MEMBERSHIP [MFHOM(OSTEO/CHIRO/PHYSIO)] EXAMINATION

Guidelines 2017

Contents

SECTION 1

1. Introduction………………………………………………………..……..………… 3

2. The examination…………………….……………………………………..…….... 43. The application process…..………………………………………....…………. 4

4. Entry criteria……………………………………………………………..…….…… 5

5. Examination format………………………………………….…..………….…… 8

6. Results……………………………………………………………...………………. 12

7. Practical details….…….………………………………………..…….………..….. 12- Venues and fees…………………………………………………….…… 12- Withdrawals and transfers………………………………………... 12- Re-sitting the examination……….…………………………….…… 12- Appeals………………………………………………………….…….….. 12- Faculty contact details………………………………………….……..… 12

8. Faculty membership…………………………………………………………….... 13

SECTION 2

A. Core Curriculum…………..…………………………………………………..…….. 14

B. Materia medica A-Z………………………………......................................……. 18

C. Sample case histories...................................................................................... 21

D. Practitioner Profiles for Osteopaths and Chiropractors................... 34

Faculty of Homeopathy

THE MEMBERSHIP (MFHom) EXAMINATION FOR PHYSICAL THERAPISTSMFHom(Osteo), MFHom(Chiro), MFHom(Physio)

SECTION 1

1. IntroductionThe MFHom(Osteo/Chiro/Physio) examination has been developed for physical therapists who are statutorily registered as either osteopaths, chiropractors or physiotherapists, and who have undertaken the MFHom curriculum, following an accredited training programme in general medical homeopathy. This includes the preparation of 10 case histories.

Please read Section 1 of this document before applying for the examination. You should retain this document until you have completed the entire examination process since you will need to refer to it at various times.

Section 2 provides detailed information about the format of the examination - how you will be tested, what you will be tested on and how your performance will assessed. To ensure that you are fully prepared for each part of the examination please read this section carefully. An outline of the core curriculum is provided.

Please note that a good standard of general medicine, for the purpose of differential diagnosis, as well as your specific physical therapy discipline will be expected, and the MFHom(Osteo/Chiro/Physio) Clinical Examination will test this aspect of your knowledge.

This document will assist you by providing:

❖ guidance for applying for the MFHom(Osteo/Chiro/Physio) clinical examination,❖ information about the structure of the examination❖ information on how to proceed through each stage

For information about the courses that lead to the MFHom(Osteo/Chiro/Physio) examination contact the Education & Quality Officer on 020 3640 5903.

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2. The examination

The purpose of the examination is to evaluate the candidate’s understanding of homeopathic principles, therapeutics and materia medica and skill in applying them, not merely the candidate’s ability to memorise facts. It also expects and tests a high standard of clinical medicine.

In terms of passing or failing the examination, the essential criterion is whether or not, in the examiners’ view, the candidate has demonstrated competence to practise homeopathy safely and effectively in:

❖ independent (private) practice within the scope of the candidate’s primary profession.❖ NHS primary or secondary care within the scope of the candidate’s primary profession.

3. The application process

]MfhoM

AT LEAST 3 MONTHS BEFORE

APPLYING

You will need to have passed the PHCE exam and be a LFHom(Osteo/Chiro/Physio) before you can apply for the

MFHom(Osteo/Chiro/Physio)

AT LEAST 1 MONTH BEFORE

APPLYING

Ensure you have correct supporting documentation for your application

1. Copy of current registration certificate with The General Osteopathic Council, The General Chiropractic Council or the Health Professions Council

2. Evidence of undertaking of Faculty accredited training

MFHom

AT LEAST THREE MONTHS BEFORE

THE EXAM

Submit your completed application form by the advertised deadline.

The supporting documentation listed above must be included. When applying you must also provide the following documents:

1. Testimonial confirming clinical experience in homeopathy2. Two copies of ten case histories

If your cases are judged to be satisfactory, you may proceed to the clinical section of the examination

CLINICAL EXAMINATION

Candidates will attend a clinical examination which is described in detail on pages 8-12

4. Entry criteria

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Important Note: the following regulations apply to all candidates entering the MFHom(Osteo/Chiro/Physio) examination. The Faculty reserves the right to refuse admission to any part of the MFHom examination.

Applications for entry must be made on the appropriate form that is available from the Education & Quality Officer. The application form, fully completed and accompanied by the appropriate fee and any other documents required, must reach the Education & Quality Officer either by email or at the Faculty office in London before the published closing date. Late or incomplete applications will not be accepted.

SECTION 1: PRIMARY OSTEOPATHY, CHIROPRACTIC OR PHYSIOTHERAPY QUALIFICATIONCandidates must hold a qualification in osteopathy, chiropractic or physiotherapy and show current registration with their appropriate UK registering body, The General Osteopathic Council, The General Chiropractic Council or the Health Professions Council.

• Candidates must provide a copy of their specific physical therapy qualification; their appropriate registration number; and a copy of their annual certificate of registration with either The General Osteopathic Council, The General Chiropractic Council or the Health Professions Council.

• Important – overseas candidatesYour primary physical therapy qualification must be registrable, as an overseas member, with either The General Osteopathic Council, The General Chiropractic Council, or the Health Professions Council.

SECTION 2: PRIOR FACULTY MEMBERSHIPCandidates will need to have passed the Primary Health Care Examination and must have been a Licenced Associate for at least three months before they can apply for the MFHom (Osteo/Chiro/Physio).

Applications for membership may be made through the Membership Department at the Faculty of Homeopathy. You can contact the Membership Officer at the Faculty on 020 3640 5903 or via the website at http://www.facultyofhomeopathy.org.

SECTION 3: COMPLETION OF FACULTY-ACCREDITED TRAININGCandidates must have received formal teaching approved by the Faculty of Homeopathy or, by prior agreement with the Faculty of Homeopathy, present evidence of equivalent study and experience.

Candidates must obtain a signed certificate from the Faculty-accredited training centre where they studied to confirm an adequate undertaking of part of the course (including coursework) prior to application for sitting the MFHom.

In the case of candidates whose training has been acquired at more than one centre, certificates for each stage of their training will be required.

SECTION 4: CLINICAL EXPERIENCE IN HOMEOPATHYCandidates are expected to gain sufficient clinical experience of homeopathic medicine in addition to their theoretical knowledge, in order to prepare themselves adequately for the clinical examination

Candidates must submit a testimonial letter when applying for the clinical examination to indicate their satisfactory training and work experience in clinical homeopathic medicine since completing their training at a Faculty-accredited teaching centre. Work experience may be gained in daily private practice, as well as observation of hospital out-patient practice, or a community clinic. During this time the candidate must be supervised by a teacher accredited for this by the Faculty of Homeopathy. Normally a teacher will be a Fellow of the Faculty or a

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Member of the Faculty of at least five years’ standing. The teacher will be required to sign the testimonial. The decision of the Faculty in this matter is final.

SECTION 5: CASE HISTORIESTwo copies of ten case histories must accompany the application form and fee. These must be presented by the advertised closing date for applications.

EXPECTED CONTENTEach case should be of between one and two thousand words, to illustrate different types of patients and clinical diagnoses, repertory rubric selection, case analysis and homeopathic treatment strategies. One or two cases of unsuccessful treatment are as acceptable as successful cases where they demonstrate a good understanding of therapeutic principals, patient care, obstacles to cure, irrespective of the outcome.

Each case should indicate:❖ the patient’s initials or some other coding for identification❖ sex, age on presentation (not date of birth), marital status and occupation❖ the full history, examination and investigations necessary for establishing clinical diagnosis and

homeopathic prescription❖ rubrics chosen and the reasons for their selection (the candidate’s own choice of repertory is

permitted)❖ a computer repertorisation❖ brief discussion of the reasons for the particular management subsequently undertaken,

including its integration with other aspects of patient’s care❖ history of the management and response to treatment, with at least three months follow-up of

chronic cases❖ a full appraisal of the results of the treatment given

A variety of acute and chronic cases may be included of which a maximum of two may be acute. Acute cases should reflect some finer points of acute case management rather than commonplace, if correct, acute prescribing (such as Bryonia backache).

MANAGEMENT OF CASESOne or two cases in which the advice of another colleague has been obtained may be included but this must be acknowledged. Generally the management should be by the candidate, and the insights gained and lessons learned from such advice should be reflected in the appraisal of the case.

