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The classic homeopathic constitution, a different approach

The treatment of our ill fellow man, is a complicated matter. We, homeopaths, aim for a total approach and a holistic treatment of the patient. This immediately raises several questions. How do I give direction to this aspiration? How do I treat the patient and his or her pattern of symptoms and how do I translate this into a treatment that will do justice to all the aspects of the patient’s illness? And how am I going to be able to do this from the perspective of the similarity principle?

In the following article I will give an overview with regard to the different aspects that I believe are in the treatment of patients, to achieve a gentle and lasting recovery. During the consult I have a patient sitting in front of me that tells me, the homeopath, about his or her complaints. These are in most cases the symptoms the patients suffers from at this moment in time. This stage is important because it is the most recent stage in the disease of the patient. These symptoms are the last link of the patient’s chain of life and most patients are able to provide a very detailed picture, including mental and emotional symptoms. It is this kind of information that we need to be able to correctly make an analysis, repertorisation and differential diagnosis in order to come to the right choice of medication. It affects the patient in this moment with symptoms of this moment, the picture the patient gives of himself, apart from his biographic past and apart from possible hereditary defects.

Obtaining the right information is an art in itself. About the qualifications a homeopaths needs to have, Hahnemann writes in §83: “This individualising examination of a case of illness demands nothing from the medical practitioner but an open-mind and common sense, observation and accuracy in the description of the clinical picture. ” Further on in §98: “But still, on the other hand all illnesses, but especially the chronic diseases, require a lot of prudence, presence of mind, judgement of human nature, carefulness in the definition of the problem and a lot of patience to be able to discover the real, complete clinical picture in all it’s details ”

To finish in §104 the anamnesis paragraph with: “Once the totality of the symptoms, that determine and define the case of illness in particular, in other words when the clinical picture has been noted, the toughest part of the job has been done.”

The qualities a homeopath needs to have are listed: accuracy, common sense, he needs to be cautious, he needs to have presence of mind and judgement of human nature, caution in his definition of a problem and a very patient.
The calling of the homeopath requires these qualities because these are the key to the success of the treatment. It is not possible that a poor anamnesis (basically the result of poor contact with the patient) results in an adequate selection of medication. The result of a treatment depends to a great extent on the quality of the anamnesis.

With regard to being ill, we can make a distinction between several kinds of illnesses: acute, chronic and chronic miasmatic diseases, based on a transmittable hereditary miasmatic tendency, elaborately described by Hahnemann in his work The Chronic Diseases. Through anamnesis and analysis we focus our mind on situation of the patient in front of us, this is how a process of tuning or becoming similar is taking place. If we would not focus our mind on the patient, we would not be able to obtain an accurate understanding of the problems of the patient and therefore we would not be able to find the right medication for that patient.

Depending on the etiology of the illness of the patient, and the nature of the illness at that moment, we determine whether it is an acute, sub-acute or chronic hereditary transmitted kind of illness, and bases on those assumptions, we select the medicine from the group of medicine that fit this situation best and that cover the symptoms that are similar to the symptoms of the patient.

In case of an acute disease, we usually prescribe a vegetable medicine, or an animal medicine. Chronic symptoms are often treated with mineral remedies, these medicines can be considered the constitutional remedies. In some chronic situations, animal medicines are indicated as well (animal and vegetable medicines can have constitutional effects, but they are not constitutional remedies. The human constitution expresses itself in the physical condition, and the physical body consists, besides water, mainly of minerals). When the vital reaction of the patient is blocked by either an improper endured disease process in the patient’s own biography or by pathological tendencies obtained through heredity of the ancestors, the remedy can be found in nosode.
The similarity is obviously not only expressed in the similarity of symptoms of the remedy, but it also has to be similar to the length of the disease or the depth of the pathology. In chronic situations, the remedy should be prescribed, according to Hahnemann in §205, like this:

