Omisch is stated to the written that “as much more one masters the Materia Medica, and trained in Constitutional thoughts and practice, so much less will the Repertory be required.” That is not really so, I shall show through some Ignatia cases.
The Ignatia constitution particularly the mental constitution, is well known, as Hahnemann has written in his pure Meteria Medica, that the medicine is suitable for persons predisposed to certain states of the constitution and that it is a major medicine to persons who react to mental injury. “Typical of Ignatia is that the Mental state is very much extraordinarily affected, pronounced sadness and a tendency to grieve silently. The further characteristic is a striking alternation of the mood between the maximum extremes .” Superficially, one recognizes Ignatia patients by their extraordinary mental involvement and course on the side suppressed grief and on the other side alternating mental states.
But strangely in the appears to be different. If some of the other Ignatia symptoms of the patient are available to the physician, he may not then consider these mental symptoms. Hahnemann has not said that in all Ignatia cases one finds a quick alteration of gaiety with weepiness, but that, “Ignatia is suitable to such persons .” Further “Ignatia serves as the main remedy in cases of vexation in persons who keep the vexation to themselves,” We should make use of the symptoms only so. We should not at all ask for these mental symptoms in a case in which we think of Ignatia for other reasons. Of course , often in these other cases without expressly asking for it , at least implied mood instability or a “being vexed” in a broad sense, something like by a bereavement, can be located, We can take it thankfully as a corroboration or assurance of our choice of the remedy, but we may not demand for the manifestation of this mental “constitution ,” they are by no means pre-requisites for prescribing Ignatia .
In my practice in a large number of these patients no mental symptoms came up if we were to consider as symptoms only those which the patient gives out spontaneously or those which can be observed in the patient without having put questions in such a manner as to obtain a reply in one way or another. Also the observation of  Mazger that it is “typical’ of Ignatia that the mental state is affected very much, must be understood correctly. If we have a case in which the mind is affected extraordinarily much, we think of Ignatia. It is not always so that in all Ignatia cases the mental state is altered apparently. There are many other symptoms of Ignatia, purely physical, which are so well recorded that any single one if it occurs in our patients, make us think of Ignatia. Sometimes, this single symptom is sufficient to decide the selection of the remedy, that is to say if it is described in full and also if in its fullness it agrees with an equally full proving symptom. Also, not all Ignatia symptoms come up for observation in particular patients but always a small portion. Sometimes only a single one. For these reasons we cannot demand that particular symptoms must come up in all cases.
Just as in a single patient only this or that symptom of Ignatia comes up so it is in a prover. Every prover can bring out only those symptom to which he is disposed to . which has been slumbering in him, as Hering put it in 1861:
“In his original report on China proving Hahnemann said clearly: “All those symptoms which I experienced in intermittent fever, made their appearance”. Hahnemann had been in Siebenburgen and contracted there the intermittent fever probably repeatedly, and all characteristic symptoms which he experienced, now made their appearance. “It would be a nonsense to wish: Peruvian bark should bring about intermittent fever in every mortal in the earth. The bark can do so in such persons only who are already so placed; only where it is slumbering, it is possible to arouse, may be the residue of earlier as the commencement of a new .”In Hahnemann, the same paroxysm revived itself, when he took the Peruvian bark again, every time. “I stopped it and I was well”.
Even as in the prover only the symptoms preexisting can be aroused so also only those symptoms in the individual patients can make their appearance as disease results to which he is predisposed and which are contained in his constitution and are slumbering. Even as the prover with same constitution can prove different medicines, the patient with the same constitution can suffer from different diseases which require different curative medicines. It is not constitution which indicates the medicines but the disease.It is simply not possible that in an individual patient or in an individual prover all the symptoms which a medicine can call forth, appear. This is one of the reasons as to why in Homoeopathy there is no indispensable or obligatory symptoms in every individual patient; naturally, such symptoms are only in ideal total picture of the medicine.
