Synthesis ed. 7: Schroyens 1997). 3.10.2 THE MATERIA MEDICA All symptoms were written up into a typical Materia Medica format that again closely adhered to the sections laid out in Synthesis ed. 7 (1997) for ease of reference and standardization. The following headings were used: Mind Vertigo Head Eye Vision Ear Hearing Nose Face Mouth Teeth Throat External throat Stomach Abdomen Rectum Stool Bladder Urine Genitalia/sex Larynx and trachea Respiration Chest Back Extremities Sleep Dreams Generals 20 CHAPTER 4 – THE RESULTS THE MATERIA MEDICA AND REPERTORY OF BITIS GABONICA GABONICA 4.1 KEY The following form is used to reference the symptoms of the Materia Medica: (Prover number)(sex) (day: hour: minute) The symptoms are listed according to section and theme (where relevant) in both the Materia Medica (4.2) and Rubrics (4.3) and the sections follow the order found in the repertory (Synthesis edition 7: 1997). The Rubrics are presented in the same format as they would be found in Synthesis: (Rubric)(subrubric/s) (Synthesis page number) New symptoms suggested by the proving are underlined and indicated by a capital N instead of a page number. The grading (intensity) of the symptom is, where necessary, indicated by the font, as in Synthesis: Grade three in bold type. Grade two in Italics. Grade one in normal type. New symptoms are underlined. 21 4.2 MATERIA MEDICA 4.2.1 MIND ISOLATION/ALONE/DESIRE TO BE ALONE I feel very alone and insecure. Everything they say hurts as if they are deliberately saying things to hurt. I have disconnected myself from the conversation...I do not feel like talking...especially about me. I like my own space and want it now. 10F 1:1630 Sense of isolation. Anger. Confused. Overwhelmed. Self pity. 01F 1:1310 Feel alone and on the outside. Wish I could get more support and encouragement at home - might snap and scream at them. 03F 3:xxxx Feeling some isolation from companions. 03F 9:xxxx Tired and despondent. Feel alone, isolated, far from those that love me. 03F 9:xxxx Distanced from issues around me. 18F 1:1400 Want to talk to people about experiences but aware that they may not care so say nothing. 01F 13:xxxx Feeling very alone. Unconnected to others. 03F 7:xxxx 22 Feeling alone. Not connecting. 03F 11:xxxx Depressed and lonely. 04F 6:xxxx Feel unconfident, just want to hide away for a while, disconnect. 19M 3:xxxx Still feeling disconnected. 19M 4:xxxx Feel am hiding away from the world and self. 19M 20:xxxx Still sighing. Don‟t think I‟m proving. Enjoying my own company. Not as sociable, don‟t converse with flat mates with the same fervour. 08M 3:xxxx Want to be alone. Don‟t want to talk to anyone and especially about me. 10F 10:xxxx Don‟t want to be around people; want to lie still in bed with a warm blanket. Feel better lying on my side. 03F 13:xxxx PANIC/FEELING THREATENED Have been having panic attacks. Mental exertion. Occupation till late. 01F 0:1900 Feel mentally energetic. 01F 2:0715 Racing thoughts. Looping over same thoughts again and again. 19M 11:xxxx 32 Thinking too much. Can‟t sleep late. 05F 7:xxxx Feel a bit breathless. 18F 5:xxxx Mental/emotional overload, too much going on. 18F 9:xxxx Energetic, hyperactive. Tense. Shallow breath, can‟t relax. 19M 2:xxxx Feel hyper and unfocussed, can‟t sit still. 19M 16:xxxx When playing a memory game feel incapable, stupid, slow and being hunted. 05F 2:xxxx. Overwhelmed, tired. 18F 0:1600 Feel flat as usual, neutral. 18F 1:0700 Very slowed up. 18F 10:xxxx Tired at night and unable to study. 15M 4:xxxx 33 CONFUSION/CALM Confused about feelings for others. >Talking and hugs. 05F 14:xxxx Woke not knowing where I was. 19M 3:xxxx Feel great, relaxed, clear head. Bizarre distant memories, images, unresolved relationships. Or street I didn‟t like when I was young. 19M 5:xxxx Aura of calm. 05F 15:xxxx Feeling of order and rest restored. 17F 0:xxxx I am very gently learning to live life supported and cared for. 17F 5:xxxx BLOATING/EXPANSION Imagined my body getting bigger 5 min after remedy dissolved 01F 0:0600 PLACEBO Fed up that I'm sure I'm on placebo. Feel well and really good mentally. 12F 3:xxxx 34 OTHER Regression moment of suckling…being very sick as a child, battling to sit up and receive a drink. 17F 4:xxxx 4.2.2 VERTIGO Feel like I'm falling. 19M 17:xxxx Light headed and dizzy on computer. >Sitting, closing eyes. 05F 0:1330 Faint and dizzy around 1400. 10F 16:xxxx Still a bit dizzy. 12F 0:1600 Dizzyness in head. Feels like spongy brain. 12F 1:1200 Dizzy 1/2 hr after remedy. 12F 3:xxxx Slight dizzyness in head. 12F 7:xxxx Head became dizzy. 15F 5:xxxx 35 4.2.3 HEAD Frontal headache. Sharp ache. 01F 4:xxxx Headache frontal, root of nose. Rest. Since 1230. 01F 4:1415 Headache dull frontal. >Distraction. < Thinking on it. 01F 4:xxxx Woke with frontal headache. Dull pressing pain. And < in waves. 05F 3:xxxx Headache on the left eye, which was „cracking‟. 15M 13:xxxx Headache on the left, pulling the eye. 15M 15:xxxx Headache on left from left ear to left eye; goes up and disappeared. < Lying face down. 15M 16:xxxx Headache on left, pulling left eye inward, not see clearly, painful, neck becomes tired. 15M 16:xxxx 37 Headache thorn like (throbbing) moving above the eyes. During the day eyes unable to see clearly because of this headache, which attacks both eyes sideways. 15M 1:xxxx Headache between eyes, On side. Must keep still. 01F 9:xxxx Headache, temples. >Heat. 03F 7:xxxx Woke with headache right temple. >Lying on left side. 05F 3:xxxx Headache at base of skull (occiput) and temples. Constant ache. >Lying and closing eyes. 10F 19:xxxx 38 Headache slight at temples. 18F 2:xxxx Tension in temples going down into jaw. 12F 1:1430 Headache at temples sleep. 06F 3:xxxx Had one beer but effects pretty weird - nausea, drunk and light headed. Passed within 2 hrs but felt run-down for rest of evening. 13M 3:xxxx Stuffy head. 10F 21:xxxx Head tight. 01F 8:xxxx Headache very bad. 15M 16:xxxx 4.2.4 EYES For last week left eyeball tender to light pressure. Rubbing. 10F 9:xxxx Eyes swollen, puffy, dry. 03F 8:xxxx Dull ache to touch on right eyelid. Red spot of inflammation. 09F 11:xxxx Inflammation worse. Sharp pain on blinking/touch. Otherwise dull ache. 09F 12:xxxx Inflammation on eye looks like pimple, opened with a pin and resolved. 09F 13:xxxx Eyeballs feel dry. 03F 0:0530 Sun feels too bright. Shade is soothing. 03F 0:1230 Red eyes. 03F 1:0530 Eyes red itchy irritated. 03F 2:xxxx Feels like a mild allergic reaction to something. Eyes a bit scratchy, nose tingling. 19M 1:0640 43 Burning. 19M 17:xxxx Heavy. 03F 1:1220 Eyes heavy. Tired. 05F 1:1100 Anxiety in eyes. 03F 8:xxxx Eyes aching - slight. 18F 0:1600 Eyes have healed. 17F wk3 During the day eyes unable to see clearly because of this headache, which attacks both eyes sideways: the land was full of mist during the day; it will come and go. 15M 1:xxxx Left eye strained back (pull) and unable to see clearly. 15M 5:xxxx 4.2.5 EAR Right ear canal itchy, Eating. for pressure. For 10mins. 01F 1:1120 Sore spot on tongue, right, as if bitten, like a blocked duct. 12F 1:1200 Tongue sensitive. Pain when I eat. 12F 1:1800 Tongue still sore. 12F 2:xxxx Ulcers in mouth trying to happen. 17F 3:xxxx Ulcer ran away. Tiny cuts inside mouth. 17F 4:xxxx Cuts in mouth healed, jaw clenching virtually stopped. 17F Week 3 Very dry lips. 05F 1:1100 54 Lips sensitive to cold. 05F 10:xxxx 4.2.9 THROAT Woke with burning dry throat. 01F 11:xxxx Unable to swallow anything…esophagus painful like a person who swallowed hot food or as if I was walking in a hot windy place. 15M 3:xxxx Sensation of cold air in larynx 5mins after remedy. Came and went. 03F 0:0800 Sensation of lump in the throat. 03F 7:xxxx Sore aching. Lump in throat when swallowing. 09F 8:xxxx Anxiety in throat. 03F 8:xxxx Mucus in throat. 09F 1:0730 Scratchy. 03F 4:xxxx 55 Scratchy throat. 09F 0:1330 Scratchy. 18F 1:1400 Sore throat. 06F 1:2145 Mild sore throat. 09F 3:xxxx Very sore. 09F 9:xxxx Throat sore on first waking. 13M 7:xxxx Slight sore, dry. 09F 9:xxxx Sore throat, sharp sensation. >Food and drink. 09F 2:xxxx Sore and scratchy. 09F 5:xxxx Slight sore throat and mucus. 09F 6:xxxx Have to keep clearing throat. 12F7:xxxx 56 Feels sore/tight. Mild sensitivity to cold juice. 18F 1:1700 Throat slight tightness. 18F 2:xxxx 4.2.10 EXTERNAL THROAT Jaw/throat tight sensitive just below jaw line at my throat. 18F 3:xxxx Throat tender just below jaw 18F 5:xxxx 4.2.11 STOMACH Burning discomfort in stomach/epigastrium. 01F 0:1900 Burning pain in stomach from 1200. >Eating after. 01F 2:1300 Unsettled. Burning sensation, acid, deep in my stomach. 19M 6:xxxx Sensation of a knot in stomach. 01F 10:xxxx Ache. 03F 14:xxxx 57 Ate late lunch after a run, stomach started to grumble and felt awkward. 13M 0:1430 Sensitive to food, stranger dislikes than usual. 18F 1:1700 Ravenous hunger at 1pm and very thirsty for water. 01F 11:xxxx Very thirsty. 01F 4:xxxx Thirsty. 03F 0:0930 Hungry but can‟t decide what I want. 01F 7:xxxx Still huge appetite, never satisfied. 05F 7:xxxx Huge appetite. 05F 15:xxxx Big appetite for breakfast. 05F 16:xxxx Food is very important to me. I can eat a lot, unhappy when it is not right. 03F 6:xxxx Felt like I didn't need breakfast. Desperately hungry late morning. 13M 7:xxxx 58 No appetite, averse food. Had to force myself to eat. 10F 2:xxxx Appetite is not back completely but making sure I am eating…did not have anything for Lunch. 10F 3:xxxx Appetite decreased. 05F 9:xxxx Wasn‟t hungry. 05F 14:xxxx Wave of nausea for 1min after remedy. >Cold fresh air. 05F 1:1430 Very big wave of nausea, in intestines. Lots of wind, burping. 