HOMOEOPATHIC CONSTITUTION THERAPY
Before we start upon the real subject of this book, the doctrine of the mineral medicinal agents, it is proper to discuss the meaning of the constitutional method of consideration and constitutional therapy in homoeopathy. Likewise in this field the new orientation of homoeopathy and the inclusion of the therapeutic aim is decisive for obtaining a fixed point in the actual relations to be studied.
UNION OF DRUG ACTIONS AND CONSTITUTIONAL TYPES.
One must not forget that the point of departure for homoeopathy is a practical therapeutic one, and theory plays a secondary role. The method of treatment of disease according to the simile rule is oriented on the uttermost individualization. One proceeds from the proving on the healthy individuals whereby single individuals succumb to definite substances earlier than others and one recovers easier and earlier from effects than the other. These persons indicate that they have a lowered threshold to a stimulus in a definite direction; it may be that an organ shows itself as especially sensitive perhaps by the appearance of frequent micturition and burning from small doses of cantharis or a hypersensitivity of the entire person perhaps against phosphorus by the occurrence of a great number of disturbances of general well-being in a proving. Likewise drug proving on the healthy determines the differences of men in degree and direction of adaptability to the influences of materials of the environment. Now the homoeopathic method at the same time contains the task of again discovering these symptomatically demonstrated sensitivities in sick patients and indeed from the symptoms of their natural disease. These, too, are signs of failure against some type of damaging influence, signs of reversion, of insufficient adaptability of man or single-organ systems in certain directions. The finer the symptoms are, the earlier they appear, the more usable they are for the differentiations necessary here. The gross symptoms which forcibly appear in all men after sufficiently large doses are much less characteristic. So the physician familiar with the homoeopathic drug pictures recognizes in the rare, peculiar, many times often nonsensical sounding symptoms, the characteristics of the patient concerned, and with their help is able to determine the adaptability of the drug to a differential- therapeutic point (whereby he must always remain conscious of the danger of overpointing!). Thereby a special significance is gained exactly by the psychic symptoms and the so-called modalities, that is, the dependence of the symptoms, the improvement or aggravation by accompanying circumstances (weather, temperature, position of the body, time of day). According to the recognition of characteristic traits of a patient in an image of drug actions, one speaks in homoeopathy of a lachesis case, of a sulphur man or a phosphorus type. The originally practical therapeutic consideration becomes a fruitful discovery and division principle for constitutions.
This pivotal point of all homoeopathic constitutional considerations will be appreciated exactly if one will compare it with the modern doctrine of constitutions. The conception of a patient in terms of healing agents is found even in Paracelsus. Even at the beginning of the volume Paramirum it states: stress in our drugs the cure and not the causes because the healing shows us the cause. His successor of the last century, Rade-macher, has taken over the founding and the nomenclature of diseases ex juvantibus from him. But homoeopathy has though experiment, the proving on the healthy, first subjected the union of state of disease with drugs to systematic observation. Thereby an entirely new promising way is opened for the investigation of constitution.
Naturally, one does not interpret constitution by a rigid and sterile meaning which conceives only the totality of inherited individual characteristics nor does one proceed form the establishment of a general law of inheritance rather than from the conception of personality. To establish inborn and inherited factors signifies practically a determination of boundaries for the physician. He can utilize positively only a dynamic clinical constitutional conception in that the tendencies to deviation, the disturbances of bodily configuration in definite directions come into expression. In this the conception of diathesis and disposition is included. The constitutional method of consideration of the physician must be subordinated to the general biologic principle of adaptation. We will discover in the constitution of a man, degree and direction of adaptability. The individual lines which interest the clinician are those from susceptibility up to the breakdown of functions. Increased demand in a given direction, in general, conditions greater deterioration in this direction.