The homoeopathic physician never treats one of these primary symptoms of chronic miasms, nor yet one of their secondary affections that result from their further development, by local remedies (neither by those external agents that act dynamically, (2) nor yet by those that act mechanically), but he cures, in cases where the one or the other appears, only the great miasm on which they depend, whereupon its primary, as also its secondary symptoms disappear spontaneously, but as this was not the mode pursued by the old-school practitioners who preceded him in the treatment of the case, the homoeopathic physician generally, alas! finds that the primary symptoms (3) have already been destroyed by them by means of external remedies, and that he has now to do more with the secondary ones, i.e. , the affections resulting from the breaking forth and development of these inherent miasms, but especially with the chronic diseases evolved from internal psora, the internal treatment of which, as far as a single physician can elucidate it by many years of reflection, observation and experience, I have endeavoured to point out in my work on Chronic Diseases, to which I must refer the reader. (1) I cannot therefore advise, for instance, the local extirpation of the so-called cancer of the lips and face ["(the product of highly developed psora?) (the product of highly developed psora not infrequently in conjunction with syphilis)" in the Sixth Edition] by means of the arsenical remedy of Frère Cosme, not only because it is excessively painful and often fails, but more for this reason, because, if this dynamic remedy should indeed succeed in freeing the affected part of the body from the malignant ulcer locally, the basic malady is thereby not diminished in the slightest, the preserving vital force is therefore necessitated to transfer the field of operation of the great internal malady to some more important part (as it does in every case of metaschematism), and the consequence is blindness, deafness, insanity, suffocative asthma, dropsy, apoplexy, ..etc. But this ambiguous local liberation of the part from the malignant ulcer by the topical arsenical remedy only succeeds, after all, in those cases where the ulcer has not yet attained any great size, and when the vital force is still very energetic; but it is just in such a state of things that the complete internal cure of the whole original disease is also still practicable. The result is the same, without previous cure of the inner miasm, when cancer of the face or breast is removed by the knife alone and when encysted tumours are enucleated; something worse ensues, or at any rate death is hastened. This has been the case time without number, but the old school still goes blindly on in the same way in every new case, with the same disastrous results. (3) Itch eruption, chancre (bubo), condylomata.

Over the years, it became obvious to me that comprehension of the chronic miasma and treatment based on the underlying chronic miasma is very important to accomplish a lasting recovery. It also makes it possible to give a very adequate prognosis of the progress of the disease. Understanding of the miasmas, psora, sycosis and syphilis provides better comprehension of the dynamics of the disease and therefore better comprehension of the speed in which some diseases seem to develop and also the rapidity with which these diseases can be cured. The miasmatic dogma is basically the dogma of the disease dynamics. Knowledge about the miasmas provides the homeopath with better knowledge about when to repeat a remedy or when to switch medicines. The process of locating the right medicine remains the same: anamnesis, repertorisation, analysis, differential diagnostics, determination of the potency and the frequency, but in the process of recovery of the patient, the homeopath has a much better insight in which stage of the treatment the patient is and what is about to come. He is also able to make much better use of the remedies that are in some cases needed as ‘intermedius remedy’ to bring the patient another step further on his way to recovery. When we are dealing with disease symptoms that proceed from the psora miasma, the homeopathic treatment usually takes more time. Basically the patient suffers from a poor response pattern, which makes it difficult for him to respond adequately curative, there is not enough energy and a failing response.

This does not mean that is won’t be possible to achieve a considerable improvement with regard to the pattern of complaints, but because the psora miasma can be compared to a two-headed monster that, as Hahnemann describes it, has gotten into mankind for many centuries and made more victims than all the wars together. We always encounter secondary psora as well, and if we want to be able to judge whether a durable psoric silence has been achieved or not, it is important to ask the patient to immediately contact the homeopath when the symptoms are getting worse, even if this happens after a longer period of time. Psora is usually characterized by lingering disease dynamics with temporary acute recoveries.

The psora miasma, also called scab miasma by Hahnemann, primary and secondary expresses itself through exanthema. The beginning of each kind of illness starts with exanthema and the end of each successful homeopathic constitution treatment should be characterized by the disappearance of his rash, as a last sign of recovery from his manifest psoric burden.
Every homeopath knows how difficult it can be in some cases, to control this burning, itching, psoric rash, especially when it has accompanied the family for many generations. And each homeopath knows how much suffering the suppression of exanthema causes, the suppression of psora, a seemingly endless diversity of complaints.