05F 2:xxxx Nausea after food. Lots of wind. Nausea came and went all day eating (travel?). 01F 14:xxxx Once again constipated. 12F 5:xxxx Constipated. Bloated, tired. Quite stressed. 19M 7:xxxx Very constipated, bloated. 19M 14:xxxx Bowel cleared for first time in days. 12F 4:xxxx Diarrhea with gas, watery, frothy. 03F 13:xxxx Excessive defecation. 05F 10:xxxx Some diarrhea this morning. Sense of spotting or urging followed me till I got home. Second evacuation also soft. 08M 3:xxxx Sudden profuse clear jellylike discharge. One lot. 08M 4:xxxx Stomach (bowel?) always feels not completely empty, not going properly. 12F 2:xxxx 62 Gone from very loose to constipated in one day. 19M 14:xxxx Going to the bathroom often but nothing serious, not even gas. 20 F 4:xxxx 4.2.14 URINE Excessive urination. 05F 10:xxxx 4.2.15 FEMALE GENITALIA/SEX Sharp squeezing pain in left ovary. >Sitting, bending left leg. 01F 1:0945 Pain in symphysis pubis, after walking. Sharp pain. >Sit still. Horrible pain. Lasted 1/2hr. 01F 7:xxxx Pain on intercourse. Desire present but pleasure absent. Insensible. Bruised sensation. 01F 13:xxxx Increased sexual desire over last few days. 03F 1:1900 Horny again. 17F 2:xxxx 63 Low libido. 03F 4:xxxx White bland leukorrhea. 03F 5:xxxx Thick bland leukorrhea. 03F 9:xxxx Woken by cramps. As if something grabbing my uterus and wringing/ twisting it. Intermittent Pain. Lower back and lower abdomen hurt and feels hot to touch, >rubbing. Desire to stretch, >. Pains lasted till 1630 when subsided. Still feel crampy, achy. Flow began at 1000. 10F 17:xxxx Period pain starting. As if lower back and lower abdomen in a vice. Pain waxes and wanes. 03F 13:xxxx Period pains worse. Feel miserable. > Lying on my side. After sleep. 03F 13:xxxx First day of menses. Tender and sore. 0830 took cataflam for constant pain. >Rubbing.1830 took another. 05F 11:xxxx Cramps of period pains, usually only start after bleeding begun. 10F 16:xxxx 64 Premenstrual build up exactly 1/2 before. I was so uncomfortable, tired, fretting, irritated, etc, and then it passed. Amazing! 17F Wk3 Period very slight after downpour. 6 days only. 17F Wk4 Slight candida. 09F 9:xxxx No vaginal itch or discharge for a few days. 12F 4:xxxx 4.2.16 RESPIRATION Slight constriction in air pipes in bed. 03F 6:xxxx Slight wheeze. 03F 11:xxxx Much sighing. Desire to sigh, often. Just loves the feeling of expanding lungs to capacity and then let it ebb away. 08M 1:xxxx Still sighing. More when lying. 08M 4:xxxx 65 Hoarse, non productive cough, like cold. 09F 9:xxxx 4.2.17 Chest Sternum pain behind. Oppressive. >After eating, belching. 01F 1:1310 Sensation of a great weight on my chest (cardiac area). 10F 1:1630 Heavy feeling. 04F 0:1000 Slight constriction of chest lying in bed. 03F 7:xxxx Slight tight chest. 03F 10:xxxx 4cm from right of posterior sternum it was tight about 3 minutes, but no pain. 15M 13:xxxx Anxiety in chest. 03F 8:xxxx Slight chest pain on right. 04F 0:1600 Slight chest pain, upper right. 04F 4:xxxx 66 Tender breasts. 05F 7:xxxx Perspiration under arms a lot. 05F 10:xxxx Sharp shooting pain in left lower rib cage, antero-lateral. 1-2 seconds. 09F 7:xxxx Pulse normal rate but pounding. Feels as if heart wants to escape. 12F 0:1430 Chest dry. 15M 10:xxxx 4.2.18 BACK Slight neck pain. 04F 5:xxxx Neck stiff on right. 09F 7:xxxx Neck muscles very painful at night on left. 15M 1:xxxx 67 Neck tired at night as from a heavy load. 15M 15:xxxx Neck problem posterior part where the head begins. Start at 0300.No different in the day. 15M 24:xxxx Stiff neck. 19M 3:xxxx Tension in left trap. 01F 0:0800 Back and neck tense. 03F 4:xxxx Back and shoulders stiff and aching. >Lying on back. 05F 3:xxxx Shoulders lazy to lift up. 15M 16:xxxx Burning between shoulders. get up and move. 12F 4:xxxx Bones in head and back are sore. 05F 3:xxxx Desire to stretch. For a while now, forgot to mention it. Get a perverse pleasure, especially the back. 08M 4:xxxx Woke with tender kidneys. 19M 1:0640 4.2.19 EXTREMITIES Left thumb muscle twitch. 03F 1:1220 69 Muscle twitches in left arm. 03F 3:xxxx Muscle twitch in right arm, left leg later (resting). 03F 10:xxxx Muscle twitch left arm and left side. 03F 11:xxxx Twitch in hand and forearm on left. 03F 14:xxxx Left arm twitch. Unusual amount of muscle twitches. Twitching on rest/falling asleep. 03F 15:xxxx Sore shoulder on left. 13M 1:xxxx Cramp in left leg when walking. >Rubbing. 05F 6:xxxx Dull uncomfortable pain in right hip antero-laterally. 09F 0:1610 Right knee aching and painful (lateral) when pressure put on it. 09F 6:xxxx Right knee pain, sore to walk, lateral and posterior. 09F 7:xxxx 70 Sciatica < sitting. 12F 3:xxxx Ligaments very painful. 15M 5:xxxx Pain in my joints (a rainy day). 19M 4:xxxx Small boil inside left thigh above knee. 19M 2:xxxx Small boil on left bum. 19M 4:xxxx Rash inside arms. 19M 9:xxxx Found rash inside legs, been there a few days at least. Dry raised skin. Looks a bit stretched. 19M 10:xxxx Very dry feet. Sweaty hands and armpits. 05F 1:1100 Dry skin between toes on left. 13M 7:xxxx Slight athletes foot on left. 13M 10:xxxx 71 Hands sensitive to cold. >rub and warmth. 05F 10:xxxx Fingers went from cold to warm. 01F 0:1200 4.2.20 SLEEP No desire for sleep. Seems like a waste of time. 01F 1:1310 Could not sleep deeply. 01F 9:xxxx Restless night. Up at all hours. 05F 9:xxxx Light sleep from 0230. 01F 10:xxxx Difficulty falling asleep. 04F 3:xxxx Bad night. 06F 2:xxxx Tossed and turned all night as left hip too sore to sleep on, right side pins and needles. Clenched jaws on back. 17F 1:xxxx 72 Disturbed, woke often. 01F 14:xxxx Woke at 0330 for no reason. 08M 3:xxxx Woke at 02h00… could not do anything. I feel tired even at 0900. 15M 19:xxxx Woke early. 05F 5:xxxx Woke early again. Can‟t sleep late! 05F 6:xxxx Tired on waking. 01F 7:xxxx Felt I needed more sleep when I woke up. 13M 0:xxxx Tired on waking. 05F 1:xxxx Woke feeling awful, heavy feeling of dread in my chest. 03F 12:xxxx Woke feeling I'd had a proper sleep. 05F 16:xxxx Desire to stay in bed >Getting up. 01F 2:xxxx 73 Slept through to 0900 (unusual). 01F 3:xxxx Yawning, faint, pooped. >Eating. Usually only at 1500. 01F 10:xxxx Yawning all afternoon. 10F 0:1330 Really tired in afternoon. 1hr nap. Felt good. 13M 1:0930 Drowsy and tired…could not sleep at night. 15M 17:xxxx Slept all day. 05F 15:xxxx Desire to sleep. 06F 3:xxxx Thick stuffy nose, can‟t sleep. 01F 11:xxxx 74 4.2.21 DREAMS ISOLATION Of wearing a plaster of paris mask, bees trying to get in, not too afraid. Of being on a small tropical island … 13M 2:xxxx Embarrassment in front of people, being laughed at. 03F 1:0530 Shut out, lonely rejected. 03F 12:xxxx Dancing a short number, furious to be on stage, as I hate acting or dancing on stage. 17F 2:xxxx CHAOTIC/ FRAGMENTED A lot of people at home. A big ceremony…shield spears and sticks…slaughtering cows…plenty of meat…waiting for food…right nose running mucus (clear)…not eating…left side was blocked…blood blocked…opened it a little…a little blood came out…woke up…after that not scared. 15M 0:0658 Busy, disjointed, lots of things happening, small flashes of scenes. 12F 4:xxxx Chaos dream. 12F 6:xxxx 75 PARENTS/RELATIVES Of being on a small tropical island with grandmother and mother, needed to get to other side, but too far for grandmother. I went into sea and there was a sand bank going all the way to where we were meant to meet. 13M 2:xxxx Owning plot on my own with lots of pine trees on one side and mentioning I want to chop them down and my dad going for me as he always did. Memory of having to work with the horses - dust kicking, running in small spaces and being terrified. As I always was. Seemed to be a memory of how I was always intimidated by parents. 17F 3:xxxx Faint memory of mum in dream. 17F 6:xxxx Of dead grandfather. It was weird. 06F 4:xxxx Of day at beach with family and friends. 06F 6:xxxx PANIC/THREAT/EXCITEMENT Of being chased by a bear. 08M 2:xxxx Of conflict. 19M 3:xxxx 76 Nightmare. Someone entered room, was paralyzed, screamed a strangled scream and woke. 01F 17:xxxx Of being threatened and hurried. 01F 4:xxxx Huge discomfort around Adams apple on inside of throat. Like it has been banged. Nausea and racing feeling through body. Very uncomfortable. 17F 1:xxxx Epic, exciting, challenging (knights and dragons). 01F 7:xxxx Intense dream about freedom. 19M 6:xxxx Sexually charged but not sexual at all. People waving red shirts. 01F 10:xxxx OTHER Of visiting ex girl friend with present girl friend. 13M 1:xxxx 4.2.22 SKIN Bumps and red spots appearing. Rash between legs, >any cream. 05F 1:2200 Dry, especially lips, inside thighs, breasts. 05F 15:xxxx 77 4.2.23 GENERALS TEMPERATURE Sensation of heat all over. 01F 0:0800 Sensation of heat all over, head and chest especially. 01F 0:1200 Heat in upper body with some perspiration. 01F 1:1310 Sensation of heat uncovering. Exhausting pain. 01F 9:xxxx Feel hot/warm all over. 08M 3:xxxx Hot and cold during the day. 15M 4:xxxx I feel some cold. 10mins and disappeared. 15M 0:1150 I sweat. Feel colder than before. 15M 4:xxxx 78 FOOD Strong desire for coffee. No desire for cheese for a long time. 01F 16:xxxx Craving coffee. 12F 3:xxxx Craving coffee. 18F 1:0900 Thirst for hot drinks. 03F 4:xxxx Desire hot drinks, food (comforting). 03F 8:xxxx Thirsty. Desire for hot drinks. Aversion to cold is much less of late, a big thing for me. 03F 9:xxxx Quite dehydrated. 19M 1:0640 Craving sweets. 12F 3:xxxx Craving sweet things. 18F 0:2030 Wanting sweet stuff. 18F 1:0700 79 Craving sweets. 18F 2:xxxx Preference for plainer things. 