The Ignatia headache , for example is well –known . The headaches are if a nail was being driven through the head , which are better by lying on the side . It has been stated so in Kent’s Materia Medica and in the Keynotes of H.C.Allen . In the proving , the symptom No.297 is given only as : “One sided headache , as if a nail is pressed into the brain” . The modality of amelioration from pressure or by lying on the painful side is of clinical origin. Hering’s Guiding symptoms provides this symptom with double bars indication that it has been repeatedly verified . I too have a number of such cases :
Mr .St . on 14.10.1980 :     I always have a headache , since recently . It is mostly one-sided , at a small spot it comes suddenly which I have never had before . Mostly it is drawing into the ear , it is then just like something pulling and if I put something on it is better . If I lie on it also it is better .
Mr . Br .  on  29.9.1980 :   In the last few days I have been having such a headache up there . Throughout the day it was better , evenings and nights it goes here into the left eye and in the left side of the back of neck as if ants were running there . But only left half . But up there this pain , I do not know exactly how to put it , as if a nail has been driven or something like it . Throughout the day I have tied a scarf around it, yes , it is then slightly better.”
Mrs . Ho .on 11.2.1975 :     Migraine I have had since I was small . On the right side , it goes into the right ear , and stays there in the neck . The pain goes through the eye . Often it is sharp , stitching pain . I have had occasions when I wanted to deaden the migraine pain by striking it with the hand . Then I have by chance pressed my face with cold water and also pressed the painful part and for once I observed : it did good ! At times the pain is boring . The headache is better by lying on that side.
That an Ignatia patient wants to hit his forehead , to ameliorate the pain , I have observed in another case :
Mr . Am .on 11.2.1975 :      Boring in the root of the nose , also going upto the eyes occipital protuberance . Sometimes I knock upon the forehead , it ameliorates . Knocking and pressing well”.
There is something else that accompanies this headache , as from a nail which becomes better from pressure . One can hear it in actually all the cases –that the pain is one-sided , that it does not stay in one spot , but it draws towards other places , to the ear , the occiput or to the eye on the affected side . A proving symptom (No.24)  points out something similar : “Stupefaction of the head which changes into a pressing pain in the vertex , this then draws up to the forehead and to the left eye”.
Voisin has indeed indicated the headache as from nail , only as “frequently appearing” and not as “essential” but nevertheless it is only from of headache he cites Ignatia H.C.Allen, in his small but admirable book for quick reference, Keynotes , mentions the same headache . One might take it that “the” Ignatia headache in the concept of “Constitution” is the headache as from a nail better by pressure is part of the Ignatia constitution . Now another case ;
THE TENSION HEADACHE :                                                     
Mr . Th . on 11.12.1979 :    I have severe pressure on my head . Then the pressure came on the head as if one has been running , only that it did not pulsate. In the forehead I have sensation as if it goes to the back of the head . The pressure goes from inside out , a sensation as if there was plenty of blood in the head . A tension . Better when lying and better by bending forward while sitting”.
Nothing about a pain in a small location , better by lying on the painful side , and let us consult a Repertory even if we believe that we think and act ‘constitutional’. For headache better by lying and bending we find 5 remedies in the Boger –Boenninghaussen , Ignatia the only remedy in higher grade . If we compare our case with the head symptoms , not only the well-known symptoms but all those which appeared in the proving , we come upon following symptom No .19 “Heaviness of the head , as if filled with too much blood with acute pain in the occiput which becomes better by lying on the back aggravated by sitting erect but most relived by bending the head forward very low”.
Here is the rare occassion of a complex symptom of modalities and sensation exactly the same upto wordings , between the patient and prover , although both occurrences are 150 years apart . That was in December 1979 , in November 1980 came another such a case :
Mrs . C1 . on 17.11.1980:   Headache over the entire head , more on the right . A tense , a fairly tight sensation , as though everything drawing together , and always drawing through . If I lie low, sometimes it becomes better . Better when I lie on the back , when I turn to the side it sometimes returns again . Lying on back ameliorates”.