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PRESENTATIONCases should be typed in double-line spacing with wide margins on A4 paper and two copies submitted, kept together by a convenient lightweight method (such as treasury tags) to ensure secure assembly of all the pages. Pages should be put together in such a way that they can easily be taken apart and photocopied and all pages should be numbered for the same reason. Ring binders are not acceptable. Cases should be numbered and the whole presentation prefaced by an index of cases.

The last page of the presentation must consist of a signed and dated declaration that the work has been undertaken by the candidate. The candidate’s name should not be mentioned in any other part of the document.

You may also submit your case histories electronically to the Education & Quality Officer. If you are submitting your case histories electronically the declaration outlined above should also be printed in hard copy, signed and dated by the candidate, scanned in and emailed to the Education & Quality Officer.

ASSESSMENTEach candidate’s case histories will be marked by one examiner. If they are considered unsatisfactory, they will then be marked independently by a second examiner. Before awarding a final mark the examiners will discuss the candidate’s case histories together. Candidates whose cases are deemed unsatisfactory after this procedure will not be allowed to proceed to the clinical examination, and will be asked to resubmit their cases in an indicated time-span.

The criteria listed below will be used by the Faculty when judging case histories by candidates. You are advised to use these to augment the samples given on pages 21-33.

A good case study should:❖ Be complete: that is, sufficiently comprehensive in respect of the presenting problem.❖ Demonstrate competence in conventional clinical management.❖ Show the quality of rapport with the patient, and awareness of non-verbal clues.❖ Clearly identify key symptoms, and their relative value (weighting).❖ Emphasise the individualising characteristics of the patient, the illness and the case.❖ Show appropriate symptom selection for case analysis or repertorisation.❖ Demonstrate appropriate and competent use of the repertory and/or materia medica.❖ Include appropriate and intelligent discussion of the differential diagnosis of the homeopathic

prescription.❖ Explain clearly the rationale for the choice of medicine, potency and dosage regime.❖ Demonstrate adequate and intelligent follow-up.❖ Provide intelligent and critical appraisal of the case.

Entry to the examination room

PROOF OF IDENTITYCandidates will be admitted to the examination in their full name as given on their original registration certificates, or qualification documents, or official translations of these, or as in the current edition of the registers of the General Osteopathic Council or the General Chiropractic Council of the United Kingdom. When candidates attend any part of the examination, they must produce upon request some means of identification in addition to the admission document. Admission to the examination will be at the discretion of the invigilator.

CHANGE OF NAMECandidates who change their name by marriage or deed poll must submit documentary proof of this if they wish to be admitted to the examination in their new name. 5. Examination format

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The MFHom(Osteo/Chiro/Physio) Clinical Examination consists of three elements:

❖ one long and one short case❖ two Objective Standardised Clinical Examinations (OSCEs)❖ an oral examination (Viva voce)

The long case:

TIMINGThe candidate will have a one hour consultation with a patient, followed by half an hour with two examiners during which time s/he will be asked to present the case and discuss the patient’s management. Candidates are warned that the time allocated for this section will be strictly adhered to.

ASSESSMENTAs with case presentations at the previous stage of the exam, the candidate will be expected to approach the homeopathic management of the patient within the context of their general medical care, and in relation to any conventional treatment that they are receiving, or may require. The candidate should undertake any examination that is regarded as necessary to elicit symptoms and signs relevant to the general and homeopathic management of the patient (excluding any internal examination), but should not spend time on a comprehensive physical examination that does not have a bearing on the problem.

The candidate will not be expected to have repertorised the case, but should, if possible, leave a little time at the end of the consultation to use the repertory to help them explore key symptoms and possible homeopathic medicines. The candidate should not be concerned if s/he runs out of time and is not able to do this. The candidate should, however, at least have made a note of the key symptoms, and considered the rubrics that might prove useful for case analysis. The candidate should also have considered what their ‘differential diagnosis’ of possible homeopathic medicines for the treatment plan might be. The candidate will not be expected to have chosen ‘the’ right prescription, but to have thought intelligently about the medicines they consider to be indicated, and how they might be employed in a treatment plan.

When presenting the case, the candidate will be expected to review the patient’s history at some stage, but should not spend unnecessary time reporting routine information that has no direct bearing on their perception of the patient or the analysis of the case. The candidate may present the case in their own style, giving priority and emphasis to those aspects that are judged important, but without omitting any significant information.

An examiner may spend a little time with the candidate observing the consultation at some stage - if this is the case the candidate should continue as normal. Afterwards, the patient may be asked how they experienced the consultation. You may wish to explain to the patient how the artificial context of the exam may affect the consultation.

The clinical notes made by the candidate may be scrutinised and/or retained by the examiners.

In summary the long case examination will test:❖ The quality of the candidate’s relationship with the patient.❖ Whether the candidate has identified the problems that the patient presents after taking an

adequate conventional history and full homeopathic history and after any appropriate physical examination (a vaginal and rectal examination should not be carried out).

❖ What investigations the candidate would seek and his/her interpretation of these.❖ The candidate’s appreciation of the essential homeopathic features of the case.❖ The selection of suitable rubrics for repertorisation.

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❖ The ability of the candidate to plan the management and homeopathic treatment of the patient’s illness.

EQUIPMENTThe candidate must bring a book or computer repertory of their choice to this part of the examination. Other essential equipment is provided.

The short case:

TIMINGThere will be one short case lasting 15 minutes during which an examiner will be present.

ASSESSMENTShort cases will be chosen to present a circumscribed problem that can be assessed in the time available. A case may involve symptoms or signs that need to be elicited by brief examination, but it may require a verbal history only. The case will have been chosen to allow key prescribing information for the presenting complaint to be elicited in the time available by a competent candidate. Appropriate examination tools will be provided, if the need for examination is anticipated.

Cases may present problems in any system which is amenable to targeted clinical prescribing. The presenting symptomatology will involve only one system. If a patient has a problem in a number of systems, they will have been coached to present only the symptoms of the problem selected for the purpose of the examination, unless the candidate specifically enquires about other symptoms in order to confirm or exclude a choice of medicine. Patients will have been instructed to give information only in response to direct questions from the candidate. They should not give information about current or previous homeopathic medication.

Candidates will be encouraged to spend 8-10 minutes questioning or examining the patient, as in a brief routine primary care consultation, allowing 5-7 minutes discussion with the examiner. However candidates may tell the examiner if they are ready to discuss the case sooner.

Candidates will be expected to demonstrate awareness of the relevant symptomatology, and the ability to elicit and construe this intelligently in terms of possible, appropriate homeopathic prescriptions. They should not stray beyond the local aspects of the presenting problem, unless they deliberately intend to use general or psychological symptoms, concomitant symptoms or constitutional features to confirm or exclude the choice of a particular medicine.

Attention will be paid by the examiner to the candidate’s technique in eliciting symptoms and physical signs, to their approach to, and consideration for the patient as well as to their interpretation of the information available and their ability to choose suitable management and homeopathic treatment.

Objective Standardised Clinical Examinations (OSCEs):

TIMINGThere will be two specific clinical scenarios presented as OSCEs and fifteen minutes will be allowed for the candidate to prepare each OSCE. An examiner will then ask the candidate to answer the set questions on each case.

ASSESSMENT

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Objective Standardised Clinical Examinations will be chosen to present a wide range of clinical conditions, tasks and scenarios. Cases will usually take the form of written accounts but may also include photographs or video clips where appropriate.

Each case/scenario will be presented in the following format:

❖ Presentation of the case or scenario – including the conventional diagnosis, history of treatment, age of the patient, clinician’s observations and clinical examination

❖ The patient’s description of their illness, usually in their own words.

After reading each case or scenario the candidate will be expected to consider:

❖ Various tasks to perform and scenarios/management decisions: e.g. the indicated homeopathic medicine, potency and dose regime, relevant rubrics, totality of symptoms, strange rare and peculiar symptom, hierarchy of symptoms.

❖ Patient management (relevant to the case presented) including integration of conventional and homeopathic treatment, assessment of vitality, anticipating or managing a homeopathic aggravation, consideration of evolving clinical scenarios after initial management and obstacles to cure.

Tasks and questions may cover any part of the core curriculum including principles of practice.