18F 5:xxxx Craving chocolate milkshake. 04F 4:xxxx Craving chocolate. 04F 6:xxxx ENERGY Tired. 03F 1:0930 Tired most of the day. 04F 0:1000 Energetic most of the day. Tired in the evening. 04F 7:xxxx Energy high by evening. 04F 5:xxxx Increased energy at midday. Tired in afternoon. 04F 8:xxxx Tired in the morning, like a person who lifts heavy things. 15M 16:xxxx 80 Usually shaky by now if haven‟t eaten but feel fine, unusual. 01F 7:xxxx Nervous system has not been well. Exhausted due to no sleep and lack of energy. 17F wk4 Unwell, tired, general malaise 19M 7:xxxx Feel sick, drained. Whole body aching. >Rest, lying. 05F 2:xxxx Feeling strong and comfortable. 17F 6:xxxx OTHER Looked and felt bloated. 05F 3:xxxx 4.2.24 Toxicology Hypotension and Tachycardia (Wildi et al, 2001:54) Hypotensive (82/50 mm Hg) ten minutes after admission 767 Hypotension due to vasodilation and plasma leakage (Wildi et al, 2001:54) Profound irreversible hypotension due to reduced cardiac output and vasodilation (Marsh et al 1997:767) Haemorrhage affecting the soft tissues (Marsh et al 1997:764) Profound capillary disruption via separation of the endothelial cells from one another (Marsh et al 1997:764) Angioneurotic oedema, without dyspnoea or stridor (Wildi et al, 2001:54) 81 Truncal erythroderma (Wildi et al, 2001:54) Swollen eyelids, lips, tongue (Wildi et al, 2001:54) Petechiae on tongue and palate (Wildi et al, 2001:54) Swelling, haemorrhagic blisters at site (Wildi et al, 2001:54) Massive haemorrhage (Wildi et al, 2001:54) Severe macrohaematuria and haematochezia (Wildi et al, 2001:54) Local necrosis at the puncture sites (Marsh et al 1997:768) Superficial necrosis at site (Wildi et al, 2001:54) Condition like disseminated intravascular coagulation from the gabonase enzyme (Wildi et al, 2001:54) True disseminated intravascular coagulation evidenced by the profuse bleeding (Marsh et al 1997:767) Rapid DIC with deposition of solid thrombi in the vascular tree (Marsh et al 1997:768) Unstable circulation, severe coagulation disorder (Wildi et al, 2001:54) Markedly decreased platelet count (15x109 per litre at the lowest count) (Marsh et al 1997:767) Mildly thrombocytopaenic (lowest platelet count 101x109 per litre) (Marsh et al 1997:767) Severely reduced cardiac output and ventricular filling and thus complete haemodynamic arrest and death (Marsh et al 1997:766) Disturbances of atrio-ventricular conduction (Marsh et al 1997:765) 82 4.3 RUBRICS (NB: * = Symptoms that appear in Bit-a) 4.3.1 MIND *Mind, Absentminded S1 Mind, Anger S8 *Mind, Anxiety S14 Mind, Anxiety, alternating with, contentment S16 Mind, Anxiety, alternating with tranquillity S16 Mind, Anxiety, alternating with, cheerfulness S16 Mind, Anxiety, excitement, from S18 Mind, Aversion, persons, all to S24 Mind, Brooding S27 Mind, Capriciousness S28 *Mind, Cheerful S30 Mind, Cheerful, sadness, after S32 Mind, Company, aversion to S34 *Mind, Company, desire for S34 Mind, Concentration difficult S36 Mind, Concentration difficult, attention cannot fix S36 *Mind, Concentration, difficult, studying (=reading) S36 Mind, Confidence want of self S37 Mind, Confidences, want of, support, desires, family and friends from S37 Mind, Confident S37 *Mind, Confusion S37 83 Mind, Confusion, waking, on S38 Mind, Confusion, mental exertion from S40 Mind, Consolation, aversion N Mind, Conversation, aggravates S42 Mind, Conversation aversion S43 Mind, Decisive S46 *Mind, Delusions, alone, being S52 Mind, Delusion, appreciated, she is not S52 *Mind, Delusion, body, out of S53 Mind, Delusion, body, ugly, body looks S55 Mind, Delusion, child, sick child, she is N Mind, Delusion division S60 *Mind, Delusion, enlarged, body is S61 Mind, Delusion, friendless, he is S65 Mind, Delusion, herself, she is not S68 Mind, Delusion, ignorant, she is N *Mind, Delusion, medicine, taken, he had, placebo *Mind, Delusion, world, from the, separated, he is S79 Mind, Delusion, separated, he were separated from himself S79 *Mind, Delusion separated, body and mind are S79 Mind, Delusion separated, body and mind are, talking, while N Mind, Detached S91 *Mind, Dullness S95 *Mind, Dullness, morning S96 Mind, Ecstasy S99 Mind, Excitement, afternoon S102 84 Mind, Fear S106 Mind, Fear, death, of S109 Mind, Fear, breath away, takes S107 Mind, Fear, sudden, night, waking, on S116 Mind, Fear, waking, on S117 Mind, Firmness S118 *Mind, Forgetful S119 Mind, Forsaken S120 *Mind, Forsaken, isolation, sensation of S120 Mind, Frightened, waking, on S121 Mind, Ideas abundant, clearness of mind S131 Mind, Ideas abundant, clearness of mind, waking, on N *Mind, Impatience S132 Mind, Indifference, work, with aversion to S136 Mind, Insecurity, mental S140 Mind, Irresolution S140 *Mind, Irritability S141 Mind, Irritability, morning S142 Mind, Irritability, alternating, cheerfulness, with S142 Mind, Irritability, family, to her S144 Mind, Irritable, overheated, when becomes N Mind, Irritability, waking on S145 Mind, Irritability, sleepiness, with S145 *Mind, Irritability, trifles S145 Mind, Irritability, 16h, until N 85 Mind, Joy S146 Mind, Loathing, oneself at S153 Mind, Marriage unendurable, idea of seemed S157 Mind, Medicine, desire for more N Mind, Memory, weakness, done, for what just S159 Mind, Memory, weakness, facts, recent S159 Mind, Memory, weakness, heard, for what he has S159 Mind, Mental exertion, aversion S161 Mind, Mistakes, time in, confounds days S164 *Mind, Mistakes writing in S164 *Mind, Mistakes, writing in, omitting letters S165 *Mind, Mistakes, writing in, transposing letters S165 Mind, Mood changeable S166 Mind, Mood, alternating S166 Mind, Occupation ameliorates S172 Mind, Offended easily S172 Mind, Pessimistic S173 Mind, Pities herself S173 Mind, Prostration of mind, night S175 *Mind, Prostration S175 Mind, Prostration, vexation, from S176 Mind, Quiet, wants to be S177 Mind, Rest, desire for S182 Mind, Restlessness, anxious S183 Mind, Restlessness, move must S186 *Mind, Sadness S187 86 Mind, Sadness, afternoon S189 Mind, Sadness, alone, when S189 Mind, Sadness, afternoon, ameliorates S189 Mind, Sadness, evening S189 Mind, Sadness, alone, when S189 Mind, Sadness, company aggravates S190 Mind, Sadness, occupation ameliorates S192 Mind, Sadness, trifles S192 Mind, Sadness, waking on S193 Mind, Sadness, when unoccupied S193 Mind, Sensitive S194 Mind, Sensitive, criticism, to S195 Mind, Sensitive, noise, to S195 Mind, Sensitive, reprimands, to S196 Mind, Sighing S200 *Mind, Spaced out feeling S202 Mind, Slowness S202 Mind, Timidity S220 Mind, Taciturn S213 Mind, Thoughts, disconnected S216 Mind, Thoughts, past, of the S217 Mind, Thoughts, persistent S217 Mind, Thoughts rapid S217 Mind, Thoughts, repetition of S218 Mind, Tranquillity S221 Mind, Weeping, causeless S229 Mind, Weeping, consolation aggravates S230 Mind, Weeping, consolation, comforted, no desire to be S230 87 Mind, Weeping, consolation, for want of S230 Mind, Weeping, desire to S230 Mind, Weeping, forsaken, feeling from S231 Mind, Weeping, mental exertion ameliorates S231 Mind, Weeping, silent S232 Mind, Weeping, vexation, from S232 4.3.2 VERTIGO *Vertigo S235 Vertigo, Afternoon S235 Vertigo, Closing eyes, ameliorates S237 Vertigo, Falling from a height, as if S239 Vertigo, Looking steadily S240 Vertigo, Sitting, ameliorates S243 4.3.3 HEAD *Head, Congestion S250 Head, Constriction S252 Head, Constriction, temples S254 Head, Constriction, temples, extending to, jaw N Head, Fullness S259 Head, Heaviness, forehead S268 Head, Heaviness, forehead, eyes, desire to close N Head, Pain, morning, 10h until S275 Head, Pain, morning, rising, until noon S276 Head, Pain, afternoon, 13h S276 Head, Pain, afternoon, 17h. S276 88 Head, Pain, evening S276 Head, Pain, accompanied by ear pain N Head, Pain, accompanied by, eye, pain S277 Head, Pain, accompanied by, nausea S278 Head, Pain, accompanied by, neck, pain in S278 Head, Pain, accompanied by, neck, pain in, nape of neck S278 Head, Pain, candy after S280 Head, Pain, clothing about the neck aggravates S280 Head, Pain, cold, becoming S281 Head, Pain, cold, mouth, from anything cold in S281 Head, Pain, coryza, with S281 Head, Pain, drinks, cold, aggravate N Head, Pain, drinks, cold from S282 Head, Pain, heat ameliorates S283 Head, Pain, lying, back, on, while S285 Head, Pain, lying, back, on, while, aggravates N Head, Pain, lying, side, on, ameliorates S285 Head, Pain, motion, aggravates S286 Head, Pain, occupation ameliorates S287 Head, Pain, paroxysmal S287 Head, Pain, periodical S288 Head, Pain, sleep, after, ameliorates S290 Head, Pain, sleep, waked from sleep by headache S290 Head, Pain, stooping, from S291 Head, Pain, thinking on it, aggravates N Head, Pain, violent S292 Head, Pain, extending to, eyes, left eye S295 Head, Pain, extending to, shoulder S295 89 Head, Pain, bones S295 *Head, Pain, forehead S296 Head, Pain, forehead, left S296 Head, Pain, forehead, left, extending to, right S296 Head, Pain, forehead, periodical S298 Head, Pain, forehead, periodical, hourly N Head, Pain, forehead, extending to, cheeks S300 Head, Pain, forehead, extending to neck S300 Head, Pain, forehead, extending to, teeth S300 Head, Pain, forehead, extending to, temples S300 Head, Pain, forehead, eyes above S301 Head, Pain, forehead, eyes, above, close the eyes, compels him to S302 Head, Pain, forehead, eyes behind S303 Head, Pain, forehead, eyes, behind, left eye N Head, Pain, forehead, eyes between S303 Head, Pain, forehead, nose, above root of S303 Head, Pain, forehead, nose, above root of, heat aggravates N Head, Pain, forehead, nose, above root of, rest ameliorates N Head, Pain, occiput S303 Head, Pain, occiput, closing eyes