The hungover teen in the repertory

I noticed a thread on Facebook recently where a parent was asking for advice about a teenager who'd been vomiting for hours after a night of drinking.

I understood the instinct of many of the people responding. Consequences teach. But the comments were answering a moral question when the situation was a worried mom asking for help.

Since Rubric Wise was born from the common question "how do I find this in the repertory," I thought this would be a good example to play around with.

Stomach, nausea, from disordered stomach

"Stomach, nausea, from disordered stomach" - does this rubric mean a hangover?

Not necessarily. That rubric is broader than alcohol. It covers the stomach being upset, deranged, or overloaded, which can come from overeating, unsuitable or unhealthy food, dietary errors, or a heavy meal that just didn't sit right. Alcohol can be part of that picture, for sure, but it's not the only reason we reach for the rubric. It's a small rubric though, with some potentially matching remedies in it, so it's a nice place to start.

Etiology rubrics

If the cause is alcohol and your repertory carries a rubric for the cause (etiology), that rubric earns its place in your thinking. Boenninghausen and Hahnemann both gave weight to a clear, reliable cause when one is present, and a known cause narrows the case faster.

But the Complete Repertory has a whopping 452 remedies in the rubric "Generalities, intoxication, after," which isn't much help when the rubric is so huge, so we have to pair it with what is going on right now that needs to be healed.

Boenninghausen has a rubric "ailments from alcoholism," but can we apply that in an acute case of intoxication? It seems to imply a bigger problem than the teenager suffering the consequences of a single incident of not knowing when to stop.

Acute alcohol effects vs an alcohol problem

One of the joys of repertory is trying to fit 200+ year old language into modern day issues. I remember learning the term "dipsomania" at school. I just thought that was such a fun word (for a serious problem).

Dipsomania redirects to "Mind, alcoholism" in modern software, and the semantic search in a tool like Similia is helpful here. Dipsomania describes more of a chronic pattern, a periodic and often involuntary compulsion toward drink. It belongs to the person's underlying tendency, not to the teen with a hangover sitting in front of you.

A client who overdid it at a wedding and feels sick the next day is not a dipsomania case. A client who describes a recurring, uncontrollable urge to drink until intoxicated, one they don't want and can't seem to stop, is. Mixing the two means reaching for a rubric that describes the wrong layer of the case, although the remedies may overlap based on the remedy action.

Other ways you can express the same kind of pattern may be through the repertory words "libertinism" or "debauchery."

Back to the teenager

The symptoms and the etiology are different aspects of the same case.

The etiology is the cause, in this case after alcohol/intoxication. It tells you what triggered the complaint.

The symptom is what's happening now. Nausea and vomiting. It tells you the current state.

This is where questioning mom comes in handy. What is going on with the son? Is he continually nauseous but not relieved by vomiting, which may call for Ipecac? Is he suffering the effects of "too much" alcohol with his liver compromised, which may call for Nux vomica? What else can be observed in the moment that guides the remedy choice?

To return to that Facebook thread, it had been several hours of vomiting after drinking for this teen, so the prolonged duration of the vomiting had become the uppermost concern.

My approach

So this is probably how I would have approached it in the repertory. I would have added the etiology since I knew it (after alcohol). Then the chief complaint itself, vomiting, with its modalities (as explored with mom). Then the current general state (e.g. as observed by mom): prostration, thirst or its absence, chilliness, weakness, and so on. Then any concomitants: headache, abdominal pain, sweating and so on.

"Ailments from loss of fluids" is tempting to reach for here, but I don't know if I would include it right away. Perhaps if he wasn't able to keep any water down, I might. But we can take a different rubric that describes that pattern, such as the well-known Phosphorus keynote of vomiting as water hits the stomach, "Stomach, vomiting, drinking warm, in stomach; as soon as water becomes."

The ailments from loss of fluids rubric covers the depletion that has become the characteristic state, someone weakened after prolonged vomiting, hemorrhage, profuse diarrhea etc. If the teen was still actively vomiting and sweating, I'd probably focus more on the vomiting and address the depletion after the active vomiting has passed. But what do you think? Would you give a loss of fluids remedy in the middle of losing the fluids, or after, as part of the recovery?

And with my safety hat on

I once had a trip to the ER during a prolonged bout of food poisoning while pregnant. I felt pretty rough. Hours of vomiting can produce real dehydration and electrolyte disturbance, and in this teen's situation could signal alcohol poisoning. A teenager in that state needs eyes on him. The discussion on consequences can always follow later. As a homeopath and someone who has spent many years in a corporate hospital position, I'm a big advocate for being seen by a medical facility when the situation warrants it.

Final thoughts

Many of us know the remedies we would reach for in this situation, and perhaps a repertorization isn't needed, but it's good to think it through. What needs to be healed in the moment, how can we use the cause to narrow down rubrics, what can we observe about what is happening right now, and when is an emergency an emergency?

If you want a faster route through acute cases, my Acute Prompt Cards walk you through exactly this kind of decision, cause, symptom, and current state, in the moment you need it, not after. https://rubricwise.com/acute-prompt-cards