In this part of the examination candidates will achieve marks for each step or task they perform correctly rather than an assessment based on their overall performance.

EQUIPMENTThe candidate must bring a book or computer repertory of their choice.

Sample OSCE 1

Clinical scenario55 year old man presents with Chronic Fatigue Syndrome (CFS) for 10 years. His main symptoms are joint pain, fatigue and breathlessness. The illness started with severe flu-like symptoms that did not settle, he was aching all over and feeling very weak. He describes being able to ‘feel every bone’ in his body. In week two he became increasingly breathless, had chest pains and was diagnosed with pleurisy and pneumonia and given antibiotics. He did not recover fully and was diagnosed with CFS 2 years later. He had a second episode of pneumonia 4 years ago. He has not worked for 10 years, but used to manage the gardens and woods on a large estate.

He continues to complain of joint pains particularly in his feet, and has to walk on his heels when the pains are bad. His painful feet are better for being cool and he wears sandals indoors even in winter. When the pains get worse they also affect his hands, wrists, ankles and knees.

He feels breathless, especially walking upstairs, which he puts down to ‘dragging his body around’ because of the fatigue. His mood is worsening which he is very worried about as he had a severe depression 5 years ago when he felt totally alone, and tried to kill himself by holding a knife between his chest and a tree and pushing himself onto the knife. He was found by his wife and had not sustained injuries. He cannot tolerate anti-depressant medication, and asks if Homeopathy might help his mood too?

Case analysis tasks:

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(a) Select the appropriate rubrics and repertorise(b) Select one remedy that best covers all of the symptoms

Therapeutic and Clinical Management Tasks:

(c) What potency and frequency of repetition of dose would you choose in a patient with long-standing Chronic Fatigue Syndrome?(d) How would you answer his question regarding homeopathic treatment for his mood?(e) In what order might you expect his three main physical complaints to improve?

Materia Medica Knowledge:

(f) What two other remedies would you consider for joint pains with the modality of better for being cool / cold applications?

The oral examination (Viva voce):This will follow the Clinical Examination. It will normally last approximately 30 minutes but may be extended or reduced, according to the need to determine the outcome, including the award of distinction. All examiners will attend the oral examination but will not necessarily all question each candidate. The candidate may be asked to use their book or computer repertory during this part of the examination. General questions on any aspect of homeopathic principles, therapeutics and case management may be asked.

PortfolioCandidates must bring their reflective portfolio, including their 10 case histories, with them to the examination as the examiners might refer to the portfolio or ask questions about the cases.

Number of examinersFor any MFHom examination there will be at least two Faculty of Homeopathy approved examiners present at the review of the long case and at the oral examination. One examiner will be present for the short case, and one examiner for each OSCE.

Trainee examinersThere may be trainee examiners shadowing the other examiners throughout the day. They will make themselves as inconspicuous as possible, and are there to observe and learn about the examination process rather than the performance of the candidates.

Assessment of the clinical and oral sections

PASS A candidate who passes in all sections of the examination will pass overall.

FAIL A candidate will fail the examination if he/she:

❖ fails even marginally in all the sections (long case, short case and OSCEs)❖ fails clearly in any one of these sections❖ fails marginally in any of these sections and does not compensate for this by scoring additional

marks in the remaining sections

DISTINCTIONA candidate whose grades in the examination show overall excellence will be awarded a pass with distinction.

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Review of the examination by the FacultyAfter every examination the Faculty of Homeopathy will audit that sitting. In the light of its findings, modifications to future examinations will be made where considered necessary.

6. ResultsResults may not be collected from the Faculty office, nor can they be given over the telephone.

Final results of the MFHom examination will normally be emailed within one week of the clinical examination in all centres.

7. Practical details

Venues and fees

The oral examination will usually be held in the United Kingdom at one of the following centres - Bristol, Glasgow and London. The examination may be held elsewhere (in the UK and abroad) by agreement of the Faculty.

Details of the fees payable for the examination can be found on the application form for the exam or are available by contacting the Education & Quality Officer.

Cheques should be made payable, in sterling, to the Faculty of Homeopathy.

Withdrawals and transfersNotice of withdrawal from either part of the examination must be given by email.

The examination fee less a 50% administrative charge will be refunded when notice of withdrawal is received up to 30 days before the examination is due to take place. No other refunds will normally be made. The Faculty will consider refund on withdrawal because of certified illness.

Candidates are limited to a maximum of two transfers only.

Re-sitting the examinationRe-sits by candidates who fail badly may be deferred at the discretion of the Faculty for a period of time.

Candidates whose cases did not meet the standard will not be allowed to proceed to the clinical examination. The examiners will provide feedback on the cases and students will be advised as to the work they need to do before resubmitting their cases. This may mean submitting new cases or revising existing ones to standard or both.

Candidates who fail the clinical examination will receive feedback from the Dean about the reasons why they failed. Before re-sitting the clinical examination, candidates must provide an updated testimonial from their teaching centre attesting to the candidates readiness to re-sit.

AppealsIf you would like to appeal the result of the case histories or the clinical examination, you must email the Education & Quality Officer at education@facultyofhomeopathy.org. Appeals should be sent within one month of receipt of results.

Faculty contact detailsFaculty of Homeopathy, CAN Mezzanine, 49-51 East Rd, London N1 6AHTel: 020 3640 5903 Email: education@facultyofhomeopathy.org Website: www.facultyofhomeopathy.org

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8. Faculty membership

Candidates successful in the MFHom(Osteo/Chiro/Physio) examination will receive a certificate signed by the President of the Faculty. The names of successful candidates are presented to the Faculty Council for formal election as full Members of the Faculty of Homeopathy.

Members of the Faculty of Homeopathy are elected subject to the Faculty of Homeopathy Act 1950, including its current byelaws and regulations.

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SECTION 2

A. Core curriculum

GENERAL CONTEXTAim: to understand the scope and limits of homeopathy in contemporary medicine

❖ The development of homeopathy within the science and art of medicine❖ The scope and limits of homeopathy❖ The clinical and legal bounds of competence of different practitioners❖ Integration/inter-relationship of homeopathy with other forms of treatment❖ The development of homeopathy internationally❖ The various “schools” of homeopathy and international variations

HISTORYAim: to have a broad knowledge of the historical and philosophical background to the development of homeopathic thought and practice; to understand the history and development of contemporary homeopathic medicine and its relationship to the growth of conventional medical thought

❖ The importance of historical primary sources, especially Hahnemann’s Organon, to the understanding of modern homeopathy

❖ The work of Hahnemann and his initial provings❖ Later and contemporary developments in homeopathic principles and practice

PRINCIPLES AND KEY CONCEPTSAim: to have a broad knowledge of the concepts of the homeopathic approach

Basic principles❖ The Principle of the Law of Similars: Similia Similibus Curentur❖ Individualisation of treatment❖ Directions of cure❖ Sensitivity in the ill person❖ The totality of symptoms❖ The minimum dose❖ Theories of chronic disease and miasms❖ Self-healing and placebo responses

Homeopathic concepts of health and illness, disease and cure❖ Hahnemann’s Organon❖ Concepts of suppression and obstacles to cure❖ The direction of cure (Hering’s Law)❖ The concepts of incurability❖ The theory of chronic disease and miasms: Hahnemann’s original ideas and the contribution of

later and contemporary teachers

MATERIA MEDICAAim: to gain a critical understanding of the development of homeopathic materia medicaand knowledge of a large range of homeopathic medicines

The sources and development of homeopathic materia medica

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Aim: to gain an understanding of the development and range of ‘drug pictures’, from keynote symptoms to polychrest remedies, and ideas of typology derived from –

❖ toxicology❖ provings❖ clinical symptoms

Materia medica of specified homeopathic medicinesAim: to gain a working knowledge of a selected range of homeopathic medicines

There are some 3000 homeopathic medicines in existence and a vast amount of homeopathic materia medica information to go with them. Trainees will know how to access and evaluate materia medica information in general, and will know the materia medica of a number of medicines to varying depths of knowledge, namely -

❖ Full details of the materia medica of major homeopathic medicines❖ Comparative materia medica of major medicines❖ Key features of a selection of other medicines

- as specified in the list on pages 18-20

Repertories of materia medicaAim: to gain a practical working knowledge of the concepts and techniques of repertorisation