ameliorates S304 Head, Pain, occiput, extending to ears S306 Head, Pain, occiput, extending to ears, left ear N *Head, Pain, occiput, extending to, neck, down back of S307 Head, Pain, occiput, extending to, shoulders S307 Head, Pain, occiput, extending to, left shoulder N Head, Pain, sides, left S308 Head, Pain, side, one side, extending to eye S308 Head, Pain, side, left S308 *Head, Pain, temples S310 *Head, Pain, temples, left S310 90 Head, Pain, temples, morning, waking on S310 Head, Pain, temples, heat ameliorates S311 Head, Pain, temples, lying ameliorates S311 Head, Pain, temples, lying, left, ameliorates N Head, Pain, temples, motion S311 *Head, Pain, temples and forehead S312 Head, Pain, temples and occiput S312 Head, Pain, temples, extending to eye S312 Head, Pain, temples, extending to face S312 Head, Pain, temples, extending to teeth S312 Head, Pain, burning, forehead S317 Head, Pain, cutting, forehead S321 Head, Pain, cutting, lying, ameliorates S321 Head, Pain, dull pain, forehead S326 Head, Pain, pressing, bending head forward S330 Head, Pain, pressing, stooping, on S332 Head, Pain, pressing, extending to neck, nape of S333 Head, Pain, pressing, forehead, morning, waking, on S333 Head, Pain, pressing, forehead, bending down, on bending head S333 Head, Pain, pressing, forehead, stooping, while S335 Head, Pain, pressing, occiput, burning S337 Head, Pain, pressing, occiput, extending to neck S337 Head, Pain, pulling, like, eye, left eye N Head, Pain, pulsating S342 Head, Pain, pulsating, sides, left S342 Head, Pain, sore, temples S346 Head, Pain, stitching, pulsating S348 Head, Pain, stitching, forehead, eyes, over S350 Head, Pain, waves in S361 Head, Pain, waves in S361 91 4.3.4 EYES/ VISION Eye, Discolouration, red, morning S379 Eye, Dryness, morning S380 Eye, Enlargement, sensation of S380 Eye, Enlargement, sensation of, left S381 *Eye, Heaviness S383 Eye, Inflammation, lids, upper, right S386 Eye, Itching, morning S388 Eye, Pain, evening S392 Eye, Pain, pressure aggravates S394 Eye, Pain, aching S396 Eye, Pain, burning S396 Eye, Pain, cutting, lid S399 Eye, Pain, drawing, backward, the eyeball S399 Eye, Pain, sand, as from S402 Eye, Pain, sand, as from, rubbing ameliorates N Eye, Pain, sore S402 Eye, Pain, sore, left S403 Eye, Pain, sore, night S403 Eye, Pain, sore, motion, lids of S403 Eye, Pain, sore lids S403 Eye, Pain, sore lids, right lid N Eye, Photophobia, light, daylight S407 Eye, Photophobia, light, sunlight S407 Eye, Sensitive, touch, to S409 Eye, Swelling, left S411 Eye, Swelling, morning S411 Eye, Swelling, sensation, as if S411 92 Vision, Accommodation, slow, too S417 *Vision, Blurred S417 Vision, Dim, reading S423 Vision, Foggy, headache, during-mist before eyes S426 4.3.5 EAR Ear, Formication, behind the ear S437 Ear, Fullness, sensation of S437 Ear, itching, meatus, right S439 Ear, itching, meatus, scratching aggravates S439 Ear, itching, meatus, rubbing aggravates S439 *Ear, noises, buzzing S442 Ear, Pain, right S449 Ear, Pain, left, extending to left eye, headache, during N Ear, Pain, behind the ear, right S453 Ear, Pain, behind the ear, pulsating S453 Ear, Pain, lobe S453 Ear, Pain, lobe, edge of N Ear, Pain, lobe, right, then left N Ear, Pain, meatus S453 Ear, Pain, piercing S457 Ear, Pain, soreness S458 Ear, Pain, soreness, behind the ear S458 Ear, Pain, soreness, left ear S458 Ear, Pain, soreness, front of ear, in S458 Ear, Pain, soreness, lobe S458 Ear, Pain, stitching S458 93 4.3.6 NOSE Nose, Catarrh, right S471 Nose, Catarrh, postnasal S472 Nose, Coryza, morning S473 Nose, Coryza, discharge, with, morning S474 Nose, Coryza, discharge, without S474 Nose, Coryza, headache, with S475 Nose, Discharge, left S477 Nose, Discharge, daytime S477 Nose, Discharge, morning S477 Nose, Discharge, morning, rising, after N Nose, Discharge, albuminous S477 Nose, Discharge, clear S477 Nose, Discharge, copious S477 Nose, Discharge, egg white, like S478 Nose, Discharge, salty S479 Nose, Discharge, thick S480 Nose, Discharge, watery S480 Nose, Discharge, watery, left S480 Nose, Discharge, watery, morning S480 Nose, Discharge, watery, cold room in S480 Nose, Discharge, watery, coryza, without S480 Nose, Discharge, yellow S480 Nose, Dryness, inside S482 Nose, Dryness, inside, left S482 Nose, Obstruction S488 Nose, Obstruction, right S488 Nose, Obstruction, left S489 94 Nose, Obstruction, morning S489 Nose, Obstruction, night S489 Nose, Obstruction, accompanied by, discharge, watery S489 Nose, Obstruction, blowing ameliorates S489 Nose, Obstruction, Warm room S490 Nose, Pain, dryness, from S492 Nose, Pain, pressure aggravates S492 Nose, Pain, burning S493 Nose, Pain, burning, left S493 Nose, Pain, rawness, blowing, after S495 Nose, Pain, sore S495 Nose, Pain, sore, posterior nares S495 Nose, Smell, acute S497 Nose, Sneezing S498 Nose, Sneezing, night S499 Nose, Sneezing, cold air in S499 Nose, Sneezing, coryza, without S499 Nose, Sneezing, eating ameliorates N Nose, Sneezing, frequent S499 Nose, Tension, inside S501 4.3.7 FACE Face, Coldness, perspiration with N Face, Dry, lips S513 Face, Heat, flushes S526 Face, Heat, flushes, cheeks S527 Face, Itching S528 95 Face, Pain, pressing S539 Face, Pain, pressing, maxillary sinus S539 Face, Sensitive, cold to, lips N Face, swelling, eyes around, morning S546 Face, Tension, eyes, below S548 Face, Tension, jaws S548 *Face, Tension, jaws, lower S548 Face, Tension, jaws, lower, right N Face, Tension, mouth and nose, around S548 4.3.8 MOUTH *Mouth, Dryness, lips S567 Mouth, Itching, tongue S573 Mouth, Itching, tongue, under N Mouth, Pain, sore, palate S581 Mouth, Pain, sore, palate, right N Mouth, Pain, sore, tongue S581 Mouth, Pain, sore, tongue, spots S581 Mouth, Saliva, saltish S584 Mouth, Salivation, accompanied by, nausea S587 Mouth, Salivation, profuse S588 Mouth, Sensitive, tongue S589 Mouth, Taste metallic S596 96 Mouth, Taste metallic, remedy, after N Mouth, Ulcers S600 4.3.9 THROAT Throat, Anxiety and apprehension in throat S621 Throat, Coldness, sensation of S622 Throat, Dryness, morning, waking S624 Throat, Dryness, morning, waking on S625 Throat, Dryness, esophagus S625 *Throat, Hawk, disposition to, mucus in the throat and mouth, thick S626 *Throat, Lump, sensation of a S628 Throat, Lump, sensation of a, swallowing, on S629 Throat, Mucus S630 Throat, Mucus in throat Throat, Mucus, morning S630 *Throat, Pain S631 Throat, Pain, drinking/eating ameliorates S632 Throat, Pain, drinks, cold S632 Throat, Pain, swallowing S633 Throat, Pain, burning, esophagus S635 Throat, Pain scratching S637 Throat, Pain, sore S637 Throat, Pain, sore, accompanied by, dryness S638 Throat, Pain, sore, waking, on S638 Throat, Pain, splinter, as from a S638 Throat, Tension S644 97 4.3.10 EXTERNAL THROAT External throat, Pain, soreness S650 External throat, Sensitive, at angles of jaw S651 4.3.11 STOMACH Stomach, Anxiety S653 *Stomach, Appetite, capricious S653 Stomach, Appetite, ravenous, afternoon S655 Stomach, Eructations, anxiety, during N Stomach, Lump, sensation of a S678 Stomach, Pain, aching S690 Stomach, Pain, burning S690 Stomach, Pain, burning, noon S690 Stomach, Pain, burning, eating after, ameliorates S691 Stomach, Pain, sore S697 *Stomach, Thirst S703 *Stomach, Thirst, morning S703 Stomach, Thirst, afternoon S703 Stomach, Thirst, evening S703 4.3.12 ABDOMEN *Abdomen, Distension S721 Abdomen, Distension, night S721 Abdomen, Distension, morning, waking, on S721 98 Abdomen, Distension, constipation, during S721 Abdomen, Distension, hypogastrium S723 *Abdomen, Distension, flatus, from S722 *Abdomen, Flatulence S725 Abdomen, Heat, menses, during S729 Abdomen, Movements, in S732 Abdomen, Noises S733 Abdomen, Pain S733 Abdomen, Pain, morning S733 Abdomen, Pain, cramping, ilium, crest of, left S755 Abdomen, Pain, cramping, ilium, crest of, above S755 Abdomen, Pain, cutting, hypogastrium S759 Abdomen, Pain, stitching, sudden, once N 4.3.13 RECTUM/STOOL Rectum, Constipation, eating ameliorates N *Rectum, Constipation, ineffectual urging and straining S791 Rectum, Constipation, insufficient S791 Rectum, Diarrhea, morning S793 Rectum, Diarrhea, noon S793 Rectum, Diarrhea, alternating with, constipation S794 Rectum, Flatus S801 Rectum, Flatus, night S802 Rectum, Flatus, night, accompanied by, head pain N Rectum, Flatus, offensive, eggs, spoiled S803 Rectum, Inactivity of rectum S806 Rectum, Urging, sudden S819 99 Rectum, Urging, walking, while S819 Stool, copious S822 Stool, mucus, jelly-like S825 Stool, watery, frothy S828 4.3.14 KIDNEYS Kidneys, pain, morning, waking, on S849 4.3.15 URINE *Urine, Copious S872 4.3.16 FEMALE GENITALIA/SEX Female Genitalia/Sex, Coition, enjoyment absent S908 Female Genitalia/Sex, Coition, Painful S909 Female Genitalia/Sex, Eruptions S910 Female Genitalia/Sex, Leukorrhoea, bland S915 Female Genitalia/Sex, Leukorrhoea, thick S919 Female Genitalia/Sex, Leukorrhoea, white S920 Female Genitalia/Sex, Menses painful, beginning at S928 Female Genitalia/Sex, Pain, ovaries, left S936 Female Genitalia/Sex, Pain, ovaries, left, Bending left leg, ameliorates N Female Genitalia/Sex, Pain, ovaries, sitting, ameliorates N Female Genitalia/Sex, Pain, uterus, extending to back S938 Female Genitalia/Sex, Pain, uterus, gradually comes and goes S938 100 Female Genitalia/Sex, Pain, uterus, menses, during S938 Female Genitalia/Sex, Pain, uterus, paroxysmal S938 Female Genitalia/Sex, Pain, uterus, rubbing ameliorates N Female Genitalia/Sex, Pain, uterus, lying, side, ameliorates N Female Genitalia/Sex, Pain, uterus, Sleep ameliorates N Female Genitalia/Sex, Pain, vagina, coition, during S939 Female Genitalia/Sex, Pain, bearing down, uterus