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“Modalities” concept in homeopathy and its importance in case analysis

“No two snowflakes are alike.” Like human fingerprints, each snowflake is considered different, and no two snowflakes look exactly the same as each other. That is also the case with diseases: the same disease is experienced differently by different people – and this individuality is due to symptom modalities.

If you have already visited a homeopath, you might be aware of how many questions they ask. And this is not just to fill your appointment time, or out of their curiosity. What? Why? Where? When? How? You can definitely feel overwhelmed by this many questions. And that is not all. I feel your pain already, but in order to find the best remedy that will start the healing process, your homeopath will go into a lot of details in case taking.

What makes it worse? What makes it better? Is there a specific part of the day you feel worse/better? What weather do you like or dislike? – These answers will give individuality to the case and lead the homeopath to the similimum. The word similimum is a Latin derivate of “similis,” which means having the absolute likeness of one thing to another. It simply means having similarities in all aspects. The word similimum, in homeopathy, is the most similar remedy in a given case which covers all the totality of symptoms. In order to find the similimum, modalities play an important role. Modalities are the circumstances and conditions that affect or modify a symptom. In every individual case, prescription based on modalities is one of the main guide to choose of remedy.

There are different types of modalities: time, body posture, weather, climate, season, thermal modalities, food and drinks, psychological and mental factors, and more.

Times modalities – is related to the symptoms that increase or decrease at the same corresponding time. There are just a few examples: anxiety and panic attack can be at its worst at midnight, an asthma attack that usually occurs between 2:00-4:00 am, dry coughs at night time but wet coughs in the morning, insomnia/waking up and difficulty falling asleep after 3:00 am, all complaints are at their worst between 4:00 pm to 8:00 pm, etc…

Body posture modalities – is about the body position in which a person adapts, whether it be sitting, standing, or sleeping, in order to decrease the symptoms. Such as: feeling better when lying on the painful side, ameliorated sitting with your knees up to your chest, the pain is at its worst when bending forward, pain is better by bending double, ameliorated by crossing your legs, shortness of breath is alleviated when the person’s sleeping position is lifted by a few pillows, etc…

Weather, climate modalities – relates to the atmosphere in specific places within a short period. For example worse/better in foggy, rainy, windy, cloudy, hot, humid, cold, damp, and dry weather. A patient that needs Dulcamara will be aggravated by damp, wet, or cold weather, as well as getting wet. Aconitum is suited to the complaints that come suddenly from the cold and dry winter weather.

Thermal modalities – is how the present symptoms respond to heat or cold. When it comes to skin eruptions, an Apis-type patient’s symptoms improve from cold application and is aggravated by heat, while a Rhus toxicodendron-type patient’s symptoms improve with the application of hot water. 

Food and drinks – some people have an intense craving for one or more foods: sour, sweet, spicy, pungent, salty, and bitter. The food sensitivity could lead to the similimum, as an example, there are 21 remedies that can be useful for lactose intolerance, especially when they get diarrhea from milk. Sweet cravings in kids are more or less important, but their craving for salt is a quite valuable piece of information that could lead to the right homeopathic remedy because is unusual for kids to crave salt. The peculiar and unusual symptoms are what a homeopath is looking for. One of my patient mentioned, “cold water tastes much better than room temperature”. The child preferred cold drinks, which stands for Phosphorus in the 4th degree, and another 106 remedies are mentioned in the Repertory in rubric “desire for cold water”. One of the leading symptoms of an Ignatia case might be that the person cannot bear the smell of tobacco and have an aversion to fruits. Sometimes, you can find that what the person craves for, he is aggravated by it as well, ex: Nux vomica – stimulants, Phosphorus – salt, Argintum nitricum – sweets. One of my cases was solved when the patient mentioned: “I get my nose clogged every time after my meal, and it doesn’t matter what I eat”. In the Repertory under the rubric “Nose-obstruction-after eating” is mentioned just 2 remedies. So, the peculiar symptoms are the gold and could be the key in solving the case.

Psychological and mental factors are about the person’s internal state of being and involuntary physiological response to an object or a situation, based on tied to physical state or sensory data. Such as: aggravated by crying, better/worst by consolation, worst after the suppression of the feelings especial anger, anxiety from anticipation, ailments from bad news, worst being alone, easily lose the temper in traffic, unmoved by apologies, anger over his own mistakes… Please keep in mind, the homeopathic appointment is a judgment-free zone, and the person’s way of reacting to different emotional or physical stimulus is part of their individuality. Symptoms are seen as the body language of expressing the existing imbalance.

Modalities are always important as they give the “fingerprint” to the case and greatly help in finding the similimum. Not all modalities possess equal importance. The ones related only to particular and less important symptoms are of less importance. However, the remedy prescription is done by the totality of symptoms, the modalities could be the clue that guides the homeopath in choosing the right remedy, so they should not be ignored.

Kent says, “I have frequently known young men to mistake a modality for a symptom. This is fatal to a correct result. The symptom is a sensation or condition, and the modality is only a modification. The symptom often becomes peculiar or characteristic through its modality.”

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