Just as the prover , this patient has amelioration from lying on the back . That is again something which runs through the entire medicine , a general modality . In the Ignatia patients we find of course frequently some , who feel better generally by lying on the back . Completely different ailments are ameliorated by lying on the back , the amelioration by lying on the back or no amelioration by lying on the side , is general characteristic of Ignatia . Some examples :
Mr . Ko . on 27.2.1979 :     In the sacrum continuous tension , better if I lie down , lying is perceptibly agreeable , possibly on the back or on the abdomen . Lying on side does not give any relief .
Mrs . St . on 14.3.1979 :    I cannot lie on the side because of my spine , then I get headache and pain in neck .
Mrs . Mu . on 8. 11.1979 :   Elek nearly finished me almost and of course she had pains in abdomen to such a degree, that I thought she had an appendix. Gurgling in the abdomen and continuous belching . She must lie quietly , she lies absolutely flat on her back and somewhat bending forward when she goes to the lavatory . She lies quietly and says: “Mummy , I am terribly restless, please sit by me .”
Before we discuss the restlessness of Ignatia , I shall cite some further instances from provings for the amelioration from lying on the back , narmely No.599 : “Here and there in the periosteum in the middle of the shafts of bones , a transient pressure as with a hard body , like contused pain by day , especially by lying on one or the other side and passes of by lying on the back”. No600 .: “Nights on one or the other side , on which one is lying pain as if bruised , in the joints of the neck , back and shoulders which goes off only when lying on the back”
The restlessness of Ignatia is actually more a part of its main attribute : the quick alternation between extremes . Not only opposing moods alternate with each other quickly , but Hahnemann spoke of the altogether alternate actions , of symptoms which are exactly opposite, which quickly follow each other . Appetite and loss of appetite , painfullness and painlessness of hemorrhoids while walking , diminution and increases of sexual urges , amelioration and aggravation by lying on the back, by bending, by lying on the painful side and many others alternate often and quickly .
Mr . Th . on 11.12.1979 :    An incredible restlessness . I could not sit still anywhere , and bought something to eat , ate it , went out again for some fresh air , again came in, sat down, stood up again, wanted to lie down for a bit of sleep , within next two minutes stood up ; really such an incredible restlessness .
Well known is the temperature symptom :
“Chill with thirst , only during the chill , better by external warmth , heat without thirst, worse by covering”. And here and in the following temperature symptoms of the patient with clavus headaches, we observe the incredibly quick alternating states opposed to each other .
Mrs .Ho . on 11.2.1975 :     And also I cannot bear heat , it is now one thing and next another. I open the window , then I get too chilly , it alternates and then I run a warm bath .
So we can see that what is often indicated superficially as ‘Ignatia constitution’ or ‘Ignatia type’ corresponds more to ‘totality of the symptoms’. Behind many single symptoms are some common factors, changeableness, injured feelings , disposition to get cramps; but this is not as a rule apparent in the consultation . One cannot also classify the patients thereby, as sometimes possible theoretically, as with the usual constitutions or constitution types. Again and again one has to depend upon the individual symptoms complex to diagnose the remedy, and later one realizes that in fact the totality of the symptoms fit Ignatia . Hahnemann has elaborated these differences in his Foreword: “Ignatia is not for persons or diseases in whom anger, eagerness, violence, holds way but where a rapid alternation of hilarity and weepiness or the other emotional states”. Hahnemann said so. But that is not a general rule applicable for the choice of the remedy in every case, but only in particular cases.
To conclude, I will now narrate three individual symptoms in which Ignatia can be frequently recognized . To begin with , the well-known lump . Lump sensation can be found in many medicines but a lump which one only feels very least when not swallowing . From Hahnemann the symptom No . 163 : “choking sensation in the middle of oesophagus as if a large morsel or a plug was sticking there , felt more while not swallowing than while swallowing”. It can be observed from the following cases of mine that the lump sensation is never unilateral . From the first patient we have already heard about the tension headache :
Mrs ,C1 . on 17.11.1980 :    “Before I get the period I actually always have the throat pain for a day . The throat pain is always a little lesser while swallowing”.