❖ The historical development of the repertories❖ The structure and layout of Kent’s Repertory, Boenninghausen’s Repertory, Synthesis or the

Complete Repertory❖ Rubrics and typeface conventions❖ Commonly used repertories in book and computerised form❖ Ways of using repertories❖ The limitations of repertory use❖ The practical use of the repertory

HOMEOPATHIC PHARMACY AND PRESCRIPTION WRITINGAim: to gain a working knowledge of the preparation of homeopathic medicines, potentisation methods, prescription writing and essential aspects of pharmacy practice

❖ Source materials: vegetable, mineral, animal, synthetic, disease products❖ Mother tinctures❖ The processes of production:

o Extractiono Insoluble substances – triturationo Potentisationo Serial dilution: X(D), C and LM scaleso Succussiono Hahnemannian and Korsakovian production methods

❖ Complex and combination remedies❖ Pharmaceutical forms❖ Prescription writing/acquiring homeopathic medicines from homeopathic pharmacies❖ Pharmacopoeias in common use

SCIENTIFIC BASIS

Explanatory modelsAim: to become acquainted with conventional scientific principles which show a relationship tohomeopathic effects, and with possible explanatory models including biophysical models

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❖ Hormesis❖ Auto-regulation❖ The properties of water

RESEARCH METHODS AND EVIDENCEAim: to understand the basic principles of research methodology and be able to make critical appraisals of research in homeopathy

❖ Clinical trials in homeopathy (including veterinary homeopathy), including meta-analyses❖ Methodology design❖ Critical assessment of historic and modern papers❖ Evidence-based appraisal, audit❖ Laboratory studies in homeopathy❖ Research protocols❖ Homeopathic Pathogenic Trials (Provings)❖ Possible scientific explanatory models including biophysical models❖ The main approaches to conducting homeopathic research:

o mechanisms of actiono randomised clinical trialso placebo studieso qualitative studieso observational studieso outcome studieso attitudes and awareness studies

CONSULTATION AND CLINICAL SKILLSAim: to gain a profound understanding of how the homeopathic method can be used to enhance the therapeutic interaction; to learn to use the therapeutic relationship to achieve a rapport and depth of understanding with the patient that will enhance the quality of the consultation and the case-taking process; a detailed working knowledge of the features of the consultation, history taking and analysis skills in homeopathic care

Homeopathic history taking❖ In the acute and chronic case❖ Awareness of the natural history of the disease process❖ Placebo and nocebo effects and the possible impact of the non-homeopathic medicine aspects

of homeopathic care, such as the consultation and context❖ Categorising and evaluating symptoms and modalities❖ The concept of a hierarchy of importance of symptoms

Case analysisAim: to identify key features of the case as indicators to the choice of medicines and prescribing strategies

❖ The significance of different elements of the history❖ The significance of predisposing factors and causation❖ The concept of a hierarchy of importance of symptoms❖ The role and techniques of repertorisation❖ Discrimination between possible homeopathic medicine choices❖ The appropriate use of homeopathic decision support software

Case ManagementAim: to integrate homeopathy appropriately and effectively with a conventional osteopathic, chiropractic or physiotherapy practice, in both adults and children

Therapeutic strategiesAim: to gain a detailed knowledge and practical experience of using different prescribing strategies

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❖ Differences in acute and chronic case management❖ Therapeutic strategies based on different perspectives of the patient’s history and health

status:o Prescribing in layers and the current statuso Conventional aetiology and other aetiological influenceso The relevance of conventional diagnosis and pathologyo Patient’s disease reactionso Constitutional characteristicso Biographical and past history including family historyo Typology and drug typeso Keynoteso Totalityo Essenceo Strange, rare and peculiar reactionso Theory of chronic disease and miasmso Isopathyo Tautopathy

Patterns of response to homeopathic prescriptions, their interpretation and managementAim:to develop the ability to understand and manage the responses which can follow a prescription

❖ In acute, sub acute, chronic and incurable cases❖ The differing schools of interpretation and practice❖ Speed of responses❖ Initial reactions and aggravations❖ Direction of cure❖ Suppression❖ Obstacles to cure❖ Repetition of doses❖ Changing dosage❖ Changing homeopathic medicines

B. Materia medica A-Z

MFHom(Osteo/Chiro/Physio) learning objectives: The ability to identify indicated medicines reliably and to differentiate between them.

See the table below in which medicines are grouped according to source and the depth of knowledge required.

Highest Grade Homeopathic Medicines: Comprehensive knowledge of the materia medica and comparative materia medica.

Lower Grade Homeopathic Medicines: Keynote materia medica and important clinical/local presentations.

Topical treatments

❖ Arnica montana❖ Calendula officinalis❖ Hypericum perforatum❖ Hypericum and Calendula (‘Hypercal’)❖ Rhus toxicodendron .❖ Ruta graveolens❖ Tamus❖ Thuja occidentalis

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❖ Urtica urens

Highest Grade Homeopathic Medicines

Element & Mineral Plant Animal Nosode

Argentum nitricum Aconitum napellus Apis mellifica Carcinosinum

Arsenicum album Arnica montana Calcarea carbonicaHahnemanni

Medorrhinum

Aurum metallicum Belladonna Lachesis mutans Psorinum

Baryta carbonica Bryonia alba Sepia officinalis Syphilinum

Calcarea phosphorica Chamomilla Tuberculinum bovinum (Kent)

Causticum Gelsemium sempervirens

Graphites Ignatia amara

Hepar sulpuris calcareum Lycopodium clavatum

Kali carbonicum Nux vomica

Mercurius solubilis Pulsatilla nigricans

Natrum muriaticum Rhus toxicodendron

Phosphorus Staphisagria

Silicea terra Thuja occidentalis

Sulphur

Lower grade homeopathic medicines

Element & Mineral Plant Animal Nosode

Actea spicata* Asterias rubens* Isopathic nosodese.g. grass pollens

Alumina* Aesculus hippocastanum* Cantharis vesicatoria Sarcodes: e.g.

Ammonium carbonicum Allium cepa Falco peregrinus

Antimonium crudum Aloe socotrina Lac caninum Sciatic nerve*,

Ambrosia Intervetebral disc*

Argentum metallicum* Anacardium orientale Spongia tosta

Borax Bellis perennis* Tarentula hispanica

Calcarea fluorata* Berberis vulgaris

Calcarea sulphurica Caulophyllum thalictroides*

Cuprum metallicum Calendula officinalis

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Ferrum metallicum* China officinalis

Ferrum phosphoricum* Cimicifuga racemosa*

Fluoricum acidum* Cocculus indicus Carbons

Iodium Colchicum autumnale* Carbo animalis

Kali bichromicum Colocynthis Carbo vegetablis

Kali phosphoricum Conium maculatum Glonoinum

Kali sulphuricum Drosera rotundifolia* Petroleum

Magnesia carbonica* Dulcamara+

Eupatorium perfoliatum

Magnesia muricata Euphrasia officinalis

Magnesia phosphorica* Gnaphallium polycephalum*

Natrum carbonicum Hypericum perforatum*

Natrum sulphuricum Ipecacuanha

Natrum phosphoricum Kalmia latifolia*

Nitricum acidum Ledum palustre*

Palladium metallicum Lilium tigrinum

Phosphoricum acidum Opium

Platinum metallicum Phytolacca decandra*

Plumbum metallicum Ranunculus bulbosus*

Stannum metallicum Rhododendron*

Strontium carbonicum* Ruta graveolens*

Zincum metallicum* Sabadilla officinalis

Sanguinaria+

Sticta+

Stellaria+

Spigelia anthelmia*

Stramonium

Symphytum officinale*

Veratrum album

*The homeopathic medicines of the lower grade marked with an asterisk are highlighted “rheumatic” remedies.+Of primary interest to physiotherapists.

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C. Sample case histories

Example 1

Mrs. BS

Age on presentation: 61

Married

Housewife

PRESENTING PROBLEM:

Intermittent episodes of acute musculo-skeletal pain described by the patient as fitting one of two distinct presentations:

(a) The most long-standing symptom-picture (over 15 years) is one in the lower lumbar and sacral areas bilaterally, presenting as sub-acute intermittent episodes, relative to mechanical overstrain of this area.

