New England School of Homeopathy

Herscu Letter Sample

In order to give you a general idea of what the Herscu Letters are like, we have compiled sections from some of the early letters below.


“The format of the Letter is as follows. Each Letter is divided into 3 parts: a theoretical part, a practical example part, and lastly, an exercise part. There are several main issues in homeopathy. By identifying them one by one, over time, talking about how different homeopaths have historically dealt with each issue, we can develop a theoretical framework of homeopathic care. The theoretical part places our work in context. Every Letter will focus on one theoretical topic discussed from various points of view.

The second part will illustrate the theoretical model described by giving examples and case examples. We will end with a case or exercise to be worked on by you in a problem-based learning style. This should help you to integrate the information from the first two sections. This process continues until the topic is explored from all angles, at which point we move to the next topic. In so doing, we develop a working model and the facility to work through problems; in particular to work through the problem of finding the right remedy for the patient.”

What follows is a case example that appeared in Letter #1.

“I would like to highlight this point with a short acute case that Dr. Amy Rothenberg presented a while ago in Homeopathy Today.

The Farmers’ Hives
Amy Rothenberg ND, DHANP

I had the privilege of spending the first three years of practice in the great American Heartland of Nebraska. There were many things in Nebraska, which made my early practice interesting and incredibly enjoyable. Not least among these were the times when well-chosen remedies came in to save the day. But sometimes, the stories which came out during casetaking were so entertaining, especially for this native New Yorker, that going to work was always a pleasure. I remember one family that came to me because their then 5 year-old daughter had a terrible case of the hives.

It had begun four months before when the mother had changed laundry detergents. It began on her face and over the course of a week ran down the length of her body. However, it never left her face. Periodically, her lips would triple in size and she would have a difficult time speaking and chewing her food. Her eyes were on and off, swollen shut. As her mother reported, at those times “….she looks like someone near blew her up with a straw, then gone poured red paint on her face.”

No one else in the family was suffering in this way though they all had the same exposure.

“The ‘itchin’ was fierce,” the girl reported. She got some relief with aloe juice and it was made worse with scratching. It hurt worse on her feet and her ankles could swell up to nearly triple their usual size. There was a burning pain, which was better with cold applications. She felt a bit nauseous with these hives and dizzy. Her appetite was greatly reduced. The hives were much worse toward evening, then by morning they were almost gone. This repeated itself day in, day out. She was better in a cool bath and worse in warm water. She was also worse if she sweat.

At this point her grandfather who had come along for the ride, some six or seven hours worth of ride (Nebraska is one long state!), started to interrogate me about homeopathy, how it began, how it worked etc. I gave my simple two-minute description, ready to move on with the case.

He interrupted me, said I ought to know a thing or two about what happened in Nebraska some years back. He then went on to describe a most interesting occurrence that took place in his farming town when he was a young man. I’ll paraphrase: There were many hog farmers back then and they had a pretty good living at it. He himself was a hog farmer. Well, in that year a horrible sickness came on those hogs and they were dropping like flies. Some folk lost ‘tire populations. There were huge hog graves, everyone just burying their livelihoods. His pigs were starting to show signs of the illness, terrible diarrhea and weakness. Someone came around back then told him he ought to grind up some of those there infected baby pigs and feed them back to their mothers to curb that nasty epidemic. Well low and behold, wouldn’t you know it, it worked!! And he was the only farmer in the county who had any pigs left when it was all said and done.

At this point he wanted to know, well, was that homeopathy a little bit of the hair of the dog that bit ‘cha? I sat, my eyes opened really wide in shock and slight disbelief. I was a city girl, what did I know about pigs? This great big impressive man in overalls, with a ruddy face under his feed cap leaned in toward me, awaiting my reply. What was I to answer? Well, there were some elements of homeopathy in there, yes- I spoke on about the law of similars, about actual provings and matching symptoms to remedies. I think he heard what I was saying. He sat back in his chair, contented with the retelling of his tale.

His granddaughter responded well to Apis 1M, one dose, based mostly on the fact that she was so much worse at night, and the edematous nature of the hives. I told the parents that they could use a combination of bioflavinoids and Vitamin C-1000 mg of each 2-3x per day, to help stabilize the mast cell membranes and thereby decrease the histamine reaction. She could also take freeze-dried nettles, 1, three times a day, to decrease her allergic sensitivity. She recovered within a few days, never to see those hives again. I went on to treat a whole line of hog farmers with complaints that spanned the human condition. No one else ever spoke about a hog epidemic, and I never brought the topic up again!

Now Amy’s case presents a good starting point. It is short, and highly focused. By which I mean that there are only a few symptoms in all and that most of them point to Apis. However, even this case is relevant in the Keynote discussion. If we focus the case to the symptoms we basically have edematous swelling that feels like burning, most especially around the face and ankles, that is worse evening, heat, perspiring and scratching and is ameliorated by cold bathing, and in the morning.