and region, walking aggravates S940 Female Genitalia/Sex, Pain, cramping, menses, before S941 Female Genitalia/Sex, Pain, cramping, uterus, menses during S941 Female Genitalia/Sex, Pain, pressing, ovaries, left S944 Female Genitalia/Sex, Pain, sharp, ovaries S945 Female Genitalia/Sex, Pain, sharp, ovaries left N Female Genitalia/Sex, Pain, sore, vagina, coition during S945 Female Genitalia/Sex, Pain, squeezing, uterus S945 *Female Genitalia/Sex, Sexual desire, increased S948 Female Genitalia/Sex, Sexual desire, diminished S948 4.3.17 RESPIRATION Respiration, Coldness, of breath S972 *Respiration, Deep, des to breathe S973 Respiration, Difficult, evening, bed, in S974 Respiration, Difficult, Lying, while S976 Respiration, Impeded, lying, while S980 *Respiration, Sighing S982 Respiration, Sighing, lying, when N Respiration, Wheezing, night S983 101 4.3.18 CHEST Chest, Anxiety, in S1025 Chest, Constriction, lying, while S1030 Chest, Constriction, sternum, behind, right N Chest, Dryness S1033 *Chest, Oppression S1043 Chest, Oppression, heart S1045 Chest, Oppression, sternum, behind S1045 Chest, Pain, eating, ameliorates S1047 Chest, Pain, eructations, ameliorate S1047 Chest, Pain, sides, right S1051 Chest, Pain, sternum, behind S1054 Chest, Pain, sore, mammae S1068 Chest, Pain, stitching, ribs, lower, left S1074 *Chest, Palpitation of heart S1080 Chest, Perspiration, axilla S1085 4.3.19 BACK Back, Pain, lying, back, on, ameliorates S1105 Back, Pain, cervical region, left S1108 Back, Pain, cervical region, left, night N Back, Pain, cervical region, night S1108 Back, Pain, burning, dorsal region, scapulae, between/right S1127 Back, Pain, burning, dorsal region, scapulae, between, motion aggravates N Back, Pain, sore, cervical region S1139 Back, Pain, sore, spine S1141 Back, Pain, stitching, night S1142 Back, Pain, stitching, dorsal region, scapula, left, under S1144 102 Back, Pain, stitching, dorsal region, scapulae, under S1145 *Back, Stiffness, cervical region S1153 *Back, Stiffness, cervical region, right S1153 Back, Stretch, desire to N Back, Tension S1154 Back, Tension, cervical region S1154 Back, Tension, cervical region, left S1154 Back, Tension, dorsal region S1155 Back, Tension, lumbar region S1155 Back, Tension, lumbar region, Motion, ameliorates N 4.3.20 EXTREMITIES Extremities, Cramps, lower limbs, walking, while S1179 Extremities, Dryness, foot S1190 Extremities, Dryness, toes, between N Extremities, Eruptions, upper limb, rash S1193 Extremities, Eruptions, nates, boils S1201 Extremities, Eruptions, lower limb, thigh, rash S1202 Extremities, Eruptions, thigh, boils S1202 Extremities, Eruptions, toes, between S1205 Extremities, Jerking, upper limb, right S1229 Extremities, Jerking, upper limb, left S1229 Extremities, Jerking, forearm S1229 Extremities, Jerking, hand S1230 Extremities, Jerking, thumb, left N Extremities, Jerking, lower limb, left S1230 103 Extremities, Pain, shoulder, left S1252 Extremities, Pain, aching, hip S1280 Extremities, Pain, aching, knee S1280 Extremities, Pain, aching, knee, pressure aggravates N Extremities, Pain, aching, knee, walking, while S1280 Extremities, Perspiration, hand S1364 Extremities, Perspiration, hands, accompanied by, dryness, feet N Extremities, Sensitive, cold, to, fingers S1371 4.3.21 SLEEP Sleep, Bad S1413 *Sleep, Disturbed S1413 *Sleep, Falling asleep, difficult S1417 Sleep, Light S1419 Sleep, Restless S1422 Sleep, Remain in bed, desire to S1424 Sleep, Sleepiness, daytime S1425 Sleep, Sleepiness, afternoon S1426 Sleep, Sleepiness, afternoon/ 13h S1426 Sleep, Sleepiness, waking, after S1431 Sleep, Sleeplessness S1433 Sleep, Sleeplessness, Coryza, from S1437 Sleep, Unrefreshing S1443 Sleep, Waking, midnight, after, 0330 S1444 Sleep, Waking, foreboding/dread, with a feeling of N Sleep, Waking, early, too S1445 Sleep, Waking, late, too S1446 104 Sleep, Yawning, afternoon S1448 Sleep, Yawning, eating ameliorates S1450 4.3.22 DREAMS *Dreams, Amorous S1453 Dreams, Anxious S1454 Dreams, Chaotic N Dreams, Dead, of the S1459 Dreams, Dead, relatives S1459 Dreams, Exciting S1462 *Dreams, Family S1463 Dreams, Fantastic S1463 Dreams, Fights S1463 Dreams, Forsaken, of being N Dreams, Freedom, of N Dreams, Frightful S1464 Dreams, Humiliation S1466 Dreams, Hurry S1466 Dreams, Nauseous, of being N Dreams, Nightmare S1469 Dreams, Paralysed, of being N Dreams, People, laughing at her N *Dreams, Pursued, being, animals, by, wild S1471 105 Dreams, Pursued, being, bear, by N Dreams, Relatives, of S1471 Dreams, Relatives, of, parents N Dreams, Strange S1474 Dreams, Threats S1474 Dreams, Throat, painful N *Dreams, Unremembered S1475 4.3.23 SKIN Skin, Discolouration, red, spots S1525 Skin, Dry S1526 Skin, Eruptions, rash S1535 4.3.24 GENERALS Generals, Cold, becoming cold S1577 Generals, Cold, becoming cold, perspiration during S1577 Generals, Cold, heat and cold S1577 Generals, Food, cheese, aversion S1605 Generals, Food, chocolate, desire S1605 *Generals, Food, coffee, desire S1605 Generals, Food, rich food, aversion S1615 *Generals, Food, sweets, desire S1617 *Generals, Food, warm drinks, desire, hot S1617 Generals, Food, warm food, desire, hot S1617 106 Generals, lying on side, ameliorates S1655 Generals, Heat, flushes of S1620 Generals, Heat, flushes of, perspiration, with S1621 Generals, Heat, flushes of, extending to, upwards, hips, from the S1621 Generals, Pain, joints S1647 Generals, rubbing ameliorates S1675 Generals, Swollen sensation S1688 *Generals, Weakness S1701 Generals, Weakness, daytime S1702 Generals, Weakness, morning S1702 Generals, Weakness, morning, waking, on S1703 Generals, Weakness, afternoon S1703 Generals, Weakness, evening S1703 Generals, Weakness, sleep, from loss of S1709 108 CHAPTER 5 - DISCUSSION [Note on nomenclature: following the rules for naming as laid down by Schroyens in his Blueprint for a New Repertory (Synthesis ed.7, 1997;25) and to be in harmony with the chosen abbreviation for Bitis arietans, Bit-a (Wright:1999), it is suggested that the abbreviation for Bitis gabonica be Bit-g as it is a contraction of the official and commonly used name of the snake] 5.1 DISCUSSION The hypothesis of this Proving was that the venom of Bitis gabonica in the Homoeopathic potency 30Ch would produce in healthy provers clearly observable symptoms and signs. To the best of the researchers’ knowledge, no evidence exists to contradict the above stated hypothesis and it must therefore be concluded that it is true. The MATERIA MEDICA lists 559 symptoms as recorded by the provers. The areas most affected by the venom of Bit-g in Homoeopathic potency were: MIND with 119 symptoms, HEAD with 65, NOSE with 62, GENERALS with 34, STOMACH with 30, SLEEP with 26, EXTREMITIES with 23, THROAT, EYES, DREAMS with 21, and BACK with 20. APPENDIX E gives a graphic representation of this. Once these had been converted to 601 RUBRICS the picture changed slightly, as follows: MIND was still strongest with 132 rubrics; HEAD was next with 98, followed by NOSE with 47, EYES with 31, GENITALIA/SEX with 28, DREAMS with 26, GENERALS and EXTREMITIES with 25, THROAT with 22, EAR with 21, BACK with 20 and SLEEP with 19 . The seeming inconsistency between the two sets of figures is a product of two processes: the process of translating symptoms into rubrics, where a particular symptom statement has to be expanded to more than one rubric because it 109 actually contained more than one symptom or in order to reflect its meaning most accurately, and the process of eliminating duplications. 5.2 SYMPTOM OVERVIEW At this point in the discussion it is necessary to deal with the proving material as if the symptoms were all found in a single prover, thus painting the remedy picture of the patient who fits the remedy perfectly or which the ideal prover might generate (Sherr, 1994). MIND Various themes expressed themselves in the mental and emotional sphere during the proving: Isolation/being alone/desire to be alone Panic/feeling threatened Separation from self/scattered Depression/sadness/crying Well being Irritable Sensitivity Mistakes/poor concentration/forgetful Confidence/lack of confidence Mental activity: hyper/hypo-active Calm/confusion Placebo Bloating/expansion The most prominent symptom was the isolation, a sense of being alone, forsaken or a desire to be alone. Overall there is a feeling of social detachment, of being an ‘outsider’. We see this reflected in the peculiar symptom of feeling scattered, separated from themselves: “felt they were looking at my face and I was behind my face looking out; I wasn’t in myself; I couldn’t connect with people. I feel very alone”. This and other aspects of the remedy reflect the ‘Divided’ nature of the snake remedies. They feel panicked and as if they are 110 under threat, like most snake remedies. They have a delusion that they are divided, that body and mind are divided, that they are separated from themselves in some way. This aspect of the remedy also shows the duality of contradictory or ‘balancing’ states – that is that the subject may feel alone but at times will also want to be alone and prefers his own company. Almost all well proven remedies will show such contradictory symptomatology. Notable in this regard is the sadness and depression that is contradicted by the overwhelming sense of Well being felt at other times. We begin to see a nature which is sad, melancholic, brooding, tearful and sensitive on the one hand, while on the other it is happy, joyful, positive, motivated, at one with self and the world. The duality is further observed in the general condition of being energetic or drained, hyper- or hypo-active, in