(b) The more recent symptoms have occurred episodically over the last 10 years. These focus in the lower thoracic paraspinal muscles on the left side, radiating laterally around the lower left costal margin, and superiorly to the inferior portion of the left scapulae and its medial border. These symptoms appear suddenly, and without any significant mechanical overstrain, causing intense spasm, pain and restriction of her torso mobility.

This lady has attended various physical therapists (for physiotherapy, osteopathy, acupuncture) for over 15 years, usually at the onset of acute episodes.

HISTORY OF PRESENTING COMPLAINT:

I am going to focus on the second complaint, described above as (b), as this was the presenting symptom when this patient initially consulted me in January 2006.

The patient reported that this area had been the previous site of an episode of shingles, approximately 12-15 years prior. However, on further questioning she revealed that the very first acute spasm in this area had been 24 hours after her house had been burgled, ten years ago. Since then she had experienced at least 3-4 episodes per year, often during the second week of a holiday. (She discounted the change of bed as a trigger, as she had been entirely comfortable during the initial week of each holiday, in the same accommodation.)

The patient had needed to consult her GP, or a doctor in her holiday location, on each of the episodes, due to the severity of pain and restriction. She usually required Diazepam on each episode, and used this in combination with Co-dydramol and bed-rest for 3-5 days, before slowly recovering full mobility over the following week.

These episodes of acute spasm do not trigger the onset of her lumbar and sacral symptoms.

RELEVANT MEDICAL HISTORY:

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• Previous X-rays of the thoracic, lumbar and pelvic areas have revealed only mild degenerative changes. The various medical professionals who have examined this patient over the years have all felt that the symptoms were entirely musculo-skeletal in origin, and have not initiated further investigations for any type of referred pain from viscero-somatic causation.

• The patient has hypertension, but this has been well-controlled by medication for 8 years. She is also on medication to manage her cholesterol levels.

• Otherwise this lady is fit and healthy, and only uses the above-mentioned medications as required for acute episodes of spasm.

SOCIAL HISTORY:

This cheerful, well-presented and vivacious lady has a very busy and active lifestyle. She is constantly engaged with extensive social commitments; entertaining her husband’s business acquaintances; team activities such as curling; looking after her grandchildren; and travelling on holidays with her husband. She appears to fit as much as possible into everyday, and is always concerned with what she can do to help others, possibly to the point of physically over-extending herself.

HOMEOPATHIC HISTORY:

Manner:The episodes of acute musculo-skeletal symptoms are an inconvenience to this lady, as the severity hinders her usual pace of life. Whilst the pain experienced during these episodes is no doubt very severe, this patient does not dwell on this aspect, and in fact anticipates the inconvenience that her next potential episode will bring to her and others around her (MIND; ANXIETY; future, about).

Rubrics:

MIND; AILMENTS from; fright or fearMIND; AILMENTS from; anger, vexation; fright, shock, withMIND; ANXIETY; fear, withMIND; SENSITIVE, oversensitive; pain, toMIND; SENSITIVE, oversensitive; noise, toMIND; ANGUISH; restlessness, withMIND; IDEAS; instability of, unsettled state of mind

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REMEDY:

The patient was initially given a single split dose of Aconite 1M (3 doses of Aconite 1M at 12 hourly intervals).

REASONS FOR CHOICE OF REMEDY:

Aside from my musculo-skeletal assessment of this patient, the most outstanding feature of the case was the direct aetiology. The symptoms directly followed the trauma of a house burglary. On this basis I decided to prescribe Aconite 1M, the high potency being chosen as the direct aetiology was historically distant. The high potency was also appropriate as the remedy was chosen to address the mentals of this case, rather than symptoms at a tissue level.

MANAGEMENT AND FOLLOW-UP:

1st Return Visit: There were no aggravations, or negative reactions to use of the homeopathic medicine, and the patient reported that she was symptom-free within 72 hours of use. She had not required her usual use of Diazepam, and noted that she was back to full activity levels much more quickly than on previous episodes.

2nd Return Visit:Two months later this patient returned to the Clinic. She had been symptom-free, but was anxious to avoid her usual holiday-episodes of symptoms, and requested more of the homeopathic medicine to keep in her travel-bag. I gave her a supply of Aconite 1M to self-administer, as required.

3rd Return Visit:At the end of 2006 this patient was reviewed in order to follow her progress over the year. The patient reported that she has used the homeopathic medicine on several occasions, but at a very early stage in the symptom presentation. She describes becoming aware of a “tension” focusing over the inferior portion of the left scapulae, and around the posterior, lower-left costal margin. If she uses the homeopathic medicine at this time, this “tension” quickly recedes, and the patient continues with her full level of activity.

APPRAISAL:

I have followed this lady’s progress from January 2006 to the present, as she attends the Clinic approximately every 8-10 weeks for osteopathic assessment and treatment of the chronic lumbar and pelvic symptoms. However, since starting the use of the homeopathic Aconite, this patient has not experienced any episodes of spasm in the left scapulo-thoracic area that resembled the previous 10 years of experience. The most notable episode she recalls is a 12 hour period of discomfort, relative to symptoms arising on a day when she was significantly over-extending herself. She is extremely pleased not to be inconvenienced by days of enforced bed-rest, either at home or on holidays.

Although I chose the remedy used in this case on the basis of a direct aetiology (Mentals/Generals- anxiety states following a strong fright or a shocking event), I feel that its success may also have been re-enforced by this patient’s strong constitutional overlap with many of the Mentals and Generals of the remedy-state.

Features which suggest this are:

• the patient’s exceptional forward-planning and organisational skills• the robust, bright and happy nature, and usually excellent health of the patient

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• the tendency to hurry, and notable speed of thought and (well-planned) activity• the sudden and acute onset of the symptoms• the high level of self-sensitivity, where the patient is able to monitor the “tension” that

precedes an acute episode

Example 2

MRS. PM

Age on presentation: 38

Married

Administration/clerical work

PRESENTING PROBLEM:

Since the birth of her second daughter in 1998, this lady had experienced mood swings, increased irritability and diminished patience with the children, and considerable fluid retention, in the days prior to the onset of her menstrual cycle. However, this presentation had become significantly worse in the last 3 months. She now noted:

• the symptoms had extended in duration, and “were now worse in the week of her menstrual flow”

• she was particularly irritated by her children’s behaviour at home, and “flew off the handle” with the slightest provocation. This reactivity she deeply regretted when she reflected on the situation

• she wished to be alone, “that her children would just leave her alone, instead of being demanding at this time”. This thought always made her tearful, as it was not how she usually felt about her children

• she was aware of significantly higher stress levels, which she described as “mental turmoil”. This was exacerbated by company, especially colleagues asking her simple questions or requesting clarification of work issues

• her ability to concentrate was significantly diminished - “poor concentration”• the combination of these last 2 factors had affected her confidence at work - “poor confidence” -

rather than her normal aptitude, and she felt an “inability to cope with her usual workload during the week prior to, and the week of her menstrual cycle”

• she felt “extremely exhausted, and was falling asleep by 9pm in the evenings” of this 2 week period each month. Sleep was not disturbed, but equally was not refreshing

• she felt “extremely hot at night”• she noticed a significant increase in her fluid retention levels, generally throughout her body, in

the above-noted 2 week duration. Whilst fluid-retention had been a feature of her prior PMT presentation, this was now significantly greater, and of more concern.

HISTORY OF PRESENTING COMPLAINT:

In March 2006, this patient asked me if I could help her address her significant PMT symptoms with homeopathy (I had recently treated her daughter successfully with homeopathy). This presentation had become significantly worse within the last 3 months, and was now affecting her family-life, and her role at work.

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This lady has been a regular osteopathic patient for 11 years, initially presenting with lower back pain during her first pregnancy. The lumbo-sacral symptoms are of a mechanical nature, and their aetiology can be correlated with a side-impact road traffic accident in 1995. The patient has experienced intermittent acute episodes of lumbo-sacral pain and restriction over the years, always relative to mechanical overload. However, she usually has a more low-grade presentation of myofascial symptoms, specifically aching and general stiffness in the lumbar and scapulo-thoracic areas. This is osteopathically addressed at her regular appointments (usually at 4-6 week intervals).

The PMT symptoms aggravate any musculo-skeletal symptoms present at the time, but the patient ascribes this to her particularly low tolerance levels – “everything irritates me more”.