First I would like to describe the keynotes of several remedies. Apis of course is well known for swellings and edema, but there are other remedies that are possible here. For example, Medorrhinum has the keynotes of swelling of the ankles, being warm-blooded and aggravated by heat. Sulphur has the keynotes of burning pains, worse from heat, and scratching aggravates.

Even in a simple case, with few symptoms, keynotes can be found and those keynotes can be of several remedies, just as Kent mentions. There are actually even more remedies possible if we only take one symptom as a keynote. For example, Phosphorus and Arsenicum album both have burning eruptions as keynotes, Mercurius has perspiration aggravates as a keynote, and Natrum muriaticum has hives that are ameliorated by cool baths. This is a simple case in terms of number of symptoms yet we have seven remedies just off the top of the head that have big keynotes represented here. There are many more remedies that are possible in terms of their keynotes, but I think the point is made.

I would like you to think about two points. First, it is good to study remedies and their keynotes, as you learn important symptoms of the remedy and can do this quick, off the top of your head, analysis with many remedies. Second, and as important, every person has keynotes of many remedies. It is not likely that you will find an individual with only one keynote of one remedy. As one learns keynotes, there is a continual flow of mixing and matching of symptoms to keynotes of remedies that have those symptoms. The trick then is to settle on the keynotes that make sense to use.

To summarize Kent above, you have to use the case to justify the keynotes you will use. In this case, the first set of remedies Apis, Sulphur and Medorrhinum are the remedies that make sense in terms of the totality. The other remedies, though they have some keynote within the case, the keynotes are ancillary, not primary to the case. But these three remedies share the most important symptoms and share the keynotes that matter most. They represent the greatest whole, that of urticaria that is aggravated by all manner of heat and ameliorated by all manner of cold.

Now of these three remedies, Medorrhinum has a keynote that is opposite to the case. Medorrhinum patients are ameliorated in the night and aggravated in the morning, opposite to the patient in question. This leaves Sulphur and Apis. Apis, though, has one more keynote than Sulphur in the case. If you look at the rubric Skin; Eruption, Urticaria, night, you find a small rubric with a grand keynote of Apis. Apis is listed as Bold type here. In fact, many times the keynote of a remedy is listed as bold type in the repertory, even if the rubric is small.

Now if we turn to the materia medica, we read in the other remedies all sorts of symptoms. When we turn our attention to Apis, we read a great deal about the urticaria and edema, which is aggravated by heat and ameliorated by cold. This forms one of the major issues that Apis addresses. As an aside, to me what is interesting is that Apis who is aggravated by heat, is aggravated by being busy through the day and becomes finally overheated and aggravated at night, in keeping with the rest of the general state.

Problem-based Learning:

I would like to describe some short cases and have you work on them for the next couple of weeks. The goal is not necessarily to come up with a remedy but to find the keynotes of the case. Every case has several keynotes of several remedies. Your objective is to build an argument for which symptom could be a true keynote for the patient in question. To do this first read the case. Then read it once more, this time focusing on some common threads, or common ideas that seem to run through the case. Once you have done that, pick some key words, or symptoms that represent that general state.”

“Case number 421

Brandon is a twenty-five-year-old man who has had asthma for ten years. The asthma is mostly a tightening in his chest, most especially in his upper chest, which is worse at one in the morning and worse when he is lying down in bed. During the attack he gets up and paces, drinks some warm milk, takes his medications and putters around until the crises begins to pass.

His other complaint is gastritis. The main symptom is cramps in his upper abdomen and stomach, especially when it is empty. He has to double up, bending forward and begins to rock side to side from the pain. During the pain if he drinks tea or even drinks hot water the pain eases somewhat.

This case is meant to introduce the homework portion of the Letter. I would like the same thing done with both cases. What are the main issues running through these cases? What are the few symptoms that clearly characterize the patient? These will form the keynotes of the patient. For those with some knowledge of keynotes, work out as many keynotes as you can for as many remedies. At this point getting to the remedy is not the goal. Understanding the key symptoms for a patient is!

The next issue will continue on this topic. These cases will be discussed and the next cases presented. As we work through the process, the cases will become increasingly difficult, but the process, if adhered to, will lead to real solutions for real problems. Later on, we will focus on the remedy selection but not at this point.

Until next time,
Paul Herscu, ND, DHANP”

In a subsequent letter the case is further discussed:

“Case Number 421

There is one interesting point about Brandon’s analysis that could be brought up here. There is a keynote of stomach pain better by warm milk, which is arguably, a keynote of Chelidonium and Graphites. However, Brandon, in general did not fit either remedy. Keynotes that fit him were: A. Tightness and cramping, B. Amelioration by heat, C. Amelioration by motion. The mistake here would have been to put an overemphasis on the warm milk versus putting the correct emphasis on warmth in general. His previous homeopath had done just that and having tried both of those remedies as well as a few others was at a loss.