In homoeopathy the personal tendencies are drawn to a point through comparison with drug sensitivities. Thereby it frequently becomes a collection of properties combined with each other- perhaps a definite type of menstruation, a body habitus and a kind of mental orientation. Without such a guiding viewpoint the arrangement of interrelated signs and tendencies of a person remains statistical, very general and therefore indefinite or it is suggestive of intuition and subjected to accident and subjective arbitrariness. This does not deny the usefulness of a conception so obtained for description of frequent connections between definite manners of reaction and organization, for example Kretschmer’s attempt to discover connections between body habitus and psychologic manners of reaction and to present them statistically. It is also not to be denied that the newer investigation of constitution according to the causal side has brought to light valuable knowledge on constitutional relationships. Especially the dependence on endocrine processes (in combination with the autonomic nervous system) has brought much clarification. Moreover, the serologic and hematologic differential and division characteristics prove themselves significant. Only it is necessary that all these lines of investigation and possibilities of explanation should not be treated onesidedly and left uncombined besides each other, but an attempt at unification should always be made. The point of departure will always remain the observation of different psychosomatic organization and reaction types and the permanent acceptance will be enlightened by division according to related tendencies on the one side and according to casual explanatory possibilities on the other. The merit of all classifications rest upon the reliability of the observations on which they lie, on their agreement with facts; naturally not simply the already known but also the still to be found. All schematic classifications opposed to organic life contain something provisional.
The current usual groupings as lymphatism and arthritism, because of their great breadth, are far removed from the simple actuality of an individual and their characteristics and limits are still very poorly determined. These conceptions proceed out of a more or less intellectually guided review of clinical sequels. At present they are quite indispensable. But that their provisional nature and indefiniteness become ever more uncovered is the task of the future so that exactly observed special types gradually become more definitive (weather it is accomplished by tracing back to the remote cause, or the collection and arrangement of a discoverable tendency lying in it).
HISTORY OF THE HOMOEOPATHIC CONSTITUTION DOCTRINE
The historic development of the constitution problem in homoeopathy is very peculiar. It begins with an alteration in the Hahnemannian type of thinking which V. Grauvogl especially undertook. In his Organon of Rational Healing (1810), Hahnemann had presented his new method of healing systematically. The suitability of the curative remedy according to the similarity of the symptoms was extolled as the sole directing line. Some years later (1816-1817), he became doubtful whether his precepts up to that time also embraced chronic diseases so that the best and the most complete healing results were obtained. It occurred to him that in protracted diseases the presenting transitory symptomatic picture was not sufficiently obvious for the determination of the medicinal agent. He recognized that in chronic diseases one had to deal with a separate fraction of a deep lying original evil Then he sought for the original evil, for a cause as uniform as possible which would account for the infinite diversity of chronic disease manifestations which are so frequently alternating and vicarious in the same individual or indeed in the descendants. Here a basic damage to the human race must be found. Hahnemann was not satisfied to make the enlarge, the complex of endogenous conditions, responsible for the chronic disease relationships, but the went a step farther to the conception of a few exogenous causative damages. According to his view, they must be of a chronic miasmatic nature, or, as we say today, chronic infections. He determines this as follows:All chronic diseases of man-even those which yield of themselves, and are not aggravated through perverse treatment- show such a permanence and continuance that, as soon as, they have developed (and have not been basically cured by the art), increase ever more with the years and continue for the duration of life, not lessened even by the intrinsic powers of the most robust nature nor by a healthy mode of living and diet, still less conquered and removed, never depart of themselves, but grow and increase until death. Therefore they must have their basis and origin totally in persistent chronic miasms whose parasitic existence enables them to continually increase evermore in the human organism
Let us over look for now that this foundation is not compulsory and follow Hahnemann’s mental processes farther. The postulated chronic infection must be such that it first causes local symptoms, after whose (spontaneous or artificially effected) disappearance a great number of variable maladies follow in which no actual healing occurs. (Example: syphilis). According to Hahnemann, so far as Europe is concerned there are only three such chronic infections as causes of not all but most chronic evil, namely (1) syphilis, (2) sycosis or figwart disease,and (3) the psora which has the itch eruption lying at its base. In respect to syphilis Hahnemann gave a significance which is approximately that which we attribute to it at present. By sycosis he understood the general involvement of complicated gonorrhea in which the local symptom is expressed as the figwart. Hahnemann ascribes only a relatively insignificant role to sycosis as a cause of chronic maladies; moreover, it appears only from time to time. In the time of the French war, 1809-1814, it must have been very extensive , and if one follows Hahnemann’s report it seems to have had some extraordinary manifestations (large, elevated, brown, dry nodules in the axilla, on the outer throat, on the scalp, etc. shortening of the tendons of the flexor muscles, particularly of the finger) combined with it.
THE PSORA THEORY
Hahnemann emphasized the psora as of outstanding importance: The oldest, most universal, most pernicious and still usually mistaken chronic miasmatic disease. At least seven-eighths of all chronic illness he traces back to the psora, and only about one-eighth charges to syphilis and sycosis together.