a heightened state of mental activity or being ‘slowed up’, flat, tired. They are irritable, moody, insecure, oversensitive and confused or they are calm and confident, unusually so. An unusual amount of mistakes are made, letters are missed out when writing, dates are confused, memory is poor, concentration is lacking and the patient is unusually forgetful. Of minor importance in terms of their frequency but interesting due to their appearance in the proving of Bitis arietans are the symptoms: feeling sure they were on placebo, and sensation of bloating after taking the remedy. The former was confirmed to a greater degree than reflected in the diaries during post- proving discussions. DREAMS The dreams produced by the proving could be grouped under 4 themes: Isolation Chaotic/Fragmented Of Parents and Relatives, both dead and living 111 Of Conflict/Fear/Escape No dreams were shared between subjects in any detail beyond the thematic similarities. HEAD Headaches were very common. They tended to be left sided, mainly in forehead and temples and tended to refer to the eyes, notably though the neck was also affected. There was a strong tendency to the eyes and root of nose as well. They are worse for cold and cold drinks, better for warmth. They are better lying, especially on their left side. The pain is mainly of a pressing nature. There is heaviness and constriction. NOSE Again we see the left side being more affected and the sensitivity to cold. Discharge is mainly clear, watery or albuminous and usually worse in the morning. It is also more commonly postnasal. THROAT There is tension in the throat. It is worse in the morning, for cold drinks and swallowing in general. They have pain, mucus and dryness in the throat as well as the sensation of a lump in the throat. GENERALS They can become cold easily and they have flushes of heat. They desire coffee, chocolate, warm food and drink and sweets. They feel better for lying, especially on their sides. They can be weak at any time of the day. They have a swollen sensation and are better for rubbing and occupation and tend to be worse on waking. EYES Again more affected on the left, there is the sensation of, as well as actual, swelling and inflammation. The eyes feel heavy. They can be sore and the lids 112 tend to be more affected than the eyeballs. Vision is blurred and the eyes are light sensitive. GENITALIA/SEX Of main interest here are the pain symptoms. Again the left is more affected and the pains are better for lying on the side. They seem to be worse for movement/walking and the pains are felt mainly in the ovaries and uterus. There is vaginal discomfort during coitus. A thick, bland, white Leukorrhoea may be seen. EXTREMITIES They most notably have a lot of muscle twitches, predominantly in the upper left limb. The feet are dry and their hands perspire. Rashes and boils may be seen on upper and lower limbs. There may be pains in the knees, especially when walking. EAR They have pains in their ears, mainly on the lobe and behind the ear and in the meatus that is not better for rubbing or scratching. The right ear is more affected than the left. They have a sensation of fullness and there are buzzing noises in the ear. BACK The cervical region and the left side are most affected by stiffness and pain. The symptoms are definitely worse at night and better for lying. There is tension, stiffness or pain. Of note elsewhere are the following symptoms: distention/bloating in the abdomen; diarrhoea, constipation and sudden urging; difficult respiration, sighing and desire to breath deeply; oppression of the chest, pain and constriction behind the sternum; difficulty sleeping at night with sleepiness in the day; thirst, burning pain and the sensation of a lump in the stomach; there is a metallic taste in the mouth and profuse salivation, the palate and tongue are sore. 113 5.3 REPERTORIZATION FOR RELATED REMEDIES This was done in order to establish the closest existing remedies to Bit-g. The most prominent symptoms were used to provide the core of the remedy. The results are seen in appendix G. 5.4 OTHER CONSIDERATIONS Generally it was found that homoeopaths and homoeopathic students were more useful provers. The reason for this is most likely to be that they are more familiar with the language and the detail required by a proving. They tended to be more observant and more interested in exploring variables and modalities to the symptoms. Other than this I found the criteria for inclusion to be totally satisfactory and did not find that it imposed any unreasonable limitations on the choice of provers. I found that it was not always possible to supervise the provers as closely as I would have liked. I feel that closer attention to the subjects would have provided me with better information, particularly with regard to intensity of symptoms. It was only on processing the data that it became apparent that some of the provers actually were not as specific and detailed in their recording as imagined and it was not always possible to retrieve that information at a later date. Other than these considerations I felt the methodology to be efficient, the potency and dosage regime effective. 114 CHAPTER 6 - CONCLUSIONS AND RECOMMENDATIONS 6.1 CONCLUSIONS It can be concluded that the 30Ch potency of the venom of Bitis gabonica gabonica (Bit-g) is a remedy that should be considered in a range of conditions. If used accurately and precisely according to established Homoeopathic principles it could become a significant remedy in the clinical environment. The wide range of symptoms produced by the proving suggests an equally wide range of application for the remedy. 6.2 RECOMMENDATIONS 6.2.1 FURTHER PROVINGS Further provings of this remedy substance are necessary as this proving shows it to have some promise in the homoeopathic sphere. It should be re-proven in lower potency to further reveal its physical/physiological symptomatology, for example in the 6Ch or 12Ch potency. It would be interesting to see if any of the swelling/oedema and cardiac effects of the venom came through in the lower potencies. It would also be of great benefit, as suggested by Wright (1999) in respect of further provings of Bitis arietans, to look at certain blood factors before, during and after the proving to see if there is any correlation with the haemotoxic effects of the venom. 6.2.2 COMPARATIVE STUDIES Comparative studies of the remedy with other snake remedies and those remedies which bare a close resemblance to it should be undertaken to give the practitioner in the field the best possible idea as to what differentiates each substance in the healing context and as to where the remedy sits in the Homoeopathic armamentarium. 115 6.2.3 CLINICAL INFORMATION It is important that the remedy be used by practitioners in the field in order for the various symptoms to be clinically verified. This will also help to draw a more accurate and clearly differentiated (disease) picture of the patient who matches this remedy substance. This clinical information needs to be gathered in order to verify symptoms of the proving, to clarify areas that were not well established by the provers and to add depth to the information at hand (this assumes that the remedy becomes generally available so that practitioners can actually use it). This may go some way to filling in the gaps with respect to modalities, concomitants, aetiologies and so on. These cases should be made available to the homoeopathic community through journals or publication on the Internet. 6.2.4 DEVELOPMENT OF A SOUTHERN AFRICAN MATERIA MEDICA In the interests of expanding a Southern African Materia Medica there are other substances which need to be proven. There is a vast array of substances used medicinally by the indigenous healers in Southern Africa and the following list provides a small sample of the remedies that may be of some interest in this regard : Kigelia Africana (sausage tree) – used externally for sores, ulcers, syphilis and carcinomas. Boophane Disticha (bushman poison bulb) – for wounds and boils. Also an hallucinogenic. Leonotus Leonurus (wild dagga) – snake bite, stings, boils, eczema, cramps, asthma, hypertension. Acokanthera Oppositifolia (bushmans poison bush) – headache, snakebite, tapeworm, toxic arrow poisons. Catha Edulis (bushmans tea, khat) – stimulant, coughs, asthma, chest ailments. NB: This list is only a selection of flora, but there are many other animal substances that are of interest in respect of their medicinal properties. 116 It would be my wish for this institution (Durban Institute of Technology) to continue to be at the forefront of the proving effort in the interests of developing a substantial South African Materia Medica. 117 REFERENCES Bodman, F.H. 1987. Provers. The British Homoeopathic Journal, 76: 85-91. Cook, T.M. 1989. Homoeopathic Medicine Today. New Canaan: Keats Publishing.218p. Coulter, H.L. 1975. Divided Legacy: A History of the Schism in Medical Thought, Vol.1 The Patterns Emerge: Hippocrates to Paracelsus. Washington: Weehawken Book Co.537p. Demarque, D. 1987. The Development of Proving Methods since Hahnemann. The British Homoeopathic Journal, 76:71-75. Fisher, P. 1995. Editorial: Prove it or Improve it? The British Homoeopathic Journal, 84: 129-130. FitzSimons, V.F.M. 1980. A Field Guide to the Snakes of Southern Africa. London: Collins. 221p. ISBN 0-00-219327-2 Fuller Royal, F. 1991. Proving Homoeopathic Medicines. The British Homoeopathic Journal, 80:122-124. Gaier, H.C. 1991. Thorsons Encyclopaedic Dictionary of Homoeopathy: The definitive reference to all aspects of homoeopathy. London: Thorsons. 