All of this is completely different with regard to the treatment of complaints that are based on the syphilitic miasma. Basically, this miasma can be characterized as destructive. It destroys the existing structure. A remedy prescribed in this kind of situation has to be effective very quickly, otherwise destruction of the organ or the organic structure will be the result with possible, irreparable damage. Things are different in cases of congenital defects, that are also based on the syphilitic miasma. In those cases the illness is literally expressed in the matter and therefore impossible to correct with a homeopathic prescription (when the defect causes many complaints because of the inner syphilitic pathology, it is often possible to realize rapid improvement of those complaints, even if they have existed for a while).

In case of a syphilitic pattern of symptoms, complaints will develop rapidly and will almost immediately have an imminent character. That is why a middle ear infection with a Silicea or Hepar sulphurus patient will probably result in hearing impairments in course of time or connective tissue of the ossicles. In case of a Psoric of Sycotic miasma it is not harmful when pus runs out of the ear for a while, when the infection is based on the syphilitic miasma, where Mercury is the remedy for example, the middle ear will be destroyed in no time and the patient will suffer from deafness for the rest of his life or he will have synthetic ossicles put implanted (if this is still possible when the patient is liberated from his miasmatic syphilitic burden after an adequate homeopathic treatment).

Spectacular healings, instant recovery, all of this will only take place when the symptoms are based on an underlying syphilitic miasma. When the homeopath is not aware of this, he is often just as surprised as the patient by the rapid recovery, and when he does not work from this background, the treatment of the patient could in many cases be improved significantly. The third miasma is the syphilitic miasma where the response pattern is based on abundance, a surplus. The syphilitic and sycotic miasma belong to the group of venereal diseases, which are, according to Hahnemann, a lot easier to cure than the psora. When the energy is flowing abundantly, this miasma is often a lot easier to influence with energetic, dynamic medicine than in cases where there is hardly any dynamics. Sycosis is excessive, dynamic and abundant and will, when treated right, rapidly respond to the started treatment (except in those cases where local symptoms are based on earlier long lasting sycotic burden).

The sycotic and syphilitic miasma are usually grafted upon a psoric foundation. Symptoms of the different miasmas and medicines are often mixed up. It is very calming and reassuring, when the treatment of the patient results in a quick progression and strong improvement of the condition of the patient, when he is liberated from the sycotic elements, the character of the illness becomes calmer and the treatment can become more stable and more balanced. When a patient who suffers from COLD and bronchiëctasiën, constantly suffers from tightness of the chest and when he is therefore unable to skip his allopathic medicine, he will get some air after a few intakes of Pyrogenium in a LM potency for example. When this has been achieved it is possible to treat the underlying psoric miasma with the indicated remedies. When these patients, according to the directions in the fifth edition of the Organon and the Kentian methodology, are treated with potencies from the C-potency scale, they will be very difficult to cure. This is why Kent warned about the homeopathic treatment of people with a severe mortal pathology. For this group of patients, a treatment with LM potencies is preferred.

Working with and from the underlying miasmas makes the homeopathic treatment better connected with the course of the illness in time and that the course of the treatment will bring recuperation closer and to end in the fastest possible way. The prescription of the medicines should be similar to the needs of the patient in time. Once we have made the right choice of medication, all we need to do then, is to determine the potency and the dosage of the remedy that has been prescribed. What we basically do by determining the dosage and the potency, is to make the medicine similar to the sensitivity of the patient. When the power and the applied amount of the medicine do not correspond with the sensitivity of the patient, there will be no effect when the dosage is too low, and there will be a homeopathic deterioration, with possible serious consequences, when the dosage is too large. Worsening of the symptoms does not always contribute to the patient’s recovery in a positive way, especially when the patient also suffers from pathological organ changes that are a result of his illness.