Hahnemann published his theory of chronic diseases and with it the psora in 1828 in Vol.1 of Chronic Diseases. At that time he was seventy-three years of age. If one reads this discussion through with an open mind, then he notes, in contrast to the tense sequential speech of the Organon, many repetitions which do not serve to explain the theory farther. Although one does not have the impression of a loquacitas senilis, there is the ring of incompletely formulated mental sequences. Only in a type of summary has Hahnemann finished these thoughts and then, capricious as he was, attributed itch as the cause of psora and therewith the majority of chronic diseases. He gave the most unimportant aspect of the entire psora theory an excessive accent and there was and still is the danger that the good is cast away with the bad, that is, in this instance that theoretically and practically important thoughts on the relations of chronic diseases remain unconsidered.
If Hahnemann perceived as the point of departure of psora the infection with itch and the itch eruption as its externally localized symptom, then we cannot follow him. It is naturally to be considered that Hahnemann included much more under the conception of itch than what we know as the effect of Acarus scabiei. He includes all types of itching eruptions as local symptoms. Hahnemann would be quite understandable at present if he had made the tubercle bacillus the cause of the basic malady psora, or better, could have made it. A universally present infectious agent by which every individual is, so to speak, set apart and which revokes important defense manifestations in the skin- that appealed to him as the cause of psora. His mistake does not become less by the fact that he could base his statement on a widely spread viewpoint of the period on the results of the itch, as on Prof. Autenreith, of Tubingen. Moreover, one gains the impression from reading the sixth edition of the Organon that he later avoided calling the itch the sole cause of psora. In 78-83, which treat of the chronic diseases, the itch as is the cause or the skin eruption as the local expression of psora is not expressly mentioned and here one can interchange without further discussion chronic infections with itching skin eruptions with psora. Only in Ap.204 of the sixth edition of the Organon Hahnemann expressly mentions the itch eruption as primary, vicarious and the local symptom preventing the outbreak of internal psora. Moreover, it proceeds particularly from this paragraph that the Hahnemann of 1842 no longer generalized on the psoric origin of chronic diseases as he had in 1828. He also cites prolonged unhygienic modes of life and the damages from the prescriptions of the old school as causes of chronic disease and states that the greatest part of the remaining chronic diseases from the development of the three chronic miasms mentioned: internal syphilis, internal sycosis but particularly and in far greater proportions the internal psora prevails. If in place of psora we place tuberculinization, then Hahnemann is not far removed from our present position. Naturally, under protracted unhygienic life the psychic causes of chronic diseases must be included as Hahnemann stresses sufficiently in other places; and further, in place of drug damages one need simply place chemical intoxications because certainly the industrial agents belong here. Alcoholism can be assigned either to dietary sins or to chemical intoxications . Finally, we would not include chronic gonorrhea in a series of diseases as those chronic illnesses caused by syphilis and tuberculosis, otherwise we would have to include perhaps malaria and dysentery. But it is true that syphilis and tuberculosis among the infections are the most important reorganizers of the individual and contemporary mankind and it is fitting to speak of syphilism and tuberculism.
The theory of Hahnemann is an audacious attempt to trace back all chronic maladies to one or a few infections as causes. The attempt does not succeed. Even the proof for the infectious origin is incomplete. Hahnemann states: because not even the most robust nature and the soundest method of living will not overcome the chronic malady and avert its increase so must the cause lie in a constantly active infection with an independent parasitic existence. The conceptions of the most robust constitution and the soundest mode of living are too general. For example, in an apparently robust constitution single organs may be defective, so that the normal use in the course f life leads to chronic disease (for example, contracted kidney). Here it seems to us that Hahnemann did not sufficiently consider the living reciprocal play between external damages and internal living conditions even though the tracing back to a few infections as the cause of countless numbers of chronic maladies is excellent for that time.