601p. ISBN 0-7225-1823-4 German Homoeopathic Pharmacopoeia 1993. 5th supplement, 1991, to the 1st edition, 1978. Stuttgart: Deutscher Apotheker Verlag. 118 Hahnemann, S. 1992. Organon of Medicine. 6th edition. London: Gollancz. 270p. ISBN 0-575-03880-2 Jouanny, J. 1984. The Essentials of Homoeopathic Materia Medica. France:Editions Boiron.454p. ISBN 2-85742-010-2. Jouanny, J. 1993. The Essentials of Homoeopathic Therapeutics. France: Editions Boiron. 417p. ISBN 2-85742-014-5. Kent, J.T. 1990. Lectures on Homoeopathic Philosophy. Sittingbourne:Homoeopathic Book Service. 360p. ISBN 1-869975-05-7. Koppers, A. 1987. Testing Drugs. Personal experiences. The British Homoeopathic Journal. 76:81-84. Little, D. 1998. The Principles of Hahnemannian Homoeopathy: Chapter 3 – The Principles in Practice. www.simillimum.com/Thelittlelibrary Marsh, N. Gattullo, D. Pagliaro, P. and Losano, G. 1997. The Gaboon viper, Bitis gabonica: haemorrhagic, Metabolic, Cardiovascular and Clinical effects of the Venom. Life Sciences vol 61 No8:763-769 Nagpaul, V.M. 1987. Provings - Planning and Protocol. The British Homoeopathic Journal, 76:76-80. Raeside, J.R. 1964. A Proving of Hirudo medicinalis. The British Homoeopathic Journal, 53:22-30. Raeside, J.R. 1972. Fifteen years of drug proving in London. The British Homoeopathic Journal, 51:203-205. Riley, D.S. 1995a. Provings - Geranium robertianum. The New England Journal of Homeopathy, 4:45-55. 119 Riley, D.S. 1995b. Proving report- Veronica officinalis. The British Homoeopathic Journal, 84:144-148. Riley, D.S. 1996. Homoeopathic drug proving - principles and practice. HomInt research and development newsletter, 1:3-14. Riley, D.S. 1997. Extracting Symptoms from Homoeopathic Drug Provings. The British Homoeopathic Journal, 86:225-228. Roberts, H.A. 1993. The Principles and Art of Cure by Homoeopathy. New Delhi: B Jain Publishers. 312p. Scholten, J. 1993. Homoeopathy and Minerals. Bombay. Homoeopathic Medical Publishers 295p. ISBN 90-74817-01-7 Schroyens, F. 1997. Synthesis: Repertorium Homeopathicum Syntheticum. 7th edition. London: Homoeopathic book publishers. 1718p. ISBN 0-952274434 Sherr, J.Y. 1994. The Dynamics and Methodology of Homoeopathic Provings. West Malvern: Dynamis Books. 131p. ISBN 0-9524633-0-X Spawls, S. and Branch, B. 1995. The Dangerous Snakes of Africa. Dubai: Oriental Press. 192p. ISBN 1-86812-575-0. Stephenson, J. 1960. Homoeopathic Provings in the light of the newly formulated 'human pharmacology'. Journal of the American Institute of Homeopathy, March-April: 47-49. Taylor, E. et al 1988. Dorlands Illustrated Medical Dictionary. 27th ed. Philadelphia: W.B. Saunders Co. 1888p 120 van Wyk B. van Oudtshoorn B. and Gericke N. 1997. Medicinal Plants of South Africa. Singapore: Briza. 304p. ISBN 1-875093-09-5 Visser, J and Chapman, D.S. 1978. Snakes and Snake-bite. Cape Town: Purnell. 152p. ISBN 0-86843-011-0. Vithoulkas, G. 1986. The Science of Homoeopathy. London: Thorsons. 331p. ISBN 0-7225-1310-0. Walach, H. 1994. Editorial: Provings - the method and its future. The British Homoeopathic Journal, 83:129-131. Walach, H, Ernst-Heiber, E, Heiber, S. 1995. Effects of Belladonna 30CH and 12CH in healthy volunteers. The British Homoeopathic Journal, 84:180-181. Walach, H. 1997. The Pillar of Homoeopathy. Homoeopathic drug provings in a scientific framework. The British Homoeopathic Journal, 86:219-224. Whitmont, E.C. 1991. Psyche and Substance: Essays on Homoeopathy in the light of Jungian Psychology. Berkeley: North Atlantic Books. 238p. ISBN 1- 55643-106-6. Wieland, F. 1997. Good homoeopathic provings. The British Homoeopathic Journal 86:229-234 Wildi SM, Gamperli A, Beer G, Markwalder K. 2001. A Case of Severe envenoming by a Gaboon Viper. The Swiss Medical Weekly 2001:131:54-55. www.smw.ch Wright, C.D. 1999. A Homoeopathic Drug Proving of the Venom of Bitis arietans arietans. Mtech Thesis, Technikon Natal. APPENDIX A SUITABILITY FOR INCLUSION IN THE PROVING Surname:______________________ Name:__________________________ Age:________ Sex: ____ Address:_______________________________________________________ ______________________________________________________________ Telephone: Home:______________ Work:______________ Cell:______________ ALL INFORMATION WILL BE TREATED AS CONFIDENTIAL  Are you between the age of 18 and 65 years Yes/No  Do you consider yourself to be in a general state of good health? Yes/No  Are you on Hormone Replacement Therapy or have you been on any Oral Contraceptives in the last 6 months? Yes/No  Are you presently on any medication: chemical, homoeopathic, herbal or otherwise? Yes/No  Have you had any surgery in the past 6 weeks? Yes/No  Are you pregnant or nursing? Yes/No  Do you suffer from hypersensitivity diseases such as asthma, hayfever, allergy/food hypersensitivity? Yes/No  Do you consume more than: 2 measures of alcohol per day? (1 measure=1tot/beer/½ glass wine) 10 cigarettes per day? 3 cups of tea or coffee per day? Yes/No  Do you use recreational drugs such as cannabis, LSD, MDMA (ecstasy) on a regular basis? Yes/No  Are you willing to follow the proper procedures for the duration of the proving and to attend a short training programme prior to starting the proving? Yes/No APPENDIX B INFORMED CONSENT FORM (To be completed in duplicate by prover) TITLE OF RESEARCH PROJECT: A homoeopathic drug proving NAME OF SUPERVISOR: Dr Ashley Ross NAME OF RESEARCH STUDENT: Bruce Thomson DATE: _____________ PLEASE CIRCLE THE APPROPRIATE ANSWER 1. Have you read the patient information sheet? YES / NO 2. Have you had an opportunity to ask questions regarding this study? YES / NO 3. Have you received satisfactory answers to your questions? YES / NO 4. Have you had an opportunity to discuss this study? YES / NO 5. Have you received enough information about this study? YES / NO 6. Who have you spoken to?______________________________________ 7. Do you understand the implications of your involvement in this study? YES / NO 8. Do you understand that you are free to withdraw from this study: a) at any time? b) without having to give a reason for withdrawing, and c) without affecting your future health care. YES / NO 9. Do you agree to voluntarily participate in this study? YES / NO PATIENT/SUBJECT Name:________________________ Signature:_________________ (in block letters) WITNESS Name:_________________________________ Signature:_________________ (in block letters) RESEARCH STUDENT Name: Bruce Thomson Signature:_________________ (in block letters) APPENDIX C Case History Name: ____________________________________ Date: __________ Address: ________________________ Marital Status: M/S/W/D ________________________ ________________________ D.O.B. ____________ ________________________ Age: ______________ Tel. No. ________________________ ________________________ Occupation: ______________________ Religion: _________________________ ______________________________________________________________ P.M.H. and treatment: (childhood illnesses, hospitalisation etc.) Medication: Smoker: ROH: Childhood developments and milestones: Allergies: Vaccination hx: Family hx: (TB, Ca, DM, Heart dx, CVA…) GENERAL SYSTEMS: Symptoms from each system will be concentrated on more than pathologies – these headings are just guidelines for the researcher. Head: - Scalp, hair… - Headache: - Trauma, whiplash, any aetiology: - Modalities: - Concomitants: Neurological: - Sleep: - Dreams: - Seizures: - Sensations: - Weakness/ palsy: Visual: ENT: - Hearing: - Otitis: - Balance/ vertigo: - Tinnitus: - Allergic rhinitis: - Coryza: - Sneezing: - Sinusitis: - PND: - Sore throats: - Hoarseness: - Tonsils: IN / OUT - Modalities: Pulmonary: - Chest: - Cough: - Sputum: - Asthma: - SOB: - Bronchitis: - Pneumonia: - Modalities: CVS: - HT / HypoT: - Pain / discomfort: - Palpitations: - Syncope: - Oedema: - Phlebitis, varices, telangiectasies, anaemia, bruising… GIT and Abdomen: - Appetite: - Tastes: - Cravings: - Aversions: - Nausea / vomiting: - Indigestion / heartburn: - Bowel movement: - Constipation: - Hernia: - Ulcers: - Abdominal pain: - Bloating: - Flatulence: - Any organs particularly affected: (Liver, Pancreas, GB, Haemorrhoids…) - GI surgery: - Modalities: Urinary System: - Urine output / day: - Fluid intake: (what, how much, hot / cold…) - Pain: - Infections: - Nocturia: - Haematuria: - Past stones: - Modalities: Male system: - Libido: - Pain: - Impotence: - Emissions: - Prostate: - Swellings: - Lesions: Female system: - Contraception: How long: - Libido: - Pain: - Bloating: - Cysts: - PMS: - Menstrual cycle: 1. Interval: 2. No. of days: 3. Amt. of flow: 4. Clots: 5. Pain: - Menarche: - Menopause: - Discharge: - Coital pain: - Breast pain: - Check ups: - PAP smear: - Last gynae appointment: - Pregnancy: - Labour: - Infections: - STD's: Skin: - General appearance: - Eruptions: - Itching: - Dryness: - Turgor: - Nails: Musculoskeletal: - Muscles: - Joints: - Modalities: Generals: - Thirst: - Perspiration: - Weight change: - Energy levels: 1 -> 10 - Fitness levels: 1 -> 10 - Stress levels: 1 -> 10 - Weather: (preferences, aversions, modalities, altitude…) - Fever: - Travel: Mental / emotional: - Moods: - Anxiety: - Coping skills: - Awareness: - Memory: - Anger: - Delusions: - Fears: - Tearfulness: - Consolation: - Irritation: - Quirks: - Other: On examination: - Pulse: - Temperature: - Respiratory rate: - Blood pressure: - Hydration: - Lymph nodes: - Capillary refill: - JACCOL: - Higher function: - Skin: (appearance, temp…) - Systems: 1. Chest: 2. Abdomen: 3. Head and neck: 4. Neuro: (reflexes) 5. CVS: (pulses) 6. Miscellaneous: APPENDIX D: Instructions