RELEVANT MEDICAL HISTORY:

• Episodes of low blood pressure during first trimester of both pregnancies.• Aug. 2005 – Laser treatment to cervix for early cell changes, as noted on most recent smear

test.• Otherwise fit and well. No regular medications used.

SOCIAL HISTORY:

This lady’s husband works offshore for two out of every four weeks, a common work arrangement in North-East Scotland. Meanwhile, she continues to works part-time in the office where she worked prior to having her children – two daughters. She copes with work, child-care, and domestic considerations, without thinking to ask for help when her husband is away.

FAMILY HISTORY:

This lady’s brother died in 1997, at the age of 32, from cancer. She recalls only positive features about her brother’s final period of hospitalisation, such as his marrying his on/off Australian girlfriend, in hospital, a few days before he died. This she describes as gaining a sister-in-law. There has never been any overt expression of grief about the loss of her brother, despite the fact that she experiences a close relationship with all of her family.

HOMEOPATHIC HISTORY:

Manner:This is a well-presented, friendly and likeable lady, with an easy but direct manner of speaking. I have always considered this patient to be very responsible, both in terms of her care for her direct and extended family; and her approach to work.

Rubrics:

MIND; MENSES agg.; before MIND; IRRITABILITY, menses beforeMIND; DISCONTENTED, displeased, dissatisfied; everything, withMIND; SPOKEN to; being, agg.MIND; COMPANY; aversion toMIND; WEEPING, tearful mood; tendency; involuntaryMIND; MENTAL exertion; agg.MIND; MEMORY; weakness, loss of; mental exertion; agg.

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MIND; DULLNESS, sluggishness, think or concentrate, unable to

MIND; PROSTRATION of mind, mental exhaustion, brain fag; talking, from; longGENERALS; HEAT, flushes of; sleep; duringGENERALS; SWELLING, oedematous

REMEDY:

Natrum Muriaticum 30C once daily, to be taken for the remainder of the two week duration of her symptoms.

The following month she was advised to start the homeopathic medicine daily, one week prior to her menses, then stop as the symptoms subsided, at whatever point during the flow this may be.

REASONS FOR CHOICE OF REMEDY:

This patient has always experienced some degree of PMT (periodicy of symptoms), particularly noting features of irritability, mood swings and fluid retention. But the recent exacerbation of these symptoms, as described above, was having a detrimental effect on this lady’s usual way of coping with life: responsible, steadfast and very conscientious. These features together, plus the patient’s response to the death of her brother, led me to prescribe Natrum Muriaticum for this lady. The rubrics stated above further support the choice of this remedy.

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Alternative remedies considered for pre-menstrual complaints include: Calcarea Carbonica, Carcinosin, Chamomilla, Elaps, Lachesis, Lillium Tigrinum, Nux Vomica, Pulsatilla and Sepia. Whilst some of these remedies offered significant overlap with features in this case, but I felt none demonstrated the similimum in the same way as Natrum Muriaticum. However, the following remedies were considered:

Calcarea Carbonicum fitted the following features of this patient:• the strong sense of duty and responsibility • the feeling of being overwhelmed, with a fear of loss of mental clarity, and a tremendous

anxiety that other people perceive this confusion• back weakness and lower back pain

But it did not fit with the anger, reactivity and remorse demonstrated by the patient. Nor with the extreme sense of heat she felt at night.

Chamomilla could be considered for:• the anger and great irritability• the capriciousness and general discontentment with everything• the warm-bloodedness, and aggravation at night

But the general character of Chamomilla, with extreme hypersensitivity to pain, and an angry response to the pain, did not seem appropriate for this patient’s usual demeanour and her response to other factors in her life. Nor did it represent the dullness and prostration of mind she was experiencing.

Lillium Tigrinum also demonstrates the following features:• great irritability or rage• alternation of mental states, for example rage and remorse• premenstrual syndrome with great irritability

But again, this remedy is characterised as one for rage-filled patients, often with a deep conflict between a strong sexual nature and a strong moral side. This is a frustration that I have never been aware of in all the years I have known this lady. As with Chamomilla, this remedy state also fails to represent the dullness and prostration of mind.

Sepia would also be a possible remedy for the following overlap features:• irritability• progressive detachment from family, who are seen as a burden• anger with shrieking at the children, unable to control own temper• guilt and remorse, following anger or sarcasm• aversion to company, yet dreads being completely alone• involuntary weeping

These symptoms certainly fitted the case well, but did not cover the aspects of dullness and prostration of mind as well as Natrum Muriaticum, nor the patient’s usual strong sense of responsibility. The patient also failed to describe any bearing-down sensation in the pelvic area, or any of the other signs of weakness of smooth muscle usually associated with the Sepia state. Nor had I seen any evidence of yellow-brown discolouration on the face, at any time.

MANAGEMENT AND FOLLOW-UP:

1st Return Visit:The patient returned after 6 weeks, reporting that she had coped significantly better with her most recent menstrual cycle. This had manifested significantly less fluid retention and abdominal distension; the patient was less fatigued; and was most relieved to be coping much better at work.

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The patient was advised to continue with use of the homeopathic medicine as previously described, and this would be reviewed after a further 2 cycles. (I thought I may need to revise the potency, based upon further response.)

2nd Return Visit:In June 2006, 14 weeks after the first use of the homeopathic medicine, the patient reported much improvement of all physical symptoms relating to her PMT. There was an overall increase in energy-levels, and most significantly, an increased confidence relative to work, with her once again performing at her previous level of competence.

She volunteered at this time, information regarding a work incident in December 2005, which had undermined her role in the work-place. She acknowledged that she had felt very hurt by this challenge to her competence, and equally responsible to demonstrate a solution.

Review after 10 months:At one of the recent osteopathic treatment sessions with this patient (Jan. 2007), I enquired about her PMT symptoms. She replied that her menstrual cycle now “had a very low impact on her life,” and that she had in fact “forgotten to take her homeopathic remedy prior to her last cycle.”

APPRAISAL:

Natrium Muriaticum seems appropriate for this lady at both a constitutional level, in terms of her serious, responsible nature; and for her specific pre-menstrual symptoms.

Features of this remedy which fit with this case are:

MENTALS• Very responsible; feeling of guilt• Fastidious. Perfectionist. Always on time• Aversion to company. Desires and ameliorated by being alone• Premenstual syndrome with irritability and sadness

GENERALS• Periodic complaints• Warm blooded, aggravated from heat

PARTICULARS• Back pain and low back pain, better lying on something hard, or applying hard pressure to the

area

This patient is aware of the significant difference that the homeopathic medicine has made to her life, and may find this same remedy useful for points of stress, or further specific symptoms in the future.

Example 3

Mrs. BK

Age on presentation: 70

Widow

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Seamstress- now part-time to assist her daughter’s fashion business

PRESENTING PROBLEM:

• pain and crepitis of the left temporomandibular joint • a substantial restriction of ability to open her mouth, to the extent that this patient was now

unable to place a spoon of food within her mouth • anxiety with regard to the sudden onset and restriction of this new symptom

HISTORY OF PRESENTING COMPLAINT:

The restricted ability of this patient to open her mouth had arisen spontaneously, two days prior to presentation. There had been no trauma to the local area, or to the neck or thorax.

The patient did report that she had been particularly tired recently, and had a tendency to fall asleep on the sofa, with the neck unsupported. She often awoke with the head and neck in a sidebent position.

This lady has attended osteopaths for many decades, and myself since 1998. She presents as a chronic pain sufferer, and a long term management case, with numerous rheumatological and orthopaedic conditions throughout her spine, and most other synovial joints. This new problem was one which was first presented to myself, as the patient felt she would be unable to open her mouth sufficiently to allow a dental examination.

RELEVANT MEDICAL HISTORY:

• The patient had no previous history of problems with the temporomandibular joints, or with opening or closing of the mouth. There had been no recent dental interventions.

• However, the patient has a long history of degenerative changes and spondylosis in the cervical spine, thoracic spine, and lumbar spine. This has been documented on X-rays over the decades, together with extensive osteoarthritic changes in the gleno-humeral and acromio-clavicular joints bilaterally. In 1999, the patient reported that she had lost 3 inches of height over the previous 4 years, as noted at a hospital orthopaedic appointment.

• The patient has also been diagnosed with Rheumatoid Arthritis, although she does not demonstrate any gross bony destruction of small or large peripheral joints.