Looking at the keynotes of the patient, though, we are able to find key symptoms and then use those key symptoms to match to key symptoms of a remedy. This case too was a Nux vomica case. While there were several symptoms that helped to confirm the prescription, his homeopath did not see the potential for this remedy because he thought of Nux vomica as a 3 am keynote, of always being irritable, and of constriction in the colon, not in the chest or the stomach.

However, once we find the three keynotes of the patient, we will find the remedy. Maybe not the first or the second prescription but surely we will find the remedy.”

Dr. Herscu also describes in full detail his theory and approach using Cycles and Segments. Laying a clear philosophic foundation throughout the early letters, you will have the chance to go in-depth into understanding this useful and elegant tool and it will be presented throughout all of the letters. In part he describes his method:

“The Fundamental Segments within the Cycle

Everything you are looking at in your patient is showing the same balancing act of the vital force. Believe it. Look for it.

(1) I sincerely believe that every single symptom a person expresses is an example of one of the fundamental segments operating in that person’s cycle of disease. This includes even our strong symptoms, our mental symptoms, our sleep symptoms, everything. Each one is an example. This explains why we get in trouble when we take the keynotes literally. That is, we think the person must desire sweets in order to fit Stramonium. But sweets is only an example of the yearning for comfort in this isolated and lonely person. In other words, a symptom does not stand alone. It has a relationship of some kind to other symptoms. And so, that desire for comfort or consolation, which is one of the fundamental segments of the remedy, will show up over and over again in many places and many ways through various symptoms. Some of these symptoms will be found in rubrics, some will not. That doesn’t matter. It is the segment, the idea, that matters. That segment is something which absolutely belongs to that remedy.

The cycle itself is a flow of events that is composed of a number of fundamental segments. Each one of these segments could be described by a word or phrase, such as yearning for comfort or violent overreactions. In the model showing the cycle, you will see that each segment is linked by an arrow to the next segment, representing its direct effect leading to the one that follows. It in some way pushes the person to the next segment. Each segment flows into the next until you come full cycle again. The cycle is the disease. You can jump in at any point, start with any segment. The pattern is a continuous flow.

Another way of looking at it. Picture for a moment a circle of stepping stones surrounding a flower bed. A different cluster of flowers is planted next to each stone. As you move from one stone to the next you see a whole new cluster. Each is part of the total design. At some point you return to the original cluster. In the cycle of a remedy, these clusters are the fundamental segments of the cycle.

To stretch the metaphor a bit further, different flowers are planted and bloom and die at different times, and there may be others to come up in their place. Like that, the disease is not stationary but continuously flowing, moving, and changing—but only within certain parameters. But one thing is sure—every item that appears in a materia medica must in some way fit into one of those idea clusters, or segments, that make up the total pattern of the remedy. This is why I call it a fundamental segment—fundamental because it is intrinsic and essential, segment because it is a part of the whole cycle.

Another point. Within every remedy you will see certain segments that seem universal, such as weakness. At first this may seem confusing. How can you differentiate between dozens of remedies if they all have segments in common? Easily. The uniqueness of that remedy will be apparent in specifically how that element or segment (weakness) is expressed. Also every remedy will have at least one segment that is somewhat unique unto itself.

However, every symptom of the remedy is not unique and we cannot treat it as such, for the vital force is not split in pieces. It strains as one, it reacts as one, and it must be seen as one. This point was made clear to me eight years ago when a pregnant woman called saying that as soon as she washed her face she began to bleed from the vagina. Now there is no rubric like ‘threatened miscarriage from washing the face’. But there is one saying that washing the face causes a nosebleed. So I thought, “Well, if bathing can cause bleeding in one place, why can’t it cause it anywhere? The location is secondary to the bleeding and to the modality. The remedy chosen, Arnica montana, stopped the miscarriage and the child was born healthy. This same principle has been applied to babies who after birth have an epileptic fit when bathed and later are shown to have had a bleed within the brain.

So, at times it is possible, even useful, to generalize a symptom. Boenninghausen was the first to state this point clearly. It is the job of the homeopath to do this kind of generalizing, grouping all symptoms into segments or units that make sense. In most remedies there will be found four to six fundamental segments. Each of these can be broken down into smaller segments, giving even more flavor to the remedy. For example, in the Stramonium cycle presented here, I chose to make hyperactivity into a subsection of the violent overreaction segment.

Once you understand these clusters of ideas that belong to a remedy, you will easily be able to predict other symptoms that might fit under one segment or another. And you will also be able to predict with some accuracy the rubrics that the remedy should be found in. You can see how such an innovative tool would be invaluable in checking your findings as you never could before.”

For more information on Cycles and Segments see Stramonium with an Introduction to Analysis Using Cycles and Segments or sign up for the Letter!