A Closer Look at Keynotes
Paul Herscu ND, DHANP

One of the greatest challenges of homeopathy is the sheer volume of information the student or practitioner has to contend with. The quantity can be so overwhelming that sometimes the only way to understand case taking, case analysis, materia medica and our patients is by breaking the pieces down and looking at them from different angles -- even looking at things we thought we understood.
In every field of endeavor, it is the things we assume we understand that often lead us to failure.
These problems of perception are the blind spots I frequently confronted in my 20 plus years of busy practice. We often think that learning another rubric or a new remedy will solve these difficult cases but generally speaking, going back and addressing the blind spots is much more rewarding.
The subject of keynotes perfectly illustrates one such problem. The understanding and definition of keynotes has numerous variations, many of which conflict with each other. Many homeopaths claim that keynotes are strange, rare and peculiar symptoms that point to a specific remedy. And yet many of our best keynotes are common symptoms, as is evidenced by examining any book on keynotes.
Others say that keynotes are symptoms that fit only one remedy or a few select remedies, and yet many of our best keynotes fit many remedies. It seems a keynote can in fact, be strange, rare and peculiar, and it can be common, it can fit one remedy or many remedies, it can be a pathologic symptom that fits the disease or a physiological symptom that does not.
In short, when looking at any keynote book, from the newest ones to the original list that Guernsey compiled, it can be seen that any symptom can qualify.
So what is a keynote?
Every patient has keynotes of various remedies. The more remedies you know the more keynotes you can find in any one individual. To be specific, I have never met a person that did not have 3 or 4 keynotes of a dozen remedies, let alone a single keynote of scores of remedies. So the problem is which keynotes do we use, if we can even agree on the definition of a keynote?
It appears de facto, in our profession, that the definition of keynotes is rather 'fluid.' I believe that understanding this fundamental issue in homeopathy is essential to helping our patients get better.
If you look at any remedy in our materia medica, you will be struck by the fact that there are large general trends running through the symptoms. This point has struck every classical homeopath from Boenninghausen onward. You could in fact, make a list of every one of those large trends and find that some of them fit into even larger trends.
For example, Sulphur's 20,000 symptoms can be classified into a couple of dozen main trends, and from there into less than ten main ideas. For Sulphur, the heat of the head, eyes, face, lips, throat, etc, can all be compressed into the general trend of Heat, which I refer to as a Segment.
By looking at the large general trends of a remedy, the landscape becomes uncluttered and it becomes clear why certain symptoms are keynotes. In fact keynotes have nothing to do with how rare a symptom is, as is sometimes mentioned. Keynotes are examples, sometimes chief examples of symptoms that point to large general trends in a remedy.
The reason 'sticking the feet out' is a keynote of Sulphur has little to do with how rare the symptom is. In fact, when polling homeopaths, about 15% of their patients have this symptom. Rather, 'sticking the feet out' is a keynote because it is a chief example of the heat sensation of Sulphur.
Once we see a keynote as an example of a larger trend we can understand how to use them and how they have been misused. Kent used to say he hated keynote prescribers on the one hand and yet he used keynotes all the time. Kent was using keynotes, which represented the general state. What he abhorred was people using keynotes without looking for the general state of the patient.
Likewise Guernsey, Hering, Lippe, Boenninghausen, all used keynotes, but only when the keynote represented a larger general process of the person or remedy in question. This is the point that has been missed by our community, and the point that has led to many errors in prescribing.
There is a great deal that can be said about keynotes, which space does not allow, but let me offer some ideas:

#1. To date many people have been studying keynotes as a one-way process. They study the remedy and when a patient comes in with those same keynotes, they "recognize" the keynote and prescribe on it.
#2. The problem is that we must first find the general trends in the patient. Once we find those trends, once we establish what the large segments are, then we can look at the keynote symptoms, which exemplify those trends in the patient.
#3. Once we find the keynotes that represent the larger issue of the patient we can then investigate those. We do not have to pay attention to symptoms that exist in the patient if they do not fit their general state. Every patient has many keynotes of many remedies. This process shows you which symptoms to pay attention to and which ones to avoid.
#4. One of the biggest problems that this model highlights is that we often 'warp' our patient's symptoms into a preconceived notion rather than trying to understand the whole patient and their general trends as described by Hering and Boenninghausen. We have left out the step of finding the general symptoms of the patient and then finding the keynotes of those general trends.
#5.We can finally understand why symptoms make it into keynote books. Look: at the materia medica in this fashion: not as a haphazard list of symptoms but as symptoms that represent large, general trends. Then you see that keynote books are listing examples of those large trends, having little or nothing to do with how strong, weak, rare or common a symptom is.

Let's look at a case, which demonstrates these points:
Case number 401

Donald is a twelve-year-old boy. His main complaint is chronic headaches. They begin in his right occiput and extend to the right temple. They eventually settle over the right eye. The headaches tend to occur after a baseball game, where he pitches, or after hard work at school; both situations are due to his competitive nature.
During the headache he becomes sensitive to light, noise and conversation and wants to be alone. He becomes irritable and snaps at his mother if she tries to comfort him in any way. At times he vomits with the headache. Hot showers or hot applications to the head ameliorate the pain.
He is sensitive to cold, and shivers easily, even with the headaches. He also has growing pains, mostly around his right shin and knee, though they could be due to an injury he endured playing soccer. The leg pain feels worse at night, when he can also develop cramps in the leg. It feels better if he massages the area or takes a bath. He likes warm food.
There are two famous keynotes in this case - headache, extending from the occiput to the right eye and vomiting with the headache, both keynotes of Sanguinaria, which had been given by another homeopath, but which did not help.
Likewise there are keynotes of Rhus toxicodendron, which also did not help. There are keynotes of many other remedies listed in this short description. Think how many keynotes there are in a full case, where we have 10 pages of notes.

However, looking at the general trends in the patient first, we can list the following points:

A. Right-sided complaints, especially headaches
B. Competitive nature
C. Extreme sensitivity to stimuli
D. Irritability
E. Warmth ameliorates.

Once we have identified Donald's keynotes, we can go to the materia medica and see that Nux vomica represents a good match by having the same keynotes. This process helps us discard keynotes of other remedies because, even though they are keynotes of those remedies, they are not part of a general trend of the patient in question and therefore not keynotes of the patient.
There is a great deal more to say about this topic. By taking the large subject of keynotes and separating it into its parts, we can put it back together and develop a deeper understanding. In most cases, it is not the lack of knowledge of a remedy but rather the lack of understanding of how to apply the remedy that creates the problem.
Excerpted from the Herscu Newsletter
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