• The patient is on multiple long-term medications, but due to a hiatus hernia, and gastric and oesophageal problems, is unable to tolerate any anti-inflammatory medications.

• She also suffers from chronic sinus congestion, which was further aggravated by two surgeries to the nasal septum in 1999. This has left an element of post-nasal drip, and the patient is often trying, ineffectively, to cough and clear her throat. The sinus congestion also appears to predispose the patient to recurrent episodes of upper respiratory infections, which if left untreated for any duration, always develop into chest infections. She is subsequently on regular courses of antibiotic treatment from her GP.

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SOCIAL HISTORY:

Despite decades of chronic pain and restriction, this lady is an extremely lively and charismatic, receiving much delight from her ability to entertain and motivate others. She worked, until two years ago, as a seamstress, specialising in fitting wedding dresses and evening dresses. She was also strongly committed to making costumes for the local primary school Drama Club. However, since the death of her husband two years ago, she has acknowledged her physical limitations, with regard to lifting and moving heavy fabrics.

She now works part-time in her daughter’s dress shop, which she enjoys from the aspect of engaging with, and dressing customers. This lady loves to make the customers laugh, laughing and giggling along with them. She equally loves to see them glowing with confidence when they have been dressed in “something which is right for them”.

PREVIOUS TREATMENT HISTORY:

I have used a variety of treatment modalities with this patient, but at the time of her second husband’s death two years ago, when giving her Ignatia 30C, I realised what a strong Ignatia constitutional picture she presented. Her history of musculo-skeletal symptoms is long, and management of the chronic pain and restriction is ongoing, with the patient on numerous daily prescriptions, occasionally supplemented by a cortico-steroid joint injection, from her GP.

The following presentation is a small, but typical, presentation and response from this patient. I was most pleased in these circumstances, to have effected a relatively full resolution of a newly-manifesting symptom, which otherwise could have led to significant distress and further restriction and disability.

PHYSICAL EXAMINATION:

• The patient demonstrated that she was only able to open her mouth to leave a 10mm gap between her upper and lower teeth. This caused pain, local to the left temporomandibular joint (TMJ), and crepitis was also palpable over the joint.

• There was notable tenderness in the left masseter muscle, the left temporalis and the sternocleidomastoid muscles bilaterally, although more notable in the sternal head of the muscle on the left side.

• Tenderness was also palpated in the left trapezius and the left splenius capitus, restricting the patient’s cervical spinal range of movement more than her normal range.

• A distinct trigger point was also identified in the left temporalis muscle, although this was more likely to relate to chronic postural elements.

• The leverage of the superficial left masseter muscle was probably more responsible for the crepitis in the left TMJ joint, as it would exert a stronger unilateral leverage, causing the mandible to be deviated towards the left side.

MANAGEMENT AND FOLLOW-UP:

My initial approach to this new symptom was to act cautiously, and treat the patient with the usual gentle soft-tissue and facial release techniques, to which she usually responded very well.

1st Return Visit:

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When the patient returned a week later however, she reported minimal changes in the symptom presentation, and attempting to eat was now becoming a dreaded experience.

The patient’s chronic postural changes, of increased thoracic kyphosis and increased cervical lordosis, with anterior placement of the head, were also maintaining factors of the shortened anterior cervical-spinal soft tissues, specifically, the sternocleidomastoid muscles.

The patient was most keen to try acupuncture, despite being advised that this would require needling in facial and anterior/lateral cervical spinal muscles. She had previous experience of acupuncture for her other conditions, and expressed no anxiety about the needle points that I would need to use.

Whilst in another patient I may have considered needling the trapezius and sub-occipital area, in this case, which involved substantial degenerative spinal changes, I did not want to risk needling modified anatomical structures. I chose to needle only the tender point in the left superficial masseter muscle, and the tender points in the superior portion of the left sternocleidomastoid muscle.

The patient initially received gentle osteopathic treatment of the cervical spine and sub-occipital soft tissues. Opening of the mandible still demonstrated only a 10mm gap between upper and lower teeth, with lateral deviation of the mandible towards the left side, and significant crepitis of the left TMJ joint.

Whilst the patient was still supine, with the head and neck appropriately supported, tender points in the left masseter muscle were needled. This allowed an immediate improvement in jaw opening, to demonstrate a 25 – 30mm space between the teeth.

I then addressed the tender points in the left sternocleidomastoid muscle, after identifying and avoiding the large blood vessels in the area. The muscle was needled whilst firmly grasped in a pincer grip, and several twitch responses were elicited. Examination of jaw opening after this showed a 30 – 35mm space with a marked reduction in left TMJ crepitis, and negligible lateral deviation of the mandible towards the left side. The patient was very impressed with the instantaneous changes in her symptom pattern.

2nd Return Visit:

The patient returned for her regular follow-up appointment one week later, and reported no further problems with jaw opening, or the left TMJ joint, in terms of pain or crepitis. Examination of jaw opening now found a space of 35mm between top and bottom teeth, without applying any stretch to the patient’s demonstrated function.However, the patient was now more anxious about her appetite and eating patterns, and the re-emergence of symptoms she had previously experienced.SECOND PRESENTING PROBLEM:

• The patient reported a return of her symptoms of changeable appetite relative to difficulty with swallowing, as had been experienced about 15 months prior, and on other more historic occasions.

• Whereas she had previously felt ravenous hunger when unable to open her mouth, she was now attempting to eat, but losing her appetite very quickly, in part distracted by “ the sensation of a lump in her throat when trying to swallow”.

HISTORY OF SECOND PRESENTING COMPLAINT:

This feature of the sensation of a lump in the throat had been intermittently present over the last 8 years. It had been fully investigated by the hospital ENT department on several occasions, including

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two endoscopic examinations, with the most recent of these only 10 months prior. No abnormalities had been identified, and no further investigations were due to be undertaken. (Globus hystericus)

REMEDY

The patient was given Ignatia 30C to take daily, until her awareness of the sensation of a lump in her throat diminished, and her appetite returned.

3rd Return Visit: The patient reported a full resolution of the throat sensation within 3 days, and her appetite was “back to normal”.

APPRAISAL AND HOMEOPATHIC HISTORY:

Whilst this patient receives a multi-modality treatment approach, she is aware that she has benefited over the years from intermittent use of homeopathic Ignatia. At times of stress she often asks for a dose “to help her manage”.

Manner:She demonstrates the Ignatia features of a dramatic nature and theatricality, whilst managing to repress the expression of her own emotions. Her vocal tone is usually high and child-like, but this collapses in tone and tempo with fatigue, grief and illness. On the few occasions she has broken down, these episodes are very quickly controlled, and then apologised for.

Personal History:This involved her leaving her first husband and her four children, with their father, in order for her to marry another man. She was devoted to her second husband, who died two years ago. However, she has endured a strong sense of guilt from leaving her children, although only one of them bears a grudge with regard to this. She is still trying to make amends to her children, who are now in their 30’s and 40’s. This leads to her physically over-extending herself, always motivated by a desire to please others.

Rubrics:THROAT; LUMP; sensation of aTHROAT; LUMP; sensation of a; extending upwardspasmoMIND; LAUGHING; tendency; hysterical

MIND; LAUGHING; tendency; compulsive, spasmodicTHROAT; CHOKINGSTOMACH; APPETITE; capricious raceSTOMACH; APPETITE; ravenous

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REASONS FOR CHOICE OF REMEDY

The particular symptom of “sensation of a lump in the throat” also appears strongly in the remedies Asafoetida, Lachesis, Lobelia Inflata, Moschus, and Natrum Muriaticum. However, this lady’s case demonstrates the mentals of an Ignatia state far more strongly than any of these other remedies, especially as some of her previous experiences (and investigations) for this symptom have shown a strong association with times of grief. Additionally, she demonstrates a generally high level of muscle tension, and a tendency to spasm (tics, twitches, spasms especially coming after grief), which I have observed over many years of her attending for osteopathic consultation.

Asafoetida also appears as a remedy for Globus hystericus, with the following overlap symptoms:• Sensation of a bubble or lump in the stomach rising up into the throat• Constriction of throat• Hysteria, especially if combined with intestinal problems

But this remedy is primarily for the gastrointestinal tract, with the main characteristic being a “reversed” peristalsis, from the intestines to the oesophagus. There were no other gastrointestinal symptoms in this case which fitted with this, and Asafoetida also fails to represent the grief element of the case.