to provers: Dear prover, Welcome to one of the most exciting opportunities to participate in and experience Homoeopathy. I am sure that you will benefit from this proving in many ways. This study is a Homoeopathic proving of a certain substance, which will remain unknown to you for the duration of the study. The study requires you, the prover, to be in relatively good health, physically and mentally, and to be willing to follow the protocols of the study to the best of your ability. This study hopes to reveal a remedy-picture of this substance so that it can be included in our Materia Medica and be used to treat illness. Before the proving: Please ensure that you have the following: the correct journal read and understood these instructions had a case history taken and a physical examination performed signed the informed consent form attended the pre-proving training course The proving supervisor (Bruce Thomson) will contact you with the date to commence the pre- proving observation period and the date required to start taking the remedy. You will then also agree on a daily contact time for the supervisor to contact you. Should there be any problems or anything you don‟t fully understand, please do not hesitate to contact your supervisor. Beginning the Proving: Once you have been asked to begin the Proving, record all your symptoms daily in the journal for 1 week prior to taking the remedy. This will help you get into the habit of observing and recording your symptoms, as well as bringing you into contact with your „normal state‟. This is an important step and will establish the baseline for you as an individual prover. Taking the Remedy: Begin taking the remedy on the day that you and the supervisor have agreed upon. Record the time that you take each dose as time keeping is an important element of the proving. The remedy should be taken on an empty stomach and with a clean mouth (i.e. free of toothpaste, food, drink etc.). Dissolve the powder under the tongue. Neither food nor drink should be taken for at least half an hour before and after each dose. The remedy should not be taken more than 3 times per day and for no longer than 1 week. In the event that you experience symptoms or those around you observe any proving symptoms do not take any further doses of the remedy. (This is very important). By proving symptoms I mean: any new symptoms, i.e. ones that you have never experienced before any change or intensification of any existing symptom any strong return of an old symptom, i.e. a symptom which you haven‟t experienced in more than 1 year. If you have any doubt as to whether a symptom is in fact a „proving symptom‟, speak to your supervisor. Be on the safe side and do not take any further doses. Experience has shown repeatedly that the proving symptoms usually begin very subtly, often before the prover recognises that the remedy has begun to act. Lifestyle During the Proving: Avoid all antidoting factors such as caffeine, camphor, menthol and mints. If you normally use these substances, please stop taking them 2 weeks before and for the duration of the proving. If this is not possible and the use of these substances is not used in too much excess, please keep the use of these substances to a regular routine and endeavour to use them long after or long before taking a dose of the remedy. Protect your proving powders like any other potentised remedy: store them in a cool, dark place away from strong smelling substances, chemicals and electrical equipment. A successful proving depends on your recognising and respecting the need for moderation in the following areas: work, alcohol, smoking, exercise and diet. Try to remain within your usual framework and maintain your usual habits. Avoid taking any medication, especially antibiotics, vitamins or mineral supplements, herbal or homoeopathic remedies. In the event of a medical or dental emergency, of course common sense should prevail. Contact your homoeopath, doctor, dentist or local hospital as necessary. Please also contact your supervisor as soon as possible. Confidentiality: It is important for the quality and credibility of the proving that you discuss your symptoms only with your supervisor. Keep your symptoms to yourself and do not discuss them with fellow provers. Your privacy is something that will be protected. Only the proving supervisor will know your identity and all information will be treated in the strictest confidence. Contact with your supervisor: Your supervisor will contact you to inform you to begin your 1-week observation period and then daily from the day that you begin taking the remedy. This will later decrease to 2 or 3 times a week and then to once a week, as soon as you and the supervisor agree that there is no further need for such regular contact. This will serve to check up on your progress, ensure that you are recording the best quality symptoms possible and to judge when you need to cease taking the remedy. If you have any doubts, queries or problems during the proving contact your supervisor on the telephone number provided at any time. Recording of symptoms: When you commence the proving, note down any symptoms carefully that arise, whether they are old or new and at the time of the day or night which they occurred. This should be done as vigilantly and as frequently as possible so that the details will be fresh in your memory and that no information will be lost. Make a note even if nothing happens. Remember to note down any significant events or incidences that occur, especially if they are attributed to the remedy taken. Please start each new day on a new page with date noted at the top of the page. Also note which day of the proving it is. The day that you take your first dose is day zero. Write neatly on alternate lines, in order to facilitate the extraction process, which is the next stage of the proving. Try to keep the journal with you at all times and please be as precise as possible. Note down your symptoms in an accurate, detailed yet brief manner and in your own language. Information about location, sensation, modality, time and intensity is particularly important: LOCATION: try to be accurate in your anatomical descriptions. Simple, clear diagrams may help here. Be attentive to which side of the body is affected. SENSATION: describe this as carefully and as thoroughly as possible e.g. burning, shooting, stitching, throbbing, dull, lancinating …... MODALITY: better (>) or worse (<) from weather, food, smells, dark, light, lying, standing, people …… Try different things out to see if they affect the symptom and record any changes. TIME: note the time of onset of the symptoms and when they cease or are altered. Is it generally better (>) or worse (<) at a particular time of the day or night, and is this unusual for you? INTENSITY: briefly describe the sensation and its effect on you. AETIOLOGY: did anything seem to cause or set off the symptom and does it do this repeatedly? CONCOMITANTS: do any symptoms appear together or always seem to accompany each other or do some symptoms seem to alternate with each other? REMEMBER C - concomitants L - location A - aetiology M - modality I - intensity T - time S - sensation On a daily basis, you should run through the following checklist to ensure that you have observed and recorded all your symptoms: MIND HEAD EYES EARS MOUTH & TONGUE BACK RESPIRATORY SYSTEM DIGESTIVE SYSTEM SKIN Please give full descriptions of dreams and in particular note the general feeling or impression that the dream left with you. Mental and emotional symptoms are very important and sometimes difficult to describe - please take special care noting these. Reports from friends and relatives can be particularly enlightening, please include these where possible. At the end of the proving, please make a general summary of the proving. Please note how the proving affected you in general. How has this experience affected your health? Would you ever do another proving? As far as possible, try to classify each symptom by making a notation in brackets next to each entry according to the following key: (RS) - Recent symptom i.e. a symptom that you are suffering from now, or have been in the last year. (NS) - New symptom (OS) - Old symptom. State when the symptom previously occurred. (AS) - Alteration in a present state or old symptom (e.g. used to be on the left side, now on the right) (US) - Unusual symptom for you. Please remember to use red ink for these notations and classify your symptoms accurately. If you have any doubts, discuss them with your supervisor. Please remember that detailed observation and concise, legible writing is essential. EXTREMITIES URINARY ORGANS GENITALIA SEX TEMPERATURE SLEEP DREAMS GENERALITIES “The best opportunity for exercising our sense of observation and to perfect it is by proving medicines ourselves” - Samuel Hahnemann „The person who is proving the medicine must be pre-eminently trustworthy and conscientious...and able to express and describe his sensations in accurate terms‟ Organon Aph. 126 THANK YOU FOR PARTICIPATING IN THIS PROVING. I AM SURE THAT YOU WILL FIND THAT THERE IS NO BETTER WAY OF LEARNING AND ADVANCING HOMOEOPATHY. (Adapted from Jeremy Sherr - The Dynamics and Methodology of Homoeopathic Provings) APPENDIX E RELATIVE PROVER CONTRIBUTION prover 1 12% prover 3 15% prover 4 3% prover 5 10% prover 10 4% prover 12 5% prover 15 7% prover 17 3% prover 18 17% prover 19 8% prover 20 1% prover 9 8% prover 13 3% prover 6 2%prover 8 2% APPENDIX F Appendix G NORMAL REPERTORIZATION MINERAL FILTER ANIMAL FILTER ANIMAL – SNAKES – FILTER PLANT FILTER