Just like Hahnemann writes (in § 281) one patient can be a thousand times more sensitive that the most insensible patient. When prescribing a homeopathic medicine, one should and must keep the sensitivity of the patient in mind, in order to achieve a mild course of the treatment. Therefore there is the opportunity to administer the medicine in it’s lowest dosage through a couple of grains or a tablet under the tongue, or in a diluted dosage that has a much stronger effect.

“A similar grain and a little bit of lactose crushed, solved in water and shaken well before each administration, results in a much stronger medicine that can be used for many days. It is also possible to let the patient smell at the in alcohol diluted medicine (§284) Besides the tongue, the mouth and the stomach that are usually affected by the intake of medicine, especially the nose and the respiratory organs are susceptible to the effect of liquid medication, through smelling and inhaling through the mouth”.

And further on in § 248:
“When the treatment only prescribes the use of a bottle with a small amount of diluted alcohol, (4 gram 40%, where a globule of the medicine has been dissolved) of which the patient needs to smell every 2, 3 of 4 days, then this bottle should be shaken firmly 8 to 10 times, before each smell”.

Just like the selection of the right medication has got to be individualized, the same is the case for the dosage. There are many different occasions and processes in the biography of the patient that can cause or maintain a disease. We encounter those problems in the homeopathic anamnesis of the patient, for as far as the patient has not been able to solve these problems and through a different living pattern or through a disease, tries to compensate for this miasmatic disturbance, we can compensate for this tuberculin aptitude with COLD-like or rheumatic symptoms and when this is insufficient or not successful, the compensation takes place on the emotional level, through ADHD for example. Illnesses in the ascendency lead to compensation with the children that were born from these parents. During someone’s life, constitutional defects can declare themselves, that can be traced back to a disturbed calcium - or silica acid metabolism, based on a Tuberculin or Carcinogenic burden of which the homeopath says it is a typical Calcarea carbonica, Silica or Phosphorus, for example.

When a child suffers from an acute illness, it demonstrates Pulsatilla, Belladonna or Aconitum. When it falls from the stairs, the Arnica picture develops, and when it gets stung, Lachesis or Apis. It is apparently the case that a child with a Calcarea constitution can show a Belladonna picture in an acute stage and can be born with a tuberculinic habitus. The Calcarea constitution is based on a TB foundation in those cases. The tuberculin and the Calcarea layer are complementary with kids, as well as the Calcarea and the Belladonna condition can be complementary with this type of child.

What develops is a three-dimensional picture where it is possible to look back and treat until the ancestors. This better be the case, otherwise a child with hereditary taint can never have a lasting cure. Just like medicine in our assortment are related towards each other in a complement way, as compare ability and constitution in a complement way with human beings. In some cases they make the whole human being, they complete the human being.

In the homeopathic treatment, the mineral that is administered after the vegetable medicine, can complete the recovery. During the treatment, the use of medication needs to be similar to the picture of the patient. Also then, it becomes obvious that the patient often needs complementary medicines during the treatment, to establish a further improvement of the pattern of complaints. One could say that in the case of homeopathic medicine, the nosode (medicines made from disease products) are complementary or supplementary completing in comparison to the mineral remedies. In those cases where the response to a mineral remedy is not curative, the nosode might me able to complement the effect of the mineral. In those acute cases of illness where the deep working constitutional remedy is not able to turn the threat around, the acute working vegetable or animal medicine is complementary.

The purpose and the reach of the nosode in the homeopathic constitutional treatment is to clean up the remains of the diseases that were not lived through properly, either in the ancestors through heredity or of diseases that were not lived through properly in the patient’s own biography. In that context the nosode is not a constitutional remedy, although it definitely causes constitutional effects so that the indicated mineral remedy can have better effects. So, the effect, the purpose and the reach of the nosode are different than the effect and the reach of a mineral or vegetable or animal medicine, they are supplementary of complementary. This is how the different groups of medicine match the different aspects of the biography of the patient based on their similarity.

Hahnemann Homeopathy Foundation (by Ewald Stöteler)
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