Mr . Me . on 3.12.1980 :     “A bit of a feeling of lump in the throat , in the pit of the throat . I do not notice it while swallowing and when I swallow, for example now, independent of swallowing –hold a moment – it goes for a moment and then returns again”.
Secondly, there is a definite of the respiratory problem with Ignatia.
Mrs . Wa . on 13.2.1979:     Breathing difficulty, I suffered much to get air into my lungs , last weekend ; I have a lump in my throat , when I am in a hurry. I find it hard to breache , it doesn’t get through well , I cannot breathe properly.
Mrs . M . on 9.10.1979 :     a drawing sensation in the chest and then I struggle always with the breathing , and when I want to take in air , it doesn’t get in rightly . (To the question about the pain ) I must take in a really deep breath . When I yawn then I get sufficient air in ,it is then again o.k.
That is the well-known sighing of Ignatia or the following proving Symptom No.478: Slow inspiration , quick expiration . As is often with Ignatia , the opposite symptom also come in the proving No.658: “Short inspiration and slow expiration during the sleep”. These opposite symptoms appearing in one and the same drug is observed particularly in Ignatia . Hahnemann has said in his Foreword : “On account of the alternating actions that follow each other quickly , which it excites , it is suitable for acute ailments particularly , and for more of these , as may be seen from the symptoms corresponding in similarity to symptoms of disease , frequently met with in daily life . It is therefore rightly regarded as a medicine created for great usefulness (polychrest)”.
The occurrence of the opposite symptoms would suggest that these pairs of symptoms would be very valuable in treating patients . Hesse wrote in 1834 in connection with the proving of Berberis : “How very difficult it is , even with carefully proved remedies to come to definite conclusions with some symptoms . They will reveal themselves often in contradictory fashion in one and the same part . Everyone who has engaged himself with provings has felt the same often enough …… The observation of E.G. Helbig , ‘The Nutmeg’, Leipzig , 1833 , 8th preface,p.14): “A drug symptom is rightly useful only if the opposite symptoms also appear in one and the same part, seems to have been drawn from Nature”. Well –known is the high potency provings brought out symptoms often which were opposite of low potency provings ; in short, it cannot be said that a proving establishes clearly and one-sidedly the constitution (whichever way this may be defind).
The following proving symptom No.479 is relevant : “must often breathe deeply, and deep breathing diminished the pressure on the chest”.
The third individual symptom is a typical glittering scotoma , as graphically described in proving No.105 : “A circle of brilliant white , glittering zig-zag beyond the visual point when looking at anything whereby the letters on which the sight is directed become invisible , but those at the side are more distinct”. My patient put it like this :
Mrs . We . on 3.5.1976 :     I see a zig-zag in my eye , bright ,like a neonlight , like a quarter moon an are in zig-zag . When I have been up long and work hard then it comes again after the lunch”.
Even the aggravation after lunch is found in the proving No . 105 : “A zig-zag like and serpentine , white , glittering sideways of the visual point , soon after the lunch”. Now ,in this patient during the consultation the Ignatia proving symptom of glittering before the eyes was not known to me . I had to search it in the Repertory . Unfortunately kent has not included it ; he has given only Bryonia for scotoma after lunch , Thuja during lunch and Lycopodium in the afternoon after mid-day nap , but none of the remedies for zig-zag figures . Boger-Boenninghaussen is thorough here where in one can find the medicines for one-sided zig-zag figures on the one hand and on the other under sufferings from visual disorders particularly in the afternoon . Amongest conium, Ignatia , Lycopodium and Sepia , only Ignatia is found in italics in both the rubrics .But it should not be decisive for the prescription , but one should take the time to quickly study these remedies in the Encyclopaedia during the consultation hours , to see whether the symptom description by the patient matches strikingly to the words in the provings of one of these 4 medicines . In this case such a brief reference to the Encyclopaedia brought me the reward .

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