Natrum Muriaticum could also be considered in this case, as it presents some similar throat and grief symptoms:

• sensation of a lump in the throat• ailments from grief and disappointed love• involuntary weeping

However, this lady’s demeanour is not the serious, refined and introverted nature usually associated with Natrum Muriaticum, and whilst it is noted that there can be an opposite presentation, in which patients seem abnormally open, “having learned to be open”, I feel this lady exhibits more spontaneity of behaviour. She has a constant desire to perform, entertain, and please both friends and strangers, which does not seem consistent with the Natrum Muriaticum remedy state.

D. Practitioner Profiles for Osteopaths, Chiropractors and Physiotherapists

General ProfileGeneral profile of an osteopath/chiropractor/physiotherapist with Faculty-accredited homeopathic training:

• An osteopath/chiropractor/physiotherapist will be a fully qualified and registered osteopath/chiropractor/physiotherapist, additionally trained in homeopathic medicine and qualified to integrate the practice of homeopathy into patient care, within the context of general osteopathic/chiropractic/physiotherapy practice.

• The extent of the homeopathic component of practice will depend on the level of training in homeopathic medicine to which s/he has progressed.

• Homeopathic prescribing will only be applicable to human patients, and may not be used in any animal cases the practitioner may be seeing.

• S/he will bring to the consultation all the ethical and professional values, competence and responsibility that are expected of a registered osteopath/chiropractor/physiotherapist;

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forming an all round assessment of the patient’s needs, and collaborating with other health care practitioners whose care the patient is already receiving or may need.

Homeopathic medicine is a specialist discipline in the sense that its practice requires special knowledge and skills, but it is a generalist discipline in its clinical scope. In this respect it resembles both general practice, and many of the presentations typical in osteopathic and chiropractic practice. The clinical scope of the practitioner, that is his or her range of general clinical knowledge, may not, however, be co-extensive with the clinical scope of homeopathic medicine itself. This will be the case for registered osteopaths, chiropractors and physiotherapists, who specialise in a holistic approach to conditions of the neuromusculoskeletal system. In these circumstances it will be beholden upon the practitioner to restrict the use of homeopathy to the clinical domain with whose symptomatology and management s/he is familiar. The nature of the subject itself, the content of the training, and its multidisciplinary context will be conducive to refreshing general medical knowledge, and it is expected that by the time MFHom level training is complete, students from specialised backgrounds will usually have the necessary repertoire of generalist knowledge to be clearly aware of their limitations in this respect.

Licenced Associate [LFHom (Osteo/Chiro/Physio)] ProfileProfile of an osteopath/chiropractor/physiotherapist with basic (introductory) homeopathic training:

On successful completion of basic training students will know -

❖ what homeopathy is; its basic principles and key concepts❖ salient features of its history and contemporary development❖ what it can achieve and what its limitations are❖ how it integrates with contemporary health care❖ when a patient would benefit from referral to a specialist❖ how to arrange a specialist homeopathic referral❖ how to interpret reports and instructions and how to act supportively during care from a

homeopathic specialist ❖ how to use homeopathy in a number of specific clinical situations integrated with normal

professional practice in day-to-day patient care❖ the scientific implications of the subject and the key features of its evidence base❖ an awareness of clinical governance as it applies to medical homeopathy

Students will be encouraged to look at patients from a homeopathic point of view, to ‘think homeopathically’, and to consider how a homeopathic approach could benefit a patient’s care, without necessarily making a homeopathic ‘diagnosis’ or making a homeopathic prescription.

They will not be equipped to practise beyond the limited range of applications defined in the basic training section of the curriculum. These targeted clinical applications may augment existing professional skills when appropriate, but do not permit any more extensive use of homeopathy. The student will not be expected to know how to analyse and treat chronic or complex cases, other than by the circumscribed use of these particular targeted applications.

The only exception to these restrictions is the gradual widening of the scope of a student’s use of homeopathy, under regular supervision by a Faculty accredited tutor or supervisor, as part of their continuing education and training on an MFHom training course.

Osteopaths/chiropractors/physiotherapists who have completed basic training will usually be working in private practice, and their usual osteopathic/chiropractic/physiotherapy work should continue to be their core clinical activity. The use of homeopathy will be only complementary or supplementary to that activity. As circumstances will necessarily entail the private practice of homeopathy, this will present an ideal opportunity to record and audit the use of any

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homeopathy in practice, and then to use this prescribing information as a point of discussion for either CPD purposes, or with their supervisor, if they are following the MFHom pathway. At all times they will be expected to possess the competencies appropriate to their general osteopathic/chiropractic/physiotherapy training, and to make use of homeopathy within this role.

Osteopaths/chiropractors/physiotherapists trained to this level will be eligible to sit the Primary Health Care Exam, and if successful, to apply for Licenced Associate membership of the Faculty of Homeopathy [LFHom(Osteo/Chiro/Physio)]. This status must be maintained by fulfilling the Faculty’s published requirements for continuing professional development in homeopathy and in the relevant core medical discipline.

MFHom ProfileProfile of an osteopath/chiropractor/physiotherapist who has completed the MFHom training:

On successful completion of MFHom training, in addition to the attributes already described, osteopaths/chiropractors/physiotherapists will have -

❖ comprehensive knowledge of the history, principles and concepts of homeopathic medicine; the ability to communicate these to others

❖ enhanced skills in practitioner-patient relationships and communication❖ good skills in homeopathic case taking and analysis❖ a comprehensive knowledge of the materia medica and comparative materia medica of a

specified list of major homeopathic medicines❖ knowledge of the key features of a specified list of minor homeopathic medicines❖ the ability to identify the indicated medicines reliably and to differentiate between them❖ a thorough understanding of therapeutic method ❖ the ability to apply their knowledge appropriately to all appropriate health needs, including

chronic and complex disease❖ understanding and discrimination of the role of homeopathy in integrated patient care❖ a disciplined and informed approach to inter-professional care❖ the ability to communicate to non-homeopathic colleagues the role of homeopathy in patient

care, particularly in the shared care of individual patients❖ awareness of the limits of their personal competence and when and how to seek specialist

assistance❖ knowledge of the scientific issues, research activities and evidence relating to homeopathy; the

ability to communicate these❖ understanding of the basic principles of research methodology; some experience of auditing

their use of homeopathy in clinical practice❖ understanding of clinical governance as it applies to medical homeopathy, including a

commitment to continuous learning and clinical audit; the duty to report concerns about the professional performance of colleagues and critical and untoward incidents; awareness of patient complaint procedures

Osteopaths/chiropractors/physiotherapists trained to this level will be eligible to sit the MFHom (Osteo/Chiro/Physio) clinical examination and, if successful, to apply for Membership of the Faculty of Homeopathy. This status must be maintained by fulfilling the Faculty’s published requirements for continuing professional development in homeopathy and in their relevant core medical discipline.

Osteopaths/chiropractors/physiotherapists who have completed MFHom training will normally be working in private practice, and will apply their knowledge and skills in a way that is appropriate to their usual case presentations. Their standard case-load may continue to be their core clinical activity complemented by the occasional use of homeopathy. They will be able to manage homeopathically more complex clinical problems for their own patients than at the basic level of training, and, under supervision, to tackle more complex clinical problems for patients from other colleagues.

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Alternatively, part of their working time will be dedicated to the use of homeopathy as the main therapeutic method, in appropriate neuromusculoskeletal cases.

MFHom qualified osteopaths/chiropractors/physiotherapists may see patients on referral for homeopathic treatment for neuromusculoskeletal presentations, but are required to work with the support of a Faculty approved tutor or supervisor. At all times they will be expected to possess the competencies appropriate to their general osteopathic/chiropractic/physiotherapist training. They will be expected to be alert to problems or disorders newly arising or previously unrecognised or undiagnosed by other practitioners, in the patients consulting them for homeopathic treatment, and to manage these appropriately. They will be expected to maintain effective communication with other health care professionals involved in the care of the patient, and to make appropriate referrals to others when they recognise needs in the patient that they are unable to meet.

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Faculty of HomeopathyCAN Mezzanine49-51 East Road

LondonN1 6AH

020 3640 5903education@facultyofhomeopathy.org

www.facultyofhomeopathy.org

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