Although Hahnemann takes for a point of departure of psora only the name of itch, in actuality he includes all skin eruptions so that he places the signs of latent and manifest psora extraordinarily wide. Psora becomes for him the mother soil of almost all chronic maladies, which naturally he does not designate with names of disease but with the symptoms observed. In his register we find scrofula, rickets, tuberculosis, asthma, benign and malignant tumors, arthritis, psychosis and many others cited as springing from psora. But the unfortunate attempt at simplification is not the essential but simply the recognition of the reciprocal relation of skin manifestations with so many chronic internal maladies. In the skin manifestations he perceives always the lesser evil and in the recession, either without assistance or even through external treatment, a fatal aggravation of the total process. For this reciprocal relation whose neglect can be so harmful, he cites almost 100 examples from older writers which are added to the conclusions drawn from his own observations. Now a days one comes ever more to a recognition of the outstanding significance of the skin as a defense organ. I refer here merely to Much, Bloch, and Hoffmann and to the conception of esophylaxis. The observations of older writers on the harmful results of forcible suppression of skin eruption, of old ulcus cruris, of hemorrhoids of foot sweats, etc. and the corresponding reports from patients deserve the complete attention of physician even if a compete explanation of this reciprocal relation between the skin eruptions and internal diseases still lies in the remote future. The old physicians as domestic physicians and observers over a long time had much more occasion to determine these connections. But also among us most will concur in the probability of the correctness of such observations in one another example. The secondary exanthem of syphilis today finds a corresponding decision on its clinical course. (Naturally, the chronic results of an acute exanthem as measles are included here.) This aspect of Hahnemann’s doctrine of chronic diseases still remains living in the homoeopathic school and even today in contrast to the custom of most non-homoeopathic physicians the treatment of eczema or ulcus cruris is a radical one. But from the direction of total medicine it may be assumed as probable that in this fundamental, that is , the denial of external treatment and the necessity for internal treatment of such morbid manifestations, that the homoeopathic conception is correct- entirely apart from the characteristic homoeopathic principle of medicinal therapy.
Hahnemann’s theory of chronic diseases at first glance has nothing to do with the doctrine of constitutions. In contrast, the division into syphilis, sycosis, and psora is distinctly related to exogenous causes of disease. Further, Hahnemann expressly stresses that even the most robust constitution cannot remove a psora which has once succeeded in developing. According to him only the form and manifestation of the psora will be modified by the constitution of the individual concerned, furthermore, by the influence of the milieu, fate, mode of living and weather influences. And still the three divisions of Hahnemann have become an important part of the conception of constitutional disease and therapy in the homoeopathic school. This has its basis in that, according to Hahnemann, the three forms of life damage are so fundamental that they bequeath definite predisposition to disease from generation to generation.
So it seems likely, opposed to Hahnemann’s conception to permit three uniform causes to become the principles of division and from this three types of disease relationships and anlages. A further basis for this interpretation is found in that Hahnemann, has prescribed definite drugs or groups of drugs for the three chronic evils. The agent for syphilis is mercury, for sycosis, thuja (three of life) and in the second line nitric acid and for the diversified manifold psora, a great group of antipsoric drugs at whose peak stands sulphur. The antipsoric agents are discussed by Hahnemann in the first edition of Chronic Diseases in three volumes (twenty-one drugs) and in the second edition (1835-1838) in four volumes (forty-seven drugs). This union to related drugs gives the triple division, a classification principle which we have discovered as the characteristic for the homoeopathic conception of constitution. But thereby it is not said whether or not the division so obtained by Hahnemann is fortunate, that is approaches actuality. This can be denied with fair certainty.
ANTIPSORIC DRUGS AS CONSTITUTIONAL DRUGS.
With Hahnemann the psora as the basis of chronic diseases is overemphasized so much that one can simply speak of the psora theory and neglect syphilis and sycosis. For later homoeopathy Hahnemann’s psora became interpreted as a composite of disease susceptibilities, corresponding in extent to lymphatism and arthritism. The etiologic unification was not retained. The limits of psora had been drawn so wide that it practically included the predisposition to almost all chronic diseases. So, according to him, apart from the references mentioned to certain associations and reciprocal relations of morbid manifestations, there was nothing left if a fixed, connecting point between the tendencies lying in the psoric predisposition to a group of drugs with known symptomatic effects had not been given. Hahnemann has associated psora with a very superior class of drugs, the co-called antipsoric drugs. The erroneous conception of a uniform cause of psora did not have the consequence in his therapy whereby sulphur became a universal remedy. Much more Hahnemann stresses: For the cure of developed psora something more than mere sulphur is required . Sulphur is only an outstanding member of this class of medicinal substances. Among them are to be under stood especially agents with general and prolonged effects which are suitable for the protracted deep-seated maladies which embrace that total organism and vary in their symptomatic expressions. These agents are also selected according to the simile rule. But corresponding to the great difficulties of the task which consists not only in the removal of the obvious malady but also the predisposition, the symptom record must be taken much more completely than in acute diseases. For the cure of chronic diseases it is not sufficient to observe the symptomatic picture at the time of observation. Here more attention is to be devoted to the characteristics of the person in his earlier history, and his apparently healthy days regarded. It is exactly here that the keenest recognition is needed especially by the modalities and psychic peculiarities. These special requirements must also be met by the symptomatic picture of the drug suitable for psoric diseases. They must be generally acting remedies not affecting merely single organs; they must prove thoroughly characteristic by the modalities; in the proving symptoms they must be rich in such trends as are strikingly observed in apparently healthy men and permit recognition of a tendency to abnormalities. In homoeopathy one calls such agents constitutional drugs. But this rank is attained not only from the results of provings on the healthy but also from clinical observations. So a drug can possess the capacity for producing a general and fundamental alteration of the body composition in that after its administration signs of disease which had apparently disappeared as skin eruptions or foot sweat again appear. It is indeed no accident that Hahnemann’s antipsoric drugs (also in our meaning, constitutional agents) are predominantly inorganic substances. For them the observations of Hahnemann were surely well founded, that drugs as sulphur, calcium carbonate, sodium chloride, phosphorus, carbon preparations introduce especially general and at the same time especially persistent transformations of the organism. We should keep the physiologically active substances in mind in this sense.
