Concomitant Symptom

A concomitant symptom is a symptom that runs alongside the chief complaint yet has no obvious pathological connection to it. It appears at the same time as the main trouble — a headache attended by a flow of pale urine, a cough that ends in a sneeze, menstrual cramps that arrive with a nosebleed — and precisely because the pairing looks unrelated, it becomes one of the most individualizing features a homeopath can record. The concomitant answers a simple question about the case: what else is happening while this complaint is present?

In Practice

Concomitants earn their weight by being unexpected. Two symptoms that share no ordinary medical link, occurring together in one patient, form a combination peculiar to that person — and peculiar features carry great weight in remedy selection. A common cold is unremarkable; a common cold that arrives with a bursting frontal headache and unusual thirstlessness is a far more prescribable picture.

It helps to keep the concomitant distinct from its close neighbor, the modality. A modality tells you what makes a symptom better or worse — worse from motion, better from cold applications. A concomitant tells you what other symptom keeps it company. Both belong to what Bœnninghausen called the "complete symptom," which asks for the location, the sensation, the modality, and the concomitant before any symptom is considered fully described.

A concomitant may itself rise to the level of a keynote when the accompanying symptom is strikingly characteristic of a single remedy. The classic pairing of a cough with involuntary spurting of urine points quickly toward Causticum or Natrum muriaticum; a headache relieved by copious urination calls Gelsemium to mind; a nosebleed that appears when the menses are due — so-called vicarious menstruation — is a well-known concomitant of Bryonia. Each of these is documented in the materia medica, where the attending symptom is often exactly what separates two otherwise similar remedies.

In taking a case, the practitioner watches for these attending symptoms rather than dismissing them as coincidence. The patient who mentions, almost in passing, that her joint pain always worsens the same week her hay fever flares has offered a concomitant worth pursuing — one small thread that may lead to the correct prescription.

Historical Context

The systematic use of concomitants belongs above all to Clemens von Bœnninghausen, whose Therapeutic Pocket Book (1846) gave attending symptoms their own repertory rubrics and made them a pillar of the complete symptom. Hahnemann had already pointed the way in the Organon, where aphorism §153 directs the prescriber to weigh most heavily the "more striking, singular, uncommon and peculiar (characteristic)" signs of a case — a description that fits the unexpected concomitant precisely. Kent, in his Lectures on Homoeopathic Philosophy, likewise treated the concomitant as one of the surer guides to the simillimum. The doctrine has stayed central to careful case analysis ever since.

Related Terms

• Keynote — a strikingly characteristic feature of a remedy, which a vivid concomitant may become
• Modality — a factor that makes a symptom better or worse, distinct from an accompanying concomitant

Learn More

• Materia Medica — where each remedy's concomitants are recorded alongside its keynotes and modalities