In the undertaking of a constitutional therapy there is already the implication that the constitution is not an unalterable state. As discussed above, this conception does not involve the restriction of constitution to inherited properties but the dynamic definition presumes a psycho-somatic constitution in which the flowing connection of inherited disposition up to the present disposition is regarded. With a constitutional therapy perhaps the highest aim of medicine is reached.
The doctrine of chronic diseases and their healing is a break from the pure method of Hahnemann, which selected the drug for each patient on the symptom similarity. For the chronic evils, syphilis and sycosis, this is very distinct. Because for these Hahnemann has prescribed one or two healing remedies without regard for the individual symptoms. Here he falls into the error which he had cast at the medicine then existing namely, to base the drug indication on the name of a disease, even if here etiologically definite connections of disease are present. For psora, the central problem of older hahnemann, the break with the simile principle is however, only a seeming one. Because for this hydra-headed monster he stresses a great number of drugs and for the selection among them, the simile rule is the supreme guide. The emphasis on this group of antipsoric remedies to day we call them merely constitutional drugs is simply one limitation which the master has shown. Because the selection among them requires a more extensive perfected use of the simile rule than is necessary for acute and localized diseases. For Hahnemann the endeavor towards better accomplishment, namely, the removal of predisposition to disease in addition, has been the occasion for an improvement in method. The theoretic substructure which he erected shows many defects which are not merely temporal but also dependent upon his capricious disposition. But for constitutional investigation the drug types derived by him from a systematic elaboration can furnish a valuable contribution and medical art is shown the way out from the fatalism of apparently unalterable predisposition. The increasing insight into the constraint under which the disease predispositions arise need in no way retard the freedom of a transforming fact.
RADEMACHER’S THREE UNIVERSAL REMEDIES
Hahnemann’s triple etiologic division of chronic disease relations was the one source out of which V. Grauvogl created. From it he made without hesitation three biologic forms of illness, also predispositions. His second source was the three states of Rademacher, who determined them simply through the drugs to whose healing powers they are subject; sodium nitrate, iron and copper. For Rademacher these three agents are the universal remedies in the sense of the old alchemists or iatrochemists, particularly in that they are remedies for the basics disease of the total organism (not them alone, but as representatives of three groups; for example, sodium nitrate as chief of the earthy and alkali salts). Universal remedies are not panaceas in any sense of the word, but they are used in contradistinction to organ remedies, that is, from agents which are suitable for disease of a single organ.
First, one should note that the three states of Rademacher through their relation to healing remedies are characterized in the meaning of Paracelsus and homoeopathy. Second, the affections designated through these drugs involve the entire organism so that one should ascribe to them general universal effectiveness. Rademacher emphasizes that these materials are friendly to the body, that is, they are not poisonous foreign materials (although this naturally cannot hold for man in respect to copper). But in any case it signifies that he also perceived the physiologic substances as especially suitable for such general actions. It is also worthy of note that it is furthermore exclusively concerned with inorganic materials (also in regard to the related members of the groups).
A special choice of the agent in maladies of the total organism in contrast to these characteristics seems to be secondary with Rademacher. The selection itself seems to have arisen from his personal purely empiric search. Only in sodium nitrate does he seem to have depended upon the Elixir salis of Paracelsus, for in its method of preparation he would recognize sodium nitrate.